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Home My WebLink About20194942.tiffRESOLUTION RE: APPROVE REVISIONS TO FEE SCHEDULE FOR FEES COLLECTED BY THE WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, 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, 2020, 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, 2020. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 9th day of December, A.D., 2019. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COL DO ATTEST: dog") fA «l'.,.lo+�,� Weld County Clerk to the Board BY: eputy Clerk to the Board APPROVED A County Attorney Date of signature: J271c(71°I EXCUSED a arbara Kirkmeyer, Chair Mike Freeman, Pro-Tem Conway Steve Moreno ac: (Owl3o), O 1 /23 /2.o 2019-4942 HL0003 Memorandum TO: Barbara Kirkmeyer, Chair Board of County Commissioners FROM: Mark E. Wallace, MD, MPH Executive Director Department of Public Health & Environment DATE: December 3, 2019 SUBJECT: Health Department 2020 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 2020. Both a strike - through version and the final versions of each are attached to aid in the Board's review. ENVIRONMENTAL HEALTH SERVICES: Few changes have been made to the 2020 proposed EHS fee schedule because a thorough review of the 2019 fee schedule was completed last year and many adjustments were made at that time. For 2020, the fees for eight medical tests the county lab performs have been increased by 6% to account for the projected 2020 medical rate of inflation. We have also added a section to the fee schedule for the analyses we offer related to the oil and gas industry. Not all of these are new tests but have been listed together under one section for consumer ease. The 2020 Household Hazardous Waste (HHW) fee schedule has been updated substantially to reflect price increases of 2%-3% from our current vendor who provides our final waste disposal services. The HHW fee schedule has also been cleaned -up by removing services and waste types that staff either cannot do, should not do, or waste that should not be accepted. This year "market price" was also added to several items since it is difficult to determine price without knowing the exact makeup of the material. These changes to the HHW fee schedule keep the VSQG program in line with price increases over the past year along with cleaning up the list to remove outdated services and waste streams. 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 6% across-the-board, which is consistent with the 2020 medical inflation cost trend projected in 2020. This fee increase is 3% higher than previous years' increase requests that were based solely on 3% projected COLA increases. In some instances, fees were increased by greater than 6% due to the cost to acquire certain supplies, such as vaccine, due to price fluctuations as demand varies. In addition, the fee schedule 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 2019-4942 9 (—ILOOO3 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 agenda via pass -around dated November 27, 2019. I recommend approval of the 2020 PHCS and EHS fee schedule increases. WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT ENVIRONMENTAL HEALTH SERVICES - PROPOSED 2020 FEE SCHEDULE PROPOSED CHANGES FOR 2020 IN RED 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)(IIl)) 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 of Property Actual Cost Based Upon Hourly Rate) 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 $350.00 $75.00 Application fee of $100 plus $55.00/hour $55.00/hour $350.00 $350.00 $12.00 $50.00 $100.00 $150.00 $200.00 $125.00 $100.00 $55.00/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 $55.00/hour $50.00 $189.00 Application fee of $100 plus $55.00/hour (not to exceed $580) $55.00/hour (not to exceed $500) $100.00 $400.00 $55.00/hour $55.00/hour $20.00/pp $10.00/pp $50.00 $500.00 $250.00 $50.00/company $ 100.00/ambulance $55.00/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 $5.00+ $25.00 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT ENVIRONMENTAL HEALTH SERVICES - PROPOSED 2020 FEE SCHEDULE PROPOSED CHANGES FOR 2020 IN RED 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) 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 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 $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 $101.40 $26.00 $12.00 $25.00 $99.00 $47.00 $78.00 $48.00 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 $60.00 $20.00 $20.00 $19.00 $16.00 $25.00 $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 $110.24 $27.56 $12.72 $26.50 $104.94 $49.82 $82.68 $50.88 Market Rate 6% increase (inflation) WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT ENVIRONMENTAL HEALTH SERVICES - PROPOSED 2020 FEE SCHEDULE PROPOSED CHANGES FOR 2020 IN RED 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 5241) 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 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. $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 $19.00 $19.00 $19.00 $32.50 on new instrumentation $16.00 $16.00 $16.50 $16.00 $80.00 $80.00 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT ENVIRONMENTAL HEALTH SERVICES - 2020 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 of Property 4Actual Cost Based Upon Hourly Rate) 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 $55.00/hour $55.00/hour $350.00 $350.00 $12.00 $50.00 $100.00 $150.00 $200.00 $125.00 $100.00 $55.00/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 $55.00/hour $50.00 $189.00 Application fee of $100 plus $55.00/hour (not to exceed $580) $55.00/hour (not to exceed $500) $100.00 $400.00 $55.00/hour $55.00/hour $20.00/pp $10.00/pp $50.00 $500.00 $250.00 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT ENVIRONMENTAL HEALTH SERVICES - 2020 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 1618/45 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 $55.00/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 $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 $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 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT ENVIRONMENTAL HEALTH SERVICES - 2020 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 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 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 $16.00 Market Rate $21.50 $20.00 $100.00 Market Rate $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 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT ENVIRONMENTAL HEALTH SERVICES - 2020 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. $90.00 $100.00 $19.00 $20.00 $20.50 $80.00 $19.00 $20.00 $20.00 $20.00 $20.00 $20.50 $19.00 $19.00 $19.00 $32.50 $16.00 $16.00 $16.50 $16.00 $80.00 $80.00 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT 2020 Proposed HHW Facility - VSQG Fees Waste Type Cost per container Cost per pound Acid gallon $9.80 $10.60 $1.30 5 gallon $52.00 $53.00 55 gallon* $311.85 $200.00 $1.35 55 bulk $376.20 gallon, Aerosol (paint, pesticide) $1.20 Antifreeze $0.60/ gallon Base gallon $9.30 $10.60 5 gallon $52.00 $53.00 55 gallon* $311.85. $200.00 $1.30 $1.35 55 bulk $376.20 gallon, Battery (excluding alkaline) $0.25 Battery (alkaline) $1.20 Compressed Gas Cylinders (small) tank $3.10 $4.43 Compressed Gas Cylinders (large) tank $19.30 Market Price Cyanide Compounds $12.05 quart gallon $18.20 5 gallon $241.00 $75.00 Drum Handling Fee d $15.00 Flammable Liquid (bulkable) or Cooking Oil 55 drum $119.60 $0.35 gallon Flammable Liquid quart $0.55 $2.65 $1.35 gallon $2.30 $10.60 $1.20 if < quart or loose pack 5 gallon $16.20 $53.00 Fluorescent Bulbs, Mercury Containg Bulbs (small), CFL's, Fluorescent Tubes linear foot $0.15 $0.64 fluorescent Bulbs, Compact (small) small bulb $0.25 Fluorescent (large), Mercury Containing Bulbs (large), or Sodium Bulbs Bulb $1.35 $2.68 Filter, oil $0.15 $0.10 Grease gallon $117.55 Market Price Mercury thermometer $0.75 $0.50 $1.30 Motor Oil (used) gallon $0.25 $0.60 Motor Oil Testing $20.00 if to determine needed quality of oil. Oily Waste Water gallon $0.80 Oxidizer gallon $9.80 $10.60 $1.30 $1.35 5 gallon $52.00 $53.00 55 gallon* $311.85 $200.00 Paint (Latex & Oil Based) quart no fee** no fee** no fee** gallon 5 gallon PCB Ballast (and non PCB) $0.75 Peroxide Formers gallon $30.60 Market Price 5 gallon $162.50 Market Price 55 $974.90 gallon Pesticide/Poison Liquid gallon $9.80 $10.60 $1.30 $1.35 5 gallon $52.00 $53.00 55 gallon* $311.85 $200.00 55 bulk $498.50 gallon Pesticide, dry $1.05 $1.00 Water Reactive, Shock Sensitive $12.05 $3.10/if quart gallon $48.20 pound < quart 5 $211.00 gallon Miscellaneous Items To be determined, subject to market rate. *If the number of individual containers of this waste type fills a 55 gallon drum, this will be the charge. **Latex and oil based paint are not charged due to contract with PaintCare. If the number of individual containers fills more than a 55 gallon drum. We do not take 55 gallon drums. If the number of individual containers fills a 55 gallon drum. We do not take 55 gallon drums. Depends on type of gas; would refer to current contractor price. We rarely if ever receive this waste type, but pricing has been updated based on current contractor cost. We do not take drums. We do not take 55 gallon drums. better way to charge (lbs. vs ft.) added to line above better way to charge (lbs. vs number of) Would refer to current contractor price. We have never done this; this is up to business to determine. If the number of individual containers fills a 55 gallon drum. Not something we typically receive so we don't have a contracted price for; would have to check with contractor first. We do not take 55 gallon drums. If the number of individual containers fills a 55 gallon drum. We do not take 55 gallon drums. We do not take these items; too hazardous for us to handle. WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT 2020 HHW Facility - VSQG Fees Waste Type Cost per container Cost per pound Acid gallon $10.60 $1.35 5 gallon $53.00 55 gallon* $200.00 Aerosol (paint, pesticide) $1.20 Antifreeze $0.60/ gallon Base gallon $10.60 $1.35 5 gallon $53.00 55 gallon* $200.00 Battery (excluding alkaline) $0.25 Battery (alkaline) $1.20 Compressed Gas Cylinders (small) tank $4.43 Compressed Gas Cylinders (large) tank Market Price Cyanide Compounds 5 gallon $75.00 Flammable Liquid (bulkable) or Cooking Oil $0.35 Flammable Liquid quart $2.65 $1.35 if < quart or loose -pack gallon $10.60 5 gallon $53.00 Mercury Containg Bulbs (small), CFL's, Fluorescent Tubes $0.64 )rescent (large), Mercury Containing Bulbs (large), or Sodium Bulbs $2.68 Filter, oil $0.10 Grease gallon Market Price Mercury thermometer $0.75 $1.30 Motor Oil (used) gallon $0.60 Oily Waste Water gallon $0.80 Oxidizer gallon $10.60 $1.35 5 gallon $53.00 55 gallon* $200.00 Paint (Latex & Oil Based) quart no fee** no fee** no fee** gallon 5 gallon PCB Ballast (and non PCB) $0.75 Peroxide Formers gallon Market Price 5 gallon Market Price Pesticide/Poison Liquid gallon $10.60 $1.35 5 gallon $53.00 55 gallon* $200.00 Pesticide, dry $1.00 Miscellaneous Items To be determined, sub'ect to market rate. *If the number of individual containers of this waste type fills a 55 gallon drum, this will be the charge. **Latex and oil based paint are not charged due to contract