Blood test, clotting time (PTT)
Facility: F W Huston Medical Center
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $42
- Cash Discount Price: $43
- vs. Medicare Baseline: 6.99x 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 699% of the Medicare baseline (a markup of 599%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $23 | 383% |
| Aetna | $40 | 666% |
| Humana | $43 | 715% |
| Cigna | $46 | 765% |
Consumer Guidance & Cost Commentary
For the CPT code 85730, representing a blood test for clotting time (PTT), the facility F W Huston Medical Center in Winchester, KS, has a cash median price of $43.00 and a median negotiated rate of $42.00. This cash price is notably lower than the facility's gross charge of $54.00, offering potential savings for patients with high-deductible plans or those paying out-of-pocket. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, the negotiated rates across four payers—including Blue Cross Blue Shield, Aetna, Humana, and Cigna—range from $23.00 to $46.00. It is important to note that these negotiated amounts represent the maximum allowed by insurers and do not necessarily reflect the final patient responsibility, which depends on individual plan deductibles and copays.
When evaluating the cost of this service, it is helpful to compare the facility's pricing against the Medicare benchmark, which stands at $6.01 for this procedure. The cash price of $43.00 is significantly higher than the Medicare rate, reflecting the complex administrative costs and provider overheads inherent in commercial healthcare delivery. Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, it does not eliminate the difference between the allowed amount and the patient's deductible. To minimize costs, consumers are encouraged to explicitly request self-pay or prompt-pay discounts before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50% by bypassing insurance claim processing fees. Always verify