CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Pulaski Memorial Hospital

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $37
Cash Discount Price: $63
vs. Medicare Baseline: 8.62x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Pulaski Memorial Hospital is $37. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $63. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 8.62x the Medicare baseline. Located in 616 E 13Th St, Winamac, IN.

Cash / Self-Pay

$63

Average discount available for prompt cash payment at this facility.

Insurance Median

$37

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: $63 (1469%)

Insurance Median: $37 (862%)

Cash: $63 (1469% of Medicare)

Ins. Median: $37 (862% 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 862% of the Medicare baseline (a markup of 762%). 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
Blue Cross Blue Shield	$4 - $71	93%
Caresource Mcaid Hhw	$4	93%
Cenpatico Mcaid Hhw - All Other Plans	$4	93%
Mdwise Mcaid Hcc	$4	93%
Mdwise Mcaid Hhw	$4	93%
Mhs Mcaid Hhw/Hcc	$4	93%
UnitedHealthcare	$4 - $85	93%
Ambetter / Centene	$22 - $33	513%
Caresource Mcaid Hip	$22 - $33	513%
Caresource Mcare Hmo	$22 - $33	513%
Cenpatico Mcaid Hip	$22 - $33	513%
Mdwise Mcaid Hip - All Other Plans	$22 - $33	513%
Mhs Mcaid Hip	$22 - $33	513%
Humana	$23 - $86	536%
Mhs Mcare Allwell	$23 - $34	536%
Aetna	$26 - $39	606%
Caresource Exch Hmo Hix - All Other Plans	$28 - $41	653%
Sagamore Rose Acre	$54 - $80	1259%
Sagamore - All Other Plans	$55 - $81	1282%
Encore Ppo - All Other Plans	$61 - $91	1422%
Community Health Alliance - All Plans	$64 - $95	1492%
Encore Workers Comp	$65 - $96	1515%
Multiplan - All Plans	$65 - $96	1515%
Cigna	$68 - $102	1585%

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 $63.
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 Pulaski Memorial 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.