procedure current code description pricing description ... · 80346 benzodiazepines1-12 16.68...

Pathology and Laboratory

Codes and Rates

Procedure

CodeCode Description

Current

RatePricing Description

80047 Metabolic panel ionized ca 22.46 General Fee Schedule

80048 Metabolic panel total ca 10.91 General Fee Schedule

80050 General health panel 44.49 General Fee Schedule

80051 Electrolyte panel 9.03 General Fee Schedule

80053 Comprehen metabolic panel 13.64 General Fee Schedule

80055 Obstetric panel 31.68 General Fee Schedule

80061 Lipid panel 17.27 General Fee Schedule

80069 Renal function panel 11.19 General Fee Schedule

80074 Acute hepatitis panel 61.40 General Fee Schedule

80076 Hepatic function panel 10.54 General Fee Schedule

80150 Assay of amikacin 19.43 General Fee Schedule

80155 Drug screen quant caffeine 14.84 General Fee Schedule

80156 Assay carbamazepine total 18.77 General Fee Schedule

80157 Assay carbamazepine free 12.82 General Fee Schedule

80158 Assay of cyclosporine 23.27 General Fee Schedule

80159 Drug screen quant clozapine 19.40 General Fee Schedule

80162 Assay of digoxin total 17.11 General Fee Schedule

80163 Assay of digoxin free 17.11 General Fee Schedule

80164 Assay dipropylacetic acd tot 17.45 General Fee Schedule

80165 Dipropylacetic acid free 17.45 General Fee Schedule

80168 Assay of ethosuximide 21.05 General Fee Schedule

80169 Drug screen quant everolimus 14.40 General Fee Schedule

80170 Assay of gentamicin 21.12 General Fee Schedule

80171 Drug screen quant gabapentin 13.91 General Fee Schedule

80173 Assay of haloperidol 18.77 General Fee Schedule

80175 Drug screen quan lamotrigine 13.91 General Fee Schedule

80176 Assay of lidocaine 18.93 General Fee Schedule

80177 Drug scrn quan levetiracetam 13.91 General Fee Schedule

80178 Assay of lithium 8.52 General Fee Schedule

80180 Drug scrn quan mycophenolate 18.93 General Fee Schedule

80183 Drug scrn quant oxcarbazepin 13.91 General Fee Schedule

80184 Assay of phenobarbital 14.70 General Fee Schedule

80185 Assay of phenytoin total 17.07 General Fee Schedule

80186 Assay of phenytoin free 17.76 General Fee Schedule

80188 Assay of primidone 21.39 General Fee Schedule

80190 Assay of procainamide 21.59 General Fee Schedule

80192 Assay of procainamide 21.59 General Fee Schedule

80194 Assay of quinidine 18.82 General Fee Schedule

80195 Assay of sirolimus 13.37 General Fee Schedule

80197 Assay of tacrolimus 17.71 General Fee Schedule

80198 Assay of theophylline 18.25 General Fee Schedule

80199 Drug screen quant tiagabine 19.03 General Fee Schedule

80200 Assay of tobramycin 20.79 General Fee Schedule

80201 Assay of topiramate 15.38 General Fee Schedule

80202 Assay of vancomycin 17.45 General Fee Schedule

80203 Drug screen quant zonisamide 13.91 General Fee Schedule

80299 Quantitative assay drug 17.65 General Fee Schedule

80300 Drug screen non tlc devices 13.61 General Fee Schedule

80301 Drug screen class list a 13.61 General Fee Schedule

80302 Drug screen prsmptv 1 class 13.61 General Fee Schedule

Data for November 2015


Codes and Rates

Procedure


Current


80303 Drug screen one/mult class 15.40 General Fee Schedule

80304 Drug screen one/mult class 15.13 General Fee Schedule

80320 Drug screen quantalcohols 16.68 General Fee Schedule

80321 Alcohols biomarkers 1or 2 16.68 General Fee Schedule

80322 Alcohols biomarkers 3/more 16.68 General Fee Schedule

80323 Alkaloids nos 16.68 General Fee Schedule

80324 Drug screen amphetamines 1/2 16.68 General Fee Schedule

80325 Amphetamines 3or 4 16.68 General Fee Schedule

80326 Amphetamines 5 or more 16.68 General Fee Schedule

80327 Anabolic steroid 1 or 2 16.68 General Fee Schedule

80328 Anabolic steroid 3 or more 16.68 General Fee Schedule

80329 Analgesics non-opioid 1 or 2 16.68 General Fee Schedule

80330 Analgesics non-opioid 3-5 16.68 General Fee Schedule

80331 Analgesics non-opioid 6/more 16.68 General Fee Schedule

80332 Antidepressants class 1 or 2 16.68 General Fee Schedule

80333 Antidepressants class 3-5 16.68 General Fee Schedule

80334 Antidepressants class 6/more 16.68 General Fee Schedule

80335 Antidepressant tricyclic 1/2 16.68 General Fee Schedule

80336 Antidepressant tricyclic 3-5 16.68 General Fee Schedule

80337 Tricyclic & cyclicals 6/more 16.68 General Fee Schedule

80338 Antidepressant not specified 16.68 General Fee Schedule

80339 Antiepileptics nos 1-3 16.68 General Fee Schedule

80340 Antiepileptics nos 4-6 16.68 General Fee Schedule

80341 Antiepileptics nos 7/more 16.68 General Fee Schedule

80342 Antipsychotics nos 1-3 16.68 General Fee Schedule

80343 Antipsychotics nos 4-6 16.68 General Fee Schedule

80344 Antipsychotics nos 7/more 16.68 General Fee Schedule

80345 Drug screening barbiturates 16.68 General Fee Schedule

80346 Benzodiazepines1-12 16.68 General Fee Schedule

80347 Benzodiazepines 13 or more 16.68 General Fee Schedule

80348 Drug screening buprenorphine 16.68 General Fee Schedule

80349 Cannabinoids natural 16.68 General Fee Schedule

80350 Cannabinoids synthetic 1-3 16.68 General Fee Schedule

80351 Cannabinoids synthetic 4-6 16.68 General Fee Schedule

80352 Cannabinoid synthetic 7/more 16.68 General Fee Schedule

80353 Drug screening cocaine 16.68 General Fee Schedule

80354 Drug screening fentanyl 16.68 General Fee Schedule

80355 Gabapentin non-blood 16.68 General Fee Schedule

80356 Heroin metabolite 16.68 General Fee Schedule

80357 Ketamine and norketamine 16.68 General Fee Schedule

80358 Drug screening methadone 16.68 General Fee Schedule

80359 Methylenedioxyamphetamines 16.68 General Fee Schedule

80360 Methylphenidate 16.68 General Fee Schedule

80361 Opiates 1 or more 16.68 General Fee Schedule

80362 Opioids & opiate analogs 1/2 16.68 General Fee Schedule

80363 Opioids & opiate analogs 3/4 16.68 General Fee Schedule

80364 Opioid &opiate analog 5/more 16.68 General Fee Schedule

80365 Drug screening oxycodone 16.68 General Fee Schedule

80366 Drug screening pregabalin 16.68 General Fee Schedule

80367 Drug screening propoxyphene 16.68 General Fee Schedule



Codes and Rates

Procedure


Current


80368 Sedative hypnotics 16.68 General Fee Schedule

80369 Skeletal muscle relaxant 1/2 16.68 General Fee Schedule

80370 Skel musc relaxant 3 or more 16.68 General Fee Schedule

80371 Stimulants synthetic 16.68 General Fee Schedule

80372 Drug screening tapentadol 16.68 General Fee Schedule

80373 Drug screening tramadol 16.68 General Fee Schedule

80374 Stereoisomer analysis 16.68 General Fee Schedule

80375 Drug/substance nos 1-3 16.68 General Fee Schedule

80376 Drug/substance nos 4-6 16.68 General Fee Schedule

80377 Drug/substance nos 7/more 16.68 General Fee Schedule

80400 Acth stimulation panel 42.03 General Fee Schedule



80408 Aldosterone suppression eval 161.77 General Fee Schedule

80410 Calcitonin stimul panel 103.56 General Fee Schedule

80412 Crh stimulation panel 424.83 General Fee Schedule

80414 Testosterone response 66.25 General Fee Schedule

80415 Estradiol response panel 72.05 General Fee Schedule

80416 Renin stimulation panel 170.12 General Fee Schedule

80417 Renin stimulation panel 56.70 General Fee Schedule

80418 Pituitary evaluation panel 747.05 General Fee Schedule

80420 Dexamethasone panel 92.85 General Fee Schedule

80422 Glucagon tolerance panel 59.42 General Fee Schedule

80424 Glucagon tolerance panel 65.11 General Fee Schedule

80426 Gonadotropin hormone panel 191.36 General Fee Schedule

80428 Growth hormone panel 85.95 General Fee Schedule

80430 Growth hormone panel 101.13 General Fee Schedule

80432 Insulin suppression panel 151.41 General Fee Schedule

80434 Insulin tolerance panel 130.34 General Fee Schedule

80435 Insulin tolerance panel 132.74 General Fee Schedule

80436 Metyrapone panel 117.50 General Fee Schedule

80438 Trh stimulation panel 64.95 General Fee Schedule

80439 Trh stimulation panel 86.60 General Fee Schedule

80500 Lab pathology consultation 18.97 General Fee Schedule

80502 Lab pathology consultation 50.08 General Fee Schedule

81000 Urinalysis nonauto w/scope 4.07 General Fee Schedule

81001 Urinalysis auto w/scope 4.07 General Fee Schedule

81002 URINALYSIS NONAUTO W/SCOPE 3.29 General Fee Schedule

81003 Urinalysis auto w/o scope 2.90 General Fee Schedule

81005 URINALYSIS 2.78 General Fee Schedule

81007 Urine screen for bacteria 3.30 General Fee Schedule

81015 MICROSCOPIC EXAM OF URINE 3.90 General Fee Schedule

81020 Urinalysis glass test 4.73 General Fee Schedule

81025 URINE PREGNANCY TEST 8.15 General Fee Schedule

81050 Urinalysis volume measure 3.84 General Fee Schedule

81099 UNLISTED URINALYSIS PROCEDURE 0 Manual Price

81200 Aspa gene 846.84 General Fee Schedule

81201 Apc gene full sequence 1104.19 General Fee Schedule

