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Home My WebLink About20223241.tiffRESOLUTION RE: APPROVE REVISIONS TO FEE SCHEDULE FOR FEES COLLECTED BY 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, 2023, 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, 2023. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 21st day of November, A.D., 2022. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO ATTEST: ditifm) je:L t, Weld County Clerk to the Board County ttorney Date of signature: 1 V2? (22 (YAY) Scot K. James, Chair Mik- e- an, Pro-Tem teve Moreno (YAY) (YAY) (NAY) cc: EIL(T6), FZ(RR/cP/so), ACT(cc) of/14 /;L3 2022-3241 HL0003 Memorandum TO: Scott James, Chair Board of County Commissioners FROM: Gene O'Hara, Interim Executive Director Department of Public Health & Environment DATE: November 17, 2022 SUBJECT: Health Department 2023 Fee Schedules — Environmental Health Services & Clinical and Community Health Services For the Board's approval are the Health Department's proposed Environmental Health Services (EHS) and Clinical and Community Health Services (CCH) fees schedules for 2023. ENVIRONMENTAL HEALTH SERVICES: Program fees are evaluated on an annual basis to ensure adequate cost recovery and program sustainability. This year, using a method developed with the Weld County Director of Finance & Administration, we determined that our hourly rate should be raised to $90 per hour, up from $85 per hour in 2022. Accompanying this change in hourly rate, all program fees for the division were evaluated. It was determined that Onsite Wastewater Treatment Systems (OWTS)/septic fees, which were last adjusted in 2015, should be revised. Our suggested increase is still below neighboring jurisdictions' fees but reflects the increased costs we are experiencing operating the program in Weld. Evaluation of our temporary events program fees resulted in streamlining the fee schedule to charge fees according to an hourly rate, based on actual services being provided rather than a variety of nuanced fees for services that were similar in nature. Our Household Hazardous Waste disposal fees were impacted as well due to changing vendors in 2022, therefore those prices were adjusted accordingly, with some fees increasing, while others were decreased. CLINICAL AND COMMUNITY HEALTH: A comprehensive review of the CCH fee schedule was made to ensure that costs are adequately recovered across all clinic programs of the CCH division. Utilizing multiple methodologies, all fees for services and supplies were reviewed to determine that the Health Department is charging fees for services that are equitable and reduce financial barriers to clients. This year the Health Department is requesting the Board's approval to increase our fee schedule for services and supplies by 6.5%, which is consistent with the projected 2023 medical inflation rate. The fee schedule also reflects adjustments in our costs for lab services and medical products, some clerical changes to more precisely describe a service or product, a few services were added to the fee schedule to provide more comprehensive care for our clinic patients and a few services that we no longer provide, or products that are no longer available on the market, have been removed. On October 24, 2022, Health Department staff met with the Board in a work session to discuss the changes to the fee schedules and answer the Board's questions. The Board gave their approval to place the Health Department's 2023 fee schedules on the Board's agenda for formal approval. Staff is recommending approval of the proposed 2023 Environmental Health Services and Clinical and Community Health Services fee schedules. 2022-3241 BOCC STAFF USE Date Set: Time: BOARD OF COUNTY COMMISSIONERS WORK SESSION REQUEST WORK SESSION TITLE: 2023 Health Department Fee Schedules Review DEPARTMENT: Public Health & Environment DATE: October 4, 2022 PERSON REQUESTING: Tanya Geiser EXTENSION: 2122 Has your Commissioner Coordinator or BOCC Chair approved the work session? ❑✓ Yes, Commissioner Coordinator Yes, BOCC Chair Recommended length of time needed for discussion: ❑ 15 minutes ❑ 30 minutes ✓❑ other (list) : 45-60 minutes In addition to yourself and the board, please list who should attend: Don Warden, Gene O'Hara, Dan Joseph, Shaun May, Scott Tobey, Ryan Rose, Cheryl Pattelli, Jen Oftelie Brief description of the issue: ✓❑ Informational only ❑ Action needed The Health Department would like to review the 2023 Environmental Health and Clinic fees schedules with the Board prior to placement on the agenda for formal approval. Options for the board: Recommendation to the board: BOARD CHAIR USE Results/Outcomes: WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT ENVIRONMENTAL HEALTH SERVICES - PROPOSED 2023 FEE SCHEDULE Fees set locally Fees set by state statute Fees previously limited by statute- 2020 new legislation that allows cost recovery was approved BODY ART FACILITY SERVICES Body Art Facility License Body Art Facility - Delinquent License Surcharge Body Art Facility - Plan Review Application Fees and Pre -opening Body Art Facility - Real Estate Site Review Body Art Facility - Temporary License Body Art Facility - Mobile Facility License Autoclave Sterilization Spore Test (Steam) CHILD CARE CENTER FEES Child Care Center - Facility Inspection Fee 5-20 Children Child Care Center - Facility Inspection Fee 21-50 Children Child Care Center - Facility Inspection Fee 51-100 Children Child Care Center - Facility Inspection Fee 101+ Children Group Home - Facility Inspection Fee Residential Treatment Facility - Facility Inspection Fee Child Care Center - Plan Review/Walk-thru/Pre-opening Inspection Fee Child Care Center - Plan Review Application Fee FOOD PROTECTION SERVICES No Fee License (K-12 schools, non -profits as defined in CRS 25-4-1607(9)(a)(III)) Limited Food Service (convenience, other) Restaurant (0-100 seats) Restaurant (101-200 seats) Restaurant (>200 seats) Grocery Store (0-15,000 sq. ft.) Grocery Store (>15,000 sq. ft.) Grocery Store w/ Deli (0-15,000 sq. ft.) Grocery Store w/ Deli (>15,000 sq. ft.) Mobile Unit (prepackaged) Mobile Unit (full food service) Oil & Gas Temporary Special/Temporary Event License - Non -Profits (as defined in CRS 25-4-1607(9)(a)(III)) and Licensed Mobile Units Special/Temporary Event License - Full Service Single Event Special/Temporary Event License - Full Service Calendar Year Special/Temporary Event License Pre packaged Single Event Special/Temporary Event License Pre packaged Calendar Year Special Event License (non-TCS food) Special/Temporary Event Vendor License - Late/Expedite Fee: up to 2 days before event Special/Temporary Event Coordinator Fee (1 Vendor) Specia /Temporary Event Cooreinator Fee Non Recurring Events (submitted 301 days before event) Specia /Temporary Event Coordinator Fee Non Recurring Events {submitted <30 days before event) Specia /Temporary Event Coordinator Fee Recurring Events submitted 30t days before event. Specia /Temporary Event Cooreinator Fee Recurring Events 'submitted <30 says before event- Special/Temporary Event Coordinator Fee (plan review time & additional misc time, if applicable) PROPOSED CHANGES FOR 2023 IN RED $350.00 $75.00 Application fee of $100 plus $85.00/hour $90.00/hour $90/hour determined using method developed with Don Warden. $85.00/hour $90.00/hour $350.00 $350.00 $13.00 $170.00 $212.50 $255.00 $297.50 $212.50 $297.50 $85.00/hour $90.00/hour $100.00 $0.00 $270.00 $385.00 $430.00 $465.00 $195.00 $353.00 $375.00 $715.00 $270.00 $385.00 $855.00 $0.00 $150.00 $385.00 $100.00 $270.00 $100.00 550 00 $0.00 $100.00 $150.00 $200.00 $250.00 $85.00/hour $90.00/hour Note: Fees last updated in 2022 Note 2: Fees assessed every other year- recommend staying the same to capture 2nd year billing group. Note 3: These fees provide inspectional cost recovery Reducing # of categories & streamlining fees to reduce number of fees for those that are simpler operations WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT ENVIRONMENTAL HEALTH SERVICES - PROPOSED 2023 FEE SCHEDULE 7 Fees set locally Fees set by state statute Fees previously limited by statute- 2020 new legislation that allows cost recovery was approved Requested Full Re -inspection Plan Review Application Fees and Preopening Equipment Review Fee HACCP Plan (Written) (Not to exceed) HACCP Plan (On -site Eval.)