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Home My WebLink About20213392.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, 2022, 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, 2022. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 13th day of December, A.D., 2021. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO ATTEST: da:400 XL :el Steve Weld County Clerk to the Board BY: eputy Clerk to the Board oren Perry L. B APPS ike Freeman County A orney Date of signature: hair (AYE) (AYE) (AYE) (AYE) (NAY) CC: HLErss), FI(ve)/So%v), AerCca) 12/22/21 2.021-3392 HL0Q03- Memorandum TO: Steve Moreno, Chair Board of County Commissioners FROM: Mark Lawley, Executive Director Department of Public Health & Environment DATE: December 6, 2021 SUBJECT: Health Department 2022 Fee Schedules — Environmental Health & Public Health Clinical Services For the Board's approval are the Health Department's proposed Environmental Health Services ("EHS") and Public Health Clinical Services ("PHCS") fees schedules for 2022. 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 $85 per hour, up from $80 per hour in 2021. The change in this rate led to an evaluation of all non -laboratory program fees using this new hourly rate. The proposed fee changes incorporate this new hourly rate among other cost factors to determine the 2022 fee schedule adjustments. Rate changes recommended for childcare and ambulance inspections provide inspection activity cost recovery for those programs. The lab has continued to see costs increase as wages and prices for reagents and sampling materials increase. To more closely achieve cost recovery following those increases, we are recommending a rate increase of approximately 4.5%, based on the current Consumer Price Index, which raises our fees between $1.00 to $7.00 per service in 2022. In addition, through federal COVID ELC funding, the department was able to purchase equipment that will allow for testing for COVID and other common respiratory illnesses and some types of bacteria, which can all be run with one patient swab. The new fee added covers the cost of the test, lab employee time and other miscellaneous expenses. This fee will only be charged if ELC funding does not cover the cost for running the test as part of the grant. There were no changes to the Household Hazardous Waste fee schedules because the waste disposal price contract, as bid, did not change from previous the year. PUBLIC HEALTH CLINICAL SERVICES: A comprehensive review of the PHCS fee schedule was made to ensure that costs are adequately recovered across all clinic programs of the PHCS 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 2022 medical inflation rate. The fee schedule also reflects 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. The Board approved placement of the Health Department's Fee Schedules on the Board's acenda following a work session dated December 6, 2021. 2021-3392 I recommend approval of the proposed 2022 PHCS and EHS fee schedule changes. i4L-0003 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT ENVIRONMENTAL HEALTH SERVICES - PROPOSED 2022 FEE SCHEDULE PROPOSED CHANGES FOR 2022 IN RED imiFees 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 - Minor Service Pre-packaged Single Event Special/Temporary Event License - Minor Service Pre-packaged Calendar Year Special/Temporary Event Vendor License - Late/Expedite Fee: up to 2 days before event Special/Temporary Event Coordinator Fee (1 Vendor) Special/Temporary Event Coordinator Fee Non -Recurring Events (submitted 30+ days before event) Special/Temporary Event Coordinator Fee Non -Recurring Events (submitted <30 days before event) Special/Temporary Event Coordinator Fee Recurring Events (submitted 30+ days before event) Special/ I emporary Event Coordinator Fee Recurring Events (submitted <30 days before event) Special/Temporary Event Coordinator Fee (if applicable for additional miscellaneous time) Specia Temporary Event Ceoec Requested Full Re -inspection +eater zee Late/Expedite Fee: up to 2 days before event 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) $350.00 $75.00 Application fee of $100 plus $80.00/hour $85.00/hour $85/hour determined using method developed with Don Warden. $80.00/hour $85.00/hour $350.00 $350.00 $12.00 $13.00 $50.00 $170.00 $100.00 $212.50 $150.00 $255.00 $200.00 $297.50 $125.00 $212.50 $100.00 $297.50 $80.00/hour $85.00/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 $25.00 $50.00 $0.00 $100.00 $150.00 $250.00 $200.00 New $250.00 $80.00/hour $85.00/hour 550.0O $189.00 Application fee of $100 plus $80.00/hour $85.00/hour (not to exceed $580) $80.00/hour $85.00/hour (not to exceed $500) $100.00 $400.00 $75.00 $80.00/hour $85.00/hour Note: Fees last updated in 2016 Note 2: Fees assessed every other year Note 3: These fees provide inspectional cost recovery WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT ENVIRONMENTAL HEALTH SERVICES - PROPOSED 2022 FEE SCHEDULE PROPOSED CHANGES FOR 2022 IN RED Fees set locally Fees set by state statute Fees previously limited by statute- 2020 new legislation that allows cost recovery was approved 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) 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 $80.00/hour $85.00/hour $30.00/pp $15.00/pp $ 50.00 $640.00 $375.00 $50.00/company $170.00 Note: Fees last updated in 2014 $ 100.00/ambulance $127.50 Note 2: Fees provide inspectional cost recovery $80.00/hour 585.00/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 $80.00/hour S85.00/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 $220.00 $340.00 $80.00/hour 585.00/hour $112.00 $29.00 $120.00 Fee schedule in alignment with Public Health Services fee schedule $31.00 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT ENVIRONMENTAL HEALTH SERVICES - PROPOSED 2022 