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M anager's Recommended Fee Schedule- FY 2015-16 40 <br /> Manager's Recommended Fee Last <br /> Department/Program Description Current Fee Schedule for FY 2015-16* Revision <br /> 58300 Insert Intrauterine Device IUD $160.00 2012 <br /> 58301 IUD Removal $200.00 2012 <br /> 59025 Fetal Non Stress $90.00 2012 <br /> 59425 Anteparturn package 4-6 visits $1,900.44 2014 <br /> 59426 Anteparturn Package 7+visits $3,408.75 2014 <br /> 59430 Postpartum care only $175.00 2012 <br /> 64435 Paracervical Block $176.00 2008 <br /> 65205 Remove Foreign Body from External e $67.00 2007 <br /> 69200 Remove Foreign Body from Outer Ear Canal $140.00 2006 <br /> 69210 Remove Ear Wax $67.00 2006 <br /> 80061 Lipid Panel(Fasting)-UNC Lab $18.00 2006 <br /> 80101 Urine Toxicolo Screen UNC Lab $160.88 2010 <br /> 80178 Lithium Level NC Lab $9.46 2011 <br /> 81000 U/A W/Micro $28.00 2006 <br /> 81002 U/A i stick Only) $18.00 2006 <br /> 81025 Pregnancy Test $15.00 2012 <br /> 82040 Albumin Serum UNC Lab Test $6.00 2006 <br /> 82044 Urine 1VLcro-Albumin NC Lab $4.18 2010 <br /> 82150 Am lase UNC Rate $9.00 2006 <br /> 82239 Bile Acid Test $93.00 2006 <br /> 82247 Total Bilirubin NC Lab Test $7.00 2006 <br /> 82248 Direct Bilirubin UNC Lab Test $7.00 2006 <br /> 82251 Neonatal Bilirubin NC Lab Test $9.00 2006 <br /> 82270 Hemoccult $11.00 2008 <br /> 82306 Vitamin D 25 NC Lab $71.00 2011 <br /> 82310 Ca NC Lab Test $7.00 2008 <br /> 82374 CO2 UNC Lab Test $6.22 2014 <br /> 82435 CL UNC Lab Test $6.00 2007 <br /> 82465 Total Cholesterol NC Lab Test $6.00 2006 <br /> 82565 CREAT NC Lab Test $7.00 2007 <br /> 82607 B12 NC Lab Test $21.00 2006 <br /> 82728 iFerrifln UNC Lab Test $19.00 2006 <br /> 82746 Folate NC Lab Test $20.00 2006 <br /> 82772 Fecal occult blood,single e ec. $10.00 2006 <br /> 82784 I a NC Lab $13.58 2010 <br /> 82947 GLU UNC Lab Test $5.00 2006 <br /> 82952 GGT 3 HR $25.00 2012 <br /> 82977 GGT NC Lab Test $11.00 2006 <br /> 83001 FSH NC Lab Test $25.00 2006 <br /> 83002 Luteinizin Hormone*UNC rate $25.00 2006 <br /> 83516 T NC Lab $16.85 2010 <br /> 83540 Iron Profile(FE):IBC UNC Lab Test $9.00 2006 <br /> 83615 LDH UNC Lab Test $8.00 2006 <br /> 83690 Lipase UNC Rate $9.00 2006 <br /> 83718 Lipid Panel Non Fasting)HDL UNC Lab Test $11.00 2006 <br /> 83721 LDL NC Lab Test $13.00 2006 <br /> 84075 ALK PHOS NC Lab Test $7.00 2006 <br /> 84132 K UNC Lab Test $6.00 2006 <br /> 84146 Prolactin(UNC Lab) $27.00 2006 <br /> 84153 PSA Screen(UNC Lab) $25.00 2006 <br /> 84153 PSA Diagnostic(UNC Lab) $25.00 2006 <br /> 84155 TP-Serum NC Lab Test $5.00 2007 <br /> 84156 TP-Urine UNC Lab Test $5.00 2006 <br /> 84295 NA UNC Lab Test $6.12 2014 <br /> 84436 Thyroxine 4-UNC Lab Test $8.00 2006 <br /> 84439 Free T4 NC Lab Test $12.00 2006 <br /> * Any fee changes wi I I be included in this column; <br /> a bl ank besi de each f ee means there i s no f ee change i n FY 2015-16 Manager Recommended Fee Schedule <br />