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Home My WebLink About20133378.tiffRESOLUTION RE: APPROVE REVISIONS TO FEE SCHEDULE FOR FEES COLLECTED BY THE WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, the Board has been presented with revisions to the fee schedule for fees collected by the Weld County Department of Public Health and Environment, and WHEREAS, after study and review, the Board deems it advisable to approve the proposed revisions, effective January 1, 2014, copies of which are attached hereto and incorporated herein by reference. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the revised fee schedule for fees collected by the Weld County Department of Public Health and Environment, as attached hereto, be, and hereby are, approved, effective January 1, 2014. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 11th day of December, A.D., 2013. BOARD OF COUNTY COMMISSIONERS WELD COT , COLORADO ATTEST: t ' \ow w • - Weld County Clerk to the Boa BY: Deputy CI APPR orney Date of signature: DEC 1 2 2013 il'� F. Garcia, Chair an P. Conway Milsg Freeman fur? kiL- Barbara Kirkmeyer cc 2013-3378 HL0003 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT PUBLIC HEALTH SERVICES - 2014 SLIDING FEE SCHEDULE Procedure, Code IProcedure VISITS New Client 99201 'Minimal* 99202 Expanded* 99203 Detailed* 99204 Comprehensive* 99211 99212 99213 99214 Established Client Minimal* Focused* Expanded* Detailed* Home Visits 99341 New Client - Focused _ 99342 New Client - Expanded 99347 Est. Client - Focused 99348 Est. Client - Expanded Preventive Medicine Counseling 99401 Individual - 15 min* 99402 ,'Individual - 30 min* 99403 Individual - 45 min* Travel Visits 99404 Individual Initial Visit - 60 _ 99401W Return Visit 99412 Group Initial Visit - 60 IPreventive Medicine 99384 New Client 12-17 years old* 99385 New Client 18-39 years old* 99386 New Client 40-64 years old* 99394 Est. Client 12-17 years old* _ 99395 Est. Client 18-39 years old* 99396 Est. Client 40-64 years old* _ Code 1 HOUSEHOLD CODE SIZE Code Code Code Code 2 3 4 5 0.00 11.00 22.00 33.00 44.00 0.00 26.25 52.50 78.75 105.00 0.00 34.00 68.00 102.00 136.00 0.00 50.75 101.50 152.25 203.00 L_ 0.00 0.00 0.00 0.00 jAdditional Codes 0071W 1Community Education 1 hr. 0069W Travax Printout G9006 NHV Mother - Task Care Management T1017 NHV Child - Task Care Management STI Exam pre -pay -NP Wellness Package 99499 TB Consultation PROCEDURES 56420 Bartholin Cyst 11100 Biopsy of skin, single 57500 Cervical Lesion Biopsy 0116W Chest X -Ray (Prepay) 57452 Colposcopy without Biopsy ** 10.25' 20.50' 30.75, 41.00 17.00 34.00 51.00 68.00 22.00, 44.00; 66.00' 88.00 34.75 69.50 f 104.25 139.00 82.00 82.00 82.00 82.00 82.00 82.00 82.00 82.00 82.00 82.00 82.00 82.00 82.00 82.00 82.00 82.00' 82.00 82.00 82.00 82.00 0.001 11.00 22.00 33.00 44.00 0.00 13.50 27.00 40.50' 54.00 0.00 18.75 37.50 56.25 75.00 95.00' 95.00 95.00 95.00, 95.00 50.00 50.00 50.00 j 50.00 50.00 50.00 50.00 50.00 50.00 50.00 0.00 34.00 68.00 102.00 136.00 0.00 34.00 68.00, 102.00 136.00 0.00 36.75 73.50 110.25 147.00 0.00 22.00 44.00 66.00 88.00 0.00 22.00 44.00' 66.00 88.00 0.00' 24.25 48.50 72.75 97.00 66.00 66.00 66.00 66.00', 66.00 15.00, 15.00i 15.00 15.00 15.00 15.00' 15.00''; 15.00 15.00 15.00 15.00 15.00 15.00 15.00 15.00 172.00 172.00 172.00 172.00 172.00 45.00 45.00 45.00 45.00 45.00 41.00 41.00 41.00 41.00 41.00 31.00' 31.00 31.00 31.00 ' 31.00 29.00 29.00 2900 I 29.00', 29.00 34.00' 34.00 34.00 34.00' 34.00 59.00 59.00 59.00 59.00 59.00 95.00, 95.00; - - 0, - 0 95.00', 95.00 i 95.00 Revised 11/15/2013 Page 1 of 5 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT PUBLIC HEALTH SERVICES - 2014 SLIDING FEE SCHEDULE Procedure Code Procedure 57454 J Colposcopy with Biopsy ** 57511 Cryocautery cervix- initial or repeat 17000 17003 17004 56501 57170 58100 58110 Cryotherapy first lesion** Cryotherapy 2-14 lesions** Cryotherapy 15 + lesions** Destruction Lesion Vulva Diaphragm/Cervical Cap Fitting* Endometrial biopsy w/wo Biopsy Endometrial biopsy with Colposcopy Essure by referral*** 11400 Excisions, benign lesion 11981 Implanon Insertion* 10060 Incision & drainage of abcess, single or simple 58300 Insertion IUD* 57460 LEEP with biopsy 57461 LEEP with conization 88305 Level 4 - Surgical pathology 1st site 88305W 59025 Non Stress Test Interp 11976 11983 Removal implant, with reinsertion* 58301 Removal IUD* A4550 Surgical Tray Removal, implant contraceptive (Implanon)* Shaving of epidermal lesion, single on trunk, 11300 arms or legs, .5cm A4267 0052W A4266 A4269 Code Code l Code Code!, Code 1' 2 3 4, 5 106.00 106.00 106.00 106.00 106.001 106.00 45.00 45.0_0'_ 45.00 6.00 6.001 6.00 130.00 130.00' 130.00 94.00 94.00' 94.00 0.00 21.00 42.00 47.00 47.00 47.00 60.00 60.00 ' 60.00 0.00 0.00 0.00 82.00 82.001 82.00 0.00' 43.75'1 87.50 33.00 33.00 33.00 0.00 44.00 - 88.00 144.00 144.00 144.00 239.00 23a00 239.00 106.00 106.00 1.06.00 106.00 45.001 45.00 6.001 6.00 130.00' 130.00 94.001 94.00 63.00 84.00 47.001 47.00 60.00 60.00 0.00 0.00 82.001 82.00 131.25' 175.00 33.00 132.00' 144.00 239.00 239.00 96.00 96.00 96.00 96.00 0.00 0.00 156.00 208.00 33.00 176.00 144.00 96.00 96.00 96.00' Level 4 - Surgical Pathology 2nd site & each add( 96.00 96.00 ' 96.00 0.00 0.00 52.00 104.00 0.00 79.75j 159.50 239.25 319.00 0.00 0.00 0.00 35.25'1 70.50 105.75 141.00 63.00 63.00I 63.00 63.00. 63.00 40.00 40.00% 40.00 40.00 FAMILY PLANNING SUPPLIES Condoms pkg 10* Cycle Beads* Diaphragm* Foam Contraception* J7307 Implanon/Nexplanon* J7302 IUD Mirena* J7300 IUD Paragard* J3490 IUD Skyla* J1055 Medroxyprogesterone 150mg IM (Depo)* J7303 Nuva Ring* S4993 0068W 0065W Oral Contraceptives* Seasonale* Today's Sponge* LAB 40.00 0.00 1.75 3.50 i 5.251 7.00 0.00 3.75' 7.50 11.25' 15.00 0.00 7.25 14.50, 21.75! 29.00 0.00 3.00 6.00 9.00 1 12.00 0.00 178.25 ! 356.50 534.751 713.00 0.00 190.25 380.50 570.75 761.00 0.00 163.501 327.00 _ 490.50 654.00 0.00 200.001 400.00 600.00! 800.00 0.00 16.251 32.50 48.75 65.00 0.00 8.75 17.50 26.25 35.00 0.00 6.75' 13.50 20.25 27.00 0.00 16.25 32.50' 48.75 65.00 0.00 1.25 2.50 3.00 5.00 82947 Assay, body fluid, glucose, (FBS)* 85025 CBC w/Diff 19.00 19.001 85027 CBC w/o Diff 87491 Chlamydia PCR* 87491 NS Chlamydia PCR* - full fee 0090W Court Ordered Lab Draw 83001 FSH 87591 Gonorrhea PCR* 87591 NS Gonorrhea PCR* - full fee 82948 Glucose Random 0.001 4.50 17.001 17.00 0.001 11.50 46.00 46.00 16.00 16.00 34.00 34.00 0.00 11.50 4.6.00'' 46.00 8.00' 8.00 9.00 19.00 17.00 23.00 46.00 16.00 34.00 23.00 46.00 8.00 13.50 18.00 19.00 19.00 17.00 17.00 34.50 46.00 46.001 46.00 16.00, 16.00 34.001 34.00 34.50 46.00 46.00 ' 46.00 8.00 8.00 Revised 11/15/2013 Page 2 of 5 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT PUBLIC HEALTH SERVICES - 2014 SLIDING FEE SCHEDULE Procedure Code Procedure Code l Code Code 2, 3', 4 Code 5 Code 82951 Glucose Tolerance Test 2 hr (GTT) d 23.00 23.00', 23.00 23.00 23.00 87205 Gram Stain 1 25.00 25.00 25.00 25.00] 25.00 84702 84703 HCG Quantitative Serum Pregnancy Test 40.00, 40.00 40.00 40.00; 1 40.00 HCG Qualitative - Serum Pregnancy Test 40.001 40.00 40.00 40.00; 40.00 86706 Hep B Surface Antibody 22.00' 22.00. 22.00 22.00; 22.00 87250 - Herpes Culture 68.00, 68.00 68.00 68.00 68.00 86695 Herpes Select - Type I (89999A33) 68.00 j 68.00 68.00 _ 68.00 68.00 86696 Herpes Select - Type II (89999A33) 68.00' 68.00 68.00 68.00; 68.00 85018 HGB - (Finger Stick)* i 0.00 3.50 7.00 10.50] 14.00 86703 HIV Screen, ELISA 22.00 22.00 22.00 22.00 22.00 87621 HPV, High Risk 68.00 68.00 68.00 68.00 68.00 0081W HPV, High Risk w/ repeat pap (LabCorp use) '', 108.00' 108.00 108.00 108.00 108.00 484006W Immunohistochemical Stain 97.00 97.00 97.00 97.00 97.00 87254 Influenza - Viral Culture 42.00 42.00 42.00' 42.00 42.00 83002 LH 34.00 34.00 34.00 34.00, 34.00 80061W Lipid Panel - SFS* 0.00 9.00 18.00 27.00 36.00 80061N Lipid Panel 36.00 36.00 36.00 36.00! 36.00 80076 Liver Panel 28.00' 28.00 28.00 28.001 28.00 80048 Metabolic Panel 29.00 29.00 29.00 29.001 29.00 82274 Occult Blood Test, Fecal, IA* 0.00 6.75 13.50 20.25' 27.00 88142 Pap - Thin Prep* 0.00 10.50' 21.00 31.501 42.00 0080W Pap, repeat prep thin 42.00 42.00 42.00 42.001 42.00 84146 Prolactin 36.00 36.00 36.00 36.00'1 36.00 86592 RPR/Syphillis test 21.00, 21.00' 21.00; 21.00 21.00 87081 S Streptococcus - Hemolytic 6.001 6.00 6.001 6.00 6.00 84480 T3 45.00! 