Prices of Common Services

Pricing Details

The listed price reflects the undiscounted rate. The price you pay for a service or procedure may differ from the amount stated on this list, depending on your sliding fee discount and insurance plan benefits.

Request a price estimate: Within 3 to 10 business days after you request an estimate, you will be provided with an estimate of the anticipated charges for your non-emergency care.

Procedure codes: Procedure codes are numbers used to report the health care services provided to a patient. They are used for billing purposes.

2023 price: Medical prices listed as “2023 price” were in effect from February 1, 2023, through January 31, 2024. Dental prices listed as “2023 price” were in effect from March 1, 2023, through February 28, 2024.

2024 price: Medical prices listed as “2024 price” are in effect from February 1, 2024, through January 31, 2025. Dental prices listed as “2024 price” are in effect from March 1, 2024, through February 28, 2025.

Evaluation and Management

Procedure: New patient office visit (level III)

Procedure code: 99203

2023 price: $375.00

2024 price: $483.00

Procedure: New patient office visit (level IV)

Procedure code: 99204

2023 price: $650.00

2024 price: $869.00

Procedure: New patient office visit (level V)

Procedure code: 99205

2023 price: $850.00

2024 price: $978.00

Procedure: Established patient office visit (level II)

Procedure code: 99212

2023 price: $163.00

2024 price: $245.00

Procedure: Established patient office visit (level III)

Procedure code: 99213

2023 price: $245.00

2024 price: $394.00

Procedure: Established patient office visit (level IV)

Procedure code: 99214

2023 price: $362.00

2024 price: $555.00

Procedure: Established patient office visit (level V)

Procedure code: 99215

2023 price: $595.00

2024 price: $781.00

Procedure: Established patient (under age 1) preventive visit

Procedure code: 99391

2023 price: $285.00

2024 price: $424.00

Procedure: Telephone appointment (no video, 5–10 minutes of medical discussion)

Procedure code: 99441

2023 price: $112.00

2024 price: $244.00

Procedure: Telephone appointment (no video, 11–20 minutes of medical discussion)

Procedure code: 99442

2023 price: $224.00

2024 price: $392.00

Medicine and Behavioral Health

Procedure: Vaccine administration fee (children, first vaccine)

Procedure code: 90460

2023 price: $105.00

2024 price: $105.00

Procedure: Vaccine administration fee (children, each additional vaccine)

Procedure code: 90461

2023 price: $69.00

2024 price: $69.00

Procedure: Vaccine administration fee (adults, first vaccine)

Procedure code: 90471

2023 price: $61.00

2024 price: $61.00

Procedure: Vaccine administration fee (adults, each additional vaccine)

Procedure code: 90472

2023 price: $40.00

2024 price: $54.00

Procedure: TDAP (vaccine to prevent diphtheria, pertussis, and tetanus

Procedure code: 90715

2023 price: $83.00

2024 price: $83.00

Procedure:  Shingrix (vaccine to prevent shingles)

Procedure code: 90750

2023 price: $250.00

2024 price: $250.00

Procedure: Behavioral health appointment (30 minutes)

Procedure code: 90832

2023 price: $203.00

2024 price: $203.00

Procedure: Behavioral health appointment (45 minutes)

Procedure code: 90834

2023 price: $260.00

2024 price: $260.00

Procedure: Behavioral health appointment (60 minutes)

Procedure code: 90837

2023 price: $320.00

2024 price: $280.00

​Procedure: Therapeutic, prophylactic, or diagnostic substance injection via intramuscular or subcutaneous route

Procedure code: 96372

2023 price: $111.00

2024 price: $190.00

Pathology/Lab

Procedure: Complete metabolic panel (glucose level, electrolyte and fluid balance, kidney and liver function)

Procedure code: 80053

2023 price: $110.00

2024 price: $110.00

Procedure: Lipid panel (measurement of fats and fatty substances in blood)

Procedure code: 80061

2023 price: $138.00

2024 price: $138.00

Procedure: Urinalysis, by dip stick or tablet reagent (detects substances in urine associated with different metabolic and kidney disorders)

Procedure code: 81001

2023 price: $48.00

2024 price: $48.00

​Procedure: Blood sugar measurement

Procedure code: 83036

2023 price: $95.00

2024 price: $95.00

Procedure: Thyroid stimulating hormone (measurement of thyroid gland function)

Procedure code: 84443

2023 price: $130.00

2024 price: $138.00

Procedure: Complete blood count (measurement of red blood cells, white blood cells, and platelets)

Procedure code: 85025

2023 price: $62.00

2024 price: $80.00

Procedure: Complete blood count (measurement of red blood cells, white blood cells, platelets, hemoglobin, hematocrit)

Procedure code: 85027

2023 price: $46.00

2024 price: $47.00

Procedure: Evaluation of patient’s serum for antibodies to hepatitis C virus

Procedure code: 86803

2023 price: $145.00

2024 price: $145.00

Procedure: Test for chlamydia trachomatis using amplified nucleic acid probe technique

