85246

Clotting factor viii (vw factor) antigen

Medicare pricing data for 179 providers across 29 states

🤖AI Overview

This procedure has a 9.8x markup — hospitals charge $220.60 but Medicare allows only $22.41. Uninsured patients may face bills 9.8 times higher than what insurance negotiates. This is a specialized procedure with relatively few Medicare claims. Pricing data may be less reliable due to smaller sample sizes. 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 (vw factor) antigen (HCPCS code 85246) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $22.41, but hospitals typically charge $220.60 — a 9.8x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$4.48

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $22.41, your out-of-pocket cost would be approximately $4.48. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$22.41
Average Hospital Charge
$220.60
Markup Ratio
9.8x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$220.60
Medicare Allowed$22.41
Medicare Payment$22.41

Hospitals charge 9.8x more than what Medicare allows for this procedure. Medicare actually pays $22.41 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Georgia$22$2491193+0.3%
Hawaii$22$95212+0.3%
Illinois$22$1963112+0.3%
Iowa$22$105216+0.3%
Maine$22$81113+0.3%
Maryland$22$2393111+0.3%
Massachusetts$22$2394132+0.3%
Nevada$22$288274+0.3%
New Mexico$22$272131+0.3%
Ohio$22$2341058+0.3%
Oklahoma$22$215334+0.3%
Oregon$22$130427+0.3%
Pennsylvania$22$231772+0.3%
Tennessee$22$201147+0.3%
Utah$22$47273+0.3%
Virginia$22$95332+0.3%
Washington$22$173577+0.3%
Alabama$22$203260+0.3%
California$22$22115590+0.3%
Colorado$22$2534106+0.3%
New Jersey$22$21261,648+0.2%
North Carolina$22$2327882+0.2%
Florida$22$2587464+0.1%
Arizona$22$2252484+0.1%
Minnesota$22$271242450.0%
New York$22$3691388-0.4%
Kansas$22$241472-0.8%
Texas$22$1589410-2.1%
Wisconsin$21$202632-5.9%

⚠️ 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