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Established Patient - Adult Preventative Care
CPT Code
Service Description
Price
Immunizations
90670
Prevnar13, Age 6 weeks-17 years, 50+
$185
Immunizations
90680
Rotavirus (Rota Teq), 1st: 6-14 weeks
$99
Immunizations
90682
Flublok Influenza virus vaccine, quadrivalent .5mL
$46
Immunizations
90686
Influenza No Preservative Pediatric Dose (Quadrivalent)
$17
Immunizations
90673
Influenza No Preservative Pediatric Dose (Quadrivalent), Age 3+
$36
Immunizations
90700
DTaP, pedi (0-6)
$28
Immunizations
90710
MMR
$203
Immunizations
90713
IPV
$32
Immunizations
90715
TDaP (Adacel), Age 7+
$40
Immunizations
90716
Varicella (Varivax), Age 1+
$159
Immunizations
90732
Pneumo (Pneumovax), Age 65+
$118
Immunizations
90620
Meningococcal
$200
Immunizations
90744
Hepatitis B, Age 0-19
$23
Immunizations
90746
Hepatitis B, Age 20+
$57
Immunizations
90750
Zoster (Zostravax)
$169
Immunizations
86580
PPD (Skin test; tuberculosis, intradermal)
$7
T-Shot
99211
Nurse Visit
$25
T-Shot
J1071
Injection, testosterone cypionate, 1mg
$1
T-Shot
96372
Injections, Medicine (NOT Immunization)
$22
B-12 Shot
99211
Nurse visit
$25
B-12 Shot
J3420
Vitamin B-12, 1000 mcg
$4
B-12 Shot
96372
Injections, Medicine (NOT Immunization)
$22
Allergy Shots
99211
Nurse Visit
$25
Allergy Shots
J1200
Injection, diphenhydramine HCl, up to 50 mg/ml
$1
Allergy Shots
J2550
Injection, promethazine HCl, up to 50 mg/ml
$1
Allergy Shots
96372
Injections, Medicine (NOT Immunization)
$22
Established Patient - Adult Preventative Care
99395
Established Patient, 19-39 years
$129
Established Patient - Adult Preventative Care
99396
Established Patient, 40-64 years
$137
Established Patient - Adult Preventative Care
99397
Established Patient, >65 years
$148
Established Patient - Adult Preventative Care
G0403
EKG
$16
Established Patient - Adult Preventative Care
80053
Comprehensive Metabolic Panel
$7
Established Patient - Adult Preventative Care
80061
Lipid Panel
$9
Established Patient - Adult Preventative Care
81002
Urinalysis by dip stick, non-automated, without microscopy
$3
Established Patient - Adult Preventative Care
84480
Triiodothyronine T3; total (TT-3)
$9
Established Patient - Adult Preventative Care
84479
Thyroine (T4) level; total
$4
Established Patient - Adult Preventative Care
82270
Stool occult blood
$4
Established Patient - Adult Preventative Care
82043
Albumin level; urine, microalbumin, quantative
$4
Established Patient - Adult Preventative Care
84153
PSA- Prostate specific antigen level; total
$12
Established Patient - Adult Preventative Care
88174
Maturation Index (pap)
$14
Established Patient - Adult Preventative Care
93880
CIMT Scan
$265
Established Patient - Child Preventative Care
Established Patient - Child Preventative Care
99391
Established Patient <1 year
$108
Established Patient - Child Preventative Care
99392
Established Patient, 1-4 years
$115
Established Patient - Child Preventative Care
99393
Established Patient, 5-11 years
$115
Established Patient - Child Preventative Care
99394
Established Patient, 12-17 years
$126
Established Patient - Child Preventative Care
81002
Urinalysis by dip stick, non-automated, without microscopy
$3
Established Patient - Child Preventative Care
92552
Audiometry, screen
$25
Established Patient - Child Preventative Care
99173
Visual acuity, screening
$4
Established Patient - Sick Visit
Established Patient - Sick Visit
99213
Established Patient - Routine Office Visit
$80
Established Patient - Sick Visit
99214
Established Patient - Detailed Office Visit
$117
Established Patient - Sick Visit
99215
Established Patient - Complex Office Visit
$157
Established Patient - Sick Visit
71045
Radiologic examination, chest; 1 view
$23
Established Patient - Sick Visit
87804
Influenza, Quick Vue (for A & B)
$17
Established Patient - Sick Visit
87880
Rapid Strep Screen, in office; Streptococcus, group A
$12
Established Patient - Sick Visit
81002
Urinalysis by dip stick, non-automated, without microscopy
$3
New Patient - All- Preventative Care
99202
Routine Office Visit
$83
New Patient - All- Preventative Care
99203
Detailed Office Visit
$117
New Patient - All- Preventative Care
99204
Comprehensive Office Visit
$177
New Patient - All- Preventative Care
99205
Complex Office Visit
$223
New Patient - Adult Preventative Care
99385
Preventative 18-39 years
$143
New Patient - Adult Preventative Care
99386
Preventative 40-64 years
$166
New Patient - Adult Preventative Care
99387
Preventative > 65 years
$179
New Patient - Child Preventative Care
99381
Well Child <1 year
$120
New Patient - Child Preventative Care
99382
Well Child 1-4 years
$126
New Patient - Child Preventative Care
99383
Well Child 5-11 years
$131
New Patient - Child Preventative Care
99384
Well Child 12-17 years
$148
Immunizations
90620
Meningococcal B (Bexsero)
$200
Immunizations
90632
Hepatitis A, Age 19+
$68
Immunizations
90633
Hepatitis A, Age 1-18
$39
Immunizations
90648
Hib
$13
Immunizations
90651
HPV (Gardasil 9), Age 9-26
$204
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