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Home My WebLink About20063361.tiff RESOLUTION RE: APPROVE REVISIONS TO FEE SCHEDULES 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 schedules 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, 2007, 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 schedules for fees collected by the Weld County Department of Public Health and Environment, as attached hereto, be, and hereby are, approved, effective January 1, 2007. 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., 2006. BOARD OF COUNTY COMMISSIONERS WELD Lr , COLORADO ATTEST: L �� 1�� j B Weld County Clerk to the :t rd p +• '' 0 F )1861 ^t,v ,l 1- C1'�,}�� vid E. Long, Pro-Tem BY: gel'; ec6 \i`ei' �, , Deputy Clerk to the Bo �f, I '‘ /// %f`L✓ ,,) `--.' Willi H. Jerke APPR9D AST -F• . & \ac Robert D. Masden ounty s •mey EXCUSED Glenn Vaad Date of Signature: /°2 c?b-Cco 2006-3361 HL0003 OO: O/-O3--O'7 EHS 2007 FEES Pagel WELD COUNTY HEALTH DEPARTMENT ENVIRONMENTAL PROTECTION SERVICES 2007 FEE SCHEDULE BODY ART FACILITY SERVICES Body Art Facility License $212.50 Body Art Facility - Delinquent License Surcharge $75.00 Body Art Facility - Plan Review $45.00/hr Body Art Facility - Real Estate Site Review $45.00/hr Body Art Facility -Temporary or Mobile Facility License $150.00 Body Art Facility -Temporary or Mobile Facility Plan Review $75.00 CHILD CARE CENTER FEES Child Care Center- Facility Inspection Fee 5-20 Children $25.00 Child Care Center- Facility Inspection Fee 21-50 Children $50.00 Child Care Center- Facility Inspection Fee 51-100 Children $75.00 Child Care Center- Facility Inspection Fee 101+ Children $100.00 Child Care Center- Plan Review/Walk-thru/Pre-opening Inspection Fee $45.00/hr Child Care Center- Health & Sanitation Course- For-Profit Establistments $20.00/pp Child Care Center- Health & Sanitation Course - Non-Profit Establistments $10.00/pp FOOD PROTECTION SERVICES Retail Food Establishment- Real Estate Site Review Greater of$45/hr or$75 Retail Food Establishment- Plan Review Application fee of$75 plus hourly rate of$45/hr(total cost not to exceed $355) Retail Food Establishment- No Fee License $0.00 Restaurant 0 -100 Seats $154.00 Restaurant 101 -200 Seats $175.00 Restaurant Over 200 Seats $189.00 Grocery Store 0 -3,000 Sq Ft $55.00 Grocery Store 3,001 - 10,000 Sq Ft $100.00 Grocery Store 10,001 -20,000 Sq Ft $115.00 Grocery Store 20,001 -40,000 Sq Ft $138.00 Grocery Store 40,001 - 70,000 Sq Ft $175.00 Grocery Store Over 70,000 Sq Ft $250.00 Grocery/Deli 0 - 3,000 Sq Ft $138.00 Grocery/Deli 3,001 - 10,000 Sq Ft $225.00 Grocery/Deli 10,001 -20,000 Sq Ft $240.00 Grocery/Deli 20,001 -40,000 Sq Ft $263.00 Grocery/Deli 40,001 - 70,000 Sq Ft $300.00 Grocery/Deli Over 70,000 Sq Ft $383.00 Special/Temporary