Reddenda · Rate Intelligence · New York-Newark-Jersey City, NY-NJ

96365 under Aetna in New York-Newark-Jersey City, NY-NJ: a flat fee schedule

IV infusion, therapy/diagnostic, first hour · No dispersion to score. Flat fee schedule

• Aetna pays exactly $66.76 for CPT 96365 (IV infusion, therapy/diagnostic, first hour) to 93.6% of the 1883 providers indexed in New York-Newark-Jersey City, NY-NJ.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Aetna to publish this rate
• This cell has 1883 individual rate records and 1883 distinct providers, all converging on one number.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Aetna to publish this rate
• Because the rate is flat, there is no local percentile to claim here: every peer is paid the same, so "below median" is not a meaningful complaint against this specific file.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Aetna to publish this rate
• A rate change here would have to come from a fee-schedule renegotiation with Aetna directly, not a peer-comparison argument, since 93.6% of the local market already sits at the identical number.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Aetna to publish this rate
• Medicare's national non-facility rate for CPT 96365 is $67.14; Aetna's flat $66.76 is 99% of that Medicare rate.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Aetna to publish this rate
• A federal No Surprises Act arbitrator may weigh up to four plan years of a provider's own contracted rate history and local market share when resolving a payment dispute (45 CFR §149.510(c)(4)(iii)(B)).Source: 45 CFR §149.510(c)(4)(iii)(B) (No Surprises Act IDR)

Modeled from Aetna's own published in-network rates, not guaranteed. Peer basis: same CPT, same payer file, same metro (CBSA); never a pooled payer family, never a national average. Page generated 2026-08-25 07:13 UTC.