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Physician Office Procedures

Estimated Average Charges

These prices are for physician office visit services performed at John C. Lincoln Health Network facilities.

Procedure Code Procedure Code Description Average Charge Per Visit
90716 Varicella (Live Vaccine) $158.00
90718 TD Adult $38.00
90732 Pneumovax $112.00
90736 Zoster (Shingles) $277.00
94640 Airway Inhalation Treatment $40.00
99201 PR Office Outpatient New Level 1 $66.00
99202 PR Office Outpatient New Level 2 $118.00
99203 PR Office Outpatient New 30 Minutes $172
99204 PR Office Outpatient New 45 Minutes $268
99205 PR Office Outpatient New Level 5 $336.00
99211 PR Office Outpatient Visit Level 1 $34.00
99212 PR Office Outpatient Visit 10 Minutes $69
99213 PR Office Outpatient Visit 15 Minutes $115
99214 PR Office Outpatient Visit 25 Minutes $173
99215 PR Office Outpatient Visit Level 5 $233.00
99383 Preventative Visit 5-11 Years $154.00
99384 Preventative Visit 12-17 Years $168.00
99385 Preventative Visit 18-39 Years $168.00
99386 Preventative Visit 40-64 Years $196.00
99393 Preventative Visit Est 5-11 Years $125.00
99394 Preventative Visit Est 12-17 Years
$138.00
99395 PR Preventive Visit, Est, 18-39 $138
99396 PR Preventive Visit, Est, 40-64 $153
36415 PR Collection Venous Blood, Venipuncture $10
80050 CHG General Health Panel $96
80053 CHG Metabolic Panel, Comprehensive $44
80061 CHG Lipid Panel $67
81002 CHG Urinalysis Nonauto W/O Scope $18
81003 CHG Urinalysis, Auto, W/O Scope $29
84439 CHG Assay of Free Thyroxine $64
84443 CHG Assay Thyroid Stim Hormone $89
85025 CHG Complete CBC & Auto Diff WBC $28
85610 CHG Prothrombin Time $16
87880 CHG Strep A Assay W/Optic $61
90471 PR Immuniz Admin, 1 Single/Comb Vac/Toxoid $33
90715 PR TDAP Vaccine >7 YO, IM $69
93000 PR Electrocardiogram, Complete $67
93970 PR Duplex Extrem Venous, Bilat $71
96372 PR Injection, Therap/Proph/Diagnost, IM or Subcut $35
97110 PR Therapeutic Exercises $49
99232 PR SBSQ Hospital Care/Day 25 Minutes $106
G0439 PR PPPS, Subseq Visit $154
J0696 PR Ceftriaxone Sodium Injection $25
J1050 Depo Provera 150 mg $72.00
J1080 PR Testosterone Cypionat 200 mg $20
J1100 PR Dexamethasone Sodium Phos $10
J1885 PR Ketorolac Tromethamine Inj $10
J3301 PR Triamcinolone Acetonide Inj $3
J3420 B-12 - $5 up to 1000mg $5.00