CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Lexington Memorial Hospital Inc

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $31
Cash Discount Price: $35
vs. Medicare Baseline: 7.23x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Lexington Memorial Hospital Inc is $31. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $35. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 7.23x the Medicare baseline. Located in 250 Hospital Drive Po Box 1817, Lexington, NC.

Cash / Self-Pay

$35

Average discount available for prompt cash payment at this facility.

Insurance Median

$31

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: $35 (816%)

Insurance Median: $31 (723%)

Cash: $35 (816% of Medicare)

Ins. Median: $31 (723% 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 723% of the Medicare baseline (a markup of 623%). 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
Alliance	$7	163%
Amerihealth	$7 - $11	163%
Carolina Complete	$7	163%
Healthy Blue	$7	163%
Partners	$7	163%
Trillium	$7	163%
UnitedHealthcare	$7 - $31	163%
Vaya	$7	163%
Wellcare	$7	163%
Blue Cross Blue Shield	$10 - $16	233%
Ambetter / Centene	$11	256%
Medcost	$15 - $47	350%
Aetna	$20 - $65	466%
Oscar	$22 - $31	513%
Cigna	$30 - $31	699%
Directnet	$41	956%
Healthgram Lexington Home Brands	$50	1166%
Healthgram	$56	1305%
Private Healthcare Systems	$57	1329%
Beechstreet	$62	1445%
Humana	$62	1445%
Multiplan	$63	1469%
National Provider Network	$63	1469%

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 $35.
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 Lexington Memorial Hospital Inc 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.