96416

Administration of prolonged chemotherapy into vein

Medicare pricing data for 1,892 providers across 38 states

🤖AI Overview

Prices vary significantly by location — from $39 in Mississippi to $151 in California. Where you get this procedure matters more than almost any other factor. 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 prolonged chemotherapy into vein (HCPCS code 96416) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $129.87, but hospitals typically charge $518.27 — a 4.0x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$25.97

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $129.87, your out-of-pocket cost would be approximately $25.97. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$129.87
Average Hospital Charge
$518.27
Markup Ratio
4.0x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$518.27
Medicare Allowed$129.87
Medicare Payment$103.37

Hospitals charge 4.0x more than what Medicare allows for this procedure. Medicare actually pays $103.37 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
California$151$6823174,777+16.3%
New York$147$5411161,449+13.3%
New Jersey$146$501871,631+12.1%
Maryland$141$503931,623+8.4%
Oregon$132$60331324+1.3%
Washington$131$52135300+1.1%
Illinois$131$55786927+0.8%
New Hampshire$128$540746-1.8%
Pennsylvania$125$40166983-3.7%
Delaware$125$7771099-4.0%
Virginia$124$58873647-4.5%
Colorado$124$9902694-4.9%
New Mexico$123$51721450-5.5%
Arizona$120$40426130-7.9%
Michigan$118$250671,069-9.0%
North Carolina$118$51041281-9.2%
Florida$118$3401301,030-9.4%
Minnesota$117$52043305-9.6%
South Carolina$117$51820888-9.9%
Iowa$117$53910117-10.0%
Nebraska$116$33323859-10.4%
Utah$116$331692-10.4%
Puerto Rico$115$12213139-11.1%
Missouri$115$52224128-11.6%
Wisconsin$114$1,07918115-12.0%
Texas$113$4521681,555-12.9%
Oklahoma$113$462579-13.1%
Kentucky$112$494876-13.6%
Ohio$112$46433458-13.8%
Georgia$111$60459703-14.6%
Indiana$111$45219127-14.6%
Arkansas$109$47134471-15.9%
Tennessee$108$3141048-17.1%
Kansas$107$5031335-17.7%
Louisiana$107$46029370-17.8%
Alabama$105$53344428-19.4%
Nevada$82$4922498-37.1%
Mississippi$39$4281353-69.8%

⚠️ 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