Blood test, clotting time (PT/INR)
Facility: Salina Regional Health Center
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $15
- Cash Discount Price: $28
- 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 |
|---|---|---|
| Preferred Phsic | $10 - $39 | 233% |
| Blue Cross Blue Shield | $10 - $11 | 233% |
| Preferred Healthcare - All Other Plans | $13 - $52 | 303% |
| Cigna | $15 - $58 | 350% |
| Aetna | $15 - $58 | 350% |
| Multiplan (Mpi)-All Plans | $15 - $58 | 350% |
| Providers Care (Wppa)-All Plans | $15 - $58 | 350% |
Consumer Guidance & Cost Commentary
For this blood clotting test at Salina Regional Health Center in Salina, KS, the facility's cash median rate of $28.00 is significantly higher than the state average of $15.00, which is also the median negotiated rate for in-network payers. While commercial insurance contracts often result in higher costs due to administrative overhead and multi-layered billing structures, patients with high-deductible plans may find the cash price more affordable if their insurance allows exceed the cash rate. It is important to note that while the facility is an acute care hospital with a voluntary non-profit ownership structure, the gross charge of $40.00 represents the full list price, and commercial payers like Cigna and Aetna have negotiated rates ranging from $15.00 to $58.00 depending on the specific plan.
To minimize unexpected costs, patients should proactively request a prompt-pay discount before scheduling, as paying in full upfront can bypass costly insurance claims processing and reduce the final bill by 20% to 50%. Additionally, if you receive a bill from an out-of-network provider at this in-network facility, you may be protected by the No Surprises Act, which bans balance billing for emergency care and non-emergency services; in such cases, you should dispute any surprise charges in writing rather than paying immediately. Finally, always demand a detailed, itemized bill that lists specific CPT codes to identify any unbundled charges or services not rendered, as over 80% of hospital bills contain errors that can be corrected through a formal audit dispute sent to the billing supervisor.