Blood test, clotting time (PT/INR)
Facility: Satanta District Hospital, Clinics, & Ltcu
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $24
- Cash Discount Price: $31
- vs. Medicare Baseline: 5.59x 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 559% of the Medicare baseline (a markup of 459%). 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 |
|---|---|---|
| Direct Benefit-All Plans | $8 | 186% |
| UnitedHealthcare | $10 - $34 | 233% |
| Berkley Net-All Plans | $14 | 326% |
| Trustmark Health Benefits-All Plans | $15 | 350% |
| Aetna | $15 - $23 | 350% |
| Meritain Health-All Plans | $15 | 350% |
| Ambetter / Centene | $16 | 373% |
| Pinnacol-All Plans | $19 | 443% |
| Medi-Share-All Plans | $19 | 443% |
| Axa Equitable - All Plans | $19 | 443% |
| Presbyterian-All Plans | $21 | 490% |
| Kasb Work Comp - All Plans | $22 | 513% |
| The Kempton Group Admin-All Plans | $23 | 536% |
| Emc-All Plans | $24 | 559% |
| Wppa- All Plans | $24 | 559% |
| Providers Care Network- All Plans | $24 | 559% |
| Auxiant - All Plans | $24 | 559% |
| Sisco-All Plans | $24 | 559% |
| Gpha(Wppa)-All Other Plans | $24 | 559% |
| Gpha Employee Benefit Plan | $25 | 583% |
| First Health -All Plans | $26 | 606% |
| One Call Physician-All Plans | $26 | 606% |
| Regional Care(Wppa)-All Plans | $26 | 606% |
| Triangle-All Plans | $26 | 606% |
| Employee Benefit-All Plans | $26 | 606% |
| Christian Hospital Aid - All Plans | $27 | 629% |
| Tricare | $27 | 629% |
| Blue Cross Blue Shield | $27 | 629% |
| Humana | $29 | 676% |
| Cigna | $30 | 699% |
| Luminare Health- All Plans | $30 | 699% |
| Vaccn-All Plans | $31 | 723% |
| Deseret Mutual(Uhis)-All Plans | $31 | 723% |
| Coresource-All Plans | $31 | 723% |
| Reserve National-All Plans | $32 | 746% |
| Hma Llc-All Plans | $32 | 746% |
| Wps Vapc-All Plans | $32 | 746% |
| Medicaid / KanCare | $34 | 793% |
Consumer Guidance & Cost Commentary
For this blood clotting test (CPT 85610), the facility's cash price of $31.00 is slightly lower than the state average of $34.00, making it a competitive option for self-pay patients. While many insurance plans negotiate rates ranging from $8 to $34, these negotiated amounts often exceed the cash price due to administrative overhead and contract structures. If your insurance deductible has not yet been met, paying the cash rate of $31.00 upfront could save you money compared to the higher negotiated rates your plan might apply. We recommend asking the billing department about "prompt-pay" discounts, which can further reduce the final amount owed when settling the bill immediately.
It is important to distinguish between the facility's gross charge and the actual amount you will pay. The gross charge listed is $34.00, but the Medicare benchmark for this service is only $4.29, indicating that the facility's standard rates are significantly higher than the federal baseline. Commercial negotiated rates for this procedure vary widely across payers, with some plans paying as low as $8 and others up to $34. To avoid unexpected costs, patients should request an itemized bill to ensure no services were unbundled or double-charged, as over 80% of hospital bills contain errors. Additionally, if you receive a balance bill from an out-of-network provider, you may have protections under the No Surprises Act that prevent you from paying the difference between the negotiated rate and the full charge.