CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Rush Memorial Hospital

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $119
Cash Discount Price: $161
vs. Medicare Baseline: 27.74x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Rush Memorial Hospital is $119. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $161. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 27.74x the Medicare baseline. Located in 1300 N Main St, Rushville, IN.

Cash / Self-Pay

$161

Average discount available for prompt cash payment at this facility.

Insurance Median

$119

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: $161 (3753%)

Insurance Median: $119 (2774%)

Cash: $161 (3753% of Medicare)

Ins. Median: $119 (2774% 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 2774% of the Medicare baseline (a markup of 2674%). 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
Health Net	$29 - $113	676%
Aetna	$31 - $354	723%
Caresource Mcr Adv	$31 - $119	723%
Humana	$31 - $354	723%
My True Advantage - All Plans	$31 - $119	723%
UnitedHealthcare	$31 - $308	723%
Blue Cross Blue Shield	$32 - $282	746%
Today'S Option Mcr Adv-All Plans	$32 - $123	746%
Viant Beech St Mcr Adv	$32 - $123	746%
Caresource Marketplace-All Other Plans	$49 - $191	1142%
Cigna	$79 - $308	1841%
Phcs-All Plans	$79 - $308	1841%
Consumers Life Ins-All Plans	$89 - $346	2075%
Coventry/First Health-All Plans	$89 - $346	2075%
Sagamore-All Plans	$91 - $354	2121%
Siho-All Plans	$91 - $354	2121%
Multiplan-All Plans	$92 - $358	2145%
Community Health Alliance-All Plans	$93 - $362	2168%
Encore Health Services-All Plans	$97 - $377	2261%

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 $161.
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 Rush 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.