CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Lewisgale Hospital Alleghany

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $27
Cash Discount Price: $221
vs. Medicare Baseline: 6.29x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Lewisgale Hospital Alleghany is $27. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $221. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 6.29x the Medicare baseline. Located in One Arh Lane - Po Box 7, Low Moor, VA.

Cash / Self-Pay

$221

Average discount available for prompt cash payment at this facility.

Insurance Median

$27

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: $221 (5152%)

Insurance Median: $27 (629%)

Cash: $221 (5152% of Medicare)

Ins. Median: $27 (629% 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 629% of the Medicare baseline (a markup of 529%). 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
Aetna	$4 - $119	93%
Blue Cross Blue Shield	$4 - $27	93%
Cigna	$4	93%
Clear Spring Health Plan	$4	93%
Devoted	$4	93%
Good Samaritan Hospice	$4	93%
Health Net	$4	93%
Humana	$4	93%
Sentara Health	$4	93%
Triatlantic	$4	93%
United	$4 - $99	93%
United Behavioral Health	$4	93%
United Mine Workers	$4	93%
Virginia Premier Health	$4	93%
Align Senior Care	$5	117%
Greenbrier Sporting Club	$6	140%
Lifeworks	$42	979%
Universal Healthcare Group	$49	1142%
Virginia Health Network	$77 - $157	1795%
Greenvbrier Sporting Club	$133	3100%
Corvel	$159	3706%
Csx Hotels	$177	4126%
Occunet Workers Comp	$177	4126%
Health Payors Organization	$188	4382%
4Most	$199	4639%
Alleghany Highland Community	$199	4639%
American Postal Workers Union	$199	4639%
C&O Employees Hospital Assn	$199	4639%
Community Care Network	$199	4639%
Multiplan	$199	4639%
One Health Plan	$199	4639%

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 $221.
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 Lewisgale Hospital Alleghany 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.