fee schedule by liuqingyan

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									                             New Student Health Services Fee Schedule Effective August 1, 2010
Trans Code                               Transaction Description              Eligible         Eligible
                                                                           Health fee No    Health Fee Yes

10060        Incision and Drainage, Skin Abscess; simple or single                 $58.00            $48.00
10061        Incision and Drainage; complicated or multiple                        $93.00            $56.00
10080        Incision and Drainage, Pilonidal Cyst                                 $57.00            $47.00
10120        Removal of Foreign Body, Subcutaneous                                 $45.00            $36.00
10140        Incision and Drainage, Hematoma/Seroma/Fluid                          $57.00            $47.00
10160        Aspiration of Hematoma/Bulla/Cyst/Abcess                              $57.00            $48.00
10180        Incision and Drainage complex, post-op wound infection                $57.00            $48.00
11000        Debride Infected Skin, up to 10% Body Surface                         $72.00            $22.00
11100        Biopsy of Skin Lesion; single                                         $60.00            $50.00
11200        Removal of Skin Tags; up to 15 lesions                                $29.00            $25.00
11201        Removal of Skin Tags; each add'l 10                                    $9.00             $9.00
11300        Shave Biopsy; 0.5 cm or less (trunk/arm/leg)                          $36.00            $29.00
11305        Shave Biopsy; 0.5 cm or less (scalp/neck/hand/foot/gen)               $37.00            $30.00
11310        Shave Biopsy; 0.5 cm or less (face)                                   $37.00            $29.00
11400        Excision Benign Lesion; 0.5 cm or less (trunk/arm/leg)                $80.00            $76.00
11420        Excision Benign Lesion =<0.5 scalp/nck/hand/foot/gen                  $29.00            $25.00
11440        Excision Benign Lesion; 0.5 cm or less (face)                         $29.00            $25.00
11740        Evacuation of Subungual Hematoma                                      $29.00            $25.00
11750        Ingrown or deformed nail removal                                      $62.00            $50.00
11765        Excision of Nail Fold, Toe (ingrown)                                  $60.00            $45.00
11975        Insertion, implantable contraceptive capsules                        $100.00            $98.00
11976        Removal of implantable contraceptive                                  $78.00            $65.00
11977        Removal w/reinsertion, implantable contraceptive                     $106.00            $88.00
12001        Laceration Repair; 2.5 cm or less                                     $57.00            $50.00
10060WH      I & D Skin abscess                                                    $58.00            $48.00
10061WH      Incision and Drainage; complicated                                    $56.00            $56.00
11100WH      Skin biopsy, 1 lesion                                                 $60.00            $50.00
11200WH      Skin tag excision, 1-15                                               $29.00            $25.00
11975WH      Insertion, implantable contraceptive capsules                        $100.00            $98.00
11976WH      Removal of implantable contraceptive                                  $78.00            $65.00
11977WH      Removal w/reinsertion, implantable contraceptive                     $106.00            $88.00
12002        Laceration Repair; 2.6-7.5 cm                                         $72.00            $54.00
12011        Facial Laceration Repair; 2.5 cm or less                              $86.00            $62.00
12013        Facial Laceration Repair; 2.6-5.0 cm                                  $92.00            $67.00
12031        Lacer. Repair;scalp,trunk,arms,legs; >1 layer,<2.6 cm                 $72.00            $62.00
12032        Lacer. Repair; scalp,trunk,arms, legs;>one layer,2.5 cm               $86.00            $64.00
12041        Lacer. Repair;neck,hands,feet;>one layer,2.5cm or less                $86.00            $72.00
12042        Lacer. Repair;neck,hands,feet;>one layer>2.5 cm                       $99.00            $80.00
                             New Student Health Services Fee Schedule Effective August 1, 2010
Trans Code                                Transaction Description             Eligible          Eligible
                                                                           Health fee No     Health Fee Yes
12051        Lacer. Repair;facial;> one layer, 2.5 cm or less                       $99.00             $80.00
12052        Lacer. Repair; facial,> one layer, 2.6 cm to 5.0 cm                    $99.00             $83.00
17000        Destruction- Premalignant Skin Lesions; 1 lesion                       $17.00             $14.00
17003        Destruction- Premalignant Skin Lesions; ea add'l (2-14)                $21.00             $20.00
17004        Destruction-Premalignant Skin Lesions;15 or more                       $46.00             $39.00
17110        Destruction- Molluscum/Warts; 1-14 lesion(s)                           $23.00             $20.00
17110WH      Destruction - Molluscum/warts; 1-14                                    $20.00             $20.00
17111        Destruction- Molluscum/Warts; 15 or more                               $30.00             $25.00
20550        Injection single tendon sheath or ligament                             $67.00             $62.00
20552        Trigger point injection, 1-2 muscles                                   $60.00             $50.00
20553        Trigger point injection, 3 or more muscles                             $72.00             $62.00
20600        Arthroc, aspiration &/or injection;small jt                            $57.00             $48.00
20605        Arthroc, aspiration &/or injec;interm jt                               $68.00             $58.00
20610        Arthroc,aspiration &/or injec;major jt                                 $53.00             $42.00
20612        Aspiration of Ganglion Cyst                                            $42.00             $36.00
24650        Closed tx of radial head or neck fx w/o manipul                       $173.00            $150.00
25560        Closed treatment of radial & ulnar shaft                              $173.00            $150.00
25600        Closed tx of distal radial w/o manipulation                           $173.00            $150.00
25622        Closed tx of carpal scaphoid fx w/o manip.                            $188.00            $154.00
25630        Closed tx of carpal bone fx(not scaphoid)                             $194.00            $163.00
25650        Closed tx of ulnar styloid fracture                                   $200.00            $168.00
25675        Closed tx of distal radioulnar dislocation                            $310.00            $250.00
26600        Closed tx of metacarpal fracture,single                               $157.00            $130.00
26641        Closed tx of thumb dislocation                                        $266.00            $225.00
26720        Closed tx of proxi or mid phal fx fgr or thm                          $123.00            $102.00
26750        Closed tx of distal phalangeal fx,fgr & thumb                         $139.00            $116.00
27750        Closed tx of tibial(w/wo fibular) fracture                            $228.00            $189.00
27760        Closed tx of Medial Malleolus fracture                                $218.00            $183.00
27780        Closed tx of proximal fibula or shaft fracture                        $214.00            $173.00
27840        Closed tx of ankle dislocation                                        $276.00            $232.00
28400        Closed tx of calcaneal fracture                                       $200.00            $167.00
28450        Closed tx of tarsal fracture                                          $181.00            $154.00
28470        Closed tx of metatarsal fx w/o manipulation                           $191.00            $137.00
28490        Closed tx of fracture ; great toe                                     $102.00             $84.00
28540        Closed tx or tarsal bone dislocation                                  $147.00            $126.00
28630        Closed tx of metatarsophalangeal dislocation                          $104.00             $86.00
28660        Closed tx of interphalangeal dislocation                              $116.00             $92.00
46600        Anoscopy                                                               $42.00             $34.00
51701        Insertion of non-indwelling bladder catheter;simple                    $72.00             $58.00
                             New Student Health Services Fee Schedule Effective August 1, 2010
Trans Code                               Transaction Description              Eligible          Eligible
                                                                           Health fee No     Health Fee Yes
51702        Insertion of temporary non-idwelling catheter;simple                   $72.00             $58.00
54050        Destruction of lesions;penis, simple;chemical                          $45.00             $39.00
56405        Incision And Drainage, Vulvar or Perineal Abcess                       $75.00             $67.00
56420        Incision And Drainage, Bartholin's Gland                               $94.00             $78.00
56501        Destruction of Vulva Lesions; simple                                   $62.00             $50.00
56515        Destruction of vulvar lesion, extensive                                $85.00             $72.00
56605        Biopsy of Vulva or Perineum; one lesion                                $47.00             $37.00
56606        Biopsy of Vulva or Perineum; each add'l lesion                         $24.00             $14.00
56700        Partial Hymenectomy                                                   $125.00            $100.00
51700WH      Bladder irrigation, simple, lavage and/or instillation                 $76.00             $62.00
56405WH      I & D vulvar/perineal abscess                                          $75.00             $67.00
56420WH      I & D Bartholin's abscess                                              $94.00             $78.00
56501WH      Destruct vulvar lesion, simple                                         $62.00             $50.00
56515WH      Destruct vulvar lesion, extensive                                      $85.00             $72.00
56605WH      Biopsy vulva/perineum, 1 lesion                                        $47.00             $37.00
56606WH      Biopsy vulva/perineum, each additional                                 $24.00             $14.00
56820        Colposcopy vulva                                                       $78.00             $66.00
56821        Colposcopy vulva with biopsy                                          $157.00            $131.00
57061        Destruction vaginal lesion, simple                                     $62.00             $50.00
57065        Destruction vaginal lesion, extensive                                  $85.00             $72.00
57100        Biopsy of Vaginal Mucosa; simple                                       $64.00             $54.00
57105        Biopsy vaginal mucosa, extensive                                       $85.00             $72.00
57170        Diaphragm Fitting                                                      $58.00             $49.00
57415        Removal of foreign body (vagina)                                       $35.00             $28.00
57452        Colposcopy without Biopsy                                             $153.00            $130.00
57454        Colposcopy with Biopsy and ECC                                        $198.00            $174.00
57455        Colposcopy with Biopsy                                                $188.00            $165.00
57456        Colpo(cervix + upper vagina) + Endocervical curettage                 $183.00            $158.00
57500        Biopsy of Cervix; single or multiple lesion(s)                        $116.00             $95.00
57505        Endocervical Curettage                                                $113.00             $97.00
57511        Cryosurgery, Uterine Cervix                                           $137.00            $119.00
56700WH      Partial hymenectomy                                                   $125.00            $100.00
56820WH      Colpo vulva                                                            $78.00             $66.00
56821WH      Colpo vulva with biopsy                                               $157.00            $131.00
57061WH      Destruct vag lesion, simple                                            $62.00             $50.00
57065WH      Destruct vag lesion, extensive                                         $85.00             $72.00
57100WH      Biopsy of vaginal mucosa, simple                                       $64.00             $54.00
57105WH      Biopsy of vaginal mucosa, extensive                                    $85.00             $72.00
57170WH      Diaphragm Fitting                                                      $58.00             $49.00
                             New Student Health Services Fee Schedule Effective August 1, 2010
Trans Code                               Transaction Description              Eligible          Eligible
                                                                           Health fee No     Health Fee Yes
57415WH      Removal of foreign body (vagina)                                       $35.00             $28.00
57452WH      Colpo only(cervix + upper vagina)                                     $153.00            $130.00
57454WH      Colpo(cervix + upper vagina) + biopsy cervix+ECC                      $198.00            $174.00
57455WH      Colpo(cervix + upper vagina) + biopsy cervix                          $188.00            $165.00
57456WH      Colpo(cervix + upper vagina) + Endocervical curettage                 $183.00            $158.00
57500WH      Biopsy of Cervix (or Polyp removal)                                   $116.00             $95.00
57505WH      Endocervical Curettage Only                                           $113.00             $97.00
57511WH      Cryocautery of Cervix                                                 $137.00            $119.00
57800        Cervical Dilation                                                      $65.00             $53.00
58100        Endometrial Biopsy                                                    $104.00             $89.00
58120        Dilation and Curettage                                                $147.00             $90.00
58300        Intrauterine Device Insertion                                         $123.00            $106.00
58301        Removal of Intrauterine Device                                         $86.00             $73.00
65205        Removal of Foreign Body, External Eye                                  $35.00             $28.00
69200        Removal of Foreign Body, External Auditory Canal                       $35.00             $28.00
69210        Removal of Impacted Cerumen- One Or Both                               $18.00             $14.00
70100        Mandible < 4 views                                                     $63.00             $53.00
70110        Mandible complete; > = 4 views                                         $78.00             $65.00
70120        Mastoids; < 3 views per side                                           $72.00             $59.00
70150        Facial bones; complete minimum of 3 views                              $73.00             $62.00
70160        Nasal bones; complete minimum of 3 views                               $72.00             $59.00
70200        Orbits; complete, minimum of 4 views                                   $93.00             $77.00
70220        Sinuses, paranasal, complete, minimum of 3 views                       $85.00             $70.00
70250        Skull < 4 views                                                        $74.00             $59.00
70260        Skull minimum of 4 views                                               $84.00             $69.00
70330        TMJ, open and closed; mouth unilateral                                 $93.00             $77.00
71010        Chest; single view frontal                                             $62.00             $52.00
71020        Chest; 2 views frontal & lateral                                       $72.00             $59.00
71101        Ribs including posteroanterior chest, <= 3 views                       $85.00             $70.00
71110        Ribs bilateral; 3 views                                                $99.00             $83.00
71120        Sternum, minimum of 2 views                                            $74.00             $62.00
71130        Sternoclavicular joint or joints, min 3 views                          $77.00             $65.00
72040        Spine, cervical; 2 or 3 views                                          $74.00             $62.00
