Self-Pay Program

No Insurance? No Problem.

Introducing the Simple Self-Pay Program

We strive to create easier access to convenient, transparent, and affordable health care for the communities we serve. The Simple Self-Pay Program allows uninsured (or self-pay) patients to pay an upfront office visit fee that includes many in-house testing options (COVID-19 and Flu testing require an additional fee) and common procedures for urgent care, primary care, behavioral health care, orthopedic care, dermatology care and physical therapy needs.

In addition to the following, a good faith estimate of expected charges will be made available to all uninsured (or self-pay) patients scheduling an item or service, in accordance with 45 CFR 149.610(b)(1)(vi). A good faith estimate of expected charges may also be requested by contacting your clinic or service provider directly via phone (at the phone number published for your clinic/service provider on this website) and, for in person care, at the address published for your clinic/service provider on this website.

Self-Pay Pricing

Fast Pace Health Clinics

Base Rate Visit Charges

^{Simple Self-Pay program visits must fall into one of the categories below. Additional charges may apply depending upon the services provided- see the list of Add-On Service Charges below for additional information.}

“Self-Pay” Office Visit for urgent care and/or primary care services	$150
^{Includes all basic in-house tests, injections, x-rays, and procedures except for those listed below under Add-On Service Charges. CPT Codes 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215.}

Simple Work Physical (1 page), Childcare Physical, Sports Physical, or Basic Student Physical	$25
^{All testing outside of Fast Pace Health that requires additional certification will result in additional charges.}

Sports Physical with Urinary Drug Screen (UDS)

$90

Behavioral Health Initial Visit	$150
^{Scheduled visit with Behavioral Health Team. In-house tests/drug screens not included. CPT 90791, 90792 & 90785}

Behavioral Health Follow up Visit	$90
^{Scheduled visit with Behavioral Health Team. In-house tests/drug screens not included. CPT 99212, 99213, 99214, 99215, 90832, 90833, 90834, 90835, 90836, 90837. 90838, 90846, 90847 & 90785}

Telehealth Urgent Care Visit	$85
^{Scheduled visit with Telehealth Team. In-house tests, injections, and x-rays not included. CPT Codes 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215.}

Physical Therapy Visit	$100
^{New or Established patient. CPT 97140, 97116, 97112, & 97110}

Form Fees	$25
^{FMLA paperwork, etc.}

Add-On Service Charges

^{Services Listed below require an appropriate Simple Self-Pay Program Visit and are charged in additional to the fees collected for such visit.}

Drug Testing (not included in the Base Rate Visit Charge)	$65
^{Note that an additional $65 will be charged in the event a specimen must be sent out for confirmation testing. If the additional $65 is not paid, the specimen cannot be sent out, and results will be unavailable.}

Breath Alcohol Testing (BAT)

$50

Rapid Testing COMBO Test (Sofia 2 Flu + SARS Antigen FIA test)	$35
^{CPT 87428}

Rapid Testing – Sofia COVID only or FLU A & B Testing	$35
^{CPT 87426 & 87804×2}

IV Hydration and/or Therapy including any medications used.	$150
^{This is for any amount of time for hydration or Therapy.}

Neuropsychological Testing	$60
^{CPT 96132}

Vaccines – Charged in addition to the Simple Self-Pay Program visit fee.

^{Services Listed below require an appropriate Simple Self-Pay Program Visit and are charged in additional to the fees collected for such visit.}

Tetanus Vaccine (Td)

$36

Influenza Vaccine – (Does not require base rate charge)

Seasonal Pricing

Tdap Vaccine

$65

Special Order	Call Billing Dept.
^{Infrequent Vaccines/Medicines not Listed above will require prepayment from the patient before ordering the vaccine.}

Labs Commonly Sent Out – Charged in Addition to the Simple Self-Pay Program Visit fee.

