Blood test, clotting time (PT/INR)
Facility: Regional Medical Center
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $870
- Cash Discount Price: $29
- vs. Medicare Baseline: 202.80x 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 20280% of the Medicare baseline (a markup of 20180%). 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 |
|---|---|---|
| Medical Associates Health Plan - Tri | $870 | 20280% |
Consumer Guidance & Cost Commentary
For patients paying out of pocket, the cash rate of $29 is significantly lower than the facility's negotiated rate of $870 charged by Medical Associates Health Plan - Tri. This substantial difference highlights that self-pay options can be far more economical than using insurance, especially for those with high-deductible plans or those who prefer to avoid administrative fees. While the facility is a Critical Access Hospital in Manchester, Iowa, with a government-local ownership structure, patients should explicitly ask for "self-pay" or "prompt-pay" discounts before scheduling to ensure they are not billed the full negotiated amount.
This service, a blood test for clotting time (PT/INR), carries a Medicare benchmark of $4.29, which serves as the objective baseline for evaluating the facility's pricing markup. The cash rate of $29 is lower than the gross chargemaster price of $36 but represents a significant discount compared to the commercial rate. Although specific county or state average data is not provided in this record, the fixed Medicare amount of $4.29 offers a clear reference point for understanding the true cost of delivery versus the commercial rates. Consumers should always verify the specific billing classification and request an itemized audit if discrepancies arise between the expected cash price and the final invoice.