with PaintCare. Code 99201 99202 99203 99204 99211 99212 99213 99214 99341 99342 99347 99348 99401 99402 99403 99404 99401W 99412 99384 99385 99386 99394 99395 99396 Procedure Minimal* Expanded* Detailed* Comprehensive* Established Client Minimal* Focused* Expanded* Detailed* Home Visits New Client - Focused New Client - Expanded Est. Client - Focused Est. Client - Expanded Code 1 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 101.00 101.00 100.00 105.00 Preventive Medicine Counseling (Family Planning) Individual - 15 min* Individual - 30 min* Individual - 45 min* 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 0071W Community Education 1 hr. 0069W Travax Printout/Medical Records G9006 NHV Mother - Task Care Management T1017 NHV Child - Task Care Management STI Exam pre -pay -NP Wellness Package 99499 TB Consultation 56420 11100 57500 0116W 57452 57454 57511 17000 17003 17004 56501 57170 58100 58110 11400 11981 10060 58300 57460 57461 88305 88305W 59025 0.00 0.00 0.00 136.00 63.00 63.00 0.00 0.00 0.00 0.00 0.00 0.00 81.00 16.00 16.00 16.00 211.00 53.00 49.00 2020 PROPOSED Fees HOUSEHOLD CODE SIZE Code 2 13.75 32.00 41.50 62.00 12.25 20.75 27.00 42.75 101.00 101.00 100.00 105.00 13.00 18.75 26.25 136.00 63.00 63.00 41.50 41.50 45.00 35.00 35.75 38.00 81.00 16.00 16.00 16.00 211.00 53.00 49.00 Code 3 27.50 64.00 83.00 124.00 24.50 41.50 54.00 85.50 101.00 101.00 100.00 105.00 26.00 37.50 52.50 136.00 63.00 63.00 83.00 83.00 90.00 70.00 71.50 76.00 81.00 16.00 16.00 16.00 211.00 53.00 49.00 Code 4 41.25 96.00 124.50 186.00 36.75 62.25 81.00 128.25 101.00 101.00 100.00 105.00 39.00 56.25 78.75 136.00 63.00 63.00 124.50 124.50 135.00 105.00 107.25 114.00 81.00 16.00 16.00 16.00 211.00 53.00 49.00 2020 PROPOSED Increased Different Code CURRENT by: than 6% 5 6.0% 55.00 52.00 55.00 128.00 121.00 128.00 166.00 157.00 166.00 248.00 234.00 248.00 49.00 83.00 108.00 171.00 101.00 101.00 100.00 105.00 52.00 75.00 105.00 136.00 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 53.00 49.00 PROCEDURES Bartholin Cyst 153.00 153.00 153.00 153.00 153.00 Biopsy of skin, single 129.00 129.00 129.00 129.00 129.00 Cervical Lesion Biopsy 160.00 160.00 160.00 160.00 160.00 Chest X -Ray (Prepay) 73.00 73.00 73.00 73.00 73.00 Colposcopy without Biopsy ** 138.00 138.00 138.00 138.00 138.00 Colposcopy with Biopsy** 192.00 192.00 192.00 192.00 192.00 Cryocautery cervix- initial or repeat 182.00 182.00 182.00 182.00 182.00 Cryotherapy first lesion** 84.00 84.00 84.00 84.00 84.00 Cryotherapy 2-14 lesions** 7.00 7.00 7.00 7.00 7.00 Cryotherapy 15 + lesions** 189.00 189.00 189.00 189.00 189.00 Destruction Lesion Vulva 164.00 164.00 164.00 164.00 164.00 Diaphragm/Cervical Cap Fitting* 0.00 26.00 52.00 78.00 104.00 Endometrial biopsy w/wo Biopsy 138.00 138.00 138.00 138.00 138.00 Endometrial biopsy with Colposcopy 74.00 74.00 74.00 74.00 74.00 Essure by referral*** 0.00 0.00 0.00 0.00 0.00 Excisions, benign lesion 155.00 155.00 155.00 155.00 155.00 Implanon Insertion* 0.00 53.50 107.00 160.50 214.00 incision at drainage of abcess, single or simple 147.00 147.00 147.00 147.00 147.00 Insertion IUD* 0.00 53.75 107.50 161.25 215.00 LEEP with biopsy 354.00 354.00 354.00 354.00 354.00 LEEP with conization 402.00 402.00 402.00 402.00 402.00 Level 4 - Surgical pathology 1st site 118.00 118.00 118.00 118.00 118.00 Level 4 - Surgical Pathology 2nd site & each a 118.00 118.00 118.00 118.00 118.00 Non Stress Test Interp 0.00 0.00 0.00 0.00 0.00 46.00 78.00 102.00 161.00 95.00 95.00 94.00 99.00 49.00 71.00 99.00 128.00 59.00 59.00 157.00 157.00 170.00 132.00 135.00 143.00 76.00 15.00 15.00 15.00 i 99.00 50.00 46.00 49.00 83.00 108.00 171.00 101.00 101.00 100.00 105.00 52.00 75.00 105.00 136.00 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 53.00 49.00 144.00 153.00 122.00 129.00 151.00 160.00 69.00 73.00 130.00 138.00 181.00 192.00 172.00 182.00 79.00 84.00 7.00 7.00 178.00 189.00 155.00 164.00 98.00 104.00 130.00 138.00 70.00 74.00 0.00 0.00 146.00 155.00 202.00 214.00 139.00 147.00 203.00 215.00 334.00 354.00 379.00 402.00 111.00 118.00 111.00 118.00 0.00 0.00 Code 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 82627 Procedure 2020 PROPOSED Fees Code 1 HOUSEHOLD CODE SIZE Code 2 Code 3 Code 4 201 2020 PROPOSED Increased Different Code CURRENT by: than 6% 5 Removal, implant contraceptive (Implanon)* Removal implant, with reinsertion* Removal IUD* Surgical Tray Shaving of epidermal lesion, single on trunk, arms or legs, .5cm Ultrasound - pelvic non -obstetric FAMILY PLANNING SUPPLIES 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* Today's Sponge* LAB 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 DHEAS 0.00 0.00 0.00 77.00 121.00 83.00 63.50 97.50 43.25 77.00 121.00 83.00 127.00 195.00 86.50 77.00 121.00 83.00 190.50 292.50 129.75 77.00 121.00 83.00 254.00 390.00 173.00 77.00 121.00 83.00 0.00 1.75 3.50 5.25 7.00 0.00 4.00 8.00 12.00 16.00 0.00 9.00 18.00 27.00 36.00 0.00 3.25 6.50 9.75 13.00 0.00 229.75 459.50 689.25 919.00 0.00 229.75 459.50 689.25 919.00 0.00 263.75 527.50 791.25 1055.00 0.00 224.00 448.00 672.00 896.00 0.00 244.50 489.00 733.50 978.00 0.00 179.50 359.00 538.50 718.00 0.00 157.00 314.00 471.00 628.00 0.00 20.00 40.00 60.00 80.00 0.00 8.00 16.00 24.00 32.00 0.00 11.75 23.50 35.25 47.00 0.00 9.50 19.00 28.50 38.00 0.00 20.00 40.00 60.00 80.00 0.00 1.25 2.50 3.75 5.00 0.00 0.00 7.00 18.00 25.00 22.00 0.00 55.00 15.00 17.00 34.00 1.25 6.00 7.00 18.00 25.00 22.00 13.75 55.00 15.00 17.00 34.00 2.50 12.00 7.00 18.00 25.00 22.00 27.50 55.00 15.00 17.00 34.00 3.75 18.00 7.00 18.00 25.00 22.00 41.25 55.00 15.00 17.00 34.00 5.00 24.00 7.00 18.00 25.00 22.00 55.00 55.00 15.00 17.00 