We thank Drs Rappo and Palfrey for their comments.1 We appreciate the sensitive nature of our findings and the need for additional confirmatory studies. However, it is clear from the previous studies we referenced in our article that physicians do make decisions about the pricing and volume of their services based on many factors, including government constraints on charges for particular services.
Although we understand the American Academy of Pediatrics resource-based relative-value scale project and its relationship to CPT codes, we fail to see its relevance to this study. We feel certain that Drs Rappo and Palfrey are not trying to justify the higher charges of pediatricians in Massachusetts by implying that they are more comprehensive in their well-child assessments than are pediatricians in North Carolina and Texas. We also did not suggest that pediatricians in any of our 3 study states are overcompensated for well-child care.