96401

Administration of non-hormonal anti-neoplastic chemotherapy under skin or into muscle

Medicare pricing data for 12,280 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

Administration of non-hormonal anti-neoplastic chemotherapy under skin or into muscle (HCPCS code 96401) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $72.43, but hospitals typically charge $196.56 — a 2.7x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$14.49

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $72.43, your out-of-pocket cost would be approximately $14.49. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$72.43
Average Hospital Charge
$196.56
Markup Ratio
2.7x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$196.56
Medicare Allowed$72.43
Medicare Payment$56.62

Hospitals charge 2.7x more than what Medicare allows for this procedure. Medicare actually pays $56.62 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
California$84$21496361,540+16.0%
District of Columbia$84$225312,556+15.8%
New York$82$21578231,962+13.3%
New Jersey$81$18062448,633+12.5%
Maryland$80$19742840,803+10.9%
Massachusetts$79$2321216,143+9.1%
Connecticut$79$2161373,646+8.4%
Alaska$78$323251,264+7.9%
Virginia$76$20337937,038+4.6%
Colorado$75$19422413,090+4.2%
Rhode Island$75$165151,111+3.8%
Vermont$75$1573463+3.6%
New Hampshire$74$28227945+2.2%
Pennsylvania$74$18358247,171+1.8%
Washington$73$2341714,794+1.0%
Delaware$73$148579,615+0.1%
Illinois$73$23644625,336+0.1%
Wyoming$72$3358230-0.2%
Puerto Rico$72$8253424-0.6%
Minnesota$72$2892177,102-0.7%
Nevada$72$205925,101-1.0%
Hawaii$72$13728527-1.1%
Oregon$72$228944,380-1.3%
Florida$71$1791,689147,852-2.1%
Arizona$70$15627126,827-3.2%
Maine$69$301271,006-4.3%
Texas$69$2051,342107,025-4.8%
Michigan$69$16022210,611-5.1%
South Dakota$68$22513606-6.3%
Wisconsin$68$370972,713-6.6%
Georgia$67$33336114,515-7.0%
North Carolina$67$17026516,878-7.3%
Missouri$67$2291986,069-7.9%
Ohio$66$20725512,471-8.5%
North Dakota$66$21723488-8.7%
New Mexico$66$192863,411-8.8%
Utah$66$206644,954-8.9%
South Carolina$66$15221813,952-9.0%
Iowa$65$1861036,853-9.6%
Idaho$65$20321727-10.0%
Kansas$65$187895,844-10.2%
Nebraska$65$176717,843-10.2%
Louisiana$64$16714313,495-11.3%
Montana$64$202759-11.6%
Indiana$64$17715211,413-12.1%
Alabama$63$17026811,080-12.4%
Tennessee$63$21333317,244-12.4%
Oklahoma$63$196693,230-12.5%
Arkansas$62$21513511,742-14.1%
Kentucky$62$166795,987-14.2%
West Virginia$62$162261,349-14.9%
Mississippi$61$16413710,385-15.8%

⚠️ 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