Laboratory · 85420
Plasminogen (fibrinolytic Factor) Measurement
What Medicare pays for 85420, what providers bill, and how the price varies across 11 states, drawn from CMS 2023 claims data.
- $6.39
- Medicare pays
- $96.39
- Providers bill
- 15.1×
- Markup
- #4,513 of 9,297
- Volume rank
The verdict
Plasminogen (fibrinolytic Factor) Measurement pairs above-median national service volume with one of the steepest markups in the catalog.
- Top 49%
- national service volume
- Top 2%
- billed-to-Medicare markup
- 15.1×
- billed vs. Medicare
- $6.39
- 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 Laboratory, 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
15 Among the most affordable more affordable than 98% 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
$96.39
Prices by State
| State | Medicare Payment | Billed Charge |
|---|---|---|
| Arizona | $6.40 | $131.26 |
| Alabama | $6.40 | $74.75 |
| Florida | $6.40 | $225.24 |
| Kansas | $6.40 | $214.73 |
| New Jersey | $6.40 | $93.36 |
| New York | $6.40 | $142.62 |
| North Carolina | $6.40 | $155.28 |
| Ohio | $6.40 | $68.24 |
| Texas | $6.37 | $22.83 |
| California | $6.34 | $163.61 |
| Virginia | $6.16 | $36.29 |
What the Data Says About Plasminogen (fibrinolytic Factor) Measurement
Across 11 states with reporting providers, CPT code 85420 (Plasminogen (fibrinolytic Factor) Measurement) shows a national average Medicare payment of $6.39 against an average billed charge of $96.39. That gap, a 15.1x markup, or 1409% 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.
Laboratory procedures like this one saw 1.6K services billed to Medicare in 2023 by 63 distinct providers, serving 1.3K unique beneficiaries. State-level variation is significant: Virginia reports the lowest average payment at $6.16, while Arizona reports the highest at $6.40. At just 4%, 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 $11.82, with self-pay cash discounts commonly bringing the figure closer to $31.30. Within Laboratory, Plasminogen (fibrinolytic Factor) Measurement ranks #448 of 502 tracked procedures by national average Medicare payment.
Where this sits in the registry
Plasminogen (fibrinolytic Factor) Measurement (85420) 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 Laboratory 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 Plasminogen (fibrinolytic Factor) Measurement rank among Medicare procedures?
According to CMS Medicare Part B claims, Plasminogen (fibrinolytic Factor) Measurement (CPT 85420) ranks #4,513 of 9,297 procedures by national service volume, the same sort as the procedures listing, and #448 of 502 within Laboratory by national average Medicare payment. See /methodology#corpus-placement.
How much does Plasminogen (fibrinolytic Factor) Measurement cost?
Plasminogen (fibrinolytic Factor) Measurement (CPT 85420) is priced fairly consistently nationwide: Medicare pays $6.39 on average, and the $6.16-$6.40 state range stays relatively tight. Providers typically bill $96.39.
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 Plasminogen (fibrinolytic Factor) Measurement cost with insurance?
With commercial insurance, plasminogen (fibrinolytic factor) measurement costs an estimated $11.82 on average (range: $8.27-$16.54), a moderate premium over Medicare's $6.39. Without insurance, the estimated cash price is $31.30.
Which state has the lowest cost for Plasminogen (fibrinolytic Factor) Measurement?
Virginia and Arizona bookend the range for Plasminogen (fibrinolytic Factor) Measurement, at $6.16 and $6.40 respectively - a relatively tight $0.24 spread nationwide.
How many providers perform Plasminogen (fibrinolytic Factor) Measurement?
Plasminogen (fibrinolytic Factor) Measurement is comparatively uncommon: only 63 providers nationally billed Medicare for it in 2023, serving 1.3K beneficiaries via 1.6K total services.
What is the billed-to-Medicare markup for Plasminogen (fibrinolytic Factor) Measurement?
Providers bill 15.1x what Medicare pays for Plasminogen (fibrinolytic Factor) Measurement - one of the steepest markups in the catalog at 1409% 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 (1.6K here).
Closest average Medicare payment
Nearest codes with payment ≥ $5 ($6.39 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.