CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Adventist Health Tulare

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $6
Cash Discount Price: $36
vs. Medicare Baseline: 1.40x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Adventist Health Tulare is $6. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $36. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 1.40x the Medicare baseline. Located in 869 North Cherry Street, Tulare, CA.

Cash / Self-Pay

$36

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: $36 (839%)

Insurance Median: $6 (140%)

Cash: $36 (839% of Medicare)

Ins. Median: $6 (140% 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 Cross Blue Shield	$1 - $40	23%
Blue Shield Epn	$1 - $113	23%
Blue Shield-All Other Plans	$2 - $156	47%
Cigna	$2 - $166	47%
Hs Interplan-All Plans	$2 - $240	47%
Network By Design-All Plans	$2 - $233	47%
UnitedHealthcare	$2 - $259	47%
Western Growers - All Plans	$2 - $165	47%
Ccipa Medi-Cal - All Plans	$3 - $6	70%
Dignity Mcal Op Only	$3 - $5	70%
Healthnet Medi-Cal	$3 - $6	70%
Independence Op Only - All Plans	$3 - $5	70%
Medi-Cal	$3 - $5	70%
Multiplan - All Plans	$3 - $304	70%
Blue Shield Mcare	$4	93%
Dignity Mcr Op Only - All Other Plans	$4	93%
Fhcn Pace Mcr Adv - All Plans	$4	93%
Medicare (plans)	$4	93%
Prime Health - All Plans	$4	93%
Tricare	$4	93%
Prison Hlthcre - All Plans	$5	117%
Bright Health - All Plans	$6	140%
Cal Forensic Med Grp - All Plans	$6	140%
Ah Employee Health Plan - All Plans	$8	186%
Incentive Hlth - All Plans	$8	186%
Healthnet Hmo/Ppo - All Other Plans	$11	256%
Aetna	$34	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 $36.
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 Tulare 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.