96112

Administration of developmental test, first hour

Medicare pricing data for 235 providers across 15 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 developmental test, first hour (HCPCS code 96112) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $115.22, but hospitals typically charge $190.93 — a 1.7x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$23.04

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $115.22, your out-of-pocket cost would be approximately $23.04. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$115.22
Average Hospital Charge
$190.93
Markup Ratio
1.7x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$190.93
Medicare Allowed$115.22
Medicare Payment$90.49

Hospitals charge 1.7x more than what Medicare allows for this procedure. Medicare actually pays $90.49 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
New Jersey$137$2768316+18.6%
Delaware$125$1801172+8.8%
Georgia$124$1622134+7.7%
Arizona$123$1753619+6.5%
Nevada$122$18061,262+5.6%
North Carolina$121$1701071+4.8%
Michigan$120$262821+4.2%
Texas$120$22816460+3.7%
New York$119$297829+3.2%
Oregon$119$153639+3.2%
Missouri$116$209141,816+0.8%
Tennessee$115$2286239+0.2%
California$113$184788,982-2.3%
Florida$105$1261290-8.5%
Kentucky$105$196699-8.5%

⚠️ 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