Blood test, clotting time (PT/INR)
Facility: Graham County Hospital
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $24
- Cash Discount Price: $36
- vs. Medicare Baseline: 5.59x 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 559% of the Medicare baseline (a markup of 459%). 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 |
|---|---|---|
| UnitedHealthcare | $1 - $41 | 23% |
| Medicaid / KanCare | $7 | 163% |
| Blue Cross Blue Shield | $16 | 373% |
| Medicare (plans) | $22 - $32 | 513% |
| Celtic Commercial-All Other Plans | $24 - $35 | 559% |
| Wppa (Providers Care)-All Plans | $27 - $41 | 629% |
Consumer Guidance & Cost Commentary
For this blood clotting test at Graham County Hospital in Hill City, Kansas, the cash price is $36.00, which matches the facility's negotiated rate for Medicaid and the median amount paid by commercial payers. This cash price is significantly higher than the Medicare benchmark of $4.29, indicating a markup of 5.6 times the federal rate. While the facility is a Critical Access Hospital owned by the local government, patients should be aware that commercial insurance negotiated rates often exceed cash prices due to administrative costs and contract structures. If you have a high-deductible plan, paying the $36.00 cash price upfront might be more cost-effective than relying on insurance, which could result in a higher allowed amount after your deductible is met.
To minimize costs, patients should proactively ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these can reduce the bill by 20% to 50%. It is also important to request a full itemized bill rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as double-billing or unbundled codes that can be disputed. Since the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, you should verify that all components of your visit are covered under the same contract to avoid unexpected charges. Always compare the final allowed amount to the Medicare rate to ensure you are not overpaying for the service.