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Home My WebLink About20123503.tiff RESOLUTION 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, on December 12, 2012, the Board was presented with revisions to the fee schedule for fees collected by the Weld County Department of Public Health and Environment, at which time it was continued to December 17, 2012, to allow a representative from the Department to be present, and WHEREAS,after study and review on December 17, 2012, the Board deems it advisable to approve the proposed revisions, effective January 1, 2013, 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, 2013. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 17th day of December, A.D., 2012. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO • ATTES:.414(\g" % .Vc %ean P. C• ,ry it Weld County Clerk to the =•, f. "% ( S+ate, ill m F. Garcia, Pro-Tam ! BY: ♦ � s, . Deputy Clerk o he Board ��►f� - 76LU(ut f / /74 ,- rb Kirkmeyer �B APP ED A RM: , ca,Jl C jy avid E. Long ounty Attorney Doug s Rademacher DEC 2 0 2012 Date of signature: ' P-9-1-12— 2012-3503 HL0003 ?ACM—up PHS 2013 Fees. Page 1 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMEN1J PUBLIC HEALTH SERVICES sad 2013 SUDINO FEE SCHEDULE I Revised 10526112 I HOUSEHOLD CODE SIZE Procedure Code Codo• Code. Code Code 2012 Code Procedure 1 2; 3 4 5 FEES New Client $0201 Focused•',Urea Nair 0.00! 10.50 21.00 31.50 42.00 41.00 00200 Expanded' .0.007- 25.25 50.50 75.75 101.00 98.00 _-_ aOXa DB.wled' -- 000 33.0] 68.01 99.00 13200 128.00 sox Conpmhensivo' 0.00' 49.25 98.50 147.75 197.00 191.00 Established Ctienl Sa211 NuteeYIaIr 0.00 975 1950 29.25 3400. 38.00 00212 Focused' --- 0.00 1650 3300 49.50 156.00. 64.00 53213 E101nded' 0.00 21.25 42.50 63.75 65.000. 83.00 94914 Delated' O.D0 33.50 67.00 100.50. 134.00' 130.00 Horne Visits _ 03941 New Client-Foaled /9.00 79.00 7900; 79.00! 79.00 77.00 93942 !New Client-Exuded 7900 79.00 7903j 79.00 79.00 77.00 'ow ;Eat Client_Focused 7900 79.00 79.00 79.00 79.00 77.00 seas :Est Client-Expanded 79.03 79.00 79.00 79.00 79.00 7700 PrevontivoMediclao Counseling _ _ 05401 :1415343313181-15 min' 000 1050 21.00 31 50 42.00 41.00 954@ Indwdual-30 min' 0.00 13.00 26.00 3900 52.00 50,00 93403 Indnidual-45 min' 1 0.00 10:75 29.50 44.25 59.03 57.00 I Travel Visits I Wren._ _ . .. .. Individual Initial al Visit-50 66. 66.001 86; 6500 56.00 64.00 054001' Relum Me4 4200 4209 42.00 4200. 4200 41-00 954+2 Group Initial Veit-60 42.00 42.00' 42.00 42.00 42.00 41.00 Preventive Medialne ea3e4 NewGent 12.17 years old' 0.00 33.00 68.00 99.00 132.00 12800 99m2 New C1ee 1839 years old, 0.00 33.00 68.00 9900; 132.00 _12601 9059' New Caen!4064 year,me 0.00 3550 71.00 106.50. 142.00 135.00 99394 Est.Qom 12-17 yours old` 0.00 21:25. 42.50 53.(5 85.00 63.03 soe Est.Caen 1639 years olio 0.00 21.25 42.50 83.75 85.00 83.01 99393 Chem IIeoND64 year,OH' D.DD23.50 47.00 70.50 84.00 91.00 Additional Codes 0071W .Commun.y Education 1 hr. 64.00 84.00 64.00 64.0D 64.00! 62.00 o0avn Tawas Printout __. _ 8.00 800. 8.001 6.00 8.00 7 00 Gam ENV Mother-Task Cate MgmL 12.00 1200 I2.00'! 12.00 12.00 12.03 T10V ;;ENV CNM-Teak Care flirt _ 1200 1700. 12.00 12.00 12.00 12.09 OmY// iSwllt Annual FP 311.00. 311.03 311.00 311.00 311.00 302.00 SNEXarn pre-pay 60.00± 60.00 60.00 60.006900 5700 99499 TS Consultation 37.00: 3710 37_00 37.00 3700 3800 PROCEDURES =a.x Sallham Cyst _ 3000• 30.00 30.00 30.09 3000 29.00 Imo_ biopsy of slip,sirglo 2800' 28.00 2803 28.00. 2801 27.00 maw Cc vcai Lesion Biopsy 73.00, 33.00 33031 33.00. 33.09. 32.00 Cuero Cheat X-Ray(Prepay) 57.00. 57.00 57.00 57.09 5/.001 55.00 2012-3503 PHS 2013 Fee. Pa0►2' Procedure Code Code Code' Code Code 2012 Cod. Procedure P 2 3 4 8 rtEs_ I 57402 •I Cuaoscopy w/o Diann' 92.00 92.00, 92.00 92.00 92.03 90 CO 57154 CotposoapywithedopW" 92.00 92.00'. 