Blood test, clotting time (PTT)
Facility: Providence Medical Center
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $6
- Cash Discount Price: $6
- vs. Medicare Baseline: 1.00x 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.
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 |
|---|---|---|
| Healthy Blue | $5 - $6 | 83% |
| UnitedHealthcare | $5 - $10 | 83% |
| Medicaid / KanCare | $5 | 83% |
| Celtic | $5 - $10 | 83% |
| Tricare | $6 | 100% |
| Midland Care Connection | $6 | 100% |
| Kansas Superior Select | $6 | 100% |
| Medicare (plans) | $6 | 100% |
| Cigna | $6 | 100% |
| Aetna | $6 - $10 | 100% |
| Blue Cross Blue Shield | $6 - $14 | 100% |
| Well Path Prison | $8 | 133% |
| Employer Direct Healthcare | $8 | 133% |
| Corizon | $8 | 133% |
| Centurion | $9 | 150% |
| Naphcare | $9 | 150% |
| Comp Alliance - Fka Compresults Worker Compensation | $12 | 200% |
| Oha Networks | $13 | 216% |
| Worker Compensation | $14 | 233% |
Consumer Guidance & Cost Commentary
For the CPT code 85730, representing a blood test for clotting time (PTT), the gross charge at Providence Medical Center in Kansas City, KS is $110.00. While the facility's cash median rate is $6.00, which is significantly lower than the negotiated rates paid by insurance payers ranging from $5.00 to $14.00, patients should be aware that commercial insurance plans often result in higher out-of-pocket costs due to deductibles and administrative fees. The facility's cash price of $6.00 is notably lower than the Medicare benchmark of $6.01, suggesting that paying out-of-pocket may be the most cost-effective option for individuals with high-deductible plans or those without insurance. To maximize savings, patients are encouraged to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can further reduce the final bill by offering immediate liquidity incentives.
It is important to distinguish between the facility's negotiated rates and the actual amount a patient might owe. Although the median negotiated rate across 19 payers is $6.00, this figure represents the maximum allowed amount for in-network coverage, not necessarily the final charge after deductibles are applied. Patients should verify their specific plan's deductible status before scheduling, as paying the full negotiated rate without meeting the deductible can be more expensive than the cash price. Additionally, while the No Surprises Act protects against balance billing for emergency services at in-network facilities, patients should still request an itemized bill to ensure no unbundled codes or services not rendered are included. By comparing the facility's rates to the Medicare benchmark and actively seeking prompt