Blood test, clotting time (PTT)
Facility: Wamego Health Center
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $6
- Cash Discount Price: $28
- 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 |
|---|---|---|
| UnitedHealthcare | $5 | 83% |
| Medicaid / KanCare | $5 - $6 | 83% |
| Aetna | $5 | 83% |
| Providrs Care | $6 | 100% |
| Blue Cross Blue Shield | $31 - $172 | 516% |
Consumer Guidance & Cost Commentary
For the blood clotting time test (CPT 85730) at Wamego Health Center in Wamego, KS, the facility's cash median rate is $28.00, which is significantly lower than the gross chargemaster price of $70.00. While the facility is a Critical Access Hospital with voluntary non-profit ownership, the data does not provide specific county or state average rates for this procedure to make a direct comparison. However, patients with high-deductible plans or those without insurance may find the cash price most advantageous, as it avoids the administrative costs and potential markups associated with insurance billing. It is important to note that commercial negotiated rates, which are often higher than cash prices due to administrative overhead and contract dynamics, are not available in this dataset; the only available negotiated figure is a median of $6.00, which appears to be a specific contract rate rather than a general market average.
When using insurance, patients should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, though out-of-network ancillary services like certain lab tests can sometimes trigger unexpected bills if not properly coordinated. To ensure transparency and avoid errors, consumers should request a full itemized bill before paying, as summary bills often obscure individual code costs and unbundled charges. Additionally, patients should verify their deductible status before scheduling, as paying the full negotiated rate without meeting the deductible can result in significant out-of-pocket expenses. Finally, patients should explicitly ask the facility about self-pay or prompt-pay discounts, which can reduce the total cost by 20% to 50% if paid upfront, effectively bypass