(Not to exceed) Real Estate Review (1st hour) Real Estate Review of Property (Billed after 1st hour) Miscellaneous Services Weld Star Education Course - For-profit Establishments Weld Star Education Course - Non-profit Establishments Weld Star Education Course - Off -site Presentation Fee (charged for groups of <25) Weld Star Education Course (groups >25) - For-profit Establishments Weld Star Education Course (groups >25) - Non-profit Establishments INSTITUTION SERVICES Ambulance Inspection License Ambulance Unit Inspection Fee MISCELLANEOUS SERVICES/FEES Environmental Health Specialist Field Time Charge Biosolids Permit (160 Acre Parcel) Septage Permit (160 Acre Parcel) Cistern Usage Permit (Initial) Cistern - Variance Request Radon Kits Radon Kits (mailed) Lead Investigation - Requested Inspection (actual cost based on hourly rate, 1 hour min) Fax Fee (up to 10 pages, $.50 per each additional page) File Review Fees Per Appendix 5-D, Chapter 5, of the Weld County Code Non -Sufficient Funds (Bounced Check) Return Fees ONSITE WASTEWATER TREATMENT SYSTEM (OWTS) OWTS Permit OWTS Repair/Alteration Permit OWTS Permit Extension Commercial OWTS New Permit Commercial OWTS Repair Permit OWTS Minor Repair Permit OWTS Reinspection Fee Holding Tank/Vault Permit Weld County OWTS Regulations Systems Contractor License Renewal of Systems Contractor License (Annually) PROPOSED CHANGES FOR 2023 IN RED 5189.00 Application fee of $100 plus $85.00/hour $90.00/hour (not to exceed $580) $85.00/hour S90.00/hour (not to exceed $500) $100.00 $400.00 $75.00 $85.00/hour $90.00/hour $85.00/hour $90.00/hour $30.00/pp $15.00/pp $50.00 $640.00 5375.00 $170.00/company Note: Fees last updated in 2022 $ 127.50/ambulance $135.00 Note 2: Fees provide inspectional cost recovery $85.00/hour S90.00/hour $375.00 ($2.34 for each acre over 160 Acres) $375.00 ($2.34 for each acre over 160 Acres) $250.00 $50.00 $6.00 $8.00 $85.00/hour $90.00/hour $5.00+ $25.00 S850.00 $1,100.00 $850.00 $1,100.00 $50.00 $950.00 $1,200.00 $950.00 $1,200.00 $150.00 $250.00 $75.00 $90.00 $350.00 $450.00 $5.00 S50.00 $25.00 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT ENVIRONMENTAL HEALTH SERVICES - PROPOSED 2023 FEE SCHEDULE Fees set locally Fees set by state statute - Fees previously limited by statute- 2020 new legislation that allows cost recovery was approved Systems Cleaners License Renewal of System Cleaners License (Annually) Existing OWTS Evaluation Statement of Existing Loan Approval Inspection without Water Sample Loan Approval Inspection with Water Sample Potable Water Sample (collection and analysis) Variance Request METHAMPHETAMINE PROGRAM SERVICES Methamphetamine Lab Decontamination Permit - Covers up to 4 hours of staff time. (Review and inspection activities in excess of 4 hours will be billed at an hourly rate.) Methamphetamine Lab - Hourly Rate LABORATORY SERVICES MEDICAL Chlamydia/N. Gonorrhea Combo, Amplified Test Syphilis RPR Screen Syphilis TPPA Confirmation w/CDPHE Stat Fee for individual test TB Quantiferon Gold PLUS Trichomonas, Amplified Test HPV High Risk HPV Genotyping 16 18/45 COVID/Respiratory Panel Test WATER QUALITY - BACTERIOLOGICAL ASSESSMENT After hours Stat Fee for individual tests Total Coliform, PA Total Coliform, Quantitray Pseudomonas aeruginosa Potable Water Sample (collection and analysis), PA Potable Water Sample (collection and analysis), Quantitray WATER QUALITY - CHEMICAL ASSESSMENT Alkalinity, Total Alkalinity, Phenophthalein (hydroxide, carbonate, bicarbonate) Aluminum (reference lab) Ammonia Arsenic BTEX (benzene, toluene, ethyl benzene, xylene) Barium (reference lab) Biochemical Oxygen Demand (BOD) Bromide Cadmium Calcium as CaCO3 PROPOSED CHANGES FOR 2023 IN RED $50.00 $25.00 $200.00 $10.00 $200.00 $245.00 $45.00 $50.00 $340.00 $25.00 $248.00 $48.00 $90.00 $360.00 $85.00/hour $90.00/hour $120.00 $31.00 $14.00 $27.00 $115.00 $54.00 $91.00 $55.00 $180.00 3 x stated fee $21.50 $23.50 $32.00 $48.00 $50.00 $17.00 $17.00 Market Rate $23.00 S21.50 $106.00 Market Rate $64.00 $20.00 $21.50 $21.50 $120.00 Lab no longer conducting these tests $31.00 $14.00 $27,00 $115.00 $54.00 $91.00 $55.00 $180.00 Fees last updated in 2022 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT ENVIRONMENTAL HEALTH SERVICES - PROPOSED 2023 FEE SCHEDULE Fees set locally 11 Fees set by state statute Fees previously limited by statute- 2020 new legislation that allows cost recovery was approved Chloride Chlorine Chlorite (reference lab) Chromium Copper Dissolved Oxygen Fluoride Haloacetic Acids (reference lab) Hardness, Total Iron Lead, water Lead, paint chips Magnesium (by hardness calculation) Manganese Mercury (reference lab) Metal digestion (if necessary) Molybdenum (reference lab) Nickel (reference lab) Nitrate Nitrite Oil and Grease, Visual PH/Temperature Phosphate, Ortho Phosphate, Total WATER QUALITY - CHEMICAL ASSESSMENT (Continued' Selenium Silver (reference lab) Sodium Solids, Total Solids, Total Dissolved Solids, Total Suspended Autoclave Spore Test Specific Conductance Sulfate Thallium (reference lab) Total Kjeldahl Nitrogen Total Organic Carbon (reference lab) Total Trihalomethanes VOC screen (EPA Method 524.2) Zinc MISCELLANEOUS LABORATORY SERVICES Zoonotic Testing (rabies, tularemia, plague, WNV mosquitoe pool, etc.) Chemical Sample/Courier Sampling Fee State Sample Point ID Verification Fee PROPOSED CHANGES FOR 2023 IN RED $20.50 $17.00 Market Rate 521.50 $21.50 $15.00 $20.50 Market Rate $21.50 $21.50 $22.00 Market Rate $7.00 $21.50 Market Rate $22.50 Market Rate Market Rate $20.50 $20.50 Market Rate $17.00 $26.50 $34.50 $22.00 Market Rate $22.00 $17.00 $18.00 $18.00 $13.00 $17.00 $20.50 Market Rate $48.00 Market Rate $85.00 $159.00 $21.50 Market Rate $26.50 $6.00 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT ENVIRONMENTAL HEALTH SERVICES - PROPOSED 2023 FEE SCHEDULE Fees set locally 11 Fees set by state statute Fees previously limited by statute- 2020 new legislation that allows cost recovery was approved PROPOSED CHANGES FOR 2023 IN RED Non -Returned Sampling Bottle Fee $3.50 OIL AND GAS - LABORATORY CHEMICAL ASSESSMENT Dissolved Gasses (methane, ethane, propane) Total Bicarbonate Total Petroleum Hydrocarbons (TPH) Total Trihalomethanes Volatile Organics Group (new) NOTE: Analyses are the rates cited above unless the amount is set by a contract approved by the Board of County Commissioners. 5 $85.00 $17.00 $85.00 $85.00 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT ENVIRONMENTAL HEALTH SERVICES - 2023 FEE SCHEDULE BODY ART FACILITY SERVICES Body Art Facility License Body Art Facility - Delinquent License Surcharge Body Art Facility - Plan Review Application Fees and Pre -opening Body Art Facility - Real Estate Site Review Body Art Facility - Temporary License Body Art Facility - Mobile Facility License Autoclave Sterilization Spore Test (Steam) CHILD CARE CENTER FEES Child Care Center - Facility Inspection Fee 5-20 Children Child Care Center - Facility Inspection Fee 21-50 Children Child Care Center - Facility Inspection Fee 51-100 Children Child Care Center - Facility Inspection Fee 101+ Children Group Home - Facility Inspection Fee Residential Treatment Facility - Facility Inspection Fee Child Care Center - Plan Review/Walk-thru/Pre-opening Inspection Fee Child Care Center - Plan Review Application Fee FOOD PROTECTION SERVICES No Fee License (K-12 schools, non -profits as defined in CRS 25-4-1607(9)(a)(III)) Limited Food Service (convenience, other) Restaurant (0-100 seats) Restaurant (101-200 seats) Restaurant (>200 seats) Grocery Store (0-15,000 sq. ft.) Grocery Store (+15,000 sq. ft.) Grocery Store w/ Deli (0-15,000 sq. ft.) Grocery Store w/ Deli (+15,000 sq. ft.) Mobile Unit (prepackaged) Mobile Unit (full food service) Oil & Gas Temporary Special/Temporary Event License - Non -Profits (as defined in CRS 25-4-1607(9)(a)(III)) and Licensed Mobile Units Special/Temporary Event License - Full Service Single Event Special/Temporary Event License - Full Service Calendar Year Special Event License (non-TCS food) Special/Temporary Event Vendor License - Late/Expedite Fee: up to 2 days before Special/Temporary Event Coordinator Fee (plan review time & additional misc time Requested Full Re -inspection Plan Review Application Fees and Preopening Equipment Review Fee HACCP Plan (Written) (Not to exceed) HACCP Plan (On -site Eval.)(Not to exceed) Real Estate Review (1st hour) Real Estate Review of Property (Billed after 1st hour) Miscellaneous Services Weld Star Education Course - For-profit Establishments Weld Star Education Course - Non-profit Establishments Weld Star Education Course - Off -site Presentation Fee (charged for groups of <25) Weld Star Education Course (groups >25) - For-profit Establishments Weld Star Education Course (groups >25) - Non-profit Establishments $350.00 $75.00 Application fee of $100 plus $90.00/hour $90.00/hour $350.00 $350.00 $13.00 $170.00 $212.50 $255.00 $297.50 $212.50 $297.50 $90.00/hour $100.00 $0.00 $270.00 $385.00 $430.00 $465.00 $195.00 $353.00 $375.00 $715.00 $270.00 $385.00 $855.00 $0.00 $150.00 $385.00 $100.00 $50.00 $90.00/hour $189.00 Application fee of $100 plus $90.00/hour (not to exceed $580) $90.00/hour (not to exceed $500) $100.00 $400.00 $75.00 $90.00/hour $90.00/hour $30.00/pp $15.00/pp $50.00 $640.00 $375.00 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT ENVIRONMENTAL HEALTH SERVICES - 2023 FEE SCHEDULE INSTITUTION SERVICES Ambulance Inspection License Ambulance Unit Inspection Fee MISCELLANEOUS SERVICES Environmental Health Specialist Field Time Charge Biosolids Permit (160 Acre Parcel) Septage Permit (160 Acre Parcel) Cistern Usage Permit (Initial) Cistern - Variance Request Radon Kits Radon Kits (mailed) Lead Investigation - Requested Inspection (actual cost based on hourly rate, 1 hour Fax Fee (up to 10 pages, $.50 per each additional page) File Review Fees Per Appendix 5-D, Chapter 5, of the Weld County Code Non -Sufficient Funds (Bounced Check) Return Fees ONSITE WASTEWATER TREATMENT SYSTEM (OWTS) OWTS Permit OWTS Repair/Alteration Permit OWTS Permit Extension Commercial OWTS New Permit Commercial OWTS Repair Permit OWTS Minor Repair Permit OWTS Reinspection Fee Holding Tank/Vault Permit Weld County OWTS Regulations Systems Contractor License Renewal of Systems Contractor License (Annually) Systems Cleaners License Renewal of System Cleaners License (Annually) Existing OWTS Evaluation Statement of Existing Loan Approval Inspection without Water Sample Loan Approval Inspection with Water Sample Potable Water Sample (collection and analysis) Variance Request METHAMPHETAMINE PROGRAM SERVICES Methamphetamine Lab Decontamination Permit - Covers up to 4 hours of staff tim (Review and inspection activities in excess of 4 hours will be billed at an hourly rate.) Methamphetamine Lab - Hourly Rate LABORATORY SERVICES MEDICAL COVID/Repiratory Panel Test WATER QUALITY - BACTERIOLOGICAL ASSESSMENT After hours Stat Fee for individual tests Total Coliform, PA Total Coliform, Quantitray Pseudomonas aeruginosa Potable Water Sample (collection and analysis), PA Potable Water Sample (collection and analysis), Quantitray $170.00/company $ 130.00/ambulance $90.00/hour $375.00 ($2.34 for each acre over 160 Acres) $375.00 ($2.34 for each acre over 160 Acres) $250.00 $50.00 $6.00 $8.00 $90.00/hour $5.00+ $25.00 $850.00 $850.00 $50.00 $950.00 $950.00 $150.00 $75.00 $350.00 $5.00 $50.00 $25.00 $50.00 $25.00 $200.00 $10.00 $200.00 $245.00 $45.00 $50.00 $340.00 $85.00/hour $180.00 3 x stated fee $21.50 $23.50 $32.00 $48.00 $50.00 2 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT ENVIRONMENTAL HEALTH SERVICES - 2023 FEE SCHEDULE WATER QUALITY - CHEMICAL ASSESSMENT Alkalinity, Total Alkalinity, Phenophthalein (hydroxide, carbonate, bicarbonate) Aluminum (reference lab) Ammonia Arsenic BTEX (benzene, toluene, ethyl benzene, xylene) Barium (reference lab) Biochemical Oxygen Demand (BOD) Bromide Cadmium Calcium as CaCO3 Chloride Chlorine Chlorite (reference lab) Chromium Copper Dissolved Oxygen Fluoride Haloacetic Acids (reference lab) Hardness, Total Iron Lead, water Magnesium (by hardness calculation) Manganese Mercury (reference lab) Metal digestion (if necessary) Molybdenum (reference lab) Nickel (reference lab) Nitrate Nitrite Oil and Grease, Visual PH/Temperature Phosphate, Ortho Phosphate, Total Selenium Silver (reference lab) Sodium Solids, Total Solids, Total Dissolved Solids, Total Suspended Autoclave Spore Test Specific Conductance Sulfate Thallium (reference lab) Total Kjeldahl Nitrogen Total Organic Carbon (reference lab) Total Trihalomethanes VOC screen (EPA Method 524.2) Zinc MISCELLANEOUS LABORATORY SERVICES Zoonotic Testing (rabies, tularaemia, plague, WNV mosquitos pool, etc.) Chemical Sample/Courier Sampling Fee $17.00 $17.00 Market Rate $23.00 $21.50 $106.00 Market Rate $64.00 $20.00 $21.50 $21.50 $20.50 $17.00 Market Rate $21.50 $21.50 $15.00 $20.50 Market Rate $21.50 $21.50 $22.00 $7.00 $21.50 Market Rate $22.50 Market Rate Market Rate $20.50 $20.50 Market Rate $17.00 $26.50 $34.50 $22.00 Market Rate $22.00 $17.00 $18.00 $18.00 $13.00 $17.00 $20.50 Market Rate $48.00 Market Rate $85.00 $159.00 $21.50 Market Rate $26.50 3 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT ENVIRONMENTAL HEALTH SERVICES - 2023 FEE SCHEDULE State Sample Point ID Verification Fee Non -Returned Sampling Bottle Fee OIL AND GAS - LABORATORY CHEMICAL ASSESSMENT Dissolved Gasses (methane, ethane, propane) Total Bicarbonate Total Petroleum Hydrocarbons (TPH) Total Trihalomethanes Volatile Organic Group (new) $5.50 $3.00 $85.00 $17.00 $85.00 $85.00 $140.00 NOTE: Analyses are the rates cited above unless the amount is set by a contract approved by the Board of County Commissioners. 4 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT 2023 HHW Facility - VSQG Fees PROPOSED Waste Type Cost per container Cost per pound Acid gallon $10.80/$13.60 $1.35/ pound 5 gallon $54.00/$68.00 __ 55 gallon $216.00/$340.00 Aerosol (paint, pesticide) $1.20/ pound Antifreeze $0.60/$0.08/gallon Base gallon $10.80/$9.60 $1.35/ $1.20/pound 5 gallon $54.00/$48.00 55 gallon 5216.00/5240.00 Battery (excluding alkaline) $0.25/ pound $1.20/ $0.68/pound Battery (alkaline) Compressed Gas Cylinders (small) tank 5.35/52.63 $1.40/pound (Cyanide Cpds) Compressed Gas Cylinders (large) tank Market Price/MP Cyandie Compounds 5 gallon $85.00/$105.00 Flammable Liquid (bulkable) or Cooking Oil $0.35/$0.20/pound Flammable (non-PaintCare) Liquid quart $2.70/$1.75 $1.35/$0.87 loose pound -pack if < quart or gallon $10.80/$6.96 5 gallon $54.00/$34.80 Fluorescent Tubes Pound $0.84/$0.84 Mercury Containing Bulbs (HID, Sodium, Misc Pound 52.89/53.17 Filter, oil $0.30/ pound Grease Gallon Market Price Mercury thermometer $0.75 $5.00/pound Motor Oil (used) $0.60/$0.08/gallon Oily Waste Water $0.80/$1.40/gallon Oxidizer gallon $10.80/$31.84 $1.35/$3.98/pound 5 gallon $54.00/159.20 55 gallon 5216.00/5995.00 Paint (Latex Non-PCB/Electronic & Oil Based) Ballast quart no fee* $0.46/pound gallon no fee* 5 gallon no fee* PCB Ballast (and non PCB) $0.75/$1.50/pound Peroxide Formers gallon Market Price 5 gallon Market Price $10.80/$6.96 $1.35/$0.87/pound gallon Pesticide/Poison Liquid 5 gallon $54.00/$34.80 55 gallon $216.00/$240.00 Pesticide, cry $1.00/$1.22/pound Miscellaneous Items To be determined, subject to market rate. *Latex and certain oil based paint are not charged due to contract with PaintCare. If the number of individual containers of a waste type fills a 55 gallong drum, the drum cost will be the cost administered. WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT 2023 HHW Facility - VSQG Fees Waste Type Cost per container Cost per pound Acid gallon $13.60 $1.70/ pound $68.00 5 gallon 55 gallon $340.00 Aerosol (paint, pesticide) $1.20/ pound Antifreeze $0.60/ gallon Base gallon $9.60 $1.20/ pound 5 gallon $48.00 55 gallon $240.00 Battery (excluding alkaline) $0.25/ pound $0.68/ pound Battery (alkaline) Compressed Gas Cyi nders (small) tank $2.63 $1.40/pound $0.20/ (cyanide pound Cpds) Compressed Gas Cylinders (large) tank Market Price Cyandie Compounds 5 gallon $105.00 Flammable Liquid (bulkable) or Cooking Oil Flammable (non-PaintCare) Liquid quart $1.75 $0.87/ pound if pack < quart or loose, gallon $6.96 5 gallon $34.80 Fluorescent Tubes Pound $0.84 Mercury Containing Bulbs 0;HID, Sodium, Misc; Pound $3.17 Filter, oil $0.40/ filter Grease Gallon Market Price Mercury thermometer $0.75 $5.00/pound Motor Oil (used) $0.08/ gallon Oily Waste Water $1.40/gallon Oxidizer gallon $31.84 $3.98/ pound 5 gallon $159.20 55 gallon $995.00 Non-PCB/Electronic Paint (Latex & Oil Based) Ballast quart no fee* $0.46/pound gallon no fee* 5 gallon no fee* PCB Ballast (and non PCB) $1.50/ pound gallon Market Price Peroxide Formers 5 gallon Market Price Pesticide/Poison Liquid gallon $6.96 $0.87/ pound 5 gallon $34.80 55 gallon $240.00 Pesticide, dry $1.22/ pound Miscellaneous Items To be determined, subject to market rate. *Latex and certain oil based paint are not charged due to contract with PaintCare. if the number of individual containers of a waste type fills a 55 gallong drum, the drum cost will be the cost administered. 2023 CLINICAL AND COMMUNITY HEALTH SERVICES FEE SCHEDULE PROPOSED DRAFT =NEW/CHANGES/QUESTIONS Code Services HOUSEHOLD CODE SIZE Code Code Code Code Code 1 2 3 4 2022 2023 5 CURRENT CHANGE 99202 99203 99204 99205 99211 99212 99213 99214 99215 99401T 99402T 99202T 99203T 99211T 99212T 99213T 99214T 99215T 99341 99342 99347 99348 New Client Expanded Detailed Comprehensive Extensive Established Client Minimal Focused Expanded Detailed Comprehensive Telemedicine Preventive Medicine 15 min - Telemedicine Individual - 30 min - Telemedicine N ew Patient Focused - Telemedicine Detailed - Telemedicine Est Patient Minimal - Telemedicine Est Patient Focused - Telemedicine Est Patient Expanded - Telemedicine Detailed - Telemedicine Comprehensive - Telemedicine Home Visits N ew Client - Focused N ew Client - Expanded Est. Client - Focused Est. Client - Expanded ALL SERVICES 6.5% MEDICAL RATE OF INFLATION (ROUNDED) 0.00 37.00 75.00 112.00 0.00 48.00 97.00 145.00 0.00 72.00 145.00 217.00 0.00 74.00 148.00 222.00 0.00 0.00 0.00 0.00 0.00 14.00 24.00 32.00 50.00 62.00 28.00 49.00 63.00 99.00 124.00 42.00 73.00 95.00 149.00 185.00 149.00 193.00 289.00 296.00 56.00 97.00 126.00 198.00 247.00 0.00 15.00 30.00 45.00 60.00 0.00 22.00 44.00 65.00 87.00 0.00 37.00 75.00 112.00 149.00 0.00 48.00 97.00 145.00 193.00 0.00 14.00 28.00 42.00 56.00 0.00 24.00 49.00 73.00 97.00 0.00 32.00 63.00 95.00 126.00 0.00 50.00 99.00 149.00 198.00 0.00 62.00 124.00 185.00 247.00 118.00 118.00 118.00 118.00 118.00 118.00 118.00 118.00 117.00 117.00 117.00 117.00 122.00 122.00 122.00 122.00 118.00 118.00 117.00 122.00 140.00 181.00 271.00 278.00 53.00 91.00 118.00 186.00 232.00 56.00 82.00 140.00 181.00 53.00 91.00 118.00 186.00 232.00 111.00 111.00 110.00 115.00 9.00 12.00 18.00 18.00 3.00 6.00 8.00 12.00 15.00 4.00 5.00 9.00 12.00 3.00 6.00 8.00 12.00 15.00 7.00 7.00 7.00 7.00 COMMENTS =NEW/CHANGES/QUESTIONS Code Services Code Code Code Code Code 1 2 3 4 2022 2023 5 CURRENT CHANGE 99401 99402 99403 99404 99406 99407 G8510 G8431 99404 99401W 99412 99384 99385 99386 99394 99395 99396 0071W 0069W 0069W G9006 Preventive Medicine Counseling Individual - 15 min Individual - 30 min Individual - 45 min Individual - 60 min Tobacco use cessation counseling Tobacco use cessation counseling Maternal Depression Screening Documented Negative- N FP Maternal Depression Screening not documented- NFP Travel Visits Individual Initial Visit - 60 Return Visit Group Initial Visit (per person) - 60 Preventive Medicine New Client 12-17 years old N ew Client 18-39 years old N ew Client 40-64 years old Est. Client 12-17 years old Est. Client 18-39 years old Est. Client 40-64 years old Additional Codes Community Education 1 hr. Printout/Medical Records - Patient 1st 10 pgs Printout/Medical Records - Patient > 10 pgs/per pg NHV Mother - Task Care Management 0.00 15.00 30.00 45.00 60.00 56.00 0.00 22.00 44.00 65.00 87.00 82.00 0.00 31.00 61.00 92.00 122.00 115.00 0.00 40.00 79.00 119.00 158.00 14 8.0 0 0.00 4.00 9.00 13.00 17.00 16.00 0.00 9.00 17.00 26.00 34.00 32.00 17.00 17.00 17.00 17.00 17.00 16.00 39.00 39.00 39.00 39.00 39.00 37.00 158.00 158.00 158.00 158.00 73.00 73.00 73.00 73.00 73.00 73.00 73.00 73.00 0.00 48.00 97.00 145.00 0.00 48.00 97.00 145.00 0.00 53.00 105.00 158.00 0.00 41.00 82.00 122.00 0.00 42.00 84.00 125.00 0.00 44.00 89.00 133.00 94.00 0.00 0.50 39.00 94.00 0.00 0.50 39.00 94.00 0.00 0.50 39.00 94.00 0.00 0.50 39.00 158.00 73.00 73.00 193.00 193.00 210.00 163.00 167.00 177.00 94.00 0.00 0.50 39.00 148.00 69.00 69.00 181.00 181.00 197.00 153.00 157.00 166.00 88.00 0.00 0.50 37.00 4.00 5.00 7.00 10.00 1.00 2.00 1.00 2.00 10.00 4.00 4.00 12.00 12.00 13.00 10.00 10.00 11.00 6.00 0.00 0.00 2.00 COMMENTS N O CHANGE N O CHANGE =NEW/CHANGES/QUESTIONS Code Services Code Code Code Code Code 1 2 3 4 2022 2023 5 CURRENT CHANGE T1017 NSF 56420 11102 57500 57452 57454 57511 17000 17003 17004 56501 57170 58100 58110 11400 11981 10060 58300 57460 57461 88305 88305W 11976 11983 58301 11300 76857 N HV Child - Task Care Management N on -sufficient funds (bounced check) P ROCEDURES Bartholin Cyst Treatment Biopsy of skin, single Cervical Lesion Biopsy 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 Excisions, benign lesion Implant Insertion Incision & drainage of abscess, 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'I Removal, implant contraceptive Removal implant, with reinsertion Removal IUD Shaving of epidermal lesion, single on trunk, arms or legs, .5cm Ultrasound - pelvic non -obstetric ** 39.00 39.00 25.00 25.00 39.00 39.00 39.00 37.00 2.00 25.00 25.00 25.00 27.00 -2.00 29.00 /3.00 116.00 160.00 203.00 191.00 12.00 58.00 81.00 104.00 127.00 150.00 141.00 9.00 29.00 69.00 108.00 148.00 187.00 176.00 11.00 73.00 95.00 117.00 138.00 160.00 150.00 10.00 114.00 142.00 169.00 197.00 224.00 210.00 14.00 73.00 112.00 150.00 189.00 227.00 213.00 14.00 50.00 62.00 74.00 86.00 98.00 92.00 6.00 7.00 7.00 7.00 7.00 7.00 7.00 0.00 145.00 164.00 183.00 201.00 220.00 207.00 13.00 81.00 114.00 147.00 180.00 213.00 200.00 13.00 0.00 30.00 61.00 91.00 121.00 114.00 7.00 29.00 62.00 95.00 127.00 160.00 150.00 10.00 39.00 51.00 63.00 74.00 86.00 81.00 5.00 77.00 103.00 129.00 154.00 180.00 16 9.0 0 11.00 0.00 62.00 124.00 186.00 248.00 233.00 15.00 27.00 63.00 99.00 135.00 171.00 161.00 10.00 0.00 62.00 125.00 187.00 249.00 234.00 15.00 149.00 215.00 281.00 346.00 412.00 387.00 25.00 251.00 305.00 360.00 414.00 468.00 439.00 29.00 37.00 62.00 87.00 112.00 137.00 129.00 8.00 0.00 34.25 68.50 102.75 137.00 129.00 8.00 0.00 73.75 147.50 221.25 295.00 277.00 18.00 0.00 113.50 227.00 340.50 454.00 426.00 28.00 0.00 50.25 100.50 150.75 201.00 189.00 12.00 31.00 59.00 86.00 114.00 141.00 132.00 9.00 19.00 39.00 58.00 78.00 97.00 91.00 6.00 COMMENTS =NEW/CHANGES/QUESTIONS Code Services Code Code Code Code Code 1 2 3 4 2022 2023 5 CURRENT CHANGE A4267 0052W J7307 J7298 J7300 17301 J7297 J7296 J1050 96372 J7295 S4993 0068W 86900 82947 82565 86609 80048 85025 85027 87491W 87491 80053 0090W 87635 82627 82670 83001 87591W FAMILY PLANNING SUPPLIES Condoms pkg 10 Cycle Beads Nexplanon (Etonogestrel) IUD Mirena IUD Paragard IUD Skyla IUD Liletta IUD Kyleena Medroxyprogesterone (Depo) Admin i n fee depo- if visit for injection only EluRyng - Vaginal Ring - Replaces Nuva Ring Oral Contraceptives Seasonale/Seasonique (3 months supply) LAB ABO blood typing Assay, body fluid, glucose, (FBS) Assay of creatine Bacterium antibody Basic Metabolic Panel CBC w/Diff CBC w/o Diff Chlamydia PCR Grant Chlamydia PCR Comprehensive Metabolic Panel Court Ordered Lab Draw COVID Nasal/Nasopharyngeal Test PCR DHEAS Estradiol FSH Gonorrhea PCR Grant 0.00 2.00 4.00 5.00 0.00 5.00 9.00 14.00 0.00 274.00 549.00 823.00 0.00 307.00 613.00 920.00 0.00 261.00 521.00 782.00 0.00 284.00 568.00 852.00 0.00 32.00 64.00 96.00 0.00 271.00 541.00 812.00 0.00 5.00 9.00 14.00 0.00 9.00 19.00 28.00 0.00 14.00 27.00 41.00 0.00 3.00 6.00 8.00 0.00 8.00 16.00 24.00 7.00 18.00 1,097.00 1,226.00 1,042.00 1,136.00 128.00 1,082.00 18.00 37.00 54.00 11.00 32.00 7.00 17.00 1,030.00 1,151.00 978.00 1,067.00 120.00 1,016.00 10.00 35.00 51.00 10.00 30.00 0.00 1.00 67.00 75.00 64.00 69.00 8.00 66.00 8.00 2.00 3.00 1.00 2.00 LABS ADJUSTED TO LABCORP FEES 3.00 3.00 3.00 3.00 3.00 3.00 3.00 3.00 3.00 3.00 5.00 5.00 5.00 5.00 5.00 170.00 170.00 170.00 170.00 170.00 2.00 2.00 2.00 2.00 2.00 2.00 2.00 2.00 2.00 2.00 2.00 2.00 2.00 2.00 2.00 0.00 0.00 0.00 0.00 0.00 0.00 10.00 19.00 29.00 38.00 3.00 3.00 3.00 3.00 3.00 56.00 56.00 56.00 56.00 56.00 55.00 55.00 55.00 55.00 55.00 13.00 13.00 13.00 13.00 13.00 34.00 34.00 34.00 34.00 34.00 19.00 19.00 19.00 19.00 19.00 0.00 0.00 0-.0O 0.00 0.00 5.00 -2.00 27.00 -24.00 7.00 -2.00 36.00 134.00 39.00 -37.00 28.00 -26.00 24.00 -22.00 60.00 -22.00 16.00 -13.00 53.00 3.00 56.00 -1.00 37.00 -24.00 38.00 -4.00 45.00 -26.00 COMMENTS =NEW/CHANGES/QUESTIONS Code Services Code Code Code Code Code 1 2 3 4 2022 2023 5 CURRENT CHANGE 87591 82948 82951 87205 84702 84703 83718 86708 86709 86706 86705 86317 87340 80074 86803 87522 87255 86695 86696 85018 83036 83037 86701 86702 87389 G0435 87389W 87624 87625 0081W Gonorrhea PCR Glucose Random Glucose Tolerance Test 2 hr (GTT) Gram Stain HCG Quantitative - Serum Pregnancy Test HCG Qualitative - Serum Pregnancy Test HDL Cholesterol Hep A antibody Hep A igm antibody Hep B Surface Antibody -Qualitative Hep B core AB-Hep b core antibody igm Hep B surface AB -Quantitative Hep B surface AG* Hepatitis Panel (ABC) Hepatitis C Antibody Hepatitis C PCR Herpes Culture Herpes Select - Type I (89999A33) Herpes Select - Type II (89999A33) HGB - (Finger Stick)* HGB A1c HGB A1c (Finger Stick)* HIV 1/2 AB Diff (this is HIV 1) HIV 1/2 AB Diff (this is HIV 2) HIV - 1 antigen w/ HIV -1 & HIV -2 HIV Screen, Rapid Test HIV, State Credits HPV, High Risk HPV typing 16,18,45 HPV, High Risk w/ repeat pap (LabCorp use) 484006W Immunohistochemical Stain 87254 Influenza - Viral Culture 0.00 10.00 19.00 29.00 38.00 60.00 -22.00 2.00 2.00 2.00 2.00 2.00 9.00 -7.00 11.00 11.00 11.00 11.00 11.00 33.00 -22.00 30.00 30.00 30.00 30.00 30.00 35.00 -5.00 0.00 4.00 8.00 11.00 15.00 52.00 -37.00 0.00 2.00 4.00 6.00 8.00 52.00 -44.00 9.00 9.00 9.00 9.00 9.00 39.00 -30.00 13.00 13.00 13.00 13.00 13.00 18.00 -5.00 12.00 12.00 12.00 12.00 12.00 17.00 -5.00 11.00 11.00 11.00 11.00 11.00 32.00 -21.00 12.00 12.00 12.00 12.00 12.00 31.00 -19.00 15.00 15.00 15.00 15.00 15.00 24.00 -9.00 11.00 11.00 11.00 11.00 11.00 23.00 -12.00 48.00 48.00 48.00 48.00 48.00 73.00 -25.00 15.00 15.00 15.00 15.00 15.00 22.00 -7.00 43.00 48.00 53.00 58.00 63.00 59.00 4.00 34.00 50.00 66.00 81.00 97.00 91.00 6.00 13.00 34.00 55.00 76.00 97.00 91.00 6.00 19.00 39.00 58.00 78.00 97.00 91.00 6.00 0.00 4.00 9.00 13.00 17.00 16.00 1.00 10.00 19.00 28.00 37.00 46.00 43.00 3.00 10.00 12.00 14.00 15.00 17.00 16.00 1.00 9.00 11.00 12.00 14.00 15.00 14.00 1.00 14.00 15.00 15.00 16.00 16.00 15.00 1.00 15.00 15.00 15.00 15.00 15.00 32.00 -17.00 12.00 18.00 23.00 29.00 34.00 32.00 2.00 0.00 0.00 0.00 0.00 0.00 N/A N/A 0.00 24.00 49.00 73.00 97.00 91.00 6.00 0.00 15.00 30.00 44.00 59.00 55.00 4.00 154.00 154.00 154.00 154.00 154.00 145.00 9.00 0.00 27.00 54.00 80.00 107.00 100.00 7.00 58.00 58.00 58.00 58.00 58.00 54.00 4.00 COMMENTS =NEW/CHANGES/QUESTIONS Code Services Code Code Code Code Code 1 2 3 4 2022 2023 5 CURRENT CHANGE 96372 83525 83002 80061W 80061N 80076 86790 86376 0022W 87593 82274 88142 0080W 88175 88141 84144 84146 87633 84482 86901 87535 86592W 86592 86593W 86593 87081 84480 84481 84436 84439 84403 86800 Injection/Admin fee for Depo and antibiotics Insulin, Fasting LH Lipid Panel - SFS Lipid Panel Liver Panel MAC Elisa Microsomal antibodies Monkeypox testing Labcorp Monkeypox testing State Occult Blood Test, Fecal, IA Pap - Thin Prep Pap, repeat thin prep Pap, Thin prep, w HR HPV, Reflex 16,18.45 Physician Read Pap Progesterone Level Prolactin Respiratory Viral Panel Mixed, 12-25 Targets Reverse T3 RH blood type RNA Qualitative RPR/Syphilis test Grant RPR/Syphilis test RPR/Syphilis (Quant) Grant RPR/Syphilis (Quant) Streptococcus - Hemolytic T3 Triiodothyronine TT -3 (Free -Unbound) T4 Thyroxine T4 (Total Free -Unbound) Testosterone, Total Thyroglobulin Ab 0.00 9.00 19.00 28.00 37.00 35.00 2.00 18.00 18.00 18.00 18.00 18.00 17.00 1.00 10.00 10.00 10.00 10.00 10.00 45.00 -35.00 0.00 2.00 4.00 6.00 8.00 47.00 -39.00 8.00 8.00 8.00 8.00 8.00 47.00 -39.00 40.00 40.00 40.00 40.00 40.00 38.00 2.00 100.00 100.00 100.00 100.00 100.00 158.00 -58.00 23.00 23.00 23.00 23.00 23.00 22.00 1.00 82.00 82.00 82.00 82.00 82.00 77.00 5.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 16.00 21.00 26.00 30.00 35.00 37.00 -2.00 0.00 11.00 23.00 34.00 45.00 54.00 -9.00 54.00 54.00 54.00 54.00 54.00 0.00 39.00 79.00 118.00 157.00 147.00 10.00 0.00 12.00 24.00 35.00 47.00 44.00 3.00 26.00 26.00 26.00 26.00 26.00 24.00 2.00 50.00 50.00 50.00 50.00 50.00 47.00 3.00 687.00 687.00 687.00 687.00 687.00 645.00 42.00 26.00 26.00 26.00 26.00 26.00 24.00 2.00 7.00 7.00 7.00 7.00 7.00 7.00 0.00 59.00 59.00 59.00 59.00 59.00 55.00 4.00 0.00 0.00 0.00 0.00 4.00 11.00 19.00 26.00 33.00 31.00 2.00 0.00 0.00 0.00 0.00 0.00 4.00 7.00 10.00 12.00 15.00 14.00 1.00 16.00 16.00 16.00 16.00 16.00 15.00 1.00 62.00 62.00 62.00 62.00 62.00 58.00 4.00 62.00 62.00 62.00 62.00 62.00 58.00 4.00 12.00 12.00 12.00 12.00 12.00 11.00 1.00 14.00 14.00 14.00 14.00 14.00 13.00 1.00 46.00 46.00 46.00 46.00 46.00 43.00 3.00 26.00 26.00 26.00 26.00 26.00 24.00 2.00 COMMENTS =NEW/CHANGES/QUESTIONS Code Services Code Code Code Code Code 1 2 3 4 2022 2023 5 CURRENT CHANGE 82465 87661 86780 84443 86480 81001 81002 87086 81025 36415 36416 87210 0020W O0144 101456W 0456W 0017W J0696 0696W 0007W 0058W 0035W 87635W J8499 0003W 0059W 0011W 0012W J0561 0561W Total Cholesterol Trichomonas vaginalis - amplified Treponema pallidum TSH Tuberculosis Test-Quantiferon (IGRA) U rinalysis, complete with micro ex U rinalysis, w/o scope (UA) U rine Culture, Comprehensive U rine Pregnancy Test* Venipuncture Venipuncture - capillary blood specimen Wet Prep MEDICINES and TREATMENTS Amoxicillin 875 mg #20 Azithromycin, Z pack Azithromycin 1g - partner pack Azithromycin State supplied 500 mg #2 Cefixime 400 mg #2 Ceftriaxone 500 mg Ceftriaxone 500 mg Grant Covered Cephalexin 500 mg #14 Ciprofloxacin 500 mg #6 Condylox Descovy Doxycycline 100 mg #14 Doxycycline 100 mg #14 Grant Covered Estradiol 1 mg- #100 Fluconazole 150 mg #1 Iron LA Bicillin 2.4 Units LA Bicillin 2.4 Units -Grant Covered 32.00 32.00 32.00 32.00 32.00 0.00 15.00 29.00 44.00 58.00 18.00 18.00 18.00 18.00 18.00 46.00 46.00 46.00 46.00 46.00 122.00 122.00 122.00 122.00 122.00 7.00 7.00 7.00 7.00 7.00 3.00 6.00 8.00 11.00 13.00 8.00 10.00 11.00 13.00 14.00 0.00 5.00 9.00 14.00 18.00 0.00 3.00 5.00 8.00 10.00 0.00 3.00 5.00 8.00 10.00 0.00 9.00 17.00 26.00 34.00 30.00 54.00 17.00 43.00 115.00 7.00 12.00 13.00 17.00 9.00 9.00 32.00 2.00 4.00 1.00 3.00 7.00 0.00 1.00 1.00 1.00 1.00 1.00 2.00 4.00 4.00 4.00 4.00 4.00 4.00 0.00 3.00 3.00 3.00 3.00 3.00 3.00 0.00 3.00 3.00 3.00 3.00 3.00 3.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 7.00 7.00 7.00 7.00 7.00 N/A N/A 3.00 3.00 3.00 3.00 3.00 3.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 9.00 9.00 9.00 9.00 9.00 8.00 1.00 5.00 5.00 5.00 5.00 5.00 5.00 0.00 2.00 2.00 2.00 2.00 2.00 2.00 0.00 5.00 5.00 5.00 5.00 5.00 5.00 0.00 11.00 11.00 11.00 11.00 11.00 10.00 1.00 0.00 0.00 0.00 0.00 0.00 N/A N/A 5.00 5.00 5.00 5.00 5.00 5.00 0.00 2.00 2.00 2.00 2.00 2.00 2.00 0.00 3.00 3.00 3.00 3.00 3.00 3.00 0.00 2.00 2.00 2.00 2.00 2.00 2.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 COMMENTS =NEW/CHANGES/QUESTIONS Code Services Code Code Code Code Code 1 2 3 4 2022 2023 5 CURRENT CHANGE 0060W 0008W 0009W 0010W 0013W 0006W 0015W 0016W 0004W 0073W 90471 90472 90473 90700N 90700 90702N 90633N 90633 90632N 90632 90744N 90744 90746N 90746 90739 90647N 90647 90651N 90651 90281 Medroxyprogesterone 10 mg - #5 Metrogel Metronidazole 500 mg #4 Metronidazole 500 mg #14 Metronidazole 250 mg #28 Misoprostel (Cytotec) 200 mcg #2 Nitrofurantoin 100 mg #10 Podophyllin/TCA Sulfatrim SMX/TMP Truvada #3 IMMUNIZATIONS Imm. Admin - one vaccine Imm Admin - each addl. Vaccine Imm Admin - intranasal or oral DTaP -State supplied DTaP DT - State supplied Hepatitis A - Child - State supplied Hepatitis A - Child Hepatitis A - Adult - State supplied Hepatitis A - Adult Hepatitis B - Child - State supplied Hepatitis B - Child Hepatitis B - Adult - State supplied Hepatitis B - Adult Heplisav-B HIB - State supplied HIB HPV 9 - State supplied HPV 9 IG Hepatitis A - State supplied 4.00 4.00 4.00 4.00 4.00 4.00 4.00 4.00 6.00 6.00 6.00 6.00 12.00 12.00 12.00 12.00 18.00 18.00 18.00 18.00 5.00 5.00 5.00 5.00 4.00 4.00 4.00 4.00 4.00 4.00 4.00 4.00 4.00 4.00 4.00 4.00 18.00 18.00 18.00 18.00 4.00 4.00 6.00 12.00 18.00 5.00 4.00 4.00 4.00 18.00 4.00 13.00 6.00 11.00 17.00 5.00 N/A 4.00 4.00 17.00 0.00 - 9.00 0.00 1.00 1.00 0.00 N/A 0.00 0.00 1.00 ADJUSTED TO MARKET COSTS 21.65 21.65 21.65 21.65 21.65 21.65 21.65 21.65 21.65 21.65 21.65 21.65 21.65 21.65 21.65 21.65 21.65 21.65 0.00 0.00 0.00 0.00 0.00 0.00 24.00 24.00 24.00 24.00 24.00 38.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 34.00 34.00 34.00 34.00 34.00 40.00 0.00 0.00 0.00 0.00 0.00 0.00 77.00 77.00 77.00 77.00 77.00 85.00 0.00 0.00 0.00 0.00 0.00 0.00 19.00 19.00 19.00 19.00 19.00 25.00 0.00 0.00 0.00 0.00 0.00 0.00 53.00 53.00 53.00 53.00 53.00 60.00 87.00 87.00 87.00 87.00 87.00 130.00 0.00 0.00 0.00 0.00 0.00 0.00 32.00 32.00 32.00 32.00 32.00 45.00 0.00 0.00 0.00 0.00 0.00 0.00 299.00 299.00 299.00 299.00 299.00 240.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 -14.00 0.00 0.00 - 6.00 0.00 - 8.00 0.00 - 6.00 0.00 -7.00 -43.00 0.00 -13.00 0.00 59.00 0.00 COMMENTS NO CHANGE: STATE MANDATED R =NEW/CHANGES/QUESTIONS Code Services Code Code Code Code Code 1 2 3 4 2022 2023 5 CURRENT CHANGE COMMENTS 90686 90662 90660N 90660 90687 90687N 90688 90688N 90713N 90713 90738 90696N 90696 90734N 90734 90620 90733 90707N 90707 90611 90622 90723N 90723 90698N 90698 90732N 90732 90710N 90710 90670N 90670 Influenza - GSK Flarixvsccine Influenza - High -Dose Influenza - intranasal use - State supplied Influenza - Intranasal Adult Influenza - infant quadrivalent 6 month & up Influenza - infant quadrivalent - State supplied Influenza - 3 yrs and up - quadrivalent 0.00 10.00 20.00 30.00 40.00 39.00 1.00 80.00 80.00 80.00 80.00 80.00 N/A N/A 0.00 0.00 0.00 0.00 0.00 0.00 0.00 46.00 46.00 46.00 46.00 46.00 43.00 3.00 0.00 10.00 20.00 30.00 40.00 43.00 -3.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 10.00 20.00 30.00 40.00 42.00 -2.00 Influenza - 3 yrs and up - State supplied quadrivalent 0.00 0.00 0.00 0.00 0.00 0.00 0.00 IPV-VFC - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 0.00 IPV 43.00 43.00 43.00 43.00 43.00 50.00 -7.00 Japanese Encephalitis (new formulation) 387.00 387.00 387.00 387.00 387.00 380.00 7.00 Kinrix - (DTaP/IPV)/Quadracel - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Kinrix - (DTaP/IPV)/Quadracel 59.00 59.00 59.00 59.00 59.00 75.00 -16.00 MCV4 - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 0.00 MCV4 138.00 138.00 138.00 138.00 138.00 201.00 -63.00 MenB 210.00 210.00 210.00 210.00 210.00 176.00 34.00 MPSV4 (Menomune)(polysaccharide) 214.00 214.00 214.00 214.00 214.00 201.00 13.00 MMR - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 0.00 MMR 101.00 101.00 101.00 101.00 101.00 90.00 11.00 Monkeypox Jynneos vaccine SubQ 0.5m1 0.00 0.00 0.00 0.00 0.00 N/A N/A Monkeypox Jynneos vaccine intradermal 0.1ml 0.00 0.00 0.00 0.00 0.00 N/A N/A Pediarix (DTAP, IPV, Hep B) - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Pediarix - (DTaP/IPV/Hep B) 75.00 75.00 75.00 75.00 75.00 103.00 -28.00 Pentacel - (DTaP/IPV/HepB) - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Pentacel - (DTaP/IPV/HepB) 58.00 58.00 58.00 58.00 58.00 153.00 -95.00 Pneumovax - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Pneumovax (Pneumococcal Polysaccharide) 138.00 138.00 138.00 138.00 138.00 101.00 37.00 Proquad - MMR-Varicella 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Proquad - MMR-Varicella 292.00 292.00 292.00 292.00 292.00 240.00 52.00 Prevnar - (PCV13) - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Prevnar - (PCV13) 318.00 318.00 318.00 318.00 318.00 225.00 93.00 =NEW/CHANGES/QUESTIONS Code Services Code Code Code Code Code 1 2 3 4 2022 2023 5 CURRENT CHANGE 90675 90675N 90375 90680N 90680 90750 90714N 90714 90715N 90715 86580 90636 90691 90690 90716N 90716 90717 Rabies IM Rabies IM - State supplied RIG (rabies) - per cc Rotavirus - State supplied Rotavirus - (RV5) Shingrix Td - State supplied Td - Tdap - State supplied Tdap - Tuberculosis Interdermal Skin Test (PPD) Twinrix - Hep A & Hep B Typhoid - 1 Shot Typhoid - Oral Varivax - State supplied Varivax Yellow Fever ** Services include surgical procedure only. 351.00 351.00 351.00 351.00 351.00 330.00 21.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 381.00 381.00 381.00 381.00 381.00 424.00 -43.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 106.00 106.00 106.00 106.00 106.00 116.00 -10.00 203.00 203.00 203.00 203.00 203.00 168.00 35.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 37.00 37.00 37.00 37.00 37.00 45.00 -8.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 24.00 24.00 24.00 24.00 24.00 55.00 -31.00 10.00 10.00 10.00 10.00 10.00 58.00 -48.00 117.00 117.00 117.00 117.00 117.00 110.00 7.00 190.00 190.00 190.00 190.00 190.00 94.00 96.00 98.00 98.00 98.00 98.00 98.00 82.00 16.