What is a CPT code and why is it important for understanding healthcare pricing?

A CPT (Current Procedural Terminology) code is a five-digit numerical code used to describe medical, surgical, and diagnostic services and procedures. These codes are crucial for healthcare pricing and billing because they standardize the identification of services, allowing for consistent communication between providers, payers (insurance companies), and patients. When you want to find the cost of a specific medical service, knowing its CPT code can help you search for pricing information more accurately.

How can I find out the cost of a specific medical procedure or service before I receive it?

To find out the cost of a specific medical procedure or service, you can use various resources. For a personalized estimate based on CPT code and location, it is recommended to use tools like Payerprice. Payerprice offers a fee schedule lookup tool that allows users to search with a CPT code and specific location to get an idea of potential costs. You can also contact your insurance provider directly or the healthcare facility where you plan to receive the service.

Why do healthcare costs vary so much for the same procedure or service?

Healthcare costs can vary significantly due to a multitude of factors. These include geographical location (costs are often higher in urban areas), the type of facility (e.g., hospital vs. outpatient clinic), the specific provider's fees, negotiations with different insurance companies, and even the complexity of individual patient cases. Additionally, varying overhead costs, technology investments, and market competition contribute to price disparities.

What factors influence the final price I pay for a medical service?

The final price you pay for a medical service is influenced by several factors beyond the service's base cost. These include your insurance plan's deductible, copayment, coinsurance, and out-of-pocket maximums. Whether the provider is in-network or out-of-network with your insurance, and any additional services or complications that arise during the procedure, will also affect the total bill. For specific pricing tailored to your situation, using a tool like Payerprice with your CPT code and location can provide valuable insights.

Is there a way to compare prices for medical services before choosing a provider?

Yes, comparing prices for medical services before choosing a provider is possible and highly recommended. Utilizing online tools designed for price transparency, such as Payerprice, can be very effective. Payerprice allows you to input specific CPT codes and locations to get an estimate of various provider costs, helping you make an informed decision based on both quality and affordability. Additionally, you can directly contact different healthcare facilities or your insurance company to request price estimates for planned procedures.

CPT 85730 Fee Schedule

Last Verified: July 2026

Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.

Blood Clotting Time, Partial Thromboplastin Time Assesses The Amount Of Time It Takes For Blood To Clot. The Test Screens For Bleeding Conditions And Is Used To Monitor The Dose Of Heparin And Other Blood Thinners.

Key Fact	Detail
Service Type	Hematology and Coagulation Procedures Pathology and Laboratory Procedures
Common Place of Service	21 - Inpatient Hospital 81 - Independent Laboratory
Common Modifiers	None 26 - Professional component TC - Technical component
Complexity Level	Low
Medicare Fee Schedule	View Medicare rates for 85730

National average reimbursement for CPT 85730 by major payers:

$5.31

$4.29

$7.56

$8.82

Preview provider-level rates for...

For billing codeCPT 85730

Payer	Code	Rate	NPI	Tax ID	State	Specialty
United	85730	$3.60	1912983206 - JASON EDLING	202305158 - TRIHEALTH G, LLC	OH	Gastroenterology Physician (207RG0100X)
United	85730	$10.30	1053548891 - AMIT MORI	450226711 - ST ALEXIUS MEDICAL CENTER	SC	Gastroenterology Physician (207RG0100X)
United	85730	$2.51	1568608198 - ASHUTOSH GUPTA	352535461	TX	Gastroenterology Physician (207RG0100X)
United	85730	$3.44	1699811737 - KHIZAR AHSAN MD PA	201832351 - (TX) KHIZAR AHSAN MD PA	TX	Gastroenterology Physician (207RG0100X)
United	85730	$2.51	1922501519 - MUKESH SHARMA	352535461	TX	Gastroenterology Physician (207RG0100X)
United	85730	$11.85	1881782654 - JIMMY MORRISON	43369653 - MAINEGENERAL HEALTH	TX	Gastroenterology Physician (207RG0100X)
United	85730	$3.46	1053377051 - GOWRAPPALA RAMESH	752005254 - TEXAS DIGESTIVE DISEASE CONSULTANTS	TX	Gastroenterology Physician (207RG0100X)
United	85730	$5.73	1821309592 - GERALD MANK	20777195 - BLUE RIDGE HEALTHCARE MEDICAL GROUP INC	NC	Gastroenterology Physician (207RG0100X)
United	85730	$3.68	1932333093 - DOMENICO VITERBO	141338428 - ELLIS HOSPITAL	NY	Gastroenterology Physician (207RG0100X)
United	85730	$2.77	1891735288 - HASHIM KHANDWALLA	10593260 - (TX) DIGESTIVE AND LIVER SPECIALISTS OF HOUSTON	TX	Gastroenterology Physician (207RG0100X)
United	85730	$3.68	1962729053 - ROHIT SHARDA	562084786	WA	Gastroenterology Physician (207RG0100X)
United	85730	$2.51	1992887954 - HOWARD STEIN	203960279 - (TX) HOWARD A STEIN MD PA	TX	Gastroenterology Physician (207RG0100X)
United	85730	$4.94	1750589610 - KEVIN MEYERS	475419443	TX	Gastroenterology Physician (207RG0100X)
United	85730	$2.51	1912082355 - JOYCELYN THEARD	203573385 - (TX) TEXAS INSTITUTE OF GASTROENTEROLOGY ASSOC., P.A.	TX	Gastroenterology Physician (207RG0100X)
United	85730	$6.07	1972501252 - BAYCARE HOME CARE, INC.	593582520 - (FL) BAYCARE HOME CARE INC	FL	Home Health Agency (251E00000X)
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist

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CPT 85730 vs. Other Pathology and Laboratory Procedures Codes

The CPT 85730 code is part of the Hematology and Coagulation Procedures services used for Pathology and Laboratory Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.

The CPT 85730 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.

Code	Complexity	Description
85520-CPT	Low	Heparin Blood Test, This Test Helps To Manage Low-Dose Heparin Therapy. It Is A Simple Measure Of The Amount Of Heparin Present In A Blood Sample.
85525-CPT	Low	Removal Of Heparin From Sample, Heparin Is An Anti-Clotting Drug Frequently Given After Surgery. Prior To Testing Blood Heparin Is Removed From The Sample So That Evaluation Of Liver Function Is Accurate.
85576-CPT	Low	Platelet (Clotting) Test, Platelets Are Red Blood Cells That Clump Together When Blood Clots. This Test Adds A Material To Stimulate Clumping To A Blood Sample And Then Measures How Long Before Clumping Starts And How Well The Cells Stick Together.
85730-CPT	Low	Blood Clotting Time, Partial Thromboplastin Time Assesses The Amount Of Time It Takes For Blood To Clot. The Test Screens For Bleeding Conditions And Is Used To Monitor The Dose Of Heparin And Other Blood Thinners.

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 85730. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 85730 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.

Factors that affect fee schedules

Medicare & Medicaid Rates

Government-set reimbursement amounts

Private Insurance Rates

Negotiated rates between providers and insurance companies

Geographic Location

Costs may be higher in urban areas.

Provider Type

Hospital providers may have different rates than private practice.

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