Medical Fees

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Fee Schedule  
Allergy Injection $30.00
Allergy Inj 2 Or More Units $45.00
Anoscopy $162.26
Aqua K Pad $39.75
Aspiration $295.26
Audiometer $35.25
Avulsion Of Nail Plate $226.10
Biopsy Of Skin $259.35
Blood Pressure Monitor Kit $109.73
OTC Medication Pack For Campers $4.50
Fiberglass Cast Elbow To Fingers $351.00
Casting Elbow To Fingers $315.00
Cast Removal $147.63
Casting Of Short Leg/ankle $498.00
Conjunctivitis Test Kit $45.00
CPM Machine $94.43
CPR And/or First Aid Course $41.00
Cryocuff Therapy $47.88
Cryotherapy (Acne) $191.52
Debridement Of Wound $164.92
Ear Lavage - Doctor $53.20
Destruction Of Lesions Cryo/Chem/Cutt/Elctro $192.85
Ear Lavage/Curettage $53.20
EKG $147.63
Excision Of Lesion 0.5cm Or Less Face, Ears, Eyelids, Nose, Lips, Muc Membranes $399.00
Excision Of Lesion 0.5cm Or Less Trunk/Arms/Legs $304.57
Excision Of Lesion 0.6cm-1.0cm Trunk/Arms/Legs $385.70
Excision Of Lesion 1.1-2.0cm Trunk/Arms/Legs $501.41
Excision Of Lesion 0.5cm Or Less Scalp/Neck/Hnd/Ft $329.84
Excision Of Lesion 0.6cm-1.0cm Scalp/Neck/Hnd/Ft $422.94
Excisionof Lesion 1.1-2.0cm Scalp/Neck/Hnd/Ft $533.33
Excision Of Nail Partial/Complete $599.83
Eye Irrigation (Sterile Eye Wash) $129.01
Eye Stain $159.60
Foreign Body Removal Ear $446.88
Foreign Body Removal Eye $247.38
Flu Kit $15.00
Hand Held Nebulizer Treatment $75.81
Incision & Draining Abcess $301.91
Incision & Draining Pilonidal Cyst Simple $434.91
HPV Vaccine Gardasil9 Dose 1 $283.50
HPV Vaccine Gardasil9 Dose 2 $283.50
HPV Vaccine Gardasil9 Dose 3 $283.50
MenB Vaccine Bexsero Dose 1 $265.50
MenB Vaccine Bexsero Dose 2 $265.50
Hepatitis A Vaccine Dose 1 $104.10
Hepatitis A Vaccine Dose 2 $104.10
HepA HepB Vaccine Twinrix Dose 1 $166.50
HepA HepB Vaccine Twinrix Dose 2 $166.50
HepA HepB Vaccine Twinrix Dose 3 $166.50
Hepatitis B Vaccine Dose 1 $85.77
Hepatitis B Vaccine Dose 2 $85.77
Hepatitis B Vaccine Dose 3 $85.77
HPV Vaccine Gardasil Dose 1 $242.55
HPV Vaccine Gardasil Dose 2 $242.55
HPV Vaccine Gardasil Dose 3 $242.55
Japanese Encephalitis Vaccine $401.67
Menactra $186.50
Meningitis $174.54
MMR Vaccine Dose 1 $98.85
MMR Vaccine Dose 2 $98.85
Pneumococcal $37.50
Polio Vaccine (IPOL) $47.55
Polio Injectible $47.55
PPD Skin Test $9.24
Rabies Vaccine $476.28
Immune Globulin Rabies Treatment $1,548.77
Rubella $45.00
TB Test (Intradermal) $9.24
Tetanus Toxoid Vaccine $37.50
Td Vaccine $43.41
Tdap Vaccine Adult $61.38
MenB Vaccine Trumenba Dose 1 $190.97
MenB Vaccine Trumenba Dose 2 $190.97
MenB Vaccine Trumenba Dose 3 $190.97
Typhoid Vaccine Injectable $134.57
Varicella Vaccine Dose 2 $166.10
Varicella Vaccine Dose 1 $166.10
Yellow Fever Vaccine $212.91
Incision/Removal Foreign Body Simple $272.65
Incision Of Soft Tissue Abcess $272.65
Bentyl 20 Mg IM $64.50
Bicillin LA 120000 $54.00
Bicillin La 240000 $111.00
Ceftriaxone 250 Mg $1.80
Ceftriaxone Injectible 1 Gram $5.33
Compazine Inj. $18.00
Depo Provera $112.50
Depo-Medrol $30.00
Dexamethasone 4mg/1ml $16.50
Diphenhydramine Inj 50 Mg $64.50
Epinephrine(adrenalin) 1:1000 $64.50
Hydroxyzene HCI 100mg/2ml $16.50
Kenalog 40 $64.50
Ketorolac 30 Mg/ml $64.50
Ketorolac 60mg/2ml $64.50
