Shiloh's First Board-Certified Family Physician Appointments (618) 277-3197 Weekday AM Appointments and Exchange (618) 277-3214 E-MAIL The Country Doctor Please include your name, insurance plan, and telephone number.

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	140	New patient with minimal medications and basic illnesses. Around half of the new patient visits.
Level 3 Est.	110	Established patient, one to three illnesses, such as the patient with hypertension and high cholesterol who is well controlled with diet, exercise, and medications. Around half of the established patient visits

These are the commonly billed fees. 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, who pay the full amount at the time of the visit. Credit and debit cards will have an additional.

 

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
CMP/Chem 14	20	Includes Sodium, Potassium, Chloride, TCO2, BUN, Creatinine, Glucose, ALT, AST, Alkaline Phosphatase, Calcium, Protein, Albumin, and Bilirubin
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 and Vaccines (the injection fee is added to the vaccine or drug charge)

Code	Charge in $	Description
B12	20	For B12 deficiency. Does not include IM Injection charge
IM/SC Injection	30	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. Preservative free.
Pneumovax	140	Pneumonia Vaccine (Merck increased our cost for 2017)
Tetanus/DTAP	80	Tetanus, Diphtheria, and Pertussis protection
Hepatitis A	110	Two dose series, price is for each dose
Hepatitis B	110	Three dose series, price is for each dose
MMR	120	Measles, Mumps, and Rubella
Varicella Booster	160	If you have not had the chicken pox or if you only had the first dose of the vaccine, you need a booster
Meningitis	170	Good for college students
Gardasil/HPV	290	HPV Cervical Cancer vaccine from Merck
Shingles/Shingrix	220	GSK, per injection.

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	The convenience fee varies	The credit card company charges between 2.5-3.5% per transaction, a 26 cents network access fee per transaction, and to verify that we are U.S. Business. Points cards 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. Cash is the preferred method for office visit charges/fees/copays etc.

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 The Country Doctor, Ltd.

2310 Country Road

Shiloh, IL 62221-2570

Voice (618) 277-3197

Exchange (618) 277-3214