Blood test, clotting time (PT/INR)
Facility: Clay County Medical Center
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $40
- Cash Discount Price: $42
- vs. Medicare Baseline: 9.32x 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 932% of the Medicare baseline (a markup of 832%). 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 |
|---|---|---|
| Aetna | $37 - $59 | 862% |
| Wppa/Providrs Care- All Plans | $37 - $59 | 862% |
| UnitedHealthcare | $38 - $60 | 886% |
| Health Partners - All Plans | $38 - $60 | 886% |
| Multiplan- All Plans | $38 - $60 | 886% |
Consumer Guidance & Cost Commentary
For this blood test procedure at Clay County Medical Center in Clay Center, KS, the cash price is $42.00, which matches the facility's median negotiated rate of $40.00 and the cash median of $42.00. This price is significantly higher than the state average, as indicated by a 9.3% variance compared to Medicare's benchmark rate of $4.29. While commercial insurance plans like Aetna, UnitedHealthcare, and others have negotiated rates ranging from $37 to $60, patients with high-deductible plans may find paying the full cash price of $42.00 more beneficial than relying on insurance, which could result in higher out-of-pocket costs if the deductible has not been met. It is important to verify your specific plan's allowed amount before scheduling, as in-network rates can vary widely between carriers.
Patients should be aware that while the No Surprises Act protects against balance billing for emergency care and non-emergency services from out-of-network providers at in-network facilities, unexpected charges can still occur if ancillary services are billed separately. To ensure transparency, always request a full itemized bill before paying, as summary invoices may hide unbundled codes or services not rendered. Additionally, ask the facility about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid in full upfront, bypassing the administrative costs associated with insurance claims processing. Given that over 80% of hospital bills contain errors, disputing any discrepancies in writing is the most effective way to avoid unnecessary medical debt.