The URL can be used to link to this page

Browse Search

Home My WebLink About20203774.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, 2021, 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, 2021. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 16th day of December, A.D., 2020. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO ATTEST: Weld County Clerk to the Board Date of signature: Mike Freeman, Chair Kevin D. Ross Stev Moreno, Pro -Tern CC:H1-(TG) FI(Pw/So),Acr c%o) o►/og/al 2020-3774 HL0003 Memorandum TO: Mike Freeman, Chair Board of County Commissioners FROM: Mark Lawley Deputy Director Department of Public Health & Environment DATE: December 1, 2020 SUBJECT: Health Department 2021 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 2021. ENVIRONMENTAL HEALTH SERVICES: Program fees are evaluated on an annual basis to ensure adequate cost recovery and program sustainability. Fees for Environmental Health Services Division have remained relatively flat for the previous five years. This year, in conjunction with the Weld County Director of Finance, EHS conducted an evaluation of our environmental specialist hourly rate and determined that it should be raised to $80 per hour, up from $55 per hour in the previous two years. 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 2021 fee schedule adjustments. In addition, laboratory fees have also remained flat for the previous four years. During this time the lab has continued to see increases in cost as reagents and sampling materials have increased in price. To adjust for that increase, we are recommending a modest rate increase of approximately 1.5 to 2.5% ($0.50 to $1.50 in actual cost) beginning next year and increasing gradually over the next three years for the lab services indicated on the draft proposed fee schedule. 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. All fees for services and supplies were reviewed to determine that the Health Department is charging at least the Medicare reimbursement rate for all services provided at the Health Department. For services that are not covered by Medicare, the Medicaid reimbursement rate was used as a reimbursement floor. This year the Health Department is requesting the Board's approval to increase our fee schedule for all services and supplies by 2.5% across-the-board, which is consistent with the 2021 U.S. indexed rate of inflation. 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. As a critical component of our 2021-2023 strategic plan, we will begin evaluating all Health Department programs and services in 2021. During these program/service assessments, we will evaluate all fees associated with the services we provide. From this analysis, the Health Department will recommend necessary fee changes to the Board. I recommend approval of the 2021 PHCS and EHS fee schedule changes. 2020-3774 l -I L. OO0 3 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT ENVIRONMENTAL HEALTH SERVICES - PROPOSED 2021 FEE SCHEDULE PROPOSED CHANGES FOR 2021 IN RED 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 - Minor Service Single Event Special/Temporary Event License - Minor Service 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 (2-5 Vendors) Special/Temporary Event Coordinator Fee (6-15 Vendors) Special/Temporary Event Coordinator Fee (16+ Vendors) Special/Temporary Event Coordinator Fee (if applicable for additional miscellaneous time) Special/Temporary Event Coordinator Fee - Late/Expedite Fee: up to 2 days before event 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 (Actual Cost Based Upon Hourly Rate} (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 r=Ambulance Unit Inspection Fee $350.00 $75.00 Application fee of $100 plus $55.00/hour $80.00/hour $55.00/hour $80.00/hour $350.00 $350.00 $12.00 $50.00 $100.00 $150.00 $200.00 $125.00 $100.00 $55.00/hour $80.00/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 $100.00 $385.00 $50.00 $270.00 $25.00 $0.00 $50.00 $100.00 $200.00 $150.00 $100.00 $100.00 $150.00 $250.00 $55.00/hour $80.00/hour $50.00 $189.00 Application fee of $100 plus $55.00/hour $80.00/hour (not to exceed $580) $55.00/hour $80.00/hour (not to exceed $500) $100.00 $400.00 $75.00 $55.00/hour $80.00/hour $55.00/hour $80.00/hour $20.00/pp $30.00/pp $10.00/pp $15.00/pp $50.00 $500.00 $250.00 $50.00/company $ 100.00/ambulance $640.00 $375.00 1 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT ENVIRONMENTAL HEALTH SERVICES - PROPOSED 2021 FEE SCHEDULE PROPOSED CHANGES FOR 2021 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/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 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 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 Aluminum (reference lab) Ammonia Arsenic BTEX (benzene, toluene, ethyl benzene, xylene) Barium (reference lab) $55.00/hour $80.00/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 $55.00/hour $80.00/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 $55.00/hour $80.00/hour $110.24 $27.56 $12.72 $26.50 $104.94 $49.82 $82.68 $50.88 3 x stated fee $20.00 $22.00 $30.00 $45.00 $47.00 $24.00 $16.00 Market Rate $21.50 $20.00 $100.00 Market Rate $112.00 $29.00 $108.00 $51.00 $85.00 $52.00 $20.50 $22.50 $30.50 $46.00 $48.00 $24.50 $16.50 $22.00 $20.50 $101.50 2 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT ENVIRONMENTAL HEALTH SERVICES - PROPOSED 2021 FEE SCHEDULE PROPOSED CHANGES FOR 2021 IN RED Fees set locally -iiii;Af Fees set by state statute ^Fees previously limited by statute- 2020 new legislation that allows cost recovery was approved Biochemical Oxygen Demand (BOD) Cadmium Calcium as CaCO3 Chloride Chlorine Chlorite (reference lab) Chromium Copper Dissolved Oxygen Fluoride Haloacetic Acids (reference lab) Hardness, Total Iron