Family Medicine reimbursement rates by service line
Compare payer-published family medicine benchmarks for office visits; preventive visits; annual wellness; transitional care.
Compare national family medicine rates by payer
Use the reference codes to compare payer benchmarks, then explore office visits; preventive visits; annual wellness; transitional care. 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 | 153,942 | $103.88 | $116.02 | |||
| Cigna | Jun–Jul 2026 | 150,380 | $132.20 | $152.68 | |||
| United | Jun–Jul 2026 | 154,984 | $142.49 | $158.81 | |||
| Anthem | Jun–Jul 2026 | 136,837 | $127.72 | $151.57 |
- 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 family medicine providers compare?
Compare named provider rates with the selected payer's median and percentile distribution.
National: Family Medicine provider benchmarks (CPT 99214)
| Provider entity | State | Size | $ per service | Gap to median | Position in Aetna range |
|---|---|---|---|---|---|
| JOIE DEVIVRENPI 1003061409 · Tax ID 263339963 | IN | 2 | $69.88 | -$34.00 | Below P25 |
| ORTHOPAEDIC HOSPITAL OF WISCONSIN LLCNPI 1003996158 · Tax ID 392015655 | WI | 145 | $83.71 | -$20.17 | Below P25 |
| OZARK HEALTH INCNPI 1194783472 · Tax ID 710407683 | AR | 88 | $91.99 | -$11.89 | P25 to median |
| LUXURY WELLNESS PROVIDERSNPI 1649272907 · Tax ID 871710178 | TX | 2 | $97.60 | -$6.28 | P25 to median |
| HYNDMAN AREA HEALTH CENTER INCNPI 1124013206 · Tax ID 251343824 | NV | 91 | Median to P75 | ||
| NOVANT HEALTH PREP II LLCNPI 1982771176 · Tax ID 333355628 | NC | 55 | 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 family 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 · 9 codes | ||||
99202New patient office visit, level 2 | $70.61 | $89.90 | $107.26 | $97.16 |
99203New patient office visit, level 3 | $107.56 | $140.54 | $155.41 | $146.14 |
99204New patient office visit, level 4 | $167.11 | $217.25 | $236.07 | $225.23 |
99205New patient office visit, level 5 | $217.62 | $285.30 | $300.64 | $286.43 |
99211Established patient office visit, minimal service | $19.30 | $24.07 | $32.41 | $27.88 |
99212Established patient office visit, level 2 | $47.27 | $62.07 | $66.83 | $65.02 |
99213Established patient office visit, level 3 | $79.48 | $104.53 | $109.33 | $107.74 |
99214Established patient office visit, level 4 | $116.02 | $152.68 | $158.81 | $151.57 |
99215Established patient office visit, level 5 | $162.79 | $217.04 | $215.67 | $216.56 |
$ per reported billing unit · 8 codes | ||||
99385Preventive visit, new patient age 18–39 | $132.41 | $165.09 | $188.13 | $177.02 |
99386Preventive visit, new patient age 40–64 | $156.51 | $194.13 | $217.14 | $206.39 |
99387Init Pm E M New Pat 65 Yrs | $170.30 | $210 | $237.21 | $226.28 |
99395Preventive visit, established patient age 18–39 | $119.18 | $147.81 | $168.84 | $157.95 |
99396Preventive visit, established patient age 40–64 | $128.54 | $159.86 | $180.19 | $171.07 |
99397Preventive Medical Care | $138.43 | $171.24 | $194.59 | $186.31 |
99495Transitional care management, moderate complexity | $189.47 | $245.11 | $270.67 | $258.81 |
99496Transitional care management, high complexity, face-to-face visit within 7 days of discharge | $259.91 | $337.45 | $365.24 | $358.69 |
$ per reported billing unit · 3 codes | ||||
G0438Annual wellness visit; includes a personalized prevention plan of service (PPPS) | $190.24 | $163.55 | $247.90 | $267.45 |
G0439Annual wellness visit | $143.80 | $123.90 | $172.33 | $198.45 |
G2211Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition | $3.16 | $14.89 | $25.34 | $24.42 |
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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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Explore family medicine rates by state
Choose a state to compare payer reference averages for common services.
Questions about family 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.