Peoria Ear, Nose & Throat Group Peoria Ear, Nose & Throat Group

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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

All Uninsured (self-pay) or Out of Network Patients are required to pay an initial deposit fee of $200.00 for an office appointment prior to being seen by a provider. This deposit will be applied to the actual charge for the Evaluation and Management (E/M) office visit. However, this may not be the actual incurred charge as this can only be determined by the provider during the appointment. You can learn more about Evaluation and Management Codes at the following website:  https://www.aapc.com/resources/what-are-e-m-codes

Additional charges will apply for different Levels of Care as well as procedures, labs, and/or tests.

Listed below is a good faith estimate of potential charges that you may receive during or following a medical appointment with one of our medical providers. This is not an all-inclusive list.

New Patient Base Visit Charge

CPT CODE | DESCRIPTION | CHARGE

  • 99202 | New Patient Office Level 2 | $150.00
  • 99203 | New Patient Office Level 3 | $200.00
  • 99204 | New Patient Office Level 4 | $260.00
  • 99205 | New Patient Office Level 5 | $330.00

Established Base Visit Charge

CPT CODE | DESCRIPTION | CHARGE

  • 99212 | Established Office Level 2 | $95.00
  • 99213 | Established Office Level 3 | $150.00
  • 99214 | Established Office Level 4 | $200.00
  • 99215 | Established Office Level 5 | $275.00

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.

Other Possible Visit Charges

Depending on the reason for your visit, there are several additional procedures, labs, or tests that your medical provider may find medically necessary and reasonable for the provider to properly arrive at a diagnosis and to determine a treatment plan.  These are often not 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.

Below 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 (Evaluation and Management codes).

ADDITIONAL CHARGES THAT MAY BE MEDICALLY NECESSARY DURING YOUR OFFICE VISIT

ENT

CPT CODE | DESCRIPTION | CHARGE | CHARGE W/SELF-PAY DISCOUNT

  • 30901 | Control Nasal Hemorrhage Anterior Simple | $500.00 | $400.00
  • 31231 | Diagnostic Examination of Nasal Passages using an Endoscope | $800.00 | $640.00
  • 31237 | Nasal/Sinus Endoscopy, with Biopsy, Polypectomy, or Debridement | $1,100.00 | $880.00
  • 31238 | Control of Nasal Bleeding using an Endoscope | $1,025.00 | $820.00
  • 31575 | Laryngoscopy, Flexible Fiberoptic | $500.00 | $400.00
  • 69200 | Removal Foreign Body from External Auditory Canal | $400.00 | $320.00
  • 69210 | Removal Impacted Cerumen | $200.00 | $160.00
  • 69433 | Tympanostomy (insertion of vent tube), Local or Topical Anesthesia | $650.00 | $520.00
  • 69801 | Incision of Fluid Canals of Inner Ear w/Infusion of Drugs, Transcanal Approach | $850.00 | $680.00
  • 70480 | CT, of the Temporal Bone, without contrast | $1,300.00 | $1,040.00
  • 70486 | CT Face/Sinuses without contrast | $1,200.00 | $960.00
  • 92504 | Diagnostic Exam of Ear or Nose using Binocular Microscopy | $110.00 | $88.00
  • G0268 | Remove Impact Cerumen by MD/PA same day as Audiological Function testing | $200.00 | 160.00

ALLERGY

CPT CODE | DESCRIPTION | CHARGE | CHARGE W/SELF-PAY DISCOUNT

  • 94010 | Spirometry | $150.00 | $120.00
  • 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) | $27.00 | $22.00
  • 95044 | Allergy Patch Tests (per unit) | $27.00 | $22.00
  • 95076 | Ingestion Challenge Test | $400.00 | $320.00
  • 95165 | Preparation and Provision of Antigens for Allergen Immunotherapy (per unit) | $48.00 | $39.00

AUDIOLOGY

CPT CODE | DESCRIPTION | CHARGE | CHARGE W/SELF-PAY DISCOUNT

  • 92517 | Cervical VEMP | $250.00 | $200.00
  • 92518 | Ocular VEMP | $260.00 | $208.00
  • 92519 | Cervical and Ocular VEMP | $400.00 | $320.00
  • 92537 | Bithermal Bilateral Calorics | $150.00 | $120.00
  • 92538 | Monothermal Bilateral Calorics | $75.00 | $60.00
  • 92540 | Clinical Vestibular Function Test | $350.00 | $280.00
  • 92550 | Tympanometry and Reflex Threshold Measure | $75.00 | $60.00
  • 92552 | Pure Tone Audiometry Air Only | $120.00 | $96.00
  • 92557 | Comprehensive Audiometry Evaluation | $180.00 | $144.00
  • 92567 | Tympanometry (impedance testing) | $80.00 | $64.00
  • 92568 | Acoustic Reflex Threshold | $60.00 | $48.00
  • 92579 | Visual Reinforcement Audiometry | $150.00 | $120.00
  • 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 | $300.00 | $240.00
  • 92626 | Evaluation of Auditory Rehab Status, 1st Hour | $300.00 | $240.00
  • 92627 | Evaluation of Auditory Rehab Status, each additional 15 minutes | $75.00 | $60.00
  • S0618 | Audiometry for Purpose of Hearing Aid or Amplification | $180.00 | $144.00

PHYSICAL THERAPY

CPT CODE | DESCRIPTION | CHARGE | CHARGE W/SELF-PAY 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 | $125.00 | $100.00
  • 97112 | Neuromuscular Re-education of Movement, Balance, Coordination, etc . | $130.00 | $104.00
  • 97140 | Manual Therapy Techniques, 1 or more regions, each 15 minutes | $115.00 | $92.00
  • 97161 | Physical Therapy Evaluation: low complexity | $340.00 | $272.00
  • 97162 | Physical Therapy Evaluation: moderate complexity | $340.00 | $272.00
  • 97163 | Physical Therapy Evaluation: high complexity | $340.00 | $272.00
  • 97530 | Therapeutic Activity | $130.00 | $104.00
  • 97535 | Self-Care/Home Management Training | $120.00 | $96.00
  • 97750 | Physical Performance Test or Measurement | $130.00 | $104.00

This list is not meant to be an all-inclusive list. Pricing for recommended procedures not contained on this list will be available during or following your examination.

Listed fees are subject to change.