Blood test, clotting time (PT/INR)
Facility: Nmc Health
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $32
- Cash Discount Price: $39
- vs. Medicare Baseline: 7.46x 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 746% of the Medicare baseline (a markup of 646%). 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 |
|---|---|---|
| Wppa | $11 - $45 | 256% |
| Occunet | $12 - $49 | 280% |
| Aetna | $12 - $68 | 280% |
| Medincrease Health Plan | $13 - $53 | 303% |
| Samaritan Ministries International | $13 - $53 | 303% |
| Prime Health Services | $15 - $62 | 350% |
| Blue Cross Blue Shield | $16 | 373% |
| UnitedHealthcare | $18 - $74 | 420% |
| Cigna | $19 - $78 | 443% |
Consumer Guidance & Cost Commentary
For this blood clotting time test at Nmc Health in Newton, KS, the facility's cash price of $39.00 is significantly lower than the state average, which sits at $69.00. While many commercial payers negotiate rates ranging from $11 to $78, the cash rate remains the most affordable option for patients without insurance. It is important to note that for individuals with high-deductible plans, paying the cash price upfront can be more cost-effective than relying on insurance, as the negotiated rates paid by insurers often exceed the cash price. Patients should proactively ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can further lower the final cost.
The facility's cash rate of $39.00 is also notably higher than the Medicare benchmark of $4.29, reflecting the standard markup found in commercial healthcare pricing. Although the facility is a voluntary non-profit with a high rating, the gap between the Medicare amount and the cash price highlights the complexity of commercial billing structures. To ensure you are not overcharged, we recommend requesting a full itemized bill that lists every specific CPT code and charge, as summary bills often obscure individual line items. If you receive a balance bill for services not covered by your plan, you have the right to dispute it under federal protections, but verifying your deductible status and comparing allowed amounts with other in-network providers is the best way to avoid unexpected costs.