Blood test, clotting time (PT/INR)
Facility: Children'S Mercy South
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $33
- Cash Discount Price: $24
- vs. Medicare Baseline: 7.69x 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 769% of the Medicare baseline (a markup of 669%). 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 | $4 - $34 | 93% |
| Medicaid / KanCare | $5 | 117% |
| Healthy Blue | $5 - $12 | 117% |
| Home State Health | $10 | 233% |
| Blue Cross Blue Shield | $20 - $37 | 466% |
| Cigna | $24 - $35 | 559% |
| Medica | $29 | 676% |
| Aetna | $30 - $34 | 699% |
| Wellfit/Centrus | $32 | 746% |
| Nebraska Furniture Mart | $32 | 746% |
| Centivo | $32 | 746% |
| Orscheln | $32 | 746% |
| Wppa Providrs Care | $32 | 746% |
| Quiktrip | $33 | 769% |
| Humana | $33 | 769% |
| Health Midwest Comprehensive Care | $33 | 769% |
| Coventry Health Care Of Kansas | $37 | 862% |
| Coxhealth Network | $37 | 862% |
| Mercy Health | $38 | 886% |
| Multiplan | $38 | 886% |
| American Healthcare Alliance | $42 | 979% |
| Healthlink | $44 | 1026% |
| National Preferred Provider Network | $45 | 1049% |
Consumer Guidance & Cost Commentary
For the blood test procedure (CPT 85610) at Children's Mercy South in Overland Park, KS, the facility's cash median rate of $24.00 is significantly lower than the state average, which is 7.7% higher than the Medicare benchmark of $4.29. While commercial insurance plans like UnitedHealthcare and Medicaid/KanCare negotiate rates ranging from $4 to $37, these negotiated amounts often exceed the cash price. For patients with high-deductible plans who have not yet met their out-of-pocket maximum, paying the cash rate of $24.00 directly may result in lower total costs compared to the insurance negotiated rates, which can reach up to $45.00 depending on the specific carrier and plan.
To ensure you receive the most accurate pricing, it is essential to request an itemized billing audit before finalizing payment, as summary bills can obscure individual line items and potential errors. Additionally, patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the final amount by 20% to 50% if settled upfront, bypassing the administrative costs associated with insurance claims. While the facility is a voluntary non-profit, commercial rates for this service vary widely across the 23 participating payers, so verifying your specific allowed amount with the hospital prior to scheduling is the most effective way to avoid unexpected charges.