Fee Schedule 2008-2009

6/30/2008

OFFICE SERVICES

Immunizations

Laboratory

Burn Treatments

Hospital Services

Established Patient

New Patient

90723

Pediarix

$95

87880

Strep ID

$35

16000

Dressing/Limited

$115

Emergency Room Care

Newborn Care

Code

Charge

Code

Charge

90700

DTAP

$45

87081

Strep Culture

$20

16020

Small Debridement

$135

99281

Limited

$30

99431

Initial Admit

$80

99213

Expanded Problem

$85

99203

$130

90645

Hemophilus Vaccine

$55

81000

Urinalysis

$20

16025

Debridement Entire Extremity

$240

99282

Expanded

$55

99433

Daily Rounds

$50

99212

Focused Problem

$55

99202

$90

90713

IPV

$40

87086

Urine Culture

$25

99283

Detailed

$90

54150

Circumcision

$250

99211

Minimal Problem

$30

99201

$51

90669

Prevnar   

$105

51701

Catherization

$125

Other Office Services

99284

Comprenhesive

$155

99435

Newborn Admit/Discharge Same Day

$110

99214

Detailed Problem

$130

99204

$200

90707

MMR

$75

83655

LEAD TEST

$35

99211

Blood Pressure Check

$30

99285

Complex

$250

99215

Comprehensive Problem

$175

99205

$250

90716

Varicella

$100

85025

QBC

$25

99212

Doctor Weight Check

$55

Initial Hospital Inpatient Consult

Neonatal Intensive Care

Well Child Exams

90714

dT (over 7)

$45

82947

Glucose Test (Accucheck)

$10

24640

Nursemaid Elbow Repair

$200

99251

Limited (20 minutes)

$70

99295

Initial Admit

$1,425

Established

New Patient

90702

DT (under age 7)

$30

82945

Urine Gluclose Test

$15

99211

Nurse Weight Check

$30

99252

Expanded (40 minutes)

$120

99296

Subsequent Care (rounds)

$615

Code

Charge

Code

Charge

90715

TdaP

$55

82270

Guiac Hemocult (3 units)

$10

99214

Pre-Op Physical

$130

99253

Detailed (55 minutes)

$160

99391

Under One Year

$95

99381

$120

90649

Gardasil (HPV)

$165

81025

ICON

$20

99214

Gynelogical Exam (w/Pap)

$130

99254

Comprehensive (80 minutes)

$250

Low Birth Weight Intensive Care

99392

Physical Age 1-4

$115

99382

$135

90634

Hep A 0-18

$50

Nebulizer Treatment

$35

94664

Nebulizer Training

$25

99255

Complex (110 minutes)

$295

99295

Initial Admit

$1,425

99393

Age 5-11

$115

99383

$135

90632

Hep A 19+

$80

J7506

Orapred

$20

97535

Home Care Training

$40

Hospital Admission

99298

Subsequent Care (rounds) for pt <1500 grams

$300

99394

Age 12-17

$120

99384

$140

90744

Hep B 0-19 yr

$45

J7603

Albuteral (in Nebulizer)

$10

17250

Chemical  Cauterization

$125

99221

Simple

$130

99299

Subsequent Care (rounds) for pt >1500 grams

$325

99395

Over Age 18

$125

99385

$145

90746

Hep B 20yr+

$75

J7614

Xopenex (in Nebulizer)

$15

96110

Developmental Screening Test

$30

99222

Comprehensive  

$180

99300

Subsequent Care (rounds) for pt 2501+ grams

$225

Well Child Visits (Inculdes Vaccine Admin)

