Blood test, clotting time (PT/INR)
Facility: University Of Ks Hlth System Great Bend Campus
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $63
- Cash Discount Price: $22
- vs. Medicare Baseline: 14.69x 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 1469% of the Medicare baseline (a markup of 1369%). 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 |
|---|---|---|
| Alt Wppa [5032000964] | $24 - $70 | 559% |
| Meritain Health [503200039] | $24 - $100 | 559% |
| Wppa [503200056] | $24 - $70 | 559% |
| Alt Carelon Behavioral Health [503200905] | $28 - $83 | 653% |
| Alt Meritain Health [503999911] | $34 - $100 | 793% |
| Aha-Healthcare Preferred [503200050] | $34 - $100 | 793% |
| Allied National [503999937] | $34 - $100 | 793% |
| Aetna | $34 - $100 | 793% |
| Php [503200005] | $34 - $100 | 793% |
| National Assn Letter Carriers [503200019] | $34 - $100 | 793% |
| First Health [5032000110] | $34 - $100 | 793% |
| Cigna | $34 - $133 | 793% |
| Correct Care Solutions [50311253] | $39 - $116 | 909% |
| Workers Comp [503999901] | $48 - $141 | 1119% |
| Usa Managed Care [503999030] | $50 - $149 | 1166% |
Consumer Guidance & Cost Commentary
For the blood test procedure (CPT 85610) at the University of KS Health System Great Bend Campus, the facility's negotiated rates range from $24 to $149 depending on the insurance carrier, with the highest negotiated amount reaching $149 for USA Managed Care. These commercial rates are significantly higher than the facility's cash price of $22.00 and the state of Kansas average of $29.00 for this service. While in-network insurance plans offer protection against surprise billing, patients with high-deductible plans may find that paying the cash price of $22.00 upfront is more cost-effective than the negotiated rates exceeding $63.00, provided they can secure a prompt-pay discount. It is important to note that the facility is a government-owned hospital district, and patients should explicitly request self-pay classification and prompt-pay discounts before scheduling to avoid automatic claims submission that would void any cash savings.
The facility's pricing is also evaluated against the Medicare benchmark, which stands at $4.29 for this code, revealing a substantial markup on the federal baseline. While the facility's cash rate of $22.00 is higher than the Medicare amount, it remains lower than the median negotiated rate of $63.00 and the gross charge of $112.00. Under the No Surprises Act, patients are protected from balance billing for out-of-network services at this in-network acute care hospital, though they should still review their itemized bills to ensure no unbundled codes or services not rendered have been charged. Given that over 80% of hospital bills contain errors, consumers are advised to request a detailed,