Laboratory Fee Schedule Provider Specialty 069 Taxonomy ...€¦ · 2 days ago · 80048 basic metabolic panel $10.49 3/1/2020 80050 general health screen panel $11.83 $12.08 3/1/2020

PROCEDURE

CODE MODIFIER PROCEDURE DESCRIPTION FACILITY RATE

NON-FACILITY

RATE EFFECTIVE DATE

10035 PERQ DEV SOFT TISS 1ST IMAG $82.72 $486.42 3/1/2020

27438 ARTHROPLASTY PATELLA W/PROSTHESIS $654.02 $654.02 3/1/2020

36415 COLLECTION OF VENOUS BLOOD BY VENIPUNCTU $2.86 $2.86 3/1/2020

36456 PRTL EXCHANGE TRANSFUSE NB $101.61 $101.61 3/1/2020

72081 X-RAY EXAM ENTIRE SPI 1 VW $35.15 $35.15 3/1/2020

72081 26 X-RAY EXAM ENTIRE SPI 1 VW $12.61 $12.61 3/1/2020

72081 TC X-RAY EXAM ENTIRE SPI 1 VW $22.55 $22.55 3/1/2020

72082 X-RAY EXAM ENTIRE SPI 2/3 VW $56.29 $56.29 3/1/2020

72082 26 X-RAY EXAM ENTIRE SPI 2/3 VW $15.28 $15.28 3/1/2020

72082 TC X-RAY EXAM ENTIRE SPI 2/3 VW $41.01 $41.01 3/1/2020

72083 X-RAY EXAM ENTIRE SPI 4/5 VW $61.16 $61.16 3/1/2020

72083 26 X-RAY EXAM ENTIRE SPI 4/5 VW $16.64 $16.64 3/1/2020

72083 TC X-RAY EXAM ENTIRE SPI 4/5 VW $44.52 $44.52 3/1/2020

72084 X-RAY EXAM ENTIRE SPI 6/> VW $72.77 $72.77 3/1/2020

72084 26 X-RAY EXAM ENTIRE SPI 6/> VW $19.34 $19.34 3/1/2020

72084 TC X-RAY EXAM ENTIRE SPI 6/> VW $53.43 $53.43 3/1/2020

72275 EPIDUROGRAPHY, RADIOLOGICAL SUPERVISION $85.47 $85.47 3/1/2020

72275 26 EPIDUROGRAPHY, RADIOLOGICAL SUPERVISION $31.43 $31.43 3/1/2020

72275 TC EPIDUROGRAPHY, RADIOLOGICAL SUPERVISION $54.04 $54.04 3/1/2020

73501 X-RAY EXAM HIP UNI 1 VIEW $27.06 $27.06 3/1/2020

73501 26 X-RAY EXAM HIP UNI 1 VIEW $8.97 $8.97 3/1/2020

73501 TC X-RAY EXAM HIP UNI 1 VIEW $18.09 $18.09 3/1/2020

73502 X-RAY EXAM HIP UNI 2-3 VIEWS $37.35 $37.35 3/1/2020

73502 26 X-RAY EXAM HIP UNI 2-3 VIEWS $10.66 $10.66 3/1/2020

73502 TC X-RAY EXAM HIP UNI 2-3 VIEWS $26.69 $26.69 3/1/2020

73503 X-RAY EXAM HIP UNI 4/> VIEWS $46.64 $46.64 3/1/2020

73503 26 X-RAY EXAM HIP UNI 4/> VIEWS $13.59 $13.59 3/1/2020

73503 TC X-RAY EXAM HIP UNI 4/> VIEWS $33.05 $33.05 3/1/2020

73521 X-RAY EXAM HIPS BI 2 VIEWS $36.08 $36.08 3/1/2020

73521 26 X-RAY EXAM HIPS BI 2 VIEWS $10.98 $10.98 3/1/2020

73521 TC X-RAY EXAM HIPS BI 2 VIEWS $25.10 $25.10 3/1/2020

73551 X-RAY EXAM OF FEMUR 1 $25.11 $25.11 3/1/2020

73551 26 X-RAY EXAM OF FEMUR 1 $7.97 $7.97 3/1/2020

73551 TC X-RAY EXAM OF FEMUR 1 $17.14 $17.14 3/1/2020

73552 X-RAY EXAM OF FEMUR 2/> $29.30 $29.30 3/1/2020

73552 26 X-RAY EXAM OF FEMUR 2/> $8.97 $8.97 3/1/2020

73552 TC X-RAY EXAM OF FEMUR 2/> $20.32 $20.32 3/1/2020

76706 US ABDL AORTA SCREEN AAA $85.95 $85.95 3/1/2020

76706 26 US ABDL AORTA SCREEN AAA $26.31 $26.31 3/1/2020

76706 TC US ABDL AORTA SCREEN AAA $59.63 $59.63 3/1/2020

78265 GASTRIC EMPTYING IMAG STUDY $371.10 $371.10 3/1/2020

78265 26 GASTRIC EMPTYING IMAG STUDY $45.69 $45.69 3/1/2020

78265 TC GASTRIC EMPTYING IMAG STUDY $325.42 $325.42 3/1/2020

78266 GASTRIC EMPTYING IMAG STUDY $440.06 $440.06 3/1/2020

78266 26 GASTRIC EMPTYING IMAG STUDY $50.65 $50.65 3/1/2020

78266 TC GASTRIC EMPTYING IMAG STUDY $389.41 $389.41 3/1/2020

78267 UREA BREATH TEST, C-14 (ISOTOPIC); ACQUI $10.47 $10.47 3/1/2020

78268 UREA BREATH TEST, C-14; ANALYSIS $89.71 $89.71 3/1/2020

78456 ACUTE VENOUS THROMBOSIS IMAGING, PEPTIDE $280.97 $280.97 3/1/2020

78456 26 ACUTE VENOUS THROMBOSIS IMAGING, PEPTIDE $46.56 $46.56 3/1/2020

78456 TC ACUTE VENOUS THROMBOSIS IMAGING, PEPTIDE $234.41 $234.41 3/1/2020

80047 BASIC METABOLIC PANEL (CALCIUM, IONIZED) $10.43 $10.43 3/1/2020

80048 BASIC METABOLIC PANEL $10.49 $10.49 3/1/2020

80050 GENERAL HEALTH SCREEN PANEL $11.83 $12.08 3/1/2020

80051 ELECTROLYTE PANEL $9.02 $9.02 3/1/2020

80053 COMPREHENSIVE METABOLIC PANEL $11.06 $11.06 3/1/2020

80055 OBSTETRIC PANEL $29.51 $29.51 3/1/2020

80061 LIPID PROFILE $17.54 $17.54 3/1/2020

80069 RENAL FUNCTION PANEL $10.49 $10.49 3/1/2020

80074 ACUTE HEPATITIS PANEL $60.97 $60.97 3/1/2020

Coverage Policies on the NC Medicaid Web site.

Laboratory Fee Schedule

Provider Specialty 069

Taxonomy: 291U00000X

The inclusion of a rate on this table does not guarantee that a service is covered.

Please refer to the Medicaid Billing Guide and the Medicaid and Health Choice Clinical

