Fee Schedule

New Exams

Office Visit - 99201 - $50
Office Visit - 99202 - $80
Office Visit - 99203 - $120
Office Visit - 99204 - $170
Office Visit - 99205 - $210

Re-Check Exam or New Complaint

(Only used for new complaints or re-evaluation of existing complaint)

Office Visit-est'd - 99211 - $25
Office Visit-est'd - 99212 - $50
Office Visit-est'd - 99213 - $80
Office Visit-est'd - 99214 - $115
Office Visit-est'd - 99215 - $150

Therapies

Therapeutic Activity - 97530 - $32
PT Exercises - 97110 - $34
Manual Therapy - 97140 - $40
Infrared Laser - 97026 - $10
Dry Needling - 20561 - $50

Chiropractic Manipulative Therapy (CMT)

Spinal 1-2 segments - 98940 - $28
Spinal 3-4 segments - 98941 - $34
Spinal 5 segments - 98942 - $50
Extra-Spinal - 98943 - $25

Disclaimer

This Good Faith Estimate is not a contract and does not require you to obtain the services or items from the providers or facility identified in it. You have the right to request another Good Faith Estimate at any time during your course of care. This Good Faith Estimate shows the costs of items and services that are reasonably expected based on your health care needs. If the actual billed service charges exceed this estimate by $400 or more, then you (the patient) have the right to dispute the bill via the patient-provider dispute resolution process with the U.S. Department of Health and Human Services (HHS). For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call the No Surprises Help Desk at 1-800-985-3059.

Subsequent visits typically range from $60-$95 depending on treatment received.

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