72050        Spine, cervical; min 4 views                                          $100.00             $88.00
72070        Spine; thoracic, 2 views                                               $75.00             $63.00
57800WH      Cervical Dilation                                                      $65.00             $53.00
58100WH      Endometrial Biopsy                                                    $104.00             $89.00
58300WH      IUD Insertion                                                         $123.00            $106.00
58301WH      IUD Removal                                                            $86.00             $73.00
                            New Student Health Services Fee Schedule Effective August 1, 2010
Trans Code                             Transaction Description               Eligible           Eligible
                                                                          Health fee No      Health Fee Yes
72072        Spine; thoracic, 3 views                                              $85.00              $70.00
72100        Spine, lumbosacral; 2 or 3 views                                      $80.00              $67.00
72110        Spine, lumbosacral; min 4 views                                      $109.00              $92.00
72170        Pelvis; 1 or 2 views                                                  $76.00              $64.00
72190        Pelvis; complete, min 3 views                                         $88.00              $74.00
72200        Sacroiliac joints; < 3 views                                          $77.00              $65.00
72202        Sacroiliac joints; >= 3 views                                         $72.00              $59.00
72220        Sacrum and coccyx, min 2 views                                        $64.00              $54.00
73000L       Clavicle complete left                                                $64.00              $54.00
73000R       Clavicle complete right                                               $64.00              $54.00
73010L       Scapula complete left                                                 $64.00              $54.00
73010R       Scapula complete right                                                $64.00              $54.00
73020L       Shoulder; 1 view left                                                 $59.00              $49.00
73020R       Shoulder; 1 view right                                                $59.00              $49.00
73030L       Shoulder; complete, min 2 views left                                  $80.00              $67.00
73030R       Shoulder; complete, min 2 views right                                 $80.00              $67.00
73050        Acromioclavicular jts, bilat w/wo weighted                            $83.00              $69.00
73060L       Humerus, min 2 views left                                             $64.00              $54.00
73060R       Humerus, min 2 views right                                            $64.00              $54.00
73070L       Elbow, 2 views left                                                   $72.00              $59.00
73070R       Elbow, 2 views right                                                  $72.00              $59.00
73080L       Elbow, complete, min 3 views left                                     $72.00              $59.00
73080R       Elbow, complete, min 3 views right                                    $72.00              $59.00
73090L       Forearm, 2 views left                                                 $59.00              $49.00
73090R       Forearm, 2 views right                                                $59.00              $49.00
73100L       Wrist; 2 views left                                                   $59.00              $49.00
73100R       Wrist; 2 views right                                                  $59.00              $49.00
73110L       Wrist complete; min 3 views left                                      $69.00              $58.00
73110R       Wrist complete; min 3 views right                                     $69.00              $58.00
73130L       Hand, min 3 views left                                                $69.00              $58.00
73130R       Hand, min 3 views right                                               $69.00              $58.00
74000        Abdomen, single anteroposterior view                                  $72.00              $59.00
74020        Abdomen, complete, including decubitus                                $83.00              $69.00
86580        PPD                                                                   $24.00              $20.00
87210        Wet Prep Women's Health                                               $17.00              $15.00
90389        Tetanus immune globin, intramuscular                                 $170.00             $143.00
90470        H1N1 immunization administration (IM, Nasal)w/counsel                   $0.00               $0.00
73140L       Fingers, min 2 views left                                             $57.00              $48.00
73140R       Fingers, min 2 views right                                            $57.00              $48.00
                             New Student Health Services Fee Schedule Effective August 1, 2010
Trans Code                                Transaction Description             Eligible           Eligible
                                                                           Health fee No      Health Fee Yes
73510L       Hip, unilateral complete, min 2 views left                             $74.00              $62.00
73510R       Hip, unilateral complete, min 2 views right                            $74.00              $62.00
73550L       Femur, 2 views left                                                    $69.00              $58.00
73550R       Femur, 2 views right                                                   $69.00              $58.00
73560L       Knee, 1 or 2 views left                                                $69.00              $58.00
73560R       Knee, 1 or 2 views right                                               $69.00              $58.00
73562L       Knee, 3 views left                                                     $76.00              $64.00
73562R       Knee, 3 views right                                                    $76.00              $64.00
73564L       Knee, complete, 4 or more views left                                   $90.00              $79.00
73564R       Knee, complete, 4 or more views right                                  $90.00              $79.00
73590L       Tibia & fibula, 2 views left                                           $64.00              $54.00
73590R       Tibia & fibula, 2 views right                                          $64.00              $54.00
73600L       Ankle; 2 views left                                                    $74.00              $62.00
73600R       Ankle; 2 views right                                                   $74.00              $62.00
73610L       Ankle complete, min 3 views left                                       $74.00              $62.00
73610R       Ankle complete, min 3 views right                                      $74.00              $62.00
73630L       Foot complete, min 3 views left                                        $59.00              $49.00
73630R       Foot complete, min 3 views right                                       $59.00              $49.00
73650L       Calcaneus, min 2 views left                                            $57.00              $48.00
73650R       Calcaneus, min 2 views right                                           $57.00              $48.00
73660L       Toe(s), min 2 views left                                               $57.00              $48.00
73660R       Toe(s), min 2 views right                                              $57.00              $48.00
87210WH      Wet Prep Womens Health                                                 $17.00              $15.00
90471        Immu Admin, SC/IM; 1 vaccine                                             $9.00               $8.00
90472        Immu Admin, SC/IM; each add'l                                            $3.00               $3.00
90473        Immu Admin, Oral/Nasal; one vaccine                                      $9.00               $6.00
90474        Immu Admin, Oral/Nasal; each add'l                                       $0.00               $0.00
90632        Hepatitis A Vaccine (Adult)                                            $48.00              $40.00
90649        HPV, 3 Dose IM (Gardasil)                                             $190.00             $162.00
90658        Flu Vaccine                                                            $28.00              $15.00
90660        Intranasal Flu Vaccine (Flu Mist)                                      $57.00              $48.00
90663        Influenza virus vaccine, H1N1 IM                                         $0.00               $0.00
90675        Rabies Vaccine; Intramuscular                                         $222.00             $213.00
90691        Typhoid Vaccine- Intramuscular                                         $95.00              $79.00
90707        Mumps-Measles-Rubella Vaccine                                          $85.00              $70.00
90713        Poliomyelitis (IPV) Vaccine                                            $52.00              $43.00
90715        Tdap                                                                   $57.00              $48.00
90717        Yellow Fever Vaccine, SC                                              $120.00             $100.00
90718        Tetanus-diphtheria (Td) Vaccine                                        $55.00              $46.00
                            New Student Health Services Fee Schedule Effective August 1, 2010
Trans Code                              Transaction Description              Eligible           Eligible
                                                                          Health fee No      Health Fee Yes
90732        Pneumococcal Vaccine (Pneumovax)                                      $62.00              $58.00
90734        Menactra Vaccine                                                     $141.00             $118.00
90746        Hepatitis B Vaccine (adult)                                           $65.00              $54.00
90772        Injection- SC/IM                                                        $9.00               $8.00
90774        Injection- IV Push                                                      $9.00               $8.00
90800        Consultation Triage Visit 30 mins                                     $45.00                $0.00
90649CP      Gardasil Vaccine Cervix Project                                      $190.00             $159.00
90649-GS1    Gardasil Vaccine 1                                                   $190.00             $159.00
90649-GS2    Gardasil Vaccine 2                                                   $190.00             $159.00
90649-GS3    Gardasil Vaccine 3                                                   $190.00             $159.00
90650-CRX1   Cervarix Vaccine 1                                                   $190.00             $190.00
90650-CRX2   Cervarix Vaccine 2                                                   $190.00             $190.00
90650-CRX3   Cervarix Vaccine 3                                                   $190.00             $190.00
90663Nasal   Influenza virus vaccine, H1N1 Nasal                                     $0.00               $0.00
90800A       Consultation Triage Visit 60 mins                                     $55.00                $0.00
90801        Individ.Counseling Intake                                             $56.00                $0.00
90801A       Individ. Psychiatric Intake                                           $56.00                $0.00
90801AM      Individ. Anger Management Intake                                      $73.00                $0.00
90801AOD     Individ. AOD Intake                                                   $73.00                $0.00
90804        Individ. Psychotherapy, 20-30 minutes (1-12)                          $45.00                $0.00
90804A       Individ. Psychotherapy, 20-30 minutes (=>13)                          $45.00              $39.00
90805        Indiv Psychotherapy; 20-30 min; w/ Psychiatry E/M (1-12               $56.00                $0.00
90805A       Indiv Psychotherapy; 20-30 min; w/ Psychiatry E/M (=>13               $56.00              $45.00
90806        Individ. Psychotherapy, 45-50 minutes (1-12 visits)                   $68.00                $0.00
90806A       Indiv. Psychotherapy, 45-50 minutes (=>13 visits)                     $68.00              $58.00
90806BIT     Individ. psychotherapy, BIT                                          $103.00                $0.00
90806EDT     Individ. Psychotherapy, EDT                                          $103.00                $0.00
90806Grp     Group Psychotherapy--MH Counseling for Couples                       $103.00                $0.00
90806Trn     Individ. Psychotherapy, Training Cases                               $103.00                $0.00
90806VIP     Individ. Psychotherapy, Violence, Intervention, Prevent              $103.00                $0.00
90807        Indiv Psychotherapy; 45-50 min; w/ Psychiatry E/M (1-12)              $84.00                $0.00
90807A       Indiv Psychotherapy; 45-50 min; w/ Psychiatry E/M (=>13)              $84.00              $77.00
90808        Individ. Psychotherapy, 75-80 minutes (1-12)                          $95.00                $0.00
90808A       Individ. Psychotherapy, 75-80 minutes (=>13)                          $95.00              $88.00
90809        Individ. Psychotherapy with med eval, 75-80 min (1-12)               $106.00                $0.00
90809A       Individ. Psychotherapy w/med eval, 75-80 minutes (=>13               $106.00              $99.00
90846        Family Psychotherapy; w/o client                                      $89.00                $0.00
90847        Family Psychotherapy; w/client                                        $89.00                $0.00
90853        Group PsychotherapyGroup Psychotherapy with several cli               $78.00                $0.00
                             New Student Health Services Fee Schedule Effective August 1, 2010
Trans Code                                Transaction Description             Eligible           Eligible
                                                                           Health fee No      Health Fee Yes
90853AM4F    Group Psychotherapy-Anger Mgt 4 week Follow UP                           $0.00               $0.00
90853AM4S    Group Psychotherapy--Anger Mgt 4 week Start Up                        $101.00             $100.00
90853AM4V    Group Psychotherapy--Anger Mgt 4 week Volunteer                       $234.00             $100.00
90853AM8F    Group Psychotherapy-Anger Mgt 8 week Follow Up                           $0.00               $0.00
90853AM8S    Group Psychotherapy--Anger Mgt 8 week Start Up                        $195.00             $195.00
90853AM8V    Group Psychotherapy--Anger Mgt 8 week Volunteer                       $234.00             $100.00
90853AOD4F   Group Psychotherapy- AOD 4 week Follow UP                                $0.00               $0.00
90853AOD4S   Group Psychotherapy--AOD 4 week Start Up                              $100.00                $0.00
90853AOD4V   Group Psychotherapy--AOD 4 week Volunteer                             $234.00             $100.00
90853AOD8F   Group Psychotherapy-AOD 8 week Follow Up                                 $0.00               $0.00
90853AOD8S   Group Psychotherapy--AOD 8 week Start Up                              $195.00             $195.00
90853AOD8V   Group Psychotherapy--AOD 8 week Volunteer                             $234.00             $234.00
90853Didac   Group Psychotherapy for didactic purposes                              $28.00                $0.00
90862        Psych Medication Management                                            $47.00              $10.00
90875        Individ. psychotherapy w/biofeedbk, 30 min                             $34.00                $0.00
90876        Individ. psychotherapy w/biofeedbk, 50 min                             $39.00                $0.00
90880        Hypnotherapy                                                           $67.00                $0.00
90887        Interpretation of Results- Psych w/ Advice to Fam                        $0.00               $0.00
90889        Clinician prepares report on a client's status                           $0.00               $0.00
90901        Individ Biofeedbk w/o psych                                            $34.00                $0.00
90901BF      Individual Biofeedback w/o psych Faculty/Staff                         $28.00              $28.00
92287        Fluoroscein Stain                                                     $205.00             $190.00
93000        ECG                                                                    $57.00              $48.00
94370        Peak Flow                                                                $0.00               $0.00
94640        Airway Inhal Tx; Nebulizer,aerosol generator                           $47.00              $39.00
