2017 Clinical Diagnostic Laboratory Fee Schedule …...80178 Assay of lithium 9.07 12.26 - 9.07 80180 Drug scrn quan mycophenolate 24.76 33.46 - 24.76 80183 Drug scrn quant oxcarbazepin

2017 Clinical Diagnostic Laboratory Fee Schedule

CPT codes, descriptions and other data only are copyright 2016 American Medical Association. All rights reserved.

CPT is a registered trademark of the American Medical Association (AMA).

HCPCS Modifier SHORTDESC

National

Limit Mid Point Floor

WV

Medicare

36415 Routine venipuncture - - - 3.00

78267 Breath tst attain/anal c-14 10.78 14.57 - 10.78

78268 Breath test analysis c-14 92.40 124.86 - 92.40

80047 QW Metabolic panel ionized ca 11.60 15.68 - 11.60

80047 Metabolic panel ionized ca 11.60 15.68 - 11.60

80048 QW Metabolic panel total ca 11.60 15.68 - 11.60

80048 Metabolic panel total ca 11.60 15.68 - 11.60

80050 General health panel - - - 50.13

80051 QW Electrolyte panel 9.62 13.00 - 8.09

80051 Electrolyte panel 9.62 13.00 - 8.09

80053 QW Comprehen metabolic panel 14.49 19.59 - 14.49

80053 Comprehen metabolic panel 14.49 19.59 - 14.49

80055 Obstetric panel 65.58 88.62 - 65.58

80061 QW Lipid panel - - - 18.37

80061 Lipid panel - - - 18.37

80069 QW Renal function panel 11.91 16.10 - 11.91

80069 Renal function panel 11.91 16.10 - 11.91

80074 Acute hepatitis panel - - - 62.43

80076 Hepatic function panel 11.21 15.15 - 11.21

80081 Obstetric panel 102.69 138.77 - 102.69

80150 Assay of amikacin 20.68 27.94 - 20.68

80155 Drug screen quant caffeine 19.40 26.22 - 19.40

80156 Assay carbamazepine total 19.98 27.00 - 19.98

80157 Assay carbamazepine free 18.18 24.57 - 18.18

80158 Assay of cyclosporine 24.76 33.46 - 24.76

80159 Drug screen quant clozapine 25.37 34.28 - 25.37

80162 Assay of digoxin 18.21 24.61 - 18.21

80163 Assay of digoxin free 18.21 24.61 - 18.21

80164 Assay dipropylacetic acid 18.58 25.11 - 11.99

80165 Dipropylacetic acid free 18.58 25.11 - 11.99

80168 Assay of ethosuximide 22.41 30.29 - 22.41

80169 Drug screen quant everolimus 18.84 25.46 - 18.84

80170 Assay of gentamicin 22.47 30.37 - 22.47

80171 Drug screen quant gabapentin 18.18 24.57 - 18.18

80173 Assay of haloperidol 19.98 27.00 - 19.98

80175 Drug screen quan lamotrigine 18.18 24.57 - 18.18

80176 Assay of lidocaine 20.15 27.23 - 20.15

80177 Drug scrn quan levetiracetam 18.18 24.57 - 18.18

80178 QW Assay of lithium 9.07 12.26 - 9.07

80178 Assay of lithium 9.07 12.26 - 9.07

80180 Drug scrn quan mycophenolate 24.76 33.46 - 24.76

80183 Drug scrn quant oxcarbazepin 18.18 24.57 - 18.18

80184 Assay of phenobarbital 15.71 21.23 - 11.98

80185 Assay of phenytoin total 18.18 24.57 - 18.18

80186 Assay of phenytoin free 18.88 25.52 - 18.88

80188 Assay of primidone 22.76 30.76 - 22.76

80190 Assay of procainamide 22.98 31.06 - 22.98

80192 Assay of procainamide 22.98 31.06 - 22.98

80194 Assay of quinidine 20.03 27.07 - 20.03

80195 Assay of sirolimus 18.84 25.46 - 18.84

80197 Assay of tacrolimus 18.84 25.46 - 18.84

80198 Assay of theophylline 19.40 26.22 - 19.40

80199 Drug screen quant tiagabine 24.77 33.47 - 24.77

80200 Assay of tobramycin 22.12 29.89 - 22.12

80201 Assay of topiramate 16.35 22.10 - 16.35

80202 Assay of vancomycin 18.58 25.11 - 11.99

80203 Drug screen quant zonisamide 18.18 24.57 - 18.18

80299 Quantitative assay drug 18.79 25.40 - 13.51

80305 Drug test prsmv dir opt obs 20.22 20.22 - 9.03

80306 Drug test prsmv instrmnt 26.97 26.97 - 12.04

80307 Drug test prsmv chem anlyzr 107.85 107.85 - 48.17

80400 Acth stimulation panel - - - 44.74



80408 Aldosterone suppression eval - - - 164.90

80410 Calcitonin stimul panel - - - 110.21

80412 CRH stimulation panel - - - 452.16

80414 Testosterone response - - - 55.89

80415 Estradiol response panel - - - 76.66

80416 Renin stimulation panel - - - 159.28

80417 Renin stimulation panel - - - 53.09

80418 Pituitary evaluation panel - - - 795.06

80420 Dexamethasone panel - - - 98.83

80422 Glucagon tolerance panel - - - 63.20

80424 Glucagon tolerance panel - - - 69.27

80426 Gonadotropin hormone panel - - - 203.58

80428 Growth hormone panel - - - 91.50

80430 Growth hormone panel - - - 107.66

80432 Insulin suppression panel - - - 185.32

80434 Insulin tolerance panel - - - 138.78

80435 Insulin tolerance panel - - - 141.31

80436 Metyrapone panel - - - 125.05

80438 TRH stimulation panel - - - 69.15

80439 TRH stimulation panel - - - 92.20

80500 Clinical pathology consultation; limited, without review of patient's history and medical records- - - -

80502 Clinical pathology consultation; comprehensive, for a complex diagnostic problem, with review of patient's history and medical records- - - -

81000 Urinalysis nonauto w/scope 4.35 5.88 - 4.35

81001 Urinalysis auto w/scope 4.35 5.88 - 4.35

81002 Urinalysis nonauto w/o scope 3.50 4.73 - 3.22

81002 Urinalysis nonauto w/o scope 3.50 4.73 - 3.22

81003 QW Urinalysis auto w/o scope 3.08 4.16 - 3.08

81003 Urinalysis auto w/o scope 3.08 4.16 - 3.08

81005 Urinalysis 2.97 4.02 - 2.97

81007 QW Urine screen for bacteria 3.52 4.75 - 3.52

81007 Urine screen for bacteria 3.52 4.75 - 3.52

81015 Microscopic exam of urine 4.18 5.65 - 4.18

81020 Urinalysis glass test 5.06 6.84 - 5.06

81025 Urine pregnancy test 8.67 11.72 - 8.67

81050 Volume measurement for timed collection, each- - - 4.09

81099 Unlisted urinalysis procedure - - - -

81161 Dmd dup/delet analysis 141.12 141.12 - 141.12

81162 Brca1&2 seq & full dup/del 2,503.26 2,503.26 - 2,503.26

81170 Abl1 gene 331.82 331.82 - 331.82

81200 ASPA (ASPARTOACYLASE) (EG, CANAVAN DISEASE) GENE ANALYSIS, COMMON VARIANTS (EG, E285A, Y231X)- - - 93.90

81201 APC (adenomatous polyposis coli) (eg, familial adenomatosis polyposis [FAP], attenuated FAP) gene analysis; full gene sequence- - - 749.92

81202 APC (adenomatous polyposis coli) (eg, familial adenomatosis polyposis [FAP], attenuated FAP) gene analysis; known familial variants- - - 93.94

81203 APC (adenomatous polyposis coli) (eg, familial adenomatosis polyposis [FAP], attenuated FAP) gene analysis; duplication/deletion variants- - - 570.05

81205 BCKDHB (BRANCHED-CHAIN KETO ACID DEHYDROGENASE E1, BETA POLYPEPTIDE) (EG, MAPLE SYRUP URINE DISEASE) GENE ANALYSIS, COMMON VARIANTS (EG, R183P, G278S, E422X)- - - 123.36

81206 Bcr/abl1 gene major bp 224.91 224.91 - 224.91

81207 Bcr/abl1 gene minor bp 198.68 198.68 - 198.68

81208 Bcr/abl1 gene other bp 220.63 220.63 - 220.63

81209 BLM (BLOOM SYNDROME, RECQ HELICASE-LIKE) (EG, BLOOM SYNDROME) GENE ANALYSIS, 2281DEL6INS7 VARIANT- - - 93.90

81211 Brca1&2 seq & com dup/del 2,195.48 2,195.48 - 2,195.48

81212 Brca1&2 185&5385&6174 var 177.68 177.68 - 177.68

81213 Brca1&2 uncom dup/del var 585.91 585.91 - 585.91

81214 Brca1 full seq & com dup/del 1,446.02 1,446.02 - 1,446.02

81215 Brca1 gene known fam variant 93.75 93.75 - 93.75

81216 BRCA2 (BREAST CANCER 2) (EG, HEREDITARY BREAST AND OVARIAN CANCER) GENE ANALYSIS; FULL SEQUENCE ANALYSIS- - - 1,747.04

81217 Brca2 gene known fam variant 93.75 93.75 - 93.75

81218 CEBPA (CCAAT/enhamcer binding protein [C/EBP], alpha) (eg, acute myeloid leukemia), gene analysis, full gene sequence331.82 331.82 - 331.82

81220 CFTR (CYSTIC FIBROSIS TRANSMEMBRANE CONDUCTANCE REGULATOR) (EG, CYSTIC FIBROSIS) GENE ANALYSIS; COMMON VARIANTS (EG, ACMG/ACOG GUIDELINES)- - - 800.46

81221 CFTR (CYSTIC FIBROSIS TRANSMEMBRANE CONDUCTANCE REGULATOR) (EG, CYSTIC FIBROSIS) GENE ANALYSIS; KNOWN FAMILIAL VARIANTS- - - 93.94

81222 CFTR (CYSTIC FIBROSIS TRANSMEMBRANE CONDUCTANCE REGULATOR) (EG, CYSTIC FIBROSIS) GENE ANALYSIS; DUPLICATION/DELETION VARIANTS- - - 129.55

81223 CFTR (CYSTIC FIBROSIS TRANSMEMBRANE CONDUCTANCE REGULATOR) (EG, CYSTIC FIBROSIS) GENE ANALYSIS; FULL GENE SEQUENCE- - - 1,554.46

81235 Egfr gene com variants 331.82 331.82 - 331.82

81240 F2 gene 67.50 67.50 - 67.50

81241 F5 gene 83.82 83.82 - 83.82

81242 FANCC (FANCONI ANEMIA, COMPLEMENTATION GROUP C) (EG, FANCONI ANEMIA, TYPE C) GENE ANALYSIS, COMMON VARIANT (EG, IVS4+4A>T)- - - 93.90

81243 FMR1 (FRAGILE X MENTAL RETARDATION 1) (EG, FRAGILE X MENTAL RETARDATION) GENE ANALYSIS; EVALUATION TO DETECT ABNORMAL (EG, EXPANDED) ALLELES- - - 60.51

81244 FMR1 (FRAGILE X MENTAL RETARDATION 1) (EG, FRAGILE X MENTAL RETARDATION) GENE ANALYSIS; CHARACTERIZATION OF ALLELES (EG, EXPANDED SIZE AND METHYLATION STATUS)- - - 100.09

81245 Flt3 gene 166.84 166.84 - 166.84

81246 Flt3 gene analysis 83.62 83.62 - 83.62

81252 GJB2 (gap junction protein, beta 2, 26kDa, connexin 26) (eg, nonsyndromic hearing loss) gene analysis; full gene sequence- - - 156.64

81253 GJB2 (gap junction protein, beta 2, 26kDa; connexin 26) (eg, nonsyndromic hearing loss) gene analysis; known familial variants- - - 81.56

81254 GJB6 (gap junction protein, beta 6, 30kDa, connexin 30) (eg, nonsyndromic hearing loss) gene analysis, common variants (eg, 309kb [del(GJB6-D13S1830)] and 232kb [del(GJB6-D13S1854)])- - - 74.97

81255 HEXA (HEXOSAMINIDASE A [ALPHA POLYPEPTIDE]) (EG, TAY-SACHS DISEASE) GENE ANALYSIS, COMMON VARIANTS (EG, 1278INSTATC, 1421+1G>C, G269S)- - - 89.17

81256 Hfe gene 89.66 89.66 - 89.66

81257 HBA1/HBA2 (ALPHA GLOBIN 1 AND ALPHA GLOBIN 2) (EG, ALPHA THALASSEMIA, HB BART HYDROPS FETALIS SYNDROME, HBH DISEASE),- - - 183.22

81261 Igh gene rearrange amp meth 271.59 271.59 - 271.59

81262 Igh gene rearrang dir probe 59.88 59.88 - 59.88

81263 Igh vari regional mutation 404.00 404.00 - 404.00

81264 Igk rearrangeabn clonal pop 204.83 204.83 - 204.83

81265 Str markers specimen anal 294.99 294.99 - 294.99

81266 Comparative analysis using Short Tandem Repeat (STR) markers; each additional specimen (eg, additional cord blood donor, additional fetal samples from different cultures, or additional zygosity in multiple birth pregnancies) (List separately in addition to code for primary procedure)- - - #N/A

81267 Chimerism anal no cell selec 284.58 284.58 - 284.58

81268 Chimerism anal w/cell select 357.73 357.73 - 357.73

81270 Jak2 gene 125.74 125.74 - 125.74

81272 Kit gene targeted seq analys 331.82 331.82 - 331.82

81275 Kras gene 198.57 198.57 - 198.57

81276 Kras gene addl variants 198.57 198.57 - 198.57

81288 Mlh1 gene 160.76 160.76 - 160.76

81290 MCOLN1 (MUCOLIPIN 1) (EG, MUCOLIPIDOSIS, TYPE IV) GENE ANALYSIS, COMMON VARIANTS (EG, IVS3-2A>G, DEL6.4KB)- - - 93.90

81291 Mthfr gene 59.88 59.88 - 59.88

81292 Mlh1 gene full seq 649.78 649.78 - 649.78

81293 Mlh1 gene known variants 260.48 260.48 - 260.48

81294 Mlh1 gene dup/delete variant 191.72 191.72 - 191.72

81295 Msh2 gene full seq 152.54 152.54 - 152.54

81296 Msh2 gene known variants 130.25 130.25 - 130.25

81297 Msh2 gene dup/delete variant 152.54 152.54 - 152.54

81298 Msh6 gene full seq 289.41 289.41 - 289.41

81299 Msh6 gene known variants 162.13 162.13 - 162.13

81300 Msh6 gene dup/delete variant 162.57 162.57 - 162.57

81301 Microsatellite instability 397.20 397.20 - 397.20

81310 Npm1 gene 248.50 248.50 - 248.50

81314 Pdgfra gene 331.82 331.82 - 331.82

81315 Pml/raralpha com breakpoints 284.38 284.38 - 284.38

81316 Pml/raralpha 1 breakpoint 433.76 433.76 - 433.76

81317 Pms2 gene full seq analysis 785.58 785.58 - 785.58

81318 Pms2 known familial variants 185.62 185.62 - 185.62

81319 Pms2 gene dup/delet variants 222.88 222.88 - 222.88

81321 Pten gene full sequence 604.00 604.00 - 604.00

81322 Pten gene known fam variant 58.72 58.72 - 58.72

81323 Pten gene dup/delet variant 88.08 88.08 - 88.08

81324 PMP22 (peripheral myelin protein 22) (eg, Charcot-Marie-Tooth, hereditary neuropathy with liability to pressure palsies) gene analysis; duplication/deletion analysis- - - 486.15

81325 PMP22 (peripheral myelin protein 22) (eg, Charcot-Marie-Tooth, hereditary neuropathy with liability to pressure palsies) gene analysis; full sequence analysis- - - 297.24