Lead, water Lc\id, 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) 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 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 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 Iron Magnesium Manganese Potassium Sodium $ 60.00 $20.00 $20.00 $19.00 $16.00 Market Rate $20.00 $20.50 $14.00 $19.00 Market Rate $20.00 $20.00 $20.50 $10.00 $6.00 $20.00 Market Rate $21.00 Market Rate Market Rate $19.00 $19.00 $2.00 $16.00 $25.00 $32.50 $20.00 $12.00 $20.50 Market Rate $20.50 $16.00 $16.50 $16.50 $12.00 $16.00 $19.00 Market Rate $45.00 Market Rate $80.00 $150.00 $20.00 Market Rate $25.00 $5.00 $2.50 $90.00 $100.00 $19.00 $20.00 $20.50 $80.00 $19.00 $20.00 $20.00 $20.00 $ 20.00 $20.50 $61.00 $20.50 $20.50 $19.50 $16.50 $20.50 $20.50 $14.50 $19.50 $20.50 $20.50 $21.00 $6.50 $20.50 $21.50 $19.50 $19.50 $16.50 $25.50 $33.00 $20.50 $12.50 $21.00 $21.00 $16.50 $17.00 $17.00 $12.50 $16.50 $19.50 $46.00 $81.50 $152.25 $20.50 $25.50 $91.50 $101.50 $19.50 $20.50 $21.00 $81.50 $19.50 $20.50 $20.50 $20.50 $20.50 $21.00 3 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT ENVIRONMENTAL HEALTH SERVICES - PROPOSED 2021 FEE SCHEDULE PROPOSED CHANGES FOR 2021 IN RED Fees set locally Utf Fees set by state statute Fees previously limited by statute- 2020 new legislation that allows cost recovery was approved Sulfate Nitrate Nitrite Phosphate, Total PH/Temperature 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. $19.00 $19.00 $19.00 $32.50 $16.00 $16.00 $16.50 $16.00 $80.00 $80.00 $19.50 $19.50 $19.50 $33.00 $16.50 $16.50 $17.00 $16.50 $81.50 $81.50 4 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT ENVIRONMENTAL HEALTH SERVICES - 2021 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/Temporary Event License - Minor Service Single Event Special/Temporary Event License - Minor Service 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 (2-5 Vendors) Special/Temporary Event Coordinator Fee (6-15 Vendors) Special/Temporary Event Coordinator Fee (16+ Vendors) Special/Temporary Event Coordinator Fee (if applicable for additional miscellaneous time) Special/Temporary Event Coordinator Fee - Late/Expedite Fee: up to 2 days before event 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 $80.00/hour $80.00/hour $350.00 $350.00 $12.00 $50.00 $100.00 $150.00 $200.00 $125.00 $100.00 $80.00/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 $0.00 $100.00 $150.00 $250.00 $80.00/hour $50.00 $189.00 Application fee of $100 plus $80.00/hour (not to exceed $580) $80.00/hour (not to exceed $500) $100.00 $400.00 $75.00 $80.00/hour $80.00/hour $30.00/pp $15.00/pp $50.00 $640.00 $375.00 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT ENVIRONMENTAL HEALTH SERVICES - 2021 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 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 $50.00/company $ 100.00/ambulance $80.00/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 $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 $80.00/hour $112.00 $29.00 $12.72 $26.50 $108.00 $51.00 $85.00 $52.00 3 x stated fee $20.50 $22.50 $30.50 $46.00 $48.00 $24.50 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT ENVIRONMENTAL HEALTH SERVICES - 2021 FEE SCHEDULE WATER QUALITY - CHEMICAL ASSESSMENT Alkalinity, Total Aluminum (reference lab) Ammonia Arsenic BTEX (benzene, toluene, ethyl benzene, xylene) Barium (reference lab) Biochemical Oxygen Demand (BOD) 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 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 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 $16.50 Market Rate $22.00 $20.50 $101.50 Market Rate $61.00 $20.50 $20.50 $19.50 $16.50 Market Rate $20.50 $20.50 $14.50 $19.50 Market Rate $20.50 $20.50 $21.00 $6.00 $20.50 Market Rate $21.50 Market Rate Market Rate $19.50 $19.50 $2.00 $16.50 $25.50 $33.00 $20.50 $12.50 $21.00 Market Rate $21.00 $16.50 $17.00 $17.00 $12.50 $16.50 $19.50 Market Rate $46.00 Market Rate $81.50 $152.25 $20.50 Market Rate $25.50 $5.00 $2.50 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT ENVIRONMENTAL HEALTH SERVICES - 2021 FEE SCHEDULE 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 Iron Magnesium Manganese Potassium Sodium Sulfate Nitrate Nitrite Phosphate, Total PH/Temperature 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. $91.50 $101.50 $19.50 $20.50 $21.00 $81.50 $19.50 $20.50 $20.50 $20.50 $20.50 $21.00 $19.50 $19.50 $19.50 $33.00 $16.50 $16.50 $17.00 $16.50 $81.50 $81.50 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT PROPOSED 2021 HHW Facility - VSQG Fees Waste Type Cost per container -2020 202{. Cost per pound Acid gallon $10.60 $10.80 5 gallon $53.00 $54.00 $1.35/ pound 55 gallon $200.00 $216.00 Aerosol (paint, pesticide) $1.20/ pound Antifreeze 50.60/ gallon Base gallon $10.60 $10.80 5 gallon $53.00 $54.00 $1.35/ pound 55 gallon $200.00 $216.00 Battery (excluding alkaline) $0.25/ pound Battery (alkaline) 51.20/ pound Compressed Gas Cylinders (small) tank $4.43 $5.35 Compressed Gas Cylinders(large) tank Market Price Cyanide Compounds 5 gallon $75.00 $85.00 Flammable Liquid (bulkable) or Cooking Oil 50.35/ pound Flammable Liquid quart $2.65 $2.70 gallon $10.60 $10.80 $1.35/ pound if < quart or 5 gallon $53.00 $54.00 loose -pack 2rcury Containg Bulbs (small),CFL, Fluorescent Tut Pound $0.64 $0.84 Mercury Containing Bulbs (HID, Sodium, Misc) Pound $2.68 $2.89 Filter, oil 50.10/ $0.30/ lb pound Grease Market Price Per Gallon Mercury thermometer $0.75 51.30/ $5.00/lb pound Motor Oil (used) 50.60/ gallon Oily Waste Water ( Chlorine Free, No Solvents) $0.80/gallon Oxidizer gallon $10.60 $10.80 5 gallon $53.00 $54.00 $1.35/ pound 55 gallon $200.00 $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 $10.60 $10.80 5 gallon $53.00 $54.00 51.35/ pound 55 gallon $200.00 $216.00 Pesticide, dry 51.00/ pound Miscellaneous Items To be determined, subject to market rate. *Latex and oil based paint are not charged due to contract with PaintCare. New drum price increased costs from last year New drum price increased costs from last year New drum price increased costs from last year New price New drum price increased costs from last year New price New price New drum price increased costs from last year New drum price increased costs from last year WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT 2021 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 $10.80 $1.35/ pound 5 gallon $54.00 55 gallon $216.00 Battery (excluding alkaline) $0.25/ pound Battery (alkaline) $1.20/ pound Compressed 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 quart $270 quart $1.35/ or pound loose -pack if < gallon $10.80 5 gallon $54.00 Fluorescent Tubes Pound $0.84 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 $216.00 Pesticide, dry $1.00/ 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. PROPOSED 2021 PUBLIC HEALTH CLINICAL SERVICES FEE SCHEDULE =NEW/CHANGE Code 99201 99202 99203 99204 Services New Client Minimal* Expanded* Detailed* Comprehensive* HOUSEHOLD CODE SIZE Code Code 1 2 Code Code 3 4 Code 5 0.00 14.00 28.00 42.00 0.00 32.75 65.50 98.25 0.00 42.50 85.00 127.50 0.00 63.50 127.00 190.50 56.00 131.00 170.00 254.00 9n9,n 2021 Increased Other than CURRENT by: 2.5% 2_.5 °k 55.00 128.00 166.00 248.00 56.00 131.00 170.00 254.00 99205 Extensive* 0.00 65.25 130.50 195.75 261.00 261.00 99211 99212 99213 99214 Established Client Minimal* Focused* Expanded* Detailed* 0.00 0.00 0.00 0.00 12.50 21.25 27.75 43.75 25.00 37.50 42.50 63.75 55.50 83.25 87.50 131.25 50.00 85.00 111.00 175.00 49.00 83.00 108.00 171.00 50.00 85.00 111.00 175.00 99215 Comprehensive* 0.00 54.50 109.00 163.50 218.00 218.00 99341 99342 99347 99348 99401 99402 99403 Home Visits New Client - Focused New Client - Expanded Est. Client - Focused Est. Client - Expanded 104.00 104.00 104.00 104.00 104.00 104.00 104.00 104.00 103.00 103.00 103.00 103.00 108.00 108.00 108.00 108.00 Preventive Medicine Counseling (Family Planning} Individual - 15 min* Individual - 30 min* Individual - 45 min* 0.00 0.00 0.00 13.25 19.25 27.00 26.50 39.75 38.50 57.75 54.00 81.00 104.00 104.00 103.00 108.00 53.00 77.00 108.00 101.00 101.00 100.00 105.00 52.00 75.00 105.00 104.00 104.00 103.00 108.00 53.00 77.00 108.00 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 G8431 Documented - NFP 0.00 32.50 0.00 3.75 0.00 7.50 65.00 97.50 7.50 11.25 15.00 22.50 130.00 15.00 30.00 15.00 15.00 15.00 15.00 15.00 35.00 35.00 35.00 35.00 35.00 130.00 15.00 30.00 15.00 35.00 99404 99401W 99412 99384 99385 99386 99394 99395 99396 0071W 0069W Travel Visits Individual Initial Visit - 60 Return Visit Group Initial Visit (per person) - 60 Preventive Medicine New Client 12-17 years old* New Client 18-39 years old* New 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. Travax Printout/Medical Records ($16 for the first 10 pages; $0.50 for each additional page) G9006 NHV Mother - Task Care Management T1017 NHV Child - Task Care Management STI Exam pre -pay -NP Wellness Package 99499 TB Consultation 139.00 139.00 139.00 139.00 65.00 65.00 65.00 65.00 65.00 65.00 65.00 65.00 0.00 0.00 0.00 0.00 0.00 0.00 42.50 42.50 46.25 36.00 36.75 39.00 85.00 85.00 92.50 72.00 73.50 78.00 127.50 127.50 138.75 108.00 110.25 117.00 139.00 65.00 65.00 170.00 170.00 185.00 144.00 147.00 156.00 83.00 83.00 83.00 83.00 83.00 16.00 35.00 35.00 216.00 54.00 50.00 16.00 35.00 35.00 216.00 51.00 50.00 16.00 35.00 35.00 216.00 51.00 50.00 16.00 35.00 35.00 216.00 51.00 50.00 16.00 35.00 35.00 216.00 54.00 50.00 136.00 63.00 63.00 166.00 166.00 180.00 140.00 143.00 152.00 81.00 16.00 16.00 16.00 211.00 53.-GQ 49.00 139.00 65.00 65.00 170.00 170.00 185.00 144.00 147.00 156.00 83.00 16.00 35.00 35.00 35.00 35.00 216.00 54.00 50.00 NSF Non -sufficient funds (bounced check) 25.00 25.00 25.00 25.00 25.00 25.00 56420 11100 57500 0116W 57452 PROCEDURES Bartholin Cyst Treatment Biopsy of skin, single Cervical Lesion Biopsy Chest X -Ray (Prepay) Colposcopy without Biopsy ** 179.00 179.00 132.00 132.00 165.00 165.00 75.00 75.00 141.00 141.00 179.00 179.00 132.00 132.00 165.00 165.00 75.00 75.00 141.00 141.00 179.00 132.00 165.00 75.00 141.00 153.00 129.00 160.00 73.00 138.00 179.00 179.00 132.00 165.00 165.00 75.00 141.00 INICAL SERVICES FEE SCHEDU =NEW/CHANGE Code 57454 57511 17000 17003 17004 56501 57170 58100 58110 11400 11981 10060 58300 57460 57461 88305 88305W 59025 11976 11983 58301 A4550 11300 76857 A4267 0052W A4266 A4269 J7307 J7306 J7298 J7300 J7301 J7297 J7296 J1050 96372 J7303 S4993 0068W 0065W 86900 82947 82565 86609 85025 85027 87491 87491 NS 80053 0090W 87635 82627 82670 83001 87591 Services HOUSEH Code Code 1 2 LD C • DE SIZE Code Code 3 4 2020 Code CURRE 5 Colposcopy with Biopsy ** Cryocautery cervix- initial or repeat Cryotherapy first lesion** Cryotherapy 2-14 lesions** Cryotherapy 15 + lesions** Destruction Lesion Vulva Diaphragm/Cervical Cap Fitting* Endometrial biopsy w/wo Biopsy Endometrial biopsy with Colposcopy Essure by referral*** Excisions, benign lesion Implanon Nexplanon Insertion* Incision & drainage of abcess, single or simple Insertion IUD* LEEP with biopsy LEEP with Ionization Level 4 - Surgical pathology 1st site Level 4 - Surgical Pathology 2nd site & each adc Non Stress Test Interp Removal, implant contraceptive (lmplanon)* Removal implant, with reinsertion* Removal IUD* Surgical Tray Shaving of epidermal lesion, single on trunk, arms or legs, .5cm Ultrasound - pelvic non -obstetric F A u L. O Y 11 L 11 N NIIN `.L SUPPLES Condoms pkg 10* Cycle Beads* Diaphragm* Foam Contraception* Nexplanon (Etonogestrel)* Levonorgestrel