CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Down East Community Hospital

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $59
Cash Discount Price: $66
vs. Medicare Baseline: 13.75x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Down East Community Hospital is $59. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $66. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 13.75x the Medicare baseline. Located in 11 Hospital Drive, Machias, ME.

Cash / Self-Pay

$66

Average discount available for prompt cash payment at this facility.

Insurance Median

$59

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: $66 (1538%)

Insurance Median: $59 (1375%)

Cash: $66 (1538% of Medicare)

Ins. Median: $59 (1375% 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 1375% of the Medicare baseline (a markup of 1275%). 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	$19 - $79	443%
Humana	$19 - $43	443%
Wellcare	$19 - $43	443%
Partners Direct Health	$22 - $49	513%
Community Health Options	$36 - $81	839%
Aetna	$37 - $82	862%
UnitedHealthcare	$38 - $84	886%
Cigna	$40 - $88	932%
Harvard Pilgrim	$40 - $90	932%
Martins Point	$40 - $88	932%
Patients Advocates	$40 - $88	932%

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 $66.
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 Down East Community 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.