CMS Price Transparency Data

Blood test, clotting time (PTT)

Facility: Adventist Health Clearlake

Billing Code: 85730 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85730
Insurance Median: $27
Cash Discount Price: $13
vs. Medicare Baseline: 4.49x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PTT) at Adventist Health Clearlake is $27. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $13. Compared to the federal Medicare reimbursement reference rate of $6.01, this hospital’s rate is 4.49x the Medicare baseline. Located in 15630 18Th Ave - Hwy 53, Clearlake, CA.

Cash / Self-Pay

$13

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

$6.01

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $6.01 (100%)

Cash / Self-Pay: $13 (216%)

Insurance Median: $27 (449%)

Cash: $13 (216% of Medicare)

Ins. Median: $27 (449% 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 449% of the Medicare baseline (a markup of 349%). 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
Blue Cross Blue Shield	$1 - $70	17%
Blue Shield Mcr Adv	$1 - $49	17%
Kaiser Mcr Adv	$1 - $49	17%
Tricare	$1 - $49	17%
Ah Employee Health Plan - All Plans	$2 - $97	33%
UnitedHealthcare	$2 - $193	33%
Aetna	$4 - $173	67%
Blue Shield Epn - All Other Plans	$4 - $177	67%
Blue Shield Non-Epn	$4 - $177	67%
First Health- All Plans	$4 - $185	67%
Healthnet- All Plans	$4 - $189	67%
Western Growers- All Plans	$4 - $173	67%
Bc Managed Mcal	$5 - $7	83%
Cigna	$5 - $208	83%
Foundation- All Plans	$5 - $196	83%
Health Mgmt Network- All Plans	$5 - $196	83%
Humana	$5 - $196	83%
Interplan- All Plans	$5 - $208	83%
Kaiser- All Other Plans	$5 - $208	83%
Medi-Cal	$5 - $7	83%
Partnership Mcal - All Plans	$5 - $7	83%
Phcs- All Plans	$5 - $196	83%
Three Rivers Provider Network- All Plans	$5 - $208	83%

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 $13.
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 Adventist Health Clearlake 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.