Blood test, clotting time (PT/INR)
Facility: Stafford County Hospital
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $35
- Cash Discount Price: $36
- vs. Medicare Baseline: 8.16x 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 816% of the Medicare baseline (a markup of 716%). 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% |
| UnitedHealthcare | $2 | 47% |
| Health Partners-All Plans | $35 | 816% |
| Medica Mcr- All Plans | $36 | 839% |
| Humana | $36 | 839% |
Consumer Guidance & Cost Commentary
For this blood clotting time test at Stafford County Hospital, the cash price is $36.00, which matches the facility's negotiated rate of $35.00 and the median paid amount. This price point is notably higher than the Medicare benchmark of $4.29, reflecting the standard markup for commercial services. While the facility is a Critical Access Hospital in Stafford, KS, and is government-owned, the data does not provide specific county or state average rates for comparison. However, patients should be aware that cash-paying can sometimes be more cost-effective than using insurance if their plan's negotiated rate exceeds the cash price, though in this specific case, the cash and negotiated rates are identical.
To minimize costs, patients should proactively ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50%. It is also important to verify your deductible status, as using insurance without meeting your deductible may result in paying the full negotiated rate rather than sharing the cost. Finally, if you receive a bill, always request a detailed, itemized statement to ensure no errors or unbundled charges exist, as over 80% of hospital bills contain mistakes that can be corrected through a formal written audit dispute.