Sports Medicine reimbursement rates by service line
Compare payer-published sports medicine benchmarks for office visits; joint procedures; timed therapy; imaging.
Compare national sports medicine rates by payer
Use the reference codes to compare payer benchmarks, then explore office visits; joint procedures; timed therapy; imaging. 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 | 11,204 | $111.01 | $123.78 | |||
| Cigna | Jun–Jul 2026 | 11,104 | $144.18 | $161.06 | |||
| United | Jun–Jul 2026 | 11,311 | $161.50 | $177.03 | |||
| Anthem | Jun–Jul 2026 | 10,156 | $149.88 | $176.01 |
- 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 sports medicine providers compare?
Compare named provider rates with the selected payer's median and percentile distribution.
National: Sports Medicine provider benchmarks (CPT 99214)
| Provider entity | State | Size | $ per service | Gap to median | Position in Aetna range |
|---|---|---|---|---|---|
| IN CHARGE MEDICAL PROFESSIONALS LLCNPI 1043530165 · Tax ID 471628951 | IN | 48 | $69.88 | -$41.13 | Below P25 |
| CENTRAL FLORIDA FAMILY HEALTH CENTER INCNPI 1851619183 · Tax ID 591741286 | FL | 204 | $87.47 | -$23.54 | Below P25 |
| COMMUNITY MEDICAL GROUP, INC.NPI 1023045143 · Tax ID 061201412 | CT | 889 | $96.50 | -$14.51 | P25 to median |
| FAMILY CHOICE MEDICAL GROUPNPI 1902833734 · Tax ID 330664380 | CA | 477 | $105.13 | -$5.88 | P25 to median |
| KOOTENAI URGENT CARE LLCNPI 1417210790 · Tax ID 271618929 | MN | 139 | Median to P75 | ||
| PEDIATRIX MEDICAL GROUP OF OHIO CORPNPI 1578545273 · Tax ID 311439157 | OH | 255 | 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 sports medicine 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 · 4 codes | ||||
97110Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility | $30.72 | $40.69 | $39.15 | $66.28 |
97140Manual Therapy 1 Regions | $30.35 | $37.82 | $36.18 | $64.24 |
97112Muscle Or Nerve Training | $33.95 | $44.66 | $43.89 | $70.88 |
97530Activity Therapy | $37.18 | $48.33 | $48.04 | $74 |
$ per reported billing unit · 6 codes | ||||
99213Established patient office visit, level 3 | $84.74 | $110.56 | $122.01 | $123.64 |
99214Established patient office visit, level 4 | $123.78 | $161.06 | $177.03 | $176.01 |
99203New patient office visit, level 3 | $115.26 | $149.12 | $173.19 | $170.38 |
99204New patient office visit, level 4 | $178.16 | $231.49 | $263.11 | $261.75 |
99212Established patient office visit, level 2 | $50.39 | $64.91 | $74.50 | $74.82 |
99215Established patient office visit, level 5 | $173.73 | $229.39 | $240.19 | $246.39 |
$ per reported billing unit · 2 codes | ||||
20610Arthrocentesis, aspiration and/or injection; major joint or bursa (e.g., shoulder, hip, knee, subacromial bursa); without ultrasound guidance | $81.38 | $104.67 | $123.07 | $122.03 |
20611Large joint aspiration or injection with ultrasound guidance | $113.28 | $149.62 | $184.77 | $172.77 |
$ per reported billing unit · 8 codes | ||||
73030Shoulder X-ray | $44.11 | $54.87 | $52.64 | $68.95 |
73564Complete knee X-ray, four or more views | $59.55 | $72.82 | $71.08 | $89.19 |
73562Knee X-ray, three views | $51.97 | $64.04 | $62.20 | $78.95 |
73630Foot X-ray | $43.69 | $54.17 | $52.18 | $68.06 |
73610X-Ray Ankle; Complete | $46.47 | $57.81 | $55.53 | $70.90 |
73560Knee X-ray, one or two views | $43.72 | $54.42 | $52.92 | $67.48 |
73110Complete wrist X-ray, three or more views | $52.14 | $64.10 | $61.74 | $78.63 |
73130Radiologic Exam Hand; Minimum Of 3 Views | $46.68 | $57.91 | $55.57 | $71.91 |
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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 sports medicine 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 sports medicine rates by state
Choose a state to compare payer reference averages for common services.
Questions about sports medicine 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.