CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Boston Children's Hospital

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $50
Cash Discount Price: $70
vs. Medicare Baseline: 11.66x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Boston Children's Hospital is $50. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $70. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 11.66x the Medicare baseline. Located in 300 Longwood Avenue, Boston, MA.

Cash / Self-Pay

$70

Average discount available for prompt cash payment at this facility.

Insurance Median

$50

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: $70 (1632%)

Insurance Median: $50 (1166%)

Cash: $70 (1632% of Medicare)

Ins. Median: $50 (1166% 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 1166% of the Medicare baseline (a markup of 1066%). 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
Blue Cross Blue Shield	$13 - $46	303%
Unicare	$16	373%
Cdphp	$34 - $60	793%
Harvard Pilgrim	$36 - $47	839%
Aetna	$42 - $59	979%
United	$42 - $58	979%
Mgb/Allways	$43 - $52	1002%
Tufts Public Plan	$43	1002%
Ambetter / Centene	$44	1026%
United Ri Nj Ny	$44	1026%
Carelon Strategies/Bhs	$46	1072%
UnitedHealthcare	$46 - $60	1072%
Carelon/Beacon	$52	1212%
Fallon	$53 - $54	1235%
Health New England	$57	1329%
Cigna	$60 - $63	1399%
Ets/Lifetrac	$60	1399%
Interlink Transplant	$60	1399%
Community Health Options	$63	1469%
Humana	$63	1469%
Coventry/Hcvm/First Health	$64	1492%
Multiplan/Phcs	$64 - $66	1492%

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 $70.
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 Boston Children's Hospital 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.