2017 clinical diagnostic laboratory fee...

2017

2017 Clinical Diagnostic Laboratory Fee Schedule CPT codes, descriptions and other data only are copyright American Medical Association.2017 Codes are in RedNOTE: Zero pay (0.00) codes will be reimbursed at 45% of billed charges** The appearance on this schedule of a code and rate is not an indication of coverage

, nor a guarantee of payment.

All rights reserved. CPT is a registered trademark of the American Medical Association

HCPCS Modifier Short Description 2017 Fee Schedule

36415 Routine venipuncture $3.0078267 Breath tst attain/anal c-14 $10.7878268 Breath test analysis c-14 $92.4080047 Metabolic panel ionized ca $9.1980047 QW Metabolic panel ionized ca $9.1980048 Metabolic panel total ca $9.1980048 QW Metabolic panel total ca $9.1980051 Electrolyte panel $7.6680051 QW Electrolyte panel $7.6680053 Comprehen metabolic panel $11.5380053 QW Comprehen metabolic panel $11.5380055 Obstetric panel $65.5880061 Lipid panel $15.6280061 QW Lipid panel $15.6280069 Renal function panel $9.1980069 QW Renal function panel $9.1980074 Acute hepatitis panel $65.3480076 Hepatic function panel $9.1980081 Obstetric panel $102.6980150 Assay of amikacin $20.6880155 Drug screen quant caffeine $19.4080156 Assay carbamazepine total $19.9880157 Assay carbamazepine free $18.1880158 Assay of cyclosporine $24.7680159 Drug screen quant clozapine $25.3780162 Assay of digoxin $18.2180163 Assay of digoxin free $18.2180164 Assay dipropylacetic acid $18.5880165 Dipropylacetic acid free $18.5880168 Assay of ethosuximide $22.4180169 Drug screen quant everolimus $18.8480170 Assay of gentamicin $22.4780171 Drug screen quant gabapentin $18.1880173 Assay of haloperidol $19.9880175 Drug screen quan lamotrigine $18.1880176 Assay of lidocaine $20.15

2017





80177 Drug scrn quan levetiracetam $18.1880178 Assay of lithium $9.0780178 QW Assay of lithium $9.0780180 Drug scrn quan mycophenolate $24.7680183 Drug scrn quant oxcarbazepin $18.1880184 Assay of phenobarbital $15.7180185 Assay of phenytoin total $18.1880186 Assay of phenytoin free $18.8880188 Assay of primidone $22.7680190 Assay of procainamide $22.9880192 Assay of procainamide $22.9880194 Assay of quinidine $20.0380195 Assay of sirolimus $18.8480197 Assay of tacrolimus $18.8480198 Assay of theophylline $19.4080199 Drug screen quant tiagabine $24.7780200 Assay of tobramycin $22.1280201 Assay of topiramate $16.3580202 Assay of vancomycin $18.5880203 Drug screen quant zonisamide $18.1880299 Quantitative assay drug $18.7980305 Drug test prsmv dir opt obs $14.9680306 Drug test prsmv instrmnt $19.9580307 Drug test prsmv chem anlyzr $79.8180400 Acth stimulation panel $44.7480402 Acth stimulation panel $119.2880406 Acth stimulation panel $107.3580408 Aldosterone suppression eval $172.1580410 Calcitonin stimul panel $110.2180412 CRH stimulation panel $405.6680414 Testosterone response $70.8380415 Estradiol response panel $76.6680416 Renin stimulation panel $181.0280417 Renin stimulation panel $60.3480418 Pituitary evaluation panel $764.0880420 Dexamethasone panel $98.36

2017





80422 Glucagon tolerance panel $63.2080424 Glucagon tolerance panel $69.2780426 Gonadotropin hormone panel $203.5880428 Growth hormone panel $91.5080430 Growth hormone panel $107.6680432 Insulin suppression panel $174.2780434 Insulin tolerance panel $138.7880435 Insulin tolerance panel $141.3180436 Metyrapone panel $125.0580438 TRH stimulation panel $69.1580439 TRH stimulation panel $92.2081000 Urinalysis nonauto w/scope $4.3581001 Urinalysis auto w/scope $4.3581002 Urinalysis nonauto w/o scope $3.3081003 Urinalysis auto w/o scope $3.0881003 QW Urinalysis auto w/o scope $3.0881005 Urinalysis $2.9781007 Urine screen for bacteria $3.5281007 QW Urine screen for bacteria $3.5281015 Microscopic exam of urine $4.1881020 Urinalysis glass test $5.0681025 Urine pregnancy test $1.6581050 Urinalysis volume measure $3.8881161 Dmd dup/delet analysis $141.1281162 Brca1&2 seq & full dup/del $2,503.2681170 Abl1 gene $331.8281206 Bcr/abl1 gene major bp $224.9181207 Bcr/abl1 gene minor bp $198.6881208 Bcr/abl1 gene other bp $220.6381210 Braf gene $180.2381211 Brca1&2 seq & com dup/del $2,195.4881212 Brca1&2 185&5385&6174 var $177.6881213 Brca1&2 uncom dup/del var $585.9181214 Brca1 full seq & com dup/del $1,446.0281215 Brca1 gene known fam variant $93.7581217 Brca2 gene known fam variant $93.75

2017





81218 Cebpa gene full sequence $331.8281219 Calr gene com variants $166.8481225 Cyp2c19 gene com variants $293.4081226 Cyp2d6 gene com variants $454.0781227 Cyp2c9 gene com variants $176.0381229 CYTOGEN MICROARRAY TEST $1,250.0081235 Egfr gene com variants $331.8281240 F2 gene $67.5081241 F5 gene $83.8281245 Flt3 gene $166.8481246 Flt3 gene analysis $83.6281256 Hfe gene $89.6681261 Igh gene rearrange amp meth $271.5981262 Igh gene rearrang dir probe $59.8881263 Igh vari regional mutation $404.0081264 Igk rearrangeabn clonal pop $204.8381265 Str markers specimen anal $294.9981267 Chimerism anal no cell selec $284.5881268 Chimerism anal w/cell select $357.7381270 Jak2 gene $125.7481272 Kit gene targeted seq analys $331.8281273 Kit gene analys d816 variant $125.7481275 Kras gene $198.5781276 Kras gene addl variants $198.5781287 Mgmt gene methylation anal $83.6781288 Mlh1 gene $160.7681291 Mthfr gene $59.8881292 Mlh1 gene full seq $649.7881293 Mlh1 gene known variants $260.4881294 Mlh1 gene dup/delete variant $191.7281295 Msh2 gene full seq $152.5481296 Msh2 gene known variants $130.2581297 Msh2 gene dup/delete variant $152.5481298 Msh6 gene full seq $289.4181299 Msh6 gene known variants $162.1381300 Msh6 gene dup/delete variant $162.57

