Fee Schedule

First of all, we aim to ensure you never have surprise fees with this clinic. If you are charged for something by the clinic and this was truly not discussed with you beforehand, contact the clinic and we will work with you to straighten this out.

There are a few things to understand here before we go into specific fees:

1. When a provider contracts with a health insurance company, the insurance company dictates what the provider will receive for each service. On the fee schedule below, you may notice a visit coded 99214 (established patient of moderate complexity) is charged at a certain rate, however, when a practice accepts insurance they agree to accept the insurance company’s payments as they deem fit. This means one company may pay $120 for this and another may pay $130 for the same service and any amount over this agreed upon amount is wrote off and not billed to the patient. This is why you see on your explanation of benefits (EOB) a charge for the service and it may say “$120 paid, $5 not allowed due to over contractual obligation” and that $5 just kind of “disappears” and is not collected or charged to anyone.

2. Each service provided in a medical practice is assigned what is called a CPT or Evaluation and Management (E&M) code and this is how payment is determined. So the codes you see on the bill align with services provided and each code has a set amount associated with it as per the fee schedule below.

3. All patients must pay for services at the time of service, including copay, coinsurance, or deductible applied if billing insurance. All cash pay patients are expected to provide payment up front for services.

4. If you do not have insurance and the cost of care at our clinic is truly not affordable for you, please speak with office staff to discuss other discounts we can offer if you qualify for financial assistance!

If you read the fee schedule below and are thinking, “Okay, so, all of these codes and I have no idea which one will be used for me so I still don’t know what I will have to pay,” read this:

• New patient office visits are usually charged 99204 or 99205 depending on time and complexity (most often 99204).

• Established patient office visits are charged 99213, 99214, or 99215 depending on time and complexity. 99214 is the most commonly used code for follow ups.

• Patients seeking weight management assistance that are processing their visits through insurance will usually be charged 99401 in addition to their office visit. This indicates we discussed or addressed something that is considered preventative (like obesity management).

Fee Schedule As Follows:

99213 - low-moderate complexity office visit

$100.00

99214 - moderate complexity office visit

$125.00

99215 - high complexity office visit

$150.00

99395 - well person preventative visit, age 18 - 39

$150.00

99396 - well person preventative visit, age 40 - 65

$150.00

99397 - well person preventative visit, age 65 and over

$150.00

G0439 - Medicare well person preventative visit, established

$150.00

Q0091 - pap smear

$100.00

96372 - injection, procedure only

$40.00

90471 - vaccine injection, procedure only

$40.00

99203 - new patient, low-moderate complexity office visit

$125.00

99204 - new patient, moderate complexity office visit

$150.00

99205 - new patient, high complexity office visit

$175.00

36415 - Collection of venous blood by venipuncture

$30.00

87635 - SARS-COV-2 COVID-19 AMP PRB

$100.00

96158 - Health behavior intervention, individual, face-to-face; initial 30 minutes

$100.00

99000 - Handling and/or conveyance of specimen for transfer from the office to a laboratory

$40.00

99202 - new patient, low complexity

$110.00

99212 - low complexity office visit

$75.00

99211 - Nurse Visit

$65.00

99401 - Preventative medicine counseling and/or risk factor reduction intervention (s) provided to an individual, up to 15 minutes

$60.00

99402 - Preventive medicine counseling and/or risk factor intervention/s provided to an individual (separate procedure); approximately 30 minutes

$100.00

99406 - Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes

$30.00

99417 - Prolonged office or other outpatient evaluation and management service(s) beyond the total time of the primary procedure, requiring total time with or without direct patient contact beyond the usu...

$60.00

99441 - Phys/QHP Telephone Evaluation 5-10 minutes

$60.00

DOTPE - Medical Examination for the department of transportation FMCSA

$80.00

G0402 - Initial Preventative Exam

$175.00

G0438 - Medicare well person preventative visit, new patient

$175.00

G2023 - Specimen Collection for severe acute respiratory syndrome coronavirus 2

$30.00

99442 - Phys/QHP Telephone Evaluation 11-20 minutes

$80.00

99443 - Phys/QHP Telephone Evaluation 21-30 minutes

$100.00

99421 - ONLINE DIGITAL E/M SVC EST PT <7 DAYS 5-10 MINUTES

$31.00

99422 - ONLINE DIGITAL E/M SVC EST PT <7 DAYS 11-20 MINUTES

$60.00

99423 - ONLINE DIGITAL E/M SVC EST PT <7 DAYS 21 OR MORE MINUTES

$100.00

99358 - PROLNG E/M SVC BEFORE&/AFTER DIR PT CARE 1ST HR

$222.00

99359 - PROLNG E/M BEFORE&/AFTER DIR CARE EA 30 MINUTES

$106.00

96127 - Brief emotional/behavioral assessment (e.g., depression inventory, attention-deficit/hyperactivity disorder scale), with scoring and documentation, per standardized instrument

$12.00

LAB PRICES

We provide lab draw services in the office. We do not run many of the serum and chemistry tests in office. The blood samples are prepared in the office, packaged, and sent to an outside lab. We receive excellent prices for cash pay labs through our contract with our partner lab. We try to take advantage of this as much as we can so that we can offer great lab rates to patients of our area!

We cannot guarantee pricing if labs are processed through insurance or if you have your labs at an outside facility because we cannot predict what your insurance will pay or how much the outside clinic will charge.

If you elect to have your labs drawn in the office and would prefer to pay cash for these instead of billing your insurance, you are waiving your right to seek insurance payment to cover the cost (and this is included in the consent you sign). Each lab draw service completed in the clinic is charged $25 as a convenience fee in addition to the cost the lab charges to actually perform the test. This convenience fee covers the services of the nurse practitioner collecting the blood sample.