CMS Price Transparency Data

Blood test, clotting time (PTT)

Facility: Veterans Memorial Hospital

Billing Code: 85730 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85730
Insurance Median: $39
Cash Discount Price: $51
vs. Medicare Baseline: 6.49x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PTT) at Veterans Memorial Hospital is $39. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $51. Compared to the federal Medicare reimbursement reference rate of $6.01, this hospital’s rate is 6.49x the Medicare baseline. Located in 40 1St Street Se, Waukon, IA.

Cash / Self-Pay

$51

Average discount available for prompt cash payment at this facility.

Insurance Median

$39

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: $51 (849%)

Insurance Median: $39 (649%)

Cash: $51 (849% of Medicare)

Ins. Median: $39 (649% 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 649% of the Medicare baseline (a markup of 549%). 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 - All Other Plans	$4	67%
Wellmark Ppo	$4	67%
Amerigroup Mcaid - All Other Plans	$6	100%
Amerigroup Mcr Adv	$39	649%
Humana	$39 - $68	649%
Iowa Total Care Exchange	$39	649%
Iowa Total Care Mcr Adv	$39	649%
Medica Mcr Adv	$39	649%
Molina Mcr Adv	$39	649%
Quartz Mcr Adv	$39	649%
UnitedHealthcare	$39 - $76	649%
Welmark Mcr Adv	$39	649%
Iowa Total Care Mcaid - All Other Plans	$46	765%
Molina Mcaid - All Other Plans	$46	765%
Quartz Comm - All Other Plans	$68	1131%
Medica Comm - All Other Plans	$72	1198%

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 $51.
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 Veterans Memorial 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.