CMS Price Transparency Data
Blood test, clotting time (PTT)
Facility: Mercy Hospital Carthage
Billing Code: 85730 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 85730
- Insurance Median: $39
- Cash Discount Price: $41
- vs. Medicare Baseline: 6.49x Medicare
The contracted insurance negotiated median rate for a Blood test, clotting time (PTT) at Mercy Hospital Carthage is $39. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $41. Compared to the federal Medicare reimbursement reference rate of $6.01, this hospital’s rate is 6.49x the Medicare baseline. Located in 3125 Dr Russell Smith Way, Carthage, MO.
Cash / Self-Pay
$41
Average discount available for prompt cash payment at this facility.
Insurance Median
$39
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: $41 (682%)
Insurance Median: $39 (649%)
Cash: $41 (682% of Medicare)
Ins. Median: $39 (649% 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 649% of the Medicare baseline (a markup of 549%). 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.
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Aetna | $5 - $59 | 83% |
| Blue Cross Blue Shield | $5 - $24 | 83% |
| Humana | $5 - $20 | 83% |
| Medicaid / KanCare | $5 - $36 | 83% |
| Medicare (plans) | $6 - $20 | 100% |
| United Medical Resources Contracted [320454] | $8 - $59 | 133% |
| UnitedHealthcare | $8 - $57 | 133% |
| Cherokee Nation Health Serv Contracted [320066] | $16 - $18 | 266% |
| Cigna | $16 - $59 | 266% |
| Cross Timbers Hospice [20098] | $16 - $18 | 266% |
| Dept Of Veteran Affairs Contracted [320106] | $16 - $18 | 266% |
| Elara Caring Aspire Hospice [20433] | $16 - $18 | 266% |
| Globalhealth Contracted [320145] | $16 - $18 | 266% |
| Halo Hcr Inc Hospice Contracted [320432] | $16 - $18 | 266% |
| Halo Hcr Inc Hospice [20432] | $16 - $18 | 266% |
| Indian Health Service Contracted [320198] | $16 - $18 | 266% |
| Kindful Hospice Contracted [320434] | $16 - $18 | 266% |
| Kindful Hospice [20434] | $16 - $18 | 266% |
| Medical Associates Health Contracted [320444] | $16 - $18 | 266% |
| Mercy Hospice Okc [20252] | $16 - $18 | 266% |
| Mercy Mgd Behavioral Health Contracted [320259] | $16 - $18 | 266% |
| Pace Of The Ozarks Contracted [320518] | $16 - $18 | 266% |
| Provider Partners Health Plans Contracted [320450] | $16 - $18 | 266% |
| Qual Choice Contracted [320325] | $16 - $18 | 266% |
| Tricare | $17 - $18 | 283% |
| Point C Contracted [320238] | $21 - $59 | 349% |
| Health Systems Inc Contracted [320174] | $26 - $28 | 433% |
| Insurance System Inc Contracted [320465] | $26 - $28 | 433% |
| Administrative Payor Contracted [320005] | $27 - $30 | 449% |
| Centivo Contracted [320505] | $28 - $30 | 466% |
| Healthscope Contracted [320182] | $31 - $34 | 516% |
| Ambetter / Centene | $33 - $36 | 549% |
| Home State Health Plan Contracted [320187] | $33 - $36 | 549% |
| Novasys Contracted [320285] | $33 - $36 | 549% |
| Benefit Management Contracted [320052] | $36 - $57 | 599% |
| Auxiant Contracted [320462] | $39 - $56 | 649% |
| Healthlink Contracted [320179] | $39 - $61 | 649% |
| Preferred Health Plan Contracted [320522] | $39 - $43 | 649% |
| Workers Comp [20426] | $48 - $66 | 799% |
| 90 Degree Benefits Contracted [320436] | $51 - $56 | 849% |
| Aither Health Contracted [320449] | $51 - $56 | 849% |
| Ebms Contracted [320493] | $51 - $56 | 849% |
| Edison Health Solutions Contracted [320502] | $51 - $56 | 849% |
| Imagine 360 Contracted [320494] | $51 - $56 | 849% |
| Mercy Benefit Admin Contracted [320251] | $51 - $59 | 849% |
| Reflect Health Contracted [320492] | $51 - $56 | 849% |
| Show-Me Health Administrators Contracted [320483] | $51 - $56 | 849% |
| Yuzu Health Contracted [320521] | $51 - $56 | 849% |
| Evolutions Health Care Contracted [320124] | $52 - $57 | 865% |
| First Health Contracted [320128] | $52 - $57 | 865% |
| Medica Contracted [320239] | $52 - $57 | 865% |
| Multiplan Contracted [320270] | $52 - $57 | 865% |
| Private Health Care Systems Contracted [320320] | $52 - $57 | 865% |
| American Healthcare Alliance Contracted [320020] | $54 - $59 | 899% |
| Ppo Plus Contracted [320310] | $54 - $59 | 899% |
| Usa Managed Care Org Contracted [320429] | $54 - $59 | 899% |