Self Pay

If you are uninsured or plan to pay out of pocket, you have the right to receive a Good Faith Estimate of your expected charges before your visit, as required under the No Surprises Act. Please contact our Front Desk to request your Good Faith Estimate and to confirm current, verified pricing prior to your scheduled appointment.

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
58301
IUD - Removal
$175.00
58300
IUD - Insertion
$245.00
J7300
Paraguard - Device
$1,187.00
J7298
Mirena - Device
$1,272.44
J7301
Skyla - Device
$1,059.52
J7296
Kyleena - Device
$1,272.44
J7297
Liletta - Device
$498.94
J1050
Medroxyprogesterone (DEPO Injection)
$97.50
55250
Vasectomy
$780.00
11982
Nexplanon - Removal
$268.00
11981
Nexplanon - Insertion
$256.00
11983
Nexplanon - Replacement
$427.00
J7307
Nexplanon - Device
$1,280.10
90471
Admin Fee - 1 Injection
$44.00
90472
Admin Fee - 2+ Injections
$25.00
96372
Admin Fee - Medication Administration
$42.00
J1885 2 Units
30 mg Toradol Injection
$14.00
J1885 4 Units
60 mg Toradol Injection
$28.00
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 Injection
$7.00
J1100
10 mg Dexamethasone Injection
J0696
250 mg Rocephin
$11.00
J0697 2 Units
500 mg Rocephin
$22.00
J2550
25 mg Promethazine (Phenergan)
$4.00
90715
Tdap Vaccine (no admin fee)
$50.00
90700
DTaP Vaccine
$60.00
90698
Pentacel
$134.00
90671
Pnuemo 15
$217.00
90732
Pneumococcus 23 Valent
$125.00
90651
Gardasil HPV
$375.00
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 Vaccine (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
Ganglion Cyst
$294.00
20610
Bursa - Knee, Shoulder
$123.00
20605
Bursa - Elbow, Wrist
$102.00
20600
Bursa - Fingers, Toes
$100.00
20551
Tendon - Orgin/Insertion
$111.00
20550
Tendon - Sheath/Ligament
$101.00
20552
Trigger Points 1-2
$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 (< 14 - Non Private Area)
$205.00
17111
Wart Removal (> 15 - Non Private Area)
$235.00
54150
Circumcision
$350.00
57455
Colposcopy of Cervix w/ Biopsy
$259.00
76815
Ultrasound OB Transvaginal Limited
$218.00
76816
Ultrasound OB TransAbdominal
$210.00
76817
Ultrasound OB Transvaginal
$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 Transvaginal
$220.00
93000
EKG
$50.00
93242 or 93246
Zio Patch Installation 48 hrs to 14 days
$30.00
UPDATED 08/4/2026