Allergy & Immunology reimbursement rates by service line
Compare national allergy & immunology reimbursement benchmarks calculated from price transparency data. Reference benchmarks cover 95004, 95117 and 95165 across Aetna, Anthem, Cigna and United. Reporting periods: Jun–Jul 2026.
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Compare national allergy and immunology rates by payer
Start with three common allergy services, then compare payer ranges and named billing entities in the state relevant to your question.
Aetna state variation for 95165
National 95165 rate distribution
Each marker shows the national median published rate across billing entities for that payer.
National 95165 rates by payer
| Payer | Rate period | Provider entities | P25 | Median | P75 | P90 | Average |
|---|---|---|---|---|---|---|---|
| Aetna | Jun–Jul 2026 | 7,352 | $9.99 | $11.68 | |||
| Cigna | Jun–Jul 2026 | 7,152 | $11.56 | $15.32 | |||
| United | Jun–Jul 2026 | 7,775 | $18.05 | $23.07 | |||
| Anthem | Jun–Jul 2026 | 7,143 | $13.65 | $21.16 |
- Source
- Negotiated or fee-schedule amounts published directly by payers in their machine-readable files.
- Rate shown
- Published commercial rate for allergen extract preparation (95165).
- Method
- Eligible rates are grouped by payer and billing entity so the benchmarks use a consistent service and billing basis.
The state map uses one consistent Aetna reference series; it does not average already-aggregated payer values. The service-line table keeps unlike codes, settings, and billing units in separate comparisons.
Confirm coverage for your codes, payers and markets.
How do specific allergy and immunology providers compare?
Compare named provider rates with the selected payer's median and percentile distribution.
National: Allergy and immunology provider rates by payer (CPT 95165)
| Provider entity | State | Size | $ per service | Gap to median | Position in Aetna range |
|---|---|---|---|---|---|
| ALLERGY ASTHMA SPECIALISTS PCNPI 1043402357 · Tax ID 223320897 | NJ | 7 | $6.25 | -$3.74 | Below P25 |
| CHARLES V KLUCKA DO PANPI 1043490055 · Tax ID 650691322 | FL | 4 | $7.44 | -$2.55 | Below P25 |
| ADVANCED DERMATOLOGY AND AESTHETIC MEDICINENPI 1053552240 · Tax ID 825430226 | IL | 6 | $8.75 | -$1.24 | P25 to median |
| AMY R ELLINGSON MD PANPI 1295907152 · Tax ID 411989263 | MN | 813 | $9.82 | -$0.17 | P25 to median |
| MAIN LINE ALLERGY LLPNPI 1336282870 · Tax ID 232036080 | PA | 8 | Median to P75 | ||
| UMASS MEMORIAL HEALTH CARE INCNPI 1003898420 · Tax ID 042911067 | MA | 5,674 | Above P75 |
Choose one state to replace the mixed-state examples with payer-specific provider rates for available preview codes.
No trial or data preparation required.Which providers have the highest claim volume in the allergy and immunology market?
Provider organizations with the highest combined 2024 Medicare and Medicaid claim volume in the allergy and immunology market.
- 1WVWv Asthma & Allergy Centers INCNPI 1114005477Medicare 32,111Medicaid 2,01734,128 total
- 2VARichmond Allergy And Asthma SpecialistspcNPI 1548367733Medicare 33,361Medicaid 033,361 total
- 3MSMississippi Asthma & Allergy ClinicNPI 1902882251Medicare 13,689Medicaid 17,60131,290 total
- 4MULTIFamily Allergy and AsthmaNPI 1881785947Medicare 25,715Medicaid 1,37527,090 total
- 5SCAllergy Asthma Sinus CtrNPI 1700882388Medicare 21,077Medicaid 1,05222,129 total
- 6MDAsthma & Allergy Center LLCNPI 1912089335Medicare 14,471Medicaid 6,94521,416 total
- 7AZArizona Asthma & Allergy Legacy PLCNPI 1922762699Medicare 15,401Medicaid 16115,562 total
- 8GAAtlanta Allergy Asthma Clinic PANPI 1598796195Medicare 11,575Medicaid 3,55415,129 total
- 9OHAsthma & Allergy Center INCNPI 1720271869Medicare 12,044Medicaid 1,25513,299 total
- 10MULTIAllergy Associates Of Hartford PCNPI 1003937988Medicare 41Medicaid 13,14213,183 total
- 11CAAllergy Asthma Adult Pediatric Medical Group Of The Redwoods INCNPI 1730257932Medicare 43Medicaid 11,68711,730 total
- 12COAsthma Allergy Associates PCNPI 1043204829Medicare 52Medicaid 10,68510,737 total
- 13IDAsthma & Allergy Of IdahoNPI 1427138734Medicare 457Medicaid 10,11810,575 total
- 14MULTIAllergy Associates PANPI 1518242601Medicare 7,809Medicaid 2,55610,365 total
- 15MULTICarolina Asthma And Allergy Center PANPI 1215995444Medicare 2,152Medicaid 7,7049,856 total
- 16NJJeffrey Weiss MD PANPI 1316016629Medicare 9,669Medicaid 09,669 total
- 17MULTIAlbany Medical CollegeNPI 1497921688Medicare 588Medicaid 8,9109,498 total
- 18CTAllergy Associates Of Waterbury PCNPI 1073602959Medicare 2,021Medicaid 7,4079,428 total
- 19CAAllergy Partners of the California Central CoastNPI 1992002182Medicare 9,014Medicaid 2039,217 total
- 20AZArizona Allergy Asthma Immunology Consultants PLCNPI 1093748550Medicare 2,381Medicaid 6,2138,594 total
How reimbursement changes across allergy and immunology services
Keep testing, immunotherapy preparation and administration, pulmonary testing, office visits, biologic administration, and drug units in their appropriate billing context.
