Fee Schedule 2009-2010				7/1/2009
	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 (under 7)	$45	87081	Strep Culture	$20	16020	Small Debridement	$135		99281	Limited	$30	99460	Initial Admit (Hospital)	$85
99213	Expanded Problem	$89	99203	$135	90645	Hemophilus Vaccine	$55	81000	Urinalysis	$20	16025	Debridement Entire Extremity	$240		99282	Expanded	$60	99461	Initial Admit (Non-Hospital)	$200
99212	Focused Problem	$55	99202	$95	90713	IPV	$40	87086	Urine Culture	$25					99283	Detailed	$90	99462	Daily Rounds	$50
99211	Minimal Problem	$30	99201	$55	90669	Prevnar	$125	51701	Catherization	$125		Other Office Services			99284	Comprenhesive	$170	54150	Circumcision	$250
99214	Detailed Problem	$135	99204	$210	90707	MMR	$75	85018	Hemocue	$ 10	99211	Blood Pressure Check	$30		99285	Complex	$250	99463	Newborn Admit/Discharge Same Day	$115
99215	Comprehensive Problem	$185	99205	$265	90716	Varicella	$100	83655	LEAD TEST	$35	99212	Doctor Weight Check	$55			Initial Hospital Inpatient Consult
	Well Child Exams				90714	dT (over 7)	$45	85025	QBC	$25	24640	Nursemaid Elbow Repair	$200		99251	Limited (20 minutes)	$75		Neonatal Intensive Care< 28 days
	Established		New Patient		90702	DT (under age 7)	$35	36415	Venipuncture	$10	99211	Nurse Weight Check	$30		99252	Expanded (40 minutes)	$120	99468	Initial Admit	$1,425
Code		Charge	Code	Charge	90715	TdaP (over 7)	$55	36416	Finger Stick	$3	99214	Pre-Op Physical	$135		99253	Detailed (55 minutes)	$170	99469	Subsequent Care (rounds)	$615
99391	Under One Year	$105	99381	$125	90649	Gardasil (HPV)	$165	82947	Glucose Test (Accucheck)	$10	99214	Gynelogical Exam (w/Pap)	$135		99254	Comprehensive (80 minutes)	$250
99392	Physical Age 1-4	$115	99382	$135	90698	Pentacel-VFC ONLY	$100	82945	Urine Gluclose Test	$15	94664	Nebulizer Training	$25		99255	Complex (110 minutes)	$295		Low Birth Weight Intensive Care
99393	Age 5-11	$115	99383	$135	90634	Hep A 0-18	$50	82270	Guiac Hemocult (3 units)	$10	97535	Home Care Training	$40			Hospital Admission		99477	Initial Admit	$525
99394	Age 12-17	$125	99384	$145	90632	Hep A 19+	$80	81025	ICON	$20	17250	Chemical  Cauterization	$125		99221	Simple	$135	99478	Subsequent Care (rounds) for pt <1500 grams	$300
99395	Over Age 18	$125	99385	$145	90744	Hep B 0-19 yr	$45	94640	Nebulizer Treatment	$25	96110	Developmental Screening Test	$30		99222	Comprehensive	$180	99479	Subsequent Care (rounds) for pt >1500 grams	$325
	Well Child Visits (Inculdes Vaccine Admin)				90746	Hep B 20yr+	$80	J7506	Orapred	$20	11730	Nail Avulson	$160		99223	Complex	$265	99480	Subsequent Care (rounds) for pt 2501+ grams	$225
~246wc	2, 4 or 6 Month Visit	$456			90734	Menigococcal	$150	J7611	Albuteral (in Nebulizer)	$10	11200	Skin Tag	$130			Hosptial Daily Rounds
~9wc	9 month Visit	$133			90732	Pneumovax	$45	J7614	Xopenex (in Nebulizer)	$15	11740	Evac. Subungal Hemotoma	$125		99231	Simple	$60	99464	Attendance at Delivery	$115
~12wc	12 Month Visit	$446			90657	Influenza Inj. Under 3	$10	99000	Pap Smear sample	$0	69210	Cerumen Removal	$85		99232	Comprehensive	$100	99465	Newborn Resusitation/ventilation	$255
~18 wc	18 Month Visit	$317			90658	Influenza Inj. Over 3	$20	99211	Suture Removal	$30	10060	I&D Abcess	$180		99233	Complex	$145
~4yrwc	4 Year Well Child	$498			90471	Single Vaccine Admin	$38	92551	Audiogram	$30	99211	Deproprovera Administartion	$30						Other Services
Laceration Repair					90472	Each additional Vaccine Admin	$19	87070	Blood or Stool Culture	$25	99214	Woods lamp/Flor	$135		99238	Hospital Discharge	$100	94760	Single Oximetry	$5
