Rheumatology reimbursement rates by service line
Compare payer-published rheumatology benchmarks for office visits; joint procedures; infusion administration; laboratory testing.
Compare national rheumatology rates by payer
Use the reference codes to compare payer benchmarks, then explore office visits; joint procedures; infusion administration; laboratory testing. 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 | 8,044 | $107.09 | $123.97 | |||
| Cigna | Jun–Jul 2026 | 8,080 | $144.95 | $170.12 | |||
| United | Jun–Jul 2026 | 8,408 | $161.33 | $186.16 | |||
| Anthem | Jun–Jul 2026 | 7,625 | $161.15 | $197.01 |
- 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 rheumatology providers compare?
Compare named provider rates with the selected payer's median and percentile distribution.
National: Rheumatology provider benchmarks (CPT 99214)
| Provider entity | State | Size | $ per service | Gap to median | Position in Aetna range |
|---|---|---|---|---|---|
| ARTHRITIS CONSULTANTS INCNPI 1033590732 · Tax ID 430947490 | MO | 13 | $68.41 | -$38.68 | Below P25 |
| ANURADHA REDDY MDNPI 1407061427 · Tax ID 731644784 | MD | 2 | $87.15 | -$19.95 | Below P25 |
| HOSPITAL INTERNISTS OF NEW LONDON LLCNPI 1386751923 · Tax ID 522370131 | CT | 25 | $96.50 | -$10.59 | P25 to median |
| ARTHRITIS MEDICAL CENTER OF THE CENTRAL COAST A MEDICAL CORPORATIONNPI 1295877207 · Tax ID 770529067 | CA | 2 | $104.94 | -$2.15 | P25 to median |
| A MAINEHEALTH HCSRNPI 1083063366 · Tax ID 010238552 | ME | 5,238 | Median to P75 | ||
| LAWRENCE MEDICAL ASSOCIATES PCNPI 1902893936 · 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 rheumatology 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 · 7 codes | ||||
99214Established patient office visit, level 4 | $123.97 | $170.12 | $186.16 | $197.01 |
99213Established patient office visit, level 3 | $84.74 | $116.85 | $128.70 | $137.63 |
99204New patient office visit, level 4 | $179.59 | $241.72 | $274.75 | $294.38 |
99215Established patient office visit, level 5 | $174.13 | $241.55 | $253.02 | $272.46 |
99203New patient office visit, level 3 | $115.74 | $156.27 | $181.16 | $192.22 |
99212Established patient office visit, level 2 | $50.83 | $69.38 | $78.91 | $83.35 |
99205New patient office visit, level 5 | $233.19 | $317.29 | $350.08 | $378.19 |
$ per reported billing unit · 6 codes | ||||
85025Complete blood count with differential | $9.93 | $16.77 | $7.89 | $14.61 |
80053Comprehensive metabolic panel | $13.35 | $21.02 | $10.55 | $19.26 |
86140Blood Test For Inflammation | $6.53 | $11.42 | $5.25 | $9.56 |
86235Autoimmune Disease Test | $22.91 | $33 | $18.04 | $32.25 |
81001Automated urinalysis with microscopy | $4.03 | $6.54 | $3.84 | $6.01 |
86160Immune Function Blood Test | $15.72 | $25.56 | $12.14 | $21.83 |
$ per reported billing unit · 6 codes | ||||
96372Therapeutic injection administration | $24.26 | $30.11 | $28.55 | $39.05 |
96413Chemotherapy infusion, initial hour | $200.76 | $249.97 | $241.97 | $361.74 |
20610Arthrocentesis, aspiration and/or injection; major joint or bursa (e.g., shoulder, hip, knee, subacromial bursa); without ultrasound guidance | $81.70 | $106.84 | $123.84 | $133.24 |
96415Infusion Of Chemotherapy | $43.81 | $53.66 | $52.15 | $81.33 |
96375Therapeutic, prophylactic, or diagnostic injection, each additional sequential intravenous push of a new substance or drug | $25.53 | $31.17 | $31.81 | $42.24 |
96365Iv Infusion | $95.56 | $117.87 | $125.86 | $158.31 |
$ per reported billing unit · 1 code | ||||
73130Radiologic Exam Hand; Minimum Of 3 Views | $47.14 | $61.36 | $57.76 | $78.66 |
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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.
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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 rheumatology rates by state
Choose a state to compare payer reference averages for common services.
Questions about rheumatology 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.