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EXHIBIT C <br />INMATE MEDICAL SERVICES AGREEMENT <br />COST SCHEDULE FOR CHARGEBACK SERVICES <br />Contractor shall provide the following services, as needed, as set forth in Exhibit A, <br />Section III. A. 10 and A.11: <br />Per unit repair cost for Dentures, Plates & Partials $200.00 <br />Per study cost for mobile x-ray service $85.00 <br />(Including Radiologist interpretation, transcription <br />and delivery) <br />Cost per patient visit for OB/GYN $150.00 <br />Cost per patient visit for Ophthalmology $150.00 <br />Cost per visit for Emergency Psychiatric Crisis $50.00 <br />Intervention & Evaluation <br />Monthly administrative fee for billing service $400.00 <br />18 <br />