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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

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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

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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

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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 / ServicePrice
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

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Immunizations

(Do not require tiers 1 - 3)


ImmunizationPrice
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 visitCharges
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

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Other services / drug screens - A la carte

(Do not require tiers 1 - 3)


ServicePrice
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

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Physicals


PhysicalPrice
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 ServicePrice
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

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(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

Self-pay services pricing - reference lab

Outside labs (in addition above pricing)


Send out Lab Tests - $35 for each test ordered

  • ABO and Rh Blood Typing
  • Aldolase
  • Amylase
  • ANA w/ reflex titer #249
  • Antibiotic Sensitivity Disc
  • ASO #265
  • Type Natriuretic Peptide
  • Blood Typing ABO Group
  • Carboxyhemoglobin
  • C-Difficile Toxins A+B
  • Cholinesterase, RBC
  • C-Reactive Protein
  • C-Reactive Protein (CRP)
  • Creatine Kinase Total
  • Culture, Blood
  • Digoxin
  • Electrolyte Panel
  • Epstein- Barr Panel
  • Ferritin
  • Folate RBC
  • Folate, Serum
  • Follicle Stimulating Hormone
  • Giardia
  • Hepatitis C Virus RNA
  • Iron & Total Iron Binding
  • Lipase
  • Lyme Disease
  • Magnesium
  • Microalbumin, Urine, Random
  • MRSA Screen
  • Org ID (per finding)
  • Ova Parasites, Stool w/trichrome
  • Pap Smear
  • Partial Thromboplastin Time
  • Phosphate (Phosphorus)
  • Presumptive ID
  • Progesterone
  • Prothrombin
  • PSA, Total
  • Rabies Titer (Vaccine Response)
  • Rheumatoid Arthritis Factor
  • SED Rate / ESR
  • Sickle Cell
  • T4, Free & T3, Free
  • Testosterone
  • Tissue Pathogen
  • TSH - Thyroid Stimulation
  • Urinalysis
  • Urinalysis auto w/ scope
  • Vitamin B12 (Cobalamin)
  • Vitamin D 25 - Hydroxy
  • West Nile

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