Aspirus Clinics

Clinic Prices

Aspirus Clinics, Inc. Cost Information for Health Care Consumers

January 1, 2014 - June 30, 2014

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
2013)
2014 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 
$295.00
$235.00
$280.00
 $223.00
$250.00
$120.77
$101.89
$113.33
$45.59
$101.56
$293.00
$169.00
$268.00
$205.00
$184.00 
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 
$108.00
$200.00
$295.00
$140.00
$95.00
$102.00
$198.00
$295.00
$139.00
$85.00 
$22.86
$103.20
$120.77
$70.23
$14.04
$91.00
$221.00
$293.00
$153.00
$79.00
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 
$200.00
$140.00
 $295.00
$1,885.00
$95.00 
$198.00
$139.00
$295.00
$1,857.00
$85.00
$103.20
$70.23
$120.77
$182.99
$14.04
$221.00
$153.00
$293.00
$4,464.00
$79.00 
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
$140.00
$83.00
$3,330.00
n/a
n/a
$139.00
$81.00
 $2,083.00
$35.41
$25.62
$70.23
$31.17
$367.26
$69.00
$54.00
$153.00
$85.00
$3,527.00
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 
$3,330.00
n/a
n/a
$140.00
$83.00 
$2,083.00
 n/a
 n/a
$139.00
$81.00
$297.41
$35.41
$25.62
$70.23
$31.17
$3,527.00
$69.00
$54.00
$153.00
$85.00 
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 
$140.00
$200.00
$4,971.00
$223.00
$201.00 
$139.00
$198.00
 $2,993.00
 $223.00
$198.00 
$70.23
$103.20
$439.49
$45.59
$29.74
$153.00
$221.00
$6,152.00
$205.00
$219.00
Diabetes, w/o Surgery 99214
83036
99213
82043
80061 
Office/Outpatient Visit Est
Glycosylated Hemoglobin Test
Office/Outpatient Visit Est
Microalbumin Quantitative
Lipid Panel 
$200.00
$77.00
$140.00
$114.00
$108.00 
$198.00
$70.00
$139.00
$77.00
$102.00 
$103.20
$12.74
$70.23
$7.51
$22.86 
$221.00
$43.00
$153.00
$93.00
$91.00
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 
$108.00
$200.00
$4,093.00
$140.00
$295.00 
$102.00
$198.00
$3,433.00
$139.00
$295.00
$22.86
$103.20
$650.61
$70.23
$120.77
$91.00
$221.00
$4,295.00
$153.00
$293.00
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
$200.00
$108.00
$140.00
$295.00 
$108.00
$198.00
$102.00
$139.00
$295.00 
$22.21
$103.20
$22.86
$70.23
$120.77
$100.00
$221.00
$91.00
$153.00
$293.00 
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 
$140.00
$200.00
$173.00
$109.00
$225.00 
$139.00
$198.00
$170.00
$107.00
$221.00
$70.23
$103.20
$71.81
$42.23
$103.83
$153.00
$221.00
$187.00
$119.00
$243.00 
Acute Bronchitis 99213
99214
71020
99284
94640 
Office/Outpatient Visit Est
Office/Outpatient Visit Est
Chest X-Ray
Emergency Dept Visit
Airway Inhalation Treatment 
$140.00
$200.00
$201.00
$366.00
$70.00
$139.00
$198.00
$198.00
$360.00
$68.00 
$70.23
$103.20
$29.74
$110.46
$18.48
$153.00
$221.00
$219.00
$477.00
$79.00 
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 
$140.00
$200.00
$1,387.00
$225.00
n/a
$139.00
$198.00
 $1,119.00
$221.00
n/a
$70.23
$103.20
$169.05
$103.83
$12.68
$153.00
$221.00
$1,437.00
$243.00
$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 
$140.00
$200.00
$1,387.00
n/a
n/a 
$139.00
$198.00
 $1,119.00
n/a
n/a
$70.23
$103.20
$169.05
$6.41
$209.83
$153.00
$221.00
$1,437.00
$14.00
$837.00
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 
$140.00
$80.00
$200.00
$53.00
$366.00 
$139.00
$77.00
$198.00
$51.00
$360.00 
$70.23
$15.68
$103.20
$8.82
$110.46
$153.00
$72.00
$221.00
$42.00
$477.00 
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 
$140.00
$200.00
$255.00
$109.00
n/a
$139.00
$198.00
$251.00
$107.00
n/a
$70.23
$103.20
$57.90
$42.23
$158.15
$153.00
$221.00
$319.00
$119.00
$1,299.00 
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 
$140.00
$200.00
$356.00
n/a
$255.00
$139.00
$198.00
$350.00
n/a
$251.00 
$70.23
$103.20
$93.64
$328.56
$57.90
$153.00
$221.00
$411.00
$1,826.00
$319.00
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
$254.00 
$295.00
$95.00
$280.00
$55.00
$250.00
$120.77
$32.34
$113.33
$24.91
$125.75 
$293.00
$52.00
$268.00
$51.00
$291.00 
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
$363.00
$140.00
$200.00
$571.00
$280.00
$357.00
$139.00
$198.00
$571.00
$113.33
$67.67
$70.23
$103.20
$73.54
$268.00
$473.00
$153.00
$221.00
$657.00 
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 
$1,935.00
$1,752.00
$1,702.00
$140.00
$200.00 
$1,906.00
 $1,375.00
 $1,419.00
$139.00
$198.00
$390.96
$212.82
$212.16
$70.23
$103.20
$1,950.00
$1,853.00
$1,628.00
$153.00
$221.00 
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
$140.00
$689.00
$200.00
$109.00 
$200.00
$139.00
$689.00
$198.00
$107.00
$43.29
$70.23
$217.84
$103.20
$42.23
$69.00
$153.00
$346.00
$221.00
$119.00 
Mood Disorder, Depressed 90791
90792

99214
90862
90832
Psych Diag. Evaluation
PSY Diag. Eval w/Medical services
Office/Outpatient Visit Est
Medication Management
Psytx Patient & Family 30 Mins.
$330.00
$400.00

$200.00
n/a
$170.00 
$347.00
 $400.00
 
$198.00
 n/a
 $170.00
$146.96
 $121.70
 
$103.20
 $0.00
 $61.10
$301.00
$317.00

$221.00
 $183.00
$128.00
Other Neuropyschological
or Behavioral Disorders
90834
90791
90847
99214
99213
Psytx Patient & Family 45 Mins.
Psych Diag. Evaluation
Family Psytx W/Patient
Office/Outpatient Visit Est
Office/Outpatient Visit Est 
$217.00
$330.00
$269.00
$200.00
$140.00
$217.00
 $347.00
$269.00
$198.00
$139.00
$79.00
 $146.96
$86.80
$103.20
$70.23
$176.00
$301.00
$163.00
$221.00
$153.00
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
$140.00
n/a
n/a
n/a
n/a
$139.00
$121.70
$146.14
$19.04
$84.21
$70.23
$142.00
$174.00
$40.00
$116.00
$153.00 
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
$200.00
n/a
$140.00 
n/a
n/a
$198.00
n/a
$139.00 
$121.70
$19.04
$103.20
$146.14
$70.23
$142.00
$40.00
$221.00
$174.00
$153.00 
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
$140.00
n/a
$200.00
n/a 
n/a
$139.00
n/a
$198.00
n/a 
$121.70
$70.23
$19.04
$103.20
$146.14
$142.00
$153.00
$40.00
$221.00
$174.00 

* 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)