Blood test, clotting time (PTT)
Facility: Cloud County Health Center
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $87
- Cash Discount Price: $64
- vs. Medicare Baseline: 14.48x 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 1448% of the Medicare baseline (a markup of 1348%). 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 |
|---|---|---|
| Aetna | $22 - $109 | 366% |
| Pponext-All Plans | $23 - $111 | 383% |
| Mpi-All Plans | $23 - $111 | 383% |
| Health Partners - All Plans | $23 - $111 | 383% |
Consumer Guidance & Cost Commentary
For the CPT code 85730, representing a blood test for clotting time (PTT), Cloud County Health Center in Concordia, KS, lists a cash median price of $64.00 and a median negotiated rate of $87.00. While the facility's cash rate is lower than its negotiated rate, it is important to note that commercial insurance contracts often include administrative overheads that can inflate the final allowed amount. For patients with high-deductible plans, paying the cash price of $64.00 upfront may be more cost-effective than relying on insurance, which could result in a higher out-of-pocket expense if the deductible has not yet been met. We recommend contacting the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available, as these programs can further reduce the final bill by bypassing standard claims processing fees.
When evaluating this service against broader benchmarks, the Medicare amount for this procedure is set at $6.01. Although the commercial negotiated rate of $87.00 appears significantly higher than the Medicare baseline, this markup is standard in the healthcare industry due to the inclusion of physician work, practice expenses, and malpractice insurance. The facility's pricing structure does not provide specific data points for comparison against the Kansas state or Cloud County average rates in this report. Regardless of the markup, patients should request an itemized bill to ensure no services were double-billed or unbundled, as over 80% of hospital bills contain errors that can be corrected through a formal written audit. Always verify your specific plan's allowed amount before scheduling to avoid unexpected balance billing, particularly if you are receiving care from out-of-network providers