Blood test, clotting time (PTT)
Facility: Sheridan County Hospital
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $37
- Cash Discount Price: $50
- vs. Medicare Baseline: 6.16x 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 616% of the Medicare baseline (a markup of 516%). 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 Insurance | $29 - $37 | 483% |
| Blue Cross Blue Shield | $31 | 516% |
| UnitedHealthcare | $46 - $58 | 765% |
Consumer Guidance & Cost Commentary
For this blood clotting time test at Sheridan County Hospital in Hoxie, KS, the cash price is $50.00, which matches the facility's median paid amount. While the hospital's negotiated rates with major payers like Celtic Insurance, Blue Cross Blue Shield, and UnitedHealthcare range from $29 to $58, these amounts are significantly higher than the cash price. Because commercial insurance contracts often include administrative overhead and multi-layered pricing structures, paying cash directly can sometimes result in a lower total cost for patients with high-deductible plans, provided they qualify for self-pay or prompt-pay discounts.
To ensure you are not overcharged, it is important to understand that commercial rates are frequently compared against Medicare benchmarks rather than the hospital's inflated list prices. In this case, the Medicare amount for this service is $6.01, meaning the cash price of $50.00 represents a markup of 6.2 times the federal baseline. If you have insurance, be aware that while the No Surprises Act protects you from balance billing for emergency care at in-network facilities, unexpected ancillary services or out-of-network components could still trigger additional charges. Always request an itemized bill before paying and verify your deductible status, as paying the full negotiated rate without meeting your deductible can lead to significant out-of-pocket expenses.