These rates show our standard fees for common procedures provided by our office. We are happy to offer you a 20% cash discount if you don’t have insurance and if you pay in full at the time of service.
If you have health insurance, these rates will be discounted according to our contract with your insurance company. If you have insurance and would like to get an estimate of your cost, please contact your insurance provider beforehand.
If you have any questions or concerns with your bill, need to make payment arrangements, or discuss assistance with resolving your debt, please call our billing office at (801) 894-1335.
| Service Type | CPT Code | Code Description | Price |
|---|---|---|---|
| X-Rays | 74018 | Abdomen, single AP View | $61 |
| Allergy Testing | 95115 | Allergen Immunotherapy (Injection 1)* | $22 |
| Allergy Testing | 95117 | Allergen Immunotherapy (Injection 2)* | $28 |
| Allergy Testing | 95165 | Allergy Serum Preparation* | $21 |
| Office Procedures | 95024 | Allergy Skin Tests, Percutaneous | $11 |
| X-Rays | 73610 | Ankle, complete minimum 3 views | $70 |
| Obstetrics | 59426 | Ante partum care only, 7+ visits | $1730 |
| Fracture Care | 29075 | Application of Forearm Cast | $160 |
| Laboratory Tests | 84443 | Assay Thyroid Stimulation Hormone (TSH) | $46 |
| Obstetrics | 59618 | Attempted VBAC delivery, routine obstetric care | $4350 |
| Laboratory Tests | 80048 | Basic Metabolic Panel (BMP) | $27 |
| Immunizations | 90620 | Bexsero Men-B (Meningococcal-B) | $239 |
| Laboratory Tests | 36415 | Blood Draw | $12 |
| Laboratory Tests | 82947 | Blood Sugar-Quantitative, (Blood) | $17 |
| Immunizations | 90715 | Boostrix (TDaP) | $75 |
| Obstetrics | 59514 | Caesarean delivery only | $1774 |
| Office Procedures | 93015 | Cardiovascular stress test using Treadmill | $274 |
| X-Rays | 71045 | Chest 1 view AP | $60 |
| X-Rays | 71046 | Chest AP and Lateral | $71 |
| Laboratory Tests | 87491 | Chlamydia | $67 |
| Office Procedures | 54150 | Circumcision, clamp procedure, newborn | $275 |
| Fracture Care | 27786 | Closed Treat Distal Fibular Fracture | $614 |
| Fracture Care | 25600 | Closed Treatment, Distal Radial Fracture w/o manipulation | $633 |
| Fracture Care | 26720 | Closed Treatment, Finger/Thumb Fracture w/o manipulation | $383 |
| Fracture Care | 26605 | Closed Treatment, Metacarpal fracture w/o manipulation | $660 |
| Fracture Care | 25500 | Closed Treatment, Radial Shaft Fracture w/o manipulation | $524 |
| Surgeries | 57455 | Colposcopy w/ biopsy of cervix | $270 |
| Laboratory Tests | 85025 | Complete Blood Count (CBC) | $22 |
| Laboratory Tests | 80053 | Comprehensive Metabolic Panel (CMP) | $44 |
| Injections | J1055 | Depo Provera 150 MG | $112 |
| Office Procedures | 17000 | Destroy benign/premalignant lesion, 1st | $116 |
| Office Procedures | 17110 | Destroy flat wart, up to 14 lesions | $189 |
| X-Rays | 77080 | Dexa Bone Density, Axial (hips, pelvis, spine) | $190 |
| Office Procedures | 10060 | Drain skin abscess, simple/single | $205 |
| Office Procedures | 20605 | Drain/inject intermediate joint/bursa | $141 |
| Office Procedures | 20610 | Drain/inject major joint or bursa | $145 |
| Laboratory Tests | 80305 | Drug Screen | $51 |
| Office Procedures | 93224 | ECG Monitor/24 hrs, Complete (Holter Monitor) | $275 |
| Office Procedures | 93000 | EKG 12 Leads | $44 |
| Office Procedures | 58100 | Endometrial Biopsy, w/o Cervical DI | $185 |
| Immunizations | 90746 | Engerix-B (Hep B adult) | $121 |
| Immunizations | 90744 | Engerix-B (Hep B pediatric) | $57 |
| Office Visits | 99211 | Established Patient Office Visit, Level 1 | $38 |
| Office Visits | 99212 | Established Patient Office Visit, Level 2 | $80 |
| Office Visits | 99213 | Established Patient Office Visit, Level 3 | $130 |
| Office Visits | 99214 | Established Patient Office Visit, Level 4 | $185 |
| Office Visits | 99215 | Established Patient Office Visit, Level 5 | $260 |
| Office Procedures | 59025 | Fetal Non-Stress Test | $109 |
