Blood test, clotting time (PTT)
Facility: Bob Wilson Memorial Hospital
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $69
- Cash Discount Price: $34
- vs. Medicare Baseline: 11.48x 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 1148% of the Medicare baseline (a markup of 1048%). 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 |
|---|---|---|
| Centura Employee Plan | $8 | 133% |
| Humana | $27 | 449% |
| Kansas Health | $27 | 449% |
| Medicare (plans) | $27 | 449% |
| Aetna | $27 - $67 | 449% |
| UnitedHealthcare | $27 - $70 | 449% |
| Blue Cross Blue Shield | $30 | 499% |
| Multiplan | $76 - $78 | 1265% |
| Health Partners Of Kansas | $79 | 1314% |
| Wppa | $80 | 1331% |
Consumer Guidance & Cost Commentary
For the CPT code 85730, representing a blood test for clotting time (PTT), Bob Wilson Memorial Hospital in Ulysses, KS, lists a gross charge of $84.00. While the facility's cash median price is $34.00, commercial insurance negotiated rates range significantly higher, with the lowest allowed amount at $8 and the highest at $78 across ten different payers. Notably, the facility's cash price is substantially lower than the state average, which sits at $69.00 for this service. Because commercial negotiated rates often exceed cash prices, patients with high-deductible plans may find it financially advantageous to pay the cash rate directly, provided they confirm with the hospital that no additional administrative fees apply.
It is important to distinguish between the facility's gross charges and the actual amounts billed to patients. The Medicare benchmark for this service is $6.01, which serves as a baseline for evaluating pricing fairness, while the facility's cash rate of $34.00 reflects a standard discount structure. Patients should be aware that insurance companies negotiate specific rates for their plans, which can vary widely; for instance, Aetna allows up to $70, whereas Multiplan allows up to $78. To ensure you receive the best possible rate, you should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling your visit. These discounts can further reduce the cost if you choose to pay out-of-pocket, bypassing the higher administrative costs associated with insurance claims processing.