9200 9200 92.00 9000 575,1 Cryocauuvy cervix-mlbal or repeat I 102.00 102,00 10200 102.00 102.00 999.60 txai Clyoberapy that lesion" 27.00 27.00 27.00 27.00A:,'�- I 26.00 pm Cryoterapy2-14lesions" 27.00 27.00 27.00 27.00 i-( ' 28 CO =4 Cryoe,ompyl5.lesions" 27.0D 27,00 27.00 27D0r .., 2600 599.'1 Destruction Lesio — n Wive 91.00 9100- 91.00 9100 91.01 680 57170 oiaphreyn'Cervical Cap Filling' 0.00 20.25 40.50 6075 81.00 79.00 wile Endomogial dopey wive o41,. 45.00 4500 45.00 4500 45.00 4400 mina ErdomelyLrldolasy web Codoscopy 58.00 5600 58.00 5500 58.00 5800 Essure by referral'^ _ 0 00 000 0.00 0 0 0.00 11403 ExaaoM,benign lesion 79.00 7903 79.00 79.05; 19.00_77 00 uses Implant(i lnsedion 0.00 42.25. 84.50 126.75 169 0 164 0 into Incision 8dairope olaauee.Odle or simple 32.00 32.00 32,00 3200 32.00 3t;0 seta Insertion IUD' _ 0.00 42 50 85.00 127.50 170.00 165.00 574ae ,LEEP wall prepay 13900 13903 139.00 13900 139.00 135.00 57441 ,LEEP wth c0lkzabon 232.00 232.00. 232.00! 232.0D 232.00 225.00 man 'Level 4-SwOical pafholo3y 1st site 93.00 93.031 93.60 83.00 93.000, 90.05 oe7aw" tied4seetsi aurorae am an owl sal 90.001 93.03 93.00 93.00 93.04. 90.00 59:775. Non Suess Test Inleap I 0.00; 000 000. 0.00 0.00; 1,97a Removal,eWlael contraceptive(Impianon) 0.08 50.25 100.50 150.75 201.00 195.00 meet Removal implant w1M reinsertlan I 0.00 77,25 164.50 231.75 300.00 300.00 eaa01 RorramallCD' 0.00 34.00 88.00 102.00 138.03 132.00 Ma Surgical Tray 61 CO 61.00 81,60 61.00 61.00 59.00 Shaving or epidermal region.saute co hunk. 113w arm%cc legs,.son 35.00 38.00 36.00 38.00 38.00. 37.00 FAMILY PLANNING SUPPLJE�19 _ R42e7 Condoms pkg.10' 0.00 1,60 300 4.50, 60 6.00 005Tv Cyde Beads' 060 2.75 5.50 8.25; 11.0, (1 00 Mxa Diaphragm' 0,60 6.50 13.0 19.50 2600' 25.00 Maw Foam Contraroplon' 0.00 2.75 650 8.25 11,0` 10.00 MO/ IrepWnon'Nexptl 00 non _ 95.50 .191 IX1- 288.50 382.00, 371.00 J7s'Je IUDMIrena 000. 168.00 212.01 318.0. 424.0- 412.00 nano IIUU Per137eN 0.0'. 66.50 133.00 199.0' 25500' 258.00 41oss Medroxyprogosterone l5 IM De o' 0,0:_ 4.50 9715 13.50 1800 17.00 Lass Nova Ring 001 7,75! 15.50 23.25 31.00 31.00 San Oral ConuaceetNee' 00: 5.75:' 11.50 17.25 23.0': 2300 .._new 8 Seeeond .0 e 0 75.00� 00 30. 45.00 .0; 6000 maw Today's Sponge 0.00 1,00. 2.00 3.00 4 00 4.0 LA@ 0214) Assay,body gad,glucose,W88)' 0.00 4.25 8.50 12.75 17.0 16.00 ems CSC Wail 180 18.03 18.00 18.0' 18.0 17.0 55027 CBCwlo Dig 16.00 16.00 16.00 1600; 76.00 1500 nut Chlamyda PCR' 0.00 625 12.50 18.75 24'.00 11/45i Ns Chlemyds PCR'-full fee 25.00 250 25.00 25.00 24.0 easew Court Ordered Lab Dray 15.00 15.00 15.00 15.00 15.00 15.0 aim FSH 33.00 33.00. 35.00 33.00 3210 LAB Iconfinued) _ I one GOnonhea PCR' _ 0.00 8 25 12.500 13.75 24.00 0759915 GOnOrmea PCR'-full fee 25.00. 2.5.0 25.00' 25.0 2400 Infola Glucose Random 7.0; 7.00 7.00 7.00 7.00 8.00 snit .Gluooeerc*ranoa Teat 2 hr(611) 220' 22.0_2200 22.0 2260 21,00 once Gram Slag 24.00 24.00 24.00 24.00 24.60 23.00 a4ma ;H000uantilalivo-Senn PregnanryTeel 38.0 38.00 380 38.00 360 37.00 mice HCG Quaftafve.Semrn Pregnancy Teel 38.00. 38.00 38 CO 38.00 38.03 37.00 ewe Hop esarlscetieieoay 2166 21.00 21.00 21.00 2100 20.00 nipso _He7pee Culture 88.0: 66.00 86.0 88 CO 86 03 64.00 awes Herpes Sad-Ty o l(599997133) 64.0', 64.00 04.01 6480 64.0 62.00 PHS 2013 Fees Page 3 Procedure Code Coda Coda'- Code Code. 7012 Code Procedure 1 3 6. 4 6 FEES sem Herpes Sdorl-Tyro II(89499433) Ci CO, 84.00 64.00 84.00 84.00',---6200 sews NG6.fFinger5tltlt)• 0.00 3.25 6.50 9.75 13.001 12.00 £970) HIV Screen,ELISA 21 00. 21.00 21.00. 21.00 21.00 20.00 erezl HPV,High N Stain 66,00 BB.OD BB,CO 88.00 68.00 64 CO 0 noaazYl Immunohie0md10micI %CO 9400 94.00 94.00 %.00 91.00 1a03? LH 33.00 33.00 33.00 33.00 33.00 32.00 scam Upid Panel•SFS'- 0.00 6.50 17.00 25.50 34.00 33.00 nom Upld Panel 3400 34.00 34.00. 34.00 34.00 33.00 ee0ro liver Panel 27.00 27,00 27,00. 