Marcain Injection Per Cc Cost/gen Bupivacaine $12.00
Metoclopramide $1.65
Nitrostat $1.56
Phenergan Inj 25 1cc $64.50
Promethazine 25 Mg/ml $1.25
Solu Medrol $64.50
Sumatriptan Injectible $64.50
Injection Therapeutic $15.00
Vitamin B 12 Injection $30.00
Xylocain 1% 10mg/ml $64.50
Xylocaine 2% 20mg/1ml $19.50
Xylocaine W/Epi 1% $5.61
Xylocaine W Epi 2% $5.69
IV D5 1/2 Normal Saline 1 Liter $55.50
IV D5 1/2 NS With KCl 20 MEq $55.50
IV D5 Lactated Ringers 1 Liter $55.50
IV D5 Normal Saline 1 Liter $55.50
IV 1/2 Normal Saline 1 Liter $55.50
IV Lactated Ringers 1 Liter $55.50
IV Normal Saline 1 Liter $55.50
IV Normal Saline 500 Cc $55.50
IV Acyclovir $43.50
IV Kefzol $36.00
IV Levaquin $94.50
IV Rocephin 1 Gm $112.50
IV Rocephin 2 Gm $120.00
IV SoluCortef 100 Mg $33.00
IV SoluCortef 250mg $34.50
IV SoluMedrol 40 Mg $31.50
IV SoluMedrol 125 Mg $35.25
IV Toradol $3.42
IV Unasyn $55.50
IV Zosyn $54.00
IV Start $70.49
IV Therapy $55.50
AlereI Quick Flu Test $90.00
Draw Fee For ND Lab Tray Charges When Drawn By SBMF $30.59
Hep A Surface Antibody $46.55
KOH Prep (Here) $19.95
MMR titer $79.80
Mumps Titer $33.25
Nurse Lab Draw $19.95
Quantiferon Gold TB Test $75.81
Quick Flu Test $46.55
Quick Strep A $46.55
Rubeola Titer $45.22
Rubella Titer $47.88
Urinalysis- Dip Or Micro $13.30
Varicella Zoster Antibodies $38.57
Muscle Compartment Syndrome Monitoring $432.25
Nail Drilling/drainage $305.90
NO SHOW /patient Did Not Cancel Appt Or Walked Out $10.00
Nasal Limited Cautery/Packing $490.77
Observation - Students Off Campus $190.19
Osteopathic Manipulation 1 - 10 Areas $166.25
OV Athletic Physical $40.00
Office Visit Physician $0.00
Office Visit - GYN $232.75
Physical For Individual Travel W/RN For Non Sch Sponsored Group $13.30
Office Visit - GYN - Pap $266.00
Wellness Physical with MD $26.60
Oximeter Reading $54.53
PFT $139.65
Level 1 Physical And Counseling Session 15 Minutes $97.09
Level 2 Physical And Counseling Session 30 Minutes $114.38
Level 3 Physical And Counseling Session 45 Minutes $159.60
Level 4 Physical And Counseling Session 60 Minutes $208.81
Puncture Aspiration $299.25
Preparticipation Physical For Walk On Try Outs $99.75
Paring/Cutting Lesion $102.41
Platelet Rich Plasma Procedure - 1 Tray $450.00
Removal Foreign Body Superficial $248.71
Removal Of Ring With Cutter $77.14
Removal Skin Tags $231.42
Repair 2.5 Or Less Simple $476.14
Repair 2.6-7.5 Simple $574.56
Repair 7.6-12.5 Simple $714.21
Repair 12.6-20.0 Simple $752.78
Repair 2.5 Or Less Face/Eyebrow/Ears/Mouth $574.56
Cepastat #18 Cherry $6.27
Dermabond $67.50
Diflucan(fluconazole) 1 Tab 150mg $14.93
Dulcolax $6.36
Duration Trigger Spray $23.03
Duration Treatment $11.13
Gaviscon #30 $5.99
Gaviscon #100 $14.15
Hibiclens 4oz $10.56
Ondansetron 8mg $11.25
Ankle Support Elastic $20.27
Aerochamber $61.74
Aircast Ankle Brace $89.45
Ankle CryoC $225.00
Air Cast Leg Brace $112.50
Ankle Inner Lok 8 $49.50
Ankle Brace Stabilizer $37.43
Arch Orthotics 3/4 $41.75
Arm Splint $21.75
Back Brace $66.00
Blister Derm Jar $59.93
Calf Sleeve $31.43
Cast Cover Shower Safe Arm $39.51
Cast Cover Shower Safe Leg $39.51
Cervical Collar $17.76
Clavicle Support $40.50
Clavicle Splint $22.43
Crutches $52.50
Dermabond Pen $135.00
