Updated January 2, 2018

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1 Service Charges Updated January 2, 2018 Important Notes:! Service charges and availability are subject to change.! No show and late charges may also apply.! What you pay out-of-pocket is dependent on your health insurance plan benefits. Services with no additional charges:! Up to five (5) individual/couples/nutrition counseling sessions per semester! Group counseling services! Counseling crisis intervention services! Tobacco cessation programs! Health education and prevention programs! Note: No show and late charges may still apply. Please refer to the following tables to see general charges for services within each area. Departments are listed in alphabetical order. Allergy & Asthma Services Allergist Consultation $ $ Injections $12.00 $14.00 Pulmonary Function Test $47.00 Pulmonary Function Exercise $79.00 No Show $5.00 This listing provides a summary of procedures and services provided by CSU Health Network Allergy and Asthma services. Information on charges for additional services is available at (970) Counseling Services Missed Appointment or Late Cancellation Charges Counseling- Missed Appointment $15.00 Counseling Late Cancellation Charge $10.00 Counseling Appointment Charges Counseling Individual/Couples (1-5 sessions per semester) Counseling Individual/Couples (over 5 sessions per semester) $10.00 Group Services Crisis Intervention Services Drugs, Alcohol and You (DAY) Programs DAY Life Safe Program $90.00 DAY BASICS Program $90.00 DAY Taking Steps $ DAY Back on TRAC (for the first month) $ DAY Back on TRAC (each additional month) $ DAY Substance Use Assessment $ Page 1

2 Dental Services Adult Prophylaxis (Class 1) $67.00 Bitewing Radiographs (depending on quantity 2-4) $ $48.00 Composite Resin (tooth-colored filling; based on complexity) $ $ Crown, Gold $ Crown, Porcelain $ Diagnostic Casts $82.00 Examination (problem-focused or comprehensive) $65.00 Extraction (varies due to complexity) $ $ Periodic Oral Exam (patient comes in every six months) $37.00 Dental Records/X-Ray Copies $16.00 This listing provides a summary of selected procedures and services provided by CSU Health Network Dental Services. Information on charges for additional services and dental treatment supplies is available upon request at (970) Immunizations Please note that vaccine prices are variable and prices may need to be adjusted as vaccine costs vary. What you pay out-of-pocket is dependent on your health insurance plan benefits. Injection Fees: An injection fee of $33 for the first vaccine and $17 for each additional vaccine may apply. Injection fee prices will vary depending on insurance coverage Vaccine Name Price Per Dose 2018 Hepatitis B (need 3 doses) $85.00 per dose Hepatitis A (need 2 doses) $95.00 per dose Hepatitis A & B (Twinrix) (need 3 doses) $ per dose HPV 9 (Gardisil TM ) (need 3 doses) $ per dose Influenza (Flu shot) $35.00 (*Injection fee waived) Japanese Encephalitis (special order, must preorder for 2 doses) $ per dose Meningococcal (Menveo TM, Menactra TM ) $ Meningococcal B (Bexsero TM need 2 doses) $ per dose Pneumococcal (Pneumovax 23) $ MMR (need 2 doses) $80 per dose Polio $48.00 per dose Rabies (need 3 doses) $ per dose PPD $11.00 Tdap $50.00 Td $45.00 Typhoid Injectable $ Approximate $88.20 Typhoid Oral (need Rx filled at pharmacy) (price may vary depending on insurance coverage) Varicella $ Yellow Fever $ Yellow Fever Occupational Health $ This listing provides a summary of the most common immunizations provided by CSU Health Network. Information on charges for additional immunizations is available upon request at (970) Page 2

3 Laboratory Services CBC $15.00 Chem Panel, Basic $15.00 Comprehensive Metabolic Panel $19.00 Draw Charge $4.00 HCG Urine $11.00 Lipid Profile $23.00 Liver Panel/Hepatic Function $14.00 Mono Screen $12.00 Nasal Smear (EOS) $7.00 Ova & Parasites $16.00 Throat Culture $9.00 Triglycerides $10.00 TSH $29.00 Urinalysis, Routine $6.00 Urine Culture $14.00 Wet Prep $8.00 This listing provides a summary of the most common tests and charges by CSU Health Network Laboratory Services. Information on charges for additional laboratory tests is available upon request at (970) Massage Therapy Services Massage Therapy (1 hour) $39.00 Massage Therapy (30 minutes $23.00 Medical Services (includes Primary Care, Women & Gender Care & Psychiatry) Annual GYN Exam $ $ Aspiration of abscess/hematoma/bull/cyst $ Audio $41.00 Biopsy of Skin $ Colposcopy $ Colposcopy w/ Biopsy $ Cryocautery of Cervix $ Destruction Lesion $ Diaphragm Fitting $79.00 Ear Irrigation $ $34.00 EKG w/ rhythm strip $22.00 Eye Irrigation $72.00 Excision of Benign Lesion (0.5 cm 2.0 cm) $ $ Excision of Nail Partial/Complete $ Incision and Drainage Abscess, Cyst $ $ IUD Insertion* * $93.00 IUD Removal $ IUD Removal $ (continued next page) Page 3

