CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Lafayette Regional Health Center

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $147
Cash Discount Price: $341
vs. Medicare Baseline: 34.27x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Lafayette Regional Health Center is $147. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $341. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 34.27x the Medicare baseline. Located in 1500 State Street, Lexington, MO.

Cash / Self-Pay

$341

Average discount available for prompt cash payment at this facility.

Insurance Median

$147

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$4.29

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $4.29 (100%)

Cash / Self-Pay: $341 (7949%)

Insurance Median: $147 (3427%)

Cash: $341 (7949% of Medicare)

Ins. Median: $147 (3427% of 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 3427% of the Medicare baseline (a markup of 3327%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Aetna	$4 - $299	93%
Amerigroup	$4	93%
Healthyblue	$4	93%
Home State Health Plan	$4	93%
Medicaid / KanCare	$4	93%
Unicare	$4	93%
United	$4 - $154	93%
Corvel Corporation	$8 - $290	186%
Oha Network	$8 - $171	186%
Ambetter / Centene	$64	1492%
Nhc Advantage	$65	1515%
Universal Healthcare	$89	2075%
Humana	$115 - $147	2681%
Blue Cross Blue Shield	$130 - $341	3030%
College Park Family Care Center	$147	3427%
Oscar	$171	3986%
Cigna	$195 - $244	4545%
Wppa Providrs Care Network	$256	5967%
Multiplan	$266	6200%
Coventry	$272	6340%
Coventry Kc Mo	$272	6340%
Cco, Inc.	$290	6760%
Focus Healthcare Mgmt, Inc	$307	7156%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $341.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 85610.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Lafayette Regional Health Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 85610.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.