CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Adventist Health Ukiah Valley

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $42
Cash Discount Price: $18
vs. Medicare Baseline: 9.79x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Adventist Health Ukiah Valley is $42. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $18. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 9.79x the Medicare baseline. Located in 275 Hospital Drive, Ukiah, CA.

Cash / Self-Pay

$18

Average discount available for prompt cash payment at this facility.

Insurance Median

$42

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: $18 (420%)

Insurance Median: $42 (979%)

Cash: $18 (420% of Medicare)

Ins. Median: $42 (979% 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 979% of the Medicare baseline (a markup of 879%). 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 Shield Epn-All Other Plans	$1 - $43	23%
Blue Shield Non-Epn	$1 - $44	23%
Cigna	$2 - $89	47%
Healthnet-All Plans	$2 - $65	47%
Mendocino Lcc District-All Plans	$2 - $74	47%
Western Growers-All Plans	$2 - $59	47%
Beech Street-All Plans	$3 - $97	70%
Choice Care-All Plans	$3 - $97	70%
Foundation For Medical Care-All Plans	$3 - $86	70%
Health Mgmt Network-All Plans	$3 - $97	70%
Interplan-All Plans	$3 - $93	70%
Kaiser Medi-Cal	$3 - $5	70%
Kaiser-All Other Plans	$3 - $91	70%
Medi-Cal	$3 - $5	70%
Networks By Design-All Plans	$3 - $91	70%
Phcs Multiplan-All Plans	$3 - $91	70%
Three Rivers-All Plans	$3 - $103	70%
UnitedHealthcare	$3 - $95	70%
Blue Shield Mcr Adv	$4	93%
Kaiser Mcr Adv	$4	93%
Tricare	$4	93%
Aetna	$5 - $35	117%
Ah Employee Health Plan - All Plans	$5 - $8	117%
Blue Cross Blue Shield	$40 - $53	932%

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 $18.
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 Ukiah Valley 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.