12001	Under 2.5 Not on Face	$250			Other Oral/injectibles			87220	KOH Slide	$20	99211	Klienfelters Syndrom	$30		99239	Hospital Dis (MORE THAN 30MIN)	$175	94761	Multiple Oximetry	$10
12002	2.6 to 7.5 Not on Face	$260			J0540	Bicillin	$75	87804	Flu test A&B	$60	54150	Circumsicion(In Office)	$330		99234	Admit/Discharge Same Day (simple)	$185	99466	Physician Accompany in Ambulance	$335
12011	under 2.5 ON Face	$260			J1100	Decadron/Dexamenthazone	$50	Misc. Supplies			54150	Circumsicion(In Hospital)	$250		99235	Admit/Discharge Same Day	$245	99467	Add 30 minutes for transfer	$100
12013	2.6 to 7.5 on Face	$300			J1020	Depomedrol	$35	J2550	Phenergan	$20	94760	Single Oximetry	$5		99236	Admit/Discharge Same Day (Complex)	$350	31500	Intubation	$200
Wart Removal						ROCEPHIN		J7614	Xopenex	$15	S0220	Pharmecuetical  Mgmt	$35					36000	IV	$50
17000	1 Wart (Common or Planter)	$126			J0696	250mg	$20	J0170	Racemic Epi	$50	Psychology Services					Intensive Care (over 30 days old)		36660	Umbilical Cath	$125
17003	each additional Common or Planter	$15			J0692	500mg	$30	J7611	Albuteral	$10	90801	Diagnosis Interview	$225		99291	First 30-74 minutes	$375	62270	Spinal Tap (Lumbar Puncture)	$270
17004	15 or more Common or Planter	$282			J0697	750mg	$40	A6449	Ace Bandage 3"	$15	90804	Psych Individ Therapy 20-30 m	$95		99292	each additional 30 minutes	$170	36400	Hospital Venipuncture (under age 3)	$45
17110	up to 14 flat Warts	$175			J0694	1000mg (1 gram)	$50	L4396	Universal Ankle Support	$50	90806	Psych Individ Therapy 45-60 m	$130					36410	Hospital Venipuncture (over age 3)	$35
Foreign Body Removal					J0694*2	2000mg (2 grams)	$100	A4570	Colles Splint	$20	90808	Psych Individ Therapy 75-90m	$190		Pediatric Critical Care (29 days-24 months old)
30300	Nose	$300			96372	Antibiotic Shot Admin#____	$35	A4570	Finger Splint	$20	90847	Psych Family therapy w/Pat	$160		99471	Initial Care	$1,300
69200	Ear	$200			J8540	Dexamethasone	$25	A4570	4-Prong Finger Splint	$20	90889	Preperation of report	$125		99472	Subsequent Care (rounds)	$620
65205	Eye	$275			J3105	Terbutaline	$10	L3350	Tuli Pad	$25	99075	Deposition	$175
20520	Muscle or Tendon (Simple)	$315			J0170	Susphrine	$10	A4565	Sling	$25	90887	Interpretation/Case conf	$150
20525	Muscle or Tendon (Deep)	$450			90660	Flu Mist	$30	A7002	Nebulizer Tubing	$10	96101	Psych Testing Per 60 min	$175
10120	Skin	$220			90680	Rotateq (rotavirus)	$100	K0180	AeroChamber	$80	99071	Patient ed materials	$35
Splint/Cast Application					90473	Oral Administartion#______	$35	L4350	Air Cast	$70	96118	Neuro psych-per hour	$200
25500	Radial Shaft Fracture	$380			J2550	Phenergan	$20	29505	Knee Imobolizer	$80	90862	Pharmo mgmt	$75
25530	Ulnar Shaft Fracture	$370			86580	TB, Intradermal	$20	A4570	Plasti Casts	$65	99080	Insurance forms beyond norm	$50
25560	Radial and Ulnar Fracture	$400			99211	Synagis Administration	$30	A4627	Ace Spacer	$30	96116	Neurobehavioral test	$195
25600	Distal Radial Fracture	$445				Consults		E0555	Peak Flow	$50		Translation services
26600	Metacarpal Fracture	$425			99241	Limited	$85	A4570	Frog Splint	$20	W5023	Telephone translation	2.00/per minute
29130	Finger Splint (no fracture)	$70			99242	Expanded	$135	L3908	Elastic Wrist	$35
29515	Short Ankle Splint	$115			99243	Detailed	$185	A4322	Bulb Syringe	$5
29065	Shoulder to Hand	$300						A9552	Eye Kit	$25
29075	Elbow to Finger	$225						L3170	Heel Cups	$25
								J2405	Ondansetron	$4
						Services not listed on Encounter Form
					90748	Comvax (Hib&HepB)	$40