| Service line / billing code | Aetna | Cigna | United | Anthem |
|---|---|---|---|---|
$ per service · 2 codes | ||||
95004Percutaneous allergy testing | $6.46 | $7.33 | $7.10 | $10.10 |
95076Ingestion challenge testing | $125.54 | $160.84 | $194.20 | $233.55 |
$ per service · 4 codes | ||||
95115Single-injection immunotherapy administration | $13.39 | $16.54 | $15.67 | $24.08 |
95117Multiple-injection immunotherapy administration | $16.26 | $19.79 | $18.45 | $29.16 |
95165Allergen extract preparation | $11.68 | $15.32 | $23.07 | $21.16 |
95180Rapid desensitization | $156.11 | $194.69 | $220.99 | $275.20 |
$ per service · 3 codes | ||||
94010Spirometry | $43.87 | $52.86 | $54.98 | $74.45 |
94060Bronchodilator responsiveness | $69.73 | $82.70 | $89.49 | $119.84 |
94375Respiratory flow-volume loop | $53.40 | $66.62 | $64.14 | $87.68 |
$ per visit · 6 codes | ||||
99203New patient office visit, level 3 | $113.58 | $146.53 | $160.96 | $187.48 |
99204New patient office visit, level 4 | $176.44 | $226.88 | $244.07 | $284.82 |
99205New patient office visit, level 5 | $228.46 | $295.15 | $310.07 | $365.75 |
99213Established patient office visit, level 3 | $83.81 | $108.08 | $113.76 | $134.12 |
99214Established patient office visit, level 4 | $121.75 | $157.59 | $164.98 | $190.49 |
99215Established patient office visit, level 5 | $169.73 | $224.02 | $224.25 | $265.79 |
$ per administration · 2 codes | ||||
96372Therapeutic injection administration | $24.23 | $28.06 | $25.61 | $39.09 |
96401Antineoplastic injection administration | $101.77 | $123.21 | $120.41 | $190.95 |
$ per HCPCS unit · 4 codes | ||||
J0517Benralizumab | $195.38 | $171.22 | $185.12 | $254.98 |
J2182Mepolizumab | $37.30 | $33.07 | $35.86 | $48.84 |
J2357Omalizumab | $49.60 | $43.51 | $50.36 | $64.99 |
J3590Unclassified biologic | $244.90 | Not available | Not available | $0.03 |
Tell us the services, payers, states, and networks you need. We'll confirm available coverage and scope the comparison on a 20-minute call.
Book a 20-min scoping call No trial or data preparation required.How to read these allergy and immunology rates
Benchmarks calculated by PayerPrice from health plan price transparency files. CMS price transparency requirements.
- Published rates, not paymentsThese figures summarize negotiated rates reported by health plans. They are not claim payments, patient prices or a provider's verified contract.
- Average vs. medianThe average combines eligible billing-entity rates; the median is the middle rate. A large gap between them can signal that high or low rates are pulling the average.
- What a provider row meansA billing entity may be a clinician, practice, facility or health system. A named row does not always represent one individual provider.
- Compare like for likeMatch the code, billing component, setting, payment unit, network and reporting period. Facility, drug and other service payments may be separate.
Calculation details and specialty-specific notes
Use this methodology to understand what each published rate represents and which billing details must match before comparing allergy and immunology services.
- Rate source
- Each value is a negotiated professional rate published in a payer machine-readable file, not a paid claim, billed charge, or estimate of patient responsibility.
- Rate calculation
- National figures use eligible published records across the country; state views use records tied to the selected state. Averages and percentiles are not weighted by service or patient volume. The calculation targets the lowest and highest 2% of entity rates for removal, rounded down to whole entities. Tied boundary values stay together, so fewer rates may be removed. A payer, code and geography cohort is published only when at least 10 billing entities remain after trimming. A missing benchmark does not mean the rate is zero.
- Provider entity
- Named examples use payer-file NPI and TIN records and may represent individual clinicians, group practices, health systems, or other billing entities. Each NPI and TIN combination contributes one representative rate: its most frequent normalized value. When multiple values are equally frequent, those values are averaged.
- Comparable rates
- Match the billing code, service unit, professional billing context, payer product, and network. Testing units, extract preparation, administration, office visits, and drug HCPCS units are not interchangeable. Benchmarks keep the payer, service code, geography, reporting period and billing unit separate. Different services or payment units are not blended into one rate.
Compare Allergy and Immunology rates in your market
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Explore allergy & immunology rates by state
Choose a state to compare payer reference averages for common services.
How to interpret allergy and immunology rates
How to interpret the selected market and payer-published rates.
Which services are included in the allergy and immunology market?
This market includes allergy testing, allergen immunotherapy, pulmonary diagnostic testing, office visits, biologic administration, and selected specialty-biologic HCPCS codes represented in the source report.
Why are allergy testing and immunotherapy shown separately?
Testing, administration, and preparation of allergenic extracts use different billing codes and unit conventions. Combining them into one rate can obscure the reimbursement structure that matters in a contract.
Are biologic drug rates comparable with administration rates?
No. HCPCS drug reimbursement and professional administration services represent different units and payment methodologies and should remain in separate comparisons.
Where do the rates on this page come from?
The data comes from the May 2026 Allergy and Immunology National BUCA Market Overview report. Its negotiated or fee-schedule rates were published directly by payers in their machine-readable price-transparency files.
What does the national payer comparison represent?
The national comparison uses CPT 95165 as a consistent immunotherapy reference service. Other service lines are shown separately so their billing units are not blended together.
Can these rates be used to benchmark a contract?
They can provide market evidence, but a negotiation-ready benchmark should match the relevant state, payer, plan or network, provider peer set, billing codes, units, and contract period.