Blood test, clotting time (PTT)
Facility: Amberwell Atchison Association
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $31
- Cash Discount Price: $61
- 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 |
|---|---|---|
| UnitedHealthcare | $20 - $109 | 333% |
| Superior Select Mcr Adv - All Plans | $20 | 333% |
| Triwest - All Plans | $20 | 333% |
| Va Ccn - All Plans | $20 | 333% |
| Humana | $20 - $27 | 333% |
| Blue Cross Blue Shield | $21 - $23 | 349% |
| Ambetter / Centene | $31 | 516% |
| Cigna | $33 - $34 | 549% |
| Aetna | $33 - $34 | 549% |
| Centrus Health Direct - All Plans | $45 - $46 | 749% |
| Oscar - All Plans | $45 - $46 | 749% |
| Multiplan - All Plans | $47 - $48 | 782% |
| Wppa Providrs Care - All Plans | $54 - $55 | 899% |
Consumer Guidance & Cost Commentary
For the CPT code 85730, representing a blood test for clotting time (PTT), the cash price at Amberwell Atchison Association in Atchison, KS is $61.00, which matches the facility's median negotiated rate of $31.00 and the cash median. This cash price is significantly higher than the Medicare benchmark of $6.01, reflecting a markup common in commercial billing where rates often average 200% to 300% of the federal baseline. While the facility's negotiated rates range from $20 to $55 across 13 payers, patients with high-deductible plans may find paying the cash price directly more cost-effective than relying on insurance, as the negotiated rates can sometimes exceed the cash amount due to administrative overhead and contract structures.
To minimize costs, patients should verify if the facility offers "self-pay" or "prompt-pay" discounts, which can reduce bills by 20% to 50% for upfront payments by bypassing insurance claims processing fees. It is important to note that while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, unexpected charges can still occur if ancillary services are not covered. Consumers are advised to request a full itemized bill before payment to ensure no errors or unbundled codes are present, as over 80% of hospital bills contain discrepancies that can be resolved through a formal written audit.