# IntegrativeGyn.com

> Independent 2026 cost, CPT/ICD-10 reimbursement, clinical-protocol and practice-economics reference for integrative gynecology, bioidentical hormone therapy (BHRT) and direct specialty care (DSC) women's health in the United States. Four interactive calculators with shareable URL parameters; 54 pages. Educational information, not medical advice. Updated 2026-11-07.

Cite as: IntegrativeGyn.com (https://integrativegyn.com/). Full text of every page: https://integrativegyn.com/llms-full.txt

## Core data (2026)

### Out-of-network superbill math
- Reimbursement = (allowable − remaining OON deductible) × plan coinsurance; allowable = lesser of billed charge and the plan's UCR amount.
- CMS Medicare 2026 national non-facility baselines: CPT 99205 ≈ $236.81; CPT 99215 ≈ $183.50; CPT 99417 ≈ $32.50 per 15-minute unit; CPT 11980 ≈ $105 (procedure only).
- Typical commercial PPO allowables as a share of Medicare: Tier 1 metros (NYC, SF Bay Area, Los Angeles/Orange County, Boston, Washington DC) 220–280%; Tier 2 (Chicago, Atlanta, Austin, Dallas–Fort Worth, Houston, Miami, Phoenix, Denver, Seattle) 170–215%; Tier 3 regional/suburban (e.g., Nashville) 135–165%.
- Resulting commercial ranges: 99205 $260–$485 (to $550+ in NYC/SF/LA); 99215 $195–$365; 99417 $45–$95 per unit; 99404 $140–$295.
- 99404 billed with 99205/99215 is denied unless modifier 25 is on the E/M line and 99404 points to a preventive Z-code (e.g., Z71.89), not to N95.1 or E28.2.
- Concierge/membership access fees are not CPT-coded services and are not reimbursed by insurers; they may be HSA/FSA-payable only with a Letter of Medical Necessity under IRS §213(d) — confirm with the plan administrator.
- Hormone pellets: CPT 11980 + J3490 (compounded drug) are denied as investigational for women by most (>85%) commercial payers.

### Patient price benchmarks
- Boutique cash-pay integrative GYN: $350–$650 intake; $175–$350/month retainer ($2,100–$4,200/yr) or $180–$350 per follow-up.
- Hormone pellet clinics: $600–$1,200 per insertion, 3–4 times a year ($2,100–$4,200/yr) plus $80–$180/month nutraceutical bundles.
- Insurance-backed virtual menopause care (e.g., Midi Health): ~$250 self-pay intake or $30–$60 in-network copay; $150 self-pay follow-up.
- Hybrid memberships: Parsley Health ~$150/month plus copays; Tia ~$15–$25/month navigation fee plus in-network billing.
- DTC compounded telehealth: Winona $54–$89/month estrogen cream, $39/month progesterone, $149/month patches; Alloy $40–$120/month.
- FDA-approved transdermal estradiol + oral micronized progesterone: typically $15–$45/month with insurance.

### Functional lab prices (practitioner wholesale → clinic retail)
- DUTCH Complete $300–$395 → $449–$550 (cash-only). DUTCH Plus $395–$475 → $550–$675.
- GI-MAP + zonulin $310–$355 → $425–$549. Genova NutrEval $329–$420 → $450–$620 (list billed to insurance $1,850–$2,499).
- Comprehensive serum hormone + thyroid panel $85–$145 wholesale → $175–$295 cash; $950–$1,650 if billed at list after a medical-necessity failure.
- Hybrid strategy (serum on an insurance requisition with ICD-10 support, specialty tests at wholesale) typically saves $650–$1,400 per workup.

### Physician practice economics
- Insurance OB/GYN: 2,200–3,000 patients, 24–32 visits/day (~11 minutes), 6,200–7,500 wRVUs at $40–$46/wRVU, 58–66% overhead, $310k–$420k net with OB call.
- Integrative GYN micro-practice (GYN-only): 250–400 members; 300 × $200/month = $720k; dispensary ~$91k net; ancillary ~$140k; ~$951k gross; 28–34% overhead (~$285k); $640k–$680k physician net, 4 days/week, no L&D call. GYN-only malpractice ~$18k–$26k/yr vs ~$85k with obstetrics.