IUD Mirena* IUD Paragard* IUD Skyla* IUD Liletta IUD Kyleena Medroxyprogesterone (Depo)* Admin fee depo- if visit for injection only Nuva Ring* Oral Contraceptives* Seasonale/Seasonique (3 months supply) Today's Sponge* AB ABO blood typing Assay, body fluid, glucose, (FBS)* Assay of creatine Bacterium antibody CBC w/Diff CBC w/o Diff Chlamydia PCR* Chlamydia PCR* - full fee Comprehensive Metabolic Panel Court Ordered Lab Draw COVID Nasal/Nasopharyngeal Test DHEAS Estradiol FSH Gonorrhea PCR* 197.00 197.00 197.00 197.00 197.00 200.00 200.00 200.00 200.00 200.00 86.00 86.00 86.00 86.00 86.00 7.00 7.00 7.00 7.00 7.00 194.00 194.00 194.00 194.00 194.00 188.00 188.00 188.00 188.00 188.00 0.00 26.75 53.50 80.25 107.00 141.00 141.00 141.00 141.00 141.00 76.00 76.00 76.00 76.00 76.00 0.00 0.00 0.00 0.00 0.00 159.00 159.00 159.00 159.00 159.00 0.00 54.75 109.50 164.25 219.00 151.00 151.00 151.00 151.00 151.00 0.00 55.00 110.00 165.00 220.00 363.00 363.00 363.00 363.00 363.00 412.00 412.00 412.00 412.00 412.00 121.00 121.00 121.00 121.00 121.00 121.00 121.00 121.00 121.00 121.00 0.00 0.00 0.00 0.00 0.00 0.00 65.00 130.00 195.00 260.00 0.00 100.00 200.00 300.00 400.00 0.00 44.25 88.50 132.75 177.00 79.00 79.00 79.00 79.00 79.00 124.00 124.00 124.00 124.00 124.00 85.00 85.00 85.00 85.00 85.00 0.00 1.75 3.50 5.25 7.00 0.00 4.00 8.00 12.00 16.00 0.00 9.25 18.50 27.75 37.00 0.00 3-2,5 6,5G 9.75 13.00 0.00 235.50 471.00 706.50 942.00 0.00 235.50 471.00 706.50 942.00 0.00 270.25 540.50 810.75 1081.00 0.00 229.50 459.00 688.50 918.00 0.00 250.50 501.00 751.50 1002.00 0.00 196.75 393.50 590.25 787.00 0.00 238.50 477.00 715.50 954.00 0.00 20.50 41.00 61.50 82.00 0.00 8.25 16.50 24.75 33.00 0.00 12.00 24.00 36.00 48.00 0.00 9.75 19.50 29.25 39.00 0.00 20.50 41.00 61.50 82.00 0.00 1.25 2.50 3.75 5.00 0.00 1.25 2.50 3.75 5.00 0.00 6.25 12.50 18.75 25.00 7.00 7.00 7.00 7.00 7.00 34.00 34.00 34.00 34.00 34.00 26.00 26.00 26.00 26.00 26.00 23.00 23.00 23.00 23.00 23.00 0.00 14.00 28.00 42.00 56.00 56.00 56.00 56.00 56.00 56.00 15.00 15.00 15.00 15.00 15.00 50.00 50.00 50.00 50.00 50.00 53.00 53.00 53.00 53.00 53.00 35.00 35.00 35.00 35.00 35.00 41.00 41.00 41.00 41.00 41.00 42.00 42.00 42.00 42.00 42.00 0.00 14.00 28.00 42.00 56.00 192.00 182.00 84.00 7.00 189.00 164.00 104.00 138.00 74.00 155.00 214.00 147.00 215.00 354.00 402.00 118.00 118.00 0.0-0- 254.00 390.00 173.00 77-40 121.00 83.00 7.00 16.00 36. 0 13.00 919.00 1055.00 896.00 978.00 718.00 628.00 80.00 32.00 47.00 38.00 80.00 5.00 5.00 24.00 7.00 18.00 25.00 22.00 55.00 55.00 15.00 17.00 34.00 40.00 41.00 55.00 2021 Increased Other than by: 2.5% PPoi �,° 197.00 200.00 200.00 86.00 7.00 194.00 188.00 188.00 107.00 141.00 76.00 0.00 159.00 219.00 151.00 220.00 363.00 412.00 121.00 121.00 0.00 260.00 400.00 177.00 79.00 124.00 85.00 7.00 16.00 37.00 13.00 942.00 942.00 1081.00 918.00 1002.00 787.00 954.00 787.00 954.00 82.00 33.00 48.00 39.00 82.00 5.00 5.00 25.00 7.00 34.00 34.00 26.00 23.00 56.00 56.00 15.00 50.00 53.00 35.00 41.00 42.00 56.00 50.00 53.00 =NEW/CHANGE PROPOSED .2021 PUBLIC. HEALTH .CLINICAL SERVICES FEE SCHEDULE Code 87591 NS 82948 82951 87205 84702 84703 83718 86708 86709 86706 86705 86317 87340 80074 86803 87522 87255 86695 86696 85018 83036 86701 86702 87389 G0435 87624 87625 0081W 484006W 87254 83525 83002 80061W 80061N 80076 86790 80048 86376 82274 88142 0080W 88175 88141 84144 84146 84482 86901 87535 86592 86593 87798 87081 84480 84481 84436 84439 84403 86800 82465 87661 86780 84443 86480 Services HOUSEHOLD CODE SIZE Code Code 1 2 Code Code 3 4 Code 5 Gonorrhea PCR* - full fee 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 Al c HIV 1/2 AB Diff (this is HIV 1) HIV 1/2 AB Diff (this is HIV 2) HIV - 1 antigen wl 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 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 Reverse T3 RH blood type RNA Qaulitative RPR/Syphillis test RPR/Syphillis (Quant) Rertussis B PCR comp serum and urine 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) Q _2fl 2021 Increased Other than CURRENT by: 2.5% - 2.5%°-1 56.00 56.00 56.00 56.00 56.00 55.00 8.00 8.00 8.00 8.00 8.00 8.00 31.00 31.00 31.00 31.00 31.00 30.00 33.00 33.00 33.00 33.00 33.00 32.00 49.00 49.00 49.00 49.00 49.00 48.00 49.00 49.00 49.00 49.00 49.00 48.00 37.00 37.00 37.00 37.00 37.00 36.00 17.00 17.00 17.00 17.00 17.00 17.00 16.00 16.00 16.00 16.00 16.00 16.00 30.00 30.00 30.00 30.00 30.00 29.00 29.00 29.00 29.00 29.00 29.00 28.00 23.00 23.00 23.00 23.00 23.00 22.00 22.00 22.00 22.00 22.00 22.00 21.00 69.00 69.00 69.00 69.00 69.00 67.00 21.00 21.00 21.00 21.00 21.00 20.00 129.00 129.00 129.00 129.00 129.00 59.00 85.00 85.00 85.00 85.00 85.00 83.00 85.00 85.00 85.00 85.00 85.00 83.00 85.00 85.00 85.00 85.00 85.00 83.00 0.00 3.75 7.50 11.25 15.00 15.00 40.00 40.00 40.00 40.00 40.00 39.00 13.00 13.00 13.00 13.00 13.00 13.00 14.00 14.00 14.00 14.00 14.00 14.00 30.00 30.00 30.00 30.00 30.00 29.00 30.00 30.00 30.00 30.00 30.00 29.00 85.00 85.00 85.00 85.00 85.00 83.00 52.00 52.00 52.00 52.00 52.00 51.00 136.00 136.00 136.00 136.00 136.00 133.00 122.00 122.00 122.00 122.00 122.00 119.00 51.00 51.00 51.00 51.00 51.00 50.00 16.00 16.00 16.00 16.00 16.00 16.00 42.00 42.00 42.00 42.00 42.00 41.00 0.00 11.00 22.00 33.00 44.00 43.00 44.00 44.00 44.00 44.00 44.00 43.00 36.00 36.00 36.00 36.00 36.00 35.00 148.00 148.00 148.00 148.00 148.00 144.00 37.00 37.00 37.00 37.00 37.00 36.00 21.00 21.00 21.00 21.00 21.00 20.00 35.00 35.00 35.00 35.00 35.00 34.00 0.00 12.75 25.50 38.25 51.00 50.00 51.00 51.00 51.00 51.00 51.00 50.00 138.00 138.00 138.00 138.00 138.00 135.00 41.00 41.00 41.00 41.00 41.00 40.00 23.00 23.00 23.00 23.00 23.00 22.00 44.00 44.00 44.00 44.00 44.00 43.00 23.00 23.00 23.00 23.00 23.00 22.00 0.00 1.75 3.50 5.25 7.00 7.00 52.00 52.00 