Self-Pay Prices for Medical Services
Our goal is to make your experience as seamless as possible, so you can focus on what matters most — your child’s health and well-being. If you have any questions on the pricing below, please let the front desk know.
New Patient Well Child Visits
New Patient Well Child Visits | Fee | Prompt Pay Fee | |
|---|---|---|---|
99381 | NEW PATIENT WELL VISIT < 1 YR | $263.00 | $175.33 |
99382 | NEW PATIENT WELL VISIT 1-4 YR | $275.00 | $183.33 |
99383 | NEW PATIENT WELL VISIT 5-11 YR | $288.00 | $192.00 |
99384 | NEW PATIENT WELL VISIT 12-17 YR | $322.00 | $214.67 |
99385 | NEW PATIENT WELL VISIT 18+ YR | $313.00 | $208.67 |
Established Patient Well Child Visits
Established Patient Well Child Visits | Fee | Prompt Pay Fee | |
|---|---|---|---|
99391 | ESTABLISHED WELL VISIT < 1 YR | $238.00 | $158.67 |
99392 | ESTABLISHED WELL VISIT 1-4 YR | $252.00 | $168.00 |
99393 | ESTABLISHED WELL VISIT 5-11 YR | $251.00 | $167.33 |
99394 | ESTABLISHED WELL VISIT 12-17 YR | $277.00 | $184.67 |
99395 | ESTABLISHED WELL VISIT 18+ YR | $282.00 | $188.00 |
New Patient Sick Visits
New Patient Sick Visits | Fee | Prompt Pay Fee | |
|---|---|---|---|
99202 | NEW PATIENT SICK VISIT - LOW COMPLEXITY SICK VISIT | $175.00 | $116.67 |
99203 | NEW PATIENT SICK VISIT - MODERATE COMPLEXITY SICK VISIT | $276.00 | $184.00 |
99204 | NEW PATIENT SICK VISIT - MODERATE-HIGH COMPLEXITY SICK VISIT | $417.00 | $278.00 |
99205 | NEW PATIENT SICK VISIT - HIGH COMPLEXITY SICK VISIT | $558.00 | $372.00 |
Established Patient Sick Visits
Established Patient Sick Visits | Fee | Prompt Pay Fee | |
|---|---|---|---|
99212 | ESTABLISHED PATIENT SICK VISIT - LOW COMPLEXITY | $139.00 | $92.67 |
99213 | ESTABLISHED PATIENT SICK VISIT - MODERATE COMPLEXITY | $222.00 | $148.00 |
99214 | ESTABLISHED PATIENT SICK VISIT - MODERATE-HIGH COMPLEXITY | $316.00 | $210.67 |
99215 | ESTABLISHED PATIENT SICK VISIT - HIGH COMPLEXITY | $449.00 | $299.33 |
Forms And Medical Record Requests
Forms And Medical Record Requests | Fee | Prompt Pay Fee | |
|---|---|---|---|
FORMS | FORMS REQUEST | $10 | |
MEDREC1 | MEDICAL RECORDS REQUEST - 1ST 25 PAGES | $1.00 PER PAGE | |
MEDREC2 | MEDICAL RECORDS REQUEST - AFTER FIRST 25 PAGES | $0.25 PER PAGE | |
MEDRECCM | MEDICAL RECORDS REQUEST - CERTIFIED MAIL | $15.00 | |
MEDRECSSD | MEDICAL RECORDS REQUEST - SOCIAL SECURITY & DISABILITY | $14.00 | |
Laboratory
Laboratory | Fee | Prompt Pay Fee | |
|---|---|---|---|
81002 | URINE DIPSTICK | $8.00 | $5.33 |
81025 | URINE PREGNANCY TEST | $20.00 | $13.33 |
82270 | OCCULT BLOOD | $10.00 | $6.67 |
82465 | CHOLESTEROL (SERUM) | $12.00 | $8.00 |
82948 | GLUCOSE | $12.00 | $8.00 |
83655 | LEAD SCREENING | $28.00 | $18.67 |
83718 | CHOLESTEROL (HDL) | $22.00 | $16.00 |