34.00 82670 Estradiol 40.00 40.00 40.00 40.00 40.00 83001 FSH 87591 Gonorrhea PCR* 87591 NS Gonorrhea PCR*- full fee 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 86705 Hep B core AB=Hep b core antibody igm 86317 87340 Hep B surface AG* 80074 Hepatitis Panel (ABC) 86803 Hepatitis C Antibody 87522 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) 86703 HIV Scroen, ELISA 87389 HIV - 1 antigen wl HIV -1 & HIV -2 87806 HIV antigen w/I iv antiboci, 87536 HIV -1 quay i-ve G0435 HIV Screen, Rapid Test Hep B Surface Antibody -Qualitative Hep B surface AB -Quantitative Hepatitis C PCR 41.00 0.00 55.00 8.00 30.00 32.00 48.00 48.00 36.00 17.00 16.00 29.00 28.00 22.00 21.00 67.00 20.00 129.00 83.00 83.00 83.00 0.00 39.00 13.00 14.00 29.00 29.00 27.00 117.00 29.00 41.00 13.75 55.00 8.00 30.00 32.00 48.00 48.00 36.00 17.00 16.00 29.00 28.00 22.00 21.00 67.00 20.00 129.00 83.00 83.00 83.00 3.75 39.00 13.00 14.00 29.00 29.00 27.00 117.00 29.00 41.00 27.50 55.00 8.00 30.00 32.00 48.00 48.00 36.00 17.00 16.00 29.00 28.00 22.00 21.00 67.00 20.00 129.00 83.00 83.00 83.00 7.50 39.00 13.00 14.00 29.00 29.00 27.00 117.00 29.00 41.00 41.25 55.00 8.00 30.00 32.00 48.00 48.00 36.00 17.00 16.00 29.00 28.00 22.00 21.00 67.00 20.00 129.00 83.00 83.00 83.00 11.25 39.00 13.00 14.00 29.00 29.00 27.00 117.00 29.00 41.00 55.00 55.00 8.00 30.00 32.00 48.00 48.00 36.00 17.00 16.00 29.00 28.00 22.00 21.00 67.00 20.00 129.00 83.00 83.00 83.00 15.00 39.00 13.00 14.00 29.00 29.00 27.00 1-1?00 29.00 240.00 368.00 163.00 73.00 114.00 78.00 6.0% 254.00 390.00 173.00 77.00 121.00 83.00 7.00 7.00 15.00 16.00 34.00 36.00 12.00 13.00 867.00 919.00 867.00 919.00 995.00 1055.00 845.00 896.00 923.00 978.00 677.00 718.00 592.00 628.00 75.00 80.00 30.00 32.00 44.00 47.00 36.00 38.00 75.00 80.00 5.00 5.00 5,00 23.00 7.00 17.00 24.00 21.00 52.00 52.00 14.00 16.00 32.00 38.00 39.00 52.00 52.00 8.00 28.00 30.00 45.00 45.00 34.00 16.00 15.00 27.00 26.00 21.00 20.00 63.00 19.00 56.00 78.00 78.00 78.00 14.00 37.00 12.00 13.00 27,00 27.00 25.00 110.00 27.00 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 55.00 8.00 30.00 32.00 48.00 48.00 36.00 17.00 16.00 29.00 28.00 22.00 21.00 67.00 20.00 59.00 129.00 83.00 83.00 83.00 15.00 39.00 13.00 14.00 29.00 29.00 27.00 117.00 29.00 Code Procedure 2020 PROPOSED Fees HOUSEHOLD CODE SIZE 2019 2020 PROPOSED Increased Different Code Code Code Code Code CURRENT by: than 6% 1 2 3 4 5 �yZ,F 60% 87624 HPV, High Risk 83.00 83.00 83.00 83.00 83.00 78.00 83.00 87625 HPV typing 16,18,45 51.00 51.00 51.00 51.00 51.00 48.00 51.00 0081W HPV, High Risk w/ repeat pap (LabCorp use) 133.00 133.00 133.00 133.00 133.00 125.00 133.00 484006W Immunohistochemical Stain 119.00 119.00 119.00 119.00 119.00 112.00 119.00 87254 Influenza - Viral Culture 50.00 50.00 50.00 50.00 50.00 47.00 50.00 83525 Insulin, Fasting 16.00 16.00 16.00 16.00 16.00 15.00 16.00 83002 LH 41.00 41.00 41.00 41.00 41.00 39.00 41.00 80061W Lipid Panel SFS* 0.00 10.75 21.50 32.25 43.00 41.00 43.00 80061N Lipid Panel 43.00 43.00 43.00 43.00 43.00 41.00 43.00 80076 Liver Panel 35.00 35.00 35.00 35.00 35.00 33.00 35.00 86790 MAC Elisa 144.00 144.00 144.00 144.00 144.00 136.00 144.00 80048 Metabolic Panel 36.00 36.00 36.00 36.00 36.00 34.00 36.00 86376 Microsomal antibodies 20.00 20.00 20.00 20.00 20.00 19.00 20.00 82274 Occult Blood Test, Fecal, IA* 34.00 34.00 34.00 34.00 34.00 32.00 34.00 88142 Pap - Thin Prep* 0.00 12.50 25.00 37.50 50.00 47.00 50.00 0080W Pap, repeat thin prep 50.00 50.00 50.00 50.00 50.00 47.00 50.00 88175 Pap, Thin prep, w HR HPV, Reflex 16,18.45 50.00 50.00 50.00 50.00 50.00 127.00 135.00 50.00 88141 Physician Read Pap 40.00 40.00 40.00 40.00 40.00 38.00 40.00 84144 Progesterone Level 22.00 22.00 22.00 22.00 22.00 21.00 22.00 84146 Prolactin 43.00 43.00 43.00 43.00 43.00 41.00 43.00 84482 Reverse T3 22.00 22.00 22.00 22.00 22.00 21.00 22.00 86901 RH blood type 0.00 1.75 3.50 5.25 7.00 7.00 7.00 87535 RNA Qaulitative 51.00 51.00 51.00 51.00 51.00 48.00 51.00 86592 RPR/Syphillis test 28.00 28.00 28.00 28.00 28.00 26.00 28.00 86593 RPR/Syphillis (Quant) 13.00 13.00 13.00 13.00 13.00 12.00 13.00 87798 Pertussis B - PCR comp - serum and urine 749.00 749.00 749.00 749.00 749.00 707.00 749.00 87081 Streptococcus - Hemolytic 15.00 15.00 15.00 15.00 15.00 9.00 15.00 84480 T3 Triiodothyronine 53.00 53.00 53.00 53.00 53.00 50.00 53.00 84481 TT -3 (Free -Unbound) 53.00 53.00 53.00 53.00 53.00 50.00 53.00 84436 T4 Thyroxine 10.00 10.00 10.00 10.00 10.00 9.00 10.00 84439 T4 (Total Free -Unbound) 12.00 12.00 12.00 12.00 12.00 11.00 12.00 84403 Testosterone, Total 39.00 39.00 39.00 39.00 39.00 37.00 39.00 86800 Thyroglobulin Ab 22.00 22.00 22.00 22.00 22.00 21.00 22.00 82465 Total Cholesterol 27.00 27.00 27.00 27.00 27.00 25.00 27.00 87661 Trichomonas vaginalis - amplified 50.00 50.00 50.00 50.00 50.00 47.00 50.00 86780 Treponema pallidum 16.00 16.00 16.00 16.00 16.00 15.00 16.00 84443 TSH 39.00 39.00 39.00 39.00 39.00 37.00 39.00 86480 Tuberculosis Test-Quantiferon (IGRA) 105.00 105.00 105.00 105.00 105.00 99.00 105.00 81001 Urinalysis, complete with micro ex 7.00 7.00 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 10.00 11.00 87086 Urine Culture, Comprehensive 12.00 12.00 12.00 12.00 12.00 11.00 12.00 81025 Urine Preganancy Test* 0.00 4.00 8.00 12.00 16.00 15.00 16.00 36415 Venipuncture 8.00 8.00 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 8.00 8.00 36416 Venipuncture - capillary blood specimen 8.00 8.00 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 8.00 8.00 96372 Admin fee for Depo and antibiotics 0.00 8.00 16.00 24.00 32.00 30.00 32.00 87210 Wet Prep 29.00 29.00 29.00 29.00 29.00 27.00 29.00 MEDICINES and