## Calculator URL parameters
- /calculators/membership-superbill-reimbursement-calculator/ — model (retainer|ffs|hybrid|tele), fee, tier (1|2|3), fu, pro, prev, dutch, gimap, serum (ins|cash|none), ded, coins (50|60|70|80), tax.
- /calculators/bhrt-pellet-vs-patch-cost-calculator/ — base (pellet|patch|cream|tele), ins (3|4), pfee, boost, nutra, channel (ins|cash), copay, comp, tsub.
- /calculators/functional-lab-panel-cost-builder/ — cond (peri,pcos,endo,weight,bv,pbcs,fert), ch (retail|wholesale|hybrid).
- /calculators/obgyn-concierge-practice-transition-calculator/ — vol, days, wrvu, cf, oh, mal, panel, fee, dropob, supp, ancil.

## Calculators

- [Superbill net-cost calculator](https://integrativegyn.com/calculators/membership-superbill-reimbursement-calculator/): Free calculator that estimates out-of-network superbill reimbursement for integrative gynecology visits (CPT 99205, 99215, 99417, 99404) by metro tier, deductible, coinsurance and HSA/FSA tax bracket, and shows true net yearly cost.
- [BHRT 3-year cost comparator](https://integrativegyn.com/calculators/bhrt-pellet-vs-patch-cost-calculator/): Free calculator comparing the 1-year and 3-year cost and cost per day of hormone pellets, FDA-approved transdermal estradiol with oral progesterone, compounded BHRT cream and telehealth HRT subscriptions, with a pharmacokinetics comparison.
- [Lab panel cost builder](https://integrativegyn.com/calculators/functional-lab-panel-cost-builder/): Free builder that maps integrative gynecology symptoms to insurance-billable serum markers with ICD-10 justification codes and to cash-only specialty tests (DUTCH, GI-MAP, NutrEval, vaginal microbiome), and prices the workup by retail, wholesale or hybrid channel.
- [OB/GYN practice P&L simulator](https://integrativegyn.com/calculators/obgyn-concierge-practice-transition-calculator/): Free B2B simulator comparing an insurance OB/GYN practice with a cash-pay integrative gynecology micro-practice: membership, dispensary and ancillary revenue, overhead, malpractice, net income, hourly rate, break-even members and a 12-month ramp.

## Pillar guides

- [Superbill, CPT & HSA/FSA guide](https://integrativegyn.com/guides/out-of-network-superbill-cpt-codes-hsa-fsa-guide/): How out-of-network superbills for integrative gynecology are paid: CPT 99205, 99215, 99417, 99404 with modifier 25, allowable math, deductible examples, required superbill fields, denial appeals and an HSA/FSA Letter of Medical Necessity template.
- [DSC OB/GYN transition blueprint](https://integrativegyn.com/for-physicians/direct-specialty-care-obgyn-transition-blueprint/): B2B blueprint for OB/GYNs leaving insurance volume medicine for a cash or hybrid integrative gynecology micro-practice: P&L comparison, break-even members, CPOM and MSO structure, Medicare opt-out, malpractice changes, tech stack and a 12-month ramp.

