CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Anderson Hospital

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 85610
  • Insurance Median: $6
  • Cash Discount Price: $56
  • vs. Medicare Baseline: 1.40x Medicare
The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Anderson Hospital is $6. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $56. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 1.40x the Medicare baseline. Located in 6800 State Route 162, Maryville, IL.
Cash / Self-Pay
$56

Average discount available for prompt cash payment at this facility.

Insurance Median
$6

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: $56 (1305%)
Insurance Median: $6 (140%)
Cash: $56 (1305% of Medicare)
Ins. Median: $6 (140% 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.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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 - $7 93%
Clear Springs Health $4 93%
Devoted Health Ppo $4 93%
Essence $4 93%
Humana $4 93%
Medicaid / KanCare $4 - $5 93%
Medicare (plans) $4 93%
Tricare $4 93%
UnitedHealthcare $4 - $6 93%
Health Care Service Corporation $5 - $51 117%
Ambetter / Centene $6 140%
Blue Choice $6 140%
Mercy Aco $7 163%
Mercy Benefit Admin $7 163%
Hopetrust $11 256%
Work Comp $21 - $26,600 490%
Healthlink $22 513%
Self Pay $56 - $25,000 1305%
Blue Cross Blue Shield $60 - $62 1399%
Cigna $84 1958%
Multiplan/Phcs $84 1958%
Beech Street Corporation $100 2331%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 6800 State Route 162, Maryville, IL 62062
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals