Blood test, clotting time (PT/INR)
Facility: Trego County Lemke Memorial Hospital
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $21
- Cash Discount Price: $23
- vs. Medicare Baseline: 4.90x 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 490% of the Medicare baseline (a markup of 390%). 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 |
|---|---|---|
| Va Ccn - All Plans | $1 | 23% |
| Humana | $12 - $14 | 280% |
| Tricare | $13 - $15 | 303% |
| Medicaid / KanCare | $16 - $28 | 373% |
| UnitedHealthcare | $16 - $28 | 373% |
| Aetna | $16 - $26 | 373% |
| Ambetter / Centene | $17 - $19 | 396% |
| Blue Cross Blue Shield | $22 | 513% |
| Health Partners - All Plans | $24 - $27 | 559% |
| Healthy Blue Mcaid - All Plans | $25 - $28 | 583% |
Consumer Guidance & Cost Commentary
For the CPT code 85610, representing a blood test for clotting time (PT/INR), Trego County Lemke Memorial Hospital in Wakeeney, KS, lists a cash median price of $23.00 and a median negotiated rate of $21.00. This facility, a Critical Access Hospital owned by the local government, reports a Medicare benchmark of $4.29, which serves as the federal baseline for evaluating pricing fairness. While the cash price is higher than the Medicare rate, it is notably lower than the negotiated rates paid by most commercial payers, which range from $12 to $28 depending on the insurance plan. For patients with high-deductible plans, paying the cash price of $23.00 upfront may be more cost-effective than relying on insurance, as the negotiated rates often exceed the cash amount.
To ensure you are receiving the most accurate pricing, it is important to request an itemized bill rather than accepting a summary invoice, as hospitals may obscure individual charges under broad categories. If you choose to use insurance, be aware that the facility's negotiated rates are influenced by complex administrative structures that can inflate the baseline price. Additionally, patients should inquire about prompt-pay discounts, which can reduce the final balance by 20% to 50% if paid in full within a short window, effectively bypassing costly claims processing fees. Given that the facility is located in a Critical Access Hospital setting, verifying self-pay options and potential discounts before scheduling your visit can help avoid unexpected costs.