General Pediatrics reimbursement rates by service line
Compare payer-published general pediatrics benchmarks for office visits; age-specific preventive visits; immunization administration; developmental screening.
Compare national general pediatrics rates by payer
Use the reference codes to compare payer benchmarks, then explore office visits; age-specific preventive visits; immunization administration; developmental screening. Each rate represents a specific billing code and comparison cohort, rather than a complete episode of care.
Aetna state variation for 99213
National 99213 rate distribution
Each marker shows the national median published rate across billing entities for that payer.
National 99213 rates by payer
| Payer | Rate period | Provider entities | P25 | Median | P75 | P90 | Average |
|---|---|---|---|---|---|---|---|
| Aetna | Jun–Jul 2026 | 88,277 | $75.41 | $91.20 | |||
| Cigna | Jun–Jul 2026 | 86,823 | $108.78 | $126.23 | |||
| United | Jun–Jul 2026 | 90,989 | $116.16 | $132.10 | |||
| Anthem | Jun–Jul 2026 | 97,307 | $114.33 | $134.36 |
- 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 3 (99213).
- 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 general pediatrics providers compare?
Compare named provider rates with the selected payer's median and percentile distribution.
National: General Pediatrics provider benchmarks (CPT 99213)
| Provider entity | State | Size | $ per service | Gap to median | Position in Aetna range |
|---|---|---|---|---|---|
| HEALTHNET INCNPI 1003034562 · Tax ID 351579827 | IN | 281 | $48.43 | -$26.99 | Below P25 |
| DRS MILLER MADDEN PANPI 1023125275 · Tax ID 522184377 | MD | 4 | $58.19 | -$17.22 | Below P25 |
| CHILDREN CARE CLINIC LPNPI 1144456823 · Tax ID 562546021 | TX | 8 | $64.65 | -$10.76 | Below P25 |
| SOUTHBRIDGE MEDICAL ADVISORY COUNCIL INCNPI 1376771683 · Tax ID 237047824 | WA | 60 | $68.67 | -$6.74 | P25 to median |
| PNP PEDIATRICS LLCNPI 1417901521 · Tax ID 222160565 | NJ | 53 | Median to P75 | ||
| CARYN BELAFSKY MD LLCNPI 1902823735 · Tax ID 873388580 | OR | 2 | 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 general pediatrics 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 | $80.26 | $109.04 | $129.06 | $129.09 |
99203New patient office visit, level 3 | $123.56 | $167.75 | $186.92 | $193.44 |
99204New patient office visit, level 4 | $191.65 | $260.23 | $283.64 | $289.56 |
99205New patient office visit, level 5 | $248.60 | $338.55 | $360.75 | $367.83 |
99211Established patient office visit, minimal service | $22.06 | $29.43 | $39.24 | $39.13 |
99212Established patient office visit, level 2 | $54.40 | $75.40 | $80.96 | $82.88 |
99213Established patient office visit, level 3 | $91.20 | $126.23 | $132.10 | $134.36 |
99214Established patient office visit, level 4 | $133.17 | $185.68 | $191.26 | $189.12 |
99215Established patient office visit, level 5 | $185.24 | $262.04 | $260.14 | $265.13 |
$ per reported billing unit · 8 codes | ||||
99381Init Pm E M New Pat Infant | $121.14 | $163.30 | $187.04 | $192.30 |
99382Init Pm E M New Pat 1 4 Yrs | $128.70 | $172.88 | $196.41 | $203.86 |
99383Prev Visit New Age 5 11 | $133.02 | $179.36 | $202.83 | $208.39 |
99384Prev Visit New Age 12 17 | $151.56 | $203.34 | $228.37 | $230.66 |
99391Preventive visit, established infant | $109.60 | $145.38 | $166.78 | $163.31 |
99392Preventive visit, established patient age 1 to 4 | $118.64 | $157.67 | $178.30 | $178.58 |
99393Preventive visit, established patient age 5 to 11 | $118.09 | $157.45 | $177.63 | $177.85 |
99394Preventive visit, established patient age 12 to 17 | $130.83 | $173.72 | $195.18 | $200.33 |
$ per reported billing unit · 3 codes | ||||
90460Im Admin 1st Only Component | $22.22 | $31.12 | $30.33 | $40.85 |
90461Immunization administration, each additional vaccine component | $11.02 | $16.20 | $19.93 | $22.06 |
96110Developmental screening with scoring and documentation | $14.67 | $22.31 | $20.19 | $46.48 |
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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 general pediatrics 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 general pediatrics rates by state
Choose a state to compare payer reference averages for common services.
Questions about general pediatrics 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 3 (99213). 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.