Blood test, clotting time (PTT)
Facility: Fredonia Regional Hospital
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $27
- Cash Discount Price: $39
- vs. Medicare Baseline: 4.49x 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 449% of the Medicare baseline (a markup of 349%). 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 |
|---|---|---|
| UnitedHealthcare | $2 - $43 | 33% |
| Blue Cross Blue Shield | $15 - $24 | 250% |
| Veterans Programs - All Plans | $15 - $24 | 250% |
| Aetna | $15 - $43 | 250% |
| Reserve National-All Plans | $27 - $43 | 449% |
| Cigna | $27 - $43 | 449% |
| Meritain-All Plans | $27 - $43 | 449% |
Consumer Guidance & Cost Commentary
For this blood clotting time test at Fredonia Regional Hospital in Kansas, the cash price is $39.00, which matches the facility's median negotiated rate of $27.00 and the state average of $27.00. While the facility is a Critical Access Hospital owned by the local government, patients should note that commercial insurance plans often pay significantly higher negotiated rates than cash prices; for instance, UnitedHealthcare plans pay up to $43.00, and Aetna plans can reach $43.00, whereas the cash price remains fixed at $39.00. If you have a high-deductible plan or have not yet met your deductible, paying the cash price directly could save you money compared to the amount your insurer would allow, as the facility's cash rate is lower than the maximum negotiated amounts seen across various payers.
To ensure you are not overcharged, it is important to request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Additionally, if you are self-pay, ask specifically about "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid upfront, bypassing the administrative costs associated with insurance claims processing. While the Medicare benchmark for this service is $6.01, indicating the facility's rates are well above the federal baseline, the most effective way to minimize costs is to verify your specific plan's allowed amount and confirm whether the hospital can classify the service as self-pay to access the lower cash rate rather than the higher insurance negotiated rate.