80076 HEPATIC FUNCTION PANEL $10.49 $10.49 3/1/2020

80150 AMIKACIN $19.72 $19.72 3/1/2020

80155 DRUG ASSAY CAFFEINE $18.07 $18.07 3/1/2020

80156 CARBAMAZEPINE; TOTAL $19.05 $19.05 3/1/2020

80157 CARBAMAZEPINE; FREE $17.34 $17.34 3/1/2020

80158 DRUG ASSAY CYCLOSPORINE $23.63 $23.63 3/1/2020

80159 DRUG ASSAY CLOZAPINE $23.63 $23.63 3/1/2020

80162 ASSAY OF DIGOXIN TOTAL $17.37 $17.37 3/1/2020

80163 ASSAY OF DIGOXIN FREE $17.26 $17.26 3/1/2020

80164 ASSAY DIPROPYLACETIC ACD TOT $17.54 $17.54 3/1/2020

80165 DIPROPYLACETIC ACID FREE $17.41 $17.41 3/1/2020

80168 ETHOSUXIMIDE $21.38 $21.38 3/1/2020

80169 DRUG ASSAY EVEROLIMUS $17.54 $17.54 3/1/2020

80170 GENTAMICIN $4.53 $4.53 3/1/2020

80171 DRUG SCREEN QUANT GABAPENTIN $16.94 $16.94 3/1/2020

80173 HALOPERIDOL $19.05 $19.05 3/1/2020

80175 DRUG SCREEN QUAN LAMOTRIGINE $16.94 $16.94 3/1/2020

80176 LIDOCAINE $19.22 $19.22 3/1/2020

80177 DRUG SCRN QUAN LEVETIRACETAM $16.94 $16.94 3/1/2020

80178 LITHIUM $8.65 $8.65 3/1/2020

80180 DRUG SCRN QUAN MYCOPHENOLATE $23.07 $23.07 3/1/2020

80183 DRUG SCRN QUANT OXCARBAZEPIN $16.94 $16.94 3/1/2020

80184 PHENOBARBITAL $14.99 $14.99 3/1/2020

80185 PHENTOIN: TOTAL $17.34 $17.34 3/1/2020

80186 PHENTOIN; FREE $18.01 $18.01 3/1/2020

80188 PRIMIDONE $21.32 $21.32 3/1/2020

80190 PROCAINAMIDE $21.91 $21.91 3/1/2020

80192 PROCAINAMIDE: WITH ANTIBODIES $21.91 $21.91 3/1/2020

80194 QUINIDINE $19.09 $19.09 3/1/2020

80195 SIROLIMUS $17.94 $17.94 3/1/2020

80197 TACROLIMUS $17.94 $17.94 3/1/2020

80198 THEOPHYLLINE $18.51 $18.51 3/1/2020

80199 DRUG SCREEN QUANT TIAGABINE $23.07 $23.07 3/1/2020

80200 TOBRAMYCIN $21.08 $21.08 3/1/2020

80201 TOPIRAMATE $15.60 $15.60 3/1/2020

80202 VANCOMYCIN $17.54 $17.54 3/1/2020

80203 DRUG SCREEN QUANT ZONISAMIDE $16.94 $16.94 3/1/2020

80299 QUANTITATIVE ASSAY DRUG $17.91 $17.91 3/1/2020

80305 DRUG TEST PRSMV DIR OPT OBS $14.29 $14.29 3/1/2020

80306 DRUG TEST PRSMV INSTRMNT $19.44 $19.44 3/1/2020

80307 DRUG TEST PRSMV CHEM ANLYZR $76.26 $76.26 3/1/2020

80400 ACTH STIMULATION PANEL; $42.66 $42.66 3/1/2020



80408 ALDOSTERONE SUPPRESSION EVALUATION PANEL $164.19 $164.19 3/1/2020

80410 CALCITONIN STIMULATION PANEL (EG, CALCIU $105.09 $105.09 3/1/2020

80412 CORTICOTROPIC RELEASING HORMONE (CRH) ST $431.21 $431.21 3/1/2020

80418 COMBINED RAPID ANTERIOR PITUITARY EVALUA $755.62 $755.62 3/1/2020

80420 DEXAMETHASONE SUPPRESSION PANEL, 48 HOUR $94.24 $94.24 3/1/2020

80422 GLUCAGON TOLERANCE PANEL; $60.29 $60.29 3/1/2020

80424 GLUCAGON TOLERANCE PANEL; $66.08 $66.08 3/1/2020

80428 GROWTH HORMONE STIMULATION PANEL (EG, AR $87.23 $87.23 3/1/2020

80430 GROWTH HORMONE SUPPRESSION PANEL (GLUCOS $102.64 $102.64 3/1/2020

80432 INSULIN-INDUCED C-PEPTIDE SUPPRESSION PA $144.56 $144.56 3/1/2020

80434 INSULIN TOLERANCE PANEL; $132.31 $132.31 3/1/2020

80435 INSULIN TOLERANCE PANEL; $134.69 $134.69 3/1/2020

80436 METYRAPONE PANEL $119.26 $119.26 3/1/2020

80438 THYROTROPIN RELEASING HORMONE (TRH) STIM $63.97 $63.97 3/1/2020

80439 THYROTROPIN RELEASING HORMONE (TRH) STIM $85.28 $85.28 3/1/2020

80500 CLINICAL PATHOLOGY CONSULTATION; LIMITED $15.65 $17.72 3/1/2020

80502 CLINICAL PATHOLOGY CONSULTATION; COMPREH $54.46 $55.65 3/1/2020

80502 26 CLINICAL PATHOLOGY CONSULTATION; COMPREH $41.58 $42.34 3/1/2020

81000 URINALYSIS, BY DIP STICK OR TABLET REAGE $4.15 $4.15 3/1/2020

81001 URINALYSIS, BY DIP STICK OR TABLET REAGE $4.15 $4.15 3/1/2020

81002 URINALYSIS ROUTINE WITHOUT MICROSCOPY $3.35 $3.35 3/1/2020

81003 UA, BY DIP STICK OR TABLET; AUTOMATED, W $2.94 $2.94 3/1/2020

81005 URINE TESTS $2.84 $2.84 3/1/2020

81007 URINALYSIS; BACTERIURIA SCREEN, EXCEPT B $3.36 $3.36 3/1/2020

81015 MICROSCOPIC URINE EXAM $3.97 $3.97 3/1/2020

81020 URINALYSIS ROUTINE 2 OR 3 GLASS TEST $4.83 $4.83 3/1/2020

81025 UA PREG. TEST - COLOR COMPARISON METHOD $8.27 $8.27 3/1/2020

81050 VOLUME MEASUREMENT FOR TIMED COLLECTION, $3.92 $3.92 3/1/2020

81161 DMD (DYSTROPHY) $134.84 $134.84 3/1/2020

81240 F2 (PROTHROMBIN, COAGULATION FACTOR II) $64.05 $64.05 3/1/2020

81241 F5 (COAGULATION FACTOR V) (EG, HEREDITAR $79.54 $79.54 3/1/2020

81256 HFE (HEMOCHROMATOSIS) (EG, HEREDITARY HE $85.08 $85.08 3/1/2020

81220

cftr (cystic fibrosis transmembrane conductance

regulator) (eg, cystic $531.84 $531.84 3/1/2020

81221



81222



81223



81228

cytogenomic constitutional (genome-wide) microarray

analysis; interrogation of $859.95 $859.95 3/1/2020

81229

cytogenomic constitutional (genome-wide) microarray

analysis; interrogation of $1,108.38 $1,108.38 3/1/2020

81243

fmr1 (fragile x mental retardation 1) (eg, fragile x

mental retardation) gene $54.51 $54.51 3/1/2020

81244

fmr1 (fragile x mental retardation 1) (eg, fragile x

mental retardation) gene $42.89 $42.89 3/1/2020

81331

snrpn/ube3a (small nuclear ribonucleoprotein

polypeptide n and ubiquitin $48.79 $48.79 3/1/2020

81420 Fetal chrmoml aneuploidy $725.28 $725.28 3/1/2020

81507 dna analysis using maternal plasma $759.62 $759.62 3/1/2020

81519 ONCOLOGY BREAST MRNA $3,524.43 $3,524.43 9/1/2020

81522 ONC BREAST MRNA 12 GENES $3,524.43 $3,524.43 9/1/2020

81528 Oncology Colorectal Scr $486.22 $486.22 3/1/2020

82009 ANALYSIS FOR ACETONE OR KETONE BODIES TO $5.91 $5.91 3/1/2020

82010 ACETONE OR KETONE BODIES LEVEL $10.69 $10.69 3/1/2020

82013 ACETYLCHOLINESTERASE $14.63 $14.63 3/1/2020

82016 ACYLCARNITINES; QUALITATIVE, EACH SPECIM $18.14 $18.14 3/1/2020

82017 ACYLCARNITINES; QUANTITATIVE, EACH SPECI $22.07 $22.07 3/1/2020

82024 ACTH $50.54 $50.54 3/1/2020

82030 ADENOSINE;5'MONOPHOSPHATE,CYCLIC (CYCLIC $33.76 $33.76 3/1/2020

82040 ALBUMIN; SERUM, PLASMA OR WHOLE BLOOD $6.48 $6.48 3/1/2020

82042 ALBUMIN; URINE OR OTHER SOURCE, QUANTITA $6.77 $6.77 3/1/2020

82043 ALBUMIN; URINE, MICR, QUANTITATIVE $7.57 $7.57 3/1/2020

82044 ALBUMIN; URINE, MICRO, SEMIQUANTITATIVE $3.75 $3.75 3/1/2020

82045 ALBUMIN; ISCHEMIA MODIFIED $44.42 $44.42 3/1/2020

82075 ALCOHOL BREATH $15.76 $15.76 3/1/2020

82085 ALDOLASE $12.69 $12.69 3/1/2020

82088 ALDOSTERONE $53.32 $53.32 3/1/2020

82103 ALPHA-1-ANTITRYPSIN; TOTAL $17.58 $17.58 3/1/2020

82104 ALPHA-1-ANTITRYPSIN; PHENOTYPE $18.91 $18.91 3/1/2020

82105 ALPHA-FETOPROTEIN SERUM $21.95 $21.95 3/1/2020

82106 ALPHA-FETOPROTEIN; AMNIOTIC FLUID $21.95 $21.95 3/1/2020

82107 ALPHA-FETOPROTEIN (AFP); AFP-L3 FRACTION $84.26 $84.26 3/1/2020

82108 ALUMINUM $33.34 $33.34 3/1/2020

82120 AMINES, VAGINAL FLUID, QUALITATIVE $4.91 $4.91 3/1/2020

82127 AMINO ACIDS; SINGLE, QUALITATIVE, EACH S $18.14 $18.14 3/1/2020

82128 AMINO ACIDS; MULTIPLE, QUALITATIVE, EACH $18.14 $18.14 3/1/2020

82131 AMINO ACIDS; SINGLE, QUANTITATIVE, EACH $22.07 $22.07 3/1/2020

82135 AMINOLEVULINIC ACID DELTA $21.54 $21.54 3/1/2020

82136 AMINO ACIDS, 2 TO 5 AMINO ACIDS, QUANTIT $22.07 $22.07 3/1/2020

82139 AMINO ACIDS, 6 OR MORE AMINO ACIDS, QUAN $22.07 $22.07 3/1/2020

82140 AMMONIA $19.07 $19.07 3/1/2020

82143 AMNIOTIC FLUID SCAN $9.01 $9.01 3/1/2020

82150 AMYLASE $8.48 $8.48 3/1/2020

82154 ANDROSTANEDIOL GLUCURONIDE $37.73 $37.73 3/1/2020

82157 ANDROSTENEDIONE $38.30 $38.30 3/1/2020

82160 ANDROSTERONE $32.72 $32.72 3/1/2020

82163 ANGIOTENSIN II $26.86 $26.86 3/1/2020

82164 ANGIOTENSIN I (ACE) $19.09 $19.09 3/1/2020

82172 APOLIPOPROTEIN, EACH $20.28 $20.28 3/1/2020

82175 ARSENIC $24.82 $24.82 3/1/2020

82180 ASCORBIC ACID $12.94 $12.94 3/1/2020

82190 ATOMIC ABSORPTION SPECTROSCOPY, EACH $19.51 $19.51 3/1/2020

82232 BETA-2 MICROGLOBULIN $21.18 $21.18 3/1/2020

82239 BILE ACIDS; TOTAL $21.32 $21.32 3/1/2020

82240 BILE ACIDS; CHOLYLGLYCINE $21.32 $21.32 3/1/2020

82247 BILIRUBIN; TOTAL $6.57 $6.57 3/1/2020

82248 BILIRUBIN; DIRECT $6.57 $6.57 3/1/2020

82252 BILIRUBIN FECES QUALITATIVE $5.94 $5.94 3/1/2020

82261 BIOTINIDASE, EACH SPECIMEN $22.07 $22.07 3/1/2020

82270 BLOOD, OCCULT, BY PEROXIDASE ACTIVITY (E $4.25 $4.25 3/1/2020



82274 BLOOD, OCCULT, BY FECAL HEMOGLOBIN DETER $20.81 $20.81 3/1/2020

82286 BRADYKININ $9.01 $9.01 3/1/2020

82300 CADMIUM $30.27 $30.27 3/1/2020

82306 CALCIFEDIOL (25-OH VITAMIN D-3) $38.73 $38.73 3/1/2020

82308 CALCITONIN $35.03 $35.03 3/1/2020

82310 CALCIUM; TOTAL $6.74 $6.74 3/1/2020

82330 CALCIUM; IONIZED $17.87 $17.87 3/1/2020

82331 CALCIUM AFTER CALCIUM INFUSION TEST $6.77 $6.77 3/1/2020

82340 CALCIUM URINE QUANTITATIVE TIMED SPECIME $6.81 $6.81 3/1/2020

82355 CALCULUS; QUALITATIVE ANALYSIS $15.14 $15.14 3/1/2020

82360 CALCULUS QUANTITATIVE CHEMICAL $16.84 $16.84 3/1/2020

82365 CALCULUS QUANTITATIVE INFRARED SPECTROSC $16.86 $16.86 3/1/2020

82370 CALCULUS QUANTITATIVE X-RAY DEFRACTION $16.39 $16.39 3/1/2020

82373 CARBOHYDRATE DEFICIENT TRANSFERRIN $23.63 $23.63 3/1/2020

82374 CARBON DIOXIDE $6.41 $6.41 3/1/2020

82375 LABORATORY SERVICES,ANALYSIS $14.48 $14.48 3/1/2020

82376 CARBON DIOX COMB PARCARB MUNO QUALITATI $7.84 $7.84 3/1/2020

82378 CARCINOEMBRYONIC ANTIGEN (CEA) $24.82 $24.82 3/1/2020

82379 CARNITINE (TOTAL AND FREE), QUANTITATIVE $22.07 $22.07 3/1/2020

82380 CAROTENE $12.08 $12.08 3/1/2020

82382 CATECHOLAMINES; TOTAL URINE $22.49 $22.49 3/1/2020

82383 CATECHOLAMINES BLOOD $32.78 $32.78 3/1/2020

82384 CATECHOLAMINES FRACTIONATED $33.03 $33.03 3/1/2020

82387 CATHEPSIN-D $18.14 $18.14 3/1/2020

82390 CERULOPLASMIN $14.06 $14.06 3/1/2020

82397 CHEMILUMINESCENT ASSAY $18.14 $18.14 3/1/2020

82415 CHLORAMPHENICOL $16.58 $16.58 3/1/2020

82435 CHLORIDE, SERUM $6.01 $6.01 3/1/2020

82436 CHLORIDE, URINE $6.57 $6.57 3/1/2020

82438 CHLORIDE; OTHER SOURCE $6.41 $6.41 3/1/2020

82441 CHLORINATRD HYDROCARBONNS SCREEN $7.85 $7.85 3/1/2020

82465 CHOLESTEROL, SERUM OR WHOLE BLOOD, TOTAL $5.69 $5.69 3/1/2020

82480 CHOLINESTERASE $7.52 $7.52 3/1/2020

82482 CHOLINESTERASE $6.02 $6.02 3/1/2020

82485 CHONDRUITINE B SULFATE QUANTITATIVE $27.02 $27.02 3/1/2020

82495 CHROMIUM $26.53 $26.53 3/1/2020

82507 CITRIC ACID $36.37 $36.37 3/1/2020

82523 COLLAGEN CROSS LINKS, ANY METHOD $19.18 $19.18 3/1/2020

82525 COPPER $16.23 $16.23 3/1/2020

82528 CORTICOSTERONE $29.45 $29.45 3/1/2020

82530 CORTISOL; FREE $21.87 $21.87 3/1/2020

82533 CORTISOL; TOTAL $21.34 $21.34 3/1/2020

82540 CREATINE $6.07 $6.07 3/1/2020

82542 COL CHROMOTOGRAPHY QUAL/QUAN $23.63 $23.63 3/1/2020

82550 CREATINE KINASE (CK), (CPK); TOTAL $8.52 $8.52 3/1/2020

82552 CPK ISOENZYME (QUALITATIVE) $17.52 $17.52 3/1/2020

82553 CPK; MB FRACTION ONLY $15.11 $15.11 3/1/2020

82554 CPK; ISOFORMS $15.53 $15.53 3/1/2020

82565 CREATININE; BLOOD $6.71 $6.71 3/1/2020

82570 CREATININE; OTHER SOURCE $6.77 $6.77 3/1/2020

82575 CREATININE CLEARANCE $12.36 $12.36 3/1/2020

82585 CRYOFIBRINOGEN $11.21 $11.21 3/1/2020

82595 CRYOGLOBULIN, QUALITATIVE OR SEMI-QUANTI $8.47 $8.47 3/1/2020

82600 CYANIDE $25.39 $25.39 3/1/2020

82607 CYANOCOBALAMIN (VITAMIN B-12) $19.72 $19.72 3/1/2020

82608 CYANOCOBALAMIN UNSATURATED BINDING CAPAC $18.74 $18.74 3/1/2020

82610 CYSTATIN C $17.79 $17.79 3/1/2020

82615 CYSTINE $10.68 $10.68 3/1/2020

82626 DEHYDROEPIANDROSTERONE (DHEA) $33.06 $33.06 3/1/2020

