85300

Antithrombin iii antigen (clotting inhibitor) activity

Medicare pricing data for 257 providers across 34 states

🤖AI Overview

This procedure has a 16.6x markup — hospitals charge $192.86 but Medicare allows only $11.59. Uninsured patients may face bills 16.6 times higher than what insurance negotiates. Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.

💡 What You Should Know

Antithrombin iii antigen (clotting inhibitor) activity (HCPCS code 85300) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $11.59, but hospitals typically charge $192.86 — a 16.6x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$2.32

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $11.59, your out-of-pocket cost would be approximately $2.32. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$11.59
Average Hospital Charge
$192.86
Markup Ratio
16.6x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$192.86
Medicare Allowed$11.59
Medicare Payment$11.59

Hospitals charge 16.6x more than what Medicare allows for this procedure. Medicare actually pays $11.59 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Georgia$12$2831554+0.2%
Illinois$12$2646194+0.2%
Indiana$12$105214+0.2%
Iowa$12$86231+0.2%
Kentucky$12$47216+0.2%
Louisiana$12$205321+0.2%
Massachusetts$12$2754262+0.2%
Minnesota$12$15030314+0.2%
Nevada$12$2812147+0.2%
New Mexico$12$194151+0.2%
Oklahoma$12$214385+0.2%
Oregon$12$95440+0.2%
Pennsylvania$12$2407170+0.2%
South Dakota$12$114317+0.2%
Tennessee$12$824148+0.2%
Utah$12$57324+0.2%
Puerto Rico$12$121225+0.2%
Alabama$12$1574117+0.2%
Florida$12$27091,196+0.1%
North Carolina$12$19292,250+0.1%
California$12$213231,383+0.1%
Kansas$12$24452520.0%
New Jersey$12$182222,9920.0%
New York$12$216185180.0%
Arizona$12$19261,7110.0%
Colorado$12$16543680.0%
Maryland$12$2424249-0.2%
Texas$12$127131,801-0.2%
Wisconsin$12$1667117-0.5%
Ohio$11$1129173-0.9%
Virginia$11$455100-1.6%
Washington$11$1705101-1.7%
Hawaii$11$90251-2.2%
North Dakota$11$70411-9.0%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

Related from TheDataProject.ai

💊 Need post-procedure medications? Check costs on OpenPrescriber