PayerPriceCheck Local Rates

Neurology reimbursement rates by service line

Compare national neurology reimbursement benchmarks calculated from price transparency data. Reference benchmarks cover 64615, 95819 and 95911 across Aetna, Anthem, Cigna and United. Reporting periods: Jun–Jul 2026.

2,986,384 provider-rate observations4 payers in source data50 states represented20 billing codes
Rate data shownJun–Jul 2026About these rates
Neurology
Rate Explorer

Compare national neurology rates by payer

Compare payer benchmarks across common neurology services while preserving the code, billing-component, and drug-unit context.

Aetna state variation for 95819

LowerHigher
Alaska: $972.64 Aetna reference averageAKAlabama: $596.79 Aetna reference averageALArkansas: $473.78 Aetna reference averageARArizona: $584.42 Aetna reference averageAZCalifornia: $614.94 Aetna reference averageCAColorado: $634.32 Aetna reference averageCOConnecticut: $892.98 Aetna reference averageCTDistrict of Columbia: No preview availableDCDelaware: $792.35 Aetna reference averageDEFlorida: $502.35 Aetna reference averageFLGeorgia: $676.88 Aetna reference averageGAHawaii: $871.14 Aetna reference averageHIIowa: $682.60 Aetna reference averageIAIdaho: $652.32 Aetna reference averageIDIllinois: $614.89 Aetna reference averageILIndiana: $503.64 Aetna reference averageINKansas: $714.35 Aetna reference averageKSKentucky: $587.42 Aetna reference averageKYLouisiana: $588.41 Aetna reference averageLAMassachusetts: $711.16 Aetna reference averageMAMaryland: $665.87 Aetna reference averageMDMaine: $634.32 Aetna reference averageMEMichigan: $551 Aetna reference averageMIMinnesota: $510.73 Aetna reference averageMNMissouri: $629.72 Aetna reference averageMOMississippi: $607.33 Aetna reference averageMSMontana: $611.53 Aetna reference averageMTNorth Carolina: $578.05 Aetna reference averageNCNorth Dakota: $469.99 Aetna reference averageNDNebraska: $693.85 Aetna reference averageNENew Hampshire: $590.41 Aetna reference averageNHNew Jersey: $594.46 Aetna reference averageNJNew Mexico: $649.36 Aetna reference averageNMNevada: $564.55 Aetna reference averageNVNew York: $696.06 Aetna reference averageNYOhio: $701.80 Aetna reference averageOHOklahoma: $559.81 Aetna reference averageOKOregon: $801.89 Aetna reference averageORPennsylvania: $731.71 Aetna reference averagePARhode Island: $527.28 Aetna reference averageRISouth Carolina: $495.42 Aetna reference averageSCSouth Dakota: $758.40 Aetna reference averageSDTennessee: $545.65 Aetna reference averageTNTexas: $522.42 Aetna reference averageTXUtah: $535.26 Aetna reference averageUTVirginia: $629.03 Aetna reference averageVAVermont: $168.54 Aetna reference averageVTWashington: $951.74 Aetna reference averageWAWisconsin: $627.82 Aetna reference averageWIWest Virginia: $544.23 Aetna reference averageWVWyomingWY
National
Select a state to reveal payer percentiles and provider examples.

National 95819 rate distribution

Payer
Published rate$ per service
$400$500$600$700$800
Median
AetnaJun–Jul 2026
AetnaProviders34,743Average$602.72
$523.77median
CignaJun–Jul 2026
CignaProviders36,193Average$832.26
$719.53median
UnitedJun–Jul 2026
UnitedProviders38,892Average$835.40
$736.62median
AnthemJun–Jul 2026
AnthemProviders35,288Average$890.40
$751.48median

Each marker shows the national median published rate across billing entities for that payer.

National 95819 rates by payer

$ per service
PayerRate periodProvider entitiesP25MedianP75P90Average
AetnaJun–Jul 202634,743$523.77$602.72
CignaJun–Jul 202636,193$719.53$832.26
UnitedJun–Jul 202638,892$736.62$835.40
AnthemJun–Jul 202635,288$751.48$890.40
About these rates
Using these rates in a report or negotiation?

