Billing & Insurance

We participate with most local and many national insurance plans. However it is your responsibility to understand whether your insurance has limits on the doctors you can see, or the services you can receive.

If you provide complete and accurate information about your insurance, we will submit claims to your insurance carrier and receive payments for services. Depending on your insurance coverage, you may be responsible for co-payments, co-insurance, or other deductible amounts.

Please contact our billing office or call your insurance carrier should you have questions.

Good Faith Estimate

Uninsured or out-of-network office visits

All uninsured (self-pay) or Out-of-Network patients are required to pay an initial deposit fee of $160.00 for an office appointment prior to being seen by a provider. This fee will be applied to the actual charge for the office visit and may not be the actual incurred charge, which can only be determined by the provider during the appointment. Additional charges will apply for level of care and in-office labs, tests, or procedures.

Listed below is a good faith estimate of the possible charges you may receive during or following a medical appointment with one of our medical providers. However, actual Level of Care and any necessary in-office procedures can only be determined by the medical decision making done by the provider, taking into consideration the Reason or Reasons for Visit, Review of Systems, Past & Current Medical History, Physical Exam, and the provider’s Assessment and Plan of Care.

Possible Base Visit Charge

The code sets used to bill for Office Visits are organized into various categories and levels. In general, the more complex the visit, the higher the level of code will be billed. While actual time spent with our provider may be a factor in determining the billing level, generally this would only apply when counseling and/or coordination of care dominate the visit (greater than 50% of the visit). Usually the Office visit level (Level 2 through 5) will be determined by the provider based on your medical history, the number of medical complaints or complications and the complexity of the medical decision making.

New Patient Visit

An individual is considered a New Patient if they have not received any professional services from the physician/non-physician practitioner (NPP) or another physician of the same specialty who belongs to the same group practice within the previous 3 years.

New Patient Base Visit Charge

CPT CODE | DESCRIPTION | CHARGE

  • 99202 | New Patient Office Level 2 | $121.00
  • 99203 | New Patient Office Level 3 | $160.00
  • 99204 | New Patient Office Level 4 | $225.00
  • 99205 | New Patient Office Level 5 | $304.00

Established Base Visit Charge

CPT CODE | DESCRIPTION | CHARGE

  • 99212 | Established Office Level 2 | $74.00
  • 99213 | Established Office Level 3 | $120.00
  • 99214 | Established Office Level 4 | $160.00
  • 99215 | Established Office Level 5 | $238.00

Other Possible Visit Charges

Depending on the reason for your visit, there are several different additional procedures and/or tests that your medical provider may find medically necessary and appropriate in order for the provider to properly arrive at a diagnosis and to determine a treatment plan. These are often not entirely apparent until the provider reviews and discusses your reason or reasons for your visit, current and past medical history, reports, test and/or lab results, and begins a physical exam.

Attached is a list of possible procedures and tests that may be necessary, depending on your reason for the visit. This list is not all-inclusive and you have the right to request the charge for any procedure or in-office test. You have the right to refuse any test or procedure but please remember you are seeing a specialist and refusing a test or procedure may hinder the provider’s ability to properly treat or determine your actual medical condition.

We are happy to extend a 20% discount to Uninsured (self-pay) patients on in-office procedures and our surgeon’s fee for hospital or ambulatory center procedures. This discount does not apply to the base office visit charge.

Additional Charges that May Medically Necessary During Your Office Visit

AUDIOLOGY

CPT CODE | DESCRIPTION | CHARGE | CHARGE W/ DISCOUNT

  • 92517 | Cervical VEMP | $251.00 | $201.00
  • 92518 | Ocular VEMP | $234.00 | $188.00
  • 92519 | Cervical and Ocular VEMP | $389.00 | $312.00
  • 92537 | Bithermal Bilateral Calorics | $146.00 | $117.00
  • 92538 | Monothermal Bilateral Calorics | $73.00 | $59.00
  • 92540 | Clinical Vestibular Function Test | $336.00 | $269.00
  • 92550 | Tympanometry and Reflex Threshold Measure | $70.00 | $56.00
  • 92552 | Pure Tone Audiometry Air Only | $96.00 | $77.00
  • 92557 | Comprehensive Audiometry Evaluation | $180.00 | $144.00
  • 92567 | Tympanometry (impedance testing) | $80.00 | $64.00
  • 92568 | Acoustic Reflex Threshold | $57.00 | $46.00
  • 92590 | Hearing Aid Exam and Selection Monaural | $150.00 | $120.00
  • 92591 | Hearing Aid Exam and Selection Binaural | $150.00 | $120.00
  • 92603 | Analysis Cochlear Implant 7 Yr Programming | $435.00 | $348.00
  • 92604 | Analysis Cochlear Implant 7 Yr Subsequent Reprogramming | $257.00 | $206.00
  • 92626 | Evaluation of Auditory Rehab Status, 1st Hour | $300.00 | $240.00
  • 92627 | Evaluation of Auditory Rehab Status, each additional 15 minutes | $64.00 | $52.00
  • S0618 | Audiometry for Purpose of Hearing Aid or Amplification | $172.00 | $138.00

