|
I & D Cyst/Simple/Single Abcess
|
10060
|
$ 120.00
|
|
I & D Cyst/Complicated Multiple
|
10061
|
$ 206.00
|
|
Pairing/Cutting Benign Lesion (Corn/Callus)
|
11055
|
$ 53.00
|
|
Pairing/Cutting Benign Lesion 2-4 (Corn/Callus)
|
11056
|
$ 65.00
|
| Punch Biopsy of Skin; Single Lesion | 11104 | $ 145.00 |
| Punch Biopsy of Skin; Single Lesion | 11105 | $ 71.00 |
|
Removal Skin Tags up to 15
|
11200
|
$ 89.00
|
|
Removal 1 Nail Plate Partial/Complete
|
11730
|
$ 109.00
|
|
Removal Addtl Nail Plate
|
11732
|
$ 51.00
|
|
Insertion, Nexplanon (must be billed w/J7307)
|
11981
|
$ 152.00
|
|
Remove Implant
|
11982
|
$ 176.00
|
|
Removal w/reinsert, Nexplanon (must be billed w/J7307)
|
11983
|
$ 273.00
|
| Removal of Sutures or Staples | 15853 | $ 15.00 |
| Removal of Sutures and Staples | 15854 | $ 21.00 |
|
Destruction benign lesions other than skin tags <15
|
17110
|
$ 118.00
|
|
Destruction benign lesions other than skin tags <15
|
17111
|
$ 141.00
|
|
Veinpuncture
|
36415
|
$ 5.00
|
|
Incision Thrombosed Hemorrhoid
|
46083
|
$ 188.00
|
|
Destruction Anus Lesion (simple)
|
46900
|
$ 241.00
|
|
Destruction Anus Lesion (extensive)
|
46924
|
$ 537.00
|
|
Destruction Penis Lesion (simple)
|
54050
|
$ 148.00
|
|
Destruction Penis Lesion (extensive)
|
54065
|
$ 252.00
|
| Vulvar Abscess (I&D) | 56405 | $ 153.00 |
|
Destruction Vulva Lesion (simple)
|
56501
|
$ 182.00
|
|
Destruction Vulva Lesion (extensive)
|
56515
|
$ 307.00
|
| Vulvar Biopsy | 56605 | $ 119.00 |
|
Destruction Vaginal Lesion (simple)
|
57061
|
$ 159.00
|
|
Destruction Vaginal Lesion (extensive)
|
57065
|
$ 270.00
|
Fitting and Insertion of Pessary or Other Intravaginal Support Device
| 57160 | $ 106.00 |
|
Diaphragm Fitting & Instruct
|
57170
|
$ 120.00
|
|
Colposcopy w/o Biopsy
|
57452
|
$ 153.00
|
|
Colposcopy w/Biopsy
|
57454
|
$ 219.00
|
| Colposcopy, Biopsy only | 57455 | $ 203.00 |
| Colposcopy, ECC only | 57456 | $ 192.00
|
| Biopsy of Cervix | 57500 | $ 197.00 |
|
Cryosurgery
|
57511
|
$ 205.00
|
|
Endometrial Biopsy
|
58100
|
$ 156.00
|
|
IUD Insertion
|
58300
|
$ 124.00
|
|
IUD Removal
|
58301
|
$ 140.00
|
| Fitting and Insertion of Pressary or Other Intravaginal Support | 67160 | $ 106.00 |
|
Earwash/Removal Cerumen
|
69210
|
$ 58.00
|
| Urine Drug Test | 80305 | $ 14.00 |
|
Urinalysis Dipstick w/Micro
|
81000
|
$ 7.00
|
|
Urinalysis Dipstick w/o Micro
|
81002
|
$ 5.00
|
|
Pregnancy Test
|
81025
|
$ 12.00
|
|
Amines
|
82120
|
$ 8.00
|
|
Hemoccult Stool - 3 Card |
82270
|
$ 7.00
|
|
Hemoccult Stool - Single |
82272 |
$ 7.00
|
|
Glucose
|
82947
|
$ 8.00
|
|
Hemoglobin A1C
|
83036
|
$ 13.00
|
|
ph: Body Fluid not otherwise specified
|
83986
|
$ 7.00
|
|
Hematocrit (Spun)
|
85013
|
$ 8.00
|
|
Hemoglobin
|
85018
|
