Blood test, clotting time (PT/INR)
Facility: Scott County Hospital
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $51
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 11.89x 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 1189% of the Medicare baseline (a markup of 1089%). 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 | $4 - $54 | 93% |
| Blue Cross Blue Shield | $16 | 373% |
| Humana | $24 | 559% |
| Wppa | $34 - $1,200 | 793% |
| Aetna | $51 | 1189% |
Consumer Guidance & Cost Commentary
For this blood clotting test at Scott County Hospital in Scott City, KS, the negotiated rates paid by major insurers range from $16 to $1,200, with a median negotiated amount of $51.00. This commercial rate is significantly higher than the Medicare benchmark of $4.29, reflecting the standard administrative markup inherent in insurance contracts. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should be aware that cash prices are not listed in this report. However, for individuals with high-deductible plans, paying cash directly can sometimes result in lower out-of-pocket costs if the insurance negotiated rate exceeds the facility's self-pay price, making it essential to inquire about self-pay or prompt-pay discounts before scheduling.
To ensure you are not overcharged, it is critical to request a full itemized bill rather than accepting a summary invoice that obscures individual line items. Since over 80% of hospital bills contain errors such as unbundled codes or charges for services not rendered, a detailed audit is the most effective way to identify and dispute mistakes. Additionally, if you receive a balance bill for out-of-network services at this in-network facility, you may be protected under the No Surprises Act, which bans balance billing for emergency and non-emergency care at in-network hospitals. Always verify your deductible status before using insurance, as paying the full negotiated rate without meeting your deductible can lead to unexpected financial exposure.