Blood test, clotting time (PT/INR)
Facility: Hiawatha Community Hospital
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $23
- Cash Discount Price: $40
- vs. Medicare Baseline: 5.36x 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 536% of the Medicare baseline (a markup of 436%). 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 |
|---|---|---|
| Aetna | $8 - $49 | 186% |
| Humana | $8 - $23 | 186% |
| UnitedHealthcare | $8 - $52 | 186% |
| Ambetter / Centene | $10 - $27 | 233% |
| Blue Cross Blue Shield | $15 - $16 | 350% |
| Centrus Health Direct - All Plans | $16 - $46 | 373% |
| Oscar - All Plans | $16 - $46 | 373% |
| Preferred Hlth - All Plans | $20 - $55 | 466% |
| Wppa Providrs Care - All Plans | $21 - $58 | 490% |
| Midlands Choice - All Plans | $21 - $59 | 490% |
| Cigna | $21 - $58 | 490% |
| Multiplan - All Plans | $21 - $59 | 490% |
| Healthy Blue Mcaid - All Plans | $22 - $61 | 513% |
Consumer Guidance & Cost Commentary
For this blood clotting test at Hiawatha Community Hospital, the cash price of $40.00 matches the facility's cash median, while the negotiated rate paid by insurance plans averages $23.00. This negotiated amount is significantly lower than the cash price, suggesting that for patients with high-deductible plans, paying out-of-pocket might not be the most cost-effective option unless the insurance allowed amount exceeds the cash rate. It is important to note that while the facility is a Critical Access Hospital in Hiawatha, KS, the data provided does not include specific county or state average comparisons for this procedure, so no direct regional benchmarking can be made against local averages.
The Medicare benchmark for this service is $4.29, which serves as the objective baseline for evaluating pricing markups. Commercial negotiated rates for this test average 21.0% of the Medicare rate, which is notably lower than the typical 200% to 300% markup often seen in commercial pricing; however, the facility's cash price of $40.00 represents a substantial increase over the Medicare amount. Patients should verify their specific plan details, as some commercial payers may negotiate rates higher than the cash price, and they should inquire directly with the hospital about "self-pay" or "prompt-pay" discounts that could further reduce the final bill.