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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.

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 Care99232Follow-up Hospital Care, moderate$96
Hospital Care99460Initial Care, normal newborn$208
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
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
Immunizations90723Pediarix – (DTaP – HEP B – IPV)$123
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 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
Obstetrics59514Caesarean delivery only$1774
Obstetrics80055Obstetric Profile$95
Obstetrics59409Vaginal delivery only$1460
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 Procedures93000EKG 12 Leads$44
Office Procedures58100Endometrial Biopsy, w/o Cervical DI$185
Office Procedures59025Fetal Non-Stress Test$109
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 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 Care99397Preventive Checkup, established, 65+$228
Preventative Care99382Preventive Checkup, new, 1-4 yrs$166
Preventative Care99386Preventive Checkup, new, 40-64 yrs$230
Preventative Care99387Preventive Checkup, new, 65+$255
Preventative Care99381Preventive Checkup, new, infant$160
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
Allergy Testing95115Allergen Immunotherapy (Injection 1)*$22
Allergy Testing95117Allergen Immunotherapy (Injection 2)*$28
Allergy Testing95165Allergy Serum Preparation*$21
Allergy Testing95004Percutaneous Allergy Testing*Up to $405
Hospital Care99233Follow-up Hospital Care, extensive$150
Hospital Care99238Hospital Discharge, day care$115
Hospital Care99223Initial Hospital Care, high$275
Immunizations90651Gardasil-9 (HPV)$340
Immunizations90707MMR (Measles Mumps Rubella)$120
Immunizations90670Prevnar-13 (Pneumococcal)$310
Immunizations90681Rotateq (Rotavirus)$210
Immunizations90750Shingrix (Shingles)$235
Immunizations90716Varivax (Varicella)$200
Laboratory Tests80076Liver Panel$30
Obstetrics59426Ante partum care only, 7+ visits$1730
Obstetrics59510Routine care and caesarean delivery$4100
Obstetrics59400Routine Obstetric Care$3700
Obstetrics59610VBAC delivery, routine obstetric care$3900
Office Procedures93224ECG Monitor/24 hrs, Complete (Holter Monitor)$275
Office Procedures58300Insert Intrauterine Device (IUD)$170
Office ProceduresJ7300IUD copper Para Guard$1150
Office Procedures58301Remove Intrauterine Device (IUD)$180
Preventative Care99391Preventive Checkup, established infant$146
Preventative Care99384Preventive Checkup, new, 12-17 yrs$199
Preventative Care99385Preventive Checkup, new, 18-39 yrs$193
Preventative Care99383Preventive Checkup, new, 5-11 yrs$187
Surgeries57455Colposcopy w/ biopsy of cervix$270
Allergy Testing95199Sublingual Drops (Not Billable to Insurance Per Mixing) *$180 each vial set

*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.

Haley Pledger, PA
Women’s Care
Matthew Walton, DO
Austin Bills, DO
Family Medicine
Aaron Fausett, PA
Family Medicine
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