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Is Your Child Sick?®
Wellness Exams
The Good Faith Estimate (GFE) shows the costs of items/services that are reasonably expected for your health care needs. The GFE does not include any unknown or unexpected costs that may arise during treatment. Charges could be added if complications or special circumstances occur. Regulations establish the billed charges for any GFE to be within $400.00 of actual charges. Please contact the Billing Department for a more detailed estimate.
Our practice offers discounted cash-pay rates for patients who choose to pay out of pocket for their medical services. Please note the following:
- Rate Variance: Cash-pay rates are typically lower than the rates billed to insurance companies. These discounted rates are designed to accommodate patients without insurance or those who opt not to use their coverage.
- Insurance Billing: The rates billed to insurance companies may be higher due to contractual agreements, administrative costs, and reimbursement structures.
- Non-Applicability of Discounts: Cash-pay discounts do not apply to services billed to insurance companies. If you elect to submit a claim to your insurer, the cash-pay discount will not be honored retroactively.
- Patient Responsibility: It is your responsibility to understand the terms of your insurance plan, including out-of-pocket expenses and coverage limitations.
By choosing the cash-pay option, you acknowledge and agree to these terms. If you have questions or need clarification, our staff will be happy to assist.
3-5 Day Visit
| Visit | CPT | Price |
|---|---|---|
| 3-5 Day | 99381 | $223.00 |
| TOTAL | $223.00 |
2 Week Visit
| New Patient | CPT | Price |
|---|---|---|
| 2 Week Wellness | 99381 | $223.00 |
| Newborn Screen | 36416 | $25.00 |
| Newborn Screen card (if you don't bring your own) | S3620 | $75.00 |
| TOTAL | $323.00 | |
| Established Patient | CPT | Price |
| 2 Week Wellness | 99391 | $200.00 |
| Newborn Screen | 36416 | $25.00 |
| Newborn Screen card (if you don't bring your own) | S3620 | $75.00 |
| TOTAL | $300.00 |
IF ISSUES OUTSIDE OF THE WELLNESS ARE DISCUSSED THERE COULD BE AN ADDITIONAL VISIT CHARGE. This would be APPROXIMATELY $146-$217 depending on the nature of the issue and treatment required.
1 Month Visit
| New Patient | CPT | Price |
|---|---|---|
| 1 Month Wellness | 99381 | $223.00 |
| Maternal Depression Screen | 96161 | $13.00 |
| TOTAL | $236.00 | |
| Established Patient | CPT | Price |
| 1 Month Wellness | 99391 | $200.00 |
| Maternal Depression Screen | 96161 | $13.00 |
| TOTAL | $213.00 |
IF ISSUES OUTSIDE OF THE WELLNESS ARE DISCUSSED THERE COULD BE AN ADDITIONAL VISIT CHARGE. This would be APPROXIMATELY $146-$217 depending on the nature of the issue and treatment required.
2 Month Visit
| New Patient | CPT | Price |
|---|---|---|
| 2 Month Wellness | 99381 | $223.00 |
| Maternal Depression Screen | 96161 | $13.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $236.00 | |
| Established Patient | CPT | Price |
| 2 Month Wellness | 99391 | $200.00 |
| Maternal Depression Screen | 96161 | $13.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $213.00 |
*If you are unable to afford immunizations and sign a waiver at the visit, immunization fees will be waived*
IF ISSUES OUTSIDE OF THE WELLNESS ARE DISCUSSED THERE COULD BE AN ADDITIONAL VISIT CHARGE. This would be APPROXIMATELY $146-$217 depending on the nature of the issue and treatment required.
4 Month Visit
| New Patient | CPT | Price |
|---|---|---|
| 4 Months Wellness | 99381 | $223.00 |
| Maternal Depression Screen | 96161 | $13.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $236.00 | |
| Established Patient | CPT | Price |
| 4 Months Wellness | 99391 | $200.00 |
| Maternal Depression Screen | 96161 | $13.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $213.00 |
*If you are unable to afford vaccines and sign a waiver at the visit, immunization fees will be waived*
IF ISSUES OUTSIDE OF THE WELLNESS ARE DISCUSSED THERE COULD BE AN ADDITIONAL VISIT CHARGE. This would be APPROXIMATELY $146-$217 depending on the nature of the issue and treatment required.
