CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Penn State Health St. Joseph

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $7
Cash Discount Price: $7
vs. Medicare Baseline: 1.63x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Penn State Health St. Joseph is $7. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $7. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 1.63x the Medicare baseline. Located in 2500 Bernville Road, Reading, PA.

Cash / Self-Pay

Average discount available for prompt cash payment at this facility.

Insurance Median

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: $7 (163%)

Insurance Median: $7 (163%)

Cash: $7 (163% of Medicare)

Ins. Median: $7 (163% 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.

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 - $14	93%
Humana	$4	93%
UnitedHealthcare	$4 - $19	93%
[Amerihealth Caritas]	$4	93%
[Cbc]	$4 - $15	93%
[Geisinger]	$4 - $20	93%
[Health Partners Plans]	$4	93%
[Healthspring]	$4	93%
[Highmark Wholecare]	$4	93%
[Highmark]	$4 - $16	93%
[Ibc]	$4 - $14	93%
[Pa Health & Wellness]	$4	93%
[Upmc]	$4 - $21	93%
[Point Comfort Underwriters]	$5	117%
Cigna	$12 - $17	280%
[Highmark Choice Blue]	$13	303%
[Highmark Aca]	$14	326%
[Preferred Healthcare Systems]	$21	490%
[First Health]	$22	513%
[Multiplan]	$22	513%

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 $7.
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 Penn State Health St. Joseph 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.