CMS Price Transparency Data

Blood test, clotting time (PTT)

Facility: South Miami Hospital

Billing Code: 85730 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85730
Insurance Median: $49
Cash Discount Price: $64
vs. Medicare Baseline: 8.15x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PTT) at South Miami Hospital is $49. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $64. Compared to the federal Medicare reimbursement reference rate of $6.01, this hospital’s rate is 8.15x the Medicare baseline. Located in 6200 Sw 73Rd St, Miami, FL.

Cash / Self-Pay

$64

Average discount available for prompt cash payment at this facility.

Insurance Median

$49

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: $64 (1065%)

Insurance Median: $49 (815%)

Cash: $64 (1065% of Medicare)

Ins. Median: $49 (815% 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 815% of the Medicare baseline (a markup of 715%). 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	$2 - $195	33%
Amerigroup	$2	33%
Medicaid / KanCare	$2	33%
Sunshine State	$2	33%
UnitedHealthcare	$2 - $244	33%
Vista	$2	33%
Wellcare	$2	33%
Blue Cross Blue Shield	$4 - $158	67%
Medica Health Plan	$6	100%
Medicare (plans)	$6 - $8	100%
Avmed	$7 - $121	116%
Cigna	$7 - $195	116%
Humana	$7	116%
Leon Medical	$7	116%
Non Contracted	$9 - $90	150%
Amerihealth	$11 - $110	183%
International	$16 - $159	266%
Dimension Health Plan	$19 - $220	316%
Affordable	$21 - $207	349%
Phcs	$22 - $220	366%
Quality Health	$22 - $220	366%

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 $64.
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 South Miami Hospital 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.