45.00 45.001 45.00. 45.00 84436 T4 vaginalis , 8.00 8.00 ' 8.00 8.00 8.00 87798 Trichomonas - amplified 11.00, 11.00 11.001 11.00 11.00 84443 TSH 32.00: 32.00 32.00, 32.00 32.00 86480 Tuberculosis Test-Quantiferon (IGRA) 85.00, 85.00, 85.00 85.00' 85.00 81001 Urinalysis, complete with micro ex 7.00, 7.00 7.00; 7.00 7.00 81002 ]Urinalysis, w/o scope (UA) 10.00' 10.00 10.00' 10.00 10.00 87086 Urine Culture, Comprehensive 11.00, 11.00, 11.00, 11.00 11.00 81025 Urine Preganancy Test* 0.00 3.75 7.50[ 11.25 15.00 36415 Venipuncture 6.00, 6.00, 6.00] 6.00 6.00 36415W Venipuncture with sliding fee lab 0.00 1.50' 3.00; 4.50 6.00 87210 ,Wet Prep 22.00 22.00; 22.00' 22.00 22.00 MEDICINES and TREATMENTS ' 0036W IAldarra Cream 250.00 250.00 250.00 250.00 250.00 0020W IAmoxicillin 875 mg #20 16.00 16.001 16.00, 16.00 16.00 0062W Azythromycin, Z pack 16.00 16.00': 16.00 16.00' 16.00 101456W Azithromycin 1g - partner pack 11.00 11.001. 11.00 11.00 11.00 0456W Azithromycin State supplied 0.00 0.00 0.00 0.00 0.00 J0696 Ceftriaxone 250 mg 30.00 30.00' 30.00 30.00 30.00 0696W Ceftriaxone 250 mg State Supplied 0.00 0.001 0.00 0.00 0.00 0007W Cephalexin 500 mg #14 10.00 10.001 10.00 10.00 10.00 _ 0058W - Ciprofloxcin 500 mg #6 16.00, 16.001 16.00 16.00 16.00 0035W Condylox 10.00 10.00 10.00; 10.00 10.00 0005W Doxycycline 100 mg #14 11.00. 11.00 11.00; 11.00 11.00 0059W Estradiol 1 m -#100 g 16.00; 16.00 16.00 1 16.00 ' 16.00 --_ 0011W Fluconazole 150 mg #1 _ 19.001 19.00 19.00 19.00 19.00 0012W Iron 12.00, 12.00 12.00 12.00 12.00 Revised 11/15/2013 Page 3 of 5 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT PUBLIC HEALTH SERVICES - 2014 SLIDING FEE SCHEDULE Procedure Code Procedure J0580 LA Bicillin 2.4 Units 0060W Medroxyprogesterone 10 mg - #5 0008W Metrogel 0009W Metronidazole 500 mg #4 0010W !Metronidazole 500 mg #14 0013W Metronidazole 250 mg #28 0006W Misoprostel (Cytotec) 200 mcg #2 0061W Nitrofurantoin Macrocrystals - #14 0034W Ofloxacin 104.00 104.00 0016W Podophyllin/TCA 00006W Premarin Vaginal Cream 0192W Prenatal Vitamins 0004W Sulfatrim SMX/TMP 00180W Suprax 400 mg #1 - partner pak 25.00 25.00 00180NC Suprax 400 mg #1 - State Supplied 0.00 0.00 Code Code Code 1 2 3 Code! Code 41 5 0.00 0.00 16.00 16.00 10.00 10.00 10.00 10.00 15.00 15.00 15.00 15.00 10.00 10.00 45.00 45.00 16.00 16.00 15.00 15.00 12.00 12.00 10.00 10.00 IMMUNIZATIONS 90700N DTaP -State supplied 90700 DTaP 90702N DT - State supplied 90633N Hepatitis A - Child - State supplied 90633 Hepatitis A - Child 90632N Hepatitis A - Adult - State supplied 90632 Hepatitis A - Adult 90744N Hepatitis B - Child - State supplied 90744 Hepatitis B - Child 90746N Hepatitis B - Adult - State supplied 90746 Hepatitis B - Adult 90647N HIB - State supplied 90647 HIB 90649N HPV - State supplied 90649 HPV 90281 IG Hepatitis A - State supplied 90471 Imm. Admin - one vaccine 90472 Imm Admin - each addl. Vaccine 90473 Imm Admin - intranasal or oral 90657N Influenza infant - State supplied 90657 Influenza infant 90658N - Influenza (3 yrs to 18 yrs) - State supplied 90658 Influenza (3 yrs to 18 yrs) 90660N Influenza - intranasal use - State supplied 90660 I Influenza - Intranasal Adult G0008 Influenza -Admin. - MEDICARE 90713N IPV-VFC - State supplied 90713 IPV 90735 'Japanese Encephalitis (new formulation) _ 90696N Kinrix - (DTaP/IPV) - State supplied 90696 Kinrix - (DTaP/IPV) 90734N MCV4 - State supplied 90734 MCV4 90733 MPSV4 (Menomune)(polysaccharide) _ 90707N MMR - State supplied 90707 MMR F 0.00, 0.00 0.00 16.00' 16.00, 16.00 10.00' 10.00 10.00 10.00 10.00 10.00 15.00 15.00] 15.00 15.00 15.001 15.00 10.00 10.00 10.00 45.00 45.00!; 45.00 104.00i 104.00 104.00 16.00'' 16.00 16.00 15.00 15.00 15.00 12.00k 12.00 12.00 10.00' 10.00 10.00 25.00 25.00 25.00 0.00' 0.001 0.00 0.00' 0.00 0.00 28.00 28.00] 28.00 0.00' 0.00 0.001 0.00 0.00 0.00. 