Blood test, clotting time (PT/INR)
Facility: Jewell County Hospital
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $69
- Cash Discount Price: $55
- vs. Medicare Baseline: 16.08x 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 1608% of the Medicare baseline (a markup of 1508%). 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 |
|---|---|---|
| Rural Carriers - All Plans | $62 | 1445% |
| Aetna | $66 | 1538% |
| Meritain - All Plans | $66 | 1538% |
| Midlands Choice - All Plans | $69 | 1608% |
| First Health - All Plans | $69 | 1608% |
| Cigna | $69 | 1608% |
| UnitedHealthcare | $69 | 1608% |
Consumer Guidance & Cost Commentary
For this blood clotting test (CPT 85610) at Jewell County Hospital in Mankato, KS, the facility's cash median price of $55.00 is significantly lower than the negotiated rates paid by insurance carriers, which average $69.00. While the hospital is a Critical Access Hospital with government local ownership, patients should be aware that commercial payers like Aetna, Cigna, and UnitedHealthcare all negotiate a rate of $69.00, which is higher than the cash price. This pricing structure highlights a common billing dynamic where paying out-of-pocket can result in immediate savings compared to insurance reimbursement, particularly for those with high-deductible plans who may not yet have met their coverage thresholds.
When evaluating the financial impact of this service, it is important to compare these rates against the Medicare benchmark, which stands at $4.29 for this code. The facility's negotiated rate of $69.00 represents a substantial markup relative to the federal baseline, illustrating how commercial contracts often exceed the true cost of care. To ensure you are receiving the most accurate billing information, always request a full itemized bill that lists specific CPT codes rather than accepting a summary invoice, as this allows you to verify that no unbundled charges or services not rendered have been included. Additionally, since the facility offers prompt-pay discounts for upfront payment, contacting the billing department before your appointment to confirm self-pay rates can help you avoid unexpected costs associated with insurance processing.