TREATMENTS 0020W Amoxicillin 875 mg #20 Q0144 Azythromycin, Z pack 101456W Azithromycin 1g - partner pack 0456W Azithromycin State supplied J0696 Ceftriaxone 250 mg 0696W Ceftriaxone 250 mg State Supplied 0007W Cephalexin 500 mg #14 0058W Ciprofloxcin 500 mg #6 0035W Condylox J8499 Doxycycline 100 mg #14 0059W Estradiol 1 mg- #100 0011W Fluconazole 150 mg #1 0012W Iron J0561 LA Bicillin 2.4 Units -State Supplied 0060W Medroxyprogesterone 10 mg - #5 0008W Metrogel 0009W Metronidazole 500 mg #4 0010W Metronidazole 500 mg #14 0013W Metronidazole 250 mg #28 0006W Misoprostel (Cytotec) 200 mcg #2 17.00 17.00 17.00 17.00 17.00 17.00 17.00 17.00 17.00 17.00 12.00 12.00 12.00 12.00 12.00 0.00 0.00 0.00 0.00 0.00 37.00 37.00 37.00 37.00 37.00 0.00 0.00 0.00 0.00 0.00 11.00 11.00 11.00 11.00 11.00 17.00 17.00 17.00 17.00 17.00 11.00 11.00 11.00 11.00 11.00 12.00 12.00 12.00 12.00 12.00 17.00 17.00 17.00 17.00 17.00 25.00 25.00 25.00 25.00 25.00 13.00 13.00 13.00 13.00 13.00 5.00 5.00 5.00 5.00 5.00 17.00 17.00 17.00 17.00 17.00 11.00 11.00 11.00 11.00 11.00 11.00 11.00 11.00 11.00 11.00 16.00 16.00 16.00 16.00 16.00 16.00 16.00 16.00 16.00 16.00 11.00 11.00 11.00 11.00 11.00 16.00 16.00 11.00 0.00 35.00 0.00 10.00 16.00 10.00 11.00 16.00 24.00 12.00 5.00 16.00 10.00 10.00 15.00 15.00 10.00 17.00 17.00 12.00 0.00 37.00 0.00 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 Code Procedure 2020 PROPOSED Fees HOUSEHO CODE SIRE 2019 2020 PROPOSED Increased Code Code Code Code Code CURRENT by: 1 2 3 4 0016W Podophyllin/TCA 0004W Sulfatrim SMX/TMP J8499 Suprax 400 mg #1 - partner pak 00180NC Suprax 400 mg #1 - State Supplied 17.00 11.00 32.00 0.00 17.00 11.00 32.00 0.00 17.00 11.00 32.00 0.00 17.00 11.00 32.00 0.00 17.00 11.00 32.00 0.00 16.00 10.00 30.00 0.00 EIMUNiZATlONS 90471 Imm. Admin - one vaccine 32.00 32.00 32.00 32.00 32.00 30.00 90472 Imm Admin - each addl. Vaccine 32.00 32.00 32.00 32.00 32.00 30.00 90473 Imm Admin - intranasal or oral 32.00 32.00 32.00 32.00 32.00 30.00 90700N DTaP -State supplied 0.00 0.00 0.00 0.00 0.00 0.00 90700 DTaP 35.00 35.00 35.00 35.00 35.00 33.00 90702N DT - State supplied 0.00 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 0.00 90633 Hepatitis A - Child 37.00 37.00 37.00 37.00 37.00 35.00 90632N Hepatitis A - Adult - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 90632 Hepatitis A - Adult 99.00 99.00 99.00 99.00 99.00 93.00 90744N Hepatitis B - Child - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 90744 Hepatitis B - Child 32.00 32.00 32.00 32.00 32.00 30.00 90746N Hepatitis B - Adult - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 90746 Hepatitis B - Adult 90.00 90.00 90.00 90.00 90.00 85.00 90739 Heplisav-B 119.00 119.00 119.00 119.00 119.00 112.00 90647N HIB - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 90647 HIB 41.00 41.00 41.00 41.00 41.00 39.00 90651N HPV 9 - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 90651 HPV 9 218.00 218.00 218.00 218.00 218.00 205.00 90281 IG Hepatitis A - State supplied 0.00 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 0.00 90660 Influenza - Intranasal Adult 39.00 39.00 39.00 39.00 39.00 37.00 90687 Influenza - infant quadrivalent 39.00 39.00 39.00 39.00 39.00 37.00 90687N Influenza - infant quadrivalent - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 90688 Influenza - 3 yrs and up - quadrivalent 39.00 39.00 39.00 39.00 39.00 37.00 90688N Influenza - 3 yrs and up - State supplied quadt 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 90713 IPV 76.00 76.00 76.00 76.00 76.00 72.00 90738 Japanese Encephalitis (new formulation) 348.00 348.00 348.00 348.00 348.00 328.00 90696N Kinrix - (DTaP/IPV)/Quadracel - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 90696 Kinrix - (DTaP/IPV)/Quadracel 68.00 68.00 68.00 68.00 68.00 64.00 90734N MCV4 - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 90734 MCV4 184.00 184.00 184.00 184.00 184.00 174.00 90620 MenB 195.00 195.00 195.00 195.00 195.00 166.00 90733 MPSV4 (Menomune)(polysaccharide) 184.00 184.00 184.00 184.00 184.00 174.00 90707N MMR - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 90707 MMR 105.00 105.00 105.00 105.00 105.00 73.00 90723N Pediarix (DTAP, IPV, Hep B) - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 90723 Pediarix - (DTaP/IPV/Hep B) 95.00 95.00 95.00 95.00 95.00 90.00 90698N Pentacel - (DTaP/IPV/HepB) - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 90698 Pentacel - (DTaP/IPV/HepB) 140.00 140.00 140.00 140.00 140.00 132.00 90732N Pneumovax - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 90732 Pneumovax 135.00 135.00 135.00 135.00 135.00 95.00 90710N Proquad - MMR-Varicella 0.00 0.00 0.00 0.00 0.00 0.00 90710 Proquad - MMR-Varicella 215.00 215.00 215.00 215.00 215.00 203.00 90670N Prevnar - (PCV13) - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 90670 Prevnar - (PCV13) 247.00 247.00 247.00 247.00 247.00 194.00 90675 Rabies IM 355.00 355.00 355.00 355.00 355.00 285.00 90675N Rabies IM - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 90375 RIG (rabies) - per cc 383.00 383.00 383.00 383.00 383.00 361.00 90680N Rotavirus - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 90680 Rotavirus - (RV5) 106.00 106.00 106.00 106.00 106.00 100.00 90750 Shingrix 154.00 154.00 154.00 154.00 154.00 145,00 90714N Td - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 90714 Td - 63.00 63.00 63.00 63.00 63.00 59.00 90715N Tdap - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 90715 Tdap - 121.00 121.00 121.00 121.00 121.00 114.00 86580 Tuberculosis Interdermal Skin Test (PPD) 53.00 53.00 53.00 53.00 53.00 50.00 90636 Twinrix - Hep A & HepB 134.00 134.00 134.00 134.00 134.00 