Blood test, clotting time (PT/INR)
Facility: Community Memorial Healthcare, Inc.
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $16
- Cash Discount Price: $26
- vs. Medicare Baseline: 3.73x 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 373% of the Medicare baseline (a markup of 273%). 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 | $12 - $21 | 280% |
| UnitedHealthcare | $14 - $16 | 326% |
| Blue Cross Blue Shield | $16 | 373% |
Consumer Guidance & Cost Commentary
For this blood clotting time test at Community Memorial Healthcare, Inc. in Marysville, KS, the cash price is $26.00, which matches the facility's median negotiated rate of $16.00 when adjusted for the specific payer mix. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should be aware that commercial insurance plans, such as Aetna and UnitedHealthcare, often negotiate rates that exceed the cash price. In this case, the median amount paid by insurers is $20.00, which is lower than the cash rate, but this varies significantly by plan. If you have a high-deductible plan, paying the full cash price of $26.00 upfront might be more cost-effective than waiting for insurance to process a claim, especially if your deductible is not yet met or if your specific plan's negotiated rate is higher than the cash option.
To ensure you receive the best possible rate, it is crucial to ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling your visit. These discounts, which can range from 20% to 50%, are incentives for paying in full immediately and bypass the administrative costs associated with insurance claims processing. Additionally, while the facility's pricing is transparent, patients should request an itemized bill to verify that no services were unbundled or that charges for tests not rendered were included. Comparing this facility's rates to the broader market, the cash price of $26.00 is slightly higher than the state average for this procedure, so verifying your specific plan's allowed amount and asking about any prompt-pay reductions can help you avoid unexpected costs.