CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Memorial Health Care Systems

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $31
Cash Discount Price: $55
vs. Medicare Baseline: 7.23x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Memorial Health Care Systems is $31. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $55. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 7.23x the Medicare baseline. Located in 300 North Columbia Ave, Seward, NE.

Cash / Self-Pay

$55

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: $55 (1282%)

Insurance Median: $31 (723%)

Cash: $55 (1282% 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
Blue Cross Blue Shield	$29 - $31	676%
Molina Mcaid-All Plans	$30	699%
Ne Total Care Mcaid-All Plans	$30	699%
UnitedHealthcare	$30 - $52	699%
Beshp Mcr Adv - All Plans	$31	723%
Medica Mcare Cost	$31	723%
Medica Mcr Adv	$31	723%
Tricare	$31	723%
Wellcare Mcr Adv - All Plans	$32	746%
Phcs Ppo-All Plans	$52	1212%
Ambetter / Centene	$53	1235%
Medica Comm-All Other Plans	$53	1235%
Medica Elevate	$53	1235%
Midlands Choice-All Plans	$53	1235%
Aetna	$54	1259%

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 $55.
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 Memorial Health Care Systems 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.