Blood test, clotting time (PTT)
Facility: Clay County Medical Center
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $72
- Cash Discount Price: $77
- vs. Medicare Baseline: 11.98x 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 1198% of the Medicare baseline (a markup of 1098%). 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 | $62 - $82 | 1032% |
| Wppa/Providrs Care- All Plans | $62 - $82 | 1032% |
| Multiplan- All Plans | $63 - $84 | 1048% |
| UnitedHealthcare | $63 - $84 | 1048% |
| Health Partners - All Plans | $63 - $84 | 1048% |
Consumer Guidance & Cost Commentary
For the blood test, clotting time (PTT) service at Clay County Medical Center in Clay Center, KS, the facility's cash price is $77.00, which matches the state median cash rate. While the facility is a Critical Access Hospital owned by the local government, the negotiated rates for commercial payers range from $62.00 to $84.00, with a median negotiated amount of $72.00. This indicates that for patients with high-deductible plans, paying the cash price of $77.00 upfront could be more cost-effective than using insurance, as the negotiated rates often exceed the cash price due to administrative overhead and contract structures. Patients should verify their specific plan's deductible status before scheduling, as paying out-of-pocket may result in immediate savings if the insurance allowed amount is higher than the cash rate.
When comparing this service to federal benchmarks, the Medicare amount for this code is $6.01, highlighting a significant markup in commercial pricing. The facility's cash price of $77.00 is 1,200% higher than the Medicare rate, whereas the median negotiated rate of $72.00 remains substantially above the federal baseline. To minimize costs, patients should explicitly request a "self-pay" or "prompt-pay" discount before check-in, as hospitals often offer reductions of 20% to 50% for upfront payments to bypass costly claims processing. It is also critical to avoid accepting summary bills; instead, patients should demand a full itemized statement to ensure no unbundled codes or services not rendered are included in the final charge.