96413

Administration of chemotherapy into vein, 1 hour or less

Medicare pricing data for 14,929 providers across 52 states

🤖AI Overview

This is one of the most commonly performed procedures in Medicare, with 1.7 million services annually. Even small pricing inefficiencies here affect millions of patients. 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 chemotherapy into vein, 1 hour or less (HCPCS code 96413) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $128.35, but hospitals typically charge $477.67 — a 3.7x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$25.67

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $128.35, your out-of-pocket cost would be approximately $25.67. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$128.35
Average Hospital Charge
$477.67
Markup Ratio
3.7x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$477.67
Medicare Allowed$128.35
Medicare Payment$100.80

Hospitals charge 3.7x more than what Medicare allows for this procedure. Medicare actually pays $100.80 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
California$152$5281,291146,170+18.3%
District of Columbia$152$557532,125+18.2%
New Jersey$147$45040654,898+14.3%
New York$143$48682666,842+11.6%
Maryland$143$51144563,329+11.4%
Connecticut$141$5821787,155+9.6%
Alaska$140$716476,226+9.2%
Massachusetts$140$50216110,565+9.0%
Rhode Island$135$390261,099+4.9%
Vermont$134$44251,301+4.7%
Washington$134$49233323,132+4.3%
Colorado$134$57730328,017+4.1%
New Hampshire$133$539533,731+3.2%
Hawaii$132$26920792+3.1%
Pennsylvania$131$44059760,164+2.4%
Virginia$131$58939964,743+2.3%
Delaware$131$511609,342+2.0%
Minnesota$130$62748427,406+1.1%
Nevada$129$55013017,170+0.8%
Wyoming$129$668211,411+0.5%
Illinois$129$60061972,308+0.1%
Oregon$128$52323216,757-0.5%
Maine$128$494475,810-0.5%
Montana$126$437211,050-1.6%
Florida$126$4071,260198,920-1.9%
South Dakota$126$495281,877-2.0%
Arizona$125$45037558,404-2.6%
Texas$124$5581,513170,744-3.1%
Puerto Rico$124$137731,806-3.2%
Michigan$124$33738330,026-3.6%
North Dakota$124$418281,931-3.7%
Missouri$122$48032633,847-4.9%
Wisconsin$121$69619211,050-6.0%
North Carolina$120$36757549,058-6.3%
New Mexico$119$454848,615-7.4%
Georgia$119$55038136,079-7.4%
Ohio$118$46044339,957-7.7%
Nebraska$118$33413616,779-7.9%
Utah$118$3361098,445-8.1%
Iowa$118$37213820,944-8.4%
Kansas$117$39415323,419-8.6%
South Carolina$117$37125036,854-9.2%
Indiana$116$46825325,408-9.5%
West Virginia$115$388222,269-10.5%
Louisiana$115$44815817,256-10.5%
Idaho$115$361414,551-10.7%
Tennessee$114$39146053,082-11.1%
Alabama$114$42628234,803-11.3%
Oklahoma$113$36411917,052-11.9%
Kentucky$113$35212310,853-12.0%
Arkansas$111$43013635,414-13.5%
Mississippi$109$37812218,098-14.7%

⚠️ 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