Confirm coverage for your codes, payers and markets.

Check coverage with an analyst20-minute call. See sample rates for your markets.

How do specific neurology providers compare?

Compare named provider rates with the selected payer's median and percentile distribution.

National: Neurology provider rates by payer (CPT 95819)

6 provider examples
Provider entityStateSize$ per serviceGap to medianPosition in Aetna range
VIRTUAL NEUROLOGY TEXAS PLLCNPI 1003017427 · Tax ID 844233151FL208$213.18-$310.59
Below P25
SYMPHONY SPECIALTY GROUP LLCNPI 1881995140 · Tax ID 882438064FL6$352.35-$171.42
Below P25
KENT COUNTY MEMORIAL HOSPITALNPI 1386643294 · Tax ID 050258896RI670$415.46-$108.32
Below P25
BRIAN APATOFFNPI 1528155611NY-$460.42-$63.35
P25 to median
CONTINENTAL MEDICAL GROUPNPI 1023099124 · Tax ID 113088782NY2
Median to P75
THE VANCOUVER CLINIC, INC., PSNPI 1053721571 · Tax ID 910851599WA1,013
Above P75
Need provider rates for a specific state?

Which providers have the highest claim volume in the neurology market?

Provider organizations with the highest combined 2024 Medicare and Medicaid claim volume in the neurology market.

#StateProvider
MedicareMedicaidRanked by combined total
  1. 1CA
    Neurological Institute Of Los AngelesNPI 1659849040
    Medicare 30,262Medicaid 27330,535 total
  2. 2IN
    Indiana Clinic-Neurology LLCNPI 1578792271
    Medicare 23,722Medicaid 4,83028,552 total
  3. 3AZ
    Phoenix Neurological InstituteNPI 1336319086
    Medicare 13,104Medicaid 6,30719,411 total
  4. 4NY
    Dent Neurologic Group LLPNPI 1497850911
    Medicare 4,517Medicaid 10,59515,112 total
  5. 5MULTI
    Regents Of The University Of MichiganNPI 1053343004
    Medicare 13,039Medicaid 1,58714,626 total
  6. 6NY
    Ny Neurological Consultant PCNPI 1053629477
    Medicare 11,695Medicaid 011,695 total
  7. 7MULTI
    Univ Of Penn Medical GroupNPI 1164810271
    Medicare 1,552Medicaid 9,92411,476 total
  8. 8MI
    Glendale Neurological Associates PCNPI 1639134414
    Medicare 10,606Medicaid 83211,438 total
  9. 9CA
    UCI University NeurosciencesNPI 1205884210
    Medicare 2,917Medicaid 5,4628,379 total
  10. 10MI
    Mawan Shuayto MD PCNPI 1578819850
    Medicare 6,419Medicaid 1676,586 total
  11. 11AZ
    AZ Integrated Neuro Spine & Pain LLCNPI 1487155354
    Medicare 1,741Medicaid 4,7136,454 total
  12. 12FL
    Carlos Ramirez Calderon MD PANPI 1164825253
    Medicare 6,008Medicaid 06,008 total
  13. 13NJ
    Insite Medical Nj PANPI 1538807011
    Medicare 442Medicaid 5,5616,003 total
  14. 14AZ
    Phoenix Neurology And Sleep Medicine PLLCNPI 1285687822
    Medicare 2,634Medicaid 3,3345,968 total
  15. 15MULTI
    The Neurology GroupNPI 1376967422
    Medicare 5,381Medicaid 4275,808 total
  16. 16MA
    CH Neurology Foundation INC.NPI 1063432417
    Medicare 147Medicaid 5,6255,772 total
  17. 17DE
    Cnmri P. A.NPI 1861449498
    Medicare 5,042Medicaid 2655,307 total
  18. 18AL
    Neurology Consultants Of Tuscaloosa P.C.NPI 1972607471
    Medicare 4,317Medicaid 9655,282 total
  19. 19MI
    Associates In Neurology PCNPI 1891792628
    Medicare 4,976Medicaid 1505,126 total
  20. 20AZ
    Arizona Neurology Associates PLLCNPI 1932569324
    Medicare 3,510Medicaid 1,5835,093 total

How reimbursement changes across neurology services

Keep diagnostic studies, procedures, office visits, and drug units separated so each comparison represents the same billed service.

