Allergy & Immunology reimbursement
by service line
Compare commercial rates for allergy testing, immunotherapy, office visits, pulmonary testing, and biologic services across payers and states.
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 average published rate across billing entities for that payer.
National 95165 rates by payer
| Payer | Rate period | Provider entities | P25 | Median | P75 | P90 | Average |
|---|---|---|---|---|---|---|---|
| Aetna | May 2026 | 5,046 | $13.75 | ||||
| Cigna | May 2026 | 129 | $16.21 | ||||
| United | May 2026 | 7,720 | $22.67 |
- Source
- Negotiated rates 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.
How do specific allergy and immunology providers compare?
Compare named provider rates with the selected payer's median and percentile distribution.
Allergy and immunology provider rates by payer
| Provider entity | State | Size | $ per service | Gap to median | Position in Aetna range |
|---|
Named provider examples are available in a scoped allergy & immunology market comparison.
Choose one state to replace the mixed-state examples with payer-specific provider rates across all three preview codes.
No trial or data preparation required.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 | Nat'l avg | Aetna | Cigna | United | Anthem |
|---|---|---|---|---|---|
$ per service · 2 codes | |||||
95004Percutaneous allergy testing | $7.51 | — | |||
95076Ingestion challenge testing | $145.19 | — | |||
$ per service · 4 codes | |||||
95115Single-injection immunotherapy administration | $15.69 | — | |||
95117Multiple-injection immunotherapy administration | $19.17 | — | |||
95165Allergen extract preparation | $13.75 | — | |||
95180Rapid desensitization | $189.86 | — | |||
$ per service · 3 codes | |||||
94010Spirometry | $51.22 | — | |||
94060Bronchodilator responsiveness | $82.64 | — | |||
94375Respiratory flow-volume loop | $66.97 | — | |||
$ per visit · 6 codes | |||||
99203New patient office visit, level 3 | $128.57 | — | |||
99204New patient office visit, level 4 | $199.49 | — | |||
99205New patient office visit, level 5 | $261.07 | — | |||
99213Established patient office visit, level 3 | $94.91 | — | |||
99214Established patient office visit, level 4 | $136.81 | — | |||
99215Established patient office visit, level 5 | $193.17 | — | |||
$ per administration · 2 codes | |||||
96372Therapeutic injection administration | $27.83 | — | |||
96401Antineoplastic injection administration | $121.37 | — | |||
$ per HCPCS unit · 4 codes | |||||
J0517Benralizumab | $219.77 | — | |||
J2182Mepolizumab | $42.04 | — | |||
J2357Omalizumab | $53.60 | — | |||
J3590Unclassified biologic | — | — | — | — | — |
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 these allergy and immunology rates are calculated
Use this methodology to understand what each published rate represents and which billing details must match before comparing allergy and immunology services.
- Rate sourceEach 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 calculationNational 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.
- Provider entityNamed examples use payer-file NPI and TIN records and may represent individual clinicians, group practices, health systems, or other billing entities.
- Comparable ratesMatch 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.
Get the allergy and immunology reimbursement data you're looking for
Choose the services, payers, states, networks, and provider entities relevant to your question. We'll confirm the available coverage and prepare the comparison.
- Tell us your marketShare the specialty, geography, payers, networks, and providers.
- We find comparable ratesPayerPrice aligns billing codes, services, settings, and units.
- Get your market viewSee relevant payer and provider rates organized around your question.
We'll tell you what the data can support, where the gaps are, and the clearest way to structure the comparison.
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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 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.