Code

Test

Description Refer to PV Pricing

005009

CBC w/ Differential / Platelet

$5

335513

TSH

$35

303756

Lipid Panel

$10

322000

Comp. Metabolic Panel (CMP)(14)

$5

001453

Hemoglobin A1c

$5

008847

Urine Culture, Routine (additional fee if more than two organisms are detected)

$15

008003

Anaerobic and Aerobic Culture

$35

058495

Measles/Mumps/Rubella Immunity (MMR Titer)

$15

006530

Hepatitis B Surf AB Quant. (Titer)

$5

096206

Varicella-Zoster V AB, IGG (Titer)

$10

006726

Hepatitis A AB, Total (Titer)

$10

182879

QuantiFERON-TB Gold Plus

$60

004226

Testosterone, Serum

$5

140103

Testosterone, Free and Total

$10

322758

BMP

$5

000620

Thyroid Panel with TSH

$15

081950

Vitamin D 25-Hydroxy

$15

183160

Ct, Ng, Trich vag by NAA

$114

180060

Bacterial Vaginosis, NAA

$110

180055

C albicans + C glabrata, NAA

$70

Venipuncture Charge (Omit charge if no venipuncture)

$4

^{Disclaimers: These Rates do not apply if you elect to use your coverage under any insurance program, including high deductible health plans. If you have health insurance coverage and/or worker’s compensation coverage for healthcare services, and elect to use such coverage, all rates for such services will be determined by your insurers and/or as otherwise determined by Fast Pace Health for services provided outside of its Simple Self-Pay Program. If you are covered by any insurance program, and elect to use such coverage, you will be required to pay your applicable patient responsibility, co-pay, co-insurance, or deductible at the time of service. There may be additional items or services Fast Pace Health, Fast Pace Orthopedics, Fast Pace Dermatology, First Care Clinics, Christian Family Medicine & Pediatrics, Reelfoot Family Walk-in Clinic, Sunrise Pediatrics, Kids Are Special and/or their affiliates (collectively, the “Fast Pace Health family of Companies”) recommend as part of your course of care that must be scheduled or requested separately by you and are not reflected in good faith estimates or above. The information provided in a good faith estimate and/or above is only an estimate regarding items or services reasonably expected to be furnished at the time the good faith estimate is issued (or, in absence of a good faith estimate, in a customary visit for the services described above) and that actual items, services, or charges you receive may differ from the good faith estimate and/or those set forth above. You have the right to initiate a patient-provider dispute resolution process if the actual billed charges are substantially in excess of the expected charges included in a good faith estimate, as specified in 45 CFR 149.620. You may initiate this dispute resolution process by sending a written notice of your dispute addressed to Fast Pace Health, Attn: Chief Compliance Officer, P.O. Box 681029, Franklin, TN 37068. Your initiation of the patient-provider dispute resolution process will not adversely affect the quality of health care services furnished to you by the Fast Pace Health family of Companies or your provider(s). Neither a good faith estimate, nor the information provided above, is a contract – you are not required to obtain the items or services from any of the providers or facilities identified in a good faith estimate or above.}

Fast Pace Orthopedics

Service Rendered

Code

Description

Total Charge

^{CPT Codes 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215}

New/Established Patient Office Visit

$ 150

^{*X‐Ray’s, Steroid Injections, & Splinting included in base charge}

Add-On Service Charges

Services Listed below require an appropriate Simple Self-Pay Program Visit and are charged in additional to the fees collected for such visit.

Code

Add On Service

Total Charge

UPPER

Casting ‐ Upper Extremity

$125

LOWER

Casting ‐ Lower Extremity

$165

SUPTZ

Injection – Supartz (per injection)

$150

DULNE

Injection ‐ Durolane

$1,100

1ANGEL

Regenerative – Angel Series 1 Kit

$800

3ANGEL

Regenerative – Angel Series 3 Kits

$2,100

PRPS1

Regenerative – PRP Series 1 Kit

$425

3PRPS1

Regenerative – PRP Series 3 Kits

$1,200

PSTEP

Orthotics – Power Step Inserts

$40

Code

DME Products (Fast Pace Orthopedics locations in Louisiana Only)

