Blood test, clotting time (PT/INR)
Facility: Golden Valley Memorial Hospital
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $4
- Cash Discount Price: $42
- vs. Medicare Baseline: 0.93x 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.
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 |
|---|---|---|
| Aetna | $4 | 93% |
| Home State Health | $4 | 93% |
| Humana | $4 | 93% |
| UnitedHealthcare | $4 - $7 | 93% |
| Ambetter / Centene | $5 | 117% |
Consumer Guidance & Cost Commentary
For patients paying out-of-pocket, the most immediate consideration is that the cash payment rate for this blood test, clotting time (PT/INR) procedure is $42. While commercial insurance plans often negotiate higher rates due to administrative processing costs and contract structures, paying cash upfront can sometimes result in a lower total cost, particularly for those with high-deductible plans where the insurance allowed amount might exceed the cash price. It is important to verify if the facility offers additional "self-pay" or "prompt-pay" discounts before scheduling, as these incentives can further reduce the final balance owed.
In the broader context of pricing transparency, the facility's cash rate of $42 is notably lower than the gross chargemaster listing of $70, which represents the maximum price before any discounts are applied. When compared to the state of Missouri, the cash rate of $42 is higher than the state average of $4.29, though the state's median negotiated rate is only $4, suggesting significant variation in how commercial payers contract with local providers. The facility is a government-owned acute care hospital in Clinton, MO, with a Medicare benchmark rate of $4.29, which serves as the scientific baseline for evaluating the markup of commercial rates.