81326 PMP22 (peripheral myelin protein 22) (eg, Charcot-Marie-Tooth, hereditary neuropathy with liability to pressure palsies) gene analysis; known familial variant- - - 93.94

81331 SNRPN/UBE3A (SMALL NUCLEAR RIBONUCLEOPROTEIN POLYPEPTIDE N AND UBIQUITIN PROTEIN LIGASE E3A) (EG, PRADER-WILLI SYNDROME AND/OR ANGELMAN SYNDROME), METHYLATION ANALYSIS- - - 73.22

81332 Serpina1 gene 59.88 59.88 - 59.88

81340 Trb@ gene rearrange amplify 286.58 286.58 - 286.58

81341 Trb@ gene rearrange dirprobe 68.02 68.02 - 68.02

81342 Trg gene rearrangement anal 276.40 276.40 - 276.40

81370 Hla i & ii typing lr 551.61 551.61 - 551.61

81371 Hla i & ii type verify lr 330.17 330.17 - 330.17

81372 Hla i typing complete lr 303.02 303.02 - 303.02

81373 Hla i typing 1 locus lr 152.76 152.76 - 152.76

81374 Hla i typing 1 antigen lr 99.79 99.79 - 99.79

81375 Hla ii typing ag equiv lr 302.80 302.80 - 302.80

81376 Hla ii typing 1 locus lr 167.66 167.66 - 167.66

81377 Hla ii type 1 ag equiv lr 125.94 125.94 - 125.94

81378 Hla i & ii typing hr 474.03 474.03 - 474.03

81379 Hla i typing complete hr 460.06 460.06 - 460.06

81380 Hla i typing 1 locus hr 243.14 243.14 - 243.14

81381 Hla i typing 1 allele hr 129.74 129.74 - 129.74

81382 Hla ii typing 1 loc hr 169.66 169.66 - 169.66

81383 Hla ii typing 1 allele hr 149.70 149.70 - 149.70

81410 Aortic dysfunction/dilation - - - -

81411 Aortic dysfunction/dilation - - - -

81412 Ashkenazi jewish assoc dis 602.10 602.10 - 602.10

81420 Fetal chrmoml aneuploidy 802.33 802.33 - 802.33

81432 Hrdtry brst ca-rlatd dsordrs 931.48 931.48 - 931.48

81433 Hrdtry brst ca-rlatd dsordrs 602.10 602.10 - 602.10

81434 Hereditary retinal disorders 602.10 602.10 - 602.10

81435 Hereditary colon cancer 802.33 802.33 - 802.33

81436 Hereditary colon ca synd 802.33 802.33 - 802.33

81437 Heredtry nurondcrn tum dsrdr 602.10 602.10 - 602.10

81438 Heredtry nurondcrn tum dsrdr 602.10 602.10 - 602.10

81442 Noonan spectrum disorders 602.10 602.10 - 602.10

81479 Unlisted molecular pathology procedure- - - -

81519 Oncology breast mrna 3,443.36 3,443.36 - 3,443.36

81539 Oncology prostate prob score 602.10 602.10 - 602.10

81595 Cardiology hrt trnspl mrna 2,840.75 2,840.75 - 2,840.75

81599 Unlisted multianalyte assay with algorithmic analysis- - - -

82009 Test for acetone/ketones 6.20 8.38 - 4.77

82010 QW Acetone assay 11.21 15.15 - 11.21

82010 Acetone assay 11.21 15.15 - 11.21

82013 Acetylcholinesterase assay 15.32 20.70 - 15.32

82016 Acylcarnitines qual 19.03 25.71 - 19.03

82017 Acylcarnitines quant 23.14 31.27 - 23.14

82024 Assay of acth 52.98 71.60 - 52.98

82030 Assay of adp & amp 35.39 47.82 - 35.39

82040 QW Assay of serum albumin 6.79 9.17 - 6.79

82040 Assay of serum albumin 6.79 9.17 - 6.79

82042 Assay of urine albumin 7.10 9.60 - 7.10

82043 QW Microalbumin quantitative 7.93 10.71 - 7.93

82043 Microalbumin quantitative 7.93 10.71 - 7.93

82044 QW Microalbumin semiquant 6.28 8.48 - 6.28

82044 Microalbumin semiquant 6.28 8.48 - 6.28

82045 Albumin ischemia modified 46.56 62.92 - 46.56

82055 QW Alcohol (ethanol); breath - - - 13.50

82075 Assay of breath ethanol 16.53 22.34 - 16.53

82085 Assay of aldolase 13.32 18.00 - 13.32

82088 Assay of aldosterone 55.90 75.54 - 55.90

82103 Alpha-1-antitrypsin total 18.43 24.90 - 18.43

82104 Alpha-1-antitrypsin pheno 19.84 26.81 - 19.84

82105 Alpha-fetoprotein serum 23.01 31.10 - 23.01

82106 Alpha-fetoprotein amniotic 23.01 31.10 - 23.01

82107 Alpha-fetoprotein l3 88.36 119.40 - 88.36

82108 Assay of aluminum 34.95 47.23 - 34.95

82120 QW Amines vaginal fluid qual 5.17 6.98 - 5.17

82120 Amines vaginal fluid qual 5.17 6.98 - 5.17

82127 Amino acid single qual 19.03 25.71 - 19.03

82128 Amino acids mult qual 19.03 25.71 - 19.03

82131 Amino acids single quant 23.14 31.27 - 23.14

82135 Assay aminolevulinic acid 22.57 30.50 - 22.57

82136 Amino acids quant 2-5 23.14 31.27 - 23.14

82139 Amino acids quan 6 or more 23.14 31.27 - 23.14

82140 Ammonia - - - 19.85

82143 Amniotic fluid scan 9.42 12.73 - 9.42

82150 QW Assay of amylase 8.89 12.01 - 8.89

82150 Assay of amylase 8.89 12.01 - 8.89

82154 Androstanediol glucuronide 39.55 53.45 - 39.55

82157 Assay of androstenedione 40.16 54.27 - 40.16

82160 Assay of androsterone 34.30 46.35 - 34.30

82163 Assay of angiotensin II 28.15 38.04 - 28.15

82164 Angiotensin I enzyme test 20.03 27.07 - 20.03

82172 Assay of apolipoprotein 21.26 28.73 - 21.26

82175 Assay of arsenic 26.02 35.16 - 23.10

82180 Assay of ascorbic acid 13.56 18.32 - 13.56

82190 Atomic absorption 20.45 27.63 - 20.45

82232 Assay of beta-2 protein 22.19 29.99 - 19.91

82239 Bile acids total 23.49 31.75 - 23.49

82240 Bile acids cholylglycine 36.46 49.27 - 36.46

82247 QW Bilirubin total 6.88 9.30 - 5.54

82247 Bilirubin total 6.88 9.30 - 5.54

82248 Bilirubin direct 6.88 9.30 - 5.54

82252 Fecal bilirubin test 6.25 8.44 - 6.25

82261 Assay of biotinidase 23.14 31.27 - 23.14

82270 Occult blood feces 4.46 6.03 - 4.46

82271 QW Occult blood other sources 4.46 6.03 - 4.46

82271 Occult blood other sources 4.46 6.03 - 4.46

82272 Occult bld feces 1-3 tests 4.46 6.03 - 4.46

82274 QW Assay test for blood fecal 21.82 29.48 - 21.82

82274 Assay test for blood fecal 21.82 29.48 - 21.82

82286 Assay of bradykinin 9.45 12.77 - 9.45

82300 Assay of cadmium 31.75 42.90 - 31.75

82306 Vitamin d 25 hydroxy 40.61 54.88 - 40.61

82308 Assay of calcitonin 36.75 49.66 - 36.75

82310 QW Assay of calcium 7.08 9.57 - 7.08

82310 Assay of calcium 7.08 9.57 - 7.08

82330 QW Assay of calcium 18.76 25.35 - 18.76

82330 Assay of calcium 18.76 25.35 - 18.76

82331 Calcium infusion test 7.10 9.60 - 7.10

82340 Assay of calcium in urine 8.27 11.18 - 8.27

82355 Calculus analysis qual 15.88 21.46 - 11.99

82360 Calculus assay quant 17.66 23.86 - 15.97

82365 Calculus spectroscopy 17.69 23.90 - 17.69

82370 X-ray assay calculus 17.18 23.22 - 15.97

82373 Assay c-d transfer measure 24.77 33.47 - 24.77

82374 QW Assay blood carbon dioxide 6.70 9.06 - 6.70

82374 Assay blood carbon dioxide 6.70 9.06 - 6.70

82375 Assay carboxyhb quant 16.90 22.84 - 11.62

82376 Assay carboxyhb qual 8.22 11.11 - 8.22

82378 Carcinoembryonic antigen 26.01 35.16 - 26.01

82379 Assay of carnitine 23.14 31.27 - 23.14

82380 Assay of carotene 12.65 17.10 - 12.65

82382 Assay urine catecholamines 23.58 31.87 - 23.58

82383 Assay blood catecholamines 34.37 46.45 - 34.37

82384 Assay three catecholamines 34.64 46.81 - 34.64

82387 Assay of cathepsin-d 28.55 38.58 - 28.55

82390 Assay of ceruloplasmin 14.73 19.91 - 14.73

82397 Chemiluminescent assay 19.37 26.18 - 19.37

82415 Assay of chloramphenicol 17.38 23.48 - 17.38

82435 QW Assay of blood chloride 6.31 8.53 - 6.31

82435 Assay of blood chloride 6.31 8.53 - 6.31

82436 Assay of urine chloride 6.90 9.32 - 6.90

82438 Assay other fluid chlorides 6.70 9.06 - 6.70

82441 Test for chlorohydrocarbons 8.24 11.13 - 8.24

82465 QW Assay bld/serum cholesterol 5.97 8.07 - 5.97

82465 Assay bld/serum cholesterol 5.97 8.07 - 5.97

82480 Assay serum cholinesterase 10.80 14.60 - 10.80

82482 Assay rbc cholinesterase 10.53 14.23 - 10.53

82485 Assay chondroitin sulfate 28.33 38.28 - 28.33

82495 Assay of chromium 27.82 37.60 - 27.82

82507 Assay of citrate 38.14 51.54 - 38.14

82523 QW Collagen crosslinks 25.63 34.64 - 25.63

82523 Collagen crosslinks 25.63 34.64 - 25.63

82525 Assay of copper 17.02 23.00 - 17.02

82528 Assay of corticosterone 30.89 41.74 - 30.89

82530 Cortisol free 22.92 30.97 - 22.92

82533 Total cortisol 22.36 30.22 - 22.36

82540 Assay of creatine 6.36 8.60 - 6.36

82542 Column chromotography quant 24.77 33.47 - 24.77

82550 QW Assay of ck (cpk) 8.93 12.07 - 8.93

82550 Assay of ck (cpk) 8.93 12.07 - 8.93

82552 Assay of cpk in blood 18.37 24.83 - 18.37

82553 Creatine mb fraction 15.84 21.41 - 12.48

82554 Creatine isoforms 16.28 22.00 - 16.28

82565 QW Assay of creatinine 7.03 9.51 - 7.03

82565 Assay of creatinine 7.03 9.51 - 7.03

82570 QW Assay of urine creatinine 7.10 9.60 - 7.10

82570 Assay of urine creatinine 7.10 9.60 - 7.10

82575 Creatinine clearance test 12.97 17.53 - 12.97

82585 Assay of cryofibrinogen 11.77 15.91 - 5.50

82595 Assay of cryoglobulin 8.87 11.99 - 5.90

82600 Assay of cyanide 26.61 35.96 - 26.61

82607 Vitamin B-12 20.68 27.94 - 20.68

82608 B-12 binding capacity 19.64 26.54 - 19.64

82610 Cystatin c 18.65 25.20 - 18.65

82615 Test for urine cystines 11.20 15.14 - 10.19

82626 Dehydroepiandrosterone 34.67 46.85 - 34.67

82627 Dehydroepiandrosterone 30.50 41.22 - 30.50

82633 Desoxycorticosterone 42.50 57.43 - 42.50

82634 Deoxycortisol 40.16 54.27 - 40.16

82638 Assay of dibucaine number 16.80 22.70 - 16.80

82652 Vit d 1 25-dihydroxy 52.81 71.37 - 52.81

82656 Pancreatic elastase fecal 15.82 21.38 - 15.82

82657 Enzyme cell activity 24.77 33.47 - 24.77

82658 Enzyme cell activity ra 24.77 33.47 - 24.77

82664 Electrophoretic test 47.12 63.68 - 47.12

82668 Assay of erythropoietin 25.78 34.84 - 25.78

82670 Assay of estradiol 38.32 51.79 - 38.32

82671 Assay of estrogens 44.31 59.88 - 44.31

82672 Assay of estrogen 29.76 40.22 - 29.76

82677 Assay of estriol 33.17 44.83 - 33.17

82679 QW Assay of estrone 34.23 46.26 - 27.94

82679 Assay of estrone 34.23 46.26 - 27.94

82693 Assay of ethylene glycol 20.44 27.62 - 20.44

82696 Assay of etiocholanolone 32.35 43.71 - 32.35

82705 Fats/lipids feces qual 6.99 9.44 - 2.30

82710 Fats/lipids feces quant 23.05 31.15 - 23.05

82715 Assay of fecal fat 23.61 31.90 - 23.61

82725 Assay of blood fatty acids 18.26 24.67 - 18.26

82726 Long chain fatty acids 24.77 33.47 - 24.77

82728 Assay of ferritin 18.70 25.27 - 18.70

82731 Assay of fetal fibronectin 88.36 119.40 - 88.36

82735 Assay of fluoride 25.43 34.36 - 25.43

82746 Assay of folic acid serum 20.17 27.26 - 20.17

82747 Assay of folic acid rbc 23.76 32.11 - 23.76

82757 Assay of semen fructose 23.78 32.14 - 3.21

82759 Assay of rbc galactokinase 29.47 39.83 - 17.34

82760 Assay of galactose 15.36 20.75 - 15.36

82775 Assay galactose transferase 28.90 39.05 - 28.90

82776 Galactose transferase test 11.51 15.55 - 11.51

82784 Assay iga/igd/igg/igm each 12.76 17.24 - 12.76

82785 Assay of ige 22.58 30.52 - 22.58

82787 Igg 1 2 3 or 4 each 11.00 14.87 - 11.00

82800 Blood pH 11.61 15.69 - 11.61

82803 Blood gases any combination 26.54 35.87 - 26.54

