Blood test, clotting time (PTT)
Facility: William Newton Hospital
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $37
- Cash Discount Price: $70
- vs. Medicare Baseline: 6.16x 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 616% of the Medicare baseline (a markup of 516%). 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 | $3 - $677 | 50% |
| Triwest- All Plans | $18 - $263 | 300% |
| Blue Cross Blue Shield | $19 - $271 | 316% |
| Ambetter / Centene | $19 - $752 | 316% |
| Providrs Care Nexus | $32 - $460 | 532% |
| Providrs Care - All Other Plans | $37 - $527 | 616% |
Consumer Guidance & Cost Commentary
For the CPT code 85730, representing a blood test for clotting time (PTT), the facility's cash price is $70.00, which matches the cash median for this service. This cash rate is significantly higher than the Medicare benchmark of $6.01, indicating a substantial markup relative to the federal government's fixed reimbursement rate. While commercial insurance plans like UnitedHealthcare and Triwest have negotiated rates ranging from $18 to $752 depending on the specific plan, these figures often exceed the cash price due to administrative costs and contract structures. Patients with high-deductible plans may find it financially advantageous to pay the $70.00 cash price directly, as the insurance negotiated rate could be higher, provided they have not yet met their deductible.
The facility, William Newton Hospital in Winfield, KS, is a Critical Access Hospital owned by the local government. The median negotiated rate across all payers is $37.00, which is lower than the cash price but still represents a significant portion of the gross charge. It is important to note that the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, though patients should verify their specific plan details before scheduling. To minimize costs, consumers should explicitly request "self-pay" or "prompt-pay" discounts from the billing department prior to check-in, as these upfront payment incentives can reduce the final amount owed. Additionally, patients should always request a full itemized bill to ensure no unbundled codes or services not rendered are included in the final charge.