CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: UPMC Northwest

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $23
Cash Discount Price: $35
vs. Medicare Baseline: 5.36x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at UPMC Northwest is $23. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $35. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 5.36x the Medicare baseline. Located in 100 Fairfield Drive, Seneca, PA.

Cash / Self-Pay

$35

Average discount available for prompt cash payment at this facility.

Insurance Median

$23

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: $35 (816%)

Insurance Median: $23 (536%)

Cash: $35 (816% of Medicare)

Ins. Median: $23 (536% 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 536% of the Medicare baseline (a markup of 436%). 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	$4 - $38	93%
Blue Cross Blue Shield	$4 - $24	93%
Geisinger	$4	93%
UnitedHealthcare	$4 - $5	93%
Upmc Health Plan	$4	93%
Upmc Work Partners	$4	93%
Amerihealth Caritas	$5 - $6	117%
Highmark Wholecare (Prev Gateway)	$5 - $6	117%
Pa Health & Wellness	$5 - $7	117%
Cigna	$23 - $38	536%
Intergroup	$38 - $3,704	886%
Coventry/First Health	$41	956%
Health Coalition Partners	$42	979%
Private Health Care Systems	$46	1072%
Humana	$49	1142%

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 $35.
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 UPMC Northwest 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.