CMS Price Transparency Data

Blood test, clotting time (PTT)

Facility: Munson Healthcare Otsego Memorial Hospital

Billing Code: 85730 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85730
Insurance Median: $37
Cash Discount Price: $45
vs. Medicare Baseline: 6.16x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PTT) at Munson Healthcare Otsego Memorial Hospital is $37. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $45. Compared to the federal Medicare reimbursement reference rate of $6.01, this hospital’s rate is 6.16x the Medicare baseline. Located in 825 N Center Ave, Gaylord, MI.

Cash / Self-Pay

$45

Average discount available for prompt cash payment at this facility.

Insurance Median

$37

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$6.01

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $6.01 (100%)

Cash / Self-Pay: $45 (749%)

Insurance Median: $37 (616%)

Cash: $45 (749% of Medicare)

Ins. Median: $37 (616% of 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.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

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	$2 - $47	33%
Blue Cross Blue Shield	$3 - $37	50%
Mclaren Health Plan	$3 - $49	50%
Meridian	$3	50%
Molina	$3 - $6	50%
Priority Health	$3 - $13	50%
Aetna	$5 - $48	83%
Blue Care Network	$6	100%
Cigna	$6 - $13	100%
Hap (Health Alliance Plan)	$6 - $47	100%
Humana	$6	100%
Medicare (plans)	$6	100%
Michigan Amish Medical Board	$6	100%
Northern Michigan Mennonite Group	$6	100%
Employee Benefit Logistics	$10	166%
Hospice Of Michigan	$28 - $35	466%
Munson Hospice	$32 - $852	532%
Asr Physicians Care Network	$37 - $47	616%
Enterprise Group Planning/Employee Benefit Plan	$37 - $47	616%
Nomi Health	$37 - $47	616%
Cofinity	$39 - $53	649%
Provider Network Of America/Hawaii Mainland Administrative Group Health	$39 - $50	649%
Three Rivers Provider Network	$39 - $50	649%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $45.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 85730.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Munson Healthcare Otsego Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 85730.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.