GeographyNational
Display
Service line / billing codeAetnaCignaUnitedAnthem
$ per service · 4 codes
95700EEG setup and patient education
$275.56$503.22$451.71$592.25
95720EEG monitoring with review and report
$300.19$411.90$417.83$451.06
95816Routine EEG, awake and drowsy
$521.28$726.16$714.88$778.66
95819Routine EEG, awake and asleep
$602.72$832.26$835.40$890.40
$ per service · 8 codes
95885Limited needle EMG with nerve conduction study
$89.26$123.92$122.70$140.84
95886Complete needle EMG with nerve conduction study
$138.77$192.56$190.68$216.81
95908Nerve conduction studies, 3-4 studies
$170.73$233.67$237.96$269.73
95909Nerve conduction studies, 5-6 studies
$203.68$280.16$285.98$323.06
95910Nerve conduction studies, 7-8 studies
$268.02$367.66$376.15$423.42
95911Nerve conduction studies, 9-10 studies
$322.36$442.10$451.46$509.89
95912Nerve conduction studies, 11-12 studies
$371.29$511.11$519.80$583.34
95913Nerve conduction studies, 13 or more studies
$431.18$592.24$601.07$673.99
$ per service · 1 code
64615Chemodenervation for chronic migraine
$212.18$308.32$323.31$313.24
$ per visit · 6 codes
99203New patient office visit, low level
$121.66$171.40$190.17$200.21
99204New patient office visit, moderate level
$189.34$265.91$288.02$305.36
99205New patient office visit, high level
$245.95$346.06$367.64$391.84
99213Established patient office visit, low level
$89.43$127.03$135.68$142.17
99214Established patient office visit, moderate level
$130.73$185.13$196.19$203.57
99215Established patient office visit, high level
$183.60$263.22$267.34$284.58
$ per HCPCS unit · 1 code
J0585OnabotulinumtoxinA, one unit
$8.39$6.81$7.67$9.82
Need a comparison for another market or network?

How to read these neurology 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 neurology services.

Rate source
Each value is a payer-published negotiated or fee-schedule amount for professional neurology billing, not a claim, charge, or estimate of total allowed spending.
Rate calculation
One modal value is selected per NPI and TIN entity before trimming two percent from each tail. National and state summaries are not weighted by service 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
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
This initial view includes records without a reported modifier. Professional-component, technical-component, and global rates should not be blended. J0585 is reported per HCPCS unit and remains separate from the 64615 administration procedure. 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 Neurology 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.
Talk with a reimbursement analyst

We'll explain what's available, flag gaps and help define the comparison.

Book a 20-minute call No prep or data upload required.

Trusted by teams that need defensible reimbursement data

Buy and Bill
Acadia
Bold Steps Behavioral Health
ApolloMD
Psychiatric Alternatives & Wellness Center
EDPMA
Healthcare Leaders Association of New Jersey

Explore neurology rates by state

Choose a state to compare payer reference averages for common services.

View National Overview
Available stateNo public state averages

How to interpret neurology rates

How to interpret the selected market and payer-published rates.

Which neurology services are included?

The report includes common EEG, nerve conduction, EMG, chemodenervation, evaluation and management, and botulinum toxin drug codes.

Are professional-component rates included?

This initial view uses professional billing records without a reported modifier. Rates reported with modifier 26 or another component modifier should be compared separately.

Does the rate for CPT 64615 include botulinum toxin?

No. CPT 64615 represents the chemodenervation procedure. J0585 represents the botulinum toxin drug and is reported separately per HCPCS unit.

How are named neurology providers selected?

Provider examples are sampled from different points in each payer's published rate range. An entity may represent an individual clinician, group, health system, or another billing organization. The national overview includes public provider samples; state provider-level comparisons require a free state preview.

What should be aligned before comparing neurology rates?

Match the exact code, modifier, billing component, drug units, site of service, payer product, network, and contract period.