FEE SCHEDULE PROPOSED CHANGES FOR 2022 IN RED ii Fees set locally Fees set by state statute Fees previously limited by statute- 2020 new legislation that allows cost recovery was approved 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 Heterotrophic Plate Count 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 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) $12.72 $14.00 $26.50 $27.00 $108.00 $115.00 $51.00 $54.00 $85.00 $91.00 $52.00 $55.00 New $180.00 3 x stated fee $20.50 $21.50 Fees adjusted by roughly 4.5% (CPI) and rounded to nearest $.50 increment $22.50 $23.50 $30.50 $32.00 $46.00 $48.00 $48.00 $50.00 $24.50 Unused $16.50 $17.00 New $17.00 Market Rate $22.00 $23.00 $20.50 $21.50 $101.50 $106.00 Market Rate $61.00 $64.00 New $20.00 $20.50 $21.50 $20.50 $21.50 $19.50 $20.50 $16.50 $17.00 Market Rate $20.50 $21.50 $20.50 $21.50 $14.50 $15.00 $19.50 $20.50 Market Rate $20.50 $21.50 $20.50 $21.50 $21.00 $22.00 Market Rate $6.50 $7.00 $20.50 $21.50 Market Rate $21.50 $22.50 Market Rate Market Rate $19.50 $20.50 $19.50 $20.50 Market Rate $16.50 $17.00 $25.50 $26.50 $33.00 $34.50 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT ENVIRONMENTAL HEALTH SERVICES - PROPOSED 2022 FEE SCHEDULE PROPOSED CHANGES FOR 2022 IN RED Fees set locally Fees set by state statute Fees previously limited by statute- 2020 new legislation that allows cost recovery was approved Potassium Salinity Selenium Silver (reference lab) Sodium Solids, Total Solids, Total Dissolved Solids, Total Suspended Autoclave Spore Test Specific Conductance Sulfate Thallium (reference lab) Total Kieldahl 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 Non -Returned Sampling Bottle Fee OIL AND GAS - LABORATORY CHEMICAL ASSESSMENT Bacteriological (iron related, sulfate reducing, slime forming) BTEX (benzene, toluene, ethyl benzene, xylene) Chloride Calcium as CaCO3 Calcium Dissolved Gasses (methane, ethane, propane) Fluoride Icon Magnesium Manganese Potassium Sodium Sulfate Nitrate Nitrite Phosphate, Total PH/Tomporature Specific Conductance Solids, Total Dissolved Total Bicarbonate Total Petroleum Hydrocarbons (TPH) Total Trihalomethanes NOTE: Analyses are the rates cited above unless the amount is set by a contract approved by the Board of County Commissioners. $20.50 Unused $12.50 Unused $21.00 $22.00 Market Rate $21.00 $22.00 $16.50 $17.00 $17.00 $18.00 $17.00 $18.00 $12.50 $13.00 $16.50 $17.00 $19.50 $20.50 Market Rate $46.00 $48.00 Market Rate $81.50 $85.00 $152.25 $159.00 $20.50 $21.50 Market Rate $25.50 $5.00 $2.50 $26.50 $5.50 $3.00 $91.50 Unused $101.50 Duplicate Fees listed elsewhere in fee schedule, service still offered, eliminating so not listed in two locations. $19.50 Duplicate $20.50 Duplicate $21.00 Duplicate $81.50 $85.00 $19.50 Duplicate 520.50 Duplicate $20.50 Duplicate $20.5O Duplicate $20.50 Duplicate $21.00 Duplicate $19.50 Duplicate $19.50 Duplicate $19.50 Duplicate $33.00 Duplicate $10.50 Duplicate $16.50 Duplicate 517.00 Duplicate $16.50 $17.00 $81.50 $85.00 $81.50 $85.00 4 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT ENVIRONMENTAL HEALTH SERVICES - 2022 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 Ucense - Non -Profits (as defined in CRS 25-4-1607(9)(a)(III)) and Licensed Mobile Units Special/Temporary Event Ucense - 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/Temporary Event Vendor License - Late/Expedite Fee: up to 2 days before event Special/Temporary Event Coordinator Fee (1 Vendor) Special/Temporary Event Coordinator Fee Non -Recurring Events (submitted 30+ days before event) Special/Temporary Event Coordinator Fee Non -Recurring Events (submitted <30 days before event) Special/Temporary Event Coordinator Fee Recurring Events (submitted 30+ days before event) Special/Temporary Event Coordinator Fee Recurring Events (submitted <30 days before event) Special/Temporary Event Coordinator Fee (if applicable for additional miscellaneous 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 $85.00/hour $85.00/hour $350.00 $350.00 $13.00 $170.00 $212.50 $255.00 $297.50 $212.50 $297.50 $85.00/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 $50.00 $0.00 $100.00 $150.00 $200.00 $250.00 $85.00/hour $189.00 Application fee of $100 plus $85.00/hour (not to exceed $580) $85.00/hour (not to exceed $500) $100.00 $400.00 $75.00 $85.00/hour $85.00/hour $30.00/pp $15.00/pp $50.00 $640.00 $375.00 1 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT ENVIRONMENTAL HEALTH SERVICES - 2022 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 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) 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/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 $ 127.50/ambulance $85.00/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 $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 $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 2 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT ENVIRONMENTAL HEALTH SERVICES - 2022 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, tularemia, plague, WNV mosquitoe pool, etc.) Chemical Sample/Courier Sampling Fee State Sample Point ID Verification Fee Non -Returned Sampling Bottle 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 $5.50 $3.00 3 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT ENVIRONMENTAL HEALTH SERVICES - 2022 FEE SCHEDULE OIL AND GAS - LABORATORY CHEMICAL ASSESSMENT Dissolved Gasses (methane, ethane, propane) Total Bicarbonate Total Petroleum Hydrocarbons (TPH) Total Trihalomethanes NOTE: Analyses are the rates cited above unless the amount is set by a contract approved by the Board of County Commissioners. $85.00 $17.00 $85.00 $85.00 4 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT 2022 HHW Facility - VSQG Fees Waste Type Cost per container Cost per pound Acid gallon $10.80 $1.35/ pound 5 gallon $54.00 55 gallon $216.00 Aerosol (paint, pesticide) $1.20/ pound Antifreeze $0.60/ gallon Base gallon $1280 $1.35/ pound 5 gallon $54.00 55 gallon $216.00 Battery (excluding alkaline) $0.25/ pound Battery (alkaline) $1.20/ pound Compressec Gas Cylinders (small) tank $5.35 Compressed Gas Cylinders (large) tank Market Price Cyandie Compounds 5 gallon $85.00 Flammable Liquid (bulkable) or Cooking Oil $0.35/ pound Flammable (non-PaintCare) Liquid q quart $2.70 quart $1.35/ pound or loose if -pack < gallon $10.80 5 gallon $54.00 Fluorescent Tubes Pound $C.84 Mercury Containing Bulbs (HID, Sodium, Misc Pound $2.89 Filter, oil $0.30/ pound Grease Gallon Market Price Mercury thermometer $0.75 $5.00/pound Motor Oil (used) $0.60/ gallon Oily Waste Water $0.80/gallon Oxidizer gallon $10.80 $1.35/ pound 5 gallon $54.00 55 gallon $216.00 Paint (Latex & Oil Based) quart no fee* gallon no fee* 5 gallon no fee* PCB Ballast (and non PCB) $0.75/ pound Peroxide Formers gallon Market Price 5 gallon Market Price Pesticide/Poison Liquid gallon $10.80 $1.35/ pound 5 gallon $54.00 55 gallon $215.00 Pesticide, dry $1.00/ pound Miscellaneous Items To be determined, subject to marke- 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. PROPOSED 2022 PUBLIC HEALTH CLINICAL SERVICES FEE SCHEDULE =NEW/CHANGE Code Services HOUSEHOLD CODE SIZE Code Code 1 2 2021 2022 2022 PROPOSED PROPOSED Change Increased other than Code Code Code CURRENT by: 6.5% 3 4 5 New Client 9920-1 Minimal* 0.00 0.00 0.00 0.00 0.00 56.00 99202 99203 99204 99205 99211 99212 99213 99214 99215 Expanded Detailed Comprehensive Extensive Established Client Minimal Focused Expanded Detailed Comprehensive Telemedicine 0.00 35.00 70.00 105.00 140.00 0.00 45.25 90.50 135.75 181.00 0.00 67.75 135.50 203.25 271.00 0.00 69.50 139.00 208.50 278.00 0.00 13.25 26.50 39.75 53.00 0.00 22.75 45.50 68.25 91.00 0.00 29.50 59.00 88.50 118.00 0.00 46.50 93.00 139.50 186.00 0.00 58.00 116.00 174.00 232.00 131.00 170.00 254.00 261.00 50.00 85.00 111.00 175.00 218.00 140.00 181.00 271.00 278.00 53.00 91.00 118.00 186.00 232.00 99401T 99402T 99202T 99203T 99211T 99212T 99213T 99214T 99215T Preventive Medicine 15 min - Telemedicine Individual - 30 min - -elemedicine New Patient Focusec - Telemedicine Detailed - Telemedic ne Est Patient Minimal - Telemedicine Est Patient Focused - Telemedicine Est Patient Expanded - Telemedicine Detailed - Telemedicine Comprehensive - Telemedicine 0.00 14.00 28.00 42.00 56.00 0.00 20.50 41.00 61.50 82.00 0.00 35.00 70.00 105.00 140.00 0.00 45.25 90.50 135.75 181.00 0.00 13.25 26.50 39.75 53.00 0.00 22.75 45.50 68.25 91.00 0.00 29.50 59.00 88.50 118.00 0.00 46.50 93.00 139.50 186.00 0.00 58.00 116.00 174.00 232.00 56.00 82.00 140.00 181.00 53.00 91.00 118.00 186.00 232.00 99341 99342 99347 99348 99401 99402 99403 99404 99406 99407 G8510 G8431 99404 99401W 99412 99384 99385 99386 99394 Home Visits New Client - Focusec New Client - Expanded Est. Client - Focused Est. Client - Expanded 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- NFP 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 yeas old New Client 18-39 yeas old New Client 40-64 years old Est. Client 12-17 years old 111.00 111.00 111.00 111.00 111.00 111.00 111.00 111.00 111.00 111.00 110.00 110.00 110.00 110.00 110.00 115.00 115.00 115.00 115.00 115.00 0.00 14.00 0.00 20.50 0.00 28.75 28.00 42.00 56.00 41.00 61.50 82.00 57.50 86.25 115.00 0.00 37.00 74.00 111.00 148.00 0.00 4.00 8.00 12.00 16.00 0.00 8.00 16.00 24.00 32.00 16.00 16.00 16.00 16.00 16.00 37.00 37.00 37.00 37.00 37.00 148.00 148.00 148.00 148.00 148.00 69.00 69.00 69.00 69.00 69.00 69.00 69.00 69.00 69.00 69.00 0.00 0.00 0.00 0.00 45.25 45.25 49.25 38.25 90.50 135.75 181.00 90.50 135.75 181.00 98.50 147.75 197.00 76.50 114.75 153.00 104.00 104.00 103.00 108.00 53.00 77.00 108.00 130.00 15.00 30.00 15.00 35.00 139.00 65.00 65.00 170.00 170.00 185.00 144.00 111.00 111.00 110.00 115.00 56.00 82.00 115.00 138.00 148.00 16.00 32.00 16.00 37.00 148.00 69.00 69.00 181.00 181.00 197.00 153.00 PROPOSED 2022 PUBLIC HEALTH CLINICAL SERVICES FEE SCHEDULE =NEW/CHANGE Code Services HOUSEHOLD CODE SIZE Code Code 1 2 2021 2022 2022 PROPOSED PROPOSED Change Increased other than Code Code Code CURRENT by: 6.5% 3 4 5 99395 99396 0071W Est. Client 18-39 years old Est. Client 40-64 years old Additional Codes Community Education 1 hr 0.00 39.25 78.50 117.75 157.00 147.00 0.00 41.50 83.00 124.50 166.00 156.00 88.00 88.00 88.00 88.00 88.00 83.00 157.00 166.00 88.00 0069W 0069W Printout/Medical Records - Patient 1st 10 pgs Printout/Medical Records - Patient > 10 pages per page 0.00 0.00 0.00 0.00 0.00 16.00 0.50 0.50 0.50 0.50 0.50 0.50 0.00 0.50 G9006 T1017 N HV Mother - Task Care Management N HV Child - Task Care Management 37.00 37.00 37.00 37.00 37.00 37.00 37.00 35.00 37.00 37.00 37.00 35.00 37.00 37.00 99499 STI Exam pro pay NP Wellness Package TB Consultation 216.00 53.00 50.00 NSF 56420 11100 57500 0116W 57452 57454 57511 17000 17003 17004 56501 57170 58100 58110 11400 11981 10060 58300 57460 57461 88305 88305W 59025 11976 11983 58301 11300 76857 A4267 0052W J7307 J7298 Non -sufficient funds (bounced check) PROCEDURES Bartholin Cyst Biopsy of skin, single Cervical Lesion Biopsy Chest X Ray (Prepay} Colposcopy without Biopsy ** Colposcopy with Biopsy ** Cryocautery cervix- initial or repeat Cryotherapy first lesion** Cryotherapy 2-14 lesions** Cryotherapy 15 + lesions** Destruction Lesion Vulva Diaphragm/Cervical Cap Fitting Endometrial biopsy w/wo Biopsy Endometrial biopsy with Colposcopy 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 Non Stress Test Intorp Removal, implant contraceptive Removal implant, with reinsertion Removal IUD Shaving of epidermal lesion, single on trunk, arms or legs, .5cm U ltrasound - pelvic non -obstetric FAMILY PLANNING SUPPLIES Condoms pkg 10 