Commerce Primary Care, P.C.
Self-Pay Service Fee Amounts, Updated 8/26/2014
This is a current list of our updated self-pay prices. These prices are based off of Medicare
guidelines and will be due at the time of service. If you need to start a payment plan,
please ask to speak to our billing department to set one up.
Thank you!
New Patients
Total Cost
Office Visit- Moderate (99203)
110
Office Visit- Moderate-High (99204)
170
Office Visit- High (99205)
210
New Patient Physical (Ages 12-17)
150
New Patient Physical (Ages 18-39)
145
New Patient Physical (Ages 40-64)
170
New Patient Physical (Ages 65+)
180
Established Patients
Office Visit Moderate (99213)
75
Office Visit Moderate-High (99214)
110
Office Visit High (99215)
145
Physical (Ages 12-17)
125
Physical (Ages 18-39)
130
Physical (Ages 40-64)
140
Physical (Ages 65+)
150
Vaccine Name
Total Cost Per Dose
Influenza- Regular
25
Influenza- Intradermal, Small Needle
30
Influenza- Flumist, Live
35
Pneumovax (Pneumonia)
100
Hepatitis B
85
*Not in stock: Has to be ordered*
Hepatitis A
75
*Not in stock: Has to be ordered*
Varicella (Chickenpox)
125
*Not in stock: Has to be ordered*
Zostavax (Shingles)
200
*Not in stock: Has to be ordered*
Tetanus
25
TDAP
60
Meningitis
135
*Not in stock: Has to be ordered*
Tests
Total Cost
Influenza Test
10
TB Test
15
Rapid Strep
10
Urine Dip
5
Urine Pregnancy
10
EKG
20
Spirometry
45
Pulse Ox
5
Glucose Finger
2
FOBT
15
PT/INR Check
5
Venipuncture
3
H. Pylori
10
Injections
Total Cost per Dose
B12
25
Compazine 10 mg
30
Decadron Per 1 mg
25
Depo Medrol 20 mg
30
Depo Medrol 40 mg
30
Depo Medrol 80 mg
35
Toradol 15 mg
25
Toradol 30 mg
25
Toradol 60 mg
30
Rocephin per 250 mg
30
Testosterone
25
Allergy Shot (Single)
12
Allergy Shot (Multiple)
15
Procedures
Total Cost
Breathing Treatment
25
Remove Object/Ear
150
Ear Wash/Wax Removal
55
Suture Removal
40
Incision & Drainage, Simple
120
Incision & Drainage, Complex
215
Incision & Drainage, Hematoma
170
Hystofreeze/Scraping (Benign)
85
Incision & Removal, Foreign Body
185
Pairing/Cutting Corn/Callus
55
I&D Throm Roid
215
Skin Tag Removal, per each
90
Wart Removal, per each
115
Punch Biopsy
110
Excision, Benign, < .5 cm
130
Excision, Benign, .6-1.0 cm
155
Excision, Benign, 1.1-2.0 cm
175
Excision, Malignant, <.5 cm
235
Excision, Malignant, .6-1.0 cm
240
Excision, Malignant, 1.1-2.0 cm
260
Pap Smear
45
Small Joint Aspiration
50
Medium Joint Aspiration
70
Large Joint Aspiration
60
Trigger Point
60