Blood test, clotting time (PT/INR)
Facility: University Of Kansas Health System - St Francis Campus
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $54
- Cash Discount Price: $39
- vs. Medicare Baseline: 12.59x 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 1259% of the Medicare baseline (a markup of 1159%). 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 |
|---|---|---|
| Lucent Health [6000] | $54 | 1259% |
| Blue Cross Blue Shield | $54 | 1259% |
| Oncology Patient Assistance Programs [2295] | $54 | 1259% |
| Web Tpa [2115] | $54 | 1259% |
| Healthcare Highways [2210] | $54 | 1259% |
| Black Lung [6055] | $54 | 1259% |
| Aetna | $54 | 1259% |
| Hooray Health [8000] | $54 | 1259% |
| Department Of Corrections [1340] | $65 | 1515% |
| National Association Of Letter Carriers [1695] | $76 | 1772% |
| American Postal Workers Union [1070] | $76 | 1772% |
| Healthpartners [1500] | $76 | 1772% |
| Cigna | $76 | 1772% |
| Humana | $77 | 1795% |
| First Health [1375] | $102 | 2378% |
| American Healthcare [1055] | $102 | 2378% |
| Multiplan [1680] | $102 | 2378% |
| Administrative Concepts [1005] | $102 | 2378% |
| Coventry Healthcare [1320] | $107 | 2494% |
Consumer Guidance & Cost Commentary
For this blood clotting test (CPT 85610) at the University Of Kansas Health System - St Francis Campus in Topeka, the facility's cash price of $39.00 is significantly lower than the state average of $131.00. While the hospital's negotiated rates with insurance payers average $54.00, these amounts are still higher than the cash price, meaning patients with high-deductible plans or those without insurance may save money by paying the cash rate directly. It is important to note that commercial negotiated rates often include administrative overhead and contract markups that can inflate the baseline price by 20% to 40% compared to the true cost of care.
To ensure you are receiving the best possible rate, we recommend asking the hospital specifically about "self-pay" or "prompt-pay" discounts, which can reduce bills by 20% to 50% if paid upfront. Although the facility is in-network for many major payers, the allowed amounts vary, with some plans negotiating rates as high as $107.00. If you have already received a bill, request a full itemized statement to verify that no services were double-billed or unbundled, as over 80% of hospital bills contain errors. Always confirm your deductible status before scheduling, as paying the negotiated rate may not be covered until that threshold is met.