Blood test, clotting time (PT/INR)
Facility: Kansas Surgery & Recovery Center
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $4
- Cash Discount Price: $19
- 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 |
|---|---|---|
| UnitedHealthcare | $2 - $4 | 47% |
| Aetna | $4 - $13 | 93% |
| Triwest | $4 | 93% |
| Blue Cross Blue Shield | $4 - $11 | 93% |
| Cigna | $7 | 163% |
Consumer Guidance & Cost Commentary
For the blood test, clotting time (PT/INR) at Kansas Surgery & Recovery Center in Wichita, KS, the cash median price is $19.00, which is slightly lower than the facility's gross charge of $20.00. While the facility is a voluntary non-profit acute care hospital, the data does not provide specific county or state average rates for this procedure to compare against. It is important for patients with high-deductible plans to note that paying cash directly can sometimes be more cost-effective than using insurance, as commercial negotiated rates often exceed cash prices due to administrative overhead and contract structures. Patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can bypass the costly insurance claims cycle and result in immediate savings.
Insurance coverage for this service varies significantly across payers, with allowed amounts ranging from a low of $2.00 to a high of $13.00 depending on the specific plan. For instance, UnitedHealthcare plans show a range of $2.00 to $4.00, while Aetna plans range from $4.00 to $13.00. Because these negotiated rates are often inflated by administrative costs and contract dynamics, patients should verify their specific allowed amount before the visit. If a patient receives a bill that exceeds their insurance allowed amount, they may be facing balance billing, though the No Surprises Act protects against such charges for out-of-network services at in-network facilities. To ensure accuracy, patients should request a full itemized bill to review every CPT code and unit cost, as summary bills often obscure errors or unbundled charges that