In 2021, the National Ambulatory Medical Care Survey Health Center (NAMCS HC) Component modernized its data collection and began collecting clinical visit data from health centers using transmission of electronic health record (EHR) data. With this redesign, there are potential cost implications for a health center to participate. Beginning in 2021, a one-time set-up fee (i.e., payment) of up to $10,000 was offered to centers who participated in the NAMCS HC Component. Starting in 2022, a Set-up Fee Questionnaire was used to capture data on the use of this money. Results show on average the fee appeared adequate in covering participation costs, with the fee most often used to cover costs of health center and EHR vendor information technology staff. Although this fee was offered only during the initial year of participation, retention rates for centers appeared high. Implications from the findings of this case study on use of a set-up fee in establishment surveys are also briefly discussed.