Cycle Beads Nexplanon (Etonogestrel) IUD Mirena 27.00 27.00 27.00 27.00 27.00 25.00 29.00 70.00 110.00 151.00 191.00 57.00 78.00 99.00 120.00 141.00 29.00 66.00 103.00 139.00 176.00 71.00 112.00 71.00 49.00 6.00 142.00 79.00 0.00 91.00 137.00 107.00 60.00 6.00 158.00 109.00 28.50 111.00 161.00 142.00 71.00 7.00 175.00 140.00 57.00 130.00 186.00 178.00 81.00 7.00 191.00 170.00 85.50 150.00 210.00 213.00 92.00 7.00 207.00 200.00 114.00 29.00 38.00 76.00 0.00 59.00 90.00 120.00 150.00 49.00 60.00 70.00 81.00 99.00 123.00 146.00 169.00 58.25 116.50 174.75 233.00 27.00 61.00 94.00 128.00 161.00 0.00 58.50 117.00 175.50 234.00 146.00 206.00 267.00 327.00 387.00 246.00 294.00 343.00 391.00 439.00 36.00 59.00 83.00 106.00 129.00 27.00 179.00 191.00 132.00 141.00 165.00 176.00 75.00 141.00 150.00 197.00 210.00 200.00 213.00 86.00 92.00 7.00 7.00 194.00 207.00 188.00 200.00 107.00 114.00 141.00 150.00 76.00 81.00 159.00 169.00 219.00 233.00 151.00 161.00 220.00 234.00 363.00 387.00 412.00 439.00 121.00 129.00 0.00 32.00 65.00 97.00 129.00 121.00 129.00 0.00 69.25 138.50 207.75 277.00 0.00 106.50 213.00 319.50 426.00 0.00 47.25 94.50 141.75 189.00 31.00 56.00 82.00 107.00 132.00 19.00 37.00 55.00 73.00 91.00 0.00 1.75 3.50 5.25 7.00 0.00 4.25 8.50 12.75 17.00 0.00 257.50 515.00 772.50 1030.00 0.00 287.75 575.50 863.25 1151.00 0700 260.00 277.00 400.00 426.00 177.00 189.00 124.00 132.00 85.00 91.00 7.00 16.00 942.00 1081.00 7.00 17.00 1003.00 1030.00 1151.00 PROPOSED 2022 PUBLIC HEALTH CLINICAL SERVICES FEE SCHEDULE =NEW/CHANGE Code Services HOUSEHOLD CODE SIZE 2021 Code Code Code Code Code CURRENT 1 2 3 4 5 J7300 J7301 J7297 J7296 J1050 96372 J7303 J7295 S4993 0068W 86900 82947 82565 86609 85025 85027 87491W 87491 87491NS 80053 0090W 87635 82627 82670 83001 87591W 87591 87591 NS 82948 82951 87205 84702 84703 83718 86708 86709 86706 86705 86317 87340 80074 86803 87522 87255 86695 86696 85018 83036 86701 86702 IUD Paragard IUD Skyla IUD Liletta IUD Kyleena Medroxyprogesterone (Depo) Admin fee depo- if visit for injection only Nuva Ring D scontiiuccf EluRyng - Vaginal Ring - Replaces Nuva Ring Oral Contraceptives Seasonale LABORATORY SERVICES ABO blood typing Assay, body fluid, glucose, (FBS) Assay of creatine Bacterium antibody CBC w/Diff CBC w/o Diff Chlamydia PCR - Grant Chlamydia PCR Chlamydia PCR* full fee Comprehensive Metabolic Panel Court Ordered Lab Draw COVID Nasal/Nasopharyngeal Test PCR DHEAS Estradiol FSH Gonorrhea PCR - Gonorrhea PCR Gonorrhea PCR* Glucose Random Glucose Tolerance Test 2 hr (GTT) Gram Stain Grant full fee HCG Quantitat ve - Serum Pregnancy Test HCG Qualitative - Serum Pregnancy Test HDL Cholesterol Hep A antibody Hep A igm antioody 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 HIV 1/2 AB Diff (this is HIV 1) HIV 1/2 AB Diff (this is HIV 2) 0.00 244.50 489.00 733.50 978.00 0.00 266.75 533.50 800.25 1067.00 0.00 30.00 60.00 90.00 120.00 0.00 254.00 508.00 762.00 1016.00 0.00 2.50 5.00 7.50 10.00 0.00 8.75 17.50 26.25 35.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 12.75 2.50 7.50 25.50 38.25 51.00 5.00 7.50 10.00 15.00 22.50 30.00 5.00 5.00 5.00 5.00 5.00 27.00 27.00 27.00 27.00 27.00 7.00 7.00 7.00 7.00 7.00 36.00 36.00 36.00 36.00 36.00 28.00 28.00 28.00 28.00 28.00 24.00 24.00 24.00 24.00 24.00 0.00 0.00 0.00 0.00 0.00 35.00 41.00 48.00 54.00 60.00 0-00 0.00 0.00 0.00 0.00 16.00 16.00 16.00 16.00 16.00 53.00 53.00 53.00 53.00 53.00 56.00 56.00 56.00 56.00 56.00 37.00 37.00 37.00 37.00 37.00 38.00 38.00 38.00 38.00 38.00 45.00 45.00 45.00 45.00 45.00 0.00 0.00 0.00 0.00 0.00 60.00 60.00 60.00 60.00 60.00 N/A N/A NIA N/A N/A 9.00 9.00 9.00 9.00 9.00 33.00 33.00 33.00 33.00 33.00 35.00 35.00 35.00 35.00 35.00 0.00 13.00 26.00 39.00 52.00 0.00 13.00 26.00 39.00 52.00 39.00 18.00 17.00 32.00 31.00 24.00 23.00 73.00 22.00 39.00 18.00 17.00 32.00 31.00 24.00 23.00 73.00 22.00 39.00 18.00 17.00 32.00 31.00 24.00 23.00 73.00 22.00 39.00 18.00 17.00 32.00 31.00 24.00 23.00 73.00 22.00 39.00 18.00 17.00 32.00 31.00 24.00 23.00 73.00 22.00 43.00 34.00 13.00 19.00 47.00 48.00 33.00 37.00 51.00 63.00 52.00 55.00 55.00 77.00 72.00 73.00 59.00 91.00 91.00 91.00 0.00 4.00 8.00 12.00 16.00 10.00 18.00 9.00 10.00 13.00 13.00 27.00 35.00 43.00 12.00 13.00 14.00 14.00 14.00 15.00 918.00 1002.00 787.00 954.00 82.00 33.00 !18.00 48.00 39.00 82.00 5.00 25.00 7.00 34.00 26.00 23.00 56.00 56.00 15.00 50.00 53.00 35.00 41.00 42.00 56.00 56.00 8.00 31.00 33.00 49.00 49.00 37.00 17.00 16.00 30.00 29.00 23.00 22.00 69.00 21.00 129.00 85.00 85.00 85.00 15.00 40.00 13.00 14.00 2022 PROPOSED Increased by: 2022 PROPOSED Change other than 6.5°/0 6.5% 978.00 1067.00 838.00 120.00 1016.00 87.00 10.00 35.00 N/A 51.00 42.00 87.00 5.00 27.00 7.00 36.00 28.00 24.00 60.00 60.00 16.00 53.00 56.00 37.00 44.00 45.00 60.00 60.00 9.00 33.00 35.00 52.00 52.00 39.00 18.00 17.00 32.00 31.00 24.00 23.00 73.00 22.00 10.00 30.00 0.00 0.00 137.00 59.00 91.00 91.00 91.00 16.00 43.00 14.00 15.00 PROPOSED 2022 PUBLIC HEALTH CLINICAL SERVICES FEE SCHEDULE =NEW/CHANGE Code Services HOUSEHOLD CODE SIZE Code Code 1 2 2021 2022 2022 PROPOSED PROPOSED Change Increased other than Code Code Code CURRENT by: 6.5% 3 4 5 87389 G0435 87624 87625 0081W 484006W 87254 96372 83525 83002 80061W 80061N 80076 86790 80048 86376 82274 88142 0080W 88175 88141 84144 84146 HIV - 1 antigen w/ HIV -1 & HIV -2 HIV Screen, Rapid Test HPV, High Risk HPV typing 16,18,45 HPV, High Risk w/ repeat pap (LabCorp use) Immunohistochemical Stain Influenza - Viral Culture Injection/Admin fee for Depo and antibiotics Insulin, Fasting LH Lipid Panel - SFS Lipid Panel Liver Panel MAC Elisa Basic Metabolic Panel Microsomal antibodies 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 24.00 12.00 0.00 0.00 26.00 17.00 22.75 13.75 28.00 22.00 45.50 27.50 30.00 27.00 68.25 41.25 32.00 32.00 91.00 55.00 30.00 30.00 85.00 52.00 145.00 145.00 145.00 145.00 145.00 136.00 122.00 54.00 54.00 54.00 54.00 54.00 51.00 0.00 25.00 50.00 75.00 100.00 0.00 8.75 17.50 26.25 35.00 33.00 17.00 17.00 17.00 17.00 17.00 16.00 45.00 45.00 45.00 45.00 45.00 42.00 0.00 11.75 23.50 35.25 47.00 44.00 47.00 47.00 47.00 47.00 47.00 44.00 38.00 38.00 38.00 38.00 38.00 36.00 158.00 158.00 158.00 158.00 158.00 148.00 37.00 22.00 22.00 22.00 22.00 22.00 21.00 35.00 0.00 13.50 27.00 40.50 54.00 51.00 54.00 54.00 54.00 54.00 54.00 51.00 39.00 39.00 39.00 39.00 39.00 16.00 21.00 27.00 32.00 37.00 0.00 36.75 73.50 110.25 147.00 0.00 11.00 22.00 33.00 44.00 138.00 41.00 24.00 24.00 24.00 24.00 24.00 23.00 47.00 47.00 47.00 47.00 47.00 44.00 87633 Respiratory Viral Panel Mixed. 