CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Spotsylvania Regional Medical Center

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $17
Cash Discount Price: $287
vs. Medicare Baseline: 3.96x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Spotsylvania Regional Medical Center is $17. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $287. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 3.96x the Medicare baseline. Located in 4600 Spotsylvania Parkway, Fredericksburg, VA.

Cash / Self-Pay

$287

Average discount available for prompt cash payment at this facility.

Insurance Median

$17

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: $287 (6690%)

Insurance Median: $17 (396%)

Cash: $287 (6690% of Medicare)

Ins. Median: $17 (396% 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 396% of the Medicare baseline (a markup of 296%). 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	93%
Blue Cross Blue Shield	$4 - $22	93%
Cigna	$4 - $21	93%
Clear Spring Health Plan	$4	93%
Devoted	$4	93%
Evernorth Behavioral Health	$4	93%
Humana	$4	93%
Johns Hopkins	$4	93%
Sentara Health	$4	93%
United	$4 - $129	93%
United Behavioral Health	$4	93%
Virginia Premier Health	$4	93%
Align Senior Care	$5	117%
Bright Health	$9	210%
Lifeworks	$55	1282%
Virginia Health Network	$101 - $187	2354%
Kaiser	$170	3963%
Greenvbrier Sporting Club	$172	4009%
Multiplan	$204	4755%
Corvel	$207	4825%
Occunet Workers Comp	$230	5361%
4Most Health Nework	$259	6037%
Three Rivers Provider Network	$259	6037%

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 $287.
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 Spotsylvania Regional 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.