Blood test, clotting time (PT/INR)
Facility: Ellsworth County Medical Center
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $26
- Cash Discount Price: $31
- vs. Medicare Baseline: 6.06x 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 606% of the Medicare baseline (a markup of 506%). 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 | $13 - $16 | 303% |
| Humana | $13 - $32 | 303% |
| Healthy Blue Mcr Adv | $13 - $16 | 303% |
| Triwest -All Plans | $13 - $16 | 303% |
| Blue Cross Blue Shield | $15 - $16 | 350% |
| UnitedHealthcare | $18 - $34 | 420% |
| Aetna | $24 - $31 | 559% |
| First Health - All Plans | $24 - $31 | 559% |
| Cigna | $26 - $32 | 606% |
| Coventry Mcaid-All Plans | $27 - $34 | 629% |
| Healthy Blue Mcaid- All Other Plans | $27 - $34 | 629% |
| Medicaid / KanCare | $27 - $34 | 629% |
| Providers Care-Wppa-All Plans | $40 - $51 | 932% |
Consumer Guidance & Cost Commentary
For the blood clotting time test (CPT 85610) at Ellsworth County Medical Center in Ellsworth, Kansas, the facility's cash median price is $31.00, which matches the gross chargemaster rate. This cash rate is significantly higher than the state average for this service, which is $19.00. While commercial insurance negotiated rates range from $13 to $51 depending on the payer, patients with high-deductible plans may find paying the $31.00 cash price directly more cost-effective than relying on insurance, as the insurer's allowed amount often exceeds the cash rate. To potentially lower this cost, patients should contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final bill.
It is important to understand that commercial insurance rates are often inflated by administrative costs and contract structures, sometimes reaching 200% to 300% of the Medicare benchmark rate of $4.29 for this procedure. The facility's negotiated rate of $26.00 sits above the state average but below the highest commercial rates, illustrating how network status can influence pricing. If you receive a bill that includes charges for services not rendered, unbundled components, or items that were cancelled, you should request a full itemized audit rather than accepting a summary bill. Under federal protections like the No Surprises Act, you are generally shielded from balance billing for out-of-network services at in-network facilities, so any unexpected charges should be disputed in writing with the billing supervisor rather than paid immediately.