CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Astria Toppenish Hospital

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $19
Cash Discount Price: $20
vs. Medicare Baseline: 4.43x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Astria Toppenish Hospital is $19. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $20. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 4.43x the Medicare baseline. Located in 502 W Fourth Ave, Toppenish, WA.

Cash / Self-Pay

$20

Average discount available for prompt cash payment at this facility.

Insurance Median

$19

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: $20 (466%)

Insurance Median: $19 (443%)

Cash: $20 (466% of Medicare)

Ins. Median: $19 (443% 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 443% of the Medicare baseline (a markup of 343%). 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
Medicaid / KanCare	$2 - $16	47%
Ambetter / Centene	$3	70%
Medicare (plans)	$3 - $88	70%
Molina	$3	70%
UnitedHealthcare	$3 - $88	70%
Va	$3	70%
Aetna	$4 - $94	93%
Cigna	$4	93%
Humana	$4 - $107	93%
Li	$4	93%
Molina_Exchange	$4	93%
Regence	$4 - $36	93%
Tricare	$4	93%
Zenith	$4	93%
Premera	$5 - $40	117%
Premera_Affordable_Care	$5 - $40	117%
Chpw_Cascade_Care	$8 - $67	186%
First_Choice	$8 - $74	186%
Tpsc	$9 - $83	210%
Bcchp	$12 - $107	280%
Great_Rivers	$12 - $107	280%
Healthcomp	$12 - $107	280%
Washington_State_Hca	$12 - $107	280%
Kaiser	$16	373%

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 $20.
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 Astria Toppenish 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.