CMS Price Transparency Data

Blood test, clotting time (PTT)

Facility: Harlem Hospital Center

Billing Code: 85730 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85730
Insurance Median: $48
Cash Discount Price: Unavailable
vs. Medicare Baseline: 7.99x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PTT) at Harlem Hospital Center is $48. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $6.01, this hospital’s rate is 7.99x the Medicare baseline. Located in 506 Lenox Avenue, New York, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$48

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%)

Insurance Median: $48 (799%)

Ins. Median: $48 (799% 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 799% of the Medicare baseline (a markup of 699%). 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
Aetna	$4 - $18	67%
Healthfirst	$5 - $109	83%
Elderplan	$6	100%
Fidelis	$6 - $109	100%
Magnacare	$7	116%
Oscar	$9	150%
Oxford	$9	150%
United	$9 - $60	150%
Centerlight	$13	216%
Cigna	$14	233%
Wellcare	$15	250%
Carelon	$16 - $48	266%
Emblem	$18 - $65	300%
Blue Cross Blue Shield	$20 - $109	333%
Multiplan	$20	333%
Local 1199	$21	349%
Villagecare Max	$21	349%
Vnsny	$21 - $49	349%
Metroplus	$47 - $109	782%
Amidacare	$48	799%
Senior Whole Health	$48	799%
United Behavioral Health	$48 - $53	799%
Affinity	$49 - $109	815%
Carelon (Amida Care)	$49	815%

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 $X.
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 Harlem Hospital Center 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.