Event Plan Reviews $45.00/hr HACCP Reviews $45.00/hr Miscellaneous Services $45.00/hr Weld Star Education Course- For-profit Establishments $20.00/pp Weld Star Education Course- Non-profit Establishments $10.00/pp 2006-3361 EHS 2007 FEES Page2 INSTITUTION SERVICES Board and Care Home License (1 -2 Persons) $50.00 Ambulance Inspection License $100.00/company Ambulance Unit Inspection Fee $25.00/ambulance MISCELLANEOUS SERVICES Environmental Health Specialist Field Time Charge $45.00/hr Biosolids Permit(160 Acre Parcel) $375.00 Septage Permit(160 Acre Parcel) $375.00 Cistern Usage Permit(Initial) $150.00 Radon Kits $5.00 Radon Kits (mailed) $7.00 Fax Fee (up to 10 pages, $.50 per each additional page) $2.00 File Observation Fee $15.00/hr Copy Fee $1.25/page POOL SERVICES Swimming Pool License $200.00 Swim Pool Chemistry Inspection $48.00 Swim Pool Physical Inspection $78.00 Swim Pool Bacteriological Analysis $58.00 Complaint Response and Investigation $45.00/hr Swimming Pool Plan Review (up to 2 hours) $75.00 Swimming Pool Plan Review (each additional hour) $45.00 SEPTIC INSPECTION SERVICES Individual Sewage Disposal System Permit $470.00 Individual Sewage Disposal Repair/Alteration Permit $470.00 Individual Sewage Disposal System Permit Extension $50.00 Commercial Septic System New Permit $600.00 Commercial Septic System Repair Permit $600.00 Septic System Mindor Repair Permit $100.00 Septic System Reinspection Fee $50.00 Holding Tank/Vault Permit $150.00 Weld County I.S.D.S. Regulations $5.00 Systems Contractor License $50.00 Renewal of Systems Contractor License (Annually) $25.00 Systems Cleaners License $50.00 Renewal of System Cleaners License (Annually) $25.00 Existing Individual Sewage Disposal System Evaluation $150.00 Statement of Existing $10.00 Loan Approval Inspection without Water Sample $150.00 Loan Approval Inspection with Water Sample $170.00 Potable Water Sample (collection and analysis) $38.00 Variance Request $50.00 EHS 2007 FEES Page3 METHAMPHETAMINE PROGRAM SERVICES Methamphetamine Lab Assessment $75.00 Methamphetamine Lab Decontamination Permit-Covers up to 5 hours of staff $200.00 time. Review and inspection activities in excess of 5 hours will be billed at an hourly rate.) Methamphetamine Lab- Hourly Rate $45.00/hr Methamphetamine Lab Post-Decontamination Sampling and Analysis -will be billed at the market rate plus staff time. LABORATORY SERVICES MEDICAL/ENVIRONMENTAL Chlamydia/N. Gonorrhoeae Combo, Amplified Test $92.00 Syphilis RPR Screen $5.00 Syphilis RPR Titer for Positives $10.00 Syphilis FTA Confirmation $12.00 State Fee for individual test $25.00 State Fee for multiple tests $38.00 West Nile IgM Antibody $60.00 * Anthrax Culture $35.00 * Anthrax Confirmation $90.00 * Brucella Culture $35.00 * Brucella Confirmation $90.00 * Franciscella Tularensis Culture $50.00 * Franciscella Tularensis Confirmation $100.00 * Yersinia Pestis Culture $35.00 * Yersinia Pestis Confirmation $90.00 WATER QUALITY- BACTERIOLOGICAL ASSESSMENT Total Coliform, PA $16.00 Total Coliform, Quantitray $18.00 Fecal Coliform, Membrane Filtration $27.50 Staphylococcus aureus $20.00 Pseudomonas aeruginosa $20.00 Swim Pool Bacteriological Analysis $58.00 Potable Water Sample (collection and analysis), PA $38.00 Potable Water Sample (collection and analysis), Quantitray $40.00 WATER QUALITY -CHEMICAL ASSESSMENT Alkalinity, Total $11.00 Ammonia $15.00 Arsenic $18.00 Barium $18.00 EHS 2007 FEES Page4 Biochemical Oxygen Demand (BOD) $30.00 Cadmium $18.00 Calcium as CaCO3 $11.00 Chloride $11.00 Chlorine $9.50 Chromium $18.00 Copper $18.00 Dissolved Oxygen $5.00 Fluoride $13.00 Hardness, Total $15.00 Iron $18.00 Lead, water $18.00 Lead, paint chips (includes digestion) $38.00 Magnesium (by hardness calculation) $5.00 Manganese $18.00 Mercury $18.00 Metal digestion (if necessary) $20.00 Nitrate $12.00 Nitrite $12.00 Oil and Grease, Chemical $47.00 Oil and Grease, Visual $2.00 PH/Temperature $9.00 Phosphorous $12.00 Potassium $18.00 Selenium $18.00 Sodium $11.00 Solids, Total $12.00 Solids, Total Dissolved $12.00 Solids, Total Suspended $12.00 Solids, Volatile Suspended $15.00 Specific Conductance $9.00 Sulfate $11.00 Thallium $18.00 Total Kjeldahl Nitrogen $30.00 Total Organic Carbon (reference lab) $60.00 Turbidity $5.00 Zinc $18.00 Chemical Sample Sampling Fee $22.00 * Fee's to be applied as per Colorado Department of Public Health and Environment, Bioterrorism Laboratory Specimen Triage Guidelines. NOTE: Analyses are the rates cited above unless the amount is set by a contract approved by the Board of County Commissioners. HHW Facility-CESQG Fees Waste Type Cost per container Cost per pound gallon $7.80 Acid 5 gallon $84.50 $0.90 if<gallon 55 gallon $265.00 Aerosol (paint, pesticide) small can .65 can $1.30 Antifreeze $0.13 gallon $7.80 Base 5 gallon $84.50 $0.90 if<gallon 55 gallon $265.00 Battery-lead acid (inc. Vehicle Batteries) $0.13 Battery-other $0.65 Compressed Gas Cylinders small tank $5.20 55 gallon $520.00 quart $6.25 Cyanide compounds gallon $25.00 $4.85 if<quart 5 gallon $123.50 Drum 30 gallon $13.00 55 gallon $13.00 Fertilizer $1.45 Flammable Liq/Oil Base Paint< quart Containers<quart $ 1.30 quart $1.00 Flammable Liq/Oil Base Paint>quart gallon $3.90 $0.45 (if bulkable) 5 gallon $31.20 quart $1.15 Flammable, solid (roofing tar, adhesive) _ _ gallon $4.55 Containers< quart $ 1.30 5 gallon $36.40 Fluorescent Bulbs linear foot $0.25 Filter, oil $0.32 quart $0.30 Latex paint,bulk gallon $1.30 5 gallon $10.40 55 gallon $256.00 Lead compounds $8.75 