| Office visit new patient moderate complexity CPT 99204 • Office Visits | $159 | $159 | $159 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $210 | $210 | $210 |
| Office visit established patient minimal CPT 99211 • Office Visits | $22 | $22 | $22 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $46 | $46 | $46 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $73 | $73 | $73 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $104 | $104 | $104 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $145 | $145 | $145 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $59 | $59 | $59 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $124 | $124 | $124 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $140 | $140 | $140 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $40 | $40 | $40 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $75 | $75 | $75 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $113 | $113 | $113 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $77 | $77 | $77 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $109 | $109 | $109 |
| Consultation office low complexity CPT 99243 • Office Visits | $108 | $108 | $108 |
| Consultation office high complexity CPT 99245 • Office Visits | $202 | $202 | $202 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $113 | $113 | $113 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $127 | $127 | $127 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $123 | $123 | $123 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $142 | $142 | $142 |