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Home My WebLink About20163428.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, 2017, 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, 2017. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 7th day of November, A.D., 2016. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO ATTEST: ddtAgiv jde,Ak, Weld County Clerk to the Board BY: C . ty Clerk to the Board AS y Attorney Date of signature: 1 if (ef (Co Mike Freeman, Chair Sean P. Conway, Pro -Tern ulie, A. Cozad (At? bara Kirkmeyer CG hkLCMW/€T/ TCG) la/Ia/ICo teve Moreno 2016-3428 HL0003 Memorandum TO: FROM: DATE: SUBJECT: Mike Freeman, Chair Board of County Commissioners Mark E. Wallace, MD, MPH Executive Director Department of Public Health & Environment November 3, 2016 Proposed 2017 Fee Schedule Increases For the Board's approval are the Health Department's proposed Environmental Health Services ("EHS") and Public Health Services ("PHS") fees schedules for 2017. Both a strike -through version and the final versions of each are attached to aid in the Board's review. ENVIRONMENTAL HEALTH SERVICES: A detailed review of the EHS fee schedule was made to ensure that costs are adequately recovered across all sections of the EHS division. At the current time only one fee increase is requested because our fees are reasonable and in -line with providers of similar services. A number of fees were eliminated because a service wasn't being utilized or is no longer needed. One lab fee was added to allow for the testing of Trichomonas. As the BOCC may recall, Retail Food Establishment license fees were updated this past September. Additionally, the fee schedule was updated to reflect the nomenclature change for "septic systems" as they are now collectively referred to as Onsite Wastewater Treatment Systems (OWTS). No changes were made to the EHS Household Hazardous Waste fee schedule. PUBLIC HEALTH SERVICES: A detailed review of the PHS fee schedule was made to ensure that costs are adequately recovered across all clinic programs of the PHS division. All fees were reviewed to establish 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. Consistent with prior year fee schedule adjustments, following that comparison and after making increases where appropriate, we increased our fees for all services and supplies by 2.5% across- the-board. Again, this fee increase request is a modest increase compared to the medical rate of inflation which is anticipated to be remain consistent at approximately 6.5% in 2017. Several services were added to the fee schedule to provide more comprehensive care for our clinic patients. These fee schedules were approved for placement on the Board's agenda via pass -around dated October 31, 2016. I recommend approval of these proposed fee schedules for the Health Department. 2016-3428 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT PUBLIC HEALTH SERVICES - 2017 SLIDING FEE SCHEDULE HOUSEHOLD CODE SIZE Code ' Code Code Code Code Code Procedure 1 1 2 3 4 5 99201 Minimal* 0.00 12.25 24.50 36.75 49.00 99202 Expanded* 0.00 28.50 57.00 85.50 114.00 99203 Detailed* 0.00 37.00 74.00 111.00 148.00 99204 Comprehensive* 0.00 55.00 110.00 165.00 220.00 Established Client 99211 Minimal* 0.00 11.00 22.00 33.00 44.00 99212 Focused* 0.00 18.50 37.00 55.50 74.00 99213 Expanded* 0.00 24.00 48.00 72.00 96.00 99214 Detailed* 0.00 37.75 75.50 113.25 151.00 Home Visits 99341 New Client - Focused 89.00 89.00 89.00 89.00 89.00 99342 New Client - Expanded 89.00 89.00 89.00 89.00 89.00 99347 Est. Client - Focused 89.00 89.00 89.00 89.00 89.00 99348 Est. Client - Expanded 93.00 93.00 93.00 93.00 93.00 Preventive Medicine Counseling (Family Planning) 99401 Individual - 15 min* 0.00 11.751 23.50 35.25 47.00 99402 Individual - 30 min* 0.00 16.75 33.50 50.25 67.00 99403 Individual - 45 min* 0.00 23.25 46.5O 69.75 93.00 Travel Visits 99404 Individual Initial Visit - 60 120.00 120.00 120.00 120.00 120.00 99401W Return Visit 55.00 55.00 55.00 55.00 55.00 99412 Group Initial Visit (per person) - 60 55.00 55.00 55.00? 55.00 55.00 Preventive Medicine 99384 New Client 12-17 years old* 0.00 37.00 74.00 111.00 148.00 99385 New Client 18-39 years old* 0.00 37.00 74.00 111.00 148.00 99386 New Client 40-64 years old* 0.00 40.00 80.00 120.00 160.00 99394 Est. Client 12-17 years old* 0.00 31.00 62.00 93.00 124.00 99395 Est. Client 18-39 years old* 0.00 31.75 63.50 95.25 127.00 99396 Est. Client 40-64 years old* 0.00 33.75 67.50 101.25 135.00 Additional Codes 0071W Community Education 1 hr. 72.00 72.00 72.00 72.00 72.00 0069W Travax Printout 15.00 15.00 15.00 15.00 15.00 G9006 NHV Mother - Task Care Management 15.00 15.00 15.00 15.00 15.00 T1017 NHV Child - Task Care Management 15.00 15.00 15.00 15.00 15.00 STI Exam pre -pay -NP 187.00 187.00 187.00 187.00 187.00 Wellness Package 48.00 48.00 48.00 