How can I find out the cost of a medical procedure?

To find out the cost of a medical procedure, you can start by asking your healthcare provider for an estimate. However, for more precise and location-specific pricing information, especially when looking up costs based on CPT codes, you can utilize tools like Payerprice. Payerprice offers a fee schedule lookup tool where you can search with a CPT code and your specific location to get detailed pricing data.

What is a CPT code and why is it important for pricing?

CPT stands for Current Procedural Terminology. CPT codes are standardized numerical codes used by healthcare providers to describe medical, surgical, and diagnostic services and procedures. They are crucial for pricing because they provide a universal language for billing and reimbursement, allowing insurance companies and patients to understand exactly what services were performed and to determine the associated costs and coverage.

Where can I find a fee schedule for medical services?

Fee schedules for medical services can vary significantly based on location, provider, and insurance plan. While some general information might be available, to get specific fee schedule data tailored to a CPT code and your location, you can use specialized tools. Payerprice, for instance, provides a fee schedule lookup tool that allows users to search with a CPT code and a specific location to find relevant pricing information.

How do insurance companies determine what they pay?

Insurance companies determine what they pay based on several factors, including their contracted rates with providers, the specific terms of your health insurance plan (deductibles, copayments, coinsurance), medical necessity criteria, and the CPT codes submitted for services. They negotiate rates with providers, and these negotiated rates often form the basis of their fee schedules. The allowed amount for a service is typically the maximum an insurer will pay.

What's the difference between my provider's charge and what my insurance pays?

Your provider's charge (also known as the billed amount or sticker price) is the amount the healthcare provider initially asks for a service. What your insurance pays is often a negotiated rate, which is typically lower than the provider's charge. This negotiated rate is called the "allowed amount." After your insurance pays its portion of the allowed amount, you are responsible for the remaining balance, which may include your deductible, copayment, or coinsurance, up to your out-of-pocket maximum. The difference between the billed amount and the allowed amount is often a contractual write-off by the provider.

CPT 96413 Fee Schedule

Q: What factors affect fee schedules?

Factors that affect fee schedules include Medicare & Medicaid Rates (government-set reimbursement amounts), Private Insurance Rates (negotiated rates between providers and insurance companies), Geographic Location (costs may be higher in urban areas), and Provider Type (hospital providers may have different rates than private practice).

Last Verified: July 2026

Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.

Infusion Of Chemotherapy, Infusion Of A Chemotherapy Agent Or Other Complex Drug Into A Vein. An Infusion Delivers A Fluid And/Or Medication Slowly Over A Period Of Time.

Key Fact	Detail
Service Type	Injection and Intravenous Infusion Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration Chemotherapy Administration and Other Highly Complex Drug or Highly Complex Biologic Agent Administration
Common Place of Service	11 - Office 22 - On Campus Outpatient Hospital
Common Modifiers	None PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments PN - Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital
Complexity Level	Low
Medicare Fee Schedule	View Medicare rates for 96413

National average reimbursement for CPT 96413 by major payers:

$197.16

$181.31

$193.74

$226.93

Preview provider-level rates for...

For billing codeCPT 96413

Payer	Code	Rate	NPI	Tax ID	State	Specialty
United	96413	$270.60	1790248003 - JERAMIE KERR-ROMANO	202088165 - ATLANTIC HEALTH SYSTEM INC	NJ	Internal Medicine Physician (207R00000X)
United	96413	$225.39	1245233543 - RICHARD BEZOZO	223454267	NJ	Internal Medicine Physician (207R00000X)
United	96413	$127.80	1477844421 - ROWSONARA AKHTER	880521327 - (NJ) MEDDOC OFFICE PC	NJ	Internal Medicine Physician (207R00000X)
United	96413	$222.02	1417963455 - SCOTT INGBER	113492255	NY	Gastroenterology Physician (207RG0100X)
United	96413	$168.53	1457667602 - PRAMOD PANTANGI	550440086 - PLEASANT VALLEY HOSPITAL INC	WV	Gastroenterology Physician (207RG0100X)
United	96413	$210.57	1780656157 - ALEXEY VOLOKHOV	223521092 - (NJ) HARVEY R GROSS MD PC	NJ	Internal Medicine Physician (207R00000X)
United	96413	$153.83	1689803736 - DMITRIY KHODORSKIY	474035304 - (NY) TRIBOROUGH GI PLLC	NY	Gastroenterology Physician (207RG0100X)
United	96413	$216.46	1902874902 - EUGENE CASSONE	161533811 - (NY) GASTROENTEROLOGY ASSOCIATES OF PLATTSBURGH, P.C.	NY	Gastroenterology Physician (207RG0100X)
United	96413	$143.77	1467415851 - PAUL HIERHOLZER	20701782 - ATLANTICARE PHYSICIAN GROUP PA	NJ	Internal Medicine Physician (207R00000X)
United	96413	$153.57	1932606126 - MENALEE HAPUARACHCHI	752005254 - TEXAS DIGESTIVE DISEASE CONSULTANTS	TX	Gastroenterology Physician (207RG0100X)
United	96413	$142.27	1588979181 - SABEEN KHAN	881294087 - (NJ) SHORT HILLS MEDICAL ASSOCIATES LLC	NJ	Internal Medicine Physician (207R00000X)
United	96413	$324.85	1003160623 - ARADHANA AGGARWAL	202088165 - ATLANTIC HEALTH SYSTEM INC	NJ	Internal Medicine Physician (207R00000X)
United	96413	$377.64	1881890416 - SAIMA KHAN	474913206 - (NJ) HUNTERDON SPECIALTY CARE PC	NJ	Internal Medicine Physician (207R00000X)
United	96413	$298.54	1598173684 - JAVAD HAZEGHI	133843560 - CRYSTAL RUN HEALTHCARE PHYSICIANS, LLP	NJ	Internal Medicine Physician (207R00000X)
United	96413	$290.72	1407135593 - PRIYA SIMOES	611661781	NY	Gastroenterology Physician (207RG0100X)
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist

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CPT 96413 vs. Other Chemotherapy Administration and Other Highly Complex Drug or Highly Complex Biologic Agent Administration Codes

The CPT 96413 code is part of the Injection and Intravenous Infusion Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration services used for Chemotherapy Administration and Other Highly Complex Drug or Highly Complex Biologic Agent Administration. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.

The CPT 96413 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.

Code	Complexity	Description
96409-CPT	Low	Injection Of Drug Into Vessel, One Or More Chemotherapy Agents Or Other Complex Drugs Injected Over Several Minutes Into A Blood Vessel.
96411-CPT	Low	Chemotherapy Administration I, Chemotherapy Administration Intravenous Push Technique Each Additional Substancedrug (List Separately In Addition To Code For Primary Procedure)
96413-CPT	Low	Infusion Of Chemotherapy, Infusion Of A Chemotherapy Agent Or Other Complex Drug Into A Vein. An Infusion Delivers A Fluid And/Or Medication Slowly Over A Period Of Time.
96415-CPT	Low	Infusion Of Chemotherapy, Infusion Of A Chemotherapy Agent Or Other Complex Drug Into A Vein. An Infusion Delivers A Fluid And/Or Medication Slowly Over A Period Of Time.

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 96413. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 96413 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.

Factors that affect fee schedules

Medicare & Medicaid Rates

Government-set reimbursement amounts

Private Insurance Rates

Negotiated rates between providers and insurance companies

Geographic Location

Costs may be higher in urban areas.

Provider Type

Hospital providers may have different rates than private practice.

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