Health care fees would jump next month for the thousands of District residents who use city clinics, more than doubling for some health services and soaring from $21.75 to as much as $150 for dentures, under newly published proposed rates.

The cost of an initial visit for most patients now is $54 at the city's 15 clinics, but is scheduled to rise to $75. The rate for most follow-up visits would increase from $16 to $25.

The fee for an initial visit by a cardiology patient would go from $35.25 to $75. Adolescent or athletic physicals, now free, are to cost $50.

The new rates were published in the D.C. Register of April 29 and are to go into effect after a 30-day comment period.

Dr. Ernest Hardaway, D.C. public health commissioner, said the increases are needed to bring the city's fees more in line with costs and to get higher reimbursements under Medicaid from the federal government, which uses regular charges as the basis for payments.

"We did ourselves a disservice when we didn't update the fees," he said.

The fees were last raised in 1978, according to the commissioner's office.

The city's clinics are open to any D.C. resident, regardless of income. Last year more than 16,000 patients received general medical care at the clinics, more than 11,000 received dental care and thousands of others received specialized services of other kinds, according to city figures.

All patients at the clinics will be charged the same fees. Medicaid will cover the increased fees for some low-income families, but dental care is covered only for minors.

This means that the increased cost of dentures would have to be borne by individual adults, regardless of income. A full denture will cost $100 and a partial denture $150. Hardaway said this still is well below the price charged by private providers, which he said may be $400 or $500.

Some community organizations opposed the increases as too burdensome for lower-income persons. Cheryl Fish of the Coalition on Financial Accountability said it will become "prohibitive for people to get dentures" with the new rates.

Eve Bargmann, a physician at Zacchaeus Medical Clinic, a privately funded free clinic, said the fee increases would mean that "people won't go for the care they need . . . ."

The new rates include these increases:

For an initial visit for obstetric and gynecological services, from $43.25 to $60.

For an initial pediatric visit, from $38.25 to $50.

For an adult dental visit, from $21.75 to $36.75.

For audiology and speech services to crippled children, from $49.75 to $83.50.

For an initial visit for specialized nutrition, from $16 to $30.

For an initial visit for podiatry care, from $19 to $30.

For a nursing home visit, from $25.25 to $32.25.

A child's dental visit would continue to cost $21.75 and the cost of a simple denture repair would drop from $21.75 to $12 while a complex repair would rise from $21.75 to $35.