48.00 48.00 99499 TB Consultation 44.00 44.00 44.00 44.00 44.00 PROCEDURES 56420 Bartholin Cyst 136.00 136.00 136.00 136.00 136.00 11100 Biopsy of skin, single 115.00 115.00 115.00 115.00 115.00 57500 Cervical Lesion Biopsy 143.00 143.00 143.00 143.00 143.00 0116W 57452 Chest Colposcopy X -Ray (Prepay) without Biopsy ** 122.00 65.00 65.00 122.00 122.00 65.00 122.00 65.00 122.00 65.00 Revised 10/28/2016 Page 1 of 6 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT PUBLIC HEALTH SERVICES - 2017 SLIDING FEE SCHEDULE HOUSEHOLD CODE SIZE Code Code Code Code Code Code Procedure 1 2 3 4 5 57454 Colposcopy with Biopsy ** 171.00 171.00 171.00 171.00 171.00 57511 Cryocautery cervix- initial or repeat 162.00 162.00 162.00 162.00 162.00 17000 Cryotherapy first lesion** 75.00 75.00 75.00 75.00 75.00 17003 Cryotherapy 2-14 lesions** 6.00 6.00 6.00 6.00 6.00 17004 Cryotherapy 15 + lesions** 168.00 168.00 168.00 168.00 168.00 56501 Destruction Lesion Vulva 146.00 146.00 146.00 146.00 146.00 57170 Diaphragm/Cervical Cap Fitting* 0.00 23.00 46.00 69.00 92.00 58100 Endometrial biopsy w/wo Biopsy 122.00 122.00 122.00 122.00 122.00 58110 Endometrial biopsy with Colposcopy 66.00 66.00 66.00 66.00 66.00 Essure by referral*** 0.00 0.00 0.00 0.00 0.00 11400 Excisions, benign lesion _ 138.00 138.00 138.00 138.00 138.00 11981 Implanon Insertion* 0.00 47.50 95.00 142.50 190.00 10060 Incision simple & drainage of abcess, single or 131.00 131.00 131.00 131.00 131.00 58300 _ Insertion IUD* 0.00 47.75 95.50 143.25 191.00 57460 LEEP with biopsy 315.00 315.00 315.00 315.00 315.00 57461 LEEP with conization 357.00 357.00 357.00 357.00 357.00 88305 Level 4 - Surgical pathology 1st site 105.00 105.00 105.00 105.00 105.00 88305W Level 4 - Surgical Pathology 2nd site & eac 105.00 105.00 105.00 105.00 105.00 59025 Non Stress Test lnterp 0.00 0.00 0.00 0.00 0.00 11976 Removal, implant contraceptive (Implanon_) 0.00 56.50 113.00 169.5O 226.00 11983 Removal implant, with reinsertion* 0.00 86.75 173.50 260.25 347.00 58301 Removal IUD* 0.00 38.25 76.50 114.75 153.00 A4550 Surgical Tray 69.00 69.00 69.00 69.00 69.00 11300 Shaving trunk, of arms epidermal or legs, .5cm lesion, single on 108.00 108.00 108.00 108.00 108.00 76857 Ultrasound - pelvic non -obstetric 74.00 74.00 74.00 74.00 74.00 FAMILY PLANNING SUPPLIES A4267 Condoms pkg 10* 0.00 1.75 3.50 5.25 7.00 0052W Cycle Beads* 0.00 3.75 7.50 11.25 15.00 A4266 Diaphragm* 0.00 8.00 16.00 24.00 32.00 A4269 Foam Contraception* 0.00 3.00 6.00 9.00 12.00 J7307 Nexplanon (Etonogestrel)* _ 0.00 204.25 408.50 612.75 817.00 J7306 Levonorgestrel 0.00 204.25 408.50 612.75 817.00 J7298 IUD Mirena* 0.00 234.50 469.00 703.50 938.00 J7300 IUD Paragard* 0.00 195.00 390.00 585.00 780.00 J7301 IUD Skyla* 0.00 217.50 435.00 652.50 870.00 J7297 IUD Liletta 0.00 66.00 132.00 198.00 264.00 J1050 Medroxyprogesterone 150mg IM (Depo)* 0.00 17.75 35.50 53.25 71.00 96372 Admin fee depo- if visit for injection only 7.00 14.00 21.00 28.00 J7303 Nuva Ring* 0.00 10.50 21.00 31.50 42.00 S4993 Oral Contraceptives* 0.00 7.50 15.00 22.50 30.00 0068W Seasonale* 0.00 17.75 35.50 53.25 71.00 0065W Today's Sponge* 0.00 1.25 2.50 3.00 5.00 LAB 86900 ABO blood typing 0.00 1.25 2.50 3.75 5.00 82947 Assay, body fluid, glucose, (FBS)* 0.00 5.25 10.50 15.75 21.00 85025 CBC w/Diff 22.00 22.00 22.00 22.00 22.00 85027 'CBC w/o Diff 19.00 19.00 19.00 19.00 19.00 Revised 10/28/2016 Page 2 of 6 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT PUBLIC HEALTH SERVICES - 2017 SLIDING FEE SCHEDULE HOUSEHOLD CODE SIZE I Code Code Code Code Code Code Procedure 1 2 3 4 5 87491 Chlamydia PCR* 0.00 12.25 24.50 36.75 49.00 87491 NS Chlamydia PCR* - full fee 49.00 49.00 49.00 49.00 49.00 80053 Comprehensive Metabolic Panel 14.0O 14.00 14.00 14.00 14.00 0090W Court Ordered Lab Draw 16.00 16.00 16.00 16.00 16.00 82627 DHEAS 30.00 30.00 30.00 30.00 30.00 83001 FSH 37.00 37.00 37.00 37.00 37.00 87591 Gonorrhea PCR* 0.00 12.00 24.00 36.00 49.00 87591 NS Gonorrhea PCR* - full fee 49.00 49.00 49.00 49.00 49.00 82948 Glucose Random 8.00 8.00 8.00 8.00 8.00 82951 G Glucose Tolerance Test 2 hr (GTT) 26.00 26.00 26.00 26.00 26.00 87205 Gram Stain 28.00 28.00 28.00 28.00 28.00 84702 HCG Quantitative - Serum Pregnancy Test 43.00 43.00 43.00 43.00 43.00 84703 HCG Qualitative - Serum Pregnancy Test 43.00 43.00 43.00 43.00 43.00 83718 HDL Cholesterol 32.00 32.00 32.00 32.00 32.00 86706 Hep B Surface Antibody 25.00 25.00 25.00 25.00 25.00 87255 Herpes Culture 74.00 74.00 74.00 74.00 74.00 86695 Herpes Select - Type I (89999A33) 74.00 74.00 74.00 74.00 74.00 86696 Herpes Select - Type II (89999A33) 74.00 74.00 74.00 74.00 74.00 85018 HGB - (Finger Stick)* 0.00 3.50 7.00 10.50 14.00 83036 HGB Al c 35.00 35.00 35.00 35.00 35.00 86701 HIV 1/2 AB Diff (this is HIV 1) 12.00 12.00 12.00 12.00 12.00 86702 HIV 1/2 AB Diff (this is HIV 2) 13.00 13.00 13.00 13.00 13.00 