Chemotherapy/Infusion · 96401

Administration Of Non-Hormonal Anti-Neoplastic Chemotherapy Under Skin Or Into Muscle

What Medicare pays for 96401, what providers bill, and how the price varies across 54 states, drawn from CMS 2023 claims data.

$56.62
Medicare pays
$196.56
Providers bill
3.5×
Markup
#417 of 9,297
Volume rank

The verdict

Administration Of Non-Hormonal Anti-Neoplastic Chemotherapy Under Skin Or Into Muscle pairs top-5% national service volume with one of the smaller markups in the catalog.

Top 4%
national service volume
18th pct.
billed-to-Medicare markup
3.5×
billed vs. Medicare
$56.62
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.

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Payment tier in Chemotherapy/Infusion
Below-median in category
#15 of 27 procedures in Chemotherapy/Infusion by national average Medicare payment.
Markup tier vs. tracked procedures
Modest markup
3.5x the Medicare rate — ranks #3,460 of 4,435 tracked procedures by billed-vs-Medicare markup (rank #1 = steepest).
831.0K
Total Services
144.0K
Beneficiaries
12.3K
Providers
54
States with Data

Price Range Across States

Lowest State Avg
$46.30
West Virginia
Highest State Avg
$66.11
District of Columbia

What You Might Pay

Est. Commercial Insurance
$155.73
Range: $109.01 – $218.02
Est. Cash / Self-Pay
$108.38
Typical self-pay discount

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

3 more affordable than 18% of 8,901 procedures

1–2: 466 procedures (5%). Below this entry. 2–3: 681 procedures (8%). Below this entry. 3–4: 845 procedures (9%). This entry sits in this band. 4–5: 1,308 procedures (15%). Above this entry. 5–6: 1,725 procedures (19%). Above this entry. 6–7: 1,217 procedures (14%). Above this entry. 7–8: 801 procedures (9%). Above this entry. 8–9: 541 procedures (6%). Above this entry. 9–10: 351 procedures (4%). Above this entry. 10–11: 246 procedures (3%). Above this entry. 11–12: 151 procedures (2%). Above this entry. 12–13: 175 procedures (2%). Above this entry. 13–14: 140 procedures (2%). Above this entry. 14–15: 40 procedures (0%). Above this entry. 15–16: 39 procedures (0%). Above this entry. 16–17: 26 procedures (0%). Above this entry. 17–18: 25 procedures (0%). Above this entry. 18–19: 21 procedures (0%). Above this entry. 19–20: 12 procedures (0%). Above this entry. 20–21: 16 procedures (0%). Above this entry. 21–22: 13 procedures (0%). Above this entry. 22–23: 8 procedures (0%). Above this entry. 23–24: 9 procedures (0%). Above this entry. 24–25: 4 procedures (0%). Above this entry. 25–26: 3 procedures (0%). Above this entry. 26–27: 3 procedures (0%). Above this entry. 27–28: 4 procedures (0%). Above this entry. 28–29: 3 procedures (0%). Above this entry. 29–30: 2 procedures (0%). Above this entry. 30–31: 26 procedures (0%). Above this entry. this procedure 1 31 × markup, bucketed by value

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

Prices by State

State Medicare Payment Billed Charge
District of Columbia $66.11 $225.19
California $65.88 $214.46
New York $64.48 $214.58
New Jersey $63.37 $179.78
Maryland $63.05 $197.28
Alaska $61.55 $322.99
Connecticut $61.55 $216.43
Massachusetts $61.27 $231.74
Colorado $58.79 $193.88
Virginia $58.61 $202.92
Rhode Island $58.52 $165.05
Vermont $57.82 $156.83
Washington $57.68 $234.10
Pennsylvania $57.24 $182.59
Illinois $57.09 $236.03
New Hampshire $57.00 $282.29
Wyoming $56.98 $334.60
Minnesota $56.69 $288.56
Nevada $56.47 $205.17
Delaware $56.06 $147.63
U.S. Virgin Islands $56.03 $323.11
Guam $55.61 $82.36
Oregon $55.56 $227.83
Florida $55.55 $179.42
Maine $54.53 $300.83
Puerto Rico $54.18 $81.57
Texas $54.15 $205.33
South Dakota $53.79 $225.01
Arizona $53.74 $156.32
Michigan $53.62 $159.80
Wisconsin $53.28 $370.19
Georgia $52.83 $333.40
North Carolina $52.77 $169.89
Utah $52.30 $206.34
Ohio $51.94 $207.47
New Mexico $51.85 $191.53
Missouri $51.73 $228.90
North Dakota $51.68 $217.05
Idaho $51.66 $203.10
Iowa $51.54 $186.15
South Carolina $51.46 $151.63
Hawaii $51.32 $137.03
Kansas $51.26 $186.52
Nebraska $50.38 $176.13
Louisiana $50.26 $166.75
Indiana $50.07 $176.91
Oklahoma $49.64 $196.09
Alabama $49.60 $170.35
Tennessee $49.48 $213.34
Arkansas $49.12 $214.97
Kentucky $48.33 $165.91
Montana $47.16 $202.32
Mississippi $46.49 $163.89
West Virginia $46.30 $161.79

