Pennsylvania Self-Pay Program

Simplified Pricing for Patients without Insurance

  • Visit charge for routine problem $129
  • Lab, x-ray, and other add-on services discounted and priced separately
  • Visit charge plus add-ons capped at $299 1

Pricing for Patients without Insurance

A) Office Visit Charges
Routine Visit $129
Follow-up Visit $59
Visit for Diabetes, Cholesterol, or Prostate Cancer Screening $59
Visit for DOT Physical (price includes urinalysis) $119
Visit for 10 Panel Drug Screen (with collection) $110
Visit for Drug Screen – collection only 2 $41
Visit for Pregnancy Testing $55
Visit for Removal of Sutures Placed Elsewhere $49
Visit for TB Risk Assessment $30
Visit for TB Test $49
Visit for a School, Sports or Camp Physical 3 $49
B) Add-On Services
Lab Test (on-site), each $45
X-ray Exam, each $99
EKG $99
Burn Care (2nd and 3rd degree) $99
Fracture/Dislocation Initial Office Care $99
IV Fluids $99
Nebulizer Treatment $99
Stitches/Laceration Repair $99
Supplies & Durable Medical Equipment (crutches, etc.) Discounted 20%
A) Office Visit Charge
+
B) Add-On Services
=
Total Visit Cost (capped at $299)
Charges Not Included in the $299 Cap
Prescriptions 1 Discounted 20%
Vaccines Discounted 20%
Outside Lab Billed separately by the outside reference lab 4

This program is offered only to patients not covered by a government health insurance plan and not covered by any private insurance plan with which we participate. Terms and conditions apply.

1

Prescriptions, vaccines, and outside labs not included in cap.

2

'Drug Screen – collection only' services available only to patients who present with a completed Custody and Control Form (CCF).

3

Price applies to patients age 3 and up presenting for a sports or camp physical. Price includes physical exam, dipstick urinalysis, if required, and completion of form(s). Price does not include: other types of physicals; additional services such as additional labs (including titers), x-rays, medications (including vaccines and immunizations), dispensed prescriptions, supplies, and procedures; and follow-up visits. If additional services are required, additional charges will apply.

4

Except in Virginia. See Virginia Self-Pay Program pricing materials for outside lab pricing in Virginia.


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