86703 HIV Screen, ELISA 25.00 25.00 25.00 25.00 25.00 G0435 HIV Screen, Rapid Test 25.00 25.00 25.00 25.00 25.00 87624 HPV, High Risk 74.00 74.00 74.00 74.00 74.00 87625 HPV typing 16,18,45 46.00 46.00 46.00 46.00 46.00 0081W HPV, High Risk w/ repeat pap (LabCorp us 117.00 117.00 117.00 117.00 117.00 484006W lmmunohistochemical Stain 106.00 106.00 106.00 106.00 106.00 87254 Influenza - Viral Culture 45.00 45.00 45.00 45.00 45.00 83525 Insulin, Fasting 15.00 15.00 15.00 15.00 15.00 83002 LH 37.00 37.00 37.00 37.00 37.00 80061W Lipid Panel - SFS* 0.00 9.75 19.50 29.25 39.00 80061N Lipid Panel 39.00 39.00 39.00 39.00 39.00 80076 Liver Panel 31.00 31.00 31.00 31.00 31.00 86790 MAC Elisa 128.00 128.00 128.00 128.00 128.00 80048 Metabolic Panel 32.00 32.00 32.00 32.00 32.00 82274 Occult Blood Test, Fecal, IA* 30.00 30.00 30.00 30.00 30.00 88142 Pap - Thin Prep* 0.00 11.25 22.50 33.75 45.00 0080W Pap, repeat thin prep 45.00 45.00 45.00 45.00 45.00 88175 Pap, Thin prep, w HR HPV, Reflex 16,18.4: 119.00 119.00 119.00 119.00 119.00 88141 Physician Read Pap 36.00 36.00 36.00 36.00 36.00 84146 Prolactin 39.00 39.00 39.00 39.00 39.00 86901 RH blood type 0.00 1.75 3.50 5.25 7.00 87535 RNA Qaul. 46.00 46.00 46.00 46.00 46.00 86592 RPR/Syphillis test 24.00 24.00 24.00 24.00 24.00 87798 RT-PCR comprehensive- serum and urine 666.00 666.00 666.00 666.00 666.00 87081 Streptococcus - Hemolytic 8.00 8.00 8.00 8.00 8.00 84480 T3 Triiodothyronine 48.00 48.00 48.00 48.00 48.00 84481 TT -3 (Free -Unbound) 48.00 48.00 48.00 48.00 48.00 84436 T4 Thyroxine 9.00 9.00 9.00 9.00 9.00 84439 T4 (Total Free -Unbound) 11.00 11.00 11.00 11.00 11.00 Revised 10/28/2016 Page 3 of 6 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT PUBLIC HEALTH SERVICES - 2017 SLIDING FEE SCHEDULE HOUSEHOLD CODE SIZE Code Code Code Code Code Code Procedure 1 2 3 4 5 84403 Testosterone, Total 35.00 35.00 35.00 35.00 35.00 82465 Total Cholesterol 23.00 23.00 23.00 23.00 23.00 87798 Trichomonas vaginalis - amplified 45.00 45.00 45.00 45.00 45.00 84443 TSH 35.00 35.00 35.00 35.00 35.00 86480 Tuberculosis Test-Quantiferon (IGRA) 93.00 93.00 93.00 93.00 93.00 81001 Urinalysis, complete with micro ex 7.004 7.00 7.00 7.00 7.00 81002 Urinalysis, w/o scope (UA) 10.00' 10.00 10.00 10.00 10.00 87086 Urine Culture, Comprehensive 11.00 11.00 11.00 11.00 11.00 81025 Urine Preganancy Test* 0.00 3.75 7.50 11.25 15.00 36415 Venipuncture 6.00 6.00 6.00 6.00 6.00 36415W Venipuncture with sliding fee lab 0.00 1.50 3.00 4.50 6.00 36416 Venipuncture - capillary blood specimen 6.00 6.00 6.00 6.00 6.00 36416W Venipuncture - capillary blood specimen 0.00 1.50 3.00 4.50 6.00 96372 Admin fee for Depo and antibiotics 0.00 7.00 14.00 21.00 28.00 87210 Wet Prep 25.00 25.00 25.00 25.00 25.00 MEDICINES and TREATMENTS_ 0020W Amoxicillin 875 mg #20 16.00 16.00 16.00 16.00 16.00 0062W Azythromycin, Z pack 16.00 16.00 16.00 16.00 16.00 101456W Azithromycin 1g - partner pack 11.00 11.00 11.00 11.00 11.00 0456W Azithromycin State supplied 0.00 0.00 0.00 0.00 0.00 J0696 Ceftriaxone 250 mg 33.00 33.00 33.00 33.00 33.00 0696W Ceftriaxone 250 mg State Supplied 0.00 0.00 0.00 0.00 0.00 0007W Cephalexin 500 mg #14 10.00 10.00 10.00 10.00 10.00 0058W Ciprofloxcin 500 mg #6 16.00 16.00 16.00 16.00 16.00 0035W Condylox 10.00 10.001 10.00 10.00 10.00 0005W Doxycycline 100 mg #14 11.00 11.00 11.00 11.00 11.00 0059W Estradiol 1 mg- #100 16.00 16.00 16.00 16.00 16.00 0011W Fluconazole 150 mg #1 22.00 22.00 22.00 22.00 22.00 0012W Iron 12.00 12.00 12.00 12.00 12.00 J0561 LA Bicillin 2.4 Units 0.00 0.00 0.00 0.00 0.00 0060W Medroxyprogesterone 10 mg - #5 16.00 16.00 16.00 16.00 16.00 0008W Metrogel 10.00 10.00 10.00 10.00 10.00 0009W Metronidazole 500 mg #4 10.00 10.00 10.00 10.00 10.00 0010W Metronidazole 500 mg #14 15.00 _ 15.00 15.00 15.00 15.00 0013W Metronidazole 250 mg #28 15.00 15.00 15.00 15.00 15.00 0006W Misoprostel (Cytotec) 200 mcg #2 10.00 10.00 10.00 10.00 10.00 0016W Podophyllin/TCA 16.00 16.00 16.00, 16.00 16.00 0004W Sulfatrim SMX/TMP 10.00 10.00 10.00 10.00 10.00 00180W Suprax 400 mg #1 - partner pak 28.00 28.00 28.00 28.00 28.00 00180NC Suprax 400 mg #1 - State Supplied 0.00 0.00 0.00 0.00 0.00 IMMUNIZATIONS 90471 Imm. Admin - one vaccine 28.00 28.00 28.00 28.00 28.00 90472 Imm Admin - each addl. Vaccine 28.00 28.00 28.00 28.00 28.00 90473 Imm Admin - intranasal or oral 28.00 28.00 28.00 28.00 28.00 90700N DTaP -State supplied 0.00 0.00 0.00 0.00 0.00 90700 DTaP 31.00 31.00 31.00 31.00 31.00 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 33.00 33.00 33.00 33.00 33.00 Revised 10/28/2016 Page 4of6 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT PUBLIC HEALTH SERVICES - 2017 SLIDING FEE SCHEDULE HOUSEHOLD CODE SIZE Code Code Code Code Code Code ' Procedure 1 2 3 4 5 90632N Hepatitis A - Adult - State supplied 0.00 0.00 0.00 0.00 0.00 90632 Hepatitis A - Adult 87.00 87.00 