CMS Price Transparency Data

Blood test, clotting time (PTT)

Facility: UPMC Kane

Billing Code: 85730 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85730
Insurance Median: $26
Cash Discount Price: $41
vs. Medicare Baseline: 4.33x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PTT) at UPMC Kane is $26. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $41. Compared to the federal Medicare reimbursement reference rate of $6.01, this hospital’s rate is 4.33x the Medicare baseline. Located in 4372 Route 6, Kane, PA.

Cash / Self-Pay

$41

Average discount available for prompt cash payment at this facility.

Insurance Median

$26

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: $41 (682%)

Insurance Median: $26 (433%)

Cash: $41 (682% of Medicare)

Ins. Median: $26 (433% 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 433% of the Medicare baseline (a markup of 333%). 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 Work Partners	$6	100%
Focus Healthcare	$7 - $65	116%
UnitedHealthcare	$8 - $28	133%
UPMC Health Plan	$8 - $30	133%
Aetna	$8 - $26	133%
Geisinger	$10	166%
Highmark Wholecare (Prev Gateway)	$11 - $27	183%
Amerihealth Caritas	$12 - $27	200%
PA Health & Wellness	$13	216%
Blue Cross Blue Shield	$25 - $32	416%
Cigna	$48 - $1,531	799%
Horizon Health Plan	$48	799%
Multiplan	$51	849%
Intergroup	$54	899%
Health Coalition Partners	$54	899%

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 $41.
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 Kane 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.