HCPCS 00085300403 Prescription Drug - Brand

How Much Does Temodar 5 Mg Capsule Cost?

Also known as: TEMODAR 5 MG CAPSULE (CPT 00085300403)

Temodar 5 Mg Capsule (CPT 00085300403) costs $17 at Medicare rates.

The rates shown below represent the complete Medicare reimbursement for this service. No separate facility fee applies for this type of procedure.

Medicare (Facility)
$17
CMS PFS 2026 national rate

Procedures Commonly Done Together

These procedures are frequently performed alongside TEMODAR 5 MG CAPSULE

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How to Reduce Your Cost for TEMODAR 5 MG CAPSULE

Practical tips that can save you hundreds or thousands of dollars

  • 1
    Ask about cash-pay discounts

    Many hospitals and clinics offer 20-40% discounts for self-pay patients. Always ask before scheduling.

  • 2
    Compare facility vs. office setting costs

    Some procedures cost significantly less in an office setting than a hospital. Ask your provider about options.

  • 3
    Shop around — costs vary significantly

    Costs can vary 2-3x between providers in the same city. Get quotes from multiple facilities.

Frequently Asked Questions

How much does TEMODAR 5 MG CAPSULE cost?

The Medicare facility rate for TEMODAR 5 MG CAPSULE is $17. Commercial insurance rates typically range from 150% to 250% of Medicare (varies by plan).

How much does TEMODAR 5 MG CAPSULE cost without insurance?

Without insurance, the cost of TEMODAR 5 MG CAPSULE can range from 150% of Medicare to 500% of Medicare depending on the facility. Many hospitals and clinics offer self-pay discounts of 20-40% off their chargemaster price. Always ask about cash pricing before your visit.

Does insurance cover TEMODAR 5 MG CAPSULE?

Most commercial health insurance plans and Medicare cover TEMODAR 5 MG CAPSULE when ordered by a physician for a medically necessary reason. Your out-of-pocket cost depends on your plan's deductible, copay/coinsurance structure, and whether you use an in-network provider. Check with your insurance company before scheduling to confirm coverage and get a cost estimate.

Why does the cost vary so much by location?

Medicare adjusts payments using Geographic Practice Cost Indices (GPCIs) that reflect local differences in physician work costs, practice expenses, and malpractice insurance. Manhattan, San Francisco, and other high-cost areas pay significantly more than rural regions. Commercial insurers follow similar geographic patterns.

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