Orange County NC Website
Browse       Search
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 />90621 Meningococcal recombinant lipoprotein vaccine, <br />serogroup B, 2 or 3 dose schedule - TRUMENBA $161.00 2019 <br />Medicaid only 90621SL Meningococcal recombinant lipoprotein vaccine, <br />serogroup B, 2 or 3 dose schedule - TRUMENBA $0.00 2019 <br />90632 Hepatitis A vaccine, adult dose - HAVRIX $79.00 2019 <br />Medicaid only 90632SL Hepatitis A vaccine, adult dose - HAVRIX $0.00 2019 <br />90633 Hepatitis A vaccine, pediatric/adolescent dose, 2 <br />dose - HAVRIX $37.00 2019 <br />Medicaid only 90633SL Hepatitis A vaccine, pediatric/adolescent dose, 2 <br />dose - HAVRIX $0.00 2019 <br />90636 Hepatitis A and Hepatitis B recombinant vaccine, 3 <br />doses - TWINRIX $117.00 2019 <br />Medicaid only 90636SL Hepatitis A and Hepatitis B recombinant vaccine, 3 <br />doses - TWINRIX $0.00 2019 <br />90647 Hemophilus Influenzae B vaccine (Hib), PRP- <br />OMP conjugate, 3 dose - PedVaxHIB $40.00 2018 <br />Medicaid only 90647SL Hemophilus Influenzae B vaccine (Hib), PRP- <br />OMP conjugate, 3 dose - PedVaxHIB $0.00 2019 <br />90648 Hemophilus Influenzae B vaccine (Hib), PRP-T <br />conjugate, 4 dose - ActHIB $26.00 2018 <br />Medicaid only 90648SL Hemophilus Influenzae B vaccine (Hib), PRP-T <br />conjugate, 4 dose - ActHIB $0.00 2019 <br />90651 <br />Human Papillomavirus vaccine types 6, 11, 16, 18, <br />31, 33, 45, 52, 58, nonavalent (HPV), 2 or 3 dose - <br />GARDASIL 9 $225.00 2019 <br />Medicaid only <br />90651SL <br />Human Papillomavirus vaccine types 6, 11, 16, 18, <br />31, 33, 45, 52, 58, nonavalent (HPV), 2 or 3 dose - <br />GARDASIL 9 $0.00 2019 <br />90662 Influenza vaccine (IIV3-HD), for 65 years of age <br />and up - FLUZONE HIGH DOSE $53.00 2019 <br />90670 Pneumococcal conjugate vaccine, 13 valent <br />(PCV13) - PREVNAR 13 $217.00 2019 <br />Medicaid only 90670SL Pneumococcal conjugate vaccine, 13 valent <br />(PCV13) - PREVNAR 13 $0.00 2019 <br />90675 Rabies Vaccine - IMOVAX RABIES $357.00 2019 <br />64