Blood test, clotting time (PTT)
Facility: Holton Community Hospital
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $36
- Cash Discount Price: $30
- vs. Medicare Baseline: 5.99x 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 599% of the Medicare baseline (a markup of 499%). 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 |
|---|---|---|
| Humana | $21 - $36 | 349% |
| UnitedHealthcare | $21 - $68 | 349% |
| Kansas Superior Select - All Plans | $21 - $36 | 349% |
| Aetna | $21 - $68 | 349% |
| Blue Cross Blue Shield | $22 | 366% |
| Preferred Health Fn Select - All Other Plans | $33 - $56 | 549% |
| Preferred Health Professionals | $33 - $56 | 549% |
| Preferred Health Freedom | $33 - $56 | 549% |
| Wppa Providers - All Plans | $37 - $64 | 616% |
| Medicaid / KanCare | $39 - $68 | 649% |
Consumer Guidance & Cost Commentary
For the CPT code 85730, representing a blood test for clotting time (PTT), Holton Community Hospital in Kansas lists a cash median price of $30.00, which is lower than the facility's negotiated rates of $36.00 to $68.00 across various payers. While the facility is a Critical Access Hospital in Holton, KS, the data provided does not include specific county or state average benchmarks for comparison. However, the cash price of $30.00 may be more cost-effective for patients with high-deductible plans if their insurance negotiated rates exceed this amount, as paying out-of-pocket can sometimes result in lower total costs. Patients should verify their specific plan's allowed amount before scheduling to determine if self-pay or prompt-pay discounts are available.
It is important to note that commercial insurance contracts often result in negotiated rates that are higher than cash prices due to administrative overhead and contract dynamics. Although the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should still review their itemized bills carefully to ensure no unbundled codes or services not rendered are included. If a discrepancy arises, consumers should request a formal written audit dispute rather than accepting summary bills or settling verbally. Additionally, while the facility is a voluntary non-profit, patients should confirm their deductible status and ask for a waiver of insurance submission if they intend to pay the cash price directly to avoid automatic claims processing that could void any agreed-upon discounts.