Blood test, clotting time (PT/INR)
Facility: Hodgeman County Health Center
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $52
- Cash Discount Price: $59
- vs. Medicare Baseline: 12.12x 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 1212% of the Medicare baseline (a markup of 1112%). 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 | $15 - $16 | 350% |
| UnitedHealthcare | $47 - $70 | 1096% |
| Triwest - All Plans | $47 | 1096% |
| Medicaid / KanCare | $47 - $74 | 1096% |
| Humana | $47 | 1096% |
| Aetna | $59 | 1375% |
| First Health - All Plans | $67 | 1562% |
| Wppa (Provdrscare) - All Plans | $70 | 1632% |
| Health Partners - All Plans | $70 | 1632% |
Consumer Guidance & Cost Commentary
For the CPT code 85610, representing a blood test for clotting time (PT/INR), the Hodgeman County Health Center in Jetmore, KS, lists a cash median price of $59.00 and a median negotiated rate of $52.00. This facility, a Critical Access Hospital owned by the local government, charges significantly less than the state average for this service. While the facility's cash rate is competitive, patients should be aware that commercial insurance plans often negotiate rates higher than cash prices; for instance, UnitedHealthcare and Medicaid/KanCare plans have negotiated ranges extending up to $74.00, which exceeds the cash median. Consequently, individuals with high-deductible plans or those without insurance may find paying the cash price directly more cost-effective than relying on insurance reimbursement, provided they verify their specific plan's allowed amount beforehand.
To ensure you receive the most accurate pricing, it is essential to request a prompt-pay discount before scheduling your visit, as these upfront payment incentives can further reduce the final cost. Additionally, if you are using insurance, be cautious of balance billing, which occurs when an out-of-network provider bills you for the difference between their full charge and what your insurer pays. Fortunately, the No Surprises Act protects patients from such surprise bills for emergency care and non-emergency services at in-network facilities. If you receive a bill that seems incorrect, do not accept a summary invoice; instead, demand a full itemized audit to identify any unbundled codes or services not rendered, as over 80% of hospital bills contain errors that can be corrected through a formal written dispute.