Blood test, clotting time (PT/INR)
Facility: Phillips County Hospital
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $24
- Cash Discount Price: $23
- 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 |
|---|---|---|
| Blue Cross Blue Shield | $16 - $22 | 373% |
| UnitedHealthcare | $22 - $27 | 513% |
| Medicaid / KanCare | $27 | 629% |
| Health Partners-All Plans | $27 | 629% |
Consumer Guidance & Cost Commentary
This blood test for clotting time (PT/INR) at Phillips County Hospital in Phillipsburg, KS, carries a gross charge of $27.00, with a cash median of $23.00 and a negotiated median of $24.00. For patients with high-deductible plans, paying the cash price of $23.00 upfront may be more cost-effective than using insurance, as the negotiated rate of $24.00 exceeds the cash amount. While the facility is a government-owned Critical Access Hospital, the cash rate is notably higher than the state average of $21.00, suggesting that commercial insurance contracts in this county are currently priced above the typical cash-pay benchmark.
When comparing commercial rates to the Medicare benchmark, the facility's gross charge of $27.00 represents a 5.6% increase over the Medicare amount of $4.29, which aligns with the typical commercial markup range of 200% to 300% of Medicare. Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network services at in-network facilities, it is still advisable to request a "self-pay" or "prompt-pay" discount before scheduling, as these upfront payment incentives can further reduce the final cost. To ensure accuracy, always request a full itemized bill before payment to verify that no unbundled codes or services not rendered have been included in the total.