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 Type | CPT Code | Code Description | Price |
---|---|---|---|
Office Visits | 99211 | Established Patient Office Visit, Level 1 | $38 |
Office Visits | 99212 | Established Patient Office Visit, Level 2 | $78 |
Office Visits | 99213 | Established Patient Office Visit, Level 3 | $126 |
Office Visits | 99214 | Established Patient Office Visit, Level 4 | $178 |
Office Visits | 99215 | Established Patient Office Visit, Level 5 | $249 |
Office Visits | 99051 | Medical Services After Hours, Office | $31 |
Office Visits | 99202 | New Patient Office Visit, Level 2 | $115 |
Office Visits | 99203 | New Patient Office Visit, Level 3 | $178 |
Office Visits | 99204 | New Patient Office Visit, Level 4 | $260 |
Office Visits | 99205 | New Patient Office Visit, Level 5 | $325 |
Fracture Care | 29075 | Application of Forearm Cast | $160 |
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 |
Fracture Care | 28470 | Treat Metatarsal Fracture | $429 |
Hospital Care | 99231 | Follow-up Hospital Care, brief | $65 |
Hospital Care | 99233 | Follow-up Hospital Care, extensive | $138 |
Hospital Care | 99232 | Follow-up Hospital Care, moderate | $96 |
Hospital Care | 99238 | Hospital Discharge, day care | $108 |
Hospital Care | 99460 | Initial Care, normal newborn | $208 |
Hospital Care | 99223 | Initial Hospital Care, high | $271 |
Hospital Care | 99222 | Initial Hospital Care, moderate | $184 |
Hospital Care | 99479 | Sub Intensive Care, ea day, low birth wgt | $312 |
Immunizations | 90620 | Bexsero Men-B (Meningococcal-B) | $239 |
Immunizations | 90715 | Boostrix (TDaP) | $75 |
Immunizations | 90746 | Engerix-B (Hep B adult) | $121 |
Immunizations | 90744 | Engerix-B (Hep B pediatric) | $57 |
Immunizations | 90653 | Fluad (Infuenza virus vaccine 65+) | $65 |
Immunizations | 90686 | Flulaval (Influenza virus 3 years and up) | $30 |
Immunizations | 90651 | Gardasil-9 (HPV) | $286 |
Immunizations | 90632 | Havrix (Hep A adult) | $121 |
Immunizations | 90633 | Havrix (Hep A pediatric) | $108 |
Immunizations | 90648 | Hiberix (HIB) | $42 |
Immunizations | 90471 | Immunization admin 1 vaccine | $35 |
Immunizations | 90472 | Immunization admin ea additional vaccine | $22 |
Immunizations | 90713 | Ipol (Polio) | $80 |
Immunizations | 90696 | Kinrix (DTap-Polio) | $85 |
Immunizations | 90734 | Menveo (Meningococcal), IM | $165 |
Immunizations | 90707 | MMR (Measles Mumps Rubella) | $99 |
Immunizations | 90723 | Pediarix – (DTaP – HEP B – IPV) | $123 |
Immunizations | 90670 | Prevnar-13 (Pneumococcal) | $271 |
Immunizations | 90681 | Rotateq (Rotavirus) | $116 |
Immunizations | 90750 | Shingrix (Shingles) | $185 |
Immunizations | 90716 | Varivax (Varicella) | $171 |
Injections | J1055 | Depo Provera 150 MG | $112 |
Injections | J7321 | Hyalgan Injection per dose | $200 |
Injections | J2270 | Morphine per 10mg | $10 |
Injections | J0696 | Rocephin Injection per 250 MG | $10 |
Injections | J7325 | Synvisc | $783 |
Laboratory Tests | 84443 | Assay Thyroid Stimulation Hormone (TSH) | $46 |
