Blood test, clotting time (PTT)
Facility: Orthopaedic Hospital of Wisconsin
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $9
- Cash Discount Price: $39
- vs. Medicare Baseline: 1.50x 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.
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 |
|---|---|---|
| Humana | $6 | 100% |
| Network Health Plan | $8 | 133% |
| Blue Cross Blue Shield | $9 - $15 | 150% |
| Children'S Community Health Plan | $11 | 183% |
| The Alliance | $11 | 183% |
Consumer Guidance & Cost Commentary
Orthopaedic Hospital Of Wisconsin, located at 475 W River Woods Pkwy in Glendale, WI, offers a cash payment rate of $39 for the Blood test, clotting time (PTT) procedure. This cash price is significantly lower than the facility's gross charge of $74. For patients with high-deductible plans, paying the cash rate of $39 may be more cost-effective than relying on insurance, especially if the negotiated rates for insurers like Blue Cross Blue Shield ($9 to $15) or Children's Community Health Plan ($11) exceed the self-pay amount. It is important to verify with the hospital whether "self-pay" or "prompt-pay" discounts are available, as these upfront payments can bypass administrative fees and reduce the final bill.
The commercial negotiated rates for this service range from $8 to $15 across five payers, which is notably higher than the cash price of $39. While the facility is owned by physicians and rated as an Acute Care Hospital, there is no publicly available rating for the facility itself. The price transparency data indicates a markup of 1.5 times the Medicare amount of $6.01, reflecting the typical administrative overhead and contract dynamics that inflate commercial rates above the federal baseline. Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network services at in-network facilities, it is crucial to request an itemized bill to ensure no unexpected ancillary charges are included.