FEE STRUCTURE Tracking Cycle Procedure Type Cost Cycle Tracking (There may be additional costs for drugs during this cycle) Ultrasound Pregnancy Monitoring Approx. Out Of Pocket Expense Payment Due $265.00 $265.00 Day 2 Bloods $195.00 $115.00 Payable to U/S Clinic $140.00 $140.00 + Ultrasound 1st Attendance + Ultrasound Ovulation Induction Procedure Type Approx. Out Of Pocket Expense Payment Due $350.00 + Prescription Day 2 Bloods $195.00 $115.00 Payable to U/S Clinic $140.00 $140.00 + Ultrasound 1st Attendance Cost $350.00 OI Cycle + Prescription (There may be additional costs for drugs during this cycle) Ultrasound Pregnancy Monitoring + Ultrasound AIH / IUI Procedure Type Cost $1750.00 Artificial Insemination** Approx. Out Of Pocket Expense $1210.00 + Prescription Payment Due Day of Treatment IVF Cycle Please see ‘Non-Fertility North Fees’ for information on anaesthetist & JHC admission fees Procedure Type Cost IVF** (including Embryoscope or Blastocyst culture) $7570.00 $420 TVOA (Egg Collection) Approx. Out Of Pocket Expense Payment Due $4400.00 Day of Embryo Transfer Nil if Private Health Cover $420.00 If uninsured Day of Embryo Transfer Mechanical Endometrial Injury (MEI) - Scratching $200.00 $200.00 Day of Procedure IVF Counselling & Administration Deposit $350.00 $350.00 Day of Consent Appointment (Will go towards IVF Cycle Fee if you proceed) ICSI Cycle Please see ‘Non-Fertility North Fees’ for information on anaesthetist & JHC admission fees Procedure Type Cost ICSI**(including Embryoscope or Blastocyst culture) $8120.00 $420 TVOA (Egg Collection) Approx. Out Of Pocket Expense Payment Due $4560.00 Day of Embryo Transfer Nil if Private Health Cover $420.00 If uninsured Day of Embryo Transfer Mechanical Endometrial Injury (MEI) - Scratching $200.00 $200.00 Day of Procedure IVF Counselling & Administration Deposit $350.00 $350.00 Day of Consent Appointment (Will go towards IVF Cycle Fee if you proceed) Oocyte Retrieval Cycle Please see ‘Non-Fertility North Fees’ for information on anaesthetist & JHC admission feess Procedure Type Cost Oocyte Retrieval Cycle $6825.00 TVOA (Egg Collection) $420 Thaw of Oocytes, ICSI Insemination & Transfer $1595.00 Approx. Out Of Pocket Expense $6825 (Not Medicare eligible) Nil if Private Health Cover $420.00 If uninsured $1595 (Not Medicare eligible) Payment Due Day of Oocyte Retrieval Day of Oocyte Retrieval Day of Embryo Transfer Surgical Sperm Collection Please see ‘Non-Fertility North Fees’ for information on anaesthetist & JHC admission fees Procedure Type Cost Approx. Out Of Pocket Expense Payment Due Open Surgical Sperm Retrieval $550.00 Nil if Private Health / /Medicare Eligible $550.00 If non-Medicare Eligible Day of Procedure Surgical Sperm Collection – Laboratory Fee $150.00 $150.00 Day of Procedure Surgical Sperm Collection Procedure Type Cost Approx. Out Of Pocket Expense Payment Due Transcutaneous Sperm Retrieval $550.00 Nil if Medicare eligible Day of Procedure Surgical Sperm Collection – Laboratory Fee $150.00 $150.00 Day of Procedure AD-F-533:10 THIS IS A DOUBLE-SIDED DOCUMENT Effective Date: 01-Sep-16 Page 1 of 2 FEE STRUCTURE FET Cycle Procedure Type FET Cycle & Subsequent Frozen Embryo Transfers** (There may be additional costs for drugs during this cycle) 1st Frozen Embryo Transfer - POST FREEZE-ALL (There may be additional costs for drugs during this cycle) Frozen Embryo – Failed Thaw Cost Payment Due Approx. Out Of Pocket Expense $1800.00 + Prescription Day of Treatment Bulk Billed Prescription only N/A Bulk Billed Nil N/A $2700.00 Cryopreservation Procedure Type Sperm Freezing Process – Cost per Sample Cost $80.00 $80.00 per sample On Receipt of Invoice Oocyte Freezing Process – Cost per Oocyte Collection $100.00 $100.00 per oocyte collection On Receipt of Invoice $100.00 $100.00 per oocyte collection $380 for 1 year $210 for 6 months $110 for 3 months $40 for 1 month On Receipt of Invoice Embryo Freezing Process – Cost per Oocyte Collection Ongoing Sperm / Oocyte / Embryo Storage (from anniversary of initial storage) Export of Sperm / Oocytes / Embryos $210.00 (Administration & Processing) Approx. Out Of Pocket Expense $210.00 Payment Due Paid via direct debit arrangement On Receipt of Invoice Advanced Science Procedure Type Semen Analysis Cost $70.00 $29.15 Day of Appointment HALO Sperm (DNA Fragmentation Test) $150.00 $150.00 Day of Appointment MAR Test (Antisperm Antibodies) $30.00 $5.70 Day of Appointment Surgical Sperm Collection – Laboratory Fee $150.00 $150.00 Day of Sperm Retrieval Trial Prep $30.00 $30.00 Day of Appointment Mechanical Endometrial Injury (MEI) – Scratching $200.00 $200.00 Day of Treatment Male Factor Pack $25.00 $25.00 Day Pack Taken Non-attendance at Laboratory Appointment $55.00 $55.00 On Receipt of Invoice Approx. Out Of Pocket Expense Payment Due Counselling Session Procedure Type Counselling Session Cost $190.00 Approx. Out Of Pocket Expense $190.00 Payment Due Day of Appointment Non-Clinician Initiated Cancelled Cycle Procedure Type Global (ICSI / IVF / FET / AIH / AID) Cost $1200.00 Approx. Out Of Pocket Expense $1200.00 Payment Due At Cancellation Non-Fertility North Fees Procedure Type Anaesthetist Fee* Joondalup Hospital (JHC) Admission Fee Cost Up to $480 $1047.00 Approx. Out Of Pocket Expense Nil if Private Health Cover $340.00 if uninsured $1047.00 Payment Due Day of Admission or Receipt of Invoice Day of Admission. Paid to JHC. *Patients with Private Hospital Cover; The cost of your TVOA (egg collection), JHC admission fee and anaesthetist fee will either be billed directly to your health insurance provider (on a no gap basis) or alternatively, will be billed directly to you by Joondalup Private Hospital and/or the anaesthetists private rooms. In this instance you will be issued a receipt which can be used to claim back your admission and anaesthetist fees from your health insurance provider. The amount which you can claim is dependent on your level of cover and we advise you to confirm this with your private health fund. Eligible patients may also claim their TVOA and anaesthetist fees through Medicare. *Self-Funded Patients; Hospital admission fees will be billed directly to you by Joondalup Private Hospital. Anaesthetist fees will be billed directly to you buy either Joondalup Private Hospital or the anaesthetists private rooms. TVOA (egg collection) will be billed directly to you by the Dr’s private rooms. **A part of the cost of IVF, ICSI and FET can be claimed to Medicare only if patient is infertile for medical reasons. Please note that these prices are subject to change at any time, however all fees stated on signed Payment of Procedure forms will be honoured. AD-F-533:10 THIS IS A DOUBLE-SIDED DOCUMENT Effective Date: 01-Sep-16 Page 2 of 2
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