CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Prosser Memorial Hospital

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $66
Cash Discount Price: $54
vs. Medicare Baseline: 15.38x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Prosser Memorial Hospital is $66. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $54. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 15.38x the Medicare baseline. Located in 723 Memorial Street, Prosser, WA.

Cash / Self-Pay

$54

Average discount available for prompt cash payment at this facility.

Insurance Median

$66

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: $54 (1259%)

Insurance Median: $66 (1538%)

Cash: $54 (1259% of Medicare)

Ins. Median: $66 (1538% 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 1538% of the Medicare baseline (a markup of 1438%). 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
UnitedHealthcare	$7 - $46	163%
Kaiser Permanente	$16 - $104	373%
Community Health Plan Of Washington	$17 - $46	396%
Coordinated Care	$17 - $46	396%
Molina	$18 - $46	420%
Amerigroup	$19 - $49	443%
Health Alliance Northwest	$20 - $28	466%
Wellcare	$20 - $28	466%
Humana	$21 - $97	490%
Aetna	$25 - $97	583%
Ambetter / Centene	$57 - $88	1329%
Asuris	$66 - $103	1538%
Health Management Adminstrators	$66 - $103	1538%
Premera	$66 - $91	1538%
Regence	$66 - $103	1538%
Cigna	$67 - $93	1562%
First Choice	$70 - $97	1632%
Multiplan	$70 - $103	1632%

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 $54.
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 Prosser Memorial 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.