82627 DHEA-S $29.09 $29.09 3/1/2020

82633 DEOXYCORTICOSTERONE $40.52 $40.52 3/1/2020

82634 DEOXYCORTISOL, 11- $38.30 $38.30 3/1/2020

82638 DIBUCAINE NUMBER $16.02 $16.02 3/1/2020

82652 DIHYDROXYVITAMIN D $50.36 $50.36 3/1/2020

82656 ELASTASE, PANCREATIC (EL-1), FECAL, QUAL $14.99 $14.99 3/1/2020

82657 ENZYME ACTIVITY IN BLOOD CELLS, CULTURED $23.63 $23.63 3/1/2020

82658 ENZYME ACTIVITY IN BLOOD CELLS, CULTURED $23.63 $23.63 3/1/2020

82664 ELECTROPHORETIC TECH $44.95 $44.95 3/1/2020

82668 ERYTHROPOIETIN $24.59 $24.59 3/1/2020

82670 ESTRADIOL $31.15 $31.15 3/1/2020

82671 ESTROGENS FRACTIONATED BLOOD $42.26 $42.26 3/1/2020

82672 ESTROGENS TOTAL BLOOD $28.37 $28.37 3/1/2020

82677 ESTRIOL $31.65 $31.65 3/1/2020

82679 ESTRONE $32.67 $32.67 3/1/2020

82693 ETHYLENE GLYCOL $18.15 $18.15 3/1/2020

82696 ETIOCHOLANOLONE $30.85 $30.85 3/1/2020

82705 FECAL FAT SCREEN $6.66 $6.66 3/1/2020

82710 FAT OR LIPIDS, FECES; QUANTITATIVE $21.98 $21.98 3/1/2020

82715 FECAL FAT $22.52 $22.52 3/1/2020

82725 FATTY ACIDS, NONESTERIFIED $17.42 $17.42 3/1/2020

82726 VERY LONG CHAIN FATTY ACIDS $23.63 $23.63 3/1/2020

82728 FERRITIN SPECIFY METHOD $17.82 $17.82 3/1/2020

82731 FETAL FIBRONECTIN, CERVICOVAGINAL SECRET $84.26 $84.26 3/1/2020

82735 FLUORIDE $24.27 $24.27 3/1/2020

82746 FOLIC ACID $19.24 $19.24 3/1/2020

82747 FOLIC ACID; RBC $19.72 $19.72 3/1/2020

82757 FRUCTOSE SEMEN $22.70 $22.70 3/1/2020

82759 GALACTORINASE RBC $28.10 $28.10 3/1/2020

82760 GALACTOSE $14.65 $14.65 3/1/2020

82775 GALACTOSE-1-PHOSDHATE URIDYL TRANSFERASE $27.55 $27.55 3/1/2020

82776 GALACTOSE 1 PHOSPHATE URIDYL TRANSFERASE $10.97 $10.97 3/1/2020

82784 GAMMA GLOBULIN $12.16 $12.16 3/1/2020

82785 GAMMAGLOBULIN; IGE $21.55 $21.55 3/1/2020

82787 GAMMAGLOBULIN; IMMUNOGLOBULIN SUBCLASSES $10.49 $10.49 3/1/2020

82800 OXYGEN SATURATION PH ONLY $8.40 $8.40 3/1/2020

82803 GASES, BLOOD, ANY COMBINATION OF PH, PCO $25.33 $25.33 3/1/2020

82805 GASES, BLOOD, ANY COMBINATION OF PH, PCO $37.13 $37.13 3/1/2020

82810 GASES, BLOOD, O2 SATURATION ONLY, BY DIR $11.42 $11.42 3/1/2020

82820 HEMOGLOBIN - OXYGEN AFFINITY $13.07 $13.07 3/1/2020

82930 GASTRIC ACID ANALYSIS, INCLUDES PH IF PE $7.18 $7.18 3/1/2020

82938 GASTRIN AFTER SECRETIN STIMULATION $23.15 $23.15 3/1/2020

82941 GASTRIN $23.07 $23.07 3/1/2020

82943 GLUCAGON $18.70 $18.70 3/1/2020

82945 GLUCOSE, BODY FLUID, OTHER THAN BLOOD $5.13 $5.13 3/1/2020

82946 GLUCAGON TOLERANCE TEST $19.72 $19.72 3/1/2020

82947 GLUCOSE; QUANTITATIVE, BLOOD (EXCEPT REA $5.13 $5.13 3/1/2020

82948 GLUCOSE BLOOD STICK TEST $4.15 $4.15 3/1/2020

82950 GLUCOSE POST GLUCOSE DOSE $6.22 $6.22 3/1/2020

82951 GLUCOSE TOLERANCE $16.84 $16.84 3/1/2020

82952 GLUCOSE TOLERANCE TEST EACH ASSIT BEYOND $5.13 $5.13 3/1/2020

82955 GLUCOSE 6 PHOSPHATE DEHYDROGENASE $6.09 $6.09 3/1/2020

82960 GLUCOSE 6 PHOSPHATE DEHYDROGENASE SCREEN $7.94 $7.94 3/1/2020

82962 BLOOD GLUCOSE BY MONITORING DEVICE $3.07 $3.07 3/1/2020

82963 GLUCOSIDASE BETA $28.10 $28.10 3/1/2020

82965 GLUTAMATE DEHYDROGENASE $10.11 $10.11 3/1/2020

82977 G G T $9.42 $9.42 3/1/2020

82978 GLUTATIONE LEVEL AND STABILITY $18.65 $18.65 3/1/2020

82979 GLUTATHIONE REDUCTASE RBC $9.01 $9.01 3/1/2020

82985 GLYCATED PROTEIN $19.72 $19.72 3/1/2020

83001 GONADOTROPIN; FOLLICLE STIMULATING HORMO $24.32 $24.32 3/1/2020

83002 LUTEINIZING HORMONE (LH) $24.23 $24.23 3/1/2020

83003 GROWTH STIMULATING HORMONE $21.81 $21.81 3/1/2020

83009 HELICOBACTER PYLORI, BLOOD TEST ANALYSIS $88.13 $88.13 3/1/2020

83010 HAPTOGLOBIN $16.46 $16.46 3/1/2020

83012 HAPTOGLOBIN PHENOTYPES ELECTROPHORESIS $22.49 $22.49 3/1/2020

83013 HELICOBACTER PYLORI; BREATH TEST ANALYSI $88.13 $88.13 3/1/2020

83014 HELICOBACTER PYLORI; DRUG ADMINISTRATION $10.28 $10.28 3/1/2020

83015 HEAVY METAL QUAL ANY ANAL $24.63 $24.63 3/1/2020

83018 HEAVY METAL QUANT EACH NES $28.73 $28.73 3/1/2020

83020 HEMOGLOBIN FRACTIONATION AND QUANTITATIO $16.44 $16.44 3/1/2020

83020 26 HEMOGLOBIN FRACTIONATION AND QUANTITATIO $15.93 $15.93 3/1/2020

83021 HEMOGLOBIN FRACTIONATION AND QUANTITATIO $23.63 $23.63 3/1/2020

83026 HEMOGLOBIN; BY COPPER SULFATE METHOD $3.09 $3.09 3/1/2020

83030 HEMOGLOBIN F(FETAL) CHEMICAL $10.83 $10.83 3/1/2020

83033 HEMOGLOBIN; F (FETAL), QUALITATIVE $7.80 $7.80 3/1/2020

83036 HEMOGLOBIN; GLYCOSYLATED (A1C) $12.69 $12.69 3/1/2020

83045 METHEMOGLOBIN $6.49 $6.49 3/1/2020

83050 METHEMOGLOBIN QUANTITATIVE $9.58 $9.58 3/1/2020

83051 METHEMOGLOBIN PLASMA $9.56 $9.56 3/1/2020

83060 SULFHEMOGLOBIN QUANTITATIVE $10.83 $10.83 3/1/2020

83065 HEMOGLOBIN THERMOLABILE $9.01 $9.01 3/1/2020

83068 HEMOGLOBIN UNSTABLESCREEN $3.77 $3.77 3/1/2020

83069 HEMOGLOBIN URINE $5.16 $5.16 3/1/2020

83070 HEMOSIDERIN $0.72 $0.72 3/1/2020

83080 B-HEXOSAMINIDASE, EACH ASSAY $22.07 $22.07 3/1/2020

83088 HISTAMINE $38.64 $38.64 3/1/2020

83090 HOMOCYSTINE $22.07 $22.07 3/1/2020

83150 HOMOVANILLIC ACID (HVA) $25.33 $25.33 3/1/2020

83491 HYDROXYCORTICOSTEROIDS, 17- (17-OHCS) $22.91 $22.91 3/1/2020

83497 5 HIAA QUALITATIVE $16.86 $16.86 3/1/2020

83498 HYDROXYPROGESTERONE, 17-D $35.53 $35.53 3/1/2020

83500 HYDROXYPROLINE FREE $29.63 $29.63 3/1/2020

83505 HYDROXYPROLINE TOTAL $31.79 $31.79 3/1/2020

83516 IMMUNOASSAY FOR ANALYTE OTHER THAN INFEC $14.99 $14.99 3/1/2020

83518 IMMUNOASSAY FOR ANALYTE OTHER THAN ANTIB $10.01 $10.01 3/1/2020

83519 IMMUNOASSAY, ANALYTE, QUANTITATIVE; BY R $17.68 $17.68 3/1/2020

83520 IMMUNOASSAY ANALYTE; NOT OTHERWISE SPECI $16.94 $16.94 3/1/2020

83525 INSULIN; TOTAL $14.96 $14.96 3/1/2020

83527 INSULIN; $16.56 $16.56 3/1/2020

83528 INTRINSCIC FACTOR LEVEL $20.81 $20.81 3/1/2020

83540 IRON $8.48 $8.48 3/1/2020

83550 IBC $11.43 $11.43 3/1/2020

83570 IDH $11.58 $11.58 3/1/2020

83582 KETOGENIC STEROIDS; FRACTIONATION $18.54 $18.54 3/1/2020

83586 KETOSTEROIDS, 17- (17-KS); TOTAL $16.75 $16.75 3/1/2020

83593 KETOSTEROIDS, 17- (17-KS); FRACTIONATION $34.41 $34.41 3/1/2020

83605 LACTATES $13.98 $13.98 3/1/2020

83615 LACTATE DEHYDROGENASE (LD), (LDH) $7.91 $7.91 3/1/2020

83625 LDH ISOENZYMES $12.17 $12.17 3/1/2020

83630 LACTOFERRIN, FECAL; QUALITATIVE $26.84 $26.84 3/1/2020

83632 LACTOGEN, HUMAN PLACENTAL (HPL) $26.45 $26.45 3/1/2020

83633 LACTOSE URINE QUALITAITIVE $7.20 $7.20 3/1/2020

83655 LEAD $15.83 $15.83 3/1/2020

83661 FETAL LUNG MATURITY ASSESSMENT; LECITHIN $28.76 $28.76 3/1/2020

83662 L/S RATIO $24.75 $24.75 3/1/2020

83663 FETAL LUNG MATURITY ASSESSMENT; FLUORESC $24.75 $24.75 3/1/2020

83664 FETAL LUNG MATURITY ASSESSMENT; LAMELLAR $24.75 $24.75 3/1/2020

83670 LEUCINE AMINOPEPTIDASE (LAP) $11.99 $11.99 3/1/2020

83690 LIPASE $9.01 $9.01 3/1/2020

83695 LIPOPROTEIN (A) $16.94 $16.94 3/1/2020

83700 LIPOPROTEIN, BLOOD; ELECTROPHORETIC SEPA $14.72 $14.72 3/1/2020

83701 LIPOPROTEIN, BLOOD; HIGH RESOLUTION FRAC $32.48 $32.48 3/1/2020

83704 LIPOPROTEIN BLD QUAN PART $36.41 $36.41 3/1/2020

83718 LIPOPROTEIN, DIRECT MEASUREMENT; (HDL CH $10.71 $10.71 3/1/2020

83719 LIPOPROTEIN, DIRECT MEASUREMENT; DIRECT $15.23 $15.23 3/1/2020

83721 LIPOPROTEIN, DIRECT MEASUREMENT; LDL CHO $12.48 $12.48 3/1/2020

83727 LUTEINIZING RELEASING FACTOR (LRH) $22.49 $22.49 3/1/2020

83735 MAGNESIUM $8.77 $8.77 3/1/2020

83775 MALATE DEHYDROGENASE $9.64 $9.64 3/1/2020

83785 MANGANESE BLOOD OR URINE $32.17 $32.17 3/1/2020

83789 MASS SPECTROMETRY QUAL/QUAN $23.63 $23.63 3/1/2020

83825 MERCURY, QUANTITATIVE $21.28 $21.28 3/1/2020

83835 METHANEPHRINES $22.17 $22.17 3/1/2020

83857 METHEMALBUMIN $14.06 $14.06 3/1/2020

83861 MICROFLUIDIC ANALYSIS UTILIZING AN INTEG $21.62 $21.62 3/1/2020

83864 MUCOPOLYSACCHARIDES, ACID; QUANTITATIVE $26.05 $26.05 3/1/2020

83872 MUCIN SYNOVIAL FLUID $7.67 $7.67 3/1/2020

83873 MYELIN BASIC PROTEIN, CEREBROSPINAL FLUI $22.51 $22.51 3/1/2020

83874 MYOGLOBIN $16.89 $16.89 3/1/2020

83876 MYELOPEROXIDASE (MPO) $17.71 $17.71 3/1/2020

83880 NATRIURETIC PEPTIDE $44.42 $44.42 3/1/2020

83883 NEPHELOMETRY, EACH ANALYTE $17.79 $17.79 3/1/2020

83885 NICKEL $32.06 $32.06 3/1/2020

83915 5 NUCLEOTIDASE $14.60 $14.60 3/1/2020

83916 OLIGOCLONAL IMMUNE (OLIGOCLONAL BANDS) $26.30 $26.30 3/1/2020

83918 ORGANIC ACIDS; TOTAL, QUANTITATIVE, EACH $21.54 $21.54 3/1/2020

83919 ORGANIC ACIDS; QUALITATIVE, EACH SPECIME $21.54 $21.54 3/1/2020

83921 ORGANIC ACID, SINGLE, QUANTITATIVE $21.54 $21.54 3/1/2020

83930 OSMOLALITY BLOOD $8.65 $8.65 3/1/2020

83935 OSMOLALITY $8.91 $8.91 3/1/2020

83937 OSTEOCALCIN (BONE G1A PROTEIN) $37.25 $37.25 3/1/2020

83945 OXALATE $16.84 $16.84 3/1/2020

83950 ONCOPROTEIN, HER-2/NEU $84.26 $84.26 3/1/2020

83951 ONCOPROTEIN; DES-GAMMA-CARBOXY-PROTHROMB $88.06 $88.06 3/1/2020

83970 PARATHORMONE $54.00 $54.00 3/1/2020

83986 PH BODY FLUID EXCEPT BLOOD $4.68 $4.68 3/1/2020

83993 CALPROTECTIN, FECAL $25.67 $25.67 3/1/2020

84030 PHENYLALANINE (PKU), BLOOD $7.20 $7.20 3/1/2020

84035 PHENYLKETONES, QUALITATIVE $4.79 $4.79 3/1/2020

84060 PHOSPHATASE ACID $9.66 $9.66 3/1/2020

84066 PHOSPHATASE ACID; PROSTATIC $12.64 $12.64 3/1/2020

84075 PHOSPHATASE ALKALINE $6.77 $6.77 3/1/2020

84078 PHOSPHATASE ALKALINE BLOOD HEAT STABLE $9.54 $9.54 3/1/2020

84080 ALKALINE PHOSPHATASE ISOENZYME $19.34 $19.34 3/1/2020

84081 PHOSPHATYDYLGLYCEROL $21.62 $21.62 3/1/2020

84085 PHOSPHOGLUCONAT6 6-DEHYDROGENASE RBC $8.82 $8.82 3/1/2020

84087 PHOSPHOHEXOSE ISOMERASE $13.50 $13.50 3/1/2020

84100 PHOSPHORUS INORGANIC (PHOSPHATE) $6.21 $6.21 3/1/2020

84105 PHOSPHORUS (PHOSPHATE) URINE $6.77 $6.77 3/1/2020

84106 PORPHOBILINOGEN $5.61 $5.61 3/1/2020

84110 PORPHOBILINOGEN URINE QUANTITATIVE $11.06 $11.06 3/1/2020

84112 PLACENTAL ALPHA MICROGLOBULIN-1 (PAMG-1) $84.87 $84.87 3/1/2020

84119 PORPHYRINS QUALITATIVE $11.27 $11.27 3/1/2020

84120 PORPHYRINS, URINE; QUANTITATION AND FRAC $19.25 $19.25 3/1/2020

84126 PROPHYRINS FECES QUANITATIVE $33.33 $33.33 3/1/2020

84132 POTASSIUM SERUM $6.01 $6.01 3/1/2020

84133 POTASSIUM URINE $5.63 $5.63 3/1/2020

84134 PREALBUMIN $19.09 $19.09 3/1/2020

84135 PREGNANEDIOL $25.02 $25.02 3/1/2020

84138 PREGNANETRIOL $24.78 $24.78 3/1/2020

84140 PREGNENOLONE $26.19 $26.19 3/1/2020

84143 17-HYDROXYPREGNENOLONE $29.86 $29.86 3/1/2020

84144 PROGESTERONE $27.30 $27.30 3/1/2020

84145 PROCALCITONIN (PCT) $25.99 $25.99 3/1/2020

84146 PROLACTIN $25.36 $25.36 3/1/2020

84150 PROSTAGLANDIN, EACH $32.67 $32.67 3/1/2020

84152 PROSTATE SPECIFIC ANTIGEN (PSA); COMPLEX $24.07 $24.07 3/1/2020

84153 PROSTATE SPECIFIC ANTIGEN (PSA); TOTAL $24.07 $24.07 3/1/2020

84154 PROSTATE SPECIFIC ANTIGEN (PSA); FREE $24.07 $24.07 3/1/2020

84155 PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; $4.80 $4.80 3/1/2020



84160 PROTEIN, TOTAL, BY REFRACTOMETRY, ANY SO $6.77 $6.77 3/1/2020

84163 PREGNANCY-ASSOCIATED PLASMA PROTEIN-A (P $11.45 $11.45 3/1/2020

84165 PROTEIN; ELECTROPHORETIC FRACTIONATION A $14.00 $14.00 3/1/2020

84165 26 PROTEIN; ELECTROPHORETIC FRACTIONATION A $15.65 $15.65 3/1/2020

84166 PROTEIN; ELECTROPHORETIC FRACTIONATION A $23.34 $23.34 3/1/2020

84166 26 PROTEIN; ELECTROPHORETIC FRACTIONATION A $15.65 $15.65 3/1/2020