$ 5.00
|
|
TB Skin Test (Flate Rate) (No Charge for Exposures)
|
86580
|
$ 20.00
|
|
HIV Post Test Counseling
|
86701
|
$ 12.00
|
|
Titer - Hepatitis B - Flat Rate (OS Program)
|
86317 |
$ 53.00
|
|
Titer - Mumps - Flat Rate (OS Program)
|
86735
|
$ 74.00
|
|
Titer - Rabies - Flat Rate (OS Program)
|
86382
|
$ 133.00
|
| QuantiFERON - TB Gold (OS Program) | 86480 | $ 83.00 |
|
Titer - Rubella - Flat Rate (OS Program)
|
86762
|
$ 53.00
|
|
Titer - Rubeola (Measles) - Flat Rate (OS Program)
|
86765
|
$ 80.00
|
|
Titer - Varicella - Flat Rate (OS Program)
|
86787
|
$ 58.00
|
|
Gonorrhea Culture
|
87081
|
$ 11.00
|
|
Bacterial blood smear
|
87205
|
$ 9.00
|
|
Wet Mount
|
87210
|
$ 8.00
|
|
Rapid Flu (2 units @ $15.50 per unit)
|
87804
|
$ 31.00
|
| Rapid COVID Testing | 87811 | $ 45.00 |
|
Strep Screen Rapid
|
87880
|
$ 22.00
|
RSV, Immune Gloulin; 0.5 mL dosage (birth to 24 months) | 90380 | $ 550.00 |
| RSV, Immune Gloulin; 1 mL dosage (birth to 24 months) | 90381 | $ 550.00 |
|
Vaccine Admin (One) Injectable Vaccine
|
90471
|
$ 32.00
|
|
Vaccine Admin (Two or more) Injectable Vaccines
|
90472
|
$ 21.00
|
|
Immune Admin Oral/Nasal
|
90473
|
$ 21.00
|
|
Immune Admin Oral/Nasal - Additional
|
90474
|
$ 21.00
|
| Admin COVID | 90480 | $ 65.00 |
| Meningococcal (2 doses) MenQuadfi Vaccine * | 90619 | $ 212.00 |
|
Meningococcal B (2 doses) Bexsero Vaccine
|
90620
|
$ 255.00
|
|
Meningococcal B (3 doses) Trumenba Vaccine
|
90621
|
$ 219.00
|
|
Hepatitis A Vaccine
|
90632
|
$ 95.00
|
|
Hepatitis A Vaccine (Pediatric) (Havrix) Private
|
90633
|
$ 56.00
|
|
Hep A/Hep B Vaccine, Adult Imm
|
90636
|
$ 148.00
|
|
Pedvax HIB Vaccine (Private)
|
90647
|
$ 36.00
|
| ActHIB Vaccine 4 Doses Required | 90648 | $ 20.00 |
|
Gardasil/HPV Vaccine (9 valent)
|
90651
|
$ 333.00 |
| Flu Vaccine (6 month & older) | 90656 | $ 30.00 |
| Flu Vaccine (65+ only) High Dose | 90662 | $ 80.00 |
| Prevnar 13 TM Vaccine | 90670 | $ 315.00 |
| Vaxneuvance Vaccine (Pneumonia Vaccine) | 90671 | $ 264.00 |
| Flu Mist |
90672 |
$ 30.00
|
| Flu Vaccine (18 yrs and older) | 90673 | $ 85.00 |
|
Rabies Vaccine
|
90675
|
$ 476.00
|
RSV, Abrysvo (pregnant women 19 years and older)
| 90678 | $ 325.00 |
|
Rotavirus Vaccine (Rota Teq)
|
90680
|
$ 114.00
|
|
Rotavirus Vaccine (Rotarix)
|
90681
|
$ 152.00
|
|
Kinrix
|
90696
|
$ 130.00
|
| Vaxelis Vaccine | 90697 | $ 178.00 |
|
DTAP-HIB-IP vaccine
|
90698
|
$ 135.00
|
|
Dtap Vaccine (Infanrix)
|
90700
|
$ 40.00
|
|
MMR Vaccine
|
90707
|
$ 120.00
|
|
MMRV Vaccine
|
90710
|
$ 319.00
|
|
Poliovirus Vaccine (IPOL)
|
90713
|
$ 55.00
|
|
TD >7 yrs IM
|
90714
|
$ 39.00
|
|
TDaP Vaccine (Boostrix) (>10 and older)
|
90715
|
$ 63.00
|
|
Varicella Vaccine (Varivax)
|
90716
|
$ 198.00 |
|
