Blood test, clotting time (PT/INR)
Facility: St. Catherine Hospital - Garden City
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $19
- Cash Discount Price: $50
- vs. Medicare Baseline: 4.43x 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 443% of the Medicare baseline (a markup of 343%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $4 - $19 | 93% |
| Medicare (plans) | $4 | 93% |
| Devoted Health | $4 | 93% |
| UnitedHealthcare | $4 - $48 | 93% |
| Kaiser | $4 - $48 | 93% |
| Humana | $4 | 93% |
| Cigna | $4 - $6 | 93% |
| Kansas Health | $4 | 93% |
| Innovage | $4 | 93% |
| Aetna | $4 - $65 | 93% |
| Centura Employee Plan | $5 | 117% |
| United Colorado Doctor'S Plan | $6 | 140% |
| Direct To Employer | $8 - $69 | 186% |
| Denver Health | $41 | 956% |
| Wpaa | $54 | 1259% |
| Christian Health Aid | $61 | 1422% |
| Peak Health | $67 | 1562% |
| Multiplan | $69 - $147 | 1608% |
| Health Partners Of Kansas | $74 | 1725% |
Consumer Guidance & Cost Commentary
For the blood test, clotting time (PT/INR) procedure at St. Catherine Hospital in Garden City, KS, the facility's cash median price of $50.00 is significantly higher than the state average of $4.29 and the county average of $4.00. While the hospital's negotiated rates with major payers like Blue Cross Blue Shield and UnitedHealthcare range from $4 to $69, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket and requesting a prompt-pay discount. It is important to note that the facility's gross charge of $125.00 serves as the baseline list price, but commercial contracts cap payments at much lower levels, and the Medicare benchmark of $4.29 provides a clear reference for the true cost of this service.
Patients should be aware that balance billing is generally prohibited for in-network services under the No Surprises Act, though out-of-network ancillary services could still trigger unexpected charges. To avoid confusion, consumers should request an itemized billing audit before finalizing payment, as summary bills can obscure individual code costs. Additionally, while the facility is a voluntary non-profit church-owned hospital, the median negotiated rate of $19.00 remains well above the Medicare benchmark, suggesting that commercial contracts include administrative overheads that inflate the final price. Consumers are encouraged to verify their specific plan details and ask the billing department about self-pay discounts or prompt-pay incentives prior to scheduling to ensure they are not paying more than necessary.