Daily hospital management of continuous spinal drug administration
Medicare pricing data for 3,948 providers across 48 states
This procedure has a 6.3x markup — hospitals charge $398.29 but Medicare allows only $63.27. Uninsured patients may face bills 6.3 times higher than what insurance negotiates. 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
Daily hospital management of continuous spinal drug administration (HCPCS code 01996) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $63.27, but hospitals typically charge $398.29 — a 6.3x markup. Prices vary significantly by state and provider.
🏷️ Typical Out-of-Pocket Cost
Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $63.27, your out-of-pocket cost would be approximately $12.65. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.
What Hospitals Charge vs. What Medicare Pays
Hospitals charge 6.3x more than what Medicare allows for this procedure. Medicare actually pays $49.78 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Alaska | $82 | $611 | 36 | 98 | +30.1% |
| New York | $69 | $483 | 185 | 3,870 | +9.8% |
| Illinois | $66 | $360 | 97 | 664 | +4.4% |
| Maryland | $66 | $331 | 37 | 389 | +4.2% |
| New Jersey | $66 | $347 | 18 | 81 | +3.9% |
| California | $66 | $436 | 387 | 4,203 | +3.7% |
| Massachusetts | $65 | $422 | 135 | 1,660 | +3.3% |
| Connecticut | $65 | $546 | 58 | 202 | +2.8% |
| Washington | $64 | $342 | 208 | 1,325 | +1.6% |
| New Mexico | $64 | $349 | 6 | 73 | +1.0% |
| Delaware | $64 | $463 | 11 | 30 | +0.9% |
| Florida | $63 | $391 | 158 | 951 | +0.1% |
| Nevada | $63 | $462 | 44 | 155 | -0.5% |
| Michigan | $63 | $447 | 169 | 853 | -0.8% |
| Pennsylvania | $63 | $291 | 127 | 911 | -1.0% |
| New Hampshire | $63 | $686 | 33 | 381 | -1.1% |
| Virginia | $62 | $306 | 109 | 551 | -1.6% |
| Colorado | $62 | $451 | 163 | 1,387 | -2.0% |
| Arizona | $62 | $589 | 59 | 106 | -2.0% |
| Texas | $62 | $533 | 212 | 1,050 | -2.2% |
| Louisiana | $62 | $301 | 16 | 44 | -2.4% |
| Montana | $62 | $282 | 40 | 138 | -2.4% |
| West Virginia | $62 | $265 | 28 | 194 | -2.7% |
| Missouri | $62 | $302 | 135 | 1,100 | -2.8% |
| Wyoming | $61 | $390 | 8 | 23 | -3.2% |
| Oregon | $61 | $313 | 122 | 895 | -3.3% |
| Ohio | $61 | $231 | 103 | 651 | -3.4% |
| Georgia | $61 | $337 | 43 | 239 | -3.5% |
| Maine | $61 | $314 | 65 | 400 | -3.8% |
| Vermont | $61 | $375 | 13 | 44 | -4.1% |
| South Carolina | $61 | $488 | 26 | 251 | -4.3% |
| North Carolina | $61 | $390 | 108 | 1,369 | -4.3% |
| Oklahoma | $60 | $368 | 23 | 47 | -4.4% |
| North Dakota | $60 | $344 | 9 | 25 | -4.7% |
| Utah | $60 | $325 | 62 | 425 | -4.8% |
| Minnesota | $60 | $402 | 120 | 665 | -5.2% |
| South Dakota | $60 | $246 | 36 | 136 | -5.3% |
| Hawaii | $60 | $319 | 10 | 49 | -5.4% |
| Kansas | $60 | $290 | 82 | 528 | -5.6% |
| Iowa | $59 | $371 | 105 | 570 | -6.2% |
| Idaho | $59 | $326 | 20 | 35 | -6.3% |
| Wisconsin | $59 | $488 | 106 | 609 | -6.3% |
| Indiana | $59 | $351 | 104 | 1,156 | -6.4% |
| Kentucky | $59 | $316 | 78 | 669 | -7.0% |
| Arkansas | $59 | $245 | 68 | 346 | -7.0% |
| Nebraska | $59 | $281 | 68 | 568 | -7.4% |
| Tennessee | $58 | $437 | 59 | 576 | -8.7% |
| Alabama | $55 | $183 | 23 | 100 | -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.
💊 Need post-procedure medications? Check costs on OpenPrescriber