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 |
---|---|---|---|
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 |
Allergy Testing | 95115 | Allergen Immunotherapy (Injection 1)* | $22 |
Allergy Testing | 95117 | Allergen Immunotherapy (Injection 2)* | $28 |
Allergy Testing | 95165 | Allergy Serum Preparation* | $21 |
Allergy Testing | 95004 | Percutaneous Allergy Testing* | Up to $405 |
Allergy Testing | 95199 | Sublingual 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.
© Copyright 2022 Canyon View Family Medicine. All Right Reserved. Powered by FUEL Marketing