CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: UPMC Bedford Memorial

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $27
Cash Discount Price: $30
vs. Medicare Baseline: 6.29x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at UPMC Bedford Memorial is $27. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $30. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 6.29x the Medicare baseline. Located in 10455 Lincoln Highway, Everett, PA.

Cash / Self-Pay

$30

Average discount available for prompt cash payment at this facility.

Insurance Median

$27

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: $30 (699%)

Insurance Median: $27 (629%)

Cash: $30 (699% of Medicare)

Ins. Median: $27 (629% 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 629% of the Medicare baseline (a markup of 529%). 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	$2 - $34	47%
Blue Cross Blue Shield	$4 - $26	93%
Health Partners Plans (Jefferson Health Plan)	$4	93%
UnitedHealthcare	$4 - $34	93%
Upmc Health Plan	$4 - $13	93%
Upmc Work Partners	$4	93%
Amerihealth Caritas	$5 - $6	117%
Cigna	$5 - $34	117%
Highmark Wholecare (Prev Gateway)	$5 - $6	117%
Pa Health & Wellness	$5 - $7	117%
Geisinger	$6	140%
Intergroup	$32 - $45	746%
Coventry/First Health	$35	816%
Preferred Healthcare System	$40	932%
Health Coalition Partners	$45	1049%
Humana	$45	1049%
Private Health Care Systems	$45	1049%
Selectcare	$45	1049%

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 $30.
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 Bedford Memorial 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.