DTAP-Hep B-IPV Vaccine
|
90723
|
$ 113.00
|
|
Pneumonia Vaccine
|
90732
|
$ 143.00
|
| Hepatitis B Vaccine Peds |
90744 |
$ 46.00 |
|
Hepatitis B Vaccine |
90746
|
$ 84.00
|
| CCA/Psychiatric Diagnostic Evaluation | 90791 | $ 250.00 |
| CCA/Psychiatric Diagnostic Evaluation w/Medical Services | 90792 | $ 234.00 |
| Individual Counseling/Psychotherapy (30 minutes) | 90832 | $ 95.00 |
Individual Counseling/Psychotherapy (45 minutes)
| 90834 | $ 135.00 |
Individual Counseling/Psychotherapy (60 minutes)/EMDR
| 90837 | $ 190.00 |
| Add on for 90839 - each additional 30 minutes | 90840 | $ 108.00 |
| Family Psychotherapy, 50 minutes w/o patient | 90846 | $ 136.00 |
| Family Psychotherapy, 50 minutes w/patient | 90847 | $ 153.00 |
| CBT Group/Multi Family Group | 90849 | $ 50.00 |
| TFCBT Group/Multi Family Group | 90853 | $ 50.00 |
| Moderna COVID-19 Vaccine (6 months to 11 yrs) | 91321 | $ 165.00 |
| Moderna COVID-19 Vaccine (12 yrs old and up) | 91322 | $ 165.00 |
| Hearing Screening |
92551 |
$ 23.00 |
| OAE Hearing Screening | 92558 | $ 65.00 |
|
EKG
|
93000
|
$ 28.00
|
|
Spirometry
|
94010
|
$ 40.00
|
|
Inhalation Treatment
|
94640
|
$ 16.00
|
|
Developmental Screening
|
96110
|
$ 14.00
|
|
Brief Emotional/Behavioral Assessment
|
96127
|
$ 7.00
|
|
Admin. of Patient-Focused Health Risk Assessment
|
96160
|
$ 9.00
|
|
Admin. of Caregiver-Focused Health Risk Assessment
|
96161
|
$ 9.00
|
|
Medication Injection
|
96372
|
$ 26.00
|
|
Medical Nutrition Therapy (Int ea 15 min)
|
97802
|
$ 38.00
|
|
Medical Nutrition Therapy (Subs ea 15 min)
|
97803
|
$ 33.00
|
|
Form Completion
|
99080
|
$ 10.00
|
|
Vision Screening
|
99173
|
$ 13.00
|
|
Photo Screening
|
99177
|
$ 14.00
|
|
New Patient Level 2
|
99202
|
$ 139.00
|
|
New Patient Level 3
|
99203
|
$ 198.00
|
|
New Patient Level 4
|
99204
|
$ 291.00
|
|
New Patient Level 5
|
99205
|
$ 365.00
|
|
Established Patient Level 1
|
99211
|
$ 51.00
|
|
Established Patient Level 2
|
99212
|
$ 85.00
|
|
Established Patient Level 3
|
99213
|
$ 118.00
|
|
Established Patient Level 4
|
99214
|
$ 183.00
|
|
Established Patient Level 5
|
99215
|
$ 272.00
|
| Office Consultation New/Est Patient - 20 minutes | 99242 | $ 116.00 |
| Office Consultation New/Est Patient - 30 minutes | 99243 | $ 160.00 |
|
Office Consultation New/Est Patient - 60 minutes
|
99244
|
$ 235.00
|
|
Office Consultation New/Est Patient - 80 minutes
|
99245
|
$ 290.00
|
|
New PT Well Check Age 0-1
|
99381
|
$ 135.00
|
|
New PT Well Check Age 1-4
|
99382
|
$ 135.00
|
|
New PT Well Check Age 5-11 (CH/FP) |
99383
|
$ 230.00
|
|
New PT Well Check Age 12-17 (CH/FP) |
99384
|
$ 253.00
|
|
New PT Well Check Age 18-39 (CH/FP) |
99385
|
$ 250.00
|
|
New PT Well Check Age 40-64
|
99386
|
$ 297.00
|
|
