CMS Price Transparency Data

Blood test, clotting time (PTT)

Facility: Iowa Specialty Hospital - Clarion

Billing Code: 85730 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85730
Insurance Median: $78
Cash Discount Price: $67
vs. Medicare Baseline: 12.98x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PTT) at Iowa Specialty Hospital - Clarion is $78. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $67. Compared to the federal Medicare reimbursement reference rate of $6.01, this hospital’s rate is 12.98x the Medicare baseline. Located in 1316 South Main Street, Clarion, IA.

Cash / Self-Pay

$67

Average discount available for prompt cash payment at this facility.

Insurance Median

$78

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: $67 (1115%)

Insurance Median: $78 (1298%)

Cash: $67 (1115% of Medicare)

Ins. Median: $78 (1298% 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 1298% of the Medicare baseline (a markup of 1198%). 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
Wellmark Hmo	$31	516%
Wellmark Ppo - All Other Plans	$34	566%
Tricare	$35	582%
Triwest Va - All Plans	$35	582%
Healthscope Stellar-All Plans	$59	982%
Auxiant Clarion Schools-All Plans	$73	1215%
Health Partners Prestage	$84	1398%
Health Partners Ish-All Other Plans	$90	1498%
Aetna	$95	1581%
UnitedHealthcare	$106	1764%
Cigna	$109	1814%
Midlands Choice-All Plans	$109	1814%

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 $67.
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 Iowa Specialty Hospital - Clarion 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.