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Page 4 of 6 <br />CPT Code Description Current Fee <br />Requested Fee <br />Change for FY <br />2015-16 <br />Last <br />Revision <br />ORANGE COUNTY HEALTH DEPARTMENT FEE SCHEDULE <br />PERSONAL HEALTH SERVICES + NUTRITION <br />90473 Immunization Adm. - Intranasal/Oral $13.71 2014 <br />90474 Immunization Adm. - Intranasal/Oral Additional $13.71 2014 <br />90620 Meningococcal Group B (Bexsero)New $177.00 <br />90621 Meningococcal Group B (Trumenba)New $248.00 <br />90632 Hep A - Adult $45.00 2012 <br />90633 Hep A (Ped/Adol)$25.00 2010 <br />90636 Twinrix New $102.00 <br />90647 PedVaxHIS Self Pay $40.00 2012 <br />90648 HIB Vaccine $26.00 2012 <br />90649 Gardasil $136.00 $162.00 2012 <br />90651 HPV 9 (Gardasil 9)New $180.00 <br />90654 Intradermal flu vaccine $20.00 2012 <br />90655 Preservative free influenza vaccine 6-35 mo $16 $17.00 2011 <br />90656 Preservative free influenza vaccine $18.00 2012 <br />90657 Influenza Split 6-35 mo.$14.00 2009 <br />90658 Influenza Split 3yr and Above $15.00 2012 <br />90660 Influenza Virus Vaccine Live for Intranasal $23.00 2012 <br />90662 Influenza - high dose (65+)$40.00 2012 <br />90669 Prevnar (PCV7) -Pneumococcal Vaccine $116.00 2009 <br />90670 Prevnar (PCV13) -Pneumococcal Vaccine $130.00 $167.00 2012 <br />90672 Intranasal administration of live quadrivalent <br />influenza vaccine New $26.00 <br />90675 Rabies (IM)$237.00 $269.00 2009 <br />90676 Rabies vaccine, for intradermal use New $212.00 <br />90680 Rotateq (Rotavirus Vaccine)$99.00 2009 <br />90681 Rotarix New $124.00 <br />90685 Influenza vac quadrivalent prsrv free 6-35 mo IM New $16.00 <br />90686 Influenza vac 4 valent prsrv free 3 yrs plus IM New $18.00 <br />90696 Kinrix (DTaP/IPV)$52.00 2012 <br />90698 Pentacel (DTaP/IPV/Hlb)New $95.00 <br />90700 Dtap Vaccine (Pediatric) Self Pay $32.00 2012 <br />90702 Diptheria tetanus toxoid absorbed>7yr IM New $40.00 <br />90707 Adult MMR $56.00 $66.00 2009 <br />90713 Inactived Polio Vaccine (IPV)$31.00 2009 <br />90714 Td (pres. free)New $35.00 <br />90715 Tdap Vaccine $39.49 2014 <br />90716 Varicella vaccine $89.00 $111.00 2008 <br />90723 Pediarix (DTaP/Hep B/IPV)New $91.00 <br />90732 Immunization: Pneumococcal - State $65.00 $80.00 2012 <br />90733 Meningococcal Vaccine, Subcutaneous/Jet $100.00 2008 <br />90734 Menactra Meningococcal Vaccine $106.87 $127.00 2014 <br />90736 Zostavax vaccine $179.00 $207.00 2007 <br />90744 Pediatric Hep B Vaccine Self Pay $30.00 2012 <br />90746 Immunization: Hep B (20+ yrs)$58.00 2007 <br />90760 IV Infusion Up to One Hour $140.00 2007 <br />90772 Therapeutic prophylactic/diagonostic injection $23.00 2008 <br />90801 Psychiatric Diagnostic Interview Exam $151.00 2008 <br />90802 Psychiatric Diag Interview Exam, Interactive $161.00 2009 <br />90804 Psychother, Indiv, Insight, 20-30 min.$65.00 2009 <br />90806 Psychother, Indiv, Insight, 45-50 min.$97.00 2007 <br />90808 Psychother, Indiv, Insight, 75-80 min.$146.00 2008 <br />90810 Psychother, Indiv, Interac, 20-30 min.$70.00 2007 <br />90812 Psychother, Indiv, Interac, 45-50 min.$103.00 2009 <br />90814 Psychother, Indiv, Interac, 75-80 min.$152.00 2009 <br />90846 Psychotherapy, Family, w/o Patient $95.00 2009 <br />90847 Psychotherapy, Family, (Conjoint) W/Pt Present $115.00 2009