94645        Continous inhal tx, each add'l                                         $15.00              $13.00
94760        Pulse Oximetry                                                           $0.00               $0.00
95115        Allergy Injection; single                                              $24.00              $20.00
95117        Allergy Injection; 2 or more injections                                $32.00              $26.00
96101        Psychological Testing and Interpretation by clinician                  $84.00              $20.00
96360        IV Fluid Hydration; 31 mins up to 1 hour                               $28.00              $24.00
96361        IV Fluid Hydration;each add'l hour, up to 8 hpurs                      $15.00              $15.00
96372        Injection, IM, SQ                                                        $9.00               $8.00
97001        Physical Therapy Evaluation                                            $30.00              $25.00
97002        Physical Therapy Re-evaluation                                         $25.00              $20.00
97010        Hot/Cold Pack                                                            $9.00               $8.00
97014        Electrical Stimulation Therapy                                         $24.00              $20.00
97032        Elect Stimulation Therapy-manual, ea 15 min                            $43.00              $36.00
97033        Iontophoresis; each 15 min                                             $25.00              $20.00
                            New Student Health Services Fee Schedule Effective August 1, 2010
Trans Code                             Transaction Description               Eligible           Eligible
                                                                          Health fee No      Health Fee Yes
97035        Ultrasound Treatment; each 15 min                                     $19.00              $16.00
97039        Ultrasound/stimulation with meds                                      $25.00              $25.00
97110        Therapeutic Exercise; each 15 min                                     $20.00              $16.00
97112        Neuromuscular Reeducation of movement                                 $20.00              $15.00
97116        Gait Training Therapy; each 15 min                                    $20.00              $16.00
97124        Massage Therapy; each 15 min                                          $16.00              $14.00
97140        Manual Therapy; each 15 min                                           $20.00              $16.00
97799        PT Consult                                                              $0.00               $0.00
99024        Post-op follow up/dressing change                                       $6.00               $0.00
99078        Physician Group Health Education                                        $0.00               $0.00
99201        New Patient; Problem Focused                                          $36.00                $0.00
96372WH      Injection IM, SC                                                        $9.00               $8.00
97035A       Phonophoresis                                                         $17.00              $17.00
97039A       Ultrasound/stimulation without meds                                   $23.00              $23.00
97124F/S     Massage 30 minutes--Faculty Staff                                     $28.00              $28.00
97124S       Massage 30 minutes--Students                                          $25.00              $20.00
97802F/S     Med Nutri Therapy; initial--Faculty Staff                             $50.00              $50.00
97802S       Med Nutri Therapy; initial--Student                                   $27.00                $0.00
97803F/S     Med Nutri Therapy reassess-Faculty Staff                              $39.00              $39.00
97803S       Med Nutri Therapy; reassess--Student                                  $27.00                $0.00
99024WH      Post-Op Follow-up                                                       $0.00               $0.00
99201OM      New Patient; Problem Focused                                          $36.00              $15.00
99202        New Patient; Expanded Problem Focused                                 $59.00                $0.00
99203        New Patient; Detailed                                                 $77.00                $0.00
99204        New Patient; Comprehensive                                           $100.00                $0.00
99205        New Patient; Complex                                                 $136.00                $0.00
99211        Established Patient; Brief                                            $31.00                $0.00
99212        Established Patient; Problem Focused                                  $47.00                $0.00
99213        Established Patient; Expanded Problem Focused                         $59.00                $0.00
99214        Established Patient; Detailed                                         $84.00                $0.00
99201SM      New Patient; Problem Focused                                          $58.00              $15.00
99201WH      New Patient; Problem Focused                                          $58.00                $0.00
99202OM      New Patient; Expanded Problem Focused                                 $59.00              $15.00
99202SM      New Patient; Expanded Problem Focused                                 $70.00              $15.00
99202WH      New Patient; Expanded Problem Focused                                 $70.00                $0.00
99203OM      New Patient; Detailed                                                 $77.00              $15.00
99203SM      New Patient; Detailed                                                 $77.00              $15.00
99203WH      New Patient; Detailed                                                 $77.00                $0.00
99204OM      New Patient; Comprehensive                                           $100.00              $15.00
                            New Student Health Services Fee Schedule Effective August 1, 2010
Trans Code                             Transaction Description               Eligible          Eligible
                                                                          Health fee No     Health Fee Yes
99204SM      New Patient; Comprehensive                                           $100.00             $15.00
99204WH      New Patient; Comprehensive                                           $100.00               $0.00
99205OM      New Patient; Complex                                                 $136.00             $15.00
99205SM      New Patient; Complex                                                 $136.00             $15.00
99205WH      New Patient; Complex                                                 $136.00               $0.00
99211OM      Established Patient; Brief                                            $31.00             $15.00
99211SM      Established Patient; Brief                                            $31.00             $15.00
99211WH      Established Patient; Brief                                            $35.00               $0.00
99212OM      Established Patient; Problem Focused                                  $47.00             $15.00
99212SM      Established Patient; Problem Focused                                  $47.00             $15.00
99212WH      Established Patient; Problem Focused                                  $47.00               $0.00
99213OM      Established Patient;Exp Prob Focused                                  $52.00             $15.00
99213SM      Established Patient; Exp Prob Focused                                 $52.00             $15.00
99213WH      Established Patient; Exp Prob Focused                                 $52.00               $0.00
99215        Established Patient; Comprehensive                                    $84.00               $0.00
99241        Office Consult; Minor Problem                                         $47.00               $0.00
99242        Office Consult; Expanded Problem Focused                              $53.00               $0.00
99243        Office Consult; Detailed                                              $62.00               $0.00
99244        Office Consult; Comprehensive/Moderate Complexity                     $67.00               $0.00
99245        Office Consult; Comprehensive/High Complexity                         $95.00               $0.00
99354        Prolonged Services- Direct Contact; 30-74 min                         $62.00               $0.00
99384        Preventive Medicine New Pt. 12-17                                     $50.00               $0.00
99385        Preventive Medicine New Pt. 18-39                                     $50.00               $0.00
99214OM      Established Patient; Detailed                                         $84.00             $15.00
99214SM      Established Patient; Detailed                                         $84.00             $15.00
99214WH      Established Patient; Detailed                                         $84.00               $0.00
99215OM      Established Patient; Comprehensive                                    $84.00             $15.00
99215SM      Established Patient; Comprehensive                                    $84.00             $15.00
99215WH      Established Patient; Comprehensive                                    $84.00               $0.00
99241OM      Office Consult; Minor Problem                                         $47.00             $15.00
99241SM      Office Consult; Minor Problem                                         $47.00             $15.00
99241WH      Office Consult; Minor Problem                                         $47.00               $0.00
99242OM      Office Consult; Expanded Problem Focused                              $53.00             $15.00
99242SM      Office Consult; Expanded Problem Focused                              $53.00             $15.00
99242WH      Office Consult; Expanded Problem Focused                              $53.00               $0.00
99243OM      Office Consult; Detailed                                              $62.00             $15.00
99243SM      Office Consult; Detailed                                              $62.00             $15.00
99243WH      Office Consult; Detailed                                              $62.00               $0.00
99244OM      Office Consult; Comp/Moderate Complexity                              $67.00             $15.00
                             New Student Health Services Fee Schedule Effective August 1, 2010
Trans Code                               Transaction Description              Eligible           Eligible
                                                                           Health fee No      Health Fee Yes
99244SM      Office Consult; Comp/Moderate Complexity                               $67.00              $15.00
99244WH      Office Consult; Comp/Moderate Complexity                               $67.00                $0.00
99245OM      Office Consult; Comp/High Complexity                                   $95.00              $15.00
99245SM      Office Consult; Comp/High Complexity                                   $95.00              $15.00
99245WH      Office Consult; Comp/High Complexity                                   $95.00                $0.00
99384WH      Preventive Medicine New Pt. 12-17                                      $50.00                $0.00
99386        Preventive Medicine New Pt. 40-64                                      $50.00                $0.00
99387        Preventive Medicine New Pt. 65 or Over                                 $72.00                $0.00
99394        Preventive Medicine Est. Pt. 12-17                                     $50.00                $0.00
99395        Preventive Medicine Est. Pt. 18-39                                     $50.00                $0.00
99396        Preventive Medicine Est. Pt. 40-64                                     $50.00                $0.00
99397        Preventive Medicine Est. Pt. 65 or Over                                $72.00                $0.00
99401        Preventative Medicine Counseling; 15 min                                 $0.00               $0.00
99402        Travel Visit Brief (30 minutes)                                        $50.00              $30.00
99404        Travel Consult (60 minutes)                                            $64.00              $40.00
99442        Phone E/M by Phys, 11-20 min                                           $12.00                $0.00
99385WH      Preventive Medicine New Pt. 18-39                                      $50.00                $0.00
99386WH      Preventive Medicine New Pt. 40-64                                      $50.00                $0.00
99387WH      Preventive Medicine New Pt. 65 or Over                                 $72.00                $0.00
99394WH      Preventive Medicine Est. Pt. 12-17                                     $50.00                $0.00
99395WH      Preventive Medicine Est. Pt. 18-39                                     $50.00                $0.00
99396WH      Preventive Medicine Est. Pt. 40-64                                     $50.00                $0.00
99397WH      Preventive Medicine Est. Pt. 65 or Over                                $72.00                $0.00
99406/S      Smoking Cessa counsel;<= 10 min/Student                                  $0.00               $0.00
99406F/S     Smoking Cess counsel; <=10 min /Faculty Staff                            $0.00               $0.00
99407/S      Smoking Cessa counsel; > 10 min /Student                                 $0.00               $0.00
99407F/S     Smoking Cess counsel; > 10 min /Faculty Staff                            $0.00               $0.00
99408/S      Alco & othr subs abuse screen; 15-30 min /Student                        $0.00               $0.00
99408F/S     Alco & othr subs abuse screen; 15-30 min /Faculty Staff                  $0.00               $0.00
A4556        Electrodes/pair                                                        $12.00              $12.00
AceWrap      Ace wrap                                                                 $5.00               $4.00
AnkelLong    Ankle Walker, long                                                     $78.00              $65.00
AnkelShort   Ankle Walker, short                                                    $78.00              $65.00
AnkleFig8    Ankle, elastic, Figure 8                                               $17.00              $15.00
AnkleStab    Ankle stabilizing support                                              $57.00              $48.00
AnkleTough   Ankle Tough Kit                                                        $36.00              $30.00
AnklPulOvr   Ankle, pullover                                                        $73.00              $60.00
BAPT-001     Pltelet Function Screen                                               $184.00             $147.00
BAPT-8185    Malaria                                                                $85.00              $72.00
                            New Student Health Services Fee Schedule Effective August 1, 2010
Trans Code                              Transaction Description                 Eligible           Eligible
                                                                             Health fee No      Health Fee Yes
BAPT-85025   CBC (Automated Differential) (Bapt)                                      $40.00              $40.00
BAPT-85379   D-Dimer (Stat, Baptist)                                                  $50.00              $42.00
BAPT-87324   C Difficile A&B (Stat, Baptist)                                          $65.00              $54.00
BeltRib      Belt, rib                                                                $48.00              $40.00
BEST-001     QuantiFERON TB Gold Test                                                 $66.00              $66.00
BEST-002     T-Spot (TB test)                                                         $93.00              $93.00
BraceElb     Brace, elbow                                                            $621.00             $519.00
BracWrVel    Brace, wrist, velcro                                                     $22.00              $18.00
CamWalk      Cam walker (all sizes)                                                  $259.00             $217.00
CaneAlum     Cane, aluminum                                                           $36.00              $30.00
Cariso350    Carisoprodol 350mg x30tab                                                $26.00              $26.00
CastArm      Cast, arm, short plaster                                                 $23.00              $19.00
CastFiber2   Cast, Fiberglass, 2                                                      $29.00              $25.00
CastFiber3   Cast, Fiberglass, 3                                                      $28.00              $25.00
CastFiber4   Cast, Fiberglass, 4                                                      $30.00              $25.00
CastFiber5   Cast, Fiberglass, 5                                                      $30.00              $25.00
