$45.00

Standard Office Visit Fee (if no insurance). Add this to most items below (once per visit).
This is for Self Pay (Uninsured) and some CICP. See payment page for more details.

$20.00

School sports physical. This is instead of our regular visit charge. If you need an EKG or blood tests, those cost more.

$26.00

G0101+Q0091

Pap smear and gyn (woman) exam, including lab cost for basic pap (88164). This is in addition to our regular visit charge (so total cost is $71). You may need more labwork than just a basic pap, depending on your personal history.

99173

Vision Screening (if separate from a wellness exam)

Preventive counseling: 99401 (15min), 2 (30), 3 (45), 99404 (60).

Labs drawn and sent out - thousands of tests available.
Your cost for labs will usually be about $25-$40, depending on what you need.

$20.00

36415

Blood Draw we charge this once regardless of how many tests you have

$3.00

Here is one example of a blood test: Cholesterol test (aka fasting lipids). Most common labs are similar price. So if you only need a cholesterol test, your lab cost will be $23 (and add the $45 visit cost).

$20.00

Fit Kit colon cancer screening, stool test (no blood draw fee)

$60

83014

H. Pylori urea breath test, including administration and the 83013 lab test

99195

Therepautic Phlebotomy

Labs done in clinic

$2.00

82962

blood sugar (home glucometer)

$3.00

82270

hemoccult guiac v76.51 (not MCR) (in house lab)

$10.00

83036

Hemoglobin A1C

$3.00

81002

Urine dip (in house lab). $13 more to send to lab for culture.

$6.00

81025

Urine HCG pregnancy test (in house lab)

$5.00

87880

Rapid Strep test. $5 more to send to lab for culture.

$4.00

87210

Microscopic Potassium Hydroxide (KOH OR Wet Prep)

Medications given in clinic

$20.00

86580 + V74.1

Tb (Tuberculosis) skin test (PPD). Includes placement and reading 2-3 days later (for readings, remember we are not open on weekends, so we can not place the test on Thursdays.)

PPD reading visit: included in the $20 above. 99211 + V74.1 (if neg) 795.51 (if +).

96372

IM injection code (for shots, eg bill along with Depo or Penicillin)

$50.00

J1055

Depo-Provera (per 150 mg standard dose)

$5.00

J0558

Penicillin per 100,000 Units (x12 for 1.2 Million Units = $60)

$2.00

J7613

Albuterol Solution

$13.00

94640, J7613

Albuterol nebulizer treatment (i.e. the neb and the albuterol)

94664

Teach how to use an inhaler or nebulizer.

Procedures done in clinic. Remember: add our office visit charge to any of these.

$33

69210

Earwax removal (cerumen disimpact) 380.4 (1-2 units)

$13

93000

EKG with interpretation

$62

11730

Nail removal, partial (without matrix)

11750

Nail removal with matrix, partial or complete

$31

11740

Trephination of a subungual hematoma (evacuation of a blood blister under nail)

$11

58301

Remove IUD (intra uterine device birth control)

$63

11976-FP

Implantable Contraceptive Removal (V25.43), eg Remove Implanon from arm

$63

12001

Suture superficial wound <1 inch

12002

Suture superficial wound 1-3 inches

$50

17000

Common or Plantar Wart (078.10), or AK (not tags) - destroy benign or premalignant lesion- eg freezing.

17003

Same as 17000, but for #2-14 lesions (warts or AK), once for each additional.

$55

11200

Skin Tags (701.9) removal up to 15

$111

11100

Biopsy (eg punch) - first biopsy only. This includes lab pathology ($67 for biopsy + $44 for lab code 88304). (Yes the price and the code are both 111)

$95

11401

Skin lesion Excision - Benign - trunk/arm/leg 0.6 - 1.0 cm lesion benign

$146

11601

Skin lesion Excision - Malignant - trunk/arm/leg 0.6 - 1.0 cm

10120

removal of foreign body - simple (eg splinter)

$20

97602

Wound Care

16000

Initial dressing of 1st degree burn

$72

10060

I&D (Incision and Drainage) of abscess, simple or single

$120

10061

I&D Skin abscess, complex or multiple

$102

10140

I&D of hematoma/seroma

$35

20552

Trigger Point Injection 1-2 muscles (includes lidocaine)

$40

20553

Trigger Point Injection 3+ muscles (includes lidocaine)

$35

20600

Inject or aspirate a small joint or bursa (fingers, toes), add steroid also.

$38

20605

Inject or aspirate a medium joint or bursa (wrist, elbow, ankle), add steroid also.

$50

20610

Inject or aspirate a large joint or bursa (shoulder, hip, knee), add steroid also.

$8

J1030

Steroid (DepoMedrol) 40mg injection (eg 1ml of 40mg/ml). (+/- 96372).

$8

J3301

Steroid (Triamcinolone) 10mg injection (eg 1ml of 10mg/ml). (+/- 96372).

Immunizations - Shots - Vaccines - Jabs

$14.00

90471/2

Vaccine administration fee. You do not have to pay this extra, unless you are a child who qualifies for VFC but not Medicaid (we rarely see this), or you are an adult who qualifies for shots from the Merck program. We record all shots in the state immunization registry

Adult Shots
1. Medicaid gets these free.
2. Medicare only covers flu, pneumonia (ppsv23), and hepB (and zoster but not by an outpatient doctor).
3. All other insurances (Blue Cross, etc) pay for these directly.
4. CICP and uninsured have to pay these prices...

...However, you may qualify to get some of these discounted to $25 (includes the $14 shot fee), based on your income (the ones with ***). This is very handy for green card shots if you are not a refugee....