What the Data Says About Administration Of Non-Hormonal Anti-Neoplastic Chemotherapy Under Skin Or Into Muscle

Across 54 states with reporting providers, CPT code 96401 (Administration Of Non-Hormonal Anti-Neoplastic Chemotherapy Under Skin Or Into Muscle) shows a national average Medicare payment of $56.62 against an average billed charge of $196.56. That gap, a 3.5x markup, or 247% above the Medicare allowed amount, is among the tightest billed-to-paid spreads we track, this code's chargemaster rate tracks unusually close to the Medicare benchmark.

Chemotherapy/Infusion procedures like this one saw 831.0K services billed to Medicare in 2023 by 12.3K distinct providers, serving 144.0K unique beneficiaries. State-level variation is significant: West Virginia reports the lowest average payment at $46.30, while District of Columbia reports the highest at $66.11. The 43% 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 $155.73, with self-pay cash discounts commonly bringing the figure closer to $108.38. Within Chemotherapy/Infusion, Administration Of Non-Hormonal Anti-Neoplastic Chemotherapy Under Skin Or Into Muscle ranks #15 of 27 tracked procedures by national average Medicare payment.

Where this sits in the registry

Administration Of Non-Hormonal Anti-Neoplastic Chemotherapy Under Skin Or Into Muscle (96401) 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 Administration Of Non-Hormonal Anti-Neoplastic Chemotherapy Under Skin Or Into Muscle rank among Medicare procedures?

According to CMS Medicare Part B claims, Administration Of Non-Hormonal Anti-Neoplastic Chemotherapy Under Skin Or Into Muscle (CPT 96401) ranks #417 of 9,297 procedures by national service volume, the same sort as the procedures listing, and #15 of 27 within Chemotherapy/Infusion by national average Medicare payment. See /methodology#corpus-placement.

How much does Administration Of Non-Hormonal Anti-Neoplastic Chemotherapy Under Skin Or Into Muscle cost?

Medicare's national average payment for Administration Of Non-Hormonal Anti-Neoplastic Chemotherapy Under Skin Or Into Muscle (CPT 96401) is $56.62, with providers billing $196.56 on average; state rates run from $46.30 to $66.11, 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 Administration Of Non-Hormonal Anti-Neoplastic Chemotherapy Under Skin Or Into Muscle cost with insurance?

With commercial insurance, administration of non-hormonal anti-neoplastic chemotherapy under skin or into muscle costs an estimated $155.73 on average (range: $109.01-$218.02), a moderate premium over Medicare's $56.62. Without insurance, the estimated cash price is $108.38.

Which state has the lowest cost for Administration Of Non-Hormonal Anti-Neoplastic Chemotherapy Under Skin Or Into Muscle?

West Virginia has the lowest average Medicare payment for Administration Of Non-Hormonal Anti-Neoplastic Chemotherapy Under Skin Or Into Muscle at $46.30, while District of Columbia has the highest at $66.11 - a meaningful $19.80 spread.

How many providers perform Administration Of Non-Hormonal Anti-Neoplastic Chemotherapy Under Skin Or Into Muscle?

Administration Of Non-Hormonal Anti-Neoplastic Chemotherapy Under Skin Or Into Muscle is a widely-performed procedure: 12.3K providers billed Medicare for it in 2023 across 54 states, together handling 831.0K services for 144.0K beneficiaries.

What is the billed-to-Medicare markup for Administration Of Non-Hormonal Anti-Neoplastic Chemotherapy Under Skin Or Into Muscle?

Providers bill 3.5x what Medicare pays for Administration Of Non-Hormonal Anti-Neoplastic Chemotherapy Under Skin Or Into Muscle - one of the smaller markups in the catalog at 247% 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.

Related Guides

Negotiating Your Medical Bill

Tips to reduce out-of-pocket costs
Hospital Price Transparency

Your right to upfront pricing
Understanding Medicare Costs

How Medicare payments work
How to Read a Medical Bill

Decode charges and codes
Hospital Markup Explained

Why bills exceed actual costs
Why Costs Vary by State

Geographic pricing factors

Data from CMS Medicare Physician & Other Practitioners (2023).

Read our methodology - how this data is sourced, computed, and verified.

Related

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Data sourced from the CMS Medicare Physician and Other Practitioners dataset. See our methodology for details. Retrieved and formatted by PlainProcedure

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.