Blood test, clotting time (PT/INR)
Facility: Monument Health Rapid City Hospital
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $15
- Cash Discount Price: $20
- vs. Medicare Baseline: 3.50x 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 350% of the Medicare baseline (a markup of 250%). 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 | $4 - $75 | 93% |
| Medicare (plans) | $4 | 93% |
| Minnesota Health Care Programs 12K16 [3081295] | $4 - $25 | 93% |
| Tricare | $4 - $23 | 93% |
| UnitedHealthcare | $4 - $55 | 93% |
| Va Black Hills Health Care System 12115 [3081206] | $4 | 93% |
| Health Partners Sx009 [3081102] | $7 - $51 | 163% |
| Healthpartners [3081368] | $7 | 163% |
| Coresource 38225 [3081146] | $9 - $56 | 210% |
| Govt Employees Health Assn [3081090] | $9 - $55 | 210% |
| National Telephone Cooperative Assn 52103 [3081149] | $9 - $55 | 210% |
| Risk Admin Svs [3081167] | $9 - $66 | 210% |
| Surest [3081369] | $9 - $55 | 210% |
| United Medical Resources 39026 [3081194] | $9 - $55 | 210% |
| Avera Health Plans 46045 [3081018] | $10 - $61 | 233% |
| Rocky Mountain Admin Llc 83028 [3081168] | $11 - $66 | 256% |
| Employee Benefit Management 12X44 [3081079] | $12 - $71 | 280% |
| Medica (Commercial) 94265 [3081118] | $12 - $69 | 280% |
| Pacificsource Health Plans [3081333] | $12 - $71 | 280% |
| Tlc Advantage Llc [3081189] | $12 - $78 | 280% |
| Aetna | $13 - $75 | 303% |
| Allied Benefit Systems Inc [3081320] | $13 - $80 | 303% |
| Cigna | $13 - $80 | 303% |
| Fedmed Inc [3081283] | $13 - $79 | 303% |
| Group And Pension Administrators Inc [3081098] | $13 - $75 | 303% |
| Key Benefit Administrators [3081332] | $13 - $80 | 303% |
| Meritain Health [3081135] | $13 - $80 | 303% |
| Midlands Choice 47080 [3081136] | $13 - $80 | 303% |
| Multiplan Inc 34080 [3081285] | $13 - $75 | 303% |
| Preferred One 41147 [3081160] | $13 - $80 | 303% |
| Sanford Health Plan 91184 [3081174] | $13 - $75 | 303% |
| Blue Cross Blue Shield | $36 | 839% |