Insurance pricing consists of multiple factors
- E&M code with the visit complexity
- CPT Codes: In-house labs, in-house procedures, in-house x-ray, medical supplies, medication, DME supplies given while you were at the clinic
- Most private insurance company pays certain percentage of billed rate and never full rates.
- Each private insurance companies have negotiated different rates with each medical practices. Smaller practices do not have negotiating power, so usually their rates tend to be cheaper than large corporate practices attached to the hospital system or with hundreds of clinics. For detailed rates, please contact your insurance company.
- Co-Pay
- Co-Insurance
- Deductible
- Out of Pocket Maximum
*Participation in self-pay pricing cannot be used in combination with commercial insurance benefits nor can it be provided to patients participating in U.S. government health plans. Please note that some procedures are excluded from self-pay pricing. We reserve the right to change our pricing at any time, without prior notice. For more pricing information, please contact a clinic near you.
**You have the right to receive a “Good Faith Estimate” explaining how much your health care will cost.
Under the law, health care providers need to give patients who don’t have certain types of health care coverage or who are not using certain types of health care coverage an estimate of their bill for health care items and services before those items or services are provided.
- You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
- If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling. You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask.
- If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises/consumers, email FederalPPDRQuestions@cms.hhs.gov, or call 1- 800-985-3059.