2017





81301 Microsatellite instability $397.2081310 Npm1 gene $248.5081311 Nras gene variants exon 2&3 $297.8681313 Pca3/klk3 antigen $262.0881314 Pdgfra gene $331.8281315 Pml/raralpha com breakpoints $284.3881316 Pml/raralpha 1 breakpoint $433.7681317 Pms2 gene full seq analysis $785.5881318 Pms2 known familial variants $185.6281319 Pms2 gene dup/delet variants $222.8881321 Pten gene full sequence $604.0081322 Pten gene known fam variant $58.7281323 Pten gene dup/delet variant $88.0881327 Sept9 methylation analysis $83.6781332 Serpina1 gene $59.8881340 Trb@ gene rearrange amplify $286.5881341 Trb@ gene rearrange dirprobe $68.0281342 Trg gene rearrangement anal $276.4081370 Hla i & ii typing lr $551.6181371 Hla i & ii type verify lr $330.1781372 Hla i typing complete lr $303.0281373 Hla i typing 1 locus lr $152.7681374 Hla i typing 1 antigen lr $99.7981375 Hla ii typing ag equiv lr $302.8081376 Hla ii typing 1 locus lr $167.6681377 Hla ii type 1 ag equiv lr $125.9481378 Hla i & ii typing hr $474.0381379 Hla i typing complete hr $460.0681380 Hla i typing 1 locus hr $243.1481381 Hla i typing 1 allele hr $129.7481382 Hla ii typing 1 loc hr $169.6681383 Hla ii typing 1 allele hr $149.7081410 Aortic dysfunction/dilation $0.0081411 Aortic dysfunction/dilation $0.0081412 Ashkenazi jewish assoc dis $602.1081413 Car ion chnnlpath inc 10 gns $802.33

2017





81414 Car ion chnnlpath inc 2 gns $802.3381415 Exome sequence analysis $0.0081416 Exome sequence analysis $0.0081417 Exome re-evaluation $0.0081420 Fetal chrmoml aneuploidy $802.3381422 Fetal chrmoml microdeltj $802.3381425 Genome sequence analysis $0.0081426 Genome sequence analysis $0.0081427 Genome re-evaluation $0.0081430 Hearing loss sequence analys $0.0081431 Hearing loss dup/del analys $0.0081432 Hrdtry brst ca-rlatd dsordrs $931.4881433 Hrdtry brst ca-rlatd dsordrs $602.1081434 Hereditary retinal disorders $602.1081435 Hereditary colon cancer $802.3381436 Hereditary colon ca synd $802.3381437 Heredtry nurondcrn tum dsrdr $602.1081438 Heredtry nurondcrn tum dsrdr $602.1081439 Inherited cardmypthy 5 gns $802.3381440 Mitochondrial gene $0.0081442 Noonan spectrum disorders $602.1081445 Targeted genomic seq analys $602.1081450 Targeted genomic seq analys $652.9481455 Targeted genomic seq analys $0.0081460 Whole mitochondrial genome $0.0081465 Whole mitochondrial genome $0.0081470 X-linked intellectual dblt $0.0081471 X-linked intellectual dblt $0.0081490 Autoimmune rheumatoid arthr $590.6181493 Cor artery disease mrna $1,042.3581519 Oncology breast mrna $3,443.3681525 Oncology colon mrna $3,125.7381528 Oncology colorectal scr $509.0581535 Oncology gynecologic $583.5281536 Oncology gynecologic $178.8081538 Oncology lung $2,126.78

2017





81539 Oncology prostate prob score $602.1081540 Oncology tum unknown origin $2,920.3081545 Oncology thyroid $3,222.4081595 Cardiology hrt trnspl mrna $2,840.7582009 Test for acetone/ketones $6.2082010 Acetone assay $11.2182010 QW Acetone assay $11.2182013 Acetylcholinesterase assay $15.3282016 Acylcarnitines qual $19.0382017 Acylcarnitines quant $2.7982024 Assay of acth $45.2382030 Assay of adp & amp $35.3982040 Assay of serum albumin $6.7882040 QW Assay of serum albumin $6.7882042 Assay of urine albumin $7.1082042 QW Assay of urine albumin $7.1082043 Microalbumin quantitative $7.9382043 QW Microalbumin quantitative $7.9382044 Microalbumin semiquant $6.2882044 QW Microalbumin semiquant $6.2882045 Albumin ischemia modified $46.5682075 Assay of breath ethanol $15.9582085 Assay of aldolase $13.3282088 Assay of aldosterone $55.9082103 Alpha-1-antitrypsin total $18.4382104 Alpha-1-antitrypsin pheno $19.8482105 Alpha-fetoprotein serum $23.0182106 Alpha-fetoprotein amniotic $23.0182107 Alpha-fetoprotein l3 $88.3682108 Assay of aluminum $34.9582120 Amines vaginal fluid qual $5.1782120 QW Amines vaginal fluid qual $5.1782127 Amino acid single qual $19.0382128 Amino acids mult qual $19.0382131 Amino acids single quant $23.1482135 Assay aminolevulinic acid $22.57

2017





82136 Amino acids quant 2-5 $2.7982139 Amino acids quan 6 or more $2.7982140 Assay of ammonia $19.9982143 Amniotic fluid scan $9.4282150 Assay of amylase $8.8982150 QW Assay of amylase $8.8982154 Androstanediol glucuronide $39.5582157 Assay of androstenedione $40.1682160 Assay of androsterone $34.3082163 Assay of angiotensin II $23.9382164 Angiotensin I enzyme test $20.0382172 Assay of apolipoprotein $19.4482175 Assay of arsenic $26.0282180 Assay of ascorbic acid $7.9882190 Atomic absorption $20.4582232 Assay of beta-2 protein $22.1982239 Bile acids total $23.4982240 Bile acids cholylglycine $30.0482247 Bilirubin total $6.8882247 QW Bilirubin total $6.8882248 Bilirubin direct $6.8882252 Fecal bilirubin test $6.2582261 Assay of biotinidase $2.7982270 Occult blood feces $4.4682271 Occult blood other sources $4.4682271 QW Occult blood other sources $4.4682272 Occult bld feces 1-3 tests $4.4682274 Assay test for blood fecal $21.8282274 QW Assay test for blood fecal $21.8282286 Assay of bradykinin $9.4582300 Assay of cadmium $31.7582306 Vitamin d 25 hydroxy $37.4982308 Assay of calcitonin $36.7582310 Assay of calcium $7.0882310 QW Assay of calcium $7.0882330 Assay of calcium $18.76

2017





82330 QW Assay of calcium $18.7682331 Calcium infusion test $7.1082340 Assay of calcium in urine $5.4182355 Calculus analysis qual $15.8882360 Calculus assay quant $17.6682365 Calculus spectroscopy $17.6982370 X-ray assay calculus $17.1882373 Assay c-d transfer measure $24.7782374 Assay blood carbon dioxide $6.7082374 QW Assay blood carbon dioxide $6.7082375 Assay carboxyhb quant $16.9082376 Assay carboxyhb qual $8.2282378 Carcinoembryonic antigen $26.0182379 Assay of carnitine $2.7982380 Assay of carotene $12.6582382 Assay urine catecholamines $23.5882383 Assay blood catecholamines $34.3782384 Assay three catecholamines $34.6482387 Assay of cathepsin-d $28.5582390 Assay of ceruloplasmin $14.7382397 Chemiluminescent assay $19.3782415 Assay of chloramphenicol $17.3882435 Assay of blood chloride $6.3182435 QW Assay of blood chloride $6.3182436 Assay of urine chloride $6.9082438 Assay other fluid chlorides $6.7082441 Test for chlorohydrocarbons $7.1882465 Assay bld/serum cholesterol $5.9782465 QW Assay bld/serum cholesterol $5.9782480 Assay serum cholinesterase $10.8082482 Assay rbc cholinesterase $10.5382485 Assay chondroitin sulfate $28.3382495 Assay of chromium $27.8282507 Assay of citrate $38.1482523 Collagen crosslinks $25.6382523 QW Collagen crosslinks $25.63