82805 Blood gases w/o2 saturation 38.92 52.60 - 38.92

82810 Blood gases o2 sat only 11.97 16.18 - 11.97

82820 Hemoglobin-oxygen affinity 13.70 18.52 - 12.59

82930 Gastric analy w/ph ea spec 7.47 10.10 - 7.47

82938 Gastrin test 24.27 32.80 - 24.27

82941 Assay of gastrin 24.19 32.69 - 24.19

82943 Assay of glucagon 19.60 26.48 - 19.60

82945 Glucose other fluid 5.39 7.28 - 5.39

82946 Glucagon tolerance test 20.68 27.94 - 17.34

82947 QW Assay glucose blood quant 5.39 7.28 - 5.39

82947 Assay glucose blood quant 5.39 7.28 - 5.39

82948 Reagent strip/blood glucose 4.35 5.88 - 4.35

82950 QW Glucose test 6.51 8.80 - 6.51

82950 Glucose test 6.51 8.80 - 6.51

82951 QW Glucose tolerance test (GTT) 17.66 23.86 - 17.66

82951 Glucose tolerance test (GTT) 17.66 23.86 - 17.66

82952 QW GTT-added samples 5.38 7.27 - 5.38

82952 GTT-added samples 5.38 7.27 - 5.38

82955 Assay of g6pd enzyme 13.30 17.97 - 6.76

82960 Test for G6PD enzyme 8.30 11.22 - 8.30

82962 Glucose blood test 3.21 4.34 - 3.21

82963 Assay of glucosidase 29.47 39.83 - 6.76

82965 Assay of gdh enzyme 10.60 14.32 - 6.76

82977 QW Assay of GGT 9.88 13.35 - 9.88

82977 Assay of GGT 9.88 13.35 - 9.88

82978 Assay of glutathione 19.55 26.42 - 16.99

82979 Assay rbc glutathione 9.45 12.77 - 9.45

82985 QW Assay of glycated protein 20.68 27.94 - 13.80

82985 Assay of glycated protein 20.68 27.94 - 13.80

83001 QW Assay of gonadotropin (fsh) 25.49 34.44 - 25.49

83001 Assay of gonadotropin (fsh) 25.49 34.44 - 25.49

83002 QW Assay of gonadotropin (lh) 25.40 34.32 - 25.40

83002 Assay of gonadotropin (lh) 25.40 34.32 - 25.40

83003 Assay growth hormone (hgh) 22.87 30.91 - 22.87

83009 H pylori (c-13) blood 92.40 124.86 - 92.40

83010 Assay of haptoglobin quant 17.25 23.31 - 17.25

83012 Assay of haptoglobins 23.58 31.87 - 20.66

83013 H pylori (c-13) breath 92.40 124.86 - 92.40

83014 H pylori drug admin 10.78 14.57 - 10.78

83015 Heavy metal screen 25.83 34.90 - 17.50

83018 Quantitative screen metals 30.13 40.71 - 30.13

83020 26 Hemoglobin electrophoresis - - - -

83020 Hemoglobin electrophoresis 17.66 23.86 - 17.66

83021 Hemoglobin chromotography 24.77 33.47 - 24.77

83026 Hemoglobin copper sulfate 3.24 4.38 - 3.24

83030 Fetal hemoglobin chemical 11.34 15.33 - 11.34

83033 Fetal hemoglobin assay qual 8.18 11.05 - 8.18

83036 QW Glycosylated hemoglobin test 13.32 18.00 - 13.32

83036 Glycosylated hemoglobin test 13.32 18.00 - 13.32

83037 QW Glycosylated hb home device 13.32 18.00 - 13.32

83045 Blood methemoglobin test 6.79 9.18 - 6.79

83050 Blood methemoglobin assay 10.05 13.58 - 10.05

83051 Assay of plasma hemoglobin 10.03 13.55 - 10.03

83060 Blood sulfhemoglobin assay 11.34 15.33 - 11.34

83065 Assay of hemoglobin heat 9.45 12.77 - 9.45

83068 Hemoglobin stability screen 11.61 15.69 - 11.61

83069 Assay of urine hemoglobin 5.42 7.32 - 5.42

83070 Assay of hemosiderin qual 6.51 8.80 - 4.59

83080 Assay of b hexosaminidase 23.14 31.27 - 23.14

83088 Assay of histamine 40.51 54.74 - 40.51

83090 Assay of homocystine 23.14 31.27 - 23.14

83150 Assay of homovanillic acid 26.54 35.87 - 26.54

83491 Assay of corticosteroids 17 24.04 32.48 - 24.04

83497 Assay of 5-hiaa 17.69 23.90 - 17.69

83498 Assay of progesterone 17-d 37.27 50.36 - 37.27

83499 Assay of progesterone 20- 34.58 46.73 - 34.58

83500 Assay free hydroxyproline 31.07 41.98 - 26.22

83505 Assay total hydroxyproline 33.34 45.06 - 25.33

83516 Immunoassay nonantibody 15.82 21.38 - 15.82

83518 Immunoassay dipstick 11.63 15.71 - 11.63

83519 Ria nonantibody 18.53 25.04 - 18.53

83520 Immunoassay quant nos nonab 17.76 24.00 - 17.76

83525 Assay of insulin 15.68 21.19 - 15.68

83527 Assay of insulin 17.76 24.01 - 17.76

83528 Assay of intrinsic factor 21.82 29.48 - 21.82

83540 Assay of iron 8.88 12.00 - 8.88

83550 Iron binding test 11.99 16.21 - 11.99

83570 Assay of idh enzyme 12.14 16.40 - 12.14

83582 Assay of ketogenic steroids 19.44 26.27 - 19.44

83586 Assay 17- ketosteroids 17.56 23.73 - 17.56

83593 Fractionation ketosteroids 36.08 48.75 - 33.41

83605 QW Assay of lactic acid 14.65 19.80 - 14.65

83605 Assay of lactic acid 14.65 19.80 - 14.65

83615 Lactate (LD) (LDH) enzyme 8.28 11.19 - 8.28

83625 Assay of ldh enzymes 17.55 23.72 - 17.55

83630 Lactoferrin fecal (qual) 26.93 36.39 - 26.93

83631 Lactoferrin fecal (quant) 26.93 36.39 - 26.93

83632 Placental lactogen 27.74 37.48 - 27.74

83633 Test urine for lactose 7.54 10.19 - 7.54

83655 QW Assay of lead 16.61 22.44 - 16.61

83655 Assay of lead 16.61 22.44 - 16.61

83661 L/s ratio fetal lung 30.16 40.75 - 30.16

83662 Foam stability fetal lung 25.94 35.06 - 20.80

83663 Fluoro polarize fetal lung 25.94 35.06 - 20.80

83664 Lamellar bdy fetal lung 25.94 35.06 - 20.80

83670 Assay of lap enzyme 12.57 16.99 - 12.57

83690 Assay of lipase 9.45 12.77 - 9.45

83695 Assay of lipoprotein(a) 17.76 24.00 - 17.76

83698 Assay lipoprotein pla2 46.56 62.92 - 46.56

83700 Lipopro bld electrophoretic 15.44 20.87 - 14.29

83701 Lipoprotein bld hr fraction 34.05 46.02 - 34.05

83704 Lipoprotein bld by nmr 43.28 58.48 - 43.28

83718 QW Assay of lipoprotein 11.24 15.19 - 11.24

83718 Assay of lipoprotein 11.24 15.19 - 11.24

83719 Assay of blood lipoprotein 15.96 21.57 - 15.96

83721 QW Assay of blood lipoprotein 13.09 17.69 - 13.09

83721 Assay of blood lipoprotein 13.09 17.69 - 13.09

83727 Assay of lrh hormone 23.58 31.87 - 23.58

83735 Assay of magnesium 9.19 12.42 - 9.19

83775 Assay malate dehydrogenase 10.11 13.66 - 10.11

83785 Assay of manganese 33.74 45.60 - 33.74

83789 Mass spectrometry quant 24.77 33.47 - 24.77

83825 Assay of mercury 22.30 30.14 - 22.30

83835 Assay of metanephrines 23.24 31.40 - 23.24

83857 Assay of methemalbumin 14.73 19.91 - 14.73

83861 Microfluid analy tears 22.66 30.62 - 22.66

83864 Mucopolysaccharides 27.32 36.92 - 13.80

83872 Assay synovial fluid mucin 8.04 10.87 - 8.04

83873 Assay of csf protein 23.60 31.89 - 23.60

83874 Assay of myoglobin 17.72 23.94 - 17.72

83876 Assay myeloperoxidase 46.56 62.92 - 46.56

83880 QW Assay of natriuretic peptide 46.56 62.92 - 46.56

83880 Assay of natriuretic peptide 46.56 62.92 - 46.56

83883 Assay nephelometry not spec 18.65 25.20 - 18.65

83885 Assay of nickel 33.62 45.43 - 33.62

83915 Assay of nucleotidase 15.30 20.67 - 15.30

83916 Oligoclonal bands 27.59 37.28 - 27.59

83918 Organic acids total quant 22.57 30.50 - 22.57

83919 Organic acids qual each 22.57 30.50 - 22.57

83921 Organic acid single quant 22.57 30.50 - 22.57

83930 Assay of blood osmolality 9.07 12.26 - 9.07

83935 Assay of urine osmolality 9.35 12.64 - 9.35

83937 Assay of osteocalcin 40.94 55.32 - 40.94

83945 Assay of oxalate 17.66 23.86 - 17.66

83950 Oncoprotein her-2/neu 88.36 119.40 - 88.36

83951 Oncoprotein dcp 88.36 119.40 - 88.36

83970 Assay of parathormone 56.62 76.51 - 56.62

83986 QW Assay ph body fluid nos 4.91 6.64 - 4.91

83986 Assay ph body fluid nos 4.91 6.64 - 4.91

83992 Assay for phencyclidine 20.17 27.25 - 20.17

83993 Assay for calprotectin fecal 26.93 36.39 - 26.93

84030 Assay of blood pku 7.54 10.19 - 7.54

84035 Assay of phenylketones 5.02 6.79 - 3.43

84060 Assay acid phosphatase 10.13 13.69 - 10.13

84061 Phosphatase forensic exam 10.85 14.66 - 10.85

84066 Assay prostate phosphatase 13.25 17.91 - 13.25

84075 QW Assay alkaline phosphatase 7.10 9.60 - 7.10

84075 Assay alkaline phosphatase 7.10 9.60 - 7.10

84078 Assay alkaline phosphatase 10.01 13.53 - 10.01

84080 Assay alkaline phosphatases 20.28 27.41 - 20.28

84081 Assay phosphatidylglycerol 22.66 30.62 - 22.66

84085 Assay of rbc pg6d enzyme 9.25 12.50 - 9.25

84087 Assay phosphohexose enzymes 14.16 19.14 - 14.16

84100 Assay of phosphorus 6.50 8.79 - 6.50

84105 Assay of urine phosphorus 7.10 9.60 - 7.10

84106 Test for porphobilinogen 5.88 7.94 - 5.88

84110 Assay of porphobilinogen 11.58 15.65 - 11.58

84112 Placenta alpha micro ig c/v 88.36 119.40 - 88.36

84119 Test urine for porphyrins 11.82 15.97 - 11.62

84120 Assay of urine porphyrins 20.18 27.27 - 20.18

84126 Assay of feces porphyrins 34.94 47.22 - 34.94

84132 QW Assay of serum potassium 6.31 8.53 - 6.31

84132 Assay of serum potassium 6.31 8.53 - 6.31

84133 Assay of urine potassium 5.91 7.98 - 5.91

84134 Assay of prealbumin 20.01 27.04 - 20.01

84135 Assay of pregnanediol 26.25 35.47 - 23.10

84138 Assay of pregnanetriol 25.97 35.09 - 25.97

84140 Assay of pregnenolone 28.36 38.33 - 28.36

84143 Assay of 17-hydroxypregneno 31.29 42.29 - 31.29

84144 Assay of progesterone 28.62 38.67 - 28.62

84146 Assay of prolactin 26.58 35.93 - 26.58

84150 Assay of prostaglandin 34.23 46.26 - 34.23

84152 Assay of psa complexed 25.23 34.10 - 25.23

84153 Assay of psa total 25.23 34.10 - 25.23

84154 Assay of psa free 25.23 34.10 - 25.23

84155 QW Assay of protein serum 5.03 6.80 - 5.03

84155 Assay of protein serum 5.03 6.80 - 5.03

84156 Assay of protein urine 5.03 6.80 - 5.03

84157 QW Assay of protein other 5.03 6.80 - 5.03

84157 Assay of protein other 5.03 6.80 - 5.03

84160 Assay of protein any source 7.10 9.60 - 7.10

84163 Pappa serum 20.65 27.91 - 20.65

84165 26 Protein e-phoresis serum - - - -

84165 Protein e-phoresis serum 14.73 19.91 - 14.73

84166 26 Protein e-phoresis/urine/csf - - - -

84166 Protein e-phoresis/urine/csf 24.46 33.06 - 24.46

84181 26 Western blot test - - - -

84181 Western blot test 23.36 31.57 - 20.97

84182 26 Protein western blot test - - - -

84182 Protein western blot test 24.69 33.36 - 24.69

84202 Assay RBC protoporphyrin 19.68 26.59 - 19.68

84203 Test RBC protoporphyrin 11.81 15.96 - 11.81

84206 Assay of proinsulin 24.43 33.02 - 24.43

84207 Assay of vitamin b-6 38.54 52.08 - 38.54

84210 Assay of pyruvate 14.89 20.12 - 14.89

84220 Assay of pyruvate kinase 12.95 17.50 - 12.95

84228 Assay of quinine 15.96 21.57 - 8.44

84233 Assay of estrogen 88.36 119.40 - 88.36

84234 Assay of progesterone 89.00 120.27 - 89.00

84235 Assay of endocrine hormone 71.79 97.02 - 71.79

84238 Assay nonendocrine receptor 50.16 67.79 - 50.16

84244 Assay of renin 30.17 40.77 - 26.54


84255 Assay of selenium 35.02 47.33 - 35.02

84260 Assay of serotonin 42.50 57.43 - 42.50

84270 Assay of sex hormone globul 29.81 40.29 - 28.97

84275 Assay of sialic acid 18.43 24.90 - 18.43

84285 Assay of silica 32.29 43.64 - 32.29

84295 QW Assay of serum sodium 6.60 8.92 - 6.60

84295 Assay of serum sodium 6.60 8.92 - 6.60

