Blood test, clotting time (PT/INR)
Facility: Northeast Regional Medical Center
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $53
- Cash Discount Price: $47
- vs. Medicare Baseline: 12.35x 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 1235% of the Medicare baseline (a markup of 1135%). 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 |
|---|---|---|
| UnitedHealthcare | $4 - $167 | 93% |
| Blue Prefrerred | $4 | 93% |
| Blue Access | $4 | 93% |
| Medicaid / KanCare | $4 - $6 | 93% |
| Medicare (plans) | $4 | 93% |
| Node VA | $4 | 93% |
| Veterans Eval Services | $4 | 93% |
| Node Hospice Non Par Agree | $4 | 93% |
| Tricare | $4 | 93% |
| Blue Cross Blue Shield | $4 - $68 | 93% |
| Node Champva | $4 | 93% |
| Blue Pathway/Pathway X | $4 | 93% |
| Node Devoted Health McR Adv | $4 | 93% |
| Us Department of Labor | $5 | 117% |
| Centurion Correctional | $5 | 117% |
| Home State Exchange | $8 | 186% |
| Naphcare | $8 | 186% |
| Immergrun | $9 | 210% |
| Self Pay | $18 - $123 | 420% |
| Cigna | $25 - $87 | 583% |
| Aetna | $27 - $186 | 629% |
| Access Health Services, LLC | $48 - $145 | 1119% |
| Healthlink | $55 - $178 | 1282% |
| Multiplan | $55 - $178 | 1282% |
| Coventry Wc | $59 - $178 | 1375% |
Consumer Guidance & Cost Commentary
For this blood test, clotting time (PT/INR) procedure at Northeast Regional Medical Center in Kirksville, MO, the cash median rate is $47. This facility's cash price is significantly lower than the state average of $148 and the county average of $53. While the facility's negotiated rates range from $4 to $186 depending on the insurance plan, the cash price may be the most economical option for patients with high-deductible plans or those without coverage, as commercial negotiated rates often exceed the cash price due to administrative overhead.
Patients should verify their specific plan's allowed amount before scheduling, as in-network rates can vary widely by carrier. For instance, UnitedHealthcare negotiates a rate of $167, while Self Pay is listed at $123. If you choose to pay out of pocket, ask the hospital about prompt-pay discounts, which can reduce the bill by 20% to 50% if paid upfront, bypassing the costly insurance billing cycle. Additionally, remember that the Medicare amount for this service is $4.29, which serves as a benchmark to understand the markup on commercial rates; comparing your final cost to this federal rate helps ensure you are not overpaying.