Blood test, clotting time (PT/INR)
Facility: Memorial Hospital
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 |
|---|---|---|
| Humana | $8 - $32 | 186% |
| Tricare | $8 - $32 | 186% |
| Medicare (plans) | $8 - $33 | 186% |
| Ambetter / Centene | $9 - $36 | 210% |
| Blue Cross Blue Shield | $11 | 256% |
| Preferred Healthcare-All Plans | $15 - $61 | 350% |
| Health Partners Of Kansas - All Plans | $15 - $61 | 350% |
| Coventry - All Other Plans | $15 - $58 | 350% |
| Wppa/Providers Care-All Plans | $23 - $90 | 536% |
Consumer Guidance & Cost Commentary
For the CPT code 85610, representing a blood test for clotting time (PT/INR), Memorial Hospital in Abilene, KS, lists a cash price of $40.00. This cash rate is identical to the facility's median negotiated rate of $21.00, which is significantly lower than the gross charge of $40.00. While the facility is a Critical Access Hospital with a government ownership structure, patients should be aware that commercial insurance plans often negotiate rates higher than cash prices due to administrative overhead and contract dynamics. For instance, the highest negotiated rate among the nine payers listed is $90.00 for Wppa/Providers Care, which far exceeds the cash price. Consequently, individuals with high-deductible plans or those without insurance may find paying the $40.00 cash price more cost-effective than relying on an in-network plan that could result in a higher allowed amount.
When evaluating this service against broader benchmarks, the Medicare amount for this procedure is $4.29. Commercial rates, including the facility's median negotiated rate of $23.00, average between 200% and 300% of the Medicare baseline, whereas fair pricing is typically defined as 120% to 150% of Medicare. It is important to note that the data provided does not include specific county or state average comparisons for this specific code, so patients cannot directly compare this facility's pricing to regional norms based on the available figures. To minimize costs, patients should contact Memorial Hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can reduce bills by 2