CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Atrium Health Cleveland

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $59
Cash Discount Price: $68
vs. Medicare Baseline: 13.75x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Atrium Health Cleveland is $59. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $68. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 13.75x the Medicare baseline. Located in 201 E Grover St, Shelby, NC.

Cash / Self-Pay

$68

Average discount available for prompt cash payment at this facility.

Insurance Median

$59

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: $68 (1585%)

Insurance Median: $59 (1375%)

Cash: $68 (1585% of Medicare)

Ins. Median: $59 (1375% 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 1375% of the Medicare baseline (a markup of 1275%). 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	$4 - $104	93%
Cigna	$4 - $108	93%
Humana	$4	93%
Alliance	$5 - $23	117%
Amerihealth Caritas	$5 - $19	117%
Blue Cross Blue Shield	$5 - $55	117%
Carolina Complete Health	$5 - $19	117%
Choicecare	$5 - $111	117%
Healthy Blue	$5 - $19	117%
Partners	$5 - $19	117%
Trillium	$5 - $20	117%
UnitedHealthcare	$5 - $72	117%
Vaya	$5 - $20	117%
Wellcare	$5 - $19	117%
Ambetter / Centene	$43 - $49	1002%
Employers Health Network	$60 - $72	1399%
Physician Reach Out	$68	1585%
Medcost	$76 - $90	1772%
Magellan	$81	1888%
Gmmi	$88	2051%
Quik Trip	$88	2051%
Carolina Behavioral Health	$97 - $108	2261%
Healthgram	$108	2517%
First Health	$115	2681%
Lifesynch Community Choice Care	$115	2681%
Private Health Care Systems	$122	2844%
Beechstreet	$125	2914%
Multiplan	$129	3007%

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 $68.
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 Atrium Health Cleveland 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.