96367

Infusion into a vein for therapy, prevention, or diagnosis, additional sequential infusion, 1 hour or less

Medicare pricing data for 8,073 providers across 52 states

🤖AI Overview

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

Infusion into a vein for therapy, prevention, or diagnosis, additional sequential infusion, 1 hour or less (HCPCS code 96367) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $28.61, but hospitals typically charge $118.89 — a 4.2x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$5.72

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $28.61, your out-of-pocket cost would be approximately $5.72. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$28.61
Average Hospital Charge
$118.89
Markup Ratio
4.2x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$118.89
Medicare Allowed$28.61
Medicare Payment$22.62

Hospitals charge 4.2x more than what Medicare allows for this procedure. Medicare actually pays $22.62 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
California$33$148885101,751+15.0%
New Jersey$32$13724345,151+12.9%
District of Columbia$32$12818280+12.4%
Maryland$32$11418332,607+12.2%
New York$32$10948544,828+12.0%
Hawaii$32$624711+10.9%
Alaska$31$214333,274+9.6%
Connecticut$31$199713,170+8.8%
Massachusetts$31$110632,049+8.0%
Vermont$31$12231,675+7.6%
Rhode Island$30$9910150+3.6%
Washington$30$961859,812+3.3%
Colorado$29$14016415,550+3.0%
Delaware$29$176182,195+2.2%
New Hampshire$29$184231,385+2.1%
Virginia$29$11523124,952+1.6%
Montana$29$108945+0.7%
Minnesota$29$1612268,236+0.6%
Pennsylvania$29$10520326,636+0.4%
Oregon$28$126894,879-0.7%
Illinois$28$14839941,935-1.7%
Nevada$28$116957,701-2.1%
Wyoming$28$158162,148-2.2%
Florida$28$90761120,441-2.7%
Puerto Rico$28$35623,982-2.7%
Texas$28$1301,007132,922-2.9%
Maine$28$121241,041-3.0%
Arizona$28$8823327,885-3.3%
Michigan$28$7918015,712-3.7%
Missouri$27$16120015,350-5.0%
Wisconsin$27$199952,273-5.1%
South Dakota$27$12715516-5.9%
Nebraska$27$72709,976-6.2%
New Mexico$27$109636,075-6.4%
South Carolina$27$1568920,339-6.8%
North Carolina$27$10716714,613-6.9%
North Dakota$27$9520886-6.9%
Ohio$27$11819117,384-7.3%
Georgia$27$12417727,136-7.3%
Utah$26$69616,278-7.8%
Idaho$26$85181,944-8.0%
Indiana$26$10910510,916-8.1%
Iowa$26$868514,640-8.3%
Oklahoma$26$71458,096-9.0%
Kansas$26$10710218,966-9.1%
Kentucky$26$118422,686-9.2%
West Virginia$26$695518-9.5%
Tennessee$26$11127337,093-9.5%
Louisiana$26$109576,358-10.1%
Alabama$26$12015322,214-10.4%
Arkansas$25$986519,343-12.2%
Mississippi$25$1143810,070-13.0%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

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💊 Need post-procedure medications? Check costs on OpenPrescriber