| Immunizations | 90653 | Fluad (Infuenza virus vaccine 65+) | $65 |
| Immunizations | 90686 | Flulaval (Influenza virus 3 years and up) | $30 |
| Hospital Care | 99231 | Follow-up Hospital Care, brief | $65 |
| Hospital Care | 99233 | Follow-up Hospital Care, extensive | $150 |
| Hospital Care | 99232 | Follow-up Hospital Care, moderate | $96 |
| X-Rays | 73620 | Foot AP and Lateral views | $68 |
| X-Rays | 73630 | Foot, complete minimum 3 views | $70 |
| Immunizations | 90651 | Gardasil-9 (HPV) | $340 |
| Laboratory Tests | 82950 | Glucose test | $41 |
| Laboratory Tests | 87591 | Gonorrhea | $67 |
| Laboratory Tests | 86677 | H-Pylori | $56 |
| X-Rays | 73120 | Hand, 2 views | $54 |
| X-Rays | 73130 | Hand, minimum of 3 views | $66 |
| Immunizations | 90632 | Havrix (Hep A adult) | $121 |
| Immunizations | 90633 | Havrix (Hep A pediatric) | $108 |
| Laboratory Tests | 85018 | Hemoglobin | $16 |
| Laboratory Tests | 83036 | Hemoglobin A1C | $31 |
| Laboratory Tests | 86803 | Hepatitis C | $45 |
| Immunizations | 90648 | Hiberix (HIB) | $42 |
| Laboratory Tests | 86701 | HIV | $55 |
| Hospital Care | 99238 | Hospital Discharge, day care | $115 |
| Injections | J7321 | Hyalgan Injection per dose | $200 |
| Surgeries | 58563 | Hysteroscopy w/ endometrial ablation | $3695 |
| Surgeries | 58565 | Hysteroscopy/sterilization | $3400 |
| Immunizations | 90471 | Immunization admin 1 vaccine | $35 |
| Immunizations | 90472 | Immunization admin ea additional vaccine | $22 |
| Laboratory Tests | 87804 | Influenza - Rapid | $45 |
| Laboratory Tests | 87502 | Influenza- PCR | $125 |
| Hospital Care | 99460 | Initial Care, normal newborn | $208 |
| Hospital Care | 99223 | Initial Hospital Care, high | $275 |
| Hospital Care | 99222 | Initial Hospital Care, moderate | $184 |
| Behavioral Health | 99492 | Initial Psychiatric CoCM | $250 |
| Office Procedures | 58300 | Insert Intrauterine Device (IUD) | $170 |
| Immunizations | 90713 | Ipol (Polio) | $80 |
| Office Procedures | J7300 | IUD copper Para Guard | $1245 |
| Office Procedures | J7298 | IUD Mirena | $1537 |
| Office Procedures | J7301 | IUD Skyla | $1280 |
| Immunizations | 90696 | Kinrix (DTap-Polio) | $85 |
| X-Rays | 73562 | Knee, complete 3 views | $88 |
| Office Procedures | J7296 | Kyleena, 19.5 mg | $1537 |
| Laboratory Tests | 80061 | Lipid Profile | $44 |
| Laboratory Tests | 80076 | Liver Panel | $30 |
| Office Visits | 99051 | Medical Services After Hours, Office | $31 |
| Immunizations | 90734 | Menveo (Meningococcal), IM | $165 |
| Laboratory Tests | 82043 | Microalbumin - Urine | $39 |
| Immunizations | 90707 | MMR (Measles Mumps Rubella) | $120 |
| Injections | J2270 | Morphine per 10mg | $10 |
| Office Visits | 99202 | New Patient Office Visit, Level 2 | $120 |
| Office Visits | 99203 | New Patient Office Visit, Level 3 | $180 |
| Office Visits | 99204 | New Patient Office Visit, Level 4 | $265 |
| Office Visits | 99205 | New Patient Office Visit, Level 5 | $345 |
| Office Procedures | J7307 | Nexplanon | $1520 |
| Office Procedures | 94640 | Non Pressurized Inhalation Treatment | $38 |
| Obstetrics | 80055 | Obstetric Profile | $95 |
| Immunizations | 90723 | Pediarix – (DTaP – HEP B – IPV) | $123 |
| Allergy Testing | 95004 | Percutaneous Allergy Testing* | Up to $405 |
| Office Procedures | 11750 | Permanent removal of nail bed | $371 |
| Laboratory Tests | 81025 | Pregnancy - Urine | $34 |
| Preventative Care | 99392 | Preventive Checkup, established 1-4 yrs | $165 |
| Preventative Care | 99394 | Preventive Checkup, established 12-17 yrs | $185 |
| Preventative Care | 99395 | Preventive Checkup, established 18-39 yrs | $185 |
| Preventative Care | 99396 | Preventive Checkup, established 40-64 yrs | $200 |
| Preventative Care | 99393 | Preventive Checkup, established 5-11 yrs | $165 |
| Preventative Care | 99391 | Preventive Checkup, established infant | $150 |
| Preventative Care | 99397 | Preventive Checkup, established, 65+ | $230 |