27.00 2700 1 .00 °coo Metabolic Panel _ 78 CO 26.0D 2800 28.00 28.00 27.00 422?. Occult Mood Test Fecal IA 0.00 6.50 13.00 19.50 26.00 25.00 45142 Pap-Then Prep' 0.00 moo 20.00. 30.00 40.00 37.00 aeon• Pap,repeat thin prep 40 CO 4040 40.00 40.00 40001 3700 *BO, Proedin 34.00 34.00 34.00 34.00 34.00' 33.00 50522 RPRJSyphillis tea: 20.00 20.00 20.00 20.00 20.00 19.00 £4453 Ts 43.00 43.00 43.00 43.00 43.00 42.00 14430 14 7.00 700 7.00 7 00 7.00 800 4774 TriGpmpnas veinal*-amplified 10.00 10.00 1000 10.00 10.00 M4.] ITSi. 1 31.00 31.00 31.00 31.001 31.00 31.00 i£4s] Tu_eiCutSe TCsl'Olanbie(Or(IGRAI I 62.00 82.00 62.00 82.00 82 CO 82:00 431001 Urinalyset complete vim micro ex 6.00 6.00 6.00 8.00 6.00 $1002 lUnnalysis.WO 3COM(JAI I 9.00 9.001 9C0 9.001 9.00 603 woes Urine Culture.Comp:hereof. 10.00 10.00 10.00 10.00 10.00 41025 Urine PreganancyTezr 0.00 3.00 6.00 9.00 12.00 11.00 alms Ven ncmre 5.00 5.00 5.00 5.00 5.00 lou - ZOOlsil VeePrep rerlth 994110fee lab . 1.25 2.50. 3.75 1.00 00 $720 Wee Prep 21.0019.00 21.00. 21.00 21.00 21.00 MEDICINES and TREATMENTS _ COMMA Adana cream 25.00 25.00 25.00 '25.00 25.00 ammo (Am.9wcllm 815 mg*20 14.00 14.00 14.00 14.00 14 CO 13.00 m oz4' Aaylhrornycir.2 park 1400 14.00 14 CO 14.00 14.00 13.00 wow. Azehromycn lg-padrar pads 10.00 10.00 10.00 10.00 10.00 11.00 olesw Arehromycm Stale syppllsd 040 0.00 0.00'. 0.00 000 J03Oa CeMaxone 250 mg 27.00 27.00 2740 27.00 27.00 26.00 meow tCeMexorre 25D mfs1ete Supplied 0.00 -0:00- 000 0.Oo 0.00 _ acano I Cephalexil500rrg 814 9.00. 9:00_ 900 9.00 9.00 8.00 mem 'Ciprobxon 500 mg M 14.00 14.00 14 D7 14.00 14.00 13.00 icasr Condylox 7.00 7.00 _ 7.00 7.00 7.00 6i0 aasw I DOxycychno 100 mgd14 1000 10.00 1000 10.00 10.00 9.00 wane Eslradial 1 mg NIOO _ 14.00 14.00 14 00 14.00 14 CO 13.00 cplmv IFluconazole 150 mg*1 1700 17.00 17 CC 17.00 17.00 16.0D maw t Iron 11 CO 11.00 11 DC 11.00, 11.00 10.00 JOS90 I LA Bidllin 2.4 Unas O:C0 0.00 O 3C 0.00' 000. came HAe5roxyprcgeserone 10 mg-*O 14 CO 1400 14 00 :4.00 1400 13.00 cam: I Mmr000l _ 9.00 9.00 9 DO 9.00 900i 8.00 crow Melronidaxole 500 mg IM 9C0 9.00 900 5.00 300 8.00 COmy Melionmezote 503 mg d14 1000 10.00 1003 000 17001 - 00 5.00 coin. Melronldszde 250 mg 028 1500 15:00 1500 '500 1500 14. came 61Hoprostel(Cylmec)200 mcg 62 700 7.00 70J 7.00 7.001. 6.00 c01w I NIooMrenmin Macrocrystals-0l4 41.00: 41.00 41.03 41.00 41.07 40.00 memo Ofloxacn -� 95.00 96.00 96.00 66.00 9640 03.00 wow PpdophyllinrTCJ1__. 14.001 14.00 14.00 14.00 14.00 13.00 00558 ;P!omarn Vaginal Cream 13.00; 13.00 13.00 13.00 13.00 12.00 _4.97N PrenatalWoman _ 11.001 1100. 11.00 11 00 11.00 11.00 cot.? SURemrn SMX(TMP 9.00 9.00 9.00 9.00_ 9.00 8.00 mow' .Suprex400 mg el-palmm pak 23.00 23.00 23.0D 2300 23.00 cols,C Suprax 400 mg 01-Stale Suppled I 0.00 0.00 0.00 000 000, PHS 2013 Fees PeDe4 Procedure Code Coda Coda Code Code 2012 Code Procedure 1. 2 3 4 b FEES IMMUNIZATIONS 007.10 Convex-Moo B B HIo 0.00 0.00 0.00 0 00; 0.00 007a DTaP-VFC 0.00 000; 0.00 0.00) 0.00 some DTaP-Child 27.00 27.00 27.00 27.00 21.00 sego DTP 0.001 000? 0.00'. 0.001 0.00 ECg3 He ones A-VFC 0.00I 0.00I 0.00: 0 ool 0.00 se= Hepatitis A-Chili 29.00 29.00 29.00 29.00 2000 5eo53 I Iicpales A-Mull I 4500 4511 45.00 45.001 45.00' 650] “744 Hepalls B•VFC 0.CO ODD 0.00 0.00 0.00 00744 Hepatlt B-CMb 24.00 24.00 24.00 24.00 24.00 alb f H4cetlta B-Rdait 1 45.00 45.001 45.00 45.00' 45.00 45.00 0x47 !NIB-VFC 0.00 0.00 000 0.00 000 seem HIB-Child 3300 33.00 33.00 33.00 33.00 _ axe HPV-VFC 1 000 0.001 0.031 0.00 ono_ 114$C HPV-Chili 16000 160.00 160.00 160.00 100.00 0vws/1 MPV-Adult 16D.00 160.00' 16.0.00 16000 160.03' 160.00 0x49/1* HPV-Adult-317 vaccine 000 0.00 0.00 0.00 0.00 ant 0Hopali6sA _ 003; 0.00 0.00 0.00 0.03 Sawn Inn,Attalla one vaccine 14.70 14.70 10.70 _14.70 14.70 0547, nmMm4h-each addl.Vaocinc 14.70 14.10 14.70 7470 14.70 00175 Iran.Admen-intranasol or oral 14.10 14.70 14,70 14.70: 14.70 