Blood test, clotting time (PTT)
Facility: Kiowa District Hospital
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $42
- Cash Discount Price: $35
- 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 |
|---|---|---|
| Healthchoice-All Plans | $9 | 150% |
| Tricare | $17 | 283% |
| Blue Cross Blue Shield | $22 | 366% |
| UnitedHealthcare | $35 - $44 | 582% |
| Health Partners Of Ks-All Plans | $39 | 649% |
| Humana | $40 | 666% |
| Gbs Insurance - All Plans | $41 | 682% |
| Multiplan-All Plans | $41 | 682% |
| Aetna | $42 | 699% |
| Triwest-All Plans | $42 | 699% |
| Medicare (plans) | $42 | 699% |
| Medicaid / KanCare | $44 | 732% |
| Providers Care (Wppa)-All Plans | $66 | 1098% |
| Liberty Healthshare-All Plans | $71 | 1181% |
Consumer Guidance & Cost Commentary
For the blood clotting time test (PTT) at Kiowa District Hospital in Kiowa, KS, the cash price of $35.00 is lower than the facility's negotiated rates with most major payers, which range from $35.00 to $71.00. While the facility's cash rate is $35.00, the median negotiated amount across all payers is $42.00, meaning patients with high-deductible plans might save money by paying the cash price directly, provided they do not have other coverage that would trigger balance billing. It is important to note that while the No Surprises Act protects patients from balance billing for emergency care and non-emergency services from out-of-network providers at in-network facilities, patients should still verify their specific plan status and ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling to ensure they are not inadvertently enrolled in a billing cycle that could result in unexpected charges.
The facility's cash rate of $35.00 is also notably lower than the Medicare benchmark of $6.01, which serves as a federal cost baseline for this service. Although commercial negotiated rates typically average between 200% and 300% of Medicare rates, the specific contracts here result in a median paid amount of $41.00, which is still significantly higher than the cash option. Patients should be aware that hospitals often issue summary bills that obscure individual costs, so requesting a full itemized CPT-coded statement is essential to identify any errors, unbundled codes, or services not rendered. If a patient receives a bill that appears higher than the cash rate, they should dispute