Clinic Prices
Aspirus Clinics, Inc. Cost Information for Health Care Consumers
January 1, 2013 - December 31, 2013
Please note that CPT codes illustrated on this page are not inclusive of treatment and may include additional codes (charges).
Questions?
If you have questions about any of the information below, please contact your Aspirus Clinic. (Go to clinic location map to find contact information)
|
Common Medical Conditions Seen at Aspirus Clinics |
CPT Code |
Description |
Current Billed Charge |
Median Billed Charge (Jan-June 2011) |
2013 Medicare Reimbursement (Aspirus Payment from Medicare) |
Typical Charge in this Area* |
| Routine Exam |
99396 99392 99395 77057 99393 |
Prev Visit Est Age 40-64
Prev Visit Est Age 1-4 Prev Visit Est Age 18-39 **Mammogram Screening Prev Visit Est Age 5-11 |
$295.00
$235.00 $280.00 $223.00 $250.00 |
$250.00
$192.50 $234.00 n/a $203.50 |
$118.21 $99.32 $110.77 $44.95 $98.99 |
$255.00 $147.00 $233.00 $194.00 $160.00 |
| Hyperlipidemia, Other |
80061 99214 99396 99213 80053 |
Lipid Panel Office/Outpatient Visit Est Prev Visit Est Age 40-64 Office/Outpatient Visit Est Comprehen Metabolic Panel |
$102.00 $198.00 $295.00 $139.00 $85.00 |
$102.00 $189.00 $250.00 $131.00 $85.50 |
$18.97 $100.63 $118.21 $67.98 $14.97 |
$127.00 $192.00 $255.00 $132.00 $111.00 |
| Hypertension |
99214 99213 99396 93306 80053 |
Office/Outpatient Visit Est Office/Outpatient Visit Est Prev Visit Est Age 40-64 Tte W/Doppler Complete Comprehen Metabolic Panel |
$198.00 $139.00 $295.00 $1,857.00 $85.00 |
$189.00 $131.00 $250.00 $1,858.00 $85.50 |
$100.63 $67.98 $118.21 $205.62 $14.97 |
$192.00 $132.00 $255.00 $2,052.00 $111.00 |
|
Other Minor Orthopedic Disorders - Back |
98941 98940 99213 97110 72148 |
Chiropractic Manipulation Chiropractic Manipulation Office/Outpatient Visit Est Therapeutic Exercises **MRI Lumbar Spine W/O Dye |
n/a n/a $139.00 $81.00 $2,083.00 |
n/a n/a $131.00 $81.00 n/a |
$34.30 $24.80 $67.98 $29.88 $344.59 |
$67.00 $52.00 $132.00 $83.00 $3,008.00 |
|
Joint Degeneration, Localized Back, w/o Surgery |
72148 98941 98940 99213 97110 |
**MRI Lumbar Spine W/O Dye Chiropractic Manipulation Chiropractic Manipulation Office/Outpatient Visit Est Therapeutic Exercises |
$2,083.00 n/a n/a $139.00 $81.00 |
n/a n/a n/a $131.00 $81.00 |
$344.59 $34.40 $24.80 $67.98 $29.88 |
$3,008.00 $67.00 $52.00 $132.00 $83.00 |
|
Isolated Signs, Symptoms & Specific Diagnoses or Conditions |
99213 99214 70553 77057 71020 |
Office/Outpatient Visit Est Office/Outpatient Visit Est **MRI Brain W/O & W/Dye **Mammogram Screening Chest X-Ray |
$139.00 $198.00 $2,993.00 $223.00 $198.00 |
$131.00 $189.00 n/a n/a $170.50 |
$67.98 $100.63 $521.37 $44.95 $29.75 |
$132.00 $192.00 $5,058.00 $194.00 $211.00 |
| Diabetes, w/o Surgery |
99214 83036 99213 82043 80061 |
Office/Outpatient Visit Est Glycosylated Hemoglobin Test Office/Outpatient Visit Est Microalbumin Quantitative Lipid Panel |
$198.00 $70.00 $139.00 $77.00 $102.00 |
$189.00 $70.50 $131.00 $77.50 $102.00 |
$100.63 $13.75 $67.98 $8.19 $18.97 |
$192.00 $87.00 $132.00 $112.00 $127.00 |
| Obesity, w/o Surgery |
80061 99214 95811 99213 99396 |