41.67 nfuonia infant.VFC(8 mu tlw 35 me] 0.00 0 CO 0.00 0.00: 0.00 eaosme nfuorde Intel.ChM(6 No dim 35 mo) 25.00 25.03 25.00 25.0D 25.00 $O%11+ Miriama-VFC(3 years thru IS rears) 0.001 0.00 0.00 0.001 0001 memo ntsnza-Child(3 Years dlru 18 Yeas) 25.00 25.00 25.00 25.00 25.00 soesu nlltenia-AdUt(Ages 198 aver) I 0.00) 0.D0 000 0.00 0.00' cease/. nfluanza-MU;(Stale Vaccine) 0.00) 000' 0.00 0.0D 0.00' HMO nluonia- iMranasal use 0.00; 0.00 0.00 0.00 0.00 lee oA neuenxa.Intranaeal Ad11t 31.00 31.00 31.00- 31.00 31 CO 25.00 coax enema-InWanaea'Child _ 31.00 31.00 31.00 31.00 31.00 naxe nfuenza-Mmin.-MEDIGRE 14.70 14.70 1470 14,70; 14.70 14.70 seem PV-VFC 0.00 0.00 000 0.00 0.00 sodas PV-Ott 46.00 45.00 45.00 45.00 45.00 45.00 a)31µ PV•AdNI 45.00 45.00 45.00 45 CO 45.00 mss apanese EnoephM%(row formulation) 245.00 245.00 245.00 245 CO 245.00 '2,30.00 00690 Ken%-VFC(DTaP/IPVl I 0.00 0.001 0OD 0.00 000. ammo Kmdx-Chid(DTaP/1PV) 53.00 53.00 53.00 53.00 53.00 110/34 Menem.VFC 0.DD; 0.00 0.001 000 0.001 semen Marmara-Chin (MCV4) 145.00 14500 146.00 145.00 145.00 omen Monsclra-Adult(Menveo)(con)uguel 12500 125.00 :25.00_ 125.00. 125.00' 120.00 eete.t&' Menecira Mull-317 Vaccine 0.00 0.00 0.00 000; 0.00 aril Meningms-(MenamulejpolysaCd)abe) 126.00 12500 12500 125.01 125.00 120/00 00707 MMR-VFC 0.00 0.00 0.00' 0.00 0.00 encore WAR ChM 61.00 61.00 61.00 81.00 61.00 007074 MAN-Adult 61.001 61.00'; 81.00 61.00 61.00 6100 00So74r 'WAR-Adult-317 Vann 0.00: 0.07) 0.00 _ 0.00 000 cone IMMRV 0.04R 8 Waive)*Produad 0.00 0.00_ 0.00 0.00 0.00 7z1 s4 Pododx-VFC(01AP,IPV,Hop B) 0.00 0.00 0.00 0.00 0.W some PcW1dx-ChM(DTaP4PVMbp co 75.00 75.00 7500 75.00 76.00 see'.+ IPerdacel-VFC 1 0.00 0.001 000 0.00 0.00; ,camc Penises]-Child(DTePAPV?HOPS) 110.00 110.00 110.00 110.00 110.00 ae70 Pnetenccecal conjugate I. 000 0.00! D.OD 0.00 000 _ 10732 kneunwvax-VFC I 000; 0.00 0.00 0.00 000 %?32C Pneu,novex-Child(PPSV23) 80.00 ao.DO 80.00 60.00 00.00 YA5u IPneumonx -Adolf 73.00 73.00 73.00 7300 73.00 6'7.00 aoe30AT Pneumovax-Mut-311VaCC 0.00 0.00 000 0.03. 0.00 0053E Pnaumovax Admin -MEDICARE 14.70 14.70 14.70_ 14 70; 14.70 0310 Prevnar 0.00 0.00 0.00, 0031 .0.00 PHS 2013 Fees Pete 5 Procedure _ Code Code Code! Code Code 2012 Code Procedure 1 2 3 4 5 FEES atomic Prevnar-ChM 1PCV134Fkwor 145,00 145.00 14$00 14500 145.00 wars I Ramos 114 235.00. 235.001 235.00 235.CO 235.00 227.00 4x757 Rates ltA-Aden Temporary 000 0.00 000 0.00 000 00183 Rotaveus-VFC O0C. 0.001 0.00 000 000 nem Rotovlrue-Chad IRV5J 83.00 83.00 63.00 8300 63.00 axe) Rotaro(-VFC 000', 0.00 0.001 0.00 ODD) exe,c Rotarbt-Child IRVIO 115.00 115.00 115.00 115.00 115.00 an:e Td-VFC 000; 0.00 0.001 000 0.001 >ntC Td-Child 44.00 44.00 44.00 4400 44.00 ems* Td-Adult 44.00 44.00 44.00 44.00 44.00 en15 Tdao-VFC 0 Kii 0.00 0.001 000 0.001 eatraC Tdap-Chad 44.00 44.00 44.00 44.00 44.00 *0715, Tdap-Mull 44.00 49.00 44.00 44.00 44.00 on'axr Tdao Adult-3❑vane 000 0.00 0.00 000, 0.00 ease] rubereuloeie lnlerdermal Ski Test(PPE)) 25.00 2500 25.00 25.00 25.00 Tuberculosis Inlerdermal 5kil TestlPPOJ 015117/ reading only MOD 0.00 0.00 0.01 0.00 _.. rave Twndx-Hap A 811ep B 87.00 67.00 67.00 67.00i 67.00 67.00 00/0617 IvanraMon 317 vaccine I lea A8 Ilea 0 0.00 0.00 0.00 0.000 0.00 sow lyphold-1 Snot 68.00 8800 68.00 65001 88.00 6700 some lyphod-Orel 570D 57 CO 57.00 57_02 57.00 57.00 aorta .Vanvax-VFC 0.00 CC0 0.00, ODD) 0.00 some Vadvax-Child 105.00 10500 105.00 105.00 106.00 mane% Var.vax /VIA100.00 100.00 100.00 100.00 100.00 9601 Bn _15AT Vaevax-Adult-317 Vaccine 0.00 000 0.00 ODD 000_ 50717 7elbly Fever 109.00 109.00 109.001 109.00 109.00 103.00 1 •'Fens only side for the Famty Panning Program. Charges ter all abler pregrama are the Coda 5 fee. " services Include surgical procedure only. I 1 I I _Miscellaneous II -.