Blood test, clotting time (PTT)
Facility: Mitchell County Hospital Health Systems
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $80
- Cash Discount Price: $77
- vs. Medicare Baseline: 13.31x 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 1331% of the Medicare baseline (a markup of 1231%). 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 | $6 - $88 | 100% |
| Blue Cross Blue Shield | $23 | 383% |
| Triwest Well Mark All Plans | $71 - $75 | 1181% |
| First Health-All Plans | $76 - $79 | 1265% |
| Pref Hlth Care Sytms Comm - All Plans | $76 - $79 | 1265% |
| Aetna | $76 - $79 | 1265% |
| Phc Leased Ntwrk Access - All Plans | $80 - $84 | 1331% |
| Multiplan Ppo - All Plans | $80 - $84 | 1331% |
| Auxiant-All Plans | $80 - $84 | 1331% |
| Cigna | $83 - $87 | 1381% |
| Health Partners Ks-All Plans | $83 - $87 | 1381% |
Consumer Guidance & Cost Commentary
For this blood clotting time test (CPT 85730), the facility's cash price of $77.00 is lower than the state average of $85.00, making it a cost-effective option for self-pay patients. While most commercial insurance plans negotiate rates between $76.00 and $88.00, these negotiated amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket. To maximize savings, patients should explicitly ask for "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50% by bypassing costly insurance claims processing.
The facility's negotiated rates are also lower than the Medicare benchmark of $6.01, with a median negotiated payment of $80.00 across 11 payers. This indicates that the facility is pricing competitively relative to federal standards, though commercial rates remain higher than the cash option due to administrative overhead. Patients should be aware that while the No Surprises Act protects against balance billing for emergency care at in-network facilities, unexpected charges can still occur if ancillary services like lab tests are billed out-of-network. Always request a full itemized bill before paying to verify that no unbundled codes or services not rendered have been included in the final charge.