Pulmonary Disease reimbursement rates by service line
Compare payer-published pulmonary disease benchmarks for office visits; pulmonary testing; hospital care; sleep context.
Compare national pulmonary disease rates by payer
Use the reference codes to compare payer benchmarks, then explore office visits; pulmonary testing; hospital care; sleep context. 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 | 25,239 | $109.20 | $126.47 | |||
| Cigna | Jun–Jul 2026 | 26,217 | $154.65 | $170.93 | |||
| United | Jun–Jul 2026 | 26,505 | $166.99 | $184.15 | |||
| Anthem | Jun–Jul 2026 | 23,376 | $149.78 | $181.03 |
- 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 pulmonary disease providers compare?
Compare named provider rates with the selected payer's median and percentile distribution.
National: Pulmonary Disease provider benchmarks (CPT 99214)
| Provider entity | State | Size | $ per service | Gap to median | Position in Aetna range |
|---|---|---|---|---|---|
| CARLE HEALTH CARE INCORPORATEDNPI 1154653947 · Tax ID 371140016 | IL | 2,236 | $65.03 | -$44.17 | Below P25 |
| BIRMINGHAM PULMONARY GROUPPCNPI 1275574295 · Tax ID 630717705 | AL | 7 | $84.15 | -$25.05 | Below P25 |
| URMILA SHIVARAMNPI 1215025473 | NY | - | $93.64 | -$15.56 | Below P25 |
| DS MEDICAL DIAGNOSTICS PCNPI 1336171040 · Tax ID 830933188 | NY | 6 | $100.65 | -$8.55 | P25 to median |
| SOUTHCOAST HOSPITALS GROUP INCNPI 1073670303 · Tax ID 222592333 | MA | 329 | Median to P75 | ||
| LAWRENCE MEDICAL ASSOCIATES PCNPI 1093081911 · 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 pulmonary disease 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 · 13 codes | ||||
99214Established patient office visit, level 4 | $126.47 | $170.93 | $184.15 | $181.03 |
99213Established patient office visit, level 3 | $86.33 | $117.73 | $127.55 | $126.66 |
99233Subsequent hospital inpatient or observation care, level 3 | $124.16 | $179.15 | $176.69 | $189.49 |
99232Subsequent hospital inpatient or observation care, level 2 | $90.21 | $122.11 | $121.50 | $130.75 |
99204New patient office visit, level 4 | $182.03 | $246.86 | $271.35 | $272.16 |
99215Established patient office visit, level 5 | $177.17 | $244.18 | $250.98 | $253.33 |
99223Initial hospital inpatient or observation care, level 3 | $214.90 | $309.47 | $318.97 | $342.14 |
99203New patient office visit, level 3 | $117.03 | $159.01 | $179.31 | $177.67 |
99222Initial hospital inpatient or observation care, level 2 | $155.50 | $220.55 | $222.63 | $239.67 |
99205New patient office visit, level 5 | $236.56 | $322.16 | $345.85 | $350.81 |
99239Hospital discharge management, more than 30 minutes | $125.61 | $179.13 | $179.17 | $194.40 |
99212Established patient office visit, level 2 | $51.35 | $69.80 | $78.19 | $76.60 |
99231Subsequent hospital inpatient or observation care, level 1 | $63 | $71.44 | $68.78 | $75.42 |
$ per reported billing unit · 6 codes | ||||
94729Pulmonary diffusing capacity test | $79.96 | $106.46 | $103.01 | $123.33 |
94060Bronchodilator responsiveness | $69.67 | $90.12 | $99.04 | $113.51 |
94726Whole-Body Air Volume Test | $77.89 | $104.47 | $99.73 | $123.62 |
94010Spirometry | $44.28 | $57.54 | $60.78 | $70.11 |
94727Gas dilution or washout for determination of lung volumes | $62.14 | $82.98 | $80.22 | $98.35 |
95810Overnight Sleep Study | $937.61 | $1,197.94 | $1,173.81 | $1,486.01 |
$ per reported billing unit · 1 code | ||||
71046Chest X-ray, two views | $43.51 | $56.85 | $54.32 | $73.90 |
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 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 pulmonary disease 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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Explore pulmonary disease rates by state
Choose a state to compare payer reference averages for common services.
Questions about pulmonary disease 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.