81202 Apc gene known fam variants 67.44 General Fee Schedule

81203 Apc gene dup/delet variants 526.57 General Fee Schedule



Codes and Rates

Procedure


Current


81206 Bcr/abl1 gene major bp 143.48 General Fee Schedule

81207 Bcr/abl1 gene minor bp 143.48 General Fee Schedule

81208 Bcr/abl1 gene other bp 166.64 General Fee Schedule

81209 Blm gene 846.84 General Fee Schedule

81210 Braf gene 165.83 General Fee Schedule

81211 Brca1&2 seq & com dup/del 2958.34 General Fee Schedule

81212 Brca1&2 185&5385&6174 var 186.07 General Fee Schedule

81213 Brca1&2 uncom dup/del var 903.21 General Fee Schedule

81214 Brca1 full seq & com dup/del 1536.81 General Fee Schedule

81215 Brca1 gene known fam variant 96.30 General Fee Schedule

81216 Brca2 gene full sequence 2142.46 General Fee Schedule

81217 Brca2 gene known fam variant 96.20 General Fee Schedule

81220 Cftr gene com variants 1550.66 General Fee Schedule

81221 Cftr gene known fam variants 86.86 General Fee Schedule

81222 Cftr gene dup/delet variants 424.96 General Fee Schedule

81223 Cftr gene full sequence 4055.59 General Fee Schedule

81224 Cftr gene intron poly t 76.28 General Fee Schedule

81228 Cytogen micrarray copy nmbr 662.92 General Fee Schedule

81229 Cytogen m array copy no&snp 2296.26 General Fee Schedule

81235 Egfr gene com variants 250.62 General Fee Schedule

81240 F2 gene 61.65 General Fee Schedule

81241 F5 gene 40.87 General Fee Schedule

81242 Fancc gene 846.84 General Fee Schedule

81243 Fmr1 gene detection 216.01 General Fee Schedule

81244 Fmr1 gene characterization 92.46 General Fee Schedule

81245 Flt3 gene 83.13 General Fee Schedule

81250 G6pc gene 86.74 General Fee Schedule

81251 Gba gene 846.84 General Fee Schedule

81252 Gjb2 gene full sequence 196.20 General Fee Schedule

81253 Gjb2 gene known fam variants 75.33 General Fee Schedule

81254 Gjb6 gene com variants 0 Manual Price

81255 Hexa gene 846.84 General Fee Schedule

81256 Hfe gene 35.92 General Fee Schedule

81257 Hba1/hba2 gene 169.24 General Fee Schedule

81260 Ikbkap gene 846.84 General Fee Schedule

81261 Igh gene rearrange amp meth 116.42 General Fee Schedule

81262 Igh gene rearrang dir probe 45.23 General Fee Schedule

81264 Igk rearrangeabn clonal pop 154.71 General Fee Schedule

81265 Str markers specimen anal 221.13 General Fee Schedule

81266 Str markers spec anal addl 46.66 General Fee Schedule

81267 Chimerism anal no cell selec 42.32 General Fee Schedule

81268 Chimerism anal w/cell select 46.66 General Fee Schedule

81270 Jak2 gene 56.69 General Fee Schedule

81275 Kras gene 307.53 General Fee Schedule

81280 Long qt synd gene full seq 1097.84 General Fee Schedule

81290 Mcoln1 gene 846.84 General Fee Schedule

81292 Mlh1 gene full seq 1097.84 General Fee Schedule

81293 Mlh1 gene known variants 67.44 General Fee Schedule

81294 Mlh1 gene dup/delete variant 144.81 General Fee Schedule

81295 Msh2 gene full seq 926.11 General Fee Schedule



Codes and Rates

Procedure


Current


81296 Msh2 gene known variants 67.44 General Fee Schedule

81297 Msh2 gene dup/delete variant 115.22 General Fee Schedule

81298 Msh6 gene full seq 1441.31 General Fee Schedule

81299 Msh6 gene known variants 67.44 General Fee Schedule

81300 Msh6 gene dup/delete variant 122.79 General Fee Schedule

81301 Microsatellite instability 300.01 General Fee Schedule

81302 Mecp2 gene full seq 328.24 General Fee Schedule

81303 Mecp2 gene known variant 108.71 General Fee Schedule

81304 Mecp2 gene dup/delet variant 78.90 General Fee Schedule

81310 Npm1 gene 67.15 General Fee Schedule

81315 Pml/raralpha com breakpoints 79.23 General Fee Schedule

81316 Pml/raralpha 1 breakpoint 327.62 General Fee Schedule

81317 Pms2 gene full seq analysis 1097.84 General Fee Schedule

81318 Pms2 known familial variants 67.44 General Fee Schedule

81319 Pms2 gene dup/delet variants 168.34 General Fee Schedule

81321 Pten gene full sequence 1078.57 General Fee Schedule

81322 Pten gene known fam variant 44.35 General Fee Schedule

81323 Pten gene dup/delet variant 1078.57 General Fee Schedule

81324 Pmp22 gene dup/delet 564.52 General Fee Schedule

81325 Pmp22 gene full sequence 0 Manual Price

81326 Pmp22 gene known fam variant 86.77 General Fee Schedule

81330 Smpd1 gene common variants 846.84 General Fee Schedule

81331 Snrpn/ube3a gene 488.18 General Fee Schedule

81332 Serpina1 gene 54.35 General Fee Schedule

81340 Trb@ gene rearrange amplify 216.46 General Fee Schedule

81341 Trb@ gene rearrange dirprobe 51.38 General Fee Schedule

81342 Trg gene rearrangement anal 137.71 General Fee Schedule

81370 Hla i & ii typing lr 416.63 General Fee Schedule

81371 Hla i & ii type verify lr 15.70 General Fee Schedule

81372 Hla i typing complete lr 228.87 General Fee Schedule

81373 Hla i typing 1 locus lr 15.70 General Fee Schedule

81376 Hla ii typing 1 locus lr 15.70 General Fee Schedule

81378 Hla i & ii typing hr 78.49 General Fee Schedule

81380 Hla i typing 1 locus hr 15.70 General Fee Schedule

81382 Hla ii typing 1 loc hr 15.70 General Fee Schedule

81400 Mopath procedure level 1 57.94 General Fee Schedule








81408 Mopath procedure level 9 0 Manual Price

81420 Fetal chrmoml aneuploidy 58.57 General Fee Schedule

81479 Unlisted molecular pathology 0 Manual Price

81507 Fetal aneuploidy trisom risk 58.57 General Fee Schedule

82009 Test for acetone/ketones 5.82 General Fee Schedule

82010 Acetone assay 10.54 General Fee Schedule

82013 ACETYLCHOLINESTERASE ASSAY 14.41 General Fee Schedule



Codes and Rates

Procedure


Current


82016 Acylcarnitines qual 17.87 General Fee Schedule

82017 Acylcarnitines quant 3.42 General Fee Schedule

82024 Assay of acth 14.35 General Fee Schedule

82030 Assay of adp & amp 18.27 General Fee Schedule

82040 Assay of serum albumin 6.38 General Fee Schedule

82042 Assay of urine albumin 3.71 General Fee Schedule

82043 Microalbumin quantitative 7.48 General Fee Schedule

82044 Microalbumin semiquant 5.90 General Fee Schedule

82045 Albumin ischemia modified 31.80 General Fee Schedule

82075 Assay of breath ethanol 15.55 General Fee Schedule

82085 Assay of aldolase 12.52 General Fee Schedule

82088 Assay of aldosterone 52.51 General Fee Schedule

82103 Alpha-1-antitrypsin total 17.31 General Fee Schedule

82104 Alpha-1-antitrypsin pheno 18.64 General Fee Schedule

82105 Alpha-fetoprotein serum 21.62 General Fee Schedule

82106 Alpha-fetoprotein amniotic 21.62 General Fee Schedule

82107 Alpha-fetoprotein l3 66.27 General Fee Schedule

82108 Assay of aluminum 32.85 General Fee Schedule

82120 Amines vaginal fluid qual 2.21 General Fee Schedule

82127 Amino acid single qual 17.87 General Fee Schedule

82128 Amino acids mult qual 17.87 General Fee Schedule

82131 Amino acids single quant 3.42 General Fee Schedule

82135 Assay aminolevulinic acid 21.22 General Fee Schedule

82136 Amino acids quant 2-5 3.42 General Fee Schedule

82139 Amino acids quan 6 or more 3.42 General Fee Schedule

82140 ASSAY OF AMMONIA 18.79 General Fee Schedule

82143 AMNIOTIC FLUID SCAN 8.86 General Fee Schedule

82150 ASSAY OF AMYLASE 8.35 General Fee Schedule

82154 ANDROSTANEDIOL GLUCURONIDE 19.21 General Fee Schedule

82157 ASSAY OF ANDROSTENEDIONE 37.74 General Fee Schedule

82160 Assay of androsterone 32.25 General Fee Schedule

82163 ASSAY OF ANGIOTENSIN II 26.46 General Fee Schedule

82164 ANGROTENSIN I-ENZYME TEST 18.82 General Fee Schedule

82172 Assay of apolipoprotein 19.97 General Fee Schedule

82175 ASSAY OF ARSENIC 24.45 General Fee Schedule

82180 ASSAY OF ASCORBIC ACID 12.74 General Fee Schedule

82190 ATOMIC ABSORPTION 19.21 General Fee Schedule

82232 Assay of beta-2 protein 20.86 General Fee Schedule

82239 Bile acids total 10.86 General Fee Schedule

82240 Bile acids cholylglycine 16.48 General Fee Schedule

82247 Bilirubin total 6.47 General Fee Schedule

82248 Bilirubin direct 6.47 General Fee Schedule

82252 FECAL BILIRUBIN TEST 1.78 General Fee Schedule

82261 Assay of biotinidase 3.42 General Fee Schedule

82270 Occult blood feces 4.18 General Fee Schedule

82271 Occult blood other sources 3.16 General Fee Schedule

82272 Occult bld feces 1-3 tests 3.16 General Fee Schedule

82274 Assay test for blood fecal 4.18 General Fee Schedule

82286 ASSAY OF BRADYKININ 8.87 General Fee Schedule

82300 Assay of cadmium 29.82 General Fee Schedule



Codes and Rates

Procedure


Current


82306 Vitamin d 25 hydroxy 38.14 General Fee Schedule

82308 ASSAY OF CALCITONIN 34.51 General Fee Schedule

82310 Assay of calcium 6.63 General Fee Schedule

82330 Assay of calcium 17.62 General Fee Schedule

82331 CALCIUM INFUSION TEST 6.66 General Fee Schedule

82340 Assay of calcium in urine 7.76 General Fee Schedule

82355 Calculus analysis qual 14.91 General Fee Schedule

