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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 />84153 PSA Screen (UNC Lab)$20.44 2019 <br />84153 PSA Diagnostic (UNC Lab)$20.44 2019 <br />84155 TP-Serum (UNC Lab)$4.53 2019 <br />84156 TP-Urine (UNC Lab)$4.07 2019 <br />84295 NA (UNC Lab)$5.94 2019 <br />84436 Thyroxine (T4) - (UNC Lab)$7.63 2019 <br />84439 T4 - Thyroid (UNC Lab)$10.02 2019 <br />84443 TSH (UNC Lab)$20.75 2019 <br />84450 SGOT, AST (UNC Lab)$6.39 2019 <br />84460 SGPT, ALT (UNC Lab)$6.54 2019 <br />84466 Iron Profile/Tranferrin: % Saturation (UNC Lab)$14.18 2019 <br />84478 TRIG (UNC Lab)$7.09 2019 <br />84479 T3U (UNC Lab)$7.18 2019 <br />84480 T3 - Total (UNC Lab)$15.75 2019 <br />84481 T3 - Free (UNC Lab) $18.82 2019 <br />84520 BUN (UNC Lab)$4.88 2019 <br />84550 Uric Acid (UNC Lab)$5.58 2019 <br />84702 QUANT HCG/Serum (UNC Lab)$16.73 2019 <br />85014 Hematocrit (UNC Lab)$2.93 2019 <br />85018 Hemoglobin (OCHD Lab)$11.00 2009 <br />85025 CBC with Diff (UNC Lab)$8.63 2019 <br />85027 CBC w/o Diff (UNC Lab)$7.18 2019 <br />85046 Reticyte/hgb concentrate (UNC Lab)$6.19 2019 <br />85611 Prothrombin Time (UNC Lab)$4.38 2019 <br />85651 SED Rate (UNC Lab)$4.27 2019 <br />60