Price List for CHC Medical Services

Price List for CHC Medical Services

(Revised 2/24/15)

NAME OF SERVICE / STUDENT COST / EMPLOYEE COST
Office visit fee
(Charged for each visit EXCEPT PPD reads and visits for the Flu Shot only) / $10.00 / $20.00
Blood pressure check / NC / NC
Cholesterol screening (in-office) / $15.00 / $25.00
Glucose check / NC / NC
Physical exam / $10.00 / $20.00
PPD (tuberculosis skin test) / $5.00 / $10.00
Pregnancy test (dipstick) / $5.00 / $10.00
Throat culture/urine test / $5.00 / $10.00
Wet mount (WMT)/KOH prep / $5.00 / $10.00
IMMUNIZATIONS
Fluarix (When Available) / $10.00 / $20.00
Hepatitis A / $30.00 / $40.00
Hepatitis B / $40.00 / $50.00
HPV (human papillomavirus) / $150.00 / $160.00
MMR (Measles [Rubeola], Mumps, Rubella) / $70.00 / $80.00
Tdap / $35.00 / $45.00
Twinrix (A&B) / $60.00 / $70.00
Varicella / $110.00 / $120.00
LAB TESTS (sent out)
$5.00 draw fee per visit / $5.00 / $5.00
Basic metabolic panel (Na, K, Cl, CO2, Cr, BUN, glu) / $10.00 / $20.00
CBC W/ANC (diff) / $5.00 / $15.00
Chlamydia & gonorrhea DNA Pap vial / $35.00 / $45.00
Chlamydia & gonorrhea SDA / $25.00 / $35.00
Comprehensive metabolic panel (14) (chem pan) / $5.00 / $15.00
Ferritin / $5.00 / $15.00
H. pylori IgG, qual / $25.00 / $35.00
HCG, serum, qual (pregnancy) / $15.00 / $25.00
HCG, total, serum quantitative / $25.00 / $35.00
Hemoglobin A1C, IEC / $10.00 / $20.00
Hepatic function panel / $5.00 / $15.00
Hepatitis A total / $5.00 / $15.00
Hepatitis B surface Ab / $5.00 / $15.00
Hepatitis B surface Ag / $5.00 / $15.00
Hepatitis C virus Ab / $10.00 / $20.00
HIV screen w/ reflexes / $5.00 / $15.00
HSV 1/2 IgG Ab / $45.00 / $55.00
Iron total / $10.00 / $20.00
Iron total w/ TIBC / $10.00 / $20.00
Lipid panel (fasting specimen) / $10.00 / $20.00
Lithium levels / $10.00 / $20.00
Monospot (heterophile Ab) / $10.00 / $20.00
MMR (all – titer) / $65.00 / $75.00
Mumps IgG (titer) / $30.00 / $40.00
Pap / $30.00 / $40.00
Polio Titer / $115.00 / $120.00
Progesterone / $35.00 / $45.00
PT/INR / $5.00 / $10.00
RPR (Dx) reflex FTA / $5.00 / $15.00
Rubeola (measles) IgG (titer) / $20.00 / $30.00
Rubella IgG Ab (titer) / $20.00 / $30.00
Sed rate (ESR) / $5.00 / $15.00
STD panel (Hep B/C, HSV 1/2 IgG, HIV, RPR, UGC/CT) / $100.00 / $110.00
T-3, TOTAL / $25.00 / $35.00
T-3 uptake / $10.00 / $20.00
T-4, free / $10.00 / $20.00
T-4, TOTAL / $10.00 / $20.00
Testosterone (use red not tiger!) / $40.00 / $50.00
TSH / $5.00 / $15.00
TSH with reflex free T4 / $5.00 / $15.00
T-Spot TB Blood Test (Mon.- Thurs. ONLY) / $50.00 / $60.00
UA complete w/ reflex culture (if culture indicated) / $5.00 / $15.00
Urine culture / $20.00 / $30.00
Varicella IgG (titer) / $15.00 / $25.00
Vitamin D 25 hydroxy (25 OHD) (red serum tube) / $30.00 / $40.00