Blood test, clotting time (PTT)
Facility: Stormont Vail Hospital
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $18
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 3.00x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 300% of the Medicare baseline (a markup of 200%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Ambetter / Centene | $5 | 83% |
| UnitedHealthcare | $5 | 83% |
| Blue Cross Blue Shield | $5 - $23 | 83% |
Consumer Guidance & Cost Commentary
This blood test for clotting time (PTT) at Stormont Vail Hospital in Topeka, KS, has a median negotiated payment of $15,750, which is significantly higher than the state average of $6.01. While the facility is a voluntary non-profit acute care hospital, the gap between the negotiated rate and the Medicare benchmark suggests a substantial markup. Patients with high-deductible plans should be aware that paying cash directly might result in lower out-of-pocket costs if the insurance negotiated rate exceeds the cash price, though the cash median for this service is not currently available. It is crucial to verify your specific plan's deductible status before scheduling, as paying the full negotiated amount without meeting your deductible can lead to unexpected financial strain.
To avoid potential balance billing or errors, consumers should request a detailed, itemized bill rather than accepting a summary invoice that obscures individual charges. If you receive a bill for this service, ensure it breaks down the specific CPT code and unit costs to identify any unbundled items or services not rendered. Additionally, ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the total cost by 20% to 50% if paid upfront, bypassing the administrative overhead associated with insurance claims. If you encounter a surprise bill, do not pay immediately; instead, dispute the amount in writing and request a review under the No Surprises Act to protect yourself from unexpected out-of-pocket expenses.