Assessing the true cost of infusion care: Comparing hospital chargemaster, cash, and negotiated prices for infusion CPT codes across top-ranked US hospitals.

Abstract

e23186 Background: Patients in the United States often lack clear, actionable information about the prices of common outpatient infusion services across hospitals and payers. Recent federal policy, including the No Surprises Act of 2022, require hospitals to publish negotiated prices for all services, creating an opportunity to quantify variation in hospital prices for common infusion services. Despite extensive research documenting price variation across healthcare services, the relationship between hospitals’ prices and Medicare benchmark rates for common infusion services remains poorly characterized. Methods: We extracted publicly available price transparency data from the Turquoise Health aggregate database from 12 top-ranked US hospitals for five common infusion CPT codes. For each code, we captured (1) chargemaster price, (2) discounted cash price, and (3) payer-specific negotiated rates; we summarized inter-facility variation using the median and range across hospitals. We compared median negotiated rates to the 2025 Medicare OPPS benchmark rates for each service. Results: Across 12 top US hospitals, prices for common infusion services varied widely across facilities for all five CPT codes. Median negotiated rates showed especially large inter-facility dispersion, with up to 53-fold variation across hospitals. Three infusion services had median negotiated rates ≥2× the Medicare benchmark rate. Median discounted cash prices exceeded median negotiated rates for all five services, with average cash price 136% of median negotiated rate. Conclusions: Among 12 top US hospitals, there is substantial inter-facility variation in prices for common infusion services, with negotiated rates frequently exceeding Medicare benchmarks. For several infusion codes, median negotiated rates were 2–3× Medicare OPPS benchmark rates. These findings suggest that even routine infusion services expose patients and payers to unpredictable and frequently elevated pricing, underscoring the need for increased transparency for negotiated rates for common infusion services. Hospital prices for 5 common infusion-related cpt codes, as compared to medicare opps benchmark rates. CPT Code Service Medicare OPPS Benchmark ($) Chargemaster Median (Range) Discounted Cash Median (Range) Median Negotiated Rate (Range) Negotiated Price / Medicare Benchmark 96413 Chemo infusion, initial hr $332 $1,181 ($553–$2,091) $743 ($221–$1,608) $670 ($117–$1,286) 2.02 96415 Chemo infusion, additional hr $71 $503 ($118–$843) $367 ($47–$592) $233 ($25–$809) 3.27 96365 Non-chemo infusion, initial hr $211 $643 ($307–$1,324) $408 ($146–$960) $348 ($56–$1,057) 1.65 96366 Non-chemo infusion, additional hr $46 $300 ($95–$545) $230 ($39–$368) $142 ($19–$1,015) 3.07 96360 IV fluid hydration, initial hr $211 $587 ($191–$1,324) $370 ($76–$1,297) $277 ($30–$755) 1.32