82360 Calculus assay quant 16.60 General Fee Schedule

82365 Calculus spectroscopy 16.62 General Fee Schedule

82370 X-ray assay calculus 16.15 General Fee Schedule

82373 Assay c-d transfer measure 9.28 General Fee Schedule

82374 Assay blood carbon dioxide 3.66 General Fee Schedule

82375 Assay carboxyhb quant 15.89 General Fee Schedule

82376 Assay carboxyhb qual 6.42 General Fee Schedule

82378 CARCINOEMBRYONIC ANTIGEN 24.45 General Fee Schedule

82379 Assay of carnitine 3.42 General Fee Schedule

82380 Assay of carotene 11.88 General Fee Schedule

82382 Assay urine catecholamines 22.15 General Fee Schedule

82383 Assay blood catecholamines 32.31 General Fee Schedule

82384 Assay three catecholamines 32.55 General Fee Schedule

82387 Assay of cathepsin-d 10.41 General Fee Schedule

82390 Assay of ceruloplasmin 13.84 General Fee Schedule

82397 CHEMILUMINESCENT ASSAY 10.41 General Fee Schedule

82415 Assay of chloramphenicol 16.33 General Fee Schedule

82435 Assay of blood chloride 3.60 General Fee Schedule

82436 Assay of urine chloride 6.48 General Fee Schedule

82438 Assay other fluid chlorides 6.30 General Fee Schedule

82441 TEST FOR CHLOROHYDROCARBONS 7.73 General Fee Schedule

82465 Assay bld/serum cholesterol 5.63 General Fee Schedule

82480 Assay serum cholinesterase 10.16 General Fee Schedule

82482 Assay rbc cholinesterase 9.90 General Fee Schedule

82485 Assay chondroitin sulfate 22.89 General Fee Schedule

82486 Gas/liquid chromatography 23.28 General Fee Schedule

82487 CHROMATOGRAPHY--QUALITATIVE--ANALYTE NES 20.57 General Fee Schedule

82488 CHROMATOGRAPHY--QUALITATIVE PAPER 2-DIME 27.55 General Fee Schedule

82489 THIN LAYER CHROMATOGRAPHY 23.85 General Fee Schedule

82491 Chromotography quant sing 23.28 General Fee Schedule

82492 Chromotography quant mult 23.28 General Fee Schedule

82495 Assay of chromium 26.15 General Fee Schedule

82507 Assay of citrate 35.85 General Fee Schedule

82523 Collagen crosslinks 24.10 General Fee Schedule

82525 Assay of copper 15.98 General Fee Schedule

82528 Assay of corticosterone 29.02 General Fee Schedule

82530 Cortisol free 21.55 General Fee Schedule

82533 TOTAL CORTISOL 21.01 General Fee Schedule

82540 Assay of creatine 5.97 General Fee Schedule

82541 Column chromotography qual 23.28 General Fee Schedule

82542 Column chromotography quant 23.28 General Fee Schedule

82543 Column chromotograph/isotope 23.28 General Fee Schedule

82544 Column chromotograph/isotope 23.28 General Fee Schedule



Codes and Rates

Procedure


Current


82550 Assay of ck (cpk) 8.40 General Fee Schedule

82552 Assay of cpk in blood 17.27 General Fee Schedule

82553 Creatine mb fraction 14.87 General Fee Schedule

82554 Creatine isoforms 15.30 General Fee Schedule

82565 Assay of creatinine 6.61 General Fee Schedule

82570 Assay of urine creatinine 6.66 General Fee Schedule

82575 CREATININE CLEARANCE TEST 12.18 General Fee Schedule

82585 Assay of cryofibrinogen 9.12 General Fee Schedule

82595 Assay of cryoglobulin 8.35 General Fee Schedule

82600 Assay of cyanide 25.01 General Fee Schedule

82607 VITAMIN B-12 19.43 General Fee Schedule

82608 B-12 BINDING CAPACITY 18.46 General Fee Schedule

82610 Cystatin c 5.82 General Fee Schedule

82615 TEST FOR URINE CYSTINES 10.54 General Fee Schedule

82626 DEHYDROEPIANDROSTERONE 32.57 General Fee Schedule

82627 DEHYDROEPIANDROSTERONE 28.65 General Fee Schedule

82633 DESOXYCORTICOSTERONE 39.93 General Fee Schedule

82634 DESOXYCORTISOL 37.74 General Fee Schedule

82638 Assay of dibucaine number 15.78 General Fee Schedule

82652 Vit d 1 25-dihydroxy 49.62 General Fee Schedule

82656 Pancreatic elastase fecal 11.26 General Fee Schedule

82657 Enzyme cell activity 23.28 General Fee Schedule

82658 Enzyme cell activity ra 23.28 General Fee Schedule

82664 ELECTROPHORETIC TEST 44.29 General Fee Schedule

82668 Assay of erythropoietin 24.21 General Fee Schedule

82670 Assay of estradiol 36.03 General Fee Schedule

82671 Assay of estrogens 41.64 General Fee Schedule

82672 Assay of estrogen 27.96 General Fee Schedule

82677 Assay of estriol 31.18 General Fee Schedule

82679 Assay of estrone 32.19 General Fee Schedule

82693 Assay of ethylene glycol 19.20 General Fee Schedule

82696 Assay of etiocholanolone 30.39 General Fee Schedule

82705 Fats/lipids feces qual 6.58 General Fee Schedule

82710 Fats/lipids feces quant 21.65 General Fee Schedule

82715 Assay of fecal fat 12.82 General Fee Schedule

82725 Assay of blood fatty acids 17.16 General Fee Schedule

82726 Long chain fatty acids 23.28 General Fee Schedule

82728 Assay of ferritin 17.57 General Fee Schedule

82731 Assay of fetal fibronectin 83.02 General Fee Schedule

82735 Assay of fluoride 23.92 General Fee Schedule

82746 Assay of folic acid serum 18.94 General Fee Schedule

82747 Assay of folic acid rbc 22.18 General Fee Schedule

82757 Assay of semen fructose 10.07 General Fee Schedule

82759 Assay of rbc galactokinase 20.06 General Fee Schedule

82760 Assay of galactose 14.44 General Fee Schedule

82775 ASSAY GALACTOSE TRANSFERASE 27.15 General Fee Schedule

82776 GALACTOSE TRANSFERASE TEST 7.36 General Fee Schedule

82784 Assay iga/igd/igg/igm each 7.36 General Fee Schedule

82785 Assay of ige 21.23 General Fee Schedule

82787 Igg 1 2 3 or 4 each 5.93 General Fee Schedule



Codes and Rates

Procedure


Current


82800 BLOOD PH 10.91 General Fee Schedule

82803 Blood gases any combination 24.94 General Fee Schedule

82805 Blood gases w/o2 saturation 36.57 General Fee Schedule

82810 Blood gases o2 sat only 11.26 General Fee Schedule

82820 HEMOGLOBIN-OXYGEN AFFINITY 12.49 General Fee Schedule

82930 Gastric analy w/ph ea spec 5.97 General Fee Schedule

82938 GASTIN TEST 22.84 General Fee Schedule

82941 ASSAY OF GASTIN 22.75 General Fee Schedule

82943 Assay of glucagon 18.41 General Fee Schedule

82945 Glucose other fluid 5.06 General Fee Schedule

82946 Glucagon tolerance test 17.20 General Fee Schedule

82947 Assay glucose blood quant 5.06 General Fee Schedule

82948 REAGENT STRIP/BLOOD GLUCOSE 4.08 General Fee Schedule

82950 GLUCOSE TEST 6.10 General Fee Schedule

82951 GLUCOSE TOLERANCE TEST (GTT) 8.28 General Fee Schedule

82952 GTT-added samples 5.06 General Fee Schedule

82955 Assay of g6pd enzyme 12.50 General Fee Schedule

82960 TEST FOR G6PD ENZYME 7.80 General Fee Schedule

82962 GLUCOSE BLOOD TEST 2.34 General Fee Schedule

82963 Assay of glucosidase 27.71 General Fee Schedule

82965 Assay of gdh enzyme 9.96 General Fee Schedule

82977 ASSAY OF GGT 9.28 General Fee Schedule

82978 Assay of glutathione 13.74 General Fee Schedule

82979 Assay rbc glutathione 8.87 General Fee Schedule

82985 Assay of glycated protein 19.43 General Fee Schedule

83001 Assay of gonadotropin (fsh) 23.97 General Fee Schedule

83002 Assay of gonadotropin (lh) 23.89 General Fee Schedule

83003 Assay growth hormone (hgh) 21.49 General Fee Schedule

83009 H pylori (c-13) blood 65.69 General Fee Schedule

83010 Assay of haptoglobin quant 8.55 General Fee Schedule

83012 Assay of haptoglobins 22.15 General Fee Schedule

83013 H pylori (c-13) breath 86.82 General Fee Schedule

83014 H pylori drug admin 10.13 General Fee Schedule

83015 HEAVY METAL SCREEN 24.27 General Fee Schedule

83018 Quantitative screen metals 28.30 General Fee Schedule

83020 Hemoglobin electrophoresis 13.19 26 Fee Schedule

83021 Hemoglobin chromotography 23.28 General Fee Schedule

83026 Hemoglobin copper sulfate 3.05 General Fee Schedule

83030 Fetal hemoglobin chemical 8.06 General Fee Schedule

83030 Fetal hemoglobin chemical 7.75 26 Fee Schedule

83033 Fetal hemoglobin assay qual 7.68 General Fee Schedule

83036 Glycosylated hemoglobin test 12.52 General Fee Schedule

83037 Glycosylated hb home device 15.52 General Fee Schedule

83045 BLOOD METHEMOGLOBIN TEST 6.38 General Fee Schedule

83050 BLOOD METHEMOGLOBIN ASSAY 9.44 General Fee Schedule

83051 Assay of plasma hemoglobin 4.55 General Fee Schedule

83060 HEMOGLOBIN-- 10.66 General Fee Schedule

83065 Assay of hemoglobin heat 8.87 General Fee Schedule

83068 HEMOGLOBIN STABILITY SCREEN 10.91 General Fee Schedule

83069 Assay of urine hemoglobin 5.09 General Fee Schedule



Codes and Rates

Procedure


Current


83070 Assay of hemosiderin qual 6.13 General Fee Schedule

83080 Assay of b hexosaminidase 3.43 General Fee Schedule

83088 Assay of histamine 38.06 General Fee Schedule

83090 Assay of homocystine 21.74 General Fee Schedule

83150 Assay of homovanillic acid 24.94 General Fee Schedule

83491 Assay of corticosteroids 17 22.58 General Fee Schedule

83497 Assay of 5-hiaa 16.62 General Fee Schedule

83498 Assay of progesterone 17-d 35.02 General Fee Schedule

83499 Assay of progesterone 20- 32.48 General Fee Schedule

83500 Assay free hydroxyproline 29.21 General Fee Schedule