84181 PROTEIN; WESTERN BLOT, W REPORT & INTERP $15.38 $15.38 3/1/2020

84181 26 PROTEIN; WESTERN BLOT, W REPORT & INTERP $15.65 $15.65 3/1/2020

84182 PROTEIN; IMMUNO PROBE FOR BAND ID, EACH $15.38 $15.38 3/1/2020

84182 26 PROTEIN; IMMUNO PROBE FOR BAND ID, EACH $16.14 $16.14 3/1/2020

84202 PROTOPORPHYRIN RBC QUANTITATIVE $18.78 $18.78 3/1/2020

84203 PROTOPORPHYRIN RBC SCREEN $11.27 $11.27 3/1/2020

84206 PROINSULIN $23.31 $23.31 3/1/2020

84207 PYRIDOXINE VITAMINE B-6 $36.76 $36.76 3/1/2020

84210 PYRUVATE $14.20 $14.20 3/1/2020

84220 PYRUVATE KINASE $12.34 $12.34 3/1/2020

84228 QUININE $15.23 $15.23 3/1/2020

84233 RECEPTOR ASSAY ESTROGEN (ESTRADIOL) $84.26 $84.26 3/1/2020

84234 RECEPTOR ASSAY PROGESTERONE $84.87 $84.87 3/1/2020

84235 RECEPTOR ASSAY ENDOCRINE NOT ESTROGEN OR $68.47 $68.47 3/1/2020

84238 RECEPTOR ASSAY; NON-ENDOCRINE (SPECIFY R $47.84 $47.84 3/1/2020

84244 RENIN $28.77 $28.77 3/1/2020

84252 RIBOFLAVIN $26.48 $26.48 3/1/2020

84255 SELENIUM $33.40 $33.40 3/1/2020

84260 SEROTONIN $21.32 $21.32 3/1/2020

84270 SHBG $28.43 $28.43 3/1/2020

84275 SIALIC ACID $17.58 $17.58 3/1/2020

84285 SILICA $30.81 $30.81 3/1/2020

84295 SODIUM BLOOD $6.30 $6.30 3/1/2020

84300 SODIUM URINE $6.36 $6.36 3/1/2020

84302 SODIUM; OTHER SOURCE $6.36 $6.36 3/1/2020

84305 SOMATOMEDIN $18.14 $18.14 3/1/2020

84307 SOMATOSTATIN $18.14 $18.14 3/1/2020

84311 SPECTROPHOMETRY, NOT ELSEWHERE SPECIFIED $9.15 $9.15 3/1/2020

84315 SPECIFIC GRAVITY CEXCE PT URINE $3.29 $3.29 3/1/2020

84375 SUGAR CHOMATOGRAPHIC TLC/PAPER CHOMATOGA $25.64 $25.64 3/1/2020

84376 SUGARS (MON-, DI, AND OLIGOSACCHARIDES); $7.20 $7.20 3/1/2020




84392 SULFATE, URINE $6.22 $6.22 3/1/2020

84402 TESTOSTERONE; FREE $33.31 $33.31 3/1/2020

84403 TESTOSTERONE; TOTAL $33.78 $33.78 3/1/2020

84410 TESTOSTERONE BIOAVAILABLE $33.78 $33.78 3/1/2020

84425 THIAMINE $27.78 $27.78 3/1/2020

84430 THIOCYANATE $7.54 $7.54 3/1/2020

84431 THROMBOXANE METABOLITE(S), INCLUDING THR $17.36 $17.36 3/1/2020

84432 THYROGLOBULIN $21.01 $21.01 3/1/2020

84436 THYROXINE; TOTAL $7.54 $7.54 3/1/2020

84437 THYROXINE; REQUIRING ELUTION (EG, NEONAT $8.47 $8.47 3/1/2020

84439 THYROXINE; FREE $11.80 $11.80 3/1/2020

84442 TBG BY RIA $19.34 $19.34 3/1/2020

84443 TSH $21.33 $21.33 3/1/2020

84445 THYROID STIMULATING IMMUNE GLOBULINS (TS $66.54 $66.54 3/1/2020

84446 VITAMIN E $18.55 $18.55 3/1/2020

84449 TRANSCORTIN (CORTISOL BINDING GLOBULIN) $23.55 $23.55 3/1/2020

84450 TRANSFERASE; ASPARTATE AMINO (AST) (SGOT $6.76 $6.76 3/1/2020

84460 TRANSFERASE; ALANINE AMINO (ALT) (SGPT) $6.93 $6.93 3/1/2020

84466 TRANSFERRIN $16.71 $16.71 3/1/2020

84478 TRIGLYCERIDES $7.53 $7.53 3/1/2020

84479 THYROID HORMONE (T3 OR T4) UPTAKE OR THY $7.80 $7.80 3/1/2020

84480 TRIIODOTHYRONINE T3; TOTAL (TT-3) $18.55 $18.55 3/1/2020

84481 TRIDOTHYRONINE (T-3); FREE $22.17 $22.17 3/1/2020

84482 T-3; REVERSE $20.62 $20.62 3/1/2020

84484 TROPONIN, QUANTITATIVE $12.87 $12.87 3/1/2020

84485 TRYPSIN DUODENAL FLUID $9.83 $9.83 3/1/2020

84488 TRYPSIN; FECES, QUALITATIVE $9.54 $9.54 3/1/2020

84490 TRYPSIN FECES QUANTITATIVE $9.95 $9.95 3/1/2020

84510 TYROSINE $13.61 $13.61 3/1/2020

84512 TROPONIN, QUALITATIVE $8.14 $8.14 3/1/2020

84520 UREA NITROGEN; QUANTITATIVE $5.16 $5.16 3/1/2020

84525 UREA NITROGEN; SEMIQUANTITATIVE (EG, REA $4.91 $4.91 3/1/2020

84540 LABORATORY SERVICES,ANALYSIS $6.22 $6.22 3/1/2020

84545 UREA CLEARANCE $7.54 $7.54 3/1/2020

84550 URIC ACID; BLOOD $5.91 $5.91 3/1/2020

84560 URIC ACID; OTHER SOURCE $6.22 $6.22 3/1/2020

84577 FECAL UROBILINOGEN QUANTITATIVE $16.32 $16.32 3/1/2020

84578 UROBILINOGEN QUALITATIVE $3.07 $3.07 3/1/2020

84580 UROBILINOGEN URINE QUANTITATIVE $9.29 $9.29 3/1/2020

84583 UROBILINOGEN URINE SEMIQUANTITATIVE $6.57 $6.57 3/1/2020

84585 UMA $20.29 $20.29 3/1/2020

84586 VASOACTIVE INTESTINAL PEPTIDE (VIP) $20.91 $20.91 3/1/2020

84588 VASOPRESSIN (ANTIDIURETIC HORMONE, ADH) $44.42 $44.42 3/1/2020

84590 VITAMIN A $15.17 $15.17 3/1/2020

84597 VITAMIN K $17.93 $17.93 3/1/2020

84600 VOLATILES $18.22 $18.22 3/1/2020

84620 D-XYLOSE TOLERANCE $15.50 $15.50 3/1/2020

84630 ZINC $14.90 $14.90 3/1/2020

84681 C-PEPTIDE ANY METHOD $20.79 $20.79 3/1/2020

84702 GONADOTROPIN CHORIONIC QUANTITATIVE $11.45 $11.45 3/1/2020

84703 GONADOTROPIN CHORIONIC QUALITATIVE $9.83 $9.83 3/1/2020

84704 GONADOTROPIN, CHORIONIC (HCG); FREE BETA $11.45 $11.45 3/1/2020

85002 BLEEDING TIME $5.89 $5.89 3/1/2020

85004 BLOOD COUNT; AUTOMATED DIFFERENTIAL WBC $8.47 $8.47 3/1/2020

85007 BLOOD COUNT; BLOOD SMEAR, MICROSCOPIC EX $4.50 $4.50 3/1/2020

85008 BLOOD COUNT; BLOOD SMEAR, MICROSCOPIC EX $4.50 $4.50 3/1/2020

85009 BLOOD COUNT; MANUAL DIFFERENTIAL WBC COU $4.86 $4.86 3/1/2020

85013 BLOOD COUNT; SPUN MICROHEMATOCRIT $3.10 $3.10 3/1/2020

85014 BLOOD COUNT; HEMATOCRIT (HCT) $3.10 $3.10 3/1/2020

85018 BLOOD COUNT; HEMOGLOBIN (HGB) $3.10 $3.10 3/1/2020

85025 BLOOD COUNT; COMPLETE (CBC), AUTOMATED ( $10.16 $10.16 3/1/2020

85027 BLOOD COUNT; COMPLETE (CBC), AUTOMATED ( $8.47 $8.47 3/1/2020

85032 BLOOD COUNT; MANUAL CELL COUNT (ERYTHROC $5.63 $5.63 3/1/2020

85041 BLOOD COUNT; RED BLOOD CELL (RBC), AUTOM $3.93 $3.93 3/1/2020

85044 BLOOD COUNT; RETICULOCYTE, MANUAL $5.63 $5.63 3/1/2020

85045 BLOOD COUNT; RETICULOCYTE, AUTOMATED $5.24 $5.24 3/1/2020

85046 BLOOD COUNT; RETICULOCYTES, AUTOMATED, I $7.31 $7.31 3/1/2020

85048 BLOOD COUNT; LEUKOCYTE (WBC), AUTOMATED $3.33 $3.33 3/1/2020

85049 BLOOD COUNT; PLATELET, AUTOMATED $5.86 $5.86 3/1/2020

85055 RETICULATED PLATELET ASSAY $35.03 $35.03 3/1/2020

85060 BLOOD SMEAR, PERIPHERAL, INTERP BY PHYSI $19.30 $19.30 3/1/2020

85060 26 BLOOD SMEAR, PERIPHERAL, INTERP BY PHYSI $13.88 $13.88 3/1/2020

85097 BONE MARROW, SMEAR INTERPRETATION $40.17 $72.52 3/1/2020

85097 26 BONE MARROW, SMEAR INTERPRETATION $31.27 $62.80 3/1/2020

85130 CHROMOGENIC SUBSTRATE ASSAY $15.56 $15.56 3/1/2020

85170 CLOT RETRACTION $4.74 $4.74 3/1/2020

85175 CLOT LYSIS TIME WHOLE BLOOD DILUTION $5.94 $5.94 3/1/2020

85210 CLOTTING FACTOR II PROTHROMBIN SPECIFIC $16.99 $16.99 3/1/2020

85220 BLOOC CLOT FACTOR V TEST $23.09 $23.09 3/1/2020

85230 CLOTTING FACTOR VII $23.43 $23.43 3/1/2020

85240 CLOTTING FACTOR VIII ONE STAGE $23.43 $23.43 3/1/2020

85244 CLOTTING; FACTOR VIII RELATED ANTIGEN $26.71 $26.71 3/1/2020

85245 CLOTTING; FACTOR 8 $30.02 $30.02 3/1/2020

85246 CLOTTING; FACTOR 8, VW FACTOR ANTIGEN $30.02 $30.02 3/1/2020

85247 CLOTTING; FACTOR 8, MULTIMETRIC ANALYSIS $30.02 $30.02 3/1/2020

85250 CLOTTING FACTOR IX $24.92 $24.92 3/1/2020

85260 CLOTTING FACTOR X $23.43 $23.43 3/1/2020

85270 CLOTTING FACTOR XI $23.43 $23.43 3/1/2020

85280 CLOTTING FACTOR XII $25.33 $25.33 3/1/2020

85290 CLOTTING FACTOR XIII $21.38 $21.38 3/1/2020

85291 CLOTTING FACTOR XIII FIBRIN STABILIZING $11.62 $11.62 3/1/2020

85292 CLOTTING; FACTOR II PREKALLIKREIN ASSAY $24.78 $24.78 3/1/2020

85293 CLOTTING; FACTOR II MOLECULAR WEIGHT ASS $24.78 $24.78 3/1/2020

85300 CLOTTING INHIBITORS OR ANTICOAGULANTS AN $15.50 $15.50 3/1/2020

85301 CLOTTING INHIBITORS; ANTITHROMBIN III, A $14.15 $14.15 3/1/2020

85302 CLOTTING INHIBITORS OR ANTICOAGULANTS; P $15.73 $15.73 3/1/2020

85303 CLOTTING INHIBITORS OR ANTICOAG; PROTEIN $18.09 $18.09 3/1/2020

85305 CLOTTING INHIBITORS OR ANTICOAGULANTS; P $15.17 $15.17 3/1/2020

85306 CLOTTING INHIBITORS OR ANTICOAG; PROTEIN $18.70 $18.70 3/1/2020

85307 ACTIVATED PROTEIN C (APC) RESISTANCE ASS $18.70 $18.70 3/1/2020

85335 FACTOR INHIBITOR TEST $16.84 $16.84 3/1/2020

85337 THROMBOMODULIN $13.64 $13.64 3/1/2020

85345 COAGULATION TIME $5.63 $5.63 3/1/2020

85347 COAGULATION TIME OTHER METHODS $5.57 $5.57 3/1/2020

85348 COAGULATION TIME OTHER METHODS $4.87 $4.87 3/1/2020

85360 EUGLOBULIN LYSIS $10.99 $10.99 3/1/2020

85362 FIBRIN DEGREDATION PRODUCTS $9.01 $9.01 3/1/2020

85370 FDP; QUANTITATIVE $12.05 $12.05 3/1/2020

85378 FIBRIN DEGRADATION PRODUCTS, D-DIMER; QU $9.33 $9.33 3/1/2020

85379 FDP, D-DIMER; QUANTITATIVE $12.05 $12.05 3/1/2020

85380 FIBRIN DEGRADATION PRODUCTS, D-DIMER; UL $12.05 $12.05 3/1/2020

85384 FIBRINOGEN; ACTIVITY $11.11 $11.11 3/1/2020

85385 FIBRINOGEN; ANTIGEN $11.11 $11.11 3/1/2020

85390 FIBRINOLYSINS OR COAGULOPATHY SCREEN, IN $6.76 $6.76 3/1/2020

85390 26 FIBRINOLYSINS OR COAGULOPATHY SCREEN, IN $15.93 $15.93 3/1/2020

85396 COAGULATION/FIBRINOLYSIS ASSAY, WHOLE BL $16.24 $16.24 3/1/2020

85397 COAGULATION AND FIBRINOLYSIS, FUNCTIONAL $31.37 $31.37 3/1/2020

85400 FIBRINOLYTIC MECHANISMS PLASMIN $11.58 $11.58 3/1/2020

85410 FIBRINOLYTIC MECHANISMS ANTIPLASMIN $10.08 $10.08 3/1/2020

85415 FIBRINOLYTIC FACTORS & INHIBITORS $22.49 $22.49 3/1/2020

85420 FIBRINOLYTIC MECHANISMS PLASMINOGEN $8.55 $8.55 3/1/2020

85421 PLASMINOGEN, ANTIGENIC ASSAY $13.32 $13.32 3/1/2020

85441 HEINZ BODIES DIRECT $5.50 $5.50 3/1/2020

85445 HEINZ BODIES INDUCED ACETYL PHENYLHYDRAZ $8.91 $8.91 3/1/2020

85460 HEMOGLOBIN OR RBCS, FETAL, FOR FETOMATER $9.86 $9.86 3/1/2020

85461 HEMOGLOBIN FETAL $8.67 $8.67 3/1/2020

85475 HEMOLYSIN, ACID $9.86 $9.86 3/1/2020

85520 HEPARIN ASSAY $17.13 $17.13 3/1/2020

85525 HEPARIN NEUTRALIZATION $15.50 $15.50 3/1/2020

85530 HEPARIN-PROTAMINE TOLERANCE TEST $18.55 $18.55 3/1/2020

85536 IRON STAIN, PERIPHERAL BLOOD $8.47 $8.47 3/1/2020

85540 LEUKOCYTE ALKALINE PHOSPHATASE $11.26 $11.26 3/1/2020

85547 RBC FRAGILITY $5.37 $5.37 3/1/2020

85549 MURAMIDASE $24.54 $24.54 3/1/2020

85555 OSMOTIC FRAGILITY, RBC; UNINCUBATED $8.75 $8.75 3/1/2020

85557 OSMOTIC FRAGILITY INCUBATED QUANTITATIVE $17.47 $17.47 3/1/2020

85576 PLATELET; AGGREGATION (IN VITRO), EACH A $28.10 $28.10 3/1/2020

85576 26 PLATELET; AGGREGATION (IN VITRO), EACH A $15.93 $15.93 3/1/2020

85597 PLATELET NEUTRALIZATION $23.52 $23.52 3/1/2020

85598 PHOSPHOLIPID NEUTRALIZATION; HEXAGONAL P $23.69 $23.69 3/1/2020

85610 PROTHROMBIN TIME $5.15 $5.15 3/1/2020

85611 PROTHROMBIN TIME $5.16 $5.16 3/1/2020

85612 RUSSELL VIPER VENOM TIME (INCLUDES VENOM $12.53 $12.53 3/1/2020

85613 RUSSELL VIPOR VENOM TIME; DULUTED $12.53 $12.53 3/1/2020

85635 REPTILASE TEST $12.88 $12.88 3/1/2020

85651 SEDIMENTATION RATE, ERYTHROCYTE, NON-AUT $4.64 $4.64 3/1/2020

85652 SEDIMENTATION RATE, ERYTHROCYTE; AUTOMAT $3.53 $3.53 3/1/2020

85660 SICKLING RBC REDUCTION SLIDE METHOD $7.22 $7.22 3/1/2020

85670 THROMBIN TIME PLASMA $7.55 $7.55 3/1/2020

85675 THROMBIN TIME TITER $8.98 $8.98 3/1/2020

85705 THROMBOPLASTIN INHIBITION; TISSUE $12.60 $12.60 3/1/2020

85730 PTT $7.85 $7.85 3/1/2020

85732 THROMBOPLASTIN TIME, PARTIAL (PTT); SUBS $8.47 $8.47 3/1/2020

85810 VISCOSITY $13.26 $13.26 3/1/2020

86000 AGGLUTINS FEBRILE EA $9.12 $9.12 3/1/2020

86001 ALLERGEN SPECIFIC IGG QUANTITATIVE OR SE $6.84 $6.84 3/1/2020

86003 ALLERGEN SPECIFIC IGE; QUANTITATIVE OR S $6.84 $6.84 3/1/2020

86005 ALLERGEN SPECIFIC IGE; QUALITATIVE, MULT $10.44 $10.44 3/1/2020

86008 AllG SPEC IGE RECOMB EA $21.16 $21.16 3/1/2020

86021 ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBO $19.70 $19.70 3/1/2020