- mc Scv.Incudes Follow-up Care 0.00 -DAO 0A0 o.OD 0.00 55212 Antepartum Care I viol 64.00 64.00 64.00 64.00 64.00 11112.5 Aniepartum care 48 visits 586.00 586.00 586.00 586.00 586.00 !9ma5 Ante_partum care 7 orlmre ass 1205 CO'' 1205.00 1205.00 1205.00 1205.00 won_ PE Establshng Medical Recnnf 56.00 55.00 56.00 56.00 5.6.00 wawa Phone rail _ 0.00 0.00 000 000 0.00 stow PO*t Parton Only 10800 106.00 10602 106.00 105.00 moos Prenatal Plus(14 visits) 17000 170.00 170.00 170.00 170.00 111001 Prenatal Plus,16avisial 451.00 954.00 954,00 454.001 45400 111505 Prenatal Plus(10 vlalrej 852 03 652,00 852.00 852.00 852.00 *loos_ Prenatal Plus(11 or more visits) 985.00 965.00 965.00 965.00; 965.00 Re1/.1177/12 I Clean ye-Ys/cu PHS 2013 Fees Page 1 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT I PUBLIC HEALTH SERVICES and -� 2013 SLIDING FEE SCHEDULE Revised 11/7/12 - HOUSEHOLD CODE SIZE Procedure Code Code Code Code Code Code Procedure 1 2 3 4 5 VISITS ' New Client 99201 Focused-nurse visit 0.00 10.50 21.00 31.50 42.00 99202 Expanded* 0.00 25.25 50.50 75.75r 101.00 99203 Detailed* _ _ 0.00 33.00 66.00 99.00 132.00 99204 Comprehensive* 0.00 49.25. 98.50 147.75 197.00, Established Client 99211 Nurse Visit* 0.00 9.75 19.50 29.25 39.00 99212 '..Focused* 0.00 16.50 33.00 49.50 66.00 99213 Expanded* 0.00 21.25 42.50 63.75 85.00 99214 Detailed* 0.00 33.50 67.00 100.50 134.00 Home Visits -- - - -- -� _ 99341 New Client-Focused 79.00 79.00 79.00 79.00 79.00' 99342 New Client-Expanded 79.00 79.00 79.00 79.00 79.00 99347 Est. Client-Focused 79.00 79.00 7900. 79.00 79.00 99348 Est. Client-Expanded 79.00 79.00 79.00+ 79.00 79.00 Preventive Medicine Counseling _ - 99401 Individual- 15 min* 0.00 10.50 21.00 31.50 42.00 99402 Individual-30 min* 0.00 13.00 26.00 39.00 52.00' 99403 Individual-45 min* 0.00 14.75 29.50 44.25 59.00 - Travel Visits _ _ - --- 99404 Individual Initial Visit-60 66.00 _ 66.00 66.00 66.00, 66.00 99401W Return Visit 42.00 _ 42.00 42.00 42.00 42.00 99412 Group Initial Visit-60 42.00 42.00 42.00 42.00 42.00 Preventive Medicine 99384 New Client 12-17 years old* 0.00, 33.00 66.00 99.00 132.00', 99385 _ New Client 18-39 years old* _ _0.00 33.00 66.00 _ 99.00 132.00 99386 New Client 40-64 years old* 0.00 35.50 71.00 106.50 142.00 99394 _ Est.Client 12-17 years old* _ 0.00 21.25 _ 42.50' 63.75 85.00 99395 Est. Client 18-39 years old* 0.00 21.25 42.50 63.75 85.00 99396 Est. Client 40-64 years old*_ - 0.00 23.501 _ 47.00 70.50 94.00 Additional Codes 0071W Community Education 1 hr. ; 64.00 64.00 64.00 _ 64.00. 64.00 0069W Travax Printout 8.00 8.00 8.00' 8.00 8.00 O9006 NHV Mother-Task Care Mgmt. 12.00 12.00 12.00 12.00 12.00 T1017 NHV Child-Task Care Mgmt. _ _ 12.00 _ 12.00 _ 12.00 12.00 12.00L 0072W 'Swift Annual FP _ _ _ 311.00 311.00, _311.00 311.00 311.00 STI Exam pre-pay _ _ _ _ 60.00' 60.00 60.00 60.00, 60.00 99499 TB Consultation 37.00 37.00 37.00 37.00' 37.00 'PROCEDURES 56420 Bartholin Cyst 30.00' 30.00 30.00 30.00. 30.00 11100 Biopsy of skin, single _ _ 28.00 28.00 28.00 28.00 28.00 57500 Cervical Lesion Biopsy _ 33.00 33.00 33.00 33.00 33.00 0116w Chest X-Ray(Prepay) 57.00 57.00. 57.00 57.00 57.00', PHS 2013 Fees Page 2 Procedure Code Code Code Code Code Code Procedure 1 2 3 4 5 57452 Colposcopy w/o Biopsy** 9.2.00 92.00 92.00 92.00 92.00 Procedures(continued) _ - - - 57454 IColposcopy with Biopsy** 92.00 92.00 92.00 92.00 92.00 57511 Cryocautery cervix-initial or repeat 102.00 102.00 102.00 102.00 102.00 17000 Cryotherapy first lesion** 27.00 27.00 _2T00 27.00 27.00 17003 Cryotherapy 2-14 lesions** 27.00 27.00 27.00 27.00 27.00 17004 Cryotherapy 15+lesions** I 27.00 27.00 27.00 _ 27.00 27.00 56501 Destruction Lesion Vulva 9.1.00 91.00 91.00 91.00 91.00 57170 'Diaphragm/Cervical Cap Fitting* 0.00 20.25 40.50 60.75 81.00 58100 Endometrial biopsy w/wo Biopsy 45.00, 45.00 45.00 45.00 45.00 -- 58110_ Endometrial biopsy with Colposcopy _ 58.00 58.00 58.00 58.00 58.00 _ Essure by referral*** - 0.00 0.00 0.00 