Blood test, clotting time (PT/INR)
Facility: Kansas Medical Center Llc
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $4
- Cash Discount Price: $28
- 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 |
|---|---|---|
| United | $2 | 47% |
| Humana | $4 | 93% |
| Medadv_Wellcare | $4 | 93% |
| Ambetter / Centene | $4 | 93% |
| Indian Health | $4 | 93% |
| Medicaid / KanCare | $4 | 93% |
| Blue Cross Blue Shield | $4 - $10 | 93% |
| Three_Rivers | $9 | 210% |
| Aetna | $12 | 280% |
| Wppa | $19 | 443% |
Consumer Guidance & Cost Commentary
For the blood test procedure (CPT 85610) at Kansas Medical Center Llc in Andover, KS, the cash median price is $28.00, while the median amount paid by insurance is $35.00. This indicates that for patients with high-deductible plans, paying cash directly may be more cost-effective than using insurance, as the negotiated rates often exceed the cash price. Although the facility is in-network for ten payers including United, Humana, and Blue Cross Blue Shield, the actual amount your insurer pays ($35.00) is higher than the cash rate. To minimize costs, patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can lower the total bill significantly compared to standard insurance processing.
The facility's pricing is benchmarked against Medicare, which sets a baseline of $4.29 for this service. The commercial negotiated rate of $4.00 is slightly lower than the Medicare amount, suggesting a competitive pricing structure relative to federal standards. However, it is important to note that commercial rates often include administrative overhead and contract dynamics that can inflate the final charge. If you receive a bill that appears to include balance billing for out-of-network ancillary services, such as emergency physician fees or lab tests, you may be protected under the No Surprises Act, which bans balance billing for non-emergency services at in-network facilities. In such cases, you should dispute the bill in writing rather than paying immediately, and request a formal itemized audit to identify any unbundled codes or services not rendered.