CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Jacksonville Memorial Hospital

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $47
Cash Discount Price: $106
vs. Medicare Baseline: 10.96x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Jacksonville Memorial Hospital is $47. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $106. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 10.96x the Medicare baseline. Located in 1600 W Walnut St, Jacksonville, IL.

Cash / Self-Pay

$106

Average discount available for prompt cash payment at this facility.

Insurance Median

$47

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: $106 (2471%)

Insurance Median: $47 (1096%)

Cash: $106 (2471% of Medicare)

Ins. Median: $47 (1096% 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 1096% of the Medicare baseline (a markup of 996%). 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
Blue Cross Blue Shield	$4 - $147	93%
Coventry	$4 - $23	93%
Health Alliance	$4 - $100	93%
Humana	$4 - $125	93%
Medicare (plans)	$4 - $23	93%
Tricare	$4 - $27	93%
UnitedHealthcare	$4 - $106	93%
Medicaid / KanCare	$7	163%
Molina Healthcare	$7	163%
Corvel/Corcare	$25 - $42	583%
Illinois Workers Compensation	$26 - $50	606%
Health Alliance Mh Employee Plan	$30 - $68	699%
Current Health Network	$36 - $110	839%
6 Degrees Health	$39 - $88	909%
Hope Trust	$39 - $88	909%
Hst	$39 - $88	909%
Aetna	$45 - $118	1049%
Cigna	$45 - $102	1049%
Commercial Workers Compensation	$47	1096%
Healthlink	$55 - $125	1282%
Phcs/Multiplan	$58 - $132	1352%
Hfn	$62 - $140	1445%
Liability	$65 - $147	1515%

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 $106.
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 Jacksonville 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.