Code
|
Description
|
Cash Price
|
| 99202 |
New Pt eval level 2 (15-29min) |
$110.00 |
| 99203 |
New Pt eval level 3 (30-44 min) |
$165.00 |
| 99204 |
New Pt eval level 4 (45-59min) |
$250.00 |
| 99205 |
New Pt eval level 5 (60-74min) |
$300.00 |
|
|
|
| 99212 |
Follow up (established) level 2 (10-19min) |
$65.00 |
| 99213 |
Follow up (established) level 3 (20-29min) |
$110.00 |
| 99214 |
Follow up (established) level 4 (30-39min) |
$165.00 |
| 99215 |
Follow up (established) level 5 (40-54min) |
$220.00 |
|
|
|
|
|
|
|
|
|
| 99417 |
PROLONG EA 15 MIN (75/55+) |
$50.00 |
|
|
|
| 99358 |
Non-face-to face prolonged service 1st hour (30-74mins) |
$170.00 |
| 99359 |
Non-face-to-face (each) extra 30min increment |
$85.00 |
|
|
|
| 99441 |
Telephone E/M 5-10 mins |
$70.00 |
| 99442 |
Telephone E/M 11-20 mins |
$115.00 |
| 99443 |
Telephone E/M 21-30 mins |
$165.00 |
|
|
|
| 99421-95 |
Online E/M, est pt, up to 7 days cumul. 5-10 minutes |
$70.00 |
| 99422-95 |
Online E/M, est pt, up to 7 days cumul. 11—20 minutes |
$115.00 |
| 99423-95 |
Online E/M, est pt, up to 7 days cumul. 21+ mins |
$165.00 |
|
|
|
| 99391 |
Est. WCC <1 yr (30 min) |
$165.00 |
| 99392 |
Est. WCC 1-4 yrs (30 min) |
$165.00 |
| 99393 |
Est. WCC 5-11 yrs (30 min) |
$165.00 |
| 99394 |
Est. WCC 12-17 yrs (30 min) |
$165.00 |
| 99395 |
Est. WCC 18-39yrs (30 min) |
$165.00 |
|
|
|
| 99381 |
New Pt WCC <1 yr (45min) |
$200.00 |
| 99382 |
New Pt WCC 1-4 yrs (45min) |
$200.00 |
| 99383 |
New Pt WCC 5-11 yrs (45min) |
$200.00 |
| 99384 |
New Pt WCC 12-17 yrs (45min) |
$200.00 |
| 99385 |
New Pt WCC 18-39yrs (45min) |
$200.00 |
|
|
|
| 99050 |
Services provided in the office outside of office hours |
$125.00 |
| 99051 |
Service provided during scheduled evening/weekend/holiday office hours |
$85.00 |
| 99056 |
Service typically provided in office, provided out of office at patient's request |
$100.00 |
| 99058 |
Svcs prov'd on an emergency basis in office, disrupts office sch'd scvs |
$290.00 |
|
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|
|
|
|
| 92551 |
Hearing Screening test, pure tone, air only |
$20.00 |
| 92650 |
Newborn hearing screening |
|
| 94760 |
pulseox x1 |
$4.00 |
| 94761 |
pulseox mult |
$6.00 |
| 96110 |
ASQ/MCHAT |
$10.00 |
| 96127 |
teen depression/PHQ9 |
$10.00 |
| 96160 |
Asthma Screening, HEEADSSS, CRAFFT |
$5.00 |
| 96161 |
EDPS (PPD) |
$5.00 |
| 99173 |
vision |
$5.00 |
| 99401 |
counseling 15min |
$60.00 |
| 99402 |
counseling 30min |
$100.00 |
| 99403 |
counseling 45min |
$135.00 |
| 99404 |
counseling 60min |
$170.00 |
|
|
|
| 11200 |
Accessory Digit ligation |
$145.00 |
| 17250 |
Chemical cauterization of granulation tissue |
$100.00 |
| 36410 |
MD Venipuncture >3yrs |
$25.00 |
| 36415 |
Collection of venous blood by venipuncture |
$5.00 |
| 36416 |
Collection of capillary blood specimen |
$5.00 |
| 36591 |
Blood draw port |
$35.00 |
| 36592 |
Blood Draw PICC |
$40.00 |
| 38220 |
Diagnostic bone marrow; aspiration(s) |
$250.00 |
| 38221 |
Bone Marrow biopsy (ies) |
$250.00 |
| 38222 |
Bone Marrow biopsy (ies) and aspiration(s) |
$250.00 |
| 41010 |
Frenulotomy |
$200.00 |
| 54150 |
Circumcision with block |
$200.00 |
| 10060 |
incision and drainage of a simple or single abscess |
$185.00 |
| 62270 |
Lumbar Puncture |
$200.00 |
| 69210 |
Remove impacted ear wax (-50 modifier if bilateral) |
$70.00 |
| 99000 |
Handling/conveyance of specimen from office to a lab |
$15.00 |
| S0630 |
Suture removal by phys other than orig phys |
$75.00 |
|
|
|
| 90460 |
IM admin Vaccine 1st/only component 0-18yo |
$35.00 |
| 90461 |
IM admin Vaccine each addl component 0-18yo |
$20.00 |
| 90471 |
IM/SubQ Immunization no-doc or >18yo |
$35.00 |
| 90472 |
Immunization admin each add no-doc or >18yo |
$20.00 |
| 90473 |
Immune admin oral/nasal |
$35.00 |
| 90474 |
Immune admin oral/nasal addl |
$20.00 |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction for therapeutic purposes and/or for diagnostic purposes |
$20.00 |
| 96360 |
Initial hydration up to 1 hour; must be at least 31 minutes |
$50.00 |
| 96361 |
Each hour of hydration; must be 31 minutes or longer |
$20.00 |
| 96365 |
Initial infusion up to 1 hour (16-90mins) |
$105.00 |
| 96366 |
Each additional hour (31 mins +, >90mins total time ) |
$30.00 |
| 96367 |
Sequential infusion up to 1 hour (use 96366 for add'l hrs of seq inf) |
$45.00 |
| 96368 |
Concurrent infusion (report only one per encounter) |
$30.00 |
| 96372 |
IM/SubQ Injection |
$20.00 |
| 96374 |
Initial push or infusion less than 16 minutes |
$60.00 |
| 96375 |
IV push, each push of a different drug |
$25.00 |
| 96376 |
Each IV push of the same drug at intervals > than 30 minutes |
$25.00 |