86022 ANTIBODY IDENTIFICATION PLATELET ANTIBOD $24.02 $24.02 3/1/2020

86023 ANTIBODY ID PLATELET ASSOCIATED IMMUNOGL $16.29 $16.29 3/1/2020

86038 ANTINUCLEAR ANTIBODIES (ANA); $15.81 $15.81 3/1/2020

86039 ANA; TITER $14.62 $14.62 3/1/2020

86060 ASO TITER $9.54 $9.54 3/1/2020

86063 ANTISTREPTOLYSIN SCREEN $7.55 $7.55 3/1/2020

86077 BLOOD BANK SERVICES; EVALUATION OF IRREG $40.27 $42.04 3/1/2020

86077 26 BLOOD BANK SERVICES; EVALUATION OF IRREG $30.63 $31.92 3/1/2020

86078 BLOOD BANK IRREGULAR ANTIB INVESTIGATION $40.27 $42.64 3/1/2020

86078 26 BLOOD BANK IRREGULAR ANTIB INVESTIGATION $30.91 $32.61 3/1/2020

86079 BLOOD BANK AUTHORIZATION FOR DEVIATION S $40.56 $42.93 3/1/2020

86079 26 BLOOD BANK AUTHORIZATION FOR DEVIATION S $30.72 $32.21 3/1/2020

86140 CRP $6.77 $6.77 3/1/2020

86141 C-REACTIVE PROTEIN; HIGH SENSITIVITY (HS $16.94 $16.94 3/1/2020

86146 BETA 2 GLYCOPROTEIN I ANTIBODY, EACH $18.98 $18.98 3/1/2020

86147 CARDIOLIPIN ANTIBODY EA IG $18.98 $18.98 3/1/2020

86148 ANTI-PHOSPHATIDYLSERINE (PHOSPHOLIPID) A $19.53 $19.53 3/1/2020

86155 CHEMOTHAXIS ASSAY SPECIFY METHOD $20.91 $20.91 3/1/2020

86156 COLD AGGLUTININ; SCREEN $8.40 $8.40 3/1/2020

86157 COLD AGGULTININ; TITER $8.40 $8.40 3/1/2020

86160 COMPLEMENT; ANTIGEN, EACH COMPONENT $15.71 $15.71 3/1/2020

86161 COMPLEMENT; FUNCTIONAL ACTIVITY, EACH $15.71 $15.71 3/1/2020

86162 COMPLEMENT TOTAL $26.58 $26.58 3/1/2020

86171 COMPLEMENT FIXATION TEST, EACH $13.11 $13.11 3/1/2020

86200 CYCLIC CITRULLINATED PEPTIDE (CCP), ANTI $16.94 $16.94 3/1/2020

86215 ASH TITER $17.33 $17.33 3/1/2020

86225 DEOXYRIBONUCLEIC ACID (DNA) ANTIBODY; NA $17.98 $17.98 3/1/2020

86226 DNA ANTIBODY; SINGLE STRANDED $15.84 $15.84 3/1/2020

86235 EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY $23.46 $23.46 3/1/2020

86255 FLUORESCENT NONINFECTIOUS AGENT ANTIBODY $15.76 $15.76 3/1/2020

86255 26 FLUORESCENT NONINFECTIOUS AGENT ANTIBODY $15.93 $15.93 3/1/2020

86256 FLOURESCENT ANTIBODY TITER $15.76 $15.76 3/1/2020

86256 26 FLOURESCENT ANTIBODY TITER $15.93 $15.93 3/1/2020

86277 GROWTH HORMONE, HUMAN (HGH), ANTIBODY $20.59 $20.59 3/1/2020

86280 HEMAGGLUTINATION INHIBITON $10.71 $10.71 3/1/2020

86294 IMMUNOASSAY FOR TUMOR ANTIGEN, QUALITATI $25.66 $25.66 3/1/2020

86300 IMMUNOASSAY FOR TUMOR ANTIGEN, QUANTITAT $27.22 $27.22 3/1/2020



86308 HETEROPHILE ANTIBODIES; SCREENING $6.77 $6.77 3/1/2020

86309 HETEROPHILE ANTIBODIES; TITER $8.47 $8.47 3/1/2020

86310 HETEROPHILE ABSORPTION $9.64 $9.64 3/1/2020

86316 IMMUNOASSAY FOR TUMOR ANTIGEN; OTHER ANT $27.22 $27.22 3/1/2020

86317 IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBOD $18.98 $18.98 3/1/2020

86318 IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBOD $16.94 $16.94 3/1/2020

86320 IMMUNOELECTROPHORESIS; SERUM $29.33 $29.33 3/1/2020

86320 26 IMMUNOELECTROPHORESIS; SERUM $15.93 $15.93 3/1/2020

86325 IMMUNOELECTROPHORESIS; OTHER FLUIDS (EG, $29.25 $29.25 3/1/2020

86325 26 IMMUNOELECTROPHORESIS; OTHER FLUIDS (EG, $15.65 $15.65 3/1/2020

86327 IMMUNOELECTROPHORESIS SERUM EACH SPECIME $29.68 $29.68 3/1/2020

86327 26 IMMUNOELECTROPHORESIS SERUM EACH SPECIME $18.33 $18.33 3/1/2020

86328 IA NFCT AB SARSCOV2 COVID19 $45.23 $45.23 4/10/2020

86329 IMMUNODIFFUSION, NOT ELSEWHERE SPECIFIED $18.36 $18.36 3/1/2020

86331 GEL DIFFUSION QUALITATIVE OUCHTERLONY $14.85 $14.85 3/1/2020

86332 IMMUNE COMPLEX ASSAY $31.89 $31.89 3/1/2020

86334 IMMUNOFIXATION ELECTROPHORESIS; SERUM $29.22 $29.22 3/1/2020

86334 26 IMMUNOFIXATION ELECTROPHORESIS; SERUM $15.93 $15.93 3/1/2020

86335 IMMUNOFIXATION ELECTROPHORESIS; OTHER FL $38.39 $38.39 3/1/2020

86335 26 IMMUNOFIXATION ELECTROPHORESIS; OTHER FL $15.65 $15.65 3/1/2020

86336 INHIBIN A $22.00 $22.00 3/1/2020

86337 INSULIN ANTIBODIES $28.02 $28.02 3/1/2020

86340 INTRINSIC FACTOR ANTIBODIES $19.72 $19.72 3/1/2020

86341 ISLET CELL ANTIBODY $17.58 $17.58 3/1/2020

86344 LEUKOCYTE PHAGOCYTOSIS $10.46 $10.46 3/1/2020

86353 LYMPHOCYTE TRANSFORMATION, MITOGEN (PHYT $64.13 $64.13 3/1/2020

86355 B CELLS, TOTAL COUNT $49.35 $49.35 3/1/2020

86356 MONONUCLEAR CELL ANTIGEN, QUANTITATIVE ( $35.03 $35.03 3/1/2020

86357 NATURAL KILLER (NK) CELLS, TOTAL COUNT $49.35 $49.35 3/1/2020

86359 T CELLS; $49.35 $49.35 3/1/2020

86360 T CELLS; ABSOLUTE CD4 AND CD8 COUNT, INC $61.48 $61.48 3/1/2020

86361 T CELLS; ABSOLUTE CD4 COUNT $35.03 $35.03 3/1/2020

86367 STEM CELLS (IE, CD34), TOTAL COUNT $49.35 $49.35 3/1/2020

86376 MICROSOMAL ANTIBODIES (EG, THRYOID OR LI $18.13 $18.13 3/1/2020

86382 NEUTRALIZATION TEST VIRAL $22.11 $22.11 3/1/2020

86384 NBT TEST $14.90 $14.90 3/1/2020

86403 PARTICLE AGGLUTINATION; SCREEN, EACH ANT $13.34 $13.34 3/1/2020

86406 PARTICLE AGGLUTINATION; $13.92 $13.92 3/1/2020

86430 RHEUMATOID FACTOR; QUALITATIVE $7.43 $7.43 3/1/2020

86431 RHEUMATOID FACTOR; QUANTITATIVE $7.43 $7.43 3/1/2020

86480 TUBERCULOSIS TEST, CELL MEDIATED IMMUNIT $81.08 $81.08 3/1/2020

86481 TUBERCULOSIS TEST, CELL MEDIATED IMMUNIT $81.67 $81.67 3/1/2020

86485 SKIN TEAT; CANDIDA $6.51 $6.51 3/1/2020

86486 SKIN TEST; UNLISTED ANTIGEN, EACH $3.97 $3.97 3/1/2020

86490 SENSITIVITY TEST COCCIDIOIDOMYCOSIS $5.45 $5.45 3/1/2020

86510 SENSITIVITY TEST HISTOPLASMOSIS $5.45 $5.45 3/1/2020

86580 SENSITIVITY TEST TUBERCULOSIS $5.75 $5.75 3/1/2020

86590 STREPTOKINASE ANTIBODY $14.43 $14.43 3/1/2020

86592 SYPHILIS, PRECIPITATION OR FLOCCULATION $5.58 $5.58 3/1/2020

86593 SYPHILLIS PRECIPITATION FLOCCULATION TES $5.78 $5.78 3/1/2020

86602 ANTIBODY; ACTINOMYCES $13.31 $13.31 3/1/2020

86603 ANTIBODY; ADENOVIRUS $16.68 $16.68 3/1/2020

86606 ANTIBODY; ASPIRGILLUS $16.68 $16.68 3/1/2020

86609 ANTIBODY; BACTERIUM, NOT ELSEWHERE SPECI $16.68 $16.68 3/1/2020

86611 ANTIBODY; BARTONELLA $13.31 $13.31 3/1/2020

86612 ANTIBODY; BLASTOMYCES $16.68 $16.68 3/1/2020

86615 ANTIBODY; BORDETELLA $17.25 $17.25 3/1/2020

86617 ANTIBODY; $15.49 $15.49 3/1/2020

86618 ANTIBODY; LYME DISEASE $18.98 $18.98 3/1/2020

86619 ANTIBODY; BORRELIA $17.50 $17.50 3/1/2020

86622 ANTIBODY; BRUCELLA $9.86 $9.86 3/1/2020

86625 ANTIBODY; CAMPYLOBACTOR $9.86 $9.86 3/1/2020

86628 ANTIBODY; CANDIDA $14.85 $14.85 3/1/2020

86631 ANTIBODY; CHLAMYDIA $15.47 $15.47 3/1/2020

86632 ANTIBODY; CHLAMIDA, IGM $16.61 $16.61 3/1/2020

86635 ANTIBODY, COCCIDIOIDES $15.02 $15.02 3/1/2020

86638 ANTIBODY; Q FEVER $15.87 $15.87 3/1/2020

86641 ANTIBODY; CRYPTOCOCCUS $18.86 $18.86 3/1/2020

86644 ANTIBODY; CMV $18.80 $18.80 3/1/2020

86645 ANTIBODY; CMV, IGM $18.98 $18.98 3/1/2020

86648 ANTIBODY; DIPTHERIA $18.98 $18.98 3/1/2020

86651 ANTIBODY; ENCEPHALITIS, CALIFORNIA $17.25 $17.25 3/1/2020

86652 ANTIBODY; ENCEPHALITIS, EASTERN EQUINE $17.25 $17.25 3/1/2020

86653 ANTIBODY; ENCEPHALITIS ST, LOUIS $17.25 $17.25 3/1/2020

86654 ANTIBODY;ENCEPHALITIS WESTERN EQUINE $17.25 $17.25 3/1/2020

86658 ANTIBODY; ENTEROVIRUS $16.68 $16.68 3/1/2020

86663 ANTIBODY; EPSTEIN-BARR, EARLY ANTIGEN $17.17 $17.17 3/1/2020

86664 ANTIBODY; EPSTEIN-BARR, NUCLEAR ANTIGEN $18.98 $18.98 3/1/2020

86665 ANTIBODY; EPSTEIN-BARR VIRAL CAPSID $21.26 $21.26 3/1/2020

86666 ANTIBODY; EHRLICHIA $13.31 $13.31 3/1/2020

86668 ANTIBODY; FRACISELLA TULARENSIS $13.61 $13.61 3/1/2020

86671 ANTIBODY; FUNGUS $16.04 $16.04 3/1/2020

86674 ANTIBODY; GIARDIA LAMBLIA $18.98 $18.98 3/1/2020

86677 ANTIBODY; HELICOBACTER PYLOUI $18.98 $18.98 3/1/2020

86682 ANTIBODY; HELMINTH $17.01 $17.01 3/1/2020

86684 ANTIBODY; HEMOPHILUS INFLUENZA $18.98 $18.98 3/1/2020

86687 HTLV-I ANTIBODY $10.98 $10.98 3/1/2020

86688 HTLV-II ANTIBODY $15.38 $15.38 3/1/2020

86689 HTLV/HIV CONFIRMJ ANTIBODY $25.34 $25.34 3/1/2020

86692 ANTOBODY; HEPATITIS, DELTA AGENT $18.98 $18.98 3/1/2020

86694 ANTIBODY; HERPES SIMPLEX, NON-SPECIFIC $18.80 $18.80 3/1/2020

86695 ANTIBODY; HERPES SIMPLEX. TYPE I $17.25 $17.25 3/1/2020

86696 ANTIBODY; HERPES SIMPLEX, TYPE 2 $25.34 $25.34 3/1/2020

86698 ANTOBODY; HISTOPLASM $16.35 $16.35 3/1/2020

86701 ANTIBODY; HIV-1 $11.61 $11.61 3/1/2020

86702 ANTIBODY; HIV-2 $15.38 $15.38 3/1/2020

86703 ANTIBODY; HIV-1 & HIV-2, SINGLE ASSAY $15.38 $15.38 3/1/2020

86704 HEPATITIS B CORE ANTIBODY (HBCAB), TOTAL $15.23 $15.23 3/1/2020

86705 HEPATITIS B CORE ANTIBODY (HBCAB); IGM A $15.39 $15.39 3/1/2020

86706 HEPATITIS B SURFACE ANTIBODY (HBSAB) $14.06 $14.06 3/1/2020

86707 HEPATITIS BE ANTIBODY (HBEAB) $15.14 $15.14 3/1/2020

86708 HEPATITIS A ANTIBODY $16.21 $16.21 3/1/2020

86709 HEPATITIS A ANTIBODY (HAAB); IGM ANTIBOD $14.72 $14.72 3/1/2020

86710 ANTIBODY, INFLUENZA VIRUS $17.75 $17.75 3/1/2020

86711 ANALYSIS FOR ANTIBODY TO JOHN CUNNINGHAM $18.49 $18.49 3/1/2020

86713 ANTIBODY; LEGIONELLA $20.02 $20.02 3/1/2020

86717 ANTIBODY; LEISHMANIA $10.97 $10.97 3/1/2020

86720 ANTIBODY; LEPTOSPIRA $12.90 $12.90 3/1/2020

86723 ANTIBODY; LISTERIA MONOCYTOGENES $17.25 $17.25 3/1/2020

86727 ANTIBODY; LYMPHOCYTIC CHORIOMENINGITIS $16.68 $16.68 3/1/2020

86732 ANTIBODY; MUCORMYCOSIS $17.25 $17.25 3/1/2020

86735 ANTIBODY; MUMPS $17.07 $17.07 3/1/2020

86738 ANTIBODY; MYCOPLASMA $17.33 $17.33 3/1/2020

86744 ANTIBODY; NOCARDIA $17.25 $17.25 3/1/2020

86747 ANTIBODY; PARVOVIRUS $18.98 $18.98 3/1/2020

86750 ANTIBODY; MALARIA $17.25 $17.25 3/1/2020

86753 ANTIBODY; PROTOZOA, NOT ELSEWHERE SPECI $10.97 $10.97 3/1/2020

86756 ANTIBODY; RESPIRATORY SYNCYTIAL VIRUS $16.86 $16.86 3/1/2020

86757 ANTIBODY; RICKETTSIA $25.34 $25.34 3/1/2020

86759 ANTIBODY; ROTAVIRUS $16.68 $16.68 3/1/2020

86762 ANTIBODY; RUBELLA $18.80 $18.80 3/1/2020

86765 ANTIBODY; RUBEOLA $16.85 $16.85 3/1/2020

86768 ANTIBODY; SALMONELLA $17.25 $17.25 3/1/2020

86769 SARS-COV-2 COVID-19 ANTIBODY $42.13 $42.13 4/10/2020

86771 ANTIBODY; SHIGELLA $17.25 $17.25 3/1/2020

