| CPT Codes | Charged Amount | Commercial Average Reimbursement | MN MA Average Reimbursement | |||||
| Outpatient office visits for established patients, by level of complexity | ||||||||
|---|---|---|---|---|---|---|---|---|
| 99211 | $62.78 | $50.46 | $17.83 | |||||
| 99212 | $124.57 | $100.14 | $34.83 | |||||
| 99213 | $205.00 | $164.80 | $57.69 | |||||
| 99214 | $300.15 | $241.28 | $83.61 | |||||
| 99215 | $402.16 | $323.29 | $112.31 | |||||
| Outpatient office visits for new patients, by level of complexity | ||||||||
| 99201 | $126.53 | $101.72 | $35.11 | |||||
| 99202 | $210.89 | $169.53 | $58.24 | |||||
| 99203 | $299.17 | $240.49 | $82.79 | |||||
| 99204 | $454.15 | $365.08 | $125.69 | |||||
| 99205 | $570.87 | $458.91 | $158.58 | |||||
| Periodic preventive medicine for established patients, by age | ||||||||
| 12-17 Years | 99394 | $322.71 | $259.42 | $90.02 | ||||
| 18-39 Years | 99395 | $329.57 | $264.94 | $92.24 | ||||
| 40-64 Years | 99396 | $351.15 | $282.28 | $98.10 | ||||
| 65 and Olds | 99397 | $377.64 | $303.57 | $105.34 | ||||
| Periodic preventive medicine for new patients, by age | ||||||||
| 12-17 Years | 99385 | $377.64 | $303.57 | $105.34 | ||||
| 18-39 Years | 99385 | $364.89 | $293.32 | $102.28 | ||||
| 40-64 Years | 99386 | $423.74 | $340.63 | $118.16 | ||||
| 65 and Olds | 99387 | $459.05 | $369.02 | $128.20 | ||||
| Other Common Services | ||||||||
| IUD Insertion | 58300 | $223.64 | $179.78 | $65.68 | ||||
| IUD Removal | 58301 | $264.84 | $212.90 | $71.84 | ||||
| Admin of Injection | 96372 | $69.80 | $37.06 | $10.00 | ||||
| Admin of Vaccine | 90471 | $69.80 | $37.06 | $10.86 | ||||
| Tdap | 90715 | $68.06 | $33.64 | $33.63 | ||||
| HPV vaccine | 90651 | $410.50 | $232.36 | $273.37 | ||||
| DEXA | 77080 | $112.75 | $89.10 | $28.22 | ||||