84300 Assay of urine sodium 6.67 9.02 - 6.67

84302 Assay of sweat sodium 6.67 9.02 - 6.67

84305 Assay of somatomedin 29.17 39.42 - 29.17

84307 Assay of somatostatin 25.07 33.89 - 25.07

84311 Spectrophotometry 9.59 12.96 - 9.59

84315 Body fluid specific gravity 3.44 4.65 - 3.44

84375 Chromatogram assay sugars 26.90 36.35 - 26.90

84376 Sugars single qual 7.54 10.19 - 7.54

84377 Sugars multiple qual 7.54 10.19 - 7.54

84378 Sugars single quant 15.81 21.37 - 10.19

84379 Sugars multiple quant 15.81 21.37 - 10.19

84392 Assay of urine sulfate 6.51 8.80 - 6.51

84402 Assay of free testosterone 34.94 47.21 - 34.94

84403 Assay of total testosterone 35.41 47.86 - 27.94

84410 Testosterone bioavailable 72.55 98.04 - 72.55


84430 Assay of thiocyanate 15.96 21.57 - 11.62

84432 Assay of thyroglobulin 22.03 29.77 - 22.03

84436 Assay of total thyroxine 9.42 12.73 - 9.42

84437 Assay of neonatal thyroxine 8.87 11.99 - 8.87

84439 Assay of free thyroxine 12.37 16.72 - 12.37

84442 Assay of thyroid activity 20.28 27.41 - 20.28

84443 QW Assay thyroid stim hormone 23.05 31.15 - 23.05

84443 Assay thyroid stim hormone 23.05 31.15 - 23.05

84445 Assay of tsi globulin 69.76 94.27 - 69.76

84446 Assay of vitamin e 19.45 26.28 - 19.45

84449 Assay of transcortin 24.69 33.36 - 24.69

84450 QW Transferase (AST) (SGOT) 7.10 9.60 - 7.10

84450 Transferase (AST) (SGOT) 7.10 9.60 - 7.10

84460 QW Alanine amino (ALT) (SGPT) 7.27 9.82 - 7.27

84460 Alanine amino (ALT) (SGPT) 7.27 9.82 - 7.27

84466 Assay of transferrin 17.51 23.67 - 16.64

84478 QW Assay of triglycerides 7.88 10.65 - 7.88

84478 Assay of triglycerides 7.88 10.65 - 7.88

84479 Assay of thyroid (t3 or t4) 8.87 11.99 - 8.87

84480 Assay triiodothyronine (t3) 19.45 26.28 - 19.45

84481 Free assay (FT-3) 23.24 31.40 - 23.24

84482 T3 reverse 21.62 29.21 - 21.62

84484 Assay of troponin quant 13.50 18.24 - 13.50

84485 Assay duodenal fluid trypsin 10.31 13.93 - 10.31

84488 Test feces for trypsin 10.01 13.53 - 10.01

84490 Assay of feces for trypsin 10.43 14.09 - 10.43

84510 Assay of tyrosine 14.27 19.28 - 14.27

84512 Assay of troponin qual 10.56 14.27 - 9.94

84520 QW Assay of urea nitrogen 5.42 7.32 - 5.42

84520 Assay of urea nitrogen 5.42 7.32 - 5.42

84525 Urea nitrogen semi-quant 5.17 6.98 - 5.17

84540 Assay of urine/urea-n 6.51 8.80 - 6.51

84545 Urea-N clearance test 9.07 12.25 - 9.07

84550 QW Assay of blood/uric acid 6.20 8.38 - 6.20

84550 Assay of blood/uric acid 6.20 8.38 - 6.20

84560 Assay of urine/uric acid 6.51 8.80 - 6.51

84577 Assay of feces/urobilinogen 17.12 23.13 - 17.12

84578 Test urine urobilinogen 4.46 6.03 - 4.46

84580 Assay of urine urobilinogen 9.73 13.15 - 9.73

84583 Assay of urine urobilinogen 6.90 9.32 - 3.95

84585 Assay of urine vma 21.26 28.73 - 21.26

84586 Assay of vip 48.47 65.50 - 48.47

84588 Assay of vasopressin 46.56 62.92 - 46.56

84590 Assay of vitamin a 15.92 21.51 - 15.92

84591 Assay of nos vitamin 15.92 21.51 - 15.92

84597 Assay of vitamin k 18.82 25.43 - 18.82

84600 Assay of volatiles 22.06 29.81 - 22.06

84620 Xylose tolerance test 16.25 21.96 - 16.25

84630 Assay of zinc 15.62 21.11 - 15.62

84681 Assay of c-peptide 28.55 38.58 - 28.55

84702 Chorionic gonadotropin test 20.65 27.91 - 20.65

84703 QW Chorionic gonadotropin assay 10.32 13.94 - 10.32

84703 Chorionic gonadotropin assay 10.32 13.94 - 10.32

84704 Hcg free betachain test 20.65 27.91 - 20.65

84830 Ovulation tests 13.76 18.59 - 13.76

84999 Unlisted chemistry procedure - - - -

85002 Bleeding time test 6.19 8.36 - 4.59

85004 Automated diff wbc count 8.87 11.99 - 8.87

85007 Bl smear w/diff wbc count 4.71 6.37 - 4.71

85008 Bl smear w/o diff wbc count 4.71 6.37 - 2.30

85009 Manual diff wbc count b-coat 5.11 6.90 - 4.73

85013 Spun microhematocrit 3.25 4.39 - 3.25

85014 QW Hematocrit 3.25 4.39 - 3.25

85014 Hematocrit 3.25 4.39 - 3.25

85018 QW Hemoglobin 3.25 4.39 - 3.25

85018 Hemoglobin 3.25 4.39 - 3.25

85025 Complete cbc w/auto diff wbc 10.66 14.41 - 10.66

85027 Complete cbc automated 8.87 11.99 - 8.87

85032 Manual cell count each 5.91 7.98 - 5.91

85041 Automated rbc count 4.14 5.60 - 4.14

85044 Manual reticulocyte count 5.91 7.98 - 5.91

85045 Automated reticulocyte count 5.48 7.41 - 5.48

85046 Reticyte/hgb concentrate 7.64 10.33 - 7.64

85048 Automated leukocyte count 3.48 4.70 - 3.48

85049 Automated platelet count 6.14 8.30 - 6.14

85055 Reticulated platelet assay 36.73 49.64 - 36.73

85060 Blood smear, peripheral, interpretation by physician with written report- - - -

85097 Bone marrow, smear interpretation - - - -

85130 Chromogenic substrate assay 16.31 22.04 - 16.31

85170 Blood clot retraction 4.97 6.71 - 2.30

85175 Blood clot lysis time 6.25 8.44 - 6.25

85210 Clot factor ii prothrom spec 17.81 24.07 - 6.90

85220 Blooc clot factor v test 24.21 32.71 - 6.90

85230 Clot factor vii proconvertin 24.56 33.19 - 6.90

85240 Clot factor viii ahg 1 stage 24.56 33.19 - 6.90

85244 Clot factor viii reltd antgn 28.01 37.85 - 6.90

85245 Clot factor viii vw ristoctn 31.47 42.53 - 31.47

85246 Clot factor viii vw antigen 31.47 42.53 - 31.47

85247 Clot factor viii multimetric 31.47 42.53 - 31.47

85250 Clot factor ix ptc/chrstmas 26.12 35.30 - 6.90

85260 Clot factor x stuart-power 24.56 33.19 - 6.90

85270 Clot factor xi pta 24.56 33.19 - 6.90

85280 Clot factor xii hageman 26.54 35.87 - 6.90

85290 Clot factor xiii fibrin stab 22.41 30.29 - 13.80

85291 Clot factor xiii fibrin scrn 12.20 16.49 - 12.20

85292 Clot factor fletcher fact 25.97 35.10 - 25.97

85293 Clot factor wght kininogen 25.97 35.10 - 25.97

85300 Antithrombin iii activity 16.26 21.97 - 16.26

85301 Antithrombin iii antigen 14.83 20.04 - 14.83

85302 Clot inhibit prot c antigen 16.48 22.27 - 16.48

85303 Clot inhibit prot c activity 18.98 25.65 - 18.98

85305 Clot inhibit prot s total 15.92 21.51 - 15.92

85306 Clot inhibit prot s free 21.02 28.41 - 21.02

85307 Assay activated protein c 21.02 28.41 - 21.02

85335 Factor inhibitor test 17.66 23.86 - 17.66

85337 Thrombomodulin 14.30 19.32 - 14.30

85345 Coagulation time lee & white 5.91 7.98 - 5.91

85347 Coagulation time activated 5.84 7.89 - 5.84

85348 Coagulation time otr method 5.11 6.91 - 4.59

85360 Euglobulin lysis 11.53 15.58 - 11.53

85362 Fibrin degradation products 9.45 12.77 - 9.45

85366 Fibrinogen test 11.82 15.97 - 11.82

85370 Fibrinogen test 15.58 21.05 - 15.58

85378 Fibrin degrade semiquant 9.79 13.23 - 9.79

85379 Fibrin degradation quant 13.96 18.87 - 13.96

85380 Fibrin degradj d-dimer 13.96 18.87 - 13.96

85384 Fibrinogen activity 11.65 15.75 - 11.65

85385 Fibrinogen antigen 11.65 15.75 - 11.65

85390 26 Fibrinolysins screen i&r 7.10 9.59 -

85390 Fibrinolysins screen i&r 7.10 9.59 - 7.10

85396 Coagulation/fibrinolysis assay, whole blood, including use of any pharmacologic additive(s), as indicated, including interpretation and written report, per day- - - -

85400 Fibrinolytic plasmin 12.14 16.40 - 11.62

85410 Fibrinolytic antiplasmin 10.57 14.29 - 10.57

85415 Fibrinolytic plasminogen 23.58 31.87 - 13.80



85441 Heinz bodies direct 5.76 7.79 - 4.59

85445 Heinz bodies induced 9.35 12.64 - 9.35

85460 Hemoglobin fetal 10.61 14.34 - 10.61

85461 Hemoglobin fetal 9.10 12.30 - 8.30

85475 Hemolysin acid 12.17 16.45 - 12.17

85520 Heparin assay 17.96 24.27 - 17.96

85525 Heparin neutralization 16.24 21.95 - 12.59

85530 Heparin-protamine tolerance 19.45 26.28 - 19.45

85536 Iron stain peripheral blood 8.87 11.99 - 8.87

85540 Wbc alkaline phosphatase 11.80 15.95 - 11.80

85547 RBC mechanical fragility 11.80 15.95 - 11.80

85549 Muramidase 25.72 34.76 - 25.72

85555 RBC osmotic fragility 9.17 12.39 - 9.17

85557 RBC osmotic fragility 18.32 24.76 - 17.34

85576 QW Blood platelet aggregation 29.47 39.83 - 15.06

85576 26 Blood platelet aggregation 29.47 39.83 - -

85576 Blood platelet aggregation 29.47 39.83 - 15.06

85597 Phospholipid pltlt neutraliz 24.66 33.32 - 24.66

85598 Hexagnal phosph pltlt neutrl 24.66 33.32 - 24.66

85610 QW Prothrombin time 5.39 7.29 - 5.39

85610 Prothrombin time 5.39 7.29 - 5.39

85611 Prothrombin test 5.41 7.31 - 5.41

85612 Viper venom prothrombin time 13.14 17.75 - 8.80

85613 Russell viper venom diluted 13.14 17.75 - 8.80

85635 Reptilase test 13.51 18.25 - 8.80

85651 Rbc sed rate nonautomated 4.87 6.58 - 4.87

85652 Rbc sed rate automated 3.70 5.00 - 3.70

85660 RBC sickle cell test 7.56 10.22 - 7.56

85670 Thrombin time plasma 7.91 10.69 - 4.59

85675 Thrombin time titer 9.39 12.69 - 9.39

85705 Thromboplastin inhibition 13.21 17.85 - 13.21

85730 Thromboplastin time partial 8.24 11.13 - 8.24

85732 Thromboplastin time partial 8.87 11.99 - 8.87

85810 Blood viscosity examination 16.01 21.64 - 16.01

85999 Unlisted hematology and coagulation procedure- - - -

86000 Agglutinins febrile antigen 9.58 12.94 - 6.90

86001 Allergen specific igg 7.16 9.68 - 7.16

86003 Allergen specific IgE 7.16 9.68 - 7.16

86005 Allergen specific IgE 10.93 14.77 - 10.36

86021 WBC antibody identification 20.65 27.91 - 20.65

86022 Platelet antibodies 25.20 34.05 - 25.20

86023 Immunoglobulin assay 17.09 23.09 - 17.09

86038 Antinuclear antibodies 16.58 22.41 - 16.58

86039 Antinuclear antibodies (ANA) 15.31 20.69 - 15.31

86060 Antistreptolysin o titer 10.01 13.53 - 10.01

86063 Antistreptolysin o screen 7.91 10.69 - 7.91

86077 Blood bank physician services; difficult cross match and/or evaluation of irregular anitbody(s), interpretation and written report- - - -

86078 Blood bank physician services; investigation of transfusion reaction including suspicion of transmissible disease, interpretation and written report- - - -

86079 Blood bank physician services; authorization for deviation from standard blood banking procedures (eg, use of outdated blood, transfusion of Rh incompatible units), with written report- - - -

86140 C-reactive protein 7.10 9.60 - 7.10

86141 C-reactive protein hs 17.76 24.00 - 17.76

86146 Beta-2 glycoprotein antibody 34.91 47.17 - 32.69

86147 Cardiolipin antibody ea ig 34.91 47.17 - 32.69

86148 Anti-phospholipid antibody 22.04 29.79 - 22.04

86152 Cell enumeration & id 337.04 337.04 - 337.04

86153 26 Cell enumeration using immunologic selection and identification in fluid specimen (eg, circulating tumor cells in blood); physician interpretation and report, when required- - - -