Dressing For Large Burn $52.50
Elbow Sleeve $25.50
Ezy-Wrap Shoulder Wrap Pad $51.75
First Aid Kit $67.50
Foam Roller $23.63
Heel WonderZorb $37.43
Heating Pad $36.45
Humidier 1 Gal $50.49
Humidier 1.5 Gal $53.78
Shaving Of Lesions 0.5cm Or Less $166.50
Irom Don Joy Brace $262.50
IV 3000 Transparent Dressing 1 Box $101.25
Knee Eco Hinged Brace $132.00
Knee Immobilizers $64.50
Knee Sleeve - Closed $33.00
Knee Sleeve - Open $33.00
Knee Supports Stromgen $52.50
Slit Lamp Corneal (Removal FB) $79.80
Lumbar Support Pillow $30.00
Morgan Lens Deliver Set $120.00
Morgan Lens Single Lens $120.00
O 2 Face Mask With Oxygen Use $45.00
Patella Strap $40.50
Peak Flow Meter $30.00
Splinting Short Arm (Forearm To Hand) $271.50
Polar Ice Foot/Ankle $60.00
Polar Ice CPM Knee $79.50
Polar Ice Large Knee $79.50
Polar Ice Standard Knee $60.00
Polar Ice Wrist/Elbow $60.00
Pneumatic Patellar Brace $46.50
Patellar Tape Kit $82.50
Puff Pack $112.50
Rocket Sock Ankle $71.25
Rib Belt $31.50
Rid Complete Kit $36.62
Shoulder Immobilizer $40.50
Shin Sleeve $30.00
Spacer Aerochamber $61.74
Swede-O Ankle $49.50
Thumbkeeper $73.50
Thumbspica $69.00
Travel First Aid Kit $45.00
Evacuation Of Subungual Hematoma $106.40
Suture Removal From Off Campus Providers $106.40
Walker Air Brace $142.50
Walker Short Foot $90.00
Walker Tall Foot $112.50
Wrist Support Proflex $49.46
Trigger Point Injection//Dry Needling $262.01
Tympanography $70.49
Ultrasound Supplies $26.60
Visual Acuity Test - Machine $26.60
Walk In Visit With Doc Or RN $6.65
Wart Removal With Candida $202.16
X-Ray Abdomen $170.24
X-Ray AC Joint $227.43
X-Ray Ankle - 3 View $171.57
X-Ray Ankle - 2 View $113.05
X-Ray Forearm $172.90
X-Ray Chest PA & Lat $223.44
X-Ray Chest - 3 View $299.68
X-Ray Chest - Single View $172.90
X-Ray Clavicle $179.55
X-Ray C-Spine Flexion And Extension $367.08
X-Ray C-Spine - Min 4 View $308.56
X-Ray Elbow $194.18
X-Ray Facial Bones $202.16
X-Ray Facial Bones Complete $250.04
X-Ray Femur Anter/Lateral $180.88
X-Ray Fingers $135.66
X-Ray Foot - 2 Views $150.29
X-Ray Foot - 3 Views $168.91
X-Ray Hand - 3 Views $183.54
X-Ray Heel/Calcaneus $147.63
X-Ray Hip - 2 Views $194.18
X-Ray Hip Unilateral - 1 View $169.79
X-Ray Pelvis Bilateral - 2 Views $234.08
X-Ray Humerus $202.16
X-Ray Knee - 1 Or 2 Views $163.59
X-Ray Knee Complete $218.12
X-Ray Lumbar Spine W/oblique Views $327.18
X-Ray Lumbosacral Spine - 2/3 Views $226.10
X-Ray Mandible Complete - 3 Views $219.45
X-Ray Nasal Bones $148.96
X-Ray Orbits - 4 Views $252.70
X-Ray Pelvis $211.47
X-Ray Ribs - 3 Views $258.02
X-Ray Sacroliac Joints $199.50
X-Ray Sacrum Coccyx - 2 Views $223.44
X-Ray Scapula Complete $204.82
X-Ray Scoliosis Study $287.28
X-Ray Shoulder - 1 View $154.28
X-Ray Shoulder - 2 View Or Complete $219.45
X-Ray Feet Both - Single View $75.15
X-Ray Sinus - 4 Views $285.95
X-Ray Skull - 4 Views $285.95
X-Ray Skull - Less Than 4 Views $202.16
X-Ray Cervical Spine - 2 Or 3 View $219.45
X-Ray Spine Thoracic - 3 View $254.03
X-Ray Sternum - 2 Views $224.77
X-Ray Spine Thoracic - 2 View $239.40
X-Ray Tibia / Fibula $162.26
X-Ray Toes - Min 2 Views $138.32
X-Ray Wrist - 3 Views $184.87
X-Ray Wrist - 2 View $133.00

updated spring 2017