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Commissioner Approved Fee Schedule - FY 2016-17 ATTACHMENT 4 <br /> 46 <br /> Approved Fee Change for Last <br /> Department/Program Description Current Fee FY 2016-17 Revision <br /> 87420 RSV(Respiratory Syncytial Virus)Antigen <br /> Screen NC Lab $16.00 2008 <br /> 87880 Streptococcus Group A Assay W/Optic(UNC <br /> Lab) $20.00 2009 <br /> 88175 Cytopath CN 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 hi er $8.84 2012 <br /> 90470 Administration of HlN1 Vaccine $18.00 2010 <br /> 90471 Admin Fee(1 vaccine) $18.00 2012 <br /> 90472 Admin Fee(2+vaccines) $18.00 2012 <br /> 90473 Immunization Adm.-Intranasal/Oral $13.71 2014 <br /> 90474 Immunization Adm.-Intranasal/Oral Additional $13.71 2014 <br /> 90620 Menin ococcal Group B exsero $177.00 2015 <br /> 90621 Menin ococcal Group B Trmnenba $248.00 2015 <br /> 90632 Hep A-Adult $45.00 2012 <br /> 90633 Hep A Ped/Adol $25.00 2010 <br /> 90636 Twimix $102.00 2015 <br /> 90647 PedVaxHIS SelfPay $40.00 2012 <br /> 90648 HIB Vaccine $26.00 2012 <br /> 90649 Gardasil $162.00 2015 <br /> 90651 HPV 9 Gardasil9 $180.00 2015 <br /> 90654 1 Intradermal flu vaccine $20.00 2012 <br /> 90655 Preservative free influenza vaccine 6-35 mo $17 2015 <br /> 90656 Preservative free influenza vaccine $18.00 2012 <br /> 90657 Influenza Split 6-35 mo. $14.00 2009 <br /> 90658 Influenza Split 3yr and Above $15.00 2012 <br /> 90660 Influenza Virus Vaccine Live for Intranasal $23.00 2012 <br /> 90662 Influenza-hi dose 65+ $40.00 2012 <br /> 90669 Prevnar CV7-Pneumococcal Vaccine $116.00 2009 <br /> 90670 Prevnar CV13)-Pnmmococcal Vaccine $167.00 2015 <br /> 90672 Irtranasal administration of live quadrivalent <br /> infuenza vaccine $26.00 2015 <br /> 90675 Rabies $269.00(6) $288.00 2015 <br /> 90676 Rabies vaccine for intradermal use $212.00 2015 <br /> 90680 Rotat Rotavirus Vaccine $99.00 2009 <br /> 90681 Rotarix $124.00 2015 <br /> 90685 Influenza vac quadrivalent Instv free 6-35 mo IM $16.00 2015 <br /> 90686 1 Influenza vac 4 valent prstv free 3 yrs plus IM $18.00 2015 <br /> 90696 Kinrix TaP/IP $52.00 2012 <br /> 90698 Pentacel TaP/IPV/Hlb $95.00 2015 <br /> 90700 Dtap Vaccine(Pediatric)SelfPay $32.00 2012 <br /> 90702 Di theria tetanus toxoid absorbed 17 yr IM $40.00 2015 <br /> 90707 Adult MMR $66.00 2015 <br /> 90713 Inactived Polio Vaccine PV $31.00 2009 <br /> 90714 Td res.Free $35.00 2015 <br /> 90715 Tdap Vaccine $39.49 2014 <br /> 90716 Varicella vaccine $111.00 2015 <br /> 90723 Pediarix DTaP/He B/IPV $91.00 2015 <br /> 90732 Immunization:Pnmmococcal-State $80.00 2015 <br /> 90733 Menin ococcal Vaccine,Subcutaneous/Jet $100.00 2008 <br /> 90734 Menactra Menin ococcal Vaccine $127.00 2015 <br /> 90736 Zostavax vaccine $207.00 2015 <br /> 90744 Pediatric Hep BVaccine Self Pa $30.00 2012 <br /> 90746 Immunization:Hep B 20+ s $58.00 2007 <br /> 90760 N Infusion Up to One Hour $140.00 2007 <br /> 90772 Therapeutic prophylactic/diagonostic injection $23.00 2008 <br /> 90801 Psychiatric Diagnostic Interview Exam $151.00 2008 <br /> 90802 Psychiatric iag Interview Exam Interactive $161.00 2009 <br /> 90804 Ps chother Indiv,Insi t 20-30 min. $65.00 2009 <br /> 90806 Ps chother Indiv,Insi t 45-50 min. $97.00 2007 <br /> 90808 Ps chother Indiv,Insight,75-80 min. 1$146.00 1 2008 <br /> * Any fee changes wi I I be included in this column; <br /> a blank beside each fee means there is no fee change in FY 2016-17 Manager Recommended Fee Schedule <br />