CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Caribou Medical Center

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $54
Cash Discount Price: $32
vs. Medicare Baseline: 12.59x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Caribou Medical Center is $54. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $32. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 12.59x the Medicare baseline. Located in 300 South 3Rd West, Soda Springs, ID.

Cash / Self-Pay

$32

Average discount available for prompt cash payment at this facility.

Insurance Median

$54

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: $32 (746%)

Insurance Median: $54 (1259%)

Cash: $32 (746% of Medicare)

Ins. Median: $54 (1259% 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 1259% of the Medicare baseline (a markup of 1159%). 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
Aetna	$13 - $69	303%
First Choice Health-All Plans	$18 - $63	420%
Bc Qualified Hp (Qhp)	$19 - $65	443%
Deseret Healthcare-All Plans	$19 - $66	443%
Blue Cross Blue Shield	$20 - $255	466%
Montana Health Co-Op-All Plans	$20 - $69	466%
Pacific Source-All Other Plans	$20 - $68	466%
Regence Blue Shield-All Other Plans	$20 - $69	466%
Select Health-All Other Plans	$20 - $69	466%
Humana	$32 - $252	746%
Pacific Source Mcr Adv	$32 - $252	746%
Regence Blue Shield Mcr	$32 - $252	746%
Select Health Mcr Adv	$32 - $252	746%
Select Health/Bright Path Mcr Adv	$32 - $252	746%
UnitedHealthcare	$68	1585%
Cigna	$69	1608%

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 $32.
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 Caribou Medical 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.