83505 Assay total hydroxyproline 31.33 General Fee Schedule

83516 Immunoassay nonantibody 14.87 General Fee Schedule

83518 Immunoassay dipstick 10.92 General Fee Schedule

83519 Ria nonantibody 17.42 General Fee Schedule

83520 Immunoassay quant nos nonab 16.70 General Fee Schedule

83525 ASSAY OF INSULIN 14.75 General Fee Schedule

83527 ASSAY OF INSULIN 16.32 General Fee Schedule

83528 Assay of intrinsic factor 20.49 General Fee Schedule

83540 Assay of iron 8.35 General Fee Schedule

83550 IRON BINDING TEST 11.28 General Fee Schedule

83570 Assay of idh enzyme 11.41 General Fee Schedule

83582 Assay of ketogenic steroids 18.28 General Fee Schedule

83586 Assay 17- ketosteroids 16.50 General Fee Schedule

83593 Fractionation ketosteroids 33.90 General Fee Schedule

83605 Assay of lactic acid 1.78 General Fee Schedule

83615 LACTATE (LD) (LDH) ENZYME 7.77 General Fee Schedule

83625 Assay of ldh enzymes 7.66 General Fee Schedule

83630 Lactoferrin fecal (qual) 19.14 General Fee Schedule

83631 Lactoferrin fecal (quant) 26.94 General Fee Schedule

83632 PLACENTAL LACTOGEN 26.05 General Fee Schedule

83633 TEST URINE FOR LACTOSE 7.11 General Fee Schedule

83655 Assay of lead 15.60 General Fee Schedule

83661 L/s ratio fetal lung 12.82 General Fee Schedule

83662 Foam stability fetal lung 24.83 General Fee Schedule

83663 Fluoro polarize fetal lung 12.19 General Fee Schedule

83664 Lamellar bdy fetal lung 6.10 General Fee Schedule

83670 Assay of lap enzyme 11.81 General Fee Schedule

83690 Assay of lipase 8.87 General Fee Schedule

83695 Assay of lipoprotein(a) 12.61 General Fee Schedule

83698 Assay lipoprotein pla2 33.55 General Fee Schedule

83700 Lipopro bld electrophoretic 13.55 General Fee Schedule

83701 Lipoprotein bld hr fraction 24.17 General Fee Schedule

83704 Lipoprotein bld by nmr 30.73 General Fee Schedule

83718 Assay of lipoprotein 10.55 General Fee Schedule

83719 Assay of blood lipoprotein 14.99 General Fee Schedule

83721 Assay of blood lipoprotein 12.30 General Fee Schedule

83727 Assay of lrh hormone 22.15 General Fee Schedule

83735 Assay of magnesium 8.65 General Fee Schedule

83775 Assay malate dehydrogenase 9.52 General Fee Schedule

83785 ASSAY OF MANGANESE 31.70 General Fee Schedule



Codes and Rates

Procedure


Current


83788 Mass spectrometry qual 23.28 General Fee Schedule

83789 Mass spectrometry quant 23.28 General Fee Schedule

83825 Assay of mercury 20.96 General Fee Schedule

83835 Assay of metanephrines 21.85 General Fee Schedule

83857 Assay of methemalbumin 13.84 General Fee Schedule

83861 Microfludic analysis tear osmolarity 18.36 General Fee Schedule

83864 MUCOPLOYSACCHARIDES 25.66 General Fee Schedule

83872 ASSAY SYNOVIAL FLUID MUCIN 7.59 General Fee Schedule

83873 Assay of csf protein 22.17 General Fee Schedule

83874 Assay of myoglobin 16.64 General Fee Schedule

83876 Assay myeloperoxidase 12.63 General Fee Schedule

83880 Assay of natriuretic peptide 42.48 General Fee Schedule

83883 Assay nephelometry not spec 7.31 General Fee Schedule

83885 Assay of nickel 31.59 General Fee Schedule

83915 Assay of nucleotidase 14.38 General Fee Schedule

83916 Oligoclonal bands 25.93 General Fee Schedule

83918 Organic acids total quant 21.22 General Fee Schedule

83919 Organic acids qual each 21.22 General Fee Schedule

83921 Organic acid single quant 21.22 General Fee Schedule

83930 Assay of blood osmolality 8.52 General Fee Schedule

83935 Assay of urine osmolality 8.78 General Fee Schedule

83937 Assay of osteocalcin 19.21 General Fee Schedule

83945 Assay of oxalate 16.60 General Fee Schedule

83950 Oncoprotein her-2/neu 83.02 General Fee Schedule

83951 Oncoprotein dcp 69.24 General Fee Schedule

83970 ASSAY OF PARATHORMONE 53.21 General Fee Schedule

83986 Assay ph body fluid nos 4.61 General Fee Schedule

83987 Exhaled breath condensate 17.45 General Fee Schedule

83992 ASSAY FOR PHENCYCLIDINE 18.93 General Fee Schedule

83993 Assay for calprotectin fecal 20.19 General Fee Schedule

84030 Assay of blood pku ** 7.11 General Fee Schedule

84035 Assay of phenylketones 3.95 General Fee Schedule

84060 ASSAY ACID PHOSPHATASE 9.53 General Fee Schedule

84061 Phosphatase forensic exam 10.21 General Fee Schedule

84066 ASSAY PROSTATE PHOSPHATASE 12.45 General Fee Schedule

84075 PHOSPHATASE, ALKALINE 6.66 General Fee Schedule

84078 ASSAY ALKALINE PHOSPATASE 9.42 General Fee Schedule

84080 ASSAY ALKALINE PHOSPHATASES 19.04 General Fee Schedule

84081 Assay phosphatidylglycerol 21.32 General Fee Schedule

84085 Assay of rbc pg6d enzyme 8.69 General Fee Schedule

84087 ASSAY PHOSPHOHEXOSE ENZYMES 13.31 General Fee Schedule

84100 Assay of phosphorus 6.13 General Fee Schedule

84105 Assay of urine phosphorus 6.66 General Fee Schedule

84106 TEST FOR PORPHOBILINOGEN 5.50 General Fee Schedule

84110 Assay of porphobilinogen 10.89 General Fee Schedule

84112 Eval amniotic fluid protein 70.55 General Fee Schedule

84119 TEST URINE FOR PORPHYRINS 11.10 General Fee Schedule

84120 Assay of urine porphyrins 18.95 General Fee Schedule

84126 Assay of feces porphyrins 32.83 General Fee Schedule

84132 Assay of serum potassium 5.92 General Fee Schedule



Codes and Rates

Procedure


Current


84133 Assay of urine potassium 5.56 General Fee Schedule

84134 Assay of prealbumin 7.31 General Fee Schedule

84135 Assay of pregnanediol 24.66 General Fee Schedule

84138 Assay of pregnanetriol 24.39 General Fee Schedule

84140 Assay of pregnenolone 19.21 General Fee Schedule

84143 Assay of 17-hydroxypregneno 19.21 General Fee Schedule

84144 Assay of progesterone 20.06 General Fee Schedule

84145 Procalcitonin (pct) 21.40 General Fee Schedule

84146 Assay of prolactin 24.98 General Fee Schedule

84150 ASSAY OF PROSTAGLANDIN 32.19 General Fee Schedule

84152 Assay of psa complexed 23.71 General Fee Schedule

84153 Assay of psa total 23.71 General Fee Schedule

84154 Assay of psa free 23.71 General Fee Schedule

84155 Assay of protein serum 4.71 General Fee Schedule

84156 Assay of protein urine 4.89 General Fee Schedule

84157 Assay of protein other 4.89 General Fee Schedule

84160 Assay of protein any source 6.66 General Fee Schedule

84163 Pappa serum 14.68 General Fee Schedule

84165 Protein e-phoresis serum 13.45 26 Fee Schedule

84166 Protein e-phoresis/urine/csf 11.69 26 Fee Schedule

84181 WESTERN BLOT TEST 12.93 26 Fee Schedule

84182 Protein western blot test 12.93 26 Fee Schedule

84202 ASSAY RBC PROTOPORPYRIN 18.49 General Fee Schedule

84203 TEST RBC PROTOPORPHYRIN 11.09 General Fee Schedule

84206 ASSAY OF PROINSULIN 22.89 General Fee Schedule

84207 Assay of vitamin b-6 36.21 General Fee Schedule

84210 Assay of pyruvate 13.99 General Fee Schedule

84220 Assay of pyruvate kinase 12.16 General Fee Schedule

84228 Assay of quinine 14.99 General Fee Schedule

84233 Assay of estrogen 83.02 General Fee Schedule

84234 Assay of progesterone 83.63 General Fee Schedule

84235 Assay of endocrine hormone 67.45 General Fee Schedule

84238 Assay nonendocrine receptor 47.12 General Fee Schedule

84244 ASSAY OF RENIN 28.35 General Fee Schedule


84255 Assay of selenium 32.91 General Fee Schedule

84260 Assay of serotonin 23.98 General Fee Schedule

84270 Assay of sex hormone globul 28.02 General Fee Schedule

84275 Assay of sialic acid 17.31 General Fee Schedule

84285 Assay of silica 30.35 General Fee Schedule

84295 Assay of serum sodium 6.21 General Fee Schedule

84300 Assay of urine sodium 6.26 General Fee Schedule

84302 Assay of sweat sodium 6.33 General Fee Schedule

84305 Assay of somatomedin 25.29 General Fee Schedule

84307 Assay of somatostatin 23.58 General Fee Schedule

84311 SPECTROPHOTOMETRY 9.01 General Fee Schedule

84315 BODY FLUID SPECIFIC GRAVITY 3.23 General Fee Schedule

84375 Chromatogram assay sugars 3.08 General Fee Schedule

84376 Sugars single qual 7.11 General Fee Schedule

84377 Sugars multiple qual 7.11 General Fee Schedule



Codes and Rates

Procedure


Current


84378 Sugars single quant 14.84 General Fee Schedule

84379 Sugars multiple quant 14.84 General Fee Schedule

84392 Assay of urine sulfate 6.13 General Fee Schedule

84402 Assay of free testosterone 32.82 General Fee Schedule

84403 Assay of total testosterone 33.29 General Fee Schedule


84430 Assay of thiocyanate 14.99 General Fee Schedule

84431 Thromboxane urine 14.29 General Fee Schedule

84432 Assay of thyroglobulin 19.71 General Fee Schedule

84436 Assay of total thyroxine 8.86 General Fee Schedule

84437 Assay of neonatal thyroxine 8.35 General Fee Schedule

84439 Assay of free thyroxine 10.52 General Fee Schedule

84442 Assay of thyroid activity 14.97 General Fee Schedule

84443 THYROID STIM HORMONE 21.65 General Fee Schedule

84445 Assay of tsi globulin 65.56 General Fee Schedule

