Blood test, clotting time (PT/INR)
Facility: Osborne County Memorial Hospital
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $30
- Cash Discount Price: $28
- vs. Medicare Baseline: 6.99x 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 699% of the Medicare baseline (a markup of 599%). 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 |
|---|---|---|
| UnitedHealthcare | $25 | 583% |
| Health Partners Of Kansas | $28 | 653% |
| Wppa | $31 | 723% |
| Blue Cross Blue Shield | $32 | 746% |
Consumer Guidance & Cost Commentary
For this blood clotting test (CPT 85610) at Osborne County Memorial Hospital in Osborne, KS, the facility's cash price of $28.00 is notably lower than the negotiated rates paid by major insurers, which range from $25.00 to $32.00 depending on the specific plan. While the median negotiated rate across these four payers is $30.00, the cash price remains the most affordable option at $28.00, which is also lower than the facility's gross charge of $33.00. It is important to note that for patients with high-deductible plans who have not yet met their out-of-pocket maximum, paying the cash price upfront can sometimes result in lower total costs than the insurance negotiated rate, as the patient would otherwise be responsible for the full difference between the allowed amount and their deductible.
To maximize savings, patients should explicitly ask the hospital about "prompt-pay" discounts, which can reduce the bill by 20% to 50% for upfront payment, and verify if "self-pay" rates are available before scheduling. Although the facility is a Critical Access Hospital with government-local ownership, the data does not provide a specific county or state average for comparison, so the $28.00 cash price stands as the primary benchmark for self-pay patients. If you are using insurance, be aware that the Medicare benchmark for this service is $4.29, which serves as a baseline for evaluating the markup of commercial rates; however, since the cash price is already below the facility's gross charge, the most effective strategy for many patients is to secure the cash or prompt-pay rate directly