Blood test, clotting time (PT/INR)
Facility: Lmh
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $91
- Cash Discount Price: $32
- vs. Medicare Baseline: 21.21x 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 2121% of the Medicare baseline (a markup of 2021%). 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 |
|---|---|---|
| UnitedHealthcare | $4 - $151 | 93% |
| Humana | $4 - $149 | 93% |
| Blue Cross Blue Shield | $4 - $96 | 93% |
| Medicare (plans) | $4 - $149 | 93% |
| Allwell | $4 | 93% |
| Cigna | $4 - $149 | 93% |
| Haskell Indian Health Services | $4 | 93% |
| Aetna | $5 - $123 | 117% |
| Ambetter / Centene | $7 | 163% |
| Non Contracted | $96 - $119 | 2238% |
| First Health | $112 - $138 | 2611% |
Consumer Guidance & Cost Commentary
For the CPT code 85610, representing a blood test for clotting time (PT/INR), the facility in Lawrence, KS, lists a cash median price of $32.00, which is significantly lower than the state average of $91.00. While commercial insurance carriers like UnitedHealthcare and Cigna have negotiated rates ranging from $4 to $151, these amounts often exceed the cash price due to administrative overhead and contract structures. Patients with high-deductible plans may find it financially advantageous to pay the cash rate directly, provided they verify that the insurance negotiated rate is indeed higher than the cash amount before scheduling. It is also important to check with the hospital for potential "self-pay" or "prompt-pay" discounts, which can further reduce the out-of-pocket cost for those choosing to pay upfront.
This service is benchmarked against Medicare, which sets a fixed reimbursement rate of $4.29 for this procedure. The facility's cash price of $32.00 represents a markup of 21.2% over the Medicare amount, aligning with fair pricing standards that typically range between 120% and 150% of the federal baseline. Although the facility is owned by the local government, commercial payers negotiate rates that can vary widely, with some non-contracted plans potentially charging up to $119. To avoid unexpected costs, patients should request an itemized bill to ensure no errors or unbundled charges are included and should confirm whether their specific plan has met its deductible before relying on insurance coverage for this test.