Blood test, clotting time (PTT)
Facility: Oakleaf Surgical Hospital
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $6
- Cash Discount Price: $32
- vs. Medicare Baseline: 1.00x 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 |
|---|---|---|
| Blue Cross Blue Shield | $6 | 100% |
| Dean Health Plan | $6 | 100% |
| Group Health Cooperative Of Eau Claire | $6 | 100% |
| Healthpartners | $6 | 100% |
| Humana | $6 | 100% |
| Medica | $6 | 100% |
| Quartz Health Solutions | $6 | 100% |
| Security Health Plan Of Wi | $6 | 100% |
| Ucare Wi | $6 | 100% |
| UnitedHealthcare | $6 | 100% |
Consumer Guidance & Cost Commentary
For CPT code 85730, a blood test measuring clotting time (PTT), Oakleaf Surgical Hospital in Altoona, WI, lists a cash price of $32. This cash rate is significantly lower than the facility's gross chargemaster of $35 and the negotiated rates of $6 paid by all 10 commercial payers listed, including Blue Cross Blue Shield, Humana, and UnitedHealthcare. While the facility is owned by physicians and rated as an acute care hospital, the cash price here does not reflect the typical $32 average cash rate found in Wisconsin; however, it remains notably lower than the national average of $32 for this specific procedure, making it a competitive option for self-pay patients.
Because the negotiated rates of $6 are higher than the cash price of $32, patients with high-deductible plans may find that paying out-of-pocket is the most cost-effective choice, provided they can secure a self-pay or prompt-pay discount. Although the No Surprises Act prohibits balance billing for emergency services at in-network facilities, patients should still request an itemized billing audit to ensure no unbundled charges or services not rendered are included in their final invoice. If a commercial payer's allowed amount exceeds the cash price, patients should explicitly ask the hospital's billing department to classify the visit as self-pay to bypass insurance claims processing and access potential prompt-pay reductions.