Blood test, clotting time (PT/INR)
Facility: Decatur Health
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $23
- Cash Discount Price: $27
- vs. Medicare Baseline: 5.36x 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 536% of the Medicare baseline (a markup of 436%). 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 |
|---|---|---|
| Humana | $18 | 420% |
| UnitedHealthcare | $18 - $23 | 420% |
| Wppa/Providrs Care- All Plans | $18 | 420% |
| Blue Cross Blue Shield | $21 | 490% |
| Midlands Choice- All Plans | $27 | 629% |
| Aetna | $27 - $30 | 629% |
| Medicaid / KanCare | $30 | 699% |
Consumer Guidance & Cost Commentary
For this blood clotting test (PT/INR) at Decatur Health in Oberlin, Kansas, the facility's cash price of $27.00 is slightly lower than the state average of $30.00, though it remains above the national average of $22.00. While commercial insurance plans like UnitedHealthcare and Aetna have negotiated rates ranging from $18 to $30, these figures often exceed the cash price due to administrative costs and contract structures. Patients with high-deductible plans may find paying the cash rate directly more cost-effective than relying on insurance, which could result in higher out-of-pocket expenses if the negotiated allowed amount surpasses the cash price.
To ensure you receive the most accurate billing, it is important to understand that commercial rates are benchmarks, not guarantees of the lowest possible cost. The facility's cash rate of $27.00 is notably higher than the national cash median of $22.00, suggesting that asking for a "self-pay" or "prompt-pay" discount before scheduling could lower your final bill. Additionally, since Medicare rates for this service are $4.29, commercial negotiated rates are significantly higher, reflecting the complex administrative layers involved in insurance billing. Always verify your specific plan's deductible status and request a waiver of insurance submission if you choose to pay cash upfront to avoid automatic claims processing that might void any potential discounts.