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Care Type
Code
Description
Price
Adult Preventative Care
99396
Established Patient, 40-64 years
$137
Adult Preventative Care
99397
Established Patient, >65 years
$148
Adult Preventative Care
G0403
EKG
$16
Adult Preventative Care
80053
Comprehensive Metabolic Panel
$7
Adult Preventative Care
80061
Lipid Panel
$9
Adult Preventative Care
81002
Urinalysis by dip stick, non-automated, without microscopy
$3
Adult Preventative Care
84480
Triiodothyronine T3; total (TT-3)
$9
Adult Preventative Care
84479
Thyroine (T4) level; total
$4
Adult Preventative Care
82270
Stool occult blood
$4
Adult Preventative Care
82043
Albumin level; urine, microalbumin, quantative
$4
Adult Preventative Care
84153
PSA- Prostate specific antigen level; total
$12
Adult Preventative Care
88174
Maturation Index (pap)
$14
Adult Preventative Care
93880
CIMT Scan
$265
Child Preventative Care
99391
Established Patient <1 year
$108
Child Preventative Care
99392
Established Patient, 1-4 years
$115
Child Preventative Care
99393
Established Patient, 5-11 years
$115
Child Preventative Care
99394
Established Patient, 12-17 years
$126
Child Preventative Care
81002
Urinalysis by dip stick, non-automated, without microscopy
$3
Child Preventative Care
92552
Audiometry, screen
$25
Child Preventative Care
99173
Visual acuity, screening
$4
Sick Visit
99213
Established Patient - Routine Office Visit
$80
Sick Visit
99214
Established Patient - Detailed Office Visit
$117
Sick Visit
99215
Established Patient - Complex Office Visit
$157
Sick Visit
71045
Radiologic examination, chest; 1 view
$23
Sick Visit
87804
Influenza, Quick Vue (for A & B)
$17
Sick Visit
87880
Rapid Strep Screen, in office; Streptococcus, group A
$12
Sick Visit
81002
Urinalysis by dip stick, non-automated, without microscopy
$3

Established Patient

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