New PT Well Check Age 65->
|
99387
|
$ 321.00
|
|
Est PT Well Check Age 0-1
|
99391
|
$ 135.00
|
|
Est PT Well Check Age 1-4
|
99392
|
$ 135.00
|
|
Est PT Well Check Age 5-11 (CH/FP) |
99393
|
$ 188.00
|
|
Est PT Well Check Age 12-17 (CH/FP) |
99394
|
$ 218.00
|
|
Est PT Well Check Age 18-39 (CH/FP) |
99395
|
$ 212.00
|
|
Est PT Well Check Age 40-64
|
99396
|
$ 236.00
|
|
Est PT Well Check Age 65->
|
99397
|
$ 262.00
|
Preventative Medicine Counseling and/or risk factor reduction intervention(s) provided to an individual
(separate procedure); approximately 15 mins | 99401 | $ 46.00 |
|
Smoking Cessation (3-10 minutes)
|
99406
|
$ 18.00
|
|
Smoking Cessation (>10 minutes)
|
99407
|
$ 35.00
|
|
Alcohol and/or Substance Screening (15-30 minutes)
|
99408
|
$ 46.00
|
|
Alcohol and/or Substance Screening (>30 minutes)
|
99409
|
$ 91.00
|
| Add on for 99205 (75+ mins) & 99215 (55+ mins) | 99417 | $ 93.00 |
| Telephone E&M 5-10 minutes (CR modifier) |
99441 |
$ 68.00 |
| Telephone E&M 11-20 minutes (CR modifier) |
99442 |
$ 94.00 |
| Telephone E&M 21-30 minutes (CR modifier) |
99443 |
$ 146.00 |
|
Post Partum Visits (Mom)
|
99501
|
$ 135.00
|
|
Newborn Assessment (Baby)
|
99502
|
$ 187.00
|
| Pressary, Rubber, Any Type | A4561 | $ 150.00 |
| Pressary, Non-Rubber, Any Type | A4562 | $ 150.00 |
|
Oral Evaluation (Bill in conjunction w/1206)
|
D0145
|
$ 42.00
|
|
Topical Fluoride Varnish (Bill in conjunction w/0145)
|
D1206
|
$ 26.00
|
|
Vaccine Admin (Medicare/Medicare HMO Flu)
|
G0008
|
$ 32.00
|
|
Vaccine Admin (Medicare/Medicare HMO Pneumonia)
|
G0009
|
$ 32.00
|
| Specimen Collection & Handling (COVID-19 only) |
G2023 |
$ 24.00 |
| Buprenorphine/Naloxone, oral <3 mg | J0572
| Acquisition Cost |
Buprenorphine/Naloxone, oral >10 mg
| J0574 | Acquisition Cost
|
| Rocephin (250 mg) |
J0696 |
$ 0.00 |
Depo Medrol 1mg (40mg $6 & 80 mg $12)
| J1010 | $ 0.15 |
|
Depo Provera (birth control) (0.84 per unit) 104 units |
J1050
|
$ 87.36 |
|
Depo Provera (birth control) (0.84 per unit) 150 units
|
J1050
|
$ 126.00
|
|
Paragard IUD
|
J7300
|
$ 1,124.00
|
|
Skyla IUD
|
J7301
|
$ 1,092.00
|
|
Mirena IUD
|
J7298
|
$ 1,198.00 |
|
Contraceptive Vaginal Ring (1 pk = 3 rings)
|
J7295 |
$ 36.00 |
|
Nexplanon Implant
|
J7307
|
$ 1,254.00
|
|
Kyleena IUD
|
J7296
|
$ 1,212.00
|
|
Albuterol
|
J7620
|
$ 1.00
|
Clonidine, oral .1 mg
| J8499 | Acquisition Cost |
|
Oral Contraceptives (Females 11-55 yr old) (Max of 14 pks per 365 days)
|
S4993FP
|
$ 7.68 |
| Generic Emergency Contraception | S5000 | Acquisition Cost |
| Brand Name Emergency Contraception | S5001
| Acquisition Cost |
|
RN Services - per unit (4 units max) |
T1002
|
$ 28.00
|
|
Community Prescription Assistance Program
|
|
$ 2.00
per prescription |