Blood test, clotting time (PTT)
Facility: Trego County Lemke Memorial Hospital
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $30
- Cash Discount Price: $32
- vs. Medicare Baseline: 4.99x 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 499% of the Medicare baseline (a markup of 399%). 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 |
|---|---|---|
| Va Ccn - All Plans | $2 | 33% |
| Humana | $17 - $20 | 283% |
| Tricare | $19 - $22 | 316% |
| Aetna | $22 - $37 | 366% |
| UnitedHealthcare | $22 - $41 | 366% |
| Medicaid / KanCare | $22 - $41 | 366% |
| Ambetter / Centene | $24 - $28 | 399% |
| Blue Cross Blue Shield | $31 | 516% |
| Health Partners - All Plans | $33 - $39 | 549% |
| Healthy Blue Mcaid - All Plans | $35 - $41 | 582% |
Consumer Guidance & Cost Commentary
For the blood clotting time test (CPT 85730), Trego County Lemke Memorial Hospital in Wakeeney, KS, lists a cash median price of $32.00, which is lower than the facility's negotiated rates for most major payers. While the facility is a Critical Access Hospital owned by the local government, patients with high-deductible plans may find paying the cash price directly more cost-effective than using insurance, as the facility's negotiated rates often exceed the cash amount. It is important to note that while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should still verify their specific plan details before scheduling to ensure they are not subject to unexpected charges.
The facility's cash median of $32.00 is significantly lower than the Medicare benchmark of $6.01, which serves as the federal baseline for healthcare costs, and is also below the state and county averages implied by the wide range of negotiated rates (from $2 to $41) across ten different payers. This pricing structure suggests that commercial insurance contracts may be inflating the baseline price due to administrative overhead and contract dynamics, whereas paying cash avoids these layers. Patients are encouraged to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available, as paying in full upfront can sometimes result in further fee reductions beyond the listed cash median.