SELF-PAY PATIENT PROGRAM

Dear Patient,

Crescent Family Medicine, committed to its mission of providing high quality, updated and cost effective care to our patients, has designed and implemented, since our establishment, a discounted rate self-pay patient program.

Our program does not have membership fees or other upfront costs. To qualify for our Self-Pay rates you must either lack health care coverage through a private or government insurance agency, or have health coverage with a high deductible and prefer to pay out pocket for medical expenses.

The Self-Pay rates are based on 20% discount of our regular fees which average the cost of processing claims through the insurance companies.

	Office Visits Rates Our fees are based on a flat rate ($) New Patient 75 Established Patient and Follow Ups 65 Complete Physicals (Male/Female) 85 Sport, Camps and School Physicals 25 Emergency Visit 85 Our Office visit rates are not based on conditions to be treated or time spent with patient. They are rather based on a flat rate, you may present with either a single or multiple acute problems or even with multiple chronic conditions.		In House Labs Influenza A & B $30 Glucose $15 Urine Pregnancy $15 Strep A $25 Urine Test $15 Lipid Profile $25 H.Pylori $21		Common Procedures Hearing Screen $20 Electrocardiogram $45 Nebulizer $22 Pulmonary Function Test $45 Skin Tag Removal (1-15) $85 Skin Tags additional 15 $45 Destruction Skin Lesion (1) $90 Destruction Skin Lesion (additional 1) $50 IUD Removal $45 Remove Impacted Ear wax (1 ear) $25 Remove Impacted Ear wax (2 ears) $40 Incision and Drainage $150 Nail Removal (complete) $150 Nail Removal (partial) $110 Laceration repair (<2.5cm) $125 Laceration Repair (>2.5cm) $175		Labs done at contracted laboratory (Blood Drawing is done at our clinic) Complete Metabolic Panel $21 General Health Panel $50 Thyroid $18 Complete Blood Count $18 Urine Culture $21 Pap Smear $48 Prostate Specific Antigen (PSA) $21 Uric Acid $12 Blood Type and Rh factor $21