Dallas Ft. Worth Sarcoma Group
Office Information: Fee Schedule
All Fees Are to be Paid to Service
Expect 10 days to 3 weeks depending on difficulty.
$50 for 48 hours depending on difficulty.
Forms |
Charges |
| Aflac | $35.00 |
| Appointment No Show Fee | $25.00 |
| Appointment Cancellation More Than 3 Times | $50.00 |
| Disabled Parking Short Term | $35.00 |
| Disabled Parking Long Term | $50.00 |
| Disability Forms Short Term | $35.00 |
| Disability Forms Long Term | $45.00 additional pages $1 per page |
| Faxing Rx to Insurance For Prior Auth | $15.00 |
| Fax Rx to Pharmacy | $5.00 |
| Fax Refills to Pharmacy | $5.00 |
| FMLA | $35.00 |
| Home Health Forms | $35.00 |
| Medical Records Basic Retrieva May Take 2–4 Weeks Depending on Volume |
$20.00 first 20 pages and .50¢ each additional page |
| Notary Fees Admin Oath or Affirmation | $6.00 |
| Affidavits | $15.00 |
| Taking Proofs of Signature | $6.00 additional signature $1 |
| Certifying a Photocopy | $6.00 |
| School Forms Sports | $15.00 |
| Statement Copies Additional | $10.00 |
| Sports Physical 1 Page | $10.00 additional pages $1 per page |
| Telephone Consult | $35.00–$75.00 |
| Workmans Comp Form | $35.00 additional pages $1 per page |
| Xray Copies on CD | $10.00 |