|
Manager Recommended Fee Schedule - FY 2022-23 50
<br /> Last
<br /> Department/Program Description Current Fee Revision
<br /> Diphteria,tetanus toxoids,acellular pertussis vaccine,
<br /> 90723 Hepatitis B,and inactivated poliovirus vaccine(DTaP-
<br /> Hep B-IPV)-PEDIARIX $74.20 2022
<br /> Diphteria,tetanus toxoids,acellular pertussis vaccine,
<br /> 90723SL Hepatitis B,and inactivated poliovirus vaccine(DTaP-
<br /> Medicaid only Hep B-IPV)-PEDIARIX $0.00 2019
<br /> Pneumococcal polysaccharide vaccine,23-valent
<br /> 90732 (PPSV23),adult or immunosuppressed patient dosage,
<br /> when administered to 2 years or older-
<br /> PNEUMOVAX 23 $117.08 2022
<br /> Pneumococcal polysaccharide vaccine,23-valent
<br /> 90732SL (PPSV23),adult or immunosuppressed patient dosage,
<br /> when administered to 2 years or older-
<br /> Medicaid only PNEUMOVAX 23 $0.00 2019
<br /> 90734 Meningococcal conjugate vaccine,serogroups A,C,Y
<br /> and W-135 quad(MenACWY or MCV4)-MENVEO $114.30 2022
<br /> 90734SL Meningococcal conjugate vaccine,serogroups A,C,Y
<br /> Medicaid only and W-135 quad(MenACWY or MCV4)-MENVEO $0.00 2019
<br /> Meningococcal conjugate vaccine,serogroups A,C,Y
<br /> 90734 and W-135 quad(MenACWY or MCV4)-
<br /> MENACTRA $141.00 2022
<br /> Meningococcal conjugate vaccine,serogroups A,C,Y
<br /> 90734SL and W-135 quad(MenACWY or MCV4)-
<br /> Medicaid only MENACTRA $0.00 2019
<br /> 90744 Hepatitis B vaccine(Hep B),pediatric/adolescent
<br /> dosage,3 dose-ENGERIX PEDS $17.06 2022
<br /> 90744SL Hepatitis B vaccine(Hep B),pediatric/adolescent
<br /> Medicaid only dosage,3 dose-ENGERIX PEDS $0.00 2019
<br /> 90744 Hepatitis B vaccine(Hep B),pediatric/adolescent
<br /> dosage,3 dose-RECOMBIVAX HB PEDS $20.14 2022
<br /> 90744SL Hepatitis B vaccine(Hep B),pediatric/adolescent
<br /> Medicaid only dosage,3 dose-RECOMBIVAX HB PEDS $0.00 2019
<br /> 90746 Hepatitis B vaccine(Hep B),adult dosage-
<br /> ENGERIX-B $43.12 2022
<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 $108.41 2022
<br /> 90739SL Hepatitis B vaccine(Hep B),adult dosage,2 dose-
<br /> HEPLISAV $0.00 2019
<br /> 90750 Zoster Vaccine recombinant,adjuvanted,50 years or
<br /> older-SHINGRIX $161.85 2022
<br /> 90750SL Zoster Vaccine recombinant,adjuvanted,50 years or
<br /> Medicaid only 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 1 Electrocardiogram,Complete 1$33.00 12009
<br /> 93005 1 Electrocardiogram,Tracing Only 1$22.00 12009
<br />
|