## Comparisons

- [Midi vs Tia vs Parsley](https://integrativegyn.com/compare/midi-health-vs-tia-vs-parsley-health/): Midi (insurance-billed menopause telehealth, no membership), Tia (small membership plus in-network care) and Parsley Health (about $150/month functional medicine) compared on fees, coverage, labs and HRT, with 12-month cost estimates.
- [Winona vs Evernow vs Alloy](https://integrativegyn.com/compare/winona-vs-evernow-vs-alloy-menopause-hrt/): Winona (compounded creams plus patches), Evernow and Alloy (FDA-approved estradiol and progesterone) compared on monthly price, product type, labs and safety checks, with 12-month math against generic HRT through insurance.
- [BioTE vs EvexiPEL vs SottoPelle](https://integrativegyn.com/compare/biote-vs-evexipel-vs-sottopelle-hormone-pellets/): BioTE, EvexiPEL and SottoPelle are pellet-therapy networks whose member clinics typically charge $600–$1,200 per female insertion three to four times a year, plus consults, labs and optional supplements, with little insurance coverage. Compared with FDA-approved transdermal HRT.
- [Pellets vs estradiol patches](https://integrativegyn.com/compare/hormone-pellets-vs-transdermal-estradiol-patches/): Pellets typically cost $6,300–$16,800 over three years with little insurance coverage; FDA-approved estradiol patches plus oral progesterone cost $1,290–$3,720 through insurance. Patches give steady, adjustable levels; pellets cannot be adjusted once inserted.
- [DUTCH vs serum hormone panel](https://integrativegyn.com/compare/dutch-complete-test-vs-standard-serum-hormone-panel/): DUTCH Complete costs $449–$550 cash and measures urine hormone metabolites and daily cortisol; a serum panel costs $0–$250 through insurance and remains the standard for diagnosis, thyroid and metabolic risk. Split serum markers onto insurance and pay cash only for specialty tests.
- [Allara vs cash-pay PCOS care](https://integrativegyn.com/compare/allara-health-vs-cash-pay-integrative-gynecologist-pcos/): Allara Health offers virtual PCOS care with a provider and registered dietitian via membership or insurance; a cash-pay integrative gynecologist offers longer visits, exams and ultrasound access with superbill reimbursement. 12-month costs, lab codes and who fits which.
- [Compounded vs FDA-approved BHRT](https://integrativegyn.com/compare/compounded-bhrt-vs-fda-approved-bioidentical-hormones/): FDA-approved bioidentical estradiol and oral micronized progesterone cost $15–$45 a month through insurance; compounded BHRT runs $65–$160 a month and is not FDA-approved. Covers 503A vs 503B pharmacies, testosterone dosing for women and when compounding makes sense.
- [Integrative GYN vs FM vs ND](https://integrativegyn.com/compare/integrative-gynecologist-vs-functional-medicine-doctor-vs-naturopath/): Integrative OB/GYNs (MD/DO) have full prescribing and surgical scope and reimbursable superbills; functional medicine is a training approach whose scope depends on the underlying license; licensed NDs have state-dependent prescribing, no surgery and limited reimbursement. Fees and fit compared.
- [Vaginal laser vs local estrogen](https://integrativegyn.com/compare/monalisa-touch-laser-vs-vaginal-estrogen-prp-gsm/): Vaginal laser costs $2,400–$3,600 cash for a series and is not FDA-cleared for GSM; low-dose vaginal estradiol is FDA-approved, minimally absorbed and costs $10–$45 a month through insurance. Compares DHEA inserts, PRP and pelvic floor therapy with 3-year costs.
- [Hint vs Cerbo vs Elation (B2B)](https://integrativegyn.com/compare/hint-health-vs-cerbo-vs-elation-emr-integrative-gyn/): B2B comparison of Hint Health plus Elation, Cerbo and Practice Better for integrative GYN micro-practices: membership billing, EPCS for testosterone, Quest/Labcorp and functional-lab links, Fullscript integration, superbills and estimated annual cost per provider.

