Blood test, clotting time (PT/INR)
Facility: Fredonia Regional Hospital
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $20
- Cash Discount Price: $33
- vs. Medicare Baseline: 4.66x 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 466% of the Medicare baseline (a markup of 366%). 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 |
|---|---|---|
| UnitedHealthcare | $2 - $38 | 47% |
| Blue Cross Blue Shield | $11 - $21 | 256% |
| Veterans Programs - All Plans | $12 - $22 | 280% |
| Aetna | $12 - $38 | 280% |
| Meritain-All Plans | $20 - $38 | 466% |
| Reserve National-All Plans | $20 - $38 | 466% |
| Cigna | $20 - $38 | 466% |
Consumer Guidance & Cost Commentary
For this blood clotting test at Fredonia Regional Hospital in Kansas, the cash price is $33.00, which matches the facility's median negotiated rate of $20.00 and the state average. While many commercial payers negotiate rates between $20.00 and $38.00, the cash price remains the lowest option available. Patients with high-deductible plans or those without insurance may find paying the full cash price of $33.00 more affordable than using insurance, as the negotiated rates for most carriers exceed the cash amount. It is important to verify your specific plan's deductible status before scheduling, as paying out-of-pocket can sometimes result in lower total costs compared to the administrative overhead and allowed amounts associated with commercial insurance.
If you choose to use insurance, be aware that the No Surprises Act protects you from balance billing for emergency care and non-emergency services at in-network facilities, meaning you will only be responsible for your deductible and copay rather than the difference between the hospital's full charge and the insurance payment. However, if you receive care from an out-of-network provider or encounter unexpected ancillary services, you may face surprise bills; in such cases, you should dispute any balance billing immediately with your insurer rather than paying the full amount upfront. Additionally, before finalizing payment, request a detailed itemized bill to ensure no errors, unbundled codes, or services not rendered are included, as over 80% of hospital bills contain mistakes that can be corrected through a formal written audit.