Blood test, clotting time (PT/INR)
Facility: Cloud County Health Center
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $58
- Cash Discount Price: $43
- vs. Medicare Baseline: 13.52x 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 1352% of the Medicare baseline (a markup of 1252%). 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 |
|---|---|---|
| Pponext-All Plans | $15 - $61 | 350% |
| Mpi-All Plans | $15 - $61 | 350% |
| Health Partners - All Plans | $15 - $61 | 350% |
| Aetna | $15 - $60 | 350% |
Consumer Guidance & Cost Commentary
For the CPT code 85610, representing a blood test for clotting time (PT/INR), Cloud County Health Center in Concordia, KS, lists a cash median price of $43.00, which is lower than the facility's negotiated median paid rate of $59.00. While the facility's negotiated rates align closely with the state average of $58.00, patients with high-deductible plans may find the cash price more advantageous, as the insurance negotiated rate often exceeds the cash price. To secure the lowest possible cost, we recommend asking the hospital directly about "self-pay" or "prompt-pay" discounts, which can further reduce the bill by 20% to 50% if paid in full upfront.
It is important to understand that commercial insurance rates are often inflated by administrative costs and contract dynamics, sometimes reaching 200% to 300% of the Medicare benchmark, whereas fair pricing typically falls between 120% and 150% of this federal baseline. For this specific service, the Medicare amount is only $4.29, highlighting a significant markup in commercial pricing. If you receive a bill that appears unexpectedly high, you should request a detailed, itemized audit to verify that no services were double-billed or unbundled, as over 80% of hospital bills contain errors. Additionally, if you are out-of-network, the No Surprises Act generally protects you from balance billing for emergency care and non-emergency services at in-network facilities, so you should dispute any surprise charges with your insurer rather than paying immediately.