Laboratory Tests | 80048 | Basic Metabolic Panel (BMP) | $27 |
Laboratory Tests | 36415 | Blood Draw | $12 |
Laboratory Tests | 82947 | Blood Sugar-Quantitative, (Blood) | $17 |
Laboratory Tests | 87491 | Chlamydia | $67 |
Laboratory Tests | 85025 | Complete Blood Count (CBC) | $22 |
Laboratory Tests | 80053 | Comprehensive Metabolic Panel (CMP) | $44 |
Laboratory Tests | 80305 | Drug Screen | $51 |
Laboratory Tests | 82950 | Glucose test | $41 |
Laboratory Tests | 87591 | Gonorrhea | $67 |
Laboratory Tests | 86677 | H-Pylori | $56 |
Laboratory Tests | 85018 | Hemoglobin | $16 |
Laboratory Tests | 83036 | Hemoglobin A1C | $31 |
Laboratory Tests | 86803 | Hepatitis C | $45 |
Laboratory Tests | 86701 | HIV | $55 |
Laboratory Tests | 87804 | Influenza - Rapid | $45 |
Laboratory Tests | 87502 | Influenza- PCR | $125 |
Laboratory Tests | 80061 | Lipid Profile | $44 |
Laboratory Tests | 80061 | Liver Panel | $30 |
Laboratory Tests | 82043 | Microalbumin - Urine | $39 |
Laboratory Tests | 81025 | Pregnancy - Urine | $34 |
Laboratory Tests | 85610 | Pro-Time | $17 |
Laboratory Tests | 84154 | Prostate (PSA) | $50 |
Laboratory Tests | 85651 | Sed rate | $18 |
Laboratory Tests | 99000 | Specimen Handling | $20 |
Laboratory Tests | 87651 | Strep Screen - PCR | $71 |
Laboratory Tests | 87880 | Strep Screen - Rapid | $26 |
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 |
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 |
Lacerations | 12015 | Repair superficial wounds, face | $300 |
Lacerations | 12001 | Repair superficial wounds, trunk | $221 |
Obstetrics | 59426 | Ante partum care only, 7+ visits | $1430 |
Obstetrics | 59514 | Caesarean delivery only | $1774 |
Obstetrics | 80055 | Obstetric Profile | $95 |
Obstetrics | 59510 | Routine care and caesarean delivery | $3780 |
Obstetrics | 59400 | Routine Obstetric Care | $3360 |
Obstetrics | 59409 | Vaginal delivery only | $1460 |
Obstetrics | 59610 | VBAC delivery, routine obstetric care | $3550 |
Office Procedures | 95024 | Allergy Skin Tests, Percutaneous | $11 |
Office Procedures | 93015 | Cardiovascular stress test using Treadmill | $274 |
Office Procedures | 54150 | Circumcision, clamp procedure, newborn | $275 |
Office Procedures | 17000 | Destroy benign/premalignant lesion, 1st | $116 |
Office Procedures | 17110 | Destroy flat wart, up to 14 lesions | $189 |
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 |
Office Procedures | 93224 | ECG Monitor/24 hrs, Complete (Holter Monitor) | $274 |
Office Procedures | 93000 | EKG 12 Leads | $44 |
Office Procedures | 58100 | Endometrial Biopsy, w/o Cervical DI | $185 |
Office Procedures | 59025 | Fetal Non-Stress Test | $109 |
Office Procedures | 58300 | Insert Intrauterine Device (IUD) | $154 |
Office Procedures | J7300 | IUD copper Para Guard | $1061 |
Office Procedures | J7298 | IUD Mirena | $1150 |
Office Procedures | J7296 | Kyleena, 19.5 mg | $1143 |
Office Procedures | J7307 | Nexplanon | $1178 |
Office Procedures | 94640 | Non Pressurized Inhalation Treatment | $38 |
Office Procedures | 11750 | Permanent removal of nail bed | $371 |
