CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Sanford Vermillion Medical Center

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $28
Cash Discount Price: $32
vs. Medicare Baseline: 6.53x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Sanford Vermillion Medical Center is $28. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $32. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 6.53x the Medicare baseline. Located in 20 South Plum Street, Vermillion, SD.

Cash / Self-Pay

$32

Average discount available for prompt cash payment at this facility.

Insurance Median

$28

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: $32 (746%)

Insurance Median: $28 (653%)

Cash: $32 (746% of Medicare)

Ins. Median: $28 (653% 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 653% of the Medicare baseline (a markup of 553%). 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	$11 - $13	256%
Wellmark Sd	$11 - $13	256%
Aetna	$12 - $38	280%
Health Partners	$12 - $33	280%
Medicare (plans)	$12 - $15	280%
Primewest	$12 - $15	280%
Ucare	$12 - $39	280%
UnitedHealthcare	$12 - $37	280%
Sanford Health Plan	$15 - $23	350%
Security Health Plan	$20 - $24	466%
Medica	$31 - $39	723%
Wellmark	$32 - $38	746%
First Choice Health Network	$33 - $40	769%
Healthez	$33 - $40	769%
Multiplan	$33 - $40	769%

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 $32.
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 Vermillion 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.