Blood test, clotting time (PTT)
Facility: Nmc Health
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $48
- Cash Discount Price: $49
- vs. Medicare Baseline: 7.99x 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 799% of the Medicare baseline (a markup of 699%). 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 |
|---|---|---|
| Aetna | $19 - $70 | 316% |
| Blue Cross Blue Shield | $23 | 383% |
| Wppa | $30 - $47 | 499% |
| Occunet | $32 - $51 | 532% |
| Medincrease Health Plan | $35 - $55 | 582% |
| Samaritan Ministries International | $35 - $55 | 582% |
| Prime Health Services | $41 - $64 | 682% |
| UnitedHealthcare | $49 - $77 | 815% |
| Cigna | $51 - $81 | 849% |
Consumer Guidance & Cost Commentary
For this blood clotting time test (CPT 85730) at Nmc Health in Newton, KS, the facility's cash price of $49.00 is notably lower than the state average, which sits at $55.00. While the facility's negotiated rates with major insurers like Aetna and UnitedHealthcare range from $19 to $81, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket. It is important to note that commercial negotiated rates frequently include administrative overhead and can be significantly higher than the true cost of care, which is best represented by the Medicare benchmark of $6.01. To maximize savings, patients should verify if their specific insurance plan has a deductible that would otherwise require them to pay the higher negotiated rate, as paying the cash price directly could result in immediate cost avoidance.
Patients should be aware that while the No Surprises Act protects against balance billing for emergency services at in-network facilities, unexpected charges can still arise from out-of-network ancillary services or errors in billing. If you receive a bill that seems inconsistent with the data above, request a formal itemized audit to identify any unbundled codes or services not rendered, as over 80% of hospital bills contain errors. Additionally, you may be eligible for a prompt-pay discount if you settle the bill in full upfront, which can reduce the cost by 20% to 50% by bypassing the administrative costs associated with insurance claims processing. Always confirm with the hospital's billing department regarding self-pay or prompt-pay options before scheduling your appointment to ensure you are not inadvertently enrolled in a billing cycle that