Blood test, clotting time (PT/INR)
Facility: Stevens County Hospital
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $48
- Cash Discount Price: $78
- vs. Medicare Baseline: 11.19x 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 1119% of the Medicare baseline (a markup of 1019%). 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 |
|---|---|---|
| Aetna | $3 - $85 | 70% |
| Blue Cross Blue Shield | $15 - $16 | 350% |
| Humana | $26 - $31 | 606% |
| First Health - All Plans | $63 - $76 | 1469% |
| Wppa - All Plans | $66 - $81 | 1538% |
| Medicaid / KanCare | $70 - $85 | 1632% |
Consumer Guidance & Cost Commentary
For the blood clotting time test (CPT 85610) at Stevens County Hospital in Hugoton, Kansas, the facility's cash price of $78.00 is significantly higher than the state average, which sits at $4.29. While the hospital is a Critical Access Hospital owned by the local government, patients should be aware that paying cash upfront often results in a lower total cost than using insurance, as commercial negotiated rates can sometimes exceed the cash price. The median amount paid by commercial payers is $63.00, which is still above the Medicare benchmark of $4.29, indicating a substantial markup on the service. Because the facility is in-network for six major payers including Aetna, Blue Cross Blue Shield, and Humana, members should verify their specific plan's deductible status before scheduling, as high deductibles can lead to paying the full negotiated rate rather than a share of the cost.
To minimize out-of-pocket expenses, patients should proactively ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full before or shortly after the service. Although the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, it is crucial to request an itemized bill to ensure no unexpected charges for ancillary services are included. Given that over 80% of hospital bills contain errors, patients should review their statement line-by-line to identify any unbundled codes or services not rendered before making a payment. By comparing the facility's rates directly to the Medicare benchmark and seeking prompt-pay incentives, consumers can avoid the