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- <br />KVLJJEF-�L <br />Kittitas Valley Healthcare <br />Yvwr H&Hce fo-r He,Vbt 4 <br />KVH Workplace Health <br />General Information <br />Pricing <br />Company Name: <br />Kittitas County Sheriff's Office <br />Physical Street Address: <br />307 W. Umptanum Rd. <br />City, State, Zip: <br />Ellensburg, WA 98926 <br />Mailing Address (if different from physical): <br />❑Standard: $83 <br />Primary Contact: <br />Kim Dawson <br />Office Phone: <br />509-962-7089 <br />Contact Email: <br />Kim.dawson@co.kittitas.wa.us <br />Office Fax: <br />❑Standard: $40 <br />Secondary Contact (if applicable): <br />❑Standard: $45 <br />Secondary Contact Phone: <br />❑Standard: $60 <br />Guarantor Information <br />®Check if the same as physical address <br />Company Name: <br />Street Address (Mailing): <br />City, State, Zip: <br />Phone: <br />Fax: <br />Services <br />Pricing <br />Physical Examination <br />❑Standard: $100 <br />Audiogram <br />❑Standard: $55 <br />Venipuncture <br />❑Standard: $22 <br />Exec 1 Panel <br />❑Standard: $83 <br />Non -Federal Drug Screen, 5 panel <br />❑Standard: $45 <br />EKG <br />❑Standard: $75 <br />U/A with micro <br />❑Standard: $27 <br />Stool Guaiac <br />❑Standard: $40 <br />Range of Motion <br />❑Standard: $45 <br />Spirometry <br />❑Standard: $60 <br />PA Chest X -Ray (1 view) <br />❑Standard: $100 <br />L Spine X -Ray <br />❑Standard: $60 <br />T Spine X -Ray <br />❑Standard: $60 <br />Optional Services <br />Hep B Titer <br />❑Standard: $60 <br />Hep B Injections, each (series of 3) <br />❑Standard: $103 <br />PSA (if medically indicated) <br />❑Standard: $100 <br />Total w/o Optional Services <br />$772 <br />