CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Black River Memorial Hospital

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $64
Cash Discount Price: $63
vs. Medicare Baseline: 14.92x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Black River Memorial Hospital is $64. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $63. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 14.92x the Medicare baseline. Located in 711 W Adams St, Black River Falls, WI.

Cash / Self-Pay

$63

Average discount available for prompt cash payment at this facility.

Insurance Median

$64

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: $63 (1469%)

Insurance Median: $64 (1492%)

Cash: $63 (1469% of Medicare)

Ins. Median: $64 (1492% 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 1492% of the Medicare baseline (a markup of 1392%). 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	$3 - $36	70%
Group Health Cooperative Of Eau Claire	$4 - $68	93%
My Choice Wisconsin, Inc.	$4 - $36	93%
Quartz Health Solutions, Inc	$4 - $64	93%
UnitedHealthcare	$4 - $66	93%
Humana	$36 - $65	839%
Security Health Plan	$36 - $65	839%
Corvel	$43	1002%
The Alliance	$60 - $67	1399%
Triology Health Solutions	$63 - $66	1469%
Medica	$65	1515%
Association Benefits Solution	$66	1538%
Family Health Center Of Marshfield	$66	1538%
First Health Group Corporation	$66	1538%
Provider Network Of America	$66	1538%
Cigna	$68	1585%
Cofinity	$68	1585%
Coventry Health Care	$68	1585%
Custom Benefit Administrators	$68	1585%
Healthpartners, Inc.	$68	1585%
Multiplan	$68 - $69	1585%
Wisconsin Physicians Service Insurance Corp	$68	1585%
Chorus	$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 $63.
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 Black River Memorial Hospital 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.