2017





82525 Assay of copper $17.0282528 Assay of corticosterone $30.8982530 Cortisol free $22.9282533 Total cortisol $22.3682540 Assay of creatine $6.3682542 Column chromotography quant $24.7782550 Assay of ck (cpk) $8.5782550 QW Assay of ck (cpk) $8.5782552 Assay of cpk in blood $18.3782553 Creatine mb fraction $9.0382554 Creatine isoforms $16.2882565 Assay of creatinine $7.0382565 QW Assay of creatinine $7.0382570 Assay of urine creatinine $7.1082570 QW Assay of urine creatinine $7.1082575 Creatinine clearance test $11.7282585 Assay of cryofibrinogen $11.7782595 Assay of cryoglobulin $8.1782600 Assay of cyanide $26.6182607 Vitamin B-12 $20.6882608 B-12 binding capacity $19.6482610 Cystatin c $18.6582615 Test for urine cystines $11.2082626 Dehydroepiandrosterone $34.6782627 Dehydroepiandrosterone $30.5082633 Desoxycorticosterone $42.5082634 Deoxycortisol $40.1682638 Assay of dibucaine number $16.8082652 Vit d 1 25-dihydroxy $52.8182656 Pancreatic elastase fecal $14.9382657 Enzyme cell activity $24.7782658 Enzyme cell activity ra $24.7782664 Electrophoretic test $47.1282668 Assay of erythropoietin $25.7882670 Assay of estradiol $38.3282671 Assay of estrogens $44.31

2017





82672 Assay of estrogen $29.7682677 Assay of estriol $33.1782679 Assay of estrone $34.2382679 QW Assay of estrone $34.2382693 Assay of ethylene glycol $20.4482696 Assay of etiocholanolone $32.3582705 Fats/lipids feces qual $1.5982710 Fats/lipids feces quant $23.0582715 Assay of fecal fat $4.5782725 Assay of blood fatty acids $18.2682726 Long chain fatty acids $24.7782728 Assay of ferritin $18.7082731 Assay of fetal fibronectin $88.3682735 Assay of fluoride $25.4382746 Assay of folic acid serum $20.1782747 Assay of folic acid rbc $23.7682757 Assay of semen fructose $23.7882759 Assay of rbc galactokinase $29.4782760 Assay of galactose $15.3682775 Assay galactose transferase $28.9082776 Galactose transferase test $11.5182777 Galectin-3 $30.1782784 Assay iga/igd/igg/igm each $12.7682785 Assay of ige $22.5882787 Igg 1 2 3 or 4 each $10.4882800 Blood pH $9.8782803 Blood gases any combination $21.5482805 Blood gases w/o2 saturation $30.9182810 Blood gases o2 sat only $9.3782820 Hemoglobin-oxygen affinity $13.7082930 Gastric analy w/ph ea spec $7.4782938 Gastrin test $24.2782941 Assay of gastrin $24.1982943 Assay of glucagon $7.9882945 Glucose other fluid $5.3982946 Glucagon tolerance test $20.68

2017





82947 Assay glucose blood quant $5.3982947 QW Assay glucose blood quant $5.3982948 Reagent strip/blood glucose $4.3582950 Glucose test $6.5182950 QW Glucose test $6.5182951 Glucose tolerance test (GTT) $17.6682951 QW Glucose tolerance test (GTT) $17.6682952 GTT-added samples $5.3882952 QW GTT-added samples $5.3882955 Assay of g6pd enzyme $13.3082960 Test for G6PD enzyme $8.3082962 Glucose blood test $3.2182963 Assay of glucosidase $29.4782965 Assay of gdh enzyme $9.8182977 Assay of GGT $9.8882977 QW Assay of GGT $9.8882978 Assay of glutathione $19.5582979 Assay rbc glutathione $9.4582985 Assay of glycated protein $20.6882985 QW Assay of glycated protein $20.6883001 Assay of gonadotropin (fsh) $25.4983001 QW Assay of gonadotropin (fsh) $25.4983002 Assay of gonadotropin (lh) $25.4083002 QW Assay of gonadotropin (lh) $25.4083003 Assay growth hormone (hgh) $22.8783006 Growth stimulation gene 2 $30.1783009 H pylori (c-13) blood $92.4083010 Assay of haptoglobin quant $17.2583012 Assay of haptoglobins $23.5883013 H pylori (c-13) breath $92.4083014 H pylori drug admin $10.7883015 Heavy metal screen $25.8383018 Quantitative screen metals $30.1383020 Hemoglobin electrophoresis $17.6683021 Hemoglobin chromotography $24.7783026 Hemoglobin copper sulfate $3.24

2017





83030 Fetal hemoglobin chemical $11.3483033 Fetal hemoglobin assay qual $8.1883036 Glycosylated hemoglobin test $13.3283036 QW Glycosylated hemoglobin test $13.3283037 Glycosylated hb home device $13.3283037 QW Glycosylated hb home device $13.3283045 Blood methemoglobin test $6.7983050 Blood methemoglobin assay $7.9883051 Assay of plasma hemoglobin $10.0383060 Blood sulfhemoglobin assay $7.9883065 Assay of hemoglobin heat $7.9883068 Hemoglobin stability screen $11.6183069 Assay of urine hemoglobin $5.4283070 Assay of hemosiderin qual $6.5183080 Assay of b hexosaminidase $2.7983088 Assay of histamine $40.5183090 Assay of homocystine $23.1483150 Assay of homovanillic acid $26.5483491 Assay of corticosteroids 17 $24.0483497 Assay of 5-hiaa $16.7583498 Assay of progesterone 17-d $37.2783499 Assay of progesterone 20- $34.5883500 Assay free hydroxyproline $31.0783505 Assay total hydroxyproline $33.3483516 Immunoassay nonantibody $14.9383516 QW Immunoassay nonantibody $14.9383518 Immunoassay dipstick $10.1283518 QW Immunoassay dipstick $10.1283519 Ria nonantibody $18.5383520 Immunoassay quant nos nonab $17.7683520 QW Immunoassay quant nos nonab $17.7683525 Assay of insulin $15.6883527 Assay of insulin $17.7683528 Assay of intrinsic factor $21.8283540 Assay of iron $8.8883550 Iron binding test $11.99

2017





83570 Assay of idh enzyme $11.5783582 Assay of ketogenic steroids $19.4483586 Assay 17- ketosteroids $17.5683593 Fractionation ketosteroids $36.0883605 Assay of lactic acid $14.6583605 QW Assay of lactic acid $14.6583615 Lactate (LD) (LDH) enzyme $8.2883625 Assay of ldh enzymes $17.5583630 Lactoferrin fecal (qual) $26.9383631 Lactoferrin fecal (quant) $26.9383632 Placental lactogen $27.7483633 Test urine for lactose $7.5483655 Assay of lead $16.6183655 QW Assay of lead $16.6183661 L/s ratio fetal lung $30.1683662 Foam stability fetal lung $25.9483663 Fluoro polarize fetal lung $25.9483664 Lamellar bdy fetal lung $25.9483670 Assay of lap enzyme $12.5783690 Assay of lipase $9.4583695 Assay of lipoprotein(a) $17.7683698 Assay lipoprotein pla2 $46.5683700 Lipopro bld electrophoretic $14.3483701 Lipoprotein bld hr fraction $34.0583704 Lipoprotein bld by nmr $43.2883718 Assay of lipoprotein $11.2483718 QW Assay of lipoprotein $11.2483719 Assay of blood lipoprotein $12.7783721 Assay of blood lipoprotein $13.0983721 QW Assay of blood lipoprotein $13.0983727 Assay of lrh hormone $22.1883735 Assay of magnesium $9.1983775 Assay malate dehydrogenase $10.1183785 Assay of manganese $33.7483789 Mass spectrometry quant $24.7783825 Assay of mercury $22.30