87.00 87.00 87.00 90744N Hepatitis B - Child - State supplied 0.00 0.00 0.00 0.00 0.00 90744 Hepatitis B - Child 28.00 28.00 28.00 28.00 28.00 90746N Hepatitis B - Adult - State supplied 0.00j 0.00 0.00 0.00 0.00 90746 Hepatitis B - Adult 81.00 81.00 81.00 81.00 81.00 90647N HIB - State supplied 0.00 0.00 0.00 0.00 0.00 90647 HIB 37.00 37.00 37.00 37.00 37.00 90651 N HPV 9 - State supplied 0.00 0.00 0.00 0.00 0.00 90651 HPV 9 179.00 179.00 179.00 179.00 179.00 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 35.00 35.00 35.00 35.00 35.00 90687 Influenza - infant quadrivalent 35.00 35.00 35.00 35.00 35.00 90687N Influenza - infant quadrivalent - State suppl 0.00 0.00 0.00 0.00 0.00 90688 Influenza - 3 yrs and up - quadrivalenl 35.00 35.00 35.00 35.00 35.00 90688N Influenza - 3 yrs and up - State supplied qu 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 68.00 68.00 68.00 68.00 68.00 90738 Japanese Encephalitis (new formulation) 309.00 309.00 309.00 309.00 309.00 90696N Kinrix - (DTaP/IPV) - State supplied 0.00 0.00 0.00 0.00 0.00 90696 Kinrix - (DTaP/IPV) 60.00 60.00 60.00 60.00 60.00 90734N MCV4 - State supplied 0.00 0.00 0.00 0.00 0.00 90734 MCV4 164.00 164.00 164.00 164.00 164.00 90733 MPSV4 (Menomune)(polysaccharide) 164.00 164.00 164.00 164.00 164.00 90707N MMR - State supplied 0.00 0.00 0.00 0.00 0.00 I 90707 MMR 69.00 69.00 69.00 69.00 69.00 90723N Pediarix (DTAP, IPV, Hep B) - State suppli 0.00 0.00 0.00 0.00 0.00 90723 Pediarix - (DTaP/IPV/Hep B) 84.00 84.00 84.00 84.00 84.00 90698N Pentacel - (DTaP/IPV/HepB) - State supplic 0.00 0.00 0.00 0.00 0.00 90698 Pentacel - (DTaP/IPV/HepB) 124.00 124.001 124.00 124.00 124.00 90732N Pneumovax - State supplied 0.00 0.00 0.00 0.00 0.00 90732 Pneumovax 84.00 84.00 84.00 84.00 84.00 90670N Prevnar - (PCV13) - State supplied 0.00 0.00 0.00 0.00 0.00 90670 Prevnar - (PCV13) 183.00 183.00 183.00 183.00 183.00 90675 Rabies IM 262.00 262.00 262.00 262.00 262.00 90675N Rabies IM - State supplied 0.00 0.00 0.00 0.00 0.00 90375 RIG (rabies) - per cc 234.00 234.00 234.00 234.00 234.00 90680N Rotavirus - State supplied 0.00 0.00 0.00' 0.00 0.00 90680 Rotavirus - (RV5) 94.00 94.00 94.00 94.00 94.00 90714N Td - State supplied 0.00 0.00 0.00 0.00 0.00 90714 Td - 55.00 55.00 55.00 55.00 55.00 90715N Tdap - State supplied 0.00 0.00 0.00 0.00 0.00 90715 Tdap - 108.00 108.00 108.00 108.00 108.00 86580 Tuberculosis Interdermal Skin Test (PPD) 48.00 48.00 48.00 48.00 48.00 90636 Twinrix - Hep A & Hep B 118.00 118.00 118.00 118.00 118.00 90691 Typhoid - 1 Shot 77.00 77.00' 77.00 77.00 77.00 90690 Typhoid - Oral 67.00 67.00 67.00 67.00 67.00 90716N Varivax - State supplied 0.00 0.00 0.00 0.00 0.00 90716 Varivax 118.00 118.00 118.00 118.00 118.00 90717 Yellow Fever 151.00 151.00 151.00 151.00 151.00 Revised 10/28/2016 Page 5 of 6 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT PUBLIC HEALTH SERVICES - 2017 SLIDING FEE SCHEDULE HOUSEHOLD CODE SIZE Code Code Code Code Code Code P Procedure 1 2 3 4 5 M Miscellaneous INC Service Includes Follow-up Care 0.00 0.00 0.00 0.00 0.00 99212 Antepartum Care 1 visit 74.00 74.00 74.00 74.00 74.00 59425 Antepartum care 4-6 visits 657.00 657.00 657.00 657.00 657.00 59426 Antepartum care 7 or more visits 1350.00 1350.00 1350.00 1350.00 1350.00 99402W PE Establishing Medical Record 64.00 64.00 64.00 64.00 64.00 0255W Phone visit 0.00 0.00 0.00 0.00 0.00 59430 Post Partum Only 210.00 210.00 210.00 210.00 210.00 H1005 Prenatal Plus (1-4 visits) 191.00 191.00 191.00 191.00 191.00 H1005 Prenatal Plus (5-9 visits) 508.00 508.00 508.00 508.00 508.00 H1005 Prenatal Plus (10 visits) 954.00 954.00 954.00 954.00 954.00 H1005 Prenatal Plus (11 or more visits) 1081.00 1081.00 1081.00 1081.00 1081.00 * 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 10/26/2016 revised Revised 10/28/2016 Page 6 of 6 2017 HHW Facility - CESQG Fees Waste Type Cost per container Cost per pound Acid gallon $9.80 $1.30/ pound 5 gallon $52.00 55 gallon $311.85 55 gallon, bulk $376.20 Aerosol (paint, pesticide) $1.20/ pound Antifreeze 50.60/ gallon Base gallon $9.80 $1.30/ pound 5 gallon $52.00 55 gallon $311.85 55 gallon, bulk $376.20 Battery (excluding alkaline) $0.25/ pound Battery (alkaline) $1.20/ pound Compressed Gas Cylinders (small) tank $3.10 Compressed Gas Cylinders (large) tank $19.30 Cyanide Compounds quart $12.05 gallon $48.20 5 gallon $241.00 Drum Handling Fee drum $15.00 Flammable Liquid (bulkable) 55 gallon drum $149.60 $0.35/ pound Flammable Liquid quart $0.55 gallon $$2.30 $1.20/ pound if < quart or loose -pack 5 gallon $16.20 Fluorescent Bulbs linear foot $0.15 Fluorescent Bulbs, Compact (small) Fluorescent (large) or Sodium Bulbs small bulb $0.25 Bulb $1.35 Filter, oil $0.15/ pound Grease 30 gallon $147.55 Mercury thermometer $0.75 $0.50/ pound Motor Oil (used) or Cooking Oil $0.25/ gallon Motor Oil Testing $20.00 if needed to determine