Hemophilia Clotting Factor, Not Otherwise Classified
What Medicare pays for J7199, what providers bill, and how the price varies across 0 states, drawn from CMS 2023 claims data.
J7199 · the short answer
For hemophilia clotting factor, not otherwise classified, Medicare pays about $5.82 while providers bill $9.60 on average, a 1.6× markup, one of the smaller markups in the catalog.
- Medicare pays
- $5.82
- Providers bill
- $9.60
- Markup
- 1.6×
- Markup percentile
- 3th
Medicare amounts are CMS-published; markup = average submitted charge ÷ average Medicare payment.
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: Drugs (Administered) 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
2 more affordable than 3% 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
What the Data Says About Hemophilia Clotting Factor, Not Otherwise Classified
Across 0 states with reporting providers, CPT code J7199 (Hemophilia Clotting Factor, Not Otherwise Classified) shows a national average Medicare payment of $5.82 against an average billed charge of $9.60. That gap, a 1.6x markup, or 65% above the Medicare allowed amount, is among the tightest billed-to-paid spreads we track, this code's chargemaster rate tracks unusually close to the Medicare benchmark.
Drugs (Administered) procedures like this one saw 763.7K services billed to Medicare in 2023 by 20 distinct providers, serving 26 unique beneficiaries. Regional variation is limited in the underlying CMS file. Where state-level figures exist for hemophilia clotting factor, not otherwise classified, Geographic Practice Cost Indices (GPCIs), local malpractice premiums, and practice-expense adjustments are the usual drivers of any difference.
Applying RAND 2024 commercial-to-Medicare ratios specific to the Drugs (Administered) category (2.24x), the estimated commercial insurance price lands near $16.36, with self-pay cash discounts commonly bringing the figure closer to $8.12. Within Drugs (Administered), Hemophilia Clotting Factor, Not Otherwise Classified ranks #287 of 530 tracked procedures by national average Medicare payment.
What to do with this
If you may have hemophilia clotting factor, not otherwise classified 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 hemophilia clotting factor, not otherwise classified 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 Hemophilia Clotting Factor, Not Otherwise Classified cost?
The national average Medicare payment for Hemophilia Clotting Factor, Not Otherwise Classified (CPT J7199) is $5.82, while providers typically bill $9.60.
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 Hemophilia Clotting Factor, Not Otherwise Classified cost with insurance?
With commercial insurance, hemophilia clotting factor, not otherwise classified costs an estimated $16.36 on average (range: $11.45-$22.90), a moderate premium over Medicare's $5.82. Without insurance, the estimated cash price is $8.12.
How many providers perform Hemophilia Clotting Factor, Not Otherwise Classified?
Hemophilia Clotting Factor, Not Otherwise Classified is comparatively uncommon: only 20 providers nationally billed Medicare for it in 2023, serving 26 beneficiaries via 763.7K total services.
What is the billed-to-Medicare markup for Hemophilia Clotting Factor, Not Otherwise Classified?
Providers bill 1.6x what Medicare pays for Hemophilia Clotting Factor, Not Otherwise Classified - one of the smaller markups in the catalog at 65% 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.