CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Astria Sunnyside Hospital

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $59
Cash Discount Price: $96
vs. Medicare Baseline: 13.75x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Astria Sunnyside Hospital is $59. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $96. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 13.75x the Medicare baseline. Located in 1016 Tacoma Avenue, Sunnyside, WA.

Cash / Self-Pay

$96

Average discount available for prompt cash payment at this facility.

Insurance Median

$59

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: $96 (2238%)

Insurance Median: $59 (1375%)

Cash: $96 (2238% of Medicare)

Ins. Median: $59 (1375% 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 1375% of the Medicare baseline (a markup of 1275%). 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	$3 - $59	70%
Molina	$3 - $48	70%
Aetna	$4 - $171	93%
Healthcomp_Ihs	$4	93%
Humana	$4 - $175	93%
Medicare (plans)	$4	93%
Tricare	$4	93%
Va	$4	93%
Regence	$6 - $100	140%
Cigna	$7 - $116	163%
Li	$7 - $119	163%
First_Choice	$8 - $146	186%
Kaiser	$9 - $152	210%
Premera	$9 - $158	210%
Tpsc	$9 - $151	210%
UnitedHealthcare	$9 - $165	210%
Fhpw	$10 - $171	233%
Healthcomp	$10 - $175	233%
Bcchp	$11 - $194	256%
Great_Rivers	$11 - $194	256%
Zenith	$11 - $194	256%

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 $96.
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 Sunnyside 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.