86774 ANTIBODY; TETANUS $18.98 $18.98 3/1/2020

86777 ANTIBODY; TOXOPLASMA $18.80 $18.80 3/1/2020

86778 ANTIBODY; TOXOPLASMA, IGM $18.84 $18.84 3/1/2020

86780 TREPONEMA PALLIDUM $17.76 $17.76 3/1/2020

86784 ANTIBODY; TRICHINELLA $16.43 $16.43 3/1/2020

86787 ANTIBODY; VARICELLA-ZOSTER $16.85 $16.85 3/1/2020

86788 ANTIBODY; WEST NILE VIRUS, IGM $18.98 $18.98 3/1/2020

86789 ANTIBODY; WEST NILE VIRUS $18.80 $18.80 3/1/2020

86790 ANTIBODY; VIRUS, NOT ELSEWHERE SPECIFIED $16.85 $16.85 3/1/2020

86793 ANTIBODY; YERSINIA $17.25 $17.25 3/1/2020

86794 ZIKA VIRUS IGM ANTIBODY $19.88 $19.88 3/1/2020

86800 THYROGLOBULIN ANTIBODY $20.81 $20.81 3/1/2020

86803 HEPATITIS C ANTIBODY; $18.68 $18.68 3/1/2020

86804 HEPATITIS C ANTIBODY; CONFIRMATORY TEST $15.49 $15.49 3/1/2020

86805 LYMPHOCYTOTOXICITY ASSAY, VISUAL XM; W/ $68.41 $68.41 3/1/2020

86806 LYMPHOCYTOTOXICITY ASSAY, VISUAL XM; W/O $62.27 $62.27 3/1/2020

86807 SERUM SCREENING FOR CYTOTOXIC PRA; STAND $51.77 $51.77 3/1/2020

86808 SERUM SCREENING FOR CYTOTOXIC PRA; QUICK $38.84 $38.84 3/1/2020

86812 TISSUE TYPING HLA TYPING A,B, OR C SINGL $33.76 $33.76 3/1/2020

86813 TISSUE TYPING HLA TYPING A,B, &/OR C MUL $75.87 $75.87 3/1/2020

86816 HLA TYPING; DR/DQ, SINGLE ANTIGEN $36.45 $36.45 3/1/2020

86817 HLA TYPING; DR/DQ, MULTIPLE ANTIGENS $84.22 $84.22 3/1/2020

86821 TISSUE TYPING LYMPNOCYTE CULTURE MIXED ( $73.86 $73.86 3/1/2020

86825 HUMAN LEUKOCYTE ANTIGEN (HLA) CROSSMATCH $107.73 $107.73 3/1/2020

86826 HUMAN LEUKOCYTE ANTIGEN (HLA) CROSSMATCH $35.91 $35.91 3/1/2020

86828 ASSESSMENT OF ANTIBODY TO HUMAN LEUKOCYT $50.94 $50.94 3/1/2020








86850 ANTIBODY SCREEN, RBC, EACH SERUM TECHNIQ $15.24 $15.24 3/1/2020

86860 ANTIBODY ELUTION, EACH ELUTION $14.91 $14.91 3/1/2020

86870 ANTIBODY ID, EACH PANEL FOR EACH SERUM T $26.91 $26.91 3/1/2020

86880 COOMBS TEST; DIRECT, EACH ANTISERUM $7.02 $7.02 3/1/2020

86885 ANTIHUMAN GLOBULIN TEST INDIRECT, QUALIT $7.48 $7.48 3/1/2020

86886 COOMBS TEST, INDIRECT TITER, EACH ANTISE $6.77 $6.77 3/1/2020

86900 BLOOD TYPING SEROLOGIC ABO $3.90 $3.90 3/1/2020

86901 BLOOD TYPING SEROLOGIC RH(D) $3.90 $3.90 3/1/2020

86902 BLOOD TYPING; ANTIGEN TESTING OF DONOR B $5.04 $5.04 3/1/2020

86904 BLOOD TYPING; ANTIGEN SCREENING, PER UNI $12.43 $12.43 3/1/2020

86905 BLOOD TYPING; RBC ANTIGENS, EACH $5.00 $5.00 3/1/2020

86906 BLD TYPING SEROLOGIC RH PHNT $10.14 $10.14 3/1/2020

86940 HEMOLYSINS/AGGLUTININS, AUTO, SCREEN, EA $10.73 $10.73 3/1/2020

86941 HEMOLYSINS/ AGGLUTININS, EACH; INCUBATED $15.84 $15.84 3/1/2020

87003 ANIMAL INNOCULATION SMALL ANIMAL W/OBSER $22.02 $22.02 3/1/2020

87015 CONCENTRATION (ANY TYPE), FOR INFECTIOUS $8.74 $8.74 3/1/2020

87040 CULTURE, BACTERIAL; BLOOD, AEROBIC, WITH $13.50 $13.50 3/1/2020

87045 CULTURE, BACTERIAL; STOOL, AEROBIC, WITH $12.34 $12.34 3/1/2020

87046 CULTURE, BACTERIAL; STOOL, AEROBIC, ADDI $12.34 $12.34 3/1/2020

87070 CULTURE, BACTERIAL; ANY OTHER SOURCE EXC $11.27 $11.27 3/1/2020

87071 CULTURE, BACTERIAL; QUANTITATIVE, AEROBI $12.34 $12.34 3/1/2020

87073 CULTURE, BACTERIAL; QUANTITATIVE, ANAERO $12.34 $12.34 3/1/2020

87075 CULTURE, BACTERIAL; ANY SOURCE, EXCEPT B $12.38 $12.38 3/1/2020

87076 CULTURE, BACTERIAL; ANAEROBIC ISOLATE, A $10.56 $10.56 3/1/2020

87077 CULTURE, BACTERIAL; AEROBIC ISOLATE, ADD $10.56 $10.56 3/1/2020

87081 CULTURE, PRESUMPTIVE, PATHOGENIC ORGANIS $7.54 $7.54 3/1/2020

87084 CULTURE W COLONY ESTIMATION FROM DENSITY $11.27 $11.27 3/1/2020

87086 CULTURE, BACTERIAL; QUANTITATIVE COLONY $10.55 $10.55 3/1/2020

87088 CULTURE, BACTERIAL; WITH ISOLATION AND P $10.58 $10.58 3/1/2020

87101 CULTURE, FUNGI (MOLD OR YEAST) ISOLATION $10.08 $10.08 3/1/2020

87102 CULTURE FUNGI ISOLATION OTHER SOURCE $10.99 $10.99 3/1/2020

87103 BLOOD CULTURE FOR FUNGI $11.80 $11.80 3/1/2020

87106 CULTURE, FUNGI, DEFINITIVE IDENTIFICATIO $13.50 $13.50 3/1/2020

87107 CULTURE, FUNGI, DEFINITIVE IDENTIFICATIO $13.50 $13.50 3/1/2020

87109 CULTURE MYCOPLASM ANY SOURCE $20.14 $20.14 3/1/2020

87110 CULTURE, CHLAMYDIA, ANY SOURCE $25.63 $25.63 3/1/2020

87116 CULTURE, TUBERCLE OR OTHER ACID-FAST BAC $14.14 $14.14 3/1/2020

87118 CULTURE, MYCOBACTERIAL, DEFINITIVE IDENT $14.31 $14.31 3/1/2020

87140 CULTURE, TYPING; IMMUNOFLUORESCENT METHO $7.30 $7.30 3/1/2020

87143 CULTURE, TYPING; GAS LIQUID CHROMATOGRAP $16.39 $16.39 3/1/2020

87147 CULTURE, TYPING; IMMUNOLOGIC METHOD, OTH $6.77 $6.77 3/1/2020

87149 CULTURE, TYPING; IDENTIFICATION BY NUCLE $26.24 $26.24 3/1/2020


87152 CULTURE, TYPING; IDENTIFICATION BY PULSE $6.85 $6.85 3/1/2020


87158 CULTURE TYPING OTHER METHODS $6.85 $6.85 3/1/2020

87164 DARKFIELD EXAMINATION $8.28 $8.28 3/1/2020

87164 26 DARKFIELD EXAMINATION $15.65 $15.65 3/1/2020

87166 DARK FIELD EXAM ANY SOURCE W/O COLLECTIO $14.77 $14.77 3/1/2020

87168 MACROSCOPIC EXAMINATION; ARTHROPOD $4.99 $4.99 3/1/2020

87169 MACROSCOPIC EXAMINATION; PARASITE $4.99 $4.99 3/1/2020

87172 PINWORM EXAM (EG, CELLOPHANE TAPE PREP) $4.99 $4.99 3/1/2020

87176 HOMOGENIZATION, TISSUE, FOR CULTURE $7.70 $7.70 3/1/2020

87177 OVA AND PARASITES $11.63 $11.63 3/1/2020

87181 SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AG $6.22 $6.22 3/1/2020







87197 SERUM BACTERICIDAL TITER $19.66 $19.66 3/1/2020

87205 SMEAR, PRIMARY SOURCE WITH INTERPRETATIO $5.58 $5.58 3/1/2020



87207 26 SMEAR, PRIMARY SOURCE WITH INTERPRETATIO $15.93 $15.93 3/1/2020



87220 TISSUE EXAMINATION BY KOH SLIDE OF SAMPL $5.58 $5.58 3/1/2020

87230 TISSUE CULTURE LYMPHOCYTE $25.84 $25.84 3/1/2020

87250 VIRUS ISOLATION; INOCULATION OF EMBRYONA $21.32 $21.32 3/1/2020

87252 VIRUS ISOLATION; TISSUE CULTURE INOCULAT $21.32 $21.32 3/1/2020

87253 VIRUS ISOLATION; TISSUE CULTURE, ADDITIO $21.32 $21.32 3/1/2020

87254 VIRUS ISOLATION; CENTRIFUGE ENHANCED (SH $21.32 $21.32 3/1/2020

87255 VIRUS ISOLATION; INCLUDING IDENTIFICATIO $31.97 $31.97 3/1/2020

87260 INFECTIOUS AGENT ANTIGEN DETECTION BY IM $14.99 $14.99 3/1/2020

87265 INFECTIOUS AGENT ANTIGEN DETECTION BY DI $14.99 $14.99 3/1/2020



















87301 ADENOVIRUS AG IA $14.99 $14.99 3/1/2020

87305 ASPERGILLUS AG IA $14.99 $14.99 3/1/2020

87320 CHYLMD TRACH AG IA $14.99 $14.99 3/1/2020

87324 CLOSTRIDIUM AG IA $14.99 $14.99 3/1/2020

87327 CRYPTOCOCCUS NEOFORM AG IA $14.99 $14.99 3/1/2020

87328 CRYPTOSPORIDIUM AG IA $14.99 $14.99 3/1/2020

87329 GIARDIA AG IA $14.99 $14.99 3/1/2020

87332 CYTOMEGALOVIRUS AG IA $14.99 $14.99 3/1/2020

87335 E COLI 0157 AG IA $14.99 $14.99 3/1/2020

87336 ENTAMOEB HIST DISPR AG IA $14.99 $14.99 3/1/2020

87337 ENTAMOEB HIST GROUP AG IA $14.99 $14.99 3/1/2020

87338 HPYLORI STOOL IA $18.82 $18.82 3/1/2020

87339 H PYLORI AG IA $14.99 $14.99 3/1/2020

87340 HEPATITIS B SURFACE AG IA $12.17 $12.17 3/1/2020

87341 HEPATITIS B SURFACE AG IA $12.17 $12.17 3/1/2020

87350 HEPATITIS BE AG IA $14.48 $14.48 3/1/2020

87380 HEPATITIS DELTA AG IA $21.48 $21.48 3/1/2020

87385 HISTOPLASMA CAPSUL AG IA $14.99 $14.99 3/1/2020

87389 INFECTIOUS AGENT ANTIGEN DETECTION BY EN $31.42 $31.42 3/1/2020

87390 HIV-1 AG IA $23.08 $23.08 3/1/2020

87391 HIV-2 AG IA $23.08 $23.08 3/1/2020

87400 INFLUENZA A/B AG IA $14.99 $14.99 3/1/2020

87420 RESP SYNCYTIAL AG IA $14.99 $14.99 3/1/2020

87425 ROTAVIRUS AG IA $14.99 $14.99 3/1/2020


87427 SHIGA-LIKE TOXIN AG IA $14.99 $14.99 3/1/2020

87430 STREP A AG IA $14.99 $14.99 3/1/2020

87449 AG DETECT NOS IA MULT $14.99 $14.99 3/1/2020

87450 AG DETECT NOS IA SINGLE $10.01 $10.01 3/1/2020

87451 AG DETECT POLYVAL IA MULT $10.01 $10.01 3/1/2020

87471 INFECTIOUS AGENT DETECTION BY NUCLEIC AC $32.09 $32.09 3/1/2020







87483 CNS DNA AMP PROBE TYPE 12-25 $258.26 $258.26 3/1/2020







87493 CLOSTRIDIUM DIFFICILE, TOXIN GENE(S), AM $32.89 $32.89 3/1/2020




87498 DETECTION TEST FOR ENTEROVIRUS (INTESTIN $32.09 $32.09 3/1/2020


87501 INFLUENZA DNA AMP PROB 1+ $37.75 $37.75 3/1/2020

87502 INFLUENZA DNA AMP PROBE $70.06 $70.06 3/1/2020


87505 NFCT AGENT DETECTION GI $93.10 $93.10 3/1/2020

87506 IADNA-DNA/RNA PROBE TQ 6-11 $141.05 $141.05 3/1/2020

87507 IADNA-DNA/RNA PROBE TQ 12-25 $260.90 $260.90 3/1/2020







87521 DETECTION TEST FOR; HEPATITIS C VIRUS $32.09 $32.09 3/1/2020

87522 DETECTION TEST FOR; HEPATITIS C VIRUS $42.61 $42.61 3/1/2020











87535 DETECTION TEST FOR HIV-1 VIRUS $32.09 $32.09 3/1/2020

















87563

DETECTION OF MYCOPLASMA GENITALIUM BY DNA OR RNA

PROBE$33.53 $33.53

3/1/2020







87623 HPV LOW-RISK TYPES $31.90 $31.90 3/1/2020

87624 HPV HIGH-RISK TYPES $31.90 $31.90 3/1/2020

87625 HPV TYPES 16 & 18 ONLY $31.90 $31.90 3/1/2020

87631 RESP VIRUS 3-5 TARGETS $92.16 $92.16 3/1/2020



87634 RSV DNA/RNA AMP PROBE $82.80 $82.80 3/1/2020

87635 SARS-COV-2 COVID-19 AMP PRB $70.06 $70.06 3/1/2020








87661 TRICHOMONAS VAGINALIS AMPLIF $31.33 $31.33 3/1/2020

87662 ZIKA VIRUS DNA/RNA AMP PROBE $60.53 $60.53 3/1/2020









87806 HIV ANTIGEN W/HIV ANTIBODIES $30.81 $30.81 3/1/2020




87810 INFECTIOUS AGENT DETECTION BY IMMUNOASSA $14.99 $14.99 3/1/2020




87900 INFECTIOUS AGENT DRUG SUSCEPTIBILITY PHE $106.56 $106.56 3/1/2020

87901 ANALYSIS TEST FOR HIV-1 VIRUS $102.12 $102.12 3/1/2020

87902 INFECTIOUS AGENT GENOTYPE ANALYSIS BY NU $102.12 $102.12 3/1/2020

87903 INFECTIOUS AGENT PHENOTYPE ANALYSIS BY N $356.08 $356.08 3/1/2020

87904 INFECTIOUS AGENT PHENOTYPE ANALYSIS BY N $21.32 $21.32 3/1/2020

87905 INFECTIOUS AGENT ENZYMATIC ACTIVITY OTHE $17.42 $17.42 3/1/2020

87906 ANALYSIS TEST FOR HIV-1 VIRUS $51.43 $51.43 3/1/2020

87910 ANALYSIS TEST FOR CYTOMEGALOVIRUS $100.45 $100.45 3/1/2020

87912 ANALYSIS TEST FOR HEPATITIS B VIRUS $100.45 $100.45 3/1/2020

88104 BODY FLUID CYTOLOGY $50.83 $50.83 3/1/2020

