Self-pay pricing

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Home New Patients Self-pay pricing

We offer transparent, discounted self-pay rates so every child in Suwanee and surrounding communities receives quality pediatric care — regardless of insurance status.

New Patient

Sick Visit:  Illness Complexity *

 

Low: $120

Moderate:  $170

High:  $220

 

 

Well Visit:  Age

 

0-4 years:  $160

4+ years: $200

Established Patient

Sick Visit:  Illness Complexity* 

 

Low: $100

Moderate:  $140

High:  $180

 

 

Well Visit:  Age

 

0-4 years:  $140

4+ years: $180

*NOTE: Illness complexity is based on the physician’s medical judgement strictly following the CMS defined coding guidelines.

Frequently Asked Questions (FAQs)

Here are some trusted sources on finding out about CPT codes:

  1. AAP (Healthychildren.org): How Your Pediatrician is Paid: Coding Information for Parents
  2. Centers for Medicare & Medicaid Services (CMS): List of CPT/HCPCS Codes

Here is how the Centers for Medicare & Medicaid Services (CMS) officially defines common well visit CPT codes:

99391 — Periodic comprehensive preventive medicine reevaluation and management including age and gender appropriate history, examination, counseling, anticipatory guidance, risk factor reduction interventions, and ordering of laboratory/diagnostic procedures. Established patient — Infant (younger than 1 year).
99392 — Periodic comprehensive preventive medicine reevaluation and management including age and gender appropriate history, examination, counseling, anticipatory guidance, risk factor reduction interventions, and ordering of laboratory/diagnostic procedures. Established patient — Early Childhood (age 1 through 4 years).
99393 — Periodic comprehensive preventive medicine reevaluation and management including age and gender appropriate history, examination, counseling, anticipatory guidance, risk factor reduction interventions, and ordering of laboratory/diagnostic procedures. Established patient — Late Childhood (age 5 through 11 years).
99394 — Periodic comprehensive preventive medicine reevaluation and management including age and gender appropriate history, examination, counseling, anticipatory guidance, risk factor reduction interventions, and ordering of laboratory/diagnostic procedures. Established patient — Adolescent (age 12 through 17 years).
99395 — Periodic comprehensive preventive medicine reevaluation and management including age and gender appropriate history, examination, counseling, anticipatory guidance, risk factor reduction interventions, and ordering of laboratory/diagnostic procedures. Established patient — Age 18 through 39 years.

Here is how the Centers for Medicare & Medicaid Services (CMS) officially defines common sick visit CPT codes:

🟢 Low Complexity

99211 — Office or outpatient visit for evaluation and management of an established patient that may not require the presence of a physician. Presenting problems are minimal. Typically 5 minutes.
99212 — Office or outpatient visit requiring at least 2 of 3 key components: problem focused history, problem focused examination, straightforward medical decision making. Presenting problems are self-limited or minor. Typically 10 minutes face-to-face.

🟠 Medium Complexity

99213 — Office or outpatient visit requiring at least 2 of 3 key components: expanded problem focused history, expanded problem focused examination, medical decision making of low complexity. Presenting problems are of low to moderate severity. Typically 15 minutes face-to-face.
99214 — Office or outpatient visit requiring at least 2 of 3 key components: detailed history, detailed examination, medical decision making of moderate complexity. Presenting problems are of moderate to high severity. Typically 25 minutes face-to-face.

🔴 High Complexity

99215 — Office or outpatient visit requiring at least 2 of 3 key components: comprehensive history, comprehensive examination, medical decision making of high complexity. Presenting problems are of moderate to high severity. Typically 40 minutes face-to-face.