Direct Primary Care, in plain language
Direct Primary Care is a model in which a primary-care practice is paid a flat monthly fee directly by the patient, in exchange for unlimited primary-care visits, longer appointments, and direct access to the clinician. It is not insurance. It does not cover hospitalizations, specialist care, imaging, labs, or prescriptions. It is described in detail by the AAFP — Direct Primary Care policy paper.
At Pharos the membership is $95/month per adult and is optional. Most of our patients use insurance and pay no membership; some use both. Our membership pathway is intended for two specific groups: patients who are uninsured and want a low-cost continuity-of-care relationship, and patients who are insured but want longer visits and direct phone access. The membership and the insurance pathway both yield the same clinical care — the differences are in access and billing.
What membership covers
| Service | Member | Insured (no membership) | Cash (no insurance, no membership) |
|---|---|---|---|
| CCH-001 visits (adult) | $0 | copay per plan | $120 (visit, 20 min) / $180 (visit, 40 min) |
| CCH-002 visits (pediatric) | $0 (with parent membership) | copay per plan | $110 (well-child) / $90 (sick) |
| CCH-003 visits (behavioral health) | $0 | copay per plan | $220 (90792 new eval) / $140 (follow-up) |
| CCH-004 visits (reproductive) | $0 | copay per plan | $160 (visit) + device cost at IUC/Nexplanon |
| CCH-005 procedures (most) | $0 | copay per plan + procedure CPT | see published procedure menu below |
| CCH-006 acute / after-hours | $0 | same as above (no separate fee) | $120 (acute visit) / no charge for after-hours line for established patients |
| POC ultrasound | $40 cash | $40 cash | $40 cash |
| Sports physicals out-of-cycle | $40 cash | $40 cash | $40 cash |
What membership does not cover
- Vaccines (covered by insurance or VFC; cash rate is the practice's cost plus 10%).
- Labs (covered by insurance or self-pay at Quest / Labcorp rates).
- Imaging (we will refer to Quest Imaging or to hospital radiology and the imaging facility bills separately).
- Prescriptions (filled at the pharmacy of your choice).
- Specialist referrals (referred specialists bill separately).
- Hospital-based care (HealthAlliance Broadway; bills separately per hospital pricing).
Office-procedure cash rates
The cash rates below are the published rates. Members pay $0 except for the items annotated. The rates are for established patients; non-established patients are referred (see CCH-005 § Population).
| Procedure | Cash rate | Member |
|---|---|---|
| Punch / shave biopsy | $140 + path | $0 + path |
| Cyst / lipoma excision < 4 cm | $280 + path | $0 + path |
| Joint injection (any single joint) | $140 + medication cost | $0 + medication |
| IUC placement (visit + insertion) | $220 + device | $0 + device |
| Nexplanon placement | $140 + device | $0 + device |
| Suture / laceration repair | $160–$340 by complexity | $0 |
| Cerumen lavage | $60 | $0 |
| Toenail matrixectomy | $280 | $0 |
| POC ultrasound (focused) | $40 | $40 |
Devices are billed at our cost. Common 2026 device prices: Mirena $880, Liletta $90 (sliding-scale eligible at Liletta), Skyla $880, Kyleena $880, Paragard $700, Nexplanon $620.
Sliding scale
For uninsured patients with documented household income below 250% of the Federal Poverty Level, we offer a sliding-scale on cash rates above. Documentation required is a recent tax return or three months of pay stubs. The sliding-scale schedule is published as a one-page document at the front desk; nobody on the sliding scale is identified to anyone outside Maritza, the medical director, and the clinician of record.
Why this is published
Many primary-care practices ask "contact us for pricing" because pricing is genuinely complex. We have written this page because we believe a small primary-care practice should be able to commit to numbers in writing and take responsibility for them. Where the numbers are wrong (as they sometimes are; insurance contracts shift), we will update them at the next quarterly revision, and the prior version will be on the errata page.