SPECIAL FEES, FINES, PENALTIES,
AND SERVICE CHARGES
2011-12
Department Name Fee Amount Fee Range Index Acct Fund Prog Actv
Health Center
A standard fee list for services and procedures is available in the administrator's office, medical records, Clinics A, B, C, NSC, Sports
Medicine, lab, pharmacy, dental, and X-Ray department.
Fee for elective physical examinations 25.00 - 75.00
Missed medical care appointment fee (based on appointment length) 10.00 - 25.00
Missing Specialty Care Appointment with medical consultants, surgery
procedures, dentist 20.00 - 35.00
Medical supplies and equipment (minimum charge) Cost + basis
Non Students charges for medical practitioner, exam room, office visit (academic
year fee plus) 30.00
Physician, Nurse Practitioner or Dentist (per visit) 6.00 - 25.00
Dentist, Dental Hygienist, Dental Assistant
Dental basic exam (includes screening of teeth and bite wing x-rays) 41.00 - 81.00
Dental exam supplies (includes screening of teeth and bite wing x-rays) Cost + basis
Dental procedures minimum charge to maximum charge, per procedure (other
than basic dental exam) 6.00 - 80.00
Laboratory Services
Laboratory Phlebotomy fee 10.00
Laboratory minimum charge to maximum charge 3.00 - 600.00
Clinical Services
Allergy injections 10.00 - 30.00
Various nursing/clinical procedures and services 2.00 - 900.00
Pulmonary function testing 10.00 - 35.00
Patient's Medical Records
One copy of patient's medical record (per record volume) 5.00-50.00
Pharmaceuticals
All pharmaceuticals, drugs, over-the counter supplies, injectables, and vaccines Cost + basis
Minimum charge 3.50
Sports Medicine or Physical Therapy
Minimum charge to maximum charge (per procedure) 4.00 - 85.00
Supplies/equipment Cost + basis
X-ray
X-Ray minimum charge to maximum charge (per x-ray) 25.00 - 150.00
X-ray film duplication charge 1.00 - 5.00