Blood test, clotting time (PTT)
Facility: Ellinwood District Hospital
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $22
- Cash Discount Price: $27
- vs. Medicare Baseline: 3.66x 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 366% of the Medicare baseline (a markup of 266%). 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 |
|---|---|---|
| Cigna | $13 - $33 | 216% |
| Aetna | $13 - $33 | 216% |
| Humana | $13 - $33 | 216% |
| Blue Cross Blue Shield | $13 - $33 | 216% |
| UnitedHealthcare | $13 - $33 | 216% |
Consumer Guidance & Cost Commentary
For this blood clotting time test (CPT 85730) at Ellinwood District Hospital in Kansas, the facility's cash median price is $27.00, which is lower than the state average of $32.00. While the hospital's negotiated rates with major payers like Cigna, Aetna, and UnitedHealthcare range from $13.00 to $33.00, patients should note that cash payments can sometimes be more cost-effective if their insurance negotiated rate exceeds the cash price. Because this is a Critical Access Hospital, the facility may offer prompt-pay discounts for upfront payments, which can significantly reduce the final bill by bypassing administrative costs and avoiding balance billing risks associated with out-of-network services.
To ensure you receive the best possible rate, it is recommended to contact the hospital directly to confirm their specific self-pay or prompt-pay discounts before scheduling your visit. Since the facility is owned by a hospital district, they may have unique billing structures that differ from standard commercial contracts. If you choose to use insurance, be aware that while the allowed amounts for these plans fall within the $13.00 to $33.00 range, the actual amount your plan pays could vary based on your deductible status. Always request an itemized bill after your visit to verify that all charges align with the negotiated or cash rates discussed, ensuring you are not subject to unexpected balance billing or unbundled fees.