Blood test, clotting time (PTT)
Facility: Lmh
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $61
- Cash Discount Price: $29
- vs. Medicare Baseline: 10.15x 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 1015% of the Medicare baseline (a markup of 915%). 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 | $5 - $46 | 83% |
| Blue Cross Blue Shield | $5 - $96 | 83% |
| Humana | $6 | 100% |
| Haskell Indian Health Services | $6 | 100% |
| Cigna | $6 - $99 | 100% |
| Allwell | $6 | 100% |
| Medicare (plans) | $6 | 100% |
| Aetna | $7 - $123 | 116% |
| Ambetter / Centene | $9 | 150% |
| Non Contracted | $74 - $119 | 1231% |
| First Health | $86 - $138 | 1431% |
Consumer Guidance & Cost Commentary
For this blood clotting time test (CPT 85730) at Lmh in Lawrence, KS, the facility's cash price of $29.00 is significantly lower than the state average, which ranges from $5 to $119 depending on the insurance plan. While many commercial payers negotiate rates between $5 and $96, the cash rate remains the lowest option available. If you have a high-deductible plan or no insurance, paying the cash price directly may save you money compared to your insurer's negotiated rate, which often includes administrative overhead that inflates the final cost. We recommend asking the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can further reduce the bill by bypassing the costly insurance claims process.
The facility's negotiated rates vary widely among insurers, with some plans paying as little as $5 while others pay up to $138, and the facility is not contracted with all major payers. It is important to note that Medicare benchmarks this service at $6.01, meaning commercial negotiated rates are often substantially higher than the federal baseline. If you receive a bill that exceeds the allowed amount for your plan, you may be facing balance billing, where the provider charges the difference between their full list price and what your insurance covers. To avoid unexpected charges, always request an itemized bill to verify that no services were unbundled or double-charged, and dispute any discrepancies in writing rather than accepting summary totals.