0.00 0.00 11400 Excisions, benign lesion 79.00 79.00 79.00 79.00 79.00 11981 _ Implanon Insertion I 0.00 - 42.25 84.50 126.75 169.00 10060 Incision&drainage of abcess,single or simple 32.00 32.00 32.00 32.00: 32.00 58300 Insertion IUD* _ 0.00 42.50 85.001 127.50 170.00 57460 LEEP with biopsy - 139.00 139.00 139.00 139.00 139.00 57461 WEEP with conization _ _ 232.00, 232.00 232.00 232.00 232.00 88305 !Level 4-Surgical pathology 1st site 93.00 93.00 93.00 93.00 93.00 88305W Level 4-Surgical Pathology 2nd site&each add! 93.00 93.00 93.00 93.00 93.00 59025 Non Stress Test Interp - 0.00 0.00, 0.00 _ 0.00 0.00 11976 Removal, implant contraceptive(Implanon) 0.00 50.25' 100.50 _ 150.75 201.00 11981 Removal implant,with reinsertion 0.00 77.25 154.50 231.75; 309.00 58301 Removal IUD* 0.00 34.00 68.00 102.00 136.00 A4550 Surgical Tray - 61.00. 61.00 61.00' 61.00 61.00' Shaving of epidermal lesion, single on trunk, 11300 arms or legs, .5cm 38.00 38.00 38.00 38.00 38.00 FAMILY PLANNING SUPPLIES A4267 Condoms pkg. 10* 0.00 1.50, 3.00 4.50, 6.00 0052W Cycle Beads* 0.00 2.75 5.50 8.25 11.00 A4266 'Diaphragm* _ 0.00 6.50 13.00 19.50 26.00 A4269 Foam Contraception* 0.00: 2.75 5.50' 8.25 11.00; J7307 'Implanon/Nexplanon 0.00 95.50 191.00 286.50 382.00 J7302 _ IUD Mirena _ 0.00' 106.00 212.00 318.00 424.00 J7300 IUD Paragard - 0.00 66.50 133.00 199.50 266.00 J1055 Medroxyprogesterone 150mg IM(Depo)* 0.00 4.50._ 9.00 13.50 18.00 I J7303 _ Nuva Ring - _ 0.00 _ 7.751 15.50 23.25: 31.00 S4993 Oral Contraceptives* 0.00 5.75 11.50 17.25 23.00 0068W ISeasonale 0.00 15.00 30.00, 45.00 6.0.00 0065W SpoToday'snge P 9 S e 0.00' 1.00 2.00' 3.00 4.001 LAB 82947 Assay, body fluid,glucose, (FBS)* __. 0.00 4.25 8.50 12.75 _ 17.001 85025 CBC w/diff _ - 18.00 18.00. 18.00 18.00 18.00 85027 CBC w/o Diff 16.00 16.00 16.00 16.00 16.00 87491 Chlamydia PCR* 0.00 6.25 12.50 18.75 25.00 87491NS Chlamydia PCR*-full fee 25.00 25.00 25.00, 25.00: 25.00 0090W Court Ordered Lab Draw 15.00 15.00 15.00' 15.00 15.00 83001 FSH 33.00. 33.00 33.00 33.00 33.00 87591 Gonorrhea PCR* 0.00 6.25 12.50 18.75 25.00 87591NS Gonorrhea PCR*-full fee 25.00 25.00 25.00 _25.00 25.00 82948 Glucose Random _ 7.00 7.00 TOO 7.00 7.00, 82951 Glucose Tolerance Test 2 hr (GTT) 22.00 22.00 _22.00 22.00 - 22.00 87205 IGram Stain _ _ 24.00 24.00 24.00 24.00 24.00' 84702 HCG Quantitative-Serum Pregnancy Test 38.00 38.00! 38.00 38.00 38.00 84703 HCG Qualitative-Serum Pregnancy Test _ 38.00 38.00' _ 38.00 38.00 38.00 86706 'Hep B Surface Antibody 21.00 21.00 21.00 21.00 21.00 87250 Herpes Culture 66.00 66.00 66.00 66.00' 66.00 86695 I Herpes Select-Type I (89999A33) 64.00 64.00 64.00; 64.00 64.00 PHS 2013 Fees Page 3 Procedure _ Code Code Code Code Code Code Procedure 1 2 3 4 5 86696 Herpes Select-Type II(89999A33) 64.00 64.00 64.00 64.00 64.00 85018 HGB-(Finger Stick)* - - 0.00 3.25 6.50 9.75 13.00 86703 HIV Screen, ELISA 21.00: 21.00 21.00 _ 21.00 21.00 87621 HPV, High Risk 66.00' 66.00 66.00 66.00 66.00 484006W Immunohistochemical Stain 94.00 94.00 94.00 94.00 94.00 83002 LH 33.00 33.00 33.00 33.00 33.00 80061W Lipid Panel SFS* 0.00 8.50 17.00: 25.50 34.00 80061N Lipid Panel 34.00 34.00 34.001 34.00 34.00 80076 Liver Panel 27.00 27.00 27.00' 27.00 _ 27.00 80048 Metabolic Panel 28.00 2.8.00 28.00 28.00 28.00 82274 Occult Blood Test, Fecal, IA 0.00 6.50 13.00 19.50 26.00 88142 Pap-Thin Prep* 0.00 10.00 20.00 30.00 40.00 0080W Pap, repeat thin prep 40.00 40.00 40.00 40.00 40.00 84146 Prolactin 34.00 34.00 34.00 34.00 34.00 86592 RPR/Syphillis test 20.00 20.00 20.00 20.00 20.00 84480 T3 43.00 _ 43.00 43.00 43.00 43.00 84436 T4 7.00 7.00 7.00 7.00 7.00 87798 Trichomonas vaginalis-amplified 10.00 10_.00 10.00 10.00 10.00 84443 TSH 31.00 31.00 31.00 31.00 31.00 86480 Tuberculosis Test-Quantiferon(IGRA) i 82.00 82.00 82.00 82.00 82.00 81001 Urinalysis, complete with micro ex 6.00 6.00 6.00 6.00 6.00 Y scope( ) ----- - 81002_ Urinalysis,w/o UA 9.00' 9.00 9.00 9.00 9.00 87086 Urine Culture, Comprehensive 10.00 10.00 10.00 10.001 10.00 1 81025 Urine Preganancy Test* 0.00, 3.00 6.00 9.00; 12.00 36415 i Ve n i pun ctu re 5.00' _ 5.00 5.00 5.00 5.00: 36415w Pt sliding fee lab___- _ - 21.00 21.00 21.001 87210 Wet Pfeure with 21.0O 21.03.75 0 MEDICINES and TREATMENTS ! 