Pricing

Charges for Healthcare Services

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
S9083 Global Fee Urgent Care Centers $ 115 $ 69
87804 Laadiadoo Inf $ 83 $ 50
96372 Prophylactic Injection $ 43 $ 25
87880 Streptoccus Lab $ 83 $ 50
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 Collj Ven Bld Vnpnxr $ 7 $ 4
69210 Removal Impacted Cerumen $ 58 $ 35

RADIOLOGY

Procedure Code

Procedure Description

Standard Rate

Prompt Pay*

71020 XRAY Chest 2 Views $ 128 $ 76
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 $ 64
77052 Computer Aided Screening Mammogram $ 30 $ 18
G0202 Screening Mammogram $ 348 $ 209
93880 Dup-Scan Xtrc Art Compl Bi Std $ 534 $ 320
77080 Bone Density $ 183 $ 110
XRCOPY XRAY Copy $ 5 $ 3

PHYSICAL THERAPY

Procedure Code

Procedure Description

Standard Rate

Prompt Pay*

97001 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

© 2017 Bonita Community Health Center.