52.00 52.00 52.00 51.00 29.00 29.00 29.00 29.00 29.00 28.00 13.00 13.00 13.00 13.00 13.00 13.00 768.00 768.00 768.06 768.00- 768.00 74-94;0 15.00 15.00 15.00 15.00 15.00 '15.00 54.00 54.00 54.00 54.00 54.00 53.00 54.00 54.00 54.00 54.00 54.00 53.00 10.00 10.00 10.00 10.00 10.00 '10.00 12.00 12.00 12.00 12.00 12.00 12.00 40.00 40.00 40.00 40.00 40.00 39.00 23.00 23.00 23.00 23.00 23.00 22.00 28.00 28.00 28.00 28.00 28.00 27.00 51.00 51.00 51.00 51.00 51.00 50.00 16.00 16.00 16.00 16.00 16.00 16.00 40.00 40.00 40.00 40.00 40.00 39.00 108.00 108.00 108.00 108.00 108.00 105.00 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 21.00 129.00 129.00 85.00 85.00 85.00 15.00 40.00 13.00 14.00 30.00 30.00 85.00 52.00 136.00 122.00 51.00 16.00 42.00 44.00 44.00 36.00 148.00 37.00 21.00 35.00 51.00 51.00 138.00 41.00 23.00 44.00 23.00 7.00 52.00 29.00 13.00 768-00 15.00 54.00 54.00 10.00 12.00 40.00 23.00 28.00 51.00 16.00 40.00 108.00 PROPOSED 2021 PUBLIC HEALTH CLINICAL SERVICES FEE SCHEDULE =VIEW/CHANGE Code 81001 81002 87086 81025 36415 36415W 36416 36416W 96372 87210 0020W 00144 101456W 0456W J0696 0696W 0007W 0058W 0035W J8499 0059W 0011W 0012W Services HOUSE Code Code 1 2 HOLD CODE SIZE Code Code 3 4 Code CURRENT 5 Urinalysis, complete with micro ex Urinalysis, w/o scope (UA) Urine Culture, Comprehensive Urine Preganancy Test* Venipuncture Venipuncture (with sliding fee lab) Venipuncture - capillary blood specimen Venipuncture - capillary blood specimen Admin fee for Depo and antibiotics Wet Prep MEDHCINES and TREA`ThVENTS Amoxicillin 875 mg #20 Azythromycin, Z pack Azithromycin 1g - partner pack Azithromycin 500 mg #2 Ceftriaxone 250 mg Ceftriaxone 250 mg State Supplied Cephalexin 500 mg #14 Ciprofloxcin 500 mg #6 Condylox Doxycycline 100 mg #14 Estradiol 1 mg- #100 Fluconazole 150 mg #1 Iron J0561 LA Bicillin 2.4 Units 0060W 0008W 0009W 0010W 0013W 0006W 0016W 0004W J8'199 00180NC Medroxyprogesterone 10 mg - #5 Metrogel Metronidazole 500 mg #4 Metronidazole 500 mg #14 Metronidazole 250 mg #28 Misoprostel (Cytotec) 200 mcg #2 Podophyllin/TCA Sulfatrim SMX/TMP Suprax 400 mg #1 partner pak Suprax 400 mg #1 State _ upplied 7.00 7.00 7.00 7.00 11.00 11.00 11.00 11.00 12.00 12.00 12.00 12.00 0.00 4.00 8.00 12.00 8.00 8.00 8.00 8.00 0.00 2.00 4.00 6.00 8.00 8.00 8.00 8.00 0.00 2.00 4.00 6.00 0.00 8.25 16.50 24.75 30.00 30.00 30.00 30.00 17.00 17.00 13.00 10.00 10.00 0.00 11.00 17.00 11.00 12.00 17.00 10.00 13.00 5.00 17.00 15.00 11.00 16.00 16.00 11.00 17.00 11.00 33.00 0.00 17.00 17.00 13.00 10.00 10.00 0.00 11.00 17.00 11.00 12.00 17.00 10.00 13.00 5.00 17.00 15.00 11.00 16.00 16.00 11.00 17.00 11.00 33.00 0.00 17.00 17.00 13.00 10.00 10.00 0-00 11.00 17.00 11.00 12.00 17.00 10.00 13.00 5.00 17.00 15.00 11.00 16.00 16.00 11.00 17.00 11.00 33.00 0.00 17.00 17.00 13.00 10.00 10.00 0.00 11.00 17.00 11.00 12.00 17.00 10.00 13.00 5.00 17.00 15.00 11.00 16.00 16.00 11.00 17.00 11.00 33.00 0.00 7.00 11.00 12.00 16.00 8.00 8.00 8.00 8.00 33.00 30.00 17.00 17.00 13.00 10.00 10.00 0.00 11.00 17.00 11.00 12.00 17.00 10.00 13.00 5.00 17.00 15.00 11.00 16.00 16.00 11.00 17.00 11.00 33.00 0.00 7.00 11.00 12.00 16.00 8.00 8.00 8.00 8.00 32.00 29.00 17.00 17.00 12.00 0.00 37.00 GT0-0 11.00 17.00 11.00 12.00 17.00 25.00 13.00 5.00 17.00 11.00 11.00 16.00 16.00 11.00 17.00 11.00 32.00 0-40 2020 2021 Increased Other than by: 2.5% 7.00 11.00 12.00 16.00 8.00 8.00 8.00 8.00 33.00 30.00 17.00 17.00 13.00 10.00 10.00 0.00 11.00 17.00 11.00 12.00 17.00 13.00 10.00 10.00 10.00 10.00 13.00 5.00 17.00 15.00 15.00 11.00 16.00 16.00 11.00 17.00 11.00 33.00 0.00 87635 Truvada #3 45.00 45.00 45.00 45.00 45.00 45.00 90471 90472 90473 90700N 90700 90702N 90633N 90633 90632N 90632 90744N 90744 90746N 90746 90739 90647N 90647 90651N 90651 90281 90660N 90660 90687 0P111V1UND7DOHS 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 Influenza - intranasal use - State supplied Influenza - Intranasal Adult enza infant quadrivalent 33.00 33.00 33.00 33.00 33.00 33.00 33.00 33.00 33.00 33.00 33.00 33.00 33.00 33.00 33.00 0.00 0.00 0.00 0.00 0.00 36.00 36.00 36.00 36.00 36.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 38.00 38.00 38.00 38.00 38.00 0.00 0.00 0.00 0.00 0.00 101.00 101.00 101.00 101.00 101.00 0.00 0.00 0.00 0.00 0.00 33.00 33.00 33.00 33.00 33.00 0.00 0.00 0.00 0.00 0.00 92.00 92.00 92.00 92.00 92.00 122.00 122.00 122.00 122.00 122.00 0.00 0.00 0.00 0.00 0.00 42.00 42.00 42.00 42.00 42.00 0.00 0.00 0.00 0.00 0.00 228.00 228.00 228.00 228.00 228.00 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 40.00 40.00 40.00 40.00 40.00 32.00 32.00 32.00 0.00 35.00 0.00 0.00 37.00 0.00 99.00 0.00 32.00 0.00 90.00 119.00 0.00 41.00 0.00 217.00 0.00 0.00 39.00 39 0-0 33.00 33.00 33.00 0.00 36.00 0.00 0.00 38.00 0.00 101.00 0.00 33.00 0.00 92.00 122.00 0.00 42.00 0.00 228.00 228.00 0.00 0.00 40.00 10.00 =NEW/CHANGE �v M hI D L.l� ., �OSE� Ct�21 PUBLIC H��TH LI�I�AL :EVICES EEE SC , Code 90687N 90688 90688N 90713N 90713 90738 90696N 90696 90734N 90734 90620 90733 90707N 90707 90723N 90723 90698N 90698 90732N 90732 90710N 90710 90670N 90670 90675 90675N 90375 90680N 90680 90750 90714N 90714 90715N 90715 86580 90636 90691 90690 90716N 90716 90717 INC- 99212 59125 59426 99402W 0255W 5` 30 H1005 H1005 H1005 H1005 Services HOUSEHOLD CODE SIZE Code Code 1 2 Code Code 3 4 Code 5 Influenza infant quadrivalent State supplied Influenza - quadrivalent Influenza - State supplied quadrivalent IPV-VFC - State supplied IPV Japanese Encephalitis (new formulation) Kinrix - (DTaP/IPV)/Quadracel - State supplied Kinrix - (DTaP/IPV)/Quadracel MCV4 - State supplied MCV4 MenB MPSV4 (Menomune)(polysaccharide) MMR - State supplied MMR Pediarix (DTAP, IPV, Hep B) - State supplied Pediarix - (DTaP/IPV/Hep B) Pentacel - (DTaP/IPV/HepB) - State supplied Pentacel - (DTaP/IPV/HepB) Pneumovax - State supplied Pneumovax Proquad - MMR-Varicella Proquad - MMR-Varicella Prevnar - (PCV13) - State supplied Prevnar - (PCV13) 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 Miscellaneous Service Includes Follow up Care Antepartum Care 1 visit Antepart care 4-6 visits Antepartum care 7 or more visits PE Establishing Medical Record Phone visit Post Partum Only Prenatal Plus (1-4 visits) Prenatal Plus (5 9 visits) Prenatal Plus (10 visits) Prenatal Plus (11 or more visits) 2020 2021 Increased Other than CURRENT by: 2.5% 0 2.5��fly- 0.00 0.00 0.00 0.00 0.00 0.00 0,04 40.00 40.00 40.00 40.00 40.00 39.00 40.00 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 78.00 78.00 78.00 78.00 78.00 76.00 78.00 357.00 357.00 357.00 357.00 357.00 348.00 357.