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Commissioner Approved Fee Schedule- FY 2017-18 ATTACHMENT 4 39 <br /> Commissioner Approved <br /> Fee Change for Last <br /> Department/Program, Description Current Fee FY 2017-18* Revision <br /> 84450 SGOT,AST(UNC Lab Test) $7.00 2006 <br /> 84460 SGPT,ALT(UNC Lab Test) $7.00 2008 <br /> 84466 Iron Profile/Tranferrin:%Saturation(UNC <br /> Lab Test) $17.00 2006 <br /> 84478 TRIG(UNC Lab Test) $8.00 2006 <br /> 84479 1 T3U(UNC Lab Test) $8.00 2006 <br /> 84481 Free T3(UNC Lab) $42.00 2010 <br /> 84520 BUN(UNC Lab Test)(11) $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)(11) $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-Qua[(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 $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 <br /> Test) $16.00 2009 <br /> 87272 Parasitology Test#9807-Cryptosporidium <br /> (UNC Lab) $16.00 2009 <br /> 87340 HBsAG(UNC Lab Test) $13.00 2009 <br /> 87420 RSV(Respiratory Syncytial Virus)Antigen <br /> Screen(UNC 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 higher$8.84 2012 <br /> 90470 AdminishationofHIN1 Vaccine $18.00 2010 <br /> 90471 Admin Fee 1 vaccine $18.00 2012 <br /> 90472 Admin Fee(2+vaccines) $18.00 2012 <br /> 90473 Immuni.anon Adm.-Int axisal/Oral $13.71 2014 <br /> 90474 I-niaation Adm.-hnranasal/Oml Additional $13.71 2014 <br /> 90620 Meningococcal Group B sero $177.00 2015 <br /> 90621 Mengococcal Group B --ba $248.00 2015 <br /> 90632 Hep A-Adult $45.00 2012 <br /> 90633 Hep A ed/Adol $25.00 2010 <br /> 90636 'IWinrix $102.00 2015 <br /> 90647 PedVaxHls Sell'Pay $40.00 2012 <br /> 90648 HIB Vaccine $26.00 2012 <br /> 90649 Gardasil $162.00 2015 <br /> 90651 HPV9 Gardasil 9 $180.00 2015 <br /> 90654 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 WItt Slit 6-35 mo. $14.00 2009 <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 />