If you make an appointment for an office visit, then need a special exam that requires extra equipment (scoping of any sort) you may be rightfully billed for that procedure. It involves use of instruments that must be sterilized between uses or perhaps new for each patient. We once had an orthopaedic surgeon bill us for diagnosing and casting a fracture then try to charge for the succeeding checkup and to remove the cast. That all comes under the heading of fracture care and there should have been one charge, the original, unless cast was broken and needed to be reapplied.