2017





83835 Assay of metanephrines $23.2483857 Assay of methemalbumin $14.7383861 Microfluid analy tears $22.6683861 QW Microfluid analy tears $22.6683864 Mucopolysaccharides $27.3283872 Assay synovial fluid mucin $6.2083873 Assay of csf protein $23.6083874 Assay of myoglobin $17.7283876 Assay myeloperoxidase $46.5683880 Assay of natriuretic peptide $46.5683880 QW Assay of natriuretic peptide $46.5683883 Assay nephelometry not spec $18.6583885 Assay of nickel $33.6283915 Assay of nucleotidase $12.3683916 Oligoclonal bands $27.5983918 Organic acids total quant $22.5783919 Organic acids qual each $22.5783921 Organic acid single quant $22.5783930 Assay of blood osmolality $9.0783935 Assay of urine osmolality $9.3583937 Assay of osteocalcin $39.0683945 Assay of oxalate $17.6683950 Oncoprotein her-2/neu $88.3683951 Oncoprotein dcp $88.3683970 Assay of parathormone $56.6283986 Assay ph body fluid nos $4.9183986 QW Assay ph body fluid nos $4.9183987 Exhaled breath condensate $16.0383992 Assay for phencyclidine $20.1783993 Assay for calprotectin fecal $26.9384030 Assay of blood pku $7.5484035 Assay of phenylketones $5.0284060 Assay acid phosphatase $10.1384061 Phosphatase forensic exam $10.8584066 Assay prostate phosphatase $13.2584075 Assay alkaline phosphatase $7.10

2017





84075 QW Assay alkaline phosphatase $7.1084078 Assay alkaline phosphatase $9.5984080 Assay alkaline phosphatases $20.2884081 Assay phosphatidylglycerol $22.6684085 Assay of rbc pg6d enzyme $9.2584087 Assay phosphohexose enzymes $14.1684100 Assay of phosphorus $6.5084105 Assay of urine phosphorus $7.1084106 Test for porphobilinogen $5.8884110 Assay of porphobilinogen $11.5884112 Placenta alpha micro ig c/v $88.3684119 Test urine for porphyrins $11.8284120 Assay of urine porphyrins $20.1884126 Assay of feces porphyrins $34.9484132 Assay of serum potassium $6.3184132 QW Assay of serum potassium $6.3184133 Assay of urine potassium $5.9184134 Assay of prealbumin $20.0184135 Assay of pregnanediol $26.2584138 Assay of pregnanetriol $25.9784140 Assay of pregnenolone $28.3684143 Assay of 17-hydroxypregneno $31.2984144 Assay of progesterone $28.6284145 Procalcitonin (pct) $36.7584146 Assay of prolactin $26.5884150 Assay of prostaglandin $34.2384152 Assay of psa complexed $25.2384153 Assay of psa total $25.2384154 Assay of psa free $25.2384155 Assay of protein serum $5.0384155 QW Assay of protein serum $5.0384156 Assay of protein urine $5.0384157 Assay of protein other $5.0384157 QW Assay of protein other $5.0384160 Assay of protein any source $7.1084163 Pappa serum $20.65

2017





84165 Protein e-phoresis serum $14.7384166 Protein e-phoresis/urine/csf $23.8084181 Western blot test $23.3684182 Protein western blot test $24.6984202 Assay RBC protoporphyrin $19.6884203 Test RBC protoporphyrin $11.8184206 Assay of proinsulin $24.4384207 Assay of vitamin b-6 $38.5484210 Assay of pyruvate $14.8984220 Assay of pyruvate kinase $12.9584228 Assay of quinine $15.9684233 Assay of estrogen $88.3684234 Assay of progesterone $89.0084235 Assay of endocrine hormone $71.7984238 Assay nonendocrine receptor $50.1684244 Assay of renin $30.1784252 Assay of vitamin b-2 $27.7684255 Assay of selenium $35.0284260 Assay of serotonin $42.5084270 Assay of sex hormone globul $29.8184275 Assay of sialic acid $18.4384285 Assay of silica $32.2984295 Assay of serum sodium $6.6084295 QW Assay of serum sodium $6.6084300 Assay of urine sodium $6.6784302 Assay of sweat sodium $6.6784305 Assay of somatomedin $29.1784307 Assay of somatostatin $25.0784311 Spectrophotometry $9.5984315 Body fluid specific gravity $3.4484375 Chromatogram assay sugars $26.9084376 Sugars single qual $7.5484377 Sugars multiple qual $7.5484378 Sugars single quant $15.8184379 Sugars multiple quant $15.8184392 Assay of urine sulfate $6.51

2017





84402 Assay of free testosterone $34.9484403 Assay of total testosterone $35.4184410 Testosterone bioavailable $72.5584425 Assay of vitamin b-1 $29.1284430 Assay of thiocyanate $15.9684431 Thromboxane urine $23.0584432 Assay of thyroglobulin $22.0384436 Assay of total thyroxine $9.4284437 Assay of neonatal thyroxine $8.8784439 Assay of free thyroxine $12.3784442 Assay of thyroid activity $20.2884443 Assay thyroid stim hormone $23.0584443 QW Assay thyroid stim hormone $23.0584445 Assay of tsi globulin $69.7684446 Assay of vitamin e $15.3584449 Assay of transcortin $24.6984450 Transferase (AST) (SGOT) $7.1084450 QW Transferase (AST) (SGOT) $7.1084460 Alanine amino (ALT) (SGPT) $7.2784460 QW Alanine amino (ALT) (SGPT) $7.2784466 Assay of transferrin $17.5184478 Assay of triglycerides $7.8884478 QW Assay of triglycerides $7.8884479 Assay of thyroid (t3 or t4) $8.8784480 Assay triiodothyronine (t3) $19.4584481 Free assay (FT-3) $23.2484482 T3 reverse $21.6284484 Assay of troponin quant $13.5084485 Assay duodenal fluid trypsin $10.3184488 Test feces for trypsin $10.0184490 Assay of feces for trypsin $10.4384510 Assay of tyrosine $14.2784512 Assay of troponin qual $8.5284520 Assay of urea nitrogen $5.4284520 QW Assay of urea nitrogen $5.4284525 Urea nitrogen semi-quant $5.17

