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INDIAN RR/ER COUNTY HEALTH DEPARTMENT FEE SCHEDULE - Procedures with set charges 0%-A 17%- B 33%- C 50%- D 67%- E 83%- F 100%- G CY 18-19 Fee 71020 Chest X -Ray $0.00 $9.35 $18.15 $27.50 $36.85 $45.65 $55.00 NO CHANGE Tubal Ugation Current contracted rate 17%-B NO CHANGE Vasectomy Current contracted rate 83%- F NO CHANGE Nutritional Counseling - per hour $0.00 $5.95 $11.55 $17.50 $23.45 529.05 $35.00 NO CHANGE TO Quantfferon-GOLD Test NO SLIDING FEE $40.00 NO CHANGE TST Evaluation • (Prepayment) NO SLIDING FEE $5.00 CHANGE placement 0 NO SLIDING FEE $15 00 CO CHANGE • 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 fora: Insurance will be billed If insurance information is available. Per CDC guidelines, vaccine for childhood Immunizations are covered under the Vaccine for Children Program and are provided at no cost to children age 0-18. Charges for communicable disease control issues will be waived with authorization. CY 18-19 Fee IMMUNIZATIONS Travel Immunizations (Sliding Fee Scale does not apply -- Per Injection) Travel Immunization Consult Visit $40.00 UPDATE old ($35.00) 4dministration Fee - 90471 1st shot 0%-A 17%-B 33%-C 50%-D ,,67%-E 83%- F 100%-G CY 18-19 Fee renza $0.00 $4.25 $8.25 $12.50 $16.75 $20.75 $25.00 NO CHANGE umococcal Pneumonia $0.00 $15.76 $30.60 $46.37 $62.13 $76.97 $92.73 NO CHANGE vac (Tetanus -Td) $0.00 $8.58 $16.65 $25.23 $33.30 $41.87 $50.45 O CHANGE cel (Tdap) $0.00 $8.92 $17.31 $26.23 $35.14 $43.53 $52.45 O CHANGE cted Polio Vaccine $0.00 $7.72 $14.99 $22.71 $30.43 $37.70 $45.42 O CHANGE tingotoccal $0.00 $21.02 $40.80 $6182 $8Z.83 $102.61 $123.63 O CHANGE fes Vaccine (per injection) $0.00 $S1A7 $99.91 $151.38 $202.84 $251.28 $302.75 O CHANGE Rabies Imm Globulin - Per 2cc Mal $0.00 $106.78 $207.29 $314.07 $420.35 $521.36 $628.14 O CHANGE atitis A Vaccine (per Injection) $0.00 $3.65 $16.80 $25.46 $34.11 $42.26 $50.91 O CHANGE atitis B Vaccine (per in)ection) $0.00 $9.53 $18.50 $23.04 $3757 $46.54 $56.07 O CHANGE nrbt -Hep A & B (per injection) $0.00 $13A7 $26.14 $39.61 $53.08 $65.75 $79.22 O CHANGE igles Vaccine-2ostavax $205.22 O CHANGE Basil (Cervical Cancer Vaccine) $0.00 $30.69 $59.53 $90.27 $120.96 $149.35 $180.54 O CHANGE Per CDC guidelines, vaccine for childhood Immunizations are covered under the Vaccine for Children Program and are provided at no cost to children age 0-18. Charges for communicable disease control issues will be waived with authorization. Paye 3 of 7 711111=18 CY 18-19 Fee Travel Immunizations (Sliding Fee Scale does not apply -- Per Injection) Travel Immunization Consult Visit $40.00 UPDATE old ($35.00) 4dministration Fee - 90471 1st shot $20.00 NO CHANGE 1ldministration Fee, additional shot - 90472 $5.00 NO CHANGE Hepatitis B Vaccine $56.07 NO CHANGE Hepatitis B Vaccine - Children $35.72 NO CHANGE All vaccines eq cost Hep B Immune Globulin* per ml $163.20 NO CHANGE plus $20.00 (as sbn leftt will Hepatitis A Vaccine $50.91 NO CHANGE ter Hepatitis A Vaccine - Children $40.45 NO CHANGE Hep A Immune Globulin* per 2 ml dose $88.88 NO CHANGE rwinrix (HepA & B) $79.22 NO CHANGE Meningococcal 123.63 NO CHANGE rinivac (Tetanus -Td) $50.45 NO CHANGE Measles/Mumps/Rubella $78.21 NO CHANGE Varivax (Chicken Pox) 121.ZZ NO CHANGE Itdacel (Tdap)• 52.45 NO CHANGE ryphoid (injection) $77.34 NO CHANGE (oral is also available - check for pricing) fellow Few 5138.39 NO CHANGE 4CTHIB (Tetanus Toxoid Conjugate) $41.10 _ NO CHANGE PREVNAR (Pneumococcal 13 VALCor+DIP) $174.82 NO CHANGE Recombivax HB (Hep B - HI Dose) $176.06 NO CHANGE 'As available Paye 3 of 7 711111=18