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Commissioner Approved Fee Schedule - FY 2018-19 <br />* Any fee changes will be included in this column; <br />a blank beside each fee means there is no fee change in FY 2018-19 Commissioner Approved Fee Schedule <br />Department/Program Description Current Fee <br />Commissioner Approved <br />Fee Change for <br />FY 2018-19* <br />Last <br />Revision <br />90672 Irtranasal administration of live quadrivalent <br />infuenza vaccine $26.00 2015 <br />90675 Rabies (IM)$288.00 $313.33 2016 <br />90676 Rabies vaccine, for intradermal use $212.00 2015 <br />90680 Rotateq (Rotavirus Vaccine)$99.00 2009 <br />90681 Rotarix $124.00 2015 <br />90685 Influenza vac quadrivalent prsrv free 6-35 mo IM $16.00 2015 <br />90686 Influenza vac 4 valent prsrv free 3 yrs plus IM $18.00 2015 <br />90696 Kinrix (DTaP/IPV)$52.00 2012 <br />90698 Pentacel (DTaP/IPV/Hlb)$95.00 2015 <br />90700 Dtap Vaccine (Pediatric) Self Pay $32.00 2012 <br />90702 Diptheria tetanus toxoid absorbed > 7 yr IM $40.00 2015 <br />90707 Adult MMR $66.00 2015 <br />90713 Inactived Polio Vaccine (IPV)$31.00 2009 <br />90714 Td (pres. Free)$35.00 2015 <br />90715 Tdap Vaccine $39.49 2014 <br />90716 Varicella vaccine $111.00 2015 <br />90723 Pediarix (D TaP/Hep B/IPV $91.00 2015 <br />90732 Immunization: Pneumococcal - State $80.00 2015 <br />90733 Meningococcal Vaccine, Subcutaneous/Jet $100.00 2008 <br />90734 Menactra Meningococcal Vaccine $127.00 2015 <br />90736 Zostavax vaccine $207.00 2015 <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 <br />61