12-25 Targets 645.00 645.00 645.00 645.00 645.00 84482 86901 87535 86592W 86592 86593W 86593 87081 84480 84481 84436 84439 84403 86800 82465 87661 86780 84443 86480 81001 81002 87086 81025 36415 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 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 24.00 24.00 7.00 7.00 55.00 55.00 24.00 24.00 24.00 7.00 7.00 7.00 55.00 55.00 55.00 0.00 4.00 0.00 4.00 0.00 11.00 0.00 7.00 0.00 0.00 18.00 24.00 0.00 0.00 9.00 12.00 0.00 31.00 0.00 14.00 15.00 58.00 58.00 11.00 13.00 43.00 24.00 30.00 15.00 58.00 58.00 11.00 13.00 43.00 24.00 30.00 15.00 58.00 58.00 11.00 13.00 43.00 24.00 30.00 15.00 58.00 58.00 11.00 13.00 43.00 24.00 30.00 15.00 58.00 58.00 11.00 13.00 43.00 24.00 30.00 0.00 13.50 27.00 40.50 54.00 17.00 17.00 17.00 17.00 17.00 43.00 43.00 43.00 43.00 43.00 115.00 115.00 115.00 115.00 115.00 7.00 7.00 7.00 7.00 7.00 3.00 5.00 8.00 10.00 12.00 8.00 9.00 11.00 12.00 13.00 0.00 4.25 8.50 12.75 17.00 0.00 2.25 4.50 6.75 9.00 23.00 7.00 52.00 29.00 13.00 15.00 54.00 54.00 10.00 12.00 40.00 23.00 28.00 51.00 16.00 40.00 108.00 7.00 11.00 12.00 16.00 8.00 Er 6.5% 32.00 32.00 91.00 55.00 145.00 130.00 100.00 54.00 35.00 17.00 45.00 47.00 47.00 38.00 158.00 39.00 22.00 37.00 54.00 54.00 147.00 44.00 24.00 47.00 24.00 7.00 55.00 31.00 14.00 15.00 58.00 58.00 11.00 13.00 43.00 24.00 30.00 54.00 17.00 43.00 115.00 7.00 12.00 13.00 17.00 9.00 36415W Venipuncture with sliding fee lab 0.00 2.25 4.50 6-75 9.00 8.00 9.00 36416 Venipuncture - capillary blood specimen 0.00 2.25 4.50 6.75 9.00 8.00 9.00 36416W Venipuncture capillary blood specimen 0.00 2.25 4.50 6.75 9.00 a-00 3-00 PROPOSED 2022 PUBLIC HEALTH CLINICAL SERVICES FEE SCHEDULE =NEW/CHANGE Code Services HOUSEHOLD CODE SIZE Code Code 1 2 2022 2022 PROPOSED PROPOSED Change Increased other than Code Code Code CURRENT by: 6.5% 3 4 5 87210 0020W Q0144 101456W 0456W J0696 0696W 0007W 0058W 0035W J8499 0059W 0011W 0012W J0561 0561W 0060W 0008W 0009W 0010W 0013W 0006W 0016W 0004W 87635 87635W Wet Prep MEDICINES and TREATMENTS Amoxicillin 875 mg #20 Azithromycin, Z pack Azithromycin 1g - partner pack Azithromycin State supplied 500 mg #2 Ceftriaxone 500 mg Ceftriaxone 500 mg Grant Covered Cephalexin 500 mg #14 Ciprofloxacin 500 mg #6 Condylox Doxycycline 100 mg #14 Estradiol 1 mg- #100 Fluconazole 150 mg #1 Iron LA Bicillin 2.4 Units LA Bicillin 2.4 Units -Grant Covered Medroxyprogesterone 10 mg - #5 Metrogel Metronidazole 500 mg #4 Metronidazole 500 mg #14 Metronidazole 250 mg #28 Misoprostel (Cittotec) 200 mcg #2 Podophyllin/TCA Sulfatrim SMX/TMP Truvada #3 Descovy IMMUNIZATIONS 0.00 8.00 16.00 24.00 32.00 30.00 4.00 4.00 4.00 4.00 4.00 17.00 3.00 3.00 3.00 3.00 3.00 17.00 3.00 3.00 3.00 3.00 3.00 13.00 0.00 0.00 0.00 0.00 0.00 10.00 3.00 3.00 3.00 3.00 3.00 37.00 0.00 0.00 0.00 0.00 0.00 0.00 8.00 8.00 8.00 8.00 8.00 11.00 5.00 5.00 5.00 5.00 5.00 17.00 2.00 2.00 2.00 2.00 2.00 11.00 10.00 10.00 10.00 10.00 10.00 12.00 5.00 5.00 5.00 5.00 5.00 17.00 2.00 2.00 2.00 2.00 2.00 10.00 3.00 3.00 3.00 3.00 3.00 13.00 2.00 2.00 2.00 2.00 2.00 5.00 0.00 0.00 0.00 0.00 0.00 4.00 4.00 4.00 4.00 4.00 17.00 13.00 13.00 13.00 13.00 13.00 11.00 6.00 6.00 6.00 6.00 6.00 11.00 11.00 11.00 11.00 11.00 11.00 16.00 17.00 17.00 17.00 17.00 17.00 16.00 5.00 5.00 5.00 5.00 5.00 11.00 4.00 4.00 4.00 4.00 4.00 17.00 4.00 4.00 4.00 4.00 4.00 11.00 17.00 17.00 17.00 17.00 17.00 45.00 5.00 5.00 5.00 5.00 5.00 90471 90472 90473 Imm. Admin - cfie vaccine Imm Admin - each addl. Vaccine Imm Admin - intranasal or oral 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 90700N 90700 90702N 90633N 90633 90632N 90632 90744N 90744 90746N 90746 90739 90647N 90647 90651N 90651 90281 90660N 90660 90687 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 Influenza - intra nasal use - State supplied Influenza - Intranasal Adult 33.00 33.00 33.00 0.00 0.00 0.00 0.00 0.00 0.00 38.00 38.00 38.00 38.00 38.00 36.00 0.00 0.00 0.00 0.00 0.00 0 00 0.00 0.00 0.00 0.00 0.00 0.00 40.00 40.00 40.00 40.00 40.00 38.00 0.00 0.00 0.00 0.00 0.00 0.00 101.00 0.00 0.00 0.00 0.00 0.00 0.00 33.00 0.00 0.00 0.00 0.00 0.00 0.00 9200 122.00 0.00 42.00 0.00 228.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 43.00 43.00 43.00 43.00 43.00 40.00 85.00 85.00 85.00 85.00 85.00 25.00 25.00 25.00 25.00 25.00 60.00 60.00 60.00 60.00 60.00 130.00 130.00 130.00 130.00 130.00 0.00 0.00 0.00 0.00 0.00 45.00 45.00 45.00 45.00 45.00 0.00 0.00 0.00 0.00 0.00 240.00 240.00 240.00 240.00 240.00 Influenza - infant quadrivalent 6 month & up 43.00 43.00 43.00 43.00 43.00 40.00 32.00 18.00 18.00 14.00 11.00 39.00 0.00 12.00 18.00 12.00 13.00 18.00 11.00 14.00 5.00 18.00 12.00 12.00 17.00 17.00 12.00 18.00 12.00 48.00 Cost +$2 4.00 3.00 3.00 0.00 3.00 0.00 8.00 5.00 2.00 10.00 5.00 2.00 3.00 2.00 0.00 4.00 13.00 6.00 11.00 17.00 5.00 4.00 4.00 17.00 5.00 35.00 35.00 35.00 21.65 21.65 21.65 0.00 38.00 0.00 0.00 40.00 0.00 108.00 85.00 0.00 35.00 25.00 0.00 98.00 60.00 130.00 0.00 45.00 0.00 243.00 240.00 0.00 0.00 43.00 43.00 84.00 90.00 90696N Kinrix - (DTaP/IPV)/Quadracel - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 