30.00 30.00 30.00', 0.00 0.00] 0.00'1 81.00 81.00 81.00 81.00 0.00 0.00 28.00 28.00 0.00, 0.00 0.001, 0.00 30.00 ] 30.00 0.001 0.00 81.00 0.00 0.00 0.00; 0.00 0.00 25.00 25.00 25.00 25.00 25.00 0.00 0.00'' 0.001, 0.00 0.00 75.00 75.00 75.00 75.00 75.00 0.00 0.001 0.00 0.00 0.00 34.00 34.00, 34.00 34.00 34.00 0.00 0.00 0.00 0.00] 0.00 165.00 165.001, 165.00 165.00 165.00 0.00 0.001 0.00' 0.00 0.00 22.00 22.00 22.00 22.00 22.00 22.00, 22.00!, 22.00' 22.00 22.00 22.00 22.001 22.00 22.00 22.00 0.00 0.00 0.00 0.00 0.00 32.00 32.00; 32.00 _ 32.00 32.00 0.00 0.00] 0.00' 0.00 0.00 32.00 32.00 32.00 32.00 32.00 0.00 0.00, 0.00 0.00 0.00 32.00 32.00'1 32.00 32.00 32.00 22.00 22.00 22.00 22.00 22.00 0.00 0.00 0.00 0.00 0.00 47.00 47.00 47.00 47.00 47.00 253.00 253.00 253.00 253.00 253.00 0.00 0.00] 0.00 0.00 0.00 55.00 55.00 55.00 55.00 55.00 0.00 0.00 0.00 0.00 0.00 150.00 150.00 150.00 150.00 150.00 150.00 150.00 150.00, 150.00 150.00 0.00 0.00 0.00 0.00 0.00 63.00 63.00 63.00 63.00 63.00 Revised 11/15/2013 Page 4 of 5 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT PUBLIC HEALTH SERVICES - 2014 SLIDING FEE SCHEDULE Procedure l Code Code! Code Code Code Code 'Procedure 1' 2 3 4 5 90723N Pediarix (DTAP, IPV, Hep B) - State supplied 0.00 0.00 0.00 0.00 0.00 90723 Pediarix - (DTaP/IPV/Hep B) 78.00 78.00 78.00 78.00 78.00 90698N ' Pentacel - (DTaP/IPV/HepB) - State supplied 0.00 0.00 0.00 0.00' 0.00 90698 Pentacel -DTaP/IPV/He B ( p ) 114.00 0.00, 114.00 0.00 114.00 0.00 114.00 0.00 114.00 0.00 90732N Pneumovax - State supplied 90732 Pneumovax 78.00' 78.00' 78.00 78.00 78.00 G0009 _ _ Pneumovax Admin. Fee- MEDICARE 22.00 22.00 22.00 22.00 22.00 90669N Prevnar - (PCV13) - State supplied 0.00 0.00. 0.00, 0.00', 0.00 90669 ;,Prevnar-(PCV13) 159.00' 159.00 159.00' 159.00' 159.00 9 90675 - Rabies iIM 242.00 242.00 242.00 1 242.00 242.00 90675N Rabies IM - State supplied 0.00 0.00 0.00', 0.00 0.00 90375 ' RIG (rabies) - per cc 215.00 215.00 215.00' 215.00 215.00 90680N Rotavirus - State supplied 0.00 0.00 0.00 0.00 0.00 90680 Rotavirus - (RV5) 8.6.00 86.00 86.00 86.00 86.00 90714N Td - State supplied _ _ 0.00 0.00' 0.00, 0.00 0.00 90714 Td - 46.00 46.00 46.00, 46.00 46.00 90715N Tdap - State supplied I 0.00 0.00, 0.00 0.00 0.00_ 90715 ITdap - 99.00 99.00' 99.00 99.00 9900 86580 Tuberculosis Interdermal Skin Test (PPD) 45.00! 45.00 45.00 45.00 45.00 8658W Tuberculosis Interdermal Skin Test (PPD) reading only I 0.00 0.00 0.00 , 0.00 0.00 90636 T Twinrix - Hep A & HepB I 109.00 109.001 109.00 109.001 109.00 90691 (Typhoid - 1 Shot 71.00 71.00, 71.00, 71.00', 71.00 90690 Typhoid - Oral 61.00 _ 61.001 61.00 ' 61.00! 61.00 90716N - - Varivax - State supplied 0.00 0.00 0.00 0.00 0.00 9.0716 Varivax 109.00 109.00, 109.00 109.00 109.00 90717 Yellow Fever 116.00, 116.00 116.00 116.00 116.00 *onlyFamily Fees slide for the Planning Pro ram. 9 Program. Charges all for alother programs are the Code 5 fee. ** Services include surgical procedure only.. *** These items are for referral _ — Miscellaneous INC Service Includes Follow-up Care 0.00' 0.00 0.00, 0.00 0.00 99212 Antepartum Care 1 visit 66.00 66.00 66.00 66.00 66.00 59425 !Antepartum care 4-6 visits 604.00 604.00 604.00, 604.00 604.00 59426 (Antepartum care 7 or more visits _ 1242.00' 1242.00 1242.00 1242.00 1242.00 99402W PE Establishing Medical Record 58.00' 5.8.00 58.00 58.00 58.00 0255W Phone visit 0.001 0.00 0.00 0.00 0.00 59430 Post Partum Only 110.00' 110.00 110.00 110.00 110.00 H1005 Prenatal Plus (1-4 visits) 176.00'' 176.00 176.00 176.00 176.00 H1005 Prenatal Plus (5-9 visits) 468.00, 468.00 468.00 468.00 468.00 H1005 Prenatal Plus (10 visits) 878.00 878.00 878.00' 878.00 878.00 H1005 Prenatal Plus (11 or more visits) 994.001 994.00 994.00 994.00 994.00 1 Revised 11/15/2013 Page5 of 5 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT HOUSEHOLD HAZARDOUS WASTE & CESQG FEES 2014 Waste Type Cost per container I Cost per pound Acid gallon I $$.55 $1.20/ pound if < gallon 5 gallon $51.00 55 gallon $305.00 Aerosol (paint, pesticide) $0.50/ small $1.00/ large Antifreeze $0.60/ gallon Base gallon $1.55 $1.20/ pound if < gallon 5 gallon $51.00 55 gallon $305.00 Battery -lead acid (inc. Vehicle Batteries) ... ... . $0.15/ pound Battery -other .. . $1.20/ pound Compressed Gas Cylinders small single lard $4.00 s r. Compressed Gas Cylinders large $25.00 each