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I CABARRUS COUNTY HEALTH D£PARTHENT i Fees for Ileal~h Department Physician Provided Services To Health Department Patients To Be Effective 1-1-91 I CPT Code* Fee Procedure 54150 $ 120.00 Circumcision, using clamp, newborn I 56160 250.00 Circumcision, surgical, other than clamp, newborn 56600 50.00 I & D Vulva Abscess 56620 60.00 I 6 D Bartholin Abscess 57452 150.00 Col~oscopy (vaginoscopy) I 57454 150.00 with of the cervix Colposcopy biopsy 57520 250.00 Cervical biopsy, with or without fulguration 57700 500.00 Cerclage of uterine cervix, non-obstetrical I 59320 500.00 Cerclage of cervix during pregnancy 58600 850.00 Tubal Ligation/Operative 58605 600.00 Postpartum bilateral tubal ideation, during same i hospitalization 58611 1,200.00 C-Section Bilateral tubal ligation 58982 500.00 Tubal ligation, Laparoscopy, with fulguration of oviducts I 58983 500.00 Tubal ligation, Laparoscopy, with occlusion of oviducts by device 59000 150.00 A~niocentesis I 59025 60.00 Fetal non-stress test 59160 250,00 D & C postpartum & hemorrhage 58120 250.00 D & C diagnostic and/or therapeutic, non-obstetrical 59410 800.00 Vaginal delivery with postpartum care I 59515 1,000.00 Cesarean with delivery postpartum care 59812 200.00 Treatment of spontaneous abortion, any trimester, completed surgically I 59820 250.00 Treatment of missed abortion, any trimester; completed surgically, 1st trimester 59821 250.00 Treatment of missed abortion, any trimester; i completed surgically, 2nd trimester 76805 90.00 OB Ultrasound, 1st, complete maternal & fetal eval. 76815 90,00 OB Ultrasound, 1st, limited (gestationaal age, fetal position, heart beat, placental location, etc.) I 76816 50.00 OB Ultrasound, follo~p or repeat 76818 10O.00 Fetal biophysical profile 90782 35.00 Therapeutic/diagnostic injection (subcu or IM), I (specify injection, e.g. Rhogam) Daily In-Patient Hospital Care (non post-partum) - Ne~ Patient 90200 85.00 Brief (See definitions for levels of service on back) I 90215 115.00 Intermediate 90220 195.00 Comprehensive I Daily In-Patient Hospital Care (non post-partum) - Established Patient 90260 45.00 Brief (See definitions for levels of service on back) 90250 55.00 Limited i 90260 62.00 Intermediate 90220 96.00 Extended 90280 105.00 Comprehensive I (Over)