Blood test, clotting time (PT/INR)
Facility: Stanton County Hospital
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $57
- Cash Discount Price: $41
- vs. Medicare Baseline: 13.29x 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 1329% of the Medicare baseline (a markup of 1229%). 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 | $15 - $230 | 350% |
| Healthy Blue Mcr Adv - All Other Plans | $57 - $238 | 1329% |
| Healthy Blue Mcaid | $58 - $207 | 1352% |
Consumer Guidance & Cost Commentary
For this blood clotting time test at Stanton County Hospital in Johnson, KS, the cash price is $41.00, which matches the facility's median paid amount. This cash rate is significantly lower than the state average for this procedure, offering a clear opportunity for cost savings. While the facility is a Critical Access Hospital owned by the local government, patients with high-deductible plans or those without insurance may find paying cash directly more affordable than using insurance. In this case, the negotiated rates for in-network payers like Blue Cross Blue Shield range from $57 to $238, which are higher than the cash price. If your insurance plan has a high deductible, you might save money by paying the $41.00 cash rate upfront and seeking a prompt-pay discount, rather than waiting for your deductible to be met.
It is important to verify your specific plan's coverage before scheduling, as commercial insurance contracts can vary widely. Although the No Surprises Act protects patients from balance billing for emergency care and non-emergency services from out-of-network providers at in-network facilities, unexpected charges can still occur if ancillary services like lab tests are billed separately. If you receive a bill that seems too high, request a full itemized audit to ensure no unbundled codes or services not rendered are included. Additionally, always ask the hospital directly about self-pay or prompt-pay discounts before check-in, as these upfront fee reductions can lower your total cost significantly compared to the standard negotiated rates your insurer would otherwise pay.