## Contract & pricing audits

- [Parsley Health cost audit](https://integrativegyn.com/audits/parsley-health-membership-contract-cost-audit/): A 12-month cost audit of a Parsley Health-style hybrid membership: the ~$1,500–$1,800 retainer, how it stacks with in-network copays, cash specialty labs and supplements, and which contract clauses to check before signing.
- [Tia billing audit](https://integrativegyn.com/audits/tia-health-membership-in-network-billing-audit/): A billing audit of a Tia-style hybrid clinic: a small annual membership plus in-network insurance billing, why high-deductible members get split-billed preventive visits, a 12-month ledger and the questions to ask first.
- [Midi Health billing audit](https://integrativegyn.com/audits/midi-health-insurance-billing-cpt-code-audit/): A billing and scope audit of insurance-billed menopause telehealth such as Midi Health: no membership fee, CPT codes billed, 12-month cost on PPO, HDHP and self-pay, and what standard visits leave out, including testosterone and specialty labs.
- [BioTE pellet pricing audit](https://integrativegyn.com/audits/biote-hormone-pellet-clinic-pricing-contract-audit/): A 12-month cost and contract audit of female hormone pellet therapy at BioTE-network clinics: $600–$1,200 insertions, labs, supplement bundles, why CPT 11980 and pellet drug codes are rarely reimbursed, HSA/FSA rules and the clauses to request.
- [Concierge retainer red flags](https://integrativegyn.com/audits/concierge-integrative-gyn-retainer-contract-red-flags/): A generic audit of $2,500–$5,000 boutique integrative gynecology retainers: a 12-month ledger by tier and seven fine-print traps (auto-renewal, commitment terms, non-covered services, lab and supplement markups, superbills, price changes, Medicare and HSA status) with wording to request.
- [Functional lab billing audit](https://integrativegyn.com/audits/rupa-health-vs-direct-functional-lab-billing-audit/): A billing audit of functional lab ordering: one DUTCH, GI-MAP and serum workup priced through clinic retail markup, a pass-through ordering platform such as Rupa Health and an insurance hybrid, plus Genova prompt-pay pricing, CPT codes and the clauses to request.
- [Supplement dispensary audit](https://integrativegyn.com/audits/fullscript-dispensary-supplement-markup-audit/): An audit of integrative clinic supplement dispensaries such as Fullscript: 12-month costs for three protocol sizes, how practitioner margins and discounts work, private-label bundles, HSA/FSA rules with ICD-10 examples and an evidence-based triage of common products.
- [Pellet licensing ROI (B2B)](https://integrativegyn.com/audits/evexipel-sottopelle-licensing-roi-audit-for-obgyns/): A B2B ROI audit for OB/GYNs considering pellet licensing programs such as EvexiPEL or SottoPelle: year-one P&L at 60 and 150 patients, break-even on $10k–$25k certification fees, independent 503B sourcing, DEA duties, payer reality and contract clauses to negotiate.

## Condition playbooks

- [Perimenopause protocol](https://integrativegyn.com/conditions/perimenopause-hormone-optimization-protocol-cost/): Perimenopause playbook: why short visits miss it, the serum panel with CPT and ICD-10 codes, FDA-approved first-line options versus compounded and pellets, evidence-graded supplements, and a $480–$5,250 12-month budget.
- [PCOS phenotypes playbook](https://integrativegyn.com/conditions/pcos-four-phenotypes-metabolic-integrative-protocol/): PCOS playbook: Rotterdam phenotypes A–D versus the popular four-type framework, the full PCOS panel with CPT and ICD-10 codes, evidence for metformin, inositol, berberine and GLP-1s, and a $450–$5,420 12-month budget before GLP-1 costs.
