Blood test, clotting time (PT/INR)
Facility: Great Plains Of Sabetha
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $18
- Cash Discount Price: $27
- vs. Medicare Baseline: 4.20x 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 420% of the Medicare baseline (a markup of 320%). 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 |
|---|---|---|
| UnitedHealthcare | $1 - $27 | 23% |
| Aetna | $4 - $27 | 93% |
| Medicaid / KanCare | $4 - $27 | 93% |
| Celtic Mcr Adv | $4 - $14 | 93% |
| Celtic Comm Exchange-All Other Plans | $5 - $18 | 117% |
| Cigna | $12 - $26 | 280% |
| Humana | $12 - $26 | 280% |
| Blue Cross Blue Shield | $15 - $27 | 350% |
| Great West Healthcare-All Plans | $23 | 536% |
| Century/Wppa/Providers-All Plans | $24 - $26 | 559% |
| Multiplan-Phcs-All Plans | $26 | 606% |
| Federated Mutual Ins-All Plans | $26 | 606% |
Consumer Guidance & Cost Commentary
For the blood test procedure (CPT 85610) at Great Plains Of Sabetha in Sabetha, Kansas, the facility's cash price of $27.00 matches the state average, while the median negotiated rate for commercial payers is $18.00. This facility is a Critical Access Hospital with a voluntary non-profit ownership structure, and its pricing aligns closely with the Medicare benchmark of $4.29, which serves as the federal baseline for cost evaluation. Although the facility's negotiated rates are lower than its cash price, patients with high-deductible plans may find the cash option more cost-effective if their insurance allows, as the commercial negotiated rate of $18.00 is still significantly higher than the cash-pay amount. It is important to verify specific plan details, as some commercial contracts may include administrative overhead that inflates the baseline price compared to direct cash payments.
Patients should proactively contact the hospital before scheduling to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% when paid upfront. Since this facility is in-network for twelve payers, including UnitedHealthcare, Aetna, and Medicaid/KanCare, the No Surprises Act generally protects patients from balance billing for out-of-network services at this location. However, patients must ensure they do not inadvertently trigger automatic claims submission by providing insurance information at registration, as this could void any agreed-upon cash discount. To maximize savings, consumers should request an itemized billing audit to review every line item and confirm that no unbundled codes or services not rendered have been included in the final invoice.