CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Lovelace UNM Rehabilitation Hospital

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $168
Cash Discount Price: $56
vs. Medicare Baseline: 39.16x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Lovelace UNM Rehabilitation Hospital is $168. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $56. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 39.16x the Medicare baseline. Located in 505 Elm Street Ne, Albuquerque, NM.

Cash / Self-Pay

$56

Average discount available for prompt cash payment at this facility.

Insurance Median

$168

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: $56 (1305%)

Insurance Median: $168 (3916%)

Cash: $56 (1305% of Medicare)

Ins. Median: $168 (3916% 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 3916% of the Medicare baseline (a markup of 3816%). 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
The Health Plan [2915]	$36	839%
Healthscope Benefits [2290]	$90	2098%
UnitedHealthcare	$90	2098%
Benefit Management [1175]	$94	2191%
Zelis [2385]	$94	2191%
American Medical Security [2190]	$168	3916%
Boon-Chapman [2375]	$168	3916%
Coresource [1315]	$168	3916%
Coventry Healthcare [1320]	$168	3916%
Emblem Health [2430]	$168	3916%
Employee Benefit Management Services [2445]	$168	3916%
First Health [1375]	$168	3916%
Fmh Benefit Services [1390]	$168	3916%
Healthcost Solutions [2415]	$168	3916%
Healthnet [1495]	$168	3916%
Healthsmart [1505]	$168 - $174	3916%
Kaiser Permanente [1560]	$168	3916%
Multiplan [1680]	$168	3916%
Mutual Of Omaha [1685]	$168	3916%
National Telephone Cooperative [1700]	$168	3916%
Northamerica Administrators [1725]	$168	3916%
Pan American Life Insurance Co [1770]	$168	3916%
Phcs [1780]	$168	3916%
Trustmark [2030]	$168	3916%

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 $56.
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 Lovelace UNM Rehabilitation 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.