CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Buffalo Hospital

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $42
Cash Discount Price: $43
vs. Medicare Baseline: 9.79x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Buffalo Hospital is $42. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $43. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 9.79x the Medicare baseline. Located in 303 Catlin Street, Buffalo, MN.

Cash / Self-Pay

$43

Average discount available for prompt cash payment at this facility.

Insurance Median

$42

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: $43 (1002%)

Insurance Median: $42 (979%)

Cash: $43 (1002% of Medicare)

Ins. Median: $42 (979% 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 979% of the Medicare baseline (a markup of 879%). 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 - $86	93%
Blue Cross Blue Shield	$4 - $52	93%
Medica	$4 - $110	93%
Medicaid / KanCare	$4	93%
Medicare (plans)	$4	93%
South Country Health Alliance	$4	93%
Ucare Pmap (A B C D E G N O S U R H)	$7 - $29	163%
Health Partners	$14 - $107	326%
Medica Health System	$19 - $116	443%
Healthpartners	$25 - $98	583%
UnitedHealthcare	$26 - $99	606%
Medica Mhps	$28 - $110	653%
Americas Ppo (Araz)(B D N O R S V)	$29 - $111	676%
Americas Ppo (Araz) (B D N H O R S)	$31 - $121	723%
First Health (A C E G H U B D N O R S)	$31 - $121	723%
All Other Contracted Care (A B C D E G H N O R S U)	$37 - $144	862%

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 $43.
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 Buffalo Hospital 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.