Blood test, clotting time (PTT)
Facility: Lane County Hospital
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $50
- Cash Discount Price: $50
- vs. Medicare Baseline: 8.32x 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 832% of the Medicare baseline (a markup of 732%). 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 | $45 - $50 | 749% |
| Aetna | $45 - $48 | 749% |
| Healthy Blue Mcaid | $50 | 832% |
| Healthy Blue Mcr Adv - All Other Plans | $50 | 832% |
| Medicaid / KanCare | $50 - $55 | 832% |
| Wppa Providers-All Plans | $75 | 1248% |
Consumer Guidance & Cost Commentary
For the CPT code 85730, representing a blood test for clotting time (PTT), Lane County Hospital in Dighton, KS, lists a cash median price of $50.00, which matches the facility's negotiated median rate. This cash price is notably higher than the state average for this service, which is $6.01, and significantly exceeds the Medicare benchmark of $6.01. While commercial payers like UnitedHealthcare and Aetna negotiate rates between $45.00 and $50.00, patients with high-deductible plans may find paying the full cash price of $50.00 more cost-effective than relying on insurance, as the negotiated allowed amounts often exceed the cash rate. To minimize costs, patients should verify if their specific plan has a deductible that would otherwise require them to pay the higher negotiated rate.
Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network services at in-network facilities, it is crucial to request an itemized bill to ensure no unbundled charges or services not rendered are included. If a patient chooses to pay out-of-pocket, they should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the $50.00 charge by 20% to 50% if paid in full upfront. Since the facility is a Critical Access Hospital owned by a Government Hospital District, patients should confirm their coverage status before scheduling to avoid unexpected administrative fees or the need to dispute potential errors on their final invoice.