0036W Aldarra cream 25.00 25.00 25.00 25.00 25.00 oozow Amoxicillin 875 mg#20 14.00 14.00 14.00 14.00 14.00 0062W Azythromycin,Z pack 14.00 14.00 14.00 14.00 14.00__ 101456W Azithromycin 1g-partner pack 10.00 10.00 10.00 10.00 10.00 0456W Azithromycin State supplied 0.00 0.00 0.00 0.00 0.00 J0696 Ceftriaxone 250 mg 27.00 27.00 27.00 27.00 27.00 0696W Ceftriaxone 250 mg State Supplied 0.00 0.00; 0.00 0.00 0.00 0007W Cephalexin 500mg#14 9.00 9.00 9.00 9.00 9.00 000sw Ciprofloxcin 500 mg #6 14.00 14.00 14.00 14.00 14.00 0035W Condylox 7.00 7.00 7.00 7.00 7.00 000sw Doxycycline 100 mg#14 10.00 10.00 10.00 10.00 10.00 0ossw Estradiol 1 mg-#100 • 14.00 14.00 14.00 14.00 14.00 0011w Fluconazole 150 mg#1 17.00 17.00 17.00 17.00 17.00 0012W .l 1___-- . ,..- _ 11.00 11.00 11.00 11.00 O J0580 LA Bicillin 2.4 Units 0.0 0.00 0.00 0.00 0.00 O 060W Medroxyprogesterone 10 mg-#5 14.00 14.00 14.00 14.00 14.00 0008W Metrogel 9.00! 9.00 9.00 9.00 9.00 mow Metronidazole 500 mg#4 9.00. 9.00 9.00 9.00 9.00 O 010W Metronidazole 500 mg#14 10.00 10.00 10.00 10.00 10.00 0013W Metronidazole 250 mg#28 15.00 15.00 15.00 15.00 15.00 mom Misoprostel (Cytotec)200 mcg#2 7.00 7.00 7.00 7.00 7.00 0061W Nitrofurantoin Macrocrystals-#14 41.00' 41.00 41.00 41.00 41.00 0034W Ofloxacin 96.00' 96.00 96.00 96.00 96.00 maw Podophyllin/TCA 14.00 14.00 14.00 14.00 14.00 00006W Premarin Vaginal Cream 13.00. 13.00 13.00 13.00 13.00 0192W Prenatal Vitamins 11.00 11.00 11.00 11.00 11.00 0004W Sulfatrim SMXTTMP 9.00 9.00 9.00 9.00 9.00 ool8ow Suprax 400 mg#1 -partner pak 23.00. 23.00 23.00 23.00 23.00 oo180Nc Suprax 400 mg#1 -State Supplied 0.00, 0.00 0.00 0.00 0.00 PHS 2013 Fees Page 4 Procedure Code Code Code Code Code Code Procedure 1 2 3 4 5 • IMMUNIZATIONS 90748 Comvax-Hep B&Hib 0.00 0.00 0.00 0.00 0.00 90700 DTaP-VFC 0.00 0.00 0.00 0.00 0.00 90700O DTaP-Child 27.00 27.00. 27.00 27.00 27.00 90702 DT 0.00 0.00; 0.00 0.00 0.00 90633 _ Hepatitis A-VFC 0.00 0.00; 0.00 0.00 0.00 90633O Hepatitis A_Child 29.00 29.001 29.00 29.00 29.00 90632 HepatitisA-Adult 45.00 45.001 45.00 45.00 45.00 90744 Hepatitis B-VFC 0.00 0.001 0.00 0.00 0.00 90744O Hepatitis B Child 24.00 24.00' 24.00 24.00 24.00 90746 Hepatitis B-Adult 45.00 45.00 45.00 45.00 45.00 90647 HIB-VFC 0.00 0.00 0.00 0.00 0.00 90647C HIB-Child _ 33.00 33.001 33.00 3.3.00 33.00 90649 HPV-VFC 0.00 0.00 0.00 0.00 0.00 90649O HPV-Child 160.00 160.00 160.00 160.00 160.00 90649A HPV-Adult 160.00 160.00 160.00 160.00 160.00 90649AT HPV-Adult -317 vaccine 0.00 0.00 0.00 0.00 0.00, 90281 IG Hepatitis A 0.00 0.00 0.00 0.00 0.00' 90471 Imm.Admin-one vaccine 14.70 14.70 14.70 14.70 14.70'1 90472 Imm Admin-each addl.Vaccine 14.70 14.70 14.70 14.70 14.701 90473 Imm Admin-intranasal or oral 14.70 14.70 14.70 14.70 14.701 90657 Influenza infant-VFC(6 mo thru 35 mo) 0.00 0.00 0.00 0.00 0.00 90657C Influenza infant-Child(6 mo thru 35 mo) 25.00 25.00 25.00 25.00 25.00 90658 Influenza-VFC (3 years thru 18 years) 0.00 0.00 0.00 0.00 0.00 90658C Influenza-Child(3 years thru 18 years) 25.00 25.00 25.00 25.00 25.00 90658A Influenza-Adult(Ages 19&over) 0.00 0.00 0.00 0.00 0.00. 