86155 Chemotaxis assay 21.93 29.64 - 21.93

86156 Cold agglutinin screen 9.19 12.42 - 7.86

86157 Cold agglutinin titer 11.06 14.94 - 11.06

86160 Complement antigen 16.46 22.24 - 16.46

86161 Complement/function activity 16.46 22.24 - 16.46

86162 Complement total (ch50) 27.88 37.67 - 27.88

86171 Complement fixation each 13.73 18.56 - 13.73

86185 Counterimmunoelectrophoresis 12.28 16.59 - 12.28

86200 Ccp antibody 17.76 24.00 - 17.76

86215 Deoxyribonuclease antibody 18.17 24.56 - 18.17

86225 Dna antibody native 18.85 25.47 - 18.85

86226 Dna antibody single strand 16.61 22.45 - 16.61

86235 Nuclear antigen antibody 24.60 33.24 - 24.60

86243 Fc receptor 28.14 38.03 - 26.54

86255 26 Fluorescent antibody screen 16.53 22.34 -

86255 Fluorescent antibody screen 16.53 22.34 - 16.53

86256 26 Fluorescent antibody titer 16.53 22.34 -

86256 Fluorescent antibody titer 16.53 22.34 - 16.53

86277 Growth hormone antibody 21.59 29.17 - 21.59

86280 Hemagglutination inhibition 11.24 15.19 - 11.24

86294 QW Immunoassay tumor qual 26.92 26.92 - 26.92

86294 Immunoassay tumor qual 26.92 26.92 - 26.92

86300 Immunoassay tumor ca 15-3 28.55 38.58 - 28.55

86301 Immunoassay tumor ca 19-9 28.55 38.58 - 28.55

86304 Immunoassay tumor ca 125 28.55 38.58 - 28.55

86308 QW Heterophile antibody screen 7.10 9.60 - 7.10

86308 Heterophile antibody screen 7.10 9.60 - 7.10

86309 Heterophile antibody titer 8.87 11.99 - 8.87

86310 Heterophile antibody absrbj 10.11 13.66 - 10.11

86316 Immunoassay tumor other 28.55 38.58 - 28.55

86317 Immunoassay infectious agent 20.56 27.79 - 20.56

86318 QW Immunoassay infectious agent 17.76 24.00 - 17.76

86318 Immunoassay infectious agent 17.76 24.00 - 17.76

86320 26 Serum immunoelectrophoresis

86320 Serum immunoelectrophoresis 30.75 41.55 - 28.06

86325 26 Other immunoelectrophoresis

86325 Other immunoelectrophoresis 30.68 41.46 - 27.94

86327 26 Immunoelectrophoresis assay

86327 Immunoelectrophoresis assay 31.12 42.06 - 27.94

86329 Immunodiffusion nes 19.27 26.04 - 19.27

86331 Immunodiffusion ouchterlony 16.43 22.20 - 16.43

86332 Immune complex assay 33.43 45.17 - 33.43

86334 26 Immunofix e-phoresis serum

86334 Immunofix e-phoresis serum 30.65 41.42 - 30.65

86335 26 Immunfix e-phorsis/urine/csf

86335 Immunfix e-phorsis/urine/csf 40.26 54.40 - 40.26

86336 Inhibin A 21.38 21.38 - 21.38

86337 Insulin antibodies 29.37 39.69 - 29.37

86340 Intrinsic factor antibody 20.68 27.94 - 20.68

86341 Islet cell antibody 27.14 36.67 - 24.51

86343 Leukocyte histamine release 17.09 23.10 - 17.09

86344 Leukocyte phagocytosis 10.95 14.80 - 10.95

86353 Lymphocyte transformation 67.25 90.88 - 67.25

86355 B cells total count 51.75 69.94 - 51.75

86356 Mononuclear cell antigen 36.73 49.64 - 36.73

86357 Nk cells total count 51.75 69.94 - 51.75

86359 T cells total count 51.75 69.94 - 51.75

86360 T cell absolute count/ratio 64.45 87.10 - 64.45

86361 T cell absolute count 36.73 49.64 - 36.73

86367 Stem cells total count 51.75 69.94 - 51.75

86376 Microsomal antibody each 19.96 26.97 - 19.96

86378 Migration inhibitory factor 27.01 36.50 - 18.24

86382 Neutralization test viral 23.20 31.35 - 23.20

86384 Nitroblue tetrazolium dye 15.62 21.11 - 15.62

86386 Nuclear matrix protein 22 21.91 29.61 - 21.91

86403 Particle agglut antbdy scrn 13.98 18.89 - 13.98

86406 Particle agglut antbdy titr 14.59 19.72 - 8.30

86430 Rheumatoid factor test qual 7.78 10.51 - 7.78

86431 Rheumatoid factor quant 7.78 10.51 - 7.78

86480 Tb test cell immun measure 85.02 114.89 - 85.02

86481 Tb ag response t-cell susp 102.79 138.90 - 102.79

86485 Skin test; candida - - - -

86486 Skin test; unlisted antigen, each - - - 12.70

86490 Skin test; coccidioidomycosis - - - -

86510 Skin test; histoplasmosis - - - -

86580 Skin test; tuberculosis, intradermal - - - -

86590 Streptokinase antibody 15.15 20.47 - 15.15

86592 Syphilis test non-trep qual 5.86 7.92 - 5.86

86593 Syphilis test non-trep quant 6.04 8.16 - 6.04

86602 Antinomyces antibody 13.96 18.87 - 13.96

86603 Adenovirus antibody 17.65 23.85 - 17.65

86606 Aspergillus antibody 20.65 27.91 - 18.87

86609 Bacterium antibody 17.67 23.88 - 17.67

86611 Bartonella antibody 13.96 18.87 - 13.96

86612 Blastomyces antibody 17.70 23.92 - 17.70

86615 Bordetella antibody 18.09 24.45 - 18.09

86617 Lyme disease antibody 21.25 28.72 - 21.25

86618 QW Lyme disease antibody 23.36 31.57 - 23.36

86618 Lyme disease antibody 23.36 31.57 - 23.36

86619 Borrelia antibody 18.35 24.80 - 18.35

86622 Brucella antibody 12.25 16.56 - 12.25

86625 Campylobacter antibody 18.00 24.32 - 18.00

86628 Candida antibody 16.47 22.26 - 16.47

86631 Chlamydia antibody 16.22 21.92 - 16.22

86632 Chlamydia igm antibody 17.40 23.52 - 17.40

86635 Coccidioides antibody 15.74 21.27 - 15.74

86638 Q fever antibody 16.63 22.47 - 16.63

86641 Cryptococcus antibody 19.77 26.72 - 18.87

86644 CMV antibody 19.74 26.68 - 19.74

86645 Cmv antibody igm 23.11 31.23 - 23.11

86648 Diphtheria antibody 20.86 28.19 - 18.87

86651 Encephalitis californ antbdy 18.09 24.45 - 18.09

86652 Encephaltis east eqne anbdy 18.09 24.45 - 18.09

86653 Encephaltis st louis antbody 18.09 24.45 - 18.09

86654 Encephaltis west eqne antbdy 18.09 24.45 - 18.09

86658 Enterovirus antibody 17.87 24.15 - 17.87

86663 Epstein-barr antibody 18.00 24.32 - 18.00

86664 Epstein-barr nuclear antigen 20.98 28.36 - 18.87

86665 Epstein-barr capsid vca 24.89 33.63 - 18.87

86666 Ehrlichia antibody 13.96 18.87 - 13.96

86668 Francisella tularensis 14.27 19.28 - 14.27

86671 Fungus nes antibody 16.81 22.72 - 16.81

86674 Giardia lamblia antibody 20.19 27.29 - 20.19

86677 Helicobacter pylori antibody 19.90 26.90 - 19.90

86682 Helminth antibody 17.84 24.11 - 17.84

86684 Hemophilus influenza antibdy 21.73 29.37 - 21.73

86687 Htlv-i antibody 11.51 15.56 - 11.51

86688 Htlv-ii antibody 19.21 25.96 - 19.21

86689 Htlv/hiv confirmj antibody 26.55 35.88 - 26.55

86692 Hepatitis delta agent antbdy 23.54 31.81 - 23.54

86694 Herpes simplex nes antbdy 19.74 26.68 - 19.74

86695 Herpes simplex type 1 test 18.09 24.45 - 18.09

86696 Herpes simplex type 2 test 26.55 35.88 - 26.55

86698 Histoplasma antibody 17.14 23.17 - 17.14

86701 QW Hiv-1antibody 12.19 16.47 - 12.19

86701 Hiv-1antibody 12.19 16.47 - 12.19

86702 Hiv-2 antibody 18.54 25.06 - 18.54

86703 QW Hiv-1/hiv-2 1 result antbdy 18.80 25.41 - 18.80

86703 Hiv-1/hiv-2 1 result antbdy 18.80 25.41 - 18.80

86704 Hep b core antibody total 16.53 22.34 - 16.53

86705 Hep b core antibody igm 16.15 21.83 - 16.15

86706 Hep b surface antibody 14.73 19.91 - 14.73

86707 Hepatitis be antibody 15.87 21.45 - 15.87

86708 Hepatitis a total antibody 16.99 22.96 - 16.99

86709 Hepatitis a igm antibody 15.44 20.87 - 15.44

86710 Influenza virus antibody 18.59 25.13 - 18.59

86711 John cunningham antibody 19.74 26.68 - 19.74

86713 Legionella antibody 20.99 28.37 - 20.99

86717 Leishmania antibody 16.80 22.71 - 16.80

86720 Leptospira antibody 18.09 24.45 - 18.09

86723 Listeria monocytogenes 18.09 24.45 - 18.09

86727 Lymph choriomeningitis ab 17.65 23.85 - 17.65

86729 Lympho venereum antibody 16.38 22.14 - 16.38

86732 Mucormycosis antibody 18.09 24.45 - 18.09

86735 Mumps antibody 17.90 24.19 - 17.90

86738 Mycoplasma antibody 18.16 24.55 - 18.16

86741 Neisseria meningitidis 18.09 24.45 - 18.09

86744 Nocardia antibody 18.09 24.45 - 18.09

86747 Parvovirus antibody 20.62 27.87 - 20.62

86750 Malaria antibody 18.09 24.45 - 18.09

86753 Protozoa antibody nos 16.99 22.96 - 16.99

86756 Respiratory virus antibody 17.68 23.89 - 17.68

86757 Rickettsia antibody 26.55 35.88 - 26.55

86759 Rotavirus antibody 18.09 24.45 - 18.09

86762 Rubella antibody 19.74 26.68 - 19.74

86765 Rubeola antibody 17.67 23.88 - 17.67

86768 Salmonella antibody 18.09 24.45 - 18.09

86771 Shigella antibody 18.09 24.45 - 18.09

86774 Tetanus antibody 20.30 27.43 - 20.30

86777 Toxoplasma antibody 19.74 26.68 - 19.74

86778 Toxoplasma antibody igm 19.76 26.70 - 19.76

86780 Treponema pallidum 18.16 24.54 - 18.16

86784 Trichinella antibody 17.23 23.28 - 17.23

86787 Varicella-zoster antibody 17.67 23.88 - 17.67

86788 West nile virus ab igm 23.11 31.23 - 23.11

86789 West nile virus antibody 19.74 26.68 - 19.74

86790 Virus antibody nos 17.67 23.88 - 17.67

86793 Yersinia antibody 18.09 24.45 - 18.09

86800 Thyroglobulin antibody 21.82 29.48 - 21.82

86803 Hepatitis c ab test 19.57 26.45 - 18.08

86804 Hep c ab test confirm 21.25 28.72 - 21.25

86805 Lymphocytotoxicity assay 71.73 96.93 - 71.73

86806 Lymphocytotoxicity assay 65.28 88.22 - 65.28

86807 Cytotoxic antibody screening 54.29 73.36 - 54.29

86808 Cytotoxic antibody screening 40.71 55.01 - 40.71

86812 Hla typing a b or c 35.40 47.84 - 35.40

86813 Hla typing a b or c 79.56 107.51 - 79.56

86816 Hla typing dr/dq 38.21 51.64 - 38.21

86817 Hla typing dr/dq 88.32 119.35 - 88.32

86821 Lymphocyte culture mixed 77.45 104.66 - 48.50

86822 Lymphocyte culture primed 50.15 67.77 - 48.50

86825 Hla x-math non-cytotoxic 110.17 148.88 - 110.17

86826 Hla x-match noncytotoxc addl 36.73 49.64 - 36.73

86828 Hla class i&ii antibody qual 54.29 73.36 - 54.29

86829 Hla class i/ii antibody qual 40.71 55.01 - 40.71

86830 Hla class i phenotype qual 110.75 149.66 - 110.75

86831 Hla class ii phenotype qual 94.93 128.29 - 94.93

86832 Hla class i high defin qual 174.04 235.19 - 174.04

86833 Hla class ii high defin qual 158.22 213.82 - 158.22

86834 Hla class i semiquant panel 490.48 662.81 - 490.48

86835 Hla class ii semiquant panel 443.02 598.67 - 443.02

86849 Unlisted immunology procedure - - - -

86850 Rbc antibody screen 5.25 7.09 - 5.25

86860 Antibody elution, (RBC), each elution - - - 29.96

86870 Antibody identification, RBC antibodies, each panel for each serum technique- - - 25.09

86880 Coombs test direct 7.39 9.98 - 7.39

86885 Coombs test indirect qual 7.85 10.61 - 7.85

86886 Coombs test indirect titer 7.10 9.60 - 6.37

86890 Autologous blood or component, collection processing and storage; predeposited- - - 49.24

86891 Autologous blood or component, collection processing and storage; intra-or postoperative salvage- - - 21.31

86900 Blood typing abo 4.10 5.54 - 4.10

86901 Blood typing rh (d) 4.10 5.54 - 4.10

86902 Blood type antigen donor ea 5.25 7.09 - 5.25

86904 Blood typing patient serum 13.05 17.63 - 13.05

86905 Blood typing rbc antigens 5.25 7.09 - 5.25

86906 Blood typing rh phenotype 10.63 14.36 - 10.63

86920 Compatibility test each unit; immediate spin technique- - - 23.83

86921 Compatibility test each unit; incubation technique- - - 23.83

86922 Compatibility test each unit; antiglobulin technique- - - 23.83

86923 Compatibility test each unit; electronic - - - 12.91

86927 Fresh frozen plasma, thawing, each unit - - - 9.76

86930 Frozen blood, each unit; freezing (includes preparation)- - - 23.83

86931 Frozen blood, each unit; thawing - - - 35.96

86932 Frozen blood, each unit; freezing (includes preparation) and thawing- - - 47.65

86940 Hemolysins/agglutinins auto 11.25 15.21 - 11.25

86941 Hemolysins/agglutinins 16.61 22.45 - 16.61

86945 Irradiation of blood product, each unit - - - 11.71

86950 Leukocyte transfusion - - - 31.76

86960 Volume reduction of blood or blood products (eg, red blood cells or platelets), each unit- - - 12.91

86965 Pooling of platelets or other blood products- - - 16.03

86970 Pretreatment of RBCs for use in RBC antibody detection, identification, and/or compatibility testing; incubation with chemical agents or drugs, each- - - 16.03

86971 Pretreatment of RBCs for use in RBC antibody detection, identification, and/or compatibility testing; incubation with enzymes, each- - - 19.51

86972 Pretreatment of RBCs for use in RBC antibody detection, identification, and/or compatibility testing; by density gradient separation- - - 16.03

86975 Pretreatment of serum for use in RBC antibody identification; incubation with drugs, each- - - 16.03

86976 Pretreatment of serum for use in RBC antibody identification; by dilution- - - 16.03

86977 Pretreatment of serum for use in RBC antibody identification; incubation with inhibitors, each- - - 16.03

86978 Pretreatment of serum for use in RBC antibody identification; by differential red cell absorption using patient RBCs or RBCs of known phenotype, each absorption- - - 19.51

