CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Aurora Medical Center

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 85610
  • Insurance Median: $33
  • Cash Discount Price: $31
  • vs. Medicare Baseline: 7.69x Medicare
The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Aurora Medical Center is $33. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $31. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 7.69x the Medicare baseline. Located in 975 Port Washington Road, Grafton, WI.
Cash / Self-Pay
$31

Average discount available for prompt cash payment at this facility.

Insurance Median
$33

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: $31 (723%)
Insurance Median: $33 (769%)
Cash: $31 (723% of Medicare)
Ins. Median: $33 (769% 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 769% of the Medicare baseline (a markup of 669%). 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.

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
UnitedHealthcare $3 - $59 70%
Aurora Caregiver $4 93%
Blue Cross Blue Shield $4 - $60 93%
Centivo $9 210%
Common Ground $9 210%
Aetna $10 - $58 233%
Health Payment Systems $11 256%
Healthpartners $11 - $52 256%
Quartz One $11 256%
Cigna $12 - $59 280%
Everpointe Elite $12 280%
Hs Technology $12 280%
Molina Exchange $12 280%
Quartz Group $12 280%
Wisconsin Physician Service $14 - $15 326%
Trilogy $15 350%
Health Eos Plus $33 - $42 769%
Health Eos $44 - $56 1026%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 975 Port Washington Road, Grafton, WI 53024
  • CMS Rating: ★★★★★
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals