Prices of Common Services
Pricing Details
The listed price reflects the undiscounted rate. The price you pay for a service or procedure may differ from the amount stated on this list, depending on your sliding fee discount and insurance plan benefits.
Please email billing@anhc.org to request a price estimate. Within 3 to 10 business days after you request an estimate, you will be provided with an estimate of the anticipated charges for your non-emergency care.
Procedure codes are numbers used to report the health care services provided to a patient. They are used for billing purposes.
Evaluation & Management
Brief virtual check-in with an established patient (5–10 minutes)
Procedure code: 98016
2025 Price: $164.00
2026 Price: $164.00
New patient office visit (level III)
Procedure code: 99203
2025 Price: $483.00
2026 Price: $507.00
New patient office visit (level IV)
Procedure code: 99204
2025 Price: $869.00
2026 Price: $869.00
Established patient office visit (level II)
Procedure code: 99212
2025 Price: $245.00
2026 Price: $257.00
Established patient office visit (level III)
Procedure code: 99213
2025 Price: $394.00
2026 Price: $411.00
Established patient office visit (level IV)
Procedure code: 99214
2025 Price: $555.00
2026 Price: $585.00
Established patient office visit (level V)
Procedure code: 99215
2025 Price: $781.00
2026 Price: $830.00
Established patient (under age 1) preventive visit
Procedure code: 99391
2025 Price: $424.00
2026 Price: $424.00
Established patient (age 1–4) preventive visit
Procedure code: 99392
2025 Price: $340.00
2026 Price: $340.00
Initial hospital care for a normal newborn
Procedure code: 99462
2025 Price: $336.00
2026 Price: $336.00
Medicine & Behavioral Health
Vaccine administration fee (children, first vaccine)
Procedure code: 90460
2025 Price: $105.00
2026 Price: $105.00
Vaccine administration fee (children, each additional vaccine)
Procedure code: 90461
2025 Price: $69.00
2026 Price: $69.00
Vaccine administration fee (adults, first vaccine)
Procedure code: 90471
2025 Price: $61.00
2026 Price: $96.00
Vaccine administration fee (adults, each additional vaccine)
Procedure code: 90472
2025 Price: $54.00
2026 Price: $70.00
TDAP (vaccine to prevent diphtheria, pertussis, and tetanus)
Procedure code: 90715
2025 Price: $83.00
2026 Price: $83.00
Shingrix (vaccine to prevent shingles)
Procedure code: 90750
2025 Price: $250.00
2026 Price: $250.00
Behavioral health appointment (30 minutes)
Procedure code: 90832
2025 Price: $203.00
2026 Price: $285.00
Behavioral health appointment (45 minutes)
Procedure code: 90834
2025 Price: $260.00
2026 Price: $368.00
Behavioral health appointment (60 minutes)
Procedure code: 90837
2025 Price: $280.00
2026 Price: $537.00
Therapeutic, prophylactic, or diagnostic substance injection via intramuscular or subcutaneous route
Procedure code: 96372
2025 Price: $190.00
2026 Price: $190.00
Pathology/Lab
Complete metabolic panel
(glucose level, electrolyte and fluid balance, kidney and liver function)
Procedure code: 80053
2025 Price: $110.00
2026 Price: $110.00
Lipid panel
(measurement of fats and fatty substances in blood)
Procedure code: 80061
2025 Price: $138.00
2026 Price: $138.00
Urinalysis, by dip stick or tablet reagent
(detects substances in urine associated with different metabolic and kidney disorders)
Procedure code: 81001
2025 Price: $48.00
2026 Price: $48.00
Blood sugar measurement
Procedure code: 83036
2025 Price: $95.00
2026 Price: $95.00
Thyroid stimulating hormone
(measurement of thyroid gland function)
Procedure code: 84443
2025 Price: $138.00
2026 Price: $138.00
Complete blood count
(measurement of red blood cells, white blood cells, and platelets)
Procedure code: 85025
2025 Price: $80.00
2026 Price: $80.00
Complete blood count
(measurement of red blood cells, white blood cells, platelets, hemoglobin, hematocrit)
Procedure code: 85027
2025 Price: $47.00
2026 Price: $47.00
Evaluation of patient’s serum for antibodies to hepatitis C virus
Procedure code: 86803
2025 Price: $145.00
2026 Price: $145.00
Test for chlamydia trachomatis using amplified nucleic acid probe technique
Procedure code: 87491
2025 Price: $220.00
2026 Price: $220.00
Test for Neisseria gonorrhoeae using amplified nucleic acid probe technique
Procedure code: 87591
2025 Price: $220.00
2026 Price: $220.00
Radiology
X-ray of chest (single view)
Procedure code: 71045
2025 Price: $69.00
2026 Price: $110.00
X-ray of chest (2 views)
Procedure code: 71046
2025 Price: $236.00
2026 Price: $236.00
X-ray of spine (2 views)
Procedure code: 72100
2025 Price: $295.00
2026 Price: $295.00
X-ray of shoulder (2 views)
Procedure code: 73030
2025 Price: $280.00
2026 Price: $280.00
X-ray of hand (3+ views)
