CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Texas Scottish Rite Hospital for Children

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $52
Cash Discount Price: $119
vs. Medicare Baseline: 12.12x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Texas Scottish Rite Hospital for Children is $52. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $119. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 12.12x the Medicare baseline. Located in 2222 Welborn Street, Dallas, TX.

Cash / Self-Pay

$119

Average discount available for prompt cash payment at this facility.

Insurance Median

$52

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: $119 (2774%)

Insurance Median: $52 (1212%)

Cash: $119 (2774% of Medicare)

Ins. Median: $52 (1212% 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 1212% of the Medicare baseline (a markup of 1112%). 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	$4 - $54	93%
Tricare	$5	117%
Blue Cross Blue Shield	$13 - $52	303%
Children Med Center Health Plan - All Plans	$52	1212%
Community First Health Plan-All Plans	$52	1212%
Cook Childrens Hp-All Plans	$52	1212%
Driscoll Childrens-All Plans	$52	1212%
Medicaid / KanCare	$52	1212%
Molina Commercial - All Other Plans	$52	1212%
Soonercare-All Plans	$52	1212%
UnitedHealthcare	$52 - $77	1212%
Firstcare Health Mcaid	$55	1282%
Tx Childrens Hlth Mcaid-All Plans	$55	1282%
Firstcare Health Comm - All Other Plans	$83	1935%
Cigna	$89	2075%
Healthscope - All Plans	$89	2075%
Scott & White Comm- All Other Plans	$89	2075%

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 $119.
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 Scottish Rite Hospital for Children 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.