quality of oil. Oily Waste Water $0.80/gallon Oxidizer gallon $9.80 5 gallon $52.00 $1.30/ pound 55 gallon $311.85 Paint (Latex & Oil Based) quart no fee* gallon no fee* $0.25/ pound or $15 minimum handling fee 5 gallon no fee* PCB Ballast (and non PCB) $0.75/ pound Peroxide Formers gallon $30.50 5 gallon $162.50 55 gallon $974.90 gallon $9.80 Pesticide/Poison Liquid 5 gallon $52.00 55 gallon $311.85 55gallon bulk $498.50 Pesticide, dry $1.05/ pound quart $12.05 Water Reactive, Shock Sensitive gallon $48.20 $3.10/ pound if < quart 5 gallon $241.00 Miscellaneous Items To be determined, subject to market rate. Minimum Fee $15 *Latex and oil based paint are not charged due to contract with PaintCare. WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT PUBLIC HEALTH SERVICES - 2017 SLIDING FEE SCHEDULE Yellow - New Procedures/Codes 2.5% Increase from Medicaid/Medicare/Actual Floor 2017 Proposed HOUSEHOLD CODE SIZE 2016 2017 Code Code Code Code Code CURRENT PROPOSED - - ---- - - Code Procedure 1 2 3 4 5 2.5% increase 99201 Minimal* 0.00 12.25 24.50 36.75 49.00 46.00 49.00 99202 Expanded* 0.00 28.50 57.00 85.50 114.00 111.00 114.00 99203 Detailed* 0.00 37.00 74.00 111.00 148.00 144.00 148.00 99204 Comprehensive* 0.00 55.00 110.00 165.00 220.00 215.00 220.00 Established Client 99211 Minimal* 0.00 11.00 22.00 33.00 44.00 43.00 44.00 99212 Focused* 0.00 18.50 37.00 55.50 74.00 72.00 74.00 99213 Expanded* 0.00 24.00 48.00 72.00 96.00 94.00 96.00 99214 Detailed* 0.00 37.75 75.50 113.25 151.00 147.00 151.00 Home Visits 99341 New Client - Focused 89.00 89.00 89.00 89.00 89.00 87.00 89.00 99342 New Client - Expanded 89.00 89.00 89.00 89.00 89.00 87.00 89.00 99347 Est. Client - Focused 89.00 89.00 89.00 89.00 89.00 87.00 89.00 99348 Est. Client - Expanded 93.00 93.00 93.00 93.00 93.00 87.00 93.00 Preventive Medicine Counseling (Family Planning) 99401 Individual - 15 min* 0.00 11.75 23.50 35.25 47.00 46.00 47.00 99402 Individual - 30 min* 0.00 16.75 33.50 50.25 67.00 65.00 67.00 99403 ' Individual - 45 min* 0.00 23.25 46.50 69.75 93.00 91.00 93.00 Travel Visits 99404 Individual Initial Visit - 60 120.00 120.00 120.00 120.00 120.00 117.00 120.00 99401W Return Visit 55.00 55.00 55.00 55.00 55.00 54.00 55.00 99412 Group Initial Visit (per person) - 60 55.00 55.00 55.00 55.00 55.00 54.00 55.00 Preventive Medicine 99384 New Client 12-17 years old* 0.00 37.00 74.00 111.00 148.00 144.00 148.00 99385 New Client 18-39 years old* 0.00 37.00 74.00 111.00 148.00 144.00 148.00 99386 New Client 40-64 years old* 0.00 40.00 80.00 120.00 160.00 156.00 160.00 99394 Est. Client 12-17 years old* 0.00 31.00 62.00 93.00 124.00 121.00 124.00 99395 Est. Client 18-39 years old* 0.00 31.75 63.50 95.25 127.00 124.00 127.00 99396 Est. Client 40-64 years old* 0.00 33.75 67.50 } 101.25 135.00 132.00 135.00 Additional Codes 0071W Community Education 1 hr. 72.00 72.00 72.00 72.00 72.00 70.00 72.00 0069W Travax Printout 15.00 15.00 15.00 15.00 15.00 15.00 15.00 G9006 NHV Mother - Task Care Management 15.00 15.00 15.00 15.00 15.00 15.00 15.00 T1017 NHV Child - Task Care Management 15.00 15.00 15.00 15.00 15.00 15.00 15.00 STI Exam pre -pay -NP 187.00 187.00 187.00 187.00 187.00 182.00 187.00 Wellness Package 48.00 48.001 48.00 48.00 48.00 47.00 48.00 99499 TB Consultation 44.00 44.00 44.00 44.00 44.00 43.00 44.00 PROCEDURES 56420 Bartholin Cyst 136.00 136.00 136.00 136.00 136.00 129.00 136.00 11100 Biopsy of skin, single 115.00 115.00 115.00 115.00 115.00 109.00 115.00 57500 Cervical Lesion Biopsy 143.00 143.00 143.00 143.00 143.00 136.00 143.00 0116W Chest X -Ray (Prepay) 65.00 65.00 65.00 65.00 65.00 63.00 65.00 57452 Colposcopy without Biopsy ** 122.00 122.00 122.00 122.00 122.00 116.00 122.00 57454 Colposcopy with Biopsy ** 171.00 171.00 171.00 171.00 171.00 163.00 171.00 57511 Cryocautery cervix- initial or repeat 162.00 162.00 162.00 162.00 162.00 155.00 162.00 17000 Cryotherapy first lesion** 75.00 75.00 75.00 75.00 75.00 70.00 75.00 17003 Cryotherapy 2-14 lesions** 6.00 6.00 6.00 6.00 6.00 6.00 6.00 17004 Cryotherapy 15 + lesions** 168.00 168.00 168.00 168.00 168.00 158.00 168.00 56501 Destruction Lesion Vulva 146.00 146.00 146.00 146.00 146.00 139.00 146.00 57170 Diaphragm/Cervical Cap Fitting* 0.00 23.00 46.00 69.00 92.001 90.00 92.00 58100 Endometrial biopsy w/wo Biopsy 122.00 122.00 122.00 122.00 122.00 116.00 122.00 58110 Endometrial biopsy with Colposcopy 66.00 66.00 66.00 66.00 66.00 64.00 ' 66.00 Essure by referral*** 0.00 0.00 0.00 0.00 0.00 0.00 0.00 11400 Excisions, benign lesion 138.00 138.00 138.00 138.00 138.00 131.00 138.00 11981 Implanon Insertion* 0.00 47.50 95.00 142.501 190.00( 185.00 190.00 Revised 10/28/2016 Page 1 of 5 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT PUBLIC HEALTH SERVICES - 2017 SLIDING FEE SCHEDULE HOUSEHOLD CODE SIZE 2016 2017 Code Code Code Code Code CURRENT PROPOSED Code Procedure 2 