Blood test, clotting time (PT/INR)
Facility: Hospital District #6 Patterson Health Center
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $28
- Cash Discount Price: $25
- vs. Medicare Baseline: 6.53x 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 653% of the Medicare baseline (a markup of 553%). 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 - $16 | 350% |
| UnitedHealthcare | $18 - $43 | 420% |
| Providers Care (Wppa)-All Plans | $35 - $75 | 816% |
Consumer Guidance & Cost Commentary
For this blood clotting time test at Hospital District #6 Patterson Health Center in Anthony, KS, the facility's cash median price of $25.00 is lower than the negotiated rates paid by major insurers like UnitedHealthcare ($18–$43) and Providers Care ($35–$75). While the facility's negotiated rate of $28.00 is slightly below the state average, patients with high-deductible plans may find paying the cash price of $25.00 more cost-effective than relying on insurance, which could result in higher out-of-pocket costs if the deductible has not been met. It is important to verify your specific plan's allowed amount before scheduling, as in-network rates vary significantly even within the same facility.
The facility's Medicare benchmark of $4.29 serves as the baseline for evaluating pricing fairness, with the cash price representing a significant markup relative to this federal rate. Under the No Surprises Act, patients are protected from balance billing for out-of-network services at in-network facilities, though they should still request a full itemized bill to ensure no unbundled charges or errors exist. To minimize costs, patients should ask the hospital about "self-pay" or "prompt-pay" discounts before check-in, which can reduce the final bill by 20% to 50% if paid upfront, bypassing the administrative overhead associated with insurance claims.