Blood test, clotting time (PT/INR)
Facility: Cheyenne County Hospital
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $19
- Cash Discount Price: $24
- vs. Medicare Baseline: 4.43x 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 443% of the Medicare baseline (a markup of 343%). 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 | $1 - $26 | 23% |
| First Health - All Plans | $13 - $18 | 303% |
| Aetna | $14 - $25 | 326% |
| Healthy Blue Mcr Adv | $14 - $19 | 326% |
| Tricare | $14 - $19 | 326% |
| Choice Care - All Plans | $14 - $19 | 326% |
| Firstguard - All Plans | $15 - $21 | 350% |
| Blue Cross Blue Shield | $16 | 373% |
| Wppa - All Plans | $17 - $23 | 396% |
| Cpm - All Plans | $18 - $25 | 420% |
| Preferred Hc - All Plans | $18 - $25 | 420% |
| Healthwave Mcaid - All Plans | $19 - $26 | 443% |
| Midlands Choice - All Plans | $19 - $25 | 443% |
| Healthy Blue Mcaid - All Other Plans | $19 - $26 | 443% |
| Ppo Next - All Plans | $19 - $25 | 443% |
| Integrated Hp - All Plans | $19 - $25 | 443% |
| Health Partners - All Plans | $19 - $25 | 443% |
| Unicare - All Plans | $19 - $25 | 443% |
| Childrens Mercy - All Plans | $19 - $26 | 443% |
| Providers Care-All Plans | $29 - $39 | 676% |
Consumer Guidance & Cost Commentary
For this blood clotting test at Cheyenne County Hospital, the cash price is $24.00, which matches the facility's cash median. This rate is significantly lower than the state average, as the Medicare benchmark of $4.29 indicates that commercial rates often carry a substantial markup compared to the federal baseline. While many insurance plans negotiate rates around $19.00, which is slightly lower than the cash price, patients with high-deductible plans may find paying the $24.00 cash rate directly more cost-effective if their insurance allowed amount exceeds this figure. It is important to verify your specific plan's deductible status before scheduling, as paying out-of-pocket can sometimes result in lower total costs than waiting for insurance to process a claim.
Patients should be aware that while the No Surprises Act protects against balance billing for emergency services at in-network facilities, unexpected charges can still arise from out-of-network ancillary services like certain lab tests. If you receive a bill that seems higher than expected, request a full itemized audit to identify any unbundled codes or services not rendered, as over 80% of hospital bills contain errors. Additionally, you may be eligible for a prompt-pay discount if you choose to settle the bill in full upfront, which can reduce the amount owed by 20% to 50%. Always ask the hospital directly about self-pay or prompt-pay options before check-in to ensure you are not inadvertently enrolled in a billing cycle that could result in higher administrative fees.