Blood test, clotting time (PT/INR)
Facility: Grisell Memorial Hospital
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $22
- Cash Discount Price: $38
- vs. Medicare Baseline: 5.13x 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 513% of the Medicare baseline (a markup of 413%). 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 | $2 - $29 | 47% |
| Blue Cross Blue Shield | $15 | 350% |
| Medicaid / KanCare | $40 | 932% |
| Humana | $40 | 932% |
Consumer Guidance & Cost Commentary
For the CPT code 85610, representing a blood test for clotting time (PT/INR), Grisell Memorial Hospital in Ransom, KS, lists a gross charge of $40.00. This amount is significantly higher than the facility's own cash median of $38.00 and the median paid by insurers at $35.00. When compared to the national benchmark, the facility's rate is 5.1% above the Medicare amount of $4.29. While the hospital is a Critical Access Hospital owned by a Government Hospital District, patients should be aware that commercial insurance plans, such as UnitedHealthcare, Blue Cross Blue Shield, Medicaid/KanCare, and Humana, negotiate rates that often exceed the cash price. For instance, the median negotiated rate is $22.00, which is lower than the gross charge but may still be higher than the cash option depending on individual plan deductibles.
Patients with high-deductible plans might find that paying the cash price directly is more cost-effective than relying on insurance, as the administrative overhead and negotiated rates can sometimes result in higher out-of-pocket costs. It is important to ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the total bill by 20% to 50%. Additionally, if you receive a bill from an out-of-network provider or for ancillary services like emergency care, you may be protected under the No Surprises Act, which bans balance billing for these specific scenarios. Always request a detailed, itemized bill to verify that all charges are accurate and that no services were rendered, as over