CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Southwest Health Center

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $48
Cash Discount Price: $44
vs. Medicare Baseline: 11.19x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Southwest Health Center is $48. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $44. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 11.19x the Medicare baseline. Located in 1400 East Side Rd, Platteville, WI.

Cash / Self-Pay

$44

Average discount available for prompt cash payment at this facility.

Insurance Median

$48

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: $44 (1026%)

Insurance Median: $48 (1119%)

Cash: $44 (1026% of Medicare)

Ins. Median: $48 (1119% 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 1119% of the Medicare baseline (a markup of 1019%). 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	$16 - $77	373%
Care Wisconsin	$16 - $50	373%
UnitedHealthcare	$17 - $63	396%
Dean Health Plan	$25	583%
Quartz	$34 - $60	793%
Wps	$41 - $58	956%
Cigna	$41 - $58	956%
Group Health Cooperative of Sc	$44 - $67	1026%
Humana	$50 - $69	1166%
Healthchoice	$52 - $73	1212%
Group Health South Central	$55 - $77	1282%
Group Health Eau Claire	$55 - $77	1282%

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 $44.
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 Southwest Health Center 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.