84446 Assay of vitamin e 18.29 General Fee Schedule

84449 Assay of transcortin 19.21 General Fee Schedule

84450 TRANSFERASE, ASPARTATE AMINO (AST) (SGOT 6.65 General Fee Schedule

84460 ALANINE AMINO (ALT) (SGPT) 6.81 General Fee Schedule

84466 84478 16.45 General Fee Schedule

84478 Assay of triglycerides 7.42 General Fee Schedule

84479 Assay of thyroid (t3 or t4) 8.35 General Fee Schedule

84480 Assay triiodothyronine (t3) 18.29 General Fee Schedule

84481 FREE ASSAY (FT-3) 21.85 General Fee Schedule

84482 T3 reverse 20.32 General Fee Schedule

84484 Assay of troponin quant 8.64 General Fee Schedule

84485 ASSAY DUODENAL FLUID TRYPSIN 5.50 General Fee Schedule

84488 TRYPSIN FECES FOR TRYPSIN 5.50 General Fee Schedule

84490 Assay of feces for trypsin 7.36 General Fee Schedule

84510 Assay of tyrosine 13.42 General Fee Schedule

84512 Assay of troponin qual 9.92 General Fee Schedule

84520 Assay of urea nitrogen 5.09 General Fee Schedule

84525 UREA NITROGEN SEMI-QUANT 2.21 General Fee Schedule

84540 Assay of urine/urea-n 6.13 General Fee Schedule

84545 UREA-N CLEARANCE TEST 8.51 General Fee Schedule

84550 Assay of blood/uric acid 5.82 General Fee Schedule

84560 Assay of urine/uric acid 6.13 General Fee Schedule

84577 Assay of feces/urobilinogen 16.07 General Fee Schedule

84578 TEST URINE UROBILINOGEN 1.78 General Fee Schedule

84580 Assay of urine urobilinogen 9.10 General Fee Schedule

84583 Assay of urine urobilinogen 6.46 General Fee Schedule

84585 Assay of urine vma 19.89 General Fee Schedule

84586 Assay of vip 19.12 General Fee Schedule

84588 Assay of vasopressin 41.84 General Fee Schedule

84590 Assay of vitamin a 14.88 General Fee Schedule

84591 Assay of nos vitamin 15.67 General Fee Schedule

84597 Assay of vitamin k 17.59 General Fee Schedule

84600 Assay of volatiles 20.63 General Fee Schedule

84620 XYLOSE TOLERANCE TEST 15.20 General Fee Schedule

84630 Assay of zinc 14.62 General Fee Schedule



Codes and Rates

Procedure


Current


84681 Assay of c-peptide 22.41 General Fee Schedule

84702 CHORIONIC GONADOTROPIN TEST 19.40 General Fee Schedule

84703 CHORIONIC GONADOTROPIN ASSAY 8.99 General Fee Schedule

84704 Hcg free betachain test 15.49 General Fee Schedule

84830 OVULATION TESTS 12.94 General Fee Schedule

84999 UNLISTED CHEMISTRY PROCEDURE 0 Manual Price

85002 BLEEDING TIME TEST 5.79 General Fee Schedule

85004 Automated diff wbc count 6.49 General Fee Schedule

85007 Bl smear w/diff wbc count 4.45 General Fee Schedule

85008 Bl smear w/o diff wbc count 4.45 General Fee Schedule

85009 Manual diff wbc count b-coat 4.78 General Fee Schedule

85013 Spun microhematocrit 3.05 General Fee Schedule

85014 Hematocrit 3.05 General Fee Schedule

85018 Hemoglobin 3.05 General Fee Schedule

85025 Complete cbc w/auto diff wbc 9.10 General Fee Schedule

85027 Complete cbc automated 6.42 General Fee Schedule

85032 Manual cell count each 5.62 General Fee Schedule

85041 Automated rbc count 3.87 General Fee Schedule

85044 Manual reticulocyte count 5.56 General Fee Schedule

85045 Automated reticulocyte count 5.16 General Fee Schedule

85046 Reticyte/hgb concentrate 7.20 General Fee Schedule

85048 Automated leukocyte count 3.28 General Fee Schedule

85049 Automated platelet count 6.15 General Fee Schedule

85055 Reticulated platelet assay 24.19 General Fee Schedule

85060 Blood smear interpretation 16.42 General Fee Schedule

85097 Bone marrow interpretation 4.30 General Relative Value

85130 CHROMOGENIC SUBSTRATE ASSAY 9.10 General Fee Schedule

85170 BLOOD CLOT RETRACTION 4.66 General Fee Schedule

85175 BLOOD CLOT LYSIS TIME 5.85 General Fee Schedule

85210 Clot factor ii prothrom spec 16.75 General Fee Schedule

85220 Blooc clot factor v test 22.76 General Fee Schedule

85230 Clot factor vii proconvertin 23.07 General Fee Schedule

85240 Clot factor viii ahg 1 stage 23.07 General Fee Schedule

85244 Clot factor viii reltd antgn 26.31 General Fee Schedule

85245 Clot factor viii vw ristoctn 29.60 General Fee Schedule

85246 Clot factor viii vw antigen 29.60 General Fee Schedule

85247 Clot factor viii multimetric 29.60 General Fee Schedule

85250 Clot factor ix ptc/chrstmas 24.53 General Fee Schedule

85260 Clot factor x stuart-power 23.07 General Fee Schedule

85270 Clot factor xi pta 23.07 General Fee Schedule

85280 Clot factor xii hageman 24.94 General Fee Schedule

85290 Clot factor xiii fibrin stab 21.05 General Fee Schedule

85291 Clot factor xiii fibrin scrn 11.47 General Fee Schedule

85292 Clot factor fletcher fact 24.40 General Fee Schedule

85293 Clot factor wght kininogen 24.40 General Fee Schedule

85300 Antithrombin iii activity 15.28 General Fee Schedule

85301 Antithrombin iii antigen 13.94 General Fee Schedule

85302 Clot inhibit prot c antigen 15.50 General Fee Schedule

85303 Clot inhibit prot c activity 17.82 General Fee Schedule

85305 Clot inhibit prot s total 14.94 General Fee Schedule



Codes and Rates

Procedure


Current


85306 Clot inhibit prot s free 19.77 General Fee Schedule

85307 Assay activated protein c 19.77 General Fee Schedule

85335 FACTOR INHIBITOR TEST 11.86 General Fee Schedule

85337 THROMBOMODULIN 13.45 General Fee Schedule

85345 Coagulation time lee & white 5.56 General Fee Schedule

85347 Coagulation time activated 5.51 General Fee Schedule

85348 Coagulation time otr method 4.78 General Fee Schedule

85360 EUGLOBULIN LYSIS 5.98 General Fee Schedule

85362 FIBRIN DEGRADATION PRODUCTS 8.87 General Fee Schedule

85366 FIBRINOGEN TEST 11.10 General Fee Schedule

85370 FIBRINOGEN TEST 14.65 General Fee Schedule

85378 Fibrin degrade semiquant 9.20 General Fee Schedule

85379 Fibrin degradation quant 10.43 General Fee Schedule

85380 Fibrin degradj d-dimer 10.55 General Fee Schedule

85384 Fibrinogen activity 10.94 General Fee Schedule

85385 Fibrinogen antigen 10.94 General Fee Schedule

85390 Fibrinolysins screen i&r 12.21 26 Fee Schedule

85396 Clotting assay whole blood 17.30 General Fee Schedule

85397 Clotting funct activity 24.67 General Fee Schedule

85400 FIBRINOLYTIC PLASMIN 11.41 General Fee Schedule

85410 FIBRINOLYTIC ANTIPLASMIN 9.12 General Fee Schedule

85415 FIBRINOLYTIC PLASMINOGEN 22.15 General Fee Schedule



85441 Heinz bodies direct 5.43 General Fee Schedule

85445 Heinz bodies induced 8.78 General Fee Schedule

85460 Hemoglobin fetal 9.97 General Fee Schedule

85461 Hemoglobin fetal 8.56 General Fee Schedule

85475 Hemolysin acid 11.45 General Fee Schedule

85520 HEPARIN ASSAY 13.74 General Fee Schedule

85525 Heparin neutralization 15.28 General Fee Schedule

85530 HEPARIN-PROTAMINE TOLERANCE 18.29 General Fee Schedule

85536 Iron stain peripheral blood 8.35 General Fee Schedule

85540 Wbc alkaline phosphatase 11.08 General Fee Schedule

85547 RBC mechanical fragility 11.08 General Fee Schedule

85549 MURAMIDASE 24.17 General Fee Schedule

85555 RBC osmotic fragility 8.63 General Fee Schedule

85557 RBC osmotic fragility 17.23 General Fee Schedule

85576 Blood platelet aggregation 13.21 26 Fee Schedule

85597 Phospholipid pltlt neutraliz 19.83 General Fee Schedule

85598 Hexagnal phosph pltlt neutrl 16.83 General Fee Schedule

85610 PROTHROMBIN TIME-- 5.07 General Fee Schedule

85611 PROTHROMBIN TEST 5.09 General Fee Schedule

85612 VIPER VENOM PROTHROMBIN TIME 12.34 General Fee Schedule

85613 Russell viper venom diluted 12.34 General Fee Schedule

85635 REPTILASE TEST 12.70 General Fee Schedule

85651 Rbc sed rate nonautomated 4.59 General Fee Schedule

85652 Rbc sed rate automated 3.48 General Fee Schedule

85660 RBC SICKLE CELL TEST 7.13 General Fee Schedule

85670 Thrombin time plasma 7.43 General Fee Schedule



Codes and Rates

Procedure


Current


85675 Thrombin time titer 8.80 General Fee Schedule

85705 THROMBOPLASTIN INHIBITION 8.96 General Fee Schedule

85730 Thromboplastin time partial 7.70 General Fee Schedule

85732 Thromboplastin time partial 8.32 General Fee Schedule

85810 BLOOD VISCOSITY EXAMINATION 15.03 General Fee Schedule

85999 UNLISTED HEMATOLOGY PROCEDURE 0 26 Requires manual Price

85999 UNLISTED HEMATOLOGY PROCEDURE 0 Manual Price

86000 Agglutinins febrile antigen 9.00 General Fee Schedule

86001 Allergen specific igg 6.16 General Fee Schedule

86003 ALLERGEN SPECIFIC IGE 6.16 General Fee Schedule

86005 ALLERGEN SPECIFIC IgE 8.98 General Fee Schedule

86021 WBC ANTIBODY IDENTIFICATION 19.40 General Fee Schedule

86022 Platelet antibodies 23.68 General Fee Schedule

86023 Immunoglobulin assay 16.04 General Fee Schedule

86038 ANTINUCLEAR ANTIBODIES 15.59 General Fee Schedule

86039 ANTINUCLEAR ANTIBODIES (ANA) 14.40 General Fee Schedule

86060 Antistreptolysin o titer 7.27 General Fee Schedule

86063 Antistreptolysin o screen 4.60 General Fee Schedule

86077 Phys blood bank serv xmatch 36.14 General Fee Schedule

