CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Sanford Clear Lake Medical Center

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $47
Cash Discount Price: $48
vs. Medicare Baseline: 10.96x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Sanford Clear Lake Medical Center is $47. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $48. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 10.96x the Medicare baseline. Located in 701 Third Avenue South, Clear Lake, SD.

Cash / Self-Pay

$48

Average discount available for prompt cash payment at this facility.

Insurance Median

$47

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: $48 (1119%)

Insurance Median: $47 (1096%)

Cash: $48 (1119% of Medicare)

Ins. Median: $47 (1096% 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 1096% of the Medicare baseline (a markup of 996%). 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
Sanford Health Plan Align	$27 - $34	629%
Aetna	$29 - $57	676%
Health Partners	$29 - $50	676%
Medicare (plans)	$29 - $37	676%
Security Health Plan	$29 - $36	676%
Ucare	$29 - $58	676%
UnitedHealthcare	$29 - $55	676%
Wellmark Sd	$29 - $36	676%
Primewest	$30 - $37	699%
Sanford Health Plan	$37 - $61	862%
Blue Cross Blue Shield	$43 - $61	1002%
Medica	$44 - $58	1026%
Wellmark	$46 - $57	1072%
Cigna	$48 - $59	1119%
First Choice Health Network	$48 - $59	1119%
Healthez	$48 - $59	1119%
Multiplan	$48 - $59	1119%

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 $48.
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 Sanford Clear Lake Medical Center 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.