Blood test, clotting time (PT/INR)
Facility: Nemaha Valley Community Hospital
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $23
- Cash Discount Price: $40
- vs. Medicare Baseline: 5.36x 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 536% of the Medicare baseline (a markup of 436%). 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 |
|---|---|---|
| Va Ccn - All Plans | $2 | 47% |
| Humana | $19 | 443% |
| Aetna | $20 - $37 | 466% |
| Celtic Comm Exch - All Plans | $21 | 490% |
| Partners Direct Health - All Plans | $23 | 536% |
| Multiplan - All Plans | $40 | 932% |
| Health Partners - All Plans | $42 | 979% |
| Midlands Choice - All Plans | $42 | 979% |
Consumer Guidance & Cost Commentary
For the blood clotting time test (CPT 85610) at Nemaha Valley Community Hospital in Seneca, KS, the cash median price is $40.00, which is $5.40 higher than the Medicare benchmark rate of $4.29. While the facility's negotiated rates with major payers like Aetna and Humana range from $19 to $42, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket. It is important to note that commercial insurance contracts can sometimes result in higher allowed amounts than cash rates due to administrative overhead and network tiering, so verifying your specific plan's allowed amount before scheduling is essential. Additionally, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full upfront, bypassing the costly insurance claims processing cycle.
This service is provided at a Critical Access Hospital with a voluntary non-profit ownership structure, and the facility is located in Seneca (ZIP 66538). While the data does not include explicit county or state average comparisons for this specific code, the significant gap between the Medicare rate and the cash price highlights the importance of understanding your payment options. If you receive a bill from an out-of-network provider or encounter unexpected charges, you have the right to request an itemized audit to identify errors such as double-billing or unbundled codes, as over 80% of hospital bills contain inaccuracies. Furthermore, under the No Surprises Act, you are protected from balance billing for emergency care and non