Blood test, clotting time (PTT)
Facility: Susan B Allen Memorial Hospital
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $554
- Cash Discount Price: $16
- vs. Medicare Baseline: 92.18x 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 9218% of the Medicare baseline (a markup of 9118%). 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 |
|---|---|---|
| UnitedHealthcare | $350 | 5824% |
| Providrs Care | $757 | 12596% |
Consumer Guidance & Cost Commentary
For the CPT code 85730, representing a blood test for clotting time (PTT), Susan B Allen Memorial Hospital in El Dorado, KS, lists a cash median price of $16.00, which is significantly lower than the facility's gross charge of $25.00. While the hospital's negotiated rates with UnitedHealthcare and Providrs Care are set at $350 and $757 respectively, these amounts often exceed the cash price, meaning patients with high-deductible plans or those without insurance might save money by paying the cash rate directly. It is important to note that commercial negotiated rates frequently include administrative overhead and are often 200% to 300% of the Medicare benchmark rate of $6.01 for this procedure, whereas fair pricing is typically defined as 120% to 150% of Medicare. Consumers should verify their specific plan's deductible status before relying on insurance, as paying the full negotiated rate without meeting the deductible can result in higher out-of-pocket costs than the cash option.
Patients should be aware that hospitals often issue summary bills that obscure individual line items, making it difficult to identify errors or unbundled charges; therefore, requesting a full itemized CPT-coded bill before negotiating is a critical step to ensure accuracy. Additionally, if a patient receives care from an out-of-network provider or encounters unexpected ancillary services, they may face balance billing for the difference between the provider's chargemaster and the insurance allowed amount, though the No Surprises Act provides federal protections against such surprise bills for emergency and non-emergency services at in-network facilities. To minimize costs, individuals should proactively ask