Blood test, clotting time (PT/INR)
Facility: Stormont Vail Hospital
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $13
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 3.03x 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 303% of the Medicare baseline (a markup of 203%). 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 - $16 | 93% |
| UnitedHealthcare | $4 | 93% |
| Ambetter / Centene | $4 | 93% |
Consumer Guidance & Cost Commentary
For the CPT code 85610, representing a blood test for clotting time (PT/INR), Stormont Vail Hospital in Topeka, KS, has a median negotiated payment of $13,378.00, which is significantly higher than the Medicare benchmark of $4.29. This indicates a substantial markup relative to the federal government's cost-based rate. While the facility offers a median negotiated rate of $13.00 to commercial payers like Blue Cross Blue Shield, UnitedHealthcare, and Ambetter/Centene, patients should be aware that cash-pay options may sometimes result in lower out-of-pocket costs if their insurance deductible has not yet been met. It is important to verify the specific cash price and inquire about self-pay or prompt-pay discounts before scheduling, as these upfront payment incentives can bypass the administrative overhead and higher negotiated rates associated with insurance billing.
When reviewing your final invoice, always request a detailed itemized bill rather than accepting a summary statement, as hospitals often use broad categories to obscure individual charges. Since over 80% of hospital bills contain errors, such as unbundled codes or services not rendered, a line-by-line audit is the most effective way to identify and correct mistakes. Additionally, be cautious of balance billing, which occurs when a provider charges you for the difference between their full list price and what your insurance allowed. Under the No Surprises Act, you are protected from balance billing for emergency care and non-emergency services at in-network facilities, so you should dispute any surprise bills with your insurer rather than paying them immediately.