6 Month Visit
| New Patient | CPT | Price |
|---|---|---|
| 6 Month Wellness | 99381 | $223.00 |
| SPOT Vision Screen | 99177 | $27.50 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $250.50 | |
| Established Patient | CPT | Price |
| 6 Month Wellness | 99391 | $200.00 |
| SPOT Vision Screen | 99177 | $27.50 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $227.50 |
*If you are unable to pay for immunizations and sign a waiver at the visit, those fees will be waived.*
IF ISSUES OUTSIDE OF THE WELLNESS ARE DISCUSSED THERE COULD BE AN ADDITIONAL VISIT CHARGE. This would be APPROXIMATELY $146-$217 depending on the nature of the issue and treatment required.
9 Month Visit
| New Patient | CPT | Price |
|---|---|---|
| 9 Month Wellness | 99381 | $223.00 |
| CHAT/SWYC Screening | 96110 | $19.00 |
| TOTAL | $242.00 | |
| Established Patient | CPT | Price |
| 9 Month Wellness | 99391 | $200.00 |
| CHAT/SWYC Screening | 96110 | $19.00 |
| TOTAL | $219.00 |
*If you are unable to pay for immunizations and sign a waiver at the visit, those fees will be waived.*
IF ISSUES OUTSIDE OF THE WELLNESS ARE DISCUSSED THERE COULD BE AN ADDITIONAL VISIT CHARGE. This would be APPROXIMATELY $146-$217 depending on the nature of the issue and treatment required.
12 Month Visit
| New Patient | CPT | Price |
|---|---|---|
| 12 Month Wellness | 99382 | $233.00 |
| SPOT Vision Screen | 99177 | $27.50 |
| Lead & Hemoglobin | 85018, 83655, 36416 | $57.00 |
| Fluoride Treatment | 99188 | $48.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $365.50 | |
| Established Patient | CPT | Price |
| 12 Month Wellness | 99392 | $214.00 |
| SPOT Vision Screen | 99177 | $27.50 |
| Lead & Hemoglobin | 85018, 83655, 36416 | $57.00 |
| Fluoride Treatment | 99188 | $48.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $346.50 |
*If you are unable to pay for immunizations and sign a waiver at the visit, those fees will be waived.*
IF ISSUES OUTSIDE OF THE WELLNESS ARE DISCUSSED THERE COULD BE AN ADDITIONAL VISIT CHARGE. This would be APPROXIMATELY $146-$217 depending on the nature of the issue and treatment required.
15 Month Visit
| New Patient | CPT | Price |
|---|---|---|
| 15 Month Wellness | 99382 | $233.00 |
| Fluoride Treatment | 99188 | $48.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (immunizations not included) | $281.00 | |
| Established Patient | CPT | Price |
| 15 Month Wellness | 99392 | $214.00 |
| Fluoride Treatment | 99188 | $48.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (immunizations not included) | $262.00 |
*If you are unable to pay for immunizations and sign a waiver at the visit, those fees will be waived.*
IF ISSUES OUTSIDE OF THE WELLNESS ARE DISCUSSED THERE COULD BE AN ADDITIONAL VISIT CHARGE. This would be APPROXIMATELY $146-$217 depending on the nature of the issue and treatment required.
18 Month Visit
| New Patient | CPT | Price |
|---|---|---|
| 18 Month Wellness | 99382 | $233.00 |
| SPOT Vision Screen | 99177 | $27.50 |
| Fluoride Treatment | 99188 | $48.00 |
| Developmental Testing | 96110 | $19.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $327.50 | |
| Established Patient | CPT | Price |
| 18 Month Wellness | 99392 | $214.00 |
| SPOT Vision Screen | 99177 | $27.50 |
| Fluoride Treatment | 99188 | $48.00 |
| Developmental Testing | 96110 | $19.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $308.50 |
*If you are unable to pay for immunizations and sign a waiver at the visit, those fees will be waived.* IF ISSUES OUTSIDE OF THE WELLNESS ARE DISCUSSED THERE COULD BE AN ADDITIONAL VISIT CHARGE. This would be APPROXIMATELY $146-$217 depending on the nature of the issue and treatment required.
