Self Pay

New Patient Office Visits
New Patient - 30 Minutes (99203)
$258
New Patient - 60 Minutes (99204)
$386
New Patient - 60+ Minutes (99205)
$510
Established Patient Office Visits
Establish Patient - Limited Care (99213)
$210
Established Patient - Intermediate Care (99214)
$296
Established Patient - Lengthy Care (99215)
$415
Established Patient Wellness Exams
Well Child Exam (0-11 months) (99391)
$200
Well Child Exam (1-4 years) (99392)
$273
Well Child Exam (5-11 years) (99393)
$273
Well Child Exam (12-17 years) (99394)
$306
Adult Wellness Exam (18-39 years) (99395)
$298
Adult Wellness Exam (40-64 years) (99396)
$286
Adult Wellness Exam (65+ years) (99397)
$308
Other
Sleep Study
$200
Telemedicine (Same as In-Person Office Visit)
Oregon Medical Weight Loss
New Patient Orientation
$0
OMWL Program Start Fee
$189
Medical Intake (New Patient)
$230
Follow-Up Medical Appts
$130
Group Medical Office Visits
$130
Physical Therapy
Physical Therapy - New Patient
$165
Physical Therapy - Follow-Up Appts
$140
Acupuncture (Collin Stoll, MAcOM, LAc) - All Appts
$110
Mental Health Counseling (Simone & Scarlet)
New Patients
$195
Follow ups
$175
Updated 11.21.25
CPT
Description
Cash Pay
J7307
Nexplanon
$1,200.00
J7300
Paraguard
$1,200.00
J7298
Mirena
$1,250.00
J7301
Skyla
$1,050.00
J1050
Medroxyprogesterone (DEPO)
$69.00
J7296
Kyleena
$1,250.00
J7297
Liletta
$480.00
J1885 4 Units
60 mg toradol injection
$28.00
J1885 2 Units
30 mg toradol injection
$14.00
J3301
10 mg kenalog Injection
$4.00
J3301 4 Units
40 mg Kenalog injection
$14.00
J1030
40 mg depomedrol Injection
$4.00
J1030 2 Units -OR- J1040
80 mg depomedrol
$7.00
J1100
10 mg Dexamethasone Injection
J0696
250 mg Rocephin
$11.00
J0697 2 Units
500 mg Rocephin
$22.00
J2550
25 mg Promethozine (Phenergan)
$4.00
90715
Tdap shot (no admin fee)
$50.00
90700
DTAP
$60.00
90698
Pentacel
$134.00
90671
Pnuemo 15
$217.00
90732
Pneumococcus 23 Valent
$125.00
90651
Gardasil HPV
$375.00
86580
PPD - TB Screening (don't do anymore)
$25.00
90633
HEP A Peds/Teens
$60.00
90632
HEP A Adults
$85.00
90620
Bexsero
$195.00
90648
HIB
$25.00
90734
Meningoccal Conjugate Vaccine
$116.00
90743
HEP B peds/teens
$60.00
90746
HEP B adults
$60.00
90707
MMR
$94.00
90723
Pediarix
$88.00
90621
Trumenba
$123.00
90680
Rotavirus
$90.00
90713
IPOL
$45.00
90656
Flu (no admin fee)
$40.00
90750
Shinrix
$215.00
90716
Varicella/ Chickenpox Immunization
$180.00
S0020
.25% Marcaine
$4.00
S0020 2 Units
.50% Marcaine
$4.00
J2003
1% Lidocaine
$4.00
J2003 2 Units
2% Lidocaine
$4.00
10060
Incision and Drainage Simple
$457.00
10061
Incision and Drainage Complex with packing
$500.00
11055
Corn/Callous removal by paring
$154.00
11056
PARING - 2-4 LESIONS
$165.00
20612
Gangloin Cyst
$294.00
20610
Bursa - Knee, Shoulder
$123.00
20605
Bursa - Elbow, Wrist
$102.00
20600
Bursa - Fingures, Toes
$100.00
20551
Tendon Orgin/Insertion
$111.00
20550
Tendon Sheath/Ligament
$101.00
20552
Trigger Points 1 0r 2
$102.00
20553
Trigger points 3+
$116.00
20526
Carpal Tunnel Injection
$140.00
11200
Skin Tag Removal
$153.00
17000
Destruction of lesion (freeze/cauterization)
$124.00
17110
Destruction of Warts <14
$208.00
17111
Destruction of Warts >15
$244.00
11730
Nail Removal Partial
$171.00
11750
Nail Removal Permanent
$386.00
17110
Wart Removal (less than 14 - non private area)
$205.00
17111
Wart Removal (over 15 - non private area)
$235.00
54150
Circumcision
$350.00
55250
Vasectomy
$780.00
57455
Colposcopy Cervix w/ Biopsy
$259.00
76815
Ultrasound OB Transvag Limited
$218.00
76816
Ultrasound OB TransAbdominal
$210.00
76817
Ultrasound OB Transvag
$175.00
76813
Ultrasound OB 1st Trimester Nuchal Translucency
$221.00
76811
Ultrasound OB Maternal Detailed Eval
$330.00
76818
Fetal Biophysical with Non Stress Test
$223.00
76819
Fetal Biophysical w/out Non Stress Test
$163.00
59025
Fetal Non Stress Test
$98.00
76830
Ultrasound NONOB TransVag
$220.00
58301
IUD - Removal
$175.00
58300
IUD - Insertion
$245.00
11982
Nexplonan Removal
$268.00
11981
Nexplonan Insertion
$256.00
11983
Nexplonan Replacement
$427.00
93000
EKG
$50 ($90 billed to ins)
93242 or 93246
Zio patch 48 hrs to 14 days
$30
90471
Admin fee of 1st immunization
$44.00
90472
Admin fee of 2nd or more immunizations
$25.00
96372
Medication administration
$42.00
UPDATED 03/25/2025