Blood test, clotting time (PT/INR)
Facility: Rawlins County Health Center
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $44
- Cash Discount Price: $45
- vs. Medicare Baseline: 10.26x 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 1026% of the Medicare baseline (a markup of 926%). 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 | $16 | 373% |
| UnitedHealthcare | $44 - $48 | 1026% |
Consumer Guidance & Cost Commentary
For the blood clotting time test (CPT 85610) at Rawlins County Health Center in Atwood, Kansas, the cash price is $45.00, which is $8.00 lower than the facility's gross charge of $53.00. This cash rate is notably higher than the state of Kansas average, which is $45.00, and also exceeds the Medicare benchmark of $4.29. While commercial insurance plans like Blue Cross Blue Shield and UnitedHealthcare have negotiated rates ranging from $16.00 to $48.00, these amounts often include administrative overhead and may exceed the cash price for patients with high-deductible plans. Because insurance negotiated rates can sometimes be higher than the cash price, patients with significant out-of-pocket costs may find paying directly for the service to be the most economical option, provided they confirm the facility's self-pay or prompt-pay discounts before scheduling.
Patients should be aware that commercial insurance contracts often create a ceiling on what is allowed, but this does not guarantee the lowest possible cost. For instance, while UnitedHealthcare's negotiated rate can reach $48.00, the cash price of $45.00 represents a direct alternative that avoids potential balance billing if the patient is out-of-network or if ancillary services are not covered under the plan. If a patient receives a bill that appears to include charges for services not rendered or unbundled components, they should request a full itemized audit to verify the line items against the CPT code. Additionally, since prompt-pay discounts are commonly offered to bypass administrative processing fees, patients are encouraged to ask the billing department specifically about