Blood Test · 85130
Assessment Of Blood Clotting Function
What Medicare pays for 85130, what providers bill, and how the price varies across 4 states, drawn from CMS 2023 claims data.
- $11.65
- Medicare pays
- $80.99
- Providers bill
- 7.0×
- Markup
- #5,674 of 9,297
- Volume rank
The verdict
Assessment Of Blood Clotting Function pairs modest national service volume with an above-median markup.
- 39th pct.
- national service volume
- Top 37%
- billed-to-Medicare markup
- 7.0×
- billed vs. Medicare
- $11.65
- Medicare pays, national avg
Volume percentile ranks this code's national service volume against every tracked procedure; markup percentile ranks its billed-to-Medicare ratio the same way. The same two figures drive both the verdict sentence and the chips above.
According to the Centers for Medicare & Medicaid Services (CMS), the 2023 Medicare Physician & Other Practitioners dataset records payments for 9,297 procedure codes billed across 5,426 hospitals in 56 states and territories; see our methodology for how each figure is sourced and computed.
Jurisdiction coverage for this code
56states and territories in the CMS extract
Price Range Across States
What You Might Pay
Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.
How we estimate these prices
These estimates are based on the RAND Hospital Price Transparency Study (4th Edition, 2024). We map each PlainProcedure category onto a RAND CPT-section bucket (Surgery, Radiology, Pathology and Laboratory, Medicine, Anesthesia, Evaluation and Management) or fall back to the national average when no bucket matches. For Blood Test, the applied ratio is 1.85x Medicare (RAND 2024 Pathology and Laboratory bucket (1.85x) + CMS Medicare baseline). Cash/self-pay estimates blend typical cash discounts (55% of billed charges) with Medicare-based estimates (150% of allowed amounts). These are statistical estimates, not quotes. Contact your insurer or provider for actual costs.
Where this markup sits nationally
Markup (billed ÷ Medicare) across 8,901 procedures with a meaningful Medicare rate
7 Among the most affordable more affordable than 63% of 8,901 procedures
Each bar is a 1-wide band; taller bars hold more procedures. The dashed line + filled bar mark this entry. Hover or tap any bar for its full count, share, and where it sits relative to this entry.
Source CMS Medicare Physician & Other Practitioners · 2023
What the billed charge breaks down into
$80.99
Prices by State
| State | Medicare Payment | Billed Charge |
|---|---|---|
| Minnesota | $11.65 | $49.57 |
| New Jersey | $11.65 | $180.17 |
| New Mexico | $11.65 | $223.69 |
| Washington | $11.65 | $101.19 |
What the Data Says About Assessment Of Blood Clotting Function
Across 4 states with reporting providers, CPT code 85130 (Assessment Of Blood Clotting Function) shows a national average Medicare payment of $11.65 against an average billed charge of $80.99. That gap, a 7.0x markup, or 595% above the Medicare allowed amount, is roughly in line with what most procedures show, chargemaster pricing that no major payer pays in full but that still anchors negotiations.
Blood Test procedures like this one saw 552 services billed to Medicare in 2023 by 95 distinct providers, serving 136 unique beneficiaries. State-level variation is significant: Washington reports the lowest average payment at $11.65, while Minnesota reports the highest at $11.65. At just 0%, this procedure prices remarkably consistently nationwide, GPCI adjustments barely move the needle for this particular code. Applying the RAND 2024 commercial-to-Medicare ratio for this category (1.85x Medicare; RAND 2024 Pathology and Laboratory bucket (1.85x) + CMS Medicare baseline), the estimated commercial insurance price lands near $21.55, with self-pay cash discounts commonly bringing the figure closer to $31.01. Within Blood Test, Assessment Of Blood Clotting Function ranks #69 of 145 tracked procedures by national average Medicare payment.
Where this sits in the registry
Assessment Of Blood Clotting Function (85130) is a CMS 2023 Part B code. These pages keep the volume map and the markup map separate.
- National volume versus markup on the statistics page, the same two maps as this capsule. Statistics
- Other Blood Test codes, ranked by Medicare payment inside the category. Category
- How volume rank and markup rank are computed. Methodology
- The full procedures listing in volume order. Procedures
Figures here are CMS averages, not a quote for any patient, plan, or visit.
Frequently Asked Questions
Where does Assessment Of Blood Clotting Function rank among Medicare procedures?
According to CMS Medicare Part B claims, Assessment Of Blood Clotting Function (CPT 85130) ranks #5,674 of 9,297 procedures by national service volume, the same sort as the procedures listing, and #69 of 145 within Blood Test by national average Medicare payment. See /methodology#corpus-placement.
How much does Assessment Of Blood Clotting Function cost?
Assessment Of Blood Clotting Function (CPT 85130) is priced fairly consistently nationwide: Medicare pays $11.65 on average, and the $11.65-$11.65 state range stays relatively tight. Providers typically bill $80.99.
Why do providers charge more than Medicare pays?
Providers set their own chargemaster rates (billed charges), which are typically much higher than what any insurer pays. Medicare pays a fixed rate based on the procedure code and geographic location. The billed charge is relevant mainly for uninsured patients, who may face prices closer to the submitted charge.
How much does Assessment Of Blood Clotting Function cost with insurance?
With commercial insurance, assessment of blood clotting function costs an estimated $21.55 on average (range: $15.09-$30.17), a moderate premium over Medicare's $11.65. Without insurance, the estimated cash price is $31.01.
Which state has the lowest cost for Assessment Of Blood Clotting Function?
Washington and Minnesota bookend the range for Assessment Of Blood Clotting Function, at $11.65 and $11.65 respectively - a relatively tight $0.00 spread nationwide.
How many providers perform Assessment Of Blood Clotting Function?
Assessment Of Blood Clotting Function is comparatively uncommon: only 95 providers nationally billed Medicare for it in 2023, serving 136 beneficiaries via 552 total services.
What is the billed-to-Medicare markup for Assessment Of Blood Clotting Function?
Providers bill 7.0x what Medicare pays for Assessment Of Blood Clotting Function - an above-median markup at 595% above the Medicare rate.
Nationwide similar CPT codes
Data-derived peers across the CMS Physician & Other Practitioners extract: nearest national service volume and nearest average Medicare payment. Not clinical substitutes: claim-mass and payment neighborhoods only.
Closest national service volume
Nearest codes with ≥100 services (552 here).
Closest average Medicare payment
Nearest codes with payment ≥ $5 ($11.65 here).
Related Guides
Tips to reduce out-of-pocket costs
Your right to upfront pricing
How Medicare payments work
Decode charges and codes
Why bills exceed actual costs
Geographic pricing factors
Data from CMS Medicare Physician & Other Practitioners (2023).
Read our methodology - how this data is sourced, computed, and verified.
Related
Every figure on PlainProcedure is rendered directly from CMS Medicare Physician & Other Practitioners data, no number is typed in by an editor. This page draws directly on CMS Medicare Physician & Other Practitioners data, no figure is typed in by an editor. See our editorial standards & corrections policy, the methodology behind these numbers, the data changelog, or report a data error.