2017





84540 Assay of urine/urea-n $6.5184545 Urea-N clearance test $7.9884550 Assay of blood/uric acid $6.2084550 QW Assay of blood/uric acid $6.2084560 Assay of urine/uric acid $6.5184577 Assay of feces/urobilinogen $15.5684578 Test urine urobilinogen $4.1284580 Assay of urine urobilinogen $9.7384583 Assay of urine urobilinogen $6.9084585 Assay of urine vma $5.6084586 Assay of vip $21.9384588 Assay of vasopressin $46.5684590 Assay of vitamin a $9.7984591 Assay of nos vitamin $9.7984597 Assay of vitamin k $18.8284600 Assay of volatiles $16.1084620 Xylose tolerance test $11.9784630 Assay of zinc $15.6284681 Assay of c-peptide $26.3384702 Chorionic gonadotropin test $20.6584703 Chorionic gonadotropin assay $10.3284703 QW Chorionic gonadotropin assay $10.3284704 Hcg free betachain test $20.6584830 Ovulation tests $13.7685002 Bleeding time test $6.1985004 Automated diff wbc count $8.8785007 Bl smear w/diff wbc count $3.2185008 Bl smear w/o diff wbc count $4.7185009 Manual diff wbc count b-coat $3.2185013 Spun microhematocrit $2.9285014 Hematocrit $2.9285014 QW Hematocrit $2.9285018 Hemoglobin $2.9285018 QW Hemoglobin $2.9285025 Complete cbc w/auto diff wbc $10.6685027 Complete cbc automated $8.87

2017





85032 Manual cell count each $5.9185041 Automated rbc count $3.9985044 Manual reticulocyte count $5.7685045 Automated reticulocyte count $5.4885046 Reticyte/hgb concentrate $7.6485048 Automated leukocyte count $3.2885049 Automated platelet count $6.1485055 Reticulated platelet assay $36.7385130 Chromogenic substrate assay $16.3185170 Blood clot retraction $3.9985175 Blood clot lysis time $6.2585210 Clot factor ii prothrom spec $17.8185220 Blooc clot factor v test $24.2185230 Clot factor vii proconvertin $24.5685240 Clot factor viii ahg 1 stage $24.5685244 Clot factor viii reltd antgn $28.0185245 Clot factor viii vw ristoctn $31.4785246 Clot factor viii vw antigen $31.4785247 Clot factor viii multimetric $31.4785250 Clot factor ix ptc/chrstmas $26.1285260 Clot factor x stuart-power $24.5685270 Clot factor xi pta $24.5685280 Clot factor xii hageman $26.5485290 Clot factor xiii fibrin stab $22.4185291 Clot factor xiii fibrin scrn $12.2085292 Clot factor fletcher fact $25.9785293 Clot factor wght kininogen $25.9785300 Antithrombin iii activity $16.2685301 Antithrombin iii antigen $14.8385302 Clot inhibit prot c antigen $16.4885303 Clot inhibit prot c activity $18.9885305 Clot inhibit prot s total $15.9285306 Clot inhibit prot s free $21.0285307 Assay activated protein c $21.0285335 Factor inhibitor test $17.6685337 Thrombomodulin $14.30

2017





85345 Coagulation time lee & white $5.9185347 Coagulation time activated $5.8485348 Coagulation time otr method $4.1685360 Euglobulin lysis $11.5385362 Fibrin degradation products $9.4585366 Fibrinogen test $11.8285370 Fibrinogen test $15.5885378 Fibrin degrade semiquant $9.7985379 Fibrin degradation quant $13.9685380 Fibrin degradj d-dimer $13.9685384 Fibrinogen activity $11.6585385 Fibrinogen antigen $11.6585390 Fibrinolysins screen i&r $7.1085397 Clotting funct activity $31.4785400 Fibrinolytic plasmin $12.1485410 Fibrinolytic antiplasmin $10.5785415 Fibrinolytic plasminogen $23.5885420 Fibrinolytic plasminogen $8.9685421 Fibrinolytic plasminogen $13.9785441 Heinz bodies direct $5.7685445 Heinz bodies induced $9.3585460 Hemoglobin fetal $10.6185461 Hemoglobin fetal $9.1085475 Hemolysin acid $12.1785520 Heparin assay $17.9685525 Heparin neutralization $16.2485530 Heparin-protamine tolerance $19.4585536 Iron stain peripheral blood $8.8785540 Wbc alkaline phosphatase $11.8085547 RBC mechanical fragility $9.5985549 Muramidase $25.7285555 RBC osmotic fragility $9.1785557 RBC osmotic fragility $18.3285576 Blood platelet aggregation $29.4785576 QW Blood platelet aggregation $29.4785597 Phospholipid pltlt neutraliz $24.66

2017





85598 Hexagnal phosph pltlt neutrl $24.6685610 Prothrombin time $5.3985610 QW Prothrombin time $5.3985611 Prothrombin test $5.4185612 Viper venom prothrombin time $13.1485613 Russell viper venom diluted $13.1485635 Reptilase test $13.5185651 Rbc sed rate nonautomated $4.8785652 Rbc sed rate automated $3.7085660 RBC sickle cell test $7.5685670 Thrombin time plasma $7.9185675 Thrombin time titer $9.3985705 Thromboplastin inhibition $13.2185730 Thromboplastin time partial $8.2485732 Thromboplastin time partial $8.8785810 Blood viscosity examination $16.0186000 Agglutinins febrile antigen $9.5886001 Allergen specific igg $7.1686003 Allergen specific IgE $7.1686005 Allergen specific IgE $10.9386021 WBC antibody identification $20.6586022 Platelet antibodies $25.2086023 Immunoglobulin assay $17.0986038 Antinuclear antibodies $16.5886039 Antinuclear antibodies (ANA) $15.3186060 Antistreptolysin o titer $7.0486063 Antistreptolysin o screen $7.0486140 C-reactive protein $5.2586141 C-reactive protein hs $17.7686146 Beta-2 glycoprotein antibody $34.9186147 Cardiolipin antibody ea ig $34.9186148 Anti-phospholipid antibody $22.0486152 Cell enumeration & id $337.0486155 Chemotaxis assay $21.9386156 Cold agglutinin screen $9.1986157 Cold agglutinin titer $11.06

2017





86160 Complement antigen $16.4686161 Complement/function activity $16.4686162 Complement total (ch50) $27.8886171 Complement fixation each $13.7386185 Counterimmunoelectrophoresis $12.2886200 Ccp antibody $17.7686215 Deoxyribonuclease antibody $18.1786225 Dna antibody native $16.2686226 Dna antibody single strand $16.6186235 Nuclear antigen antibody $24.6086243 Fc receptor $28.1486255 Fluorescent antibody screen $7.1886256 Fluorescent antibody titer $14.7586277 Growth hormone antibody $21.5986280 Hemagglutination inhibition $9.8186294 Immunoassay tumor qual $25.4386294 QW Immunoassay tumor qual $25.4386300 Immunoassay tumor ca 15-3 $28.5586301 Immunoassay tumor ca 19-9 $28.5586304 Immunoassay tumor ca 125 $28.5586305 Human epididymis protein 4 $28.5586308 Heterophile antibody screen $7.1086308 QW Heterophile antibody screen $7.1086309 Heterophile antibody titer $7.9886310 Heterophile antibody absrbj $10.1186316 Immunoassay tumor other $28.5586317 Immunoassay infectious agent $20.5686318 Immunoassay infectious agent $17.7686318 QW Immunoassay infectious agent $17.7686320 Serum immunoelectrophoresis $24.6186325 Other immunoelectrophoresis $30.6886327 Immunoelectrophoresis assay $31.1286329 Immunodiffusion nes $14.3486331 Immunodiffusion ouchterlony $15.9586332 Immune complex assay $33.4386334 Immunofix e-phoresis serum $30.65

