Emergency Medicine reimbursement rates by service line
Compare national emergency medicine reimbursement benchmarks calculated from price transparency data. Reference benchmarks cover 99283, 99284 and 99285 across Aetna, Anthem, Cigna and United. Reporting periods: Aug 2026.
Rate Explorer
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 median published rate across billing entities for that payer.
National 99284 rates by payer
| Payer | Rate period | Provider entities | P25 | Median | P75 | P90 | Average |
|---|---|---|---|---|---|---|---|
| Aetna | Aug 2026 | 62,242 | $122.73 | $154.35 | |||
| Cigna | Aug 2026 | 92,588 | $221.85 | $252.41 | |||
| United | Aug 2026 | 74,036 | $208.09 | $228.69 | |||
| Anthem | Aug 2026 | 126,368 | $245.12 | $252.50 |
- Source
- Negotiated or fee-schedule amounts 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.
Confirm coverage for your codes, payers and markets.
How do specific emergency medicine providers compare?
Compare named provider rates with the selected payer's median and percentile distribution.
National: Emergency medicine provider rates by payer (CPT 99284)
| Provider entity | State | Size | $ per service | Gap to median | Position in Aetna range |
|---|---|---|---|---|---|
| WECARE HEALTH CLINICNPI 1013236975 · Tax ID 841850569 | AL | 4 | $78.30 | -$44.43 | Below P25 |
| DUPONT ANESTHESIA PSCNPI 1508851171 · Tax ID 611121906 | FL | 31 | $92.35 | -$30.38 | Below P25 |
| KEJO MEDICAL PLLCNPI 1548524861 · Tax ID 813502792 | TN | 5 | $108.78 | -$13.95 | P25 to median |
| LITTLE LANTERN CLINIC LLCNPI 1053501809 · Tax ID 831807390 | TX | 26 | $116.55 | -$6.18 | P25 to median |
| PUBLIC HOSPITAL DISTRICT 3 OF PACIFIC COUNTYNPI 1609292671 · Tax ID 916001012 | NY | 86 | Median to P75 | ||
| EMERGENCY PHYSICIAN ASSOCIATES OF SOUTH JERSEY P CNPI 1003009630 · Tax ID 223586506 | NY | 529 | 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 emergency medicine market?
Provider organizations with the highest combined 2024 Medicare and Medicaid claim volume in the emergency medicine market.
- 1MULTICep America CaliforniaNPI 1396044491Medicare 642,359Medicaid 174,816817,175 total
- 2MULTISoutheastern Emergency Physicians LLCNPI 1356379382Medicare 184,867Medicaid 150,269335,136 total
- 3MNEmergency Physicians Professional AssociationNPI 1801871934Medicare 136,248Medicaid 24,171160,419 total
- 4SCACS Primary Care Physicians Southeast PCNPI 1861430555Medicare 60,388Medicaid 64,049124,437 total
- 5ALParagon Contracting Services INC.NPI 1225071459Medicare 73,726Medicaid 41,927115,653 total
- 6WANorthwest Emergency Physicians INC.NPI 1235172370Medicare 71,063Medicaid 42,002113,065 total
- 7OHEmergency Professional ServicesNPI 1093762353Medicare 76,265Medicaid 27,580103,845 total
- 8MULTINorthwest Acute Care Specialists PCNPI 1215983200Medicare 95,438Medicaid 1,47796,915 total
- 9OHMid-Ohio Emergency Services LLCNPI 1386691780Medicare 71,765Medicaid 23,47595,240 total
- 10FLEmergency Physicians of Central Florida LLPNPI 1326033341Medicare 85,563Medicaid 4,22689,789 total
- 11NJEmergency Physician Associates of South Jersey PCNPI 1215965231Medicare 77,879Medicaid 11,86789,746 total
- 12FLFlorida Emergency Physicians Kang & Associates M.D. INCNPI 1811983752Medicare 72,047Medicaid 15,45687,503 total
- 13OHMiami Valley Emergency SpecialistsNPI 1821189085Medicare 75,896Medicaid 10,75786,653 total
- 14UTEmergency Physicians Integrated CareNPI 1578598199Medicare 5,516Medicaid 74,02379,539 total
- 15CAEmergency Physicians Associates San Jose PCNPI 1306311576Medicare 4,393Medicaid 74,95579,348 total
- 16MULTIUniv Of Penn Medical GroupNPI 1952799074Medicare 4,661Medicaid 71,03775,698 total
- 17FLInphynet South Broward LLCNPI 1871521880Medicare 63,613Medicaid 7,32670,939 total
- 18CASeven Star Hospital Associates INCNPI 1144823246Medicare 58,186Medicaid 7,20065,386 total
- 19TXTexas Medicine Resources LLPNPI 1376581900Medicare 48,566Medicaid 14,03062,596 total
- 20NCWake Emergency Physicians P.A.NPI 1922063387Medicare 61,310Medicaid 97862,288 total
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 | Aetna | Cigna | United | Anthem |
|---|---|---|---|---|
$ per service · 5 codes | ||||
99281Emergency department visit, minimal complexity | $34.76 | $38.83 | $38.08 | $46.42 |
99282Emergency department visit, straightforward complexity | $58.02 | $86.13 | $81.49 | $90.66 |
99283Emergency department visit, low complexity | $88.82 | $144.96 | $127.69 | $159.56 |
99284Emergency department visit, moderate complexity | $154.35 | $252.41 | $228.69 | $252.50 |
99285Emergency department visit, high complexity | $219.09 | $367.40 | $331.77 | $362.69 |
$ per service · 2 codes | ||||
99291Critical care, first 30–74 minutes | $332 | $527.70 | $512.63 | $496.76 |
99292Critical care, each additional 30 minutes | $153.87 | $240.81 | $227.34 | $208.89 |
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 emergency medicine 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
We start with negotiated or fee-schedule 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 source
- The 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.
- Rate calculation
- National 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. 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 a physician group, staffing organization, health system, or other billing entity. 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 exact emergency department level or critical care time code, professional billing component, modifier, payer product, and network. Facility charges remain separate. 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 Emergency Medicine rates in your market
Tell us the services, payers and locations you need. We'll confirm coverage and scope the comparison.
- Define the scopeChoose the codes, payers, networks and providers.
- Match the billing detailsWe align services, settings and payment units.
- Compare the ratesReview payer and provider rates for your selected market.
We'll explain what's available, flag gaps and help define the comparison.
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Explore emergency medicine rates by state
Choose a state to compare payer reference averages for common services.
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?
Provider examples are sampled across each payer's published rate range. An entity may represent a physician group, health system, staffing organization, or other contracted billing organization. The national overview includes public provider samples; state provider-level comparisons require a free state preview.