Total Charge

L4360

Walking Boots

$70

L3260

Surgical Shoe

$15

L3670

Shoulder Immobilizer

$30

E0114

Crutches

$30

L3908

Wrist Splint

$35

L3908

Wrist Splint w/thumb

$35

L3927

Finger Splint

$15

L1830

Knee Immobilizer

$50

L1831

Hinged Knee

$50

L1940

Ankle Brace

$40

Fast Pace Dermatology

FPH Dermatology logo

Service Rendered

Code

Description

Total Charge

^{CPT Codes 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215}

New/Established Patient Office Visit

$ 150

^{*Simple Closures included in office visit}

Add-On Service Charges

Services Listed below require an appropriate Simple Self-Pay Program Visit and are charged in additional to the fees collected for such visit.

Code

Add On Service

Total Charge

^{Labs Sent Out to a third party testing lab will incur additional fees.}

BIOSPY

Biopsy

$200

BIOPSYAD

Each Additional Biopsy

$50

DSCPCL1

Destruction Precancerous Lesion (First)

$100

DSCPCLADD

Destruction Precancerous Lesion (2‐14)

$10 each

DSPCL15

Destruction Precancerous Lesion (15+)

$275

NAVUL

Nail Avulsion

$150

SHVLES

Shave Lesions (first)

$200

SHVLESAD

Shave Lesions (Each Additional)

$100

DESMALES

Destruction Malignant Lesion (Each)

$400

DESBNLES

Destruction Benign Lesion (Each)

$300

BENEXC

Benign Excision (Each)

$400

MALEXC

Malignant Excision

$500

INTCLO

Intermediate Closures (Visit included)

$400

Code

Self‐Pay Cosmetics

Total Charge

BOTOX

Botox – Per Unit Price

$12

TCAPEEL

TCA Peels

$125

MICNED

Microneedling (Per Treatment)

$250

MCNDPRP1

Microneedling with PRP (Single Treatment)

$500

MCNDPRP3

Microneedling with PRP (Set of 3)

$1,350

First Care Clinics

Base Rate Visit Charges

^{Simple Self-Pay program visits must fall into one of the categories below. Additional charges may apply depending upon the services provided – see the list of Add-On Service Charges below for additional information.}

“Self-Pay” Office Visit for urgent and/or primary care services	$150
^{Includes all basic in-house tests, injections, x-rays, and procedures except for those listed below under Add-On Service Charges. CPT Codes 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215.}

Simple Work Physical (1 page), Childcare Physical, Sports Physical, or Basic Student Physical	$25
^{All testing outside of Fast Pace Health that requires additional certification will result in additional charges.}

Sports Physical with Urinary Drug Screen (UDS)

$90

Form Fees	$25
^{FMLA paperwork, etc.}

Add-On Service Charges

^{Services Listed below require an appropriate Simple Self-Pay Program Visit and are charged in additional to the fees collected for such visit.}

Drug Testing (not included in the Base Rate Visit Charge)

$65

^{Note that an additional $65 will be charged in the event a specimen must be sent out for confirmation testing. If the additional $65 is not paid, the specimen cannot be sent out, and results will be unavailable.}

Breath Alcohol Testing (BAT)

$50

Rapid Testing COMBO Test (Sofia 2 Flu + SARS Antigen FIA test)	$35
^{CPT 87428}

Rapid Testing – Sofia COVID only or FLU A & B Testing	$35
^{CPT 87426 & 87804×2}

IV Hydration and/or Therapy including any medications used.	$150
^{This is for any amount of time for hydration or Therapy.}

Vaccines – Charged in addition to the Self-Pay Program visit fee.

^{Services Listed below require an appropriate Simple Self-Pay Program Visit and are charged in additional to the fees collected for such visit.}

Tetanus Vaccine (Td)

$36

Tdap Vaccine

$65

Labs Commonly Sent Out – Charged in Addition to the Simple Self-Pay Program Visit fee.

