80164

Valproic acid level, total

Medicare pricing data for 1,376 providers across 47 states

🤖AI Overview

This procedure has a 5.3x markup — hospitals charge $70.14 but Medicare allows only $13.26. Uninsured patients may face bills 5.3 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

Valproic acid level, total (HCPCS code 80164) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $13.26, but hospitals typically charge $70.14 — a 5.3x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$2.65

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $13.26, your out-of-pocket cost would be approximately $2.65. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$13.26
Average Hospital Charge
$70.14
Markup Ratio
5.3x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$70.14
Medicare Allowed$13.26
Medicare Payment$13.26

Hospitals charge 5.3x more than what Medicare allows for this procedure. Medicare actually pays $13.26 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Delaware$13$263414+0.1%
Florida$13$484226,185+0.1%
Georgia$13$67186,630+0.1%
Idaho$13$565193+0.1%
Illinois$13$687310,136+0.1%
Kentucky$13$20232,138+0.1%
Maryland$13$55132,748+0.1%
Mississippi$13$38121,045+0.1%
Missouri$13$34161,186+0.1%
New Hampshire$13$116857+0.1%
New Mexico$13$803329+0.1%
Oklahoma$13$37133,729+0.1%
Oregon$13$597630+0.1%
Rhode Island$13$613371+0.1%
South Carolina$13$32141,012+0.1%
South Dakota$13$7511365+0.1%
Texas$13$719413,922+0.1%
Utah$13$3715352+0.1%
Virginia$13$43303,019+0.1%
West Virginia$13$90661+0.1%
Arkansas$13$22152,113+0.1%
Kansas$13$111215,3100.0%
Louisiana$13$59345,8530.0%
Massachusetts$13$781048,1710.0%
Nevada$13$4186,5010.0%
New Jersey$13$852524,4420.0%
New York$13$88172,6160.0%
North Carolina$13$932512,8860.0%
Ohio$13$762417,6880.0%
Pennsylvania$13$89184,2380.0%
Alabama$13$89274,6310.0%
California$13$786317,9640.0%
Colorado$13$7191,7040.0%
Indiana$13$448557-0.1%
Washington$13$98332,192-0.1%
Arizona$13$106192,520-0.1%
Iowa$13$667416-0.2%
Maine$13$612350-0.2%
North Dakota$13$6413665-0.2%
Tennessee$13$66701,735-0.2%
Hawaii$13$712187-0.2%
Michigan$13$32242,956-0.4%
Puerto Rico$13$184674-0.4%
Minnesota$13$752851,433-0.5%
Nebraska$13$424210-0.6%
Wisconsin$13$105371,285-0.8%
Connecticut$13$975470-0.9%

⚠️ 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