Blood test, clotting time (PT/INR)
Facility: Neosho Memorial Regional Medical Center
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $21
- Cash Discount Price: $49
- vs. Medicare Baseline: 4.90x 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 490% of the Medicare baseline (a markup of 390%). 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 |
|---|---|---|
| Medicaid / KanCare | $4 | 93% |
| Blue Cross Blue Shield | $18 - $21 | 420% |
| Tricare | $20 | 466% |
| Va_Ccn | $21 | 490% |
| Medadv_Allwell | $21 | 490% |
| Aetna | $21 | 490% |
| Medicare (plans) | $21 | 490% |
| Medadv_Uhc | $21 | 490% |
| Humana | $21 | 490% |
| Ambetter / Centene | $22 | 513% |
| Wppa_Providrscare | $54 | 1259% |
| United | $55 | 1282% |
| Coventry | $62 | 1445% |
| Cigna | $62 | 1445% |
| Hpk | $62 | 1445% |
Consumer Guidance & Cost Commentary
For this blood clotting test at Neosho Memorial Regional Medical Center in Chanute, KS, the cash price is $49.00, which is lower than the facility's negotiated rates of $21.00 to $62.00 across 15 different payers. While many commercial plans negotiate rates that exceed the cash price, patients with high-deductible plans might save money by paying the $49.00 cash rate directly, as the insurance allowed amount could be higher. It is important to note that this facility is a Critical Access Hospital with a government-local ownership structure, and the Medicare benchmark for this service is $4.29, providing a clear baseline for evaluating the facility's pricing markup against federal standards.
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 you are not overcharged, always request a full itemized bill before paying, as summary invoices may hide unbundled codes or services not rendered. Additionally, since this facility offers prompt-pay discounts for upfront payment, you should contact the billing department before scheduling to confirm self-pay rates and avoid automatic claims submission that could void any cash savings.