96523

Irrigation of implanted venous access drug delivery device

Medicare pricing data for 5,913 providers across 50 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

Irrigation of implanted venous access drug delivery device (HCPCS code 96523) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $24.94, but hospitals typically charge $92.97 — a 3.7x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$4.99

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $24.94, your out-of-pocket cost would be approximately $4.99. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$24.94
Average Hospital Charge
$92.97
Markup Ratio
3.7x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$92.97
Medicare Allowed$24.94
Medicare Payment$18.25

Hospitals charge 3.7x more than what Medicare allows for this procedure. Medicare actually pays $18.25 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
California$30$10254811,603+21.6%
District of Columbia$30$841052+20.1%
New Jersey$29$1061402,412+15.4%
Maryland$28$811495,663+11.2%
Connecticut$28$9940718+11.1%
New York$28$1343513,807+10.6%
Vermont$27$91448+9.6%
Alaska$27$12821380+9.0%
Massachusetts$27$7943500+8.1%
Colorado$26$108811,391+5.8%
New Hampshire$26$11520405+4.8%
Delaware$26$11016298+4.3%
Washington$26$1031702,257+3.2%
Maine$25$10314215+1.6%
Oregon$25$9683580+1.6%
Virginia$25$931883,243+1.6%
Minnesota$25$110145642+1.3%
Pennsylvania$25$761262,687+1.2%
Nevada$25$86702,773+0.6%
Wyoming$25$12220162+0.2%
Puerto Rico$25$6337286-0.1%
South Dakota$25$14925159-0.8%
Michigan$25$681182,211-1.6%
Florida$25$764056,526-1.6%
Illinois$24$1072594,453-2.2%
Texas$24$10966415,158-2.3%
Arizona$24$891905,510-2.5%
Wisconsin$23$149116718-6.0%
Montana$23$1011228-6.1%
North Carolina$23$831411,730-6.2%
North Dakota$23$11758226-6.3%
New Mexico$23$121441,233-6.6%
Ohio$23$1001683,987-7.2%
Nebraska$23$60622,237-7.9%
South Carolina$23$100831,866-8.1%
Iowa$23$82861,213-8.4%
Idaho$23$7716227-8.6%
Indiana$23$1051032,916-8.7%
Kansas$23$791023,890-8.8%
Oklahoma$23$61541,268-9.7%
Tennessee$23$712734,956-9.8%
Georgia$22$1001122,664-9.9%
Louisiana$22$7252877-10.1%
Missouri$22$751052,146-10.2%
West Virginia$22$5911586-10.9%
Utah$22$5846604-11.5%
Alabama$22$561182,295-12.0%
Kentucky$22$6564663-12.3%
Arkansas$22$82821,704-12.8%
Mississippi$21$88491,480-13.8%

⚠️ 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

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