2017





86335 Immunfix e-phorsis/urine/csf $40.2686336 Inhibin A $20.5686337 Insulin antibodies $29.3786340 Intrinsic factor antibody $20.6886341 Islet cell antibody $27.1486343 Leukocyte histamine release $17.0986344 Leukocyte phagocytosis $10.9586352 Cell function assay w/stim $186.3786353 Lymphocyte transformation $67.2586355 B cells total count $51.7586356 Mononuclear cell antigen $36.7386357 Nk cells total count $51.7586359 T cells total count $51.7586360 T cell absolute count/ratio $64.4586361 T cell absolute count $36.7386367 Stem cells total count $51.7586376 Microsomal antibody each $19.9686378 Migration inhibitory factor $27.0186382 Neutralization test viral $23.2086384 Nitroblue tetrazolium dye $15.6286386 Nuclear matrix protein 22 $21.9186386 QW Nuclear matrix protein 22 $21.9186403 Particle agglut antbdy scrn $13.9886406 Particle agglut antbdy titr $14.5986430 Rheumatoid factor test qual $7.7886431 Rheumatoid factor quant $7.7886480 Tb test cell immun measure $85.0286481 Tb ag response t-cell susp $102.7986590 Streptokinase antibody $11.1586592 Syphilis test non-trep qual $5.8686593 Syphilis test non-trep quant $6.0486602 Antinomyces antibody $13.9686603 Adenovirus antibody $17.6586606 Aspergillus antibody $20.6586609 Bacterium antibody $17.6786611 Bartonella antibody $13.96

2017





86612 Blastomyces antibody $17.7086615 Bordetella antibody $18.0986617 Lyme disease antibody $21.2586618 Lyme disease antibody $23.3686618 QW Lyme disease antibody $23.3686619 Borrelia antibody $18.3586622 Brucella antibody $12.2586625 Campylobacter antibody $18.0086628 Candida antibody $16.4786631 Chlamydia antibody $16.2286632 Chlamydia igm antibody $17.4086635 Coccidioides antibody $15.7486638 Q fever antibody $16.6386641 Cryptococcus antibody $19.7786644 CMV antibody $19.7486645 Cmv antibody igm $23.1186648 Diphtheria antibody $20.8686651 Encephalitis californ antbdy $18.0986652 Encephaltis east eqne anbdy $18.0986653 Encephaltis st louis antbody $18.0986654 Encephaltis west eqne antbdy $18.0986658 Enterovirus antibody $17.8786663 Epstein-barr antibody $18.0086664 Epstein-barr nuclear antigen $20.9886665 Epstein-barr capsid vca $24.8986666 Ehrlichia antibody $13.9686668 Francisella tularensis $14.2786671 Fungus nes antibody $16.8186674 Giardia lamblia antibody $20.1986677 Helicobacter pylori antibody $19.9086682 Helminth antibody $17.8486684 Hemophilus influenza antibdy $21.7386687 Htlv-i antibody $11.5186688 Htlv-ii antibody $19.2186689 Htlv/hiv confirmj antibody $26.5586692 Hepatitis delta agent antbdy $23.54

2017





86694 Herpes simplex nes antbdy $19.7486695 Herpes simplex type 1 test $18.0986696 Herpes simplex type 2 test $26.5586698 Histoplasma antibody $17.1486701 Hiv-1antibody $12.1986701 QW Hiv-1antibody $12.1986702 Hiv-2 antibody $18.5486703 Hiv-1/hiv-2 1 result antbdy $18.8086704 Hep b core antibody total $16.5386705 Hep b core antibody igm $16.1586706 Hep b surface antibody $14.7386707 Hepatitis be antibody $15.8786708 Hepatitis a total antibody $16.9986709 Hepatitis a igm antibody $15.4486710 Influenza virus antibody $18.5986711 John cunningham antibody $19.7486713 Legionella antibody $20.9986717 Leishmania antibody $16.8086720 Leptospira antibody $18.0986723 Listeria monocytogenes $18.0986727 Lymph choriomeningitis ab $17.6586729 Lympho venereum antibody $16.3886732 Mucormycosis antibody $18.0986735 Mumps antibody $17.9086738 Mycoplasma antibody $18.1686741 Neisseria meningitidis $18.0986744 Nocardia antibody $18.0986747 Parvovirus antibody $20.6286750 Malaria antibody $18.0986753 Protozoa antibody nos $16.9986756 Respiratory virus antibody $17.6886757 Rickettsia antibody $26.5586759 Rotavirus antibody $18.0986762 Rubella antibody $19.7486765 Rubeola antibody $17.6786768 Salmonella antibody $18.09

2017





86771 Shigella antibody $18.0986774 Tetanus antibody $20.3086777 Toxoplasma antibody $19.7486778 Toxoplasma antibody igm $19.7686780 Treponema pallidum $8.7586780 QW Treponema pallidum $8.7586784 Trichinella antibody $17.2386787 Varicella-zoster antibody $17.6786788 West nile virus ab igm $23.1186789 West nile virus antibody $19.7486790 Virus antibody nos $17.6786793 Yersinia antibody $18.0986800 Thyroglobulin antibody $21.8286803 Hepatitis c ab test $19.5786803 QW Hepatitis c ab test $19.5786804 Hep c ab test confirm $21.2586805 Lymphocytotoxicity assay $71.7386806 Lymphocytotoxicity assay $65.2886807 Cytotoxic antibody screening $54.2986808 Cytotoxic antibody screening $40.7186812 Hla typing a b or c $29.7286813 Hla typing a b or c $79.5686816 Hla typing dr/dq $38.2186817 Hla typing dr/dq $88.3286821 Lymphocyte culture mixed $77.4586822 Lymphocyte culture primed $50.1586825 Hla x-math non-cytotoxic $110.1786826 Hla x-match noncytotoxc addl $36.7386828 Hla class i&ii antibody qual $54.2986829 Hla class i/ii antibody qual $40.7186830 Hla class i phenotype qual $104.5786831 Hla class ii phenotype qual $89.6486832 Hla class i high defin qual $164.3286833 Hla class ii high defin qual $149.4086834 Hla class i semiquant panel $463.1286835 Hla class ii semiquant panel $418.30

2017





86850 Rbc antibody screen $5.2586880 Coombs test direct $7.3986885 Coombs test indirect qual $7.8586886 Coombs test indirect titer $7.1086900 Blood typing abo $4.1086901 Blood typing rh (d) $4.1086902 Blood type antigen donor ea $5.2586904 Blood typing patient serum $13.0586905 Blood typing rbc antigens $5.2586906 Blood typing rh phenotype $10.6386940 Hemolysins/agglutinins auto $11.2586941 Hemolysins/agglutinins $16.6187003 Small animal inoculation $23.1087015 Specimen infect agnt concntj $6.1687040 Blood culture for bacteria $14.1687045 Feces culture aerobic bact $12.7787046 Stool cultr aerobic bact ea $12.7787070 Culture othr specimn aerobic $11.8287071 Culture aerobic quant other $12.7787073 Culture bacteria anaerobic $12.7787075 Cultr bacteria except blood $12.9987076 Culture anaerobe ident each $11.0887077 Culture aerobic identify $11.0887077 QW Culture aerobic identify $11.0887081 Culture screen only $9.0987084 Culture of specimen by kit $11.8287086 Urine culture/colony count $11.0787088 Urine bacteria culture $11.1087101 Skin fungi culture $10.5787102 Fungus isolation culture $11.5387103 Blood fungus culture $12.3787106 Fungi identification yeast $12.3187107 Fungi identification mold $12.3187109 Mycoplasma $21.1187110 Chlamydia culture $26.8887116 Mycobacteria culture $14.82

