Blood test, clotting time (PT/INR)
Facility: Holton Community Hospital
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $29
- Cash Discount Price: $30
- vs. Medicare Baseline: 6.76x 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 676% of the Medicare baseline (a markup of 576%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $16 | 373% |
| Aetna | $17 - $48 | 396% |
| UnitedHealthcare | $17 - $48 | 396% |
| Humana | $17 - $26 | 396% |
| Kansas Superior Select - All Plans | $17 - $26 | 396% |
| Preferred Health Fn Select - All Other Plans | $27 - $40 | 629% |
| Preferred Health Freedom | $27 - $40 | 629% |
| Preferred Health Professionals | $27 - $40 | 629% |
| Wppa Providers - All Plans | $31 - $46 | 723% |
| Medicaid / KanCare | $32 - $48 | 746% |
Consumer Guidance & Cost Commentary
For this blood clotting test at Holton Community Hospital, the cash price of $30.00 is lower than the facility's negotiated rates, which range from $16.00 to $48.00 depending on the insurance plan. While the facility's cash rate is slightly higher than the state average of $26.00, it remains significantly below the gross chargemaster price of $40.00. Patients with high-deductible plans may find paying the cash price directly more affordable than using insurance, as the negotiated rates for in-network payers like Aetna and UnitedHealthcare often exceed the cash amount. To maximize savings, patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full upfront before services are rendered.
When reviewing your final invoice, it is critical to request a detailed itemized bill rather than accepting a summary statement that groups charges into broad categories like "Laboratory." This audit helps identify errors such as unbundled codes or services that were never delivered, which are common in over 80% of hospital bills. Additionally, this service's Medicare benchmark rate is $4.29, meaning the facility's cash price of $30.00 represents a markup of 6.8 times the federal baseline. While commercial negotiated rates often average 200% to 300% of Medicare, fair pricing is typically defined as 120% to 150% of the Medicare amount. If you receive a balance bill for the difference between the allowed amount and your cash rate,