Blood test, clotting time (PT/INR)
Facility: Norton County Hospital
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $23
- Cash Discount Price: $36
- 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 |
|---|---|---|
| Blue Cross Blue Shield | $23 | 536% |
Consumer Guidance & Cost Commentary
For this blood clotting test at Norton County Hospital, the cash price of $36.00 is significantly lower than the facility's negotiated rate of $23.00, which is the amount Blue Cross Blue Shield pays. This cash price also represents a substantial discount compared to the national average for this procedure, which is $52.00. While the facility is a Critical Access Hospital in Norton, KS, and is owned by the local government, patients with high-deductible plans may find paying the cash price directly more cost-effective than using insurance, as the negotiated rate often exceeds the cash price. To maximize savings, patients should explicitly ask the hospital staff about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can further reduce the final bill.
It is important to understand that commercial insurance rates are often inflated by administrative costs and contract structures, making the cash price a more transparent benchmark for value. Although the facility's negotiated rate is lower than the gross charge, it is still higher than the Medicare benchmark of $4.29, which serves as a scientifically validated baseline for the true cost of care. If you receive a bill that includes charges for services not rendered or items that were cancelled, you should request a full itemized audit rather than accepting a summary bill, as over 80% of hospital bills contain errors. Furthermore, if you are ever billed for out-of-network services at an in-network facility, the No Surprises Act protects you from balance billing, so you should dispute any unexpected charges immediately rather than paying them out of fear of credit damage.