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CPT Service Type Medicaid FEE <br />56420 Drainage of Gland Abscess $128.43 $155.00 <br />65205 Remove Foreign Body From Eye $45.87 $60.00 <br />69200 Clear Outer Ear Canal $105.57 $125.00 <br />82040 Alb (UNC lab test) *change in rate $6.92 $6.00 <br />82248 Neonatal Bilirubin *change in rate $7.02 $7.00 <br />82310 Ca (UNC lab test) $7.39 $7.00 <br />82374 CO2 (UNC lab test) $6.83 $6.00 <br />82435 CI (UNC lab test) $6.42 $6.00 <br />82465 Total Chol (UNC lab test) $6.08 $6.00 <br />82565 Creat (UNC lab test) $7.16 $7.00 <br />82607 612 (UNC lab test) $21.01 $21.00 <br />82728 Ferritin (UNC lab test) $19.03 $19.00 <br />82746 Folate (UNC lab test) $20.54 $20.00 <br />82947 Glu (UNC lab test) $5.48 $5.00 <br />83001 FSH (UNC lab test $25.97 $25.00 <br />83001 LH (UNC lab test) $25.88 $25.00 <br />83D36 Hemoglobin A1C (UNC lab test) $13.56 $13.00 <br />83540 Fe (UNC lab test) $9.05 $9.00 <br />83550 IBC (UNC lab test) $12.21 $12.00 <br />83718 HDL(UNC lab test) $11.44 $11.00 <br />83721 LDL (UNC lab test) $13.33 $13.00 <br />84075 Alk Phos (UNC lab test) *change in rate $7.23 $7.00 <br />84132 K (UNC lab test) $6.42 $6.00 <br />84155 TP (serum) (UNC lab test) $5.12 $5.00 <br />84156 Total Protein: 24 hrs (urine) (UNC lab test) $5.12 $5.00 <br />84295 Na (UNC lab test) $6.72 $6.00 <br />84439 Free T4 (UNC lab test) $12.60 $12.00 <br />84443 TSH (UNC lab test) $22.77 $22.00 <br />84446 T4 (UNC lab test) $19.81 $19.00 <br />84478 Trig (UNC lab test) $8.04 $8.00 <br />84479 T3U (UNC lab test) $8.33 $8.00 <br />84520 BUN (UNC lab test $5.51 $5.00 <br />84702 Quan[. HCG/Serum (UNC lab test) $12.54 $12.00 <br />85021 CBC without dill (UNC lab test) $9.04 $9.00 <br />85025 CBC with dill (UNC lab test) $10.86 $10.00 <br />85651 Sed Rate (UNC lab test) $4.96 $4.00 <br />86308 Mono Spot (UNC lab test) $7.23 $7.00 <br />86430 RA factors - Qual. (UNC lab test) $7.93 $7.00 <br />86431 RA factors - Quan. (UNC lab test) $7.93 $7.00 <br />86677 H.pylori (UNC lab test) $20.28 $20.00 <br />86762 Rubella (UNC lab test) $20.80 $20.00 <br />87081 Throat Culture (UNC lab test) $8.06 $8.00 <br />87086 Urine Culture (UNC lab test) $11.28 $11.00 <br />87184 ID and Sensitivity (UNC lab test) $9.63 $9.00 <br />87210 Skin Scraping (KOH) (UNC lab test) $5.33 $5.00 <br />87340 HBsAG (UNC lab test) $13.00 $13.00 <br />87880 Strep A Assay w/optic (in-house) $16.01 $20.00 <br />93000 Electrocardiogram, Complete $23.53 $30.00 <br />93005 Electrocardiogram, Tracing $15.30 $20.00 <br />94664 Aerosol or Vapor Inhalations $11.44 $20.00 <br />99175 Induction of Vomiting $48.42 $60.00 <br />J0696 Ceftriaxone Sodium, per 250 mg (Rocephin) $13.47 $20.00 <br />J1200 Diphenhydramine HCL, up to 50 mg (Benadryl) $1.11 $5.00 <br />