2017





87118 Mycobacteric identification $12.3187140 Culture type immunofluoresc $4.8887143 Culture typing glc/hplc $17.1887147 Culture type immunologic $7.1087149 Dna/rna direct probe $27.0687150 Dna/rna amplified probe $48.1487152 Culture type pulse field gel $7.1887153 Dna/rna sequencing $158.2487158 Culture typing added method $7.1887164 Dark field examination $10.1287166 Dark field examination $10.1287168 Macroscopic exam arthropod $4.9287169 Macroscopic exam parasite $4.9287172 Pinworm exam $4.9287176 Tissue homogenization cultr $6.1687177 Ova and parasites smears $11.9787181 Microbe susceptible diffuse $1.2287184 Microbe susceptible disk $9.4687185 Microbe susceptible enzyme $1.2287186 Microbe susceptible mic $11.8687187 Microbe susceptible mlc $11.8687188 Microbe suscept macrobroth $9.1187190 Microbe suscept mycobacteri $5.6087197 Bactericidal level serum $20.6187205 Smear gram stain $5.8687206 Smear fluorescent/acid stai $7.3887207 Smear special stain $8.2287209 Smear complex stain $24.6687210 Smear wet mount saline/ink $4.9287210 QW Smear wet mount saline/ink $4.9287220 Tissue exam for fungi $5.8687230 Assay toxin or antitoxin $27.0887250 Virus inoculate eggs/animal $26.8387252 Virus inoculation tissue $35.7687253 Virus inoculate tissue addl $27.7187254 Virus inoculation shell via $26.83

2017





87255 Genet virus isolate hsv $46.4587260 Adenovirus ag if $15.7187265 Pertussis ag if $15.7187267 Enterovirus antibody dfa $15.7187269 Giardia ag if $15.7187270 Chlamydia trachomatis ag if $15.7187271 Cytomegalovirus dfa $15.7187272 Cryptosporidium ag if $15.7187273 Herpes simplex 2 ag if $15.7187274 Herpes simplex 1 ag if $15.7187275 Influenza b ag if $15.7187276 Influenza a ag if $15.7187277 Legionella micdadei ag if $15.7187278 Legion pneumophilia ag if $15.7187279 Parainfluenza ag if $15.7187280 Respiratory syncytial ag if $15.7187281 Pneumocystis carinii ag if $15.7187283 Rubeola ag if $15.7187285 Treponema pallidum ag if $15.7187290 Varicella zoster ag if $15.7187299 Antibody detection nos if $15.7187300 Ag detection polyval if $15.7187301 Adenovirus ag eia $15.7187305 Aspergillus ag eia $15.7187320 Chylmd trach ag eia $15.7187324 Clostridium ag eia $15.7187327 Cryptococcus neoform ag eia $15.7187328 Cryptosporidium ag eia $15.7187329 Giardia ag eia $15.7187332 Cytomegalovirus ag eia $15.7187335 E coli 0157 ag eia $15.7187336 Entamoeb hist dispr ag eia $15.7187337 Entamoeb hist group ag eia $15.7187338 Hpylori stool eia $19.7387338 QW Hpylori stool ia $19.7387339 H pylori ag eia $15.71

2017





87340 Hepatitis b surface ag eia $14.1787341 Hepatitis b surface ag eia $14.1787350 Hepatitis be ag eia $15.8187380 Hepatitis delta ag eia $22.5187385 Histoplasma capsul ag eia $15.7187389 Hiv-1 ag w/hiv-1 & hiv-2 ab $33.0387389 QW Hiv-1 ag w/hiv-1 & hiv-2 ab $33.0387390 Hiv-1 ag eia $24.2087391 Hiv-2 ag eia $24.2087400 Influenza a/b ag eia $15.7187420 Resp syncytial ag eia $15.7187425 Rotavirus ag eia $15.7187427 Shiga-like toxin ag eia $15.7187430 Strep a ag eia $15.7187449 Ag detect nos eia mult $15.7187449 QW Ag detect nos eia mult $15.7187450 Ag detect nos eia single $10.2787451 Ag detect polyval eia mult $10.2787470 Bartonella dna dir probe $27.0687471 Bartonella dna amp probe $48.1487472 Bartonella dna quant $58.7687475 Lyme dis dna dir probe $27.0687476 Lyme dis dna amp probe $48.1487477 Lyme dis dna quant $58.7687480 Candida dna dir probe $27.0687481 Candida dna amp probe $48.1487482 Candida dna quant $57.2887483 Cns dna amp probe type 12-25 $571.7287485 Chylmd pneum dna dir probe $27.0687486 Chylmd pneum dna amp probe $48.1487487 Chylmd pneum dna quant $58.7687490 Chylmd trach dna dir probe $27.0687491 Chylmd trach dna amp probe $48.1487492 Chylmd trach dna quant $47.9587493 C diff amplified probe $48.1487495 Cytomeg dna dir probe $27.06

2017





87496 Cytomeg dna amp probe $48.1487497 Cytomeg dna quant $58.7687498 Enterovirus probe&revrs trns $48.1487500 Vanomycin dna amp probe $48.1487501 Influenza dna amp prob 1+ $70.3987502 Influenza dna amp probe $116.7387502 QW Influenza dna amp probe $116.7387503 Influenza dna amp prob addl $28.4987505 Nfct agent detection gi $175.9887506 Iadna-dna/rna probe tq 6-11 $292.7787507 Iadna-dna/rna probe tq 12-25 $571.7287510 Gardner vag dna dir probe $27.0687511 Gardner vag dna amp probe $48.1487512 Gardner vag dna quant $57.2887515 Hepatitis b dna dir probe $27.0687516 Hepatitis b dna amp probe $48.1487517 Hepatitis b dna quant $58.7687520 Hepatitis c rna dir probe $27.0687521 Hepatitis c probe&rvrs trnsc $48.1487522 Hepatitis c revrs trnscrpj $58.7687525 Hepatitis g dna dir probe $27.0687526 Hepatitis g dna amp probe $48.1487527 Hepatitis g dna quant $57.2887528 Hsv dna dir probe $27.0687529 Hsv dna amp probe $48.1487530 Hsv dna quant $58.7687531 Hhv-6 dna dir probe $27.0687532 Hhv-6 dna amp probe $48.1487533 Hhv-6 dna quant $57.2887534 Hiv-1 dna dir probe $27.0687535 Hiv-1 probe&reverse trnscrpj $48.1487536 Hiv-1 quant&revrse trnscrpj $116.7387537 Hiv-2 dna dir probe $27.0687538 Hiv-2 probe&revrse trnscripj $48.1487539 Hiv-2 quant&revrse trnscripj $58.7687540 Legion pneumo dna dir prob $27.06

