Blood test, clotting time (PT/INR)
Facility: Kiowa County Memorial Hospital
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $53
- Cash Discount Price: $50
- vs. Medicare Baseline: 12.35x 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 1235% of the Medicare baseline (a markup of 1135%). 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 - $53 | 373% |
| UnitedHealthcare | $47 - $59 | 1096% |
| Health Partners Of Ks-All Plans | $52 | 1212% |
| Medica Prime Mcare Cost-All Plans | $53 | 1235% |
| Humana | $53 | 1235% |
| Aetna | $53 | 1235% |
| Celtic Comml Exchange-All Other Plans | $53 | 1235% |
| Medicaid / KanCare | $59 | 1375% |
| Providrs Care/Wppa-All Plans | $88 | 2051% |
Consumer Guidance & Cost Commentary
For the CPT code 85610, representing a blood test for clotting time (PT/INR), the negotiated rates for this service at Kiowa County Memorial Hospital in Greensburg, KS, range from $16 to $88 across nine different payers. While the facility's cash median price is $50.00, which is lower than the state average of $52.00, patients should be aware that commercial insurance negotiated rates often exceed cash prices due to administrative overhead and contract structures. For individuals with high-deductible plans, paying the cash price of $50.00 upfront may result in significant savings compared to the higher allowed amounts charged by insurers like UnitedHealthcare ($47–$59) or Blue Cross Blue Shield ($16–$53). It is advisable to contact the hospital directly to confirm "self-pay" or "prompt-pay" discounts, which can further reduce the final cost before any insurance claim is processed.
When evaluating the cost of this procedure, it is important to compare the facility's pricing against the federal Medicare benchmark rather than the hospital's inflated chargemaster list. The Medicare amount for this specific code is $4.29, and the facility's cash rate of $50.00 represents a markup of 12.4% above the Medicare rate, which falls within the range of fair pricing typically defined as 120% to 150% of the Medicare baseline. If a patient receives care from an out-of-network provider or encounters unexpected ancillary services, they may face balance billing for the difference between the provider's full charge and the insurance allowed amount; however, the No