CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Elmhurst Hospital Center

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $34
Cash Discount Price: Unavailable
vs. Medicare Baseline: 7.93x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Elmhurst Hospital Center is $34. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 7.93x the Medicare baseline. Located in 79-01 Broadway, Elmhurst, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$34

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%)

Insurance Median: $34 (793%)

Ins. Median: $34 (793% 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 793% of the Medicare baseline (a markup of 693%). 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	$3 - $12	70%
Healthfirst	$3 - $75	70%
Elderplan	$4	93%
Fidelis	$4 - $75	93%
Magnacare	$5	117%
Oscar	$6	140%
Oxford	$6	140%
United	$6 - $42	140%
Centerlight	$8	186%
Cigna	$10	233%
Wellcare	$10	233%
Carelon	$11 - $34	256%
Emblem	$12 - $45	280%
Blue Cross Blue Shield	$13 - $75	303%
Multiplan	$13	303%
Local 1199	$14	326%
Villagecare Max	$14	326%
Vnsny	$14 - $34	326%
Metroplus	$32 - $75	746%
Affinity	$34 - $75	793%
Amidacare	$34	793%
Carelon (Amida Care)	$34	793%
Senior Whole Health	$34	793%
United Behavioral Health	$34 - $37	793%

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 $X.
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 Elmhurst Hospital Center 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.