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17110 N. Dallas Parkway
Suite 200
Dallas, TX 75248
Phone: (972) 380-7070
Fax: (972) 380-7043

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Primary Care - Sample Fees

The following represents some of the most common office visit charges. Other services are available at comparable discounts - discuss with your physician.

 
Usual Retail Charges
Jefferson Fees
Establihed 4 year old well child exam without immunizations
99392 Preventive Exam, Age 1 to 4 175 95
92551 Audiometry, screening 65 35
99173 Visual Acuity, screening 45 5
81002 Urinalysis, dipstick 25 5
Total 310 140
New Patient 50 year old male physical with one immunization
99386 New Patient Preventive, Age 40 to 64 275 165
92551 Audiometry, screening 65 35
99173 Visual Acuity, screening 45 5
81002 Urinalysis, dipstick 25 5
93000 EKG 60 35
71020 Chest, 2 view x-ray 73 44
80050 General Health Panel (CMP, CBC, and TSH) 150 57
80061 Lipid Panel 110 14
84153 PSA 150 35
90715 Adacel (Tetanus, Diptheria, A-Pertussis) 65 45
Total 1018 440
Established 35 year old female well woman exam with immunization
99385 Preventative Exam, Age 18 to 39 265 145
92551 Audiometry, screening 65 35
99173 Visual Acuity, screening 45 5
81002 Urinalysis, dipstick 25 5
93000 EKG 60 35
80050 General Health Panel (CMP, CBC, and TSH) 150 57
80061 Lipid Panel 110 14
88142 Liquid based pap smear 95 40
87621 Human Papiloma Typing 250 40
90715 Adacel (Tetanus, Diptheria, A-Pertussis) 65 45
Total 1130 412
Physical 15 year old boy
99394 Preventative Exam, Age 12 to 17 200 120
92551 Audiometry, screening 65 35
99173 Visual Acuity, screening 45 5
81002 Urinalysis, dipstick 25 5
Total 335 165
Sore Throat, established patient
99213 Routine, established patient 123 78
87430 Strep screen, rapid 75 10
Total 198 88
Influenza with cough, established patient
99213 Routine, established pateint 123 78
87804 Quick Vue Influenza Type A 100 30
87804 Quick Vue Influenza Type B 100 30
Total 323 138
Chronic Cough with Asthma, established patient
99214 Detailed, established patient 186 113
71020 Chest, 2 View x-ray 73 44
94060 Spirometery, with broncholdilator 120 78
94640 Nebulizer treatment 45 23
Total 424 258
High Fever, new patient
99203 Detailed, new patient exam 220 123
85025 CBC 55 10
Total 275 133
High Fever, established patient
99213 Routine, established pateint 123 78
85025 CBC 55 10
Total 178 88
Pain with urination, new patient
99203 Detailed, new patient exam 220 123
81000 Urinalysis, dipstick and micro 30 5
87086 Urine Culture 75 10
Total 325 138
Left ankle injury, established patient
99214 Detailed, established patient 186 113
73610 Ankle, 3 view x-ray (left only) 63 37
Total 249 150
Other Fees
Office Visits
99201 Limited Office Visit, new patient 82 52
99202 Routine office visit, new patient 140 83
99203 Detailed office visit, new patient 220 123
99204 Comprehensive office visit, new patient 288 180
99205 Complex office visit, new patient 360 228
99381 Preventive office visit, under 1yo, new 185 98
99382 Preventive office visit, 1 - 4 yo, New 225 98
99383 Preventive office visit, 5-11 yo, new 250 98
99384 Preventive office visit,  12-17 yo, new 250 125
99385 Preventive office visit, 18-39 yo, new 265 145
99386 Preventive office visit, 40-64 yo, new 275 165
99387 Preventive office visit, 65+, new 300 175
99211 Minimal office visit, est. patient 42 28
99212 Limited Office Visit, est. patient 76 50
99213 Routine office visit, est. patient 123 78
99214 Detailed office visit, est. patient 186 113
99215 Complex office visit, est. patient 252 170
99391 Preventive office visit, under 1yo, est. 150 95
99392 Preventive office visit, 1 - 4 yo, est. 175 95
99393 Preventive office visit, 5-11 yo, est 175 95
99394 Preventive office visit,  12-17 yo, est 200 120
99395 Preventive office visit, 18-39 yo, est 200 140
99396 Preventive office visit, 40-64 yo, est. 225 160
99397 Preventive office visit, 65+, est. 250 165
Procedures
92551 Audiometry, screening 65 35
99173 Visual, screening 45 5
92567 Tympanometry 46 15
69210 Remove impacted ear cerumen 130 40
93000 Electrocardiogram 60 35
93224 ECG monitor 24 Hr complete (Holter Monitor) 320 214
94010 Spirometry, routine 75 40
94060 Spirometry, with bronchodilater 120 60
94640 Airway inhalation treatment, Nebulizer 45 23
10060 Drain skin abscess, simple 195 110
11100 Biopsy of skin lesion, 1st 172 110
