Sheet1
OFFICE VISITS SPECIALTY SERVICES
LAB SERVICES
CPT
Price
CPT
Price
CPT
Price
Problem Visit New Patients BLOOD DRAW / INJECTION
IN-CENTER LAB WORK
99202 15-29 min 128.00$ 36415
Blood Draw/Venipuncture
12.00$
83986 PH of Body Fluid
7.00$
99203 30-44 min 184.00$ 36416 Finger Stick 8.00$
84014 Hemoblobin Level
5.00$
99204 45-59 min 246.00$ 96372 Medication Injection 20.00$
81002 Urinalysis
8.00$
99205 60 min 348.00$ 90471 Vaccine injection 15.00$
81025 Pregnancy (Urine)
12.00$
90472
2nd+ Vaccine Injection
20.00$
87880 Rapid Strep Test
28.00$
Problen Visit Established Patients
86703 Rapid HIV Test
26.00$
99211 No Clinician Time 41.00$
INJECTABLES
87210 Wet Mount Read
10.00$
99212 10-19 min 84.00$ 90651 Gardasil 9 / dose 267.00$
99213 20-29 min 132.00$ J1050 Depo 120.00$
OUTSIDE LAB SERVICES
99214 30-39 min 196.00$ J1580
Rocephin / Ceftriaxone
3.00$
84520T BUN / Urea Nirogen
6.00$
99215 40-54 min 260.00$
J1580
Gentamiacin/Geramycin
3.00$
85025T CBC
12.00$
80053T
CMP/ Comp Metabolic Panel
18.00$
Preventive Visit New Patient IMPLANT SYSTEM
87801T CT/GC ORCH
37.00$
99385 18-39 yo 188.00$ 11982 Implant removal 225.00$ 7.00$
99386 40-64 yo 192.00$ 11981 Implant Insertion 225.00$ 40.00$
99387 65+ 220.00$ 11983
Implant removal/insertion
350.00$ 12.00$
J7307 Nexplanon Sys 1,300.00$ 17.00$
Preventive Visit Est Patients
15.00$
99395 18-39 yo 162.00$
IUD/IUC
21.00$
99396 40-64 yo 180.00$ 58300 Insert IUC 172.00$ 3.00$
99397 65+ 192.00$ 58301 Remove IUC 172.00$
82565T Creatinine
82670T Estradiol
80076T Hepatic Func Panel
86708T Hep A AB
87340T Hep B IG
86803T Hep C AB
85014T Hemocrit
87389T HIV Test
35.00$
J7296 Kyleena 19.5 Mg $1,200.00
86695T HSV1 ORCH
19.00$
PAP SERVICES
J7297 Liletta 19.5 MCG $1,200.00 86696T HSV2 ORCH 27.00$
88142 PAP Lab Fee 65.00$ J7300 Paragard $1,200.00
87255T
HSV Culture ORCH 49.00$
COLPOSCOPY+LAB FEES
J7301 Skyla $1,200.00
80061T Lipid Panel
21.00$
57455 Biopsy(s) of Cervix 295.00$
80048T Metabolic Panel
15.00$
88305
Pathology of Colp Bx(s)
$165.00
IN-CENTER BC PILLS
86592T RPR / Syphilis
6.00$
NORABE
Nora-Be Micronor) $26.00 84403T
Testosterone Level Total
38.00$
LEEP SERVICES + LAB FEES
TARINA Tarina EQ 1/20 $26.00 84443T
TSH / Thyroid Stim Hormone
24.00$
57461 LEEP Procedure $590.00
CHATEAL
Chateal EQ
$26.00 84703T Pregnancy (Blood)
11.00$
88307 Path. of LEEP spec $180.00 84132T
Potassium
7.00$
EMERGENCY CONT/ 'PLAN B'
87661T Trich
51.00$
ECONTRAEZ
Econtra EZ $36.00
87086T Urine Culture
12.00$
MEDICATIONS AVAILABLE IN THE HEALTH CENTER
AC400100
Acyclovir #15 6.00$ DIFLU Diflucan 24.00$ MET4 Metronidazole 4 8.00$
AC400 Acyclovir #100 26.00$ DOX14 Doxi #14 20.00$
ZMAX Azithromycin 250mg 3.00$ FLUZOL Flucanozole 26.00$
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