96402

Administration of hormonal anti-neoplastic chemotherapy under skin or into muscle

Medicare pricing data for 12,633 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

Administration of hormonal anti-neoplastic chemotherapy under skin or into muscle (HCPCS code 96402) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $33.54, but hospitals typically charge $115.49 — a 3.4x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$6.71

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $33.54, your out-of-pocket cost would be approximately $6.71. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$33.54
Average Hospital Charge
$115.49
Markup Ratio
3.4x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$115.49
Medicare Allowed$33.54
Medicare Payment$25.62

Hospitals charge 3.4x more than what Medicare allows for this procedure. Medicare actually pays $25.62 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
California$39$1331,27241,897+15.0%
New York$38$14175418,455+14.5%
New Jersey$38$12740813,829+13.1%
Alaska$37$175391,362+11.6%
District of Columbia$37$12128431+11.6%
Connecticut$36$1221292,735+8.8%
Maryland$36$11530211,380+8.1%
Massachusetts$36$1161652,995+7.8%
Hawaii$36$9131689+7.7%
New Hampshire$34$11940743+2.2%
Rhode Island$34$9627161+1.3%
Colorado$34$1242004,562+1.1%
Washington$34$1132985,683+1.0%
Vermont$34$1188136+0.3%
Montana$34$7636544+0.2%
Virginia$34$13136511,4860.0%
Minnesota$33$1503085,750-0.5%
Illinois$33$13952514,706-0.8%
Oregon$33$1151713,556-0.8%
Delaware$33$108442,059-1.6%
Pennsylvania$33$10051512,115-1.7%
Maine$33$11631974-1.7%
Nevada$33$1171214,626-1.8%
Florida$33$971,14439,772-2.0%
Texas$33$1161,09326,846-3.1%
Puerto Rico$33$42831,045-3.1%
Wyoming$32$11116370-3.2%
Arizona$32$11434810,378-3.7%
Michigan$32$842634,893-3.8%
South Dakota$32$11344993-5.6%
Missouri$31$1172654,989-6.2%
Wisconsin$31$2292012,598-6.3%
New Mexico$31$124482,065-6.4%
North Dakota$31$11240359-6.9%
North Carolina$31$1013657,968-7.1%
Ohio$31$1214048,495-7.4%
Georgia$31$11934510,500-7.6%
Utah$31$84952,112-7.7%
Nebraska$31$801194,897-8.7%
South Carolina$31$1202036,347-8.7%
Indiana$30$992867,051-9.2%
West Virginia$30$8717243-9.2%
Kansas$30$901294,912-9.6%
Louisiana$30$921373,270-9.7%
Tennessee$30$983178,827-9.9%
Idaho$30$94441,011-10.0%
Iowa$30$951463,918-10.2%
Oklahoma$30$721263,636-10.2%
Kentucky$30$93872,079-10.5%
Alabama$30$982226,765-10.8%
Mississippi$29$971055,086-15.0%
Arkansas$28$1011146,407-15.9%

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

Related from TheDataProject.ai

💊 Need post-procedure medications? Check costs on OpenPrescriber