CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Carle Eureka Hospital

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $53
Cash Discount Price: $111
vs. Medicare Baseline: 12.35x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Carle Eureka Hospital is $53. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $111. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 12.35x the Medicare baseline. Located in 101 S Major St, Eureka, IL.

Cash / Self-Pay

$111

Average discount available for prompt cash payment at this facility.

Insurance Median

$53

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: $111 (2587%)

Insurance Median: $53 (1235%)

Cash: $111 (2587% of Medicare)

Ins. Median: $53 (1235% 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 1235% of the Medicare baseline (a markup of 1135%). 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 - $84	93%
Humana	$4 - $57	93%
Wellcare	$4	93%
Meridian	$6 - $61	140%
Molina	$13 - $61	303%
UnitedHealthcare	$29 - $78	676%
Community Partners Health Plan (Cphp)	$39 - $76	909%
Cigna	$40 - $79	932%
Healthlink	$42 - $83	979%
Blue Cross Blue Shield	$44 - $107	1026%
Multiplan/Phcs	$49 - $95	1142%

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 $111.
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 Carle Eureka 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.