Translation of the Japanese May 1, 2022 version of the Rules of Charges.

Some of the items listed on the fee schedule are currently not yet available.
Items Department Fee (JPY)
Consultation Fee (free of charge for students) Common to all 100
Smoking Cessation (free of charge for students) Smoking Cessation 100
Patient ID card reissuing fee (free of charge for students) Common to all 100
Vaccine booklet reissuing fee Common to all 100
Medical certificate with a signature of medical doctor 1,000
Issuing Certificate of check-up results 100
documents Refferal letter to other medical institute Common to all 300
etc. Medical Communication Note to university office 0
Doctor's Opinion Note to univeristy office 0
X-ray examination 400
CD/DVD copy of X-ray digital data 500
Electrocardiography 350
Holter electrocardiography 3,000
Urinalysis 150
Blood Cell Count (On-site) 50
Medical
Outsourced laboratory testing (except for ※1) remuneration
points × 3
Erythrocyte sedimentation rate 140
T-SPOT.TB 7,000
IgE-CAP-16（Specific allergen 16） 8,000
View allergy 39 9,000
Fatty acid fraction 2,500
1α,25-(OH)2 Vitamin D 3,500
SARS-CoV-2 Total Antibody (Roche) 2,500
SARS-CoV-2 Antibody (Abbott)
3,500 (each)
(IgM(S), IgG(S), or IgG(N))
COVID-19 RNA detection test (PCR) 25,000
COVID-19 Quantitative antigen test (outsourcing) 6,500
Toxicology test (not covered by insurance) 17,600
Ferritin 400
Gonorrhea nucleic acid amplification testing : PCR 1,980
Chlamydia nucleic acid amplification testing : PCR 1,890
Urinary methylhippuric acid 1,210
Urinary N-Methylformamide 1,210
※1 Styrene metabolites 2,200
Total trichloride 1,210
Urinary trichloroacetic acid 1,210
Common to all
Urinary hippuric acid 1,050
Urinary 2,5-hexanedione 1,050
Urinary delta-aminolevulinic acid 1,050
Blood lead 830
Serum indium 11,550
Serum KL-6 930
Blood cadmium 6,380
Urinary β2-microglobulin 640

Urine sediment cytology by Papanicolaou method 2,200

Urinary mandelic acid 1,210

 Urinary ortho-toluidine 16,500
Urinary antimony 16,500
Urinary MOCA 13,200
Urinary methyl isobutyl ketone 5,000
Eryhtrocyte protoporphyrin 1,100
Treatment / Medical
surgery On-site laboratory testing (except ※2) remuneration
points × 10
Rapid Influenza Diagnostic Test 1,100
※2 COVID-19 qualitative antigen test (high sensitivity) 4,500
COVID-19 quantitative antigen test (On-site) 4,500
Tuberculin skin test 1,500
Ultrasonography 500
Bone densitometry (QUS: qualitative ultrasonography ) 300
Pulmonary function test 1,600
At-home sleep apnea test A 1,000
At-home sleep apnea test B 2,000
Exhaled nitric oxide test A 1,500
Exhaled nitric oxide test B 600
Pure tone audiometry (PTA) 150
Pure tone audiometry (PTA) (Air conduction only) 100
Tympanometry 100
Standard equilibrium test Otorhinolaryngology 20
Positional testing 150
Nasopharyngeal endoscopy 200
Pharyngeal endoscopy 200
Medical procedures 150
Pharmaceutical
Injection
Common to all cost + 100
Pharmaceutical
Intravenous drip
cost + 300
Nasal medical procedure 50
Ear precedure 50
Eustachian tube procedure (Single side) 50
Oropharyngeal procedure 0
Post-sinus surgery treatment (Single side) 50
Otorhinolaryngology
Tympanic membrane puncture (Single side) 50
Tympanic cavity Irrigation 50
Ear-wax removal 100
Nebulizer 100
Auricular hematoma puncture 30
Test puncture of peritonsillaritis or peritonsillar abscess (Single
100
side)
Nosebleeding treatment (Tampon) 100
Auricular hematoma drainage 200
Removal of foreign body from ear (Simple) 100
Removal of foreign body from ear (Complicated) Otorhinolaryngology 300
Myringotomy 200
Tympanostomy-tube placement 800
Nasal foreign body removal 200
Pharyngeal foreign body removal (Simple) 200
Pharyngeal foreign body removal (Complicated) 300
Treatment of sprained ankle Common to all 500
Knee ligament injury treatment 1,000
Finger cast or splint 500
Half limb cast or splint 1,500
Orthopedics
Upper or lower limb cast or splint 2,000
Joint aspiration 200
Reposition of fracture or dislocation 1,000
Treatment aid equipments (example: medical supporter) Common to all Actual cost
Blood sample collection (for research purpose) 300

