310 E. Torrance Ave., P. O. Box 650
Pontiac, Illinois 61764 map
PH. 1-815-844-7174 FAX 1-815-842-2408 TDD 1-800-526-0844
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310 E. Torrance Ave., P. O. Box 650 Pontiac, Illinois 61764 map PH. 1-815-844-7174 FAX 1-815-842-2408 TDD 1-800-526-0844 |
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COPYING FEE $5.00 (up to 5 pages) Any request for information with the exception of immunization records. Each additional page $.50 per page. FEE SCHEDULE
Sanitarian Consultations for Real Estate Transactions:
$150.00 Well inspection which includes a water sample $150.00 Septic inspection $300.00 Both septic inspection and well inspection including water sample · 3 copies of the inspection will be furnished (1 to the buyer, 1 to the seller, & 1 to the bank.). · Additional copies would be $5 each. · Faxed copies would also be $5 each.
$ 10.00 Contractor registration $100.00 Septic permit
$100.00 Water well permits (state statute) $ 20.00 Water samples-private well $ 20.00 New well water sample $100.00 Geothermal Exchange System permit per every 5 vertical or horizontal loop wells. $ 10.00 Geothermal Contractor registration fee.
$100.00 Plan review for new food establishments $10.00 Per day shall be charged for each day the permit fee is not paid after expiration of the establishment permit. $110.00 Mobile food stand TEMPORARY FOOD STAND PERMITS: $35.00 Advance Food permit if application is made 2 weeks prior to event. $70.00 Onsite permit
$110.00 Annual permit (Advance only) $ .00 Non-profit permit if made 2 weeks prior to event. $100.00 Certified Food Manager-Certification Class $35.00 Certified Food Manager-Refresher Course $20,00 Late fee for temporary food stand permits
Category I Establishment EFFECTIVE 01/01/ 2011
FEE SEATING CAPACITY
$225.00 >100 $200.00 75-99 $170.00 50-74 $145.00 25-49 $120.00 <25 $110.00 Retail sale of food $110.00 Deli/Off-site catering
Category II Establishment
FEE SEATING CAPACITY
$200.00 >100 $175.00 75-99 $145.00 50-74 $120.00 25-49 $ 95.00 <25 $110.00 Retail sale of food $110.00 Deli/Off-site catering
Category III Establishment
FEE SEATING CAPACITY
$200.00 >100 $175.00 75-99 $145.00 50-74 $120.00 25-49 $ 95.00 <25 $110.00 Retail sale of food
$10.00 Dog registration-1 year (Paid within 30 days) $10.00 Intact fee (per year) (state statute) $25.00 Impoundment fee /public safety fine-State statute
Immunizations $15.00 Eligible “Vaccine for Children” clients only $15.00 plus cost of vaccine Private purchase vaccine for non-eligible “Vaccine for Children” clients, adults . and international travel $30.00 Flu $40.00 Pneumonia $15.00 Injection $20.00 Edinburgh Postnatal Depression Scale CODE #99420
Approved by Board of Health Sept.13, 2010
$ 8.00 Mantoux skin test $ 16.00 2-Step Mantoux test $ 10 + Cost Aplisol or Tubersol vial
All third party payments will be sought for services rendered. This includes Medicaid, HMO and private insurance payments. The Health Department will handle the billing requirements for the skin tests if they are Public Aid or Family Case Management reimbursable. No one will be denied services due to an inability to pay. The provision of all of the services enumerated above by the Livingston County Tuberculosis Care and Treatment Board is contingent upon the availability of funds appropriated for the control and treatment of tuberculosis on an annual basis. If a client has any type of insurance that covers the cost of the chest X-ray and medications (Such as a HMO), have the client bill their own insurance. If they do not have insurance, the tax levy will pay the costs including lab, medication, and physician costs.. Adopted: 1966
EPSDT /School Based Health Clinic
$36.00 Health exam (New, 0-11 Mo.) #99381 $36.00 Health exam (New, 1- 4 Yrs.) #99382 $36.00 Health exam #99385 $36.00 Health exam (est., 0-11 Mo.) #99391 $36.00 Health exam (est., 1- 4 Yrs.) #99392 $25.00 Denver Developmental Screening $25.00 Ages and Stages Developmental Screening $64.00 New patient - #99202 $86.00 New patient - #99203 $106.00 New Patient - #99204 SBHC $28.00 Established patient #99211 SBHC $38.00 Established patient #99212 SBHC $61.00 Established patient #99213 SBHC $85.00 Established patient #99214 SBHC $10.00 Urinalysis CODE # 81000 $10.00 Urinalysis CODE #81002 $10.00 Urinalysis CODE #81005 $10.00 Wet Prep CODE #87210 $ 7.00 Herpes Culture $12.00 Pap Smear CODE #88150 conventional $26.00 Pap Smear Liquid base #88174 $10.00 Nose/throat culture CODE #87060 $12.00 Blood glucose CODE #82948 $15.00 Rapid Strep $20.00 Risk assessment (IGAP) $ 4.00 Hematocrit $10.00 Hemoglobin
