CMS Price Transparency Data
Blood test, clotting time (PT/INR)
Facility: St Charles Madras
Billing Code: 85610 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 85610
- Insurance Median: $17
- Cash Discount Price: $28
- vs. Medicare Baseline: 3.96x Medicare
The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at St Charles Madras is $17. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $28. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 3.96x the Medicare baseline. Located in 470 Ne A Street, Madras, OR.
Cash / Self-Pay
$28
Average discount available for prompt cash payment at this facility.
Insurance Median
$17
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: $28 (653%)
Insurance Median: $17 (396%)
Cash: $28 (653% of Medicare)
Ins. Median: $17 (396% 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 396% of the Medicare baseline (a markup of 296%). 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.
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Medicare (plans) | $2 - $19 | 47% |
| Medicaid / KanCare | $3 - $28 | 70% |
| Advanced Health [534] | $4 - $28 | 93% |
| Aetna | $4 - $58 | 93% |
| Ageright Advantage [142] | $4 | 93% |
| Allcare Health Plan [538] | $4 - $28 | 93% |
| Blue Cross Blue Shield | $4 - $15 | 93% |
| Bridgespan [342] | $4 | 93% |
| Cascade Health Alliance [532] | $4 - $28 | 93% |
| Champ Va [700] | $4 | 93% |
| Cigna | $4 - $42 | 93% |
| Columbia Pacific Coordinated Care Llc [539] | $4 - $28 | 93% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund | $4 | 93% |
| Devoted Health Inc [145] | $4 | 93% |
| Health Market Care Assured [134] | $4 | 93% |
| Health Net Med Adv [135] | $4 | 93% |
| Health Share Care Oregon [526] | $4 - $28 | 93% |
| Health Share Kaiser [543] | $4 - $28 | 93% |
| Health Share Ohsu Ohp [552] | $4 - $28 | 93% |
| Health Share Providence [548] | $4 - $28 | 93% |
| Health Share [537] | $4 - $28 | 93% |
| Humana | $4 | 93% |
| Indian Health [704] | $4 | 93% |
| Intercommunity Health [530] | $4 - $28 | 93% |
| Jackson Care Connect [542] | $4 - $28 | 93% |
| Kaiser Permanente Med Adv [136] | $4 | 93% |
| Law Enforcement [701] | $4 - $33 | 93% |
| Pacificsource Community Solutions [525] | $4 | 93% |
| Pacificsource [345] | $4 - $37 | 93% |
| Primary Health Of Jospehine County Llc [547] | $4 - $28 | 93% |
| Samaritan Health Plan Med Adv [141] | $4 | 93% |
| Tricare | $4 | 93% |
| Umpqua Health [533] | $4 - $28 | 93% |
| Unicare [133] | $4 | 93% |
| UnitedHealthcare | $4 - $62 | 93% |
| Veterans [706] | $4 | 93% |
| Wellcare [132] | $4 | 93% |
| Willamette Valley Community Health [536] | $4 - $28 | 93% |
| Yamhill County Coordinated Care Org [550] | $4 - $28 | 93% |
| Otj Dept Of Labor Federal Emp [652] | $5 | 117% |
| Otj Us Department Of Labor [669] | $5 | 117% |
| Providence Health Plan [347] | $6 - $59 | 140% |
| Us Benefits [326] | $6 - $42 | 140% |
| Rocky Mountain Administrators [405] | $7 - $54 | 163% |
| Rx Internal [4100003] | $7 - $55 | 163% |
| First Choice Health [317] | $8 - $58 | 186% |
| Health Net [340] | $8 - $63 | 186% |
| Kaiser Permanente [334] | $8 - $58 | 186% |
| Meritain Health [300] | $8 - $58 | 186% |
| Moda [310] | $8 - $58 | 186% |
| Samaritan [376] | $8 - $58 | 186% |
| Administrative Concepts Inc [402] | $9 - $66 | 210% |
| Auto Allstate Insurance [602] | $9 - $67 | 210% |
| Auto American Family Insurance [603] | $9 - $67 | 210% |
| Auto Country Insurance Claims [604] | $9 - $67 | 210% |
| Auto Dairyland Insurance [617] | $9 - $67 | 210% |
| Auto Farmers [605] | $9 - $67 | 210% |
| Auto Geico Claims Oregon [606] | $9 - $67 | 210% |
| Auto Hartford [612] | $9 - $67 | 210% |
| Auto Liberty Mutual Auto Ins [613] | $9 - $67 | 210% |
| Auto Mutual Of Enumclaw [610] | $9 - $67 | 210% |
| Auto Nationwide Allied Insuranc [601] | $9 - $67 | 210% |
| Auto Oregon Mutual [614] | $9 - $67 | 210% |
| Auto Progressive [608] | $9 - $67 | 210% |
| Auto Safeco Concentra [600] | $9 - $67 | 210% |
| Auto State Farm Claims [609] | $9 - $67 | 210% |
| Auto Sublimity Insurance [616] | $9 - $67 | 210% |
| Auto Travelers Insurance [615] | $9 - $67 | 210% |
| Auto Usaa [611] | $9 - $67 | 210% |
| First Health [339] | $9 - $66 | 210% |
| Generic Auto [649] | $9 - $67 | 210% |
| Generic Workers Comp [699] | $9 - $67 | 210% |
| Manhattan Life Insurance Company [379] | $9 - $66 | 210% |
| Otj Broadspire Services [670] | $9 - $67 | 210% |
| Otj Ccmsi [618] | $9 - $67 | 210% |
| Otj Chartis Claims [650] | $9 - $67 | 210% |
| Otj City County Ins Services [662] | $9 - $67 | 210% |
| Otj Corvel [676] | $9 - $67 | 210% |
| Otj Esis West Wc Claims [653] | $9 - $67 | 210% |
| Otj Gallagher Bassett [654] | $9 - $67 | 210% |
| Otj Hartford [655] | $9 - $67 | 210% |
| Otj Intermountain Claims Inc [666] | $9 - $67 | 210% |
| Otj Liberty Mutual Wausau Underwriters [671] | $9 - $67 | 210% |
| Otj Penser No American [663] | $9 - $67 | 210% |
| Otj Pinnacle Risk Mgmt [661] | $9 - $67 | 210% |
| Otj Saif [667] | $9 - $67 | 210% |
| Otj Sedgwick Cms [660] | $9 - $67 | 210% |
| Otj Sedgwick [668] | $9 - $67 | 210% |
| Otj Travelers Insurance [672] | $9 - $67 | 210% |
| Otj Tristar [673] | $9 - $67 | 210% |
| Philadelphia American Life Insurance Company [395] | $9 - $66 | 210% |
| Planned Administrators Inc [375] | $9 - $66 | 210% |
| Asuris Northwest Health [202] | $15 | 350% |
| Healthcare Management Admin [201] | $15 | 350% |
| Regence Group Administrators [203] | $15 | 350% |