Blood test, clotting time (PT/INR)
Facility: Saint John Hospital
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $5
- Cash Discount Price: $4
- vs. Medicare Baseline: 1.17x 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 |
|---|---|---|
| Cigna | $4 | 93% |
| UnitedHealthcare | $4 - $6 | 93% |
| Midland Care Connection | $4 | 93% |
| Celtic | $4 - $50 | 93% |
| Tricare | $4 | 93% |
| Medicare (plans) | $4 | 93% |
| Healthy Blue | $4 | 93% |
| Kansas Superior Select | $4 | 93% |
| Aetna | $4 - $7 | 93% |
| Medicaid / KanCare | $4 | 93% |
| Employer Direct Healthcare | $6 | 140% |
| Corizon | $6 | 140% |
| Centurion | $6 | 140% |
| Well Path | $6 | 140% |
| Naphcare | $7 | 163% |
| Worker Compensation | $8 | 186% |
| Blue Cross Blue Shield | $8 - $16 | 186% |
| Comp Alliance Workers Comp | $8 | 186% |
| Oha Networks | $8 | 186% |
Consumer Guidance & Cost Commentary
For this blood clotting test at Saint John Hospital in Leavenworth, KS, the cash price is $4.00, which is significantly lower than the facility's negotiated rates of $5.00 and the median paid amount of $71.00. While the facility is a voluntary non-profit acute care hospital, patients with high-deductible plans may find paying cash upfront more economical than relying on insurance, as the negotiated rates often exceed the cash price. It is important to note that while the facility offers a cash rate, commercial payers like Cigna and UnitedHealthcare have negotiated rates that can be substantially higher, meaning self-pay patients should verify if their specific plan has a deductible that would otherwise result in a higher out-of-pocket cost.
The facility's pricing structure operates under standard billing principles where commercial rates are often inflated compared to the Medicare benchmark of $4.29 for this procedure. Although the facility is located in Leavenworth (ZIP 66048), the data provided does not include specific county or state average comparisons for this service code. Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network services at in-network facilities, it is still advisable to request an itemized bill to ensure no unbundled charges or services not rendered are included. If you choose to pay cash, you may be eligible for additional prompt-pay discounts by asking the billing department before scheduling your visit, as these upfront payments can reduce the total cost further than the listed cash rate.