Blood test, clotting time (PTT)
Facility: Lincoln County Hospital
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $23
- Cash Discount Price: $74
- 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 |
|---|---|---|
| Blue Cross Blue Shield | $23 | 383% |
Consumer Guidance & Cost Commentary
For the blood clotting time test (CPT 85730) at Lincoln County Hospital in Lincoln, KS, the cash price is $74.00, which is significantly lower than the facility's gross charge of $82.00. While the facility is a Critical Access Hospital owned by the local government, the negotiated rate with Blue Cross Blue Shield is $23.00, a figure that falls well below the cash price. This pricing structure highlights a common billing dynamic where commercial insurance contracts can result in lower out-of-pocket costs for insured patients compared to self-pay, though this depends entirely on your specific plan's deductible and coinsurance. If you have a high-deductible plan where your deductible has not yet been met, paying the cash price of $74.00 upfront may be more cost-effective than having your insurance process the claim, as the negotiated rate of $23.00 might still exceed your personal financial responsibility after deductibles are applied.
To ensure you are not overcharged, it is important to understand that hospitals often issue summary bills that obscure individual line items, making it difficult to spot errors or unbundled charges. Before paying any invoice, request a full itemized bill that lists every specific CPT code and unit cost to verify that services were actually rendered and that no unnecessary fees were added. Additionally, if you choose to pay out-of-network or if your insurance denies a claim, be aware that balance billing could occur, where the hospital bills you for the difference between their full charge and what your insurer allowed. However, federal protections under the No Surprises Act may prevent these surprise bills for emergency care or non-emergency services at in-network facilities.