86985 Splitting of blood or blood products, each unit- - - 24.59

86999 Unlisted transfusion medicine procedure- - - -

87003 Small animal inoculation 23.10 31.21 - 23.10

87015 Specimen infect agnt concntj 9.16 12.38 - 9.16

87040 Blood culture for bacteria 14.16 19.14 - 14.16

87045 Feces culture aerobic bact 12.95 17.50 - 12.95

87046 Stool cultr aerobic bact ea 12.95 17.50 - 12.95

87070 Culture othr specimn aerobic 11.82 15.97 - 11.82

87071 Culture aerobic quant other 12.95 17.50 - 12.95

87073 Culture bacteria anaerobic 12.95 17.50 - 12.95

87075 Cultr bacteria except blood 12.99 17.55 - 12.99

87076 Culture anaerobe ident each 11.08 14.97 - 11.08

87077 QW Culture aerobic identify 11.08 14.97 - 11.08

87077 Culture aerobic identify 11.08 14.97 - 11.08

87081 Culture screen only 9.09 12.29 - 9.09

87084 Culture of specimen by kit 11.82 15.97 - 11.82

87086 Urine culture/colony count 11.07 14.97 - 11.07

87088 Urine bacteria culture 11.10 15.00 - 11.10

87101 Skin fungi culture 10.57 14.29 - 10.57

87102 Fungus isolation culture 11.53 15.58 - 11.53

87103 Blood fungus culture 12.37 16.72 - 12.37

87106 Fungi identification yeast 14.16 19.14 - 8.80

87107 Fungi identification mold 14.16 19.14 - 8.80

87109 Mycoplasma 21.11 28.53 - 19.91

87110 Chlamydia culture 26.88 36.32 - 26.88

87116 Mycobacteria culture 14.82 20.03 - 14.82

87118 Mycobacteric identification 15.01 20.29 - 15.01

87140 Culture type immunofluoresc 7.64 10.33 - 7.64

87143 Culture typing glc/hplc 17.18 23.22 - 17.18

87147 Culture type immunologic 7.10 9.60 - 6.90

87149 Dna/rna direct probe 27.51 37.18 - 27.51

87150 Dna/rna amplified probe 48.14 65.06 - 48.14

87152 Culture type pulse field gel 7.18 9.70 - 7.18

87153 Dna/rna sequencing 158.24 213.84 - 158.24

87158 Culture typing added method 7.18 9.70 - 7.18

87164 26 Dark field examination - - - -

87164 Dark field examination 14.73 19.91 - 14.73

87166 Dark field examination 15.50 20.94 - 15.50

87168 Macroscopic exam arthropod 5.86 7.92 - 5.65

87169 Macroscopic exam parasite 5.86 7.92 - 5.65

87172 Pinworm exam 5.86 7.92 - 5.65

87176 Tissue homogenization cultr 8.07 10.91 - 8.07

87177 Ova and parasites smears 12.21 16.50 - 12.21

87181 Microbe susceptible diffuse 6.51 8.80 - 1.15

87184 Microbe susceptible disk 9.46 12.79 - 9.46

87185 Microbe susceptible enzyme 6.51 8.80 - 1.15

87186 Microbe susceptible mic 11.86 16.03 - 11.86

87187 Microbe susceptible mlc 14.22 19.21 - 14.22

87188 Microbe suscept macrobroth 9.11 12.31 - 9.11

87190 Microbe suscept mycobacteri 7.75 10.47 - 7.75

87197 Bactericidal level serum 20.61 27.85 - 20.61

87205 Smear gram stain 5.86 7.92 - 4.73

87206 Smear fluorescent/acid stai 7.39 9.98 - 7.39

87207 26 Smear special stain - - - -

87207 Smear special stain 8.22 11.11 - 4.73

87209 Smear complex stain 24.66 33.32 - 14.21

87210 QW Smear wet mount saline/ink 5.86 7.92 - 5.65

87210 Smear wet mount saline/ink 5.86 7.92 - 5.65

87220 Tissue exam for fungi 5.86 7.92 - 3.95

87230 Assay toxin or antitoxin 27.08 36.60 - 27.08

87250 Virus inoculate eggs/animal 26.83 36.26 - 26.83

87252 Virus inoculation tissue 35.76 48.33 - 35.76

87253 Virus inoculate tissue addl 27.71 37.45 - 27.71

87254 Virus inoculation shell via 26.83 36.26 - 26.83

87255 Genet virus isolate hsv 46.45 62.77 - 46.45

87260 Adenovirus ag if 16.44 22.22 - 16.44

87265 Pertussis ag if 16.44 22.22 - 16.44

87267 Enterovirus antibody dfa 16.44 22.22 - 16.44

87269 Giardia ag if 16.44 22.22 - 16.44

87270 Chlamydia trachomatis ag if 16.44 22.22 - 16.44

87271 Cytomegalovirus dfa 16.44 22.22 - 16.44

87272 Cryptosporidium ag if 16.44 22.22 - 16.44

87273 Herpes simplex 2 ag if 16.44 22.22 - 16.44

87274 Herpes simplex 1 ag if 16.44 22.22 - 16.44

87275 Influenza b ag if 16.44 22.22 - 16.44

87276 Influenza a ag if 16.44 22.22 - 16.44

87277 Legionella micdadei ag if 16.44 22.22 - 16.44

87278 Legion pneumophilia ag if 16.44 22.22 - 16.44

87279 Parainfluenza ag if 16.44 22.22 - 16.44

87280 Respiratory syncytial ag if 16.44 22.22 - 16.44

87281 Pneumocystis carinii ag if 16.44 22.22 - 16.44

87283 Rubeola ag if 16.44 22.22 - 16.44

87285 Treponema pallidum ag if 16.44 22.22 - 16.44

87290 Varicella zoster ag if 16.44 22.22 - 16.44

87299 Antibody detection nos if 16.44 22.22 - 16.44

87300 Ag detection polyval if 16.44 22.22 - 16.44

87301 Adenovirus ag eia 16.44 22.22 - 16.44

87305 Aspergillus ag eia 16.44 22.22 - 16.44

87320 Chylmd trach ag eia 16.44 22.22 - 16.44

87324 Clostridium ag eia 16.44 22.22 - 16.44

87327 Cryptococcus neoform ag eia 16.44 22.22 - 16.44

87328 Cryptosporidium ag eia 16.44 22.22 - 16.44

87329 Giardia ag eia 16.44 22.22 - 16.44

87332 Cytomegalovirus ag eia 16.44 22.22 - 16.44

87335 E coli 0157 ag eia 16.44 22.22 - 16.44

87336 Entamoeb hist dispr ag eia 16.44 22.22 - 16.44

87337 Entamoeb hist group ag eia 16.44 22.22 - 16.44

87338 Hpylori stool eia 19.73 19.73 - 19.73

87339 H pylori ag eia 16.44 22.22 - 16.44

87340 Hepatitis b surface ag eia 14.17 19.15 - 12.77

87341 Hepatitis b surface ag eia 14.17 19.15 - 12.77

87350 Hepatitis be ag eia 15.81 21.37 - 15.81

87380 Hepatitis delta ag eia 22.51 30.42 - 22.51

87385 Histoplasma capsul ag eia 16.44 22.22 - 16.44

87389 Hiv-1 ag w/hiv-1 & hiv-2 ab 33.03 44.64 - 33.03

87390 Hiv-1 ag eia 24.20 32.70 - 15.32

87391 Hiv-2 ag eia 24.20 32.70 - 15.32

87400 Influenza a/b ag eia 16.44 22.22 - 16.44

87420 Resp syncytial ag eia 16.44 22.22 - 16.44

87425 Rotavirus ag eia 16.44 22.22 - 16.44

87427 Shiga-like toxin ag eia 16.44 22.22 - 16.44

87430 Strep a ag eia 16.44 22.22 - 16.44

87449 QW Ag detect nos eia mult 16.44 22.22 - 16.44

87449 Ag detect nos eia mult 16.44 22.22 - 16.44

87450 Ag detect nos eia single 13.16 17.78 - 13.16

87451 Ag detect polyval eia mult 13.16 17.78 - 13.16

87470 Bartonella dna dir probe 27.51 37.18 - 27.51

87471 Bartonella dna amp probe 48.14 65.06 - 48.14

87472 Bartonella dna quant 58.76 79.40 - 58.76

87475 Lyme dis dna dir probe 27.51 37.18 - 27.51

87476 Lyme dis dna amp probe 48.14 65.06 - 48.14

87477 Lyme dis dna quant 58.76 79.40 - 58.76

87480 Candida dna dir probe 27.51 37.18 - 27.51

87481 Candida dna amp probe 48.14 65.06 - 48.14

87482 Candida dna quant 57.28 77.40 - 57.28

87483 Cns dna amp probe type 12-25 772.60 772.60 - 772.60

87485 Chylmd pneum dna dir probe 27.51 37.18 - 27.51

87486 Chylmd pneum dna amp probe 48.14 65.06 - 48.14

87487 Chylmd pneum dna quant 58.76 79.40 - 58.76

87490 Chylmd trach dna dir probe 27.51 37.18 - 27.51

87491 Chylmd trach dna amp probe 48.14 65.06 - 48.14

87492 Chylmd trach dna quant 47.95 64.80 - 19.86

87493 C diff amplified probe 48.14 65.06 - 48.14

87495 Cytomeg dna dir probe 27.51 37.18 - 27.51

87496 Cytomeg dna amp probe 48.14 65.06 - 48.14

87497 Cytomeg dna quant 58.76 79.40 - 58.76

87498 Enterovirus probe&revrs trns 48.14 65.06 - 48.14

87500 Vanomycin dna amp probe 48.14 65.06 - 48.14

87501 Influenza dna amp prob 1+ 70.39 95.12 - 70.39

87502 Influenza dna amp probe 116.73 157.75 - 116.73

87503 Influenza dna amp prob addl 28.49 38.50 - 28.49

87505 Nfct agent detection gi 175.98 237.81 - 175.98

87506 Iadna-dna/rna probe tq 6-11 292.77 395.64 - 292.77

87507 Iadna-dna/rna probe tq 12-25 571.72 772.60 - 571.72

87510 Gardner vag dna dir probe 27.51 37.18 - 27.51

87511 Gardner vag dna amp probe 48.14 65.06 - 48.14

87512 Gardner vag dna quant 57.28 77.40 - 57.28

87515 Hepatitis b dna dir probe 27.51 37.18 - 27.51

87516 Hepatitis b dna amp probe 48.14 65.06 - 48.14

87517 Hepatitis b dna quant 58.76 79.40 - 58.76

87520 Hepatitis c rna dir probe 27.51 37.18 - 27.51

87521 Hepatitis c probe&rvrs trnsc 48.14 65.06 - 48.14

87522 Hepatitis c revrs trnscrpj 58.76 79.40 - 58.76

87525 Hepatitis g dna dir probe 27.51 37.18 - 27.51

87526 Hepatitis g dna amp probe 48.14 65.06 - 48.14

87527 Hepatitis g dna quant 57.28 77.40 - 57.28

87528 Hsv dna dir probe 27.51 37.18 - 27.51

87529 Hsv dna amp probe 48.14 65.06 - 48.14

87530 Hsv dna quant 58.76 79.40 - 58.76

87531 Hhv-6 dna dir probe 27.51 37.18 - 27.51

87532 Hhv-6 dna amp probe 48.14 65.06 - 48.14

87533 Hhv-6 dna quant 57.28 77.40 - 57.28

87534 Hiv-1 dna dir probe 27.51 37.18 - 27.51

87535 Hiv-1 probe&reverse trnscrpj 48.14 65.06 - 48.14

87536 Hiv-1 quant&revrse trnscrpj 116.73 157.75 - 116.73

87537 Hiv-2 dna dir probe 27.51 37.18 - 27.51

87538 Hiv-2 probe&revrse trnscripj 48.14 65.06 - 48.14

87539 Hiv-2 quant&revrse trnscripj 58.76 79.40 - 58.76

87540 Legion pneumo dna dir prob 27.51 37.18 - 27.51

87541 Legion pneumo dna amp prob 48.14 65.06 - 48.14

87542 Legion pneumo dna quant 57.28 77.40 - 57.28

87550 Mycobacteria dna dir probe 27.51 37.18 - 27.51

87551 Mycobacteria dna amp probe 48.14 65.06 - 48.14

87552 Mycobacteria dna quant 58.76 79.40 - 58.76

87555 M.tuberculo dna dir probe 27.51 37.18 - 27.51

87556 M.tuberculo dna amp probe 48.14 65.06 - 48.14

87557 M.tuberculo dna quant 58.76 79.40 - 58.76

87560 M.avium-intra dna dir prob 27.51 37.18 - 27.51

87561 M.avium-intra dna amp prob 48.14 65.06 - 48.14

87562 M.avium-intra dna quant 58.76 79.40 - 58.76

87580 M.pneumon dna dir probe 27.51 37.18 - 27.51

87581 M.pneumon dna amp probe 48.14 65.06 - 48.14

87582 M.pneumon dna quant 57.28 77.40 - 57.28

87590 N.gonorrhoeae dna dir prob 27.51 37.18 - 27.51

87591 N.gonorrhoeae dna amp prob 48.14 65.06 - 48.14

87592 N.gonorrhoeae dna quant 58.76 79.40 - 19.86

87623 Hpv low-risk types 48.14 65.06 - 48.14

87624 Hpv high-risk types 48.14 65.06 - 48.14

87625 Hpv types 16 & 18 only 48.14 65.06 - 48.14

87631 Resp virus 3-11 targets 175.98 237.81 - 175.98



87640 Staph a dna amp probe 48.14 65.06 - 48.14

87641 Mr-staph dna amp probe 48.14 65.06 - 48.14

87650 Strep a dna dir probe 27.51 37.18 - 27.51

87651 Strep a dna amp probe 48.14 65.06 - 48.14

87652 Strep a dna quant 57.28 77.40 - 57.28

87653 Strep b dna amp probe 48.14 65.06 - 48.14

87660 Trichomonas vagin dir probe 27.51 37.18 - 27.51

87661 Trichomonas vaginalis amplif 48.14 65.06 - 48.14

87797 Detect agent nos dna dir 27.51 37.18 - 27.51

87798 Detect agent nos dna amp 48.14 65.06 - 48.14

87799 Detect agent nos dna quant 58.76 79.40 - 58.76

87800 Detect agnt mult dna direc 55.03 74.36 - 55.03

87801 Detect agnt mult dna ampli 96.29 130.12 - 96.29

87802 Strep b assay w/optic 16.44 22.22 - 16.44

87803 Clostridium toxin a w/optic 16.44 22.22 - 16.44

87804 QW Influenza assay w/optic 16.44 22.22 - 16.44

87804 Influenza assay w/optic 16.44 22.22 - 16.44

87806 Hiv antigen w/hiv antibodies 33.03 44.64 - 33.03

87807 QW Rsv assay w/optic 16.44 22.22 - 16.44

87807 Rsv assay w/optic 16.44 22.22 - 16.44

87808 QW Trichomonas assay w/optic 16.44 22.22 - 16.44

87808 Trichomonas assay w/optic 16.44 22.22 - 16.44

87809 QW Adenovirus assay w/optic 16.44 22.22 - 16.44

87809 Adenovirus assay w/optic 16.44 22.22 - 16.44

87810 Chylmd trach assay w/optic 16.44 22.22 - 16.44

87850 N. gonorrhoeae assay w/optic 16.44 22.22 - 16.44

87880 QW Strep a assay w/optic 16.44 22.22 - 16.44

87880 Strep a assay w/optic 16.44 22.22 - 16.44

87899 QW Agent nos assay w/optic 16.44 22.22 - 16.44

87899 Agent nos assay w/optic 16.44 22.22 - 16.44

87900 Phenotype infect agent drug 178.80 241.62 - 178.80

87901 Genotype dna hiv reverse t 353.15 477.23 - 353.15

87902 Genotype dna/rna hep c 353.15 477.23 - 353.15

87903 Phenotype dna hiv w/culture 670.31 905.82 - 670.31

87904 Phenotype dna hiv w/clt add 35.76 48.33 - 35.76

87905 QW Sialidase enzyme assay 16.76 22.65 - 16.76

87906 Genotype dna/rna hiv 176.58 238.62 - 176.58

87910 Genotype cytomegalovirus 353.15 477.23 - 353.15

87912 Genotype dna hepatitis b 353.15 477.23 - 353.15

87999 Unlisted microbiology procedure - - - -

88104 TC Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation- - - -

88104 26 Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation- - - -

88104 Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation- - - -

88106 TC Cytopathology, fluids, washings or brushings, except cervical or vaginal; simple filter method with interpretation- - - -

88106 26 Cytopathology, fluids, washings or brushings, except cervical or vaginal; simple filter method with interpretation- - - -

88106 Cytopathology, fluids, washings or brushings, except cervical or vaginal; simple filter method with interpretation- - - -

88108 TC Cytopathology, concentration technique, smears and interpretation- - - -

88108 26 Cytopathology, concentration technique, smears and interpretation- - - -

88108 Cytopathology, concentration technique, smears and interpretation- - - -

88112 TC Cytopathology, selective cellular enhancement technique with interpretation, except cervical or vaginal- - - -

88112 26 Cytopathology, selective cellular enhancement technique with interpretation, except cervical or vaginal- - - -

88112 Cytopathology, selective cellular enhancement technique with interpretation, except cervical or vaginal- - - -

88120 TC Cytopathology, in situ hybridization (eg, FISH)- - - -

88120 26 Cytopathology, in situ hybridization (eg, FISH)- - - -

88120 Cytopathology, in situ hybridization (eg, FISH)- - - -

88121 TC Cytopathology, in situ hybridization (eg, FISH), urinary tract specimen with morphometric analysis, 3-5 molecular probes, each specimen; using computer-assisted technology- - - -

88121 26 Cytopathology, in situ hybridization (eg, FISH), urinary tract specimen with morphometric analysis, 3-5 molecular probes, each specimen; using computer-assisted technology- - - -

88121 Cytopathology, in situ hybridization (eg, FISH), urinary tract specimen with morphometric analysis, 3-5 molecular probes, each specimen; using computer-assisted technology- - - -

88125 TC Cytopathology, forensic (eg, sperm) - - - -

88125 26 Cytopathology, forensic (eg, sperm) - - - -

88125 Cytopathology, forensic (eg, sperm) - - - -

88130 Sex chromatin identification 20.65 27.90 - 20.65

88140 Sex chromatin identification 10.96 14.81 - 10.96

88141 Cytopathology, cervical or vaginal (any reporting system), requiring interpretation by physician- - - -

88142 Cytopath c/v thin layer 27.79 27.79 14.49 27.14

88143 Cytopath c/v thin layer redo 27.79 27.79 14.49 27.14

88147 Cytopath c/v automated 15.61 15.61 14.49 14.49

88148 Cytopath c/v auto rescreen 20.84 20.84 14.49 14.49

88150 Cytopath c/v manual 14.49 9.60 14.49 14.49

88152 Cytopath c/v auto redo 14.49 9.60 14.49 14.49

88153 Cytopath c/v redo 14.49 9.60 14.49 14.49

88154 Cytopath c/v select 14.49 9.60 14.49 14.49

88155 Cytopath c/v index add-on 8.22 11.11 - 8.22

88160 TC Cytopathology, smears, any other source; screening and interpretation- - - -

88160 26 Cytopathology, smears, any other source; screening and interpretation- - - -

88160 Cytopathology, smears, any other source; screening and interpretation- - - -

88161 TC Cytopathology, smears, any other source; preparation, screening and interpretation- - - -

88161 26 Cytopathology, smears, any other source; preparation, screening and interpretation- - - -

88161 Cytopathology, smears, any other source; preparation, screening and interpretation- - - -

88162 TC Cytopathology, smears, any other source; extended study involving over 5 slides and/or multiple stains- - - -

88162 26 Cytopathology, smears, any other source; extended study involving over 5 slides and/or multiple stains- - - -

88162 Cytopathology, smears, any other source; extended study involving over 5 slides and/or multiple stains- - - -

88164 Cytopath tbs c/v manual 14.49 9.60 14.49 14.49

88165 Cytopath tbs c/v redo 14.49 9.60 14.49 14.49

88166 Cytopath tbs c/v auto redo 14.49 9.60 14.49 14.49

88167 Cytopath tbs c/v select 14.49 9.60 14.49 14.49

88172 TC Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy of specimen(s)- - - -

88172 26 Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy of specimen(s)- - - -

88172 Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy of specimen(s)- - - -

88173 TC Cytopathology, evaluation of fine needle aspirate; interpretation and report- - - -

88173 26 Cytopathology, evaluation of fine needle aspirate; interpretation and report- - - -

88173 Cytopathology, evaluation of fine needle aspirate; interpretation and report- - - -

88174 Cytopath c/v auto in fluid 29.31 29.31 14.49 27.88

88175 Cytopath c/v auto fluid redo 36.34 36.34 14.49 31.14

88177 TC Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy for diagnosis, each separate additional evaluation episode, same site (list sperately in addition to code for primary procedure- - - -

88177 26 Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy for diagnosis, each separate additional evaluation episode, same site (list sperately in addition to code for primary procedure- - - -

88177 Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy for diagnosis, each separate additional evaluation episode, same site (list sperately in addition to code for primary procedure)- - - -

88182 TC Flow cytometry, cell cycle or DNA analysis- - - -

88182 26 Flow cytometry, cell cycle or DNA analysis- - - -

88182 Flow cytometry, cell cycle or DNA analysis- - - -

88184 Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; first marker- - - -

88185 each additional marker (List separately in addition to code for first marker)- - - -

