CMS Price Transparency Data

Blood test, clotting time (PTT)

Facility: Children's Hospital of Philadelphia

Billing Code: 85730 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85730
Insurance Median: $215
Cash Discount Price: $512
vs. Medicare Baseline: 35.77x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PTT) at Children's Hospital of Philadelphia is $215. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $512. Compared to the federal Medicare reimbursement reference rate of $6.01, this hospital’s rate is 35.77x the Medicare baseline. Located in 3401 Civic Center Blvd, Philadelphia, PA.

Cash / Self-Pay

$512

Average discount available for prompt cash payment at this facility.

Insurance Median

$215

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: $512 (8519%)

Insurance Median: $215 (3577%)

Cash: $512 (8519% of Medicare)

Ins. Median: $215 (3577% 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 3577% of the Medicare baseline (a markup of 3477%). 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
Geisinger Medical Assistance	$10	166%
Highmark Wholecare	$11	183%
Horizon Nj Health	$11	183%
Medicaid / KanCare	$84	1398%
UnitedHealthcare	$85 - $281	1414%
Health Partners	$96	1597%
Aetna	$121 - $256	2013%
Upmc Medical Assistance	$140	2329%
Keystone First Chip	$159	2646%
Keystone Health Plan East	$162	2696%
Blue Cross Blue Shield	$181 - $205	3012%
Geisinger Health Plan Commercial	$225	3744%
Jefferson Health Plans	$242	4027%
Cigna	$256	4260%
Highmark	$256	4260%
Qualcare	$281	4676%
First Health Network	$332	5524%
Devon Health, Intergroup, Multiplan, Valley Preferred/Populytics	$409	6805%
Private Health Care Systems	$409	6805%
Choice Care Network	$460	7654%

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 $512.
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 Children's Hospital of Philadelphia 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.