Blood test, clotting time (PTT)
Facility: Ashland Health Center
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $31
- Cash Discount Price: $26
- vs. Medicare Baseline: 5.16x 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 516% of the Medicare baseline (a markup of 416%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $10 - $11 | 166% |
| Compalliance-All Plans | $25 - $26 | 416% |
| Health Partners Of Kansas-All Plans | $27 - $28 | 449% |
| Healthy Blue Mcr Adv - All Other Plans | $31 - $33 | 516% |
| Aetna | $31 - $33 | 516% |
| UnitedHealthcare | $31 - $33 | 516% |
| Medica Mcare - All Plans | $31 - $33 | 516% |
| Medicaid / KanCare | $31 - $33 | 516% |
| Health Choice-All Plans | $31 - $33 | 516% |
| Medicare (plans) | $31 - $33 | 516% |
| Multiplan-All Plans | $31 - $32 | 516% |
| Providers Care (Wppa)-All Plans | $47 - $50 | 782% |
Consumer Guidance & Cost Commentary
For the CPT code 85730, representing a blood test for clotting time (PTT), Ashland Health Center in Ashland, KS, lists a gross charge of $32.00. The facility's cash median price is $26.00, which is lower than the negotiated rates of $31.00 paid by most insurance plans, including Blue Cross Blue Shield, Aetna, and UnitedHealthcare. This price difference highlights a common billing dynamic where cash-pay options can be more affordable for patients with high-deductible plans or those without insurance, as the insurance negotiated rate often exceeds the cash price due to administrative costs and contract structures. Patients should verify if "self-pay" or "prompt-pay" discounts are available before scheduling, as paying upfront can sometimes bypass the higher insurance-allowed amounts.
When evaluating this cost against federal benchmarks, the Medicare amount for this service is $6.01. The facility's cash rate of $26.00 represents a significant markup compared to the Medicare baseline, illustrating how commercial pricing structures can differ substantially from government-set rates. While the data does not provide specific county or state average comparisons for this exact code, understanding that Medicare rates serve as a scientifically validated cost baseline helps patients recognize that commercial rates often include additional layers of pricing. To ensure you are receiving the most accurate pricing, it is recommended to request an itemized bill that breaks down each CPT code and unit cost, rather than accepting a summary invoice that may obscure individual charges or bundled services.