| Service Description | Type of | CHARGE |
| Service | ||
| TB Test at Student Health Center | Inj | $5.00 |
| TB test at clinic site (Nurses, teachers) | Inj | $5.00 |
| TB test reading | Inj | $0.00 |
| Vistaril Injection- | Inj | $10.00 |
| Toradol Injection- | Inj | $12.00 |
| Benadryl injection | Inj | $6.00 |
| Epinephrine injection | Inj | $6.00 |
| Hepatitis B Injection - | Inj | $28.00 |
| Flu shot for faculty | Inj | $20.00 |
| Flu shot for students | Inj | $0.00 |
| Depo Provera injection- | Inj | $52.00 |
| Meningitis injection- (Menactra) | Inj | $90.00 |
| Hepatitis A Injection - | Inj | $26.00 |
| Tetanus injection with Pertussis (Adacel) | Inj | $45.00 |
| Twinrix (combined Hepatitis A and B) | Inj | $49.00 |
| IV infusion for hydration | Inj | $20.00 |
| Complete Blood Count (CBC)-Auto | Lab | $15.00 |
| Complete Blood Count-Manual procedure done by lab | Lab | $19.00 |
| Cholesterol - fingerstick | Lab | $4.00 |
| Lipid profile | Lab | $20.00 |
| Liver profile (SGOT, SGPT) | Lab | $25.00 |
| Urinalysis | Lab | $10.00 |
| Pregnancy test (urine) | Lab | $7.50 |
| Mononucleosis (Mono) test | Lab | $14.00 |
| Strep screen | Lab | $11.00 |
| Glucose - fingerstick | Lab | $3.00 |
| Occult blood in stool | Lab | $11.00 |
| ESR | Lab | $12.00 |
| HIV Testing | Lab/visit | $15.00 |
| Wet Prep/Gram Stain | Lab | $6.00 |
| Chlamydia | Lab | $11.00 |
| VDRL | Lab | $10.00 |
| Chlam/GC without pap | Lab | $11.00 |
| Herpes culture | Lab | $10.00 |
| Ace Wrap - 3" | Merchandise | $2.50 |
| Ace Wrap - 4" | Merchandise | $3.00 |
| Crutches--Charged only if crutches not returned | Merchandise | $50.00 |
| Finger splint | Merchandise | $6.00 |
| Heating Pad --Charged only if not returned | Merchandise | $20.00 |
| Wrist Splint | Merchandise | $26.00 |
| Arm sling | Merchandise | $8.50 |
| Condoms--(Bag of 20 assorted) | Merchandise | $2.00 |
| Gyn Exam/Pap Smear | Pelvic | $24.00 |
| Cryo - male penile | Pelvic | $11.00 |
| Cryo-female perineal | Pelvic | $11.00 |
| Genital exam not charged elsewhere, ie, HPV check, lesion, painful sex, tampon removal | Pelvic | $12.50 |
| Wart remove (liq nitrogen) | Surg | $2.00 |
| Anoscope | Surg | $15.50 |
| Remove foreign body (from ear, hand, etc) | Surg | $13.00 |
| Dye and deaden for corneal abrasion | surg | $11.00 |
| Incision and drainage of abscess | Surg | $15.50 |
| Remove skin tags | Surg | $15.50 |
| Excision benign lesion, except skin tag | Surg | $32.00 |
| Suture removal (sutures done elsewhere) | Surg | $5.50 |
| Suture removal (Sutures done at ESU) | Surg | $0.00 |
| Stitches put in (<2.5 cm) | Surg | $31.00 |
| Stitches put in 2.6 to5cm | Surg | $41.00 |
| steri strip a wound closed | surg | $10.50 |
| Debridement of wound-small | Surg | $5.50 |
| Debridement of wound-medium | Surg | $10.50 |
| Debridement of wound-large | Surg | $15.50 |
| Office Visit | Visit | $0.00 |
| Urgent visit (>30") | Visit | $25.00 |
| Missed 30" appointment or > 2 missed 15" appointments | Visit | $11.00 |
| Albuterol inhalation treatment | Visit | $11.50 |
| Nurse irrigates ear | Visit | $10.50 |
| Dressing change-Small | Visit | $3.00 |
| Dressing Change-Medium | Visit | $4.00 |
| Dressing Change-Large | Visit | $7.00 |
| Physical (Brief) | Visit | $11.00 |
| Physical (Moderate) | Visit | $14.00 |
| Physical (Extended) | Visit | $26.00 |
| Pulse oximetry (measures oxygen in blood quickly) | Visit | $1.50 |
Last Updated October 4, 2007