96372

Injection of drug or substance under skin or into muscle

Medicare pricing data for 215,286 providers across 52 states

🤖AI Overview

This is one of the most commonly performed procedures in Medicare, with 7.2 million services annually. Even small pricing inefficiencies here affect millions of patients. 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

Injection of drug or substance under skin or into muscle (HCPCS code 96372) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $13.40, but hospitals typically charge $54.48 — a 4.1x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$2.68

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $13.40, your out-of-pocket cost would be approximately $2.68. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$13.40
Average Hospital Charge
$54.48
Markup Ratio
4.1x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$54.48
Medicare Allowed$13.40
Medicare Payment$9.79

Hospitals charge 4.1x more than what Medicare allows for this procedure. Medicare actually pays $9.79 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$16$9462911,791+20.1%
New York$16$9011,423331,688+16.6%
District of Columbia$16$605036,243+16.2%
New Jersey$15$656,216191,460+14.3%
California$15$5617,601754,366+13.7%
Maryland$15$604,209138,550+9.8%
Connecticut$15$732,39644,619+9.4%
Massachusetts$15$704,73083,531+9.0%
Hawaii$15$4774615,286+8.6%
Puerto Rico$14$281832,080+4.3%
Rhode Island$14$486718,311+3.7%
Delaware$14$5766222,797+3.5%
Washington$14$604,38869,334+2.8%
Illinois$14$687,086219,352+2.8%
Virginia$14$545,547184,397+2.5%
Pennsylvania$14$569,201203,357+2.3%
New Hampshire$14$7985214,438+1.9%
Colorado$14$603,45959,274+1.9%
Vermont$14$562282,926+1.6%
Florida$14$5215,802689,090+1.1%
Minnesota$14$633,74547,848+1.0%
Nevada$14$631,85558,129+0.9%
Maine$13$663996,719+0.2%
Michigan$13$476,624182,562+0.1%
Montana$13$475577,800-0.5%
Oregon$13$562,32137,356-0.7%
North Dakota$13$6946313,155-0.9%
Wyoming$13$5746113,016-1.9%
Wisconsin$13$923,19144,013-1.9%
South Dakota$13$5645411,047-2.1%
Texas$13$5317,675604,716-2.9%
Arizona$13$485,455195,335-3.1%
Ohio$13$496,876134,808-4.3%
Missouri$13$523,38897,255-4.7%
Utah$13$432,07949,590-4.8%
North Carolina$13$539,125271,923-4.9%
Georgia$13$537,479307,825-5.0%
Kansas$13$522,14478,906-5.3%
Nebraska$13$511,70864,002-5.4%
Indiana$13$455,445136,928-5.4%
Iowa$13$582,19552,951-6.0%
South Carolina$13$504,275176,266-6.3%
New Mexico$13$461,08328,909-6.6%
Louisiana$12$443,595164,722-7.5%
West Virginia$12$471,12429,951-8.1%
Kentucky$12$473,426113,980-8.8%
Alabama$12$384,541323,978-9.0%
Tennessee$12$497,355346,232-9.1%
Idaho$12$451,08120,342-9.3%
Oklahoma$12$483,151185,746-9.6%
Arkansas$12$482,571136,734-10.0%
Mississippi$12$442,742215,681-12.8%

⚠️ 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