Blood test, clotting time (PT/INR)
Facility: Lindsborg Community Hospital
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $16
- Cash Discount Price: $28
- vs. Medicare Baseline: 3.73x 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 373% of the Medicare baseline (a markup of 273%). 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 |
|---|---|---|
| Coventry Mcr Adv | $8 - $31 | 186% |
| Tricare | $8 - $30 | 186% |
| Cigna | $14 - $55 | 326% |
| UnitedHealthcare | $15 - $58 | 350% |
| Coventry Comm-All Other Plans | $15 - $58 | 350% |
| Phcs Preferred-All Plans | $15 - $60 | 350% |
| Century Health-All Plans | $15 - $61 | 350% |
| Wppa-All Plans | $15 - $61 | 350% |
| Multiplan-All Plans | $15 - $60 | 350% |
| Coventry Wc | $15 - $61 | 350% |
| Health Partners -All Plans | $15 - $61 | 350% |
| Blue Cross Blue Shield | $16 | 373% |
Consumer Guidance & Cost Commentary
For this blood clotting test at Lindsborg Community Hospital, the cash price of $28.00 is notably lower than the facility's negotiated rates, which range from $8 to $61 depending on the insurance carrier. While the facility's cash rate is higher than the state of Kansas average, it remains significantly below the gross chargemaster price of $40.00. Patients with high-deductible plans may find paying the cash price upfront more cost-effective than using insurance, as the negotiated rates for many payers exceed the cash amount. To maximize savings, consumers should explicitly request "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50% by bypassing administrative claim processing fees.
The facility's cash rate of $28.00 is also higher than the median paid amount of $21.00 and the median negotiated rate of $16.00, suggesting that commercial insurance contracts may result in lower out-of-pocket costs for those with active coverage. However, because the cash price is well below the gross charge, it serves as a strong baseline for comparison against the Medicare benchmark of $4.29, which represents the federal government's fixed reimbursement rate for this service. It is important to note that while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should still review their itemized bills to ensure no unbundled charges or services not rendered are included. Always verify your specific plan's deductible status and allowed amounts before proceeding, as paying the cash rate may be the most economical option if your insurance coverage does not fully