0.00 90696 Kinrix - (DTaP/IPV)/Quadracel 75.00 75.00 75.00 75.00 75.00 70.00 75.00 90734N MCV4 - State supplied 0.03 0.00 0.00 0.00 0.00 0.00 0.00 90734 MCV4 201.03 201.00 201.00 201.00 201.00 189.00 201.00 90620 MenB 176.03 176.00 176.00 176.00 176.00 176.00 176.00 90733 MPSV4 (Menomune)(polysaccharide) 201.03 201.00 201.00 201.00 201.00 189.00 201.00 90707N MMR - State supplied 0.03 0.00 0.00 0.00 0.00 0.00 0.00 90707 MMR 79.00 Pediarix (DTAP, IPV, Hep B) - State 90723N supplied 0.03 0.00 0.00 0.00 0.00 0.00 0.00 90723 Pediarix - (DTaP/IPV/Hep B) 103.03 103.00 103.00 103.00 103.00 97.00 103.00 83.00 50.00 Influenza - infant quadrivalent - State 90687N supplied 0.00 0.00 0.00 0.00 0.00 0.00 0.00 90688 Influenza - 3 yrs and up - quadrivalent 42.00 42.00 42.00 42.00 42.00 39.00 42.00 Influenza - 3 yrs and up - State supplied 90688N quadrivalent 0.00 0.00 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 0.00 0.00 90713 IPV 78.00 90738 Japanese Encephalitis (new formulation) 380.00 380.00 380.00 380.00 380.00 357.00 380.00 PROPOSED 2022 PUBLIC HEALTH CLINICAL SERVICES FEE SCHEDULE =NEW/CHANGE Code Services HOUSEHOLD CODE SIZE 2021 2022 2022 PROPOSED PROPOSED Change Increased other than Code Code Code Code Code CURRENT by: 6.5% 1 2 3 4 5 Ls 6.50/0 50.00 50.00 50.00 50.00 50.00 90.03 90.00 90.00 90.00 90.00 90698N Pentacel - (DTaP/IPV/HepB) - State supplied 0.03 0.00 0.00 0.00 0.00 0.00 0.00 90698 Pentacel - (DTaP/IPV/HepB) 153.03 153.00 153.00 153.00 153.00 144.00 153.00 90732N Pneumovax - State supplied 0.03 0.00 0.00 0.00 0.00 0.00 0.00 90732 Pneumovax 101.03 101.00 101.00 101.00 101.00 104.00 101.00 90710N Proquad - MMR-Varicella 0.00 0.00 0.00 0.00 0.00 0.00 0.00 90710 Proquad - MMR-Varicella 240.00 240.00 240.00 240.00 240.00 225.00 240.00 90670N Prevnar - (PCV13) - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 0.00 90670 Prevnar - (PCV13) 225.00 225.00 225.00 225.00 225.00 211.00 225.00 90675 Rabies IM 330.00 330.00 330.00 330.00 330.00 310.00 330.00 90675N Rabies IM - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 0.00 90375 RIG (rabies) - per cc 424.00 424.00 424.00 424.00 424.00 398.00 424.00 90680N Rotavirus - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 0.00 90680 Rotavirus - (RV5) 116.00 116.00 116.00 116.00 116.00 109.00 116.00 90750 Shingrix 168.00 168.00 168.00 168.00 168.00 158.00 168.00 90714N Td - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 0.00 90714 Td - 65.00 90715N Tdap - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 0.00 90715 Tdap - 124.00 86580 Tuberculosis Interdermal Skin Test (PPD) 58.00 58.00 58.00 58.00 58.00 54.00 58.00 90636 Twinrix - Hep A & Hep B 137.00 90691 Typhoid - 1 Shot 94.00 94.00 94.00 94.00 94.00 88.00 94.00 90690 Typhoid - Oral 82.00 82.00 82.00 82.00 82.00 77.00 82.00 90716N Varivax - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 0.00 90716 Varivax 137.00 90717 Yellow Fever 186.00 186.00 186.00 186.00 186.00 175,00 186.00 69.00 45.00 132.00 55.00 146.00 110.00 146.00 150.00 45.00 45.00 45.00 45.00 45.00 55.00 55.00 55.00 55.00 55.00 110.00 110.00 110.00 110.00 110.00 150.00 150.00 150.00 150.00 150.00 ** Services include surgical procedure only. *** These items are for referral 11/23/2021 revised CODE Services 2022 PUBLIC HEALTH CLINICAL SERVICES FEE SCHEDULE 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 99401T Preventive Medicine 15 min - Telemedicine 99402T Individual - 30 min - Telemedicine 99202T New Patient Focused - Telemedicine 99203T Detailed - Telemedicine 99211T Est Patient Minimal - Telemedicine 99212T Est Patient Focused - Telemedicine 99213T Est Patient Expanded - Telemedicine 99214T Detailed - Telemedicine 99215T 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 G8510 Negative- NFP Maternal Depression Screening not documented - G8431 NFP Travel Visits 99404 Individual Initial Visit - 60 99401W Return Visit 99412 Group Initial Visit (per person) - 60 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 35.00 70.00 105.00 140.00 0.00 45.25 90.50 135.75 181.00 0.00 67.75 135.50 203.25 271.00 0.00 69.50 139.00 208.50 278.00 0.00 13.25 26.50 39.75 53.00 0.00 22.75 45.50 68.25 91.00 0.00 29.50 59.00 88.50 118.00 0.00 46.50 93.00 139.50 186.00 0.00 58.00 116.00 174.00 232.00 0.00 14.00 28.00 42.00 56.00 0.00 20.50 41.00 61.50 82.00 0.00 35.00 70.00 105.00 140.00 0.00 45.25 90.50 135.75 181.00 0.00 13.25 26.50 39.75 53.00 0.00 22.75 45.50 68.25 91.00 0.00 29.50 59.00 88.50 118.00 0.00 46.50 93.00 139.50 186.00 0.00 58.00 116.00 174.00 232.00 111.00 111.00 111.00 111.00 111.00 111.00 111.00 111.00 111.00 111.00 110.00 110.00 110.00 110.00 110.00 115.00 115.00 115.00 115.00 115.00 0.00 14.00 28.00 42.00 56.00 0.00 20.50 41.00 61.50 82.00 0.00 28.75 57.50 86.25 115.00 0.00 37.00 74.00 111.00 148.00 0.00 4.00 8.00 12.00 16.00 0.00 8.00 16.00 24.00 32.00 16.00 16.00 16.00 16.00 16.00 37.00 37.00 37.00 37.00 37.00 148.00 148.00 148.00 148.00 148.00 69.00 69.00 69.00 69.00 69.00 69.00 69.00 69.00 69.00 69.00 0.00 45.25 90.50 135.75 181.00 0.00 45.25 90.50 135.75 181.00 0.00 49.25 98.50 147.75 197.00 0.00 38.25 76.50 114.75 153.00 0.00 39.25 78.50 117.75 157.00 0.00 41.50 83.00 124.50 166.00 CODE Services 2022 PUBLIC HEALTH CLINICAL SERVICES FEE SCHEDULE Household Code Size Code Code Code Code Code 1 2 3 4 5 Additional Codes 0071W Community Education 1 hr. 88.00 88.00 88.00 88.00 88.00 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 37.00 37.00 37.00 37.00 37.00 T1017 NHV Child - Task Care Management 37.00 37.00 37.00 37.00 37.00 NSF Non -sufficient funds (bounced check) 27.00 27.00 27.00 27.00 27.00 PROCEDURES 56420 Bartholin Cyst Treatment 29.00 70.00 110.00 151.00 191.00 11102 Biopsy of skin, single 57.00 78.00 99.00 120.00 141.00 57500 Cervical Lesion Biopsy 29.00 66.00 103.00 139.00 176.00 57452 Colposcopy without Biopsy ** 