CMS Price Transparency Data

Blood test, clotting time (PTT)

Facility: Hamilton Memorial Hospital

Billing Code: 85730 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85730
Insurance Median: $40
Cash Discount Price: $56
vs. Medicare Baseline: 6.66x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PTT) at Hamilton Memorial Hospital is $40. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $56. Compared to the federal Medicare reimbursement reference rate of $6.01, this hospital’s rate is 6.66x the Medicare baseline. Located in 611 S Marshall Avenue, McLeansboro, IL.

Cash / Self-Pay

$56

Average discount available for prompt cash payment at this facility.

Insurance Median

$40

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$6.01

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $6.01 (100%)

Cash / Self-Pay: $56 (932%)

Insurance Median: $40 (666%)

Cash: $56 (932% of Medicare)

Ins. Median: $40 (666% of 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 666% of the Medicare baseline (a markup of 566%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Medicaid / KanCare	$16 - $36	266%
Blue Cross Blue Shield	$17 - $82	283%
Aetna	$18 - $81	300%
Health Alliance	$18 - $72	300%
Humana	$18 - $36	300%
Medicare (plans)	$18 - $36	300%
UnitedHealthcare	$18 - $65	300%
Wellcare	$18 - $36	300%
Alliance Coal	$31 - $63	516%
Healthscope	$31 - $63	516%
Wellfirst (Ssmhic)	$31 - $63	516%
Hope Trust	$33 - $68	549%
Cigna	$35 - $71	582%
Hfn, Inc	$35 - $81	582%
Healthlink	$37 - $81	616%
Multiplan	$37 - $77	616%
Siho	$40 - $81	666%
Three Rivers Provider	$40 - $81	666%
Healthsmart	$42 - $86	699%
Stratose	$42 - $86	699%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $56.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 85730.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Hamilton Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 85730.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.