Blood test, clotting time (PTT)
Facility: Minneola District Hospital
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $32
- Cash Discount Price: $25
- 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 |
|---|---|---|
| Va Community Care Program-All Plans | $23 | 383% |
| UnitedHealthcare | $23 - $35 | 383% |
| Humana | $23 | 383% |
| Blue Cross Blue Shield | $23 | 383% |
| Providrs Care Network-All Plans | $30 | 499% |
| Corporate Plan Management-All Plans | $30 | 499% |
| Triwest-All Plans | $32 | 532% |
| Preferred Health Care (Coventry)-All Other Plans | $32 | 532% |
| Aetna | $33 - $35 | 549% |
| Phc (Coventry) Leased Network | $33 | 549% |
| Health Partners Of Kansas-All Plans | $33 | 549% |
| Medicaid / KanCare | $35 | 582% |
Consumer Guidance & Cost Commentary
For this blood clotting time test at Minneola District Hospital, the cash price is $25.00, which is lower than the facility's negotiated rates of $32.00 and the median paid amount of $31.00. While the facility is a Critical Access Hospital in Kansas, the specific data provided does not include state or county average comparisons for this procedure. However, patients with high-deductible plans may find paying the cash price of $25.00 more cost-effective than using insurance, as the negotiated rates exceed the cash amount. It is important to note that while the facility is a Government-owned Hospital District, patients should verify their specific plan details before scheduling to ensure they understand any potential out-of-pocket costs.
The Medicare benchmark for this service is $6.01, which serves as a baseline for evaluating the facility's pricing structure. The cash price of $25.00 represents a significant markup over the Medicare rate, a common occurrence in commercial billing where negotiated rates often range from 200% to 300% of the Medicare amount. If a patient receives care from an out-of-network provider, they could face balance billing for the difference between the provider's full charge and the insurance allowed amount, though the No Surprises Act protects emergency care and non-emergency services at in-network facilities. To avoid unexpected costs, patients should request a prompt-pay discount if paying in full upfront, which can reduce the bill by 20% to 50%, and always demand an itemized bill to review every charge before agreeing to payment.