Burnsville: (952) 435-4190 | Edina: (952) 920-2200

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Primary Care Price Transparency

Frequently billed Services
CPT Code Description Billed Charge Average Commercial Rate (Allowed Amount) Medicare Rate Medical Assistance Rate
99201 Office/E & M Service Problem Focused; New Patient $115.00 $91.36 $45.64 $31.34 Evaluation & Management
99202 Office/E & M Service Expanded Problem; New Patient $198.00 $154.48 $76.10 $53.17
99203 Office/E & M Service Detailed; New Patient $281.00 $220.11 $107.29 $76.30
99204 Office/E & M Service Comprehensive; New Patient $432.00 $319.15 $162.82 $116.11
99205 Office/E & M Service Comprehensive; New Patient $533.00 $423.79 $204.48 $145.40
99211 Office/E & M Service Minimal $56.00 $40.88 $23.01 $14.38
99212 Office/E & M Service Problem Focused $121.00 $88.12 $45.15 $31.08
99213 Office/E & M Service Expanded Problem $190.00 $149.19 $74.13 $51.89
99214 Office/E & M Service Detailed $279.00 $217.65 $108.56 $76.56
99215 Office/E & M Service Comprehensive $376.00 $292.98 $145.04 $102.76
99384 Preventive Service 12 To 17 Years New Patient $359.00 $276.43 $136.68 $96.84 Preventive
99385 Preventive Service 18 To 39 Years New Patient $349.00 $268.86 $132.21 $93.76
99386 Preventive Service 40 To 64 Years New Patient $406.00 $310.67 $153.20 $108.93
99394 Preventive Service 12 To 17 Years $302.00 $223.48 $116.86 $82.72
99395 Preventive Service 18 To 39 Years $318.00 $236.56 $119.39 $84.52
99396 Preventive Service 40 To 64 Years $338.00 $252.90 $127.11 $89.92
99397 Preventive Service 65 Years And Over $364.00 $279.61 $136.68 $97.10
G0101 Pelvic & Clinical Breast Examination $146.00 $102.20 $38.73 $25.44
76817 Ob Ultrasound, Transvaginal $273.00 $201.27 $97.77 $67.11 Other
76816 Ultra Sound - Ob (Fetal Evaluation/Growth Evaluation) $315.00 $235.31 $115.48 $79.55
76830 Ultrasound Transvaginal $337.00 $249.87 $123.90 $76.58
76857 Follicular and/or GYN Ultrasound $252.00 $116.85 $49.15 $29.14
76819 Ultrasound, Fetal Biophysical W/O Nst $250.00 $184.02 $89.88 $61.25
76856 Ultra Sound,Gyn Transabdominal $308.00 $235.76 $111.14 $68.86
76805 Ultrasound-Ob Fetal And Maternal Evaluation $398.00 $297.52 $142.39 $98.10