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 178.00 178.00 178.00 178.00 178.00 150.00 28.00 202.00 202.00 202.00 202.00 202.00 186.00 16.00 COMMENTS 2023 CLINICAL AND COMMUNITY HEALTH SERVICES FEE SCHEDULE PROPOSED FINAL CODE Services Household Code Size Code Code Code Code Code 1 2 3 4 5 New Client 99202 Expanded 99203 Detailed 99204 Comprehensive 99205 Extensive Established Client 99211 Minimal 99212 Focused 99213 Expanded 99214 Detailed 99215 Comprehensive Telemedicine 99401T Preventive Medicine 15 min - Telemedicine 99402T Individual - 30 min - Telemedicine 99202T New Patient Focused - Telemedicine 99203T Detailed - Telemedicine 992111 Est Patient Minimal - Telemedicine 99212T Est Patient Focused - Telemedicine 99213T Est Patient Expanded - Telemedicine 99214T Detailed - Telemedicine 9921ST Comprehensive - Telemedicine 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 99404 Individual - 60 min 99406 Tobacco use cessation counseling 99407 Tobacco use cessation counseling Maternal Depression Screening Documented Negative - G8510 NFP G8431 Maternal Depression Screening not documented- NFP Travel Visits 99404 Individual Initial Visit - 60 99401W Return Visit 99412 Group Initial Visit (per person) - 60 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 118.00 118.00 117.00 122.00 0.00 0.00 0.00 0.00 0.00 0.00 17.00 39.00 158.00 73.00 73.00 37.00 48.00 72.00 74.00 14.00 24.00 32.00 50.00 62.00 15.00 22.00 37.00 48.00 14.00 24.00 32.00 50.00 62.00 118.00 118.00 117.00 122.00 15.00 22.00 31.00 40.00 4.00 9.00 17.00 39.00 158.00 73.00 73.00 75.00 97.00 145.00 148.00 28.00 49.00 63.00 99.00 124.00 30.00 44.00 75.00 97.00 28.00 49.00 63.00 99.00 124.00 118.00 118.00 117.00 122.00 30.00 44.00 61.00 79.00 9.00 17.00 17.00 39.00 158.00 73.00 73.00 112.00 145.00 217.00 222.00 42.00 73.00 95.00 149.00 185.00 45.00 65.00 112.00 145.00 42.00 73.00 95.00 149.00 185.00 118.00 118.00 117.00 122.00 45.00 65.00 92.00 119.00 13.00 26.00 17.00 39.00 158.00 73.00 73.00 149.00 193.00 289.00 296.00 56.00 97.00 126.00 198.00 247.00 60.00 87.00 149.00 193.00 56.00 97.00 126.00 198.00 247.00 118.00 118.00 117.00 122.00 60.00 87.00 122.00 158.00 17.00 34.00 17.00 39.00 158.00 73.00 73.00 CODE Services Code Code Code Code Code 1 2 3 4 5 Preventive 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 0 00 48 00 97 00 145 00 193 00 0 00 48 00 97 00 145 00 193 00 0 00 53 00 105 00 158 00 210 00 0 00 41 00 82 00 122 00 163 00 0 00 42 00 84 00 125 00 167 00 0 00 44 00 89 00 133 00 177 00 Additional Codes 0071W Community Education 1 hr 94 00 94 00 94 00 94 00 94 00 0069W Printout/Medical Records - Patient 1st 10 pgs 0 00 0 00 0 00 0 00 0 00 0069W Printout/Medical Records - Patient > 10 pgs per pg 0 50 0 50 0 50 0 50 0 50 G9006 NHV Mother - Task Care Management 39 00 39 00 39 00 39 00 39 00 T1017 NHV Child- Task Care Management 39 00 39 00 39 00 39 00 39 00 NSF Non -sufficient funds (bounced check) 25 00 25 00 25 00 25 00 25 00 PROCEDURES 56420 Bartholin Cyst Treatment 11102 Biopsy of skin, single 57500 Cervical Lesion Biopsy 57452 Colposcopy without Biopsy 00 57454 Colposcopy with Biopsy ** 57511 Cryocautery cervix- initial or repeat 17000 Cryotherapy first lesion** 17003 Cryotherapy 2-14 lesions** 17004 Cryotherapy 15 + lesions** 56501 Destruction Lesion Vulva 57170 Diaphragm/Cervical Cap Fitting 58100 Endometrial biopsy w/wo Biopsy 58110 Endometrial biopsy with Colposcopy 11400 Excisions, benign lesion 11981 Implant Insertion 10060 Incision & drainage of abscess, single or simple 58300 Insertion IUD 57460 LEEP with biopsy 57461 LEEP with conization 88305 Level 4 - Surgical pathology 1st site 88305W Level 4 - Surgical Pathology 2nd site & each add'I 11976 Removal, implant contraceptive 11983 Removal implant, with reinsertion 58301 Removal IUD Shaving of epidermal lesion, single on trunk, arms or 11300 legs, 5cm 76857 Ultrasound - pelvic non -obstetric FAMILY PLANNING SUPPLIES A4267 Condoms pkg 10 0052W Cycle Beads 29 00 73 00 116 00 160 00 203 00 58 00 81 00 104 00 127 00 150 00 29 00 69 00 108 00 148 00 187 00 73 00 95 00 117 00 138 00 160 00 114 00 142 00 169 00 197 00 224 00 73 00 112 00 150 00 189 00 227 00 50 00 62 00 74 00 86 00 98 00 700 700 700 700 700 145 00 164 00 183 00 201 00 220 00 81 00 114 00 147 00 180 00 213 00 0 00 30 00 6100 9100 12100 29 00 62 00 95 00 127 00 160 00 39 00 51 00 63 00 74 00 86 00 77 00 103 00 129 00 154 00 180 00 0 00 62 00 124 00 186 00 248 00 27 00 63 00 99 00 135 00 171 00 0 00 62 00 125 00 187 00 249 00 149 00 215 00 281 00 346 00 412 00 25100 305 00 360 00 414 00 468 00 37 00 62 00 87 00 112 00 137 00 0 00 37 00 68 00 103 00 137 00 0 00 74 00 147 00 221 00 295 00 0 00 114 00 227 00 340 00 454 00 0 00 50 00 100 00 150 00 200 00 31 00 59 00 86 00 114 00 14100 19 00 39 00 58 00 78 00 97 00 0 00 2 00 4 00 5 00 7 00 000 500 900 1400 1800 CODE Services Code Code Code Code Code 1 2 3 4 5 J7307 Nexplanon (Etonogestrel) J7298 IUD Mirena J7300 IUD Paragard J7301 IUD Skyla J7297 IUD Liletta J7296 IUD Kyleena J1050 Medroxyprogesterone (Depo) 96372 Admin fee depo- if visit for injection only J7295 EluRyng - Vaginal Ring - Replaces Nuva Ring S4993 Oral Contraceptives 0068W Seasonale/Seasonique (3 months supply) LAB 86900 ABO blood typing 82947 Assay, body fluid, glucose, (FBS) 82565 Assay of creatine 86609 Bacterium antibody 80048 Basic Metabolic Panel 85025 CBC w/Diff 85027 CBC w/o Diff 87491 Chlamydia PCR 80053 Comprehensive Metabolic Panel 0090W Court Ordered Lab Draw 87635 COVID Nasal/Nasopharyngeal Test PCR 82627 DHEAS 82670 Estradiol 83001 FSH 87591 Gonorrhea PCR 82948 Glucose Random 82951 Glucose Tolerance Test 2 hr (GTT) 87205 Gram Stain 84702 HCG Quantitative - Serum Pregnancy Test 84703 HCG Qualitative - Serum Pregnancy Test 83718 HDL Cholesterol 86708 Hep A antibody_ 86709 Hep A igm antibody 86706 Hep B Surface Antibody -Qualitative 86705 Hep B core AB-Hep b core antibody igm 86317 Hep B surface AB -Quantitative 87340 Hep B surface AG* 80074 Hepatitis Panel (ABC) 86803 Hepatitis C Antibody 87522 Hepatitis C PCR 87255 Herpes Culture 86695 Herpes Select - Type I (89999A33) 86696 Herpes Select - Type II (89999A33) 85018 HGB - (Finger Stick)* 83036 HGB A1c 83037 HGB A1c (Finger Stick)* 0 00 0 00 0 00 0 00 0 00 0 00 0 00 0 00 0 00 0 00 0 00 274 00 307 00 26100 284 00 32 00 27100 5 00 9 00 14 00 3 00 8 00 549 00 613 00 52100 568 00 64 00 541 00 9 00 19 00 27 00 6 00 16 00 823 00 920 00 782 00 852 00 96 00 812 00 14 00 28 00 4.100 8 00 24 00 1,097 00 1,226 00 1,042 00 1,136 00 128 00 1,082 00 18 00 3700 54 00 1100 32 00 300 300 300 300 300 300 300 300 300 300 500 500 500 500 500 170 00 170 00 170 00 170 00 170 00 2 00 2 00 2 00 2 00 2 00 200 200 200 200 200 2 00 2 00 2 00 2 00 2 00 0 00 10 00 19 00 29 00 38 00 300 300 300 300 300 56 00 56 00 56 00 56 00 56 00 55 00 55 00 55 00 55 00 55 00 1300 1300 1300 1300 1300 34 00 34 00 34 00 34 00 3490 1900 1900 1900 1900 1900 0 00 10 00 19 00 29 00 38 00 200 200 200 200 200 11 00 1100 11 00 1100 11 00 30 00 30 00 30 00 30 00 30 00 000 400 800 1100 1500 000 200 400 600 800 900 900 900 900 900 13 00 13 00 13 00 13 00 13 00 12 00 12 00 12 00 12 00 12 00 1100 1100 11 00 1100 11 00 12 00 12 00 12 00 12 00 12 00 1500 1500 1500 1500 1500 11 00 11 00 11 00 11 00 11 00 48 00 48 00 48 00 48 00 48 00 1500 1500 1500 1500 1500 43 00 48 00 53 00 58 00 63 00 34 00 50 00 66 00 8100 97 00 13 00 34 00 55 00 76 00 97 00 19 00 39 00 58 00 78 00 97 00 000 400 900 1300 1700 10 00 19 00 28 00 37 00 46 00 10 00 12 00 14 00 15 00 17 00 c CODE Services Code Code Code Code Code 1 2 3 4 5 86701 HIV 1/2 AB Diff (this is HIV 1) 86702 HIV 1/2 AB Duff (this is HIV 2) 87389 HIV - 1 antigen w/ HIV -1 & HIV -2 G0435 HIV Screen, Rapid Test 87389W HIV, State Credits 87624 HPV, High Risk 87625 HPV typing 16,18,45 0081W HPV, High Risk w/ repeat pap (LabCorp use) 484006W Immunohistochemical Stain 87254 Influenza - Viral Culture 96372 Injection/Admin fee for Depo and antibiotics 83525 Insulin, Fasting 83002 LH 80061W Lipid Panel - SFS 80061N Lipid Panel 80076 Liver Panel 86790 MAC Elisa 86376 Microsomal antibodies 0022W Monkeypox testing Labcorp 87593 Monkeypox testing State 