Blood test, clotting time (PT/INR)
Facility: Centura St. Catherine-Dodge City
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $67
- Cash Discount Price: $41
- vs. Medicare Baseline: 15.62x 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 1562% of the Medicare baseline (a markup of 1462%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $4 - $19 | 93% |
| Humana | $4 | 93% |
| Kansas Health | $4 | 93% |
| Cigna | $4 | 93% |
| Medicare (plans) | $4 | 93% |
| Kaiser | $4 | 93% |
| Aetna | $4 - $82 | 93% |
| Centura Employee Plan | $5 | 117% |
| UnitedHealthcare | $67 | 1562% |
| Wpaa | $71 | 1655% |
| Christian Health Aid | $82 | 1911% |
| Multiplan | $82 - $92 | 1911% |
| Health Partners Of Kansas | $92 | 2145% |
Consumer Guidance & Cost Commentary
For this blood clotting time test (CPT 85610) at Centura St. Catherine-Dodge City, the facility's cash median price of $41.00 is significantly lower than the state average of $67.00. While many commercial payers like Aetna and Multiplan have negotiated rates ranging from $4 to $92, the cash price remains the most affordable option for patients without insurance. It is important to note that for individuals with high-deductible plans, paying the cash price upfront can be more cost-effective than relying on insurance, which may result in a higher allowed amount that exceeds the cash rate. Patients should proactively ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can further lower the final cost.
The facility's negotiated rates vary widely among payers, with some plans paying as low as $4 while others pay up to $92, reflecting the complexity of insurance contracts. However, the Medicare benchmark of $4.29 provides a clear baseline for fair pricing, showing that the cash price is already well below the typical commercial markup seen in many markets. To ensure you are not overcharged, always request a detailed, itemized bill rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as double-billing or unbundled codes. If you receive a balance bill from an out-of-network provider, remember that the No Surprises Act protects you from paying the difference for emergency care and non-emergency services at in-network facilities.