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Clinic Pricing

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.

If you are looking for pricing for an item not listed, please click the following button to request pricing via email.

Service TypeCPT CodeCode DescriptionPrice
Office Visits99211Established Patient Office Visit, Level 1$38
Office Visits99212Established Patient Office Visit, Level 2$78
Office Visits99213Established Patient Office Visit, Level 3$126
Office Visits99214Established Patient Office Visit, Level 4$178
Office Visits99215Established Patient Office Visit, Level 5$249
Office Visits99051Medical Services After Hours, Office$31
Office Visits99202New Patient Office Visit, Level 2$115
Office Visits99203New Patient Office Visit, Level 3$178
Office Visits99204New Patient Office Visit, Level 4$260
Office Visits99205New Patient Office Visit, Level 5$325
Fracture Care29075Application of Forearm Cast$160
Fracture Care27786Closed Treat Distal Fibular Fracture$614
Fracture Care25600Closed Treatment, Distal Radial Fracture w/o manipulation$633
Fracture Care26720Closed Treatment, Finger/Thumb Fracture w/o manipulation$383
Fracture Care26605Closed Treatment, Metacarpal fracture w/o manipulation$660
Fracture Care25500Closed Treatment, Radial Shaft Fracture w/o manipulation$524
Fracture Care28470Treat Metatarsal Fracture$429
Hospital Care99231Follow-up Hospital Care, brief$65
Hospital Care99233Follow-up Hospital Care, extensive$138
Hospital Care99232Follow-up Hospital Care, moderate$96
Hospital Care99238Hospital Discharge, day care$108
Hospital Care99460Initial Care, normal newborn$208
Hospital Care99223Initial Hospital Care, high$271
Hospital Care99222Initial Hospital Care, moderate$184
Hospital Care99479Sub Intensive Care, ea day, low birth wgt$312
Immunizations90620Bexsero Men-B (Meningococcal-B)$239
Immunizations90715Boostrix (TDaP)$75
Immunizations90746Engerix-B (Hep B adult)$121
Immunizations90744Engerix-B (Hep B pediatric)$57
Immunizations90653Fluad (Infuenza virus vaccine 65+)$65
Immunizations90686Flulaval (Influenza virus 3 years and up)$30
Immunizations90651Gardasil-9 (HPV)$286
Immunizations90632Havrix (Hep A adult)$121
Immunizations90633Havrix (Hep A pediatric)$108
Immunizations90648Hiberix (HIB)$42
Immunizations90471Immunization admin 1 vaccine$35
Immunizations90472Immunization admin ea additional vaccine$22
Immunizations90713Ipol (Polio)$80
Immunizations90696Kinrix (DTap-Polio)$85
Immunizations90734Menveo (Meningococcal), IM$165
Immunizations90707MMR (Measles Mumps Rubella)$99
Immunizations90723Pediarix – (DTaP – HEP B – IPV)$123
Immunizations90670Prevnar-13 (Pneumococcal)$271
Immunizations90681Rotateq (Rotavirus)$116
Immunizations90750Shingrix (Shingles)$185
Immunizations90716Varivax (Varicella)$171
InjectionsJ1055Depo Provera 150 MG$112
InjectionsJ7321Hyalgan Injection per dose$200
InjectionsJ2270Morphine per 10mg$10
InjectionsJ0696Rocephin Injection per 250 MG$10
Laboratory Tests84443Assay Thyroid Stimulation Hormone (TSH)$46
Laboratory Tests80048Basic Metabolic Panel (BMP)$27
Laboratory Tests36415Blood Draw$12
Laboratory Tests82947Blood Sugar-Quantitative, (Blood)$17
Laboratory Tests87491Chlamydia$67
Laboratory Tests85025Complete Blood Count (CBC)$22
Laboratory Tests80053Comprehensive Metabolic Panel (CMP)$44
Laboratory Tests80305Drug Screen$51
Laboratory Tests82950Glucose test$41
Laboratory Tests87591Gonorrhea$67
Laboratory Tests86677H-Pylori$56
Laboratory Tests85018Hemoglobin$16
Laboratory Tests83036Hemoglobin A1C$31
Laboratory Tests86803Hepatitis C$45
Laboratory Tests86701HIV$55
Laboratory Tests87804Influenza - Rapid$45
Laboratory Tests87502Influenza- PCR$125
Laboratory Tests80061Lipid Profile$44
Laboratory Tests80061Liver Panel$30
Laboratory Tests82043Microalbumin - Urine$39
Laboratory Tests81025Pregnancy - Urine$34
Laboratory Tests85610Pro-Time$17
Laboratory Tests84154Prostate (PSA)$50
Laboratory Tests85651Sed rate$18
Laboratory Tests99000Specimen Handling$20
Laboratory Tests87651Strep Screen - PCR$71
Laboratory Tests87880Strep Screen - Rapid$26
Laboratory Tests86580TB Test$19
Laboratory Tests84403Testosterone$95
