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Commissioner Approved Fee Schedule - FY 2019-20 <br />* Any fee changes will be included in this column; <br />a blank beside each fee means there is no fee change in FY 2019-20 Commissioner Approved Fee Schedule <br />Department/Program Description Current Fee <br />Commissioner Approved <br />Fee Change for <br />FY 2019-20* <br />Last <br />Revision <br />90658 Influenza Split 3yr and Above $15.00 Delete fee 2012 <br />90660 Influenza Virus Vaccine Live for Intranasal $23.00 Delete fee 2012 <br />90662 Influenza vaccine (IIV3-HD), for 65 years of age <br />and up - FLUZONE HIGH DOSE $40.00 $53.00 2019 <br />90669 Prevnar (PCV7) -Pneumococcal Vaccine $116.00 Delete fee 2009 <br />90670 Pneumococcal conjugate vaccine, 13 valent <br />(PCV13) - PREVNAR 13 $167.00 $217.00 2019 <br />Medicaid only 90670SL Pneumococcal conjugate vaccine, 13 valent <br />(PCV13) - PREVNAR 13 $0.00 2019 <br />90672 Intranasal - live quadrivalent influenza vaccine $26.00 Delete fee 2015 <br />Medicaid only 90672SL Intranasal - live quadrivalent influenza vaccine $0.00 Delete fee 2016 <br />90675 Rabies Vaccine - IMOVAX RABIES 313.33 (per shot)$357.00 2019 <br />90680 Rotavirus vaccine, pentavalent (RV5), 3 dose - <br />ROTATEQ $99.00 $113.00 2019 <br />Medicaid only 90680SL Rotavirus vaccine, pentavalent (RV5), 3 dose - <br />ROTATEQ $0.00 2019 <br />90681 Rotavirus vaccine, human, attenuated (RV1), live, <br />oral, 2 dose - ROTARIX $124.00 $138.00 2019 <br />Medicaid only 90681SL Rotavirus vaccine, human, attenuated (RV1), live, <br />oral, 2 dose - ROTARIX $0.00 2019 <br />65