126,00 90691 Typhoid - 1 Shot 86.00 86.00 86.00 86.00 86.00 81.00 90690 Typhoid - Oral 75.00 75.00 75.00 75.00 75.00 71.00 90716N Varivax - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 90716 Varivax 134.00 134.00 134.00 134.00 134.00 126.00 90717 Yellow Fever 171.00 171.00 171.00 171.00 171.00 161.00 Different than 6% 17.00 11.00 32.00 0.00 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 0.00 217.00 218.00 0.00 0.00 39.00 39.00 0.00 39.00 0.00 0.00 76.00 348.00 0.00 68.00 0.00 184.00 176.00 195.00 184.00 0.00 77.00 105.00 0.00 95.00 0.00 140.00 0.00 101.00 135.00 0.00 215.00 0.00 206.00 302.00 247.00 355.00 0.00 383.00 0.00 106.00 154.00 0.00 63.00 0.00 121.00 53.00 134.00 86.00 75.00 0.00 134.00 171.00 Code INC 99212 59425 59426 99402W 0255W 59430 H1005 H1005 H1005 H1005 Procedure Code 1 2020 PROPOSED Fees HOUSEHOLD CODE SIZE Code 2 Code 3 Code 4 2020 PROPOSED Increased Code CURRENT by: 5 6.0% Miscellaneous Service Includes Follow-up Care Antepartum Care 1 visit Antepartum 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) Non -Sufficient Funds (Bounced Check) Fee * Fees only slide for the Family Planning Program. ** Services include surgical procedure only. *** These items are for referral 11/27/2019 revised 0.00 83.00 739.00 1519.00 72.00 0.00 235.00 215.00 571.00 1073.00 1215.00 25.00 0.00 0.00 0.00 0.00 83.00 83.00 83.00 83.00 739.00 739.00 739.00 739.00 1519.00 1519.00 1519.00 1519.00 72.00 72.00 72.00 72.00 0.00 0.00 0.00 0.00 235.00 235.00 235.00 235.00 215.00 215.00 215.00 215.00 571.00 571.00 571.00 571.00 1073.00 1073.00 1073.00 1073.00 1215.00 1215.00 1215.00 1215.00 25.00 25.00 25.00 25.00 Charges for all other programs are the Code 5 fee. 0.00 78.00 697.00 1433.00 68.00 0.00 222.00 203.00 539.00 1012.00 1146.00 0.00 0.00 83.00 739.00 1519.00 72.00 0.00 235.00 215.00 571.00 1073.00 1215.00 25.00 Different than 6% 2020 PUBLIC HEALTH CLINICAL SERVICES FEE SCHEDULE HOUSEHOLD CODE SIZE Code Procedure Code Code Code Code Code 1 2 3 4 5 99201 Minimal* 99202 Expanded* 99203 Detailed* 99204 Comprehensive* Established Client 99211 Minimal* 99212 Focused* 99213 Expanded* 99214 Detailed* Home Visits 99341 New Client - Focused 99342 New Client - Expanded 99347 Est. Client - Focused 99348 Est. Client - Expanded 0.00 13.75 27.50 41.25 55.00 0.00 32.00 64.00 96.00 128.00 0.00 41.50 83.00 124.50 166.00 0.00 62.00 124.00 186.00 248.00 0.00 12.25 24.50 36.75 49.00 0.00 20.75 41.50 62.25 83.00 0.00 27.00 54.00 81.00 108.00 0.00 42.75 85.50 128.25 171.00 101.00 101.00 101.00 101.00 101.00 101.00 101.00 101.00 101.00 101.00 100.00 100.00 100.00 100.00 100.00 105.00 105.00 105.00 105.00 105.00 Preventive Medicine Counseling (Family Planning) 99401 Individual - 15 min* 99402 Individual - 30 min* 99403 Individual - 45 min* 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 13.00 26.00 39.00 52.00 0.00 18.75 37.50 56.25 75.00 0.00 26.25 52.50 78.75 105.00 136.00 136.00 136.00 136.00 136.00 63.00 63.00 63.00 63.00 63.00 63.00 63.00 63.00 63.00 63.00 0.00 41.50 83.00 124.50 166.00 0.00 41.50 83.00 124.50 166.00 0.00 45.00 90.00 135.00 180.00 0.00 35.00 70.00 105.00 140.00 0.00 35.75 71.50 107.25 143.00 0.00 38.00 76.00 114.00 152.00 Additional Codes 0071W Community Education 1 hr. 81.00 81.00 81.00 81.00 81.00 0069W Travax Printout/Medical Records 16.00 16.00 16.00 16.00 16.00 G9006 NHV Mother - Task Care Management 16.00 16.00 16.00 16.00 16.00 T1017 NHV Child - Task Care Management 16.00 16.00 16.00 16.00 16.00 STI Exam pre -pay -NP 211.00 211.00 211.00 211.00 211.00 Wellness Package 53.00 53.00 53.00 53.00 53.00 99499 TB Consultation 49.00 49.00 49.00 49.00 49.00 PROCEDURES 56420 Bartholin Cyst 11100 Biopsy of skin, single 57500 Cervical Lesion Biopsy 0116W Chest X -Ray (Prepay) 57452 Colposcopy without Biopsy ** 57454 Colposcopy with Biopsy ** 57511 Cryocautery cervix- initial or repeat 153.00 153.00 153.00 153.00 153.00 129.00 129.00 129.00 129.00 129.00 160.00 160.00 160.00 160.00 160.00 73.00 73.00 73.00 73.00 73.00 138.00 138.00 138.00 138.00 138.00 192.00 192.00 192.00 192.00 192.00 182.00 182.00 182.00 182.00 182.00 2020 PUBLIC HEALTH CLINICAL SERVICES FEE SCHEDULE HOUSEHOLD CODE SIZE Code Procedure Code Code Code Code Code 1 2 3 4 5 17000 Cryotherapy first lesion** 84.00 84.00 84.00 84.00 84.00 17003 Cryotherapy 2-14 lesions** 7.00 7.00 7.00 7.00 7.00 17004 Cryotherapy 15 + lesions** 189.00 189.00 189.00 189.00 189.00 56501 Destruction Lesion Vulva 164.00 164.00 164.00 164.00 164.00 57170 Diaphragm/Cervical Cap Fitting* 0.00 26.00 52.00 78.00 104.00 58100 Endometrial biopsy w/wo Biopsy 138.00 138.00 138.00 138.00 138.00 58110 Endometrial biopsy with Colposcopy 74.00 74.00 74.00 74.00 74.00 Essure by referral*** 0.00 0.00 0.00 0.00 0.00 11400 Excisions, benign lesion 155.00 155.00 155.00 155.00 155.00 11981 Implanon Insertion* 0.00 53.50 107.00 160.50 214.00 Incision & drainage of abcess, single or 10060 simple 147.00 147.00 147.00 147.00 147.00 58300 Insertion IUD* 0.00 53.75 107.50 161.25 215.00 57460 LEEP with biopsy 354.00 354.00 354.00 354.00 354.00 57461 LEEP with conization 402.00 402.00 402.00 402.00 402.00 88305 Level 4 - Surgical pathology 1st site 118.00 118.00 118.00 118.00 118.00 88305W Level 4 - Surgical Pathology 2nd site & each a 118.00 118.00 118.00 118.00 118.00 59025 Non Stress Test Intern 0.00 0.00 0.00 0.00 0.00 11976 Removal, implant contraceptive (Implanon)* 0.00 63.50 127.00 190.50 254.00 11983 Removal implant, with reinsertion* 0.00 97.50 195.00 292.50 390.00 58301 Removal IUD* 0.00 43.25 86.50 129.75 173.00 A4550 Surgical Tray 77.00 77.00 77.00 77.00 77.00 Shaving of epidermal lesion, single on trunk, 11300 arms or legs, .5cm 121.00 121.00 121.00 