Mercy Medical Clinics Inc.

Private Fees for Uninsured Services

Please bring cash or Interac-e-transfer for payment.

A. Forms:

1. Insurance Company (Disability/Travel/Time Off): $50.00 (Add $25.00 for additional pages)

2. Income Tax Disability: $60.00 (Add $25.00 for additional pages)

3. Special Authority Form (Asked by 3rd Party Insurer): $75.00

4. Time Off/Sick Note (School/Work, etc.): $30.00

5. Forms - Parking/Handy-Dart: $30.00

6. Employers Occupational Fitness Assessment Form: $150.00

7. Handwritten Note/Letter: $30.00

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B. Examinations:

1. Driver's License Exam: $150.00

2. Driver's Medical Examination Report (DMER): $125.00

3. Participatory Fitness for Sports/Camp: $75.00

4. Private Office Visit: $95.00

5. Medical Exam (Required by Employer/School/Sports): $150.00

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C. Treatment/Surgery:

1. Liquid Nitrogen (If not covered by MSP): $65.00

2. Influenza Vaccine for Individuals (If not covered by MSP): $25.00

3. Wart Treatment for Hand (17 yrs. and up): $30.00

4. Minor Laceration: $50.00

5. Tray Fee for Minor Laceration: $25.00

6. Tray Fee for Major Laceration: $50.00

7. Major Laceration: $80.00

8. Travel Vaccine: $50.00

9. Immunization Under 19 Years of Age (Per Injection): $20.00 (Office visit extra)

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D. Others:

1. Transfer of Records - Basic Fee: $50.00

2. Transfer of Records - Photocopy per Page: $2.00 (If more than 10 pages. Over 10 pages: $0.40 per page)

3. Physician Review of Records (From Other Clinics - Medical/Legal): $117.00

4. Missed Appointment Charge for Family Physician: $55.00

5. Missed Appointment Charge for Specialist Physician: $150.00 - $250.00

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E. Specialist Private Fees:

1. Pediatrician: $250.00 - $450.00

2. Orthopedic: $150.00 - $200.00

3. Pain Clinic: $275.00 - $300.00

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Feel free to contact us if you have any questions about these fees!