© 2013 JPG
17110 N. Dallas Parkway
Suite 200
Dallas, TX 75248
Phone: (972) 380-7070
Fax: (972) 380-7043

Web Design by TXprogrammer
 

Primary Care - Sample Fees

The following represents some of the most common office visit charges. Other services are available at comparable discounts - discuss with your physician.

Established 4 year old well child exam with immunizations
Jefferson Fees
99392 Preventive Exam, Age 1 to 4 95
99173 Visual Acuity, screening 5
92587 Hearing, screening 20
81002 Urinalysis, dipstick 5
90713 IPV 35
90707 MMR 60
90716 Varivax/Varicella 100
90700 DTaP 30
Total 350
Establihed 4 year old well child exam without immunizations
Jefferson Fees
99392 Preventive Exam, Age 1 to 4 95
99173 Visual Acuity, screening 5
81002 Urinalysis, dipstick 5
Total 105
New Patient 50 year old male physical with one immunization
Jefferson Fees
99386 New Patient Preventive, Age 40 to 64 165
99173 Visual Acuity, screening 5
81002 Urinalysis, dipstick 5
93000 EKG 35
71020 Chest, 2 view x-ray 44
80050 General Health Panel (CMP, CBC, and TSH) 57
80061 Lipid Panel 14
84153 PSA 35
Total 360
Established 35 year old female well woman exam with immunization
Jefferson Fees
99395 Preventative Exam, Age 18 to 39 145
99173 Visual Acuity, screening 5
81002 Urinalysis, dipstick 5
93000 EKG 35
80050 General Health Panel (CMP, CBC, and TSH) 57
80061 Lipid Panel 14
88142 Liquid based pap smear 31
87621 Human Papiloma Typing 48
Total 340
Physical 15 year old boy
Jefferson Fees
99394 Preventative Exam, Age 12 to 17 120
99173 Visual Acuity, screening 5
81002 Urinalysis, dipstick 5
Total 130
Sore Throat, established patient
Jefferson Fees
99213 Routine, established patient 78
87430 Strep screen, rapid 15
Total 93
Influenza with cough, established patient
Jefferson Fees
99213 Routine, established pateint 78
87804 Quick Vue Influenza Type A 30
87804 Quick Vue Influenza Type B 30
Total 138
Chronic Cough with Asthma, established patient
Jefferson Fees
99214 Detailed, established patient 113
71020 Chest, 2 View x-ray 44
94060 Spirometery, with broncholdilator 78
94640 Nebulizer treatment 23
Total 258
High Fever, new patient
Jefferson Fees
99203 Detailed, new patient exam 123
85025 CBC 10
Total 133
High Fever, established patient
Jefferson Fees
99213 Routine, established pateint 78
85025 CBC 10
Total 88
Pain with urination, new patient
Jefferson Fees
99203 Detailed, new patient exam 123
81000 Urinalysis, dipstick and micro 5
87086 Urine Culture 10
Total 138
Left ankle injury, established patient
Jefferson Fees
99214 Detailed, established patient 113
73610 Ankle, 3 view x-ray (left only) 37
Total 150
Other Fees
Office Visits
Jefferson Fees
99201 Limited Office Visit, new patient 48
99202 Routine office visit, new patient 83
99203 Detailed office visit, new patient 123
99204 Comprehensive office visit, new patient 180
99205 Complex office visit, new patient 228
99381 Preventive office visit, under 1yo, new 98
99382 Preventive office visit, 1 - 4 yo, New 98
99383 Preventive office visit, 5-11 yo, new 98
99384 Preventive office visit,  12-17 yo, new 125
99385 Preventive office visit, 18-39 yo, new 150
99386 Preventive office visit, 40-64 yo, new 165
99387 Preventive office visit, 65+, new 175
99211 Minimal office visit, est. patient 28
99212 Limited Office Visit, est. patient 50
99213 Routine office visit, est. patient 78
99214 Detailed office visit, est. patient 113
99215 Complex office visit, est. patient 170
99391 Preventive office visit, under 1yo, est. 95
99392 Preventive office visit, 1 - 4 yo, est. 95
99393 Preventive office visit, 5-11 yo, est 95
99394 Preventive office visit,  12-17 yo, est 120
99395 Preventive office visit, 18-39 yo, est 145
99396 Preventive office visit, 40-64 yo, est. 160
99397 Preventive office visit, 65+, est. 165
Procedures
Jefferson Fees
92551 Audiometry, screening 35
99173 Visual, screening 5
92567 Tympanometry 15
92587 Hearing, screening 20
69210 Remove impacted ear cerumen 40
93000 Electrocardiogram 35
93224 ECG monitor 24 Hr complete (Holter Monitor) 214
94010 Spirometry, routine 40
94060 Spirometry, with bronchodilater 78
