Blood test, clotting time (PT/INR)
Facility: Kansas City Orthopaedic Institute
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $29
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 6.76x 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 676% of the Medicare baseline (a markup of 576%). 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 |
|---|---|---|
| Aetna | $4 | 93% |
| Cigna | $4 - $57 | 93% |
| UnitedHealthcare | $4 - $66 | 93% |
| Blue Cross Blue Shield | $7 - $73 | 163% |
| Medica | $28 - $62 | 653% |
Consumer Guidance & Cost Commentary
For the CPT code 85610, representing a blood test for clotting time (PT/INR), the Kansas City Orthopaedic Institute in Leawood, KS, has a median negotiated rate of $29.00. This rate is significantly higher than the state average, which is $4.29, and exceeds the Medicare benchmark of $4.29 by 6.8 times. While the facility is owned by a physician group and serves five major payers including Aetna, Cigna, UnitedHealthcare, Blue Cross Blue Shield, and Medica, the high negotiated rates reflect the administrative costs and contract structures typical of in-network billing. Patients should be aware that commercial negotiated rates often include multi-layered administrative fees that can inflate the baseline price, and these rates may not represent the lowest possible cost for this service.
Given that the cash median and median paid amounts are not available for this specific code, patients with high-deductible plans might find that paying out-of-pocket is more cost-effective if the insurance negotiated rate exceeds the cash price. It is crucial to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid in full upfront. Additionally, if a patient receives an itemized bill, they should request a full line-by-line audit to identify any errors, unbundled codes, or services not rendered, as over 80% of hospital bills contain mistakes. Finally, if a patient encounters a balance bill from an out-of-network provider at this in-network facility, they should verify the legality of the charge under the No Surprises Act before