00658W Influenza-Adult(State Vaccine) 0.00 0.00 0.00 0.00 0.00; 90660 Influenza- intranasal use 0.00 0.00 0.00 0.00 0.0O1 90660A Influenza-Intranasal Adult 31.00 31.00 31.00 31.00 31.001 90660O Influenza-Intranasal Child 31.00 31.00 31.00 31.00 31.00' G000e Influenza-Admin. -MEDICARE -_ 14.70 14.70 14.70 14.70 14.70 90713 IPV-VFC 0.00 0.00 0.00 0.00 0.00 90713C IPV-Child _ 45.00 45.00 45.00 45.00 45.00 90713A IPV-Adult 45.00 45.00 45.00 45.00 45.00 90735 Japanese Encephalitis(new formulation) 245.00 245.00 245.00 245.00 245.00 90696 Kinrix-VFC(DTaP/IPV) 0.00 0.00 0.00 0.00 0.00 90696O Kinrix-Child(DTaP/IPV) 53.00 53.00 53.00 53.00 53.00 90734 Menectra-VFC 0.00 0.00 0.00 0.00 0.00 90734O Menectra-Child (MCV4) 145.00 145.00 145.00 145.00 145.00 90734A Menectra-Adult(Menveo)(conjugate) 125.00 125.00 125.00 125.00 125.00 90734AT Menectra Adult-317 Vaccine 0.00 0.00 0.00 0.00 0.00 90733 Meningitis-(Menomune)(polysaccharide) 125_00 125.00 125.00 125.00 125.00 90707 MMR-VFC 0.00 0.00 0.00 0.0O: 0.00 90707C MMR-Child 61.00 61.00 61.00 61.001 61.00 90707A MMR-Adult 61.00 61.00 61.00 61.00', 61.00 90707AT MMR-Adult-317 Vaccine 0.001 0.00 0.00 0.00: 0.00 90710 __ MMRV(MMR&Varivax) Proquad 0.00!! 0.00 0.00 0.00 0.00 90723 Pediarix-VFC (DTAP, IPV, Hep B) 0.00. 0.00 0.00 0.00 0.00 90723c Pediarix-Child (DTaP/IPV/Hep B) _ 75.00: 75.00 75.00 75.00 75.00 90698 Pentacel-VFC _ 0.00' 0-00 0.00i 0.00 0.00 90698C Pentacel-Child(DTaP/IPV/HepB) 110.00'' 110.00 110.0O 110.00 110.00 90670 Pneumococal conjugate 0.001 0.00 _ 0.00 0.00 0.00 90732 Pneumovax-VFC 0.00 0.00 0.00 0.00 0.00' 90732O Pneumovax-Child(PPSV23) 80.00 80.00 80.00 80.00 80.001 90732A Pneumovax -Adult 73.00 73.00 73.00 73.00 73.0O1 9o732AT Pneumovax-Adult-317 Vacc. 0.00 0.00 0.00 0.00 0.00 G0009 Pneumovax Admin.-MEDICARE 14.70 14.70 14.70 14.70 14.70, PHS 2013 Fees Page 5 Procedure Code Code Code Code Code Code Procedure 1 2 3 4 5 90669 Prevnar 0.00 000 0.00 0.00 0.00 906690 Prevnar-Child(PCV13)Flwoer 145.00 145.00 145.00 145.00 145.00 90675 Rabies IM 235.00 235.00 235.00 2.35.00 235.00 90675AT Rabies IM-Adult Temporary 0.00 0.00 0.00 0.00 0.00 Immunizations(continued) 90680 _ Rotavirus VFC _ 0.00 0.00 0.00 0.001 0.00 90680O Rotovirus Child(RV5) 83.00 83.00 83.00 83.004 83.00 90681 Rotarix-VFC 0.00 0.00 0.00 0.00 0.00 906810 Rotarix-Child(RV10 115.00 115.00 115.00 115.001 115.00 90718 Td-VFC 0.00 0.00 0.00 0.001 0.00 907180 Td-Child 44.00 44.00 44.00 44.001 44.00 90718A Td -Adult 44.00 44.00 44.00 44.00 44.00 90715 Tdap-VFC 0.00 0.00 0.00 0.00 0.00 90715C Tdap-Child 44.00 44.00 44.00 44.00 44.0O, 90715A Tdap-Adult 44.00 44.00 44.00 44.00 44.001 90715AT Tdap Adult-317 vaccine 0.00 0.00 0.00 0.00 0.0& 86580 Tuberculosis Interdermal Skin Test(PPD) 25.00 25.00 25.00 25.00 25.00. Tuberculosis Interdermal Skin Test(PPD) 8658W reading only 0.00 0.00 0.00 0.00 0.00. 90636 Twinrix-Hep A&Hep B 67.00 67.00 67.00 67.00 67.00 90636AT Twinrix Adult-317 vaccine-Hep A&Hep B 0.00 0.00 0.00 0.00 0.00 90691 Typhoid-1 Shot 68.00 68.00 68.00 68.00 68.00 90690 Typhoid-Oral 57.00 57.00'1 57.00 57.00 57.00 90716 _ Varivax-VFC 0.00 0.001 0.00 0.00 0.00 907160 Varivax-Child 105.00 105.0W 105.00 105.00 105.00 90716A Varivax-Adult 100.00 100.00' 100.00 100.00 100.00 90716AT Varivax-Adult 317 Vaccine _ 0.00 0.00: 0.00 0.00 0.00; 90717 Yellow Fever 109.00 109.00;: 109.00 109.00 109.001 • Fees only slide for the Family Planning Program. Charges for all other programs are the Code 5 fee. ** Services include surgical procedure only. "' These items are for referral Miscellaneous -- INC Scv. Includes Follow-up Care 0.00 0.00 0.00 0.00 0.00,, 99212 Antepartum Care 1 visit 64.00 64.00 64.00 64.00 64.00 59425 Antepartum care 4-6 visits 586.00 586.00 586.00 586.00 586.00 59426 Antepartum care 7 or more visits 1205.00 1205.00 1205.00 1205.00 1205.00 99402W PE Establishing Medical Record 56.00 56.00 56.00 56.00 56.00 0255W Phone visit _ 0.00 0.00 0.00 0.00 0.00 59430 PostPartum Only _ 106.00, 106.00 106.00 106.00 106.00 Fit 005 Prenatal Plus(1-4 visits) 170.001 170.00 170.00 170.00 170.00 H1005 Prenatal Plus(5-9)visits) - _ - 454.004 454.00 454.00 454.00 454.00 - H1oos Prenatal Plus(10 visits) 852.00j 852.00 852.00 852.00 1 852.00 H1005 Prenatal Plus(11 or more visits) 965.00 965.00 965.00 965.00 965.00 Rev. 11/7/12 Hello