CastLegPls   Cast, leg plaster adult                                                  $36.00              $31.00
CastRoll3    Plaster Cast Roll-3                                                      $14.00              $12.00
CastRoll4    Plaster Cast Roll-4                                                      $15.00              $13.00
CastRoll6    Plaster Cast Roll-6                                                      $27.00              $23.00
CathTray     Catheter Tray                                                            $22.00              $18.00
CervFoam     Collars, cervical foam                                                   $32.00              $26.00
CHDCDNKA30   Counseling Center - Did Not Keep Appointment - 30 minute appt            $17.00              $17.00
CHDCDNKA60   Counseling Center - Did Not Keep Appointment - 60 minute appt            $28.00              $28.00
CHDCDNKABF   Counseling Center Biofeedback Did Not Keep Appointment                   $20.00              $20.00
COPYMEDREC   Medical Records- Paper Copy Fee                                            $0.00               $0.00
COPYRADIOL   Radiology- Film Copy Fee                                                   $0.00               $0.00
CrutchAdlt   Crutches, adult                                                          $50.00              $41.00
CrutchTall   Crutches, adult, tall                                                    $58.00              $47.00
CS-002295A   Immunoglobulin Fraction                                                  $42.00              $34.00
CS-002295B   IgE, Total                                                               $44.00              $34.00
CS-003129A   Creatinine 24 hr urine                                                   $40.00              $34.00
CS-003129B   Protein Urine 24 hour, Total                                             $14.00              $14.00
CS-070813A   Arsenic                                                                 $154.00             $129.00
CS-070813B   Cadmium                                                                 $154.00             $129.00
CS-070813C   Creatinine 24 hr urine                                                   $40.00              $34.00
CS-070813D   Lead                                                                    $154.00             $129.00
CS-070813E   Mercury                                                                 $154.00             $128.00
CS-102590A   Amylase Isoenzymes                                                      $102.00              $88.00
                             New Student Health Services Fee Schedule Effective August 1, 2010
Trans Code                                Transaction Description             Eligible          Eligible
                                                                           Health fee No     Health Fee Yes
CS-102590B   Amylase, Serum                                                         $40.00             $30.00
CS-103A      Mono layer PAP Smear                                                   $57.00             $47.00
CS-103B      HPV Hybrid Capture (High Risk Only)                                    $78.00             $65.00
CS-108       Biopsy (CERVX) x2                                                     $156.00             $67.00
CS-109       Biopsy (CERVX) x3                                                     $156.00             $67.00
CS-111       Biopsy (DERM) x2                                                      $156.00             $67.00
CS-112       Biopsy (DERM) x3                                                      $156.00             $67.00
CS-117954A   Russell Viper Venom Time, diluted                                     $189.00            $151.00
CS-117954B   Thrombin Time                                                          $95.00             $76.00
CS-117954C   Thromboplastin inhibition, tissue                                     $118.00             $95.00
CS-117954D   Thrombo plastin inhibition, sustitutions                              $165.00            $150.00
CS-1214A     Bilirubin, Total (Serum)                                               $39.00             $33.00
CS-1214B     Bilirubin, Direct (Serum)                                              $39.00             $33.00
CS-121679A   Hgb Chromatography                                                     $32.00             $27.00
CS-121679B   Sickle Cell Screen                                                     $12.00               $9.00
CS-1321B     Iron Binding Capacity                                                  $14.00             $14.00
CS-138210A   Strep pneumonia IgG 1                                                  $52.00             $43.00
CS-140285A   Microalbumin, 24-Hour, Urine                                           $53.00             $44.00
CS-140285B   Creatinine 24 hr urine                                                 $40.00             $34.00
CS-15594A    Antithrombin III, activity                                            $108.00             $90.00
CS-15594B    Antithrombin III, antigen                                             $107.00             $89.00
CS-161802A   Cardiolipin (phopholipid) Ab                                           $75.00             $63.00
CS-162388A   Flourescent Ab Titer, noninfectious                                   $138.00            $116.00
CS-163303A   Parvo Virus IgG                                                       $135.00            $113.00
CS-163303B   Parvo Virus IgM                                                       $135.00            $113.00
CS-163600A   Borrelia - Western Blot                                                $92.00             $76.00
CS-163758A   Mycoplasma IgG                                                         $75.00             $65.00
CS-163758B   Mycoplasma IgM                                                         $75.00             $66.00
CS-163915A   Beta2 Glycoprotein 1 Ab                                                $70.00             $56.00
CS-164133A   HTLV I Immunoblot                                                     $170.00            $137.00
CS-164133B   HTLV II Immunoblot                                                    $199.00            $165.00
CS-164517A   Protein S Total                                                       $211.00            $172.00
CS-164517B   Protein S Functional                                                  $211.00            $183.00
CS-164905A   Herpes (HSV) Type I                                                    $58.00             $47.00
CS-164905B   Herpes (HSV) Type II                                                   $85.00             $59.00
CS-165092A   Endomysial Antibody IgA                                                $47.00             $36.00
CS-165092B   Extractable Nuclear Antigen                                           $149.00            $125.00
CS-165126A   Gammaglobulin IgA, IgD, IgG, or IgM                                   $127.00            $102.00
CS-165126B   Immunoassay for analyte                                               $127.00            $102.00
                              New Student Health Services Fee Schedule Effective August 1, 2010
Trans Code                                 Transaction Description             Eligible          Eligible
                                                                            Health fee No     Health Fee Yes
CS-165126C   Flourescent non-infectious antibody                                    $127.00            $102.00
CS-165134A   Immunoglobulin A serum                                                  $47.00             $39.00
CS-165134B   Tissue Transglutaminase (tTA) IgA                                      $158.00            $118.00
CS-165134C   Tissue transglutiminase (tTG) IgG                                      $158.00            $116.00
CS-165134D   Endomysial Antibody IgA                                                $158.00            $135.00
CS-165142A   Immunoglobulin A serum                                                  $47.00             $39.00
CS-165142B   Tissue Transglutaminase (tTA) IgA                                      $158.00            $118.00
CS-165142C   Endomysial Antibody IgA                                                $158.00            $134.00
CS-167082A   Isolation or extraction of highly purified nucleic acid                 $37.00             $20.00
CS-167082B   separation by gel electrophoresis                                       $16.00             $13.00
CS-167082C   Nuclceic acid probe                                                     $14.00             $12.00
CS-167082D   amplification, nucleic acid sequence                                    $16.00             $13.00
CS-167082E   interpretation                                                          $38.00             $22.00
CS-182378A   Concentration, infectious agent                                         $54.00             $44.00
CS-182378B   Flourescent or Acid Fast Stain                                          $54.00             $43.00
CS-182675A   Concentration, infectious agent                                         $14.00             $12.00
CS-182675B   Culture, Acid Fast Bacteria                                            $220.00            $184.00
CS-183194A   GC by Amplification (Swab/Urine)                                        $28.00             $23.00
CS-183194B   Chlamydia by Amplification                                              $28.00             $23.00
CS-186200A   GC by Amplification (Swab/Urine)                                        $28.00             $23.00
CS-186200B   Chlamydia by Amplification                                              $28.00             $23.00
CS-1917A     Glucose 6-Phosphate Dehydorgnase                                        $58.00             $48.00
CS-1917B     RBC Count, Automated                                                    $12.00               $9.00
CS-202945A   CBC(automated differential)                                             $40.00             $34.00
CS-202945B   RPR, serum                                                              $16.00             $13.00
CS-202945C   Hepatitis B Surf. Antigen (HBSAg)                                       $22.00             $18.00
CS-202945D   Rubella antibodies, IgG                                                 $24.00             $24.00
CS-202945E   Antibody Screen                                                        $205.00            $181.00
CS-202945F   ABO typing                                                              $28.00             $23.00
CS-202945G   RH typing                                                               $29.00             $24.00
CS-209601A   Total IgG                                                               $74.00             $63.00
CS-209601B   Subclass IgG                                                            $74.00             $58.00
CS-211728A   Liver Profile /Hepatic Function                                         $17.00             $12.00
CS-211728B   Gamma Glutamyl Transpeptidase (GGT)                                     $11.00             $12.00
CS-2154A     CK(Creatine kinase)                                                     $40.00             $34.00
CS-2154B     CK Isoenzymes                                                           $27.00             $20.00
CS-216655A   Epstein-Barr Virus, Early Antigen IgG                                   $65.00             $56.00
CS-216655B   Epstein-Barr Virus Nuclear Ag, IgG                                      $69.00             $57.00
CS-216655C   Epstein-Barr Virus(VCA)IgG                                              $72.00             $59.00
                             New Student Health Services Fee Schedule Effective August 1, 2010
Trans Code                              Transaction Description               Eligible           Eligible
                                                                           Health fee No      Health Fee Yes
CS-223586A   Lyme Disease Antibody IgG                                              $93.00              $77.00
CS-223586B   Lyme Disease Antibody IgM                                              $93.00              $77.00
CS-24943A    Uric Acid, serum                                                         $8.00               $7.00
CS-24943B    Sedimentation Rate                                                       $8.00               $6.00
CS-24943C    ANA: Antinuclear Antibody                                              $23.00              $19.00
CS-24943D    Rheumatoid Factor, RA                                                    $9.00               $8.00
CS-24943E    Antistreptolysin O (ASO) Titer                                         $16.00              $12.00
CS-250555A   Russell Viper Venom Time, diluted                                     $189.00             $151.00
CS-250555B   Thrombo plastin inhibition, sustitutions                              $165.00             $134.00
CS-250555C   Cardiolipin (phopholipid) Ab                                           $78.00              $70.00
CS-264994A   Glucose, Plasma                                                        $33.00              $16.00
CS-264994B   Glucose, 2Hr. PP (1 spec.)                                             $33.00              $15.00
CS-27011A    T3 Uptake                                                              $55.00              $44.00
CS-27011B    T4 (Thyroxine) Total                                                   $55.00              $44.00
CS-27011C    T3 (Tri-iodothyronine) Total                                           $55.00              $10.00
CS-27011D    TSH                                                                    $28.00              $28.00
CS-271A      DHEC Viral ID                                                            $0.00               $0.00
CS-27623A    Metabolic Profile, Comp.                                               $15.00              $12.00
CS-27623B    Lipid Screen                                                           $16.00              $13.00
CS-27623C    Iron, serum                                                              $6.00               $5.00
CS-27623D    LDH (Blood)                                                              $6.00               $5.00
CS-27623E    Uric Acid, serum                                                         $5.00               $5.00
CS-27623F    Phosphorus                                                               $5.00               $5.00
CS-283655A   Protein C Antigen                                                     $200.00             $174.00
CS-283655B   Protein C, Functional                                                 $218.00             $175.00
CS-28480A    Follical-Stimulating Hormone (FSH), Serum                              $65.00              $53.00
CS-28480B    LH (Luteinizing Hormone)                                               $66.00              $54.00
CS-286161A   VMA                                                                    $74.00              $58.00
CS-286161B   Catecholemines, fractionated                                          $111.00              $96.00
CS-3121A     Iron, serum                                                            $37.00              $28.00
CS-3368A     Protein Urine 24 hour, Total                                           $64.00              $43.00
CS-3368B     Protein Electrophoresis urine                                          $53.00              $50.00
CS-38158A    Protoporpyrin, RBC                                                     $55.00              $43.00
CS-38158B    Lead (blood)                                                           $52.00              $43.00
CS-4044A     Creatinine urine                                                       $35.00              $30.00
CS-4044B     Meprobamate                                                           $237.00             $197.00
CS-42846A    Thyroglobulin Ab                                                      $108.00              $90.00
CS-42846B    Thyroglobulin                                                         $108.00              $89.00
CS-455A      T4 (Thyroxine) Total                                                   $12.00                $9.00
                             New Student Health Services Fee Schedule Effective August 1, 2010
Trans Code                               Transaction Description              Eligible           Eligible
                                                                           Health fee No      Health Fee Yes
CS-455B      T3 Uptake                                                              $12.00                $9.00
Cs-46532A    Testosterone                                                           $43.00              $33.00
CS-46532B    Prolactin, serum                                                       $49.00              $33.00
CS-511154A   extraction , nucleic acid                                             $119.00              $96.00
CS-511154B   seperation by gel elec.                                               $119.00              $95.00
CS-511154C   amplification                                                          $28.00              $27.00
CS-511154D   interpretaion & report                                                 $33.00              $28.00
