Blood test, clotting time (PT/INR)
Facility: Providence Medical Center
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $5
- Cash Discount Price: $4
- vs. Medicare Baseline: 1.17x 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 |
|---|---|---|
| Medicare (plans) | $4 | 93% |
| Tricare | $4 | 93% |
| Aetna | $4 - $7 | 93% |
| Blue Cross Blue Shield | $4 - $10 | 93% |
| UnitedHealthcare | $4 - $6 | 93% |
| Medicaid / KanCare | $4 | 93% |
| Midland Care Connection | $4 | 93% |
| Kansas Superior Select | $4 | 93% |
| Healthy Blue | $4 | 93% |
| Cigna | $4 | 93% |
| Celtic | $4 - $7 | 93% |
| Corizon | $6 | 140% |
| Employer Direct Healthcare | $6 | 140% |
| Well Path Prison | $6 | 140% |
| Centurion | $6 | 140% |
| Naphcare | $7 | 163% |
| Worker Compensation | $8 | 186% |
| Oha Networks | $8 | 186% |
| Comp Alliance - Fka Compresults Worker Compensation | $8 | 186% |
Consumer Guidance & Cost Commentary
For this blood clotting time test (CPT 85610) at Providence Medical Center in Kansas City, KS, the facility's cash median rate is $4.00, which is significantly lower than the state average of $5.00. While many commercial payers negotiate rates that average $5.00, Medicare reimbursement stands at $4.29, placing the facility's cash price slightly below the federal benchmark. Patients with high-deductible plans may find it financially advantageous to pay the $4.00 cash rate directly, as this avoids the administrative fees and higher negotiated rates often associated with insurance claims. To secure this lower price, patients should explicitly request a "self-pay" classification and ask about prompt-pay discounts before scheduling, ensuring the billing system does not automatically submit a claim to an insurance carrier.
The facility's negotiated rates vary widely across its 19 payer contracts, ranging from $4.00 to $7.00 depending on the insurance plan, with a median negotiated amount of $5.00. This variation highlights that being in-network does not guarantee the lowest possible cost, as some commercial contracts exceed the cash price. If a patient receives a bill higher than the $4.00 cash rate, they should request an itemized billing audit to verify that no unbundled codes or services not rendered are included, as over 80% of hospital bills contain errors. Additionally, under the No Surprises Act, patients are protected from balance billing for out-of-network services at this in-network facility, meaning any unexpected charges should be disputed with the insurer rather than paid immediately.