Blood test, clotting time (PTT)
Facility: Nemaha Valley Community Hospital
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $33
- Cash Discount Price: $57
- vs. Medicare Baseline: 5.49x 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 549% of the Medicare baseline (a markup of 449%). 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 |
|---|---|---|
| Va Ccn - All Plans | $4 | 67% |
| Humana | $28 | 466% |
| Aetna | $28 - $54 | 466% |
| Celtic Comm Exch - All Plans | $30 | 499% |
| Partners Direct Health - All Plans | $33 | 549% |
| Multiplan - All Plans | $57 | 948% |
| Health Partners - All Plans | $60 | 998% |
| Midlands Choice - All Plans | $60 | 998% |
Consumer Guidance & Cost Commentary
For the blood clotting time test (CPT 85730) at Nemaha Valley Community Hospital in Seneca, KS, the cash price is $57.00, which is $5.50 higher than the state average. While commercial insurance plans like Aetna and Humana negotiate rates ranging from $28 to $54, these negotiated amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket. Because the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, it is advisable to contact the billing department directly to confirm if "self-pay" or "prompt-pay" discounts are available before scheduling, as these upfront incentives can significantly reduce the final cost compared to standard insurance billing cycles.
Patients should be aware that commercial negotiated rates frequently include administrative overhead and do not represent the lowest possible price for this service. To ensure you are not overcharged, always request a full itemized bill that lists specific CPT codes rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as unbundled charges or services not rendered. If you receive a balance bill from an out-of-network provider, even at an in-network facility, you may have protections under the No Surprises Act that prevent you from paying the difference between the provider's full charge and your insurance allowed amount; in such cases, you should dispute the bill in writing with the insurer rather than paying immediately to avoid unexpected debt.