83721 | CHOLESTEROL (LDL) | $24.00 | $13.33 |
85013 | HEMATOCRIT | $16.00 | $10.67 |
85018 | HEMOGLOBIN | $6.00 | $4.00 |
86308 | MONO SPOT | $12.00 | $8.00 |
87804 | FLU A & FLU B TEST | $38.00 | $25.33 |
87807 | RSV | $30.00 | $20.00 |
87880 | STREP TEST | $38.00 | $77.33 |
87635 | COVID | $116.00 | $68.00 |
Vaccines (Commercial Insurance, Out-of-Network)
Vaccines (Commercial Insurance, Out-of-Network) | Fee | Prompt Pay Fee | |
|---|---|---|---|
90380 | NIRSEVIMAB (RSV), < 11 LBS | $720.00 | $480.00 |
90381 | NIRSEVIMAB (RSV), > 11 LBS | $720.00 | $480.00 |
90619 | MCV4 | $273.00 | $182.00 |
90620 | MENINGOCOCCAL B, BEXSERO | $280.00 | $186.67 |
90621 | MENINGOCOCCAL B, TRUMENBA | $245.00 | $163.33 |
90632 | HEPATITIS A (ADULT) | $111.00 | $74.00 |
90633 | HEPATITIS A | $47.00 | $38.00 |
90648 | HIB | $57.00 | $38.00 |
90651 | HPV | $500.00 | $333.33 |
90660 | FLUMIST (LIVE NASAL FLU VACCINE) | $45.00 | $30.00 |
90661 | FLUCELVAX (CELL-BASED FLU VACCINE) | $75.00 | $50.00 |
90670 | PREVNAR 20 | $298.00 | $198.67 |
90673 | FLUBLOK (RECOMBINANT FLU VACCINE) | $148.00 | $98.67 |
90677 | PREVNAR 20 (PCV20) | $470.00 | $313.33 |
90680 | ROTOVIRUS | $140.00 | $93.33 |
90696 | QUADRACEL (DTAP, IPV) | $80.00 | $53.33 |
90698 | PENTACEL (DTAP, HIP, IPV) | $148.00 | $98.67 |
90700 | DTAP | $39.00 | $26.00 |
90707 | MMR II | $140.00 | $93.33 |
90710 | PROQUAD (MMRV) | $420.00 | $280.00 |
90713 | IPV (POLIO) | $56.00 | $37.33 |
90715 | TDAP ADACEL | $70.00 | $46.67 |
90716 | VARIVAX (CHICKEN POX) | $280.00 | $186.67 |
90732 | PNEUMOVAX 23 (PPSV23) | $301.00 | $200.67 |
90734 | MENQUADFI | $197.00 | $131.33 |
90744 | HEPATITIS B | $50.00 | $33.33 |
91318 | PFIZER COVID 6 MOS - 4 YRS | $204.00 | $136.00 |
91319 | PFIZER COVID 5 YRS - 11 YRS | $214.00 | $142.67 |
91320 | PFIZER COVID 12+ YRS | $253.00 | $168.67 |
Diagnostic/Therapeutic Injections
Diagnostic/Therapeutic Injections | Fee | Prompt Pay Fee | |
|---|---|---|---|
96372 | THERAPEUTIC INJECTIONS | $36.00 | $24.00 |
J0696 | ROCEPHIN - 25MG/UNIT | $2.00 | $1.33 |
J1100 | DECADRON - 1 MG - 4 MG | $1.00 | $0.67 |
J2405 | ZOFRAN - INJECTION | $1.00 | $0.67 |
S0119 | ZOFRAN - ORAL | $30.00 | $20.00 |
J2550 | PHENERGAN - UP TO 50 MG | $9.00 | $6.00 |
J7613 | ALBUTEROL, INHALATION - 1 MG | $1.00 | $0.67 |
J7620 | ALBUTEROL & IPRATROPIUM | $1.00 | $0.67 |
J7644 | IPRATROIM BROMIDE, INHALATION | $1.00 | $0.67 |
Immunization Administration (Commercial Insurance, Out-of-Network)
Immunization Administration (Commercial Insurance, Out-of-Network) | Fee | Prompt Pay Fee | |
|---|---|---|---|
90460 | IMMUNIZATION Administration < 19 YR | $55.00 | $36.67 |
90461 | IMMUNIZATION Administration > 19 YR | $21.00 | $14.00 |
90471 | ADMINISTRATION 19+ /NURSE | $51.00 | $34.00 |
