Blood test, clotting time (PTT)
Facility: Mcpherson Hospital
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $94
- Cash Discount Price: $92
- vs. Medicare Baseline: 15.64x 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 1564% of the Medicare baseline (a markup of 1464%). 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 |
|---|---|---|
| Tricare | $5 | 83% |
| Wellcare Mcr Adv - All Plans | $6 | 100% |
| Healthy Blue Mcr Adv | $6 | 100% |
| Va Ccn - All Plans | $6 | 100% |
| UnitedHealthcare | $6 - $136 | 100% |
| Humana | $6 | 100% |
| Blue Cross Blue Shield | $6 | 100% |
| Ambetter / Centene | $7 | 116% |
| Wppa - All Plans | $32 - $95 | 532% |
| Central Plains - All Plans | $34 - $102 | 566% |
| Medical Associates - All Plans | $34 - $102 | 566% |
| Christian Health Aid - All Plans | $37 - $109 | 616% |
| Aetna | $38 - $136 | 632% |
| Multiplan - All Plans | $41 - $122 | 682% |
| Cigna | $44 - $129 | 732% |
| Health Partners - All Plans | $44 - $129 | 732% |
| First Health - All Plans | $44 - $129 | 732% |
| Medicaid / KanCare | $46 - $136 | 765% |
| Health Blue Mcaid - All Other Plans | $47 - $139 | 782% |
Consumer Guidance & Cost Commentary
For this blood clotting time test at McPherson Hospital in McPherson, Kansas, the cash price is $92.00, which is lower than the facility's negotiated rates with most insurance plans. While the hospital's cash rate is significantly lower than the gross chargemaster price of $124.00, patients with high-deductible plans may find paying cash directly more affordable than relying on insurance, as many commercial payers have negotiated rates exceeding the cash price. The facility offers a prompt-pay discount for upfront payments, which can further reduce the final cost, and patients are encouraged to ask the billing department specifically about self-pay or cash-pay rates before scheduling to ensure they receive the most favorable pricing available.
The facility's cash rate of $92.00 is notably lower than the state average for this procedure, offering a potential savings opportunity for those without insurance coverage. However, it is important to note that the median amount paid by insurance members is $96.00, which is higher than the cash price, and the facility's negotiated rates with major carriers like UnitedHealthcare and Aetna range from $32.00 to $136.00. Because commercial insurance contracts often include administrative overhead and multi-layered pricing structures, the cash price can sometimes represent the truest value for the service. Patients should verify their specific plan's deductible status and allowed amounts, as paying the cash rate upfront may avoid the higher negotiated fees that insurance companies charge for this specific CPT code.