94640 Airway inhalation treatment, Nebulizer 23
10060 Drain skin abscess, simple 110
11100 Biopsy of skin lesion, 1st 110
11101 Biopsy of skin lesion, ea add. 30
11057 Paring/cut benign skin lestion 4+ 75
11200 Removal of skin-tags, up to 15 93
11201 Removal of ea. add. 10 skin tags 20
17000 Destroy benign lesion , 1st 83
17003 Destroy benign lesions, 2-14 add. 5
17004 Destroy benign lestions, 15 or more 175
17110 Destroy flat wart up to 14 lesions 100
17111 Destroy flat wart, up to 15 or more lesions 125
54450 Foreskin manipulation 40
17250 Granulation cauterization 80
93882 Duplex scan of extracranial arteries (CIMT) 204
Stress Echo (93015, 93350, 93320, 93325, 93307) 204
Radiology
Jefferson Fees
71020 Chest x-ray, 2 views 44
73562 X-ray exam of knee, 3 views 40
72040 X-ray exam of neck spine, 2-3 views 45
72050 X-ray exam of neck spine, 4+ views 55
72100 X-ray exam of lower spine, 2-3 views 60
72110 X-ray exam of lower spine, lumbrosacral, 4+ views 45
73110 X-ray exam of wrist, 3 views 35
73610 X-ray exam of ankle 37
Laboratory
Jefferson Fees
80050 General health panel 57
80048 Basic metabolic panel  5
80053 Comprehensive metabolic panel 15
83540 Assy, serum iron 5
84550 Assy, uric acid, blood 5
80076 Hepatic function panel 10
82977 Assy, GGT Enzyme 5
83615 LDH 5
82150 Assy, serum amylase 7
86038 Assy, antinuclear antibodies 10
86060 Antistreptolysin O titer 7
86140 C-reactive protein 10
86141 C-reactive protein, cardiac 10
85025 CBC, complete diff 10
82550 Assy, CPK in blood 5
82670 Assy, estradiol 20
82728 Assy, ferritin 15
82746 Assy, blood folic acid 10
83001 Assy, pituitary gonadotropin 15
82962 Glucose, capillary 5
83036 Glycated hemoglobin 12
86677 Antibody, helicobacter pylori 15
86701 Antibody, HIV-1 10
83090 Homocystine 18
82306 Vit - D-25 67
83525 Assy, insulin total 16
83002 Assy, pituitary gonadotropin, LH 15
83690 Assy, blood lipase 10
80061 Lipid panel 14
86308 Heterophile antibody screen, mono 10
84153 Assy, PSA total 35
85610 Prothrombin time, PT 5
83970 Assy, Parathormone, PTH 60
85730 Thromboplastin time, partical, PTT 5
84146 Assy, prolactin 15
86431 Rheumatoid factor assy 5
86593 Syphillis assy, RPR 5
85651 RBC sedementation rate - non auto 5
84443 Assy, thyroid stimulating hormone, TSH 18
84436 Assy, true thyroxine, T4 8
84479 Assy, thyroid hormone T-3, T-4 8
84403 Assy, blood testosterone, total 20
84402 Assy, blood testosterone, free 20
86695 HSV, type I 40
86696 HSV, type II 33
82043 Urine microalbumin 7
81000 Urinalysis, non  automated w/scope 10
81002 Urinalysis, dipstick 5
81025 Urine Pregnancy Test 12
82270 Blood occult feces 1-3 5
89055 Fecal leukocyte 10
87177 Ova & parasites smear 22
87324 Clostridium difficile Toxim 15
87220 Skin fungal, wet mount 8
87210 Smear, stain & interpret wet 8
Arthritis Panel (86038, 86431, 85651, 84550) 30
Celiac Panel (83516, 86255) 80
Hepatitis Panel (86708, 87340, 86706, 86704, 86803) 50
Cultures & Pathology
Jefferson Fees
87490 Chlamydia, DNA probe 30
87590 GC, DNA probe 30
87252 Herpes antigen detection 55
87070 Misc. routine culture 15
87430 Strep screen rapid 15
87081 Strep culture 10
87807 RSV 21
87804 Quick Vue Influenza (X2) 30
87086 Urine Routine culture 10
88164 Pap Smear 17
88142 Pap Smear liquid 31
87621 Human Papiloma Typing 48
88304 Pathology - level 3 45
88305 Pathology - level 4 85
36415 routine blood draw 5
36416 Finger, heel, ear stick 5
Immunizations
Jefferson Fees
90471 Immunization Admin 24
90472 Immunization Admin 10
90700 Dtap, pediatric 30
90715 Adacel, adult 45
90703 Tetanus vaccine 40
90718 Td, adult 25
90721 Dtap/Hib 65
90648 Hib 30
90707 MMR 60
90713 IPV 35
90716 Varicella 100
90649 Gardasil 140
90633 Hep A Vac, pediatric 45
90632 Hep A, adult 75
90744 Hep B  10 mcg 40
90746 Hep B, adult, 20 mcg 75
90657 Flu vaccine, 6-35 months 20
90658 Flu vaccine, 3+ 20
90655 Influenza, preservative free 35
90734 Meningococcal 120
90732 Pneumococcal 68
90669 Prevnar Pneumococcal 140
90691 Typhoid 68
86580 PPD - TB Intradermal Test 10
90680 Rota Teq 82
90736 Zostavax 180
96372 Injection, non vaccine 25
J0698
 Claforan, 1000 mg 10
J0696
 Rocephin, 250 mg 10

 

website tracking software