Blood test, clotting time (PT/INR)
Facility: Susan B Allen Memorial Hospital
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $554
- Cash Discount Price: $17
- vs. Medicare Baseline: 129.14x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 12914% of the Medicare baseline (a markup of 12814%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| UnitedHealthcare | $350 | 8159% |
| Providrs Care | $757 | 17646% |
Consumer Guidance & Cost Commentary
For the blood test procedure (CPT 85610) at Susan B Allen Memorial Hospital in El Dorado, KS, the facility's cash median price of $17.00 is significantly lower than the state average of $554.00 and the negotiated rate of $554.00. While commercial payers like UnitedHealthcare and Providrs Care have negotiated rates of $350 and $757 respectively, these figures often exceed the cash price, meaning patients with high-deductible plans may save money by paying out-of-pocket. It is important to note that the Medicare benchmark for this service is $4.29, which serves as the objective baseline for evaluating pricing markups; commercial rates are frequently 200% to 300% of this amount, whereas fair pricing is typically defined as 120% to 150%.
Patients should verify if the hospital offers "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% for upfront payment and bypass costly insurance administrative fees. Although the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, it is crucial to request a waiver of insurance submission before check-in to ensure the cash discount is applied correctly. If you receive a summary bill, always demand a full itemized statement to identify any errors, double-billing, or unbundled codes, as over 80% of hospital bills contain inaccuracies that can be corrected through a formal written audit dispute.