Blood test, clotting time (PT/INR)
Facility: Ellinwood District Hospital
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $25
- Cash Discount Price: $30
- vs. Medicare Baseline: 5.83x 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 583% of the Medicare baseline (a markup of 483%). 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 |
|---|---|---|
| Cigna | $16 - $33 | 373% |
| Humana | $16 - $33 | 373% |
| UnitedHealthcare | $16 - $33 | 373% |
| Aetna | $16 - $33 | 373% |
| Blue Cross Blue Shield | $16 - $33 | 373% |
Consumer Guidance & Cost Commentary
For the blood clotting time test (CPT 85610) at Ellinwood District Hospital, the cash price of $30.00 is lower than the facility's negotiated rates of $25.00 and the median paid amount of $32.00. This suggests that for patients with high-deductible plans, paying cash directly could result in lower out-of-pocket costs compared to using insurance, as the negotiated rates often exceed the cash price. The facility is a Critical Access Hospital in Ellinwood, KS, and while specific county or state average data was not provided in this report, patients should verify their specific plan's allowed amount with the hospital before scheduling to ensure they are not overpaying.
To minimize potential billing errors, it is recommended to request an itemized bill that lists every specific CPT code and unit cost, rather than accepting a summary invoice that obscures individual charges. Since over 80% of hospital bills contain errors such as unbundled services or charges for items not rendered, obtaining a detailed statement is the most effective way to identify and dispute inaccuracies. Additionally, patients should inquire about prompt-pay discounts, which can reduce the total bill by 20% to 50% if paid in full upfront, bypassing the administrative costs associated with insurance claims processing.