CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Caromont Regional Medical Center

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $13
Cash Discount Price: $89
vs. Medicare Baseline: 3.03x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Caromont Regional Medical Center is $13. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $89. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 3.03x the Medicare baseline. Located in 2525 Court Dr, Gastonia, NC.

Cash / Self-Pay

$89

Average discount available for prompt cash payment at this facility.

Insurance Median

$13

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: $89 (2075%)

Insurance Median: $13 (303%)

Cash: $89 (2075% of Medicare)

Ins. Median: $13 (303% 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 303% of the Medicare baseline (a markup of 203%). 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
Avalon	$3	70%
Humana	$3 - $99	70%
UnitedHealthcare	$3 - $26	70%
Absolute Total Care	$4	93%
Aetna	$4 - $41	93%
Blue Cross Blue Shield	$4 - $37	93%
Devoted Health	$4	93%
Healthteam	$4	93%
Longevity Health	$4	93%
Molina	$4	93%
Corporate Benefits Service	$5	117%
Carolina Complete Health	$6	140%
Medcost	$6 - $43	140%
Partners Behavioral Health	$6	140%
Alliance Behavioral Health	$7	163%
Amerihealth Caritas	$7	163%
Carolina Complete Health Tailored Plans	$7	163%
Vaya Behavioral Health	$7	163%
Wellcare	$7	163%
Cigna	$8 - $13	186%
Surgery Plus	$8	186%
Carolina Caring	$11 - $89	256%
Beech Street	$13 - $92	303%
Gaston County Jail	$13	303%
Multiplan	$13 - $92	303%
Self Pay	$14 - $101	326%
First Health Network	$15 - $106	350%

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 $89.
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 Caromont Regional 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.