Chemotherapy/Infusion · 96365
Infusion Into A Vein For Therapy, Prevention, Or Diagnosis, 1 Hour Or Less
What Medicare pays for 96365, what providers bill, and how the price varies across 54 states, drawn from CMS 2023 claims data.
- $49.03
- Medicare pays
- $217.38
- Providers bill
- 4.4×
- Markup
- #307 of 9,297
- Volume rank
The verdict
Infusion Into A Vein For Therapy, Prevention, Or Diagnosis, 1 Hour Or Less pairs top-5% national service volume with a below-median markup.
- Top 3%
- national service volume
- 30th pct.
- billed-to-Medicare markup
- 4.4×
- billed vs. Medicare
- $49.03
- Medicare pays, national avg
Volume percentile ranks this code's national service volume against every tracked procedure; markup percentile ranks its billed-to-Medicare ratio the same way. The same two figures drive both the verdict sentence and the chips above.
According to the Centers for Medicare & Medicaid Services (CMS), the 2023 Medicare Physician & Other Practitioners dataset records payments for 9,297 procedure codes billed across 5,426 hospitals in 56 states and territories; see our methodology for how each figure is sourced and computed.
Jurisdiction coverage for this code
56states and territories in the CMS extract
Price Range Across States
What You Might Pay
Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.
How we estimate these prices
These estimates are based on the RAND Hospital Price Transparency Study (4th Edition, 2024). We map each PlainProcedure category onto a RAND CPT-section bucket (Surgery, Radiology, Pathology and Laboratory, Medicine, Anesthesia, Evaluation and Management) or fall back to the national average when no bucket matches. For Chemotherapy/Infusion, the applied ratio is 2.15x Medicare (RAND 2024 Medicine bucket (2.15x) + CMS Medicare baseline). Cash/self-pay estimates blend typical cash discounts (55% of billed charges) with Medicare-based estimates (150% of allowed amounts). These are statistical estimates, not quotes. Contact your insurer or provider for actual costs.
Where this markup sits nationally
Markup (billed ÷ Medicare) across 8,901 procedures with a meaningful Medicare rate
4 more affordable than 30% of 8,901 procedures
Each bar is a 1-wide band; taller bars hold more procedures. The dashed line + filled bar mark this entry. Hover or tap any bar for its full count, share, and where it sits relative to this entry.
Source CMS Medicare Physician & Other Practitioners · 2023
What the billed charge breaks down into
$217.38
Prices by State
| State | Medicare Payment | Billed Charge |
|---|---|---|
| District of Columbia | $57.54 | $237.43 |
| New York | $56.71 | $250.92 |
| California | $56.62 | $228.55 |
| New Jersey | $55.63 | $226.96 |
| Hawaii | $55.46 | $154.65 |
| Maryland | $54.83 | $226.26 |
| Connecticut | $52.92 | $310.10 |
| Vermont | $52.25 | $217.96 |
| Massachusetts | $52.23 | $263.54 |
| Alaska | $51.91 | $397.43 |
| Washington | $51.29 | $240.99 |
| Rhode Island | $51.16 | $216.84 |
| Guam | $50.92 | $90.52 |
| Colorado | $50.89 | $230.70 |
| Virginia | $49.86 | $216.73 |
| Pennsylvania | $49.57 | $211.51 |
| Montana | $49.30 | $162.59 |
| Nevada | $49.23 | $241.56 |
| Illinois | $49.16 | $271.59 |
| Wyoming | $48.94 | $382.14 |
| Minnesota | $48.60 | $256.26 |
| Delaware | $48.21 | $207.86 |
| Florida | $48.16 | $180.42 |
| Puerto Rico | $48.10 | $86.13 |
| New Hampshire | $47.98 | $355.68 |
| Oregon | $47.73 | $229.70 |
| Maine | $47.42 | $285.52 |
| U.S. Virgin Islands | $47.10 | $433.61 |
| Texas | $47.08 | $239.01 |
| South Dakota | $46.77 | $203.21 |
| Georgia | $46.42 | $208.08 |
| Wisconsin | $46.28 | $293.58 |
| Michigan | $46.27 | $198.91 |
| North Dakota | $46.14 | $232.20 |
| Arizona | $46.09 | $187.35 |
| Missouri | $45.14 | $198.92 |
| West Virginia | $45.14 | $212.95 |
| North Carolina | $45.05 | $205.37 |
| New Mexico | $44.48 | $187.94 |
| Nebraska | $44.24 | $157.22 |
| Ohio | $44.17 | $236.39 |
| Indiana | $44.13 | $202.03 |
| Iowa | $43.91 | $197.50 |
| Kansas | $43.89 | $198.80 |
| South Carolina | $43.79 | $211.46 |
| Oklahoma | $43.67 | $180.35 |
| Utah | $43.62 | $161.93 |
| Idaho | $43.39 | $153.61 |
| Kentucky | $43.32 | $164.42 |
| Alabama | $43.18 | $194.25 |
| Tennessee | $42.81 | $182.36 |
| Louisiana | $42.07 | $140.64 |
| Arkansas | $41.71 | $203.91 |
| Mississippi | $40.91 | $201.43 |
What the Data Says About Infusion Into A Vein For Therapy, Prevention, Or Diagnosis, 1 Hour Or Less
Across 54 states with reporting providers, CPT code 96365 (Infusion Into A Vein For Therapy, Prevention, Or Diagnosis, 1 Hour Or Less) shows a national average Medicare payment of $49.03 against an average billed charge of $217.38. That gap, a 4.4x markup, or 343% above the Medicare allowed amount, is narrower than most procedures in our dataset, suggesting providers price this code closer to what payers actually reimburse.