Cyanide, Lead, Mercury Compounds quart $6.00 If < quart, $5 flat rate fee gallon _ $32.00 5 gallon $170.00 Drum Handling Fee 30 gallon $15.00 _ 55 gallon $15.00 Fertilizer ' see • dry pesticide Flammable liquid (bulkable) $0.60/ pound Flammable Liq/Oil Base Paint > quart quart $0.70 80.35/ pound if < quart gallon $2.75 5 gallon _ $20.00 Fluorescent Bulbs linear foot $0.40 Compact Fluorescent Bulbs small $1.00 large $2.00 Filter, oil $0.15/ pound Grease gallon 5 gallon 20 gallon $8.0D $62.50 $100.00 Latex paint,buUc quart $0.30 gallon $1.30 5 gallon $10.40 55gallon drum $237.50 Lead compounds <..... see cyanide compounds Mercury thermometer $0.75 see:cyanide compounds Motor Oil (used) 50.251 gallon ' ' ti Motor Oil Testing $20.00 if needed to determine quality of oil, Oily Waste Water $0.50/gallon Oxidizer gallon $25.00 $3.00/ pound (less than gallon) 5 gallon $15000 30 gallon $368.00 PCO Ballast (and non BCB) $1.75/ pound Pesticide/Poison Liq Watt $2.40 $1.00/ pound if <quart gallon _ _ $11.00 5 gallon $60.00 55gallon bulk $875.00 Pesticide, dry $1.00/ pound Reactive quart $10.25 $3.00/pound if <quart gallon $30,75 5 gallon $200.00 Miscellaneous Items To be determined, subject to market rate. 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CD) O_ 7 2O o O N C1 -C m O O to to O O _ -- N .c a) — a) O) ii E N N 0> g O o U (U 7 m C Cl)°' C >. r1 O v N m I 2) C N ).. t+1 O m N m CD cC N O N C c Co -0 y m C E G1 v m UU CD O U7 U O Z 7 10 N Cr co >° �, z, O o C tU a o N C`s O C 3 cU .c CU ` il'� i y d e .0 CD co O U c U)) (O CU U C u CO (D Cr) N O M - O r CD r o o Lc) Ni CO O r N r-- r O d' 00 to CA In R r- CO CO N O (n CO r N CO r OO 1` CO r CO 1-- CO .- CO I-- CO r- 00 CO (N.I M CD N- LO P-- C7 0 to CO CO C7) N- CO CO N r) Vt CO N r) nt CO CO CD O) O) N U) to CD M M r r r U) to N 00 to N to CO N (O 00 O N C) L0 CO rt N C CO CO N r CO CO N r 0 O T- 00 O r r O 03 CD CO I- 2 w CC re D O 0 0 0 0 N r 0 r 0 0 0 0 N N Cr) 0) r r 0 O O C7 0 O O CO 0 O Lti CO 0 O 4 (') r 0 0 O ti 0 0 O C` 0 0 O N- 0 0 O) N- 0 O N V- 0 0 O O N O) to to 0 O (O (O 0 O N v 0 O N v 0 0 0 0 0 0 N N N C) Cr) V- r r r 0 0 U) OD 0 0 tf) OD 0 0 4 C7) 0 O 4 CO 0 O co 0 O N r 0 CD N r 0 0 O o O N (D M PROPOSED Code 5 44.0O 105.00 105.0O 0 O CO C7 r 203.00 I O 0 r 4 o 0 co CO 0 0 W CO 0 0 (T C7 r 0 0 0 0 0 0 N N N CO CO CD 11 0 0 N OO 1 0 0 0 0 `0' 4 • - to 0 0 to N- l_ I L. 0 0 to co 0 0 O to 0 0 O to 0 0 CO Cr) r 0 0 CD . co r 0 0 N rC r 0 0 CO CO 0 0 0 0 OD N CO C) I I 0 cc (O CO 0 0 C[) r 0 r 0 0 r 0 L) r 15.00 15.001 0 0 r ��DD # 0 0 0 N0 to0 0 r N Ns- 'Trr r 41 13 O U it Ott) O N (7 OJ (h N 102.00 to N N to r 30.75 00 0 •r rCO to 0 • CO ~ 104.25 �O 0000 0 0 N N CO co 0 0 CD N N CO CO 0 N co 0 CN/ co 00 0 to M O 07 q (t) N (O to 000 0 to 0 0 O to 0 O t[) 102.00 102.00 _ 110.25 00 O CD (D to O N CO C. (D N•- 000 0 (O (D 172.00 172.00 172.00 45.00 45.00 45.00 41.00 41.00 41.00 C) O U CO 0 0 0 to N N N ti) 0 O CO (O I 50.75[ 101.50 10.25 20.50 O 0 s� M 44.00 34.75 69.50 0 0 N O 0 0 N O 0 0 0 0 N N N N 37.50 0 0 10 0) 0 0 0 to 0 0 0 to 0 0 0 0 CO CA co co 73.50 44.00 0 0 0 to et C D v v 0 0 (O (O 0 0 to r 0 0 to r 0 0 to r 0 0 r r O o O U N I O (n O N r (D r N I 0 O 4 C') I 0 0 n: r 0 0 N N I O 0 0 0 N N op co 82.00 82.00 O 0 O (o r co r r I 1.0 C` co r 0 0 to a) 0 0 O to 0 O O it, I 0 O O O 4 4 C) M 36.75 O O N N I 0 0 O to O N N 4 N N 0 0 0 0 O 0 (O (D 0 0 (D (D O O to r 0 0 tototo r O 0 t1) r 0 0 r O 0 to r 0 0 r m o r O O 0000 O O O O O O O 0 0000 O 0 O 0 O 0 0 0 O O N NNN OO O0 0 O c0 O O c0 O O 0 0 000 O 0 O 0 to00 (7) O 0 to O 0 U) 0 0 000000 0 0 0 0 0 0 0 0 0 0 N for f` •tt •7 I.. m o L d in U) > C — a 3 d z5woo a N E .E N c a X a a) 2 N a co (z E O a) 0 Ts .c y co« U) w2wwo • a To E .- . p a) to ° O - CD 'LJ c (U X� a 'D ci '(a a) S N > d E O 2zzww 10 O U C •_0 U 3 0 V a) CO - W° c •— U 3 O ,0 CJJ Dm U u_ c ._� U -c a) o. x w C ._� U % a) C c 3 O 0 C •v tvNs- > �+ C > d a a .C to To CU 'o .≥ e-6- c • .C o co O -0 ≥ c .0 .C to CU J ≥ c y-o > m F_ o CD I 5 -S fU 7 _≥ -O .