Blood test, clotting time (PT/INR)
Facility: Clara Barton Hospital
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $39
- Cash Discount Price: $30
- vs. Medicare Baseline: 9.09x 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 909% of the Medicare baseline (a markup of 809%). 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% |
| 6 Degrees Health - All Plans | $25 - $45 | 583% |
| Wppa-All Plans | $29 - $51 | 676% |
| Phcs - All Plans | $32 - $58 | 746% |
| UnitedHealthcare | $32 - $58 | 746% |
| Aetna | $32 - $58 | 746% |
| Hlth Partners Of Ks-All Plans | $33 - $59 | 769% |
Consumer Guidance & Cost Commentary
For this blood clotting time test at Clara Barton Hospital in Hoisington, KS, the facility's cash price of $30.00 is lower than the state average of $34.00, making it a cost-effective option for self-pay patients. While the hospital's negotiated rates with major insurers like Blue Cross Blue Shield and UnitedHealthcare range from $25 to $58, these amounts often exceed the cash price, which can be advantageous for individuals with high-deductible plans who have not yet met their coverage thresholds. Patients should verify their specific plan's deductible status before scheduling, as paying the cash price upfront may result in immediate savings compared to the insurance negotiated rate, provided they do not have other coverage that would trigger a higher allowed amount.
To ensure you are not overcharged, it is recommended to request a full itemized bill before finalizing payment, as summary bills can obscure individual line items and potential errors. If you receive a balance bill for the difference between the provider's full charge and your insurance allowed amount, you may be protected under the No Surprises Act, which bans such billing for emergency care and non-emergency services at in-network facilities. Additionally, you can often reduce your final cost by asking the hospital about prompt-pay discounts, which typically offer a fee reduction for upfront payment and bypass the administrative costs associated with insurance claims processing.