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INDIAN RIVER COUNTY HEALTH DEPARTMENT <br /> FEE SCH <br /> t r 3qt, d u 4w ..:Nur e - s t. Wee <br /> 4 � � .� w t t,' ^ * 7 t.., .u1..� , �?rt:,, % F 63 z Fr 40/0 G'58301 IUD Removal $0.00 $10.20 $19.80 <br /> $30.0011765 Ingrown Toenail Treatment $0.00 $8.50 $16.50 $25.00 $39.50 $41.20 1.50.80 $50.00$50.0017000 Wart Treatment-First $0.00 $5.95 <br /> $11.55 $17.50 $23.45 $29.05 $35.17003 Wart Treatment-Each additional wart $0.00 $1.02 $1.98 $3.00 $402 $10060 Incision and Drainage $0.00 $9.35 <br /> $18.15 $27.50 $36.85 $45.65 $55.0094640 Respiratory Treatment* $0.00 $1.70 $3.30 $5.00 $6.70 8.30 $10.0093000 EKG $0.00 $5.10 $9.90 $15.00 <br />$2010 $24.90 $30.00 <br /> *There is an additional charge for medication <br /> CY 12-13 <br /> Fee <br /> 71020 Chest X-Ra $0.00 $9.35 $18.15 $27.50 <br /> $36.85 $45.65[ 5.001 $55.0 N/A <br /> Tubal Ligation Under contract with Indian River Medical Center <br /> -90 YAWAW <br /> Vasectomy 4 - a *616 <br /> Nutritional Counseling-per hour $0.00 $5.95] $11.551 $17.501 $23.451 $29.051 $35.00 $35.0 <br /> TB Quantiferon-GOLD Test $40.00 <br /> TST Evaluation* (Prepayment) O SL DI F� s' , <br /> t. $5.00 $5.0 <br /> TST placement* �.O SL h!�._. { .i, ;, 14,. 1 $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 as such on the Client encounter form. <br /> Insurance will be billed if insurance information is available. <br /> -Any additienal slin+^rfees 1 mediGal PFGGedWes will be GhaFged at Medioald rates plus 26a <br /> a <br />�A) Page 3 of 9 <br />