Blood test, clotting time (PTT)
Facility: Charleston Area Medical Center
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $86
- Cash Discount Price: $98
- vs. Medicare Baseline: 14.31x 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 1431% of the Medicare baseline (a markup of 1331%). 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 |
|---|---|---|
| The Health Plan of West Virginia Inc. | $5 - $97 | 83% |
| Unicare Health Plan of West Virginia Inc. | $5 - $6 | 83% |
| Aetna | $5 - $98 | 83% |
| West Virginia Senior Advantage Inc. | $6 | 100% |
| UnitedHealthcare | $6 - $98 | 100% |
| Blue Cross Blue Shield | $6 - $91 | 100% |
| Choicecare Network | $6 - $98 | 100% |
| Optimum Choice Inc. | $6 | 100% |
| Triwest VA | $6 | 100% |
| Integrated Medical Solutions | $12 | 200% |
| Naphcare | $12 | 200% |
| Caresource | $15 | 250% |
| Tricare | $54 - $60 | 899% |
| City of Charleston | $68 - $75 | 1131% |
| Cigna | $84 - $93 | 1398% |
| Three Rivers Providers Network | $87 - $97 | 1448% |
| Healthsmart | $88 - $98 | 1464% |
| Multiplan | $88 - $98 | 1464% |
Consumer Guidance & Cost Commentary
For the procedure "Blood test, clotting time (PTT)," the Charleston Area Medical Center lists a cash median rate of $98, which is identical to the facility's gross charge and significantly higher than the state average of $86. While the facility is a voluntary non-profit private hospital in Charleston, WV, patients should be aware that cash-pay options can sometimes be more cost-effective than insurance claims, particularly for those with high-deductible plans where the insurer's negotiated rate exceeds the cash price. It is advisable to verify if the hospital offers "self-pay" or "prompt-pay" discounts before scheduling, as paying upfront can often reduce the final amount owed.
The facility's cash rate of $98 is notably higher than the Medicare benchmark of $6.01, indicating a substantial markup compared to the federal government's fixed reimbursement baseline. Although the facility has negotiated rates with 18 payers, many of these rates, such as those from Aetna and UnitedHealthcare, can also reach $98, meaning patients might not realize savings by using insurance for this specific service. Given that over 80% of hospital bills contain errors, consumers should request an itemized billing audit to ensure no unbundled codes or services not rendered are included, and they should avoid signing out-of-network cost waivers to protect themselves from potential balance billing issues.