Mercury thermometer $0.65 $7.80 Motor Oil $0.06 gallon $16.25 Oxidizer 5 gallon $130.00 $3.25 if<gallon 30 gallon $343.00 PCB Ballast(and non BCB) $1.30 quart $1.95 Pesticide/Poison Liq gallon $7.80 5 gallon $39.00 55 gallon $246.00 Pesticide/Poison (liquid <quart) $1.30 if<quart Pesticide, dry $1.55 quart $6.25 Reactive _ gallon $25.00 _ $4.85 if<quart 5 gallon $123.50 Miscellaneous Items To be determined,subject to market rate. CHS 2007 Fees Page 1 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT COMMUNITY HEALTH SERVICES PROPOSED 2007 SLIDING FEE SCHEDULE HOUSEHOLD CODE SIZE I I — Procedure, Code Code Code Code Code Code Procedure 1 2 3 4 5 r VISITS I i New Client 99201 !Focused —nurse visit* 0.001 11.1. 10 20.35 29.60 37.00 99202 ',Expanded` 0.00 25.20 46.20 67.20 84.00 99203 Detailed* f 0.001 33.60 61.60 89.60 112.00 99204 Comprehensive* 0.00 50.10 9185 133.60 167.00 Established Client 99211 Nurse Visit` 0.00, 10.20 18.70 27.20 34.00 99212 Focused` 0.00 16.50 30.251 4400 55.00 99212-PN Prenatal Visit 55.001 55.00 55.00 55.00 55.00 99213 Expanded` 0.00 21.60 39.60 57.60 72.00 99214 Detailed* 0.00 32.40 59.40 86.40 108.00 99215 Comprehensive` 0.00. 45.00 82.50 120.00 150.00 I Home Visits 99341 New Client- Focused 71.00' 71.00 71.00 71.00 71.00 99342 New Client- Expanded 71.00 71.00 71.00171.00 71.00 99347 Est. Client- Focused 71.00 71.00. 71.00 71.00 71.00 99348 Est. Client- Expanded 71.00 71.001 71.00' 71.00 71.00 Travel Visits 99401 Individual - 15 37.00 37.00I 37.00 37.001 37.00 99402 Individual -30 37.00 37.00' 0 37.00', 37.00'. 37.00 99403 Individual -45 37.00 37.00 37.00 37.00 37.00 99404 Individual -60 58.00 58.0O 58.001 58.00. 58.00 99411 Group- 30 19.00 19.00! 19.001 19.00 19.00 99412 Group-60 32.00 32.00 32.00 32.00 32.00 Preventive Medicine 99382 New Client 1-4 years old 70.00 70.00' 70.00 70.00 70.00 99383 New Client 5-11 years old 70.00 70.00 70.00'] 70.00 70.00 99384 New Client 12-17 years old 70.00 70.00 70.00' 70.00 11 70.00 .0 0 . 70.00 I y l 99385 New Client 18-39 years old 70.00 70.00 70.00 70 00 51.00 99392 Est. Client 1-4 ears old 51.00 51.00 51.00 51.00 99393 Est. Client 5-11 years old 51.00 51.00 51.00 51.00' 51.00 99394 Est. Client 12-17 years old 51.00 51.00 51.00 51.001 51.00 99395 :Est Client 18-39 years old 51.00 51.00 51.00 51.00, 51.00 I CHS 2007 Fees Page 2 Procedure Code C ode;! Code' Code' Code Code Procedure 1 21 3 4 5 Miscellaneous INC _ IScv. Includes Follow-up Care 0.00 0.00 0.00 0.001 0.00 99212 Antepartum Care 1 visit 53.00 59425 Antepartum care 4-6 visits 533.00 533.00 533,00 533.001 533.00 59426 Antepartum care 7 or more visits 1098.00 1098.00 1098.00 1098.001 1098.00 69012 PE Establishing Medical Record 64.00 64.00 64.00 64.00, 64.00 PE-CHP Intake 0.00 0.00 0.00 0.0O 0.00 PE CHP