| Clinical Services | ||
| 100 | Uninsured office visit (age 2-49) | $125 |
| 120 | Uninsured complete physical exam (age 2-49) | $160 |
| – | Missed 10-minute appointment | $50 |
| – | Missed long appointment | $80 |
| 00190+00044 | Cryotherapy for non-insured lesions | $60 |
| 13620 +00090 | Excision Mole (cosmetic)-non facial | $150 |
| – | Injections (such as flu shots) for non eligible patients | $40 |
| A00049 | Advice by telephone on the establishing of a tentative diagnosis and prescribing treatment per 15 minutes or portion thereof | $80 |
| A00001 | General Insurance Examination, industrial (to include M.O.T. $195.00 examinations for pilots and air traffic controllers), pre-placement and periodic examinations, CPP examinations | $200 |
| 96220 | OSMV Driver’s Medical Examination and Report (DMER) – stand-alone | $200 |
| A00068 | Physical fitness examination for school, summer camp, etc., including certificate A00058 | $70 |
| Non-clinical Services | ||
| A00060 | One-page forms including: School/Work time off, Government UIC form, Parking form, Handi dart application | $40 |
| A00070 | For filling out an ordinary printed form reporting on a patient’s condition or submitting like information in letter form, such as Employer’s Work Capability form | $165 |
| A00070 | Insurance Company typed letter -short (½ page), Typed off work letter | $165 |
| A00071 | A 5 or form is defined as a short factual written communication given to any lay person (e.g. lawyer, insurance representative) in relation to a patient for some purpose primarily unconnected with treatment | $345 |
| A00072 | A Medico-Legal Report is one, which will recite symptoms, history and records and gives diagnosis, treatment, results and present condition. This is a factual summary of all the information available on the case. It could also contain prognostic information about when the patient will be able to return to work and might mention whether there will be a permanent disability | $1030 |
| A00073 | A Medico-Legal Opinion will usually include the information contained in the medical – legal report and will differ from it primarily in the field of expert opinion. This may be opinion as to the course of events when these cannot be known for sure. It can include opinion as to long term consequences and possible complications in the further development of the condition. All the known facts will probably be mentioned, but in addition there will be extensive exercise of expert knowledge and judgement with respect to those facts with a detailed prognosis. | $1725 |
| A00095 | Review of EMR records (15 min) | $100 |
| A00047 | Renewal of prescription by fax or telephone (per call) | $30 |
| A00093 | Transferring charts out of clinicThis fee is recommended for a simple transfer of records. Photocopying may be charged in addition. ii). Other direct costs, such as courier services, may be charged in addition based on the actual cost. iii). A fee for review of records may be charged in addition if the physician reviews the records for the purpose of selecting current and necessary medical information to be transferred. iv). Original records must be retained by the transferring physician as required by Law v). When multiple records are being transferred, the total time spent should be taken into account. | $50 |
| A00096 | Photocopying per page (paper copies) (first 10 pages) – subsequent pages – 30¢ per page NOTES: i) A00096 is extra to A00093 and/or A00095 ii) The fee for this service does not include review and/or summary of the patient’s chart | $1.65 |
| A94523 | Completion of Drug Benefit Form for third party insurer (including non-indicated Special Authority forms) | $75 |
| A00069 | Insurance company form to include review of records-short report (1 page) | $145 |
| A00059 | Insurance company form to include review of records-long report (more than 1 page) | $190 |
*Our fees are subject to change.