- [Endometriosis & adenomyosis](https://integrativegyn.com/conditions/endometriosis-estrobolome-immune-integrative-protocol/): Endometriosis and adenomyosis playbook: imaging-first diagnosis, labs with CPT and ICD-10 codes, FDA-approved hormonal options, excision co-management, honest evidence on LDN and the estrobolome, and a $570–$8,600 12-month budget before surgery.
- [Menopause longevity protocol](https://integrativegyn.com/conditions/menopause-bhrt-cardiovascular-bone-longevity-protocol/): Menopause longevity playbook: who benefits from hormone therapy, transdermal estradiol and micronized progesterone dosing, testosterone for low libido only, ApoB, Lp(a) and DEXA testing with CPT and ICD-10 codes, and a $450–$6,150 annual budget versus pellets.
- [GSM & pelvic floor](https://integrativegyn.com/conditions/genitourinary-syndrome-of-menopause-gsm-pelvic-floor/): GSM and pelvic floor playbook: why short visits miss it, the urinary and vaginal workup with CPT and ICD-10 codes, low-dose vaginal estrogen, prasterone and ospemifene, pelvic floor PT codes, bladder pain care, laser evidence, and a $450–$5,710 12-month budget.
- [Thyroid-ovarian axis](https://integrativegyn.com/conditions/hashimotos-thyroid-ovarian-axis-integrative-gyn/): Thyroid-ovarian axis playbook: how Hashimoto’s and subclinical hypothyroidism affect cycles and fertility, the full thyroid panel with CPT and ICD-10 codes, levothyroxine, T3 and desiccated thyroid evidence, selenium, and a $240–$4,200 12-month budget.
- [Post-birth control recovery](https://integrativegyn.com/conditions/post-birth-control-syndrome-micronutrient-hormone-recovery/): PBCS is not a formal diagnosis, but post-pill SHBG changes, nutrient shifts and unmasked conditions are real. This playbook covers the timed lab panel with CPT/ICD-10 codes, an evidence-graded protocol and a 12-month budget.
- [Recurrent BV & yeast](https://integrativegyn.com/conditions/recurrent-bv-yeast-vaginal-microbiome-pcr-protocol/): Recurrent BV and yeast playbook: why single-course care fails, molecular vs consumer microbiome testing with CPT/ICD-10 codes, CDC-based suppressive, boric acid and partner-treatment protocols, and a 12-month budget.
- [PMDD protocol](https://integrativegyn.com/conditions/pmdd-luteal-phase-progesterone-allopregnanolone-protocol/): PMDD is an abnormal brain sensitivity to normal luteal hormone changes. This playbook covers daily-rating diagnosis, rule-out labs with CPT/ICD-10 codes, FDA-approved SSRI and drospirenone options, evidence-graded supplements and a 12-month budget.
- [Surgical menopause & POI](https://integrativegyn.com/conditions/surgical-menopause-premature-ovarian-insufficiency-poi/): POI and surgical menopause under 45 need hormone therapy until about age 51 to protect bone, heart and brain. This playbook covers the diagnostic workup with CPT/ICD-10 codes, estradiol and progesterone dosing, testosterone, and a 12-month budget.
- [Preconception & luteal phase](https://integrativegyn.com/conditions/unexplained-infertility-luteal-phase-defect-integrative-prep/): Preconception and recurrent pregnancy loss playbook: ASRM-aligned couple workup with CPT/ICD-10 codes, the truth about luteal phase defect and progesterone, evidence-graded CoQ10/NAC protocols, autoimmune screening before IVF, and a 12-month budget.
- [Midlife metabolic & GLP-1](https://integrativegyn.com/conditions/midlife-insulin-resistance-glp1-microdosing-menopause/): Midlife metabolic playbook: why visceral fat rises in menopause, the metabolic panel with CPT/ICD-10 codes, FDA-approved vs compounded GLP-1 status after the shortage ended, muscle-preserving protein, training and creatine, and a 12-month budget.