Establish Medical Record 0255W Phone visit F 64 00 4.001 64.00 64.00 64.001 64.00 0.00 0.00 0.00 0.00 59430 Post Partum Only 97.0O. 97.00 97.00 97.00 97.00 H1005 Prenatal Plus (1-4 visits) 155.00 155.00 155.00 155.00 155.00 H1005 ,Prenatal Plus (5-9) visits) 414.00., 414.00 414.00 414.00 414.00 H1005 I Prenatal Plus (10 visits) 776.00 776,00 776.00 776.00 776.00 H1005 LPrenatal Plus (11 or more visits) 880.00 880.00 880.00 880.00 880.00 G9006 NHV Mother-Task Care Mgmt_ 64.00 64.00 64.001 64.00 64.00 T1017 NHV Child -Task Care Mgmt. 64.00 64.00 64.001 64.00 64.00 L I Lab 86850 Antibody Screen 26.00 26.00 26.00. 26.00'. 26.00 82947 Blood Sugar(FBS)* 0.00 4.50 8.25, 12.00 15.00 85025 CBC w/dill 13.00 13.00 13.001 13.N 13.00 85027 4C BC w/o Diff 11.00 11.00 11.001 11.00 11.00 87491 IChlamy dia PCR* 0.00 13.80 25.30 36.80 46.00 83001 I FSH 27.00 27.00 27.00 27.00 27.00 --_--- 87591 Gonorrhea PCR* 0.00 13.80, 25.30 36.80 46.00 82948 Glucose Random 3.00 3.001 3.00 3.00 3.00 82950 Glucose Tolerance Test 1 hr 13.00 13.00 13.00 13.00 13.00 82951 Glucose Tolerance Test 3 hr 38.00 38.00 38.001 38.00 38.00 87205 '.Gram Stain 1 19.00 19.00 19.00 19.0O 19.00 86706 Hep B Surface Antibody 16.00 16.001 16.00 16.00 16.00 87528 Herpes Culture 54.00 54.001 54.00 54.00 54.00 86695/86696 Herpes Select 60.00 60.00 60.00 60.00 60.00 85018 HGB - Finger Stick* 0.00 3.30 6.05 8.80 11.00 86701 HIV Test 16.00! 16.00 16.00 16.00 16.00 87621 HPV/DNA Testing 97.001 97.00 97.00 97.00 97.00 83002 LH I 27.00 27.00 27.00 27.00' 27.00 80061 Lipid Profile* 0.00 9.00 16.50 24.00! 30.00 80076 Liver Panel 22.00 22.00 22.00 22.001 22.00 80048 Metabolic Panel 23.00 23.00 23.00 23.00! 23.00 88142 Pap Smear-Thin Prep* 0.00 10.50 19.25! 28.00! 35.00 81025 Pregnancy Test- Urine* 0.00 6.60 12.10 17.60. 22.00 84703 Pregnancy Test-Serum 30.00 30.00 I 30.00' 30.00! 30.00 ;84146 Prolactin 28.00 28.001 28.00 28.00. 28.00 0080W Repeat Pap 30.00' 30.001 30.0O 30M0 30.00 86592 RPR 16.001 16.00- 16.00 16.00' 16.00 82465 Total Cholesterol 18.001! 18.00 18.00. 18.00' 18.00 84443 TSH 25.00 25.00 25.00, 25.00 25 00'7UA-Dip 5.007 5.001 5 00 5 00! 844 8 5.00 CHS 2007 Fees Page 3 Procedure Code Code Code Code Code Code Procedure 1 2 3 4 5 Lab (cont.) 36415 Venipuncture 3.00 3.00 300]_. -_ 3.00 3.00 87210 Wet Prep 19.00 19.00 19.00. 19.00 19.00 Medicines and Treatments oo20W Amoxicillin 875 mg#20 10.00 10.00 10.00 10.00 10.00 J0456 Azithromycin* 0.00 7.80 14.30 20.80: 26.00 0456W Azithromycin NC _-_ _ 0.00 0.00 _ 0.00 0.00'. 0.00 Y _ * 0057W Ciprofloxacin 500 mg -#1 5.00! 5.00 5.00 5.00 5.00 0058W 'Ciprofloxacin 500 mg -#6 10.00', 10.00 10.00 10.00 10.00 o011 W Diflucan 16.00 16.00 16.00 16.00 16.00 0005w Doxycycline 14 Capsules 7.00 7.00 7.00 7.00 7.00 0059W Estradiol 1 mg-#100 10.00 10.00 10.00 10.00 10.00 0009W Flagyl 5.00 0.00 0010W Flagyl 14 Tablets 10.00 10.00 10.00 10.00 10.00 0013W Flagyl 28 Tablets - 10.00 1.0.00; 10.00' 10.00 10.00 0012W Iron 7.00 7.00'. 