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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 />87206 Fungal Direct Test (FDIR) (UNC Lab)$5.99 2019 <br />87210 Wet Prep (OCHD Lab)$18.00 2009 <br />87220 Skin KOH (UNC Lab)$4.75 2019 <br />87255 Herpes Simplex Culture (UNC Lab)Delete fee 2019 <br />87269 Parasitology Test #9807-Giardia (UNC Lab)$13.61 2019 <br />87272 Parasitology Test #9807-Cryptosporidium (UNC <br />Lab)$13.32 2019 <br />87340 HBsAG (UNC Lab)$11.48 2019 <br />87341 Hep B Surface Ag Eia (UNC Lab)$11.48 2019 <br />87389 HIV-1 Ag with HIV-1 and HIV-2 AB (UNC Lab)$29.73 2019 <br />87420 RSV Antigen Screen (UNC Lab)$13.91 2019 <br />87491 GC NAAT -Bill Together with 87591 (Durham Co. L$38.99 2019 <br />87502 Influenza Test (UNC Lab)$105.06 2019 <br />87506 Microbiology Stool (GI Panel (UNC Lab)$262.99 2019 <br />87522 Hep C Viral (UNC Lab)$47.60 2019 <br />87529 HSV 1 & 2 PCR (UNC Lab)$38.99 2019 <br />87591 GC NAAT - Bill Together with 87491(Durham Co. L$38.99 2019 <br />87624 Pap HPV (Wake Med Lab)$38.99 2019 <br />87800 Detection Test for Multiple Organisms (UNC Lab)$44.57 2019 <br />87802 Strep B (UNC Lab)$13.32 2019 <br />87804 Influenza A & B (UNC Lab)$16.55 2019 <br />87880 Strep A (UNC Lab)$16.53 2019 <br />87902 Hep C Genotype (UNC Lab)$286.05 2019 <br />88141 Pap Smear with Dr. Interpretation (Wake Med Lab)$80.00 2016 <br />88175 Pap Thin Prep (Wake Med Lab)$29.44 2019 <br />90470 Administration of H1N1 Vaccine $18.00 2010 <br />90471 Admin Fee (1 vaccine) $18.00 2012 <br />90472 Admin Fee (2+ vaccines) $18.00 2012 <br />90473 Immunization Adm. - Intranasal/Oral $13.71 2014 <br />90474 Immunization Adm. - Intranasal/Oral Additional $13.71 2014 <br />90620 <br />Meningococcal recombinant protein and outer <br />membrane vesicle vaccine, serogroup B (MenB- <br />4C), 2 dose schedule - BEXSERO $195.50 2019 <br />Medicaid only <br />90620SL <br />Meningococcal recombinant protein and outer <br />membrane vesicle vaccine, serogroup B (MenB- <br />4C), 2 dose schedule - BEXSERO $0.00 2019 <br />63