Virginia Commercial reimbursement
General Pediatrics reimbursement rates in Virginia
Compare price transparency averages for CPT 96110, CPT 99213 and CPT 99392 across Aetna, Anthem, Cigna and United. Preview Virginia medians, rate ranges and named provider rates for free.
Price transparency averages
Virginia averages by payer
| Service | Aetna | Cigna | United | Anthem |
|---|---|---|---|---|
| CPT 96110Developmental screening with scoring and documentation | $14.35 | $16.49 | $16.20 | $16.20 |
| CPT 99213Established patient office visit, level 3 | $86.51 | $99.73 | $114.95 | $105.85 |
| CPT 99392Preventive visit, established patient age 1 to 4 | $123.59 | $127.30 | $163.01 | $121.37 |
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CPT 96110 - Developmental screening with scoring and documentation
| Payer | Virginia | National | Difference |
|---|---|---|---|
| Aetna | $14.35 | $14.67 | -2.2% |
| Cigna | $16.49 | $22.31 | -26.1% |
| United | $16.20 | $20.19 | -19.8% |
| Anthem | $16.20 | $46.48 | -65.1% |
CPT 99213 - Established patient office visit, level 3
| Payer | Virginia | National | Difference |
|---|---|---|---|
| Aetna | $86.51 | $91.20 | -5.1% |
| Cigna | $99.73 | $126.23 | -21.0% |
| United | $114.95 | $132.10 | -13.0% |
| Anthem | $105.85 | $134.36 | -21.2% |
CPT 99392 - Preventive visit, established patient age 1 to 4
| Payer | Virginia | National | Difference |
|---|---|---|---|
| Aetna | $123.59 | $118.64 | +4.2% |
| Cigna | $127.30 | $157.67 | -19.3% |
| United | $163.01 | $178.30 | -8.6% |
| Anthem | $121.37 | $178.58 | -32.0% |
Sources and methodology
Averages calculated by PayerPrice from health plan price transparency files.
- 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.
Published negotiated rates are not claim payments or a provider's verified contract.
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