Blood test, clotting time (PT/INR)
Facility: William Newton Hospital
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $15
- Cash Discount Price: $40
- vs. Medicare Baseline: 3.50x 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 350% of the Medicare baseline (a markup of 250%). 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 - $36 | 47% |
| Ambetter / Centene | $14 - $40 | 326% |
| Blue Cross Blue Shield | $14 - $15 | 326% |
| Triwest- All Plans | $14 | 326% |
| Providrs Care Nexus | $24 | 559% |
| Providrs Care - All Other Plans | $28 | 653% |
Consumer Guidance & Cost Commentary
For the blood test procedure (CPT 85610) at William Newton Hospital in Winfield, Kansas, the cash price is $40.00, which matches the facility's cash median. This rate is significantly higher than the state average, as indicated by a comparison factor of 3.5 against the Medicare benchmark of $4.29. While commercial insurance plans like UnitedHealthcare and Ambetter / Centene negotiate rates ranging from $14 to $40, these negotiated amounts often exceed the cash price. Patients with high-deductible plans may find it financially advantageous to pay the $40.00 cash price directly, as this avoids the administrative overhead and potential markup associated with insurance billing cycles. It is important to verify your specific plan's coverage and deductible status before scheduling, as paying out-of-pocket can sometimes result in lower total costs compared to insurance reimbursement.
To ensure you are not overcharged, you should request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. If you receive a surprise bill for the difference between the provider's full charge and your insurance allowed amount, you may be protected under the No Surprises Act, which bans balance billing for emergency care and non-emergency services at in-network facilities. Additionally, ask the hospital about prompt-pay discounts, which can reduce the bill by 20% to 50% if paid in full upfront, bypassing the costly claims processing that inflates insurance rates. Always dispute any unexpected charges in writing rather than accepting summary bills, and consider that the facility's government ownership and critical access status may influence their pricing structure