CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: St Mary's General Hospital

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $4
Cash Discount Price: $4
vs. Medicare Baseline: 0.93x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at St Mary's General Hospital is $4. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 0.93x the Medicare baseline. Located in 350 Boulevard, Passaic, NJ.

Cash / Self-Pay

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: $4 (93%)

Insurance Median: $4 (93%)

Cash: $4 (93% of Medicare)

Ins. Median: $4 (93% 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
Humana	$3	70%
UnitedHealthcare	$3 - $4	70%
Aetna	$4 - $9	93%
Ally-Align (Fka Spartan Plan Nj, Inc.)	$4	93%
Amerihealth	$4	93%
Clover Health	$4	93%
Horizon	$4 - $52	93%
Medicare (plans)	$4	93%
Tricare	$4	93%
Wellcare	$4 - $6	93%
Wellpoint Amerigroup	$4	93%
Fairprice Healthcare Holdings	$5	117%
Cigna	$6	140%
Employer Direct Healthcare	$6	140%
Coventry	$9	210%

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 $4.
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 St Mary's General Hospital 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.