2 Year Visit
| New Patient | CPT | Price |
|---|---|---|
| 24 Month Wellness | 99382 | $233.00 |
| SPOT Vision Screen | 99177 | $27.50 |
| Fluoride Treatment | 99188 | $48.00 |
| Developmental Testing | 96110 | $19.00 |
| Lead & Hemoglobin Screen | 85018, 83655, 36416 | $57.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $384.50 | |
| Established Patient | CPT | Price |
| 24 Month Wellness | 99392 | $214.00 |
| SPOT Vision Screen | 99177 | $27.50 |
| Fluoride Treatment | 99188 | $48.00 |
| Developmental Testing | 96110 | $19.00 |
| Lead & Hemoglobin Screen | 85018, 83655, 36416 | $57.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $365.50 |
*If you are unable to pay for immunizations and sign a waiver at the visit, those fees will be waived.*
IF ISSUES OUTSIDE OF THE WELLNESS ARE DISCUSSED THERE COULD BE AN ADDITIONAL VISIT CHARGE. This would be APPROXIMATELY $146-$217 depending on the nature of the issue and treatment required.
2.5 Year Visit
| New Patient | CPT | Price |
|---|---|---|
| 2.5 Year Wellness | 99382 | $233.00 |
| SPOT Vision Center | 99177 | $27.50 |
| Fluoride Treatment | 99188 | $48.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $308.50 | |
| Established Patient | CPT | Price |
| 2.5 Year Wellness | 99392 | $214.00 |
| SPOT Vision Center | 99177 | $27.50 |
| Fluoride Treatment | 99188 | $48.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $289.50 |
*If you are unable to pay for immunizations and sign a waiver at the visit, those fees will be waived.*
IF ISSUES OUTSIDE OF THE WELLNESS ARE DISCUSSED THERE COULD BE AN ADDITIONAL VISIT CHARGE. This would be APPROXIMATELY $146-$217 depending on the nature of the issue and treatment required.
3 Year Visit
| New Patient | CPT | Price |
|---|---|---|
| 3 Year Wellness | 99382 | $233.00 |
| Vision Screen | 99173 | $5.50 |
| Fluoride Treatment | 99188 | $48.00 |
| Audiogram | 92552 | $63.00 |
| Immunizations as needed | $20.13 each* | |
| CHAT/SWYC | 96110 | $19.00 |
| TOTAL (does not include immunizations) | $368.50 | |
| Established Patient | CPT | Price |
| 3 Year Wellness | 99392 | $214.00 |
| Vision Screen | 99173 | $5.50 |
| Fluoride Treatment | 99188 | $48.00 |
| Audiogram | 92552 | $63.00 |
| Immunizations as needed | $20.13 each* | |
| CHAT/SWYC | 96110 | $19.00 |
| TOTAL (does not include immunizations) | $349.50 |
*If you are unable to pay for immunizations and sign a waiver at the visit, those fees will be waived.*
IF ISSUES OUTSIDE OF THE WELLNESS ARE DISCUSSED THERE COULD BE AN ADDITIONAL VISIT CHARGE. This would be APPROXIMATELY $146-$217 depending on the nature of the issue and treatment required.
4 Year Visit
| New Patient | CPT | Price |
|---|---|---|
| 4 Year Wellness | 99382 | $233.00 |
| SPOT Vision Screen | 99177 | $27.50 |
| Fluoride Treatment | 99188 | $48.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $308.50 | |
| Established Patient | CPT | Price |
| 4 Year Wellness | 99392 | $214.00 |
| SPOT Vision Screen | 99177 | $27.50 |
| Fluoride Treatment | 99188 | $48.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $289.50 |
*If you are unable to pay for immunizations and sign a waiver at the visit, those fees will be waived.*
IF ISSUES OUTSIDE OF THE WELLNESS ARE DISCUSSED THERE COULD BE AN ADDITIONAL VISIT CHARGE. This would be APPROXIMATELY $146-$217 depending on the nature of the issue and treatment required.
5 Year Visit
| New Patient | CPT | Price |
|---|---|---|
| 5 Year Wellness | 99383 | $242.00 |
| Snellen Vision Screen | 99173 | $5.50 |
| Audiogram | 92552 | $63.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $310.50 | |
| Established Patient | CPT | Price |
| 5 Year Wellness | 99393 | $213.00 |
| Snellen Vision Screen | 99173 | $5.50 |
| Audiogram | 92552 | $63.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $281.50 |
*If you are unable to pay for immunizations and sign a waiver at the visit, those fees will be waived.*
IF ISSUES OUTSIDE OF THE WELLNESS ARE DISCUSSED THERE COULD BE AN ADDITIONAL VISIT CHARGE. This would be APPROXIMATELY $146-$217 depending on the nature of the issue and treatment required.
