Emergency Medicine reimbursement
by service line
Compare national commercial emergency medicine rates for emergency department evaluation, high-acuity care, and critical care services across payers.
Compare national emergency medicine rates by payer
Compare national payer benchmarks for common emergency department and critical care services.
Aetna state variation for 99284
National 99284 rate distribution
Each marker shows the national average published rate across billing entities for that payer.
National 99284 rates by payer
| Payer | Rate period | Provider entities | P25 | Median | P75 | P90 | Average |
|---|---|---|---|---|---|---|---|
| Aetna | Q2 2026 | 50,275 | $193.68 | ||||
| Cigna | Q2 2026 | 1,865 | $398.84 | ||||
| United | Q2 2026 | 74,557 | $227.60 | ||||
| Anthem | Q2 2026 | 746 | $329.06 |
- Source
- Negotiated rates published directly by payers in their machine-readable files.
- Rate shown
- Published commercial rate for emergency department visit, high severity (99284).
- 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 emergency medicine providers compare?
Compare named provider rates with the selected payer's median and percentile distribution.
Emergency medicine 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 emergency medicine 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 emergency medicine services
Keep emergency department levels and time-based critical care services in their own code and billing context so payer rates remain comparable.
| Service line / billing code | Nat'l avg | Aetna | Cigna | United | Anthem |
|---|---|---|---|---|---|
$ per service · 5 codes | |||||
99281Emergency department visit, minimal complexity | $41.02 | — | |||
99282Emergency department visit, straightforward complexity | $71.89 | — | |||
99283Emergency department visit, low complexity | $113.05 | ||||
99284Emergency department visit, moderate complexity | $193.68 | ||||
99285Emergency department visit, high complexity | $278.20 | ||||
$ per service · 2 codes | |||||
99291Critical care, first 30–74 minutes | $443.98 | — | |||
99292Critical care, each additional 30 minutes | $210.30 | — | |||
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 emergency medicine rates are calculated
We start with negotiated rates published in payer machine-readable files and included in the underlying professional emergency medicine report. For each selected billing code, eligible records are grouped by payer and summarized as averages and percentile distributions.
- Rate sourceThe displayed amount is a negotiated professional emergency medicine rate published in a payer machine-readable file, not a paid claim, billed charge, or hospital facility payment.
- CalculationNational values summarize eligible published records across available states. State views use records associated with the selected state, and averages are not weighted by encounter volume or acuity mix.
- Provider entityNamed examples use payer-file NPI and TIN records and may represent a physician group, staffing organization, health system, or other billing entity.
- Comparable ratesMatch the exact emergency department level or critical care time code, professional billing component, modifier, payer product, and network. Facility charges remain separate.
Get the emergency medicine 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.
Trusted by teams that need defensible reimbursement data
How to interpret emergency medicine rates
How to interpret the selected market and payer-published rates.
Which emergency medicine codes are included?
The public view focuses on emergency department evaluation and management codes 99281 through 99285 and critical care codes 99291 and 99292.
Why should emergency department levels be compared separately?
Each level represents a different intensity of evaluation and management. Mixing levels can obscure the rate attached to the actual billed service.
Do these rates include the hospital facility charge?
No. This report is configured for professional emergency medicine services, so facility charges should be analyzed separately.
How should critical care rates be compared?
Compare the initial critical care code separately from each additional time increment. Confirm documented time, code combination, professional billing context, payer product, and network.
How are named emergency medicine providers selected?
The public table selects billing entities across each payer's published rate range. An entity may represent a physician group, health system, staffing organization, or other contracted billing organization.