CMS Price Transparency Data

Blood test, clotting time (PTT)

Facility: SSM Health St Mary's Hospital - Madison

Billing Code: 85730 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85730
Insurance Median: $11
Cash Discount Price: $31
vs. Medicare Baseline: 1.83x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PTT) at SSM Health St Mary's Hospital - Madison is $11. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $31. Compared to the federal Medicare reimbursement reference rate of $6.01, this hospital’s rate is 1.83x the Medicare baseline. Located in 700 South Park St, Madison, WI.

Cash / Self-Pay

$31

Average discount available for prompt cash payment at this facility.

Insurance Median

$11

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: $31 (516%)

Insurance Median: $11 (183%)

Cash: $31 (516% of Medicare)

Ins. Median: $11 (183% 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.

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
Molina	$5	83%
Dean Health Plan	$6	100%
Centivo	$8	133%
The Alliance	$11	183%
Blue Cross Blue Shield	$49 - $53	815%

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 $31.
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 SSM Health St Mary's Hospital - Madison 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.