Blood test, clotting time (PTT)
Facility: Northeast Regional Medical Center
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $139
- Cash Discount Price: $154
- vs. Medicare Baseline: 23.13x 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 2313% of the Medicare baseline (a markup of 2213%). 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 |
|---|---|---|
| Medicaid / KanCare | $5 - $9 | 83% |
| Tricare | $5 | 83% |
| Node Champva | $5 | 83% |
| Medicare (plans) | $6 | 100% |
| Node VA | $6 | 100% |
| Veterans Eval Services | $6 | 100% |
| Node Hospice Non Par Agree | $6 | 100% |
| Blue Access | $6 | 100% |
| Blue Cross Blue Shield | $6 - $119 | 100% |
| UnitedHealthcare | $6 - $292 | 100% |
| Blue Pathway/Pathway X | $6 | 100% |
| Blue Prefrerred | $6 | 100% |
| Node Devoted Health McR Adv | $6 | 100% |
| Centurion Correctional | $8 | 133% |
| Us Department of Labor | $8 | 133% |
| Naphcare | $11 | 183% |
| Home State Exchange | $11 | 183% |
| Immergrun | $12 | 200% |
| Self Pay | $94 - $214 | 1564% |
| Cigna | $132 - $152 | 2196% |
| Aetna | $145 - $325 | 2413% |
| Access Health Services, LLC | $253 | 4210% |
| Healthlink | $292 - $312 | 4859% |
| Multiplan | $292 - $312 | 4859% |
| Coventry Wc | $312 | 5191% |
Consumer Guidance & Cost Commentary
For this blood clotting time test (PTT) at Northeast Regional Medical Center in Kirksville, the most significant benchmark is the Medicare rate of $6.01, which serves as the federal baseline for this service. The facility's cash price of $154 is substantially higher than the Medicare amount, reflecting a markup of 23.1% above the federal benchmark, while the gross charge listed on the facility's chargemaster reaches $390. When comparing against commercial insurance, the facility's median negotiated rate of $139 is also notably higher than the cash price, illustrating that for some patients, paying directly may result in a lower out-of-pocket cost than using an insurance plan.
The data indicates that 25 different payers have negotiated rates for this procedure, with the highest variation seen in the Self Pay category, which ranges from $152 to $214, and Aetna plans, which range from $145 to $325. It is important to note that while commercial insurance contracts set a ceiling on what insurers pay, these negotiated rates often exceed the cash price due to administrative costs and contract dynamics. Patients should verify their specific plan details, as the "Self Pay" rate of $152 to $214 suggests that paying upfront without insurance could be more cost-effective than relying on a plan with a high deductible or a negotiated rate that exceeds the cash price. Additionally, patients should inquire about prompt-pay discounts, which can reduce the bill further if paid in full within a short window, bypassing the standard insurance billing cycle.