Blood test, clotting time (PT/INR)
Facility: F W Huston Medical Center
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $28
- Cash Discount Price: $29
- vs. Medicare Baseline: 6.53x 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 653% of the Medicare baseline (a markup of 553%). 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% |
| Aetna | $27 | 629% |
| Humana | $28 | 653% |
| Cigna | $31 | 723% |
Consumer Guidance & Cost Commentary
For this blood clotting test at F W Huston Medical Center in Winchester, KS, the facility's cash price of $29.00 is lower than the average negotiated rates paid by major insurers like Blue Cross Blue Shield ($16.00), Aetna ($27.00), Humana ($28.00), and Cigna ($31.00). While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients with high-deductible plans may find paying the cash price directly more cost-effective than relying on insurance, as the negotiated rates exceed the cash amount. It is important to note that while the facility is in-network for these payers, the specific contract terms vary, and patients should verify their deductible status before scheduling to avoid unexpected out-of-pocket costs.
The facility's cash rate of $29.00 is also notably higher than the Medicare benchmark of $4.29, which serves as the objective baseline for evaluating hospital pricing markups. Although the data does not provide specific county or state average comparisons for this service, the significant gap between the Medicare rate and the commercial cash price highlights the potential for substantial markups in commercial billing. To minimize costs, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before check-in, as paying in full upfront can sometimes bypass administrative fees and reduce the final bill. Additionally, if a balance bill arises from an out-of-network ancillary service, patients should dispute the charge in writing rather than paying immediately, as federal protections may apply.