Understand Your Healthcare
At Eastern Plains Medical Clinic, one of our pillars is transparency and ensuring that you are always aware of your health care treatment plans and costs of services. Regardless if you have insurance or not, our team will always discuss your options with you and make sure you know how much you can expect to spend.
If there’s ever a time when we’re unable to give you an exact cost, we will do our best to provide an estimate that’s as accurate as possible. In addition, we will make all financial information available to you so you can understand your financial responsibilities and make informed decisions regarding your healthcare.
We want to make sure you understand your financial rights as a patient. Remember, these rights always apply to you no matter where you receive medical services.
The Federal Government has enacted legal requirements and initiated programs to publicize costs associated with certain health care services. This mandate attempts to promote efforts to improve transparency in health charges and provider payments.
Effective January 1, 2021, CMS requires hospitals to make available a list of their current standard charges,
cash prices of services for self-pay and uninsured patients, insured patient out-of-pocket pricing on a select group of common services, pay or specific contract rates for services and the de-identified minimum and maximum contract rate for each service. The information provided below is intended to meet the
requirements of the CMS regulation. Actual charges on the final bill, and corresponding patient out-of-pocket pricing, may vary for a variety of reasons which may include the patient’s medical condition, additional tests or procedures, unknown circumstances or complications, final diagnosis, and treatment ordered by the attending provider and care received.
Please be advised that while we attempt to estimate the cost of care as accurately as possible, there may be significant variations between the estimate provided and the price reflected on your final bill.
The pricing only covers the specific service listed and provided through Eastern Plains Medical Clinic and
does not provide pricing in situations where services are provided by healthcare providers and or facilities
that are not employed by Eastern Plains Medical Clinic. Please contact them directly for price information associated with care and services received from them.
| CPT Code | Description | Cost |
|---|---|---|
| 0001A | COVID 19 Vaccine Administration | $50.00 |
| 10060 | I & D SIMPLE | $152.00 |
| 10061 | I & D COMPLEX | $247.00 |
| 10120 | REMOVE FOREIGN BODY | $200.00 |
| 11102 | BIOPSY OF SKIN LESION | $152.00 |
| 11200 | REMOVAL OF SKIN TAGS | $105.00 |
| 11730 | REMOVAL OF NAIL PLATE | $152.00 |
| 11981 | INSERT DRUG IMPLANT DEVICE | $200.00 |
| 11982 | REMOVE DRUG IMPLANT DEVICE | $200.00 |
| 12001 | LACERATION REPAIR; 2.5 CM OR LESS | $152.00 |
| 12011 | REPAIR SUPERFICIAL WOUND(S) | $152.00 |
| 17000 | DESTROY BENIGN/PREMLG LESION OR WART | $105.00 |
| 17003 | DESTROY LESIONS, 2-14 | $57.00 |
| 20550 | INJ TENDON SHEATH/LIGAMENT | $105.00 |
| 20552 | INJECT TRIGGER POINT, 1 OR 2 | $57.00 |
| 20600 | DRAIN/INJECT, JOINT/BURSA | $105.00 |
| 20610 | DRAIN/INJECT, JOINT/BURSA; MAJOR JOINT | $120.00 |
| 28190 | REMOVAL OF FOOT FOREIGN BODY | $143.00 |
| 58300 | IUD INSERTION | $247.00 |
| 58301 | IUD REMOVAL | $200.00 |
| 69200 | FOREIGN BODY/EAR | $152.00 |
| 69210 | EAR IRRIGATION | $57.00 |
| 81002 | URINALYSIS (UA) | $28.00 |