90472 | ADMINISTRATION Additional/NURSE | $37.00 | $24.67 |
90473 | ORAL/NASAL Administration | $41.00 | $27.33 |
90480 | COVID VACCINE Administration - ALL | $108.00 | $72.00 |
Immunization Administration (VFC - Medicaid Insurance, Uninsured)
Immunization Administration (VFC - Medicaid Insurance, Uninsured) | Fee | Prompt Pay Fee | |
|---|---|---|---|
90380 | NIRSEVIMAB (RSV), < 11 LBS | $24.01 | |
90381 | NIRSEVIMAB (RSV), > 11 LBS | $24.01 | |
90620 | MENINGOCOCCAL B, BEXSERO | $24.01 | |
90621 | MENINGOCOCCAL B, TRUMENBA | $24.01 | |
90633 | HEPATITIS A | $24.01 | |
90648 | HIB | $24.01 | |
90651 | HPV 9 | $24.01 | |
90660 | FLUMIST (LIVE NASAL FLU VACCINE) | $24.01 | |
90661 | FLUCELVAX (CELL-BASED FLU VACCINE) | $24.01 | |
90670 | PREVNAR 13 | $24.01 | |
90673 | FLUBLOK (RECOMBINANT FLU VACCINE) | $24.01 | |
90677 | PREVNAR 20 (PCV20) | $24.01 | |
90680 | ROTOVIRUS | $24.01 | |
90696 | DTAP - IPV | $24.01 | |
90698 | PENTACEL (DTAP, HIP, IPV) | $24.01 | |
90700 | DTAP | $24.01 | |
90707 | MMR II | $24.01 | |
90710 | MMRV | $24.01 | |
90713 | IPV (POLIO) | $24.01 | |
90715 | TDAP ADACEL | $24.01 | |
90716 | VARIVAX (CHICKEN POX) | $24.01 | |
90732 | PNEUMOVAX 23 (PPSV23) | $24.01 | |
90734 | MENACTRA | $24.01 | |
90744 | HEPATITIS B | $24.01 | |
91318 | PFIZER COVID 6 MOS - 4 YRS | $24.01 | |
91319 | PFIZER COVID 5 YRS - 11 YRS | $24.01 | |
91320 | PFIZER COVID 12+ YRS | $24.01 | |
Vaccines (Parents/Guardians)
Vaccines (Parents/Guardians) | Fee | Prompt Pay Fee | |
|---|---|---|---|
90660 | FLUMIST (LIVE NASAL FLU VACCINE) | $45.00 | $30.00 |
90661 | FLUCELVAX (CELL-BASED FLU VACCINE) | $75.00 | $50.00 |
90715 | TDAP ADACEL | $70.00 | |
Mental Health Visits — Therapy
Mental Health Visits — Therapy | Fee | Prompt Pay Fee | |
|---|---|---|---|
90832 | PSYCHOTHERAPY - 30 MIN | $195.00 | $130.00 |
90837 | PSYCHOTHERAPY - 45 MIN | $379.00 | $252.67 |
90847 | FAMILY THERAPY - 50 MIN | $249.00 | $166.00 |
90791 | EVALUATION, PSYCH DIAGNOSTIC | $393.00 | $262.00 |
Spacers/Masks
Spacers/Masks | Fee | Prompt Pay Fee | |
|---|---|---|---|
A4627 | SPACER ONLY | $30.00 | $30.00 |
A4627SM | SPACER W/SMALL MASK | $35.00 | $35.00 |
A4627MED | SPACER W/MED MASK | $35.00 | $35.00 |
Procedures
Procedures | Fee | Prompt Pay Fee | |
|---|---|---|---|
10060 | ABSCESS, Incision/DRAIN | $300.00 | $200.00 |
10120 | INCISION & REMOVAL OF FOREIGN BODY Subcutaneous | $366.00 | $244.00 |
11740 | EVACUATION, Subdermal HEMATOMA | $133.00 | $88.67 |
12001 | REPAIR SUPERFICIAL WOUND | $271.00 | $180.67 |
15853 | REMOVAL OF SUTURES OR STAPLES | $32.00 | $21.33 |
15854 | REMOVAL SUTURES AND/OR STAPLES | $41.00 | $27.33 |
17110 | WART REMOVAL | $257.00 | $171.33 |
17250 | CHEMICAL CAUTERIZATION - UMBILICAL | $210.00 | $140.00 |
24640 | CLOSED TREATMENT, NURSEMAID ELBOW | $242.00 | $161.33 |
