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Commissioner Approved Fee Schedule- FY 2017-18 ATTACHMENT 4 38 <br /> Commissioner Approved <br /> Fee Change for Last <br /> De artment/Pro ram Description Current Fee FY 2017-18* Revision <br /> 51701 Insertion ofnm-dmlling bladder cath $94.00 2009 <br /> 54050 Destroy Lesion a $315.00 2012 <br /> 56405 hicision/Drainage of Vulva or Perineum $140.00 2009 <br /> 56420 Incision/Drainage ofGland Abscess $173.00 2009 <br /> 56501 Destroy Lesions(Female) $260.00 2012 <br /> 57170 Diaphragm Fit $95.00 2009 <br /> 57452 Colposcopy ofthe cervix without biopsy) $160.00 2012 <br /> 57454 Colposcopy ofthe cervix,with biopsy and <br /> endocervical curettage $208.00 2012 <br /> 57455 Colposcony ofthe cervix,With bio s $193.00 2012 <br /> 57456 Colposcopy ofthe cervix,with endocervical <br /> curettage $183.00 2012 <br /> 58300 Insert hnramerme Device $160.00 2012 <br /> 58301 JIM Removal $200.00 2012 <br /> 59025 Fetal Non Stress $90.00 2012 <br /> 59425 An,artum acka a 4-6 visits $1,900.44 2014 <br /> 59426 An artmn acka e7+visits $3,408.75 2014 <br /> 59430 Pos arturn care onl $175.00 2012 <br /> 64435 Paraoervical Block $176.00 2008 <br /> 65205 R_emove Forei 1 from External E e $67.00 2007 <br /> 69200 Remove Forei Bod 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 Toxicology Screen(UNC Lab) $160.88 2010 <br /> 80178 Lithium Level(UNC Lab) $9.46 2011 <br /> 81000 U/A MBcro $28.00 2006 <br /> 81002 U/A(Dipstick Only) $18.00 2006 <br /> 81025 Pre Test $15.00 2012 <br /> 82040 Albumin Serum(UNC Lab Test) $6.00 2006 <br /> 82044 Urine Micro-Albumin(UNC Lab) $4.18 2010 <br /> 82150 Amylase(UNC Rate) $9.00 2006 <br /> 82239 Bile Acid Test $93.00 2006 <br /> 82247 Total Bilirubin(UNC Lab Test) $7.00 2006 <br /> 82248 Dina Bilirubin(UNC Lab Test) $7.00 2006 <br /> 82251 Neonatal Bilimbin(UNC Lab Test) $9.00 2006 <br /> 82270 Hemoccult $11.00 2008 <br /> 82306 Vitamin D 25(UNC Lab) $71.00 2011 <br /> 82310 Ca(UNC 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(UNC Lab Test) $6.00 2006 <br /> 82565 CREAT(UNC Lab Test) $7.00 2007 <br /> 82607 BI (UNC Lab Test) $21.00 2006 <br /> 82728 Ferritin(UNC Lab Test) $19.00 2006 <br /> 82746 Folate(UNC Lab Test) $20.00 2006 <br /> 82772 Fecal occult blood,single spec. $10.00 2006 <br /> 82784 Iga(UNC Lab) $13.58 2010 <br /> 82947 GLU(UNC Lab Test) $5.00 2006 <br /> 82952 GGT 3 HR $25.00 2012 <br /> 82977 GGT(UNC Lab Test) $11.00 2006 <br /> 83001 FSH(UNC Lab Test) $25.00 2006 <br /> 83002 Luteinizing Hormone*UNC rate $25.00 2006 <br /> 83516 Ttg(UNC 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(UNC Lab Test) $13.00 2006 <br /> 84075 ALK PROS(UNC 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(UNC 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(T4)-(UNC Lab Test) $8.00 2006 <br /> 84439 Free T4(UNC Lab Test) $12.00 2006 <br /> 84443 TSH(UNC Lab Test) $22.00 2006 <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 2017-18 Commissioner Approved Fee Schedule <br />