| CPT Codes | Charged Amount | Commercial Average Reimbursement | MN MA Average Reimbursement | |||||
| Outpatient office visits for established patients, by level of complexity | ||||||||
|---|---|---|---|---|---|---|---|---|
| 99211 | $61.00 | $43.67 | $17.57 | |||||
| 99212 | $121.00 | $88.19 | $34.87 | |||||
| 99213 | $199.00 | $146.59 | $57.19 | |||||
| 99214 | $291.00 | $216.42 | $83.97 | |||||
| 99215 | $390.00 | $291.26 | $112.15 | |||||
| Outpatient office visits for new patients, by level of complexity | ||||||||
| 99201 | $123.00 | $96.44 | $35.15 | |||||
| 99202 | $204.00 | $162.26 | $58.86 | |||||
| 99203 | $290.00 | $233.45 | $82.86 | |||||
| 99204 | $440.00 | $355.91 | $125.82 | |||||
| 99205 | $553.00 | $447.76 | $158.19 | |||||
| Periodic preventive medicine for established patients, by age | ||||||||
| 12-17 Years | 99384 | $366.00 | $273.15 | $105.74 | ||||
| 18-39 Years | 99385 | $353.00 | $264.80 | $102.11 | ||||
| 40-64 Years | 99386 | $410.00 | $307.23 | $118.57 | ||||
| 65 and Olds | 99387 | $445.00 | $332.73 | $128.34 | ||||
| Periodic preventive medicine for new patients, by age | ||||||||
| 12-17 Years | 99394 | $313.00 | $233.58 | $90.39 | ||||
| 18-39 Years | 99395 | $319.00 | $238.59 | $92.34 | ||||
| 40-64 Years | 99396 | $340.00 | $254.08 | $98.20 | ||||
| 65 and Olds | 99397 | $366.00 | $273.86 | $105.74 | ||||
| Other Common Services | ||||||||
| IUD Insertion | 58300 | $217.00 | $153.68 | $56.32 | ||||
| IUD Removal | 58301 | $257.00 | $199.13 | $66.81 | ||||
| Admin of Injection | 96372 | $68.00 | $43.45 | $11.77 | ||||
| Admin of Vaccine | 90471 | $68.00 | $40.85 | $12.83 | ||||
| Tdap | 90715 | $66.00 | $39.12 | $23.33 | ||||
| HPV vaccine | 90651 | $398.00 | $220.84 | $217.11 | ||||
| DEXA | 77080 | $256.00 | $82.23 | $28.67 | ||||