3 5 2.5% increase 10060 Incision & drainage of abcess, single or simple 131.00 131.00 131.00 131.00 158300 Insertion IUD* r 0.00 47.75 95.50 143.25 with biopsy 315.00 315.00 315.00 315.00 57461 LEEP with conization 357.00 357.00 357.00 357.00 88305 Level 4 - Surgical pathology 1st site 105.00 105.00 105.00 105.00 88305W Level 4 - Surgical Pathology 2nd site &_ eacl 105.00 _ 105.00 105.00 105.00 59025 Non Stress Test Intern 0.00 0.00 0.00 0.00 11976 Removal, implant contraceptive (Implanon)' 0.00 56.50 113.00 169.50 11983 Removal implant, with reinsertion* 0.00 86.75 173.50 260.25 58301 Removal IUD* 0.00 38.25 76.50 114.75 A4550 Surgical Tray 69.00 69.00 69.00 69.00 11300 aving of epiaermai lesion, single on trunk, arms or legs, .5cm 108.00 108.00 108.00 108.00 76857 Ultrasound - pelvic non -obstetric 74.00 74.00 74.00 74.00 FAMILY PLANNING SUPPLIES A4267 Condoms pkg 10* 0.00 1.75 3.50 5.25 0052W Cycle Beads* 0.00 3.75 7.50 11.25 A4266 Diaphragm* 0.00 8.00 16.00 24.00 A4269 Foam Contraception* 0.00 3.00 6.00 9.00 J7307 Nexplanon (Etonogestrel)* 0.00 204.25 408.50 612.75 J7306 Levonorgestrel 0.00 204.25 408.50 612.75 J7298 IUD Mirena* 0.00 234.50 469.00 703.50 J7300 IUD Paragard* 0.00 195.00 390.00 585.00 J7301 IUD Skyla* 0.00 217.50 435.00 652.50 J7297 IUD Liletta 0.00 66.00 132.00 198.00 J1050 Medroxyprogesterone 150mg IM (Depo)* 0.00 17.75 35.50 53.25 min fee depo- if visit for injection only J7303 Nuva Ring* S4993 Oral Contraceptives 0.00 7.00 10.50 14.00 21.00 21.00 31.50 131.00 191.00 315.00 357.00 105.00 124.00 186.00' 299.00 339.00 102.00 131.00 191.00 315.00 357.00 105.00 105.00 0.00 102.00 105.00 0.00 0.00 226.00 220.00 226.00 347.00 153.00 69.00 108.00 74.00 339.00 347.00 149.00 153.00 67.00 69.00 102.00 72.00 108.00 74.00 7.00 7.00 7.00 15.00 15.00 15.00 32.00 12.00 817.00 31.00 32.00 12.00 12.00 797.00 817.00 817.00 797.00 817.00 938.00 915.00 938.00 780.00 761.00 780.00 870.00 849.00 870.00 264.00 71.00 _ 28.00 42.00 258.00 69.00 264.00 15.00 41.00 71.00 28.00 42.00 0.00 7.50 15.00 22.50 30.00 29.00 30.00 0068W Seasonale* 0.00 17.75 35.50 53.25 71.00 69.00 71.00 0065W Today's Sponge 0.00 1.25 2.50 3.00 5.00 5.00 5.00 86900 LAB ABO blood typing 0.00 1.25 2.50 3.75 5.00 5.00 5.00 82947 Assay, body fluid, glucose, (FBS)* 0.00 5.25 10.50 15.75 21.00, 20.00 21.00 85025 CBC w/Diff 22.00 22.00 22.00 22.00 22.00 21.00 22.00 85027 CBC w/o Diff 19.00 19.00 19.00 19.00 19.00 19.00 19.00 87491 Chlamydia PCR* 0.00 12.25 24.50 36.75 49.00 48.00 49.00 87491 NS Chlamydia PCR*- full fee 49.00 49.00 49.00 49.00 49.00 48.00 49.00 80053 Comprehensive Metabolic Panel 14.00 14.00 14.00 14.00 14.00 14.00 14.00 0090W Court Ordered Lab Draw 16.00 16.00 16.00 16.00 16.00 16.00 16.00 82627 DHEAS 30.00 30.00 30.00 30.00 30.00 29.00 30.00 83001 FSH 37.00 37.00 37.00 37.00 37.00 36.00 4 37.00 87591 Gonorrhea PCR* 0.00 12.00 24.00 36.00 49.00 48.00 49.00 87591 NS Gonorrhea PCR* - full fee __ 49.00 49.00 49.00 49.00 49.00 48.00 49.00 82948 Glucose Random 8.00 8.00 8.00 8.00 8.00 8.00 8.00 82951 Glucose Tolerance Test 2 hr (GTT) 26.00 26.00 26.00 26.00 26.00 25.00 26.00 87205 Gram Stain 28.00 28.00 28.00 28.00 28.00 27.00 28.00 84702 HCG Quantitative - Serum Pregnancy Test 43.00 43.00 43.00 43.00 43.00 42.00 43.00 84703 HCG Qualitative - Serum Pregnancy Test 43.00 43.00 43.00 43.00 43.00 42.00 43.00 83718 HDL Cholesterol 32.00 32.00 32.00 32.00 32.00 31.00 32.00 86706 Hep B Surface Antibody 25.00 25.00 25.00 25.00 25.00 24.00 25.00 87255 Herpes Culture 74.00 74.00 74.00 74.00 74.00 72.00 74.00 86695 Herpes Select - Type I (89999A33) 74.00 74.00 74.00 74.00 74.00 72.00 74.00 86696 Herpes Select - Type II (89999A33) 74.00 74.00 74.00 74.00 74.00 72.00 74.00 85018 HGB - (Finger Stick)* 0.00 3.50 7.00 10.50 14.00 14.00 14.00 83036 HGB Al c 35.00 35.00 35.00 35.00 35.00 34.00 35.00 86701 HIV 1/2 AB Diff (this is HIV 1) 12.00 12.00 12.00 12.00 12.00 12.00 12.00 86702 86703 HIV 1/2 AB Diff (this is HIV 2) HIV Screen, ELISA 13.00 25.00 13.00 25.00 13.00 25.00 13.00 25.00 13.00 25.00 13.00 24.00 13.00 25.00 G 04 35 HIV Screen, Rapid Test 25.00 25.00 25.00 25.00 25.00 24.00 25.00 87624 HPV, High Risk 87625 HPV typing 16,18,45 00811A/ HPV, High Risk w/ repeat pap (LabCorp us 74.00 46.00 117.00 74.00 46.00 117.00 74.00 46.00 117.00 74.00 46.00 117.00 74.00 _ 46.00 _ 117.001 72.00 74.00 45.00 46.00 114.00 117.00 Revised 10/28/2016 Page 2 of 5 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT PUBLIC HEALTH SERVICES - 2017 SLIDING FEE SCHEDULE HOUSEHOLD CODE SIZE 2016 2017 Code Code Code Code Code CURRENT PROPOSED Code Procedure 1 2 3 4 5 2.5% increase 484006W Immunohistochemical Stain 106.00 106.00 106.00 106.00 106.00 103.00 106.00 87254 Influenza - Viral Culture 45.00 45.00 45.00 45.00 45.00 44.00 45.00 83525 Insulin, Fasting 15.00 15.00 15.00 15.00 15.00 15.00 15.00 83002 LH 37.00 37.00 37.00 37.00 37.00 36.00 37.00 80061W