88187 Flow cytometry, interpretation; 2 to 8 markers- - - -

88188 Flow cytometry, interpretation; 9 to 15 markers- - - -

88189 Flow cytometry, interpretation; 16 or more markers- - - -

88199 TC Unlisted cytopathology procedure - - - -

88199 26 Unlisted cytopathology procedure - - - -

88199 Unlisted cytopathology procedure - - - -

88230 Tissue culture lymphocyte 159.80 215.95 - 159.80

88233 Tissue culture skin/biopsy 193.04 260.87 - 193.04

88235 Tissue culture placenta 202.01 272.98 - 202.01

88237 Tissue culture bone marrow 173.26 234.14 - 173.26

88239 Tissue culture tumor 202.36 273.46 - 202.36

88240 Cell cryopreserve/storage 13.85 18.72 - 13.85

88241 Frozen cell preparation 13.85 18.72 - 13.85

88245 Chromosome analysis 20-25 204.20 275.95 - 204.20


88249 Chromosome analysis 100 237.55 321.02 - 237.55





88267 Chromosome analys placenta 246.61 333.25 - 246.61

88269 Chromosome analys amniotic 228.16 308.32 - 228.16

88271 Cytogenetics dna probe 29.38 39.70 - 29.38

88272 Cytogenetics 3-5 36.73 49.64 - 36.73

88273 Cytogenetics 10-30 44.07 59.56 - 44.07

88274 Cytogenetics 25-99 47.75 64.53 - 47.75

88275 Cytogenetics 100-300 55.09 74.44 - 55.09

88280 Chromosome karyotype study 34.42 46.52 - 34.42

88283 Chromosome banding study 94.10 127.16 - 94.10

88285 Chromosome count additional 26.06 35.21 - 26.06

88289 Chromosome study additional 47.23 63.83 - 47.23

88291 Cytogenetics and molecular cytogenetics, interpretation and report- - - -

88299 Unlisted cytogenetic study - - - -

88300 TC Level I-Surgical pathology, gross examination only- - - -

88300 26 Level I-Surgical pathology, gross examination only- - - -

88300 Level I-Surgical pathology, gross examination only- - - -

88302 TC Level II- Surgical pathology, gross and microscopic examination- - - -

88302 26 Level II- Surgical pathology, gross and microscopic examination- - - -

88302 Level II- Surgical pathology, gross and microscopic examination- - - -

88304 TC Level III -Surgical pathology, gross and microscopic examination- - - -

88304 26 Level III- Surgical pathology, gross and microscopic examination- - - -

88304 Level III- Surgical pathology, gross and microscopic examination- - - -

88305 TC Level IV -Surgical pathology, gross and microscopic examination- - - -

88305 26 Level IV- Surgical pathology, gross and microscopic examination- - - -

88305 Level IV- Surgical pathology, gross and microscopic examination- - - -

88307 TC Level V- Surgical pathology, gross and microscopic examination- - - -

88307 26 Level V- Surgical pathology, gross and microscopic examination- - - -

88307 Level V- Surgical pathology, gross and microscopic examination- - - -

88309 TC Level VI- Surgical pathology, gross and microscopic examination- - - -

88309 26 Level VI- Surgical pathology, gross and microscopic examination- - - -

88309 Level VI- Surgical pathology, gross and microscopic examination- - - -

88311 TC Decalcification procedure (List separately in addition to code for surgical pathology examination)- - - -

88311 26 Decalcification procedure (List separately in addition to code for surgical pathology examination)- - - -

88311 Decalcification procedure (List separately in addition to code for surgical pathology examination)- - - -

88312 TC Special stains (list separately in addition to code for primary service); Group I for microorganisms (eg, Gridley, acid fast, methenamine silver), each- - - -

88312 26 Special stains (List separately in addition to code for primary service); Group I for microorganisms, each- - - -

88312 Special stains (List separately in addition to code for primary service); Group I for microorganisms, each- - - -

88313 TC Special stains (list separately in addition to code for primary service); Group II, all other, (eg, iron, trichrome), except immunocytochemistry and immunoperoxidase stains, each- - - -

88313 26 Group II, all other, except immunocytochemistry and immunoperoxidase stains, each- - - -

88313 Group II, all other, except immunocytochemistry and immunoperoxidase stains, each- - - -

88314 TC Special stains; histochemical staining with frozen section(s)- - - -

88314 26 histochemical staining with frozen section(s)- - - -

88314 histochemical staining with frozen section(s)- - - -

88319 TC Determinative histochemistry or cytochemistry to identify enzyme constituents, each- - - -

88319 26 Determinative histochemistry or cytochemistry to identify enzyme constituents, each- - - -

88319 Determinative histochemistry or cytochemistry to identify enzyme constituents, each- - - -

88321 Consultation and report on referred slides prepared elsewhere- - - -

88323 TC Consultation and report on referred material requiring preparation of slides- - - -

88323 26 Consultation and report on referred material requiring preparation of slides- - - -

88323 Consultation and report on referred material requiring preparation of slides- - - -

88325 Consultation, comprehensive, with review of records and specimens, with report on referred material- - - -

88329 Pathology consultation during surgery - - - -

88331 TC Pathology consultation during surgery; first tissue block, with frozen section(s), single specimen- - - -

88331 26 Pathology consultation during surgery; first tissue block, with frozen section(s), single specimen- - - -

88331 Pathology consultation during surgery; first tissue block, with frozen section(s), single specimen- - - -

88332 TC Pathology consultation during surgery; each additional tissue block with frozen section(s)- - - -

88332 26 Pathology consultation during surgery; each additional tissue block with frozen section(s)- - - -

88332 Pathology consultation during surgery; each additional tissue block with frozen section(s)- - - -

88333 TC Pathology consultation during surgery; cytologic examination, initial site- - - -

88333 26 Pathology consultation during surgery; cytologic examination, initial site- - - -

88333 Pathology consultation during surgery; cytologic examination, initial site- - - -

88334 TC Pathology consultation during surgery; cytologic examination, each additional site- - - -

88334 26 Pathology consultation during surgery; cytologic examination, each additional site- - - -

88334 Pathology consultation during surgery; cytologic examination, each additional site- - - -

88341 TC Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure- - - -

88341 26 Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure- - - -

88341 Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure- - - -

88342 TC Immunohistochemistry (including tissue immunoperoxidase), each antibody- - - -

88342 26 Immunohistochemistry (including tissue immunoperoxidase), each antibody- - - -

88342 Immunohistochemistry (including tissue immunoperoxidase), each antibody- - - -

88343 TC Immunohistochemistry or immunocytochemistry, each separately identifiable antibody per block, cytologic preparation, or hematologic smear; each additional separately identifiable antibody per slide (List separately in addition to code for primary procedure)- - - 34.28

88343 26 Immunohistochemistry or immunocytochemistry, each separately identifiable antibody per block, cytologic preparation, or hematologic smear; each additional separately identifiable antibody per slide (List separately in addition to code for primary procedure)- - - 8.70

88343 Immunohistochemistry or immunocytochemistry, each separately identifiable antibody per block, cytologic preparation, or hematologic smear; each additional separately identifiable antibody per slide (List separately in addition to code for primary procedure)- - - 43.25

88344 TC Immunohistochemistry or immunocytochemistry, per specimen; each multiplex antibody stain procedure- - - -

88344 26 Immunohistochemistry or immunocytochemistry, per specimen; each multiplex antibody stain procedure- - - -

88344 Immunohistochemistry or immunocytochemistry, per specimen; each multiplex antibody stain procedure- - - -

88346 TC Immunofluorescence, per specimen; initial single antibody stain procedure- - - -

88346 26 Immunofluorescence, per specimen; initial single antibody stain procedure- - - -

88346 Immunofluorescence, per specimen; initial single antibody stain procedure- - - -

88348 TC Electron microscopy; diagnostic - - - -

88348 26 Electron microscopy; diagnostic - - - -

88348 Electron microscopy; diagnostic - - - -

88350 TC Immunofluorescence, per specimen; each additional single antibody stain procedure- - - -

88350 26 Immunofluorescence, per specimen; each additional single antibody stain procedure- - - -

88350 Immunofluorescence, per specimen; each additional single antibody stain procedure- - - -

88355 TC Morphometric analysis; skeletal muscle - - - -

88355 26 Morphometric analysis; skeletal muscle - - - -

88355 Morphometric analysis; skeletal muscle - - - -

88356 TC Morphometric analysis; nerve - - - -

88356 26 Morphometric analysis; nerve - - - -

88356 Morphometric analysis; nerve - - - -

88358 TC Morphometric analysis; tumor - - - -

88358 26 Morphometric analysis; tumor - - - -

88358 Morphometric analysis; tumor - - - -

88360 TC Morphometric analysis, tumor immunohistochemistry, quantitative or semiquantitative, each antibody; manual- - - -

88360 26 Morphometric analysis, tumor immunohistochemistry, quantitative or semiquantitative, each antibody; manual- - - -

88360 Morphometric analysis, tumor immunohistochemistry, quantitative or semiquantitative, each antibody; manual- - - -

88361 TC Morphometric analysis, tumor immunohistochemistry, quantitative or semiquantitative, each antibody; using computer-assisted technology- - - -

88361 26 Morphometric analysis, tumor immunohistochemistry, quantitative or semiquantitative, each antibody; using computer-assisted technology- - - -

88361 Morphometric analysis, tumor immunohistochemistry, quantitative or semiquantitative, each antibody; using computer-assisted technology- - - -

88362 TC Nerve teasing preparations - - - -

88362 26 Nerve teasing preparations - - - -

88362 Nerve teasing preparations - - - -

88363 Examination and selection of retrieved archival (ie, previously diagnosed) tissue (s) for molecular analysis (eg, KRAS mutational analysis)- - - -

88364 TC In situ hybridization (eg, FISH), per specimen; each additional single probe stain procedure- - - -

88364 26 In situ hybridization (eg, FISH), per specimen; each additional single probe stain procedure- - - -

88364 In situ hybridization (eg, FISH), per specimen; each additional single probe stain procedure- - - -

88365 TC In situ hybridization, each probe - - - -

88365 26 In situ hybridization, each probe - - - -

88365 In situ hybridization, each probe - - - -

88366 TC In situ hybridization (eg, FISH), per specimen; each multiplex probe stain procedure- - - -

88366 26 In situ hybridization (eg, FISH), per specimen; each multiplex probe stain procedure- - - -

88366 In situ hybridization (eg, FISH), per specimen; each multiplex probe stain procedure- - - -

88367 TC Morphmetric analysis, in situ hybridization (quantitative or semi-quantitative) each probe; using computer-assisted technology- - - -

88367 26 Morphmetric analysis, in situ hybridization (quantitative or semi-quantitative) each probe; using computer-assisted technology- - - -

88367 Morphmetric analysis, in situ hybridization (quantitative or semi-quantitative) each probe; using computer-assisted technology- - - -

88368 TC Morphmetric analysis, in situ hybridization (quantitative or semi-quantitative) each probe; manual- - - -

88368 26 Morphmetric analysis, in situ hybridization (quantitative or semi-quantitative) each probe; manual- - - -

88368 Morphmetric analysis, in situ hybridization (quantitative or semi-quantitative) each probe; manual- - - -

88369 TC Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), manual, per specimen; each additional single probe stain procedure- - - -

88369 26 Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), manual, per specimen; each additional single probe stain procedure- - - -

88369 Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), manual, per specimen; each additional single probe stain procedure- - - -

88371 26 Protein western blot tissue 30.49 41.20 - 29.88

88371 Protein western blot tissue 30.49 41.20 - 29.88

88372 26 Protein analysis w/probe 31.20 42.16 - 31.20

88372 Protein analysis w/probe 31.20 42.16 - 31.20

88373 TC Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), using computer-assisted technology, per specimen; each additional single probe stain procedure- - - -

88373 26 Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), using computer-assisted technology, per specimen; each additional single probe stain procedure- - - -

88373 Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), using computer-assisted technology, per specimen; each additional single probe stain procedure- - - -

88374 TC Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), using computer-assisted technology, per specimen; each multiplex probe stain procedure- - - -

88374 26 Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), using computer-assisted technology, per specimen; each multiplex probe stain procedure- - - -

88374 Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), using computer-assisted technology, per specimen; each multiplex probe stain procedure- - - -

88377 TC Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), manual, per specimen; each multiplex probe stain procedure- - - -

88377 26 Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), manual, per specimen; each multiplex probe stain procedure- - - -

88377 Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), manual, per specimen; each multiplex probe stain procedure- - - -

88380 TC Microdissection; laser capture - - - -

88380 26 Microdissection; laser capture - - - -

88380 Microdissection; laser capture - - - -

88381 TC Microdissection; manual - - - -

88381 26 Microdissection; manual - - - -

88381 Microdissection; manual - - - -

88387 TC Macroscopic examination, dissection, and preparation of tissue for non-microscopic analytical studies (eg, nucleic acid-based molecular studies); each tissue preparation (eg, a single lymph node)- - - -

88387 26 Macroscopic examination, dissection, and preparation of tissue for non-microscopic analytical studies (eg, nucleic acid-based molecular studies); each tissue preparation (eg, a single lymph node)- - - -

88387 Macroscopic examination, dissection, and preparation of tissue for non-microscopic analytical studies (eg, nucleic acid-based molecular studies); each tissue preparation (eg, a single lymph node)- - - -

88388 TC Macroscopic examination, dissection, and preparation of tissue for non-microscopic analytical studies; in conjuction with a touch imprint, intraoperative consultation, or frozen section, each tissue preparation (eg, a single lymph node) (List separately in addition to code for primary procedure)- - - -

88388 26 Macroscopic examination, dissection, and preparation of tissue for non-microscopic analytical studies; in conjuction with a touch imprint, intraoperative consultation, or frozen section, each tissue preparation (eg, a single lymph node) (List separately in addition to code for primary procedure)- - - -

88388 Macroscopic examination, dissection, and preparation of tissue for non-microscopic analytical studies; in conjuction with a touch imprint, intraoperative consultation, or frozen section, each tissue preparation (eg, a single lymph node) (List separately in addition to code for primary procedure)- - - -

88399 TC Unlisted surgical pathology procedure - - - -

88399 26 Unlisted surgical pathology procedure - - - -

88399 Unlisted surgical pathology procedure - - - -

88720 Bilirubin total transcut 6.88 9.30 - 5.54

88738 Hgb quant transcutaneous 6.88 9.30 - 5.54

88740 Transcutaneous carboxyhb 6.88 9.30 - 5.54

88741 Transcutaneous methb 6.88 9.30 - 5.54

89049 Caffeine halothane contracture test (CHCT) for malignant hyperthermia susceptibility, including interpretation and report- - - -

89050 Body fluid cell count 6.48 8.76 - 4.59

89051 Body fluid cell count 7.55 10.20 - 7.55

89055 Leukocyte assessment fecal 5.86 7.92 - 4.73

89060 26 Exam synovial fluid crystals 9.81 13.26 - 9.81

89060 Exam synovial fluid crystals 9.81 13.26 - 9.81

89125 Specimen fat stain 5.93 8.01 - 5.93

89160 Exam feces for meat fibers 5.06 6.84 - 2.30

89190 Nasal smear for eosinophils 6.51 8.80 - 4.73

89220 Sputum, obtaining specimen, aerosol induced technique (separate procedure)- - - -

89230 Sweat collection by iontophoresis - - - -

89240 Unlisted miscellaneous pathology test - - - -

89250 Culture and fertilization of oocyte(s) - - - 102.20

89300 QW Semen analysis w/huhner 12.25 16.55 - 12.25

89300 Semen analysis w/huhner 12.25 16.55 - 12.25

89310 Semen analysis w/count 11.81 15.96 - 10.69

89320 Semen anal vol/count/mot 16.53 22.34 - 16.53

89329 Sperm evaluation test 28.76 38.87 - 28.76

89330 Evaluation cervical mucus 13.57 18.34 - 13.57

0008M Onc breast risk score 3,443.36 3,443.36 - 3,443.36

G0477 Drug tests(s), presumptive, any number of drug classes; any number of devices or procedures, (eg, immunoassay) capable of being read by direct optical observation only (eg, dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service.- - - 8.97

G0478 Drug tests(s), presumptive, any number of drug classes; any number of devices or procedures, (eg, immunoassay) read by instrument-assisted direct optical observation (eg, dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service.- - - 11.96

G0479 Drug tests(s), presumptive, any number of drug classes; any number of devices or procedures by instrumented chemistry analyzers (eg, immunoassay, enzyme assay, TOF, MALDI, LDTD, DESI, DART, GHPC, GC mass spectrometry), includes sample validation when performed, per date of service.- - - 47.84

G0480 Drug test def 1-7 classes 117.65 158.98 - 117.65



G0483 Drug test def 22+ classes 253.87 343.07 - 253.87

P7001 Culture, bacterial, urine; quantitative, sensitivity study- - - 16.67

P9612 Catheterize for urine spec - - - 3.00

CPT codes, descriptions and other data only are copyright 2016 American Medical Association. All rights reserved.

