Otolaryngology reimbursement rates by service line
Compare payer-published otolaryngology benchmarks for office visits; nasal endoscopy; laryngoscopy; audiology; sinus procedures.
Compare national otolaryngology rates by payer
Use the reference codes to compare payer benchmarks, then explore office visits; nasal endoscopy; laryngoscopy; audiology; sinus procedures. Each rate represents a specific billing code and comparison cohort, rather than a complete episode of care.
Aetna state variation for 99214
National 99214 rate distribution
Each marker shows the national median published rate across billing entities for that payer.
National 99214 rates by payer
| Payer | Rate period | Provider entities | P25 | Median | P75 | P90 | Average |
|---|---|---|---|---|---|---|---|
| Aetna | Jun–Jul 2026 | 14,836 | $111.01 | $127.61 | |||
| Cigna | Jun–Jul 2026 | 14,246 | $152.47 | $168.14 | |||
| United | Jun–Jul 2026 | 15,368 | $159.14 | $180.99 | |||
| Anthem | Jun–Jul 2026 | 13,861 | $161.91 | $194.52 |
- Source
- Negotiated or fee-schedule amounts published directly by payers in their machine-readable files.
- Rate shown
- Published commercial rate for established patient office visit, level 4 (99214).
- 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 otolaryngology providers compare?
Compare named provider rates with the selected payer's median and percentile distribution.
National: Otolaryngology provider benchmarks (CPT 99214)
| Provider entity | State | Size | $ per service | Gap to median | Position in Aetna range |
|---|---|---|---|---|---|
| CHILDRENS CLINICS FOR REHABILITATIVE SERVICESNPI 1114990892 · Tax ID 860667510 | AZ | 288 | $70.59 | -$40.43 | Below P25 |
| BANNER-UNIVERSITY MEDICAL GROUPNPI 1528090008 · Tax ID 942958258 | AZ | 5,470 | $87.77 | -$23.24 | Below P25 |
| SHIN C CHIU MD A PROFESSIONAL CORPORATIONNPI 1679645311 · Tax ID 953359718 | CA | 2 | $95.40 | -$15.61 | P25 to median |
| CALIFORNIA CANCER SPECIALISTS MEDICAL GROUP, INC.NPI 1912006636 · Tax ID 953147370 | CA | 9 | $104.94 | -$6.07 | P25 to median |
| TRIANGLE PHYSICIAN NETWORK LLCNPI 1477089613 · Tax ID 271081647 | NC | 1,883 | Median to P75 | ||
| LAWRENCE MEDICAL ASSOCIATES PCNPI 1225205891 · Tax ID 264076297 | NY | 671 | Above P75 |
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.Explore otolaryngology services
Compare codes within the same billing context. A reported billing unit may describe a timed service, supply quantity, daily service or procedure; it does not always mean one visit.
| Service line / billing code | Aetna | Cigna | United | Anthem |
|---|---|---|---|---|
$ per reported billing unit · 15 codes | ||||
31237Scope Surgery Of Nose Or Sinus | $337.98 | $423.07 | $492.61 | $537.85 |
69210Removal of impacted cerumen requiring instrumentation, unilateral | $59.08 | $76.78 | $89.64 | $92.88 |
92567Tympanom.(Impedance Tsting) | $19.71 | $26.23 | $29.02 | $34.40 |
95117Multiple-injection immunotherapy administration | $16.77 | $21.25 | $20.02 | $29.81 |
30117Remove Abnormal Tissue Nose | $979 | $1,213.73 | $1,724.63 | $1,342.21 |
31579Vocal Cord Vibration Test | $255.15 | $314.38 | $370.68 | $409.04 |
69706Nose And Throat Surgery | $2,276.74 | $3,308.86 | $6,165.77 | $5,370.30 |
31296Nasal/Sinus Endoscopy | $1,859.72 | $2,301.69 | $3,902.18 | $4,660.45 |
92504Binocular Microscopy | $28.47 | $38.03 | $52.14 | $51.59 |
30469Repair Nasl Vlv Collapse Low Nrg Subq/Sbmcsl Rmdlg | $1,899.21 | $2,433.05 | $4,969.20 | $3,258.75 |
31231Diagnostic nasal endoscopy | $199.94 | $258.29 | $360.97 | $355.31 |
31575Diagnostic flexible laryngoscopy | $150.37 | $187.06 | $230.85 | $245.81 |
31298Nasalsinus Endoscopy Surgica | $2,818.54 | $3,992.33 | $6,710.32 | $6,814.37 |
31295Nasal/Sinus Endoscopy | $1,545.52 | $2,043.93 | $3,553.96 | $3,482.23 |
92557Series Of Hearing Tests | $51.53 | $66.91 | $68.85 | $86.46 |
$ per reported billing unit · 5 codes | ||||
99244Office or outpatient consultation, level 4 | $206.28 | $256.51 | $295.65 | $305.94 |
99214Established patient office visit, level 4 | $127.61 | $168.14 | $180.99 | $194.52 |
99213Established patient office visit, level 3 | $87.43 | $114.65 | $124.92 | $136.50 |
99204New patient office visit, level 4 | $184.04 | $242.36 | $267.56 | $291.90 |
99203New patient office visit, level 3 | $118.79 | $156.43 | $176.38 | $191.91 |
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Book a 20-min scoping call No trial or data preparation required.How to interpret these benchmarks
Payer-published rates provide market context. They do not establish a practice's contracted rate or the total cost of care.
- Source and periodRates come from the specialty's national report. The displayed period follows the processed data included in the latest published snapshot and updates when that snapshot is refreshed.
- Comparable ratesComparisons use positive professional fee-for-service negotiated and fee-schedule dollar amounts. Percentages, bundled arrangements and per-diem rate types are excluded. Modifier cohorts and code-specific amounts remain separate.
- CalculationRates are reduced to one modal value per NPI and TIN entity, averaging tied modes. Two percent per tail is targeted for trimming while keeping boundary ties. Benchmarks require at least 10 included entities and are not weighted by patient volume.
- CoverageNational report coverage does not guarantee every payer or state is available for every code. Anthem represents the displayed Anthem cohort, rather than all regional Blue plans. Missing benchmarks are not zero rates.
- Billing contextMatch the exact code, billing unit, modifier, setting and network. Equipment rentals and supplies require their own interval and quantity checks. Professional rates exclude facility charges; anesthesia conversion factors are outside these comparisons.
Get the otolaryngology reimbursement data you're looking for
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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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Explore otolaryngology rates by state
Choose a state to compare payer reference averages for common services.
Questions about otolaryngology benchmarks
How to interpret the selected market and payer-published rates.
What does the national benchmark compare?
The headline uses Established patient office visit, level 4 (99214). The other reference codes and service lines provide separate comparisons rather than combining unlike services.
Why is a payer or state missing?
A benchmark appears only when the selected code and cohort meet the publication rules, including at least 10 entities after trimming. Report-wide coverage can be broader than an individual comparison.
Will the reporting period change?
Yes. The period displayed with the benchmark follows the processed source data when the publication snapshot is refreshed.