Blood test, clotting time (PT/INR)
Facility: Smith County Memorial Hospital
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $24
- Cash Discount Price: $25
- vs. Medicare Baseline: 5.59x 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 559% of the Medicare baseline (a markup of 459%). 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 | 373% |
| Medicaid / KanCare | $18 - $25 | 420% |
| Multiplan-All Plans | $22 | 513% |
| Health Partners Of Ks Ppo-All Plans | $24 | 559% |
| UnitedHealthcare | $24 | 559% |
| Midlands Choice-All Plans | $24 | 559% |
| Wppa-All Plans | $24 | 559% |
Consumer Guidance & Cost Commentary
Smith County Memorial Hospital's cash price for a blood test measuring clotting time (PT/INR) is $25.00, which matches the facility's negotiated rate and the state average for this service. While the hospital's cash price aligns with the state average, the Medicare benchmark for this procedure is significantly lower at $4.29, indicating that the facility's rates are approximately 5.6 times the federal baseline. For patients with high-deductible plans, paying the full cash price of $25.00 upfront may be more cost-effective than relying on insurance, as the negotiated rates paid by insurers range from $16.00 to $25.00 depending on the specific plan, often resulting in higher out-of-pocket costs if deductibles are not yet met.
Patients should be aware that while the No Surprises Act protects against balance billing for emergency care and non-emergency services from out-of-network providers at in-network facilities, it is still critical to request a full itemized bill before paying to avoid errors or unbundled charges. Since over 80% of hospital bills contain mistakes, consumers should demand a detailed line-by-line statement rather than accepting a summary invoice. Additionally, because the facility is a Critical Access Hospital owned by the local government, patients should proactively ask about "self-pay" or "prompt-pay" discounts before scheduling, as paying in full within a short window can often reduce the final amount owed by bypassing administrative claim processing fees.