4 Medical Services - (cont.) IUD Removal $ IV Therapy $75.00 Nebulizer (w/ medication) $24.00 Nexplanon Insertion* * $ Nexplanon Removal $ Office Visit $ $ Subungal Hematoma $64.00 Tympanometry $19.00 Wart Treatment $ Wound Repair, Simple (2.5cm or less) $ $ Wound Repair, Simple (2.6 cm 7.5 cm) $ $ No Show (Medical Services) $ $15.00 No Show (Psychiatry) $20.00 * Separate charges are applicable for the cost of the device CSU Health Network provides a variety of medical services. The listing provides a summary of common procedure and services. Information on charges for additional services is available upon request at (970) Medical Records Medical Records (sent to self, insurance company or legal representative) Immunization Records Summary of Behavioral Health or Psychiatric Services (Behavioral Health and Psychiatric records are released at the discretion of the provider) First 10 pages: $14.00 Pages 11-40: $0.50/page Each additional page: $0.33/page $25.00 Nutrition Consultation for Disordered Eating Nutrition Consultations for Eating Disorders Students may receive up of five (5) individual sessions of nutrition consultation and psychological counseling through Counseling Services at no additional charge each semester. Additional nutrition or counseling appointment are $10/session. Missed Appointments $15.00 Late Cancellations $10.00 CSU Health Network provides nutrition consultation for disordered eating (bulimia, anorexia nervosa, binging and purging, use of laxatives or diet pills). Additional nutrition services are available on campus. Visit for more information. Page 4

5 Optometry Services Comprehensive Eye Exam $90.00 Comprehensive Eye Exam w/ Contacts $ Office Visit $ $ No Show (Optometry) $20.00 This listing provides a summary of the most common services provided by CSU Health Network Optometry Services. Information on charges for additional optometry services is available upon request at (970) Pharmacy Services CSU Health Network operates a full-service pharmacy that is open to the public and can fill most prescriptions. Please contact the CSU Pharmacy at (970) with questions regarding current products and pricing. Physical Therapy Services Cast Application, Short Leg* *$ Cast Application, Elbow Finger* *$ Orthopedic Consultation $ $ PT New/Initial Visit $ PTV, Manual Therapy $39.00 PTV, Mechanical Traction $21.00 PTV, Neuromuscular Reeducation $44.00 PTV, Therapeutic Activities $45.00 PTV, Therapeutic Exercise $42.00 Taping, Ankle* *$34.00 Taping, Hand/Finger* *$38.00 Taping, Patellar* *$37.00 Taping, Shoulder* *$37.00 Ultrasound $17.00 Electrical Stimulation (MANS) $25.00 No Show (Ortho) $21.00 No Show (Physical Therapy Initial Visit) $25.00 No Show (Physical Therapy) $15.00 * Cost of supplies are additional. This listing provides a summary of the most common services provided by CSU Health Network Physical Therapy Services. Information on charges for additional physical therapy services and supplies is available upon request at (970) Page 5

6 Radiology Services * Ankle $77.00 Chest, PA, & Lateral $ $72.00 Elbow $80.00 Finger $81.00 Foot $75.00 Hand $80.00 Leg, Lower $74.00 Shoulder $75.00 Toe $72.00 Wrist $91.00 * These charges include both the cost of taking the X-ray and the cost of Radiological Interpretation by a board-certified Radiologist. CSU Health Network, in partnership with UCHealth, provides comprehensive radiological services for students. This listing provides a summary of the most common x-ray procedures. Information on charges for additional services is available upon request at (970) Tobacco Cessation No Show Charge $15.00 CSU Health Network provides Tobacco Cessation services to fee-paying enrolled students. More information is available upon request at (970) Page 6

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