CMS Price Transparency Data

Blood test, clotting time (PTT)

Facility: Margaretville Memorial Hospital

Billing Code: 85730 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85730
Insurance Median: $73
Cash Discount Price: $165
vs. Medicare Baseline: 12.15x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PTT) at Margaretville Memorial Hospital is $73. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $165. Compared to the federal Medicare reimbursement reference rate of $6.01, this hospital’s rate is 12.15x the Medicare baseline. Located in 42084 State Highway 28, Margaretville, NY.

Cash / Self-Pay

$165

Average discount available for prompt cash payment at this facility.

Insurance Median

$73

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: $165 (2745%)

Insurance Median: $73 (1215%)

Cash: $165 (2745% of Medicare)

Ins. Median: $73 (1215% 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 1215% of the Medicare baseline (a markup of 1115%). 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	$9 - $73	150%
Oxford	$9	150%
Aetna	$16 - $165	266%
Mvp	$26	433%
Mvp Hmo/Ppo	$30	499%
Blue Cross Blue Shield	$35 - $73	582%
Self-Pay	$51	849%
Mvp Gold (McR)	$73	1215%
Hamaspik (McR)	$73	1215%
Medicare (plans)	$73 - $109	1215%
Affinity By Molina McR	$76	1265%
Cdphp	$80	1331%
Emblem Ghi/Hip Ppo/Cbp	$102	1697%
Mvp Exchange	$107	1780%
Emblem Select Care (Exchange)	$112	1864%
Magnacare Standard	$116	1930%
Oxford Exchange	$116	1930%
Todays Options	$120	1997%
Emblem Ghi/Hip Hmo/Epo/Pos	$132	2196%
Multiplan	$135	2246%
First Health	$148	2463%
Magnacare Preferred	$652	10849%

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 $165.
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 Margaretville 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.