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) | $162 |
Office Procedures | 95806 | Sleep Study, Unattended | $350 |
Office Procedures | 94010 | Spirometer | $65 |
Office Procedures | 55450 | Vasectomy | $925 |
Preventative Care | 99392 | Preventive Checkup, established 1-4 yrs | $154 |
Preventative Care | 99394 | Preventive Checkup, established 12-17 yrs | $178 |
Preventative Care | 99395 | Preventive Checkup, established 18-39 yrs | $185 |
Preventative Care | 99396 | Preventive Checkup, established 40-64 yrs | $196 |
Preventative Care | 99393 | Preventive Checkup, established 5-11 yrs | $164 |
Preventative Care | 99391 | Preventive Checkup, established infant | $143 |
Preventative Care | 99397 | Preventive Checkup, established, 65+ | $228 |
Preventative Care | 99382 | Preventive Checkup, new, 1-4 yrs | $166 |
Preventative Care | 99384 | Preventive Checkup, new, 12-17 yrs | $197 |
Preventative Care | 99385 | Preventive Checkup, new, 18-39 yrs | $191 |
Preventative Care | 99386 | Preventive Checkup, new, 40-64 yrs | $230 |
Preventative Care | 99383 | Preventive Checkup, new, 5-11 yrs | $181 |
Preventative Care | 99387 | Preventive Checkup, new, 65+ | $255 |
Preventative Care | 99381 | Preventive Checkup, new, infant | $160 |
Surgeries | 57455 | Colposcopy w/ biopsy of cervix | $240 |
Surgeries | 58563 | Hysteroscopy w/ endometrial ablation | $3695 |
Surgeries | 58565 | Hysteroscopy/sterilization | $3400 |
Surgeries | 57288 | Repair bladder defect | $1276 |
Surgeries | 57260 | Repair of vagina | $1460 |
Surgeries | 58150 | Total hysterectomy | $2050 |
Surgeries | 58152 | Total hysterectomy with suspension | $2114 |
Surgeries | 58260 | Vaginal hysterectomy | $1796 |
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 |
X-Rays | 74018 | Abdomen, single AP View | $61 |
X-Rays | 73610 | Ankle, complete minimum 3 views | $70 |
X-Rays | 71045 | Chest 1 view AP | $60 |
X-Rays | 71046 | Chest AP and Lateral | $71 |
X-Rays | 77080 | Dexa Bone Density, Axial (hips, pelvis, spine) | $190 |
X-Rays | 73620 | Foot AP and Lateral views | $68 |
X-Rays | 73630 | Foot, complete minimum 3 views | $70 |
X-Rays | 73120 | Hand, 2 views | $54 |
X-Rays | 73130 | Hand, minimum of 3 views | $66 |
X-Rays | 73562 | Knee, complete 3 views | $88 |
X-Rays | 72100 | Spine lumbosacral AP and Lateral | $79 |
X-Rays | 73590 | Tibia and Fibula AP and Lateral | $72 |
X-Rays | 73110 | Wrist complete, minimum 3 views | $76 |
99211 – Established Patient Office Visit, Level 1 – $38
99212 – Established Patient Office Visit, Level 2 – $74
99213 – Established Patient Office Visit, Level 3 – $120
99214 – Established Patient Office Visit, Level 4 – $170
99215 – Established Patient Office Visit, Level 5 – $237
99051 – Medical Services After Hours, Office – $31
99202 – New Patient Office Visit, Level 2 – $115
99203 – New Patient Office Visit, Level 3 – $170
99204 – New Patient Office Visit, Level 4 – $260
99205 – New Patient Office Visit, Level 5 – $325
29075 – Application of Forearm Cast – $160
27786 – Closed Treat Distal Fibular Fracture – $614
25600 – Closed Treatment, Distal Radial Fracture w/o manipulation – $633
