“Self Pay” Office Charge List

Office Visit Type CPT code Premier ‘Self pay’ Charge
New patient visit level 2  99202  $  75
New patient visit level 3  99203  $ 105
Recheck level 2  99212  $  45
Recheck level 3  99213  $  70
Injection (not including medication)  20610  $  60
X-ray Foot  73630  $  30
X-ray Ankle  73610  $  30
X-ray Knee  73562  $  35
X-ray Hip/Pelvis  73522  $  45
X-ray Shoulder  73030  $  30
X-ray Hand  73130  $  30


We work with local bracing and equipment suppliers to obtain the highest quality braces and durable medical equipment (DME) made in the U.S.A. for the best price and then pass that savings on to our patients. While no medical office can carry every type of brace, Premier Orthopedic Specialists of Tulsa carries a wide variety of braces for the most common orthopedic conditions. If we do not carry the proper brace for you, we can usually order the proper brace with the help of customized bracing suppliers, however we have no control over pricing for braces supplied outside our office. The following is a current list of braces that we carry and the charge for them.

Brace Type Premier Orthopedics Charge
 Knee – Patellofemoral    Stabiliz.  $ 40
 Knee – Patellar Tendon Strap  $ 15
 Knee – Neoprene Hinged  $ 75
 Ankle Lace-up  $ 25
 Rigid Shoe  $ 15
 Tibial Walker  $ 40
 Toe Splint  $ 10
 Bunion Splint  $ 30
 Heel Wedge  $ 15
 Wrist Lace-up  $ 25
 Finger Strap  $  5
 Shoulder Sling  $ 15
 Back Brace  $ 120


We at Premier orthopedic Specialists of Tulsa are honored to have partnered with Zerocard to provide orthopedic services to their participants. We are Fastpass providers which means that Zerocard participants can contact Premier Orthopedics directly and schedule appointments and in office services without preauthorization or a copay.
Contact your Zerocard representative at www.zerocard.com for any questions.


Bundling is the process by which surgical services (Hospital charge, surgeon’s fee, anesthesia fee) are grouped together as one price for the costs of a surgical procedure. Various companies encourage this practice, which can significantly lower the overall cost of inpatient or outpatient procedures. Premier Orthopedics Specialists of Tulsa actively participates with Oklahoma Surgical Hospital in bundling with a variety of participating companies. We are always happy to discuss these options that are available to patients that have this option with their insurance plan or that chose this option if paying with cash/credit card outside of an insurance plan.