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67 <br /> Commissioner Approved <br /> Fee Changes for Last <br /> Department/Program Description Current Fee FY 2021-22* Revision <br /> 90746 Hepatitis B vaccine(Hep B),adult dosage- <br /> ENGERIX-B $67.00 2019 <br /> 90746SL Hepatitis B vaccine(Hep B),adult dosage- <br /> Medicaid only ENGERIX-B $0.00 2019 <br /> 90739 Hepatitis B vaccine(Hep B),adult dosage,2 dose- <br /> HEPLISAV $132.00 2019 <br /> 90739SL Hepatitis B vaccine(Hep B),adult dosage,2 dose- <br /> HEPLISAV $0.00 2019 <br /> 90750 Zoster Vaccine recombinant,adjuvanted,50 years <br /> or older-SHINGRIX $166.00 2019 <br /> 90750SL Zoster Vaccine recombinant,adjuvanted,50 years <br /> Medicaid only or older-SHINGRIX $0.00 2019 <br /> 90772 Therapeutic prophylactic/diagonostic injection $23.00 2008 <br /> 90846 Psychotherapy,Family,w/o Patient $95.00 2009 <br /> 90847 Psychotherapy,Family,(Conjoint)W/Pt Present $115.00 2009 <br /> 90853 Psychotherapy,Group $32.00 2009 <br /> 92551 Audiometry $18.00 2008 <br /> 92587 OAE(Limited) $100.00 2012 <br /> 93000 Electrocardiogram,Complete $33.00 2009 <br /> 93005 Electrocardiogram,Tracing Only $22.00 2009 <br /> 94150 Peak Flow $3.25 2018 <br /> 94640 Airway Inhalation Treatment $22.00 2009 <br /> 94664 Aerosol Inhalation Treatment-Teaching $22.00 2009 <br /> 94760 Pulse Oxygen $8.00 2009 <br /> 96110 Developmental Test $23.00 2012 <br /> 96125 ASQ-Developmental $78.38 2018 <br /> 96127 Social-emotional Screens $6.00 2017 <br /> 96152 Health&Behavior Intervention $55.00 2015 <br /> 96160 Adolescent Risk&Strength Screening $9.20 2017 <br /> 96161 Maternal Depression Screening $9.20 2017 <br /> 96372 Ther/Proph/Diag inj/SC/IM $60.00 2012 <br /> 97802 Medical Nutrition Therapy/Initial 15 min.Unit $34.00 2015 <br /> 97803 Medical Nutrition Therapy/Re-Assess 15 min.Unit $34.00 2016 <br /> 97804 Medical Nutrition Therapy-Group(2 or more) $15.00 2011 <br /> 97804ud MDPP Fee $25.00 2017 <br />