82274 Occult Blood Test, Fecal, IA 88142 Pap - Thin Prep 88175 Pap, Thin prep, w HR HPV, Reflex 16,18 45 88141 Physician Read Pap 84144 Progesterone Level 84146 Prolactin 87633 Respiratory Viral Panel Mixed, 12-25 Targets 84482 Reverse T3 86901 RH blood type 87535 RNA Qualitative 86592 RPR/Syphilis test 86593 RPR/Syphilis (Quant) 87081 Streptococcus - Hemolytic 84480 T3 Triiodothyronine 84481 TT -3 (Free -Unbound) 84436 T4 Thyroxine 84439 T4 (Total Free -Unbound) 84403 Testosterone, Total 86800 Thyroglobulin Ab 82465 Total Cholesterol 87661 Trichomonas vaginalis - amplified 86780 Treponema pallidum 84443 TSH 86480 Tuberculosis Test-Quantiferon (IGRA) 81001 Urinalysis, complete with micro ex 81002 Urinalysis, w/o scope (UA) 87086 Urine Culture, Comprehensive 81025 Urine Pregnancy Test* 36415 Venipuncture 9 00 14 00 15 00 12 00 0 00 0 00 0 00 154 00 0 00 58 00 0 00 18 00 10 00 0 00 8 00 40 00 100 00 23 00 82 00 0 00 16 00 0 00 0 00 0 00 26 00 50 00 687 00 26 00 7 00 59 00 4 00 4 00 16 00 62 00 62 00 12 00 14 00 46 00 26 00 32 00 0 00 18 00 46 00 122 00 7 00 3 00 8 00 0 00 0 00 1100 15 00 15 00 18 00 0 00 24 00 15 00 154 00 27 00 58 00 9 00 18 00 10 00 2 00 8 00 40 00 100 00 23 00 82 00 0 00 21 00 1100 39 00 12 00 26 00 50 00 687 00 26 00 7 00 59 00 1100 7 00 16 00 62 00 62 00 12 00 14 00 46 00 26 00 32 00 15 00 18 00 46 00 122 00 7 00 6 00 10 00 5 00 3 00 12 00 15 00 15 00 23 00 0 00 49 00 30 00 154 00 54 00 58 00 19 00 18 00 10 00 4 00 8 00 40 00 100 00 23 00 82 00 0 00 26 00 23 00 79 00 24 00 26 00 50 00 687 00 26 00 7 00 59 00 19 00 10 00 16 00 62 00 62 00 12 00 14 00 46 00 26 00 32 00 29 00 18 00 46 00 122 00 7 00 8 00 11 00 9 00 5 00 14 00 16 00 15 00 29 00 0 00 73 00 44 00 154 00 80 00 58 00 28 00 18 00 10 00 6 00 8 00 40 00 100 00 23 00 82 00 0 00 30 00 34 00 118 00 35 00 26 00 50 00 687 00 26 00 7 00 59 00 26 00 12 00 16 00 62 00 62 00 12 00 14 00 46 00 26 00 32 00 44 00 18 00 46 00 122 00 7 00 1100 13 00 14 00 8 00 15 00 16 00 15 00 34 00 0 00 97 00 59 00 154 00 107 00 58 00 3700 18 00 10 00 8 00 8 00 40 00 100 00 23 00 82 00 0 00 35 00 45 00 157 00 47 00 26 00 50 00 687 00 26 00 7 00 59 00 33 00 15 00 16 00 62 00 62 00 12 00 14 00 46 00 26 00 32 00 58 00 18 00 46 00 122 00 7 00 13 00 14 00 18 00 10 00 CODE Services Code Code Code Code Code 1 2 3 4 5 36416 Venipuncture - capillary blood specimen 87210 Wet Prep MEDICINES and TREATMENTS 0020W Amoxicillin 875 mg #20 O0144 Azithromycin, Z pack 101456W Azithromycin 1g - partner pack 0456W Azithromycin State supplied 500 mg #2 0017W Cefixime 400 mg #2 J0696 Ceftriaxone 500 mg 0696W Ceftnaxone 500 mg Grant Covered 0007W Cephalexin 500 mg #14 0058W Ciprofloxacin 500 mg #6 0035W , Condylox -87635W Descovy J8499 Doxycycline 100 mg #14 0059W Estradiol 1 mg- #100 0011W Fluconazole 150 mg #1 0012W Iron J0561 LA Bicillin 2 4 Units 0561W LA Bicillin 2 4 Units -Grant Covered 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 0015W Nitrofurantoin 100 mg #10 0016W Podophyllin/TCA 0004W Sulfatrim SMX/TMP 0073W Truvada #3 IMMUNIZATIONS 90471 Imm Admin - one vaccine 90472 Imm Admit - each addl Vaccine 90473 Imm Admin - intranasal or oral 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 90739 Heplisav-B 90647N HIB - State supplied 000 300 500 800 1000 0 00 9 00 17 00 26 00 34 00 4 00 3 00 3 00 0 00 7 00 3 00 0 00 9 00 5 00 2 00 5 00 1100 5 00 2 00 3 00 2 00 0 00 4 00 4 00 6 00 12 00 18 00 5 00 _ 4 00 4 00 4 00 18 00 21 65 21 65 2165 0 00 24 00 0 00 0 00 34 00 0 00 77 00 0 00 19 00 0 00 53 00 87 00 0 00 4 00 3 00 3 00 - 0 00 7 00 3 00 0 00 9 00 5 00 2 00 5 00 1100 5 00 2 00 3 00 2 00 0 00 4 00 4 00 6 00 12 00 18 00 5 00 4 00 4 00 4 00 18 00 21 65 21-65 21 65 0 00 24 00 0 00 0 00 34 00 0 00 77 00 0 00 19 00 0 00 53 00 87 00 0 00 4 00 3 00 3 00 0 00 7 00 3 00 0 00 9 00 5 00 2 00 5 00 1100 5 00 2 00 3 00 2 00 0 00 4 00 4 00 6 00 12 00 18 00 5 00 4 00 4 00 4 00 18 00 21 65 21 65 _2165 0 00 24 00 0 00 0 00 34 00 0 00 77 00 0 00 19 00 0 00 53 00 87 00 0 00 400 X400 3 00 3 00 0 00 7 00 3 00 0 00 9 00 5 00 2 00 5 00 1100 5 00 2 00 3 00 2 00 0 00 4 00 4 00 6 00 12 00 18 00 5 00 4 00 4 00 4 00 18 00 21 65 21 65 21 65 0 00 24 00 0 00 0 00 34 00 0 00 77 00 0 00 19 00 0 00 53 00 8700 0 00 3 00 3 00 0 00 7 00 3 00 0 00 9 00 5 00 2 00 5 00 11 00 5 00 2 00 3 00 2 00 0 00 4 00 4 00 6 00 12 00 18 00 5 00 4 00 4 00 4 00 18 00 2165 21 65 21 65 0 00 24 00 0 00 0 00 34 00 0 00 77 00 0 00 19 00 0 00' 53 00 87 00 0 00 CODE Services Code Code Code Code Code 1 2 3 4 5 90647 , HIB 32 00 32 00 32 00 32 00 32 00 90651N HPV 9 - State supplied 0 00 0 00 0 00 0 00 0 00 90651 HPV 9 299 00 299 00 299 00 299 00 299 00 90281 IG Hepatitis A - State supplied 0 00 0 00 0 00 0 00 0 00 90686 Influenza - GSK Flarixvsccine 0 00 10 00 20 00 30 00 40 00 90662 Influenza - High -Dose 72 00 72 00 72 00 72 00 72 00 90660N Influenza - intranasal use - State supplied 0 00 0 00 0 00 0 00 0 00 90660 Influenza - Intranasal Adult 39 00 39 00 39 00 39 00 39 00 90687 Influenza - infant quadrivalent 6 month & up 39 00 39 00 39 00 39 00 39 00 90687N Influenza - infant quadrivalent - State supplied 0 00 0 00 0 00 0 00 0 00 90688 Influenza - 3 yrs and up - quadrivalent 39 00 39 00 39 00 39 00 39 00 90688N Influenza - 3 yrs and up - State supplied quadrivalent 0 00 0 00 0 00 0 00 0 00 90713N IPV-VFC - State supplied 0 00 0 00 0 00 0 00 0 00 90713 IPV 43 00 43 00 43 00 43 00 43 00 90738 Japanese Encephalitis (new formulation) 387 00 387 00 387 00 387 00 387 00 90696N Kinrix - (DTaP/IPV)/Quadracel - State supplied 0 00 0 00 0 00 0 00 0 00 90696 Kinrix - (DTaP/IPV)/Quadracel 59 00 59 00 59 00 59 00 59 00 90734N MCV4 - State supplied 0 00 0 00 0 00 0 00 0 00 90734 MCV4 138 00 138 00 138 00 138 00 138 00 90620 MenB 210 00 210 00 210 00 210 00 210 00 90733 MPSV4 (Menomune)(polysaccharide) 214 00 214 00 214 00 214 00 214 00 90707N- MMR - State supplied 0 00 0 00 0 00 0 00 0 00 90707 MMR 10100 10100 10100 10100 10100 90611 Monkeypox Jynneos vaccine SubQ 0 5ml State 0 00 0 00 0 00 0 00 0 00 90622 Monkeypox Jynneos vaccine intradermal 0 1ml State 0 00 0 00 0 00 0 00 0 00 90723N Pediarix (DTAP, IPV, Hep B) - State supplied 0 00 0 00 0 00 0 00 0 00 90723 Pediarix - (DTaP/IPV/Hep B) 75 00 75 00 75 00 75 00 75 00 90698N Pentacel - (DTaP/IPV/HepB) - State supplied 0 00 0 00 0 00 0 00 0 00 90698 Pentacel - (DTaP/IPV/HepB) 58 00 58 00 58 00 58 00 58 00 90732N Pneumovax - State supplied 0 00 0 00 0 00 0 00 0 00 90732 Pneumovax (Pneumococcal Polysaccharide) 138 00 138 00 138 00 138 00 138 00 90710N Proquad - MMR-Varicella 0 00 0 00 0 00 0 00 0 00 90710 Proquad - MMR-Varicella 292 00 292 00 292 00 292 00 292 00 90670N Prevnar - (PCV13) - State supplied 0 00 0 00 0 00 0 00 0 00 90670 Prevnar - (PCV13) 318 00 318 00 318 00 318 00 318 00 90675 Rabies IM 35100 35100 35100 351 00 351 00 90675N Rabies IM - State supplied 0 00 0 00 0 00 0 00 0 00 90375 RIG (rabies) - per cc 381 00 381 00 381 00 38100 38100 90680N Rotavirus - State supplied 0 00 0 00 0 00 0 00 0 00 90680 Rotavirus - (RV5) 106 00 106 00 106 00 106 00 106 00 90750 Shingrix 203 00 203 00 203 00 203 00 203 00 90714N Td - State supplied 0 00 0 00 0 00 0 00 0 00 90714 Td - 37 00 37 00 37 00 37 00 37 00 90715N Tdap - State supplied 0 00 0 00 0 00 0 00 0 00 90715 Tdap - 24 00 24 00 24 00 24 00 24 00 86580 Tuberculosis Interdermal Skin Test (PPD) 10 00 10 00 10 00 10 00 10 00 90636 Twinrix - Hep A & Hep B 117 00 117 00 117 00 117 00 117 00 90691 Typhoid - 1 Shot 190 00 190 00 190 00 190 00 190 00 90690 Typhoid - Oral 98 00 98 00 98 00 98 00 98 00 CODE Services Code Code Code Code Code 1 2 3 4 5 90716N Vanvax - State supplied 90716 Vanvax 90717 Yellow Fever ** Services include surgical procedure only 10/21/2022 revised 0 00 178 00 202 00 0 00 178 00 202 00 0 00 178 00 202 00 0 00 178 00 202 00 0 00 178 00 202 00 Hello