CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Texas Childrens Hospital

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $92
Cash Discount Price: $99
vs. Medicare Baseline: 21.45x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Texas Childrens Hospital is $92. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $99. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 21.45x the Medicare baseline. Located in 6621 Fannin Street, Houston, TX.

Cash / Self-Pay

$99

Average discount available for prompt cash payment at this facility.

Insurance Median

$92

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: $99 (2308%)

Insurance Median: $92 (2145%)

Cash: $99 (2308% of Medicare)

Ins. Median: $92 (2145% 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 2145% of the Medicare baseline (a markup of 2045%). 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
Superior Chip	$4	93%
Driscoll Children'S Health Plan Mcd	$5	117%
Community Health Choice	$8 - $102	186%
First Care Health Plan	$31 - $102	723%
UnitedHealthcare	$31 - $102	723%
Molina Mcd	$34 - $48	793%
Blue Cross Blue Shield	$40 - $100	932%
Community First Health Plan Mcd	$46 - $64	1072%
Cook Children'S Health Plan	$46 - $64	1072%
Cigna	$66 - $102	1538%
Aetna	$74 - $102	1725%
Kelseycare	$75 - $103	1748%
Healthsmart	$80 - $111	1865%
Evolutions Healthcare	$86 - $119	2005%
First Health	$101 - $151	2354%
Multiplan	$104 - $143	2424%
Galaxy Health Network	$109 - $151	2541%

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 $99.
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 Texas Childrens 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.