Blood test, clotting time (PTT)
Facility: Children'S Mercy South
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $46
- Cash Discount Price: $34
- vs. Medicare Baseline: 7.65x 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 765% of the Medicare baseline (a markup of 665%). 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 | $5 - $48 | 83% |
| Healthy Blue | $6 - $16 | 100% |
| Medicaid / KanCare | $6 | 100% |
| Home State Health | $14 | 233% |
| Blue Cross Blue Shield | $29 - $53 | 483% |
| Cigna | $34 - $49 | 566% |
| Medica | $41 | 682% |
| Aetna | $43 - $48 | 715% |
| Quiktrip | $46 | 765% |
| Nebraska Furniture Mart | $46 | 765% |
| Centivo | $46 | 765% |
| Orscheln | $46 | 765% |
| Wppa Providrs Care | $46 | 765% |
| Health Midwest Comprehensive Care | $46 | 765% |
| Wellfit/Centrus | $46 | 765% |
| Humana | $47 | 782% |
| Coxhealth Network | $53 | 882% |
| Coventry Health Care Of Kansas | $53 | 882% |
| Mercy Health | $53 | 882% |
| Multiplan | $54 | 899% |
| American Healthcare Alliance | $60 | 998% |
| Healthlink | $62 | 1032% |
| National Preferred Provider Network | $64 | 1065% |
Consumer Guidance & Cost Commentary
For the CPT code 85730, representing a blood test for clotting time (PTT), the facility Children's Mercy South in Overland Park, KS, lists a gross charge of $71.00. The cash median price for this service is $34.00, which is significantly lower than the facility's negotiated rates. While the facility's negotiated rate of $46.00 is higher than the cash price, it remains below the gross charge. For patients with high-deductible plans, paying the cash median of $34.00 upfront may be more cost-effective than relying on insurance, as the negotiated rate often exceeds the cash price. Patients should explicitly ask for "self-pay" or "prompt-pay" discounts before scheduling to ensure they receive the lowest possible rate, as these incentives can reduce the final bill by 20% to 50%.
When comparing this service to state and county benchmarks, the Medicare amount of $6.01 serves as the objective baseline for evaluating pricing markups. The facility's gross charge of $71.00 represents a substantial markup compared to the Medicare rate, which is a standard practice in healthcare billing. However, the negotiated rate of $46.00 provides a more realistic picture of the cost for insured patients. It is important to note that commercial negotiated rates often include administrative overhead and contract dynamics that can inflate the baseline price. Consumers should verify their specific plan's allowed amount, as in-network rates vary by payer and can differ significantly from the facility's published negotiated rate.