26720 – Closed Treatment, Finger/Thumb Fracture w/o manipulation – $383
26605 – Closed Treatment, Metacarpal fracture w/o manipulation – $660
25500 – Closed Treatment, Radial Shaft Fracture w/o manipulation – $524
28470 – Treat Metatarsal Fracture – $429
99231 – Follow-up Hospital Care, brief – $65
99233 – Follow-up Hospital Care, extensive – $138
99232 – Follow-up Hospital Care, moderate – $96
99238 – Hospital Discharge, day care – $108
99460 – Initial Care, normal newborn – $208
99223 – Initial Hospital Care, high – $271
99222 – Initial Hospital Care, moderate – $184
99479 – Sub Intensive Care, ea day, low birth weight – $312
90620 – Bexsero Men-B (Meningococcal-B) – $239
90715 – Boostrix (TDaP) – $75
90746 – Engerix-B (Hep B adult) – $121
90744 – Engerix-B (Hep B pediatric) – $57
90653 – Fluad (Infuenza virus vaccine 65+) – $65
90686 – Flulaval (Influenza virus 3 years and up) – $30
90651 – Gardasil-9 (HPV) – $286
90632 – Havrix (Hep A adult) – $121
90633 – Havrix (Hep A pediatric) – $108
90648 – Hiberix (HIB) – $42
90471 – Immunization admin 1 vaccine – $35
90472 – Immunization admin ea additional vaccine – $22
90713 – Ipol (Polio) – $80
90696 – Kinrix (DTap-Polio) – $85
90707 – MMR (Measles Mumps Rubella) – $99
90734 – Menveo (Meningococcal), IM – $165
90723 – Pediarix – (DTaP – HEP B – IPV) – $123
90670 – Prevnar-13 (Pneumococcal) – $271
90681 – Rotateq (Rotavirus) – $116
90750 – Shingrix (Shingles) – $185
90716 – Varivax (Varicella) – $171
J1055 – Depo Provera 150 MG – $112
J7321 – Hyalgan Injection per dose – $200
J2270 – Morphine per 10mg – $10
J0696 – Rocephin Injection per 250 MG – $10
J7325 – Synvisc – $783
84443 – Assay Thyroid Stimulation Hormone (TSH) – $46
80048 – Basic Metabolic Panel (BMP) – $27
36415 – Blood Draw – $12
82947 – Blood Sugar-Quantitative, (Blood) – $17
87491 – Chlamydia – $67
85025 – Complete Blood Count (CBC) – $22
80053 – Comprehensive Metabolic Panel (CMP) – $44
80305 – Drug Screen – $51
82950 – Glucose test – $41
87591 – Gonorrhea – $67
86677 – H-Pylori – $56
86701 – HIV – $55
85018 – Hemoglobin – $16
83036 – Hemoglobin A1C – $31
86803 – Hepatitis C – $45
87804 – Influenza – Rapid – $45
87502 – Influenza- PCR – $125
80061 – Lipid Profile – $44
80076 – Liver Panel – $30
82043 – Microalbumin – Urine – $39
81025 – Pregnancy – Urine – $34
85610 – Pro-Time – $17
84154 – Prostate (PSA) – $50
85651 – Sed rate – $18
99000 – Specimen Handling – $20
87651 – Strep Screen – PCR – $71
87880 – Strep Screen – Rapid – $26
86580 – TB Test – $19
84403 – Testosterone – $95
84439 – Thyroid Function – $35
84479 – Thyroid Hormone T3 or T4 – $14
81003 – Urinalysis, automated w/o scope (Big Dip) – $11
81001 – Urinalysis, automated w/scope (UA Micro) – $15
81002 – Urinalysis, non-auto w/o scope (OB Dip) – $11
87086 – Urine Culture – $29
12015 – Repair superficial wounds, face – $300
12001 – Repair superficial wounds, trunk – $221
59426 – Ante partum care only, 7+ visits – $1,430
59514 – Caesarean delivery only – $1,774
80055 – Obstetric Profile – $95
59400 – Routine Obstetric Care – $3,360
