Blood test, clotting time (PTT)
Facility: Girard Medical Center
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $44
- Cash Discount Price: $75
- vs. Medicare Baseline: 7.32x 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 732% of the Medicare baseline (a markup of 632%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $23 - $44 | 383% |
| UnitedHealthcare | $44 - $119 | 732% |
| Ambetter / Centene | $44 | 732% |
| Humana | $44 | 732% |
| Kansas Superior Select-All Plans | $44 | 732% |
| Medicare (plans) | $44 | 732% |
| Aetna | $44 - $219 | 732% |
| Multiplan-All Plans | $116 | 1930% |
| Uhhis-All Plans | $119 | 1980% |
Consumer Guidance & Cost Commentary
For the CPT code 85730, representing a blood test for clotting time (PTT), Girard Medical Center in Kansas has a cash median price of $75.00 and a median negotiated rate of $44.00. This cash price is notably higher than the facility's Medicare benchmark of $6.01, which serves as the federal baseline for cost. While the negotiated rates for major payers like UnitedHealthcare and Aetna range from $44.00 to $119.00, patients with high-deductible plans may find the cash price of $75.00 more affordable if their insurance allowed amount exceeds this figure. It is important to note that the facility is a Critical Access Hospital owned by a Government Hospital District, and while the facility holds a rating of 2, the specific pricing for this service does not include a direct comparison to state or county averages in the provided data.
To minimize costs, patients should actively request "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can significantly reduce the final bill by bypassing administrative claim processing fees. Although the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, it is crucial to verify that all ancillary services, such as specific lab components, are covered under the facility's network agreements. If a patient receives an itemized bill, they should request a full line-by-line audit to identify any unbundled codes or services not rendered, as over 80% of hospital bills contain errors that can be corrected through formal written disputes rather than verbal agreements.