Chemotherapy/Infusion procedures like this one saw 1.4M services billed to Medicare in 2023 by 23.2K distinct providers, serving 328.1K unique beneficiaries. State-level variation is significant: Mississippi reports the lowest average payment at $40.91, while District of Columbia reports the highest at $57.54. The 41% spread here is a moderate, fairly ordinary GPCI effect, local cost-of-practice adjustments nudging the allowed amount up or down without reshaping it. Applying the RAND 2024 commercial-to-Medicare ratio for this category (2.15x Medicare; RAND 2024 Medicine bucket (2.15x) + CMS Medicare baseline), the estimated commercial insurance price lands near $135.42, with self-pay cash discounts commonly bringing the figure closer to $107.02. Within Chemotherapy/Infusion, Infusion Into A Vein For Therapy, Prevention, Or Diagnosis, 1 Hour Or Less ranks #17 of 27 tracked procedures by national average Medicare payment.
Where this sits in the registry
Infusion Into A Vein For Therapy, Prevention, Or Diagnosis, 1 Hour Or Less (96365) is a CMS 2023 Part B code. These pages keep the volume map and the markup map separate.
- National volume versus markup on the statistics page, the same two maps as this capsule. Statistics
- Other Chemotherapy/Infusion codes, ranked by Medicare payment inside the category. Category
- How volume rank and markup rank are computed. Methodology
- The full procedures listing in volume order. Procedures
Figures here are CMS averages, not a quote for any patient, plan, or visit.
Frequently Asked Questions
Where does Infusion Into A Vein For Therapy, Prevention, Or Diagnosis, 1 Hour Or Less rank among Medicare procedures?
According to CMS Medicare Part B claims, Infusion Into A Vein For Therapy, Prevention, Or Diagnosis, 1 Hour Or Less (CPT 96365) ranks #307 of 9,297 procedures by national service volume, the same sort as the procedures listing, and #17 of 27 within Chemotherapy/Infusion by national average Medicare payment. See /methodology#corpus-placement.
How much does Infusion Into A Vein For Therapy, Prevention, Or Diagnosis, 1 Hour Or Less cost?
Medicare's national average payment for Infusion Into A Vein For Therapy, Prevention, Or Diagnosis, 1 Hour Or Less (CPT 96365) is $49.03, with providers billing $217.38 on average; state rates run from $40.91 to $57.54, a meaningful but not extreme spread.
Why do providers charge more than Medicare pays?
Providers set their own chargemaster rates (billed charges), which are typically much higher than what any insurer pays. Medicare pays a fixed rate based on the procedure code and geographic location. The billed charge is relevant mainly for uninsured patients, who may face prices closer to the submitted charge.
How much does Infusion Into A Vein For Therapy, Prevention, Or Diagnosis, 1 Hour Or Less cost with insurance?
With commercial insurance, infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less costs an estimated $135.42 on average (range: $94.80-$189.59), a moderate premium over Medicare's $49.03. Without insurance, the estimated cash price is $107.02.
Which state has the lowest cost for Infusion Into A Vein For Therapy, Prevention, Or Diagnosis, 1 Hour Or Less?
Mississippi has the lowest average Medicare payment for Infusion Into A Vein For Therapy, Prevention, Or Diagnosis, 1 Hour Or Less at $40.91, while District of Columbia has the highest at $57.54 - a meaningful $16.63 spread.
How many providers perform Infusion Into A Vein For Therapy, Prevention, Or Diagnosis, 1 Hour Or Less?
Infusion Into A Vein For Therapy, Prevention, Or Diagnosis, 1 Hour Or Less is a widely-performed procedure: 23.2K providers billed Medicare for it in 2023 across 54 states, together handling 1.4M services for 328.1K beneficiaries.
What is the billed-to-Medicare markup for Infusion Into A Vein For Therapy, Prevention, Or Diagnosis, 1 Hour Or Less?
Providers bill 4.4x what Medicare pays for Infusion Into A Vein For Therapy, Prevention, Or Diagnosis, 1 Hour Or Less - a below-median markup at 343% above the Medicare rate.
Nationwide similar CPT codes
Data-derived peers across the CMS Physician & Other Practitioners extract: nearest national service volume and nearest average Medicare payment. Not clinical substitutes: claim-mass and payment neighborhoods only.
Closest national service volume
Nearest codes with ≥100 services (1.4M here).
Closest average Medicare payment
Nearest codes with payment ≥ $5 ($49.03 here).
Related Guides
Tips to reduce out-of-pocket costs
Your right to upfront pricing
How Medicare payments work
Decode charges and codes
Why bills exceed actual costs
Geographic pricing factors
Data from CMS Medicare Physician & Other Practitioners (2023).
Read our methodology - how this data is sourced, computed, and verified.
Related
Every figure on PlainProcedure is rendered directly from CMS Medicare Physician & Other Practitioners data, no number is typed in by an editor. This page draws directly on CMS Medicare Physician & Other Practitioners data, no figure is typed in by an editor. See our editorial standards & corrections policy, the methodology behind these numbers, the data changelog, or report a data error.