Blood test, clotting time (PT/INR)
Facility: Mitchell County Hospital Health Systems
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $63
- Cash Discount Price: $59
- vs. Medicare Baseline: 14.69x 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 1469% of the Medicare baseline (a markup of 1369%). 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 - $66 | 93% |
| Blue Cross Blue Shield | $16 | 373% |
| Triwest Well Mark All Plans | $56 | 1305% |
| Aetna | $59 | 1375% |
| First Health-All Plans | $59 | 1375% |
| Pref Hlth Care Sytms Comm - All Plans | $59 | 1375% |
| Phc Leased Ntwrk Access - All Plans | $63 | 1469% |
| Multiplan Ppo - All Plans | $63 | 1469% |
| Auxiant-All Plans | $63 | 1469% |
| Health Partners Ks-All Plans | $65 | 1515% |
| Cigna | $65 | 1515% |
Consumer Guidance & Cost Commentary
For the blood clotting time test (CPT 85610) at Mitchell County Hospital Health Systems in Beloit, KS, the facility's cash price of $59.00 is significantly lower than the gross charge of $66.00. While the facility's negotiated rates for in-network insurance plans range from $4 to $66, with most plans settling around $59 to $65, the cash price aligns closely with the median negotiated amount of $63.00. This suggests that for patients without insurance or with high-deductible plans, paying the cash price directly may be more cost-effective than relying on insurance, which often incurs higher administrative costs and potential deductibles. The facility's cash rate is also notably higher than the Medicare benchmark of $4.29, reflecting standard commercial pricing structures where negotiated rates typically exceed federal reimbursement by a significant margin.
Patients should be aware that while the facility is a Critical Access Hospital with government-local ownership, the variation in allowed amounts across different payers indicates that in-network status does not guarantee the lowest possible price. To minimize costs, individuals should explicitly request "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can bypass the complex claims processing that inflates insurance rates. Furthermore, since the facility is located in a rural area (Zip 67420), it is advisable to verify the specific allowed amount for your plan prior to the procedure, as some commercial carriers may negotiate rates that exceed the cash price due to their own administrative overhead and contract dynamics.