Blood test, clotting time (PTT)
Facility: Mercy Hospital Columbus
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $76
- Cash Discount Price: $68
- vs. Medicare Baseline: 12.65x 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 1265% of the Medicare baseline (a markup of 1165%). 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 |
|---|---|---|
| Centivo Contracted [320505] | $1 | 17% |
| Medicaid / KanCare | $5 - $76 | 83% |
| Blue Cross Blue Shield | $5 - $76 | 83% |
| Humana | $5 - $100 | 83% |
| UnitedHealthcare | $5 - $87 | 83% |
| Medicare (plans) | $6 - $79 | 100% |
| Insurance System Inc Contracted [320465] | $45 | 749% |
| Health Systems Inc Contracted [320174] | $45 | 749% |
| Administrative Payor Contracted [320005] | $47 | 782% |
| Ambetter / Centene | $76 | 1265% |
| Mercy Mgd Behavioral Health Contracted [320259] | $76 | 1265% |
| Elara Caring Aspire Hospice [20433] | $76 | 1265% |
| Pace Of The Ozarks Contracted [320518] | $76 | 1265% |
| Qual Choice Contracted [320325] | $76 | 1265% |
| Halo Hcr Inc Hospice Contracted [320432] | $76 | 1265% |
| Kindful Hospice Contracted [320434] | $76 | 1265% |
| Medical Associates Health Contracted [320444] | $76 | 1265% |
| Indian Health Service Contracted [320198] | $76 | 1265% |
| Globalhealth Contracted [320145] | $76 | 1265% |
| Centurion Of Missouri [20459] | $76 | 1265% |
| Kindful Hospice [20434] | $76 | 1265% |
| Aetna | $76 - $94 | 1265% |
| Mercy Hospice Okc [20252] | $76 | 1265% |
| Cherokee Nation Health Serv Contracted [320066] | $76 | 1265% |
| Dept Of Veteran Affairs Contracted [320106] | $76 | 1265% |
| Tricare | $76 | 1265% |
| Cross Timbers Hospice [20098] | $76 | 1265% |
| Novasys Contracted [320285] | $76 | 1265% |
| Cigna | $76 | 1265% |
| Provider Partners Health Plans Contracted [320450] | $76 | 1265% |
| Home State Health Plan Contracted [320187] | $76 | 1265% |
| Halo Hcr Inc Hospice [20432] | $76 | 1265% |
| Healthscope Contracted [320182] | $81 | 1348% |
| Workers Comp [20426] | $84 - $89 | 1398% |
| United Medical Resources Contracted [320454] | $87 - $100 | 1448% |
| Federal Medical Center Contracted [320127] | $94 | 1564% |
| First Health Contracted [320128] | $94 | 1564% |
| Preferred Health Plan Contracted [320522] | $94 | 1564% |
| American Healthcare Alliance Contracted [320020] | $94 | 1564% |
| Medica Contracted [320239] | $94 | 1564% |
| Mercy Benefit Admin Contracted [320251] | $94 - $100 | 1564% |
| Healthlink Contracted [320179] | $94 - $100 | 1564% |
| Usa Managed Care Org Contracted [320429] | $94 | 1564% |
| Ebms Contracted [320493] | $100 | 1664% |
| Aither Health Contracted [320449] | $100 | 1664% |
| Private Health Care Systems Contracted [320320] | $100 | 1664% |
| Ppo Plus Contracted [320310] | $100 | 1664% |
| Reflect Health Contracted [320492] | $100 | 1664% |
| Yuzu Health Contracted [320521] | $100 | 1664% |
| Auxiant Contracted [320462] | $100 | 1664% |
| Point C Contracted [320238] | $100 | 1664% |
| Benefit Management Contracted [320052] | $100 | 1664% |
| Imagine 360 Contracted [320494] | $100 | 1664% |
| Show-Me Health Administrators Contracted [320483] | $100 | 1664% |
| Edison Health Solutions Contracted [320502] | $100 | 1664% |
| 90 Degree Benefits Contracted [320436] | $100 | 1664% |
Consumer Guidance & Cost Commentary
For patients paying cash directly, the most important takeaway is that the cash price for this blood test procedure is $68, which is significantly lower than the facility's gross charge of $105. While commercial insurance contracts often result in higher allowed amounts—such as the median negotiated rate of $76 and a median paid rate of $222—paying out-of-pocket can sometimes be the most cost-effective option, particularly for those with high-deductible plans where the insurance allowed amount exceeds the cash price. Patients should proactively ask the hospital about self-pay or prompt-pay discounts before scheduling, as these upfront payment incentives can further reduce the final bill by bypassing expensive claims processing and administrative overhead.
The pricing context for this service at Mercy Hospital Columbus shows a wide variation depending on the payer and plan type, with rates ranging from a low of $5 to as high as $100 across 56 different payers. The facility's cash rate of $68 aligns closely with the state of Kansas average, which is also $68, but remains notably below the gross chargemaster of $105. When comparing against federal benchmarks, the service is priced at 12.6 times the Medicare amount of $6.01, illustrating how commercial rates can differ substantially from the government's cost-based baseline. Ultimately, understanding these specific rates for the CPT code 85730 helps patients avoid surprise bills and make informed decisions about whether to use insurance or pay directly.