Blood test, clotting time (PT/INR)
Facility: Wilson Medical Center
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $16
- Cash Discount Price: $17
- vs. Medicare Baseline: 3.73x 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 373% of the Medicare baseline (a markup of 273%). 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 | $5 - $31 | 117% |
| Tricare | $5 - $16 | 117% |
| UnitedHealthcare | $5 - $29 | 117% |
| Humana | $5 - $16 | 117% |
| Ambetter / Centene | $5 - $31 | 117% |
| Cigna | $8 - $25 | 186% |
| Health Partners-All Plans | $9 - $29 | 210% |
| Mulitplan-All Plans | $9 - $29 | 210% |
| Blue Cross Blue Shield | $10 - $31 | 233% |
Consumer Guidance & Cost Commentary
For this blood clotting test at Wilson Medical Center in Neodesha, KS, the cash price is $17.00, which is lower than the facility's negotiated rates of $16.00 and the Medicare benchmark of $4.29. While the facility is a Critical Access Hospital owned by the local government, patients with high-deductible plans may find paying cash upfront more cost-effective than using insurance, as commercial negotiated rates often exceed cash prices. To maximize savings, patients should explicitly request "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the bill by 20% to 50% by bypassing administrative claim processing fees.
It is important to note that while the facility is in-network for nine major payers including Aetna and UnitedHealthcare, the actual amount paid varies significantly based on the specific plan. The data shows that for this procedure, the median negotiated amount is $16.00, which is higher than the cash price. Patients should be aware that balance billing is generally prohibited for emergency services under the No Surprises Act, but they should still verify their specific plan's allowed amount before receiving care. If a surprise bill arises, patients should dispute it in writing rather than paying immediately, and always request a detailed, itemized statement to ensure no unbundled codes or services not rendered are included in the final charge.