Blood test, clotting time (PT/INR)
Facility: Goodland Regional Medical Center
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $39
- Cash Discount Price: $39
- vs. Medicare Baseline: 9.09x 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 909% of the Medicare baseline (a markup of 809%). 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% |
| Wppa | $37 - $39 | 862% |
| UnitedHealthcare | $39 | 909% |
Consumer Guidance & Cost Commentary
For the blood test procedure (CPT 85610) at Goodland Regional Medical Center in Goodland, KS, the facility's cash median rate of $39.00 is notably higher than the Medicare benchmark of $4.29, reflecting a markup of 9.1 times the federal baseline. While the facility is a Critical Access Hospital owned by the local government, patients should be aware that commercial insurance rates can sometimes exceed cash prices due to administrative overhead and contract structures. In this case, the median negotiated rates across payers like Blue Cross Blue Shield, Wppa, and UnitedHealthcare range from $37 to $39, which aligns closely with the cash price. This suggests that for patients with high-deductible plans, paying cash directly might result in lower out-of-pocket costs compared to using insurance, provided the deductible has been met.
To maximize savings, patients should proactively request "self-pay" or "prompt-pay" discounts before scheduling, as these programs often offer reductions of 20% to 50% for upfront payment by bypassing costly insurance claims processing. It is important to verify your specific plan's allowed amount before the visit, as assuming in-network status guarantees the lowest price can lead to unexpected balances if your deductible is not yet satisfied. Additionally, if you receive an itemized bill, review it carefully for errors or unbundled charges, as over 80% of hospital bills contain mistakes that can be corrected through a formal written audit dispute rather than accepting the summary total immediately.