CMS Price Transparency Data

Blood test, clotting time (PTT)

Facility: Major Hospital

Billing Code: 85730 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85730
Insurance Median: $52
Cash Discount Price: $29
vs. Medicare Baseline: 8.65x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PTT) at Major Hospital is $52. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $29. Compared to the federal Medicare reimbursement reference rate of $6.01, this hospital’s rate is 8.65x the Medicare baseline. Located in 2451 Intelliplex Dr, Shelbyville, IN.

Cash / Self-Pay

$29

Average discount available for prompt cash payment at this facility.

Insurance Median

$52

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: $29 (483%)

Insurance Median: $52 (865%)

Cash: $29 (483% of Medicare)

Ins. Median: $52 (865% 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 865% of the Medicare baseline (a markup of 765%). 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
UnitedHealthcare	$2 - $68	33%
Blue Cross Blue Shield	$6 - $52	100%
Caresource Mrktplce -All Plans	$11	183%
Ambetter / Centene	$12	200%
Sho Direct-All Plans	$15 - $58	250%
Phcs - All Plans	$21 - $80	349%
Aetna	$24 - $88	399%
Siho-All Plans	$24 - $91	399%
Humana	$25 - $95	416%
First Health - All Plans	$26 - $99	433%
Cigna	$28 - $104	466%

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 $29.
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 Major 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.