CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Ira Davenport Memorial Hospital

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $49
Cash Discount Price: $19
vs. Medicare Baseline: 11.42x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Ira Davenport Memorial Hospital is $49. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $19. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 11.42x the Medicare baseline. Located in 7571 State Route 54, Bath, NY.

Cash / Self-Pay

$19

Average discount available for prompt cash payment at this facility.

Insurance Median

$49

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: $19 (443%)

Insurance Median: $49 (1142%)

Cash: $19 (443% of Medicare)

Ins. Median: $49 (1142% 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 1142% of the Medicare baseline (a markup of 1042%). 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
Empire	$2	47%
Amerihealth Caritas Mcr Adv - All Plans	$4	93%
Blue Cross Blue Shield	$4 - $274	93%
Fidelis	$4	93%
Humana	$4 - $81	93%
Tricare	$4	93%
UnitedHealthcare	$8 - $95	186%
Fidelis Care - Exchange - All Plans	$9 - $50	210%
Geisinger - All Plans	$9 - $53	210%
Cigna	$10 - $56	233%
Independent Health - All Plans	$10 - $59	233%
Mvp Health Plan - All Plans	$10 - $56	233%
Pomco Inc - All Plans	$11 - $65	256%
Upmc - All Plans	$11 - $62	256%
Aetna	$12 - $81	280%
Emblem Health - All Plans	$14 - $80	326%
Emblem/Ghi	$14 - $84	326%
Martins Point - All Plans	$16 - $90	373%
Healthnow - All Plans	$51 - $298	1189%

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 $19.
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 Ira Davenport Memorial 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.