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Orange County Commissioner Approved Fee Schedule - FY 2013 -14 43 <br />Department/Program <br />Description <br />Current Fee <br />\` \ <br />Last <br />Revision <br />Preventive/Estab Pt 5-11 yrs. <br />$200.00 <br />2012 <br />Preventive/Estab Pt 12 -17 yrs. <br />$205.00 <br />2012 <br />Preventive/Estab Pt 18 -39 yrs. <br />$225.00 <br />2012 <br />Preventive/Estab Pt 40 -64 yrs. <br />$220.00 <br />2012 <br />Preventive/Estab Pt 65+ yrs. <br />$212.00 <br />2009 <br />Home Visit for Postnatal Assmt & F/U Care <br />$200.00 <br />2012 <br />Home Visit for Newborn Care & Assessment <br />$200.00 <br />2012 <br />Newborn EPSDT Screen Home -Visit <br />$50.00 <br />2008 <br />Health Risk Appraisal <br />$12.00 <br />2004 <br />Oral Evaluation G3 yrs with counseling <br />$55.00 <br />2012 <br />Topical Fluoride Appl <br />$47.00 <br />2012 <br />Adm of Influenza Vaccine <br />$18.00 <br />2009 <br />Adm ofPneumococcal Vaccine <br />$18.00 <br />2009 <br />Behavioral Health Counseling & Therapy <br />$120.00 <br />2012 <br />Mental Health Assessment <br />$120.00 <br />2012 <br />Ceftriaxone Sodium/Rocephin per 250mg <br />$22.00 <br />2007 <br />Depo Provera Injection <br />$40.00 <br />2012 <br />Diphenhydramine HCUBenadryl up to 50mg <br />$6.00 <br />2007 <br />Promethazine _ mg <br />$8.00 <br />2007 <br />B -12 Injection <br />$6.00 <br />2007 <br />Mirena IUD <br />$480.00 <br />2012 <br />Sports Physical <br />$44.00 <br />2008 <br />Camp Physical <br />$44.00 <br />2008 <br />College Physical <br />$44.00 <br />2008 <br />I -693 Form Completion <br />$25.00 <br />2012 <br />RN Services up to 15 min. <br />$21.00 <br />2007 <br />Child Service Coordination <br />$21.74 <br />2005 <br />Maternity Care Coordination <br />$29.30 <br />2005 <br />Maternal Skilled HV <br />$88.00 <br />2005 <br />Birthing Classes (S9442) (9) <br />N/A <br />New <br />Education Classes <br />$30.00/hr <br />2004 <br />Consultant Services (Health Educators) <br />$20.00 /hr <br />2004 <br />Intermediate <br />$10.66 <br />2012 <br />Tobacco Use Cessation Counseling - Intensive <br />$22.10 <br />2012 <br />Patient Education (non Physician) <br />$35 /unit <br />2010 <br />Amylase (UNC Rate) <br />$9.00 <br />2006 <br />RMSF (Convalescent) (UNC Rate) <br />$27.00 <br />2006 <br />Therapeutic prophylactic /diagnostic injection <br />$23.00 <br />2007 <br />Ther/Proph/Diag/SC/IM <br />$60.00 <br />2012 <br />ANA (anti - nuclear antibody) titer (UNC Rat <br />$16.00 <br />2006 <br />Confirmation, if ANA+ (UNC Rate) <br />$15.00 <br />2006 <br />Paracervical Block <br />$176.00 <br />2009 <br />Lipase (UNC Rate) <br />Isq.00 <br />2006 <br />*Any fee changes wi I I be included in this column; <br />a bl ank besi de each f ee means there i s no f ee change i n FY 2013 -14 Comm i ssi oner Approved Fee Schedule <br />