Blood test, clotting time (PT/INR)
Facility: Hamilton County Hospital
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $40
- Cash Discount Price: $44
- vs. Medicare Baseline: 9.32x 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 932% of the Medicare baseline (a markup of 832%). 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 | $8 - $16 | 186% |
| First Health Coventry - All Plans | $37 | 862% |
| Cigna | $42 | 979% |
| UnitedHealthcare | $42 | 979% |
| Va Ccn - All Plans | $44 | 1026% |
| Aetna | $75 | 1748% |
Consumer Guidance & Cost Commentary
For the CPT code 85610, representing a blood test for clotting time (PT/INR), Hamilton County Hospital in Syracuse, KS, lists a cash median price of $44.00, which matches the facility's gross charge. This cash rate is significantly higher than the state average, as indicated by a 9.3% variance against the Medicare benchmark of $4.29. While commercial payers negotiate rates ranging from $8 to $75 depending on the plan, patients with high-deductible plans may find the cash price more affordable if the insurance negotiated rate exceeds $44.00. It is important to note that commercial rates often include administrative overhead and contract premiums that can inflate the baseline price by 20% to 40% compared to the true cost of care.
Patients should verify whether "self-pay" or "prompt-pay" discounts are available before scheduling, as these upfront payment incentives can reduce the total cost by bypassing the administrative costs associated with insurance claims processing. Although the facility is a Critical Access Hospital with government-local ownership, the lack of a facility rating suggests further review of their pricing structure is warranted. To ensure you are not overcharged, request a full itemized CPT-coded bill rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as double-billing or unbundled codes. Always compare the final allowed amount against the Medicare benchmark to confirm the facility is charging a fair markup relative to the federal cost baseline.