Blood test, clotting time (PTT)
Facility: Hamilton County Hospital
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $51
- Cash Discount Price: $57
- vs. Medicare Baseline: 8.49x 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 849% of the Medicare baseline (a markup of 749%). 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 | $11 - $23 | 183% |
| First Health Coventry - All Plans | $48 | 799% |
| UnitedHealthcare | $54 | 899% |
| Cigna | $54 | 899% |
| Va Ccn - All Plans | $57 | 948% |
| Aetna | $97 | 1614% |
Consumer Guidance & Cost Commentary
For this blood clotting time test (CPT 85730) at Hamilton County Hospital in Syracuse, KS, the cash price of $57.00 is significantly lower than the facility's negotiated rates with major insurers like Aetna ($97.00) and First Health Coventry ($48.00). While the facility's median negotiated rate of $51.00 is slightly below the gross charge of $57.00, it remains higher than the cash price, illustrating that paying out-of-pocket can sometimes be the most cost-effective option for patients with high-deductible plans. Given that the facility is a Critical Access Hospital with government-local ownership, patients should explicitly ask about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront incentives can further reduce the final bill by bypassing administrative fees and claim processing costs.
When evaluating the value of this service, it is important to compare rates against the Medicare benchmark rather than the hospital's inflated chargemaster list. The Medicare amount for this code is $6.01, meaning the cash price of $57.00 represents a markup of approximately 8.5 times the federal baseline, which is well above the typical 120% to 150% range considered fair pricing. Although the facility's location in Syracuse (ZIP 67878) does not provide specific county or state average data in this report, the stark difference between the Medicare rate and the cash price highlights the importance of verifying allowed amounts with your insurance carrier. To ensure you are not overcharged, request a full itemized bill before payment and dispute any errors, as over 80