Cash Pay Rates
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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 | Prolonged visit each 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 5-10 mins | $70.00 |
| 99442 | Telephone 11-20 mins | $115.00 |
| 99443 | Telephone 21-30 mins | $165.00 |
| 99421 | Telemedicine video 5-10 minutes | $70.00 |
| 99422 | Telemedicine video 11—20 minutes | $115.00 |
| 99423 | Telemedicine video 21+ mins | $165.00 |
| 99391 | Established patient Well Child visit <1 yr | $165.00 |
| 99392 | Established patient Well Child visit 1-4 yrs | $165.00 |
| 99393 | Established patient Well Child visit 5-11 yrs | $165.00 |
| 99394 | Established patient Well Child visit 12-17 yrs | $165.00 |
| 99395 | Established patient Well Child visit 18yr+ | $165.00 |
| 99381 | New patient Well Child visit < 1 yr | $200.00 |
| 99382 | New patient Well Child visit 1-4 yrs | $200.00 |
| 99383 | New patient Well Child visit 5-11 yrs | $200.00 |
| 99384 | New patient Well Check visit 12-17 yrs | $200.00 |
| 99385 | New patient Well Check visit 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 | Services provided on an emergency basis in office | $290.00 |
| 92551 | Hearing Screening test, pure tone, air only | $20.00 |
| 92650 | Newborn hearing screening | N/A |
| 94760 | Pulseox x1 | $4.00 |
| 94761 | Pulseox mult | $6.00 |
| 96110 | ASQ/MCHAT | $10.00 |
| 96127 | Teen depression screening /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 |
| 41010 | Frenulotomy | $200.00 |
| 54150 | Circumcision with block | $200.00 |
| 10060 | incision and drainage of a simple or single abscess | $185.00 |
| 69210 | Remove impacted ear wax | $70.00 |
| S0630 | Suture removal | $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 | Nebulizer inhalation treatment | $20.00 |
| 96360 | Initial hydration up to 1 hour | $50.00 |
| 96361 | Each additional hour of hydration | $20.00 |
| 96365 | Initial infusion up to 1 hour | $105.00 |
| 96366 | Each additional hour of infusion | $30.00 |
| 96367 | Sequential infusion up to 1 hour | $45.00 |
| 96368 | Concurrent infusion | $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 |