6 Year Visit
| New Patient | CPT | Price |
|---|---|---|
| 6 Year Wellness | 99383 | $242.00 |
| Snellen Vision Screen | 99173 | $5.50 |
| Audiogram | 92552 | $63.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $310.50 | |
| Established Patient | CPT | Price |
| 6 Year Wellness | 99393 | $213.00 |
| Snellen Vision Screen | 99173 | $5.50 |
| Audiogram | 92552 | $63.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $281.50 |
*If you are unable to pay for immunizations and sign a waiver at the visit, those fees will be waived.*
IF ISSUES OUTSIDE OF THE WELLNESS ARE DISCUSSED THERE COULD BE AN ADDITIONAL VISIT CHARGE. This would be APPROXIMATELY $146-$217 depending on the nature of the issue and treatment required.
7 Year Visit
| New Patient | CPT | Price |
|---|---|---|
| 7 Year Wellness | 99383 | $242.00 |
| Snellen Vision Screen | 99173 | $5.50 |
| Audiogram | 92552 | $63.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $310.50 | |
| Established Patient | CPT | Price |
| 7 Year Wellness | 99393 | $213.00 |
| Snellen Vision Screen | 99173 | $5.50 |
| Audiogram | 92552 | $63.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $281.50 |
*If you are unable to pay for immunizations and sign a waiver at the visit, those fees will be waived.*
IF ISSUES OUTSIDE OF THE WELLNESS ARE DISCUSSED THERE COULD BE AN ADDITIONAL VISIT CHARGE. This would be APPROXIMATELY $146-$217 depending on the nature of the issue and treatment required.
8 Year Visit
| New Patient | CPT | Price |
|---|---|---|
| 8 Year Wellness | 99383 | $242.00 |
| Snellen Vision Screen | 99173 | $5.50 |
| Audiogram | 92552 | $63.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $310.50 | |
| Established Patient | CPT | Price |
| 8 Year Wellness | 99393 | $213.00 |
| Snellen Vision Screen | 99173 | $5.50 |
| Audiogram | 92552 | $63.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $281.50 |
*If you are unable to pay for immunizations and sign a waiver at the visit, those fees will be waived.*
IF ISSUES OUTSIDE OF THE WELLNESS ARE DISCUSSED THERE COULD BE AN ADDITIONAL VISIT CHARGE. This would be APPROXIMATELY $146-$217 depending on the nature of the issue and treatment required.
9 Year Visit
| New Patient | CPT | Price |
|---|---|---|
| 9 Year Wellness | 99383 | $242.00 |
| Snellen Vision Screen | 99173 | $5.50 |
| Audiogram | 92552 | $63.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $310.50 | |
| Established Patient | CPT | Price |
| 9 Year Wellness | 99393 | $213.00 |
| Snellen Vision Screen | 99173 | $5.50 |
| Audiogram | 92552 | $63.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $281.50 |
*If you are unable to pay for immunizations and sign a waiver at the visit, those fees will be waived.*
IF ISSUES OUTSIDE OF THE WELLNESS ARE DISCUSSED THERE COULD BE AN ADDITIONAL VISIT CHARGE. This would be APPROXIMATELY $146-$217 depending on the nature of the issue and treatment required.
10 Year Visit
| New Patient | CPT | Price |
|---|---|---|
| 10 Year Wellness | 99383 | $242.00 |
| Snellen Vision Screen | 99173 | $5.50 |
| Audiogram | 92552 | $63.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $310.50 | |
| Established Patient | CPT | Price |
| 10 Year Wellness | 99393 | $213.00 |
| Snellen Vision Screen | 99173 | $5.50 |
| Audiogram | 92552 | $63.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $281.50 |
*If you are unable to pay for immunizations and sign a waiver at the visit, those fees will be waived.*
IF ISSUES OUTSIDE OF THE WELLNESS ARE DISCUSSED THERE COULD BE AN ADDITIONAL VISIT CHARGE. This would be APPROXIMATELY $146-$217 depending on the nature of the issue and treatment required.