CS-511238A   extraction , nucleic acid                                              $56.00              $45.00
CS-511238B   enzymatic digestion                                                    $56.00              $45.00
CS-511238C   seperation by gel elec                                                 $57.00              $45.00
CS-511238D   amplification                                                          $28.00              $27.00
CS-511238E   interpretaion & report                                                 $33.00              $28.00
CS-511345A   extraction , nucleic acid                                              $70.00              $56.00
CS-511345B   enzymatic digestion                                                    $70.00              $56.00
CS-511345C   amplification                                                          $28.00              $27.00
CS-511345D   interpretaion & report                                                 $33.00              $28.00
CS-51162A    extraction , nucleic acid                                              $80.00              $64.00
CS-51162B    enzymatic digestion                                                    $79.00              $64.00
CS-51162C    seperation by gel elec.                                                $79.00              $64.00
CS-51162D    amplification                                                          $28.00              $27.00
CS-51162E    interpretaion & report                                                 $33.00              $28.00
CS-58545A    Hepatitis B Core Antibody, Total                                       $63.00              $57.00
CS-58545B    Hepatitis B Core Antibody IgM                                          $72.00              $59.00
CS-58545C    Hepatitis B Surf. Antibody (HBSAb)                                     $22.00              $18.00
CS-58545D    Hepatitis Be Antibody                                                  $72.00              $57.00
CS-58545E    Hepatitis B Surf. Antigen (HBSAg)                                      $22.00              $18.00
CS-58545F    Hepatitis Be Antigen                                                   $72.00              $57.00
CS-6049A     ABO typing                                                             $28.00              $24.00
CS-6049B     RH typing                                                              $29.00              $24.00
CS-620A      TSH                                                                    $17.00              $14.00
CS-620B      T3 Uptake                                                                $6.00               $5.00
CS-620C      T4 (Thyroxine) Total                                                     $6.00               $6.00
CS-6338A     Extractable Nuclear Antigen                                           $149.00             $125.00
CS-670654    RAST-Latex Related Allergen                                            $29.00              $22.00
CS-6924A     Molecular isolation                                                    $14.00              $12.00
CS-6924B     dot/blot production nucleic acid                                       $15.00              $12.00
CS-6924C     nucleic acid probe                                                     $14.00              $12.00
CS-6924D     amplification                                                          $28.00              $28.00
CS-6924E     interpretaion & report                                                 $33.00              $28.00
                             New Student Health Services Fee Schedule Effective August 1, 2010
Trans Code                               Transaction Description              Eligible           Eligible
                                                                           Health fee No      Health Fee Yes
CS-7773A     Creatinine urine                                                       $34.00              $29.00
CS-7773B     Mercury                                                               $136.00             $111.00
CS-7856A     Phenobarbital Level (Luminal)                                          $74.00              $60.00
CS-7856B     Primidone                                                              $70.00              $60.00
CS-810A      Vitamin B12                                                            $78.00              $65.00
CS-810B      Folic Acid/Folates                                                     $34.00              $28.00
CS-8144A     Stool Aerobic                                                          $16.00              $14.00
CS-8144B     Stool additional pathogens                                             $15.00              $14.00
CS-8144C     Shiga like toxin                                                       $20.00              $15.00
CS-8565A     Chlamydia Trachomatis Culture, any source                              $75.00              $64.00
CS-8565B     Chlamydia Trachomatis Culture, typing                                  $28.00              $23.00
CS-8755A     Concentration, infectious agent                                        $14.00              $12.00
CS-8755B     Flourescent or Acid Fast Stain                                         $50.00              $43.00
CS-90399A    Glucose Tolerance,FBS                                                  $24.00              $20.00
CS-90399B    Glucose, Beyond Three Specimens                                        $22.00              $14.00
CS-91108A    Hepatitis B Surf. Antibody (HBSAb)                                     $22.00              $18.00
CS-91108B    Hepatitis Be Antibody                                                  $85.00              $72.00
CS-91108C    Hepatitis B Surf. Antigen (HBSAg)                                      $23.00              $18.00
CS-91108D    Hepatitis Be Antigen                                                   $85.00              $70.00
CS-98418A    Hepatitis B Core Antibody, Total                                       $63.00              $53.00
CS-98418B    Hepatitis B Core Antibody IgM                                          $66.00              $54.00
CS-9993A     T3 Uptake                                                              $47.00              $39.00
CS-9993B     T4 (Thyroxine) Total                                                   $47.00              $39.00
CS-9993C     T3 (Tri-iodothyronine) Total                                           $48.00              $40.00
CS-D5.5NS>   Charge Set IV D5/.5NS addl bag and 1 hr observation                    $28.00              $28.00
CS-D5/.5NS   Charge set IV D5/.5NS Start                                            $58.00              $58.00
CS-D5/LR     Charge Set IV D5 and Lactated Ringers Start                            $58.00              $58.00
CS-D5/LR>1   Charge Set IV D5 Lactated Rin addl bag and 1 hr observ                 $28.00              $28.00
CS-D5/NS>1   Charge Set IV D5 and NS addl bag and 1hr observation                   $28.00              $28.00
CS-D5W>1     Charge Set IV D5W additional bag and 1 hr observation                  $36.00              $36.00
CS-H1N1      Charge Set H1N1 Vaccine IM                                               $0.00               $0.00
CS-H1N1Nas   Charge Set H1N1 Vaccine Nasal                                            $0.00               $0.00
CS-HEP-A     Hepatitis A Vaccine (Adult)                                            $82.00              $82.00
CS-HEP-B     Charge Set Hepatitis B Vaccine Adult                                   $74.00              $74.00
CS-HPVCerv   Charge Set Cervix Project Vaccine                                     $199.00             $199.00
CS-HPVVac    Charge Set HPV Vaccine                                                $199.00             $199.00
CS-IPV       Charge Set Poliomyelitis IPV Vaccine                                   $60.00              $60.00
CS-IV.5NS    Charge Set IV.5 Normal Saline Start                                    $58.00              $58.00
CS-IVD5/NS   Charge Set IV D5 and Normal Saline Start                               $58.00              $58.00
                            New Student Health Services Fee Schedule Effective August 1, 2010
Trans Code                              Transaction Description                Eligible           Eligible
                                                                            Health fee No      Health Fee Yes
CS-IVLR      Charge Set IV Lactated Ringers Start                                    $59.00              $59.00
CS-IVSTAD5   Charge Set IV D5W Start                                                 $63.00              $63.00
CS-IVSTAMI   Charge Set IVMINI Start and 1 hr Observation                            $49.00              $49.00
CS-IVSTANS   Charge Set IV Normal Saline Start                                       $58.00              $58.00
CS-LR>1      Charge Set Lactated Ringers addl bag and 1 hr observati                 $36.00              $36.00
Cs-Menactr   Charge Set Menactra Vaccine                                            $150.00             $150.00
CS-Mini>1    Charge set additional bag and 1 hr of observation                       $24.00              $24.00
CS-MMR       Charge Set Mumps-Measles-Rubella Vaccine                                $94.00              $94.00
CS-NS>1      Charge Set Normal Saline addl bag and 1 hr observation                  $28.00              $28.00
CS-Pneumo    Charge Set Pneumococcal Vaccine (Pneumovax)                             $70.00              $70.00
CS-PST       Charge Set Potassium Sensitvity Test (PST)                                $0.00               $0.00
CS-Rabies    Charge Set Rabies Vaccine; Intramuscular                               $231.00             $231.00
CS-Tdap      Charge Set Tdap                                                         $66.00              $66.00
CS-Tet-Dip   Charge Set Tetanus-Diphtheria Vaccine                                   $64.00              $64.00
CS-Tetanus   Charge Set Tetanus immune globin, intramusular                         $179.00             $179.00
CS-Typhoid   Charge Set Typhoid Vaccine - Intramuscular                             $104.00             $104.00
CS-Yellow    Charge Set Yellow Fever Vaccine, SC                                    $104.00             $104.00
CSIVSTDWLR   Charge Set IV D5W/Lactated Ringers START                                $58.00              $58.00
CstFbrArm    Casting, fiberglass, arm                                                $22.00              $18.00
CstSurBoot   Cast, surgical boot/shoe                                                $23.00              $19.00
CWDNKA15FS   Did Not Keep Appointment 15 min Nutrition appt Faculty/Staff            $17.00              $17.00
CWDNKA15S    Did Not Keep Appointment 30 min Nutrition appt Student                  $17.00              $17.00
CWDNKA60FS   Did Not Keep Appointment 60 min Nutrition appt Faculty/Staff            $28.00              $28.00
CWDNKA60S    Did Not Keep Appoinment Nutrition appt Student                          $28.00              $28.00
CWDNKAMasF   Did Not Keep Appointment Massage Faculty/Staff                          $17.00              $17.00
CWDNKAMasS   Did Not Keep Appointment Massage Student                                $17.00              $17.00
DepoMedrol   Depo-Medrol 80 mg                                                         $9.00             $10.00
DHEC-271     DHEC FLU                                                                  $0.00               $0.00
DHEC-715     DHEC TB Panel (liver profile/vp)                                          $0.00               $0.00
Diaphrm60    Diaphragm All Flex 60                                                   $72.00              $59.00
Diaphrm65    Diaphragm All Flex-65                                                   $72.00              $59.00
Diaphrm70    Diaphragm All Flex-70                                                   $72.00              $59.00
Diaphrm75    Diaphragm All Flex -75                                                  $72.00              $59.00
Diaphrm80    Diaphragm All Flex -80                                                  $72.00              $59.00
Diaphrm85    Diaphragm All Flex - 85                                                 $72.00              $59.00
DisCautery   Disposable Cautery                                                      $24.00              $24.00
DRESSCHG     Dressing Change                                                         $15.00                $9.00
E0000        PT- Hot/Cold Pack Reusable Gel                                            $6.00               $6.00
E0230        Hot/Cold Pack                                                             $7.00               $6.00
                              New Student Health Services Fee Schedule Effective August 1, 2010
Trans Code                                 Transaction Description             Eligible           Eligible
                                                                            Health fee No      Health Fee Yes
Epi0.1mg     Epinephrine 1:1000-0.1mg                                                  $9.00               $8.00
Epi0.2mg     Epinephrine 1:1000-0.2mg                                                $13.00              $13.00
Epi0.3mg     Epinephrine 1:1000-0.3mg                                                $19.00              $16.00
Epi0.4mg     Epinephrine 1:1000-0.4mg                                                $24.00              $20.00
Epi0.5mg     Epinephrine 1:1000-0.5mg                                                $28.00              $24.00
Fexof180mg   Fexofenadine HCL 180 mg x 30 tabs                                       $50.00              $50.00
GelfoamPac   Gelfoam, single pack                                                      $8.00               $7.00
GelfomSpng   Gelfoam, single sponge                                                    $8.00               $7.00
GICocktail   GICocktail 30 cc                                                          $6.00               $6.00
GMCAdminPE   Administrative Physical General Medicine                                $30.00              $29.00
HateCrime    Hate Crime                                                                $0.00               $0.00
HepLock      Hep-lok 10 u/cc                                                         $13.00              $11.00
Immob18      Immobilizer, knee, 18""                                                 $96.00              $80.00
Immob22      Immobilizer, knee, 22""                                                 $96.00              $80.00
Immodium     Imodium 2mg PO                                                            $0.00               $0.00
Implanon     Implanon                                                               $877.00             $855.00
Instagluco   Instaglucose                                                              $0.00               $0.00
IUDmirena    Mirena IUD                                                             $952.00             $930.00
IUDParaGrd   ParaGard IUD                                                           $439.00             $431.00
IV.5NS1st    IV Fuild, 1/2 normal saline one (1) liter first bag                     $22.00              $18.00
IV.5NSAddl   IV Fuild, 1/2 normal saline one (1) liter add'tl bag                    $14.00              $12.00
IVD5.5NS>1   IV Fluid D5 1/2 normal saline (1) liter add'tl bag                      $14.00                $0.00
IVD5.5NS1    IV Fluid D5 1/2 normal saline (1) liter 1st Bag                         $22.00                $6.00
IVD5LR       IV Fluid, D5, Lactated Ringers (1) liter 1st bag                        $22.00              $22.00
IVD5LRAddl   IV Fluid, D5, Lactated Ringers add'l bag                                $14.00                $0.00
IVD5NS1st    IV Fluid, D5 normal saline one (1) liter first bag                      $22.00              $22.00
IVD5NSAddl   IV Fluid, D5 normal saline one (1) liter add'tl bag                     $14.00                $0.00
IVD5W1st     IV Fluid, D5W one (1) liter first bag                                   $26.00              $13.00
IVD5WAddl    IV Fluid, D5W one (1) liter add'tl bag                                  $22.00              $19.00
IVKit        IV Start up kit                                                           $9.00               $9.00
IVLRin1st    IV Fluid, lactated ringers one (1) liter first bag                      $26.00              $22.00
IVLRinaddl   IV Fluid, lactated ringers one (1) liter add'tl bag                     $22.00              $19.00
IVMini1st    IV Fluid minibag, first bag (250cc's or<)                               $13.00              $11.00
IVMiniAddl   IV Fluid minibag, add'tl bag (250cc's or<)                                $9.00               $8.00
IVNS1stBag   IV Fuild, normal saline one (1) liter first bag                         $22.00              $19.00
IVNSAddl     IV Fluid, normal saline one (1) liter add'tl bag                        $14.00              $12.00
IVSTALAC     CS-IV START LACTATED RINGERS                                            $63.00              $63.00
IVSTANSD5    CS-IV START NORMAL SALINE D5                                            $58.00              $58.00
IVStartD5W   IV Start-up kit with D5W                                                $63.00              $63.00
                           New Student Health Services Fee Schedule Effective August 1, 2010
