Blood test, clotting time (PT/INR)
Facility: Kansas Heart Hospital
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $4
- Cash Discount Price: $21
- 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 |
|---|---|---|
| Aetna | $1 | 23% |
| Humana | $4 | 93% |
| Medicaid / KanCare | $4 | 93% |
| Tricare | $4 | 93% |
| UnitedHealthcare | $4 | 93% |
| Celtic Mcr Adv | $4 | 93% |
| Blue Cross Blue Shield | $11 | 256% |
| Wppa - All Plans | $13 | 303% |
| Multiplan - All Plans | $30 | 699% |
Consumer Guidance & Cost Commentary
For this blood clotting time test (CPT 85610) at Kansas Heart Hospital in Wichita, the cash median price is $21.00, which is lower than the facility's negotiated rates of $4.00 and the median paid by insurers at $22.00. While the facility's cash rate is competitive, it is important to note that commercial insurance plans often pay significantly higher amounts due to administrative overhead and contract structures. Patients with high-deductible plans may find it financially advantageous to pay the cash price directly, as the insurance negotiated rate can sometimes exceed the out-of-pocket cost of paying cash upfront. To maximize savings, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these programs can reduce the final bill by 20% to 50% when paid in full within a short window.
When evaluating the cost of this service, it is critical to compare the facility's rates against the objective baseline of the Medicare benchmark rather than the hospital's inflated chargemaster list. The Medicare amount for this code is $4.29, which serves as the scientifically validated "true cost" of delivery, revealing that commercial rates often include substantial markups. Although the data provided does not include specific county or state average figures for comparison, the principle remains that patients should ignore "savings" calculated off the full list price and instead verify that the negotiated or cash rate aligns with fair pricing standards relative to Medicare. If a patient receives an itemized bill that includes unexpected charges or services not rendered, they should request a formal written audit to dispute errors before making any payment, ensuring they are not paying for unnecessary ancillary