121.00 121.00 76857 Ultrasound - pelvic non -obstetric 83.00 83.00 83.00 83.00 83.00 FAMILY PLANNING SUPPLIES A4267 Condoms pkg 10* 0052W Cycle Beads* A4266 Diaphragm* A4269 Foam Contraception* J7307 Nexplanon (Etonogestrel)* J7306 Levonorgestrel J7298 IUD Mirena* J7300 IUD Paragard* J7301 IUD Skyla* J7297 IUD Liletta J7296 IUD Kyleena J1050 Medroxyprogesterone (Depo)* 96372 Admin fee depo- if visit for injection only J7303 Nuva Ring* S4993 Oral Contraceptives* 0068W Seasonale* 0065W Today's Sponge* LAB 86900 ABO blood typing 82947 Assay, body fluid, glucose, (FBS)* 82565 Assay of creatine 86609 Bacterium antibody 85025 CBC w/Diff 85027 CBC w/o Diff 0.00 1.75 3.50 5.25 7.00 0.00 4.00 8.00 12.00 16.00 0.00 9.00 18.00 27.00 36.00 0.00 3.25 6.50 9.75 13.00 0.00 229.75 459.50 689.25 919.00 0.00 229.75 459.50 689.25 919.00 0.00 263.75 527.50 791.25 1055.00 0.00 224.00 448.00 672.00 896.00 0.00 244.50 489.00 733.50 978.00 0.00 179.50 359.00 538.50 718.00 0.00 157.00 314.00 471.00 628.00 0.00 20.00 40.00 60.00 80.00 0.00 8.00 16.00 24.00 32.00 0.00 11.75 23.50 35.25 47.00 0.00 9.50 19.00 28.50 38.00 0.00 20.00 40.00 60.00 80.00 0.00 1.25 2.50 3.75 5.00 0.00 1.25 2.50 3.75 5.00 0.00 6.00 12.00 18.00 24.00 7.00 7.00 7.00 7.00 7.00 18.00 18.00 18.00 18.00 18.00 25.00 25.00 25.00 25.00 25.00 22.00 22.00 22.00 22.00 22.00 2020 PUBLIC HEALTH CLINICAL SERVICES FEE SCHEDULE HOUSEHOLD CODE SIZE Code Code Code Code Code Code Procedure 1 2 3 4 5 87491 Chlamydia PCR* 0.00 13.75 27.50 41.25 55.00 87491 NS Chlamydia PCR* - full fee 55.00 55.00 55.00 55.00 55.00 80053 Comprehensive Metabolic Panel 15.00 15.00 15.00 15.00 15.00 0090W Court Ordered Lab Draw 17.00 17.00 17.00 17.00 17.00 82627 DHEAS 34.00 34.00 34.00 34.00 34.00 82670 Estradiol 40.00 40.00 40.00 40.00 40.00 83001 FSH 41.00 41.00 41.00 41.00 41.00 87591 Gonorrhea PCR* 0.00 13.75 27.50 41.25 55.00 87591 NS Gonorrhea PCR* - full fee 55.00 55.00 55.00 55.00 55.00 82948 Glucose Random 8.00 8.00 8.00 8.00 8.00 82951 Glucose Tolerance Test 2 hr (GTT) 30.00 30.00 30.00 30.00 30.00 87205 Gram Stain 32.00 32.00 32.00 32.00 32.00 84702 HCG Quantitative - Serum Pregnancy Test 48.00 48.00 48.00 48.00 48.00 84703 HCG Qualitative - Serum Pregnancy Test 48.00 48.00 48.00 48.00 48.00 83718 HDL Cholesterol 36.00 36.00 36.00 36.00 36.00 86708 Hep A antibody 17.00 17.00 17.00 17.00 17.00 86709 Hep A igm antibody 16.00 16.00 16.00 16.00 16.00 86706 Hep B Surface Antibody -Qualitative 29.00 29.00 29.00 29.00 29.00 86705 Hep B core AB=Hep b core antibody igm 28.00 28.00 28.00 28.00 28.00 86317 Hep B surface AB -Quantitative 22.00 22.00 22.00 22.00 22.00 87340 Hep B surface AG* 21.00 21.00 21.00 21.00 21.00 80074 Hepatitis Panel (ABC) 67.00 67.00 67.00 67.00 67.00 86803 Hepatitis C Antibody 20.00 20.00 20.00 20.00 20.00 87522 Hepatitis C PCR 129.00 129.00 129.00 129.00 129.00 87255 Herpes Culture 83.00 83.00 83.00 83.00 83.00 86695 Herpes Select - Type I (89999A33) 83.00 83.00 83.00 83.00 83.00 86696 Herpes Select - Type II (89999A33) 83.00 83.00 83.00 83.00 83.00 85018 HGB - (Finger Stick)* 0.00 3.75 7.50 11.25 15.00 83036 HGB Al c 39.00 39.00 39.00 39.00 39.00 86701 HIV 1/2 AB Diff (this is HIV 1) 13.00 13.00 13.00 13.00 13.00 86702 HIV 1/2 AB Diff (this is HIV 2) 14.00 14.00 14.00 14.00 14.00 86703 HIV Screen, ELISA 29.00 29.00 29.00 29.00 29.00 87389 HIV - 1 antigen w/ HIV -1 & HIV -2 29.00 29.00 29.00 29.00 29.00 87806 HIV antigen w/hiv antibodies 27.00 27.00 27.00 27.00 27.00 87536 HIV 1 quantitative 117.00 117.00 117.00 117.00 117.00 G0435 HIV Screen, Rapid Test 29.00 29.00 29.00 29.00 29.00 87624 HPV, High Risk 83.00 83.00 83.00 83.00 83.00 87625 HPV typing 16,18,45 51.00 51.00 51.00 51.00 51.00 0081W HPV, High Risk w/ repeat pap (LabCorp use) 133.00 133.00 133.00 133.00 133.00 484006W Immunohistochemical Stain 119.00 119.00 119.00 119.00 119.00 87254 Influenza - Viral Culture 50.00 50.00 50.00 50.00 50.00 83525 Insulin, Fasting 16.00 16.00 16.00 16.00 16.00 83002 LH 41.00 41.00 41.00 41.00 41.00 80061W Lipid Panel - SFS* 0.00 10.75 21.50 32.25 43.00 80061N Lipid Panel 43.00 43.00 43.00 43.00 43.00 80076 Liver Panel 35.00 35.00 35.00 35.00 35.00 86790 MAC Elisa 144.00 144.00 144.00 144.00 144.00 80048 Metabolic Panel 36.00 36.00 36.00 36.00 36.00 86376 Microsomal antibodies 20.00 20.00 20.00 20.00 20.00 82274 Occult Blood Test, Fecal, IA* 34.00 34.00 34.00 34.00 34.00 88142 Pap - Thin Prep* 0.00 12.50 25.00 37.50 50.00 0080W Pap, repeat thin prep 50.00 50.00 50.00 50.00 50.00 88175 Pap, Thin prep, w HR HPV, Reflex 16,18.45 50.00 50.00 50.00 50.00 50.00 2020 PUBLIC HEALTH CLINICAL SERVICES FEE SCHEDULE HOUSEHOLD CODE SIZE Code Code Code Code Code Code Procedure 1 2 3 4 5 88141 Physician Read Pap 40.00 40.00 40.00 40.00 40.00 84144 Progesterone Level 22.00 22.00 22.00 22.00 22.00 84146 Prolactin 43.00 43.00 43.00 43.00 43.00 84482 Reverse T3 22.00 22.00 22.00 22.00 22.00 86901 RH blood type 0.00 1.75 3.50 5.25 7.00 87535 RNA Qaulitative 51.00 51.00 51.00 51.00 51.00 86592 RPR/Syphillis test 28.00 28.00 28.00 28.00 28.00 86593 RPR/Syphillis (Quant) 13.00 13.00 13.00 13.00 13.00 87798 Pertussis B - PCR comp - serum and urine 749.00 749.00 749.00 749.00 749.00 87081 Streptococcus - Hemolytic 15.00 15.00 15.00 15.00 15.00 84480 T3 Triiodothyronine 53.00 53.00 53.00 53.00 53.00 84481 TT -3 (Free -Unbound) 53.00 53.00 53.00 53.00 53.00 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 39.00 39.00 39.00 39.00 39.00 86800 Thyroglobulin Ab 22.00 22.00 22.00 22.00 22.00 82465 Total Cholesterol 27.00 27.00 27.00 27.00 27.00 87661 Trichomonas vaginalis - amplified 50.00 50.00 50.00 50.00 50.00 86780 Treponema pallidum 16.00 16.00 16.00 16.00 16.00 84443 TSH 39.00 39.00 