Blood test, clotting time (PTT)
Facility: Smith County Memorial Hospital
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $33
- Cash Discount Price: $35
- vs. Medicare Baseline: 5.49x 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 549% of the Medicare baseline (a markup of 449%). 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 | $22 | 366% |
| Medicaid / KanCare | $24 - $35 | 399% |
| Multiplan-All Plans | $31 - $32 | 516% |
| Health Partners Of Ks Ppo-All Plans | $33 | 549% |
| Midlands Choice-All Plans | $33 | 549% |
| Wppa-All Plans | $33 | 549% |
| UnitedHealthcare | $33 | 549% |
Consumer Guidance & Cost Commentary
For this blood clotting time test (CPT 85730) at Smith County Memorial Hospital in Smith Center, Kansas, the cash price is $35.00, which matches the facility's negotiated rate of $33.00 and the median paid amount. This cash price is notably higher than the Medicare benchmark of $6.01, reflecting a significant markup common in commercial billing. While the facility is a Critical Access Hospital owned by the local government, patients should be aware that commercial negotiated rates often exceed cash prices due to administrative costs and contract structures. If you have a high-deductible plan, paying the $35.00 cash price upfront might be more cost-effective than relying on insurance, which could result in a higher allowed amount after your deductible is met.
To maximize savings, we recommend asking the hospital directly about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid in full before or shortly after the service. Although the data shows a median negotiated rate of $33.00 across seven payers, including Medicaid/KanCare and UnitedHealthcare, these rates are contractual ceilings that do not guarantee the lowest possible price for every individual plan. Before scheduling, verify your specific deductible status and request an itemized bill to ensure no errors or unbundled charges are included, as over 80% of hospital bills contain discrepancies. Always confirm whether any ancillary services, such as lab supplies, are billed separately to avoid unexpected balance billing, even at an in-network facility.