| 81025 | URINE PREGNANCY TEST | $57.00 |
| 82272 | OCCULT BLOOD, FECES, SINGLE | $10.00 |
| 82947 | ASSAY, GLUCOSE, BLOOD QUANT | $27.00 |
| 85018 | HEMOGLOBIN | $24.00 |
| 85610 | INR | $28.00 |
| 87426 | COVID 19 Rapid antigen test | $45.00 |
| 87804 | INFLUENZA ASSAY W/OPTIC | $57.00 |
| 87880 | STREP A ASSAY W/OPTIC | $31.00 |
| 90471 | IMMUNIZATION ADMIN | $15.00 |
| 90472 | IMMUNIZATION ADMIN, EACH ADD | $10.00 |
| 90473 | IMMUNE ADMIN ORAL/NASAL | $25.00 |
| 93000 | ELECTROCARDIOGRAM, COMPLETE | $74.00 |
| 93005 | EGC, technical component | $42.00 |
| 93010 | ELECTROCARDIOGRAM REPORT | $57.00 |
| 94010 | SPIROMETRY | $70.00 |
| 94640 | NEBULIZER | $57.00 |
| 94761 | MEASURE BLOOD OXYGEN LEVEL | $57.00 |
| 96127 | BRIEF EMOTIONAL/BEHAV ASSMT | $10.00 |
| 96372 | THER PROPH DIAG INJ, SC IM | $30.00 |
| 97602 | WOUND(S) CARE NON-SELECTIVE | $57.00 |
| 99202 | Office Visit, New Pt., Level 2 | $200.00 |
| 99203 | Office Visit, New Pt., Level 3 | $250.00 |
| 99204 | Office Visit, New Pt., Level 4 | $319.00 |
| 99205 | Office Visit, New Pt., Level 5 | $402.00 |
| 99211 | Office Visit, Est Pt., Level 1 | $57.00 |
| 99212 | Office Visit, Est Pt., Level 2 | $110.00 |
| 99213 | Office Visit, Est Pt., Level 3 | $142.00 |
| 99214 | Office Visit, Est Pt., Level 4 | $209.00 |
| 99215 | Office Visit, Est Pt., Level 5 | $281.00 |
| 99381 | Preventive Care New Pt. Age less than 1 Year | $175.00 |
| 99382 | Preventive Care New Pt. Age 1-4 | $185.00 |
| 99383 | Preventive Care New Pt. Age 5-11 | $195.00 |
| 99384 | Preventive Care New Pt. Age 12-17 | $210.00 |
| 99385 | Preventive Care New Pt. Age 18-39 | $225.00 |
| 99386 | Preventive Care New Pt. Age 40-64 | $250.00 |
| 99387 | Preventive Care New Pt. Age 65 and over | $275.00 |
| 99391 | Preventive Care Est. Pt. Age less than 1 Year | $152.00 |
| 99392 | Preventive Care Est. Pt. Age 1-4 | $170.00 |
| 99393 | Preventive Care Est. Pt. Age 5-11 | $185.00 |
| 99394 | Preventive Care Est. Pt. Age 12-17 | $200.00 |
| 99395 | Preventive Care Est. Pt. Age 18-39 | $215.00 |
| 99396 | Preventive Care Est. Pt. Age 40-64 | $225.00 |
| 99397 | Preventive Care Est. Pt. Age 65 and over | $250.00 |
| 99406 | BEHAV CHNG SMOKING 3-10 MIN | $28.00 |
| 99407 | BEHAV CHNG SMOKING < 10 MIN | $57.00 |
| 99495 | TRANS CARE MGMT 14 DAY DISCH | $195.00 |
| 99496 | TRANS CARE MGMT 7 DAY DISCH | $235.00 |
| 99497 | ADVNCD CARE PLAN 30 MIN | $142.00 |
| G0296 | Counseling for lung cancer screening | $35.00 |
| G0402 | Welcome to Medicare Visit | $250.00 |
| G0438 | ANNUAL WELLNES VST; PERSNL PPS INIT | $250.00 |
| G0439 | ANNUAL WELLNESS VST; PPS SUBSQT VST | $200.00 |
| G0506 | CCM-Face to Face | $64.00 |
| G0511 | CCM 20 MIN IN RHC/FQHC | $80.00 |
| G2025 | RHC Distant Site Telehealth Services | $180.00 |
| J7296 | KYLEENA 19.5 MG | $1,000.00 |
| J7298 | MIRENA LNG-RELEASING IUD SYS 52MG 5 YR DUR | $1,075.00 |
| J7300 | INTRAUTERINE COPPER CONTRACEPTIVE | $900.00 |
| J7301 | LEVONORGESTREL-REL IUD 13.5 MG | $904.00 |
| J7307 | NEXPLANON (ETONOGESTREL) IMPLANT SYSTEM | $1,000.00 |
At Eastern Plains Medical Clinic, You Come First
Whether you’re a long-term patient or visit us for the first time for a sprained ankle, we will always discuss your financial obligations with you before treatment. At Eastern Plains Medical Clinic, our entire team is committed to ensuring you have all the information you need to be comfortable making decisions about your care. The next time you need to see someone, make sure to visit us and experience a higher level of healthcare.
