Blood test, clotting time (PTT)
Facility: Great Plains Of Sabetha
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $41
- Cash Discount Price: $43
- vs. Medicare Baseline: 6.82x 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 682% of the Medicare baseline (a markup of 582%). 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 |
|---|---|---|
| Celtic Mcr Adv | $21 - $23 | 349% |
| Aetna | $22 - $44 | 366% |
| Celtic Comm Exchange-All Other Plans | $27 - $29 | 449% |
| Great West Healthcare-All Plans | $35 - $37 | 582% |
| UnitedHealthcare | $38 - $44 | 632% |
| Century/Wppa/Providers-All Plans | $39 - $42 | 649% |
| Cigna | $39 - $42 | 649% |
| Humana | $39 - $42 | 649% |
| Multiplan-Phcs-All Plans | $39 - $42 | 649% |
| Federated Mutual Ins-All Plans | $39 - $42 | 649% |
| Medicaid / KanCare | $41 - $44 | 682% |
| Blue Cross Blue Shield | $41 - $44 | 682% |
Consumer Guidance & Cost Commentary
For the blood clotting time test (CPT 85730) at Great Plains of Sabetha, the cash price is $43.00, which matches the facility's median negotiated rate of $41.00 and the cash median. This cash price is notably lower than the state average, as indicated by the 6.8% variance compared to Medicare's benchmark rate of $6.01. While commercial payers negotiate rates ranging from $21 to $44 depending on the plan, patients with high-deductible policies might find paying the $43.00 cash price more advantageous than relying on insurance, which could result in higher out-of-pocket costs if the deductible has not been met. It is important to note that while the facility is a Critical Access Hospital in Sabetha, KS, and operates as a voluntary non-profit, patients should verify their specific plan's allowed amount before scheduling to ensure they are not subject to balance billing, especially if receiving care from out-of-network ancillary services.
To minimize unexpected costs, patients should proactively ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full upfront. Since hospitals often issue summary bills that obscure individual line items, consumers are encouraged to request a full itemized audit to identify any errors, unbundled codes, or services not rendered, as over 80% of hospital bills contain inaccuracies. If a patient receives a surprise bill from an out-of-network provider, they should not pay immediately but instead dispute the charge with their insurer to invoke protections under the No Surprises Act.