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 

• DOT or Coast Guard Physical (CPT 99455)                       $120.00 

• Vaccine Administration, Initial (CPT 90471)                      $17.50 

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

• Intramuscular or Subcutaneous Inj (CPT 96372)             $20.00