Premier Extended Plan
Cost
Monthly Payment Information
· The cost is $15 per month per individual. (Due the 1st of each month.)
OFFICE VISITS
· Primary Care Office Visits $5
· Transportation to the network Medical Center visit $7
· Physical Therapy office based $15 per treatment
PRESCRIPTION DRUGS
· Prescriptions dispensing $5 per medication
LABORATORY TESTING
Laboratory: $15
· PT, PTT, INR
· Complete Blood Count (CBC)
· Hemoglobin / Hematocrit
· Basic Metabolic Panel
· Comprehensive Metabolic Panel
· Electrolyte Panel
· Lipid Panel
· Liver Function Panel
· Routine Culture (Throat, Urine, Stool, Tissue, Genital)
Other tests:
· Pap Smear Test $15
* Other laboratory tests available.
MINOR SURGERY / PROCEDURES
Office based minor surgery $140
* Other procedures available
PULMONARY SERVICES
· Spirometry $40
· Aerosol Treatments $18
RADIOLOGY SERVICES
· Plain X-Rays (2 views) $30
DIAGNOSTIC ULTRASOUNDS
· Aorta, Kidneys or Pancreas $95
· Breast $75
· Scrotum $95
· Thyroid $90
CARDIOVASCULAR
· Electrocardiogram $25
· Extremities vascular Imaging $ 130
· Carotid Arterial Imaging/ Doppler $210
· Echocardiogram $210