CMS Price Transparency Data

Blood test, clotting time (PTT)

Facility: UPMC Presbyterian Shadyside

Billing Code: 85730 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85730
Insurance Median: $62
Cash Discount Price: $174
vs. Medicare Baseline: 10.32x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PTT) at UPMC Presbyterian Shadyside is $62. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $174. Compared to the federal Medicare reimbursement reference rate of $6.01, this hospital’s rate is 10.32x the Medicare baseline. Located in 200 Lothrop Street, Pittsburgh, PA.

Cash / Self-Pay

$174

Average discount available for prompt cash payment at this facility.

Insurance Median

$62

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: $174 (2895%)

Insurance Median: $62 (1032%)

Cash: $174 (2895% of Medicare)

Ins. Median: $62 (1032% 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 1032% of the Medicare baseline (a markup of 932%). 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
Amerihealth Caritas	$6 - $12	100%
Cigna	$6	100%
Highmark Wholecare (Prev Gateway)	$6 - $11	100%
Pa Health & Wellness	$6 - $13	100%
UnitedHealthcare	$6 - $9	100%
Upmc Work Partners	$6	100%
Aetna	$7 - $10	116%
Multiplan	$7 - $402	116%
Upmc Health Plan	$7 - $8	116%
Health Partners Plans (Jefferson Health Plan)	$8	133%
Blue Cross Blue Shield	$12 - $52	200%
Geisinger	$12	200%
Preferred Healthcare System	$51 - $326	849%
Coventry/First Health	$55 - $351	915%
Fidelis	$58 - $376	965%
Intergroup	$58 - $427	965%
Health Coalition Partners	$62 - $402	1032%
Private Health Care Systems	$62 - $402	1032%
Selectcare	$62 - $402	1032%
Health Payors Organization	$66 - $427	1098%
Humana	$66 - $427	1098%

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 $174.
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 Presbyterian Shadyside 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.