CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Sanford Sheldon Medical Center

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $38
Cash Discount Price: $46
vs. Medicare Baseline: 8.86x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Sanford Sheldon Medical Center is $38. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $46. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 8.86x the Medicare baseline. Located in 118 North Seventh Avenue, Po Box 250, Sheldon, IA.

Cash / Self-Pay

$46

Average discount available for prompt cash payment at this facility.

Insurance Median

$38

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: $46 (1072%)

Insurance Median: $38 (886%)

Cash: $46 (1072% of Medicare)

Ins. Median: $38 (886% 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 886% of the Medicare baseline (a markup of 786%). 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
Sanford Health Plan Align	$16 - $17	373%
Aetna	$17 - $53	396%
Blue Cross Blue Shield	$17 - $19	396%
Health Partners	$17 - $46	396%
Medicare (plans)	$17 - $19	396%
Primewest	$17 - $19	396%
Ucare	$17 - $54	396%
UnitedHealthcare	$17 - $51	396%
Wellmark	$28 - $32	653%
Sanford Health Plan	$29 - $38	676%
Security Health Plan	$30 - $34	699%
Medica	$45 - $54	1049%
First Choice Health Network	$50 - $55	1166%
Healthez	$50 - $55	1166%
Multiplan	$50 - $55	1166%

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 $46.
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 Sanford Sheldon Medical Center 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.