11 Year Visit
| New Patient | CPT | Price |
|---|---|---|
| 11 Year Wellness | 99383 | $242.00 |
| Vision Screen | 99173 | $5.50 |
| Audiogram | 92552 | $63.00 |
| Cholesterol Screen | 82465, 36416 | $28.50 |
| Depression Rating Scale | 96127 | $14.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $353.00 | |
| Established Patient | CPT | Price |
| 11 Year Wellness | 99393 | $213.00 |
| Vision Screen | 99173 | $5.50 |
| Audiogram | 92552 | $63.00 |
| Cholesterol Screen | 82465, 36416 | $28.50 |
| Depression Rating Scale | 96127 | $14.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $324.00 |
*If you can't afford immunizations and sign a waiver at the visit, those fees will be waived.*
IF ISSUES OUTSIDE OF THE WELLNESS ARE DISCUSSED THERE COULD BE AN ADDITIONAL VISIT CHARGE. This would be APPROXIMATELY $146-$217 depending on the nature of the issue and treatment required.
12 Year Visit
| New Patient | CPT | Price |
|---|---|---|
| 12 Year Wellness | 99384 | $274.00 |
| Snellen Vision Screen | 99173 | $5.50 |
| Audiogram | 92552 | $63.00 |
| Patient Health Questionnaire (PHQ-9) | 96127 | $14.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $356.50 | |
| Established Patient | CPT | Price |
| 12 Year Wellness | 99394 | $234.00 |
| Snellen Vision Screen | 99173 | $5.50 |
| Audiogram | 92552 | $63.00 |
| Patient Health Questionnaire (PHQ-9) | 96127 | $14.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $316.50 | |
| TOTAL (does not include immunizations) | $324.00 |
*If you sign an immunization waiver at the time of the visit, those fees will be waived*
IF ISSUES OUTSIDE OF THE WELLNESS ARE DISCUSSED THERE COULD BE AN ADDITIONAL VISIT CHARGE. This would be APPROXIMATELY $146-$217 depending on the nature of the issue and treatment required.
13 Year Visit
| New Patient | CPT | Price |
|---|---|---|
| 13 Year Wellness | 99384 | $274.00 |
| Snellen Vision Screen | 99173 | $5.50 |
| Audiogram | 92552 | $63.00 |
| Patient Health Questionnaire (PHQ-9) | 96127 | $14.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $356.50 | |
| Established Patient | CPT | Price |
| 13 Year Wellness | 99394 | $234.00 |
| Snellen Vision Screen | 99173 | $5.50 |
| Audiogram | 92552 | $63.00 |
| Patient Health Questionnaire (PHQ-9) | 96127 | $14.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $316.50 |
*If you cannot afford immunizations and sign a waiver at the visit, those fees will be waived.*
IF ISSUES OUTSIDE OF THE WELLNESS ARE DISCUSSED THERE COULD BE AN ADDITIONAL VISIT CHARGE. This would be APPROXIMATELY $146-$217 depending on the nature of the issue and treatment required.
14 Year Visit
| New Patient | CPT | Price |
|---|---|---|
| 14 Year Wellness | 99384 | $274.00 |
| Snellen Vision Screen | 99173 | $5.50 |
| Audiogram | 92552 | $63.00 |
| Patient Health Questionnaire (PHQ-9) | 96127 | $14.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $356.50 | |
| Established Patient | CPT | Price |
| 14 Year Wellness | 99394 | $234.00 |
| Snellen Vision Screen | 99173 | $5.50 |
| Audiogram | 92552 | $63.00 |
| Patient Health Questionnaire (PHQ-9) | 96127 | $14.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $316.50 |
*If you cannot afford immunizations and sign waiver at the time of the visit, those fees will be waived.*
IF ISSUES OUTSIDE OF THE WELLNESS ARE DISCUSSED THERE COULD BE AN ADDITIONAL VISIT CHARGE. This would be APPROXIMATELY $146-$217 depending on the nature of the issue and treatment required.
15 Year Visit
| New Patient | CPT | Price |
|---|---|---|
| 15 Year Wellness | 99384 | $274.00 |
| Snellen Vision Screen | 99173 | $5.50 |
| Audiogram | 92552 | $63.00 |
| Patient Health Questionnaire (PHQ-9) | 96127 | $14.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $356.50 | |
| Established Patient | CPT | Price |
| 15 Year Wellness | 99394 | $234.00 |
| Snellen Vision Screen | 99173 | $5.50 |
| Audiogram | 92552 | $63.00 |
| Patient Health Questionnaire (PHQ-9) | 96127 | $14.00 |
| Immunizations as needed | 82465, 36416 | $20.13 each* |
| TOTAL (does not include immunizations) | $316.50 |
*If you are unable to afford immunizations and sign a waiver at the time of the visit, those fees will be waived.*
IF ISSUES OUTSIDE OF THE WELLNESS ARE DISCUSSED THERE COULD BE AN ADDITIONAL VISIT CHARGE. This would be APPROXIMATELY $146-$217 depending on the nature of the issue and treatment required.
