CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Southcoast Hospitals Group

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $5
Cash Discount Price: $18
vs. Medicare Baseline: 1.17x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Southcoast Hospitals Group is $5. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $18. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 1.17x the Medicare baseline. Located in 363 Highland Avenue, Fall River, MA.

Cash / Self-Pay

$18

Average discount available for prompt cash payment at this facility.

Insurance Median

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: $18 (420%)

Insurance Median: $5 (117%)

Cash: $18 (420% of Medicare)

Ins. Median: $5 (117% 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.

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 - $27	93%
Blue Cross Blue Shield	$4 - $8	93%
Commonwealth Care Alliance [1080501]	$4	93%
Evercare [1010304]	$4	93%
Medicare (plans)	$4 - $9	93%
Tufts Health Public Plans [1010213]	$4	93%
Tufts Senior Care Options [1010315]	$4	93%
UnitedHealthcare	$4 - $5	93%
Wellsense Health Plan Senior Care Options [1020208	$4	93%
Eternal Health [1010322]	$5	117%
Fallon [1000114]	$6	140%
Wellsense Health Plan Clarity Connectorcare & Meta	$8	186%
Harvard Pilgrim [1010602]	$9	210%
Cigna	$10	233%
Wellpoint [1000102]	$12	280%
Tufts [1010701]	$15	350%
Mass General Brigham Health Plan Commercial [10122	$20	466%
Mass General Brigham Health Plan Connectorcare [10	$20	466%
Group Insurance Service Center [1013001]	$22	513%
Innovative Health Plan [1025001]	$22	513%
Priority Health [1015001]	$22	513%
PHCS [1000125]	$23	536%
First Health [1000130]	$27	629%

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 $18.
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 Southcoast Hospitals Group 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.