Laboratory Tests84439Thyroid Function$35
Laboratory Tests84479Thyroid Hormone T3 or T4$14
Laboratory Tests81003Urinalysis, automated w/o scope (Big Dip)$11
Laboratory Tests81001Urinalysis, automated w/scope (UA Micro)$15
Laboratory Tests81002Urinalysis, non-auto w/o scope (OB Dip)$11
Laboratory Tests87086Urine Culture$29
Lacerations12015Repair superficial wounds, face$300
Lacerations12001Repair superficial wounds, trunk$221
Obstetrics59426Ante partum care only, 7+ visits$1430
Obstetrics59514Caesarean delivery only$1774
Obstetrics80055Obstetric Profile$95
Obstetrics59510Routine care and caesarean delivery$3780
Obstetrics59400Routine Obstetric Care$3360
Obstetrics59409Vaginal delivery only$1460
Obstetrics59610VBAC delivery, routine obstetric care$3550
Office Procedures95024Allergy Skin Tests, Percutaneous$11
Office Procedures93015Cardiovascular stress test using Treadmill$274
Office Procedures54150Circumcision, clamp procedure, newborn$275
Office Procedures17000Destroy benign/premalignant lesion, 1st$116
Office Procedures17110Destroy flat wart, up to 14 lesions$189
Office Procedures10060Drain skin abscess, simple/single$205
Office Procedures20605Drain/inject intermediate joint/bursa$141
Office Procedures20610Drain/inject major joint or bursa$145
Office Procedures93224ECG Monitor/24 hrs, Complete (Holter Monitor)$274
Office Procedures93000EKG 12 Leads$44
Office Procedures58100Endometrial Biopsy, w/o Cervical DI$185
Office Procedures59025Fetal Non-Stress Test$109
Office Procedures58300Insert Intrauterine Device (IUD)$154
Office ProceduresJ7300IUD copper Para Guard$1061
Office ProceduresJ7298IUD Mirena$1150
Office ProceduresJ7296Kyleena, 19.5 mg$1143
Office ProceduresJ7307Nexplanon$1178
Office Procedures94640Non Pressurized Inhalation Treatment$38
Office Procedures11750Permanent removal of nail bed$371
Office Procedures69210Removal of impacted cerumen$85
Office Procedures11200Removal of skin tags, up to 15$158
Office Procedures58301Remove Intrauterine Device (IUD)$162
Office Procedures95806Sleep Study, Unattended$350
Office Procedures94010Spirometer$65
Office Procedures55450Vasectomy$925
Preventative Care99392Preventive Checkup, established 1-4 yrs$154
Preventative Care99394Preventive Checkup, established 12-17 yrs$178
Preventative Care99395Preventive Checkup, established 18-39 yrs$185
Preventative Care99396 Preventive Checkup, established 40-64 yrs$196
Preventative Care99393Preventive Checkup, established 5-11 yrs$164
Preventative Care99391Preventive Checkup, established infant$143
Preventative Care99397Preventive Checkup, established, 65+$228
Preventative Care99382Preventive Checkup, new, 1-4 yrs$166
Preventative Care99384Preventive Checkup, new, 12-17 yrs$197
Preventative Care99385Preventive Checkup, new, 18-39 yrs$191
Preventative Care99386Preventive Checkup, new, 40-64 yrs$230
Preventative Care99383Preventive Checkup, new, 5-11 yrs$181
Preventative Care99387Preventive Checkup, new, 65+$255
Preventative Care99381Preventive Checkup, new, infant$160
Surgeries57455Colposcopy w/ biopsy of cervix$240
Surgeries58563Hysteroscopy w/ endometrial ablation$3695
Surgeries57288Repair bladder defect$1276
Surgeries57260Repair of vagina$1460
Surgeries58150Total hysterectomy$2050
Surgeries58152Total hysterectomy with suspension$2114
Surgeries58260Vaginal hysterectomy$1796
Ultrasounds76770U/S abdomen (Renal U/S)$215
Ultrasounds76700U/S abdomen, complete $281
Ultrasounds76801U/S OB < 14 weeks single fetus$258
Ultrasounds76805U/S OB complete, routine 20 weeks$280
Ultrasounds76856U/S pelvic B scan complete$247
Ultrasounds76870U/S testicle/scrotal$206
X-Rays74018Abdomen, single AP View$61
X-Rays73610Ankle, complete minimum 3 views$70
X-Rays71045Chest 1 view AP$60
X-Rays71046Chest AP and Lateral$71
X-Rays77080Dexa Bone Density, Axial (hips, pelvis, spine)$190
X-Rays73620Foot AP and Lateral views$68
X-Rays73630Foot, complete minimum 3 views$70
X-Rays73120Hand, 2 views$54
X-Rays73130Hand, minimum of 3 views$66
X-Rays73562Knee, complete 3 views$88
X-Rays72100Spine lumbosacral AP and Lateral$79
X-Rays73590Tibia and Fibula AP and Lateral$72
X-Rays73110Wrist complete, minimum 3 views$76