Prescription / dispensing fee Common to all 300

Prescription/
dispensing Pharmaceutical
Prescribed medicine Common to all
cost
Oral check-up 100
Orthodontic consultation 500
X-ray dental fee (Hongo) 200
X-ray pantomography fee (Hongo) 400
X-ray dental fee (Komaba) 100
X-ray pantomography fee (Komaba) 600
Certificate・Medical certificate 1,000
Dental anesthesia fee (per ample) 150
Prescription 300
Extraction・Anterior tooth 300
Extraction・Posterior tooth 400
Extraction・Wisdom tooth 500
Incisional drainage fee 180
Minor surgery fee (sutures etc.) 600
Gingivectomy fee 200
Hemostatic procedure 1,250
Irrigation 300
Removal of sutures 50
Periodontal examination 1,220
Intraoral photographs (5 pc) 100
Tooth Brush Instruction 200
Calcium deposit removal (per a jaw) 300
Calcium deposit removal second time or later in a session (per a jaw) 200
Polishing teeth 150
PMTC（Professional Mechanical Tooth Cleaning） 150
Occlusal adjustment (morphological correction) 100
Acute inflammation procedure fee, 1 vial/ample of local antibiotic treatment 500
Saliva test fee (cavities susceptibility test) CRT series 1,500
Dentistry
Saliva test fee (cavities susceptibility test) CAT21 series 700
Hypersensitivity treatment 200
Medication application 100
Fluoride application 200
Small cavities treatment 200
Eugenol temporary sealing 150
Duraseal temporary sealing 200
Caviton Temporary sealing 100
Temporary cement sealing 200
Metal crown reattachment + glass ionomer cement fee 250
Metal crown reattachment + super bond fee 600
Resin filling, polishing, and treatment fee (simple) 550
Resin filling, polishing, and treatment fee (complicated) 600
Add resin-filling tooth surface 150
Dental amalgam filling and treatment fee 500
Pulpectomy (including 1 local anesthesia) 1 root 1,200
Pulpectomy (including 1 local anesthesia) 2 roots 1,400
Pulpectomy (including 1 local anesthesia) 3 roots 1,600
Infected root canal treatment 1 root 1,000
Infected root canal treatment 2 roots 1,100
Infected root canal treatment 3 roots 1,300
Endodontic disinfection 1 root canal 200
Endodontic disinfection 2 roots canal 250
Endodontic disinfection 3 roots canal 300
Root filling 1 root 1,300
Root filling 2 roots 1,400
Root filling 3 roots 1,600
Toothbrush and other oral cleaning tools Actual expense
Malaria prophylactic drug For one week 1,050
Medicine for diarrhea (for
1,000
travelers)

Medicine for altitude

1,000
sickness/ countermeasures

Medicine for jetlag 500

Hepatitis A per 1 vaccination shot 6,000
Hepatitis B per 1 vaccination shot 5,000
Japanese encephalitis per 1 vaccination shot 5,000
Tetanus toxoid per 1 vaccination shot 1,500
Diphtheria-tetanus-
pertussis combined vaccine per 1 vaccination shot 2,500
(DPT)
Diphtheria-tetanus
per 1 vaccination shot 2,500
combined vaccine Travel Clinic
Rabies per 1 vaccination shot 12,500
Measles per 1 vaccination shot 5,000
Rubella per 1 vaccination shot 5,000
Measles-Rubella mixed per 1 vaccination shot 8,000
Chickenpox per 1 vaccination shot 6,000
Mumps per 1 vaccination shot 5,000

Absorbed Diphtheria-
purified Pertussis-tetanus-
per 1 vaccination shot 8,500
inactivated polio Combined
Vaccine (DTaP-IPV)

Inactivated Polio vaccine per 1 vaccination shot 7,000

Influenza (seasonal) per 1 vaccination shot 3,000
Meningococcal vaccine per 1 vaccination shot 20,000
Psychotherapy (Psychiatry
per 1 session Psychiatry 1,000
clinic for faculty members)

Medical Checkup A (Equivalent to regular medical checkup for staff and faculties;
Internal Medicine 5,000
includes 1 issue of medical certification)
Health-Care Room
Charges (40 min / session) 1,000
(Komaba Health Service
Center) Charges (15 min / session) 500
※ The total amount will be rounded to the nearest JPY 10.