Infusion into tissue for therapy or prevention, 1 hour or less
Medicare pricing data for 390 providers across 16 states
This is a specialized procedure with relatively few Medicare claims. Pricing data may be less reliable due to smaller sample sizes. 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 tissue for therapy or prevention, 1 hour or less (HCPCS code 96369) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $135.30, but hospitals typically charge $373.47 — a 2.8x 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 $135.30, your out-of-pocket cost would be approximately $27.06. 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 2.8x more than what Medicare allows for this procedure. Medicare actually pays $106.57 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| New York | $169 | $1,159 | 39 | 285 | +25.1% |
| New Jersey | $166 | $293 | 5 | 166 | +22.9% |
| California | $165 | $339 | 31 | 899 | +21.7% |
| Washington | $150 | $368 | 6 | 195 | +10.9% |
| Alaska | $138 | $610 | 3 | 81 | +2.2% |
| Colorado | $128 | $508 | 18 | 172 | -5.0% |
| Florida | $128 | $303 | 64 | 1,212 | -5.8% |
| Delaware | $127 | $223 | 4 | 17 | -5.8% |
| Wisconsin | $127 | $421 | 2 | 173 | -6.3% |
| Indiana | $126 | $324 | 5 | 126 | -7.0% |
| Georgia | $125 | $338 | 15 | 151 | -7.4% |
| Oklahoma | $124 | $249 | 11 | 405 | -8.2% |
| Tennessee | $123 | $392 | 18 | 562 | -9.0% |
| Texas | $123 | $334 | 78 | 805 | -9.1% |
| Louisiana | $122 | $246 | 3 | 53 | -9.8% |
| Arizona | $116 | $418 | 12 | 90 | -14.1% |
⚠️ 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