Blood test, clotting time (PT/INR)
Facility: Amberwell Atchison Association
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $20
- Cash Discount Price: $40
- 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 |
|---|---|---|
| Triwest - All Plans | $7 - $20 | 163% |
| Va Ccn - All Plans | $7 - $20 | 163% |
| UnitedHealthcare | $7 - $109 | 163% |
| Humana | $7 - $27 | 163% |
| Superior Select Mcr Adv - All Plans | $7 - $20 | 163% |
| Ambetter / Centene | $11 - $31 | 256% |
| Aetna | $12 - $34 | 280% |
| Cigna | $12 - $34 | 280% |
| Blue Cross Blue Shield | $15 - $16 | 350% |
| Oscar - All Plans | $16 - $46 | 373% |
| Centrus Health Direct - All Plans | $16 - $46 | 373% |
| Multiplan - All Plans | $17 - $48 | 396% |
| Wppa Providrs Care - All Plans | $20 - $55 | 466% |
Consumer Guidance & Cost Commentary
For the blood test procedure (CPT 85610) at Amberwell Atchison Association in Atchison, KS, the cash median price is $40.00, which matches the facility's gross charge. This cash rate is significantly lower than the average negotiated rates paid by insurance companies, with the median negotiated amount across 13 payers reaching $20.00. While commercial payers like UnitedHealthcare and Oscar typically pay between $11 and $55 per test, patients with high-deductible plans may find paying the full cash price of $40.00 upfront more cost-effective than relying on insurance, as the insurer's allowed amount often exceeds the cash rate. It is important to note that while the facility is a Critical Access Hospital in a Voluntary non-profit setting, patients should explicitly ask about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront incentives can further reduce the final cost.
The facility's pricing is evaluated against the Medicare benchmark of $4.29, which serves as the objective baseline for healthcare costs in this region. Although the cash price of $40.00 is higher than the Medicare rate, this reflects the administrative overhead and profit margins inherent in commercial billing structures, where negotiated rates often average 200% to 300% of the Medicare amount. If a patient receives care from an out-of-network provider or encounters services billed at the full chargemaster rate, they may face balance billing for the difference between the provider's full charge and the insurance allowed amount. To avoid unexpected costs, patients should request a detailed, itemized bill to verify that all charges are accurate and that