Self-pay services pricing

Standard services $180 – Tier I (PPV1)
Advanced services $235 – Tier II (PPV2)
Complex services $350 – Tier III (PPV3)
Outside labs + additional services – must have tier
Immunizations
Other services / drug screens - A la carte
Physicals
Self-pay services pricing - reference lab

View the Self Pay Services FAQs

Standard services – $180

Tier I (PPV1)

Includes UP TO 2 In House Tests or Oral Medications>2 transition to Advanced Services (Tier II)

Office Visit
Audiologic Tests
In-house lab tests (excludes send out labs noted below)
- Covid/Flu: Antigen
- Covid: Antigen
- Covid: Molecular
- Glucose Finger Stick
- Influenza Antigen
- Mono Screen
- Occult Blood, Stool Hemoccult
- Pregnancy Test, Urine
- RSV
- Strep
- Urinalysis Dip
Miscellaneous Supplies & Medicines
- Hot/Cold Pack, Eye Patch, Basin
- Visual Acuity Testing
- Color Vision - Ishihara Test
- Silver Nitrate Sticks
Oral & Topical Medications - Single Dose
- Non Prescription Drugs
- Azithromycin Tabs 16mm
- Nitroglycerin Tabs
- Prednisone
- Zofran/Ondansetron

Advanced services – $235

Tier II (PPV2)

Includes Standard Services plus:

Includes UP TO 2 X Rays or Injectable Medications>2 transition to Complex Services (Tier III)

Breathing/Nebulizer Treatment/Training
- Peak Flow
- Meds: Albuterol, Atrovent, Duo Neb
EKG
Injectable Medications (includes Administration)
- Administration
- Benadryl
- Clindamycin
- Decadron
- Epinephrine
- Kenalog
- Methylprednisolone
- Norflex (Orphenadrine)
- Phenergan 12/25 mg.
- Rocephin
- Solumedrol
- Toradol
- Zofran
Osteopathic Manipulation
Therapeutic Treatments
- Ear Wax Removal
- Wart Cryo Treatment
X-Ray
Concussion Management / Evaluation

Complex services – $350

Tier III (PPV3)

Includes Advanced Services plus:

Abscess Treatment
Biopsy/Skin
Burn/Wound
Intermediate Laceration Repair
Digital Block Anesthesia
Dislocation
Ear Wick
Excision Lesion
Eye Procedure / Morgan Lens
Foreign Body and Foreign Object Removal
Joint Injections
Nail Repair or Removal
Simple Laceration Repair
Splinting
Wound Repair - Dermabond

Follow Up Visit within 10 days - same complaint as determined by Provider: charge $50 for provider evaluation/consultation (includes lacerations + foreign object remove etc.); charge difference between tiers IF incremental services are required

Example A: $105 includes $50 f/u + $55 incremental fee FROM Standard/Tier I TO Advanced / Tier II services;

Example B: $165 includes $50 f/u + $115 incremental fee FROM Advanced/Tier II TO Complex / Tier III services;

Example C: $220 includes $50 f/u + 170 incremental fee FROM Standard/Tier I TO Complex/Tier III

Outside labs + additional services

(Must have tier)

Includes Advanced Services plus:

Lab / Service	Price
Venipuncture	$10
Send out Lab Tests - (for each test ordered) A1C Hemoglobin CBC Chlamydia Culture, Stool Culture, Throat, Other Gonorrhea Hepatitis Herpes HIV Lipid Panel Metabolic Panel MMR Titer Pregnancy Test RPR/Syphilis Uric Acid Urine Culture Varicella Titer	$35
Send out Lab Tests COVID 19 PCR COVID 19 Antibody Vaginitis/Vaginosis	$65
Send out Lab Tests QuantiFERON TB TSPOT	$100
In-house lab tests STI CT/NG/TV - molecular test	$105

Immunizations

(Do not require tiers 1 - 3)

Immunization	Price
Admin of Immunization	$52
Admin of Immunization Add’l	$0
Any COVID vaccine	$0
Gardasil 9	$260
Hepatitis A Vaccine Adult	$120
Hepatitis B Vaccine Adult 3 dose⁽²⁾	$95 per each dose
Hepatitis B Vaccine Child 3 dose⁽²⁾	$64 per each dose
Heplisav-B Adult 2 dose⁽²⁾	$165 per each dose
Hib	$80
Meningitis - Bexsero	$230
Meningitis - Menactra	$165
MMR	$110
Pneumonia 23	$145
Polio	$90
Prevnar13	$255
Shingrix	$195
Tdap - 10 yrs. or older	$75
Tetanus Diphtheria (Td) - 7 yrs. & up	$55
Twinrix	$160
Varicella Vaccine	$164

Immunization vaccine visit charges - important charge details

Reason for visit	Charges
Self Pay collection rules for a new or established patient	90471 Immunization Admin Free + Immunization
Patients presenting with an injury, requesting a TD = Provider Visit	Quote Self Pay Pricing

Other services / drug screens - A la carte

(Do not require tiers 1 - 3)

Service	Price
Telehealth Visit⁽⁴⁾	$75
Breath Alcohol Test	$50
DME	$20⁽¹⁾
Drug Screen Panel Standard 10	$50
Drug Screen Panel Standard 5	$40
Flu Shot⁽³⁾	$20
TB Reading	$0
TB Skin Test w/ Nurse Visit	$75

Physicals

Physical	Price
DOT Physical	$100
General Physical	$65
General Physical + Chest X-Ray	$150
Respirator Fit Test	$55
School or Sports Physical	$36 (promotional - $25) with baseline concussion test⁽⁴⁾ - included
School Physical w/ X Ray	$136

Physical Add on Services with General Physical:

Add on Service	Price
Audiometry	$40
Color Vision - Ishihara Test	$25
EKG	$50 (Adults only)
PFT - Spirometry	$60
QuantiFERON TB)	$100
TB (TST) PPD (each test)	$50
TSPOT	$100

⁽¹⁾ For markets leveraging a consignment closet program with a third party vendor, note third party will separately charge for DME

⁽²⁾ Collect balance for each individual dose

⁽³⁾ Do not offer high dose flu shot for seniors (Per market availability)

⁽⁴⁾ If concussion mgmt/ telehealth services are available in respective market