Blood test, clotting time (PT/INR)
Facility: Girard Medical Center
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $23
- Cash Discount Price: $40
- vs. Medicare Baseline: 5.36x 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 536% of the Medicare baseline (a markup of 436%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $16 - $23 | 373% |
| Medicare (plans) | $23 | 536% |
| Ambetter / Centene | $23 | 536% |
| Humana | $23 | 536% |
| UnitedHealthcare | $23 - $64 | 536% |
| Aetna | $23 - $117 | 536% |
| Kansas Superior Select-All Plans | $23 | 536% |
| Multiplan-All Plans | $62 | 1445% |
| Uhhis-All Plans | $64 | 1492% |
Consumer Guidance & Cost Commentary
For this blood clotting test at Girard Medical Center, the cash price of $40.00 is notably higher than the facility's negotiated rate of $23.00, which is the lowest amount charged to any of the nine insurance payers listed. While the cash price exceeds the state average of $31.00 for this service, patients with high-deductible plans may find paying out-of-pocket cheaper if their insurance negotiated rate is significantly higher than the cash price. It is important to note that commercial rates often include administrative overhead and contract markups that can inflate the baseline price, so comparing the cash option directly to the negotiated rate is more accurate than comparing it to the hospital's full list price.
The facility's Medicare benchmark rate of $4.29 serves as the objective baseline for evaluating pricing, revealing that the cash price represents a markup of 5.4 times the Medicare amount. Although the facility is a Critical Access Hospital owned by a Government Hospital District, the negotiated rates for this procedure range widely among payers, with UnitedHealthcare paying up to $64 and Aetna up to $117. To minimize costs, patients should verify their specific plan's allowed amount before scheduling and ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full upfront.