Blood test, clotting time (PT/INR)
Facility: St Luke Hospital & Living Center
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $25
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 5.83x 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 583% of the Medicare baseline (a markup of 483%). 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 |
|---|---|---|
| Bluestem Pace | $25 | 583% |
| UnitedHealthcare | $25 | 583% |
| Ambetter / Centene | $25 | 583% |
| Va Ccn | $25 | 583% |
| Humana | $25 | 583% |
| Blue Cross Blue Shield | $25 | 583% |
| Kansas Department Of Health And Environment | $25 | 583% |
Consumer Guidance & Cost Commentary
For the blood clotting time test (CPT 85610) at St Luke Hospital & Living Center in Marion, KS, the facility's negotiated rate is $25.00, which matches the lowest and highest negotiated amounts reported across all payers. This rate is significantly higher than the Medicare benchmark of $4.29, representing a markup of 5.8 times the federal baseline. While the facility is a Critical Access Hospital owned by a Government Hospital District, patients should be aware that commercial insurance rates often include administrative overhead that can inflate the final cost compared to direct cash payments. If you have a high-deductible plan where your deductible has not yet been met, paying the cash price or a prompt-pay discount directly to the hospital might result in lower out-of-pocket costs than your insurance allowing, as the negotiated rate of $25.00 exceeds the cash price.
To ensure you are not overcharged, it is crucial to request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. If you receive a surprise bill for the difference between the facility's chargemaster rate and your insurance allowed amount, you may be protected under the No Surprises Act, which bans balance billing for emergency care and non-emergency services at in-network facilities. Before scheduling, verify your specific plan's deductible status and ask the hospital to classify your visit as self-pay to access prompt-pay discounts, which can reduce the bill by 20% to 50% by bypassing costly claims processing. Always dispute any unexpected charges in writing to avoid credit damage and ensure all line items are accurate.