| Code | Description | Price | Price Type | Last Updated |
|---|---|---|---|---|
| 99211 | HC ESTAB PT VISIT - LEVEL 1 | $125 [source] | gross_charge | 2 weeks ago |
| 99212 | HC ESTAB PT VISIT - LEVEL 2 | $157 [source] | gross_charge | 2 weeks ago |
| 99213 | HC ESTAB PT VISIT - LEVEL 3 | $188 [source] | gross_charge | 2 weeks ago |
| 99214 | HC ESTAB PT VISIT - LEVEL 4 | $251 [source] | gross_charge | 2 weeks ago |