Blood test, clotting time (PTT)
Facility: Kansas City Orthopaedic Institute
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $23
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 3.83x 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 383% of the Medicare baseline (a markup of 283%). 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 | $6 - $42 | 100% |
| Cigna | $6 - $36 | 100% |
| Aetna | $6 | 100% |
| Blue Cross Blue Shield | $11 - $46 | 183% |
| Medica | $38 - $40 | 632% |
Consumer Guidance & Cost Commentary
For the CPT code 85730, representing a blood test for clotting time (PTT), the Kansas City Orthopaedic Institute in Leawood, KS, has a gross charge of $71.00. While the facility is owned by physicians and operates as an acute care hospital, the data indicates that cash and negotiated rates are currently unavailable for this specific service. The Medicare benchmark for this procedure is $6.01, which serves as the objective baseline for evaluating pricing. Although the facility is located in Leawood (ZIP 66211), the provided data does not include specific county or state average figures for comparison, so no direct regional price analysis can be performed at this time.
Insurance coverage for this service varies significantly across payers, with negotiated rates ranging from $6 to $46 depending on the plan. UnitedHealthcare and Cigna offer plans with negotiated rates between $6 and $42 and $6 and $36 respectively, while Aetna has a single plan at $6. Blue Cross Blue Shield offers seven plans with rates up to $46, and Medica plans range from $38 to $40. Because the cash median is null, patients with high-deductible plans should verify if paying out-of-pocket upfront could result in lower costs than their insurance negotiated rate, which often includes administrative overhead. It is recommended to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid in full before services are rendered.