CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Novant Health Forsyth Medical Center

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $38
Cash Discount Price: $37
vs. Medicare Baseline: 8.86x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Novant Health Forsyth Medical Center is $38. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $37. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 8.86x the Medicare baseline. Located in 3333 Silas Creek Parkway, Winston-Salem, NC.

Cash / Self-Pay

$37

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: $37 (862%)

Insurance Median: $38 (886%)

Cash: $37 (862% 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
Amerihealth	$3 - $19	70%
Blue Cross Blue Shield	$3 - $71	70%
Carolina Complete	$3 - $18	70%
Nc Department Of Public Safety	$3 - $18	70%
UnitedHealthcare	$3 - $67	70%
Wellcare	$3 - $19	70%
Aetna	$4 - $79	93%
Cigna	$4 - $59	93%
Humana	$4 - $77	93%
Liberty Health	$4	93%
Pace Of The Southern Piedmont	$4	93%
Caresource North Carolina	$7 - $40	163%
Atlantic Corporation Dba Atlantic Packaging	$10 - $56	233%
Plotkin Health	$11 - $59	256%
Amps	$12 - $64	280%
Medcost	$15 - $93	350%
Beechstreet	$16 - $89	373%
Multiplan	$16 - $89	373%
Phcs	$16 - $89	373%
Primary Physician Care	$16 - $87	373%
Employers Choice Network	$17 - $96	396%
Three Rivers Provider Network	$17 - $96	396%

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 $37.
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 Novant Health Forsyth 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.