Blood test, clotting time (PT/INR)
Facility: Overland Park Reg Med Ctr
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $76
- Cash Discount Price: $429
- vs. Medicare Baseline: 17.72x 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 1772% of the Medicare baseline (a markup of 1672%). 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 |
|---|---|---|
| Cigna | $2 - $4 | 47% |
| Blue Cross Blue Shield | $4 - $193 | 93% |
| Wellcare | $4 | 93% |
| United | $4 - $202 | 93% |
| Triwest Health Alliance | $4 | 93% |
| Humana | $4 - $10 | 93% |
| Devoted Health | $4 | 93% |
| Celtic | $4 | 93% |
| Coventry | $4 - $181 | 93% |
| Healthyblue | $4 | 93% |
| Medicaid / KanCare | $4 | 93% |
| Amerigroup | $4 | 93% |
| Unicare | $4 | 93% |
| Aetna | $4 - $229 | 93% |
| Home State Health Plan | $4 | 93% |
| Pyramid Life | $5 | 117% |
| Oscar | $7 | 163% |
| Multiplan | $7 - $333 | 163% |
| Corvel Corporation | $8 - $292 | 186% |
| Oha Network | $8 - $225 | 186% |
| Ambetter / Centene | $76 - $84 | 1772% |
| Nhc Advantage | $78 - $85 | 1818% |
| Wppa Providrs Care Network | $82 - $90 | 1911% |
| Universal Healthcare | $143 - $157 | 3333% |
| Coventry Kc Mo | $167 - $184 | 3893% |
| College Park Family Care Center | $175 - $193 | 4079% |
| Focus Healthcare Mgmt, Inc | $306 - $337 | 7133% |
| Cco, Inc. | $306 - $337 | 7133% |
Consumer Guidance & Cost Commentary
For this blood test procedure, the facility's cash price of $429.00 is significantly lower than the average negotiated rates paid by insurance companies, which range from $76.00 to over $337.00 depending on the payer. While many commercial plans negotiate rates that are higher than the cash price, patients with high-deductible plans or those without insurance may find paying the cash rate directly more cost-effective than facing a large deductible or balance bill. It is important to note that while the facility's cash rate is competitive, the negotiated rates for in-network payers like United and Aetna can vary widely, with some plans paying amounts exceeding $300. Patients should verify their specific plan's allowed amount before scheduling to ensure they are not paying more than necessary, as some commercial contracts may result in higher out-of-pocket costs compared to the cash price.
This facility operates as a Proprietary Acute Care Hospital in Overland Park, KS, and its pricing is benchmarked against Medicare, which sets the rate at $4.29 for this code. The facility's cash price of $429.00 is 17.7 times the Medicare amount, reflecting standard commercial pricing structures where negotiated rates often exceed the true cost baseline. Because this service is a laboratory test, patients should be aware that even at an in-network hospital, ancillary services or specific lab components could potentially trigger balance billing if they are out-of-network, though the No Surprises Act provides protections for emergency and non-emergency services at in-network facilities. To minimize costs, patients should request a prompt-pay discount or self-pay classification before check-in, which can reduce the bill by 2