85240

Clotting factor viii (ahg) measurement

Medicare pricing data for 230 providers across 31 states

🤖AI Overview

This procedure has a 11.6x markup — hospitals charge $203.17 but Medicare allows only $17.51. Uninsured patients may face bills 11.6 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

Clotting factor viii (ahg) measurement (HCPCS code 85240) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $17.51, but hospitals typically charge $203.17 — a 11.6x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$3.50

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $17.51, your out-of-pocket cost would be approximately $3.50. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$17.51
Average Hospital Charge
$203.17
Markup Ratio
11.6x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$203.17
Medicare Allowed$17.51
Medicare Payment$17.51

Hospitals charge 11.6x more than what Medicare allows for this procedure. Medicare actually pays $17.51 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Georgia$18$2642535+0.2%
Illinois$18$2036232+0.2%
Iowa$18$78216+0.2%
Maine$18$70120+0.2%
Maryland$18$2284176+0.2%
Massachusetts$18$2566167+0.2%
Michigan$18$48613+0.2%
Nevada$18$2672129+0.2%
North Dakota$18$138412+0.2%
Ohio$18$20911154+0.2%
Oklahoma$18$221384+0.2%
Oregon$18$98433+0.2%
Pennsylvania$18$2818152+0.2%
Tennessee$18$135392+0.2%
Utah$18$392119+0.2%
Virginia$18$133574+0.2%
Puerto Rico$18$19511+0.2%
Alabama$18$1993128+0.2%
California$18$208231,171+0.2%
New Jersey$18$20263,278+0.1%
Florida$18$2449827+0.1%
Colorado$18$21654280.0%
North Carolina$18$22271,786-0.1%
Arizona$18$20941,080-0.1%
Minnesota$17$21332267-0.1%
New York$17$19419407-0.1%
Texas$17$129121,271-0.2%
Kansas$17$2334148-0.4%
Washington$17$1725143-0.5%
Wisconsin$17$163666-1.4%
Hawaii$17$96226-2.5%

⚠️ 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