85302

Protein c, (clotting inhibitor) activity

Medicare pricing data for 129 providers across 25 states

🤖AI Overview

This procedure has a 16.8x markup — hospitals charge $197.98 but Medicare allows only $11.75. Uninsured patients may face bills 16.8 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

Protein c, (clotting inhibitor) activity (HCPCS code 85302) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $11.75, but hospitals typically charge $197.98 — a 16.8x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$2.35

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $11.75, your out-of-pocket cost would be approximately $2.35. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$11.75
Average Hospital Charge
$197.98
Markup Ratio
16.8x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$197.98
Medicare Allowed$11.75
Medicare Payment$11.75

Hospitals charge 16.8x more than what Medicare allows for this procedure. Medicare actually pays $11.75 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Florida$12$2657664+0.2%
Georgia$12$2621167+0.2%
Illinois$12$244272+0.2%
Maryland$12$2632159+0.2%
Massachusetts$12$268388+0.2%
Michigan$12$68321+0.2%
Minnesota$12$433230+0.2%
Nevada$12$271281+0.2%
Oklahoma$12$256221+0.2%
Pennsylvania$12$210538+0.2%
Tennessee$12$93227+0.2%
Utah$12$25244+0.2%
Washington$12$199318+0.2%
Wisconsin$12$144220+0.2%
Alabama$12$151285+0.2%
Colorado$12$2124188+0.2%
North Carolina$12$17661,583+0.1%
Texas$12$1319788+0.1%
Arizona$12$20048740.0%
New Jersey$12$21861,301-0.1%
California$12$22415383-0.1%
Kansas$12$229370-0.6%
Virginia$12$31473-0.9%
Ohio$12$119990-0.9%
New York$12$173662-1.4%

⚠️ 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