Blood test, clotting time (PTT)
Facility: Clara Barton Hospital
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $65
- Cash Discount Price: $50
- vs. Medicare Baseline: 10.82x 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 1082% of the Medicare baseline (a markup of 982%). 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 | $22 | 366% |
| 6 Degrees Health - All Plans | $34 - $130 | 566% |
| Wppa-All Plans | $38 - $148 | 632% |
| UnitedHealthcare | $43 - $166 | 715% |
| Phcs - All Plans | $43 - $166 | 715% |
| Aetna | $43 - $166 | 715% |
| Hlth Partners Of Ks-All Plans | $44 - $170 | 732% |
Consumer Guidance & Cost Commentary
For the blood clotting time test (CPT 85730) at Clara Barton Hospital in Hoisington, KS, the facility's cash median price is $50.00, which is lower than the state average of $54.00. While commercial insurance plans like Blue Cross Blue Shield and 6 Degrees Health have negotiated rates ranging from $22 to $130, these amounts often exceed the cash price. Patients with high-deductible plans may find it financially advantageous to pay the $50.00 cash rate directly, as the insurance negotiated rates can sometimes be significantly higher. To secure this lower amount, it is essential to explicitly request "self-pay" or "prompt-pay" discounts before scheduling the service and to ensure a waiver of insurance submission is signed to prevent automatic claims processing.
The facility's pricing is also evaluated against the Medicare benchmark, which stands at $6.01 for this procedure. The hospital's cash rate of $50.00 represents a markup of 10.8 times the Medicare amount, a figure that reflects the administrative costs and profit margins inherent in commercial billing structures. Because over 80% of hospital bills contain errors, patients should request a full itemized CPT-coded bill to verify that no unbundled charges or services not rendered are included. If a balance bill arises from an out-of-network ancillary service, patients should not pay immediately but instead dispute the charge with their insurer to invoke protections under the No Surprises Act.