Blood test, clotting time (PTT)
Facility: Hospital District #6 Patterson Health Center
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $56
- Cash Discount Price: $50
- vs. Medicare Baseline: 9.32x 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 932% of the Medicare baseline (a markup of 832%). 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 - $22 | 349% |
| UnitedHealthcare | $56 - $62 | 932% |
| Providers Care (Wppa)-All Plans | $108 | 1797% |
Consumer Guidance & Cost Commentary
For the CPT code 85730, representing a blood test for clotting time (PTT), the facility's cash median price is $50.00, which is lower than the negotiated rates paid by insurance carriers. While the facility's negotiated rate of $56.00 is slightly higher than the cash price, patients with high-deductible plans may find paying the cash price directly more cost-effective if their insurance allowed amount exceeds $50.00. It is important to note that commercial insurance rates often include administrative overhead and contractual markups, meaning the cash price can sometimes represent the most economical option for self-pay patients.
This service is provided at the Hospital District #6 Patterson Health Center in Anthony, KS, a Critical Access Hospital. The facility's negotiated rate of $56.00 is notably higher than the Medicare benchmark of $6.01, reflecting the typical markup found in commercial contracts. Additionally, the facility's cash rate of $50.00 is lower than the state average for this procedure, suggesting that patients may be able to secure a better price by requesting a self-pay or prompt-pay discount before scheduling. To avoid unexpected costs, patients should verify their specific plan's allowed amount and ask the billing department about any immediate payment discounts available prior to receiving care.