Trans Code                            Transaction Description               Eligible          Eligible
                                                                         Health fee No     Health Fee Yes
Kenalog10    Kenalog 10 mg                                                        $22.00             $19.00
Kenalog40    Kenalog 40 mg                                                        $22.00             $19.00
KncklOrth    Knuckle orthosis                                                     $59.00             $50.00
KneeBrace    Knee brace                                                           $96.00             $82.00
KneePulOvr   Kneecap, pullover                                                    $52.00             $44.00
KneeStrap    Chopat Knee Strap                                                    $20.00             $20.00
KneeSuCart   Knee support, cartilage                                              $96.00             $82.00
KnePlaymkr   Knee brace, playmaker ligament                                      $213.00            $231.00
LAB-001099   Bilirubin, Total (Serum)                                             $40.00             $34.00
LAB-001222   Bilirubin, Direct (Serum)                                            $40.00             $34.00
LAB-001453   Wellness, Hemoglobin A1C                                             $43.00             $43.00
LAB-001677   Fecal Fat, Qualitative                                               $65.00             $52.00
LAB-001776   Immunoglobulin G, serum                                              $37.00             $29.00
LAB-001792   Immunoglobulin M, serum                                              $37.00             $29.00
LAB-001800   Zinc, Plasma or Serum                                                $59.00             $47.00
LAB-001818   Wellness, Fasting Plasma Glucose                                     $22.00             $22.00
LAB-002139   Carcinoembryonic Antigen (CEA)                                       $68.00             $55.00
LAB-002295   CS-Immunoglobulin IgA, IgE, IgG, IgM                                $167.00            $134.00
LAB-003129   CS-Urine Protein/Creatinine Ratio                                    $54.00             $47.00
LAB-003269   Urine Calcium 24 Hour                                                $28.00             $21.00
LAB-004234   Metanephrines, Fractionated, Quantitative                           $151.00            $151.00
LAB-004580   Wellness, Cholesterol Profile                                        $23.00             $18.00
LAB-004648   Compliment C1 Esterase Inhibitor, Serum                              $72.00             $57.00
LAB-004655   Vitamin B6                                                          $235.00            $197.00
LAB-004804   Calcium,Ionized                                                      $60.00             $48.00
LAB-007393   Nortriptyline (Aventyl) Serum                                       $102.00             $82.00
LAB-008573   Culture, Viral General                                              $188.00            $188.00
LAB-010165   Zinc Protoporphyrin                                                  $60.00             $48.00
LAB-010413   Intrinsic Blocking Factor                                           $169.00            $136.00
LAB-015610   Parathyroid Hormone (PTH), Intact                                   $108.00             $86.00
LAB-016931   Prealbumin                                                          $146.00            $124.00
LAB-018705   Antiscleroderma 70 Ab                                               $146.00            $117.00
LAB-028142   CBC (No Diff) Routine send Out                                       $40.00             $34.00
LAB-068445   RAST Soybean                                                         $26.00             $20.00
LAB-070813   CS-Heavy Metals - Urine (24 Hour)                                   $653.00            $548.00
LAB-071316   Urine Drug Quant; Cannab (Reflex frm 071209)                        $206.00            $171.00
LAB-080283   Magnessium, RBC                                                     $129.00            $129.00
LAB-082016   Sex Hormone-binding Globulin, Serum                                 $131.00            $105.00
LAB-082719   Antiglomerular Basement Membrane Antibodies, Quant.                 $226.00            $180.00
                             New Student Health Services Fee Schedule Effective August 1, 2010
Trans Code                              Transaction Description               Eligible           Eligible
                                                                           Health fee No      Health Fee Yes
LAB-10108    C-peptide                                                              $76.00              $63.00
LAB-10116    Angiotensin-Converting Enzyme (ACE)                                    $74.00              $62.00
LAB-1016     Calcium                                                                $42.00              $34.00
LAB-1024     Phosphorus                                                             $40.00              $34.00
LAB-102590   CS-Amylase Isoenzymes                                                 $141.00             $118.00
LAB-10272    Epstein-Barr Virus Nuclear Ag, IgG                                     $78.00              $65.00
LAB-1032     Glucose,Serum                                                          $40.00              $34.00
LAB-10322    PSA                                                                    $43.00              $36.00
LAB-10389    Tri-iodothyronine (T3) Free, Direct                                   $128.00             $106.00
LAB-1040     BUN (Blood Urea Nitrogen)                                              $40.00              $34.00
LAB-1057     Uric Acid, serum                                                       $40.00              $34.00
LAB-1065     Cholesterol                                                            $22.00              $18.00
LAB-1073     Protein Total, serum                                                   $40.00              $34.00
LAB-1081     Albumin                                                                $40.00              $34.00
LAB-1107     Alkaline Phosphatase                                                   $55.00              $45.00
LAB-1115     LDH (Blood)                                                            $40.00              $34.00
LAB-1123     Aspartate Aminotransferase (AST/SGOT)                                  $40.00              $26.00
LAB-1149     T4 (Thyroxine) Total                                                   $24.00              $20.00
LAB-117054   CS-Lupus Anticoaglulant comp                                          $565.00             $471.00
LAB-1172     Triglycerides                                                          $40.00              $34.00
LAB-117705   Protein C, Functional                                                 $206.00             $171.00
LAB-117762   Activated Protein C Resistance                                        $185.00             $154.00
LAB-117838   Hexagonal Phase Phospholipid                                          $198.00             $166.00
LAB-1180     Potassium, Serum                                                       $40.00              $34.00
LAB-1198     Sodium, serum                                                          $40.00              $34.00
LAB-12005    Rapid Plasma Reagin(reflex Quant/TP-PA)                                $36.00              $30.00
LAB-120220   Compliment C1 Esterase Inhibitor, Functional                          $156.00             $150.00
LAB-1206     Chloride                                                               $40.00                $9.00
LAB-120766   CRP (C Reactive Protein) Cardiac                                       $45.00              $39.00
LAB-120790   Calculi, Urinary (kidney Stones)                                       $99.00              $83.00
LAB-120832   Troponin I                                                               $9.00               $7.00
LAB-121178   Vitamin B1 (Thiamine)                                                 $138.00             $116.00
LAB-121200   Vitamin K1                                                            $248.00             $217.00
LAB-1214     CS-Bilirubin Total & Direct                                            $78.00              $65.00
LAB-121679   CS-Hemoglobinopathy Profile                                            $43.00              $36.00
LAB-12708    Sjogren's (SS-A & SS-B)                                               $297.00             $248.00
LAB-1321     CS-Iron/Iron Binding Capacity                                          $50.00              $42.00
LAB-1339     Iron, serum                                                            $40.00              $34.00
LAB-1362     CK(Creatine kinase)                                                    $40.00              $34.00
                            New Student Health Services Fee Schedule Effective August 1, 2010
Trans Code                             Transaction Description               Eligible          Eligible
                                                                          Health fee No     Health Fee Yes
LAB-13672    Creatinine (urine)                                                    $35.00             $30.00
LAB-1370     Creatinine (Serum)                                                    $40.00             $34.00
LAB-138210   CS-Streptococcus pneumoniae AB IgG 14 SEROTYPES                      $715.00            $591.00
LAB-138318   Babesia Microti PCR                                                  $530.00            $442.00
LAB-138552   Febrile Agglutin Panel                                               $276.00            $199.00
LAB-1396     Amylase, Serum                                                        $36.00             $30.00
LAB-140050   Microalbumin, 24-Hour, Urine                                          $59.00             $50.00
LAB-140285   CS-Microalbumin/Creat. Ratio                                          $93.00             $77.00
LAB-1404     Lipase                                                                $38.00             $30.00
LAB-140612   Hep C NGI SuperQuant                                                 $608.00            $507.00
LAB-140615   Hepatitis B (HBV) DNA QuantaSure                                     $311.00            $259.00
LAB-140707   Pregnenolone                                                         $114.00             $92.00
LAB-140810   Hepatitis B, NGI SuperQuant, PCR                                     $708.00            $589.00
LAB-141408   Hepatitis C Antibody (RIBA)                                          $530.00            $442.00
LAB-143991   Hepatitis C Antibody (Screening)                                      $64.00             $54.00
LAB-144980   Testosterone, Free, Direct Serum                                     $234.00            $195.00
LAB-1453     Hemoglobin A1C                                                        $43.00             $36.00
LAB-1487     Protein Electrophoresis, Serum                                        $57.00             $47.00
LAB-1503     Vitamin B12                                                           $78.00             $65.00
LAB-15271    Lyme Disease Antibody, Total                                          $93.00             $77.00
LAB-1537     Magnesium                                                             $38.00             $33.00
LAB-1545     Alanine Aminotransferase (ALT/SGPT)                                   $40.00             $34.00
LAB-15594    CS-Antithrombin III Profile, functional                              $215.00            $179.00
LAB-1560     Ceruloplasmin                                                         $55.00             $45.00
LAB-160325   Lyme Antibody Total/ Reflex                                           $85.00             $72.00
LAB-160333   Lyme Antibody, IgM Early (Reflex to Western Blot)                     $89.00             $72.00
LAB-160499   Mumps Antibodies, IgM                                                 $64.00             $54.00
LAB-160721   Antipancreatic Islet Cells                                           $198.00            $166.00
LAB-161422   Anti-DNA(SS) Antibody                                                 $93.00             $77.00
LAB-161455   Anti-Jo Ab                                                           $156.00            $130.00
LAB-161745   Bordetella Pertussis IgG, quantitative                               $191.00            $159.00
LAB-161802   CS-Anticardiolipin (ACA) IgM,IgG                                     $149.00            $124.00
LAB-161992   Lyme Ab IgM Quant                                                     $93.00             $77.00
LAB-162050   HIV proviral, DNA PCR                                                $467.00            $389.00
LAB-162289   H.Pylori IgG                                                         $107.00             $70.00
LAB-162388   CS-ANCA antineutrophil cytoplasmic Ab                                $276.00            $230.00
LAB-163014   HSV Types I/II, IgG                                                   $69.00             $57.00
LAB-163147   HSV Type II                                                           $85.00             $72.00
LAB-163149   Herpes (HSV) Type II (Reflex from test 164020)                        $94.00             $94.00
                             New Student Health Services Fee Schedule Effective August 1, 2010
Trans Code                                Transaction Description             Eligible          Eligible
                                                                           Health fee No     Health Fee Yes
LAB-163204   H. Pylori IgM                                                          $74.00             $62.00
LAB-163303   CS-Parvovirus B19,IgG,IgM                                             $269.00            $225.00
LAB-163402   Gliadin Ab Profile IgG & IgA                                          $163.00            $136.00
LAB-163550   HIV-2 Ab                                                              $135.00            $113.00
LAB-163600   CS-Lyme Disease, Western Blot (Reflex of 160325)                      $183.00            $151.00
Lab-163758   CS-Mycoplasma pneumoniae IgG & IgM                                    $149.00            $130.00
LAB-163840   Anti-Myeloperoxidase (MPO) Abs                                        $118.00             $98.00
LAB-163915   CS-Beta2 Glycoprotein 1 Ab (IgA, IgG, IgM)                            $210.00            $167.00
LAB-163980   Anti Liver - Kidney Microsomal Ab                                      $75.00             $62.00
LAB-164020   HSV I/II IgG, w/ Reflex to Type II Specific IgG                        $62.00             $52.00
LAB-164133   CS-Relfex HTLV I and HTLV II Immunoblot                               $340.00            $272.00
LAB-164277   Human T-Cell Lymphotrophic Virus I/II                                 $134.00            $105.00
LAB-164509   von Willebrand Factor Activity                                        $184.00            $154.00
LAB-164517   CS-Protein S Antigen                                                  $410.00            $342.00
LAB-164525   Protein S Functional                                                  $206.00            $171.00
LAB-164640   Tissue Transglutaminase (tTA) IgA                                     $141.00            $118.00
LAB-164806   HSV Types I/II, IgM                                                    $64.00             $54.00
LAB-164814   Anticentromere B Ab                                                   $146.00            $117.00
LAB-164855   ANA: Antinuclear Antibody                                              $62.00             $52.00
LAB-164871   Cyclic Citrullinated Peptide (CCP) IgG                                 $66.00             $56.00
LAB-164897   Herpes (HSV) Type I, IgG                                               $58.00             $58.00
LAB-164905   CS-Herpes (HSV) Types I and II Specific Antibodies IgG                $141.00            $114.00
Lab-164913   HSV I/II IgG, w/Reflex to Type I & II Spec IgG                         $76.00             $62.00
LAB-164970   Leptospiral Ab,IgM                                                     $57.00             $47.00
LAB-164988   Tissue transglutiminase (tTG) IgG                                     $141.00            $116.00
LAB-164996   Endomysial Antibody IgA                                                $50.00             $40.00
LAB-165092   CS-ENA (ANA comprehensive profile)                                  $1,237.00          $1,031.00
LAB-165126   CS- Celiac Disease Comprehensive Antibody Profile                     $760.00            $608.00
LAB-165134   CS-Celiac Ab Profile II                                               $509.00            $407.00
LAB-165142   CS-Celiac Ab Profile                                                  $362.00            $290.00
LAB-16592    Rocky Mountain Spotted Fever, IgG                                     $114.00             $95.00
LAB-16667    Rocky Mountain Spotted Fever, IgM                                     $173.00            $144.00
LAB-167015   Apolpoprotein B                                                        $50.00             $39.00