71.00 91.00 111.00 130.00 150.00 57454 Colposcopy with Biopsy ** 112.00 137.00 161.00 186.00 210.00 57511 Cryocautery cervix- initial or repeat 71.00 107.00 142.00 178.00 213.00 17000 Cryotherapy first lesion** 49.00 60.00 71.00 81.00 92.00 17003 Cryotherapy 2-14 lesions** 6.00 6.00 7.00 7.00 7.00 17004 Cryotherapy 15 + lesions** 142.00 158.00 175.00 191.00 207.00 56501 Destruction Lesion Vulva 79.00 109.00 140.00 170.00 200.00 57170 Diaphragm/Cervical Cap Fitting 0.00 28.50 57.00 85.50 114.00 58100 Endometrial biopsy w/wo Biopsy 29.00 59.00 90.00 120.00 150.00 58110 Endometrial biopsy with Colposcopy 38.00 49.00 60.00 70.00 81.00 11400 Excisions, benign lesion 76.00 99.00 123.00 146.00 169.00 11981 Implant Insertion 0.00 58.25 116.50 174.75 233.00 10060 Incision & drainage of abscess, single or simple 27.00 61.00 94.00 128.00 161.00 58300 Insertion IUD 0.00 58.50 117.00 175.50 234.00 57460 LEEP with biopsy 146.00 206.00 267.00 327.00 387.00 57461 LEEP with conization 246.00 294.00 343.00 391.00 439.00 88305 Level 4 - Surgical pathology 1st site 36.00 59.00 83.00 106.00 129.00 88305W Level 4 - Surgical Pathology 2nd site & each add9 0.00 32.00 65.00 97.00 129.00 11976 Removal, implant contraceptive 0.00 69.25 138.50 207.75 277.00 11983 Removal implant, with reinsertion 0.00 106.50 213.00 319.50 426.00 58301 Removal IUD 0.00 47.25 94.50 141.75 189.00 Shaving of epidermal lesion, single on trunk, arms or 11300 legs, .5cm 31.00 56.00 82.00 107.00 132.00 76857 Ultrasound - pelvic non -obstetric 19.00 37.00 55.00 73.00 91.00 FAMILY PLANNING SUPPLIES A4267 Condoms pkg 10 0.00 1.75 3.50 5.25 7.00 0052W Cycle Beads 0.00 4.25 8.50 12.75 17.00 J7307 Nexplanon (Etonogestrel) 0.00 257.50 515.00 772.50 1030.00 J7298 IUD Mirena 0.00 287.75 575.50 863.25 1151.00 J7300 IUD Paragard 0.00 244.50 489.00 733.50 978.00 J7301 IUD Skyla 0.00 266.75 533.50 800.25 1067.00 J7297 IUD Liletta 0.00 30.00 60.00 90.00 120.00 J7296 IUD Kyleena 0.00 254.00 508.00 762.00 1016.00 J1050 Medroxyprogesterone (Depo) 0.00 2.50 5.00 7.50 10.00 96372 Admin fee depo- if visit for injection only 0.00 8.75 17.50 26.25 35.00 J7295 EluRyng - Vaginal Ring - Replaces Nuva Ring 0.00 12.75 25.50 38.25 51.00 S4993 Oral Contraceptives 0.00 2.50 5.00 7.50 10.00 0068W Seasonale/Seasonique (3 months supply) 0.00 7.50 15.00 22.50 30.00 LAB 86900 ABO blood typing 5.00 5.00 5.00 5.00 5.00 CODE Services 2022 PUBLIC HEALTH CLINICAL SERVICES FEE SCHEDULE Household Code Size Code Code Code Code Code 1 2 3 4 5 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 87491W Chlamydia PCR - Grant 87491 Chlamydia PCR 80053 Comprehensive Metabolic Panel 0090W Court Ordered Lab Draw 87635 COVID Nasal/Nasopharyngeal Test PCR 82627 DHEAS 82670 Estradiol 83001 FSH 87591W Gonorrhea PCR - Grant 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 86701 HIV 1/2 AB Diff (this is HIV 1) 86702 HIV 1/2 AB Diff (this is HIV 2) 87389 HIV - 1 antigen w/ HIV -1 & HIV -2 G0435 HIV Screen, Rapid Test 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 82274 Occult Blood Test, Fecal, IA 88142 Pap - Thin Prep 27.00 7.00 36.00 39.00 28.00 24.00 0.00 35.00 16.00 53.00 56.00 37.00 38.00 45.00 0.00 60.00 9.00 33.00 35.00 0.00 0.00 39.00 18.00 17.00 32.00 31.00 24.00 23.00 73.00 22.00 43.00 34.00 13.00 19.00 0.00 10.00 9.00 13.00 24.00 12.00 0.00 0.00 145.00 0.00 54.00 0.00 17.00 45.00 0.00 47.00 38.00 158.00 22.00 16.00 0.00 27.00 7.00 36.00 39.00 28.00 24.00 0.00 41.00 16.00 53.00 56.00 37.00 38.00 45.00 0.00 60.00 9.00 33.00 35.00 13.00 13.00 39.00 18.00 17.00 32.00 31.00 24.00 23.00 73.00 22.00 47.00 48.00 33.00 37.00 4.00 18.00 10.00 13.00 26.00 17.00 22.75 13.75 145.00 25.00 54.00 8.75 17.00 45.00 11.75 47.00 38.00 158.00 22.00 21.00 13.50 27.00 7.00 36.00 39.00 28.00 24.00 0.00 48.00 16.00 53.00 56.00 37.00 38.00 45.00 0.00 60.00 9.00 33.00 35.00 26.00 26.00 39.00 18.00 17.00 32.00 31.00 24.00 23.00 73.00 22.00 51.00 63.00 52.00 55.00 8.00 27.00 12.00 14.00 28.00 22.00 45.50 27.50 145.00 50.00 54.00 17.50 17.00 45.00 23.50 47.00 38.00 158.00 22.00 27.00 27.00 27.00 7.00 36.00 39.00 28.00 24.00 0.00 54.00 16.00 53.00 56.00 37.00 38.00 45.00 0.00 60.00 9.00 33.00 35.00 39.00 39.00 39.00 18.00 17.00 32.00 31.00 24.00 23.00 73.00 22.00 55.00 77.00 72.00 73.00 12.00 35.00 13.00 14.00 30.00 27.00 68.25 41.25 145.00 75.00 54.00 26.25 17.00 45.00 35.25 47.00 38.00 158.00 22.00 32.00 40.50 27.00 7.00 36.00 39.00 28.00 24.00 0.00 60.00 16.00 53.00 56.00 37.00 38.00 45.00 0.00 60.00 9.00 33.00 35.00 52.00 52.00 39.00 18.00 17.00 32.00 31.00 24.00 23.00 73.00 22.00 59.00 91.00 91.00 91.00 16.00 43.00 14.00 15.00 32.00 32.00 91.00 55.00 145.00 100.00 54.00 35.00 17.00 45.00 47.00 47.00 38.00 158.00 22.00 37.00 54.00 2022 PUBLIC HEALTH CLINICAL SERVICES FEE SCHEDULE Household Code Size Code Code Code Code Code CODE Services 1 2 3 4 5 0080W 88175 88141 84144 84146 87633 84482 86901 87535 86592W 86592 86593W 86593 87081 84480 84481 84436 84439 84403 86800 82465 87661 86780 84443 86480 81001 81002 87086 81025 36415 36416 87210 0020W Q0144 101456W 0456W J0696 0696W 0007W 0058W 0035W J8499 0059W 0011W 0012W J0561 0561W 0060W 0008W 0009W 0010W 0013W 0006W 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 Total Cholesterol Trichomonas vaginalis - amplified Treponema pallidum TSH Tuberculosis Test-Quantiferon (IGRA) Urinalysis, complete with micro ex Urinalysis, w/o scope (UA) Urine Culture, Comprehensive Urine Pregnancy Test" Venipuncture Venipuncture - capillary blood specimen Wet Prep MEDICINES and TREATMENTS Amoxicillin 875 mg #20 Azithromycin, Z pack Azithromycin 1 g - partner pack Azithromycin State supplied 500 mg #2 Ceftriaxone 500 mg Ceftriaxone 500 mg Grant Covered Cephalexin 500 mg #14 Ciprofloxacin 500 mg #6 Condylox Doxycycline 100 mg #14 Estradiol 1 mg- #100 Fluconazole 150 mg #1 Iron LA Bicillin 2.4 Units LA Bicillin 2.4 Units -Grant