| Office visit new patient moderate complexity CPT 99204 • Office Visits | $159 | $165 | $171 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $210 | $216 | $222 |
| Office visit established patient minimal CPT 99211 • Office Visits | $1 | $10 | $19 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $36 | $41 | $46 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $65 | $76 | $88 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $104 | $114 | $125 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $145 | $161 | $176 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $59 | $103 | $147 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $93 | $93 | $93 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $124 | $173 | $222 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $47 | $47 | $47 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $7 | $35 | $64 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $112 | $113 | $113 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $65 | $89 | $112 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $93 | $114 | $136 |
| Consultation office low complexity CPT 99243 • Office Visits | $108 | $113 | $117 |
| Consultation office high complexity CPT 99245 • Office Visits | $172 | $229 | $285 |
| 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 |