CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Stoughton Hospital

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $49
Cash Discount Price: $67
vs. Medicare Baseline: 11.42x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Stoughton Hospital is $49. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $67. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 11.42x the Medicare baseline. Located in 900 Ridge St, Stoughton, WI.

Cash / Self-Pay

$67

Average discount available for prompt cash payment at this facility.

Insurance Median

$49

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: $67 (1562%)

Insurance Median: $49 (1142%)

Cash: $67 (1562% of Medicare)

Ins. Median: $49 (1142% 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 1142% of the Medicare baseline (a markup of 1042%). 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
Alliance - All Plans	$3 - $7	70%
Medicaid / KanCare	$4	93%
Tricare	$18 - $40	420%
Healthnet Mcr Adv - All Plans	$20 - $45	466%
Dean Health Insurance Med Adv	$21 - $47	490%
Humana	$21 - $151	490%
Quartz Mcr Adv	$21 - $47	490%
Security Health/First Health - All Plans	$21 - $47	490%
Aetna	$22 - $143	513%
Dean Health Insurance Comm - All Other Plans	$22	513%
Dean Health Insurance Epo	$22	513%
UnitedHealthcare	$33 - $135	769%
Geha - All Plans	$56 - $126	1305%
Cigna	$60 - $135	1399%
Wisconsin Ppo Ppa Direct - All Plans	$60 - $135	1399%
Blue Cross Blue Shield	$65 - $146	1515%
Wps - All Plans	$67 - $151	1562%
Quartz Health Solutions - All Other Lans	$79	1841%

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 $67.
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 Stoughton 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.