86078 Phys blood bank serv reactj 36.90 General Fee Schedule

86079 Phys blood bank serv authrj 36.65 General Fee Schedule

86140 C-REACTIVE PROTEIN 6.66 General Fee Schedule

86141 C-reactive protein hs 16.70 General Fee Schedule

86146 Beta-2 glycoprotein antibody 19.71 General Fee Schedule

86147 Cardiolipin antibody ea ig 19.71 General Fee Schedule

86148 Anti-phospholipid antibody 20.31 General Fee Schedule

86155 CHEMOTAXIS ASSAY 19.67 General Fee Schedule

86156 Cold agglutinin screen 8.48 General Fee Schedule

86157 Cold agglutinin titer 10.18 General Fee Schedule

86160 Complement antigen 15.18 General Fee Schedule

86161 COMPLEMENT/FUNCTION ACTIVITY 15.18 General Fee Schedule

86162 Complement total (ch50) 25.69 General Fee Schedule

86171 Complement fixation each 12.67 General Fee Schedule

86185 COUNTERIMMUNOELECTROPHORESIS 11.33 General Fee Schedule

86200 Ccp antibody 12.36 General Fee Schedule

86215 Deoxyribonuclease antibody 16.74 General Fee Schedule

86225 Dna antibody native 17.37 General Fee Schedule

86226 Dna antibody single strand 15.31 General Fee Schedule

86235 NUCLEAR ANTIGEN ANTIBODY 18.85 General Fee Schedule

86243 FC RECEPTOR 25.93 General Fee Schedule

86255 Fluorescent antibody screen 13.19 26 Fee Schedule

86256 Fluorescent antibody titer 13.41 26 Fee Schedule

86277 GROWTH HORMONE ANTIBODY 19.89 General Fee Schedule

86280 HEMAGGLUTINATION INHIBITION 10.34 General Fee Schedule

86294 Immunoassay tumor qual 24.78 General Fee Schedule

86300 Immunoassay tumor ca 15-3 26.30 General Fee Schedule

86301 Immunoassay tumor ca 19-9 26.30 General Fee Schedule

86304 Immunoassay tumor ca 125 26.30 General Fee Schedule

86305 Human epididymis protein 4 (HE4) 22.52 General Fee Schedule

86308 Heterophile antibody screen 6.53 General Fee Schedule



Codes and Rates

Procedure


Current


86309 Heterophile antibody titer 8.19 General Fee Schedule

86310 Heterophile antibody absrbj 9.33 General Fee Schedule

86316 Immunoassay tumor other 26.30 General Fee Schedule

86317 Immunoassay infectious agent 18.94 General Fee Schedule

86318 Immunoassay infectious agent 16.37 General Fee Schedule

86320 SERUM IMMUNOELECTROPHORESIS 13.45 26 Fee Schedule

86325 Other immunoelectrophoresis 13.45 26 Fee Schedule

86327 IMMUNOELECTROPHORESIS ASSAY 15.42 26 Fee Schedule

86329 Immunodiffusion nes 17.74 General Fee Schedule

86331 IMMUNODIFFUSION OUCHTERLONY 15.16 General Fee Schedule

86332 IMMUNE COMPLEX ASSAY 21.77 General Fee Schedule

86334 Immunofix e-phoresis serum 13.45 26 Fee Schedule

86335 IMMUNOFIXATION ELECTROPHORESIS 16.64 26 Fee Schedule

86336 Inhibin A 16.50 General Fee Schedule

86337 INSULIN ANTIBODIES 27.06 General Fee Schedule

86340 INTRINSIC FACTOR ANTIBODIES 19.04 General Fee Schedule

86341 ISLET CELL ANTIBODY 16.97 General Fee Schedule

86343 LEUKOCYTE HISTAMINE RELEASE 15.74 General Fee Schedule

86344 LEUKOCYTE PHAGOCYTOSIS 10.11 General Fee Schedule

86352 Cell function assay w/stim 73.51 General Fee Schedule

86353 LYMPHO TRANSFORM 61.95 General Fee Schedule

86355 B cells total count 16.95 General Fee Schedule

86356 Mononuclear cell antigen 18.26 General Fee Schedule

86357 Nk cells total count 23.88 General Fee Schedule

86359 T cells total count 22.44 General Fee Schedule

86360 T cell absolute count/ratio 44.87 General Fee Schedule

86361 T cell absolute count 22.86 General Fee Schedule

86367 Stem cells total count 16.95 General Fee Schedule

86376 Microsomal antibody each 18.39 General Fee Schedule

86378 MIGRATION INHIBITORY FACTOR 24.89 General Fee Schedule

86382 Neutralization test viral 21.37 General Fee Schedule

86384 NITROBLUE TETRAZOLIUM DYE 14.39 General Fee Schedule

86386 Nuclear matrix protein 22 0 Manual Price

86403 Particle agglut antbdy scrn 8.81 General Fee Schedule

86406 Particle agglut antbdy titr 13.45 General Fee Schedule

86430 Rheumatoid factor test qual 7.19 General Fee Schedule

86431 Rheumatoid factor quant 7.19 General Fee Schedule

86480 Tb test cell immun measure 83.35 General Fee Schedule

86481 Tb ag response t-cell susp 66.56 General Fee Schedule

86486 Skin test nos antigen 3.56 General Fee Schedule

86490 SKIN TEST-- 0.93 General Relative Value



86590 Streptokinase antibody 13.47 General Fee Schedule

86592 Syphilis test non-trep qual 5.42 General Fee Schedule

86593 Syphilis test non-trep quant 5.56 General Fee Schedule

86602 ACTINOMYCES ANTIBODY 12.85 General Fee Schedule

86603 Adenovirus antibody 14.19 General Fee Schedule

86606 ASPIRGILLUS ANTIBODY 17.79 General Fee Schedule

86609 Bacterium antibody 16.29 General Fee Schedule



Codes and Rates

Procedure


Current


86611 Bartonella antibody 12.85 General Fee Schedule

86612 Blastomyces antibody 14.19 General Fee Schedule

86615 BORDETELLA ANTIBODY 16.67 General Fee Schedule

86617 LYME DISEASE ANTIBODY 19.57 General Fee Schedule

86618 LYME DISEASE ANTIBODY 21.52 General Fee Schedule

86619 BORRELIA ANTIBODY 16.91 General Fee Schedule

86622 Brucella antibody 10.34 General Fee Schedule

86625 Campylobacter antibody 16.58 General Fee Schedule

86628 Candida antibody 15.19 General Fee Schedule

86631 Chlamydia antibody 14.94 General Fee Schedule

86632 Chlamydia igm antibody 16.07 General Fee Schedule

86635 Coccidioides antibody 14.19 General Fee Schedule

86638 Q FEVER ANTIBODY 14.19 General Fee Schedule

86641 CRYPTOCOCCUS ANTIBODY 8.81 General Fee Schedule

86644 CMV ANTIBODY 18.20 General Fee Schedule

86645 Cmv antibody igm 18.05 General Fee Schedule

86648 DIPTHERIA ANTIBODY 19.24 General Fee Schedule

86651 Encephalitis californ antbdy 16.67 General Fee Schedule

86652 Encephaltis east eqne anbdy 16.67 General Fee Schedule

86653 Encephaltis st louis antbody 16.67 General Fee Schedule

86654 Encephaltis west eqne antbdy 16.67 General Fee Schedule

86658 Enterovirus antibody 14.19 General Fee Schedule

86663 EPSTEIN-BARR ANTIBODY 16.58 General Fee Schedule

86664 Epstein-barr nuclear antigen 18.05 General Fee Schedule

86665 Epstein-barr capsid vca 18.05 General Fee Schedule

86666 Ehrlichia antibody 12.85 General Fee Schedule

86668 FRANCISELLA TULARENSIS 9.87 General Fee Schedule

86671 Fungus nes antibody 14.19 General Fee Schedule

86674 Giardia lamblia antibody 18.05 General Fee Schedule

86677 Helicobacter pylori antibody 18.34 General Fee Schedule

86682 Helminth antibody 13.09 General Fee Schedule

86684 Hemophilus influenza antibdy 8.81 General Fee Schedule

86687 Htlv-i antibody 10.60 General Fee Schedule

86688 Htlv-ii antibody 12.61 General Fee Schedule

86689 Htlv/hiv confirmj antibody 24.46 General Fee Schedule

86692 Hepatitis delta agent antbdy 21.68 General Fee Schedule

86694 Herpes simplex nes antbdy 18.20 General Fee Schedule

86695 Herpes simplex type 1 test 16.67 General Fee Schedule

86696 Herpes simplex type 2 test 24.46 General Fee Schedule

86698 Histoplasma antibody 14.19 General Fee Schedule

86701 Hiv-1antibody 11.25 General Fee Schedule

86702 Hiv-2 antibody 12.61 General Fee Schedule

86703 Hiv-1/hiv-2 1 result antbdy 12.61 General Fee Schedule

86704 Hep b core antibody total 15.25 General Fee Schedule

86705 Hep b core antibody igm 14.87 General Fee Schedule

86706 Hep b surface antibody 13.57 General Fee Schedule

86707 Hepatitis be antibody 14.61 General Fee Schedule

86708 Hepatitis a total antibody 15.64 General Fee Schedule

86709 Hepatitis a igm antibody 14.22 General Fee Schedule

86710 Influenza virus antibody 17.13 General Fee Schedule



Codes and Rates

Procedure


Current


86713 Legionella antibody 18.05 General Fee Schedule

86717 Leishmania antibody 15.48 General Fee Schedule

86720 Leptospira antibody 16.67 General Fee Schedule

86723 Listeria monocytogenes 16.67 General Fee Schedule

86727 Lymph choriomeningitis ab 14.19 General Fee Schedule

86729 Lympho venereum antibody 15.10 General Fee Schedule

86732 Mucormycosis antibody 16.67 General Fee Schedule

86735 Mumps antibody 16.49 General Fee Schedule

86738 Mycoplasma antibody 16.73 General Fee Schedule

86741 NEISSERIA MENINGITIDIS 16.67 General Fee Schedule

86744 Nocardia antibody 16.67 General Fee Schedule

86747 Parvovirus antibody 18.99 General Fee Schedule

86750 Malaria antibody 16.67 General Fee Schedule

86753 Protozoa antibody nos 13.09 General Fee Schedule

86756 Respiratory virus antibody 16.29 General Fee Schedule

86757 Rickettsia antibody 24.46 General Fee Schedule

86759 Rotavirus antibody 16.67 General Fee Schedule

86762 Rubella antibody 18.20 General Fee Schedule

86765 Rubeola antibody 16.29 General Fee Schedule

86768 Salmonella antibody 16.67 General Fee Schedule

86771 Shigella antibody 16.67 General Fee Schedule

86774 Tetanus antibody 18.68 General Fee Schedule

86777 Toxoplasma antibody 18.20 General Fee Schedule

86778 Toxoplasma antibody igm 18.05 General Fee Schedule

