CPT 96413 · professional fee

Chemo iv infusion 1 hr (CPT 96413): negotiated rates by payer and state

What UnitedHealthcare, Aetna, Cigna and Blue Cross Blue Shield pay for CPT 96413, from their published in-network rate files.

GastroenterologySnapshot Aug 2026Professional fee only

National summary

Commercial in-network, four payers combined, professional fee

Median rate

$204

P10 to P90: $133 to $384

vs Medicare

153%

non-facility rate $133.27

Payer spread

1.33×

BCBS $223 vs Aetna $168

State spread

2.6×

AK $404 to TX $155

4,436 sampled providers5,194 TINs51 statesSample-based · how this is calculated

What the data shows

Generated from this code's own numbers

Blue Cross Blue Shield has the highest median for CPT 96413 in the files analyzed, at $223, 33% above Aetna ($168), the lowest of the 4 payers shown.

The state spread is 2.6×: Alaska has the highest median at $404 and Texas the lowest at $155, a gap larger than the gap between the highest and lowest payer.

Commercial rates run 153% of the Medicare non-facility rate ($133.27), which ranks 108th of 228 tracked codes by commercial-to-Medicare ratio.

Rates are tightest within Aetna (interquartile range $86) and widest within Cigna ($117).

This is a top-40 code for gastroenterology by Medicare allowed dollars, so it carries real revenue weight for that specialty.

Rates by payer

Median of per-provider median rates, with interquartile range

Payer	Median	P25	P75	vs national	Rank	Providers	Position
Blue Cross Blue Shield	$223	$173	$289	+9%	1	3,595	167% of Medicare
Cigna	$208	$168	$285	+2%	2	3,590	156% of Medicare
UnitedHealthcare	$206	$162	$277	+1%	3	3,765	155% of Medicare
Aetna	$168	$141	$227	-18%	4	2,536	126% of Medicare

Rate distribution

Box = P25 to P75, whiskers = P10 to P90, tick = median, dashed line = Medicare non-facility ($133.27)

Rates by state

Median across payers · 50 states with enough data

Rank	State	Median	vs national	Highest payer	Lowest payer	Providers
1	Alaska	$404	+98%	n/a	n/a	16
2	Oregon	$382	+87%	BCBS	Aetna	104
3	Connecticut	$318	+56%	BCBS	Aetna	121
4	Wisconsin	$305	+49%	BCBS	Cigna	110
5	Minnesota	$299	+46%	UHC	Aetna	91
6	New Hampshire	$293	+44%	UHC	Aetna	74
7	Washington	$286	+40%	UHC	Aetna	96
8	Nebraska	$284	+39%	UHC	BCBS	46
9	Massachusetts	$269	+32%	UHC	Aetna	113
10	Georgia	$252	+23%	BCBS	UHC	126
11	South Dakota	$244	+20%	BCBS	UHC	25
11	Iowa	$244	+20%	Cigna	BCBS	55
13	District of Columbia	$241	+18%	Cigna	BCBS	51
14	North Dakota	$241	+18%	BCBS	UHC	20
15	Illinois	$238	+16%	BCBS	Cigna	115
16	California	$229	+12%	UHC	Aetna	108
17	North Carolina	$226	+11%	BCBS	Aetna	124
18	New Jersey	$220	+8%	BCBS	Aetna	116
19	Ohio	$219	+7%	BCBS	UHC	123
20	Virginia	$219	+7%	BCBS	Aetna	115
21	Idaho	$217	+6%	UHC	Aetna	52
22	New Mexico	$213	+4%	UHC	BCBS	58
23	New York	$211	+4%	BCBS	Aetna	131
24	Vermont	$210	+3%	UHC	Cigna	23
25	Colorado	$210	+3%	UHC	Aetna	123
26	Maine	$208	+2%	BCBS	Aetna	53
27	Montana	$204	-0%	UHC	Cigna	28
27	Indiana	$204	-0%	BCBS	Aetna	110
29	Rhode Island	$203	-0%	UHC	Cigna	66
30	Utah	$203	-1%	Aetna	BCBS	88
31	Arizona	$200	-2%	Aetna	BCBS	98
32	Missouri	$196	-4%	BCBS	Aetna	135
33	Delaware	$193	-6%	UHC	Aetna	29
34	West Virginia	$189	-7%	BCBS	Aetna	49
35	South Carolina	$188	-8%	BCBS	Aetna	116
36	Louisiana	$186	-9%	BCBS	Aetna	121
37	Michigan	$184	-10%	BCBS	Aetna	112
38	Pennsylvania	$184	-10%	UHC	Aetna	114
39	Florida	$182	-11%	BCBS	Aetna	121
40	Tennessee	$181	-11%	UHC	Aetna	109
41	Mississippi	$179	-12%	BCBS	UHC	92
42	Kansas	$175	-14%	Cigna	Aetna	62
43	Maryland	$173	-15%	Cigna	BCBS	110
44	Nevada	$170	-17%	BCBS	Aetna	84
45	Oklahoma	$170	-17%	BCBS	Aetna	98
46	Hawaii	$168	-18%	BCBS	UHC	46
47	Alabama	$168	-18%	BCBS	UHC	114
48	Kentucky	$166	-19%	Cigna	UHC	124
49	Arkansas	$158	-22%	Cigna	UHC	81
50	Texas	$155	-24%	Cigna	Aetna	132

Frequently asked questions

Answers use this page's data

Which payer has the highest median rate for CPT 96413?

In the files we analyzed, Blue Cross Blue Shield, at a median of $223 across 3,595 sampled providers. Aetna is lowest at $168, 33% lower than the highest.

How does the commercial rate compare with Medicare?

The national median is 153% of the 2026 Medicare non-facility rate of $133.27.

Which state has the highest median for CPT 96413?

Alaska has the highest median at $404; Texas has the lowest at $155.

Is this a professional fee?

These are professional (physician) fees only. Facility, device and implant payments are priced separately and are not included.

How current is this data?

It is the August 2026 snapshot of each payer's in-network rate file. Sources and filters are listed in the methodology below.

Methodology

How these numbers are calculated

Source: in-network negotiated-rate files published under the federal Transparency in Coverage rule, August 2026 snapshot: UnitedHealthcare Choice plans (74 files); Aetna commercial plans (70 files); Cigna national PPO (1 files); BCBS licensees' own-network files (5,387 files). Payer comparisons describe these files, not each payer's entire book of business.
Sample: rates come from a random sample of up to 150 providers per state and specialty. Counts on this page are sampled providers and TINs, not totals.
Which providers count: only providers in a specialty relevant to the code, because a rate in a payer file attaches to a provider group and is listed under every provider in that group.
Filters: fee-for-service, professional billing class, no modifier, negotiated or fee-schedule dollar rates. Rates outside 1% to 1,000% of the Medicare rate are excluded.
Statistic: one median rate per provider, then percentiles across providers. A cell is shown only with at least 15 sampled providers and 4 TINs.
Medicare benchmark: CY2026 national physician fee schedule, non-QPP conversion factor, unadjusted for locality. Where the non-facility rate is more than twice the facility rate (office rates that include device or supply cost), the facility rate is used so comparisons are like for like.

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