Lipid Panel - SFS* 0.00 9.75 19.50 29.25 39.00 38.00 39.00 80061N Lipid Panel 39.00 39.00 39.00 39.00 39.00 38.00 39.00 80076 Liver Panel 31.00 31.00 31.00 31.00' 31.00 30.00 31.00 86790 MAC Elisa 128.00 128.00 128.00 128.00 128.00 125.00 128.00 80048 Metabolic Panel 32.00 32.00 32.00 32.00 32.00 31.00 32.00 82274 Occult Blood Test, Fecal, IA* 30.00 30.00 30.00 30.00 30.00 29.00 30.00 88142 Pap - Thin Prep* 0.00 11.25 22.50 33.75 45.00 44.00 45.00 0080W Pap, repeat thin prep 45.00 45.00 45.00 45.00 45.00 44.00 45.00 88175 Pap, Thin prep, w HR HPV, Reflex 16,18.4E 119.00 119.00 119.00 119.00 119.00 116.00 119.00 88141 Physician Read Pap 36.00 36.00 36.00 36.00 36.00 34.00 36.00 84146 Prolactin 39.00 39.00 39.00 39.00 39.00 38.00 39.00 86901 RH blood type 0.00 1.75 3.50 5.25 7.00 7.00 7.00 87535 RNA Qaul. 46.00 46.00 46.00 46.00 46.00 45.00 46.00 86592 RPR/Syphillis test I 24.00 24.00 24.00 24.00 24.00 23.00 24.00 87798 RT-PCR comprehensive- serum and urine 666.00 666.00 666.00 666.00 666.00 650.00 666.00 87081 Streptococcus - Hemolytic 8.00 8.00 8.00 8.00 8.00 6.00 8.00 84480 T3 Triiodothyronine 48.00 48.00 48.00 48.00 48.00 47.00 48.00 84481 TT -3 (Free -Unbound) 48.00 48.00 48.00 48.00 48.00 47.00 48.00 84436 T4 Thyroxine 9.00 9.00 9.00 9.00 9.00 8.00 9.00 84439 T4 (Total Free -Unbound) 11.00 11.00 11.00 11.00 11.00 9.00 11.00 84403 Testosterone, Total 35.00 35.00 35.00 35.00 35.00 34.00 35.00 82465 Total Cholesterol 23.00 23.00 23.00 23.00 23.00 22.00 23.00 87798 Trichomonas vaginalis - amplified 45.00 45.00 45.00 45.00 45.00 11.00 45.00 84443 TSH 35.00 35.00 35.00 35.00 35.00 34.00 35.00 86480 Tuberculosis Test-Quantiferon (IGRA) 93.00 93.00 93.00 93.00 93.00 91.00 93.00 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) 10.00 10.00 10.00 10.00 10.00 10.00 10.00 87086 Urine Culture, Comprehensive 11.00 11.00 11.00 11.00 11.00 11.00 11.00 81025 Urine Preganancy Test* 0.00 3.75 7.50 11.25 15.00 15.00 15.00 36415 Venipuncture 6.00 6.00 6.00 6.00 6.00 6.00 6.00 36415W Venipuncture with sliding fee lab 0.00 1.50 3.00 4.50 6.00 6.00 6.00 36416 Venipuncture - capillary blood specimen 6.00 6.00 6.00 6.00 6.00 6.00 6.00 36416W Venipuncture - capillary blood specimen 0.00 1.50 3.00 4.50 6.00 6.00 6.00 96372 Admin fee for Depo and antibiotics 0.00 7.00 14.00 21.00 28.00 27.00 28.00 87210 Wet Prep 25.00 25.00 25.00 25.00 25.00 24.00 25.00 MEDICINES and TREATMENTS 0020W Amoxicillin 875 mg #20 16.00 16.00 16.00 16.00 16.00 16.00 16.00 0062W Azythromycin, Z pack 16.00 16.00 16.00 16.00 16.00 16.00 16.00 101456W Azithromycin 1g - partner pack 11.00 11.00 11.00 11.00 11.00 11.00 11.00 0456W Azithromycin State supplied 0.00 0.00 0.00 0.00 0.00 0.00 0.00 J0696 Ceftriaxone 250 mg 33.00 33.00 33.00 33.00 33.00 32.00 33.00 0696W Ceftriaxone 250 mg State Supplied 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0007W Cephalexin 500 mg #14 10.00 10.00 10.00 10.00 10.00 10.00 10.00 0058W Ciprofloxcin 500 mg #6 16.00 16.00 16.00 16.00 16.00 16.00! 16.00 0035W Condylox 10.00 10.00 10.00 10.00 10.00 10.00 10.00 0005W Doxycycline 100 mg #14 11.00 11.00 11.00 11.00 11.00 11.00 11.00 0059W Estradiol 1 mg- #100 16.00 16.00 16.00 16.00 16.00 16.00 16.00 0011W Fluconazole 150 mg #1 22.00 22.00 22.00 22.00 22.00 21.00 22.00 0012W Iron 12.00 12.00 12.00 12.00 12.00 12.00 12.00 J0561 LA Bicillin 2.4 Units 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0060W Medroxyprogesterone 10 mg - #5 16.00 16.00 16.00 16.00 16.00 16.00 16.00 0008W Metrogel 10.00 10.00 10.00 10.00 10.00 10.00 10.00 0009W Metronidazole 500 mg #4 10.00 10.00 10.00 10.00 10.00 10.00 10.00 0010W Metronidazole 500 mg #14 15.00 15.00 15.00 15.00 15.00 15.00 15.00 0013W Metronidazole 250 mg #28 15.00 15.00 15.00 15.00 15.00 15.00 15.00 0006W Misoprostel (Cytotec) 200 mcg #2 _ 10.00 10.00 10.00 10.00 10.00 10.00 10.00 0016W Podophyllin/TCA 16.00 16.00 16.00 16.00 16.00 16.00 16.00 0004W Sulfatrim SMX/TMP 10.00 10.00 10.00 10.00 10.00 10.00 10.00 00180W Suprax 400 mg #1 - partner pak 28.00 28.00 28.00 28.00 28.00 27.00 28.00 00180NC Suprax 400 mg #1 - State Supplied 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Revised 10/28/2016 Page 3 of 5 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT PUBLIC HEALTH SERVICES - 2017 SLIDING FEE SCHEDULE HOUSEHOLD CODE SIZE 2016 2017 Code Code Code Code Code CURRENT PROPOSED Code Procedure 1 2 3 4 5 2.5% increase IMMUNIZATIONS 90471 Imm. Admin - one vaccine 28.00 28.00 28.00 28.00 28.00 27.00 28.00 90472 Imm Admin - each addl. Vaccine 28.00 28.00 28.00 28.00 28.00 27.00 28.00 90473 Imm Admin - intranasal or oral 28.00 28.00 28.00 28.00 28.00 27.00 28.00 90700N DTaP -State supplied 0.00 0.00 0.00 0.00 0.00 0.00 0.00 90700 DTaP 31.00 31.00 31.00 31.00 31.00 30.00 31.00 90702N DT - State supplied 0.00 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 0.00 90633 Hepatitis A - Child 33.00 33.00 33.00 33.00 33.00 32.00 33.00 90632N Hepatitis A - Adult - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 0.00 90632 Hepatitis A - Adult 87.00 87.00 87.00 87.00 87.00 85.00 87.00 90744N Hepatitis B - Child - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 0.00 90744 Hepatitis B - Child 28.00 28.00 28.00 28.00 . 