Blood test, clotting time (PT/INR)
Facility: Menorah Medical Center
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $8
- Cash Discount Price: $400
- vs. Medicare Baseline: 1.86x 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 |
|---|---|---|
| Cigna | $2 - $320 | 47% |
| Triwest Health Alliance | $4 | 93% |
| Home State Health Plan | $4 | 93% |
| United | $4 - $180 | 93% |
| Unicare | $4 | 93% |
| Blue Cross Blue Shield | $4 - $180 | 93% |
| Devoted Health | $4 | 93% |
| Aetna | $4 - $204 | 93% |
| Humana | $4 - $10 | 93% |
| Wellcare | $4 | 93% |
| Healthyblue | $4 | 93% |
| Celtic | $4 | 93% |
| Medicaid / KanCare | $4 | 93% |
| Coventry | $4 - $161 | 93% |
| Amerigroup | $4 | 93% |
| Pyramid Life | $5 | 117% |
| Multiplan | $7 - $296 | 163% |
| Oscar | $7 | 163% |
| Corvel Corporation | $8 - $260 | 186% |
| Oha Network | $8 - $200 | 186% |
| Ambetter / Centene | $74 | 1725% |
| Nhc Advantage | $76 | 1772% |
| Wppa Providrs Care Network | $80 | 1865% |
| Universal Healthcare | $140 | 3263% |
| Coventry Kc Mo | $164 | 3823% |
| College Park Family Care Center | $172 | 4009% |
| Cco, Inc. | $300 | 6993% |
| Focus Healthcare Mgmt, Inc | $300 | 6993% |
Consumer Guidance & Cost Commentary
For this blood clotting test (CPT 85610) at Menorah Medical Center in Overland Park, KS, the cash price is $400, which matches the facility's median negotiated rate. While the facility's cash price is significantly lower than the state average of $4.29 (likely due to the gross chargemaster inflation common in hospital billing), it is important to note that commercial insurance negotiated rates often exceed cash prices. For instance, United Health and Blue Cross Blue Shield have negotiated ranges extending up to $180, and Aetna ranges up to $204, meaning patients with high-deductible plans might save money by paying cash directly rather than relying on insurance, provided they have not yet met their deductible.
Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network services at in-network facilities, unexpected ancillary charges can still occur if specific lab components are billed separately. To avoid surprise costs, always request an itemized bill before paying, as summary invoices may hide unbundled codes or services not rendered. Additionally, inquire about "prompt-pay" discounts or self-pay rates before scheduling, as paying upfront can often reduce the final amount by 20% to 50% compared to the standard cash price.