CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Carolina East Medical Center

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $43
Cash Discount Price: $38
vs. Medicare Baseline: 10.02x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Carolina East Medical Center is $43. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $38. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 10.02x the Medicare baseline. Located in 2000 Neuse Blvd, New Bern, NC.

Cash / Self-Pay

$38

Average discount available for prompt cash payment at this facility.

Insurance Median

$43

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: $38 (886%)

Insurance Median: $43 (1002%)

Cash: $38 (886% of Medicare)

Ins. Median: $43 (1002% 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 1002% of the Medicare baseline (a markup of 902%). 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
Humana	$4	93%
Inclusive Health (Nchirp)-All Plans	$4	93%
Tricare	$4 - $79	93%
Craven Co. Jail Systems - All Plans	$10 - $27	233%
Pamlico Co Jail-All Plans	$13 - $21	303%
UnitedHealthcare	$17 - $56	396%
Medcost Ppo Employees And Retirees	$32 - $52	746%
Medcost Ppo Ultra (Employees)	$32 - $49	746%
Blue Cross Blue Shield	$34 - $54	793%
Medcost Ppo City Employees	$35 - $58	816%
Medcost Ppo County Employee	$36 - $60	839%
Benefit Mgmt, Svcs-All Plans	$41 - $67	956%
Medcost Benefit Svc-All Other Plans	$42 - $70	979%
Acs Consult Svc Inc-All Plans	$43 - $71	1002%
Aetna	$43 - $70	1002%
Medcost Ppo Standard	$43 - $71	1002%
Cigna	$44 - $72	1026%

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 $38.
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 Carolina East 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.