Covered Medroxyprogesterone 10 mg - #5 Metrogel Metronidazole 500 mg #4 Metronidazole 500 mg #14 Metronidazole 250 mg #28 Misoprostel (Cytotec) 200 mcg #2 54.00 54.00 54.00 54.00 54.00 0.00 36.75 73.50 110.25 147.00 0.00 11.00 22.00 33.00 44.00 24.00 24.00 24.00 24.00 24.00 47.00 47.00 47.00 47.00 47.00 645.00 645.00 645.00 645.00 645.00 24.00 24.00 24.00 24.00 24.00 7.00 7.00 7.00 7.00 7.00 55.00 55.00 55.00 55.00 55.00 0.00 0.00 0.00 0.00 0.00 4.00 11.00 18.00 24.00 31.00 0.00 0.00 0.00 0.00 0.00 4.00 7.00 9.00 12.00 14.00 15.00 15.00 15.00 15.00 15.00 58.00 58.00 58.00 58.00 58.00 58.00 58.00 58.00 58.00 58.00 11.00 11.00 11.00 11.00 11.00 13.00 13.00 13.00 13.00 13.00 43.00 43.00 43.00 43.00 43.00 24.00 24.00 24.00 24.00 24.00 30.00 30.00 30.00 30.00 30.00 0.00 13.50 27.00 40.50 54.00 17.00 17.00 17.00 17.00 17.00 43.00 43.00 43.00 43.00 43.00 115.00 115.00 115.00 115.00 115.00 7.00 7.00 7.00 7.00 7.00 3.00 5.00 8.00 10.00 12.00 8.00 9.00 11.00 12.00 13.00 0.00 4.25 8.50 12.75 17.00 0.00 2.25 4.50 6.75 9.00 0.00 2.25 4.50 6.75 9.00 0.00 8.00 16.00 24.00 32.00 4.00 4.00 4.00 4.00 4.00 3.00 3.00 3.00 3.00 3.00 3.00 3.00 3.00 3.00 3.00 0.00 0.00 0.00 0.00 0.00 3.00 3.00 3.00 3.00 3.00 0.00 0.00 0.00 0.00 0.00 8.00 8.00 8.00 8.00 8.00 5.00 5.00 5.00 5.00 5.00 2.00 2.00 2.00 2.00 2.00 10.00 10.00 10.00 10.00 10.00 5.00 5.00 5.00 5.00 5.00 2.00 2.00 2.00 2.00 2.00 3.00 3.00 3.00 3.00 3.00 2.00 2.00 2.00 2.00 2.00 0.00 0.00 0.00 0.00 0.00 4.00 4.00 4.00 4.00 4.00 13.00 13.00 13.00 13.00 13.00 6.00 6.00 6.00 6.00 6.00 11.00 11.00 11.00 11.00 11.00 17.00 17.00 17.00 17.00 17.00 5.00 5.00 5.00 5.00 5.00 CODE Services 2022 PUBLIC HEALTH CLINICAL SERVICES FEE SCHEDULE Household Code Size Code Code Code Code Code 1 2 3 4 5 0016W PodophyllinfTCA 0004W Sulfatrim SMX/TMP 87635 Truvada #3 87635W Descovy 4.00 4.00 17.00 5.00 4.00 4.00 17.00 5.00 4.00 4.00 17.00 5.00 4.00 4.00 17.00 5.00 4.00 4.00 17.00 5.00 IMMUNIZATIONS 90471 Imm. Admin - one vaccine 21.65 21.65 21.65 21.65 21.65 90472 Imm Admin - each addl. Vaccine 21.65 21.65 21.65 21.65 21.65 90473 Imm Admin - intranasal or oral 21.65 21.65 21.65 21.65 21.65 90700N DTaP -State supplied 0.00 0.00 0.00 0.00 0.00 90700 DTaP 38.00 38.00 38.00 38.00 38.00 90702N DT - State supplied 0.00 0.00 0.00 0.00 0.00 90633N Hepatitis A - Child - State supplied 0.00 0.00 0.00 0.00 0.00 90633 Hepatitis A - Child 40.00 40.00 40.00 40.00 40.00 90632N Hepatitis A - Adult - State supplied 0.00 0.00 0.00 0.00 0.00 90632 Hepatitis A - Adult 85.00 85.00 85.00 85.00 85.00 90744N Hepatitis B - Child - State supplied 0.00 0.00 0.00 0.00 0.00 90744 Hepatitis B - Child 25.00 25.00 25.00 25.00 25.00 90746N Hepatitis B - Adult - State supplied 0.00 0.00 0.00 0.00 0.00 90746 Hepatitis B - Adult 60.00 60.00 60.00 60.00 60.00 90739 Heplisav-B 130.00 130.00 130.00 130.00 130.00 90647N HIB - State supplied 0.00 0.00 0.00 0.00 0.00 90647 HIB 45.00 45.00 45.00 45.00 45.00 90651N HPV 9 - State supplied 0.00 0.00 0.00 0.00 0.00 90651 HPV 9 240.00 240.00 240.00 240.00 240.00 90281 IG Hepatitis A - State supplied 0.00 0.00 0.00 0.00 0.00 90660N Influenza - intranasal use - State supplied 0.00 0.00 0.00 0.00 0.00 90660 Influenza - Intranasal Adult 43.00 43.00 43.00 43.00 43.00 90687 Influenza - infant quadrivalent 6 month & up 43.00 43.00 43.00 43.00 43.00 90687N Influenza - infant quadrivalent - State supplied 0.00 0.00 0.00 0.00 0.00 90688 Influenza - 3 yrs and up - quadrivalent 42.00 42.00 42.00 42.00 42.00 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 50.00 50.00 50.00 50.00 50.00 90738 Japanese Encephalitis (new formulation) 380.00 380.00 380.00 380.00 380.00 90696N Kinrix - (DTaP/IPV)/Quadracel - State supplied 0.00 0.00 0.00 0.00 0.00 90696 Kinrix - (DTaP/IPV)/Quadracel 75.00 75.00 75.00 75.00 75.00 90734N MCV4 - State supplied 0.00 0.00 0.00 0.00 0.00 90734 MCV4 201.00 201.00 201.00 201.00 201.00 90620 MenB 176.00 176.00 176.00 176.00 176.00 90733 MPSV4 (Menomune)(polysaccharide) 201.00 201.00 201.00 201.00 201.00 90707N MMR - State supplied 0.00 0.00 0.00 0.00 0.00 90707 MMR 90.00 90.00 90.00 90.00 90.00 90723N Pediarix (DTAP, IPV, Hep B) - State supplied 0.00 0.00 0.00 0.00 0.00 90723 Pediarix - (DTaP/IPV/Hep B) 103.00 103.00 103.00 103.00 103.00 90698N Pentacel - (DTaP/IPV/HepB) - State supplied 0.00 0.00 0.00 0.00 0.00 90698 Pentacel - (DTaP/IPV/HepB) 153.00 153.00 153.00 153.00 153.00 90732N Pneumovax - State supplied 0.00 0.00 0.00 0.00 0.00 90732 Pneumovax 101.00 101.00 101.00 101.00 101.00 90710N Proquad - MMR-Varicella 0.00 0.00 0.00 0.00 0.00 90710 Proquad - MMR-Varicella 240.00 240.00 240.00 240.00 240.00 90670N Prevnar - (PCV13) - State supplied 0.00 0.00 0.00 0.00 0.00 90670 Prevnar - (PCV13) 225.00 225.00 225.00 225.00 225.00 90675 Rabies IM 330.00 330.00 330.00 330.00 330.00 90675N Rabies IM - State supplied 0.00 0.00 0.00 0.00 0.00 CODE Services 2022 PUBLIC HEALTH CLINICAL SERVICES FEE SCHEDULE Household Code Size Code Code Code Code Code 1 2 3 4 5 90375 RIG (rabies) - per cc 90680N Rotavirus - State supplied 90680 Rotavirus - (RV5) 90750 Shingrix 90714N Td - State supplied 90714 Td - 90715N Tdap - State supplied 90715 Tdap- 86580 Tuberculosis Interdermal Skin Test (PPD) 90636 Twinrix - Hep A & Hep B 90691 Typhoid - 1 Shot 90690 Typhoid - Oral 90716N Varivax - State supplied 90716 Varivax 90717 Yellow Fever ** Services include surgical procedure only. 11/23/2021 revised 424.00 0.00 116.00 168.00 0.00 45.00 0.00 55.00 58.00 110.00 94.00 82.00 0.00 150.00 186.00 424.00 0.00 116.00 168.00 0.00 45.00 0.00 55.00 58.00 110.00 94.00 82.00 0.00 150.00 186.00 424.00 0.00 116.00 168.00 0.00 45.00 0.00 55.00 58.00 110.00 94.00 82.00 0.00 150.00 186.00 424.00 0.00 116.00 168.00 0.00 45.00 0.00 55.00 58.00 110.00 94.00 82.00 0.00 150.00 186.00 424.00 0.00 116.00 168.00 0.00 45.00 0.00 55.00 58.00 110.00 94.00 82.00 0.00 150.00 186.00 Hello