CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: UMass Memorial Healthalliance Hospitals

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $13
Cash Discount Price: $40
vs. Medicare Baseline: 3.03x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at UMass Memorial Healthalliance Hospitals is $13. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $40. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 3.03x the Medicare baseline. Located in 60 Hospital Road, Leominster, MA.

Cash / Self-Pay

$40

Average discount available for prompt cash payment at this facility.

Insurance Median

$13

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$4.29

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $4.29 (100%)

Cash / Self-Pay: $40 (932%)

Insurance Median: $13 (303%)

Cash: $40 (932% of Medicare)

Ins. Median: $13 (303% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $4.29 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 303% of the Medicare baseline (a markup of 203%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Aetna	$4 - $28	93%
Blue Cross Blue Shield	$4 - $12	93%
Cigna	$4 - $15	93%
Commonwealth Care Mcr [10115]	$4	93%
Fallon Mcr Supp [20202]	$4	93%
Harvard Pilgrim Mcr [10106]	$4	93%
Institution [10406]	$4 - $23	93%
Masshealth [20302]	$4	93%
Medicaid / KanCare	$4 - $5	93%
Medicare (plans)	$4	93%
Mgb Mcr [10124]	$4	93%
Tufts Dual [10111]	$4	93%
Tufts Mcr [10112]	$4	93%
Tufts Us Family [11203]	$4	93%
UnitedHealthcare	$4 - $43	93%
Champva [11001]	$5	117%
Correctional Care [11003]	$5 - $7	117%
Senior Whole Health [10110]	$5	117%
Workers Compensation [20501]	$5	117%
Tufts Connectorcare [10507]	$7	163%
Tufts [11201]	$9	210%
Harvard Pilgrim [10701]	$10 - $12	233%
Wellpoint [11112]	$10	233%
Hne [11108]	$19 - $24	443%
First Health Network [11120]	$25 - $32	583%
Multiplan [11109]	$25 - $32	583%
Fallon Connectorcare [10503]	$31	723%
Connecticare [11105]	$33 - $43	769%
Fallon Carelon Hlth [28]	$33 - $43	769%
Fallon Mcaid Carelon Hlth [29]	$33 - $43	769%
Grants [20507]	$33 - $43	769%
Hsno/Free Care [10801]	$294	6853%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $40.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 85610.

Insurance In-Network Protection Plan

Contact your insurance company to confirm UMass Memorial Healthalliance Hospitals is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 85610.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.