Blood test, clotting time (PTT)
Facility: Memorial Hospital
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $50
- Cash Discount Price: $92
- vs. Medicare Baseline: 8.32x 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 832% of the Medicare baseline (a markup of 732%). 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 |
|---|---|---|
| Humana | $12 - $58 | 200% |
| Medicare (plans) | $12 - $59 | 200% |
| Tricare | $12 - $58 | 200% |
| Ambetter / Centene | $14 - $64 | 233% |
| Blue Cross Blue Shield | $16 | 266% |
| Coventry - All Other Plans | $22 - $105 | 366% |
| Preferred Healthcare-All Plans | $23 - $111 | 383% |
| Health Partners Of Kansas - All Plans | $23 - $111 | 383% |
| Wppa/Providers Care-All Plans | $34 - $164 | 566% |
Consumer Guidance & Cost Commentary
For this blood clotting time test (CPT 85730) at Memorial Hospital in Abilene, KS, the cash price is $92.00, which matches the facility's median negotiated rate. While the hospital is a Critical Access Hospital owned by a government authority, the negotiated rates for commercial payers range widely, with some plans paying as low as $12.00 and others up to $164.00. It is important to note that commercial insurance negotiated rates often exceed the cash price due to administrative costs and contract structures; however, patients with high-deductible plans may find paying the cash price of $92.00 upfront is more cost-effective than relying on insurance, which could result in higher out-of-pocket costs if the deductible has not yet been met.
To ensure you are receiving the best possible rate, we recommend contacting the hospital directly to confirm their "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full before or shortly after the service. Additionally, since Medicare allows a payment of only $6.01 for this service, commercial rates are significantly higher than the federal benchmark, highlighting the importance of verifying your specific plan's allowed amount before scheduling. Always request a detailed, itemized bill to avoid balance billing or errors, and remember that the No Surprises Act protects you from unexpected out-of-network charges for emergency services or non-emergency services provided at an in-network facility.