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Commissioner Approved Fee Schedule - FY 2020-21 Attachment 4 <br />* Any fee changes will be included in this column; <br />a blank beside each fee means there is no fee change in FY 2020-21 Commissioner Approved Fee Schedule <br />Department/Program Description Current Fee <br />Commissioner Approved <br />Fee Change for <br />FY 2020-21* <br />Last <br />Revision <br />90700 <br />Diphteria, tetanus toxoids, and acellular pertussis <br />vaccine (DTaP), for 7 years or younger - <br />DAPTACEL 2019 <br />Medicaid only <br />90700SL <br />Diphteria, tetanus toxoids, and acellular pertussis <br />vaccine (DTaP), for 7 years or younger - <br />DAPTACEL $0.00 2019 <br />90700 <br />Diphteria, tetanus toxoids, and acellular pertussis <br />vaccine (DTaP), for 7 years or younger - <br />INFANRIX $32.00 2018 <br />Medicaid only <br />90700SL <br />Diphteria, tetanus toxoids, and acellular pertussis <br />vaccine (DTaP), for 7 years or younger - <br />INFANRIX $0.00 2019 <br />90707 Measles, mumps, and rubella virus vaccine <br />(MMR), live - M-M-R II $101.00 2019 <br />Medicaid only 90707SL Measles, mumps, and rubella virus vaccine <br />(MMR), live - M-M-R II $0.00 2019 <br />90710 Measles, mumps, and rubella AND varicella <br />virus vaccine, live-PROQUAD $0.00 $260.00 New <br />90713 Poliovirus vaccine (IPV), inactivated - IPOL $34.00 2019 <br />Medicaid only 90713SL Poliovirus vaccine (IPV), inactivated - IPOL $0.00 2019 <br />67