Blood test, clotting time (PT/INR)
Facility: Wamego Health Center
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $5
- Cash Discount Price: $20
- vs. Medicare Baseline: 1.17x 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.
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 |
|---|---|---|
| Providrs Care | $4 | 93% |
| UnitedHealthcare | $4 | 93% |
| Medicaid / KanCare | $4 | 93% |
| Aetna | $4 | 93% |
| Blue Cross Blue Shield | $25 - $77 | 583% |
Consumer Guidance & Cost Commentary
For the blood test procedure (CPT 85610) at Wamego Health Center in Wamego, KS, the facility's cash median price is $20.00, which is significantly lower than the state average of $25.00. While the facility's negotiated rates with major payers like Blue Cross Blue Shield range from $25.00 to $77.00, these amounts often exceed the cash price, making self-pay a potentially more affordable option for patients with high-deductible plans or those without insurance. It is important to note that the facility's negotiated rate of $5.00 is higher than the Medicare benchmark of $4.29, illustrating that commercial contracts can sometimes result in higher costs than the federal baseline. Patients should verify their specific plan's allowed amount before scheduling, as in-network rates vary widely by carrier and can sometimes be higher than the cash price.
To avoid unexpected costs, patients should proactively request a prompt-pay discount or self-pay rate before check-in, as these upfront discounts can bypass the administrative overhead of insurance billing cycles. If a balance bill arises from an out-of-network service, such as a specific lab test within an in-network facility, the No Surprises Act may protect patients from paying the difference between the provider's chargemaster and the insurance allowed amount. Furthermore, if a summary bill is received, patients should demand a full itemized audit to identify any unbundled codes or services not rendered, as over 80% of hospital bills contain errors that can be corrected through a formal written dispute. Always confirm your deductible status and ensure you are not inadvertently signing away rights to dispute out-of-network charges before