CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Sanford Canton-Inwood Medical Center - Cah

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $31
Cash Discount Price: $33
vs. Medicare Baseline: 7.23x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Sanford Canton-Inwood Medical Center - Cah is $31. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $33. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 7.23x the Medicare baseline. Located in 440 North Hiawatha Drive, Canton, SD.

Cash / Self-Pay

$33

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: $33 (769%)

Insurance Median: $31 (723%)

Cash: $33 (769% 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
Sanford Health Plan Align	$14	326%
Aetna	$15 - $36	350%
Health Partners	$15 - $32	350%
Medicare (plans)	$15 - $16	350%
Ucare	$15 - $37	350%
UnitedHealthcare	$15 - $35	350%
Wellmark	$15 - $37	350%
Primewest	$16	373%
Sanford Health Plan	$22 - $31	513%
Security Health Plan	$23	536%
Medica	$34 - $37	793%
First Choice Health Network	$37 - $38	862%
Healthez	$37 - $38	862%
Multiplan	$37 - $38	862%

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 $33.
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 Canton-Inwood Medical Center - Cah 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.