86780 Treponema pallidum 14.33 General Fee Schedule

86784 Trichinella antibody 8.04 General Fee Schedule

86787 Varicella-zoster antibody 16.29 General Fee Schedule

86788 West nile virus ab igm 14.41 General Fee Schedule

86789 West nile virus antibody 14.51 General Fee Schedule

86790 Virus antibody nos 16.29 General Fee Schedule

86793 Yersinia antibody 16.67 General Fee Schedule

86800 THYROGLOBULIN ANTIBODY 20.09 General Fee Schedule

86803 HEPATITIS C AB TEST 18.04 General Fee Schedule

86804 Hep c ab test confirm 19.57 General Fee Schedule

86805 LYMPHOCYTOXICITY ASSAY 66.08 General Fee Schedule

86806 LYMPHOCYTOTOXICITY ASSAY 60.13 General Fee Schedule

86807 CYTOTOXIC ANTIBODY SCREENING 50.02 General Fee Schedule

86808 CYTOTOXIC ANTIBODY SCREENING 37.51 General Fee Schedule

86812 Hla typing a b or c 32.61 General Fee Schedule

86813 Hla typing a b or c 40.35 General Fee Schedule

86816 Hla typing dr/dq 35.21 General Fee Schedule

86817 Hla typing dr/dq 81.36 General Fee Schedule

86821 Lymphocyte culture mixed 71.34 General Fee Schedule

86822 Lymphocyte culture primed 46.19 General Fee Schedule

86825 Hla x-math non-cytotoxic 58.75 General Fee Schedule

86826 Hla x-match noncytotoxc addl 19.59 General Fee Schedule

86830 Hla class i phenotype qual 48.79 General Fee Schedule

86831 Hla class ii phenotype qual 48.79 General Fee Schedule

86832 Hla class i high defin qual 48.79 General Fee Schedule

86833 Hla class ii high defin qual 48.79 General Fee Schedule



Codes and Rates

Procedure


Current


86849 UNLISTED IMMUNOLOGY 0 Manual Price

86850 ANTIBODY SCREEN RBC EACH SERU TECHNIQUE 7.33 General Fee Schedule

86860 ANTIBODY ELUTION (RBC) EACH ELUTION 26.25 General Fee Schedule

86870 ANTI-IDENT RBC ANTI EACH PANEL FOR EA TE 19.99 General Fee Schedule

86880 Coombs test direct 6.78 General Fee Schedule

86885 Coombs test indirect qual 7.24 General Fee Schedule

86886 Coombs test indirect titer 6.53 General Fee Schedule

86890 AUTO BLOOD OR COM COLLECT PROCESS STORAG 75.45 General Fee Schedule

86900 Blood typing serologic abo 3.75 General Fee Schedule

86901 Blood typing serologic rh(d) 5.06 General Fee Schedule

86902 Blood type antigen donor ea 4.11 General Fee Schedule

86904 Blood typing patient serum 12.01 General Fee Schedule

86905 Blood typing rbc antigens 4.82 General Fee Schedule

86906 Bld typing serologic rh phnt 8.12 General Fee Schedule

86910 Blood typing paternity test 23.28 General Fee Schedule

86911 Blood typing antigen system 6.60 General Fee Schedule

86920 Compatibility test spin 11.70 General Fee Schedule

86921 Compatibility test incubate 13.59 General Fee Schedule

86922 Compatibility test antiglob 14.63 General Fee Schedule

86923 Compatibility test electric 7.06 General Fee Schedule

86927 Plasma fresh frozen 13.68 General Fee Schedule

86930 Frozen blood prep 36.57 General Fee Schedule

86931 Frozen blood thaw 54.87 General Fee Schedule

86932 Frozen blood freeze/thaw 73.15 General Fee Schedule

86940 Hemolysins/agglutinins auto 10.35 General Fee Schedule

86941 HEMOLYSINS/AGGLUTININS 15.31 General Fee Schedule

86945 IRRADIATION OF BLOOD PRODUCT 25.39 General Fee Schedule

86950 LEUKOCYTE TRANSFUSION 49.57 General Fee Schedule

86960 Vol reduction of blood/prod 24.17 General Fee Schedule

86965 POOLING OF PLATELETS OR OT BLOOD PRODUCT 7.06 General Fee Schedule

86970 Rbc pretx incubatj w/chemicl 3.52 General Fee Schedule

86971 Rbc pretx incubatj w/enzymes 3.62 General Fee Schedule

86972 Rbc pretx incubatj w/density 4.03 General Fee Schedule

86975 Rbc serum pretx incubj drugs 25.18 General Fee Schedule

86976 Rbc serum pretx id dilution 26.19 General Fee Schedule

86977 Rbc serum pretx incubj/inhib 16.62 General Fee Schedule

86978 Rbc pretreatment serum 25.39 General Fee Schedule

86985 SPLITTING OF BLOOD OR BLOOD PRO EACH UNI 5.47 General Fee Schedule

86999 UNLISTED TRANSFUSION MEDICINE PROCEDURE 0 26 Requires manual Price

86999 UNLISTED TRANSFUSION MEDICINE PROCEDURE 0 Manual Price

87003 Small animal inoculation 21.29 General Fee Schedule

87015 Specimen infect agnt concntj 6.26 26 Fee Schedule

87015 Specimen infect agnt concntj 8.44 General Fee Schedule

87040 Blood culture for bacteria 13.04 General Fee Schedule

87045 Feces culture aerobic bact 11.92 General Fee Schedule

87046 Stool cultr aerobic bact ea 2.98 General Fee Schedule

87070 Culture othr specimn aerobic 10.87 General Fee Schedule

87071 Culture aerobic quant other 5.97 General Fee Schedule

87073 Culture bacteria anaerobic 5.97 General Fee Schedule

87075 Cultr bacteria except blood 8.86 26 Fee Schedule



Codes and Rates

Procedure


Current


87075 Cultr bacteria except blood 9.05 General Fee Schedule

87076 Culture anaerobe ident each 6.64 26 Fee Schedule

87076 Culture anaerobe ident each 6.77 General Fee Schedule

87077 Culture aerobic identify 8.93 General Fee Schedule

87081 Culture screen only 8.38 General Fee Schedule

87084 CULTURE OF SPECIMEN BY KIT 10.87 General Fee Schedule

87086 Urine culture/colony count 10.20 General Fee Schedule

87088 Urine bacteria culture 10.22 General Fee Schedule

87101 Skin fungi culture 9.75 General Fee Schedule

87102 FUNGUS ISOLATION CULTURE 10.61 General Fee Schedule

87103 BLOOD FUNGUS CLUTRUE 11.41 General Fee Schedule

87106 Fungi identification yeast 13.04 General Fee Schedule

87107 Fungi identification mold 13.04 General Fee Schedule

87109 Mycoplasma 19.46 General Fee Schedule

87110 Chlamydia culture 24.76 General Fee Schedule

87116 Mycobacteria culture 13.65 General Fee Schedule

87118 Mycobacteric identification 13.83 General Fee Schedule

87140 Culture type immunofluoresc 7.05 General Fee Schedule

87143 Culture typing glc/hplc 15.83 General Fee Schedule

87147 Culture type immunologic 6.53 General Fee Schedule

87149 Dna/rna direct probe 25.33 General Fee Schedule

87150 Dna/rna amplified probe 37.97 General Fee Schedule

87152 Culture type pulse field gel 6.60 General Fee Schedule

87153 Dna/rna sequencing 124.81 General Fee Schedule

87158 Culture typing added method 6.60 General Fee Schedule

87164 Dark field examination 11.98 26 Fee Schedule

87166 Dark field examination 14.27 General Fee Schedule

87168 Macroscopic exam arthropod 5.42 General Fee Schedule

87169 Macroscopic exam parasite 5.42 General Fee Schedule

87172 Pinworm exam 5.42 General Fee Schedule

87176 Tissue homogenization cultr 7.46 General Fee Schedule

87177 OVA AND PARASITES SMEARS 11.27 General Fee Schedule

87181 Microbe susceptible diffuse 6.01 General Fee Schedule

87184 Microbe susceptible disk 8.71 General Fee Schedule

87185 Microbe susceptible enzyme 6.01 General Fee Schedule

87186 Microbe susceptible mic 10.90 General Fee Schedule

87187 Microbe susceptible mlc 13.11 General Fee Schedule

87188 Microbe suscept macrobroth 8.39 General Fee Schedule

87190 Microbe suscept mycobacteri 5.39 General Fee Schedule

87197 Bactericidal level serum 18.98 General Fee Schedule

87205 Smear gram stain 4.00 26 Fee Schedule

87205 Smear gram stain 5.42 General Fee Schedule

87206 Smear fluorescent/acid stai 5.04 26 Fee Schedule

87206 Smear fluorescent/acid stai 5.14 General Fee Schedule

87207 Smear special stain 13.69 26 Fee Schedule

87209 Smear complex stain 16.35 General Fee Schedule

87210 Smear wet mount saline/ink 4.00 26 Fee Schedule

87210 Smear wet mount saline/ink 4.08 General Fee Schedule

87220 Tissue exam for fungi 5.42 General Fee Schedule

87230 Assay toxin or antitoxin 24.95 General Fee Schedule



Codes and Rates

Procedure


Current


87250 Virus inoculate eggs/animal 18.32 26 Fee Schedule

87250 Virus inoculate eggs/animal 26.01 General Fee Schedule

87252 Virus inoculation tissue 32.94 General Fee Schedule

87253 Virus inoculate tissue addl 18.93 26 Fee Schedule

87253 Virus inoculate tissue addl 19.32 General Fee Schedule

87254 Virus inoculation shell via 6.18 General Fee Schedule

87255 Genet virus isolate hsv 29.56 General Fee Schedule

87260 Adenovirus ag if 15.18 General Fee Schedule

87265 Pertussis ag if 15.18 General Fee Schedule

87267 Enterovirus antibody dfa 15.34 General Fee Schedule

87269 Giardia ag if 15.72 General Fee Schedule

87270 Chlamydia trachomatis ag if 15.18 General Fee Schedule

87271 Cytomegalovirus dfa 15.34 General Fee Schedule

87272 Cryptosporidium ag if 15.18 General Fee Schedule

87273 Herpes simplex 2 ag if 15.18 General Fee Schedule

87274 Herpes simplex 1 ag if 15.18 General Fee Schedule

87275 Influenza b ag if 15.18 General Fee Schedule

87276 Influenza a ag if 15.18 General Fee Schedule

87277 Legionella micdadei ag if 15.18 General Fee Schedule

87278 Legion pneumophilia ag if 15.18 General Fee Schedule

87279 Parainfluenza ag if 15.18 General Fee Schedule

87280 Respiratory syncytial ag if 15.18 General Fee Schedule