59510 – Routine care and caesarean delivery – $3,780
59610 – VBAC delivery, routine obstetric care – $3,550
59409 – Vaginal delivery only – $1,460
95024 – Allergy Skin Tests, Percutaneous – $11 each
93015 – Cardiovascular stress test using Treadmill – $274
54150 – Circumcision, clamp procedure, newborn – $275
17000 – Destroy benign/premalignant lesion, 1st – $116
17110 – Destroy flat wart, up to 14 lesions – $189
10060 – Drain skin abscess, simple/single – $205
20605 – Drain/inject intermediate joint/bursa – $141
20610 – Drain/inject major joint or bursa – $145
93224 – ECG Monitor/24 hrs, Complete (Holter Monitor) – $274
93000 – EKG 12 Leads – $44
58100 – Endometrial Biopsy, w/o Cervical DI – $185
59025 – Fetal Non-Stress Test – $109
J7298 – IUD Mirena – $1,150
J7300 – IUD copper Para Guard – $1,061
58300 – Insert Intrauterine Device (IUD) – $154
J7307 – Nexplanon – $1,178
94640 – Non Pressurized Inhalation Treatment – $38
11750 – Permanent removal of nail bed – $371
69210 – Removal of impacted cerumen – $85
11200 – Removal of skin tags, up to 15 – $158
58301 – Remove Intrauterine Device (IUD) – $162
95806 – Sleep Study, Unattended – $350
94010 – Spirometer – $65
55450 – Vasectomy – $925
99392 – Preventive Checkup, established 1-4 yrs – $154
99394 – Preventive Checkup, established 12-17 yrs – $178
99395 – Preventive Checkup, established 18-39 yrs – $185
99396 – Preventive Checkup, established 40-64 yrs – $196
99393 – Preventive Checkup, established 5-11 yrs – $164
99391 – Preventive Checkup, established infant – $143
99397 – Preventive Checkup, established, 65+ – $228
99382 – Preventive Checkup, new, 1-4 yrs – $166
99384 – Preventive Checkup, new, 12-17 yrs – $197
99385 – Preventive Checkup, new, 18-39 yrs – $191
99386 – Preventive Checkup, new, 40-64 yrs – $230
99383 – Preventive Checkup, new, 5-11 yrs – $181
99387 – Preventive Checkup, new, 65+ – $255
99381 – Preventive Checkup, new, infant – $160
57455 – Colposcopy w/ biopsy of cervix – $240
58563 – Hysteroscopy w/ endometrial ablation – $3,695
58565 – Hysteroscopy/sterilization – $3,400
57288 – Repair bladder defect – $1,276
57260 – Repair of vagina – $1,460
58150 – Total hysterectomy – $2,050
58152 – Total hysterectomy with suspension – $2,114
58260 – Vaginal hysterectomy – $1,796
76801 – U/S OB < 14 weeks single fetus – $258
76805 – U/S OB complete, routine 20 weeks – $280
76770 – U/S abdomen (Renal U/S) – $215
76700 – U/S abdomen, complete – $281
76856 – U/S pelvic B scan complete – $247
76870 – U/S testicle/scrotal – $206
74018 – Abdomen, single AP View – $61
73610 – Ankle, complete minimum 3 views – $70
71045 – Chest 1 view AP – $60
71046 – Chest AP and Lateral – $71
77080 – Dexa Bone Density, Axial (hips, pelvis, spine) – $190
73620 – Foot AP and Lateral views – $68
73630 – Foot, complete minimum 3 views – $70
73120 – Hand, 2 views – $54
73130 – Hand, minimum of 3 views – $66
73562 – Knee, complete 3 views – $88
72100 – Spine lumbosacral AP and Lateral – $79
73590 – Tibia and Fibula AP and Lateral – $72
73110 – Wrist complete, minimum 3 views – $76
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