Blood test, clotting time (PTT)
Facility: Decatur Health
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $32
- Cash Discount Price: $38
- vs. Medicare Baseline: 5.32x 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 532% of the Medicare baseline (a markup of 432%). 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 |
|---|---|---|
| Wppa/Providrs Care- All Plans | $25 | 416% |
| Humana | $26 | 433% |
| UnitedHealthcare | $26 - $32 | 433% |
| Blue Cross Blue Shield | $29 | 483% |
| Aetna | $38 - $42 | 632% |
| Midlands Choice- All Plans | $38 | 632% |
| Medicaid / KanCare | $42 | 699% |
Consumer Guidance & Cost Commentary
For this blood clotting time test at Decatur Health in Oberlin, Kansas, the cash price of $38.00 is notably lower than the facility's negotiated rates with major insurers like UnitedHealthcare and Aetna, which range from $26 to $42. While the facility's cash rate sits slightly above the state average of $38.00, patients with high-deductible plans may find paying out-of-pocket cheaper than relying on insurance, as commercial negotiated rates often include administrative overhead that pushes the final bill higher than the actual cost of care. It is important to verify your specific plan's deductible status before scheduling, as paying the full negotiated rate without meeting your deductible can result in significantly higher out-of-pocket costs than the cash price.
To ensure you are receiving the most favorable rate, we recommend asking the hospital directly about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid upfront. Although the facility is a voluntary non-profit Critical Access Hospital, commercial rates for this service can sometimes exceed the Medicare benchmark of $6.01 by a significant margin, highlighting the value of comparing your specific insurance allowed amount against the cash price. If you receive a bill that includes charges for services not rendered or unbundled codes, you should request a full itemized audit before paying, as over 80% of hospital bills contain errors that can be corrected through a formal written dispute.