Blood test, clotting time (PT/INR)
Facility: Wesley Medical Center
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $9
- Cash Discount Price: $354
- vs. Medicare Baseline: 2.10x 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 210% of the Medicare baseline (a markup of 110%). 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 |
|---|---|---|
| Humana | $4 | 93% |
| Triwest Health Alliance | $4 | 93% |
| Coventry Health Care | $4 | 93% |
| Amerigroup | $4 | 93% |
| United | $4 - $159 | 93% |
| Medicaid / KanCare | $4 | 93% |
| UnitedHealthcare | $4 | 93% |
| Aetna | $4 - $126 | 93% |
| Ambetter / Centene | $4 - $64 | 93% |
| Devoted Health | $4 | 93% |
| Correct Care Solutions | $6 | 140% |
| First Health | $8 - $163 | 186% |
| Multiplan | $8 - $319 | 186% |
| Blue Cross Blue Shield | $12 | 280% |
| Health Partners Of Kansas | $61 - $177 | 1422% |
| Wppa | $62 | 1445% |
| Preferred Health Choices | $67 | 1562% |
| Medical Associates Health Plan | $67 | 1562% |
| Spirit Aerosystems | $113 | 2634% |
| Triwest Healthcare Alliance | $230 | 5361% |
| Usa Managed Care | $301 | 7016% |
Consumer Guidance & Cost Commentary
For this blood clotting time test at Wesley Medical Center in Wichita, KS, the cash price is $354.00, which matches the facility's median paid amount. This rate is significantly higher than the state average, as indicated by a 2.1x multiplier compared to Medicare's benchmark of $4.29. While commercial insurance plans like Humana and Triwest Health Alliance negotiate rates, these negotiated amounts often exceed the cash price due to administrative overhead and contract structures. Patients with high-deductible plans or those without insurance may find the $354.00 cash rate more cost-effective than the negotiated rates charged to insured members, provided they qualify for self-pay or prompt-pay discounts.
To ensure you are not overcharged, it is crucial to request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. If you receive a balance bill from an out-of-network provider, remember that the No Surprises Act generally protects you from paying the difference between the provider's full charge and your insurance allowed amount for emergency care and non-emergency services at in-network facilities. Always verify your specific plan's deductible status and ask the billing department about prompt-pay discounts upfront, as paying in full can sometimes reduce the total cost by 20% to 50% compared to the standard cash price.