CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Fairfield Medical Center

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $14
Cash Discount Price: $18
vs. Medicare Baseline: 3.26x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Fairfield Medical Center is $14. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $18. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 3.26x the Medicare baseline. Located in 401 North Ewing Street, Lancaster, OH.

Cash / Self-Pay

$18

Average discount available for prompt cash payment at this facility.

Insurance Median

$14

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: $18 (420%)

Insurance Median: $14 (326%)

Cash: $18 (420% of Medicare)

Ins. Median: $14 (326% 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 326% of the Medicare baseline (a markup of 226%). 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 - $39	93%
Allied Benefit Systems	$4 - $41	93%
Blue Cross Blue Shield	$4 - $26,250	93%
Buckeye Community Health	$4 - $9	93%
Caresource	$4 - $9	93%
Humana	$4 - $56	93%
Medical Mutual	$4 - $33,500	93%
Medicare (plans)	$4	93%
Medigold	$4	93%
Meritain Health	$4 - $41	93%
Molina	$4 - $9	93%
Oscar	$4	93%
The Health Plan	$4 - $41	93%
UnitedHealthcare	$4 - $16	93%
Va Ccn	$4	93%
Valor Health Plan	$4	93%
Bwc	$6	140%
Amerihealth Caritas Ohio	$9	210%
Medicaid / KanCare	$9	210%
Quality Care Partners/Ohio Ppo Connect	$14 - $42	326%
The Ohio State Health Plan	$15 - $45	350%
Cigna	$16 - $49	373%
Multiplan	$18 - $56	420%
Ohio Healthy	$18 - $55	420%
Miscellaneous Plans	$19 - $59	443%

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 $18.
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 Fairfield Medical 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.