Blood test, clotting time (PT/INR)
Facility: Lane County Hospital
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $45
- Cash Discount Price: $45
- vs. Medicare Baseline: 10.49x 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 1049% of the Medicare baseline (a markup of 949%). 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 | $40 - $43 | 932% |
| UnitedHealthcare | $40 - $45 | 932% |
| Medicaid / KanCare | $45 - $50 | 1049% |
| Healthy Blue Mcr Adv - All Other Plans | $45 | 1049% |
| Healthy Blue Mcaid | $45 | 1049% |
| Wppa Providers-All Plans | $68 | 1585% |
Consumer Guidance & Cost Commentary
For the CPT code 85610, representing a blood test for clotting time (PT/INR), Lane County Hospital in Dighton, KS, lists a cash median price of $45.00. This cash rate aligns exactly with the facility's median negotiated rate and the median amount paid by insurance payers, ranging from $40 to $68 depending on the specific plan. Notably, the facility's cash price is significantly higher than the Medicare benchmark of $4.29, which serves as the objective baseline for evaluating hospital pricing markups. While commercial rates often exceed Medicare benchmarks by 200% to 300%, this specific service shows a negotiated rate that is 10.5 times the Medicare amount, reflecting the unique contract dynamics for this laboratory procedure.
Patients should be aware that while insurance plans like Aetna and UnitedHealthcare negotiate rates between $40 and $45, paying cash directly may sometimes be more cost-effective if your insurance deductible is high or if the negotiated rate exceeds the cash price. However, since the cash median here matches the paid median, there is no immediate financial advantage to paying out-of-pocket without verifying your specific plan's allowed amount. To ensure you receive the best possible rate, it is recommended to contact the hospital directly to inquire about self-pay or prompt-pay discounts, which can further reduce the bill by bypassing administrative claim processing costs. Always request an itemized bill to confirm that no unbundled codes or services not rendered are included, as these are common sources of billing errors that can be disputed in writing.