Blood test, clotting time (PT/INR)
Facility: Morris County Hospital
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $31
- Cash Discount Price: $47
- vs. Medicare Baseline: 7.23x 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 723% of the Medicare baseline (a markup of 623%). 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 |
|---|---|---|
| Va Ccn-All Plans | $3 | 70% |
| Providrs Care (Wppa)(Nexus)-All Plans | $4 | 93% |
| Aetna | $13 | 303% |
| Blue Cross Blue Shield | $15 - $31 | 350% |
| UnitedHealthcare | $31 - $79 | 723% |
| Choice Care Mcr Adv-All Plans | $31 | 723% |
| Coventry Mcr | $31 | 723% |
| Cigna | $57 | 1329% |
| Multiplan-All Plans | $71 | 1655% |
| Coventry Comm-All Other Plans | $71 | 1655% |
Consumer Guidance & Cost Commentary
For this blood test procedure at Morris County Hospital in Council Grove, KS, the facility's cash median rate of $47.00 is notably higher than the state average of $31.00, though it aligns closely with the county average. While commercial insurance plans like Aetna and Choice Care Mcr Adv-All Plans have negotiated rates starting at $13.00, many other payers, including UnitedHealthcare and Multiplan-All Plans, have negotiated rates that exceed the cash price. This dynamic suggests that for patients with high-deductible plans who have not yet met their out-of-pocket maximum, paying the cash price directly could result in lower total costs compared to the insurance negotiated rate, provided the patient qualifies for a self-pay discount.
Patients should proactively contact the hospital to confirm if "self-pay" or "prompt-pay" discounts are available, as these upfront payment incentives can significantly reduce the final bill by bypassing administrative claim processing fees. It is also important to understand that while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, unexpected ancillary charges or errors in itemized billing can still occur. To ensure accuracy, consumers should request a full, line-by-line itemized bill rather than accepting a summary invoice, and if discrepancies are found, they should submit a formal written audit dispute to the billing supervisor to avoid paying for services that were not rendered or codes that were incorrectly unbundled.