LAB-167082   CS- Celiac Disease HLA DQ Association                                 $723.00            $579.00
LAB-16881    Hepatitis B Core Antibody IgM                                          $72.00             $59.00
LAB-1735     Thyroxine Binding Globulin                                             $83.00             $68.00
LAB-1784     Immunoglobulin A serum                                                 $47.00             $39.00
LAB-180224   Culture, Bordetella Pertussis Nasophayngeal                            $93.00             $77.00
LAB-180764   H. pylori Antigen (stool)                                             $310.00            $217.00
                            New Student Health Services Fee Schedule Effective August 1, 2010
Trans Code                              Transaction Description              Eligible           Eligible
                                                                          Health fee No      Health Fee Yes
LAB-180810   Culture, Lower Respiratory (Sputum)                                   $72.00              $59.00
LAB-1818     Glucose, Plasma                                                       $22.00              $18.00
LAB-182204   Giardia lamblia,EIA                                                   $72.00              $59.00
LAB-182246   Legionella pneumophilia Urinary Antigen                              $139.00             $139.00
LAB-182378   CS-Cryptosporidium/ Isospora smear, stool                            $107.00              $86.00
LAB-182675   CS-Culture, Acid Fast Bacteria                                       $234.00             $195.00
LAB-182776   Culture, Yeast only                                                   $72.00              $59.00
LAB-182873   QuantiFERON TB Gold                                                  $279.00             $224.00
LAB-183194   CS-GC/Chlamydia by NAA (Swab/Urine)                                   $56.00              $45.00
LAB-1834     Complement C4                                                         $56.00              $46.00
LAB-183566   No Charge - State Lab Confirmation                                      $0.00               $0.00
LAB-186072   Herpes (HSV) Culture (w/o typing)                                    $118.00              $36.00
LAB-186200   CS-GC/Chlamydia by NAA (Thin Prep)                                    $50.00              $40.00
LAB-18705    SC1-70Ab (Antisclerodermal Ab)                                       $141.00             $118.00
LAB-188078   Chlamydia by Amplification                                            $32.00              $27.00
LAB-188086   GC by Amplification (Swab/Urine)                                      $36.00              $30.00
LAB-1917     CS-Glucose 6-Phosphate Dehydorgnase                                   $69.00              $57.00
LAB-1941     Complement, Total (CH 50)                                             $85.00              $72.00
LAB-1958     Gamma Glutamyl Transpeptidase (GGT)                                   $40.00              $34.00
LAB-1974     Thyroxine (T4) Free, Direct                                           $72.00              $59.00
LAB-1982     Alpha-1 Antitrysin                                                    $62.00              $52.00
LAB-2006     Renin, Plasma                                                        $189.00             $189.00
LAB-2014     Folic Acid/Folates                                                    $64.00              $54.00
LAB-2022     Glucose, 2Hr. PP (1 spec.)                                            $24.00              $20.00
LAB-202945   CS-Prenatal Profile I with HBsAg                                     $361.00             $301.00
LAB-2030     Aldolase                                                              $55.00              $45.00
LAB-2071     Osmolality (serum)                                                    $50.00              $42.00
LAB-209601   CS-Immunoglobulin G, Subclasses(1-4)                                 $367.00             $294.00
LAB-211728   CS-Liver Profile /Hepatic Function/GGT                                $17.00              $24.00
LAB-2154     CS-CK Isoenzymes                                                      $67.00              $54.00
LAB-216655   CS-Epstein-Barr Virus, Acute Infection Ab Profile                    $276.00             $230.00
LAB-2170     Immunoglobulin E, Total                                               $69.00              $57.00
LAB-2188     T3 (Tri-iodothyronine) Total                                          $78.00              $65.00
LAB-223586   CS-Lyme Disease Antibodies, Total and IgM Responses                  $185.00             $154.00
LAB-2253     Alpha-Fetoprotein (AFP) Tumor Marker                                  $69.00              $57.00
LAB-2303     CA125                                                                 $99.00              $83.00
LAB-2402     Creatine, Serum                                                       $56.00              $42.00
LAB-24943    CS-Rheumatoid Profile                                                 $63.00              $50.00
LAB-250555   CS-Antiphospholipid Syndrome                                         $509.00             $425.00
                           New Student Health Services Fee Schedule Effective August 1, 2010
Trans Code                            Transaction Description               Eligible          Eligible
                                                                         Health fee No     Health Fee Yes
LAB-264994   CS-Glucose Screen (FBS, 2HR)                                         $65.00             $30.00
LAB-27011    CS-Thyroid,Comp(T3U,T4,T7,T3,TSH)                                   $191.00            $159.00
LAB-276024   Creatatinine Clearance-man. Calc.                                    $59.00             $13.00
LAB-27623    CS-Auto Chem Profile                                                 $50.00             $42.00
LAB-283655   CS-Protein C Deficiency Profile                                     $418.00            $348.00
LAB-28480    CS-FSH and LH                                                       $128.00            $106.00
LAB-286161   CS-VMA/Catecholemine 24 hr.                                         $185.00            $154.00
LAB-3004     Creatinine Clearance (24 HR)                                         $55.00             $45.00
LAB-3012     Creatinine 24 hr urine                                               $40.00             $34.00
LAB-303754   Electrolyte Panel                                                    $22.00             $18.00
LAB-322000   Metabolic Profile, Comp.                                             $38.00             $30.00
LAB-322744   Hep Panel, (HAV IgM, HBc IgM, HBsAg, HCV )                           $70.00             $60.00
LAB-322755   Liver Profile /Hepatic Function                                      $28.00             $24.00
LAB-322758   Metabolic Profile, Basic                                             $22.00             $18.00
LAB-322777   Renal Function Panel                                                 $38.00             $33.00
LAB-3277     Protein Urine 24 hour, Total                                         $64.00             $43.00
LAB-330015   Thyroid Cascade Profile                                              $60.00             $60.00
LAB-3368     CS-Protein Electrophoresis 24hr urine                               $114.00             $95.00
LAB-3418     Uric Acid, 24 hour urine                                             $40.00             $34.00
LAB-354928   Protein Electrophoresis Random urine                                $114.00             $95.00
LAB-38158    CS-Lead and FEP/ZPP                                                 $106.00             $85.00
LAB-4044     CS-Metanephrines, Pheochromocytoma Evaluation                       $271.00            $227.00
LAB-4051     Cortisol                                                             $72.00             $59.00
LAB-4101     DHEA serum                                                          $115.00             $64.00
LAB-4226     Testosterone                                                         $67.00             $54.00
LAB-4259     TSH                                                                  $22.00             $18.00
LAB-4283     LH (Luteinizing Hormone)                                             $74.00             $59.00
LAB-42846    CS-Thyroglobulin, Quant.                                            $216.00            $179.00
LAB-4309     Follical-Stimulating Hormone (FSH), Serum                            $93.00             $65.00
LAB-4317     Progesterone                                                        $116.00             $93.00
LAB-4333     Insulin                                                              $55.00             $45.00
LAB-4416     hCG, Serum (Quantative)                                              $43.00             $35.00
LAB-4432     Cortisol, Urinary Free, ICMA                                        $135.00            $108.00
LAB-4465     Prolactin, serum                                                     $47.00             $24.00
LAB-4515     Estradiol Level                                                     $116.00             $93.00
LAB-4549     Estrogens (serum)                                                    $99.00             $83.00
LAB-455      CS-Thyroid Function (T4, T3U, T7)                                    $23.00             $18.00
LAB-4556     hCG, Serum (Qualitative)                                             $43.00             $35.00
LAB-4580     Lipid Screen                                                         $22.00             $18.00
                            New Student Health Services Fee Schedule Effective August 1, 2010
Trans Code                             Transaction Description               Eligible          Eligible
                                                                          Health fee No     Health Fee Yes
LAB-4598     Ferritin                                                              $78.00             $24.00
LAB-46532    CS-Testosterone/Prolactin                                             $92.00             $65.00
LAB-4697     DHEA Sulfate                                                         $213.00             $76.00
LAB-4713     17-Hydroxyprogesterone                                               $213.00            $177.00
LAB-4937     Transferrin Level                                                     $62.00             $52.00
LAB-500148   von Willebrands Multimer                                             $326.00            $271.00
LAB-5009     CBC/Diff/Routine Send Out                                             $40.00             $34.00
LAB-505008   Helper T-Lymph-CD-4                                                  $163.00            $136.00
LAB-507301   Human Papillomavirus (HPV) High-risk Only                             $78.00             $65.00
LAB-511154   CS-Factor 5 Leiden Mutation                                          $326.00            $271.00
LAB-511162   CS-Factor II (Prothrombin) DNA Analysis                              $326.00            $271.00
LAB-511238   CS-Methylenetetrahydrofolate Reductase (MTHFR)                       $311.00            $259.00
LAB-511345   CS-Hereditary Hemochromatosis DNA Analysis                           $368.00            $307.00
LAB-5199     PT (Prothrombin Time)                                                 $22.00             $18.00
LAB-5207     PTT (Partial Thromboplastin Time)                                     $28.00             $24.00
LAB-5215     Sedimentation Rate                                                    $32.00             $26.00
LAB-5223     Sickle Cell Screen                                                    $64.00             $54.00
LAB-5280     Reticulocyte Count                                                    $25.00             $18.00
LAB-5462     HIV-1 Antibody Western Blot                                          $353.00            $295.00
LAB-550035   Hep C Virus, RNA PCR Quant, reflx frm 550146                         $559.00            $466.00
LAB-550146   Hep C Virus,RNA PCR Qual w/reflex to Quant                           $481.00            $401.00
LAB-550400   Hepatitis C Virus, RNA PCR, Qualitative                              $481.00            $401.00
LAB-550420   HIV-1 Ultrasensitve RNA Quant.                                       $552.00            $460.00
LAB-550475   Hepatitis C Virus Genotyping Nonreflex                               $777.00            $648.00
LAB-551432   Hepatitis B DNA, Qualitative                                         $381.00            $318.00
LAB-58545    CS-Hepatitis Profile VI (Hepatitis B Profile)                        $318.00            $265.00
LAB-6015     Antibody Screen                                                       $43.00             $36.00
LAB-6031     Antistreptolysin O (ASO) Titer                                        $45.00             $38.00
LAB-6049     CS-ABO/Rh                                                             $57.00             $47.00
LAB-6072     RPR, serum                                                            $14.00             $11.00
LAB-6197     Rubella antibodies, IgG                                               $23.00             $18.00
LAB-620      CS-Thyroid, Hypo (TSH,T3U,T4,T7)                                      $28.00             $24.00
LAB-6338     CS-Anti-ENA (Antiextractable nuclear Ag)                             $298.00            $248.00
LAB-6379     Treponema Pallidum, FTA by ABS                                        $64.00             $54.00
LAB-6395     Hepatitis B Surf. Antibody (HBSAb)                                    $22.00             $18.00
LAB-6452     Complement C3                                                         $57.00             $47.00
LAB-6460     Rapid Plasma Reagin, Quant                                            $36.00             $30.00
LAB-6494     CMV IgG                                                               $78.00             $65.00
LAB-6502     Rheumatoid Factor, RA                                                 $38.00             $33.00
                             New Student Health Services Fee Schedule Effective August 1, 2010
Trans Code                              Transaction Description               Eligible          Eligible
                                                                           Health fee No     Health Fee Yes
LAB-6510     Hepatitis B Surf. Antigen (HBSAg)                                      $22.00             $18.00
LAB-6619     Hepatitis Be Antigen                                                   $93.00             $78.00
LAB-6627     CRP (C Reactive Protein) Quant                                         $43.00             $36.00
LAB-6635     Hepatitis Be Antibody                                                  $93.00             $78.00
LAB-6643     Actin (smooth muscle) Ab                                               $78.00             $65.00
LAB-6650     Mitochondrial (M2) Ab                                                  $80.00             $67.00
LAB-6676     Thyroid Peroxidase Ab                                                  $64.00             $54.00
LAB-6692     Antithyroglobulin Antibodies                                           $76.00             $59.00
LAB-670654   CS-RAST-Latex Related Allergen                                        $144.00            $144.00
LAB-6718     Hepatitis B Core Antibody, Total                                       $57.00             $47.00
LAB-6726     Hepatitis A Antibody, Total                                            $64.00             $54.00
LAB-6734     Hepatitis A Antibody IgM                                               $64.00             $54.00
LAB-68213    RAST Buckwheat                                                         $35.00             $28.00
LAB-68494    RAST Wheat                                                             $35.00             $28.00
LAB-6924     CS-HLA-B27 Disease Association                                        $240.00            $200.00
LAB-7054     Ammonia, Plasma                                                        $83.00             $69.00
LAB-706242   Tacrolimus                                                            $114.00             $92.00
LAB-706465   Clomipramine (Anafranil), Serum                                        $92.00             $74.00
LAB-706556   Cyclosporin, Blood                                                    $114.00             $95.00
LAB-706961   Methylmalonic Aicd                                                    $295.00            $237.00
LAB-706994   Homocysteine,plasma or serum                                          $213.00            $177.00
LAB-71209    Urine Drug Screen for Cannab w/ reflex to QT                           $57.00             $47.00
LAB-716944   Lamotrigine (Lamictal)                                                $191.00            $159.00
LAB-7260     Valproic Acid (Depakote/Depakene)                                      $66.00             $56.00
LAB-7336     Theophylline                                                           $77.00             $64.00
LAB-7401     Phenytoin (Dilantin)                                                  $111.00             $93.00
LAB-7419     Carbamazepine (Tegretol)                                               $80.00             $67.00
