Blood test, clotting time (PT/INR)
Facility: Oakleaf Surgical Hospital
Billing Code: 85610 (CPT)
- CPT Billing Code: 85610
- Insurance Median: $4
- Cash Discount Price: $37
- vs. Medicare Baseline: 0.93x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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 | 93% |
| Dean Health Plan | $4 | 93% |
| Group Health Cooperative Of Eau Claire | $4 | 93% |
| Healthpartners | $4 | 93% |
| Humana | $4 | 93% |
| Medica | $4 | 93% |
| Quartz Health Solutions | $4 | 93% |
| Security Health Plan Of Wi | $4 | 93% |
| Ucare Wi | $4 | 93% |
| UnitedHealthcare | $4 | 93% |
Consumer Guidance & Cost Commentary
For this procedure, the cash price of $37 is significantly lower than the gross charge of $41 and represents a substantial discount compared to the state average of $18. While the state average suggests a higher baseline cost for similar services, the cash rate here is notably more affordable for patients seeking immediate payment without insurance involvement. It is important to note that while cash rates are often lower, they may not always be the cheapest option for all patients; if your insurance plan has a high deductible or if the negotiated rate exceeds the cash price, paying out-of-pocket could result in a lower total out-of-pocket cost.
The facility's negotiated rates average $4, which is lower than the state average of $18 but still higher than the cash price of $37. This price point is also well below the Medicare benchmark of $4.29, indicating that the facility is charging closer to the federal cost baseline than typical commercial contracts. Because the negotiated rate is higher than the cash rate, patients with high-deductible plans might find it beneficial to pay the cash price directly. To ensure you receive the best possible rate, it is recommended to ask the hospital about "self-pay" or "prompt-pay" discounts, which can further reduce the final bill if you choose to pay upfront.