...for Green Card requirements: If you arrived anywhere in the U.S. as refugee status, within the last 5 years, it is much easier and cheaper if you just go to the refugee clinic. Most adults need Varicella x2, MMR x2, Td x3 (one being TdaP), and flu if September-March. That is, you need MMR+Var+Tdap, then at least 1 month later MMR+Var+Td, then at least 6 months later Td (+ maybe flu); but you may not need to wait the 6 months for the last shot to apply for your card. In addition to shots, you also need a physical by a special "Civil Surgeon" doctor, which is usually about $200 (but the Lowry program covers all of this for refugees).

90658 v04.81

Flu (fluzone; G0008 Q2038 for MCR), required for Green Card Oct-Mar

$64.00

90707 v06.4

MMR*** Green card requires 2 doses (2nd is 1 month later) - this is the cost of 1 dose.

$105.00

90716 v05.4

Varicella (Varivax)*** Green card requires the full 2 dose series (2nd is 1 month later). This is the cost of one dose.

$35.00

90714 v06.5

Td If adult has never had, then needs 3 doses (2nd after 1 month. 3rd 6 months after 2nd. But one of the three should be TdaP instead). This is the cost of one dose.

$50.00

90715 v06.1

$75.00

90632 v05.3

Adult HepA 2 dose series (2nd is 6 months later - can be done when you return from trip). This is the cost of one dose. Adults do not require for Green Card.

$72.00

90746 v05.3

Adult HepB*** (G0010 for Medicare) 3 dose series (2nd is 1 month later. 3rd is 2 months after 2nd AND 4 months after 1st). This is the cost of one dose. Adults do not require for Green Card.

$57.00

90732 v03.82

Special order: Pneumonia PPSV23 Pneumovax*** (G0009 for MCR)- we have to order this, so it is probably easier if you just get it from King Soopers, where it is about $70, or they bill your insurance.
Mostly for age 65 and over.

$194.00

90736 v05.8

Special order: Zostavax - we have to order this, so it is probably easier if you just get it from King Soopers, where it is about $220 or they bill your insurance. Not required for Green Card.

Kids Shots
1. Free for Medicaid (using VFC), and for CHP or private insurance (using private supply)
2. CICP or underinsured up to and including age 18 may have to pay $14 per shot.
3. Since that covers everyone, most prices are not listed here; this is mostly for our own coding.

90700 v06.1

Dtap (Sanofi)

90696 v06.3

Dtap/IPV (Kinrix GSK)

90723 v06.8

Dtap/IPV/HepB (Pediarix GSK)

90657 v04.81

Flu (6mo-3yo)

90658 v04.81

Flu (over age 3)

90648 v03.81

Hib (4 dose) (ActHib)

90649 v04.89

HPV quadrivalent (Merck Gardasil)

90633 v05.3

Kids HepA (Vaqta; Merck)

90744 v05.3

Kids HepB (Recombivax; Merck)

90734 v03.89

Meningitis (Menactra)

90707 v06.4

MMR (Merck)

90713 v04.0

Polio (IPV IPOL)

90670 v03.82

Pneumococcal Conjugate (Prevnar 13, Wyeth)

90680 v04.89

Rotavirus (Rotateq 3 doses required- first at age 6-12 wk; last before 32wk) (Merck)

90714 v06.5

Td (Sanofi)

90715 v06.1

Tdap (Boostrix; GSK)

90716 v05.4

Varicella (Varivax; Merck)

90698 v06.3 & v03.81

Dtap/IPV/Hib (Pentacel) (we don't carry, we use above combos)

90748 v06.8

HIB/HepB (Comvax; we don't carry, we use above combos)

90650 v04.89

HPV bivalent (GSK Cervarix) (we don't carry this, we use Gardasil)

Other well child visit services

D1206 (0-4)
D0145 (0-2)
D0999 (3-4)

Fluoride varnish (0-4yo). + Dental eval/counsel: D0145 (0-2yo) or D0999 (3-4yo)

96110 (0-4)

Child development screening (eg PEDS, ASQ). If +, add eg ICD 313-315 or 783s. MCD covers 3/yr for 0-2yo, 2/yr for 3-4 yo.

99420 (11-20)

Risk Assessment (eg PHQ9 for Depression: V40.0 if +, V79.8 if neg). MCD covers 11-20yo.

Travel Shots
Most insurances do NOT pay for these if given only for travel reasons. You have to pay the prices below, and also our standard visit fee, but that includes some great travel advice!

$244.00

90738

Japanese Encephalitis IM - special order

$439.00

90675

Rabies - special order

$164.00

90717

Yellow Fever - special order

$75.00

90632

Adult HepA. 2 dose series (2nd is 6 months later- can be done when you return from trip). This is the cost of one dose.

$72.00

90746

Adult HepB. 3 dose series. This is the cost of one dose.

$50.00

90715

Tdap

Typhoid - we can give you a prescription for the four pill series. The four pills will cost you $56 at Walmart, $61 at Walgreen, and $62 at King Soopers (we last checked May 2011). The pills will protect you 5 years. Or, you can get the shot for about $60 from the Jefferson County Travel Clinic, and that will protect you 2 years.

Care Coordination and Transitions

Complex Care Coordination (no visit): 31-75 min for doctor (99487) or staff (99488); and ea addl 30 min for either (99489).

Transitional care mgmt: contact pt or caregiver w/in 2 days p/ d/c: and have a pt visit w/in 7 d w high MDM (99496), or w/in 14d and mod MDM (99495)

Medicare Home Health Supervision, patient not present:

G0180

G0179

G0181