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Self-Pay Prices

Below is only a condensed list of our already discounted self-pay prices. 

Well Visit and Sick Visit prices do not include 

additional routine screen, test, immunization  or bloodwork charges.

Please call our billing office for more information.

Well Visit New Patient

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99382 Under 1 Year

$122.65

99382 1-4 Years

$127.60

99383 5-11 Years

$132.55

99384 12-17 years

$149.60

Well Visit Established Patient

99391 Under 1 Year

$110.00

99392 1-4 Years

$117.15

99393 5-11 Years

$117.15

99394 12-17 Years

$127.05

Other Well Visit Charges

Chadis Questionnaire (each)

$11.00

Vaccine Administration Fee (each)

$21.24

Spot Vision Screen (Age 12m - 6yrs, special needs)

$20.00

Fluoride Vanish (6m - 5yrs)

$20.00

Other Ordered Tests, Procedures & Bloodwork

prices vary

Vaccines (Out of Network Insurance)

prices vary

Sick Visit New Patient

99202 Exp Prob Focused H&P

$83.60

99203 Detailed H&P

$121.00

99204 Comp H&P Mod

$182.60

99205 Comp H&P High

$224.95

Sick Visit Established Patient

99212 Exp Prob Focused H&P

$49.50

99213 Detailed H&P

$81.40

99214 Comp H&P Mod

$118.80

99215 Comp H&P High

$158.40

Sick Visit - Other Charges

Below is merely a sample of the diagnostic tests. Provider may order other tests, procedures and/or Labwork. Please call the office for price information.

Rapid Strep

$15.95

separate charges for Strep Culture STAT / nonSTAT

Rapid Flu A

$15.95

Rapid Flu B

$15.95

Rapid Covid

$52.00

Other ordered Tests, Procedures and Labwork

prices vary

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