30300 | REMOVE FOREIGN BODY NASAL | $495.00 | $330.00 |
41115 | FRENECTOMY | $597.00 | $398.00 |
51701 | CATHETERIZATION - SIMPLE | $108.00 | $72.00 |
54450 | FORESKIN MANIPULATION | $172.00 | $114.67 |
59061 | SALE OF EARING (NO PIERCING) | $36.00 | |
69090 | EAR PIERCING | $72.00 | |
69200 | CLEAR OUTER EAR CANAL | $193.00 | $128.67 |
69209 | CERUMEN REMOVAL LAVAGE | $40.00 | $26.67 |
69210 | EAR WAX REMOVAL | $113.00 | $75.33 |
86580 | TUBERCULIN PURIFIED PROTEIN DERIVATIVE (PPD) | $26.00 | $17.33 |
92551 | AUDIOGRAM | $32.00 | $21.33 |
92567 | TYMPANOMETRY | $37.00 | $24.67 |
94010 | BREATHING CAPACITY TEST | $69.00 | $46.00 |
94060 | EVALUATION OF WHEEZING | $100.00 | $66.67 |
94150 | VITAL CAPACITY TEST | $62.00 | $41.33 |
94640 | NEBULIZER THERAPY | $21.00 | $14.00 |
94664 | NEBULIZER/INHALER TEACHING | $47.00 | $31.33 |
94667 | MANIPULATION CHEST WALL | $64.00 | $$42.67 |
94760 | PULSE OXIMETRY | $10.00 | $6.67 |
96110 | DEVELOPMENTAL SCREEN | $29.00 | $19.33 |
96127 | MENTAL HEALTH SCREENING | $13.00 | $8.67 |
96160 | RISK SCREENING | $18.00 | $12.00 |
96161 | RISK SCREENING | $18.00 | $12.00 |
99174 | PEDIVISION | $30.00 | $20.00 |
99188 | FLOURIDE TOPICAL | $28.00 | $18.67 |
After Hours / Weekends / Emergency / Additional Visits
After Hours / Weekends / Emergency / Additional Visits | Fee | Prompt Pay Fee | |
|---|---|---|---|
99242 | Office consultation (straightforward decision-making/20 min) | $175.00 | $116.67 |
99243 | Office consultation (low decision-making/30 min) | $262.00 | $174.67 |
99244 | Office consultation (moderate decision-making/40 min) | $375.00 | $250.00 |
99050 | WEEKEND/HOLIDAY | $84.00 | $56.00 |
99051 | AFTER HOURS | $51.00 | $34.00 |
99058 | EMERGENCY VISIT | $193.00 | $128.67 |
99355 | PROLONGED Additional 30 MIN | $120.00 | $80.00 |
MHASMT | MENTAL HEALTH ASSESSMENT | $60.00 | $60.00 |
90833 | ADD-ON 16-30 MIN THERAPY | $189.00 | $126.00 |
90836 | ADD-ON 31-45 MIN THERAPY | $238.00 | $158.67 |
Effective February 1, 2024
MEDICAID ACCEPTED
Most Insurances Accepted
All kids deserve great care
Commercial insurances
Quality pediatric care with wide insurance coverage
Aetna
BlueCross/BlueShield
Cigna
UnitedHealthCare
UMR
Medicaid insurances
Quality pediatric care with wide insurance coverage
Community Care Plan
Humana Healthy Horizons
Simply Healthcare
Sunshine
CHIP insurances
Quality pediatric care with wide insurance coverage
Aetna Better Health (CHIP/Florida Healthy Kids)
Community Care Plan
Simply Healthcare
Marketplace insurances
Quality pediatric care with wide insurance coverage
AmeriHealth Caritas (formerly Prestige) Next
Molina Healthcare
Oscar
United Healthcare
Other insurances
Quality pediatric care with wide insurance coverage
ChampVa
Tricare – East Region Only
