General Pediatrics reimbursement rates by service line
Compare national general pediatrics reimbursement benchmarks calculated from price transparency data. Reference benchmarks cover 96110, 99213 and 99392 across Aetna, Anthem, Cigna and United. Reporting periods: Jun–Jul 2026.
Rate Explorer
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.
Confirm coverage for your codes, payers and markets.
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 for available preview codes.
No trial or data preparation required.Which providers have the highest claim volume in the general pediatrics market?
Provider organizations with the highest combined 2024 Medicare and Medicaid claim volume in the general pediatrics market.
- 1MULTISaltzman Tanis Pittell Levin & Jacobson LLCNPI 1639138480Medicare 577,596Medicaid 17,560595,156 total
- 2TXTopcare Medical Group INCNPI 1285016758Medicare 363,583Medicaid 47,590411,173 total
- 3NJOptum Medical Care Of New Jersey PCNPI 1578665048Medicare 184,967Medicaid 9,617194,584 total
- 4MULTIChildrens Hospital Medical CenterNPI 1609915784Medicare 163,505Medicaid 30,485193,990 total
- 5ALDothan Pediatric Clinic P ANPI 1376508788Medicare 7,439Medicaid 96,969104,408 total
- 6ILLurie Childrens Medical Group INCNPI 1518064716Medicare 24,246Medicaid 63,84588,091 total
- 7AZPhoenix Childrens Hospital INCNPI 1922112044Medicare 3,023Medicaid 79,90182,924 total
- 8TXSarojini Bose MD PANPI 1609066257Medicare 73,284Medicaid 5,59278,876 total
- 9AZArbor Medical PartnersNPI 1023546082Medicare 37,290Medicaid 39,78677,076 total
- 10CARady Childrens Hospital - San DiegoNPI 1669617197Medicare 68,403Medicaid 3,95272,355 total
- 11TXTch Pediatric Associates INCNPI 1548321334Medicare 71,905Medicaid 271,907 total
- 12MULTINorton Childrens Medical GroupNPI 1326695255Medicare 58,459Medicaid 158,460 total
- 13SCSouthern Medical Management LLCNPI 1114196557Medicare 35,862Medicaid 18,80854,670 total
- 14VAPediatrics INCNPI 1255358065Medicare 53,434Medicaid 79354,227 total
- 15MULTIChildrens Hospital Of PhiladelphiaNPI 1134494909Medicare 2,240Medicaid 51,39753,637 total
- 16AZPleasant PediatricsNPI 1477742807Medicare 2,944Medicaid 49,61652,560 total
- 17NJCooper PediatricsNPI 1144268277Medicare 46,750Medicaid 2,36149,111 total
- 18AZDesert Valley PediatricsNPI 1336354984Medicare 23,651Medicaid 23,23646,887 total
- 19ALPediatric Clinic LLCNPI 1134286248Medicare 787Medicaid 45,38946,176 total
- 20OKJust Kids PediatricsNPI 1063846699Medicare 10,554Medicaid 34,66345,217 total
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 |
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 read these general pediatrics rates
Benchmarks calculated by PayerPrice from health plan price transparency files. CMS price transparency requirements.
- Published rates, not paymentsThese figures summarize negotiated rates reported by health plans. They are not claim payments, patient prices or a provider's verified contract.
- Average vs. medianThe average combines eligible billing-entity rates; the median is the middle rate. A large gap between them can signal that high or low rates are pulling the average.
- What a provider row meansA billing entity may be a clinician, practice, facility or health system. A named row does not always represent one individual provider.
- Compare like for likeMatch the code, billing component, setting, payment unit, network and reporting period. Facility, drug and other service payments may be separate.
Calculation details and specialty-specific notes
Payer-published rates provide market context. They do not establish a practice's contracted rate or the total cost of care.
- Rate source
- Rates 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. National 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.
- Rate calculation
- Rates 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. The calculation targets the lowest and highest 2% of entity rates for removal, rounded down to whole entities. Tied boundary values stay together, so fewer rates may be removed. A payer, code and geography cohort is published only when at least 10 billing entities remain after trimming. A missing benchmark does not mean the rate is zero.
- Provider entity
- Each NPI and TIN combination contributes one representative rate: its most frequent normalized value. When multiple values are equally frequent, those values are averaged.
- Comparable rates
- Comparisons 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. Match 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. Benchmarks keep the payer, service code, geography, reporting period and billing unit separate. Different services or payment units are not blended into one rate.
Compare General Pediatrics rates in your market
Tell us the services, payers and locations you need. We'll confirm coverage and scope the comparison.
- Define the scopeChoose the codes, payers, networks and providers.
- Match the billing detailsWe align services, settings and payment units.
- Compare the ratesReview payer and provider rates for your selected market.
We'll explain what's available, flag gaps and help define the comparison.
Trusted by teams that need defensible reimbursement data
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.