Blood test, clotting time (PTT)
Facility: Graham County Hospital
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $37
- Cash Discount Price: $83
- vs. Medicare Baseline: 6.16x 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 616% of the Medicare baseline (a markup of 516%). 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 | $3 - $116 | 50% |
| Medicaid / KanCare | $8 | 133% |
| Blue Cross Blue Shield | $22 | 366% |
| Medicare (plans) | $33 - $92 | 549% |
| Celtic Commercial-All Other Plans | $37 - $101 | 616% |
| Wppa (Providers Care)-All Plans | $42 - $116 | 699% |
Consumer Guidance & Cost Commentary
For this blood clotting time test at Graham County Hospital in Hill City, Kansas, the cash price is $83.00, which matches the facility's median negotiated rate. While the hospital is a Critical Access Hospital owned by the local government, patients should be aware that commercial insurance plans often pay significantly less than the cash price due to complex administrative structures. For instance, Medicaid/KanCare and Blue Cross Blue Shield have a single plan each with a negotiated rate of $8.00 and $22.00 respectively, whereas Medicare plans average $6.01. If you have a high-deductible plan, paying the full cash price of $83.00 upfront might be more cost-effective than your insurance covering a negotiated rate that could exceed your deductible, especially since the facility's cash rate is identical to its median negotiated rate for cash payers.
To minimize costs, we recommend asking the hospital directly about "self-pay" or "prompt-pay" discounts before scheduling, as these can reduce the bill by 20% to 50% by bypassing expensive insurance claims processing. Additionally, since over 80% of hospital bills contain errors, we strongly advise requesting a detailed, itemized statement rather than accepting a summary bill, which can hide unbundled charges or services not rendered. When evaluating the facility's pricing against the broader market, the Medicare benchmark of $6.01 serves as a reliable baseline for the true cost of care, highlighting that commercial rates often include significant markups beyond the actual cost of delivery.