Sustainable development is a pressing worldwide issue and is particularly a challenge in developing countries. China, as the world's largest developing country, has recently undergone a paradigm shift in terms of development strategy and proposed a new sustainable policy in 2015, which promotes the coordinated progress of industrialization, informatization, urbanization, agricultural modernization, and greenization (“Five Modernizations”). Using panel data pertaining to 283 prefecture-level cities for 2006–2015, we assessed the development level of the “Five Modernizations” and investigated the trends, patterns, and determinants of the “Five Modernizations” with respect to scale and economic level. The results show that the “Five Modernizations” underwent significant growth during the study period. Cities with the highest coordinated development level are mainly located in the downstream areas of the Yellow River, Yangtze River Delta, and Pearl River Delta. The agglomeration degree for the coordinated development level is decreasing. Cities of different spatial and economic scales show various coordinated development level patterns. For scales, mega cities appear to be more “sufficient”, with higher comprehensive development level, while middle and small cities show more “balanced” development, with higher coupling degrees. Further, a positive spillover effect is observed from Mega cities to their neighboring cities. There exists an inverted U-shaped relationship between coordinated development level and economic level, where the most developed cities have passed the vertex and lie on the downtrend. Our results provide insights into the sustainable development pathways and patterns for policy makers in China and other developing countries.