Blood test, clotting time (PTT)
Facility: Phillips County Hospital
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $32
- Cash Discount Price: $30
- 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 |
|---|---|---|
| Blue Cross Blue Shield | $23 - $28 | 383% |
| UnitedHealthcare | $28 - $35 | 466% |
| Medicaid / KanCare | $35 | 582% |
| Health Partners-All Plans | $35 | 582% |
Consumer Guidance & Cost Commentary
For this blood clotting time test at Phillips County Hospital in Phillipsburg, KS, the facility's cash price of $30.00 is notably higher than the state average, which sits at $27.00. While the hospital is a Critical Access Hospital owned by the local government, patients should be aware that paying cash upfront can sometimes be more cost-effective than using insurance, particularly if your plan has a high deductible or if the insurance negotiated rate exceeds the cash price. The facility offers a self-pay option, and you should explicitly ask about "prompt-pay" discounts before scheduling, as paying the bill in full within a short window can often reduce the total amount owed by bypassing administrative fees and claim processing costs.
When using insurance, the negotiated rates vary by payer, ranging from $23 to $35, with the median allowed amount being $32.00. This is significantly higher than the Medicare benchmark of $6.01, illustrating the substantial markup often found in commercial contracts. It is important to verify your specific plan's allowed amount before the visit, as assuming that being in-network guarantees the lowest possible price can lead to unexpected costs if the facility charges a higher tiered rate. Additionally, if you are billed for services outside of your plan's network, you may face balance billing for the difference between the provider's full charge and the insurance payment, though federal protections exist for emergency care and non-emergency services at in-network facilities.