Blood test, clotting time (PTT)
Facility: Medicine Lodge Memorial Hospital
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $34
- Cash Discount Price: $39
- vs. Medicare Baseline: 5.66x 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 566% of the Medicare baseline (a markup of 466%). 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 |
|---|---|---|
| Tricare | $24 - $38 | 399% |
| Humana | $28 - $43 | 466% |
| Aetna | $28 - $47 | 466% |
| Hpk-All Plans | $29 - $45 | 483% |
| UnitedHealthcare | $29 - $45 | 483% |
| Medicaid / KanCare | $30 - $47 | 499% |
Consumer Guidance & Cost Commentary
For the CPT code 85730, representing a blood test for clotting time (PTT), Medicine Lodge Memorial Hospital in Medicine Lodge, KS, lists a cash price of $39.00. This cash rate is identical to the facility's median negotiated rate of $34.00 and the state average of $39.00, though it is slightly higher than the national Medicare benchmark of $6.01. While commercial payers like Tricare, Humana, and Aetna negotiate rates ranging from $24 to $47, patients with high-deductible plans may find the cash price more advantageous if their insurance allowed amount exceeds $39.00. Because this facility is a Critical Access Hospital owned by a Government Hospital District, patients should explicitly ask about "self-pay" or "prompt-pay" discounts before scheduling to ensure they are not charged the full chargemaster rate.
It is important to understand that commercial insurance rates often include administrative costs for claims processing, which can inflate the baseline price compared to direct cash payments. Although the data shows a median paid amount of $28.00 for this code, patients should verify their specific plan's allowed amount, as some insurers may negotiate higher rates than the facility's cash price. If a patient receives a bill significantly higher than the cash rate, they should request an itemized billing audit to identify any errors, double-billing, or unbundled codes, as over 80% of hospital bills contain such mistakes. Additionally, under federal protections like the No Surprises Act, patients are generally shielded from balance billing for out-of-network services at in-network facilities, so any surprise charges should