Procedure code: 87491

2023 price: $247.00

2024 price: $220.00

Procedure: Test for Neisseria gonorrhoeae using amplified nucleic acid probe technique

Procedure code: 87591

2023 price: $247.00

2024 price: $220.00

Radiology

​Procedure: 3D x-ray to screen for breast cancer

Procedure code: 77063

2023 price: $297.00

2024 price: $364.00

Procedure: X-ray to screen for breast cancer

Procedure code: 77067

2023 price: $600.00

2024 price: $1,072.00

​Procedure: X-ray of chest (2 views)

Procedure code: 71046

2023 price: $141.00

2024 price: $236.00

Procedure: X-ray of knee (3 views)

Procedure code: 73562

2023 price: $169.00

2024 price: $285.00

Procedure: X-ray of spine (2 views)

Procedure code: 72100

2023 price: $208.00

2024 price: $295.00

Procedure: X-ray of shoulder (2 views)

Procedure code: 73030

2023 price: $199.00

2024 price: $280.00

Procedure: X-ray of hip (2–3 views)

Procedure code: 73502

2023 price: $207.00

2024 price: $280.00

Procedure: X-ray of neck vertebrae (2–3 views)

Procedure code: 72040

2023 price: $207.00

2024 price: $329.00

Procedure: X-ray of ankle joint (3+ views)

Procedure code: 73610

2023 price: $162.00

2024 price: $230.00

Procedure: X-ray of hand (3+ views)

Procedure code: 73130

2023 price: $161.00

2024 price: $227.00

Surgery

Procedure: Admission to the hospital for delivery, labor management, including induction of labor, fetal monitoring, use of low forceps, and episiotomy, vaginal delivery of the fetus and placenta on the same date of service.

Procedure code: 59409

2023 price: $4,809.00

2024 price: $5,134.00

Procedure: Measurement of the heart rate of the fetus in response to its own movements

Procedure code: 59025

2023 price: $400.00

2024 price: $389.00

Procedure: Flushing of wax from external ear canal to correct hearing loss or discomfort

Procedure code: 69209

2023 price: $106.00

2024 price: $90.00

Procedure: Removal of skin tags (1–15 tags)

Procedure code: 11200

2023 price: $495.00

2024 price: $525.00

Procedure: Placement of contraceptive intrauterine device (IUD) in uterine cavity

Procedure code: 58300

2023 price: $717.00

2024 price: $785.00

Procedure: Removal of contraceptive intrauterine device (IUD) in uterine cavity

Procedure code: 58301

2023 price: $560.00

2024 price: $600.00

Procedure: Insertion of Implanon birth control device under the skin

Procedure code: 11981

2023 price: $756.00

2024 price: $800.00

Procedure: Removal of Implanon birth control device from under the skin

Procedure code: 11982

2023 price: $912.00

2024 price: $968.00

Proced​ure: Destruction of benign lesions using techniques such as cryosurgery

Procedure code: 17110

2023 price: $494.00

2024 price: $639.00

​Procedure: Removal of fluid or injection for diagnosis and/or to relieve pain and swelling in the join (one or both sides)

Procedure code: 20610

2023 price: $418.00

2024 price: $485.00

Dental

Procedure: Dental exam (established patients)

Procedure code: D0120

2023 price: $99.00

2024 price: $99.00

​Procedure: Dental exam (specific problem)

Procedure code: D0140

2023 price: $166.00

2024 price: $166.00

Procedure: Periapical x-ray (first x-ray)

A periapical x-ray captures the whole tooth, showing everything from the chewing surface of the tooth to the tip of the root.

Procedure code: D0220

2023 price: $50.00

2024 price: $50.00

Procedure: Periapical x-ray (each additional x-ray)

Procedure code: D0230

2023 price: $45.00

2024 price: $45.00

Procedure: Bitewing x-rays (set of four)

A bitewing x-ray consists of four films (two on each side) which are necessary to capture all the crowns of the back teeth.

Procedure code: D0274

2023 price: $111.00

2024 price: $111.00

Procedure: Panoramic x-ray

A panoramic x-ray is a two-dimensional x-ray that captures a picture of the entire mouth in just one image.

Procedure code: D0330

2023 price: $188.00

2024 price: $188.00

Procedure: Cleaning (to prevent gum disease)

Procedure code: D1110

2023 price: $165.00

2024 price: $165.00

Procedure: Fluoride application (to prevent tooth decay)

Procedure code: D1206

2023 price: $35.00

2024 price: $35.00

Procedure: Periodontal maintenance

Periodontal maintenance includes removal of hard and soft deposits from above and below the gum.

Procedure code: D4910

2023 price: $251.00

2024 price: $251.00

Procedure: Simple extraction of erupted tooth or exposed root

Procedure code: D7140

2023 price: $316.00

2024 price: $316.00

​CPT Copyright 2024, American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the American Medical Association.  The CPT codes are provided "as is" without warranty of any kind. The AMA specifically disclaims all liability for use or accuracy of any CPT codes. The undiscounted price may differ from what the patient actually pays. You will be provided an estimate of services upon written request.