Procedure code: 73130
2025 Price: $227.00
2026 Price: $227.00
X-ray of hip (2–3 views)
Procedure code: 73502
2025 Price: $280.00
2026 Price: $280.00
X-ray of knee (1 or 2 views)
Procedure code: 73560
2025 Price: $275.00
2026 Price: $275.00
X-ray of foot (1 view)
Procedure code: 73620
2025 Price: $200.00
2026 Price: $200.00
3D X-ray to screen for breast cancer
Procedure code: 77063
2025 Price: $364.00
2026 Price: $364.00
X-ray to screen for breast cancer
Procedure code: 77063
2025 Price: $1,072.00
2026 Price: $1,072.00
Surgery
Removal of skin tags (1–15 tags)
Procedure code: 11200
2025 Price: $525.00
2026 Price: $525.00
Insertion of Implanon birth control device under the skin
Procedure code: 11981
2025 Price: $800.00
2026 Price: $800.00
Removal of a contraceptive implant from the arm
Procedure code: 11982
2025 Price: $968.00
2026 Price: $968.00
Destruction of benign lesions using techniques such as cryosurgery
Procedure code: 17110
2025 Price: $639.00
2026 Price: $639.00
Removal of fluid or injection for diagnosis and/or to relieve pain and swelling in the joint
(one or both sides)
Procedure code: 20610
2025 Price: $485.00
2026 Price: $485.00
Placement of contraceptive intrauterine device (IUD) in uterine cavity
Procedure code: 58300
2025 Price: $785.00
2026 Price: $785.00
Removal of contraceptive intrauterine device (IUD) in uterine cavity
Procedure code: 58301
2025 Price: $600.00
2026 Price: $600.00
Measurement of the fetal heart rate of a fetus in response to its own movements
Procedure code: 59025
2025 Price: $389.00
2026 Price: $389.00
Admission to the hospital for delivery, labor management
(including induction of labor, fetal monitoring, use of low forceps, and episiotomy, vaginal delivery of the fetus and placenta on the same date of service)
Procedure code: 59409
2025 Price: $5,134.00
2026 Price: $5,134.00
Cesarean delivery only
Procedure code: 59514
2025 Price: $6,100.00
2026 Price: $6,100.00
Flush or wash out entrapped wax from a patient’s external ear canal
(with a stream of water to correct hearing loss or discomfort)
Procedure code: 69209
2025 Price: $90.00
2026 Price: $90.00
Dental
Dental exam (established patients)
Procedure code: D0120
Price: $99.00
Dental exam (specific problem)
Procedure code: D0140
Price: $166.00
Comprehensive oral evaluation
Procedure code: D0150
Price: $175.00
Periapical X-ray (first x-ray)
A periapical X-ray captures the whole tooth, showing everything from the chewing surface of the tooth to the tip of the root.
Procedure code: D0220
Price: $50.00
Periapical X-ray (each additional X-ray)
Procedure code: D0230
Price: $45.00
Bitewing x-rays (set of 4)
A bitewing X-ray consists of four films (two on each side) which are necessary to capture all the crowns of the back teeth.
Procedure code: D0274
Price: $111.00
Panoramic X-ray
A panoramic X-ray is a two-dimensional X-ray that captures a picture of the entire mouth in just one image.
Procedure code: D0330
2025 price: $188.00
Cleaning (to prevent gum disease)
Procedure code: D1110
Price: $165.00
Fluoride application (to prevent tooth decay)
Procedure code: D1206
Price: $35.00
Periodontal maintenance
Periodontal maintenance includes removal of hard and soft deposits from above and below the gum.
Procedure code: D4910
Price: $251.00
Simple extraction of erupted tooth or exposed root
Procedure code: D7140
Price: $316.00
CPT Copyright 2025, American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the American Medical Association. The CPT codes are provided "as is" without warranty of any kind. The AMA specifically disclaims all liability for use or accuracy of any CPT codes. The undiscounted price may differ from what the patient actually pays. You will be provided an estimate of services upon written request.
ANHC’s In-Network Preferred Providers
What does "in-network" mean?
A provider is considered in-network when they have a contract with your health insurance company to offer services at negotiated, lower rates. Choosing an in-network provider typically means lower costs for you.
If a provider does not have a contract with your insurance company, they are considered out-of-network. Visiting an out-of-network provider may result in higher out-of-pocket costs.
What About Out-of-Pocket Costs?
Even when your ANHC provider is in-network, some services or procedures may not be fully covered by your insurance plan. Depending on your benefits, you may still be responsible for copays, deductibles, or other out-of-pocket expenses.
Insurance Plans Accepted at ANHC
Medical
Aetna
Medicaid
Medicare
Moda
Premera Blue Cross Blue Shield
TriWest
Dental
Cigna Dental
Delta Dental
Medicaid
Premera Blue Cross Blue Shield Dental
Metlife Dental
United Concordia