Blood test, clotting time (PTT)
Facility: Saint John Hospital
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $6
- Cash Discount Price: $6
- vs. Medicare Baseline: 1.00x 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.
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 |
|---|---|---|
| Celtic | $5 - $39 | 83% |
| Healthy Blue | $5 - $6 | 83% |
| UnitedHealthcare | $5 - $8 | 83% |
| Medicaid / KanCare | $5 | 83% |
| Aetna | $6 - $10 | 100% |
| Tricare | $6 | 100% |
| Midland Care Connection | $6 | 100% |
| Kansas Superior Select | $6 | 100% |
| Cigna | $6 | 100% |
| Medicare (plans) | $6 | 100% |
| Employer Direct Healthcare | $8 | 133% |
| Well Path | $8 | 133% |
| Corizon | $8 | 133% |
| Naphcare | $9 | 150% |
| Centurion | $9 | 150% |
| Blue Cross Blue Shield | $11 - $23 | 183% |
| Comp Alliance Workers Comp | $12 | 200% |
| Oha Networks | $13 | 216% |
| Worker Compensation | $14 | 233% |
Consumer Guidance & Cost Commentary
For the CPT code 85730, representing a blood test for clotting time (PTT), Saint John Hospital in Leavenworth, KS, lists a gross charge of $110.00. While the facility's cash median rate is $6.00, which is significantly lower than the negotiated rates paid by most commercial payers, patients should be aware that commercial insurance contracts often result in higher out-of-pocket costs. For instance, UnitedHealthcare and Blue Cross Blue Shield have negotiated ranges starting at $5 and extending up to $23, respectively. In cases where a patient has a high-deductible plan, paying the cash price of $6.00 upfront may be more cost-effective than relying on insurance, which could otherwise result in a negotiated rate exceeding the cash amount. It is advisable to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available, as these can further reduce the final amount owed.
The facility's cash rate of $6.00 aligns closely with the Medicare benchmark of $6.01, suggesting that the cash price reflects a fair cost basis rather than a markup typical of commercial billing. However, the median negotiated rate across all payers is $55.00, which is substantially higher than the cash option and indicates that commercial contracts often include administrative overheads that inflate the baseline price. To ensure accuracy, patients should request an itemized bill to verify that no unbundled codes or services not rendered are included, as over 80% of hospital bills contain errors that can be corrected through a formal audit. Additionally, since the No Surprises Act prohibits balance billing for emergency care and