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5 <br /> ORANGE COUNTY HEALTH DEPARTMENT FEE SCHEDULE <br /> PERSONAL HEALTH SERVICES+NUTRITION <br /> Requested Fee <br /> CPT Code Change for FY Last <br /> Description Current Fee 2015-16 Revision <br /> 84478 TRIG(UNC Lab Test) $8.00 2006 <br /> 84479 T3U(UNC Lab Test) $8.00 2006 <br /> 84481 lFree T3(UNC Lab) $42.00 2010 <br /> 84520 BUN(UNC Lab Test) $5.01 2014 <br /> 84550 Uric Acid(UNC Lab Test) $6.00 2006 <br /> 84702 QUANT HCG/Serum(UNC Lab Test) $12.00 2006 <br /> 85025 CBC with Diff(UNC Lab Test) $10.00 2006 <br /> 85027 CBC w/o Diff(UNC Lab Test) $9.00 2006 <br /> 85611 Prothrombin Time(UNC Lab) $5.00 2006 <br /> 85651 SED Rate(UNC Lab Test) $4.51 2014 <br /> 86038 ANA(anti-nuclear antibody)titer(UNC Rate) $16.00 2006 <br /> 86039 Confirmation,if ANA+(UNC Rate) $15.00 2008 <br /> 86308 MONO Spot(UNC Lab Test) $7.00 2006 <br /> 86430 RA Factors-Qual(UNC Lab Test) $7.00 2006 <br /> 86431 RA Factors-Quan(UNC Lab Test) $7.00 2006 <br /> 86580 PPD $17.00 2012 <br /> 86677 H.Pyloric(UNC Lab Test) $20.00 2011 <br /> 86706 Hepatitis B Surface Antibody(UNC Lab) $15.38 2011 <br /> 86757 RMSF(Convalescent)(UNC Rate) $27.00 2009 <br /> 86762 Rubella(UNC Lab Test) $20.00 2009 <br /> 86787 Varicella Immune Status Test*UNC rate $17.00 2008 <br /> 86803 Hep C Antibody(UNC Lab) $20.00 2007 <br /> 86804 Hepatitis C RIBA(UNC Lab Test) $16.00 2009 <br /> 86870 Antibody Identification(UNC Lab Test) $21.00 2010 <br /> 86900 ABO Group(UNC Lab Test) $4.00 2009 <br /> 86901 RH Type(UNC Lab Test) $7.00 2009 <br /> 87070 Other Bacterial Culture(UNC Lab Test) $12.00 2008 <br /> 87081 Throat Culture(UNC Lab Test) $8.00 2008 <br /> 87086 Urine Culture(UNC Lab Test) $11.00 2006 <br /> 87101 Culture,Fungal Dermatology Screen(UNC Lab) $10.00 2008 <br /> 87184 ID&Sensitivity(UNC Lab Test) $9.00 2008 <br /> 87205 STAT Male Smear $22.00 2008 <br /> 87206 Fungal Direct Test(FDIR)(UNC Lab Test) $7.00 2008 <br /> 87210 Wet Mount $18.00 2009 <br /> 87269 Parasitology Test#9807-Giardia(UNC Lab Test) $16.00 2009 <br /> 87272 Parasitology Test#9807-Cryptosporidium(UNC Lab) $16.00 2009 <br /> 87340 HBsAG(UNC Lab Test) $13.00 2009 <br /> 87420 RSV(Respiratory Syncytial Virus)Antigen Screen(UNC <br /> Lab) $16.00 2008 <br /> 87880 Streptococcus Group A Assay W/Optic(UNC Lab) $20.00 2009 <br /> 88175 Cytopath C/V Auto Fluid Redo $35.00 2012 <br /> 90460 Admin Fee(1 vaccine)to children by RN or higher $15.70 2012 <br /> 90461 Admin Fee(2 vaccines)to children by RN or higher $8.84 2012 <br /> 90470 Administration ofH1N1 Vaccine $18.00 2010 <br /> 90471 Admin Fee(1 vaccine) $18.00 2012 <br /> 90472 Admin Fee(2+vaccines) $18.00 2012 <br /> Page 3 of 6 <br />