CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Adventist Health St Helena

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $8
Cash Discount Price: $14
vs. Medicare Baseline: 1.86x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Adventist Health St Helena is $8. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $14. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 1.86x the Medicare baseline. Located in 10 Woodland Road, Saint Helena, CA.

Cash / Self-Pay

$14

Average discount available for prompt cash payment at this facility.

Insurance Median

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: $14 (326%)

Insurance Median: $8 (186%)

Cash: $14 (326% of Medicare)

Ins. Median: $8 (186% 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.

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 Shield Behav Hlth	$2 - $95	47%
Blue Shield Epn-All Other Plans	$2 - $100	47%
Blue Shield Non-Epn	$2 - $98	47%
Choicecare-All Plans	$2 - $148	47%
Interplan-All Plans	$2 - $138	47%
Phcs-All Plans	$2 - $117	47%
UnitedHealthcare	$2 - $135	47%
Western Growers-All Plans	$2 - $112	47%
Beech Street-All Plans	$3 - $159	70%
Cigna	$3 - $170	70%
Galaxy Network-All Plans	$3 - $191	70%
Health Management Network-All Plans	$3 - $180	70%
Kaiser-All Other Plans	$3 - $174	70%
Three Rivers-All Plans	$3 - $191	70%
Va Medi-Cal	$3 - $5	70%
Blue Shield Bh Mcr Adv	$4	93%
Blue Shield Mcr Adv	$4	93%
Kaiser Mcr Adv	$4	93%
Tricare	$4	93%
Va Mcr - All Other Plans	$4	93%
Healthnet-All Plans	$7 - $9	163%
Ah Employee Health Plan - All Plans	$8	186%
Aetna	$23	536%
Blue Cross Blue Shield	$34 - $45	793%

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 $14.
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 Adventist Health St Helena 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.