Cash prices
- Brief VisitAsk what's included$60 per visit
For uninsured patients or those choosing not to use insurance. For prescription refills, quick questions, or simple paperwork.
Source: formandfunctionhealthcare.com · checked Oct 2026 - Follow Up VisitAsk what's included$100 per visit
For uninsured patients or those choosing not to use insurance. A 40-minute follow-up for ongoing management of known issues, health plans, or further tests or assessments within one year after the initial evaluation.
Source: formandfunctionhealthcare.com · checked Oct 2026 - Monthly subscription - IndividualAsk what's includedMembership$125 per month
$125/month with a 12-month subscription; automatically billed on the first of each month. Includes up to two office visits per month, portal access, and messaging. Labs billed separately to insurance or directly to you.
Source: formandfunctionhealthcare.com · checked Oct 2026 - Monthly subscription - CoupleAsk what's includedMembership$200 per month
$200/month per couple with a 12-month subscription; automatically billed on the first of each month. Includes up to two office visits per month, portal access, and messaging. Labs billed separately to insurance or directly to you.
Source: formandfunctionhealthcare.com · checked Oct 2026 - Monthly subscription - Family (up to 4)Ask what's includedMembership$400 per month
$400/month for a family of up to four with a 12-month subscription; automatically billed on the first of each month. Includes up to two office visits per month, portal access, and messaging. Labs billed separately to insurance or directly t…
Source: formandfunctionhealthcare.com · checked Oct 2026 - New Patient Visit with ExaminationAsk what's included$150 per visit
For uninsured patients or those choosing not to use insurance. Includes a 60-minute initial appointment and focused physical exam. If labs are performed, a follow-up appointment to review results is included.
Source: formandfunctionhealthcare.com · checked Oct 2026 - Payment per Visit - 100% FPLAsk what's included$25 per visit
For uninsured patients or those choosing not to use insurance who qualify for the 100% FPL tier based on household size and income. Two months of pay stubs required. Procedures receive a separate 50% discount.
Source: formandfunctionhealthcare.com · checked Oct 2026 - Payment per Visit - 150% FPLAsk what's included$40 per visit
For uninsured patients or those choosing not to use insurance who qualify for the 150% FPL tier based on household size and income. Two months of pay stubs required. Procedures receive a separate 50% discount.
Source: formandfunctionhealthcare.com · checked Oct 2026 - Payment per Visit - 175% FPLAsk what's included$50 per visit
For uninsured patients or those choosing not to use insurance who qualify for the 175% FPL tier based on household size and income. Two months of pay stubs required. Procedures receive a separate 50% discount.
Source: formandfunctionhealthcare.com · checked Oct 2026 - Payment per Visit - 200% FPLAsk what's included$60 per visit
For uninsured patients or those choosing not to use insurance who qualify for the 200% FPL tier based on household size and income. Two months of pay stubs required. Procedures receive a separate 50% discount.
Source: formandfunctionhealthcare.com · checked Oct 2026 - Sick VisitAsk what's included$90 per visit
For uninsured patients or those choosing not to use insurance. A 20-minute visit for new or acute issues. Some testing is included, such as point-of-care strep testing and urine dip.
Source: formandfunctionhealthcare.com · checked Oct 2026 - Sliding-fee visit - 100% FPLAsk what's included$25 per visit
For uninsured patients or those choosing not to use insurance who qualify for the 100% FPL tier based on household size and income. Two months of pay stubs required. Procedures receive a separate 50% discount.
Source: formandfunctionhealthcare.com · checked Oct 2026 - Sliding-fee visit - 150% FPLAsk what's included$40 per visit
For uninsured patients or those choosing not to use insurance who qualify for the 150% FPL tier based on household size and income. Two months of pay stubs required. Procedures receive a separate 50% discount.
Source: formandfunctionhealthcare.com · checked Oct 2026 - Sliding-fee visit - 175% FPLAsk what's included$50 per visit
For uninsured patients or those choosing not to use insurance who qualify for the 175% FPL tier based on household size and income. Two months of pay stubs required. Procedures receive a separate 50% discount.
Source: formandfunctionhealthcare.com · checked Oct 2026 - Sliding-fee visit - 200% FPLAsk what's included$60 per visit
For uninsured patients or those choosing not to use insurance who qualify for the 200% FPL tier based on household size and income. Two months of pay stubs required. Procedures receive a separate 50% discount.
Source: formandfunctionhealthcare.com · checked Oct 2026
Prices are published cash prices with their source and the date we last checked. Confirm with the provider before you book. Hospital prices for a billing code are often the facility charge only.