99211Established Patient Office Visit, Level 1 – $38

99212Established Patient Office Visit, Level 2$74

99213Established Patient Office Visit, Level 3$120

99214Established Patient Office Visit, Level 4$170

99215 – Established Patient Office Visit, Level 5$237

99051 – Medical Services After Hours, Office$31

99202New Patient Office Visit, Level 2$115

99203 – New Patient Office Visit, Level 3$170

99204New Patient Office Visit, Level 4$260

99205New Patient Office Visit, Level 5$325

29075Application of Forearm Cast$160

27786Closed Treat Distal Fibular Fracture$614

25600Closed Treatment, Distal Radial Fracture w/o manipulation$633

26720 – Closed Treatment, Finger/Thumb Fracture w/o manipulation$383

26605Closed Treatment, Metacarpal fracture w/o manipulation$660

25500Closed Treatment, Radial Shaft Fracture w/o manipulation$524

28470Treat Metatarsal Fracture$429

99231Follow-up Hospital Care, brief$65

99233Follow-up Hospital Care, extensive$138

99232Follow-up Hospital Care, moderate$96

99238Hospital Discharge, day care$108

99460Initial Care, normal newborn$208

99223Initial Hospital Care, high$271

99222 – Initial Hospital Care, moderate$184

99479Sub Intensive Care, ea day, low birth weight$312

90620Bexsero Men-B (Meningococcal-B)$239

90715Boostrix (TDaP)$75

90746Engerix-B (Hep B adult)$121

90744Engerix-B (Hep B pediatric)$57

90653Fluad (Infuenza virus vaccine 65+)$65

90686Flulaval (Influenza virus 3 years and up)$30

90651Gardasil-9 (HPV)$286

90632Havrix (Hep A adult)$121

90633Havrix (Hep A pediatric)$108

90648Hiberix (HIB)$42

90471Immunization admin 1 vaccine$35

90472Immunization admin ea additional vaccine$22

90713Ipol (Polio)$80

90696Kinrix (DTap-Polio)$85

90707MMR (Measles Mumps Rubella)$99

90734Menveo (Meningococcal), IM$165

90723Pediarix – (DTaP – HEP B – IPV)$123

90670Prevnar-13 (Pneumococcal)$271

90681Rotateq (Rotavirus)$116

90750Shingrix (Shingles)$185

90716Varivax (Varicella)$171

J1055Depo Provera 150 MG$112

J7321Hyalgan Injection per dose$200

J2270Morphine per 10mg$10

J0696Rocephin Injection per 250 MG$10


84443Assay Thyroid Stimulation Hormone (TSH)$46

80048Basic Metabolic Panel (BMP)$27

36415Blood Draw$12

82947Blood Sugar-Quantitative, (Blood)$17


85025Complete Blood Count (CBC)$22

80053Comprehensive Metabolic Panel (CMP)$44

80305Drug Screen$51

82950Glucose test$41


86677 – H-Pylori$56



83036Hemoglobin A1C$31

86803Hepatitis C$45

87804Influenza – Rapid$45

87502Influenza- PCR$125

80061Lipid Profile$44

80076Liver Panel$30

82043Microalbumin – Urine$39

81025Pregnancy – Urine$34


84154Prostate (PSA)$50

85651Sed rate$18

99000Specimen Handling$20

87651Strep Screen – PCR$71

87880Strep Screen – Rapid$26

86580TB Test$19


84439Thyroid Function$35

84479Thyroid Hormone T3 or T4$14

81003Urinalysis, automated w/o scope (Big Dip)$11

81001Urinalysis, automated w/scope (UA Micro)$15

81002Urinalysis, non-auto w/o scope (OB Dip)$11

87086Urine Culture$29

12015Repair superficial wounds, face – $300