^ > E ° N O _ (nl a > O 0 C) •V 'd d >c C 0000-000 > d azzzwww (375-675-5-5 cl)cn co CU — 3 a) 1- co a) O c� C . -- 3 a) CU a) co C — 3 a) C12. N QJ T R. r C . C N cam a) T co c� C . Q) Ti) T (D C W % d p CQ CO = -o 4C0)-- r C O '— U t O E E O@ > .E- a) E a) co C Co a) co -CO O ~ .'c-.. O 2 > S 4E - co E (T 0 2 a) Y N 12 .C U > S 0 2 c Q t d z T O 03 CU C aCU f. E to O (U to c X° o w ,- U Q) co O t_ ° d c.) o L d a 0 0 r O Si N O Qn1 2 O N vi Q O C) r r 6�i 0) N r-• rn M as 0) V ON) 0) V CO 0) CV V co 0) r CO o rn tD CO 0) Tr -0 O m O) O o KT as rn tv)o O 'Cr o rn o O a) rn O o w rn N V' a-, CT) V (O aa) 0)0)00)0)0)O rn to CO a) rn CO 00)) rn Q a) 00) rn t() CA 0) �) �p 0) a) rn r- o a) fn a o ° °� O- t` r ° N t` 8 O) Q�i a) 2013-3371 NM or O N cv r r D O U, O H z w 2 z 0 0C Z w 2 H J Q w 2 J a LL 0 ce z w H Q a w 0 } H z 0 U 0 J w w J C w 2 0 U) w w L Z_ 0 J 0 N CA w 0 cc w Cn H J Q w 2 0 J a Change Comments co ect y (v ,v_ WP Z O " v UI D :D co LO w V co to Wa c o t D H 7 s N co N w (O co N (9 O C) N N a) y w CO ` CO O V O CU m U _ C U O .. _T C 0 O C E N All Family Planning Supplies were increased by 8% due to medical rate of inflation increase due to actual costs -DD New service increase due to actual costs & market evaluation increase due to actual costs -DD increase due to actual costs & market evaluation CURRENT 3% 0 O O M Sr CO OO N C) O M M r N 64 LO CO CO CO I` 0 0 to tf) O) o 0 r r r 00 IC N r r co CO f` t` N N M N M C) M Sr M CO t[) M 666 V N- U) O O N- N- co O r OO I- O C) N CO O I` CD C) r r C) I- Cn co CO tf) N Sr CO O) Q) r-- 1 10 O) O M I- O O N 0 I- 00 0 r (NC')'— CO O O V M co N CD r O) C) CO 4 (D CO co r T- CO o CXJ N CO O N O co CO co r N O M r r (O to NNO O O O V' O r 00000 00000 Cn T- CO V M M T M V CO Sr N M N O CO Sr CD O M N M St sr 000 000 O M CD N M M 57.00 92.00 102.00 102.00 0000000 0000000 I� N t` ti N N r O) r (X' LO0p Nt LO 00 00 O C) N- CD r 32.00 170.00 139.00 232.00 93.00 000000 000000 M O) O r C:) N O) O M CO M r r CO 0 0 CO 0000000 0000000 M r T O N r T O Nr U) CO O O (O I- CO PROPOSED HOUSEHOLD CODE SIZE CI (3 Oi 00 66 r O CI N I _34.001 00 o O) (O 0 t[) CD 106.00 106.00 0 0 to Nt 0 0 (D 0 0 O CO r 0 0 O 0 O!O':O 0 6 I� o N 0 O CD 0 O I 0 0 CD 0 6 t[) h r 33.00 0 0 CD N- r 144.00 239.00 O 000 (D CA a (D CA 0' O I 208.00 319.00 141.00 63.00 O 0 O It O 00000 I� O to T- 0 C) N OTo N M r r r - 0.001 190.251 380.50 570.75 761.00 0.00 163.50 327.00 490.50 654.00 0.00 200.00 400.00 600.00 800.00 0.00 16.25 32.50 48.75 65.00 0.00 8.75 17.50 26.25 35.00 606 606 N N Cf)6O NNO N to CD co d' t() M o 'D O U OM V O U O V O U v N 60000 00000 r O) MNC)OCA 00000 00000 r C) M N 6 0 00000 r Q) co N M 0 co O) C) LC) O co U) 6C) Ul a O tQ co 106.00 106.00 106.00 106.00 106.00 _ 106.00 45.00 45.00 _ 45.00 0 0 (O 0 0 CO O O (O __L 130.00 130.00 130.00 94.00 94.001 94.00 0000 0000 M (- o v 0000 0000 N f` 'Y Ct O O 0 O r I- N Sr 1 o (D O 82.00 82.001 82.00 60 NO r M r 00 to h CO U) NO M Nr CO C+) 0 M CO CD M C`7 44.00 88.00 132.00 144.00 144.00 144.00 239.00 239.00 239.00 006 000 CD O)0) 000 000 (O C) O 000 CO C) CDO CO 0) O (O C) O O o O 52.00 104.00 _ 156.00 79.75 159.50 239.25 35.25 70.50 105.75 63.00 63.00 63.00 O 0 6 t 0 0 6 'd 0 O O 'O. 1.75 3.50 5.25 3.75 7.50 11.25 I 7.25 14.50 21.75 _ 3.00 6.00 9.00 178.25 356.50 534.75 O CD o 6 o6 CD o o o 000 LO M r to N M to N LO I� (D 000 000 OOO to N CO r U) N r epoo 1 C0000 00000 rC)tC)to M N 0 0 up 0 C) 106.00 106.00 0 0 IQ 6.00 130.00 94.001 0'0 6 0 ONOoICV 0 0 CD 0 0 0 0 00 0 0 O o 0 MO CO 0 0 0 0 0 0 �t oCOCOOOOOCM vt co r N o 0 O) 0 0 C) 0 0 0 6 6 0 I 0 6 0 0 CD O 0 6 NY 00000 00000 OOOOO Procedure PROCEDURES Bartholin Cyst Biopsy of skin, single Cervical Lesion Biopsy Chest X -Ray (Prepay) Colposcopy without Biopsy ** Colposcopy with Biopsy ** Cryocautery cervix- initial or repeat Cryotherapy first lesion** Cryotherapy 2-14 lesions** Cryotherapy 15 + lesions** Destruction Lesion Vulva Diaphragm/Cervical Cap Fitting* Endometrial biopsy w/wo Biopsy Endometrial biopsy with Colposcopy Essure by referral*** Excisions, benign lesion Implanon Insertion* Incision & drainage of abcess, single or simple Insertion IUD* LEEP with biopsy LEEP with conization Level 4 - Surgical pathology 1st site Level 4 - Surgical Pathology 2nd site & each add.' Non Stress Test Interp 11976 