Shiloh's First Board-Certified Family Physician Appointments (618) 277-3197 E-MAIL The Country Doctor Please include your name, insurance plan, and telephone number.

2009 Fee Schedule and list of common charges

Remember that your care is from a Board-Certified, Family Physician. You do not have to wait 2 hours to see a doctor. New and established patient visits are within 24-48 hours of the call for most people.

 

Outpatient Common Office Visit fees for new and established patients

Code	Charge in $	Description
Level 3 New	120	New patient with minimal medications and basic illnesses. About 50% of the new patient visits.
Level 4 New	160	New patient with multiple illnesses. About 20% of the new patient visits.
Level 3 Est.	80	Established patient, one to three illnesses, around 15 minutes, such as the patient with hypertension and high cholesterol who is well controlled with diet, exercise, and medications. About 50% of the patient visits.
Level 4 Est.	120	Establish patient, three or more concerns or uncontrolled illnesses. Examples include the patient with diabetes, hypertension, and high cholesterol. The patient with diabetes and cellullitis or pneumonia. About 30% of the patient visits.

These are the commonly billed fees that we charge patients. There are other levels of care. For patients with in network insurance, the claim will go to the insurance company. The insurance contracted fee usually is less than the charged fee, with a copay or deductible due for each visit and lab charge. These office visit, lab, procedure, and injectables fees are cash prices for self paying patients. Credit and debit cards will have a surcharge of around 5%.

 

Common Lab and procedure Fees (these may be in addition to office visit fees)

Lab	Charge in $	Description
ALT	10	Liver enzyme for medication monitoring
AST	10	Liver enzyme for medication monitoring
Blood Draw fee	10	Fee when obtaining labs by fingerstick or venipuncture
Glucose	10	Glucose/Sugar Test
Hemoglobin	10	Anemia screen
INR	10	INR for coumadin/warfarin monitoring
Urinalysis	10	Basic urine analysis, both manual and by machine
Urine Pregnancy	10	Urine pregnancy test
Urine Creatinine	10	Automated test for minute changes, which can be associated with kidney disease, diabetes, and hypertension
Urine Microalbumin	10	Automated test for minute changes, which can be associated with kidney disease, diabetes, and hypertension
BMP/Chem 8	15	Includes Sodium, Potassium, Chloride, TCO2, BUN, Creatinine, and Glucose
CMP/Chem 14	20	Includes Sodium, Potassium, Chloride, TCO2, BUN, Creatinine, Glucose, ALT, AST, Alkaline Phosphatase, Calcium, Protein, Albumin, and Bilirubin
H. Pylori	20	Helicobacter pylori blood test for stomach bacteria that causes ulcers
Mono	20	Mononucleosis test
Rapid Strept	20	Test for streptococcal Pharyngitis
Urine Drug Screen	25	Common drugs of abuse
Lipid Panel	25	Full cholesterol panel, including total cholesterol, triglycerides, LDL (bad) cholesterol, and HDL (good) Cholesterol
Hemoglobin A1C	30	90 day sugar average for patients with impaired glucose or diabetes
TSH	30	For hypothyroidism screening
EKG	50
Cerumen/Wax removal	70	Impacted cerumen/wax removal

Most labs charge 1 1/2 to 10 times what our lab fees are. Not all the labs are available to all insured patients, as some insurance companies have special lab contracts at outside labs. A blood draw fee is added to the cost of some of the labs.

 

Injectables (the injection fee is added to the vaccine or drug charge)

Code	Charge in $	Description
B12	10	For B12 deficiency. Does not include IM Injection charge
IM/SC Injection	25	Added to the medication or drug charge. Price is per injection.
PPD Test/TB Test	20	Tuberculosis screening
Flu shot	35	Does not include IM injection charge
Pneumovax	70	Pneumonia Vaccine (Merck increased our cost for 2009 and 2010)
Tetanus	45	Regular Tetanus, not the TDAP
Tetanus/DTAP	65	Diphtheria and Pertussis protection
Hepatitis A	90	Two shot series, price is for each shot
Hepatitis B	90	Three shot series, price is for each shot
MMR	95	Measles, Mumps, and Rubella
Varicella Booster	140	If you have not had the chicken pox or if you only had the first dose of the vaccine, teenagers need a booster
Meningitis	130	Good for college students
Gardasil/HPV	165	HPV Cervical Cancer vaccine from Merck
Shingles/Zostavax	220	This vaccine has shipping delays

Our vaccine prices are competitive with most of the local practices. Vaccine prices do not include the injection fee. An office visit fee may be added to the cost of the vaccines.

CDC Vaccine Handouts

 

Miscellaneous Fees, which are not covered by insurance.

Code	Charge in $	Description
Paperwork completion	varies	FMLA forms, disability forms, etc. Varies, depending on complexity of the form and number of questions/pages.
Record Copying fees	varies	The amount a physician can charge for copying medical records in the state of Illinois is regulated by Illinois General Assembly Senate Bill 721. The Country Doctor, Ltd. follows the fee schedule established by state law.
Faxing fee	varies	Usually no extra charge from the paperwork fees, unless it is long distance.
Bounced check fee	$30	This is in addition to the copay or deductible
No Show Fee	$30	For patients who provide less than 24 hours of notice or do not show up to an appointment. We call our patients to remind them about their appointments.
Called in medication fee	Varies	This is mainly charged to self paying patients who cannot make it into a visit. Most medication refills or new medication prescriptions will be done at office visits.
Credit or Debit card use	5% convenience fee	The credit card company required us to buy a new credit card machine, charges us between 2.5-3.5% per transaction, charges a 26 cents network access fee per transaction, and charges us to verify that we are U.S. Business multiple times a year. Points cards also cause a 1-2% deduction, and running a card over the phone adds another 1-2% deduction from the credit card company to the charged amount. I simply am passing along the fees to the consumer. Cash is the preferred method for office visit charges/fees/copays etc.

 

Home	Hours of Operation	NEW PATIENT FORMS
Accepted Insurance Plans	Physician Biography	Driving Directions/Maps
Office Pictures	Medication Questions	Links & Patient Handouts
	Health Screening Recommendations	Address Directory

*Clicking one time on any link will take you to the referenced web page.

 

 The Country Doctor, Ltd.

2310 Country Road

Shiloh, IL 62221-2570

Voice (618) 277-3197

Exchange (618) 277-3214

E-MAIL The Country Doctor