Cash Pay Rates

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

99203 New Patient Evaluation level 3 (30-44 min) 165.00
99204 New Patient Evaluation level 4 (45-59min) 250.00
99205 New Patient Evaluation level 5 (60-74min) 300.00
99212 Follow up, established patient, level 2 (10-19min) 65.00
99213 Follow up, established patient, level 3 (20-29min) 110.00
99214 Follow up, established patient, level 4 (30-39min) 165.00
99215 Follow up, established patient, level 5 (40-54min) 220.00
99417 Prolonged service, each 15 minutes 50.00
99358 Non-face-to face prolonged service 1st hour (30-74mins) 170.00
99359 Non-face-to face prolonged service (each) extra 30min increment 85.00
99441 Telephone Visit, 5-10 mins 70.00
99442 Telephone Visit, 11-20 mins 115.00
99443 Telephone Visit, 21-30 mins 165.00
99421 Online (Telemedicine) Visit, 5-10 minutes 70.00
99422 Online (Telemedicine) Visit, 11—20 minutes 115.00
99423 Online (Telemedicine) Visit, 21+ mins 165.00
99391 New Patient Well Child Checkup, <1 yr 165.00
99392 Established patient Well Child Checkup, 1-4 yrs 165.00
99393 Established patient Well Child Checkup, 5-11 yrs 165.00
99394 Established patient Well Teen Checkup, 12-17 yrs 165.00
99395 Established patient Well Adult Checkup,18-39yrs 165.00
99381 New Patient Well Child Checkup, <1 yr 200.00
99382 New Patient Well Child Checkup, 1-4 yrs 200.00
99383 New Patient Well Child Checkup, 5-11 yrs 200.00
99384 New Patient Well Teen Checkup, 12-17 yrs 200.00
99385 New Patient Well Adult Checkup, 18-39yrs 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 Services provided on an emergency basis in office that disrupts office services 290.00
92551 Hearing Screening test, pure tone, air only 20.00
94760 pulse ox x1 4.00
94761 pulse ox, multiple readings 6.00
96110 ASQ/MCHAT Questionnaire 10.00
96127 teen depression/PHQ9 questionnaire 10.00
96160 Asthma Screening, HEEADSSS, CRAFFT questionnaires 5.00
96161 EDPS (Post-Partum Depression) questionnaire 5.00
99173 vision screening 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
36410 Physician peformed Venipuncture >3yrs 25.00
36591 Blood draw from infusaport 35.00
36592 Blood Draw from a PICC line 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 “Tongue Tie Release” 200.00
54150 Circumcision with nerve block 200.00
62270 Lumbar Puncture 200.00

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