Removal, implant contraceptive (Implanon)* 11983 Removal implant, with reinsertion* 58301 Removal IUD* A4550 Surgical Tray Shaving of epidermal lesion, single on trunk, 11300 arms or legs, .5cm FAMILY PLANNING SUPPLIES A4267 Condoms pkg 10* 0052w Cycle Beads* A4266 _ Diaphragm* A4269 Foam Contraception* J7307 Implanon/Nexplanon* J7302 IUD Mirena* J7300 IUD Paragard* J3490 IUD Skyla* J1o55 LMedroxyprogesterone 150mg IM (Depo)* J7303 Nuva Ring* S4993 Oral Contraceptives* 0068W Seasonale* 0065W Today's Sponge* C) C `' aU t 000OCT) N CD �r�o� O r O n CO r r U) V' N. Un V tO ��r��in r LO LO L O 0 N. O 0 C` O 0 f` O CD CO r N. U) O r CU U") r C) CU to O OM V r 1-r _ r r O CO O 0 rLOII3 O O M CO O CO V N- _ (O V N- u")(pCOtn 0 O CO OD 0 O MO CO N 01 H z W 2 0 IY W S I — J Q W U a LL 0 H W 2 a W 0 0 U Q -J W 3 W J 0 W U U) W W LL C) 2 0 U) OD 0 cc N t W CA F J U J m C m E E o U O CD L U > O � v a) = 3 0 a) Q- a) 2 Cn Ca CD U C a 0) E CO Cn O a) Q) O 'L7 a) a) a) c > O � —, a) J 3 0 a) CL a a) 2 N tv a) U .c a a) E N to O a) co O a) a) a) c z 0) a z o "' _ m ... d m Q 0 0 r tf) �000Otf)U)U)MtCitf)�N r d' tf) r CO 4 r N M et N M tf) O 4 O r C7 CV M st N CO vt r N CO CO N N h 4OOrt`totnMr� N r M nt r OD M CO N CO co CO N cs) CD N O CD Q) M r M® co N co CO 104.00 107.12 94.00 96.82 0.00 33.00 33.99 34.00 35.02 34.00 35.02 r co t`c0CDrrtnOO4N:ci N co N CO N- N 0 N Vt O N NE N 0 CON O CD CO 0 O N O O thr`OrSC0OON It r N O O O CO r O O r M O M O O C7 CD rf 4000ONtntnr CO O O CO CO r O O N O O Co C7 T-' O O r CD C) r O O r tf) r O O tntnr t0 r O O M CO N O 0 N H W UU D 0 0 0 tii. r 0 0 otco4 r 0 0 r 0 0 ti 0 0 t it 0 0 0 0 tricvi4 r M 0 0 Nr 0 0 Nt 0 0 N.:N 0 0 N 0 0 d N 0 0 00 M 0 0 cor M 0 0 N 0 0 CD44 CD 0 0 CO 0 0 CO 0 0 M N- 0 0 rco N 0 0 CO 0 0 r•aicoOOv N 0 0 N 0 0 NV- 0 0 0 0 wit 0 0 M 0 0 O N 0 W Coo 0 ao0 W Om m 'C ' C V tC) F 0 0.O CIO r 0 CO r 0000000000000000000000000000 CD r 0 0 ti r O N- r- 0 0 CO sr tf) Ns: Cr) 0 0 CD mt O CO i' 0 0 CD r O CO r 0 O f __ O v CO 0 O o Q, Ni M 0 0 CO V' CD CO It 0 0 O O a0 0 0 M N _I O C'') N 0 0 to N 0 tf) N 0 0 O Nt 0 O t 0 0 0 0 O N N --I 0 0 O N V' N 0 0 0 0 00 al0 CO O I- I O O oO co CD CO 0 0 O 0 O 4 r 0 0 0 O O O N 00 CO N CD O I it 0 0 0 O O O ti N 'Q' O V' M O O O N N4 O Nt Cr) 0 0 0 t` N V V M.MNNrN 0 O CO M O N N 0 ao 0 O CD C) O CD Cr) 0 ca 0 0 O O al a> CV N O O o0 O N N 0 0 ol O 0 O f� N' 0 0 O O N N fl 0 O CD CO 0 O r N 0 O cc)tf) 0 CO 0 OOOOO CO O CO 0 0 cD 0 O V -r 0 to 0 O 00 0 CO 0 0 0 O O O r N t1) M oO 0 0 0 r N to r CO CO 0 O f` 0 N- 0 O O r 0 O r 0 O r r 0 r r 0 O tf) r N r r 0 O CO 0 CO 0 O COI 0 {}' 0 O N N O ' N N W° N Cl) Q 0 O _ W O I al C V. O 1C) M6 r O O 0 tt) O r O N N O O o0 C) CD O r 0 0 o0 ap r LO0000000000000tnC00 N 6 N 0 toOOOO M tf) 0 r N M ict 0 0 r N vC1N 0 CD Cr) 0 CD 0 r N 0 r a) O a) o U C") 010 OOOOOOOOO000000OOOO000000000O O) o) rrNvrU)Nv 0 r*: 0 th 0 CO 0 CD 0 0 6.06 0 CO 0 OO 0 C 7 NNSrNNCDCOCO 0 in 0 O 0 0 O I N 0 ao 0 00 0 00 0 0 N NC0OO 0 u') v 0 0o, 0 0 0 OOOOu) N tc) rC7co 0 f: 0 O rr 00 r P O OOO CD O M O N N N 0 tnOOtnoOOtnOOOOOOOOOOtnOOOOOOOOO,O 4 0 O r 0 r r O r r O (a O CD O M O O CD It O 0O 0 M N • O in N 0 O Nt 0 0 O NCO Nt N 0 CD 0 O CD 0 oO CO 0 C7 0 N N 0 O O 0 0 00 CO I-• N 4 CO O O vt M r 0 O 0 CO CO 0 0 CIO i O N leg to r-- CD 0 tn000OO000OOOOr.OtnO O r 0 N et 0 CD C7 0 r N O al O CD 0 0 r N r M 0 tf) 00 0 0 O r O r r to M 0 CD 0 0 N N a) 17 o e— 0 O a 0 O O 0 O N 0 O 0 0 O ath(0 0 O CD 0 O t 0 O O O O CO Rit 0 O CID 0 O M N O O to N O 0 O it 0 0 0 0 O (V vt N 0 0 o0 CD 0 0 O CO 0 0 co CO 0 0 O 0 0 N N 0 0 0 0 0 O 0 0 0 0 0 O N- N4 CO O CP d M r 0 CD O 0 0 CO M 0 0 0 0 0O O N N 0 0 O 0 0 0 0 O Si "It 0 0 CO CO 0 0 r N 0 0 tf) d 0 0 Cb 0 0 0 0 0 0 r N tl) r M C)O 0 0 N 0 0 O r 0 0 r r 0 0 o 0 0 CO 0 0 O 0 0 N N m 7 m i) d m Q J '� m 0 > 0 p 5 = >, la L >.33�� mUUmtva2ccUUEU0naaom-,>>E3 00003tn 000000u t O ta.a.� 0 O r W U0-0 CO y 3 r co O I 0 L J O 0(n « Ct 0U a.a.Cw CC -E-2°1)1)(000u)000-0±-f° ��oo�CiCimaiaia�'i O 0009(902222222222 O J w. t IY Ca O>> E O -o IY a) I C7 v L N H a) C to 1- i_ a) .C la °UU O H V C C O) a) a. Ecl- co ' j .-> tvw, =mmwmarirn C J N a) U CD C O a) U) O O .0 ._ Q a)'».." t a) U a) __.