CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Hermann Area District Hospital

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $35
Cash Discount Price: $37
vs. Medicare Baseline: 8.16x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Hermann Area District Hospital is $35. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $37. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 8.16x the Medicare baseline. Located in 509 W 18Th St, Hermann, MO.

Cash / Self-Pay

$37

Average discount available for prompt cash payment at this facility.

Insurance Median

$35

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: $37 (862%)

Insurance Median: $35 (816%)

Cash: $37 (862% of Medicare)

Ins. Median: $35 (816% 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 816% of the Medicare baseline (a markup of 716%). 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
Coventry - All Plans	$3	70%
UnitedHealthcare	$6 - $26	140%
Tricare	$24	559%
Cigna	$25	583%
Choicecare Mcr Adv- All Plans	$26	606%
Aetna	$27 - $58	629%
American Hlth Mcr Adv- All Plans	$27	629%
Blue Cross Blue Shield	$27 - $50	629%
Humana	$27	629%
Wellcare Mcr Adv - All Plans	$27	629%
Harmony Hp Mcaid- All Plans	$35	816%
Healthcare Usa Mcaid- All Plans	$40	932%
Healthlink Hmo	$40	932%
Ambetter / Centene	$43	1002%
Healthlink Ppo - All Other Plans	$46	1072%
Multiplan/Phcs - All Plans	$46	1072%
Comp Results - All Plans	$55	1282%
Three Rivers - All Plans	$55	1282%
Care Partners Mcaid- All Plans	$61	1422%

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 $37.
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 Hermann Area District 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.