88104 26 BODY FLUID CYTOLOGY $23.72 $23.72 3/1/2020

88104 TC BODY FLUID CYTOLOGY $27.11 $27.11 3/1/2020

88106 CYTOPATHOLOGY FILTER METHOD ONLY WITH IN $63.00 $63.00 3/1/2020

88106 26 CYTOPATHOLOGY FILTER METHOD ONLY WITH IN $23.72 $23.72 3/1/2020

88106 TC CYTOPATHOLOGY FILTER METHOD ONLY WITH IN $39.28 $39.28 3/1/2020

88108 CYTOPATHOLOGY, CONCENTRATION TECHNIQUE, $59.73 $59.73 3/1/2020

88108 26 CYTOPATHOLOGY, CONCENTRATION TECHNIQUE, $23.72 $23.72 3/1/2020

88108 TC CYTOPATHOLOGY, CONCENTRATION TECHNIQUE, $36.03 $36.03 3/1/2020

88112 CYTOPATHOLOGY, SELECTIVE CELLULAR ENHANC $85.26 $85.26 3/1/2020

88112 26 CYTOPATHOLOGY, SELECTIVE CELLULAR ENHANC $48.65 $48.65 3/1/2020

88112 TC CYTOPATHOLOGY, SELECTIVE CELLULAR ENHANC $36.61 $36.61 3/1/2020

88120 CYTOPATHOLOGY, IN SITU HYBRIDIZATION (EG $388.56 $388.56 3/1/2020

88120 26 CYTOPATHOLOGY, IN SITU HYBRIDIZATION (EG $45.54 $45.54 3/1/2020

88120 TC CYTOPATHOLOGY, IN SITU HYBRIDIZATION (EG $342.93 $342.93 3/1/2020

88121 CYTOPATHOLOGY, IN SITU HYBRIDIZATION (EG $328.17 $328.17 3/1/2020

88121 26 CYTOPATHOLOGY, IN SITU HYBRIDIZATION (EG $40.48 $40.48 3/1/2020

88121 TC CYTOPATHOLOGY, IN SITU HYBRIDIZATION (EG $287.69 $287.69 3/1/2020

88125 CYTOPATHOLOGY FORENSIC $17.94 $17.94 3/1/2020

88125 26 CYTOPATHOLOGY FORENSIC $11.21 $11.21 3/1/2020

88125 TC CYTOPATHOLOGY FORENSIC $6.73 $6.73 3/1/2020

88130 BUCCAL SMEAR $19.69 $19.69 3/1/2020

88130 26 BUCCAL SMEAR $20.70 $20.70 3/1/2020

88140 SEX CHROMATIN IDENT PERIPH BLOOD SMEAR $10.46 $10.46 3/1/2020

88140 26 SEX CHROMATIN IDENT PERIPH BLOOD SMEAR $10.55 $10.55 3/1/2020

88141 CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY $23.08 $23.08 3/1/2020



88147 CYTOPATHOLOGY SMEARS, CERVICAL OR VAGINA $13.82 $13.82 3/1/2020

88148 CYTOPATHOLOGY SMEARS, CERVICAL OR VAGINA $13.82 $13.82 3/1/2020

88150 CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGIN $13.82 $13.82 3/1/2020




88160 CYTOPATHOLOGY, SMEARS, ANY OTHER SOURCE; $42.97 $42.97 3/1/2020

88160 26 CYTOPATHOLOGY, SMEARS, ANY OTHER SOURCE; $21.20 $21.20 3/1/2020

88160 TC CYTOPATHOLOGY, SMEARS, ANY OTHER SOURCE; $21.78 $21.78 3/1/2020

88161 CYTOPATHOLOGY PREPARATION SCREEN/INTERPR $44.75 $44.75 3/1/2020

88161 26 CYTOPATHOLOGY PREPARATION SCREEN/INTERPR $20.90 $20.90 3/1/2020

88161 TC CYTOPATHOLOGY PREPARATION SCREEN/INTERPR $23.86 $23.86 3/1/2020

88162 CYTOPATHOLOGY 5 SLIDES &/OR MULTIPLE STA $64.87 $64.87 3/1/2020

88162 26 CYTOPATHOLOGY 5 SLIDES &/OR MULTIPLE STA $32.41 $32.41 3/1/2020

88162 TC CYTOPATHOLOGY 5 SLIDES &/OR MULTIPLE STA $32.46 $32.46 3/1/2020





88172 CYTOPATHOLOGY, EVALUATION OF FINE NEEDLE $43.81 $43.81 3/1/2020

88172 26 CYTOPATHOLOGY, EVALUATION OF FINE NEEDLE $25.59 $25.59 3/1/2020

88172 TC CYTOPATHOLOGY, EVALUATION OF FINE NEEDLE $18.22 $18.22 3/1/2020

88173 EVALUATION OF FINE NEEDLE ASPIRATE INTER $111.02 $111.02 3/1/2020

88173 26 EVALUATION OF FINE NEEDLE ASPIRATE INTER $58.96 $58.96 3/1/2020

88173 TC EVALUATION OF FINE NEEDLE ASPIRATE INTER $52.05 $52.05 3/1/2020



88177 CYTOPATHOLOGY, EVALUATION OF FINE NEEDLE $23.99 $23.99 3/1/2020

88177 26 CYTOPATHOLOGY, EVALUATION OF FINE NEEDLE $18.61 $18.61 3/1/2020

88177 TC CYTOPATHOLOGY, EVALUATION OF FINE NEEDLE $5.41 $5.41 3/1/2020

88182 FLOW CYTOMETRY; CELL CYCLE OR DNA ANALYS $84.29 $84.29 3/1/2020

88182 26 FLOW CYTOMETRY; CELL CYCLE OR DNA ANALYS $30.65 $30.65 3/1/2020

88182 TC FLOW CYTOMETRY; CELL CYCLE OR DNA ANALYS $53.63 $53.63 3/1/2020

88184 FLOW CYTOMETRY, CELL SURFACE, CYTOPLASMI $64.22 $64.22 3/1/2020

88185 FLOW CYTOMETRY, CELL SURFACE, CYTOPLASMI $38.10 $38.10 3/1/2020

88187 FLOW CYTOMETRY, INTERPRETATION; 2 TO 8 M $56.01 $56.01 3/1/2020

88188 FLOW CYTOMETRY, INTERPRETATION; 9 TO 15 $68.96 $68.96 3/1/2020

88189 FLOW CYTOMETRY, INTERPRETATION; 16 OR MO $88.07 $88.07 3/1/2020

88230 TISSUE CULTURE FOR NON-NEOPLASTIC DISORD $152.42 $152.42 3/1/2020

88230 26 TISSUE CULTURE FOR NON-NEOPLASTIC DISORD $124.69 $124.69 3/1/2020

88230 TC TISSUE CULTURE FOR NON-NEOPLASTIC DISORD $40.93 $40.93 3/1/2020

88233 TISSUE CULTURE, SKIN $184.12 $184.12 3/1/2020

88233 26 TISSUE CULTURE, SKIN $150.81 $150.81 3/1/2020

88233 TC TISSUE CULTURE, SKIN $49.65 $49.65 3/1/2020

88235 TISSUE CULTURE, PLACENTA $192.65 $192.65 3/1/2020

88235 26 TISSUE CULTURE, PLACENTA $157.85 $157.85 3/1/2020

88235 TC TISSUE CULTURE, PLACENTA $51.99 $51.99 3/1/2020

88237 TISSUE CULTURE FOR NEOPLASTIC DISORDERS; $165.25 $165.25 3/1/2020

88237 26 TISSUE CULTURE FOR NEOPLASTIC DISORDERS; $135.25 $135.25 3/1/2020

88237 TC TISSUE CULTURE FOR NEOPLASTIC DISORDERS; $44.47 $44.47 3/1/2020

88239 TISSUE CULTURE FOR NEOPLASTIC DISORDERS; $193.01 $193.01 3/1/2020

88239 26 TISSUE CULTURE FOR NEOPLASTIC DISORDERS; $158.14 $158.14 3/1/2020

88239 TC TISSUE CULTURE FOR NEOPLASTIC DISORDERS; $52.09 $52.09 3/1/2020

88245 CHROMOSOME ANALYSIS FOR BREAKAGE SYNDROM $194.74 $194.74 3/1/2020

88245 26 CHROMOSOME ANALYSIS FOR BREAKAGE SYNDROM $159.58 $159.58 3/1/2020

88245 TC CHROMOSOME ANALYSIS FOR BREAKAGE SYNDROM $52.56 $52.56 3/1/2020

88248 CHROMOSOME ANALYSIS FOR BREAKAGE SYNDROM $226.57 $226.57 3/1/2020

88248 26 CHROMOSOME ANALYSIS FOR BREAKAGE SYNDROM $185.80 $185.80 3/1/2020

88248 TC CHROMOSOME ANALYSIS FOR BREAKAGE SYNDROM $61.31 $61.31 3/1/2020

88261 CHROMOSOME ANALYSIS; COUNT 5 CELLS, 1 KA $231.23 $231.23 3/1/2020

88261 26 CHROMOSOME ANALYSIS; COUNT 5 CELLS, 1 KA $189.63 $189.63 3/1/2020

88261 TC CHROMOSOME ANALYSIS; COUNT 5 CELLS, 1 KA $62.58 $62.58 3/1/2020

88262 CHROMOSOME ANALYSIS OPTION III $163.07 $163.07 3/1/2020

88262 26 CHROMOSOME ANALYSIS OPTION III $133.47 $133.47 3/1/2020

88262 TC CHROMOSOME ANALYSIS OPTION III $43.86 $43.86 3/1/2020

88263 CHROMOSOME ANALYSIS $196.61 $196.61 3/1/2020

88263 26 CHROMOSOME ANALYSIS $161.11 $161.11 3/1/2020

88263 TC CHROMOSOME ANALYSIS $53.08 $53.08 3/1/2020

88264 CHROMOSOME ANALYSIS; ANALYZE 20-25 CELLS $163.07 $163.07 3/1/2020

88264 26 CHROMOSOME ANALYSIS; ANALYZE 20-25 CELLS $133.47 $133.47 3/1/2020

88264 TC CHROMOSOME ANALYSIS; ANALYZE 20-25 CELLS $43.86 $43.86 3/1/2020

88267 CHROMOSOME ANALYSIS AMNIOTIC FLUID 1-4 C $235.19 $235.19 3/1/2020

88267 26 CHROMOSOME ANALYSIS AMNIOTIC FLUID 1-4 C $192.91 $192.91 3/1/2020

88267 TC CHROMOSOME ANALYSIS AMNIOTIC FLUID 1-4 C $63.67 $63.67 3/1/2020

88269 CHROMOSOME ANALYSIS AMNIONIC FLUID $217.60 $217.60 3/1/2020

88269 26 CHROMOSOME ANALYSIS AMNIONIC FLUID $178.41 $178.41 3/1/2020

88269 TC CHROMOSOME ANALYSIS AMNIONIC FLUID $58.84 $58.84 3/1/2020

88271 MOLECULAR CYTOGENETICS; DNA PROBE, EACH $18.93 $18.93 3/1/2020

88271 26 MOLECULAR CYTOGENETICS; DNA PROBE, EACH $14.67 $14.67 3/1/2020

88271 TC MOLECULAR CYTOGENETICS; DNA PROBE, EACH $4.26 $4.26 3/1/2020

88272 MOLECULAR CYTOGENETICS; CHROMOSOMAL IN S $35.03 $35.03 3/1/2020

88272 26 MOLECULAR CYTOGENETICS; CHROMOSOMAL IN S $27.94 $27.94 3/1/2020

88272 TC MOLECULAR CYTOGENETICS; CHROMOSOMAL IN S $8.68 $8.68 3/1/2020

88273 MOLECULAR CYTOGENETICS; CHROMOSOMAL IN S $42.03 $42.03 3/1/2020

88273 26 MOLECULAR CYTOGENETICS; CHROMOSOMAL IN S $33.71 $33.71 3/1/2020

88273 TC MOLECULAR CYTOGENETICS; CHROMOSOMAL IN S $10.61 $10.61 3/1/2020

88274 MOLECULAR CYTOGENETICS; INTERPHASE IN SI $45.54 $45.54 3/1/2020

88274 26 MOLECULAR CYTOGENETICS; INTERPHASE IN SI $36.59 $36.59 3/1/2020

88274 TC MOLECULAR CYTOGENETICS; INTERPHASE IN SI $11.58 $11.58 3/1/2020

88275 MOLECULAR CYTOGENETICS; INTERPHASE IN SI $52.54 $52.54 3/1/2020

88275 26 MOLECULAR CYTOGENETICS; INTERPHASE IN SI $42.37 $42.37 3/1/2020

88275 TC MOLECULAR CYTOGENETICS; INTERPHASE IN SI $13.50 $13.50 3/1/2020

88280 CHROM ANALYSIS ADDITIONAL KAROTYPING $32.83 $32.83 3/1/2020

88280 26 CHROM ANALYSIS ADDITIONAL KAROTYPING $26.12 $26.12 3/1/2020

88280 TC CHROM ANALYSIS ADDITIONAL KAROTYPING $8.09 $8.09 3/1/2020

88283 BANDING FOR CHROMOSOME ANALYSIS $25.20 $25.20 3/1/2020

88283 26 BANDING FOR CHROMOSOME ANALYSIS $19.82 $19.82 3/1/2020

88283 TC BANDING FOR CHROMOSOME ANALYSIS $5.99 $5.99 3/1/2020

88285 CHROM ANAL ADDITIONAL CELLS COUNTED $24.85 $24.85 3/1/2020

88285 26 CHROM ANAL ADDITIONAL CELLS COUNTED $19.55 $19.55 3/1/2020

88285 TC CHROM ANAL ADDITIONAL CELLS COUNTED $5.89 $5.89 3/1/2020

88289 HIGH RESOLUTION FOR CHROMOSOME ANALYSIS $44.37 $44.37 3/1/2020

88289 26 HIGH RESOLUTION FOR CHROMOSOME ANALYSIS $35.64 $35.64 3/1/2020

88289 TC HIGH RESOLUTION FOR CHROMOSOME ANALYSIS $11.26 $11.26 3/1/2020

88291 CYTOGENETICS AND MOLECULAR CYTOGENETICS, $24.50 $24.50 3/1/2020

88300 EXAM OF SURGICAL SPECIMEN $18.99 $18.99 3/1/2020

88300 26 EXAM OF SURGICAL SPECIMEN $3.66 $3.66 3/1/2020

88300 TC EXAM OF SURGICAL SPECIMEN $15.34 $15.34 3/1/2020

88302 SURG PATHOLOGY GROSS MICROSCOPIC EXAM ID $39.81 $39.81 3/1/2020

88302 26 SURG PATHOLOGY GROSS MICROSCOPIC EXAM ID $5.57 $5.57 3/1/2020

88302 TC SURG PATHOLOGY GROSS MICROSCOPIC EXAM ID $34.24 $34.24 3/1/2020

88304 LEVEL III - SURGICAL PATHOLOGY, GROSS AN $50.70 $50.70 3/1/2020

88304 26 LEVEL III - SURGICAL PATHOLOGY, GROSS AN $9.35 $9.35 3/1/2020

88304 TC LEVEL III - SURGICAL PATHOLOGY, GROSS AN $41.36 $41.36 3/1/2020

88305 LEVEL IV - SURGICAL PATHOLOGY, GROSS AND $86.63 $86.63 3/1/2020

88305 26 LEVEL IV - SURGICAL PATHOLOGY, GROSS AND $32.10 $32.10 3/1/2020

88305 TC LEVEL IV - SURGICAL PATHOLOGY, GROSS AND $54.53 $54.53 3/1/2020

88307 LEVEL V - SURGICAL PATHOLOGY, GROSS AND $173.65 $173.65 3/1/2020

88307 26 LEVEL V - SURGICAL PATHOLOGY, GROSS AND $68.26 $68.26 3/1/2020

88307 TC LEVEL V - SURGICAL PATHOLOGY, GROSS AND $105.39 $105.39 3/1/2020

88309 SURGICAL PATHOLOGY SEVEN OR MORE BLOCKS $262.45 $262.45 3/1/2020

88309 26 SURGICAL PATHOLOGY SEVEN OR MORE BLOCKS $117.87 $117.87 3/1/2020