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 70.00 70.00 70.00 70.00 70.00 68.00 70.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 189.00 189.00 189.00 189.00 189.00 184.00 189.00 176.00 176.00 176.00 176.00 176.00 176.00 176.00 189.00 189.00 189.00 189.00 189.00 184.00 189.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 79.00 79.00 79.00 79.00 79.00 77.00 79.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 97.00 97.00 97.00 97.00 97.00 95.00 97.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 144.00 144.00 144.00 144.00 144.00 140.00 144.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 104.00 104.00 104.00 104.00 104.00 101.00 104.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 225.00 225.00 225.00 225.00 225.00 215.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 211.00 211.00 211.00 211.00 211.00 206.00 211.00 310.00 310.00 310.00 310.00 310.00 302.00 310.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 398.00 398.00 398.00 398.00 398.00 383.00 398.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 109.00 109.00 109.00 109.00 109.00 106.00 109.00 158.00 158.00 158.00 158.00 158.00 154.00 158.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 65.00 65.00 65.00 65.00 65.00 63.00 65.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 124.00 124.00 124.00 124.00 124.00 121.00 124.00 54.00 54.00 54.00 54.00 54.00 53.00 54.00 137.00 137.00 137.00 137.00 137.00 134.00 137.00 88.00 88.00 88.00 88.00 88.00 86.00 88.00 77.00 77.00 77.00 77.00 77.00 75.00 77.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 137.00 137.00 137.00 137.00 137.00 134.00 137.00 175.00 175.00 175.00 175.00 175.00 171.00 175.00 225.00 225.00 0.00 0.00 85.00 85.00 757.00 757.00 1557.00 1557.00 74.00 74.00 0.00 0.00 241.00 241.00 220.00 220.00 585.00 585.00 1100.00 1100.00 1215.00 1215.00 0.00 0.00 85.00 85.00 757.00 757.00 1557.00 1557.00 74.00 71.00 0.00 0.00 241.00 241.00 220.00 220.00 585.00 585.00 1100.00 1100.00 1215.00 1245.00 0.00 85.00 757.00 1557.00 74.00 0.00 241.00 220.00 585.00 1100.00 1215.00 * Fees only slide for the Family Planning Program. Charges for all other programs are the Code 5 fee. ** Services include surgical procedure only. *** These items are for referral 12/1/2020 revised 0.00 83.00 7-3-9.00 151-9-00 72.00 0.00 235.00 215.00 571.n9 1-073.00 4215.00 0.00 85.00 757.00 1557.00 74.00 0.00 211.00 220.00 585.00 1100.00 1215.00 398.00 2021 PUBLIC HEALTH CLINICAL SERVICES FEE SCHEDULE Code Services HOUSEHOLD CODE SIZE Code Code Code Code Code 1 2 3 4 5 New Client 99201 Minimal* 99202 Expanded* 99203 Detailed* 99204 Comprehensive* 99205 Extensive* Established Client 99211 Minimal* 99212 Focused* 99213 Expanded* 99214 Detailed* 99215 Comprehensive* Home Visits 99341 New Client - Focused 99342 New Client - Expanded 99347 Est. Client - Focused 99348 Est. Client - Expanded 0.00 14.00 28.00 42.00 56.00 0.00 32.75 65.50 98.25 131.00 0.00 42.50 85.00 127.50 170.00 0.00 63.50 127.00 190.50 254.00 0.00 65.25 130.50 195.75 261.00 0.00 12.50 25.00 37.50 50.00 0.00 21.25 42.50 63.75 85.00 0.00 27.75 55.50 83.25 111.00 0.00 43.75 87.50 131.25 175.00 0.00 54.50 109.00 163.50 218.00 104.00 104.00 104.00 104.00 104.00 104.00 104.00 104.00 104.00 104.00 103.00 103.00 103.00 103.00 103.00 108.00 108.00 108.00 108.00 108.00 Preventive Medicine Counseling (Family Planning) 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 G8431 documented- 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 0.00 0.00 0.00 0.00 0.00 13.25 19.25 27.00 32.50 3.75 7.50 26.50 38.50 54.00 65.00 7.50 15.00 39.75 57.75 81.00 97.50 11.25 22.50 53.00 77.00 108.00 130.00 15.00 30.00 15.00 15.00 15.00 15.00 15.00 35.00 35.00 35.00 35.00 35.00 139.00 139.00 139.00 139.00 139.00 65.00 65.00 65.00 65.00 65.00 65.00 65.00 65.00 65.00 65.00 0.00 0.00 0.00 0.00 0.00 0.00 42.50 42.50 46.25 36.00 36.75 39.00 85.00 85.00 92.50 72.00 73.50 78.00 127.50 127.50 138.75 108.00 110.25 117.00 170.00 170.00 185.00 144.00 147.00 156.00 Additional Codes 0071W Community Education 1 hr. 83.00 83.00 83.00 83.00 83.00 0069W Medical Records ($16 for the first 10 pages; $0.50 for each additional page) 16.00 16.00 16.00 16.00 16.00 G9006 NHV Mother - Task Care Management 35.00 35.00 35.00 35.00 35.00 T1017 NHV Child - Task Care Management 35.00 35.00 35.00 35.00 35.00 STI Exam pre -pay -NP 216.00 216.00 216.00 216.00 216.00 99499 TB Consultation 50.00 50.00 50.00 50.00 50.00 2021 PUBLIC HEALTH CLINICAL SERVICES FEE SCHEDULE Code Services HOUSEHOLD CODE SIZE Code Code Code Code Code 1 2 3 4 5 NSF Non -sufficient funds (bounced check) 25.00 25.00 25.00 25.00 25.00 PROCEDURES 56420 Bartholin Cyst Treatment 179.00 179.00 179.00 179.00 179.00 11100 Biopsy of skin, single 132.00 132.00 132.00 132.00 132.00 57500 Cervical Lesion Biopsy 165.00 165.00 165.00 165.00 165.00 0116W Chest X -Ray (Prepay) 75.00 75.00 75.00 75.00 75.00 57452 Colposcopy without Biopsy ** 141.00 141.00 141.00 141.00 141.00 57454 Colposcopy with Biopsy ** 197.00 