Blood test, clotting time (PT/INR)
Facility: Mcpherson Hospital
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $72
- Cash Discount Price: $70
- vs. Medicare Baseline: 16.78x 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 1678% of the Medicare baseline (a markup of 1578%). 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 |
|---|---|---|
| Tricare | $4 | 93% |
| UnitedHealthcare | $4 - $165 | 93% |
| Humana | $4 | 93% |
| Blue Cross Blue Shield | $4 | 93% |
| Healthy Blue Mcr Adv | $4 | 93% |
| Wellcare Mcr Adv - All Plans | $4 | 93% |
| Va Ccn - All Plans | $4 | 93% |
| Ambetter / Centene | $5 | 117% |
| Wppa - All Plans | $22 - $116 | 513% |
| Central Plains - All Plans | $24 - $124 | 559% |
| Medical Associates - All Plans | $24 - $124 | 559% |
| Christian Health Aid - All Plans | $26 - $132 | 606% |
| Aetna | $26 - $165 | 606% |
| Multiplan - All Plans | $29 - $148 | 676% |
| Cigna | $30 - $157 | 699% |
| Health Partners - All Plans | $30 - $157 | 699% |
| First Health - All Plans | $30 - $157 | 699% |
| Medicaid / KanCare | $32 - $165 | 746% |
| Health Blue Mcaid - All Other Plans | $33 - $168 | 769% |
Consumer Guidance & Cost Commentary
For the CPT code 85610, representing a blood test for clotting time (PT/INR), McPherson Hospital in McPherson, KS, lists a gross charge of $94.00. The facility's cash median rate is $70.00, while the median negotiated rate across payers is $72.00. This cash price is notably lower than the facility's Medicare benchmark of $4.29, which serves as the federal baseline for cost. Patients should be aware that while insurance plans like Tricare, UnitedHealthcare, and Aetna have negotiated rates ranging from $4 to $165, these figures often include administrative overhead and may exceed the cash price. For individuals with high-deductible plans, paying the cash median of $70.00 upfront could result in immediate savings compared to the higher negotiated amounts charged to insured members.
To maximize potential savings, patients are encouraged to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% for upfront payment. It is critical to request a waiver of insurance submission before scheduling to prevent the facility from submitting a claim that would void any cash discount agreement. Additionally, if a patient receives a bill from an out-of-network provider or encounters unexpected charges, they should review their itemized statement for errors, as over 80% of hospital bills contain mistakes such as double-billing or unbundled codes. Under federal protections like the No Surprises Act, patients are generally shielded from balance billing for emergency services or non-emergency care at in-network facilities, making it essential