88309 TC SURGICAL PATHOLOGY SEVEN OR MORE BLOCKS $144.56 $144.56 3/1/2020

88311 SURGICAL PATHOLOGY DECALCIFICATION PROCE $15.23 $15.23 3/1/2020

88311 26 SURGICAL PATHOLOGY DECALCIFICATION PROCE $10.28 $10.28 3/1/2020

88311 TC SURGICAL PATHOLOGY DECALCIFICATION PROCE $4.95 $4.95 3/1/2020

88312 SPECIAL STAINS (LIST SEPARATELY IN ADDIT $81.45 $81.45 3/1/2020

88312 26 SPECIAL STAINS (LIST SEPARATELY IN ADDIT $22.77 $22.77 3/1/2020

88312 TC SPECIAL STAINS (LIST SEPARATELY IN ADDIT $58.66 $58.66 3/1/2020

88313 SPECIAL STAINS GROUP 11 ALL OTHER SPECIA $59.15 $59.15 3/1/2020

88313 26 SPECIAL STAINS GROUP 11 ALL OTHER SPECIA $9.99 $9.99 3/1/2020

88313 TC SPECIAL STAINS GROUP 11 ALL OTHER SPECIA $49.16 $49.16 3/1/2020

88314 HISTOCHEMICAL STAINING WITH FROZEN SECTI $72.53 $72.53 3/1/2020

88314 26 HISTOCHEMICAL STAINING WITH FROZEN SECTI $19.30 $19.30 3/1/2020

88314 TC HISTOCHEMICAL STAINING WITH FROZEN SECTI $53.24 $53.24 3/1/2020

88319 HISTOCHEMISTRY TO IDENTIFY ENZYME CONSTI $113.07 $113.07 3/1/2020

88319 26 HISTOCHEMISTRY TO IDENTIFY ENZYME CONSTI $22.45 $22.45 3/1/2020

88319 TC HISTOCHEMISTRY TO IDENTIFY ENZYME CONSTI $90.63 $90.63 3/1/2020

88321 CONSULTATION ON TISSUE EXAM $68.16 $75.27 3/1/2020

88323 CONS REPORT REFERRED MATERIAL REQ PREPAR $120.09 $120.09 3/1/2020

88323 26 CONS REPORT REFERRED MATERIAL REQ PREPAR $73.97 $73.97 3/1/2020

88323 TC CONS REPORT REFERRED MATERIAL REQ PREPAR $46.11 $46.11 3/1/2020

88325 COMPREHENSIVE REVIEW RECORDS SLIDES W/RE $105.97 $159.98 3/1/2020

88329 OPERATING ROOM CONSULTATION $28.73 $41.49 3/1/2020

88331 PATHOLOGY CONSULTATION DURING SURGERY; F $75.13 $75.13 3/1/2020

88331 26 PATHOLOGY CONSULTATION DURING SURGERY; F $51.45 $51.45 3/1/2020

88331 TC PATHOLOGY CONSULTATION DURING SURGERY; F $23.67 $23.67 3/1/2020

88332 CONS DURING SURG EACH ADD FROZ SECT SAME $33.69 $33.69 3/1/2020

88332 26 CONS DURING SURG EACH ADD FROZ SECT SAME $25.27 $25.27 3/1/2020

88332 TC CONS DURING SURG EACH ADD FROZ SECT SAME $8.42 $8.42 3/1/2020

88333 PATHOLOGY CONSULTATION DURING SURGERY; C $76.92 $76.92 3/1/2020

88333 26 PATHOLOGY CONSULTATION DURING SURGERY; C $51.48 $51.48 3/1/2020

88333 TC PATHOLOGY CONSULTATION DURING SURGERY; C $25.44 $25.44 3/1/2020

88334 PATHOLOGY CONSULTATION DURING SURGERY; C $46.49 $46.49 3/1/2020

88334 26 PATHOLOGY CONSULTATION DURING SURGERY; C $30.95 $30.95 3/1/2020

88334 TC PATHOLOGY CONSULTATION DURING SURGERY; C $15.55 $15.55 3/1/2020

88341 IMMUNOHISTO ANTB ADDL SLIDE $55.37 $55.37 3/1/2020

88341 26 IMMUNOHISTO ANTB ADDL SLIDE $18.56 $18.56 3/1/2020

88341 TC IMMUNOHISTO ANTB ADDL SLIDE $36.80 $36.80 3/1/2020

88342 IMMUNOHISTO ANTB 1ST STAIN $82.30 $82.30 3/1/2020

88342 26 IMMUNOHISTO ANTB 1ST STAIN $35.61 $35.61 3/1/2020

88342 TC IMMUNOHISTO ANTB 1ST STAIN $46.70 $46.70 3/1/2020

88344 IMMUNOHISTO ANTIBODY SLIDE $96.46 $96.46 3/1/2020

88344 26 IMMUNOHISTO ANTIBODY SLIDE $34.13 $34.13 3/1/2020

88344 TC IMMUNOHISTO ANTIBODY SLIDE $62.34 $62.34 3/1/2020

88346 IMMUNOFLUOR ANTB 1ST STAIN $82.61 $82.61 3/1/2020

88346 26 IMMUNOFLUOR ANTB 1ST STAIN $36.23 $36.23 3/1/2020

88346 TC IMMUNOFLUOR ANTB 1ST STAIN $46.41 $46.41 3/1/2020

88348 ELECTRON MICROSCOPY DIAGNOSTIC $510.50 $510.50 3/1/2020

88348 26 ELECTRON MICROSCOPY DIAGNOSTIC $63.91 $63.91 3/1/2020

88348 TC ELECTRON MICROSCOPY DIAGNOSTIC $446.59 $446.59 3/1/2020

88350 IMMUNOFLUOR ANTB ADDL STAIN $65.59 $65.59 3/1/2020

88350 26 IMMUNOFLUOR ANTB ADDL STAIN $26.75 $26.75 3/1/2020

88350 TC IMMUNOFLUOR ANTB ADDL STAIN $38.84 $38.84 3/1/2020

88355 MORPHOMETRIC ANALYSIS SKELETAL MUSCLE $197.63 $197.63 3/1/2020

88355 26 MORPHOMETRIC ANALYSIS SKELETAL MUSCLE $75.02 $75.02 3/1/2020

88355 TC MORPHOMETRIC ANALYSIS SKELETAL MUSCLE $122.61 $122.61 3/1/2020

88356 MORPHOMETRIC ANALYSIS NERVE $241.12 $241.12 3/1/2020

88356 26 MORPHOMETRIC ANALYSIS NERVE $119.81 $119.81 3/1/2020

88356 TC MORPHOMETRIC ANALYSIS NERVE $121.32 $121.32 3/1/2020

88358 MORPHOMETRIC ANALYSIS; TUMOR (EG, DNA PL $64.51 $64.51 3/1/2020

88358 26 MORPHOMETRIC ANALYSIS; TUMOR (EG, DNA PL $39.05 $39.05 3/1/2020

88358 TC MORPHOMETRIC ANALYSIS; TUMOR (EG, DNA PL $25.46 $25.46 3/1/2020

88360 MORPHOMETRIC ANALYSIS, TUMOR IMMUNOHISTO $99.54 $99.54 3/1/2020

88360 26 MORPHOMETRIC ANALYSIS, TUMOR IMMUNOHISTO $46.31 $46.31 3/1/2020

88360 TC MORPHOMETRIC ANALYSIS, TUMOR IMMUNOHISTO $53.24 $53.24 3/1/2020

88361 MORPHOMETRIC ANALYSIS; TUMOR IMMUNOHISTO $125.01 $125.01 3/1/2020

88361 26 MORPHOMETRIC ANALYSIS; TUMOR IMMUNOHISTO $49.68 $49.68 3/1/2020

88361 TC MORPHOMETRIC ANALYSIS; TUMOR IMMUNOHISTO $75.33 $75.33 3/1/2020

88362 NERVE TEASING PREPARATION $217.20 $217.20 3/1/2020

88362 26 NERVE TEASING PREPARATION $91.63 $91.63 3/1/2020

88362 TC NERVE TEASING PREPARATION $125.57 $125.57 3/1/2020

88364 INSITU HYBRIDIZATION (FISH) $79.98 $79.98 3/1/2020

88364 26 INSITU HYBRIDIZATION (FISH) $23.16 $23.16 3/1/2020

88364 TC INSITU HYBRIDIZATION (FISH) $56.83 $56.83 3/1/2020

88365 TISSUE IN SITU HYBRIDIZATION, INTERP. AN $129.43 $129.43 3/1/2020

88365 26 TISSUE IN SITU HYBRIDIZATION, INTERP. AN $49.79 $49.79 3/1/2020

88365 TC TISSUE IN SITU HYBRIDIZATION, INTERP. AN $79.64 $79.64 3/1/2020

88366 INSITU HYBRIDIZATION (FISH) $123.61 $123.61 3/1/2020

88366 26 INSITU HYBRIDIZATION (FISH) $53.73 $53.73 3/1/2020

88366 TC INSITU HYBRIDIZATION (FISH) $69.88 $69.88 3/1/2020

88367 MORPHOMETRIC ANALYSIS, IN SITU HYBRIDIZA $197.30 $197.30 3/1/2020

88367 26 MORPHOMETRIC ANALYSIS, IN SITU HYBRIDIZA $53.32 $53.32 3/1/2020

88367 TC MORPHOMETRIC ANALYSIS, IN SITU HYBRIDIZA $143.97 $143.97 3/1/2020

88368 MORPHOMETRIC ANALYSIS, IN SITU HYBRIDIZA $174.09 $174.09 3/1/2020

88368 26 MORPHOMETRIC ANALYSIS, IN SITU HYBRIDIZA $56.24 $56.24 3/1/2020

88368 TC MORPHOMETRIC ANALYSIS, IN SITU HYBRIDIZA $117.85 $117.85 3/1/2020

88369 M/PHMTRC ALYSISHQUANT/SEMIQ $60.83 $60.83 3/1/2020

88369 26 M/PHMTRC ALYSISHQUANT/SEMIQ $21.42 $21.42 3/1/2020

88369 TC M/PHMTRC ALYSISHQUANT/SEMIQ $39.42 $39.42 3/1/2020

88371 26 PROTEIN ANALYSIS OF TISSUE BY WESTERN BL $15.65 $15.65 3/1/2020

88372 26 PROTEIN ANALYSIS OF TISSUE BY WESTERN BL $15.65 $15.65 3/1/2020

88372 TC PROTEIN ANALYSIS OF TISSUE BY WESTERN BL $15.97 $15.97 3/1/2020

88373 M/PHMTRC ALYS ISHQUANT/SEMIQ $49.58 $49.58 3/1/2020

88373 26 M/PHMTRC ALYS ISHQUANT/SEMIQ $18.01 $18.01 3/1/2020

88373 TC M/PHMTRC ALYS ISHQUANT/SEMIQ $31.57 $31.57 3/1/2020







88387 MACROSCOPIC EXAMINATION, DISSECTION, AND $25.92 $25.92 3/1/2020

88387 26 MACROSCOPIC EXAMINATION, DISSECTION, AND $20.87 $20.87 3/1/2020

88387 TC MACROSCOPIC EXAMINATION, DISSECTION, AND $5.04 $5.04 3/1/2020

88388 MACROSCOPIC EXAMINATION, DISSECTION, AND $15.49 $15.49 3/1/2020

88388 26 MACROSCOPIC EXAMINATION, DISSECTION, AND $13.01 $13.01 3/1/2020

88388 TC MACROSCOPIC EXAMINATION, DISSECTION, AND $2.48 $2.48 3/1/2020

88720 BILIRUBIN, TOTAL, TRANSCUTANEOUS $6.60 $6.60 3/1/2020

88738 HEMOGLOBIN (HGB), QUANTITATIVE, TRANSCUT $6.73 $6.73 3/1/2020

88740 HEMOGLOBIN, QUANTITATIVE, TRANSCUTANEOUS $6.87 $6.87 3/1/2020

88741 HEMOGLOBIN, QUANTITATIVE, TRANSCUTANEOUS $6.87 $6.87 3/1/2020

89049 CAFFEINE HALOTHANE CONTRACTURE TEST (CHC $56.24 $173.01 3/1/2020

89050 CELL COUNT, MISCELLANEOUS BODY FLUIDS (E $6.20 $6.20 3/1/2020

89051 SYNOVIAL FLUID DIFF $6.81 $6.81 3/1/2020

89055 LEUKOCYTE ASSESSMENT FECAL $5.58 $5.58 3/1/2020

89060 CRYSTAL ID, SYNOVIAL FLUID $9.36 $9.36 3/1/2020

89125 FAT STAIN, FECES, URINE, OR RESPIRATORY $5.65 $5.65 3/1/2020

89160 MEAT FIBERS FECES $4.83 $4.83 3/1/2020

89190 NASAL SMEAR FOR EOSINOPHILS $6.09 $6.09 3/1/2020

89300 SEMEN ANALYSIS; PRESENCE AND/OR MOTILITY $11.66 $11.66 3/1/2020

89310 SEMEN ANALYSIS; MOTILITY AND COUNT (NOT $10.97 $10.97 3/1/2020

89320 SEMEN ANALYSIS COMPLETE $15.76 $15.76 3/1/2020

89325 SPERM AGGLUTINATION WITH ANTIBODY TITER $13.97 $13.97 3/1/2020

92537 CALORIC VSTBLR TEST W/REC $37.57 $37.57 3/1/2020

92537 26 CALORIC VSTBLR TEST W/REC $29.98 $29.98 3/1/2020

92537 TC CALORIC VSTBLR TEST W/REC $7.58 $7.58 3/1/2020

92538 CALORIC VSTBLR TEST W/REC $19.08 $19.08 3/1/2020

92538 26 CALORIC VSTBLR TEST W/REC $14.99 $14.99 3/1/2020

92538 TC CALORIC VSTBLR TEST W/REC $4.08 $4.08 3/1/2020

94010 SPIROMETRY, INCLUDING GRAPHIC RECORD, TO $27.13 $27.13 3/1/2020

97164 PT RE-EVAL EST PLAN CARE $50.78 $50.78 3/1/2020

97165 OT EVAL LOW COMPLEX 30 MIN $72.71 $72.71 3/1/2020

97166 OT EVAL MOD COMPLEX 45 MIN $72.71 $72.71 3/1/2020

97167 OT EVAL HIGH COMPLEX 60 MIN $72.71 $72.71 3/1/2020

97168 OT RE-EVAL EST PLAN CARE $47.97 $47.97 3/1/2020

99195 THERAPEUTIC PHLEBOTOMY $57.69 $57.69 3/1/2020

C9803 HOPD COVID-19 SPEC COLLECT $24.00 $24.00 3/1/2020

G0328 COLORECTAL CANCER SCREENING; FECAL OCCUL $20.96 $20.96 3/1/2020

G0416 PROSTATE BIOPSY, ANY MTHD $524.43 $524.43 3/1/2020

G0480 DRUG TEST DEF 1-7 CLASSES $76.39 $76.39 3/1/2020

G0481 DRUF TEST DEF 8-14 CLASSES $117.52 $117.52 3/1/2020

G0482 DRUF TEST DEF 15-21 CLASSES $158.64 $158.64 3/1/2020

G0483 DRUF TEST DEF 22 OR MORE DRUG CLASSES $205.65 $205.65 3/1/2020

G2023 SPECIMEN COLLECT COVID-19 $23.46 $23.46 3/1/2020

G2024 SPEC COLL SNF/LAB COVID-19 $25.46 $25.46 3/1/2020

U0001 2019-NCOV Diagnostic P $37.71 $37.71 3/1/2020

U0002 COVID-19 Lab Test Non-CDC $53.88 $53.88 3/1/2020

U0003 COV-19 AMP PRB HGH THRUPUT $100.00 $100.00 3/18/2020

U0004 COV-19 TEST NON-CDC HGH THRU $100.00 $100.00 3/18/2020

Providers should always bill their usual and customary charges. Please use the monthly NC Medicaid Bulletins for additions, changes, and deletion to this

schedule.

Documents

Laboratory Fee Schedule Provider Specialty 069 Taxonomy ...€¦ · 2 days ago · 80048 basic metabolic panel $10.49 3/1/2020 80050 general health screen panel $11.83 $12.08 3/1/2020