CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Margaretville Memorial Hospital

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $20
Cash Discount Price: $44
vs. Medicare Baseline: 4.66x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Margaretville Memorial Hospital is $20. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $44. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 4.66x the Medicare baseline. Located in 42084 State Highway 28, Margaretville, NY.

Cash / Self-Pay

$44

Average discount available for prompt cash payment at this facility.

Insurance Median

$20

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: $44 (1026%)

Insurance Median: $20 (466%)

Cash: $44 (1026% of Medicare)

Ins. Median: $20 (466% 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 466% of the Medicare baseline (a markup of 366%). 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
Oxford	$6	140%
UnitedHealthcare	$6 - $19	140%
Aetna	$12 - $44	280%
Mvp	$18	420%
Blue Cross Blue Shield	$19 - $31	443%
Medicare (plans)	$19 - $29	443%
Mvp Gold (McR)	$19	443%
Hamaspik (McR)	$19	443%
Affinity By Molina McR	$20	466%
Cdphp	$21	490%
Mvp Hmo/Ppo	$21	490%
Emblem Ghi/Hip Ppo/Cbp	$27	629%
Mvp Exchange	$29	676%
Emblem Select Care (Exchange)	$30	699%
Magnacare Standard	$31	723%
Oxford Exchange	$31	723%
Todays Options	$32	746%
Self-Pay	$33	769%
Emblem Ghi/Hip Hmo/Epo/Pos	$35	816%
Multiplan	$36	839%
First Health	$40	932%
Magnacare Preferred	$174	4056%

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 $44.
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 Margaretville Memorial Hospital 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.