Provider Orders

Footprints offers a number of ancillary services including labs, ultrasound, and newborn circumcision. We can bill the insurance companies listed on the order form. We also offer discounted rates for self-pay patients that pay on the date of service. Additional services may be available upon request.

Payment and Scheduling Considerations

Labs
  • A lab draw/collection fee of $35 will be charged for lab visits.
Ultrasound
  • Our ultrasound technician is available Wednesdays from 9:00am – 11:00am and rotates between our Black River Falls and Greenwood locations.
  • Upcoming 2021 Black River Falls Dates: 07/07, 07/27, 08/04, 08/18, 09/01, 09/15, 09/29, 10/13, 10/27, 11/10, 11/24, 12/08, 12/22
  • Upcoming 2021 Greenwood Dates: 06/30, 07/14, 07/28, 08/11, 08/25, 09/08, 09/22, 10/06, 10/20, 11/03, 11/17, 12/01, 12/15, 12/29
  • Pricing and scheduling are for singleton ultrasounds and include a radiology read. Contact us for multiple gestation.
Newborn Circumcision
  • Infant must be no older than 14 days.
  • Call our office as soon as possible after delivery to ensure scheduling availability for circumcision.

A 25% discount is applied when payment is made on the same day of service.

Test/Procedure CPT Price
OB Panel (CBC w/ Auto Diff, ABORH, Antibody Screen, Syphilis, Rubella, Hep B) 80055 $103.00
1hr Glucose Tolerance Screen (can bring own 100% grape juice if desired) 82950 $41.00
2hr Gestational Diabetes Test (can bring own 100% grape juice if desired) 829547 + 82951 $82.00
Hemoglobin A1C 83036 $54.00
Antibody Screen 86850 $58.00
Blood Typing (ABO/Rh) 86900 + 86901 $62.00
Complete Blood Count w/ Auto Differential 85025 $46.00
Group Beta Strep Culture 87081 $52.00
Quantitative hCG 84702 $67.00
Hemoglobin 85018 $42.00
Progesterone 84144 $89.00
Early Ultrasound <14 weeks (Transvaginal) 76801 $370.00
Fetal Anatomy Scan (18 – 22 weeks) 76805 $370.00
Follow Up / Limited Ultrasound (ex: fetal growth & position, AFI) 76815 $330.00
Newborn Circumcision (≤14 days old) 54150 $255.00

Provider Orders Menu