Blood test, clotting time (PTT)
Facility: Wilson Medical Center
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $38
- Cash Discount Price: $36
- vs. Medicare Baseline: 6.32x 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 632% of the Medicare baseline (a markup of 532%). 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 - $49 | 366% |
| Humana | $25 - $26 | 416% |
| Aetna | $25 - $49 | 416% |
| UnitedHealthcare | $25 - $46 | 416% |
| Tricare | $25 - $26 | 416% |
| Ambetter / Centene | $25 - $49 | 416% |
| Cigna | $38 - $39 | 632% |
| Mulitplan-All Plans | $43 - $45 | 715% |
| Health Partners-All Plans | $43 - $45 | 715% |
Consumer Guidance & Cost Commentary
For the CPT code 85730, representing a blood test for clotting time (PTT), Wilson Medical Center in Neodesha, KS, has a gross charge of $48.00. While the facility's cash median price is $36.00 and the median negotiated rate across payers is $38.00, the Medicare benchmark amount is significantly lower at $6.01. This indicates that the facility's pricing is 6.3 times the Medicare rate, which is substantially higher than the typical fair pricing range of 120% to 150% of Medicare. Patients should be aware that while insurance plans like Blue Cross Blue Shield, Humana, and Aetna have negotiated rates ranging from $22 to $49, these amounts often exceed the cash price, making self-pay a potentially more cost-effective option for those with high-deductible plans.
To minimize costs, patients should proactively request a "prompt-pay" discount, which can reduce the bill by 20% to 50% if paid in full upfront, bypassing the administrative overhead associated with insurance claims. It is also critical to avoid balance billing by ensuring the facility is in-network, as the No Surprises Act protects patients from unexpected out-of-network charges for emergency care and services at in-network facilities. Before scheduling or paying, consumers should demand a full itemized bill to verify that no unbundled codes or services not rendered are included, as over 80% of hospital bills contain errors that can be corrected through a formal written dispute.