Uninsured fees for patients

Code Description Fee
I100A Prescription Repeat 14.00
I101A Sick Note 17.00
I102A Form Fee Standard: 25.00
Long: 50.00
I104A Missed Appointment 35.76
I105A Parking Permit Form 20.00
I106A HEP. B Vaccine (Adult) 30.00
I107A HEP. A Vaccine (Adult) 60.00
I108A Allergy Serum (DIN # 00648922) 130.00
I109A Drivers Medical Exam & Form 168.76
I110A Excision 40.00
I111A C.P.P. Medical Report 85.00
I112A Disability Certificate (OCF-3) 125.70
I113A Treatment Plan (OCF-18) 125.70
I114A VARIVAX Vaccine 80.00
I115A MENJUGATE Vaccine 120.00
I116A TYPHERIX Vaccine (+$15.00 injection fee) 35.00
I117A Functional Abilities Form 40.00
I118A HEP. A Vaccine 0.5ML (Child) 30.00
I119A HEP. B Vaccine 0.5ML (Child) 20.00
I121A E.I. Medical Certificate 25.00
I122A Section 8 Drug Renewal Form 30.00
I123A PREVNAR Vaccine 105.00
I124A TYPHIM Vi Vaccine (+$15.00 injection fee) 35.00
I125A Cash Visit 40.00
I126A Medical Report 100.00
I127A ADACEL VACCINE 45.00
I128A HPV SHOT (Gardasil) 150.00
I129A Copies - Clinical Notes & Records p. 1-20: 30.00
Each add'l page: 0.25
I130A Letter  
I131A Attending Physicians Statement 125.65
I132A Revenue Canada Federal Disability Tax Credit 42.00
I133A MENACTRA Vaccine 150.00
I200A Family Premium Plan 110.00
I300A Individual Premium Plan 70.00
I301A Pre-Employment Med. Cert. 33.00
I302A Diabetic Questionnaire for Insurance Company 83.75
I303A Hypertension Questionnaire for Insurance Co. 83.75
I304A T.T.C. Form 10.00
I305A Injection Fee 5.00
I306A Depression & Nerves Disorder Questionnaire For Ins. Co. 83.75
I307A Twinrix Vaccine (Hep A & B combined) 60.00
I308A Zostavax Vaccine (Prevention of Shingles) 195.00
I309A Treatment Confirmation (OCF-23) 117.90
I310A Twinrix Junior (Child) 30.00
I311A Out-of-Pocket Disbursements 10.00
I312A Professional Review 25.00
I313A Visit for Travel-Related Health Concerns 35.00
I314A Wart Removal 30.00