7.00 TOO] 7.00 J0580 LA Bicillin 2.4 Units 0.00 0.00 0.00 0.00, 0.00 , 0014w TLice Shampoo ' 10.00 10.00 10.00. 10.00' 10.00 0060W 'Medroxyprogesterone 10 mg -#5 10.00 10.00'.{ 10.001 10.00 10.00 doom Metrogel 22.00 22.00 22.00 22.00 22.00 0061W Nitrofurantoin Macrocrystals-#14 15.00, 15.00 15.00 15.00 15.00 0034W Ofloxacin 85.00 85.00 85.00 85.00 85.00 0016W Podophyllin/TCA 1 10.00 10.00 10.00 10.00. 10.00 0192W Prenatal Vitamins 8.00 8.00 8.00! 8.00 8.00 J0696 IRocephin 27.00, 27.00 27.007 27.00! 27.00 0004W IjSulfatrim 5.00 5.00 5.00 5 00' 5.00 0062W lZithromax Z-pack 250 mg -#6 10.00 10.00. 10.00 10.00 10.00 I Procedures 11100 Biopsy of skin, single 25.00 25.00L 25.00 25.00 25.00 57500 Cervical Lesion Biopsy _ 30.00 30.00 30.00 30.00 30.00 0116W Chest X-Ray (Prepay) 72.00 72.00', 72.00 72.00 72.00 57452 Colposcopy w/o Biopsy ** 83.00 83.00 83.00' 83.00 83.00 57454 Colposcopy with Biopsy ** 83.00 83.00 83.00 83.00 83.00 56501 Colposcopy with Cryo** 83,00 83.00 83.00 83.00 83.00 1 57511 Cryocautery - initial or repeat 90.00 90.00 90.00 90.00. 90.00 57170 Diaphragm/Cervical Ca Fittin p g * L 0.00T 21.60 3a60 57.60 72.00 58100 Endometrial biopsy w/wo Biopsy I 41.00 41.00 41.00 41.00 41.00 58110 Endometrial biopsy with Colposcopy 52.00 52.00 52.00 52.00: 52.00 11400 _Excisions, benign lesion 74.00 74.00 7400 74.00, 74.00 Incision &drainage of abcess, single 10060 or simple 28.00 28.00 28.00] 28.00 28.00 J7302 IUD Mirena* 0.00 105.00 192.50 280.00 350.00 58300 ]IUD Insertion* 0.00 45.00' 82.50 120.00! 150.00 J7300 IUD Paragard 0.00 57.90' 106.15 154.401 .193.00 58301 I IUD Removal* 0.00 36.00 66.00 96.00' 120.00 59025 I Non Stress Test Interp 0.00 0.00 0.00 0.00 0.00 P 11976 !Nor lant Removal** ! 0.00 54.00 99.00. 144.00 180.00 CHS 2007 Fees Page 4 Procedure Code Code Code Codel Code Code Procedure 1 21 3 4 5 j Procedures (cont.) Shaving of epidermal lesion, single 11300 on trunk, arms or legs, .5cm 32.00 32.00 32.00', 32.00 32.00 17000 Skin Cryo 1st lesion ** 52.00 52.00 52.001 52.00 52.00 17003 Skin Cryo 2nd-14th lesions ** 12.00 12.00 12.001 12.00 12.00 17004 Skin Cryo 15 + lesions ** 6.00 6.00 6.00 6.00 6.00 A4550 9 Surical ra Y 50.001 50.00 50.00 50.00 50.00 Additional Codes I 0071W Community Education 1 hr. 58.00`--- 58.00 58.0O1 58.00 58.00 0069W Travax Printout 6.00 6.00 6.001 6.00 6.00 Immunizations 90748 Comvax Hep B & Hib 15.00 15.00, 15.00 15.00! 15.00 90700 DTAP 15.00 15.00 15.00 15.00 15.00 90702 TDT 15.00 15.001', 15.00 15.001 15.00 90633 Hepatitis A-VFC 15.00 15.00 15.00 15.00 15.00 P 30.00 30.00 30 00 30.00 90632 He antis A-Adult 30.00, P 90744 He antis B -VFC 15.00 15.00 15.00 15.00 15.00 90746 Hepatitis B -Adult 30.00 30.00 30.00'. 