Blood test, clotting time (PTT)
Facility: St Luke Hospital & Living Center
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $40
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 6.66x 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 666% of the Medicare baseline (a markup of 566%). 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 |
|---|---|---|
| Bluestem Pace | $40 | 666% |
| UnitedHealthcare | $40 | 666% |
| Humana | $40 | 666% |
| Ambetter / Centene | $40 | 666% |
| Kansas Department Of Health And Environment | $40 | 666% |
| Blue Cross Blue Shield | $40 | 666% |
| Va Ccn | $40 | 666% |
Consumer Guidance & Cost Commentary
For this blood test, clotting time (PTT) procedure at St Luke Hospital & Living Center in Marion, KS, the cash median rate is $78. While the facility lists a gross charge of $78, the median negotiated rate across seven payers is $40, and the Medicare amount is $6.01. Although the cash price appears higher than the negotiated rate, patients with high-deductible plans may find paying out-of-pocket cheaper if their insurance allowed amount exceeds the cash price, as administrative overhead often inflates commercial rates. It is important to verify specific self-pay or prompt-pay discounts directly with the hospital before scheduling, as these upfront payments can sometimes bypass standard insurance billing cycles to reduce costs.
The pricing data indicates that the cash rate of $78 does not include a direct comparison to state or county averages in the provided dataset; however, the Medicare benchmark of $6.01 serves as the federal baseline for evaluating the facility's markup. Under the No Surprises Act, patients are protected from balance billing for out-of-network services at in-network facilities, and if a surprise bill occurs, they should dispute it in writing rather than paying immediately. Consumers should also request an itemized CPT-coded bill to ensure no unbundled charges or services not rendered appear on the invoice, as summary bills often obscure individual line items where errors may exist.