PERSONAL HEALTH SERVICES FY-2010

 VISIT

A
Donation

B
20%

C
40%

D
60%

E
80%

F
100%

Comprehensive (physician visit)

-

36

72

108

144

180

Detailed, new

-

33

66

99

132

165

Detailed, established

-

30

60

90

120

150

Office Visit, expanded

-

18

36

54

72

90

Office Visit, detailed/problem

-

14

28

42

56

70

Office Visit, brief (≥ 15 min)

-

8

16

24

32

40

Office Visit, minimal (< 15 min)

-

6

12

18

24

30

Case Management*

-

40

80

120

160

200

Crisis Care* (15 min/unit)

-

2

4

6

8

10

Dental Observation - brief exam

-

6

12

18

24

30

Nutrition Counseling/hour**

-

12

24

36

48

60

 * Case Management and Crisis Care: Used for EPSDT only.
    Fee established for average time spent per client.
 ** Nutrition Counseling: $60/hour, to be billed in 1/2 hour increments.

 PROCEDURE

A
Donation

B
20%

C
40%

D
60%

E
80%

F
100%

HPV Test Lab Fees

      Current cost: $45 - no slide

Hemoglobin/Hematocrit

-

4

8

12

16

20

IUD Insert***

-

30

60

90

120

150

IUD Removal***

-

18

36

54

72

90

Norplant/Implanon Insert***

-

30

60

90

120

150

Norplant/Implanon Removal***

-

30

60

90

120

150

HIV rapid testing
- includes $10 test kit - no slide

10

14

18

22

26

30

PPD Skin Test
- Tubersol, minimal visit

-

3

6

10

13

16

Pregnancy Test
- brief/minimal visit, kit

-

4

8

12

16

20

UA/Tape Test

-

4

8

12

16

20

Venipuncture

-

4

8

12

16

20

Wet Mount

-

4

8

12

16

20

External Lab Fees
              Liquid Pap
              DNA

 
    Current cost: $14 - no slide
    Current cost: $44 - no slide

Sealant (per tooth)

-

6

12

18

24

30

Topical Fluoride - Child

-

4

8

12

16

20

 ***IUD and Norplant/Implanon insert/removal: Surgical procedure
     (billed alone with no associated office visit code).

 SUPPLY

A
Donation

B
20%

C
40%

D
60%

E
80%

F
100%

HIV Rapid Test Kit

Current cost: $11 & $14 - no slide

 PHARMACEUTICAL

A
Donation

B
20%

C
40%

D
60%

E
80%

F
100%

CONTRACEPTIVE METHOD (New Category)

Oral Contraceptives

-

1

2

4

5

6

Diaphragm

-

4

8

11

15

19

Emergency Contraceptives

-

2

4

5

7

9

Condoms

-

1

1

2

2

3

IUD Paraguard

-

40

80

120

160

200

Thermometer Book

-

4

7

11

14

18

Cycle Beads

-

1

3

4

6

7

Jelly/Cream

-

2

4

5

7

9

Foam

-

1

2

4

5

6

DMPA (Depo Provera)

-

2

4

6

8

10

Pregnancy Test Kit

-

1

2

4

5

6

IUD Mirena

-

75

150

225

300

375

IUD from a Foundation

-

1

2

3

4

5

Patch

-

5

10

14

19

24

Nuvaring

-

10

20

30

40

50

OTHER MEDICATION (New Category)

Bicillin

Current cost: $13 - no slide

Doxycyclin

Current cost: $5 - no slide

Flagyl

Current cost: $5 - no slide

Rocephin

Current cost: $6 - no slide

Zithromax

Current cost: $5 - no slide

IMMUNIZATION SERVICES FY-2010

Clients are assessed fee for vaccine administration plus current cost of vaccine to public health.

VACCINE ADMINISTRATION
 & OTHER CLINICAL SERVICES

One injection +

14

Two injections +

26

Three or more injections +

36

PPD Skin Test (plus minimal visit)

16

Venipuncture (plus brief visit)

20

Brief visit ( 15 minutes)

40

Minimal visit (< 15 minutes)

30

 + Add vaccine charge as indicated. Also, add brief/minimal visit charge if additional questions and/or counseling (especially for DIM/OSI), and for all PPD skin tests requiring follow-up reading by SCPHD, except in outbreak/epi investigations where visit and injection charge is noted by discounted to 0.

 ADULT VACCINE (District Purchased)

 COST  7-1-2009

ATDP (Adacel)

32

Gamma Globulin

36

Hepatitis A

20

Hepatitis B

26

Hepatitis A/B Combo - (Twinrix)

43

HIB

17

HPV

130

Influenza - FluMist Nasal Spray

15

Influenza - Injection

8

IPV > 19 years (polio)

23

Menactra

99

Menomune

100

MMR

44

Pneumonia

29

TD

19

Typhim VI

40

Tubersol

3

Typhoid - Oral

35

Varicella

81

Yellow Fever

74

Zostavax

154

 CHILDREN'S VACCINE (District Purchased)

 COST  7-1-2009

DTAP

22

Hepatitis A

15

Hepatitis B

11

Hepatitis A/B Combo (Twinrix)

43

HIB

17

HPV

130

IPV (polio)

23

Menactra

99

MMR

44

Pentacil

73

Prevnar

84

Rotavirus

69

TD

19

TDAP

35

Varicella

81

ENVIRONMENTAL HEALTH SERVICES FY-2010
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 Sewage Disposal Services

Fee

Planning & Zoning Letter

25

Site Survey

150

Renewal Permit

50

Inspection - Basic System

400

Inspection - Basic System, Community

400 *

Inspection - Basic System, Replacement

200

Inspection - Complex System

600

Inspection - Complex System, Community

600 *

Inspection - Complex System, Replacement

300

Installer License - Basic

60

Installer License - Complex

120

Installer Class (per person - full day)

25

Pumper License

60

Pumper Inspection (per truck)

10

 Mortgage Survey Services

Fee

Inspection - septic and well

200

Inspection - well repeat

75

 Land Development Services

Fee

Land Division - Planning & Zoning Letter

25

Subdivision Application - City Services

50

Subdivision Application (1-99 lots)
      - septic and well (per lot)
      - preliminary /site survey (per lot)

140 **
 35

Subdivision Application (100+ lots)
      - septic and well (per lot)
      - preliminary /site survey (per lot)

130 **
 32.50

 Swimming Pool Services

Fee

Pool License Inspection

50

Pool Operators Class (per person - full day)

25

Pool Plans Review

100

 Child Care Program Services

Fee

Inspection - new

35

Inspection - existing

30

 Food Control Services

Fee

Food Handlers Class (per person - half day)

15

Inspections (per establishment)

          Temporary / Intermittent / Mobile

          Mobile with Commissary

          Regular

          Multiple Units

65

75

95

107.50

Inspection - 2^nd inspection for schools

120

Plans Review - Small

100

Plans Review - Large

200

Other Services

Fee

Consultation

60 ***

Refund Application Processing Fee

25

 * Add $30/each additional connection or 250 gallons.
 ** Preliminary application fee will be applied as a reduction to the final application payment.
 *** $60/hour to be billed in ½ hour increments.

OTHER COMMUNITY SERVICES FY-2010

 Vital Statistic Documents

Fee

Local Issuance

17 per copy*

Local Issuance - Replacement

17 first copy*

Local Issuance - Replacement, additional copies

6 per copy**

Veteran's copy

No fee

 *Includes Department of Health & Welfare portion of $13 and District handling of $4.
 **Includes Department of Health & Welfare portion of $2 and District handling of $4.