CMS Price Transparency Data

Blood test, clotting time (PTT)

Facility: UPMC Northwest

Billing Code: 85730 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85730
Insurance Median: $80
Cash Discount Price: $119
vs. Medicare Baseline: 13.31x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PTT) at UPMC Northwest is $80. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $119. Compared to the federal Medicare reimbursement reference rate of $6.01, this hospital’s rate is 13.31x the Medicare baseline. Located in 100 Fairfield Drive, Seneca, PA.

Cash / Self-Pay

$119

Average discount available for prompt cash payment at this facility.

Insurance Median

$80

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$6.01

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $6.01 (100%)

Cash / Self-Pay: $119 (1980%)

Insurance Median: $80 (1331%)

Cash: $119 (1980% of Medicare)

Ins. Median: $80 (1331% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $6.01 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 1331% of the Medicare baseline (a markup of 1231%). 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
Upmc Health Plan	$5 - $8	83%
Aetna	$6 - $129	100%
Amerihealth Caritas	$6 - $12	100%
Blue Cross Blue Shield	$6 - $37	100%
Geisinger	$6	100%
Highmark Wholecare (Prev Gateway)	$6 - $11	100%
Pa Health & Wellness	$6 - $13	100%
UnitedHealthcare	$6 - $9	100%
Upmc Work Partners	$6	100%
Cigna	$80 - $129	1331%
Intergroup	$129 - $3,704	2146%
Coventry/First Health	$139	2313%
Health Coalition Partners	$143	2379%
Private Health Care Systems	$159	2646%
Humana	$169	2812%

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 $119.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 85730.

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 85730.
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.