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Commissioner Approved Fee Schedule - FY 2023-24 50 <br /> Last <br /> Department/Program Description Current Fee Revision <br /> 87635 ADNA SARS-COV-2/COVID 19 Amplified Probe TQ $51.00 <br /> (UNC Lab) 2023 <br /> $44.00 <br /> 87800 <br /> Detection Test for Multiple Organisms(UNC Lab) 2023 <br /> 87802 Strep B(UNC Lab) $13.00 2023 <br /> 87804 Influenza A&B(UNC Lab) $17.00 2023 <br /> 87880 Strep A(UNC Lab) $17.00 2023 <br /> 87902 Hep C Genotype(UNC Lab) $257.00 2023 <br /> 88141 Pap Smear with Dr.Interpretation(Wake Med Lab) $80.00 2016 <br /> 88142 Cytopath CerNag Thin Layer(UNC Lab) $20.00 2023 <br /> 88175 Pap Thin Prep(Wake Med Lab) $27.00 2023 <br /> 88305 Tissue Exam by Pathologist-Surg Path IV(UNC) $50.00 2023 <br /> 88341 Imhistochem/Cytchm Each Addl Antibody Slide <br /> (UNC Lab) $27.37 2022 <br /> 88342 Imhistochem/Cytchm Antibody Stain Procedure(UNC <br /> Lab) $33.82 2022 <br /> 90470 Administration of H1N1 Vaccine $18.00 2010 <br /> 90471 Admin Fee(1 vaccine) $20.45 2022 <br /> 90472 Admin Fee(2+vaccines) $20.45 2022 <br /> 90473 Immunization Adm.-Intranasal/Oral $20.45 2022 <br /> 90474 Immunization Adm.-Intranasal/Oral Additional $20.45 2022 <br /> 90619 Meningococcal conjugate vaccine,serogroups ACYW- <br /> MENQUADFI $145.21 2023 <br /> Meningococcal recombinant protein and outer <br /> 90620 membrane vesicle vaccine,serogroup B(MenB-4C),2 <br /> dose schedule-BEXSERO $187.04 2023 <br /> 90620SL Mcningococcal recombinant protein and outer <br /> membrane vesicle vaccine,serogroup B(MenB-4C),2 <br /> Medicaid only dose schedule-BEXSERO $0.00 2019 <br /> 90621 Meningococcal recombinant lipoprotein vaccine, <br /> serogroup B,2 or 3 dose schedule-TRUMENBA $227.92 2023 <br /> 90621 SL Meningococcal recombinant lipoprotein vaccine, <br /> Medicaid only serogroup B,2 or 3 dose schedule-TRUMENBA $0.00 2019 <br /> 90632 Hepatitis A vaccine,adult dose-HAVRIX $68.88 2023 <br /> Medicaid only 90632SL Hepatitis A vaccine,adult dose-HAVRIX $0.00 2019 <br /> 90633 Hepatitis A vaccine,pediatric/adolescent dose,2 dose- <br /> HAVRIX $30.70 2023 <br /> 90633SL Hepatitis A vaccine,pediatric/adolescent dose,2 dose- <br /> Medicaid only HAVRIX $0.00 2019 <br /> 90636 Hepatitis A and Hepatitis B recombinant vaccine,3 <br /> doses-TWINRIX $105.33 2023 <br /> 90636SL Hepatitis A and Hepatitis B recombinant vaccine,3 <br /> Medicaid only doses-TWINRIX $0.00 2019 <br /> 90647 Hemophilus Influenzae B vaccine(Hib),PRP-OMP <br /> conjugate,3 dose-PcdVaxHIB $28.86 2023 <br /> 90647SL Hemophilus Influenzae B vaccine(Hib),PRP-OMP <br /> Medicaid only conjugate,3 dose-PcdVaxHIB J$0.00 12019 <br /> 90648 Hemophilus Influenzae B vaccine(Hib),PRP-T <br /> conjugate,4 dose-ActHIB 1$12.23 2023 <br />