CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Norton-King's Daughters' Health

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $33
Cash Discount Price: $11
vs. Medicare Baseline: 7.69x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Norton-King's Daughters' Health is $33. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $11. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 7.69x the Medicare baseline. Located in 1373 East Sr 62, Madison, IN.

Cash / Self-Pay

$11

Average discount available for prompt cash payment at this facility.

Insurance Median

$33

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: $11 (256%)

Insurance Median: $33 (769%)

Cash: $11 (256% of Medicare)

Ins. Median: $33 (769% 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 769% of the Medicare baseline (a markup of 669%). 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
Aetna	$3 - $53	70%
Blue Cross Blue Shield	$4 - $12	93%
Humana	$4	93%
Managed Health Services	$4 - $7	93%
Managed Health Services Of Indiana	$4	93%
Managed Health Services Of Kentucky	$4	93%
Passport By Molina	$4	93%
UnitedHealthcare	$4 - $47	93%
Caresource Of Indiana	$6	140%
Caresource Of Kentucky	$6	140%
Custom Design Benefits	$9 - $30	210%
Cigna	$31 - $51	723%
Encore	$31 - $51	723%
Bluegrass	$33 - $54	769%
First Health	$33 - $54	769%
Healthlink	$33 - $54	769%
Quality Care Partners	$33 - $53	769%
Vha/Tristate	$33 - $54	769%
Multiplan/Phcs	$34 - $55	793%
Indiana Health Network	$35 - $57	816%
Siho	$35 - $57	816%

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 $11.
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 Norton-King's Daughters' Health 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.