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INDIAN RIVER COUNTY HEALTH DEPARTMENT
<br /> FEE SCHEDULE --Effective Nov.01,2006
<br /> Procedures not included in office visit 0%-A 17% -B 33%-C 50%-D 67%-E 83% - F 100% -G COST
<br /> 58300 IUD Insertion $0.00 $9.35 $18.15 $27.50 $36.85 $45.65 $55.00 $55.00
<br /> 58301 IUD Removal $0.00 $10.20 $19.80 $30.00 $40.20 $49.80 $60.00 $60.00
<br /> 11975 IMPLANTABLE CONTRA INSERTION $0.00 $21.25 $41.25 $62.50 $83.75 $103.75 $125.00 $125.00
<br /> 11976 IMPLANTABLE CONTRA REMOVAL $0.00 $21.25 $41.25 $62.50 $83.75 $103.75 $125.00 $125.00
<br /> 11977 REMOVAUINSERTION $0.00 $32.30 $62.70 $95.00 $127.30 $157.70 $190.00 $190.00
<br /> 11765 Ingrown Toenail Treatment $0.00 $6.80 $13.20 $20.00 $26.80 $33.20 $40.00 $40.00
<br /> 17000 Wart Treatment- First $0.00 $5.95 $11.55 $17.50 $23.45 $29.05 $35.00 $35.00
<br /> 17003 Wart Treatment-Second- 14 $0.00 $1.02 $1.98 $3.00 $4.02 $4.98 $6.00 $6.00
<br /> 10060 Incision and Drainage $0.00 $9.35 $18.15 $27.50 $36.85 $45.65 $55.00 $55.00
<br /> 94640 Respiratory Treatment $0.00 $1.36 $2.64 $4.00 $5.36 $6.64 $8.00 $8.00
<br /> 57170 Diaphragm Fitting $0.00 $9.35 $18.15 $27.50 $36.85 $45.65 $55.00 $55.00
<br /> 57454 Colposcopy(with biopsy) $0.00 $8.50 $16.50 $25.00 $33.50 $41.50 $50.00 $50.00
<br /> 57452 Colposcopy(without biopsy) $0.00 $6.80 $13.20 $20.00 $26.80 $33.20 $40.00 $40.00
<br /> 93000 EKG $0.00 $5.10 $9.90 $15.00 $20.10 $24.90 $30.00 30.00
<br /> Procedures with set charges 0%-A 17%-B 33%-C 50%-D 67%-E 83%- F 100%-G COST
<br /> 71020 Chest X-Ray $0.00 $9.35 $18.15 $27.50 $36.85 $45.65 $55.00 $55.00
<br /> Tubal Ligation
<br /> Surgical $1,000.00 $1,000.00 $1,000.00 $1,000.00 $1,000.00 $1,000.00 $1,000.00 $1,000.00
<br /> Band or Clip $1,000.00 $1,000.00 $1,000.00 $1,000.00 $1,000.00 $1,000.00 $1,000.00 $1,000.00
<br /> Postpartum $1,000.00 $1,000.00 $1,000.00 $1,000.00 $1,000.00 $1,000.00' $1,000.00 $1,000.00
<br /> Post Cesarean $1,000.00 $1,000.00 $1,000.00 $1,000.00 $1,000.00 $1,000.00 $1,000.00 $1,000.00
<br /> Inpatient Per Diem $1,000.00 $1,000.00 $1,000.00 $1,000.00 $1,000.00 $1,000.00 $1,000.00 $1,000.00
<br /> Outpatient Fee $1,000.00 $1,000.00 $1,000.00 $1,000.00 $1,000.00 $1,000.00 $1,000.00 $1,000.00
<br /> Vasectomy $300.00 $300.00 $300.00 $300.00 $300.00 $30.00 $300.00 $300.00
<br /> Nutritional Counseling-per hour $0.00 $5.95 $11.55 $17.50 $23.45 $29.05 $35.00 $35.00
<br /> TST Eval and placement if req $0.00 $1.70 $3.30 $5.00 $6.70 $8.30 $10.00 $10.00
<br /> 10/23/2006CLFEE2006-07 Page 2 of 11
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