CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: East Morgan County Hospital

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $21
Cash Discount Price: $20
vs. Medicare Baseline: 4.90x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at East Morgan County Hospital is $21. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $20. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 4.90x the Medicare baseline. Located in 2400 W Edison St, Brush, CO.

Cash / Self-Pay

$20

Average discount available for prompt cash payment at this facility.

Insurance Median

$21

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: $20 (466%)

Insurance Median: $21 (490%)

Cash: $20 (466% of Medicare)

Ins. Median: $21 (490% 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 490% of the Medicare baseline (a markup of 390%). 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
Pinnacol Assurance Workers Comp	$5 - $21	117%
Aetna	$6 - $47	140%
Banner Health	$6 - $22	140%
Blue Cross Blue Shield	$6 - $38	140%
Clear Spring Health	$6 - $22	140%
Devoted Health Services	$6 - $24	140%
Healthspring Life & Health Insurance Company, Inc.	$6 - $22	140%
Humana	$6 - $23	140%
Longevity	$6 - $23	140%
Medica	$6 - $42	140%
Medicare (plans)	$6 - $22	140%
Triwest Healthcare Alliance Corp - Va Ccn	$6 - $22	140%
UnitedHealthcare	$6 - $47	140%
Assist Health Group	$7 - $26	163%
Denver Health Medical Plan	$10 - $41	233%
Apostrophe, Inc.	$12 - $46	280%
First Choice Health Network	$12 - $46	280%
Hue Health, Inc	$12 - $48	280%
Rocky Mountain Health Plans	$12 - $48	280%
Multiplan	$13 - $49	303%

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 $20.
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 East Morgan County 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.