CMS Price Transparency Data

Blood test, clotting time (PTT)

Facility: Hospital for Special Surgery

Billing Code: 85730 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85730
Insurance Median: $91
Cash Discount Price: $177
vs. Medicare Baseline: 15.14x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PTT) at Hospital for Special Surgery is $91. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $177. Compared to the federal Medicare reimbursement reference rate of $6.01, this hospital’s rate is 15.14x the Medicare baseline. Located in 535 East 70Th Street, New York, NY.

Cash / Self-Pay

$177

Average discount available for prompt cash payment at this facility.

Insurance Median

$91

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: $177 (2945%)

Insurance Median: $91 (1514%)

Cash: $177 (2945% of Medicare)

Ins. Median: $91 (1514% 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 1514% of the Medicare baseline (a markup of 1414%). 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	$8 - $155	133%
Blue Cross Blue Shield	$14 - $191	233%
Aetna	$88 - $91	1464%
Christian Brothers [1034]	$88 - $91	1464%
Meritain Health [1085]	$88 - $91	1464%
Nippon Life [1092]	$88 - $91	1464%
Webtpa [1356]	$88 - $91	1464%
Affinity By Molina Health Plan [1005]	$91 - $122	1514%
Connecticare [1039]	$91 - $120	1514%
Emblem Health [1043]	$91 - $120	1514%
Fidelis Essential [1323]	$91	1514%
Harvard Pilgrim [1057]	$91 - $155	1514%
Medicare (plans)	$91	1514%
Oxford [1096]	$91 - $105	1514%
Student Resources [1103]	$91 - $128	1514%
Geha [1053]	$128	2130%
Apwu [1016]	$129 - $144	2146%
Cigna	$129 - $144	2146%
Nalc [1090]	$129 - $144	2146%
Qualcare [1101]	$129 - $144	2146%
Wellfleet [1361]	$129 - $144	2146%

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 $177.
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 Hospital for Special Surgery 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.