Blood test, clotting time (PT/INR)
Facility: Republic County Hospital
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $27
- Cash Discount Price: $23
- vs. Medicare Baseline: 6.29x 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 629% of the Medicare baseline (a markup of 529%). 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 |
|---|---|---|
| Rural Carriers-All Plans | $17 - $35 | 396% |
| Meritain-All Plans | $18 - $37 | 420% |
| UnitedHealthcare | $18 - $38 | 420% |
| Aetna | $18 - $37 | 420% |
| Cigna | $19 - $39 | 443% |
| Midlands Choice-All Plans | $19 - $39 | 443% |
| First Health-All Plans | $19 - $39 | 443% |
Consumer Guidance & Cost Commentary
For the blood clotting time test (CPT 85610) at Republic County Hospital in Belleville, KS, the cash price of $23.00 is lower than the facility's negotiated rate of $27.00 and the median paid amount of $25.00. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should note that commercial insurance carriers like UnitedHealthcare and Aetna have negotiated rates ranging from $18 to $39, which often exceed the cash price. This pricing dynamic suggests that for individuals with high-deductible plans, paying the cash price directly may result in lower out-of-pocket costs compared to having insurance process the claim, as the insurer's allowed amount could be higher than the cash rate.
To maximize savings, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these programs can reduce the final bill by 20% to 50% by bypassing administrative claim processing fees. It is important to compare these rates against the Medicare benchmark of $4.29, which serves as the objective baseline for cost; commercial rates are typically marked up significantly above this federal standard. Additionally, since the facility is located in a rural area with a specific geographic wage index, patients should verify their deductible status and ensure they are not inadvertently signing waivers that could lead to balance billing, especially if any ancillary services are out-of-network.