16 Year Visit
| New Patient | CPT | Price |
|---|---|---|
| 16 Year Wellness | 99384 | $274.00 |
| Snellen Vision Screen | 99173 | $5.50 |
| Audiogram | 92552 | $63.00 |
| Cholesterol Screening | 822465, 36416 | $28.50 |
| Depression Screen Form (PHQ-9) | 96127 | $14.00 |
| Health Risk Form (CRAFFT) | 96160 | $14.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $399.00 | |
| Established Patient | CPT | Price |
| 16 Year Wellness | 9994 | $234.00 |
| Snellen Vision Screen | 99173 | $5.50 |
| Audiogram | 92552 | $63.00 |
| Cholesterol Screening | 822465, 36416 | $28.50 |
| Depression Screen Form (PHQ-9) | 96127 | $14.00 |
| Health Risk Form (CRAFFT) | 96160 | $14.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $359.00 |
*If you cannot afford immunizations and sign a waiver at the visit, those costs will be waived.*
IF ISSUES OUTSIDE OF THE WELLNESS ARE DISCUSSED THERE COULD BE AN ADDITIONAL VISIT CHARGE. This would be APPROXIMATELY $146-$217 depending on the nature of the issue and treatment required.
17 Year Visit
| New Patient | CPT | Price |
|---|---|---|
| 17 Year Wellness | 99384 | $274.00 |
| Snellen Vision Screen | 99173 | $5.50 |
| Audiogram | 92552 | $63.00 |
| Cholesterol Screening | 822465, 36416 | $28.50 |
| Depression Screen Form (PHQ-9) | 96127 | $14.00 |
| Health Risk Form (CRAFFT) | 96160 | $14.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $399.00 | |
| Established Patient | CPT | Price |
| 17 Year Wellness | 99394 | $274.00 |
| Snellen Vision Screen | 99173 | $5.50 |
| Audiogram | 92552 | $63.00 |
| Cholesterol Screening | 822465, 36416 | $28.50 |
| Depression Screen Form (PHQ-9) | 96127 | $14.00 |
| Health Risk Form (CRAFFT) | 96160 | $14.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $359.00 |
*If you cannot afford immunizations and sign a waiver at the time of the visit, those fees will be waived.*
IF ISSUES OUTSIDE OF THE WELLNESS ARE DISCUSSED THERE COULD BE AN ADDITIONAL VISIT CHARGE. This would be APPROXIMATELY $146-$217 depending on the nature of the issue and treatment required.
18+ Month Visit
| New Patient | CPT | Price |
|---|---|---|
| 18 Year Wellness | 99385 | $267.00 |
| Snellen Vision Screen | 99173 | $5.50 |
| Audiogram | 92552 | $63.00 |
| Cholesterol Screening | 822465, 36416 | $28.50 |
| Depression Screen Form (PHQ-9) | 96127 | $14.00 |
| Health Risk Form (CRAFFT) | 96160 | $14.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $392.00 | |
| Established Patient | CPT | Price |
| 18 Year Wellness | 99395 | $240.00 |
| Snellen Vision Screen | 99173 | $5.50 |
| Audiogram | 92552 | $63.00 |
| Cholesterol Screening | 822465, 36416 | $28.50 |
| Depression Screen Form (PHQ-9) | 96127 | $14.00 |
| Health Risk Form (CRAFFT) | 96160 | $14.00 |
| Immunizations as needed | $20.13 each* | |
| TOTAL (does not include immunizations) | $365.00 |
*If you cannot afford immunizations and sign a waiver at the time of the visit, those fees will be waived.*
IF ISSUES OUTSIDE OF THE WELLNESS ARE DISCUSSED THERE COULD BE AN ADDITIONAL VISIT CHARGE. This would be APPROXIMATELY $146-$217 depending on the nature of the issue and treatment required.
