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EXIII[BIT A <br />RATESICHARGES <br />City of Santa Ana Non -industrial Medical .Services <br />f'h s calw, <br />Basic Employer Physical (includes VAdip, distance vision, basic colorvisloni $35,00 <br />Annual Employer Physical linciudes undip, distencavision, basic colo(,visl in) $35,00 <br />Pre-CmploymentPhysical(Includes UA dip, distance vision, hash: color vision) $35.00 <br />F I t For Duty/Return to Work (MUST have copy ofjob description) $40,00 <br />Commercial Driver Exams $55,00 <br />Respit atory Fit Testing:. <br />Respiratory Evaluation (IncludesrMask Pit Test, 05nAquestionnoirereview, PFTI $90.00 <br />PFT $10,00 <br />OShIA Questionnaire Review $25.0(l <br />Mask Fit Test $25.00 <br />ru 5 re E; <br />Breath Alcohol Test <br />$30,00 <br />5 panel Rapid <br />$15,00 <br />10 panel Rapid <br />$20,00 <br />9 Panel Non -Dot k1793N <br />$25.00 <br />10 Panel Nan -Dot #6633N <br />$30.00 <br />DOT Drug Screen <br />$25.00 <br />MRO Interpretation of Positive Drug Screen <br />$25.00 <br />Drug Screen Collection Only (Not on Sunrise's late account) <br />$15.00 <br />Dig- %fisting; <br />Ish1hara <br />$10.00 <br />Near Vlslon <br />$5,00. <br />Jaeger <br />$5.00 <br />Snelten & Basic Color <br />$5100 <br />Qtft r er i e :. <br />Audiograms <br />$20,00 <br />Lift Test — rioor to Waist <br />$5.00 <br />Lift Test — Waist to Chest <br />$5.00 <br />EKG <br />$30,00 <br />Tg/PPD Skin Test <br />$28.00 <br />Chest X-Ray (2 Views rule outTl <br />$30.00 <br />Lumbar X-Ray (4 Views) <br />$50.00 <br />Rev, 08,11.2021 <br />