Cash Pay Rates

Our Cash-Pay (Non-Insurance) Prices – Subject To Change

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
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

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