Lipid Panel Office/Outpatient Visit Est Polysomnography W/Cpap Office/Outpatient Visit Est Prev Visit Est Age 40-64 |
$102.00 $198.00 $3,433.00 $139.00 $295.00 |
$102.00 $189.00 $3,433.50 $131.00 $205.00 |
$18.97 $100.63 $678.66 $67.98 $118.21 |
$127.00 $192.00 $4,194.00 $132.00 $255.00 |
|
Hypo-functioning Thyroid Gland, w/o Surgery |
84443 99214 80061 99213 99396 |
Assay Thyroid Stim Hormone Office/Outpatient Visit Est Lipid Panel Office/Outpatient Visit Est Prev Visit Est Age 40-64 |
$108.00 $198.00 $102.00 $139.00 $295.00 |
$108.00 $189.00 $102.00 $131.00 $250.00 |
$23.80 $100.63 $18.97 $67.98 $118.21 |
$137.00 $192.00 $127.00 $132.00 $255.00 |
| Acne |
99213 99214 99202 99212 99203 |
Office/Outpatient Visit Est Office/Outpatient Visit Est Office/Outpatient Visit New Office/Outpatient Visit Est Office/Outpatient Visit New |
$139.00 $198.00 $170.00 $107.00 $221.00 |
$131.00 $189.00 $151.00 $102.00 $196.50 |
$67.89 $100.63 $69.88 $40.94 $100.93 |
$132.00 $192.00 $155.00 $104.00 $202.00 |
| Acute Bronchitis |
99213 99214 71020 99284 94640 |
Office/Outpatient Visit Est Office/Outpatient Visit Est Chest X-Ray Emergency Dept Visit Airway Inhalation Treatment |
$139.00 $198.00 $198.00 $360.00 $68.00 |
$131.00 $189.00 $170.50 $360.50 $68.00 |
$67.98 $100.63 $29.75 $110.51 $16.85 |
$132.00 $192.00 $211.00 $402.00 $107.00 |
| Acute Sinusitis, w/o Surgery |
99213 99214 70486 99203 95165 |
Office/Outpatient Visit Est Office/Outpatient Visit Est **Ct Maxillofacial W/O Dye Office/Outpatient Visit New Antigen Therapy Services |
$139.00 $198.00 $1,119.00 $221.00 n/a |
$131.00 $189.00 n/a $196.50 n/a |
$67.98 $100.63 $187.42 $100.93 $12.36 |
$132.00 $192.00 $1,232.00 $202.00 $0.00 |
| Chronic Sinusitis, w/o Surgery |
99213 99214 70486 95004 31231 |
Office/Outpatient Visit Est Office/Outpatient Visit Est **Ct Maxillofacial W/O Dye Percut Allergy Skin Tests Nasal Endoscopy Dx |
$139.00 $198.00 $1,119.00 n/a n/a |
$131.00 $189.00 n/a n/a n/a |
$67.98 $100.63 $187.42 $6.08 $189.01 |
$132.00 $192.00 $1,232.00 $16.00 $300.00 |
|
Tonsillitis, Adenoiditis or Pharyngitis, w/o Surgery |
99213 87880 99214 87081 99284 |
Office/Outpatient Visit Est Strep A Assay W/Optic Office/Outpatient Visit Est Culture Screen Only Emergency Dept Visit |
$139.00 $77.00 $198.00 $51.00 $360.00 |
$131.00 $71.00 $189.00 $51.00 $360.50 |
$67.98 $16.99 $100.63 $9.39 $110.51 |
$132.00 $74.00 $192.00 $48.00 $402.00 |
| Otitis Media, w/o Surgery |
99213 99214 99283 99212 69436 |
Office/Outpatient Visit Est Office/Outpatient Visit Est Emergency Dept Visit Office/Outpatient Visit Est Create Eardrum Opening |
$139.00 $198.00 $251.00 $107.00 n/a |
$131.00 $189.00 $251.00 $102.00 n/a |
$67.98 $100.63 $58.26 $40.94 $158.21 |
$132.00 $192.00 $269.00 $104.00 $816.00 |
|
Otolaryngology Diseases Signs & Symptoms |
99213 99214 30901 31238 99283 |
Office/Outpatient Visit Est Office/Outpatient Visit Est Control Of Nosebleed Nasal/Sinus Endoscopy Surg Emergency Dept Visit |
$139.00 $198.00 $350.00 n/a $251.00 |
$131.00 $189.00 $272.50 n/a $251.00 |
$67.98 $100.63 $92.70 $326.74 $58.26 |
$132.00 $192.00 $300.00 $654.00 $269.00 |
| Routine Inoculation |
99396 90715 99395 90471 90649 |
Prev Visit Est Age 40-64 Tdap Vaccine >7 Im Prev Visit Est Age 18-39 Immunization Admin Hpv Vaccine 4 Valent IM |
