Blood test, clotting time (PTT)
Facility: Ellsworth County Medical Center
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $47
- Cash Discount Price: $52
- vs. Medicare Baseline: 7.82x 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 782% of the Medicare baseline (a markup of 682%). 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 | $21 - $22 | 349% |
| Humana | $24 - $49 | 399% |
| Va Ccn-All Plans | $24 | 399% |
| Triwest -All Plans | $24 | 399% |
| Healthy Blue Mcr Adv | $24 | 399% |
| UnitedHealthcare | $34 - $52 | 566% |
| First Health - All Plans | $47 | 782% |
| Aetna | $47 | 782% |
| Cigna | $49 | 815% |
| Healthy Blue Mcaid- All Other Plans | $52 | 865% |
| Medicaid / KanCare | $52 | 865% |
| Coventry Mcaid-All Plans | $52 | 865% |
| Providers Care-Wppa-All Plans | $78 | 1298% |
Consumer Guidance & Cost Commentary
For the blood clotting time test (CPT 85730) at Ellsworth County Medical Center, the cash price is $52.00, which matches the facility's gross charge and the highest negotiated rate found among payers. While the median negotiated rate across all plans is $47.00, patients with high-deductible plans may find paying cash directly more cost-effective, as the cash price is lower than the average insurance allowed amount. It is important to note that the facility's cash rate is significantly higher than the state average for this procedure, which is $37.00. To potentially lower costs, patients should explicitly request a "self-pay" or "prompt-pay" discount before scheduling, as hospitals often offer a fee reduction of 20% to 50% for upfront payment. This discount bypasses the administrative overhead of claims processing and provides immediate liquidity to the facility, but it must be secured prior to check-in to avoid automatic insurance submission.
The facility's pricing is also evaluated against the Medicare benchmark, which stands at $6.01 for this service. The cash price of $52.00 represents a substantial markup compared to the federal baseline, illustrating the difference between the true cost of care and the commercial rates charged. Although the facility is a Critical Access Hospital in Ellsworth, KS, with a proprietary ownership structure, the lack of a lower cash rate suggests that commercial negotiations or administrative fees may be inflating the price relative to the Medicare standard. Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, it does not prevent balance billing for services rendered by in-network providers who