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INDIAN RIVER COUNTY HEALTH DEPARTMENT <br /> 'FEE SCHEDULE <br /> CY 12-13 <br /> P urea ina U d in00 - Fee <br /> 58301 IUD Removal $0.00 $ 10.20 $19.80 $30. 00 $40.20 $49. 80 $60.00 $60.0 <br /> 11765 Ingrown Toenail Treatment $0. 00 $8. 50 $16. 50 $25.00 $33.50 $41 . 50 $50.00 $50. 0 <br /> 17000 Wart Treatment - First $0.00 $5.95 $11 . 55 $ 17. 50 $23.45 $29.05 $35. 00 $35.0 <br /> 17003 Wart Treatment - Each additional wart $0.00 $1 .02 $1 . 98 $3.00 $4.02 $4.98 $6.00 $6.0 <br /> 10060 Incision and Drainage $0.00 $9.35 $ 18. 15 $27.50 $36. 85 $45.65 $55.00 $55. 0 <br /> 94640 Respiratory Treatment * $0.00 $ 1 . 70 $3. 30 $5.00 $6. 70 $8. 30 $10. 00 $ 10.0 <br /> 93000 EKG $0.00 $5. 10 $9.90 $15.00 $20. 10 $24. 90 $30. 00 $30.0 <br /> * There is an additional charge for medication <br /> FewCY 12-13 <br /> ro set 1* ° - 33 C Q 83 0 Fee <br /> 71020 Chest X-Ray $0.00 $9.35 $18. 15 $27.50 $36.85 $45.65 $55.00 $55. 0 N/A <br /> Tubal Li ation Under contract with Indian River Medical Center <br /> Vasectomy G con <br /> Nutritional Counseling - per hour $0.00 $5.95 $11 .55 $17. 50 $23,451 $29.05 $35. 00 $35. 0 <br /> TB Quantiferon - GOLD Test $40.00 <br /> TST Evaluation * (Prepayment) Jil $5,001 $5.0 <br /> TST placement111 15. 00 $15. 0 <br /> * Unless included in Physical or Office Visit. If it is part of an EPI investigation , there will be no charge and should be indicated <br /> as such on the Client encounter form. <br /> Insurance will be billed if insurance information is available. <br /> Any additional Will fees 1 mediGal presedures will" be Ghaill at Medisaid rates plus 26 <br /> 0 <br /> Page 3 of 9 <br />