$295.00 $95.00 $280.00 $55.00 $250.00 |
$250.00 $68.50 $234.00 $45.50 $250.00 |
$118.21 $34.66 $110.77 $23.29 $0.00 |
$255.00 $38.00 $233.00 $43.00 $211.00 |
| Contraceptive Management |
99395 58300 99213 99214 76830 |
Prev Visit Est Age 18-39 Insert Intrauterine Device Office/Outpatient Visit Est Office/Outpatient Visit Est Transvaginal Us Non-Ob |
$280.00 $357.00 $139.00 $198.00 $571.00 |
$234.00 $357.00 $131.00 $189.00 $561.00 |
$110.77 $68.36 $67.98 $100.63 $124.22 |
$233.00 $411.00 $132.00 $192.00 $675.00 |
|
Gastroenterology Diseases Signs & Symptoms |
45378 72193 74160 99213 99214 |
Diagnostic Colonoscopy **Ct Pelvis W/Dye **Ct Abdomen W/Dye Office/Outpatient Visit Est Office/Outpatient Visit Est |
$1,906.00 $1,375.00 $1,419.00 $139.00 $198.00 |
$1,563.00 n/a n/a $131.00 $189.00 |
$383.29 $211.27 $244.28 $67.98 $100.63 |
$1,513.00 $1,581.00 $1,691.00 $132.00 $192.00 |
| Fungal Skin Infection |
11721 99213 11750 99214 99212 |
Debride Nail 6 Or More Office/Outpatient Visit Est Removal Of Nail Bed Office/Outpatient Visit Est Office/Outpatient Visit Est |
$200.00 $139.00 $689.00 $198.00 $107.00 |
$167.00 $131.00 $613.00 $189.00 $102.00 |
$42.00 $67.98 $209.44 $100.63 $40.94 |
$84.00 $132.00 $420.00 $192.00 $104.00 |
| Mood Disorder, Depressed |
90806 90801 99214 90862 90805 |
Psytx Off 45-50 Min Psy Dx Interview Office/Outpatient Visit Est Medication Management Psytx Off 20-30 Min W/E&M |
$347.00 $400.00 $198.00 n/a $170.00 |
n/a n/a $189.00 $144.00 n/a |
n/a n/a $100.63 n/a n/a |
$263.00 $277.00 $192.00 n/a $126.00 |
|
Other Neuropyschological or Behavioral Disorders |
90806 90801 90847 99214 99213 |
Psytx Off 45-50 Min Psy Dx Interview Family Psytx W/Patient Office/Outpatient Visit Est Office/Outpatient Visit Est |
$217.00 $347.00 $269.00 $198.00 $139.00 |
n/a n/a $269.50 $189.00 $131.00 |
n/a n/a $99.91 $100.63 $67.98 |
$173.00 $263.00 $167.00 $192.00 $132.00 |
|
Visual Disturbances, w/o Surgery |
92014 92004 92015 92012 99213 |
Eye Exam & Treatment Eye Exam New Patient Refraction Eye Exam Established Pat Office/Outpatient Visit Est |
n/a n/a n/a n/a $139.00 |
n/a n/a n/a n/a $131.00 |
$115.55 $139.66 $22.32 $79.67 $67.98 |
$138.00 $138.00 $43.00 $112.00 $132.00 |
| Cataract, w/o Surgery |
92014 92015 99214 92004 99213 |
Eye Exam & Treatment Refraction Office/Outpatient Visit Est Eye Exam New Patient Office/Outpatient Visit Est |
n/a n/a $198.00 n/a $139.00 |
n/a n/a $189.00 n/a $131.00 |
$115.55 $22.32 $100.63 $139.66 $67.98 |
$138.00 $43.00 $192.00 $138.00 $132.00 |
|
Inflammatory Eye Disease, w/o Surgery |
92014 99213 92015 99214 92004 |
Eye Exam & Treatment
Office/Outpatient Visit Est Refraction Office/Outpatient Visit Est Eye Exam New Patient |
n/a $139.00 n/a $198.00 n/a |
n/a
$131.00 n/a $189.00 n/a |
$115.55 $67.98 $22.32 $100.63 $139.66 |
$138.00 $132.00 $43.00 $192.00 $138.00 |
* Typical charge in this area was derived from Ingenix Custom Fee Analyzer for the zip code of 544xx (50th percentile)
** Denotes that charge is for technical component of procedure only
Please note: CPT codes illustrated in this document are not inclusive of treatment and may include additional codes (charges)