Blood test, clotting time (PT/INR)
Facility: Ascension Via Christi Hospital Manhattan, Inc
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $4
- Cash Discount Price: $14
- vs. Medicare Baseline: 0.93x 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.
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 |
|---|---|---|
| Smarthealth | $3 - $6 | 70% |
| Medicaid / KanCare | $4 | 93% |
| Providrs Care | $4 | 93% |
| Va | $4 | 93% |
| Medicare (plans) | $4 | 93% |
| UnitedHealthcare | $4 - $12 | 93% |
| Humana | $4 | 93% |
| Aetna | $4 | 93% |
| Ambetter / Centene | $7 | 163% |
| Blue Cross Blue Shield | $25 - $50 | 583% |
Consumer Guidance & Cost Commentary
For CPT code 85610, a blood test for clotting time, the facility's cash median price of $14.00 is significantly lower than the negotiated rates paid by most insurance plans. While Medicare covers this service at $4.29, the facility's negotiated rates range from $3 to $50 depending on the payer, with UnitedHealthcare and Blue Cross Blue Shield representing the highest negotiated tiers. For patients with high-deductible plans, paying the cash price of $14.00 upfront may be more cost-effective than relying on insurance, as the negotiated rates often exceed the cash amount. Additionally, patients should verify if the hospital offers self-pay or prompt-pay discounts, which can further reduce the final bill before payment is due.
This procedure is performed at Ascension Via Christi Hospital Manhattan, an acute care facility in Kansas, where the cash rate is notably lower than the state average. The facility's negotiated rates are generally higher than the Medicare benchmark of $4.29, reflecting the administrative costs and contract structures associated with commercial insurance. To ensure you are not overcharged, it is recommended to request an itemized billing audit before finalizing payment, as summary bills often obscure individual code costs. Furthermore, under the No Surprises Act, you are protected from balance billing for out-of-network services at this in-network facility, ensuring that any unexpected charges are resolved through the insurer rather than directly by the patient.