CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Novant Health Medical Park Hospital

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $50
Cash Discount Price: $47
vs. Medicare Baseline: 11.66x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Novant Health Medical Park Hospital is $50. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $47. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 11.66x the Medicare baseline. Located in 1950 S Hawthorne Rd, Winston-Salem, NC.

Cash / Self-Pay

$47

Average discount available for prompt cash payment at this facility.

Insurance Median

$50

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: $47 (1096%)

Insurance Median: $50 (1166%)

Cash: $47 (1096% of Medicare)

Ins. Median: $50 (1166% 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 1166% of the Medicare baseline (a markup of 1066%). 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 - $79	93%
Blue Cross Blue Shield	$4 - $71	93%
Cigna	$4 - $59	93%
Humana	$4 - $77	93%
Liberty Health	$4	93%
Pace Of The Southern Piedmont	$4	93%
UnitedHealthcare	$4 - $67	93%
Nc Department Of Public Safety	$9 - $23	210%
Amerihealth	$15 - $24	350%
Carolina Complete	$15 - $23	350%
Wellcare	$15 - $24	350%
Caresource North Carolina	$25 - $40	583%
Atlantic Corporation Dba Atlantic Packaging	$35 - $56	816%
Plotkin Health	$37 - $59	862%
Amps	$40 - $64	932%
Medcost	$53 - $93	1235%
Primary Physician Care	$55 - $87	1282%
Beechstreet	$56 - $89	1305%
Multiplan	$56 - $89	1305%
Phcs	$56 - $89	1305%
Employers Choice Network	$60 - $96	1399%
Three Rivers Provider Network	$60 - $96	1399%

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 $47.
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 Medical Park Hospital 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.