Price List for CHC Medical Services

(Revised January, 2016) STUDENT EMPLOYEE NAME OF SERVICE COST COST Office visit fee $10.00 $20.00 (Not charged for PPD reads and visits for the Flu Shot only) Blood pressure check NC NC Cholesterol screening (in-office) $15.00 $25.00 Glucose check NC NC Nutrition Consultation $10.00 $20.00 Physical exam $10.00 $20.00 PPD (tuberculosis skin test) $5.00 $10.00 Pregnancy test (dipstick) $5.00 $10.00 Stress Evaluation $10.00 $20.00 Throat culture/urine test $5.00 $10.00 Wet mount (WMT)/KOH prep $5.00 $10.00

IMMUNIZATIONS Fluarix (When Available) $16.00 $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 A1c $10.00 $20.00 AFFIRM (Bacterial Vaginosis, Yeast, Trichomonas Screening) $65.00 $75.00 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 GC/CT (Gonorrhea and Chlamydia Screening) $35.00 $45.00 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 (Antibody Titer) $5.00 $15.00 Hepatitis B surface Ag (Test for Infection) $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 HPV Screening $35.00 $45.00 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 (*See also: HPV screen- these are often tested concurrently) $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 (Syphilis Screening) $10.00 $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