85730

Coagulation assessment blood test, plasma or whole blood

Medicare pricing data for 5,262 providers across 50 states

🤖AI Overview

This procedure has a 7.4x markup — hospitals charge $43.55 but Medicare allows only $5.88. Uninsured patients may face bills 7.4 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 assessment blood test, plasma or whole blood (HCPCS code 85730) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $5.88, but hospitals typically charge $43.55 — a 7.4x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$1.18

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $5.88, your out-of-pocket cost would be approximately $1.18. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$5.88
Average Hospital Charge
$43.55
Markup Ratio
7.4x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$43.55
Medicare Allowed$5.88
Medicare Payment$5.88

Hospitals charge 7.4x more than what Medicare allows for this procedure. Medicare actually pays $5.88 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Delaware$6$17374+0.2%
Florida$6$4823047,949+0.2%
Georgia$6$52374,154+0.2%
Idaho$6$411094+0.2%
Montana$6$37534+0.2%
Nebraska$6$217157+0.2%
New Hampshire$6$3644191+0.2%
New Jersey$6$4531668,690+0.2%
Utah$6$1835276+0.2%
Wyoming$6$291168+0.2%
Alaska$6$55652+0.2%
California$6$4126881,048+0.2%
Colorado$6$56182,366+0.2%
Illinois$6$433036,2840.0%
Iowa$6$27621,0380.0%
Kansas$6$51422,8950.0%
Louisiana$6$33781,8240.0%
Maryland$6$41947,3830.0%
Massachusetts$6$482294,7810.0%
Minnesota$6$462182,5600.0%
Missouri$6$51567830.0%
Nevada$6$51243,9810.0%
New Mexico$6$5166100.0%
New York$6$5183630,9220.0%
North Carolina$6$4518522,3070.0%
Oklahoma$6$34181,6790.0%
Oregon$6$27466470.0%
Pennsylvania$6$40333,8490.0%
Tennessee$6$352583,0700.0%
Texas$6$4534227,1040.0%
Puerto Rico$6$74364,6470.0%
Alabama$6$44485,6630.0%
Arizona$6$479113,7470.0%
Connecticut$6$461121,4010.0%
Hawaii$6$2253,090-0.2%
Kentucky$6$2659576-0.2%
Michigan$6$20541,904-0.2%
Ohio$6$352097,108-0.2%
Rhode Island$6$267248-0.2%
Indiana$6$2854992-0.3%
Mississippi$6$58151,100-0.3%
North Dakota$6$4916257-0.3%
South Carolina$6$36371,263-0.3%
South Dakota$6$3526172-0.3%
Virginia$6$24402,856-0.3%
Wisconsin$6$50391,349-0.3%
Washington$6$441172,852-0.5%
Arkansas$6$2757569-0.9%
Maine$6$30296-1.5%
West Virginia$6$27852-1.7%

⚠️ 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

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