Blood test, clotting time (PT/INR)
Facility: Ashland Health Center
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $22
- Cash Discount Price: $18
- vs. Medicare Baseline: 5.13x 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 513% of the Medicare baseline (a markup of 413%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $4 - $20 | 93% |
| Compalliance-All Plans | $9 - $49 | 210% |
| Health Partners Of Kansas-All Plans | $9 - $52 | 210% |
| Medicare (plans) | $11 - $61 | 256% |
| Medicaid / KanCare | $11 - $61 | 256% |
| Multiplan-All Plans | $11 - $60 | 256% |
| Health Choice-All Plans | $11 - $61 | 256% |
| UnitedHealthcare | $11 - $61 | 256% |
| Aetna | $11 - $61 | 256% |
| Medica Mcare - All Plans | $11 - $61 | 256% |
| Healthy Blue Mcr Adv - All Other Plans | $11 - $61 | 256% |
| Providers Care (Wppa)-All Plans | $17 - $91 | 396% |
Consumer Guidance & Cost Commentary
For the blood clotting time test (CPT 85610) at Ashland Health Center in Ashland, KS, the facility's cash price of $18.00 is lower than the state average of $21.00. While the facility's median negotiated rate is $22.00, which matches the state average, patients with high-deductible plans may find the cash price more advantageous if their insurance negotiated rate exceeds $18.00. It is important to note that commercial insurance rates often include administrative overhead, making the direct cash price a useful benchmark for self-pay patients.
Ashland Health Center, a Critical Access Hospital, bills this service at $4.29 under Medicare, which serves as the federal baseline for pricing. The facility's cash rate of $18.00 represents a significant markup over the Medicare amount, a common practice where commercial rates are set higher to cover administrative costs and profit margins. Consumers should be aware that while the No Surprises Act protects against balance billing for out-of-network emergency services, it does not apply to routine lab work performed in-network. To minimize costs, patients should verify their specific plan's allowed amount and ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront incentives can reduce the final bill by 20% to 50%.