LAB-7476     Amitryptyline                                                          $99.00             $83.00
LAB-7625     Lead (blood)                                                           $53.00             $44.00
LAB-7708     Lithium Level                                                          $43.00             $36.00
LAB-7773     CS-Mercury, Urine                                                     $170.00            $141.00
LAB-7823     Phenobarbital Level (Luminal)                                          $74.00             $62.00
LAB-7856     CS-Primidone                                                          $144.00            $120.00
LAB-799007   Urine Drug Screen                                                      $72.00             $59.00
LAB-800340   Trophryma whippeli (PCR) Blood                                        $595.00            $489.00
LAB-800599   Factor VII Activity                                                   $259.00            $207.00
LAB-80465    Protein C Antigen                                                     $219.00            $183.00
LAB-808988   Anti-HU Ab                                                            $199.00            $168.00
LAB-810      CS-Vitamin B12 & Folic Acid                                           $111.00             $93.00
                             New Student Health Services Fee Schedule Effective August 1, 2010
Trans Code                               Transaction Description              Eligible           Eligible
                                                                           Health fee No      Health Fee Yes
LAB-810994   Imuran level                                                          $218.00             $181.00
LAB-8128     Culture, GC                                                            $43.00              $36.00
LAB-8144     CS-Culture, Stool                                                      $50.00              $42.00
LAB-8169     Culture, Strep Screen (Throat)                                         $50.00              $18.00
LAB-81950    Vitamin D, 25-Hydroxy                                                 $284.00             $236.00
LAB-820022   Anti-Chronic Urticaria Autoantibodies                                 $229.00             $229.00
LAB-8250     Herpes (HSV) Culture ( typing)                                         $69.00              $57.00
LAB-8334     Culture, Routine Genital                                               $72.00              $59.00
LAB-8342     Culture, Upper Resp. (throat/nasal)                                    $25.00              $24.00
LAB-83824    HIV-1 Antibody (ELISA - screening)                                     $22.00              $16.00
LAB-8482     Culture, Fungal (skin/nail)                                           $279.00             $224.00
LAB-85324    Mercury, Blood                                                        $170.00             $141.00
LAB-8540     Gram's Stain                                                           $36.00              $30.00
LAB-8565     CS-Culture, Chlamydia Throat                                          $103.00              $86.00
LAB-8573     Mumps viral culture                                                   $191.00             $159.00
LAB-86207    C Difficile Toxin A&B                                                  $69.00              $57.00
LAB-8623     Ova and Parasites                                                      $57.00              $47.00
LAB-86264    Factor VIII Assay                                                     $305.00             $254.00
LAB-86280    von Willebrands Antigen                                               $297.00             $248.00
LAB-8631     Pinworm Prep                                                           $40.00              $34.00
LAB-8649     Culture, Routine Aerobic (Wound)                                       $72.00              $59.00
LAB-8755     CS-Cryptosporidium smear, stool                                        $64.00              $54.00
LAB-8847     Culture, Urine                                                         $43.00              $36.00
LAB-90399    CS-Glucose Tolerance, 5Hr.                                             $66.00              $47.00
LAB-91108    CS-Hepatitis Profile (HBV follow-up)                                  $213.00             $177.00
LAB-95588    Glucose Tolerance, 2 hour (FBS, 1HR, 2 HR)                            $102.00              $85.00
LAB-96206    VaricellaTiter                                                         $36.00              $30.00
LAB-96230    Epstein-Barr Virus(VCA)IgG                                             $78.00              $65.00
LAB-96248    Epstein-Barr Virus, Early Antigen IgG                                  $78.00              $65.00
LAB-96339    Anti-DNA(DS) Antibody                                                  $85.00              $72.00
LAB-96552    Mumps Antibodies, IgG                                                  $43.00              $36.00
LAB-96560    Rubeola antibodies, IgG                                                $23.00              $18.00
LAB-96727    CMV IgM                                                                $78.00              $65.00
LAB-96735    Epstein-Barr Virus(VCA)IgM                                             $78.00              $65.00
LAB-98418    CS-Hepatitis B Core Ab, IgG/IgM Differentiation                       $128.00             $106.00
LAB-9993     CS-Thyroid,Hyper(T3U,T4,T7,T3)                                        $141.00             $118.00
LABicilin1   LA Bicillin 1.2 million units                                          $73.00              $60.00
LABicilin6   LA Bicillin 600,000 units                                              $73.00              $60.00
MIGCHG       Migrated Charge                                                          $0.00               $0.00
                             New Student Health Services Fee Schedule Effective August 1, 2010
Trans Code                               Transaction Description              Eligible           Eligible
                                                                           Health fee No      Health Fee Yes
MISC         Miscellaneous Charge                                                     $0.00               $0.00
NCHLB        No Charge Lab                                                            $0.00               $0.00
Nitrostat    Nitrostat 0.4 mg SL                                                      $7.00               $7.00
Phonophore   Phonophoresis                                                          $18.00              $18.00
PotasiumCL   Potassium Chloride, per 25mEq                                          $16.00              $13.00
PPD_Read     PPD Read                                                                 $0.00               $0.00
PPS-101      Mono layer PAP Smear                                                   $57.00              $47.00
PPS-102      Mono layer PAP Smear (reflex HPV)                                      $57.00              $47.00
PPS-103      CS- Mono layer PAP Smear & HPV                                        $135.00             $111.00
PPS-104      Mono layer PAP Smear (HPV Study)                                         $0.00               $0.00
PPS-106      Breast Smear                                                           $75.00              $69.00
PPS-107      Biopsy (CERVX)                                                         $75.00              $69.00
PPS-108      CS-Biopsy (CERVX) x2                                                  $142.00             $134.00
PPS-109      CS-Biopsy (CERVX) x3                                                  $225.00             $200.00
PPS-110      Biopsy (DERM)                                                          $75.00              $69.00
PPS-111      CS- Biopsy (DERM) x2                                                  $142.00             $134.00
PPS-112      CS- Biopsy (DERM) x3                                                  $225.00             $200.00
PPS-113      Biopsy - Cyst/skin tag/debridment                                      $75.00              $69.00
PPS-114      Reflex HPV                                                             $78.00              $65.00
PPS-115      Special Stains, Group I for microorgainisms                            $67.00              $54.00
PPS-116      Pathology Review                                                       $63.00              $63.00
PPS-117      Special Stains, Group II other substances                              $60.00              $60.00
Pr100/65/2   Propoxy/APAP 100/650 x 20 tabs                                           $4.00             $12.00
Predn10/48   Prednisone 10 mg- 48 tabs-12 day supply                                $21.00              $21.00
Predn10mg    Prednisone 10mg x21tab                                                 $17.00              $17.00
Predn20mg    Prednisone 20mgx 6 tab                                                   $7.00               $7.00
PTDNKA       Physical Therapy                                                       $17.00              $17.00
ShlderImm    Shoulder immobilizer                                                  $124.00             $104.00
ShoePostOp   Shoe, post-op                                                          $30.00              $26.00
SHP-001453   SHP-Hemoglobin A1C                                                     $28.00              $28.00
SHP-004259   SHP-TSH                                                                $27.00              $27.00
SHP-010322   SHP-Prostrate Specific Antigen                                         $43.00              $43.00
SHP-322755   SHP-Liver Profile                                                      $28.00              $28.00
SHP-322758   SHP-Metabolic Profile, Basic                                           $14.00              $14.00
SHP-4580     SHP-Lipid Screen                                                       $15.00              $15.00
SHP-5009     SHP-CBC/Diff/Routine                                                   $13.00              $13.00
SHP-99420    Preventive Worksite Health Screening                                   $47.00              $47.00
SHP322758    Metabolic Profile, Basic                                               $16.00              $16.00
SHP4580      Lipid Screen                                                           $17.00              $17.00
                              New Student Health Services Fee Schedule Effective August 1, 2010
Trans Code                                Transaction Description              Eligible           Eligible
                                                                            Health fee No      Health Fee Yes
SHP5009      CBC/Diff/Routine Send Out                                               $15.00              $15.00
SHS-001      ICTO                                                                      $0.00               $0.00
SHS-002      SSA                                                                       $0.00               $0.00
SHS-36415    Venipuncture                                                              $9.00               $8.00
SHS-36416    Capillary Blood Collection                                                $7.00               $6.00
SHS-81000    Urinalysis, non-automated                                               $23.00              $19.00
SHS-81003    Urinalysis                                                              $23.00              $19.00
SHS-81015    Urine Microscopic Evaluation                                            $12.00                $8.00
SHS-81025    hCG, Urine                                                              $28.00              $23.00
SHS-81050    Volume measurement (24 hr. urine)                                         $9.00               $8.00
SHS-82270    Stool for Blood (Occult Blood)                                          $17.00              $15.00
SHS-822703   CS-Stool for Blood x3                                                   $50.00              $44.00
SHS-82962    Wholeblood Glucose by Ascensia                                          $24.00              $20.00
SHS-85007    Manual Differntial                                                        $9.00               $8.00
SHS-85008    Smear Review                                                            $13.00                $8.00
SHS-85025    CBC(automated differential)                                             $40.00              $34.00
SHS-85025M   CBC (auto differential) Reflex Mono                                     $40.00              $34.00
SHS-85027    CBC(No Diff)                                                            $40.00              $34.00
SHS-86308    Mononucleosis                                                           $22.00              $18.00
SHS-86308a   Reflex Mono                                                             $22.00              $18.00
SHS-87081    Strep Culture (Reflex)                                                  $50.00              $18.00
SHS-87210    Wet Prep/Lab                                                            $17.00              $15.00
SHS-87220    KOH Prep                                                                $20.00              $16.00
SHS-87804    Rapid Flu Screen                                                        $46.00              $38.00
SHS-87880    Rapid Strep, Group A                                                    $36.00              $30.00
SHS-89055    Stool for WBC/C&S if ind.                                               $24.00              $20.00
SHS-99080    Handling Fee                                                              $9.00               $8.00
SlingArm     Sling, Arm/Cradle                                                       $23.00              $19.00
SlingSwath   Sling & Swath                                                          $124.00             $104.00
SoluMed125   SoluMedrol 125 mg                                                       $15.00              $13.00
SplintAC     Splint, A/C                                                             $93.00              $77.00
SplintAir    Splint, air cast                                                        $93.00              $77.00
SplintFin    Splint, fold over finger                                                $15.00              $13.00
SplintMetl   Splint, arm, wrist, metal (all sizes)                                   $29.00              $25.00
SplintStax   Splint, Stax Plaster Finger                                             $17.00              $15.00
SplintToad   Splint, Toad Metal Finger                                               $14.00              $12.00
SplntClavi   Splint, clavicle                                                        $53.00              $44.00
SplntCoUp    Splint, wrist cock up                                                   $32.00              $32.00
SplntFrArm   Splint, forearm                                                         $35.00              $29.00
                           New Student Health Services Fee Schedule Effective August 1, 2010
Trans Code                            Transaction Description               Eligible           Eligible
                                                                         Health fee No      Health Fee Yes
Splntthum    Splint, thumb (spica or thumb-o-prene)                               $35.00              $29.00
SpltMtlWr    Splint, metal wrist                                                 $328.00             $274.00
Sprintec     Sprintec .250/.035- 28tab                                              $7.00               $7.00
StabLatPat   Stabilizer, lateral patella                                         $106.00              $88.00
StalkHarra   Stalking / Harrassment                                                 $0.00               $0.00
SutureTray   Suture Tray and other supplies                                       $22.00              $18.00
Tamiflu      Tamiflu                                                              $98.00              $98.00
Taxi         Non-emergent transportation Taxi                                     $25.00              $17.00
TenElbStrp   Tennis elbow strap                                                   $60.00              $50.00
TetanusIG    Tetanus Immune Globin 250 units                                     $279.00             $234.00
Theraband    Theraband                                                              $5.00               $5.00
Theraloop    Theraband door loop                                                    $5.00               $5.00
Theraptty    Theraputty                                                             $8.00               $8.00
UltraMeds    Ultrasound/ E Stimulation with meds                                  $24.00              $20.00
UltraNoMed   Ultrasound/ E Stimulation without meds                               $22.00              $18.00
WHAdminPE    Administrative Physical Women's Health                               $30.00              $25.00
WHDNKAAnnu   Womens Health Did Not Keep Appointment Annual Exam                   $17.00              $17.00
WHDNKAColp   Womens's Health Did Not Keep Appointment Colposcopy                  $28.00              $28.00

								
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