ENT

CPT CODE | DESCRIPTION | CHARGE | CHARGE W/ DISCOUNT

  • 30901 | Control Nasal Hemorrhage Anterior Simple | $475.00 | $380.00
  • 31231 | Diagnostic Examination of Nasal Passages using an Endoscope | $781.00 | $625.00
  • 31237 | Nasal/Sinus Endoscopy, with Biopsy, Polypectomy, or Debridement | $1,416.00 | $1133.00
  • 31238 | Control of Nasal Bleeding using an Endoscope | $1,579.00 | $1263.00
  • 31575 | Laryngoscopy, Flexible Fiberoptic | $388.00 | $310.00
  • 69200 | Removal Foreign Body from External Auditory Canal | $398.00 | $318.00
  • 69210 | Removal Impacted Cerumen | $200.00 | $160.00
  • 69433 | Tympanostomy (insertion of vent tube), Local or Topical Anesthesia | $646.00 | $517.00
  • 69801 | Incision of Fluid Canals of Inner Ear w/Infusion of Drugs, Transcanal Approach | $674.00 | $539.00
  • 70480 | CT, of the Temporal Bone, without contrast | $1,396.00 | $1117.00
  • 70486 | CT Face/Sinuses without contrast | $1,138.00 | $910.00
  • 92504 | Diagnostic Exam of Ear or Nose using Binocular Microscopy | $93.00 | $74.00
  • G0268 | Remove Impact Cerumen by MD/PA same day as Audiological Function testing | $200.00 | 160.00

ALLERGY

CPT CODE | DESCRIPTION | CHARGE | CHARGE W/ DISCOUNT

  • 94010 | Spirometry | $141.00 | $113.00
  • 95004 | Percutaneous tests (scratch, puncture, prick) with allergenic extracts (per unit) | $19.00 | $15.00
  • 95018 | Skin Prick, Scratch Test or Intradermal | $75.00 | $60.00
  • 95024 | Intradermal Skin Test, Non-venom or Drugs (per unit) | $23.00 | $18.00
  • 95044 | Allergy Patch Tests (per unit) | $27.00 | $22.00
  • 95076 | Ingestion Challenge Test | $400.00 | $320.00

FYZICAL

CPT CODE | DESCRIPTION | CHARGE | CHARGE W/ DISCOUNT

  • 95992 | Canalith Repositioning Procedure(s) (ex. Epley maneuver) | $160.00 | $128.00
  • 97110 | PT to Develop Endurance, Range of Motion and Flexibility, each 15 minutes | $131.00 | $105.00
  • 97112 | Neuromuscular Re-education of Movement, Balance, Coordination, etc . | $129.00 | $103.00
  • 97140 | Manual Therapy Techniques, 1 or more regions, each 15 minutes | $119.00 | $95.00
  • 97161 | Physical Therapy Evaluation: low complexity | $270.00 | $216.00
  • 97162 | Physical Therapy Evaluation: moderate complexity | $270.00 | $216.00
  • 97163 | Physical Therapy Evaluation: high complexity | $270.00 | $216.00
  • 97530 | Therapeutic Activity | $131.00 | $105.00
  • 97535 | Self-Care/Home Management Training | $134.00 | $107.00
  • 97750 | Physical Performance Test or Measurement | $129.00 | $103.00

THIS LIST IS NOT MEANT TO BE “ALL INCLUSIVE”. PRICING FOR RECOMMENDED PROCEDURES NOT CONTAINED ON THIS LIST WILL BE AVAILABLE DURING OR FOLLOWING YOUR EXAMINATION.