CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Adventist Health and Rideout

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $20
Cash Discount Price: $12
vs. Medicare Baseline: 4.66x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Adventist Health and Rideout is $20. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $12. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 4.66x the Medicare baseline. Located in 726 4Th St, Marysville, CA.

Cash / Self-Pay

$12

Average discount available for prompt cash payment at this facility.

Insurance Median

$20

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: $12 (280%)

Insurance Median: $20 (466%)

Cash: $12 (280% of Medicare)

Ins. Median: $20 (466% 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 466% of the Medicare baseline (a markup of 366%). 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
Bc Mcal	$1	23%
Aetna	$2 - $108	47%
Healthnet Comm-All Other Plans	$2 - $92	47%
Blue Cross Blue Shield	$3 - $118	70%
Blue Shield Uc Care Members	$3 - $122	70%
Blue Shield-All Other Plans	$3 - $145	70%
Ca Health And Wellness- All Plans	$3 - $6	70%
Celtic Mcaid-All Plans	$3 - $6	70%
Cigna	$3 - $130	70%
First Health-All Plans	$3 - $134	70%
Healthnet Mcal	$3 - $31	70%
Interplan-All Plans	$3 - $138	70%
Kaiser Mcal	$3 - $5	70%
Kaiser-All Other Plans	$3 - $116	70%
Medi-Cal	$3 - $5	70%
Multiplan-All Plans	$3 - $145	70%
Partnership Hp Mcal -All Plans	$3 - $5	70%
Phcs-All Plans	$3 - $135	70%
UnitedHealthcare	$3 - $133	70%
Kaiser Mcr Adv	$4	93%
Tricare	$4	93%
Ah Employee Health Plan - All Plans	$8	186%

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 $12.
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 and Rideout 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.