85379

Coagulation function measurement, d-dimer; quantitative

Medicare pricing data for 5,713 providers across 49 states

🤖AI Overview

This procedure has a 12.6x markup — hospitals charge $125.34 but Medicare allows only $9.95. Uninsured patients may face bills 12.6 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

Coagulation function measurement, d-dimer; quantitative (HCPCS code 85379) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $9.95, but hospitals typically charge $125.34 — a 12.6x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$1.99

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $9.95, your out-of-pocket cost would be approximately $1.99. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$9.95
Average Hospital Charge
$125.34
Markup Ratio
12.6x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$125.34
Medicare Allowed$9.95
Medicare Payment$9.95

Hospitals charge 12.6x more than what Medicare allows for this procedure. Medicare actually pays $9.95 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Delaware$10$22220+0.3%
Kentucky$10$3731431+0.3%
Maine$10$4935143+0.3%
Montana$10$3431196+0.3%
New Mexico$10$18913442+0.3%
Rhode Island$10$358776+0.3%
South Dakota$10$5647266+0.3%
Wyoming$10$9140263+0.3%
Connecticut$10$12411367+0.3%
Florida$10$1671248,379+0.2%
Indiana$10$11735749+0.2%
Kansas$10$1461083,769+0.2%
Nevada$10$128521,907+0.2%
New Jersey$10$12914516,078+0.2%
Ohio$10$1511225,033+0.2%
Oregon$10$58661,096+0.2%
Virginia$10$551202,429+0.2%
Puerto Rico$10$3962172+0.2%
California$10$12415519,971+0.2%
Colorado$10$164521,496+0.2%
Louisiana$10$70521,126+0.1%
Maryland$10$118272,197+0.1%
Massachusetts$10$1053273,674+0.1%
New York$10$973626,974+0.1%
North Carolina$10$18038614,453+0.1%
Pennsylvania$10$122231,259+0.1%
Arizona$10$161356,400+0.1%
Missouri$10$115916180.0%
Texas$10$13234715,8680.0%
Illinois$10$1093224,713-0.1%
Michigan$10$5828785-0.1%
Tennessee$10$1001743,014-0.1%
Minnesota$10$646102,580-0.2%
Oklahoma$10$94202,027-0.2%
Utah$10$54161816-0.2%
Nebraska$10$31731,018-0.3%
Alabama$10$1501944,507-0.3%
Georgia$10$9876770-0.4%
Idaho$10$7029284-0.6%
Arkansas$10$28112862-0.6%
Wisconsin$10$1123112,768-0.7%
Iowa$10$502001,404-0.8%
Washington$10$1032653,556-0.8%
Hawaii$10$585754-0.9%
South Carolina$10$6174901-1.1%
Mississippi$10$48104948-1.2%
North Dakota$10$6513249-1.5%
Alaska$9$1191626-5.8%
West Virginia$9$79213-7.4%

⚠️ 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