CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: St Marys Good Samaritan Hospital

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $11
Cash Discount Price: $26
vs. Medicare Baseline: 2.56x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at St Marys Good Samaritan Hospital is $11. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $26. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 2.56x the Medicare baseline. Located in 5401 Lake Oconee Parkway, Greensboro, GA.

Cash / Self-Pay

$26

Average discount available for prompt cash payment at this facility.

Insurance Median

$11

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: $26 (606%)

Insurance Median: $11 (256%)

Cash: $26 (606% of Medicare)

Ins. Median: $11 (256% 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 256% of the Medicare baseline (a markup of 156%). 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
Amerigroup	$5	117%
Blue Cross Blue Shield	$7 - $30	163%
Aetna	$10 - $33	233%
Ambetter / Centene	$10 - $11	233%
Care Improvement Plus	$10 - $11	233%
Caresource	$10 - $11	233%
Cigna	$10 - $34	233%
Coventry	$10 - $31	233%
Eon Health Plan	$10 - $11	233%
Humana	$10 - $31	233%
Kaiser Permanente	$10 - $11	233%
Molina	$10 - $11	233%
Pruitthealth Premier	$10 - $11	233%
Todays Options Pffs	$10 - $11	233%
Todays Options Ppo	$10 - $11	233%
UnitedHealthcare	$10 - $2,632	233%
Vaccn United	$10 - $11	233%
Wellcare	$10 - $11	233%
First Health	$28 - $31	653%
Phcs	$28 - $31	653%
Meritain	$30 - $33	699%
Multiplan	$32 - $36	746%
Nova	$32 - $37	746%
Three Rivers Provider Network	$34 - $37	793%

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 $26.
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 St Marys Good Samaritan 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.