Well Visit Codes Preventive - Nurse Practitioner $100.00 Established 1 – 4 #99392 $163.00 New 5 – 11 #99383 $140.00 Established 5 -11 #99393 $178.00 New 12 – 17 #99384 $154.00 Established 12 – 17 #99394 $154.00 Established 18 – 39 #99395 $208.00 New 40 – 64 #99386 $169.00 Established 40 – 64 #99396
Code DESCRIPTION FEE
99201 Problem focused Visit (New Patient) $49.00 99211 Minimal Visit (Established Patient) $28.00 99202 Expanded Problem Focused visit (New Patient) $86.00 99212 Problem Focused visit (Established Patient) $38.00 99203 Detailed Visit (New Patient) $89.00 99213 Expanded Problem Focused visit (Est. Patient) $61.00 99204 Comprehensive visit (New Patient) $106.00 99214 Detailed visit (Est. Pati $86.00 88150 Pap Smear—C $26.00 88174 Pap Smear—Liqui $26.00 85018 Hemoglobin $10.00 81002 Urinalysis $10.00 87800 Gonorrhea/Chlamydia $20.00 81025 Urine HCG/Pregnancy Test $20.00 82948 Post Parandial Blood Glucose $12.00 82270 Fecal Occult $ 7.00 87210 Wet Mount $ 8.00 88182 HPV DNA Testing $50.00 87274 Herpes Culture $ 7.00 56501 Destruction of Vulvar Lesion $89.00 17110 Wart flat 1-14 $89.00 69210 Cerumen Removal $46.20 10060 I & D Abscess $72.00 86403 Rapid Strep $15.00 82962 Blood Glucose-fasting $12.00 36415 Venipuncture $15.00 94150 Peak Flow Monitoring $ 4.10 77078 Ultrasound Bone Density test $ 8.00
FEE SCHEDULE
$ 30.00 Wellness screening test $ 35.00 Wellness screening test-at worksite $15.00 Lipid Panel (Wellness recheck only) $15.00 Hepatic Panel $ 15.00 Thyroid Stimulating Hormone (TSH) $ 25.00 Diabetes Hgb A1C $ 20.00 PSA Lab test $ 5.00 Handling fee for extra blood tests (physician request) during wellness clinic visit $ 8.00 Ultrasound Bone Density test if included with Wellness $15.00 Venipuncture $60.00 Blood pressure check at business - 1 hr. per staff member (minimum) $ 8.00 Hearing testing $10.00 Urinalysis $ 8.00 Vision testing $30.00 Blood lead testing $20.00 Pregnancy testing $40.00 School sports physical $50.00 School nurse per hour $60.00 Adult Physical Assessment $125.00 Smoking cessation class $25.00 Nutrition, weight/height monitoring/action plan $16.00 Ultrasound Bone Density Test $25.00 Workplace Ultrasound Bone Density Test per individual if not done with Wellness (Then it is $12.00) $150.00 Ultrasound Bone Densitometer rental plus price of screening kit (Per day) $500.00 Ultrasound Bone Densitometer rental plus price of screening kit (Per week) $500.00 Ultrasound Bone Densitometer plus staff-individual contract $25.00 STD visit $20.00 CPR Certification class (Per person, minimum 5 per class) $20.00 First Aid Class (Per person, minimum 5 per class) $30.00 CPR Certification/First Aid Class (Per person, minimum 5 per class
Out of County Wellness Fees (Within 75 miles of LCHD & minimum of 25 participants) $ 50.00 Wellness workplace screening per individual (Doesn’t include PSA or Osteoporosis) $ 70.00 Wellness workplace screening per individual, including PSA (No osteoporosis) $ 62.00 Wellness workplace screening per individual, including osteoporosis (No PSA) $ 35.00 PSA Lab workplace screening per individual if not done with Wellness $ 25.00 Workplace Ultrasound Bone Density test per individual if not done with Wellness
Livingston County Community Health Care Pilot Project
Clients will be charged per a sliding fee schedule based on 0.25% and 50% co-pays. No one will be admitted to the program on full fee.
$200 Comprehensive Case Management (IDOA reimbursable) $200 Comprehensive Nursing Assessment Case Monitoring-Social Worker (IDOA reimbursable) $ 60 Nurse Visit for visits of 1 hour duration or less $30/hr Homemaker/CAN $30/hr Sitter Service $55 Installation of emergency home response device $28 Monthly cost of emergency home response device TBD Meals TBD Adult Day Care TBD Respite care
Approved by the Board of Health Sept.13, 2010 |