Price Transparency Comparison Final Draft 2020
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ABCD
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PRIMARY CARE PRICE TRANSPARENCY COMPARISON AS OF 7/1/2019
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Clinic NameAALFA Family Clinic
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CPT CodeDescriptionBilled ChargeAverage Commercial Insurance Allowed
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99211Office Visit, Established patient, Level 1 $ 46.00 $ 27.17
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99212Office Visit, Established patient, Level 2 $ 112.00 $ 60.38
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99213Office Visit, Established patient, Level 3 $ 173.00 $ 102.09
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99214Office Visit, Established patient, Level 4 $ 269.00 $ 145.88
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99215Office Visit, Established patient, Level 5 $ 305.00 $ 179.32
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99201Office Visit, New patient, Level 1 $ 112.00 $ 64.05
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99202Office Visit, New patient, Level 2 $ 193.00 $ 105.67
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99203Office Visit, New patient, Level 3 $ 279.00 $ 153.25
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99204Office Visit, New patient, Level 4 $ 329.00 $ 224.33
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99205Office Visit, New patient, Level 5 $ 258.07 $ 247.31
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99381Preventive Visit, New patient, Infant $ 215.00 $ 153.22
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99382Preventive Visit, New patient, Age 1-4 $ 224.00 $ 171.43
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99383Preventive Visit, New patient, Age 5-11 $ 233.00 $ 165.28
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99384Preventive Visit, New patient, Age 12-17 $ 265.00 $ 210.05
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99385Preventive Visit, New patient, Age 18-39 $ 257.00 $ 187.90
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99386Preventive Visit, New patient, Age 40-64 $ 296.00 $ 227.39
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99387Preventive Visit, New patient, Age 65 & Over $ 322.00 $ 218.97
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99391Preventive Visit, Established patient, Infant $ 193.00 $ 139.74
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99392Preventive Visit, Established patient, Age 1-4 $ 206.00 $ 147.34
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99393Preventive Visit, Established patient, Age 5-11 $ 205.00 $ 147.23
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99394
Preventive Visit, Established patient, Age 12-17
$ 225.00 $ 167.74
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99395
Preventive Visit, Established patient, Age 18-39
$ 230.00 $ 175.80
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99396
Preventive Visit, Established patient, Age 40-64
$ 247.00 $ 190.87
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99397
Preventive Visit, Established patient, Age 65 & Over
$ 265.00 $ 168.54
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80048Basic Metabolic Panel $ 45.00 $ 10.64
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80061Lipid Panel $ 64.00 $ 16.19
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83036Glycated Hemoglobin Test $ 50.00 $ 13.19
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84443Assay Thyroid Stimulating Hormone $ 77.00 $ 22.70
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85027Complete CBC and Auto Diff WBC $ 28.00 $ 9.91
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