University of California, Santa Cruz
Student Health Services
STUDENT HEALTH CENTER SUMMARY OF COMMON
OUT OF POCKET CHARGES
(ALL PRICES ARE SUBJECT TO CHANGE WITHOUT NOTICE)
SERVICES
UC SHIP
<PREVENTIVE>
Annual GYN Visit NO PAP
CRUZCARE
NOSHIP
COPE RN Only
Hormonal Refill (3 month recheck or ER
$0.00
$243--$308
$28
$35
$24
$8.95
$24
$16
$3.10
$22
$412.60--$468.60
$0.00
cycle) RN Only
$0.00
$0.00
$10
Contraception Initiation or
Contraception Continuation with
$0.00
$0.00
New $179.00
Est $102.00
Visit No Charge
(lab tests covered at 85%)
No Charge
$0--$300
Visit No Charge
(+ fees for lab tests)
No charge
$77--$318
Visit $82--$300
(+ fees for lab tests)
$77--$318
$77--$318
$0*
$234--$277
$234--$277
$20*
$20
$20
$35
$35
$35
Visit No Charge
Considered Illness & Inj
Other charges same as
any other UC SHIP
$73 *
$48 *
$20 **
No Charge
$0
Visit No Charge
$22 fee for Injection
visits, administering
& teaching
$73
$48
$20
No Charge
$0
$77--$318
PAP Surepath
HPV reflex typing
Chlamydia Surepath
HIV blood
Chlamydia urine
GC urine
RPR blood
Reference Lab Handling Fee
Total Charge for Annual GYN
$0.00
$243--$308
$28
$35
$24
$8.95
$24
$16
$3.10
$22
$412.60--$468.60
$20
Clinician
STI consult with Clinician (see also SelfDirected STI Screening for Asymptomatic)
Office visit – Illness/Injury
Office visit –Elective or preventive
care, or non-eligible service
All Physical Exams
Fees charged for Lab and X-Ray**
Add-on Paperwork Fee
SCUBA and brief clearances
Add-on Paperwork Fee
DMV, Fulbright, Antarctica and Peace Corps
Transgender
Travel 30 minutes
Travel 15 minutes
EAP On-line assessment
X-Ray Ankle
X-Ray Chest (PA) SCUBA
(a fee is charged for CXR done for
SCUBA & other clearances)
$5-$40 copay per mo.
Check with
Travel Medications (ciprofloxacin,
Pharmacy
anti-malarial etc.)
IUD/Nexplanon/Colposcopy—See Women’s Health Procedures Code and Cost List
$25
$25
Missed Appointment Fee
$0
$0
Suture Removal (placed off campus)
$73
$48
$20
$123
$100
Check with
Pharmacy
$25
$25
* Routine physicals/student adult preventive care – at SHS 100% coverage including tuberculosis screening
**Student is responsible for fees
For more details on UCSHIP coverage, see the UC Student Health Insurance Plan brochure or
http://www.ucop.edu/risk-services/risk-financing-claims/uc-student-health-insurance-plan-uc-ship.html
Payment Methods: Cash, check, Visa/MasterCard, ApplePay (at the Pharmacy) or may be added to your student (AIS) bill to be
paid at the UCSC Cashier’s Office
HC 818 (2/15/17)
Common Fees
University of California, Santa Cruz
SERVICES
LABORATORY TESTS
In-House
Sent out to Reference Lab
X-Rays
In-House
Student Health Services
UC SHIP
CRUZCARE
$0
$0
$22 + cost of test
Covered at 85%
$22 + cost of test
$22 + cost of test
For Illness or Injury
Not covered
$0
$91-$260
$0
PHARMACY CHARGES— ALL PRICES ARE SUBJECT TO CHANGE WITHOUT NOTICE
Not covered
Not covered
Over-The-Counter (OTC)*
$7.00 + tax
$7.00 + tax
Arnica Gel
$20 + tax
$20 + tax
Bell Bicycle Helmet
$0.25
$0.25
Honey Sticks
$3.99 + tax
$3.99 + tax
Ibuprofen #100
$4.25 + tax
$4.25 + tax
Loratadine #30
$6.99
$6.99
Medicinal Teas #16/box
$19.95 + tax
$19.95 + tax
Neti-Pot (NeilMed)
2 for $0.25
2 for $0.25
Condoms (Condom Co-op)
Contraceptives
$20
($0 w Prescription) $20
Emergency Contraception
$15 and up
$0
Prescription
Prescription-Brand name when
$40/mo.
generic available
$0-$5-$25-$40 per mo.
Rx
$40.25
Penicillin 500mg #30 (generic) $5 copay per mo.
$68
$25 copay per mo.
Pro-Air Inhaler (brand)
ORTHOPEDIC SUPPLIES
Ankle Brace - Walking
Knee Brace - Neoprene
IMMUNIZATIONS
See Vaccine Price List
TUBERCULOSIS TESTS
PPD
Quantiferon
ALLERGY INJECTIONS
NOSHIP
Not covered
Not covered
$7.00 + tax
$20 + tax
$0.25
$3.99 + tax
$4.25 + tax
$6.99
$19.95 + tax
2 for $0.25
$20
$15 and up
$40.25
$68
Covered at 85%
$5.10
$1.65
Not covered
$34
$11
Not covered
$34
$11
Preventive covered 100%
Not covered
Not covered
Covered at 85-100%
$0 if asymptomatic
$4.35 if exposure
$0 if asymptomatic
$10.80 if exposure
Not covered
Not covered
$29
$29
$22 + $50 = $72
$22 + $50 = $72
Covered at 85%
15% of $24-$32
= $3.60-$4.80
Not covered
Not covered
$24-$32
$24-$32
*Note: Prices for Over-the-Counter (OTC) items from Pharmacy are on our website including integrative medicine options and are
subject to change without notice.
Visit us at www.healthcenter.ucsc.edu for more information
HC 818 (2/15/17)
Common Fees