CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Marshfield Medical Center - Beaver Dam (Mmc-Bd)

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $42
Cash Discount Price: $68
vs. Medicare Baseline: 9.79x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Marshfield Medical Center - Beaver Dam (Mmc-Bd) is $42. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $68. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 9.79x the Medicare baseline. Located in 707 S University Ave, Beaver Dam, WI.

Cash / Self-Pay

$68

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: $68 (1585%)

Insurance Median: $42 (979%)

Cash: $68 (1585% 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
Blue Cross Blue Shield	$4 - $23	93%
Group Health Cooperative Of Eau Claire	$4 - $68	93%
Humana	$4 - $64	93%
Managed Health Services	$4 - $5	93%
Molina Healthcare Of Wi	$4 - $61	93%
My Choice	$4	93%
Network Health Plan	$4 - $60	93%
Quartz	$4 - $41	93%
Security Health Plan (Shp)	$4 - $42	93%
Trilogy	$4 - $65	93%
UnitedHealthcare	$4 - $15	93%
Veteran'S Administration (Va Ccn)	$4	93%
Icare	$5	117%
The Alliance	$37	862%
Amish/Mennonite	$40	932%
Wps Health Insurance	$48	1119%
Cigna	$49 - $53	1142%
Health Payment Systems	$50	1166%
First Health	$61	1422%
Healtheos By Multiplan Inc.	$67 - $68	1562%
Health Partners	$68	1585%
Coventry	$69	1608%

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 $68.
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 Marshfield Medical Center - Beaver Dam (Mmc-Bd) 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.