| Preventative Care | 99382 | Preventive Checkup, new, 1-4 yrs | $180 |
| Preventative Care | 99384 | Preventive Checkup, new, 12-17 yrs | $215 |
| Preventative Care | 99385 | Preventive Checkup, new, 18-39 yrs | $200 |
| Preventative Care | 99386 | Preventive Checkup, new, 40-64 yrs | $240 |
| Preventative Care | 99383 | Preventive Checkup, new, 5-11 yrs | $195 |
| Preventative Care | 99387 | Preventive Checkup, new, 65+ | $270 |
| Preventative Care | 99381 | Preventive Checkup, new, infant | $175 |
| Immunizations | 90670 | Prevnar-13 (Pneumococcal) | $310 |
| Laboratory Tests | 85610 | Pro-Time | $17 |
| Laboratory Tests | 84154 | Prostate (PSA) | $50 |
| Office Procedures | 69210 | Removal of impacted cerumen | $85 |
| Office Procedures | 11200 | Removal of skin tags, up to 15 | $158 |
| Office Procedures | 58301 | Remove Intrauterine Device (IUD) | $180 |
| Surgeries | 57288 | Repair bladder defect | $1276 |
| Surgeries | 57260 | Repair of vagina | $1460 |
| Lacerations | 12015 | Repair superficial wounds, face | $300 |
| Lacerations | 12001 | Repair superficial wounds, trunk | $221 |
| Injections | J0696 | Rocephin Injection per 250 MG | $10 |
| Immunizations | 90681 | Rotateq (Rotavirus) | $210 |
| Obstetrics | 59510 | Routine care and cesarean delivery | $4250 |
| Laboratory Tests | 85651 | Sed rate | $18 |
| Immunizations | 90750 | Shingrix (Shingles) | $235 |
| Office Procedures | 95806 | Sleep Study, Unattended | $350 |
| Laboratory Tests | 99000 | Specimen Handling | $20 |
| X-Rays | 72100 | Spine lumbosacral AP and Lateral | $79 |
| Office Procedures | 94010 | Spirometer | $65 |
| Laboratory Tests | 87651 | Strep Screen - PCR | $71 |
| Laboratory Tests | 87880 | Strep Screen - Rapid | $26 |
| Hospital Care | 99479 | Sub Intensive Care, ea day, low birth wgt | $312 |
| Allergy Testing | 95199 | Sublingual Drops (Not Billable to Insurance Per Mixing) * | $180 each vial set |
| Behavioral Health | 99493 | Subsequent Psychiatric CoCM | $235 |
| Injections | J7325 | Synvisc | $783 |
| Laboratory Tests | 86580 | TB Test | $19 |
| Laboratory Tests | 84403 | Testosterone | $95 |
| Laboratory Tests | 84439 | Thyroid Function | $35 |
| Laboratory Tests | 84479 | Thyroid Hormone T3 or T4 | $14 |
| X-Rays | 73590 | Tibia and Fibula AP and Lateral | $72 |
| Surgeries | 58150 | Total hysterectomy | $2050 |
| Surgeries | 58152 | Total hysterectomy with suspension | $2114 |
| Fracture Care | 28470 | Treat Metatarsal Fracture | $429 |
| Ultrasounds | 76770 | U/S abdomen (Renal U/S) | $215 |
| Ultrasounds | 76700 | U/S abdomen, complete | $281 |
| Ultrasounds | 76801 | U/S OB < 14 weeks single fetus | $258 |
| Ultrasounds | 76805 | U/S OB complete, routine 20 weeks | $280 |
| Ultrasounds | 76856 | U/S pelvic B scan complete | $247 |
| Ultrasounds | 76870 | U/S testicle/scrotal | $206 |
| Laboratory Tests | 81003 | Urinalysis, automated w/o scope (Big Dip) | $11 |
| Laboratory Tests | 81001 | Urinalysis, automated w/scope (UA Micro) | $15 |
| Laboratory Tests | 81002 | Urinalysis, non-auto w/o scope (OB Dip) | $11 |
| Laboratory Tests | 87086 | Urine Culture | $29 |
| Obstetrics | 59409 | Vaginal delivery only | $1460 |
| Surgeries | 58260 | Vaginal hysterectomy | $1796 |
| Obstetrics | 59400 | Vaginal Routine Obstetric Care | $3900 |
| Immunizations | 90716 | Varivax (Varicella) | $200 |
| Office Procedures | 55450 | Vasectomy | $925 |
| Obstetrics | 59610 | VBAC delivery, routine obstetric care | $4050 |
| X-Rays | 73110 | Wrist complete, minimum 3 views | $76 |
*Disclaimer: Allergy Testing Pricing Information
Please be advised that the costs associated with allergy testing, as outlined in the price table above, are presented on a per-unit basis. It is important to note that the total expense for alleray testing may vary based on the number of units required and the specific tests administered. The overall cost for allergy testing will be determined by the cumulative number of units and tests deemed necessary by the healthcare provider.