11101 Biopsy of skin lesion, ea add. 85 30
11057 Paring/cut benign skin lestion 4+ 128 75
11200 Removal of skin-tags, up to 15 175 93
11201 Removal of ea. add. 10 skin tags 50 20
17000 Destroy benign lesion , 1st 132 83
17003 Destroy benign lesions, 2-14 add. 35 5
17004 Destroy benign lestions, 15 or more 345 175
17110 Destroy flat wart up to 14 lesions 184 100
17111 Destroy flat wart, up to 15 or more lesions 216 125
54450 Foreskin manipulation 160 40
17250 Granulation cauterization 140 80
93882 Duplex scan of extracranial arteries (CIMT) 350 204
Stress Echo (93015, 93350, 93320, 93325, 93307) 950 450
Radiology
71020 Chest x-ray, 2 views 73 44
73562 X-ray exam of knee, 3 views 69 40
72040 X-ray exam of neck spine, 2-3 views 100 45
72050 X-ray exam of neck spine, 4+ views 108 55
72100 X-ray exam of lower spine, 2-3 views 80 60
72110 X-ray exam of lower spine, lumbrosacral, 4+ views 110 45
73110 X-ray exam of wrist, 3 views 65 35
73610 X-ray exam of ankle 63 37
Laboratory
80050 General health panel 150 57
80048 Basic metabolic panel  84 5
80053 Comprehensive metabolic panel 85 15
83540 Assy, serum iron 40 5
84550 Assy, uric acid, blood 40 5
80076 Hepatic function panel 65 10
82977 Assy, GGT Enzyme 38 5
83615 LDH 40 5
82150 Assy, serum amylase 45 5
86038 Assy, antinuclear antibodies 95 10
86060 Antistreptolysin O titer 65 5
86140 C-reactive protein 50 10
86141 C-reactive protein, cardiac 65 10
85025 CBC, complete diff 55 10
82550 Assy, CPK in blood 42 5
82670 Assy, estradiol 120 20
82728 Assy, ferritin 95 15
82746 Assy, blood folic acid 110 10
83001 Assy, pituitary gonadotropin 130 15
82962 Glucose, capillary 30 5
83036 Glycated hemoglobin 75 12
86677 Antibody, helicobacter pylori 150 15
86701 Antibody, HIV-1 100 10
83090 Homocystine 85 15
82306 Vit - D-25 200 67
83525 Assy, insulin total 115 16
83002 Assy, pituitary gonadotropin, LH 145 15
83690 Assy, blood lipase 75 10
80061 Lipid panel 110 14
86308 Heterophile antibody screen, mono 50 10
84153 Assy, PSA total 150 35
85610 Prothrombin time, PT 45 5
83970 Assy, Parathormone, PTH 225 60
85730 Thromboplastin time, partical, PTT 50 5
84146 Assy, prolactin 140 15
86431 Rheumatoid factor assy 65 5
86593 Syphillis assy, RPR 40 5
85651 RBC sedementation rate - non auto 35 5
84443 Assy, thyroid stimulating hormone, TSH 125 18
84436 Assy, true thyroxine, T4 50 8
84479 Assy, thyroid hormone T-3, T-4 50 8
84403 Assy, blood testosterone, total 125 20
84402 Assy, blood testosterone, free 150 20
86694 HSV,  type I 125 25
86696 HSV, type II 125 30
82043 Urine microalbumin 40 7
81000 Urinalysis, non  automated w/scope 30 10
81002 Urinalysis, dipstick 25 5
81025 Urine Pregnancy Test 45 12
82270 Blood occult feces 1-3 25 5
89055 Fecal leukocyte 50 5
87177 Ova & parasites smear 85 10
87324 Clostridium difficile Toxim 65 15
87220 Skin fungal, wet mount 50 5
87210 Smear, stain & interpret wet 45 5
Arthritis Panel (86038, 86431, 85651, 84550) 235 30
Celiac Panel (83516, 86255) 305 50
Hepatitis Panel (86708, 87340, 86706, 86704, 86803) 515 50
Cultures & Pathology
87490 Chlamydia, DNA probe 125 30
87590 GC, DNA probe 125 30
87252 Herpes antigen detection 145 30
87070 Misc. routine culture 85 15
87430 Strep screen rapid 75 10
87081 Strep culture 50 10
87807 RSV 85 21
87804 Quick Vue Influenza (X2) 100 30
87086 Urine Routine culture 75 10
88164 Pap Smear 55 17
88142 Pap Smear liquid 95 31
87621 Human Papiloma Typing 250 40
88304 Pathology - level 3 125 45
88305 Pathology - level 4 200 85
36415 routine blood draw 25 5
36416 Finger, heel, ear stick 25 5
Immunizations
90471 Immunization Admin 40 24
90472 Immunization Admin 25 10
90700 Dtap, pediatric 65 30
90715 Adacel, adult 65 45
90703 Tetanus vaccine 45 25
90718 Td, adult 45 25
90721 Dtap/Hib 120 60
90648 Hib 60 30
90707 MMR 85 60
90713 IPV 75 35
90716 Varicella 150 92
90649 Gardasil 225 150
90633 Hep A Vac, pediatric 75 45
90632 Hep A, adult 150 75
90744 Hep B  10 mcg 95 40
90746 Hep B, adult, 20 mcg 200 75
90657 Flu vaccine, 6-35 months 35 25
90658 Flu vaccine, 3+ 35 25
90655 Influenza, preservative free 40 35
90734 Meningococcal 125 115
90732 Pneumococcal 100 45
90669 Prevnar Pneumococcal 125 100
90691 Typhoid 115 68
86580 PPD - TB Intradermal Test 35 10
90680 Rota Teq 95 80
90736 Zostavax 250 180
96372 Diagnositic Injection, non vaccine 40 25
J0698
 Claforan, 1000 mg 15 10
J0696
 Rocephin, 250 mg 25 10