Antithrombin Iii Antigen (clotting Inhibitor) Activity
What Medicare pays for 85300, what providers bill, and how the price varies across 34 states, drawn from CMS 2023 claims data.
85300 · the short answer
For antithrombin iii antigen (clotting inhibitor) activity, Medicare pays about $11.59 while providers bill $192.86 on average, a 16.6× markup, one of the steepest markups in the catalog. State-level Medicare rates range 10% from lowest to highest.
- Medicare pays
- $11.59
- Providers bill
- $192.86
- Markup
- 16.6×
- Markup percentile
- 98th
Medicare amounts are CMS-published; markup = average submitted charge ÷ average Medicare payment.
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), which found that commercial insurance prices average 224% of Medicare rates nationally. We apply category-specific ratios: Immunology procedures average 2.24x Medicare rates. 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
17 Among the most affordable more affordable than 98% of 8,901 procedures
Each bar is a 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
Prices by State
| State | Medicare Payment | Billed Charge |
|---|---|---|
| Illinois | $11.61 | $263.68 |
| Alabama | $11.61 | $156.59 |
| Georgia | $11.61 | $283.39 |
| Indiana | $11.61 | $105.47 |
| Iowa | $11.61 | $86.10 |
| Kentucky | $11.61 | $46.69 |
| Louisiana | $11.61 | $205.13 |
| Massachusetts | $11.61 | $274.97 |
| Minnesota | $11.61 | $149.80 |
| Nevada | $11.61 | $281.47 |
| New Mexico | $11.61 | $193.74 |
| Oklahoma | $11.61 | $214.19 |
| Oregon | $11.61 | $95.29 |
| Pennsylvania | $11.61 | $240.18 |
| South Dakota | $11.61 | $114.12 |
| Tennessee | $11.61 | $82.00 |
| Utah | $11.61 | $57.10 |
| Puerto Rico | $11.61 | $12.49 |
| North Carolina | $11.60 | $191.65 |
| Florida | $11.60 | $269.81 |
| California | $11.60 | $213.18 |
| New Jersey | $11.59 | $181.71 |
| Arizona | $11.59 | $191.74 |
| Colorado | $11.59 | $164.81 |
| New York | $11.59 | $216.46 |
| Kansas | $11.59 | $244.31 |
| Maryland | $11.57 | $241.72 |
| Texas | $11.57 | $126.85 |
| Wisconsin | $11.53 | $165.98 |
| Ohio | $11.48 | $112.38 |
| Virginia | $11.40 | $45.45 |
| Washington | $11.39 | $169.99 |
| Hawaii | $11.33 | $89.83 |
| North Dakota | $10.55 | $70.09 |
What the Data Says About Antithrombin Iii Antigen (clotting Inhibitor) Activity
Across 34 states with reporting providers, CPT code 85300 (Antithrombin Iii Antigen (clotting Inhibitor) Activity) shows a national average Medicare payment of $11.59 against an average billed charge of $192.86. That gap, a 16.6x markup, or 1564% above the Medicare allowed amount, sits among the widest billed-to-paid spreads we track, the kind of chargemaster pricing almost no payer, insured or cash, actually honors in full.
Immunology procedures like this one saw 15.6K services billed to Medicare in 2023 by 257 distinct providers, serving 14.8K unique beneficiaries. State-level variation is significant: North Dakota reports the lowest average payment at $10.55, while Illinois reports the highest at $11.61. At just 10%, this procedure prices remarkably consistently nationwide, GPCI adjustments barely move the needle for this particular code.
Applying RAND 2024 commercial-to-Medicare ratios specific to the Immunology category (2.24x), the estimated commercial insurance price lands near $25.96, with self-pay cash discounts commonly bringing the figure closer to $61.73. Within Immunology, Antithrombin Iii Antigen (clotting Inhibitor) Activity ranks #190 of 225 tracked procedures by national average Medicare payment.
What to do with this
If you may have antithrombin iii antigen (clotting inhibitor) activity done, these steps turn the numbers above into a real-world cost estimate.
- Request a Good Faith Estimate from your provider at least 3 business days before a scheduled procedure, under the No Surprises Act it is an enforceable written price.
- Compare antithrombin iii antigen (clotting inhibitor) activity costs in your state, Medicare rates vary by locality. Browse states
- Check a hospital’s published cash price, which is often far below the billed charge. Price transparency
- Understand why billed charges run several times the Medicare rate before you negotiate. Read the guide
Figures here are averages and estimates, not a quote. Confirm coverage and out-of-pocket costs with your insurer and provider.
Frequently Asked Questions
How much does Antithrombin Iii Antigen (clotting Inhibitor) Activity cost?
Antithrombin Iii Antigen (clotting Inhibitor) Activity (CPT 85300) is priced fairly consistently nationwide: Medicare pays $11.59 on average, and the $10.55-$11.61 state range stays relatively tight. Providers typically bill $192.86.
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 Antithrombin Iii Antigen (clotting Inhibitor) Activity cost with insurance?
With commercial insurance, antithrombin iii antigen (clotting inhibitor) activity costs an estimated $25.96 on average (range: $18.17-$36.34), a moderate premium over Medicare's $11.59. Without insurance, the estimated cash price is $61.73.
Which state has the lowest cost for Antithrombin Iii Antigen (clotting Inhibitor) Activity?
North Dakota and Illinois bookend the range for Antithrombin Iii Antigen (clotting Inhibitor) Activity, at $10.55 and $11.61 respectively - a relatively tight $1.06 spread nationwide.
How many providers perform Antithrombin Iii Antigen (clotting Inhibitor) Activity?
Antithrombin Iii Antigen (clotting Inhibitor) Activity is comparatively uncommon: only 257 providers nationally billed Medicare for it in 2023, serving 14.8K beneficiaries via 15.6K total services.
What is the billed-to-Medicare markup for Antithrombin Iii Antigen (clotting Inhibitor) Activity?
Providers bill 16.6x what Medicare pays for Antithrombin Iii Antigen (clotting Inhibitor) Activity - one of the steepest markups in the catalog at 1564% above the Medicare rate.
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, or report a data error.