90734

Menigococcal

$150

99000

Pap Smear sample

$0

11730

Nail Avulson

$155

99223

Complex

$265

~246wc

2, 4 or 6 Month Visit

$423

90732

Pneumovax

$40

99211

Suture Removal

$30

11200

Skin Tag

$125

Hosptial Daily Rounds

99436

Attendance at Delivery

$115

~9wc

9 month Visit

$120

90657

Influenza Inj. Under 3

$10

92551

Audiogram

$30

61108

Evac. Subungal Hemotoma

$115

99231

Simple

$60

~12wc

12 Month Visit

$423

90658

Influenza Inj. Over 3

$15

87070

Blood or Stool Culture

$25

69210

Cerumen Removal

$85

99232

Comprehensive

$100

~18 wc

18 Month Visit

$314

90471

Single Vaccine Admin

$35

36415

Venipuncture

$10

10060

I&D Abcess

$170

99233

Complex

$145

Other Services

~4yrwc

4 Year Well Child

$492

90472

Each additional Vaccine Admin

$19

87220

KOH Slide

$20

99211

Deproprovera Administartion

$30

94760

Single Oximetry

$5

Laceration Repair

Other Oral/injectibles

87804

Flu test A&B

$60

99215

Woods lamp/Flor

$169

99238

Hospital Discharge

$95

94761

Multiple Oximetry

$10

12001

Under 2.5 Not on Face

$250

J0540

Bicillin

$75

85018

Hemocue

 $ 15

99211

Klienfelters Syndrom

$30

99234

Admit/Discharge Same Day

$180

99289

Physician Accompany in Ambulance

$335

12002

2.6 to 7.5 Not on Face

$260

J1100

Decadron/Dexamenthazone

$50

Misc. Supplies

54150

Circumsicion(In Office)

$330

99235

Admit/Discharge Same Day Complex

$240

99440

Resucitation

$220

12011

under 2.5 ON Face

$260

J1020

Depomedrol

$35

A6449

Ace Bandage 3"

$15

54150

Circumsicion(In Hospital)

$250

31500

Intubation

$200

12013

2.6 to 7.5 on Face

$300

ROCEPHIN

L4396

Universal Ankle Support

$50

94760

Single Oximetry

$5

Intensive Care (over 30 days old)

36000

IV

$50

Wart Removal

J0696

250mg

$20

A4570

Colles Splint

$20

Psychology Services

99291

First 30-74 minutes

$375

36660

Umbilical Cath

$125

17000

1 Wart (Common or Planter)

$120

J0692

500mg

$30

A4570

Finger Splint

$15

90801

Diagnosis Interview

$225

99292

each additional 30 minutes

$165

62270

Spinal Tap (Lumbar Puncture)

$270

17003

each additional Common or Planter 

$15

J0697

750mg

$40

A4570

4-Prong Finger Splint

$15

90804

Psych Individ Therapy 20-30 m

$90

36400

Hospital Venipuncture (under age 3)

$45

17004

15 or more Common or Planter

$275

J0694

1000mg (1 gram)

$50

L3350

Tuli Pad

$25

90806

Psych Individ Therapy 45-60 m

$130

Pediatric Critical Care (31 days-24 months old)

36410

Hospital Venipuncture (over age 3)

$35

17110

up to 14 flat Warts

$155

J0694*2

2000mg (2 grams)

$100

A4565

Sling

$25

90808

Psych Individ Therapy 75-90m

$190

99293

Initial Care

$1,250

51000

Suprapubic

$175

Foreign Body Removal

90772

Antibiotic Shot Admin#____

$35

A7003

Nebulizer Tubing

$10

90847

Psych Family therapy w/Pat

$160

99294

Subsequent Care (rounds)

$600

30300

Nose

$300

J8540

Dexamethasone

$25

J2550

Phenergan

$20

90889

Preperation of report

$125

69200

Ear

$200

J3105

Terbutaline

$10

K0180

AeroChamber

$80

99075

Deposition

$175

20520

Muscle or Tendon (Simple)

$315

J0170

Susphrine

$10

L4350

Air Cast

$70

90887

Interpretation/Case conf

$150

20525

Muscle or Tendon (Deep)

$450

90660

Flu Mist

$30

29505

Knee Imobolizer

$80

96101

Psych Testing Per 60 min

$175

10120

Skin

$220

90680

Rotateq (rotavirus)

$100

A4570

Plasti Casts

$65

99071

Patient ed materials

$35

Splint/Cast Application

90473

Oral Administartion#______

$35

A4627

Ace Spacer

$30

96118

Neuro psych-per hour

$205

25500

Radial Shaft Fracture

$380

J2550

Phenergan

$20

E0555

Peak Flow

$50

90862

Pharmo mgmt

$75

25530

Ulnar Shaft Fracture

$370

86580

TB, Intradermal

$20

A4570

Frog Splint

$15

99080

Insurance forms beyond norm

$50

25560

Radial and Ulnar Fracture

$385

99211

Synagis Administration

$30

L3908

Elastic Wrist

$35

96116

Neurobehavioral test

$200

25600

Distal Radial Fracture

$445

Consults

A4322

Bulb Syringe

$5

26600

Metacarpal Fracture

$350

99241

Limited

$85

A9552

Eye Kit

$25

29130

Finger Splint (no fracture)

$70

99242

Expanded   

$130

L3170

Heel Cups

$25

29515

Short Ankle Splint

$110

99243

Detailed   

$160

29065

Shoulder to Hand

$300

29075

Elbow to Finger

$225

Services not listed on Encounter Form

90748

Comvax (Hib&HepB)

$40