CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Children's Hospital of Philadelphia

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $152
Cash Discount Price: $363
vs. Medicare Baseline: 35.43x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Children's Hospital of Philadelphia is $152. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $363. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 35.43x the Medicare baseline. Located in 3401 Civic Center Blvd, Philadelphia, PA.

Cash / Self-Pay

$363

Average discount available for prompt cash payment at this facility.

Insurance Median

$152

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: $363 (8462%)

Insurance Median: $152 (3543%)

Cash: $363 (8462% of Medicare)

Ins. Median: $152 (3543% 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 3543% of the Medicare baseline (a markup of 3443%). 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
Geisinger Medical Assistance	$5	117%
Highmark Wholecare	$6	140%
Horizon Nj Health	$11	256%
Medicaid / KanCare	$60	1399%
UnitedHealthcare	$60 - $200	1399%
Health Partners	$68	1585%
Aetna	$86 - $181	2005%
Upmc Medical Assistance	$99	2308%
Keystone First Chip	$112	2611%
Keystone Health Plan East	$115	2681%
Blue Cross Blue Shield	$128 - $145	2984%
Geisinger Health Plan Commercial	$160	3730%
Jefferson Health Plans	$172	4009%
Cigna	$181	4219%
Highmark	$181	4219%
Qualcare	$200	4662%
First Health Network	$236	5501%
Devon Health, Intergroup, Multiplan, Valley Preferred/Populytics	$290	6760%
Private Health Care Systems	$290	6760%
Choice Care Network	$327	7622%

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 $363.
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 Children's Hospital of Philadelphia 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.