Blood test, clotting time (PT/INR)
Facility: Medicine Lodge Memorial Hospital
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $20
- Cash Discount Price: $21
- vs. Medicare Baseline: 4.66x 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 466% of the Medicare baseline (a markup of 366%). 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 |
|---|---|---|
| Tricare | $17 | 396% |
| Humana | $19 | 443% |
| Aetna | $19 - $21 | 443% |
| UnitedHealthcare | $20 | 466% |
| Hpk-All Plans | $20 | 466% |
| Medicaid / KanCare | $21 | 490% |
Consumer Guidance & Cost Commentary
For this blood clotting test at Medicine Lodge Memorial Hospital, the cash price of $21.00 is identical to the facility's median negotiated rate of $20.00 and the Medicare benchmark of $4.29. While the cash price appears higher than the Medicare rate, it is important to note that commercial insurance plans often negotiate rates that exceed cash prices, meaning paying out-of-pocket could sometimes result in lower total costs for patients with high deductibles. The facility, a Critical Access Hospital in Medicine Lodge, KS, does not offer a specific self-pay or prompt-pay discount in this dataset, so patients should verify current payment terms directly with the hospital before scheduling to ensure they are not charged the full chargemaster list price.
Insurance coverage for this service varies significantly across payers, with allowed amounts ranging from $17.00 for Tricare to $21.00 for Aetna and Medicaid/KanCare plans. Because the facility is a Critical Access Hospital, patients should be aware of federal protections under the No Surprises Act, which generally prevents balance billing for out-of-network services at in-network facilities, though emergency or ancillary services may still trigger unexpected charges if not properly coordinated. To avoid potential billing errors, consumers should request a full itemized bill before paying, as summary invoices often obscure individual code costs, and should dispute any discrepancies in writing rather than accepting verbal assurances from billing staff.