2017





87541 Legion pneumo dna amp prob $48.1487542 Legion pneumo dna quant $57.2887550 Mycobacteria dna dir probe $27.0687551 Mycobacteria dna amp probe $48.1487552 Mycobacteria dna quant $58.7687555 M.tuberculo dna dir probe $27.0687556 M.tuberculo dna amp probe $48.1487557 M.tuberculo dna quant $58.7687560 M.avium-intra dna dir prob $27.0687561 M.avium-intra dna amp prob $48.1487562 M.avium-intra dna quant $58.7687580 M.pneumon dna dir probe $27.0687581 M.pneumon dna amp probe $48.1487582 M.pneumon dna quant $57.2887590 N.gonorrhoeae dna dir prob $27.0687591 N.gonorrhoeae dna amp prob $48.1487592 N.gonorrhoeae dna quant $58.7687623 Hpv low-risk types $48.1487624 Hpv high-risk types $48.1487625 Hpv types 16 & 18 only $48.1487631 Resp virus 3-11 targets $175.9887631 QW Resp virus 3-5 targets $175.9887632 Resp virus 6-11 targets $292.7787633 Resp virus 12-25 targets $571.7287640 Staph a dna amp probe $48.1487641 Mr-staph dna amp probe $48.1487650 Strep a dna dir probe $27.0687650 QW Strep a dna dir probe $27.0687651 Strep a dna amp probe $48.1487651 QW Strep a dna amp probe $48.1487652 Strep a dna quant $57.2887653 Strep b dna amp probe $48.1487660 Trichomonas vagin dir probe $27.0687661 Trichomonas vaginalis amplif $48.1487797 Detect agent nos dna dir $27.0687798 Detect agent nos dna amp $48.14

2017





87799 Detect agent nos dna quant $58.7687800 Detect agnt mult dna direc $54.1087801 Detect agnt mult dna ampli $96.2987802 Strep b assay w/optic $15.7187803 Clostridium toxin a w/optic $15.7187804 Influenza assay w/optic $15.7187804 QW Influenza assay w/optic $15.7187806 Hiv antigen w/hiv antibodies $33.0387806 QW Hiv antigen w/hiv antibodies $33.0387807 Rsv assay w/optic $15.7187807 QW Rsv assay w/optic $15.7187808 Trichomonas assay w/optic $15.7187808 QW Trichomonas assay w/optic $15.7187809 Adenovirus assay w/optic $15.7187809 QW Adenovirus assay w/optic $15.7187810 Chylmd trach assay w/optic $15.7187850 N. gonorrhoeae assay w/optic $15.7187880 Strep a assay w/optic $15.7187880 QW Strep a assay w/optic $15.7187899 Agent nos assay w/optic $15.7187899 QW Agent nos assay w/optic $15.7187900 Phenotype infect agent drug $178.8087901 Genotype dna hiv reverse t $353.1587902 Genotype dna/rna hep c $353.1587903 Phenotype dna hiv w/culture $670.3187904 Phenotype dna hiv w/clt add $35.7687905 Sialidase enzyme assay $16.7687905 QW Sialidase enzyme assay $16.7687906 Genotype dna/rna hiv $176.5887910 Genotype cytomegalovirus $353.1587912 Genotype dna hepatitis b $353.1588130 Sex chromatin identification $20.6588140 Sex chromatin identification $10.9688142 Cytopath c/v thin layer $27.7988143 Cytopath c/v thin layer redo $27.7988147 Cytopath c/v automated $14.49

2017





88148 Cytopath c/v auto rescreen $14.4988150 Cytopath c/v manual $14.4988152 Cytopath c/v auto redo $14.4988153 Cytopath c/v redo $14.4988154 Cytopath c/v select $14.4988155 Cytopath c/v index add-on $8.2288164 Cytopath tbs c/v manual $14.4988165 Cytopath tbs c/v redo $14.4988166 Cytopath tbs c/v auto redo $14.4988167 Cytopath tbs c/v select $14.4988174 Cytopath c/v auto in fluid $29.3188175 Cytopath c/v auto fluid redo $35.2288230 Tissue culture lymphocyte $159.8088233 Tissue culture skin/biopsy $193.0488235 Tissue culture placenta $202.0188237 Tissue culture bone marrow $173.2688239 Tissue culture tumor $202.3688240 Cell cryopreserve/storage $13.8588241 Frozen cell preparation $13.8588245 Chromosome analysis 20-25 $186.7988248 Chromosome analysis 50-100 $237.5588249 Chromosome analysis 100 $237.5588261 Chromosome analysis 5 $242.4588262 Chromosome analysis 15-20 $170.9888263 Chromosome analysis 45 $206.1688264 Chromosome analysis 20-25 $170.9888267 Chromosome analys placenta $246.6188269 Chromosome analys amniotic $186.7988271 Cytogenetics dna probe $19.8688272 Cytogenetics 3-5 $36.7388273 Cytogenetics 10-30 $44.0788274 Cytogenetics 25-99 $47.7588275 Cytogenetics 100-300 $55.0988280 Chromosome karyotype study $34.4288283 Chromosome banding study $94.1088285 Chromosome count additional $26.06

2017





88289 Chromosome study additional $47.2388371 Protein western blot tissue $30.2788372 Protein analysis w/probe $31.2088720 Bilirubin total transcut $6.8888738 Hgb quant transcutaneous $6.8888740 Transcutaneous carboxyhb $6.8888741 Transcutaneous methb $6.8889050 Body fluid cell count $6.4889051 Body fluid cell count $7.5589055 Leukocyte assessment fecal $5.8689060 Exam synovial fluid crystals $9.8189125 Specimen fat stain $5.9389160 Exam feces for meat fibers $5.0689190 Nasal smear for eosinophils $6.5189300 Semen analysis w/huhner $12.1689300 QW Semen analysis w/huhner $12.2589310 Semen analysis w/count $11.7389320 Semen anal vol/count/mot $16.4189321 Semen anal sperm detection $16.4189321 QW Semen anal sperm detection $16.5389322 Semen anal strict criteria $21.1189325 Sperm antibody test $14.5489329 Sperm evaluation test $28.5689330 Evaluation cervical mucus $13.4889331 Retrograde ejaculation anal $26.69G0027 Semen analysis $8.92G0103 PSA screening $25.23G0123 Screen cerv/vag thin layer $27.79G0143 Scr c/v cyto,thinlayer,rescr $27.79G0144 Scr c/v cyto,thinlayer,rescr $29.31G0145 Scr c/v cyto,thinlayer,rescr $35.22G0147 Scr c/v cyto, automated sys $14.49G0148 Scr c/v cyto, autosys, rescr $14.49G0306 CBC/diffwbc w/o platelet $10.66G0307 CBC without platelet $8.87

2017





G0328 Fecal blood scrn immunoassay $21.82G0328 QW Fecal blood scrn immunoassay $21.82G0432 EIA HIV-1/HIV-2 screen $18.80G0433 ELISA HIV-1/HIV-2 screen $18.80G0433 QW ELISA HIV-1/HIV-2 screen $18.80G0435 Oral HIV-1/HIV-2 screen $15.71G0471 Ven blood coll SNF/HHA $5.00G0472 Hep c screen high risk/other $19.57G0472 QW Hep c screen high risk/other $19.57G0475 Hiv combination assay $33.03G0476 Hpv combo assay ca screen $48.14G0480 Drug test def 1-7 classes $117.65G0481 Drug test def 8-14 classes $160.99G0482 Drug test def 15-21 classes $204.34G0483 Drug test def 22+ classes $253.87G0659 Drug test def simple all cl $79.81G9143 Warfarin respon genetic test $165.59P2038 Blood mucoprotein $6.90P3000 Screen pap by tech w md supv $14.49P9612 Catheterize for urine spec $3.00P9615 Urine specimen collect mult $3.00Q0111 Wet mounts/ w preparations $4.92Q0112 Potassium hydroxide preps $5.86Q0113 Pinworm examinations $7.42Q0114 Fern test $9.81Q0115 Post-coital mucous exam $13.57

2017 clinical diagnostic laboratory fee...

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