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Commissioner Approved Fee Schedule - FY 2020-21 Attachment 4 <br />* Any fee changes will be included in this column; <br />a blank beside each fee means there is no fee change in FY 2020-21 Commissioner Approved Fee Schedule <br />Department/Program Description Current Fee <br />Commissioner Approved <br />Fee Change for <br />FY 2020-21* <br />Last <br />Revision <br />64435 Paracervical Block $176.00 2008 <br />65205 Remove Foreign Body from External Eye $67.00 2007 <br />69200 Remove Foreign Body from Outer Ear Canal $140.00 2006 <br />69210 Remove Ear Wax $67.00 2006 <br />76801-26 Ultrasound, Pregnant Uterus, Real Time with <br />Image Documentation $0.00 $50.00 New <br />76801-TC Ultrasound, Pregnant Uterus, Real Time with <br />Image Documentation $0.00 $70.00 New <br />76801 Ultrasound, Pregnant Uterus, Real Time with <br />Image Documentation $0.00 $120.00 New <br />76805-TC Ultrasound, Pregnant Uterus, B-Scan and/or <br />Real Time with Image Documentation $0.00 $90.00 New <br />76805 Ultrasound, Pregnant Uterus, B-Scan and/or <br />Real Time with Image Documentation $0.00 $135.00 New <br />76817-26 Ultrasound, Pregnant Uterus, Real Time with <br />Image Documentation, Transvaginal $0.00 $40.00 New <br />76817-TC Ultrasound, Pregnant Uterus, Real Time with <br />Image Documentation, Transvaginal $0.00 $55.00 New <br />76817 Ultrasound, Pregnant Uterus, Real Time with <br />Image Documentation, Transvaginal $0.00 $95.00 New <br />76830 Ultrasound, Transvaginal $0.00 $120.00 New <br />80048 Metabolic Panel, Basic (UNC Lab)$10.44 2019 <br />80053 Comprehensive Metabolic Panel (UNC Lab)$13.04 2019 <br />80061 Lipid Panel (Fasting) - (UNC Lab)$16.53 2019 <br />80076 Hepatic Function Panel (UNC Lab)$9.08 2019 <br />80178 Lithium Level (UNC Lab)$8.16 2019 <br />80306 Urine Toxicology Screen (UNC Lab)$17.14 2019 <br />80307 Drug Test (UNC Lab)$64.65 2019 <br />81000 U/A (W/Micro) (UNC Lab)$4.02 2019 <br />81002 U/A (Dipstick Only) (OCHD Lab)$18.00 2019 <br />81025 Pregnancy Test (OCHD Lab)$15.00 2019 <br />82040 Albumin Serum (UNC Lab)$6.11 2019 <br />82043 Urine Microalbumin/Creatinine Ratio (UNC Lab)$7.14 2019 <br />82044 Urine Micro-Albumin (UNC Lab) $6.23 2019 <br />82105 Quad Screening (UNC Lab)$18.64 2019 <br />82150 Amylase (UNC Lab)$8.00 2019 <br />56