Code

Test

Description Refer to PV Pricing

005009

CBC w/ Differential / Platelet

$5

335513

TSH

$35

303756

Lipid Panel

$10

322000

Comp. Metabolic Panel (CMP)(14)

$5

001453

Hemoglobin A1c

$5

008847

Urine Culture, Routine (additional fee if more than two organisms are detected)

$15

008003

Anaerobic and Aerobic Culture

$35

058495

Measles/Mumps/Rubella Immunity (MMR Titer)

$15

006530

Hepatitis B Surf AB Quant. (Titer)

$5

096206

Varicella-Zoster V AB, IGG (Titer)

$10

006726

Hepatitis A AB, Total (Titer)

$10

182879

QuantiFERON-TB Gold Plus

$60

004226

Testosterone, Serum

$5

140103

Testosterone, Free and Total

$10

322758

BMP

$5

000620

Thyroid Panel with TSH

$15

081950

Vitamin D 25-Hydroxy

$15

183160

Ct, Ng, Trich vag by NAA

$114

180060

Bacterial Vaginosis, NAA

$110

180055

C albicans + C glabrata, NAA

$70

Venipuncture Charge (Omit charge if no venipuncture)

$4

Christian Family Medicine & Pediatrics Clinics

^{Christian Family Medicine & Pediatrics offers Simple Self-Pay Program urgent care and primary care visits for patients for a $125.00 upfront office fee that includes most in-house testing and procedures.}

“Self-Pay” Office Visit for urgent and/or primary care services	$125
^{Includes basic in-house tests, injections, x-rays, and procedures except for those listed below. CPT Codes 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215.}

Services NOT included in the “Self-Pay” Program:
COVID/Flu/SARS Testing Vaccines IV Hydration and/or Therapy Durable Medical Equipment (DME) Drug Screening/Testing Breath Alcohol Testing Outside labs Ultrasound

Reelfoot Family Walk-in Clinic

Self-Pay Program

^{Reelfoot Family Walk-in Clinic offers Simple Self-Pay Program urgent care and primary care visits for patients for a $125.00 upfront office fee that includes most in-house testing and procedures. CPT Codes 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215.}

“Self-Pay” Office Visit for urgent and/or primary care services	$125
^{Includes basic in-house tests, injections, x-rays, and procedures except for those listed below. CPT Codes 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215.}

Services NOT included in the “Self-Pay” Program:
COVID/Flu/SARS Testing Vaccines IV Hydration and/or Therapy Durable Medical Equipment (DME) Drug Screening/Testing Breath Alcohol Testing Outside labs Ultrasound

Sunrise Pediatrics (Tullahoma, TN)

Self-Pay Program

^{Sunrise Pediatrics offers Simple Self-Pay Program urgent care and primary care visits for patients for a $125.00 upfront office fee that includes most in-house testing and procedures. CPT Codes 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215.}

“Self-Pay” Office Visit for urgent and/or primary care services	$125
^{Includes basic in-house tests, injections, x-rays, and procedures except for those listed below. CPT Codes 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215.}

Services NOT included in the “Self-Pay” Program:
COVID/Flu/SARS Testing Vaccines IV Hydration and/or Therapy Durable Medical Equipment (DME) Drug Screening/Testing Breath Alcohol Testing Outside labs Ultrasound

Kids Are Special (Shelbyville, TN)

Self-Pay Program

^{Kids Are Special offers Simple Self-Pay Program urgent care and primary care visits for patients for a $125.00 upfront office fee that includes most in-house testing and procedures. CPT Codes 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215.}

“Self-Pay” Office Visit for urgent and/or primary care services	$125
^{Includes basic in-house tests, injections, x-rays, and procedures except for those listed below. CPT Codes 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215.}

Services NOT included in the “Self-Pay” Program:
COVID/Flu/SARS Testing Vaccines IV Hydration and/or Therapy Durable Medical Equipment (DME) Drug Screening/Testing Breath Alcohol Testing Outside labs Ultrasound

For additional payment and pricing options click here.