Uninsured Services Fee Schedule

(These are services not paid for by Manitoba Health and billed directly to you)


PHYSICAL EXAMINATIONS NOT COVERED BY MHSC

WORK PHYSICAL EXAMINATION & FORM $100.00

PRVATE COMPLETE PHYSICAL EXAM & FORM (ADOPTION/SPORT/ETC.) $100.00

PRIVATE PRE-OP EXAM (PRIVATE SURGERY) & FORM $100.00

DRIVERS PHYSICAL EXAMINATION & FORM $100.00


PATIENTS WITHOUT VALID MHSC COVERAGE

INITIAL VISIT $100.00

FOLLOW-UP VISIT $50.00


FORMS

SICK NOTE $25.00

DISABILITY INSURANCE CLAIMS FORM $80.00

MODIFIED WORK DUTIES/COMPANY FORM $80.00

PARKING PERMIT $30.00

HANDI-TRANSIT FORM $30.00

DISABILITY TAX CREDIT $100.00
DISABILITY TAX CREDIT FOLLOW-UP FORM $30.00

MPI ALCOHOL/ DRUG FORM $30.00

RCMP/WPG POLICE MEDICAL HEALTH FORM $80.00

CAMP/SCHOOL FORM $60.00

TRAVEL CANCELLATION FORM $40.00


MANTOUX 

TB One-Step (Injection Only, Form Extra) $60.00

TB One-Step (Injection Only, Form Extra) $120.00

School Immunization Form Completion $60.00


IMMUNIZATIONS NOT COVERED BY MHSC

HEPATITIS A (ADMINISTRATION ONLY) $30.00

HEPATITIS B (ADMINISTRATION ONLY) $30.00 

TWINRIX (HEPATITIS A & B) $30.00

HPV VACCINE & ADMINISTRATION (GARDASIL) $190.00

ZOSTAVAX VACCINE & ADMINISTRATION $220.00

SHINGRIX VACCINE & ADMINISTRATION $320.00

PREVNAR 13 VACCINE & ADMINISTRATION $150.00

ALL OTHER INJECTIONS NOT COVERED BY MHSC $30.00


MISCELLANEOUS

PRIVATE EKG $30.00

TRANSFER OF CHARTS $50.00

(204) 231-1724

Fax: (204) 231-1829

191 Marion Street

Winnipeg, MB R2H 0T5