Blood test, clotting time (PT/INR)
Facility: Rooks County Health Center
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $18
- Cash Discount Price: $28
- vs. Medicare Baseline: 4.20x 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 420% of the Medicare baseline (a markup of 320%). 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 |
|---|---|---|
| Veterans Admin - All Plans | $2 - $26 | 47% |
| Tricare | $8 - $26 | 186% |
| Celtic Mcr Adv | $8 - $26 | 186% |
| Celtic Comm - All Other Plans | $9 - $29 | 210% |
| Blue Cross Blue Shield | $16 - $38 | 373% |
| Preferred Benefits Admin | $16 - $51 | 373% |
| UnitedHealthcare | $16 - $51 | 373% |
| Aetna | $16 - $51 | 373% |
| Preferred Hlthcare - All Other Plans | $17 - $53 | 396% |
| Health Partners - All Plans | $17 - $53 | 396% |
| Healthy Blue Mcaid - All Plans | $18 - $56 | 420% |
Consumer Guidance & Cost Commentary
For the CPT code 85610, representing a blood test for clotting time (PT/INR), Rooks County Health Center in Plainville, KS, lists a cash median price of $28.00 and a median negotiated rate of $18.00. This facility is a Critical Access Hospital owned by a Government Hospital District. While the cash price is notably higher than the state average of $22.00, it is important to note that for patients with high-deductible plans, paying the cash price of $28.00 upfront can sometimes be more cost-effective than using insurance, as the negotiated rate of $18.00 may still exceed the patient's out-of-pocket responsibility before their deductible is met. Patients are encouraged to verify their specific plan's deductible status and ask the hospital directly about "self-pay" or "prompt-pay" discounts, which can further reduce the final amount owed.
The Medicare benchmark for this service is $4.29, which serves as a scientifically validated baseline for the true cost of delivery. The facility's cash price of $28.00 represents a significant markup compared to this federal rate, illustrating how commercial pricing structures often differ from Medicare's cost-based calculations. When reviewing your bill, it is crucial to request an itemized statement rather than accepting a summary invoice, as detailed line-by-line reviews can identify errors, unbundled codes, or services not rendered that may be causing inflated charges. Additionally, if you receive a balance bill for out-of-network services at this in-network facility, you may be entitled to protections under the No Surprises Act, which bans balance billing for emergency care and non-emergency