197.00 197.00 197.00 197.00 57511 Cryocautery cervix- initial or repeat 200.00 200.00 200.00 200.00 200.00 17000 Cryotherapy first lesion** 86.00 86.00 86.00 86.00 86.00 17003 Cryotherapy 2-14 lesions** 7.00 7.00 7.00 7.00 7.00 17004 Cryotherapy 15 + lesions** 194.00 194.00 194.00 194.00 194.00 56501 Destruction Lesion Vulva 188.00 188.00 188.00 188.00 188.00 57170 Diaphragm/Cervical Cap Fitting* 0.00 26.75 53.50 80.25 107.00 58100 Endometrial biopsy w/wo Biopsy 141.00 141.00 141.00 141.00 141.00 58110 Endometrial biopsy with Colposcopy 76.00 76.00 76.00 76.00 76.00 11400 Excisions, benign lesion 159.00 159.00 159.00 159.00 159.00 11981 Nexplanon Insertion* 0.00 54.75 109.50 164.25 219.00 10060 Incision & drainage of abcess, single or simple 151.00 151.00 151.00 151.00 151.00 58300 Insertion IUD* 0.00 55.00 110.00 165.00 220.00 57460 LEEP with biopsy 363.00 363.00 363.00 363.00 363.00 57461 LEEP with conization 412.00 412.00 412.00 412.00 412.00 88305 Level 4 - Surgical pathology 1st site 121.00 121.00 121.00 121.00 121.00 88305W Level 4 - Surgical Pathology 2nd site & each ad( 121.00 121.00 121.00 121.00 121.00 11976 Removal, implant contraceptive * 0.00 65.00 130.00 195.00 260.00 11983 Removal implant, with reinsertion* 0.00 100.00 200.00 300.00 400.00 58301 Removal IUD* 0.00 44.25 88.50 132.75 177.00 Shaving of epidermal lesion, single on trunk, 11300 arms or legs, .5cm 124.00 124.00 124.00 124.00 124.00 76857 Ultrasound - pelvic non -obstetric 85.00 85.00 85.00 85.00 85.00 FAMILY PLANNING SUPPLIES A4267 Condoms pkg 10* 0.00 1.75 3.50 5.25 7.00 0052W Cycle Beads* 0.00 4.00 8.00 12.00 16.00 J7307 Nexplanon (Etonogestrel)* 0.00 235.50 471.00 706.50 942.00 J7298 IUD Mirena* 0.00 270.25 540.50 810.75 1081.00 J7300 IUD Paragard* 0.00 229.50 459.00 688.50 918.00 J7301 IUD Skyla* 0.00 250.50 501.00 751.50 1002.00 J7297 IUD Liletta 0.00 196.75 393.50 590.25 787.00 J7296 IUD Kyleena 0.00 238.50 477.00 715.50 954.00 J1050 Medroxyprogesterone (Depo)* 0.00 20.50 41.00 61.50 82.00 96372 Admin fee depo- if visit for injection only 0.00 8.25 16.50 24.75 33.00 J7303 Nuva Ring* 0.00 12.00 24.00 36.00 48.00 S4993 Oral Contraceptives* 0.00 9.75 19.50 29.25 39.00 0068W Seasonale/Seasonique (3 months supply) 0.00 20.50 41.00 61.50 82.00 LAB 86900 ABO blood typing 0.00 1.25 2.50 3.75 5.00 82947 Assay, body fluid, glucose, (FBS)* 0.00 6.25 12.50 18.75 25.00 82565 Assay of creatine 7.00 7.00 7.00 7.00 7.00 86609 Bacterium antibody 34.00 34.00 34.00 34.00 34.00 2021 PUBLIC HEALTH CLINICAL SERVICES FEE SCHEDULE Code Services HOUSEHOLD CODE SIZE Code Code Code Code 1 2 3 4 Code 5 85025 85027 87491 87491 NS 80053 0090W 87635 82627 82670 83001 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 87389 G0435 87624 87625 0081W 484006W 87254 83525 83002 80061W 80061N 80076 86790 80048 86376 82274 88142 0080W 88175 CBC w/Diff CBC w/o Diff Chlamydia PCR* Chlamydia PCR* - full fee Comprehensive Metabolic Panel Court Ordered Lab Draw COVID Nasal/Nasopharyngeal Test DHEAS Estradiol FSH Gonorrhea PCR* Gonorrhea PCR* - full fee 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 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 HPV, High Risk HPV typing 16,18,45 HPV, High Risk w/ repeat pap (LabCorp use) Immunohistochemical Stain Influenza - Viral Culture 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 26.00 26.00 23.00 23.00 0.00 14.00 56.00 56.00 15.00 15.00 50.00 50.00 53.00 53.00 35.00 35.00 41.00 41.00 42.00 42.00 0.00 14.00 56.00 56.00 8.00 8.00 31.00 31.00 33.00 33.00 49.00 49.00 49.00 49.00 37.00 37.00 17.00 17.00 16.00 16.00 30.00 30.00 29.00 29.00 23.00 23.00 22.00 22.00 69.00 69.00 21.00 21.00 129.00 129.00 85.00 85.00 85.00 85.00 85.00 85.00 0.00 3.75 40.00 40.00 13.00 13.00 14.00 14.00 30.00 30.00 30.00 30.00 85.00 85.00 52.00 52.00 136.00 136.00 122.00 122.00 51.00 51.00 16.00 16.00 42.00 42.00 0.00 11.00 44.00 44.00 36.00 36.00 148.00 148.00 37.00 37.00 21.00 21.00 35.00 35.00 0.00 12.75 51.00 51.00 138.00 138.00 26.00 23.00 28.00 56.00 15.00 50.00 53.00 35.00 41.00 42.00 28.00 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 7.50 40.00 13.00 14.00 30.00 30.00 85.00 52.00 136.00 122.00 51.00 16.00 42.00 22.00 44.00 36.00 148.00 37.00 21.00 35.00 25.50 51.00 138.00 26.00 23.00 42.00 56.00 15.00 50.00 53.00 35.00 41.00 42.00 42.00 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 11.25 40.00 13.00 14.00 30.00 30.00 85.00 52.00 136.00 122.00 51.00 16.00 42.00 33.00 44.00 36.00 148.00 37.00 21.00 35.00 38.25 51.00 138.00 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 30.00 30.00 85.00 52.00 136.00 122.00 51.00 16.00 42.00 44.00 44.00 36.00 148.00 37.00 21.00 35.00 51.00 51.00 138.00 2021 PUBLIC HEALTH CLINICAL SERVICES FEE SCHEDULE HOUSEHOLD CODE SIZE Code Code Code Code Code Code Services 1 2 3 4 5 88141 Physician Read Pap 41.00 41.00 41.00 41.00 41.00 84144 Progesterone Level 23.00 23.00 23.00 23.00 23.00 84146 Prolactin 44.00 44.00 44.00 44.00 44.00 84482 Reverse T3 23.00 23.00 23.00 23.00 23.00 86901 RH blood type 0.00 1.75 3.50 5.25 7.00 87535 RNA Qaulitative 52.00 52.00 52.00 52.00 52.00 86592 RPR/Syphillis test 29.00 29.00 29.00 29.00 29.00 86593 RPR/Syphillis (Quant) 13.00 13.00 13.00 13.00 13.00 87081 Streptococcus - Hemolytic 15.00 15.00 15.00 15.00 15.00 84480 T3 Triiodothyronine 54.00 54.00 54.00 54.00 54.00 84481 TT -3 (Free -Unbound) 54.00 54.00 54.00 54.00 54.00 84436 T4 Thyroxine 10.00 10.00 10.00 10.00 10.00 84439 T4 (Total Free -Unbound) 12.00 12.00 12.00 12.00 12.00 84403 Testosterone, Total 40.00 40.00 40.00 40.00 40.00 86800 Thyroglobulin Ab 23.00 23.00 23.00 23.00 23.00 82465 Total Cholesterol 28.00 28.00 28.00 28.00 28.00 87661 Trichomonas vaginalis - amplified 51.00 51.00 51.00 51.00 51.00 86780 Treponema pallidum 16.00 16.00 16.00 16.00 16.00 84443 TSH 40.00 40.00 40.00 