Blood test, clotting time (PT/INR)
Facility: Wichita County Health Center
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $50
- Cash Discount Price: $45
- vs. Medicare Baseline: 11.66x 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 1166% of the Medicare baseline (a markup of 1066%). 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 |
|---|---|---|
| Medicaid / KanCare | $33 - $59 | 769% |
| UnitedHealthcare | $40 - $72 | 932% |
Consumer Guidance & Cost Commentary
For this blood clotting time test at Wichita County Health Center, the cash price of $45.00 is lower than the facility's negotiated rates with UnitedHealthcare ($40.00–$72.00) and Medicaid/KanCare ($33.00–$59.00). While the cash rate is also higher than the Medicare benchmark of $4.29, patients with high-deductible plans might find paying cash directly more affordable if their insurance allows a negotiated rate that exceeds the cash price. Because the facility is a Critical Access Hospital in Leoti, KS, and is government-owned, patients should explicitly ask about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can bypass the administrative costs associated with insurance billing cycles.
It is important to understand that commercial insurance rates often include administrative overhead, which can inflate the final cost compared to direct payment. If you choose to use insurance, be aware that the facility's negotiated rates are contractually set ceilings, but the actual amount your plan pays depends on your specific deductible status and plan terms. To avoid unexpected costs, always verify your out-of-pocket maximum and deductible balance before receiving care. If you receive a bill after using insurance, request a full itemized statement to ensure no errors exist, as summary bills can obscure individual charges.