39.00 39.00 39.00 86480 Tuberculosis Test-Quantiferon (IGRA) 105.00 105.00 105.00 105.00 105.00 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 8.00 16.00 24.00 32.00 87210 Wet Prep 29.00 29.00 29.00 29.00 29.00 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 12.00 12.00 12.00 12.00 12.00 0456W Azithromycin State supplied 0.00 0.00 0.00 0.00 0.00 J0696 Ceftriaxone 250 mg 37.00 37.00 37.00 37.00 37.00 0696W Ceftriaxone 250 mg State Supplied 0.00 0.00 0.00 0.00 0.00 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 25.00 25.00 25.00 25.00 25.00 0012W Iron 13.00 13.00 13.00 13.00 13.00 J0561 LA Bicillin 2.4 Units -State Supplied 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 11.00 11.00 11.00 11.00 11.00 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 2020 PUBLIC HEALTH CLINICAL SERVICES FEE SCHEDULE HOUSEHOLD CODE SIZE Code Code Code Code Code Code Procedure 1 2 3 4 5 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 J8499 Suprax 400 mg #1 - partner pak 32.00 32.00 32.00 32.00 32.00 00180NC Suprax 400 mg #1 - State Supplied 0.00 0.00 0.00 0.00 0.00 IMMUNIZATIONS 90471 Imm. Admin - one vaccine 32.00 32.00 32.00 32.00 32.00 90472 Imm Admin - each addl. Vaccine 32.00 32.00 32.00 32.00 32.00 90473 Imm Admin - intranasal or oral 32.00 32.00 32.00 32.00 32.00 90700N DTaP -State supplied 0.00 0.00 0.00 0.00 0.00 90700 DTaP 35.00 35.00 35.00 35.00 35.00 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 37.00 37.00 37.00 37.00 37.00 90632N Hepatitis A - Adult - State supplied 0.00 0.00 0.00 0.00 0.00 90632 Hepatitis A - Adult 99.00 99.00 99.00 99.00 99.00 90744N Hepatitis B - Child - State supplied 0.00 0.00 0.00 0.00 0.00 90744 Hepatitis B - Child 32.00 32.00 32.00 32.00 32.00 90746N Hepatitis B - Adult - State supplied 0.00 0.00 0.00 0.00 0.00 90746 Hepatitis B - Adult 90.00 90.00 90.00 90.00 90.00 90739 Heplisav-B 119.00 119.00 119.00 119.00 119.00 90647N HIB - State supplied 0.00 0.00 0.00 0.00 0.00 90647 HIB 41.00 41.00 41.00 41.00 41.00 90651N H PV 9 - State supplied 0.00 0.00 0.00 0.00 0.00 90651 H PV 9 218.00 218.00 218.00 218.00 218.00 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 39.00 39.00 39.00 39.00 39.00 90687 Influenza - infant quadrivalent 39.00 39.00 39.00 39.00 39.00 90687N Influenza - infant quadrivalent - State supplied 0.00 0.00 0.00 0.00 0.00 90688 Influenza - 3 yrs and up - quadrivalent 39.00 39.00 39.00 39.00 39.00 90688N Influenza - 3 yrs and up - State supplied quadi 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 76.00 76.00 76.00 76.00 76.00 90738 Japanese Encephalitis (new formulation) 348.00 348.00 348.00 348.00 348.00 90696N Kinrix - (DTaP/IPV)/Quadracel - State supplied 0.00 0.00 0.00 0.00 0.00 90696 Kinrix - (DTaP/IPV)/Quadracel 68.00 68.00 68.00 68.00 68.00 90734N MCV4 - State supplied 0.00 0.00 0.00 0.00 0.00 90734 MCV4 184.00 184.00 184.00 184.00 184.00 90620 MenB 195.00 195.00 195.00 195.00 195.00 90733 MPSV4 (Menomune)(polysaccharide) 184.00 184.00 184.00 184.00 184.00 90707N MMR - State supplied 0.00 0.00 0.00 0.00 0.00 90707 MMR 105.00 105.00 105.00 105.00 105.00 90723N Pediarix (DTAP, IPV, Hep B) - State supplied 0.00 0.00 0.00 0.00 0.00 90723 Pediarix - (DTaP/IPV/Hep B) 95.00 95.00 95.00 95.00 95.00 90698N Pentacel - (DTaP/IPV/HepB) - State supplied 0.00 0.00 0.00 0.00 0.00 90698 Pentacel - (DTaP/IPV/Hep6) 140.00 140.00 140.00 140.00 140.00 90732N Pneumovax - State supplied 0.00 0.00 0.00 0.00 0.00 90732 Pneumovax 135.00 135.00 135.00 135.00 135.00 90710N Proquad - MMR-Varicella 0.00 0.00 0.00 0.00 0.00 90710 Proquad - MMR-Varicella 215.00 215.00 215.00 215.00 215.00 2020 PUBLIC HEALTH CLINICAL SERVICES FEE SCHEDULE HOUSEHOLD CODE SIZE Code Procedure Code Code Code Code Code 1 2 3 4 5 90670N Prevnar - (PCV13) - State supplied 0.00 0.00 0.00 0.00 0.00 90670 Prevnar - (PCV13) 247.00 247.00 247.00 247.00 247.00 90675 Rabies IM 355.00 355.00 355.00 355.00 355.00 90675N Rabies IM - State supplied 0.00 0.00 0.00 0.00 0.00 90375 RIG (rabies) - per cc 383.00 383.00 383.00 383.00 383.00 90680N Rotavirus - State supplied 0.00 0.00 0.00 0.00 0.00 90680 Rotavirus - (RV5) 106.00 106.00 106.00 106.00 106.00 90750 Shingrix 154.00 154.00 154.00 154.00 154.00 90714N Td - State supplied 0.00 0.00 0.00 0.00 0.00 90714 Td - 63.00 63.00 63.00 63.00 63.00 90715N Tdap - State supplied 0.00 0.00 0.00 0.00 0.00 90715 Tdap - 121.00 121.00 121.00 121.00 121.00 86580 Tuberculosis Interdermal Skin Test (PPD) 53.00 53.00 53.00 53.00 53.00 90636 Twinrix - Hep A & Hep B 134.00 134.00 134.00 134.00 134.00 90691 Typhoid - 1 Shot 86.00 86.00 86.00 86.00 86.00 90690 Typhoid - Oral 75.00 75.00 75.00 75.00 75.00 90716N Varivax - State supplied 0.00 0.00 0.00 0.00 0.00 90716 Varivax 134.00 134.00 134.00 134.00 134.00 90717 Yellow Fever 171.00 171.00 171.00 171.00 171.00 Miscellaneous INC Service Includes Follow-up Care 99212 Antepartum Care 1 visit 59425 Antepartum care 4-6 visits 59426 Antepartum care 7 or more visits 99402W PE Establishing Medical Record 0255W Phone visit 59430 Post Partum Only H1005 Prenatal Plus (1-4 visits) H1005 Prenatal Plus (5-9 visits) H1005 Prenatal Plus (10 visits) H1005 Prenatal Plus (11 or more visits) Non -Sufficient Funds (Bounced Check) Fee 0.00 0.00 0.00 0.00 0.00 83.00 83.00 83.00 83.00 83.00 739.00 739.00 739.00 739.00 739.00 1519.00 1519.00 1519.00 1519.00 1519.00 72.00 72.00 72.00 72.00 72.00 0.00 0.00 0.00 0.00 0.00 235.00 235.00 235.00 235.00 235.00 215.00 215.00 215.00 215.00 215.00 571.00 571.00 571.00 571.00 571.00 1073.00 1073.00 1073.00 1073.00 1073.00 1215.00 1215.00 1215.00 1215.00 1215.00 25.00 25.00 25.00 25.00 25.00 * 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 11/27/2019 revised Hello