Virginia Insurance Participation & Self-Pay Pricing
Patient First participates with most major health insurance plans. The following list should be used only as a guide as the status of the plans is subject to change. Please note the exceptions. If you have an employer-sponsored health plan and Patient First is not in-network, you may still be seen as a self-pay patient. If you have a Medicaid or Medicare Advantage plan where Patient First is not in-network, you are not eligible to be seen as self-pay. If you are uncertain as to whether your individual health benefits plan includes receiving in-network services from Patient First, please call your insurance company using the number on the back of your insurance card.
Virginia Insurance Participation
Please check with your insurance plan to confirm participation with Patient First.
| wdt_ID | Plan Name | Plan Type | Urgent Care | Primary Care | Telehealth |
|---|---|---|---|---|---|
| 1 | ACMG | Employer Sponsored | |||
| 2 | AETNA | Individual & Employer Sponsored | |||
| 3 | Medicaid | ||||
| 4 | Medicare | ||||
| 5 | Medicare D-SNP | ||||
| 6 | AETNA SIGNATURE ADMINISTRATORS | Individual & Employer Sponsored | |||
| 7 | ANTHEM | Individual & Employer Sponsored | |||
| 8 | Medicaid | ||||
| 9 | Medicare | ||||
| 10 | CAREFIRST (NORTHERN VA ONLY) | Individual & Employer Sponsored | |||
| 11 | Medicaid | ||||
| 12 | Medicare | ||||
| 13 | CIGNA/GREAT WEST | Individual & Employer Sponsored | |||
| 14 | CONNECT | Northern VA: |
Northern VA: |
Northern VA: |
|
| 15 | Richmond: |
Richmond: |
Richmond: |
||
| 16 | Hamp Roads: |
Hamp Roads: |
Hamp Roads: |
||
| 17 | Medicare | ||||
| 18 | INNOVATION HEALTH (NORTHERN VA ONLY) | Individual & Employer Sponsored | |||
| 19 | Medicare | ||||
| 20 | JOHNS HOPKINS EHP (NORTHERN VA ONLY) | Employer Sponsored | |||
| 21 | JOHNS HOPKINS USFHP | Employer Sponsored | |||
| 22 | FIRST HEALTH | Individual & Employer Sponsored | |||
| 23 | KAISER (NORTHERN VA ONLY) | Individual & Employer Sponsored | |||
| 24 | MEDCOST VA | Individual & Employer Sponsored | |||
| 25 | MEDICARE | Individual | |||
| 26 | MEDI-SHARE HEALTHCARE | Individual | |||
| 27 | MULTIPLAN | Individual & Employer Sponsored | |||
| 28 | TRICARE | Employer Sponsored | |||
| 29 | SENTARA HEALTH PLANS | Individual & Employer Sponsored | |||
| 30 | Medicaid | ||||
| 31 | Medicare | ||||
| 32 | OSCAR HEALTH | Individual & Employer Sponsored | |||
| 33 | UNITED HEALTHCARE | Individual & Employer Sponsored | |||
| 34 | Medicaid | ||||
| 35 | Medicare | ||||
| 36 | VELOCITY NATIONAL PROVIDER NETWORK | Individual | |||
| 37 | Medicare | ||||
| 38 | VETERANS CCN | Employer Sponsored | |||
| 43 | VIRGINIA STATE MEDICAID | Individual |
Virginia Self-Pay Program for Patients Without Insurance
| Visit charge for routine problem $145 | |
| Lab, x-ray, and other add-on services discounted and priced separately | |
| Visit charge plus add-ons capped at $317 1 | |
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Pricing for Patients without Insurance |
|
A) Office Visit Charges |
|
| Routine visit | $145 |
| Follow-up visit | $69 |
| Telehealth – Routine Visit | $90 |
| Telehealth – Follow-up Visit | $50 |
| Visit for diabetes, cholesterol, or prostate cancer screening | $59 |
| Visit for DOT physical (price includes urinalysis) | $135 |
| Visit for 10-panel drug screen (with collection) | $115 |
| Visit for drug screen (collection only 2 ) | $41 |
| Visit for standard-dose flu shot (ages 3+) 3 | $45 |
| Visit for high-dose flu shot (ages 65+) 3 | $88 |
| Visit for pregnancy testing | $55 |
| Visit for removal of sutures placed elsewhere | $49 |
| Visit for TB risk assessment | $35 |
| Visit for TB test | $55 |
| Visit for sports or camp physical4 | $55 |
| Visit for school physical | $96 |
B) Add-On Services |
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| Lab test on-site (each) | $62 |
| X-ray exam (each) | $120 |
| EKG | $120 |
| Burn care (2nd or 3rd degree) | $120 |
| Fracture/dislocation (initial office care) | $120 |
| IV fluids | $120 |
| Nebulizer treatment | $120 |
| Stitches or laceration repair | $120 |
| Supplies and durable medical equipment (e.g., crutches) | Discounted 20% |
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A) Office Visit Charge + B) Add-On Services = Total Visit Cost (capped at $317) |
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Charges Not Included in the $317 Cap |
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| Prescriptions and Injectable Medications | Discounted 20% |
| Vaccines | Discounted 20% |
| Outside Lab 5 | |
| Simple | $62 |
| Moderate | $80 |
| Complex | $125 |
| Highly Complex | $210 |
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, injectable medications, 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 Flu vaccine is not subject to the additional 20% discount. Flu vaccine is included in the charge for a 'Visit for Standard-Dose Flu Shot' and a 'Visit for High-Dose Flu Shot' as listed above under Office Visit Charges.
4 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.
5 Pricing only applies to Virginia centers. Outside of Virginia, outside labs are billed separately by the outside reference lab./p>