CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Rochelle Community Hospital

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $70
Cash Discount Price: $93
vs. Medicare Baseline: 16.32x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Rochelle Community Hospital is $70. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $93. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 16.32x the Medicare baseline. Located in 900 N 2Nd St, Rochelle, IL.

Cash / Self-Pay

$93

Average discount available for prompt cash payment at this facility.

Insurance Median

$70

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: $93 (2168%)

Insurance Median: $70 (1632%)

Cash: $93 (2168% of Medicare)

Ins. Median: $70 (1632% 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 1632% of the Medicare baseline (a markup of 1532%). 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 - $33	93%
The Alliance-All Plans	$4	93%
Blue Cross Blue Shield	$6 - $93	140%
Medicaid / KanCare	$6	140%
Health Alliance Mcr Adv	$33	769%
Humana	$33 - $74	769%
UnitedHealthcare	$33 - $84	769%
Va Ccn - All Plans	$33	769%
Wellcare Mcr Adv - All Plans	$33	769%
Cigna	$70	1632%
Osf Dan Ppo - All Plans	$70	1632%
Beech Street-All Plans	$74	1725%
First Health - All Plans	$74	1725%
Health Alliance-All Other Plans	$74	1725%
Ecoh-All Plans	$79	1841%
Hfn-All Plans	$79	1841%
Quartz Health Solutions-All Plans	$82	1911%
Multiplan-All Plans	$87	2028%

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 $93.
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 Rochelle Community 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.