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Price Sheet
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75%
50%
25%
Receipt
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NEW PT/OFFICE
99202
99203
99204
EST. PT/OFFICE
99211 (RN)
99212
99213
99214
IE / NEW PT
99384 (12–17)
99385 (18–39)
99386 (40–64)
AE / EST. PT
99394 (12–17)
99395 (18–39)
99396 (40–64)
Procedures
LIQUID BASED PAP
Z12.488142
CONV PAP
Z12.488164
HPV
Z11.51 87624
PATHOLOGY FEE
88141
WET MOUNT
N898
87210
CHL
Z11.3 87491
x2
x3
GC
Z11.3 87591
x2
x3
Female GENITAL WART TX
56501 A63.0
Male GENITAL WART TX
54050 A63.0
RAPID HIV
Z11.4/Z578 86703
SERUM HIV
Z11.4 87389
RPR (SYPHILIS)
Z11.3 86592
TPPA (SYPHILIS)
Z11.3 86593
HSV PCR
HSV SERUM
URINE DIP
INJ. FEE (STI TX)
Z11.3 96372
INJ. FEE (DEPO)
Z30.013/Z30.42
VENIPUNCTURE
Z11.3 36415
Pregnancy Test
POS hCG
Z32.01 81025
NEG hCG
Z32.02 81025
Medication - Initial & Repeat Codes
APRI
Z30.011 / Z30.41
CAMILA
Z30.011 / Z30.41
DEPO
Z30.013 / Z30.42
NUVA RING
Z30.015 / Z30.44
NEXPLANON
Z30.017 / (I&R)Z30.46
PARAGARD IUD
Z30.430 / (I&R)Z30.46
IMPLANT INSERT
Z30.017
IMPLANT REMOVAL
Z30.46
DOXYCYCLINE
ROCEPHIN
BICILLIN
AZITHROMYCIN
SUPRAX