30.00 30.00 90647 HIB 15.00 15.00 15.00 15.00 15.00 90281 IG Hepatitis A 0.00 0.00 0.00, 0.00 0.00 90632 IG Hepatitis A-TVL 41.00 41.00 41.001 41.00 41.00 90657 Influenza -Child (0 to 18 years) 15.00 15.00 15.001 15.00 15.00 90658 Influenza -Adult 20.00 20.00 20.00! 20.00 20.00 90660 Influenza- intranasal use 15.00 15.00 15.001 15.00 15.00 90660A Influenza Intranasal Adult 25.00 25.00 25.001 25.00 25.00 G0008 Influenza Admin. 5.00, 5.00 5.00 5.00 5.00 90713 IPV-VFC 15.00 15.00 15.00 15.00 15.00 90713A IPV-Adult 41.00 41.00 41.001 41.00 41.00 90735 Japanese Encephalitis 112.001 112.00 112.001 112.00 112.00 90733 Meningitis (Menomune) — 91.001 91.00 91.001 91.00 91.00 90734A Menectra (Adult) 91.001i 91.00 - 91.001 91.00 15.00 90734 Menectra Child 15.001 15.00 15.00 15.00 91.00 90707 MMR -VFC - 15.00; 15.00 15.00i 15.00 15.00 90707 MMR -Adult 45.001 45.00 45.00', 45.00 45.00 (MMR Proquad MMRV &Varivax) Pro uad 15.0011 15 00 15.00 ] 15.00 15 00 . 90723 Pediarix- DTAP, He B & IPV 15.001 15.00 15.00'' 15.00 15.00 90732 Pneumovax 30.00p 30.00 30.00, 30.00 30.00 Goons I Pneumovax Admin. _ 5.00 5.00 5.001 5.00 5.00 86580 PPD 10.00 10.00 10.00' 10.00 10.00 6580W PPD N/C 0.00 0.00 0.00 0.00 0.00 8658W PPD reading only 0.00 0.00 0.00 0.00 0.00 90669 Prevnar 15.00 15.00 15.00 15.00 15.00 90675 1Rabies IM 182.00'. 182.00 182.00 182.00 182.00 90680 1 Rotavirus 15.00, 15.00 15.00 15.00! 15.00 90718 TD 15.00I 15.00 15.00 P I --- 90715 Tda 15.00 15.00 15.00 15.00 15.00 15.00 90715A !Tda Adult 41.001 41.00 4100 41.00 41.00 CHS 2007 Fees Page 5 Procedure' Code Code Code Code Code Code 'Procedure 1 2 3 4 5 Immunizations (continued) 90636 Twinrix- Heb A& Hep B 47.00 47.00 47.00 47.00 47.00 90636 Twinrix NC - Heb A& Hep B i 0.00 0.00 0.00 0.00 0.00 90691 Typhoid - 1 Shot 54.00 54.00 54.00 54.00 54.00 90690 Typhoid -Oral 45.00 45.00 45.00 45.00 45.00 90716 Varivax-VFC 15.00 15.00 15.00 15.00 15.00 90716 Varivax-Adult I 70.00 70.00 70.00 70.00 70.00 90717 Yellow Fever 87.00 87.00 87.00 87.00 87.00 VFC Vaccines 15.00 15.00 15.00 15.00 15.00 (FAMILY PLANNING SUPPLIES sp g 3.30(A4267 Condoms pkg. 10* 0.00 1.80'. 4.80 6.00 0052W Cycle Beads 0.00 3.00 5.50 8.00 10.00 J1055 Depo Provera* 0.00 18.00 33.00 48.00 60.00 A4266 Diaphragm* 0.00 7.20 13.20 19.2O 24.00 J7304 Evra Patch* 0.00 10.80 19.80 28.80 36.00 A4269 Foam Contraception* 0.00 3.00 5.50 8.00, 10.00 0143W Nuva Ring* 0.00 10.80 19.80 28.80 36.00 S4993 Oral Contraceptives* j- 0.00 6.90 12.65 18.40 23.00 0047W Plan B* 0.00 5.10 9.35 13.60 17.00 •Fees only slide for the Family Planning Program. Charges for all other programs are the Code 5 fee. — Services include surgical procedure on ly. 9 P 1 - - Rev. 11/15/06 Hello