96366

Infusion into a vein for therapy, prevention, or diagnosis, each additional hour

Medicare pricing data for 10,557 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

Infusion into a vein for therapy, prevention, or diagnosis, each additional hour (HCPCS code 96366) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $19.91, but hospitals typically charge $89.32 — a 4.5x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$3.98

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $19.91, your out-of-pocket cost would be approximately $3.98. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$19.91
Average Hospital Charge
$89.32
Markup Ratio
4.5x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$89.32
Medicare Allowed$19.91
Medicare Payment$15.66

Hospitals charge 4.5x more than what Medicare allows for this procedure. Medicare actually pays $15.66 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
District of Columbia$24$6433359+19.9%
New York$23$10968143,708+14.5%
California$23$821,10372,516+14.5%
Hawaii$23$358492+13.1%
Maryland$22$8822212,158+11.7%
New Jersey$22$13629420,695+11.7%
Alaska$22$250491,006+10.6%
Vermont$22$863268+9.2%
Connecticut$21$104772,320+6.8%
Rhode Island$21$719141+6.8%
Massachusetts$21$89881,891+6.0%
Virginia$21$7625011,512+3.7%
Washington$21$702385,608+3.4%
Pennsylvania$20$7429216,385+2.0%
Nevada$20$8311515,332+1.1%
Montana$20$6917148+0.9%
Puerto Rico$20$26482,812+0.6%
Illinois$20$11249325,278+0.3%
Minnesota$20$923016,6690.0%
South Dakota$20$12127525-0.7%
Florida$20$6895669,726-1.3%
Maine$20$80331,114-1.5%
New Hampshire$20$125351,070-1.9%
Texas$19$851,09878,483-2.6%
Wisconsin$19$1121243,309-2.8%
Oregon$19$711162,684-3.2%
Colorado$19$8118313,636-3.4%
Delaware$19$70311,485-3.6%
Arizona$19$7231520,890-3.6%
Missouri$19$922948,341-4.5%
Wyoming$19$130261,195-4.6%
Michigan$19$682379,136-5.3%
North Carolina$19$14128315,560-5.8%
North Dakota$19$7121689-6.2%
Kansas$19$811126,356-6.3%
West Virginia$19$4811445-6.9%
Iowa$18$61973,934-7.8%
Ohio$18$7528113,877-7.9%
Nebraska$18$421044,828-8.0%
Alabama$18$8220716,564-8.5%
Indiana$18$801866,900-8.7%
Georgia$18$18232726,526-8.9%
Oklahoma$18$61764,465-9.0%
Tennessee$18$7736024,023-10.0%
Kentucky$18$8257701-10.3%
New Mexico$18$86521,888-10.3%
Arkansas$18$77907,654-11.3%
Idaho$18$5623559-12.0%
South Carolina$17$8416116,660-12.3%
Mississippi$17$104925,924-13.4%
Louisiana$17$5110114,097-13.6%
Utah$17$481085,063-14.5%

⚠️ 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