40.00 40.00 86480 Tuberculosis Test-Quantiferon (IGRA) 108.00 108.00 108.00 108.00 108.00 81001 Urinalysis, complete with micro ex 7.00 7.00 7.00 7.00 7.00 81002 Urinalysis, w/o scope (UA) 11.00 11.00 11.00 11.00 11.00 87086 Urine Culture, Comprehensive 12.00 12.00 12.00 12.00 12.00 81025 Urine Preganancy Test* 0.00 4.00 8.00 12.00 16.00 36415 Venipuncture 8.00 8.00 8.00 8.00 8.00 36415W Venipuncture with sliding fee lab 0.00 2.00 4.00 6.00 8.00 36416 Venipuncture - capillary blood specimen 8.00 8.00 8.00 8.00 8.00 36416W Venipuncture - capillary blood specimen 0.00 2.00 4.00 6.00 8.00 96372 Admin fee for Depo and antibiotics 0.00 8.25 16.50 24.75 33.00 87210 Wet Prep 30.00 30.00 30.00 30.00 30.00 MEDICINES and TREATMENTS 0020W Amoxicillin 875 mg #20 17.00 17.00 17.00 17.00 17.00 Q0144 Azythromycin, Z pack 17.00 17.00 17.00 17.00 17.00 101456W Azithromycin 1g - partner pack 13.00 13.00 13.00 13.00 13.00 0456W Azithromycin 500 mg #2 10.00 10.00 10.00 10.00 10.00 J0696 Ceftriaxone 250 mg 10.00 10.00 10.00 10.00 10.00 0007W Cephalexin 500 mg #14 11.00 11.00 11.00 11.00 11.00 0058W Ciprofloxcin 500 mg #6 17.00 17.00 17.00 17.00 17.00 0035W Condylox 11.00 11.00 11.00 11.00 11.00 J8499 Doxycycline 100 mg #14 12.00 12.00 12.00 12.00 12.00 0059W Estradiol 1 mg- #100 17.00 17.00 17.00 17.00 17.00 0011W Fluconazole 150 mg #1 10.00 10.00 10.00 10.00 10.00 0012W Iron 13.00 13.00 13.00 13.00 13.00 J0561 LA Bicillin 2.4 Units 5.00 5.00 5.00 5.00 5.00 0060W Medroxyprogesterone 10 mg - #5 17.00 17.00 17.00 17.00 17.00 0008W Metrogel 15.00 15.00 15.00 15.00 15.00 0009W Metronidazole 500 mg #4 11.00 11.00 11.00 11.00 11.00 0010W Metronidazole 500 mg #14 16.00 16.00 16.00 16.00 16.00 0013W Metronidazole 250 mg #28 16.00 16.00 16.00 16.00 16.00 0006W Misoprostel (Cytotec) 200 mcg #2 11.00 11.00 11.00 11.00 11.00 0016W Podophyllin/TCA 17.00 17.00 17.00 17.00 17.00 0004W Sulfatrim SMX/TMP 11.00 11.00 11.00 11.00 11.00 2021 PUBLIC HEALTH CLINICAL SERVICES FEE SCHEDULE HOUSEHOLD CODE SIZE Code Code Code Code Code Code Services 1 2 3 4 5 87635 Truvada #3 45.00 45.00 45.00 45.00 45.00 IMMUNIZATIONS 90471 Imm. Admin - one vaccine 33.00 33.00 33.00 33.00 33.00 90472 Imm Admin - each addl. Vaccine 33.00 33.00 33.00 33.00 33.00 90473 Imm Admin - intranasal or oral 33.00 33.00 33.00 33.00 33.00 90700N DTaP -State supplied 0.00 0.00 0.00 0.00 0.00 90700 DTaP 36.00 36.00 36.00 36.00 36.00 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 38.00 38.00 38.00 38.00 38.00 90632N Hepatitis A - Adult - State supplied 0.00 0.00 0.00 0.00 0.00 90632 Hepatitis A - Adult 101.00 101.00 101.00 101.00 101.00 90744N Hepatitis B - Child - State supplied 0.00 0.00 0.00 0.00 0.00 90744 Hepatitis B - Child 33.00 33.00 33.00 33.00 33.00 90746N Hepatitis B - Adult - State supplied 0.00 0.00 0.00 0.00 0.00 90746 Hepatitis B - Adult 92.00 92.00 92.00 92.00 92.00 90739 Heplisav-B 122.00 122.00 122.00 122.00 122.00 90647N HIB - State supplied 0.00 0.00 0.00 0.00 0.00 90647 HIB 42.00 42.00 42.00 42.00 42.00 90651N HPV 9 - State supplied 0.00 0.00 0.00 0.00 0.00 90651 HPV 9 228.00 228.00 228.00 228.00 228.00 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 40.00 40.00 40.00 40.00 40.00 90688 Influenza - quadrivalent 40.00 40.00 40.00 40.00 40.00 90688N Influenza - 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 78.00 78.00 78.00 78.00 78.00 90738 Japanese Encephalitis (new formulation) 357.00 357.00 357.00 357.00 357.00 90696N Kinrix - (DTaP/IPV)/Quadracel - State supplied 0.00 0.00 0.00 0.00 0.00 90696 Kinrix - (DTaP/IPV)/Quadracel 70.00 70.00 70.00 70.00 70.00 90734N MCV4 - State supplied 0.00 0.00 0.00 0.00 0.00 90734 MCV4 189.00 189.00 189.00 189.00 189.00 90620 MenB 176.00 176.00 176.00 176.00 176.00 90733 MPSV4 (Menomune)(polysaccharide) 189.00 189.00 189.00 189.00 189.00 90707N MMR - State supplied 0.00 0.00 0.00 0.00 0.00 90707 MMR 79.00 79.00 79.00 79.00 79.00 90723N Pediarix (DTAP, IPV, Hep B) - State supplied 0.00 0.00 0.00 0.00 0.00 90723 Pediarix - (DTaP/IPV/Hep B) 97.00 97.00 97.00 97.00 97.00 90698N Pentacel - (DTaP/IPV/HepB) - State supplied 0.00 0.00 0.00 0.00 0.00 90698 Pentacel - (DTaP/IPV/HepB) 144.00 144.00 144.00 144.00 144.00 90732N Pneumovax - State supplied 0.00 0.00 0.00 0.00 0.00 90732 Pneumovax 104.00 104.00 104.00 104.00 104.00 90710N Proquad - MMR-Varicella 0.00 0.00 0.00 0.00 0.00 90710 Proquad - MMR-Varicella 225.00 225.00 225.00 225.00 225.00 90670N Prevnar - (PCV13) - State supplied 0.00 0.00 0.00 0.00 0.00 90670 Prevnar - (PCV13) 211.00 211.00 211.00 211.00 211.00 90675 Rabies IM 310.00 310.00 310.00 310.00 310.00 90675N Rabies IM - State supplied 0.00 0.00 0.00 0.00 0.00 90375 RIG (rabies) - per cc 398.00 398.00 398.00 398.00 398.00 90680N Rotavirus - State supplied 0.00 0.00 0.00 0.00 0.00 90680 Rotavirus - (RV5) 109.00 109.00 109.00 109.00 109.00 2021 PUBLIC HEALTH CLINICAL SERVICES FEE SCHEDULE Code Services HOUSEHOLD CODE SIZE Code Code Code Code Code 1 2 3 4 5 90750 Shingrix 158.00 158.00 158.00 158.00 158.00 90714N Td - State supplied 0.00 0.00 0.00 0.00 0.00 90714 Td - 65.00 65.00 65.00 65.00 65.00 90715N Tdap - State supplied 0.00 0.00 0.00 0.00 0.00 90715 Tdap - 124.00 124.00 124.00 124.00 124.00 86580 Tuberculosis Interdermal Skin Test (PPD) 54.00 54.00 54.00 54.00 54.00 90636 Twinrix - Hep A & Hep B 137.00 137.00 137.00 137.00 137.00 90691 Typhoid - 1 Shot 88.00 88.00 88.00 88.00 88.00 90690 Typhoid - Oral 77.00 77.00 77.00 77.00 77.00 90716N Varivax - State supplied 0.00 0.00 0.00 0.00 0.00 90716 Varivax 137.00 137.00 137.00 137.00 137.00 90717 Yellow Fever 175.00 175.00 175.00 175.00 175.00 * Fees only slide for the Family Planning Program. Charges for all other programs are the Code 5 fee. ** Services include surgical procedure only. *** These items are for referral 12/1/2020 revised Hello