Blood test, clotting time (PT/INR)
Facility: Kiowa District Hospital
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $34
- Cash Discount Price: $29
- vs. Medicare Baseline: 7.93x 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 793% of the Medicare baseline (a markup of 693%). 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 |
|---|---|---|
| Healthchoice-All Plans | $6 | 140% |
| Tricare | $14 | 326% |
| Blue Cross Blue Shield | $16 | 373% |
| UnitedHealthcare | $29 - $36 | 676% |
| Health Partners Of Ks-All Plans | $32 | 746% |
| Humana | $32 | 746% |
| Medicare (plans) | $34 | 793% |
| Gbs Insurance - All Plans | $34 | 793% |
| Multiplan-All Plans | $34 | 793% |
| Aetna | $34 | 793% |
| Triwest-All Plans | $34 | 793% |
| Medicaid / KanCare | $36 | 839% |
| Providers Care (Wppa)-All Plans | $54 | 1259% |
| Liberty Healthshare-All Plans | $58 | 1352% |
Consumer Guidance & Cost Commentary
For the CPT code 85610, representing a blood test for clotting time (PT/INR), the facility's cash median rate is $29.00, which is lower than the negotiated rates paid by most insurance plans. While the facility's cash price is below the gross charge of $36.00, it is important to note that commercial insurance negotiated rates often exceed cash prices due to administrative costs and contract structures. For patients with high-deductible plans, paying the cash price of $29.00 upfront may result in lower out-of-pocket costs compared to having insurance pay a negotiated rate of $34.00 or higher, provided the patient has not yet met their deductible. Patients should verify their specific plan's deductible status and ask the hospital directly about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can further reduce the final bill.
This service is provided at Kiowa District Hospital, a Critical Access Hospital in Kiowa, Kansas, with a Medicare benchmark rate of $4.29. The facility's cash rate of $29.00 is significantly higher than the Medicare amount, reflecting the complexity of commercial billing and local market dynamics. Because the facility is a government-owned hospital district, pricing is subject to specific regulatory frameworks that may differ from private entities. Consumers are advised to request an itemized bill to ensure all charges are accurate and to avoid balance billing issues, especially if receiving care from out-of-network providers. If a balance bill arises, patients should dispute it with their insurer or request a No Surprises Act audit, as federal protections often ban surprise billing for emergency and non-emergency services at in-network