CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Forks Community Hospital

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $63
Cash Discount Price: $104
vs. Medicare Baseline: 14.69x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Forks Community Hospital is $63. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $104. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 14.69x the Medicare baseline. Located in 530 Bogachiel Way, Forks, WA.

Cash / Self-Pay

$104

Average discount available for prompt cash payment at this facility.

Insurance Median

$63

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: $104 (2424%)

Insurance Median: $63 (1469%)

Cash: $104 (2424% of Medicare)

Ins. Median: $63 (1469% 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 1469% of the Medicare baseline (a markup of 1369%). 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	$5 - $119	117%
Medicaid / KanCare	$42 - $51	979%
Coordinated Care (Mco) Mcd-All Plans	$45 - $52	1049%
Community Health Network Mcr-All Other Plans	$54 - $63	1259%
Humana	$54 - $63	1259%
Tricare	$54 - $63	1259%
Triwest-All Plans	$54 - $63	1259%
Ambetter / Centene	$63 - $73	1469%
Wellcare Med Adv - All Plans	$63 - $73	1469%
Regence-All Other Plans	$69 - $81	1608%
Community Health Exchange	$78 - $91	1818%
Molina Commercial-All Other Plans	$110 - $129	2564%
Aetna	$114 - $133	2657%
Blue Cross Blue Shield	$114 - $133	2657%
Cigna	$120 - $140	2797%
First Choice-All Plans	$120 - $140	2797%
Medicare (plans)	$318	7413%

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 $104.
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 Forks Community 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.