Evaluation & Management
| CPT Code | Description | Billed Charge ($) | Average Commercial Rate ($) | Medicare Rate ($) | Medical Assistance Rate ($) |
|---|---|---|---|---|---|
| 99202 | Office Visit, New Patient, 15-29 minutes | 172.00 | 144.60 | 47.66 | 52.62 |
| 99203 | Office Visit, New Patient, 30-44 minutes | 265.00 | 222.25 | 110.73 | 80.57 |
| 99204 | Office Visit, New Patient, 45-59 minutes | 395.00 | 332.00 | 131.82 | 120.61 |
| 99212 | Office Visit, Established Patient, 10-19 minutes | 133.00 | 111.79 | 56.28 | 41.04 |
| 99213 | Office Visit, Established Patient, 20-29 minutes | 215.00 | 181.50 | 90.38 | 66.22 |
| 99214 | Office Visit, Established Patient, 30-39 minutes | 305.00 | 257.08 | 127.86 | 94.17 |
| 99215 | Office Visit, Established Patient, 40-54 minutes | 426.00 | 358.55 | 179.39 | 131.43 |
| 99442 | Phone E/M by Phys 11-20 Minutes | 215.00 | 181.86 | 65.37 | 66.22 |
| 99495 | Transition Care Mgmt 14 Day From Discharge | 483.00 | 422.25 | 206.15 | 151.58 |
| 99496 | Transition Care Mgmt 7 Day From Discharge | 654.00 | 571.56 | 278.17 | 204.71 |
Preventive Services
| CPT Code | Description | Billed Charge ($) | Average Commercial Rate ($) | Medicare Rate ($) | Medical Assistance Rate ($) |
|---|---|---|---|---|---|
| 99385 | Preventive Care New Patient Age 18-39 | 309.00 | 260.20 | 0.00 | 94.92 |
| 99391 | Preventive Care Established Patient Age <1 Year | 235.00 | 197.73 | 0.00 | 72.26 |
| 99392 | Preventive Care Established Patient Age 1-4 | 251.00 | 211.24 | 0.00 | 77.05 |
| 99393 | Preventive Care Established Patient Age 5-11 | 250.00 | 210.50 | 0.00 | 76.79 |
| 99394 | Preventive Care Established Patient Age 12-17 | 273.00 | 230.17 | 0.00 | 83.59 |
| 99395 | Preventive Care Established Patient Age 18-39 | 279.00 | 235.00 | 0.00 | 85.61 |
| 99396 | Preventive Care Established Patient Age 40-64 | 297.00 | 249.85 | 0.00 | 91.15 |
| 99397 | Preventive Care Established Patient Age 65 and Over | 319.00 | 268.48 | 0.00 | 98.20 |
| G0438 | Annual Wellness Visit, Initial | 393.00 | 263.68 | 166.72 | 122.52 |
| G0439 | Annual Wellness Visit, Subsequent | 311.00 | 208.14 | 130.89 | 96.61 |
Other
| CPT Code | Description | Billed Charge ($) | Average Commercial Rate ($) | Medicare Rate ($) | Medical Assistance Rate ($) |
|---|---|---|---|---|---|
| 80048 | Basic Metabolic Panel | 24.00 | 10.97 | 8.46 | 8.46 |
| 80053 | Comprehensive Metabolic Panel | 30.00 | 13.70 | 10.56 | 10.56 |
| 80061 | Lipid Panel | 35.00 | 17.36 | 13.39 | 13.39 |
| 83036 | Glycosylated Hemoglobin (A1C) | 27.00 | 12.68 | 9.71 | 9.71 |
| 84443 | Thyroid Stimulating Hormone (TSH) | 50.00 | 21.85 | 16.80 | 16.80 |