Blood test, clotting time (PT/INR)
Facility: Kansas Spine & Specialty Hospital, Llc
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $4
- Cash Discount Price: $29
- 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 | $4 - $5 | 93% |
| Providrs Care Network | $4 | 93% |
| Aetna | $4 - $5 | 93% |
| United Mine Workers Of America | $4 | 93% |
| Blue Cross Blue Shield | $4 | 93% |
| Humana | $4 | 93% |
| Lantern Specialty Care | $7 | 163% |
Consumer Guidance & Cost Commentary
For the blood clotting time test (CPT 85610) at Kansas Spine & Specialty Hospital in Wichita, the cash median price is $29.00, which is significantly lower than the facility's negotiated rates of $4.00 and the Medicare benchmark of $4.29. While the facility is an Acute Care Hospital owned by a physician group, patients with high-deductible plans may find paying cash directly more cost-effective than relying on insurance, as the negotiated rates paid by carriers like UnitedHealthcare and Aetna often exceed the cash price. It is important to note that while the facility is in-network for seven payers, the administrative costs associated with insurance billing can sometimes make the out-of-pocket cash rate the most economical option for self-pay patients.
To ensure you are not overcharged, always request a full itemized bill before finalizing payment, as summary bills often hide unbundled codes or services not rendered. If you receive a balance bill for out-of-network ancillary services, you may be entitled to protections under the No Surprises Act, which bans balance billing for emergency and non-emergency care at in-network facilities. Additionally, you should explicitly ask the billing department about "prompt-pay" discounts, which can reduce the final amount by 20% to 50% if paid in full upfront, bypassing the higher administrative fees typically embedded in insurance claims.