Blood test, clotting time (PT/INR)
Facility: Bob Wilson Memorial Hospital
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $63
- Cash Discount Price: $31
- vs. Medicare Baseline: 14.69x 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 1469% of the Medicare baseline (a markup of 1369%). 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 |
|---|---|---|
| Centura Employee Plan | $5 | 117% |
| Blue Cross Blue Shield | $21 | 490% |
| Aetna | $25 - $61 | 583% |
| Kansas Health | $25 | 583% |
| Humana | $25 | 583% |
| Medicare (plans) | $25 | 583% |
| UnitedHealthcare | $25 - $64 | 583% |
| Multiplan | $69 - $71 | 1608% |
| Health Partners Of Kansas | $72 | 1678% |
| Wppa | $73 | 1702% |
Consumer Guidance & Cost Commentary
For this blood clotting test at Bob Wilson Memorial Hospital in Ulysses, Kansas, the facility's cash price of $31.00 is significantly lower than the median negotiated rate of $63.00 paid by insurance plans. While the hospital is a Critical Access Hospital owned by a voluntary non-profit church, patients with high-deductible plans may find paying cash directly more cost-effective, as the cash price often falls below what insurers negotiate. To maximize savings, it is advisable to ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final amount owed by bypassing administrative claim processing fees.
When comparing this facility's pricing to broader benchmarks, the Medicare rate of $4.29 serves as the most reliable baseline for understanding true costs, revealing that commercial rates are often marked up substantially above this federal standard. Although the data does not provide specific state or county average comparisons for this specific CPT code, the significant gap between the cash price and the negotiated rates highlights the importance of verifying your insurance status before treatment. If you are billed for the difference between the provider's full charge and your insurance allowed amount, known as balance billing, you may have protections under the No Surprises Act, particularly if you received care at an in-network facility, and should not feel pressured to pay unexpected bills immediately without requesting an audit.