| Office visit new patient high complexity CPT 99205 • Office Visits | $66 | $66 | $66 |
| Office visit established patient minimal CPT 99211 • Office Visits | $25 | $25 | $25 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $35 | $35 | $35 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $40 | $40 | $40 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $40 | $40 | $40 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $53 | $53 | $53 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $32 | $32 | $32 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $57 | $57 | $57 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $50 | $50 | $50 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $90 | $90 | $90 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $105 | $105 | $105 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $43 | $43 | $43 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $129 | $129 | $129 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $135 | $135 | $135 |
| Consultation office straightforward CPT 99241 • Office Visits | $25 | $25 | $25 |
| Consultation office low complexity CPT 99243 • Office Visits | $66 | $66 | $66 |
| Consultation office high complexity CPT 99245 • Office Visits | $66 | $66 | $66 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $130 | $130 | $130 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $160 | $160 | $160 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $105 | $105 | $105 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $105 | $105 | $105 |