96368

Infusion into a vein for therapy, prevention, or diagnosis concurrent with another infusion

Medicare pricing data for 4,644 providers across 47 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 concurrent with another infusion (HCPCS code 96368) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $19.69, but hospitals typically charge $72.56 — a 3.7x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$3.94

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $19.69, your out-of-pocket cost would be approximately $3.94. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$19.69
Average Hospital Charge
$72.56
Markup Ratio
3.7x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$72.56
Medicare Allowed$19.69
Medicare Payment$15.61

Hospitals charge 3.7x more than what Medicare allows for this procedure. Medicare actually pays $15.61 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
California$22$6351220,468+13.3%
Maryland$22$691133,687+11.4%
New Jersey$22$731264,939+11.2%
Alaska$22$12118497+10.6%
Vermont$21$76357+8.1%
Massachusetts$21$6023367+6.6%
Connecticut$21$13124277+6.4%
Virginia$21$701573,695+5.0%
New York$21$1011773,122+4.4%
Pennsylvania$20$591373,334+2.8%
New Hampshire$20$10315272+2.6%
Delaware$20$8713424+0.3%
Wyoming$20$9811225-0.2%
Minnesota$20$1001511,964-0.3%
Colorado$20$76731,970-0.8%
Illinois$19$922277,096-1.1%
Maine$19$8316249-1.2%
Washington$19$62931,218-1.3%
Oregon$19$6667900-1.8%
Florida$19$6246515,390-2.6%
Michigan$19$63911,492-3.4%
New Mexico$19$7033558-3.5%
Texas$19$7759319,664-3.6%
Missouri$19$1091041,852-4.0%
Arizona$19$671974,912-4.3%
South Dakota$19$788122-5.4%
Nevada$19$66642,169-5.7%
North Carolina$19$581201,840-5.9%
South Carolina$19$119451,356-5.9%
Wisconsin$18$12651416-6.4%
North Dakota$18$668104-6.9%
Georgia$18$67872,065-7.2%
Nebraska$18$54581,561-7.2%
Ohio$18$951061,864-7.4%
Indiana$18$60682,075-7.6%
Idaho$18$559313-8.1%
Iowa$18$63531,392-8.3%
Oklahoma$18$4630665-8.4%
West Virginia$18$474172-8.6%
Tennessee$18$811455,274-9.0%
Utah$18$5443903-9.3%
Kentucky$18$6226483-9.7%
Kansas$18$60562,134-10.6%
Alabama$18$82912,121-10.7%
Louisiana$18$8431635-10.7%
Arkansas$17$72481,817-11.5%
Mississippi$17$73261,344-12.6%

⚠️ 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