^ ClO Q< O a) A H t a) CO a) ~ O M a) 09.. a) >. H t -''-W a) W a)C��da. :-. Y .U— to c jr. Q 7 y N U22cc .. to EEO> L Cr) N L L (0 -J �. d a) t_ 3 -NC to L .� .C c�6 a) it U D V c c`a U N t O cc ECC2 E EJJJ m Cl) t a) CO dnQ�«.H��o v QO_> a) CC a) CCf a`)`...aQat°Ctaai J20a.a.a.Lt(/)HHHI—H»55»� cH m�dw 'U a) Q U a) u % m _O m c) a a)1E C L m C1. E C1 c n3 co C ca. U O a) N 2 N N-,Ce) L U >� U : Mv'- 'd Cg. p N C CT to > to C 0 E L (n § v o r- = C h a) I- toiti 9. a a)to�aa)a)._.__ 7•C C3 0 U E w -7.. E O3a .� ,,>.Ua Q v a) n U rn O •— L-.�-•C N C a) a O U iCa)a) .2 a a) H V c ma on 6 Y C QQ� a) SI f0 a) a) '0 to w L Y C a) a) °� CD 7 V a) u O d a) O 0 N '7 Cr) CO to N O COO N. N O CO I— 0) 'Cr N.. CO Z r> 6) V CO O al o r O O Or) r O Lt") N-- Cl) Z r O to CO CO V' CP CO r 0 Cn CO N 0 N CO N 0 f-- CO C'7 0 CO (0 0 t- CO O 0 N CO •tC) CP (O CO CO CS) (O CO co r O CO Co O N- CO N CO CO > > CO o O V N O to O V NIs- O CO coo coo r CO O m r CD O coo (0 1� O ono CO Cr O coo V I- N co N V CO 7 7 O CO o CO Cl- r OO N O D CO CO to O V CO CO CO CO M V CO CO CD N- C--- CO V V OV O CO V o r O 0 m N O 0 co CO CO 0 co to N 0 co to r V co to r V `°) O r N CO H Z w • w -J Z D 0 � w > _ Z IL co = W W J LL < (7 W 2 0 U J J Cn CD � D r. 0_ 0 U- N O ; I- Li' Z U W 2> 0_ • W < U) 0. I W I-- 0 >- a H W Z = D O 11 U w 0 D J 0_ W I - z W 2 z 0 z W 2 I - J W J a LL 0 I - W 2 I- Q' a 0 0 U 0 J W W J 0 Z 0 N W W LL 0 z 0 0 r 0 5 U) LU N x I - J Q W 0 J a C 41 E E o 0 C cocu o I CO O 0 c E a) N C Tozz O a) w U) a) (Z W O U c _E- a) CDCL) N C O O o U) m Q_ "O o O U c E- a N C O o (-9 U) a) 0_ CO 0 J 0 .2 : 4) N Ca 4) U C CO 0 7 2 D CO (O U C i N O O `.) 0 ti a) C v N N U c E a) co c To : a Q) co Cl) a) Q_ I I I I I u) NO U@ a a) o Cuo t0 co O 7 a cD a) .c 0 a) c- c f N ,� M •� -O 0 a) -. U) a) Q_ CI) Ti; U a 0 coN Ts _ U c0 O 7 t U) (U a) c a) U 2 a) N 3 z a) a (U - Co > ca CD o Z c O !� ._, C co a t_ a aiS > N t E O lmI a) a) CO co a) 0 c_ o r) M co v r m �_ O O O A O ID it I CO. O 0 a) 0 coc U ca o J v a) R WI c ' CO O 0 4? 0. •0 co > 5 O) O J U) U) CO .c --2 t„) et r LC) rrr etsr r iC)tr) r r to N to N to N to N m4 Mr rtn Mr tr)to MM ON Nrtr) N O) LU U) 149.35 149.35 62.83 to N N. 0 M Minio6O)N000to r r 0)stOtotoOOO0) r N. r r O M O V' r N O O O Nt OD ONOMto O OtoOOOto M O OO 0) N N Or O OO)Ot)OOON O (O NrrOtpN O N N LO O r O r N r r I— Z W Q! Q: D 0 000 NN v r -N v r 4tri r 0 0 N 0 0 tri N 00 ON .- Mr v 00 00 tri tri Tr N O O ri U) 00 00 tri •p' r tri •cr r 0 O r (O O 0 tri N 0 0 o r r 00 ON M4 NI— 00 00 in tri v r) r N 0 0 rin i CO 0 0 v 'Cl- 00 00 cci MN t 000 000 N 000 co t 00 00 tri 00 r of r PROPOSED HOUSEHOLD CODE SIZE Code Code Code Code Code 1 2 3 4 5 00000000000 00000000000 N N N N N O N N CO O (V Cr) O (V N Cr) N O 47.00 253.00 000 000 666 LO 150.00 150.00 000000000 000000000 O M CO O co N O Ns- r r o co N N N 0.00 159.00 242.00 115.00 115.00 115.00 115.00 x.00 0.00 0.00 0.00 0.00 0.00 46.00 46.00 46.001 46.00 46.00 0.00 0.00 0.00i 0.00 0.00 99.00 99.00 _ 99.00 99.00 99.00 45.00 45.00 45.00 45.00 45.00 0.00. 0.001 0.00 _ 0.00 0.00 109.00 ~ 109.00 109.00 109.00 109.00 71.00' 71.00; 71.00 _ 71.00 71.00 61.001 61.00 61.00 61.001 61.00 0.00 0.00 0.00 0.00 0.00 109.00 109.00 109.00 109.00 109.00 116.001 116.00 116.00 116.00 '116.00 320 1ID co O Q_ C9 a C _ C. Lt_ L 'v >. C 0 a) O O N 22.00 OOOO 0000 o N c ci 32.00 0.00 (V N ( 00'0 47.00 253.00 OOO 000 666 150.00 150.00 000000000 000000000 O c O ui O.t r O O N N 0.00 159.00 242.00 0000 0000 N N N N N O N 32.00 000000 000000 o N M O N N MN 0 47.00 47.00 253.00 253.00 o 0 o 55.00 0 o O 150.00 150.00 O 0 o 63.00 000000 000000 O 00 N O 4 r r O (x N 22.00 0.00 159.00 242.00 0.00 0.00 215.00 215.00 0.00 0.00 0000 0000 N NNN N N O 32.00 0 0 6 32.00 0.00 N mN N O 00000000000000000 00000000000000000 O M) tr) o 0 o into r r O M (O O 00 N 0 4 r r 000 NN N O ci 10"q" r N N 0000I000000000000 o N N 0 NNONONONNONMO N 0 O I 010 N 0 o M 0 o 0 o M 0 0 0 0 o o MN 0 0 0 0 o 0 'tit) N 0 0 0 o to tC) 0.00 150.00 150.00 000000000 0 OMOODO4000N 0 CO 0 0 N 0 0 r r 0 0 NN 0 0.00 159.00 242.00 ` O d V O ti. 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