28.00 27.00 28.00 90746N Hepatitis B - Adult - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 0.00 90746 Hepatitis B - Adult 81.00 8.1.00 81.00 81.00 81.00 79.00 81.00 90647N HIB - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 0.00 90647 HIB 37.00 37.00 37.00 37.00 37.00 36.00 37.00 90651N HPV 9 - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 0.00 90651 HPV 9 179.00 179.00 179.00 179.00 179.00 175.00 179.00 90281 IG Hepatitis A - State supplied 0.00 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 0.00 90660 Influenza - Intranasal Adult 35.00 35.00 35.00 35.00 35.00 34.00 35.00 90687 Influenza - infant quadrivalent 35.00 35.00 35.00 35.00 35.00 34.00 35.00 90687N Influenza - infant quadrivalent - State suppli 0.00 0.00 0.00 0.00 0.00 0.00 0.00 90688 Influenza - 3 yrs and up - quadrivalent 35.00 35.00 35.00 35.00 35.00 34.00 35.00 90688N Influenza - 3 yrs and up - State supplied qw 0.00 0.00 0.00 0.00 0.00 0.00 0.00 90713N IPV-VFC - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 0.00 90713 IPV 68.00 68.00 68.00 68.00 68.00 66.00 68.00 90738 Japanese Encephalitis (new formulation) 309.00 309.00 309.00 309.00 309.00 301.00 309.00 90696N Kinrix - (DTaP/IPV) - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 0.00 90696 Kinrix - (DTaP/IPV) 60.00 60.00 60.00 60.00 60.00 59.00 60.00 90734N MCV4 - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 0.00 90734 MCV4 164.00 164.00 164.00 164.00 164.00 160.00 164.00 90733 MPSV4 (Menomune)(polysaccharide) 164.00 164.00 164.00 164.00 164.00 160.00 164.00 90707N MMR - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 0.00 90707 MMR 69.00 69.00 69.00 69.00 69.00 67.00 69.00 90723N Pediarix (DTAP, IPV, Hep B) - State supplii 0.00 0.00 0.00 0.00 0.00 0.00 0.00 90723 Pediarix - (DTaP/IPV/Hep B) 84.00 84.00 84.00 84.00 84.00 82.00 84.00 90698N Pentacel - (DTaP/IPV/HepB) - State supplie 0.00 0.00 0.00 0.00 0.00 0.00 0.00 90698 Pentacel - (DTaP/IPV/Hep6) 124.00 124.00 124.00 124.00 124.00 121.00 124.00 90732N Pneumovax - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 0.00 90732 Pneumovax 84.00 84.00 84.00 84.00 84.00 82.00 84.00 90670N Prevnar - (PCV13) - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 0.00 90670 Prevnar - (PCV13) 183.00 183.00 183.00 183.00 183.00 179.00 183.00 90675 Rabies IM 262.00 262.00 262.00 262.00 262.00 256.00 262.00 90675N Rabies IM - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 0.00 90375 RIG (rabies) - per cc 234.00 234.00 234.00 234.00 234.00 228.00 234.00 90680N Rotavirus - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 0.00 90680 Rotavirus - (RV5) 94.00 94.00 94.00 94.00 94.00 92.00 94.00 90714N Td - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 0.00 90714 Td - 55.00 55.00 55.00 55.00 55.00 54.00 55.00 90715N Tdap - State supplied 0.00 0.00 0.00 0.00 0.00 0.00 0.00 90715 Tdap - 108.00 108.00 108.00 108.00 108.00 105.00 108.00 86580 Tuberculosis Interdermal Skin Test (PPD) 48.00 48.00 48.00 48.00 48.00 47.00 48.00 90636 Twinrix - Hep A & Hep B 118.00 118.00 118.00 118.00 118.00 115.00 118.00 90691 Typhoid - 1 Shot 77.00 77.00 77.00 77.00 77.00 75.00 77.00 90690 Typhoid - Oral 67.00 67.00 67.00 67.00 67.00 65.00 67.00 90716N Varivax - State supplied 0.00 0.00 0.00 0.00 0.00 � 0.00' 0.00 90716 Varivax 118.00 118.00 118.00 118.00 118.00, 115.00 118.00 90717 Yellow Fever 151.00 151.00 151.00 151.00 151.00 147.00 151.00 Miscellaneous INC Service Includes Follow-up Care 0 0.00 0.00 0.00 99212 Antepartum Care 1 visit 74.00 72.00 74.00 59425 Antepartum care 4-6 visits 657.00 641.00 657.00 59426 Antepartum care 7 or more visits 1350.00! 1350.00 1350.00! 1350.00 1350.00 1317.00 1350.00 Revised 10/28/2016 Page 4 of 5 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT PUBLIC HEALTH SERVICES - 2017 SLIDING FEE SCHEDULE HOUSEHOLD CODE SIZE 2016 2017 Code Code Code Code Code CURRENT PROPOSED Code Procedure 1 2 3 4 5 2.5% increase 64.00 64.00 99402W PE Establishing Medical Record 64.00 64.00 64.00 64.00 62.00 0255W Phone visit 0.00 0.00 0.00 0.00 0.00 210.00 191.00 0.00 0.00 210.00 191.00 59430 Post Partum Only 210.00 210.00 210.00 210.00 201.00 H1005 Prenatal Plus (1-4 visits) 191.00 191.00 191.00 191.00 186.00 H1005 Prenatal Plus (5-9 visits) 508.00 508.00 508.00 508.00 508.00 496.00 508.00 H1005 Prenatal Plus (10 visits) 954.00 954.00 954.00 954.00 954.00 931.00 954.00 H1005 Prenatal Plus (11 or more visits) 1081.00 1081.00 1081.00 1081.00 1081.00 1055.00 1081.00 * 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 10/26/2016 revised Revised 10/28/2016 Page 5 of 5 Hello