Blood test, clotting time (PTT)
Facility: Community Memorial Healthcare, Inc.
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $22
- Cash Discount Price: $38
- vs. Medicare Baseline: 3.66x 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 366% of the Medicare baseline (a markup of 266%). 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 | $17 - $34 | 283% |
| UnitedHealthcare | $21 - $26 | 349% |
| Blue Cross Blue Shield | $23 | 383% |
Consumer Guidance & Cost Commentary
For this blood clotting time test (CPT 85730) at Community Memorial Healthcare in Marysville, KS, the cash price is $38.00, which matches the facility's median negotiated rate of $30.00 and the state average. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, the cash price is notably higher than the Medicare benchmark of $6.01, reflecting a markup common in commercial billing. Patients with high-deductible plans may find paying the $38.00 cash price more advantageous than using insurance, as the facility's negotiated rate of $22.00 often exceeds the cash option, and the insurance allowed amount could result in higher out-of-pocket costs if the deductible has not yet been met.
To minimize costs, we recommend confirming the "self-pay" or "prompt-pay" discount rates directly with the hospital before scheduling, as these upfront payment incentives can significantly reduce the final bill by bypassing administrative claim processing fees. Although the facility is in-network for Aetna, UnitedHealthcare, and Blue Cross Blue Shield, patients should verify their specific plan's allowed amount, as commercial rates can vary widely between payers and sometimes exceed cash prices. If you receive a bill, always request a full itemized statement to review every code and unit charge, ensuring there are no errors or unbundled services before making any payment.