Blood test, clotting time (PT/INR)
Facility: Minneola District Hospital
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $23
- Cash Discount Price: $18
- 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 |
|---|---|---|
| Blue Cross Blue Shield | $16 | 373% |
| Va Community Care Program-All Plans | $17 | 396% |
| Humana | $17 | 396% |
| UnitedHealthcare | $17 - $26 | 396% |
| Corporate Plan Management-All Plans | $22 | 513% |
| Providrs Care Network-All Plans | $22 | 513% |
| Preferred Health Care (Coventry)-All Other Plans | $23 | 536% |
| Triwest-All Plans | $23 | 536% |
| Health Partners Of Kansas-All Plans | $25 | 583% |
| Phc (Coventry) Leased Network | $25 | 583% |
| Aetna | $25 - $26 | 583% |
| Medicaid / KanCare | $26 | 606% |
Consumer Guidance & Cost Commentary
For this blood test procedure at Minneola District Hospital, the cash price is $18.00, which is lower than the facility's negotiated rates of $23.00 paid by most insurance plans. This price difference highlights a common billing dynamic where commercial insurance contracts often result in higher out-of-pocket costs for patients than paying cash directly. While the facility is a Critical Access Hospital in Kansas, the cash rate of $18.00 remains below the state average for this service, making it a cost-effective option for those with high-deductible plans or those who have already met their insurance deductible. Patients should verify their specific plan details, as paying the full cash price upfront may be cheaper than the insurance negotiated rate, provided they have sufficient funds to cover the difference.
To ensure you are not overcharged, it is important to request a detailed itemized bill before finalizing payment, as summary bills can obscure individual line items and potential errors. If you receive a balance bill for the difference between the provider's chargemaster rate and your insurance allowed amount, you may be protected under the No Surprises Act, which bans surprise billing for emergency care and non-emergency services at in-network facilities. Additionally, you should inquire about prompt-pay discounts, which can reduce the cash price by 20% to 50% if paid in full within a short window, effectively bypassing the administrative costs associated with insurance claims processing. Always confirm whether your specific test is covered by your plan and whether the facility can classify the service as self-pay to secure the lowest possible rate.