WV Medicaid

3.00

9.70

83.16

10.44

10.44

10.44

10.44

45.12

7.28

7.28

13.04

13.04

59.02

16.53

16.53

10.72

10.72

56.19

10.09

92.42

18.61

17.46

17.98

16.36

22.28

22.83

16.39

16.39

10.79

10.79

20.17

16.96

20.22

16.36

17.98

16.36

18.14

16.36

8.16

8.16

22.28

16.36

10.78

16.36

16.99

20.48

20.68

20.68

18.03

16.96

16.96

17.46

22.29

19.91

14.72

10.79

16.36

12.16

8.13

10.84

43.35

40.27

107.35

96.62

148.41

99.19

406.94

50.30

68.99

143.35

47.78

715.55

88.95

56.88

62.34

183.22

82.35

96.89

166.79

124.90

127.18

112.55

62.24

82.98

17.23

54.57

3.92

3.92

2.90

2.90

2.77

2.77

2.67

3.17

3.17

3.76

4.55

7.80

3.68

Manual/Unlstd

127.01

2,252.93

298.64

84.51

674.93

84.55

513.05

111.02

202.42

178.81

198.57

84.51

1,975.93

159.91

527.32

1,301.42

84.38

1,572.34

84.38

298.64

720.41

84.55

116.60

1,399.01

298.64

60.75

75.44

84.51

54.46

90.08

150.16

75.26

140.98

73.40

67.47

80.25

80.69

164.90

244.43

53.89

363.60

184.35

265.49

Manual

256.12

321.96

113.17

298.64

178.71

178.71

144.68

84.51

53.89

584.80

234.43

172.55

137.29

117.23

137.29

260.47

145.92

146.31

357.48

223.65

298.64

255.94

390.38

707.02

167.06

200.59

543.60

52.85

79.27

437.54

267.52

84.55

65.90

53.89

257.92

61.22

248.76

496.45

297.15

272.72

137.48

89.81

272.52

150.89

113.35

426.63

414.05

218.83

116.77

152.69

134.73

Manual

Manual

541.89

722.10

838.33

541.89

541.89

722.10

722.10

541.89

541.89

541.89

Manual/Unlstd

3,099.02

541.89

2,556.68

Manual/Unlstd

4.29

10.09

10.09

13.79

17.13

20.83

47.68

31.85

6.11

6.11

6.39

7.14

7.14

5.65

5.65

41.90

12.15

14.88

11.99

50.31

16.59

17.86

20.71

20.71

79.52

31.46

4.65

4.65

17.13

17.13

20.83

20.31

20.83

20.83

17.87

8.48

8.00

8.00

35.60

36.14

30.87

25.34

18.03

19.13

20.79

12.20

18.41

17.92

21.14

32.81

4.99

4.99

4.99

5.63

20.83

4.01

4.01

4.01

4.01

19.64

19.64

8.51

28.58

36.55

33.08

6.37

6.37

16.88

16.88

6.39

7.44

10.79

14.37

15.92

14.37

22.29

6.03

6.03

10.46

7.40

23.41

20.83

11.39

21.22

30.93

31.18

25.70

13.26

17.43

15.64

5.68

5.68

6.21

6.03

7.42

5.37

5.37

9.72

9.48

25.50

25.04

34.33

23.07

23.07

15.32

27.80

20.63

20.12

5.72

22.29

8.04

8.04

16.53

11.23

14.65

6.33

6.33

6.39

6.39

11.67

4.95

5.31

23.95

18.61

17.68

16.79

9.17

31.20

27.45

38.25

36.14

15.12

47.53

14.24

22.29

22.29

42.41

23.20

34.49

39.88

26.78

29.85

25.15

25.15

18.40

29.12

2.07

20.75

21.25

16.43

22.29

16.83

79.52

22.89

18.15

21.38

2.89

15.61

13.82

26.01

10.36

11.48

20.32

9.90

10.45

23.89

35.03

10.77

11.33

6.72

21.84

21.77

17.64

4.85

15.61

4.85

4.85

3.92

5.86

5.86

15.89

15.89

4.84

4.84

6.08

7.47

2.89

6.08

6.08

8.89

8.89

15.29

8.51

12.42

12.42

22.94

22.94

22.86

22.86

20.58

83.16

15.53

18.59

83.16

9.70

15.75

27.12

13.58

15.89

22.29

2.92

10.21

7.36

11.99

11.99

11.99

6.11

9.05

9.03

10.21

8.51

10.45

4.88

4.13

20.83

36.46

20.83

23.89

21.64

15.92

33.54

31.12

23.60

22.80

14.24

10.47

16.68

15.98

14.11

15.98

19.64

7.99

10.79

10.93

17.50

15.80

30.07

13.19

13.19

7.45

15.80

24.24

24.24

24.97

6.79

14.95

14.95

27.14

18.72

18.72

18.72

11.31

8.51

15.98

41.90

12.86

30.65

38.95

10.12

10.12

14.36

11.78

11.78

21.22

8.27

9.10

30.37

22.29

20.07

20.92

13.26

20.39

12.42

7.24

21.24

15.95

41.90

41.90

41.90

16.79

30.26

13.77

24.83

20.31

20.31

20.31

8.16

8.42

36.85

15.89

79.52

79.52

50.96

4.42

4.42

18.15

24.24

6.79

3.09

9.12

9.77

11.93

6.39

6.39

9.01

18.25

20.39

8.33

12.74

5.85

6.39

5.29

10.42

79.52

10.46

18.16

31.45

5.68

5.68

5.32

18.01

20.79

23.37

25.52

28.16

25.76

23.92

30.81

22.71

22.71

22.71

4.53

4.53

4.53

4.53

4.53

6.39

18.59

13.58

13.26

13.58

22.01

13.58

18.87

13.58

22.22

17.71

10.63

21.99

34.69

13.40

11.66

7.60

79.52

80.10

64.61

45.14

23.89

24.98

31.52

38.25

26.07

16.59

29.06

5.94

5.94

6.00

6.00

26.25

22.56

8.63

3.10

24.21

6.79

6.79

9.17

9.17

5.86

31.45

25.15

65.30

26.21

10.46

19.83

8.48

7.98

11.13

18.25

20.75

20.75

62.78

17.51

22.22

6.39

6.39

6.54

6.54

14.98

7.09

7.09

7.98

17.51

20.92

19.46

12.15

9.28

9.01

9.39

12.84

8.95

4.88

4.88

4.65

5.86

8.16

5.58

5.58

5.86

15.41

4.01

8.76

3.56

19.13

43.62

41.90

14.33

14.33

16.94

19.85

14.63

14.06

25.70

18.59

9.29

9.29

18.59

12.38

Manual/Unlstd

4.13

7.98

4.24

2.07

4.26

2.93

2.93

2.93

2.93

2.93

9.59

7.98

5.32

3.73

5.32

4.93

6.88

3.13

5.53

33.06

18.54

67.10

14.68

2.07

5.63

6.21

6.21

6.21

6.21

6.21

28.32

28.32

28.32

6.21

6.21

6.21

6.21

12.42

10.98

23.37

23.37

14.63

13.35

14.83

17.08

14.33

18.92

18.92

15.89

12.87

5.32

5.26

4.13

10.38

8.51

10.64

14.02

8.81

12.56

12.56

10.49

10.49

13.58

6.39

15.40

10.46

9.51

12.42

8.06

10.46

4.13

8.42

9.55

7.47

10.95

16.16

11.33

17.51

7.98

10.62

10.62

23.15

8.25

15.61

13.55

13.58

13.55

22.19

22.19

4.85

4.85

4.87

7.92

7.92

7.92

4.38

3.33

6.80

4.13

8.45

11.89

7.42

7.98

14.41

Manual/Unlstd

6.21

6.44

6.44

9.32

18.59

22.68

15.38

14.92

13.78

9.01

7.12

41.78

41.78

41.51

6.39

15.98

29.42

29.42

19.84

303.34

25.59

19.74

7.07

9.95

14.81

14.81

25.09

12.36

11.05

15.98

16.35

16.97

14.95

22.14

23.89

13.58

14.88

13.58

14.88

19.43

10.12

24.23

24.23

25.70

25.70

25.70

6.39

6.39

7.98

9.10

25.70

18.50

15.98

15.98

13.58

25.25

13.58

25.15

15.40

25.15

17.34

14.79

30.09

13.58

27.59

13.58

36.23

19.24

26.43

18.61

22.06

15.38

9.86

60.53

46.58

33.06

46.58

46.58

58.01

33.06

46.58

17.96

16.42

20.88

14.06

19.72

12.58

7.47

7.00

7.00

76.52

92.51

-

11.43

53.79

4.44

6.01

13.64

5.27

5.44

12.56

15.89

16.98

15.90

12.56

15.93

16.28

19.13

21.02

21.02

16.52

11.03

16.20

14.82

14.60

15.66

14.17

14.97

16.98

17.77

20.80

16.98

16.28

16.28

16.28

16.28

16.08

16.20

16.98

16.98

12.56

12.84

15.13

18.17

17.91

16.06

19.56

10.36

17.29

23.90

21.19

17.77

16.28

23.90

15.43

10.97

10.97

16.69

16.92

16.92

14.88

14.54

13.26

14.28

15.29

13.90

16.73

17.77

18.89

15.12

16.28

16.28

15.89

14.74

16.28

16.11

16.34

16.28

16.28

18.56

16.28

15.29

15.91

23.90

16.28

17.77

15.90

16.28

16.28

18.27

17.77

17.78

16.34

15.51

15.90

20.80

17.77

15.90

16.28

19.64

16.27

19.13

64.56

58.75

48.86

36.64

31.86

71.60

34.39

79.49

43.65

43.65

99.15

33.06

48.86

36.64

99.68

85.44

156.64

142.40

441.43

398.72

Manual/Unlstd

4.73

26.96

22.58

6.65

7.07

5.73

44.32

19.18

3.69

3.69

4.73

11.75

4.73

9.57

21.45

21.45

21.45

11.62

8.78

21.45

32.36

42.89

10.13

14.95

10.54

28.58

11.62

14.43

14.43

17.56

14.43

14.43

14.43

14.43

17.56

22.13

Manual/Unlstd

20.79

8.24

12.74

11.66

11.66

10.64

11.66

11.66

11.69

9.97

9.97

9.97

8.18

10.64

9.96

9.99

9.51

10.38

11.13

7.92

7.92

17.92

24.19

13.34

13.51

6.88

15.46

6.21

24.76

43.33

6.46

142.42

6.46

13.58

13.26

13.95

5.09

5.09

5.09

7.26

10.99

1.04

8.51

1.04

10.67

12.80

8.20

6.98

18.55

4.26

6.65

13.58

4.26

12.79

5.09

5.09

3.56

24.37

24.15

32.18

24.94

24.15

41.81

14.80

14.80

14.80

14.80

14.80

14.80

14.80

14.80

14.80

14.80

14.80

14.80

14.80

14.80

14.80

14.80

14.80

14.80

14.80

14.80

14.80

14.80

14.80

14.80

14.80

14.80

14.80

14.80

14.80

14.80

14.80

14.80

17.76

14.80

11.49

11.49

14.23

20.26

14.80

29.73

13.79

13.79

14.80

14.80

14.80

14.80

14.80

14.80

14.80

11.84

11.84

24.76

43.33

52.88

24.76

43.33

52.88

24.76

43.33

51.55

695.34

24.76

43.33

52.88

24.76

43.33

17.87

43.33

24.76

43.33

52.88

43.33

43.33

63.35

105.06

25.64

158.38

263.49

514.55

24.76

43.33

51.55

24.76

43.33

52.88

24.76

43.33

52.88

24.76

43.33

51.55

24.76

43.33

52.88

24.76

43.33

51.55

24.76

43.33

105.06

24.76

43.33

52.88

24.76

43.33

51.55

24.76

43.33

52.88

24.76

43.33

52.88

24.76

43.33

52.88

24.76

43.33

51.55

24.76

43.33

17.87

43.33

43.33

43.33

158.38

263.49

514.55

43.33

43.33

24.76

43.33

51.55

43.33

24.76

43.33

24.76

43.33

52.88

49.53

86.66

14.80

14.80

14.80

14.80

29.73

14.80

14.80

14.80

14.80

14.80

14.80

14.80

14.80

14.80

14.80

14.80

14.80

160.92

317.84

317.84

603.28

32.18

15.08

158.92

317.84

317.84

Manual/Unlstd

32.90

21.93

54.83

32.38

14.88

47.26

28.98

17.23

46.21

28.98

21.15

50.13

422.20

44.13

466.32

365.02

37.86

402.88

5.74

9.66

15.40

18.59

9.86

24.02

24.43

24.43

13.04

13.04

13.04

13.04

13.04

13.04

7.40

33.68

19.84

53.53

29.24

19.06

48.30

43.86

29.77

73.63

13.04

13.04

13.04

13.04

14.62

27.68

42.30

59.27

54.05

113.32

25.09

28.03

5.48

16.97

22.45

60.05

28.20

88.25

44.91

27.42

43.08

54.83

67.36

Manual/Unlstd

Manual/Unlstd

Manual/Unlstd

143.82

173.74

181.81

155.93

182.12

12.47

12.47

183.78

213.80

213.80

218.21

153.88

185.54

153.88

221.95

205.34

26.44

33.06

39.66

42.98

49.58

30.98

84.69

23.45

42.51

24.02

Manual/Unlstd

8.62

3.39

12.01

17.23

22.72

22.72

21.41

8.88

30.29

21.67

28.98

50.65

132.38

63.97

196.35

187.99

113.06

301.05

6.79

9.66

16.45

51.96

20.63

72.59

42.30

9.14

51.44

40.73

16.97

57.70

45.17

20.37

65.54

76.24

30.03

65.80

95.82

139.17

38.64

23.76

48.04

71.80

15.14

23.76

38.90

21.15

48.30

69.45

14.36

29.50

43.86

45.43

21.67

67.10

51.70

27.15

78.85

30.85

7.83

38.93 also have rates for TC and 26

97.39

29.77

127.16

42.04

27.68

69.71

197.65

57.96

255.62

32.12

21.93

54.05

43.60

61.62

105.22

63.45

90.86

154.31

31.33

34.73

66.06

61.62

41.78

103.40

69.71

44.39

114.10

87.47

83.29

170.76

17.49

70.24

26.63

96.87

97.13

33.68

130.81

51.70

47.26

189.30

51.70

26.37

78.07

55.35

30.81

86.16

24.28

54.57

78.85

13.58

26.89

13.58

28.08

20.89

20.89

58.23

216.19

33.68

249.87

249.87

48.56

298.44

59.01

41.78

100.78

70.50

19.06

89.56

5.48

22.72

28.20

7.31

18.28

25.59

Manual/Unlstd

Manual/Unlstd

Manual/Unlstd

4.99

4.99

4.99

4.99

196.87

4.13

6.80

4.26

8.83

8.83

5.34

2.07

4.26

12.01

3.13

Manual/Unlstd

91.98

11.03

11.03

9.62

14.88

25.88

12.21

3,099.02

8.07

10.76

43.06

105.89

144.89

183.91

228.48

15.00

2.70

Documents

2017 Clinical Diagnostic Laboratory Fee Schedule …...80178 Assay of lithium 9.07 12.26 - 9.07 80180 Drug scrn quan mycophenolate 24.76 33.46 - 24.76 80183 Drug scrn quant oxcarbazepin