CMS Price Transparency Data

Blood test, clotting time (PTT)

Facility: UPMC Children's Hospital of Pittsburgh

Billing Code: 85730 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85730
Insurance Median: $63
Cash Discount Price: $80
vs. Medicare Baseline: 10.48x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PTT) at UPMC Children's Hospital of Pittsburgh is $63. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $80. Compared to the federal Medicare reimbursement reference rate of $6.01, this hospital’s rate is 10.48x the Medicare baseline. Located in One Children's Hospital Drive, Pittsburgh, PA.

Cash / Self-Pay

$80

Average discount available for prompt cash payment at this facility.

Insurance Median

$63

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: $80 (1331%)

Insurance Median: $63 (1048%)

Cash: $80 (1331% of Medicare)

Ins. Median: $63 (1048% 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 1048% of the Medicare baseline (a markup of 948%). 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	$5 - $74	83%
Amerihealth Caritas	$6 - $28	100%
Blue Cross Blue Shield	$6 - $50	100%
Cigna	$6 - $74	100%
Health Plan Of Upper Ohio Valley	$6 - $87	100%
Upmc Health Plan	$17 - $31	283%
Health Partners Plans (Jefferson Health Plan)	$29	483%
Highmark Wholecare (Prev Gateway)	$30	499%
Pa Health & Wellness	$30	499%
UnitedHealthcare	$30 - $63	499%
Geisinger	$31 - $60	516%
Intergroup	$87 - $114	1448%
Coventry/First Health	$107	1780%
Saudi Armed Forces	$107	1780%
Health Payors Organization	$114	1897%
Multiplan	$114	1897%
National Provider Network	$121	2013%
Private Health Care Systems	$121	2013%

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 $80.
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 Children's Hospital of Pittsburgh 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.