Blood test, clotting time (PTT)
Facility: Hiawatha Community Hospital
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $49
- Cash Discount Price: $61
- vs. Medicare Baseline: 8.15x 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 815% of the Medicare baseline (a markup of 715%). 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 | $21 - $23 | 349% |
| Humana | $22 - $23 | 366% |
| UnitedHealthcare | $22 - $52 | 366% |
| Aetna | $22 - $49 | 366% |
| Ambetter / Centene | $27 | 449% |
| Centrus Health Direct - All Plans | $45 - $46 | 749% |
| Oscar - All Plans | $45 - $46 | 749% |
| Preferred Hlth - All Plans | $54 - $55 | 899% |
| Wppa Providrs Care - All Plans | $57 - $58 | 948% |
| Cigna | $57 - $58 | 948% |
| Multiplan - All Plans | $58 - $59 | 965% |
| Midlands Choice - All Plans | $58 - $59 | 965% |
| Healthy Blue Mcaid - All Plans | $60 - $61 | 998% |
Consumer Guidance & Cost Commentary
For the CPT code 85730, representing a blood test for clotting time (PTT), Hiawatha Community Hospital in Hiawatha, KS, lists a cash median price of $61.00. This cash rate is notably higher than the facility's negotiated rates, which average $49.00 across 13 payers, and exceeds the state average for this service. While commercial insurance plans like Blue Cross Blue Shield and Humana negotiate rates between $21 and $23, and UnitedHealthcare ranges from $22 to $52, patients with high-deductible plans may find paying the full cash price of $61.00 more cost-effective than relying on insurance, which could result in higher out-of-pocket expenses if the deductible has not been met.
It is important to note that the facility's cash price is significantly higher than the Medicare benchmark of $6.01, which serves as the objective baseline for fair pricing. Although the facility is a Voluntary non-profit Critical Access Hospital, the gap between the cash rate and Medicare suggests a substantial markup relative to federal cost standards. Consumers should be aware that while the No Surprises Act protects against balance billing for out-of-network services at in-network facilities, it does not eliminate the potential for higher costs if a patient chooses to pay out-of-network or if ancillary services are billed separately. To minimize costs, patients are encouraged to contact the hospital directly to inquire about self-pay discounts or prompt-pay incentives, which can reduce the bill by 20% to 50% if paid in full upfront, bypassing the administrative overhead associated with insurance claims processing.