When comparing charges with
other medical facilities or provider practices, it is
important to understand their charges may or may not
include both the medical facilities and the doctor or other
provider services. Average charges are estimates;
your out-of-pocket expense will depend on
your individual insurance coverage (such as
co-insurance or deductibles).
URGENT CARE
Procedure Code
Procedure Description
Standard Rate
Prompt Pay*
99201
Office Outpatient New
$
125
$
75
99202
Office Outpatient New
$ 208
$ 125
99203
Office Outpatient New
$
275
$ 165
99204
Office Outpatient New
$ 458
$ 275
99205
Office Outpatient New
$ 583
$ 350
99211
Office Outpatient Established
$
83
$
50
99212
Office Outpatient Established
$ 125
$ 75
99213
Office Outpatient Established
$
191
$ 115
99214
Office Outpatient Established
$ 300
$ 180
99215
Office Outpatient Established
$ 416
$ 250
10060
Incision and Drain Abscess Simple
$
290
$
174
10120
Incision and Removal Foreign Body
$ 374
$ 224
11740
Evacuation Subungual Hematoma
$
121
$ 72
12002
Simple Repair Scalp/Neck/Trunk
$ 269
$ 161
81002
Urinalisys Dip Stick
$
41
$
25
87804
Influenza A/B
$
83
$ 50
96372
Prophylactic Injection
$ 43
$ 25
87880
Streptoccus Lab
$
42
$
25
93000
12 lead Ecg
$ 66
$ 40
85018
Hgb Lab
$
33
$ 20
80047
Basic Metabolic Panel
$ 25
$ 15
80303
Drug Screening
$
125
$
75
90715
Tdap Vaccine
$ 83
$ 50
36415
Venipuncture
$
7
$
4
69209
Removal Impacted Cerumen
$ 58
$ 35
RADIOLOGY
Procedure Code
Procedure Description
Standard Rate
Prompt Pay*
71046
XRAY Chest 2 Views
$
128
$
77
73630
XRAY Foot Complete Min 3 Views
$ 150
$ 90
72110
XRAY Lumbar Spine Minimum 4 View
$ 230
$ 138
73030
XRAY Shoulder Complete Minimum 2 View
$ 125
$ 75
73564
XRAY Knee Complete 4 or More Views
$ 125
$ 75
73610
XRAY Ankle Complete Minimum 3 Views
$ 150
$ 90
73502
XRAY Hip Unilateral 2-3 Views
$ 107
$ 65
77067
Screening Mammogram Bilateral with CAD
$ 349
$ 209
77063
Additional Charge for 3D (Tomosynthesis)
$
125
$ 75
93880
US Carotid Arteries Bilateral Complete
$ 534
$ 320
77080
Bone Density
$ 183
$ 110
70450
CT Head without Contrast
$ 375
$ 225
PHYSICAL THERAPY
Procedure Code
Procedure Description
Standard Rate
Prompt Pay*
97162
Physical Therapy Evaluation
$
206
$
123
97110
Physical Therapy 1+ Area 15 Min Each
$ 81
$ 48
G0283
Electrical Stimulation Other Than Wound
$
45
$ 27
97014
Unattended Electrical Stimulator
$ 45
$ 27
97140
Manual Therapy
$ 63
$ 38
97112
NeuroMuscular Therapy
$ 80
$ 48
97035
US 1+ Area 15 Minutes
$ 47
$ 29
G8978
US 1+ Area 15 Minutes
$ 47
$ 29
* Bonita Community Health Center has a new policy for
uninsured patients. A prompt payment
discount of 40% can be applied for payments made prior to or at
the time of service and who will not be filing an insurance claim..
The services you receive
from Bonita Community Health Center are based on your individual need and medical
condition. Actual charges will
vary based on services performed and medical condition.
Additional tests or services not listed in the estimate may be
ordered by your doctor, in order to treat, diagnose or care for
your individual needs.
For all other pricing inquires please contact our billing department at (239) 949-6152
