Blood test, clotting time (PTT)
Facility: Grisell Memorial Hospital
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $30
- Cash Discount Price: $43
- vs. Medicare Baseline: 4.99x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 499% of the Medicare baseline (a markup of 399%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 | $2 - $41 | 33% |
| Blue Cross Blue Shield | $21 | 349% |
| Humana | $35 - $55 | 582% |
| Medicaid / KanCare | $35 - $55 | 582% |
Consumer Guidance & Cost Commentary
For this blood clotting time test at Grisell Memorial Hospital in Ransom, KS, the facility's cash price of $43.00 is slightly lower than the state average, which sits at $45.00. While the hospital is a Critical Access Hospital owned by a government hospital district, patients should be aware that commercial insurance negotiated rates often exceed cash prices due to administrative overhead and contract structures. In this case, the median negotiated rate across payers is $30.00, which is lower than the cash price, meaning insurance coverage would likely result in a lower out-of-pocket cost for most members. However, if a patient has a high deductible plan that has not yet met their coverage threshold, paying the cash price of $43.00 upfront could be more cost-effective than facing the full negotiated rate, as the insurance company would not pay anything until the deductible is satisfied.
To minimize costs, patients should proactively contact the hospital billing department to confirm if "self-pay" or "prompt-pay" discounts are available before scheduling the test, as these upfront incentives can bypass standard insurance billing cycles. It is also important to request a detailed, itemized bill rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as double-billing or unbundled codes that can be disputed. Finally, while the facility's rates are competitive against the state average, patients should verify their specific plan's allowed amount, as commercial rates can vary significantly between insurers; for instance, UnitedHealthcare plans have a range of $2 to $41, whereas Medicaid/KanCare plans range from $35 to $55, highlighting the importance of checking individual coverage details