self-pay fee schedule as of january 2025

Annapolis Internal Medicine, LLC SELF-PAY FEE SCHEDULE 

Patients without insurance qualify for discounted rates if the visit is paid for at the time of service. Below is a list of discounted rates for various services provided by the Annapolis Internal Medicine clinicians. This list is not all-inclusive. If you have questions about other services, please contact our Billing Department at (410) 897-9841 and select option 4. 

• New Patient Level 2 (CPT 99202) $102.50

• New Patient Level 3 (CPT 99203) $142.50 

• New Patient Level 4 (CPT 99204) $200.00 

• New Patient Level 5 (CPT 99205) $272.50 

• Established Patient Level 2 (CPT 99212) $ 62.50 

• Established Patient Level 3 (CPT 99213) $102.50 

• Established Patient Level 4 (CPT 99214) $142.50 

• Established Patient Level 5 (CPT 99215) $200.00 

• Preventive Exam New Pt age 18-39 (CPT 99385) $157.50

• Preventive Exam New Pt age 40-64 (CPT 99386) $172.50 

• Preventive Exam New Pt age 65+ (CPT 99387) $187.50

• Preventive Exam Estab Pt age 18-39 (CPT 99395) $142.50 

• Preventive Exam Estab Pt age 40-64 (CPT 99396) $157.50 

• Preventive Exam Estab Pt age 65+ (CPT 99397) $172.50 

• Welcome to Medicare Physical (CPT G0402) $172.50 

• Medicare Wellness, Initial Visit (CPT G0438) $172.50

• Medicare Wellness, Subsequent (CPT G0439) $157.50 

OTHER SERVICES 

• Electrocardiogram/EKG (CPT 93000) $ 27.50 

• Vaccine Administration, Initial (CPT 90471) $ 17.50 

• Vaccine Administration, Each Addtl (CPT 90472) $ 12.50 

• Intramuscular or Subcutaneous Inj (CPT 96372) $ 20.00