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HomeMy WebLinkAboutC.054.93011_1233 (2)14 FEES FY 2004- FEES FY 2005- CPT CODE SERVICE DESCRIPTION 2005 2006 Immunizations/Injections 90782 Therapeutic/diag. Admin. Fee $10.00 $18.00 $26.00 $8.00 90471 Admin. single vaccine $8.00 $8.00 $10.00 $2.00 Admin. single vaccine (Medicaid 90471 EP VFC) $20.00 $20.00 $28.00 $8.00 90472 Admin. 2+ vaccines $5.00/each $5.00/each $5.00 $0.00 90788 Admin. antibiotics $23.00 $23.00 $28.00 $5.00 90384 RHO Gam $111.00 $111.00 $119.00 $8.00 J1055 Depo-Provera $45.00 $54.00 $54.00 $0.00 90636 Tvdnrix - Hep A & B 8/14/2004 $60.00 $60.00 $60.00 $0.00 90716 Adult Varicella $62.00 $67.00 $70.00 $3.00 90707 Adult MMR $40.00 $42.00 $45.00 $3.00 90733 Adult Meningitis $73.00 $87.00 $89.00 $2.00 90734 Menactra New Vaccine $83.00 $89.00 $6.00 90746 Adult Hepatitis B $64.00 $64.00 $64.00 $0.00 90632 Adult Hepatitis A $58.00 $67.00 $67.00 $0.00 90633 Ped/Adoi. Hepatitis A $30.00 $30.00 $30.00 $0.00 90658 Influenza Vaccine $10.00 $12.00 $15.00 $3.00 90657 Influenza Vaccine (1/2 dose) $10.00 $12.00 $15.00 $3.00 90732 Pneumonia Vaccine $19.00 $21.00 $22.00 $1.00 86580 PPD (TB Skin Test) $19.00 $19.00 $21.00 $2.00 90669 Prevnar- private stock $71.00 $71.00 $72.00 $1.00 90713 Polio - private stock $27.00 $27.00 $28.00 $1.00 Miscellaneous C9983/LU Pill Replacement $7.00 $7.00 $7.00_ $0.00_- S9445" MOW (billable in units) $17.00 $17.00 Discontinued T1016" Child Service Coordination $21.00 $22.00 $22.00 $0.00 T1017" MCC (billable in units) $30.00 $30.00 $30.00 $0.00 99501 Postpartum Home visit - Mom $60.00 $60.00 $60.00 $0.00 99502 Newborn Assessment - Infant $60.00 $60.00 $60.00 $0.00 RN services (TB /STD T1002'• billable in units) $20.00 $20.00 $20.00 $0.00 Health Choice PAY03 Co- Pay 3.00 $3.00 0.00 Health Choice PAY05 Co- Pay $5.00 $5.00 $0.00 Health Choice PAY70 Co-Pay $10.00 $10.00 __,$0.00 Compiet�aiofAw Rai o' i of=TB Screen - LU102 -'bHH3-3405 . _ _fl __-- _-- $10.00. 110.00 14