12001Repair superficial wounds, trunk – $221

59426Ante partum care only, 7+ visits$1,430

59514Caesarean delivery only$1,774

80055Obstetric Profile$95

59400Routine Obstetric Care$3,360

59510Routine care and caesarean delivery$3,780

59610VBAC delivery, routine obstetric care$3,550

59409Vaginal delivery only$1,460

95024Allergy Skin Tests, Percutaneous$11 each

93015Cardiovascular stress test using Treadmill$274

54150Circumcision, clamp procedure, newborn$275

17000Destroy benign/premalignant lesion, 1st$116

17110Destroy flat wart, up to 14 lesions$189

10060Drain skin abscess, simple/single$205

20605Drain/inject intermediate joint/bursa$141

20610Drain/inject major joint or bursa$145

93224ECG Monitor/24 hrs, Complete (Holter Monitor)$274

93000EKG 12 Leads$44

58100Endometrial Biopsy, w/o Cervical DI$185

59025Fetal Non-Stress Test$109

J7298 – IUD Mirena$1,150

J7300IUD copper Para Guard$1,061

58300Insert Intrauterine Device (IUD)$154


94640Non Pressurized Inhalation Treatment$38

11750Permanent removal of nail bed$371

69210Removal of impacted cerumen$85

11200Removal of skin tags, up to 15$158

58301Remove Intrauterine Device (IUD)$162

95806Sleep Study, Unattended$350



99392Preventive Checkup, established 1-4 yrs$154

99394Preventive Checkup, established 12-17 yrs$178

99395Preventive Checkup, established 18-39 yrs$185

99396Preventive Checkup, established 40-64 yrs$196

99393Preventive Checkup, established 5-11 yrs$164

99391Preventive Checkup, established infant$143

99397Preventive Checkup, established, 65+$228

99382Preventive Checkup, new, 1-4 yrs$166

99384Preventive Checkup, new, 12-17 yrs$197

99385Preventive Checkup, new, 18-39 yrs$191

99386Preventive Checkup, new, 40-64 yrs$230

99383Preventive Checkup, new, 5-11 yrs$181

99387Preventive Checkup, new, 65+$255

99381Preventive Checkup, new, infant$160

57455Colposcopy w/ biopsy of cervix$240

58563Hysteroscopy w/ endometrial ablation$3,695


57288Repair bladder defect$1,276

57260Repair of vagina$1,460

58150Total hysterectomy$2,050

58152Total hysterectomy with suspension$2,114

58260Vaginal hysterectomy$1,796

76801U/S OB < 14 weeks single fetus$258

76805U/S OB complete, routine 20 weeks$280

76770U/S abdomen (Renal U/S)$215

76700U/S abdomen, complete$281

76856U/S pelvic B scan complete$247

76870U/S testicle/scrotal$206

74018Abdomen, single AP View$61

73610Ankle, complete minimum 3 views$70

71045Chest 1 view AP$60

71046Chest AP and Lateral$71

77080Dexa Bone Density, Axial (hips, pelvis, spine)$190

73620Foot AP and Lateral views$68

73630Foot, complete minimum 3 views$70

73120Hand, 2 views$54

73130Hand, minimum of 3 views$66

73562Knee, complete 3 views$88

72100Spine lumbosacral AP and Lateral$79

73590Tibia and Fibula AP and Lateral$72

73110Wrist complete, minimum 3 views$76

Matthew Walton, DO
Austin Bills, DO
Family Medicine
Aaron Fausett, PA
Family Medicine
Stephen Takasaki, DO
Family Medicine
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