## Metro pricing hubs

- [New York City](https://integrativegyn.com/locations/new-york-city-integrative-gynecology-cost-clinics/): New York City integrative gynecology benchmarks for 2026: $500–$850 intakes, $3,000–$6,000 retainers, Tier 1 out-of-network allowables for 99205/99215, the local clinic landscape by model type, and New York telehealth, testosterone and CPOM rules.
- [Los Angeles & Orange County](https://integrativegyn.com/locations/los-angeles-orange-county-integrative-gynecology/): Los Angeles and Orange County integrative gynecology benchmarks for 2026: $450–$800 intakes, $2,700–$5,400 retainers, Tier 1 out-of-network math for Blue Shield and Anthem PPOs, why Kaiser HMOs pay nothing, the local landscape by model type, and California telehealth, testosterone and CPOM rules.
- [San Francisco Bay Area](https://integrativegyn.com/locations/san-francisco-bay-area-integrative-gynecology/): San Francisco Bay Area integrative gynecology benchmarks for 2026: $475–$825 intakes, $2,800–$5,500 retainers, Tier 1 out-of-network math for tech-employer PPOs and HSA plans, academic and boutique options including the UCSF Osher Center, and California telehealth, testosterone and CPOM rules.
- [Chicago](https://integrativegyn.com/locations/chicago-integrative-gynecology-cost-clinics/): Chicago and North Shore integrative gynecology benchmarks for 2026: $375–$650 intakes, $2,100–$4,200 retainers, Tier 2 out-of-network math for BCBSIL and other PPOs, academic options such as the Northwestern Osher Center, and Illinois telehealth, controlled-substance and CPOM rules.
- [Atlanta](https://integrativegyn.com/locations/atlanta-integrative-gynecology-cost-clinics/): Atlanta integrative gynecology benchmarks for 2026: $350–$600 intakes, $1,980–$3,900 retainers, Tier 2 out-of-network math for Anthem and other PPOs, a pellet vs FDA-approved BHRT cost audit, the local landscape by model type, and Georgia telehealth, testosterone and CPOM rules.
- [Austin](https://integrativegyn.com/locations/austin-integrative-gynecology-cost-clinics/): Austin and Central Texas integrative gynecology benchmarks for 2026: $375–$625 intakes, $2,100–$4,200 retainers, a pellet vs transdermal HRT cost comparison, Tier 2 out-of-network math for BCBSTX, HealthSelect and tech-employer PPOs, and Texas telemedicine, testosterone and CPOM rules.
- [Dallas–Fort Worth](https://integrativegyn.com/locations/dallas-fort-worth-integrative-gynecology/): Dallas–Fort Worth integrative gynecology benchmarks for 2026: $350–$625 intakes, $2,000–$4,200 concierge retainers, a pellet market audit for BioTE’s home metro, Tier 2 out-of-network math for corporate PPOs, the local landscape by model type, and Texas telemedicine, testosterone and CPOM rules.
- [Houston](https://integrativegyn.com/locations/houston-integrative-gynecology-cost-clinics/): Houston integrative gynecology benchmarks for 2026: $350–$600 intakes, $1,900–$3,900 retainers, Tier 2 out-of-network math for energy-sector and other PPOs, Texas Medical Center and functional hormone clinic options, guidance for cancer survivors, and Texas telemedicine, testosterone and CPOM rules.
- [Miami & South Florida](https://integrativegyn.com/locations/miami-south-florida-integrative-gynecology/): South Florida integrative gynecology runs $400–$700 per intake and $2,400–$6,000 per year for concierge care; Tier 2 OON allowables are about 170–215% of Medicare. Florida lets registered out-of-state clinicians treat by telehealth.
- [Scottsdale & Phoenix](https://integrativegyn.com/locations/scottsdale-phoenix-integrative-gynecology/): Phoenix and Scottsdale integrative gynecology runs $350–$600 per intake and $1,800–$4,200 per year for concierge care; pellet clinics are dense. Arizona NDs have broad prescribing scope, and Tier 2 OON allowables are about 170–215% of Medicare.
- [Denver & Boulder](https://integrativegyn.com/locations/denver-boulder-integrative-gynecology/): Denver and Boulder integrative gynecology runs $375–$625 per intake and $2,000–$4,200 per year for concierge care. Tier 2 OON allowables are about 170–215% of Medicare, but many Coloradans have HMO plans with no OON benefit.
- [Seattle & Bellevue](https://integrativegyn.com/locations/seattle-bellevue-integrative-gynecology/): Seattle and Bellevue integrative gynecology runs $375–$650 per intake and $2,100–$4,500 per year for concierge care. Washington plans must include naturopathic physicians, and Tier 2 OON allowables are about 170–215% of Medicare.
- [Boston & New England](https://integrativegyn.com/locations/boston-new-england-integrative-gynecology/): Boston integrative gynecology runs $450–$750 per intake and $2,800–$5,500 per year for concierge care. Tier 1 PPO allowables are about 220–280% of Medicare, but many Massachusetts HMO plans pay nothing out of network.
- [Washington DC & NoVA](https://integrativegyn.com/locations/washington-dc-northern-virginia-bethesda-integrative-gyn/): DC-area integrative gynecology runs $425–$700 per intake and $2,400–$5,000 per year for concierge care. Tier 1 commercial allowables are about 220–280% of Medicare; FEHB plans follow their own brochures, and FEP Basic pays nothing out of network.
- [Nashville & Franklin](https://integrativegyn.com/locations/nashville-franklin-integrative-gynecology/): Nashville and Franklin integrative gynecology runs $300–$525 per intake and $1,500–$3,600 per year for memberships. Tier 3 OON allowables are about 135–165% of Medicare, so direct specialty care memberships often compete well against superbills.

## About

- [Home](https://integrativegyn.com/): Hub for 2026 integrative gynecology pricing, out-of-network superbill and HSA/FSA math, BHRT and lab cost comparisons, condition playbooks, 15 metro price guides, and OB/GYN practice-transition economics.
- [Methodology & about](https://integrativegyn.com/about/): How IntegrativeGyn.com builds its figures (CMS PFS 2026 baselines, metro commercial multipliers, published 2026 pricing), how the calculators work, editorial independence, privacy and limitations.
- [Contact & matching](https://integrativegyn.com/contact/): Patient clinic-matching and quote second-opinion requests; physician practice-transition, directory listing and platform partnership inquiries.