Blood test, clotting time (PT/INR)
Facility: Sheridan County Hospital
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $22
- Cash Discount Price: $36
- vs. Medicare Baseline: 5.13x 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 513% of the Medicare baseline (a markup of 413%). 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 |
|---|---|---|
| Celtic Insurance | $21 - $22 | 490% |
| Blue Cross Blue Shield | $22 | 513% |
| UnitedHealthcare | $33 - $35 | 769% |
Consumer Guidance & Cost Commentary
For the CPT code 85610, representing a blood test for clotting time (PT/INR), Sheridan County Hospital in Hoxie, KS, lists a cash median price of $36.00. This cash rate is notably higher than the state of Kansas average, which is $4.29, and significantly exceeds the Medicare benchmark of $4.29. While commercial insurance payers like Celtic Insurance, Blue Cross Blue Shield, and UnitedHealthcare have negotiated rates ranging from $21 to $35, these amounts often exceed the cash price. For patients with high-deductible plans, paying the cash rate of $36.00 upfront may be more cost-effective than incurring the full negotiated amount if their insurance deductible has not yet been met.
To ensure you are not overcharged, it is critical to request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. If you choose to pay out-of-pocket, ask the hospital specifically about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% for upfront payment. Always verify your deductible status before scheduling, as paying the negotiated rate without meeting your deductible could result in higher out-of-pocket costs than paying cash directly.