87281 Pneumocystis carinii ag if 15.18 General Fee Schedule

87283 Rubeola ag if 15.18 General Fee Schedule

87285 Treponema pallidum ag if 15.18 General Fee Schedule

87290 Varicella zoster ag if 15.18 General Fee Schedule

87299 Antibody detection nos if 15.18 General Fee Schedule

87300 Ag detection polyval if 7.57 General Fee Schedule

87301 Adenovirus ag eia 15.18 General Fee Schedule

87305 Aspergillus ag eia 12.11 General Fee Schedule

87320 Chylmd trach ag eia 15.18 General Fee Schedule

87324 Clostridium ag eia 15.18 General Fee Schedule

87327 Cryptococcus neoform ag eia 15.18 General Fee Schedule

87328 Cryptosporidium ag eia 15.18 General Fee Schedule

87329 Giardia ag eia 15.72 General Fee Schedule

87332 Cytomegalovirus ag eia 15.18 General Fee Schedule

87335 E coli 0157 ag eia 15.18 General Fee Schedule

87336 Entamoeb hist dispr ag eia 15.18 General Fee Schedule

87337 Entamoeb hist group ag eia 15.18 General Fee Schedule

87338 Hpylori stool eia 15.18 General Fee Schedule

87339 H pylori ag eia 15.18 General Fee Schedule

87340 Hepatitis b surface ag eia 13.04 General Fee Schedule

87341 Hepatitis b surface ag eia 13.04 General Fee Schedule

87350 Hepatitis be ag eia 14.55 General Fee Schedule

87380 Hepatitis delta ag eia 20.74 General Fee Schedule

87385 Histoplasma capsul ag eia 15.18 General Fee Schedule

87389 Hiv-1 ag w/hiv-1 & hiv-2 ab 22.20 General Fee Schedule

87390 Hiv-1 ag eia 22.31 General Fee Schedule

87391 Hiv-2 ag eia 22.31 General Fee Schedule

87400 Influenza a/b ag eia 15.18 General Fee Schedule



Codes and Rates

Procedure


Current


87420 Resp syncytial ag eia 15.18 General Fee Schedule

87425 Rotavirus ag eia 15.18 General Fee Schedule

87427 Shiga-like toxin ag eia 15.18 General Fee Schedule

87430 Strep a ag eia 15.18 General Fee Schedule

87449 Ag detect nos eia mult 15.18 General Fee Schedule

87450 Ag detect nos eia single 12.12 General Fee Schedule

87451 Ag detect polyval eia mult 12.12 General Fee Schedule

87470 Bartonella dna dir probe 25.33 General Fee Schedule

87471 Bartonella dna amp probe 44.36 General Fee Schedule

87472 Bartonella dna quant 54.14 General Fee Schedule

87475 Lyme dis dna dir probe 25.33 General Fee Schedule

87476 Lyme dis dna amp probe 44.36 General Fee Schedule

87477 Lyme dis dna quant 52.75 General Fee Schedule

87480 Candida dna dir probe 25.33 General Fee Schedule

87481 Candida dna amp probe 44.36 General Fee Schedule

87482 Candida dna quant 54.14 General Fee Schedule

87485 Chylmd pneum dna dir probe 25.33 General Fee Schedule

87486 Chylmd pneum dna amp probe 44.36 General Fee Schedule

87487 Chylmd pneum dna quant 54.14 General Fee Schedule

87490 Chylmd trach dna dir probe 25.33 General Fee Schedule

87491 Chylmd trach dna amp probe 44.36 General Fee Schedule

87492 Chylmd trach dna quant 44.17 General Fee Schedule

87493 C diff amplified probe 37.97 General Fee Schedule

87495 Cytomeg dna dir probe 25.33 General Fee Schedule

87496 Cytomeg dna amp probe 44.36 General Fee Schedule

87497 Cytomeg dna quant 54.14 General Fee Schedule

87498 Enterovirus probe&revrs trns 35.41 General Fee Schedule

87500 Vanomycin dna amp probe 35.41 General Fee Schedule

87501 Influenza dna amp prob 1+ 55.11 General Fee Schedule

87502 Influenza dna amp probe 91.37 General Fee Schedule

87503 Influenza dna amp prob addl 22.31 General Fee Schedule

87510 Gardner vag dna dir probe 25.33 General Fee Schedule

87511 Gardner vag dna amp probe 44.36 General Fee Schedule

87512 Gardner vag dna quant 52.75 General Fee Schedule

87515 Hepatitis b dna dir probe 25.33 General Fee Schedule

87516 Hepatitis b dna amp probe 44.36 General Fee Schedule

87517 Hepatitis b dna quant 54.14 General Fee Schedule

87520 Hepatitis c rna dir probe 25.33 General Fee Schedule

87521 Hepatitis c probe&rvrs trnsc 44.36 General Fee Schedule

87522 Hepatitis c revrs trnscrpj 54.14 General Fee Schedule

87525 Hepatitis g dna dir probe 25.33 General Fee Schedule

87526 Hepatitis g dna amp probe 44.36 General Fee Schedule

87527 Hepatitis g dna quant 52.75 General Fee Schedule

87528 Hsv dna dir probe 25.33 General Fee Schedule

87529 Hsv dna amp probe 44.36 General Fee Schedule

87530 Hsv dna quant 54.14 General Fee Schedule

87531 Hhv-6 dna dir probe 25.33 General Fee Schedule

87532 Hhv-6 dna amp probe 44.36 General Fee Schedule

87533 Hhv-6 dna quant 52.75 General Fee Schedule

87534 Hiv-1 dna dir probe 25.33 General Fee Schedule



Codes and Rates

Procedure


Current


87535 Hiv-1 probe&reverse trnscrpj 44.36 General Fee Schedule

87536 Hiv-1 quant&revrse trnscrpj 107.54 General Fee Schedule

87537 Hiv-2 dna dir probe 25.33 General Fee Schedule

87538 Hiv-2 probe&revrse trnscripj 44.36 General Fee Schedule

87539 Hiv-2 quant&revrse trnscripj 54.14 General Fee Schedule

87540 Legion pneumo dna dir prob 25.33 General Fee Schedule

87541 Legion pneumo dna amp prob 44.36 General Fee Schedule

87542 Legion pneumo dna quant 52.75 General Fee Schedule

87550 Mycobacteria dna dir probe 25.33 General Fee Schedule

87551 Mycobacteria dna amp probe 44.36 General Fee Schedule

87552 Mycobacteria dna quant 54.14 General Fee Schedule

87555 M.tuberculo dna dir probe 25.33 General Fee Schedule

87556 M.tuberculo dna amp probe 44.36 General Fee Schedule

87557 M.tuberculo dna quant 54.14 General Fee Schedule

87560 M.avium-intra dna dir prob 25.33 General Fee Schedule

87561 M.avium-intra dna amp prob 44.36 General Fee Schedule

87562 M.avium-intra dna quant 54.14 General Fee Schedule

87580 M.pneumon dna dir probe 25.33 General Fee Schedule

87581 M.pneumon dna amp probe 44.36 General Fee Schedule

87582 M.pneumon dna quant 52.75 General Fee Schedule

87590 N.gonorrhoeae dna dir prob 25.33 General Fee Schedule

87591 N.gonorrhoeae dna amp prob 44.36 General Fee Schedule

87592 N.gonorrhoeae dna quant 54.14 General Fee Schedule

87623 Hpv low-risk types 44.36 General Fee Schedule

87624 Hpv high-risk types 44.36 General Fee Schedule

87625 Hpv types 16 & 18 only 44.36 General Fee Schedule

87631 Resp virus 3-5 targets 91.37 General Fee Schedule

87633 Resp virus 12-25 targets 481.52 General Fee Schedule

87640 Staph a dna amp probe 35.41 General Fee Schedule

87641 Mr-staph dna amp probe 35.41 General Fee Schedule

87650 Strep a dna dir probe 25.33 General Fee Schedule

87651 Strep a dna amp probe 44.36 General Fee Schedule

87652 Strep a dna quant 52.75 General Fee Schedule

87653 Strep b dna amp probe 35.41 General Fee Schedule

87660 Trichomonas vagin dir probe 26.28 General Fee Schedule

87661 Trichomonas vaginalis amplif 36.08 General Fee Schedule

87797 Detect agent nos dna dir 25.33 General Fee Schedule

87798 Detect agent nos dna amp 44.36 General Fee Schedule

87799 Detect agent nos dna quant 54.14 General Fee Schedule

87800 Detect agnt mult dna direc 25.38 General Fee Schedule

87801 Detect agnt mult dna ampli 44.36 General Fee Schedule

87802 Strep b assay w/optic 15.18 General Fee Schedule

87803 Clostridium toxin a w/optic 15.18 General Fee Schedule

87804 Influenza assay w/optic 15.18 General Fee Schedule

87806 Hiv antigen w/hiv antibodies 24.70 General Fee Schedule

87807 Rsv assay w/optic 11.47 General Fee Schedule

87808 Trichomonas assay w/optic 1.53 General Relative Value

87809 Adenovirus assay w/optic 12.11 General Fee Schedule

87810 Chylmd trach assay w/optic 15.18 General Fee Schedule

87850 N.GONORRHOEAE ASSAY W/OPTIC 15.18 General Fee Schedule



Codes and Rates

Procedure


Current


87880 STREP A ASSAY W/OPTIC 15.18 General Fee Schedule

87899 AGENT NOS ASSAY W/OPTIC 15.18 General Fee Schedule

87900 Phenotype infect agent drug 124.45 General Fee Schedule

87901 Genotype dna hiv reverse t 325.34 General Fee Schedule

87902 Genotype dna/rna hep c 325.34 General Fee Schedule

87903 Phenotype dna hiv w/culture 617.52 General Fee Schedule

87904 Phenotype dna hiv w/clt add 32.94 General Fee Schedule

87905 Sialidase enzyme assay 5.54 General Fee Schedule

87906 Genotype dna/rna hiv 138.23 General Fee Schedule

87910 Genotype cytomegalovirus 265.41 General Fee Schedule

87912 Genotype dna hepatitis b 265.41 General Fee Schedule

87999 Microbiology procedure 0 Manual Price

88104 Cytopath fl nongyn smears 2.50 26 Relative Value

88104 Cytopath fl nongyn smears 2.50 TC Relative Value Scale

88104 Cytopath fl nongyn smears 5.00 General Relative Value

88106 Cytopath fl nongyn filter 2.50 26 Relative Value

88106 Cytopath fl nongyn filter 2.50 TC Relative Value Scale

88106 Cytopath fl nongyn filter 5.00 General Relative Value

88108 Cytopath concentrate tech 3.00 26 Relative Value

88108 Cytopath concentrate tech 2.00 TC Relative Value Scale

88108 Cytopath concentrate tech 5.00 General Relative Value

88112 Cytopath cell enhance tech 5.25 26 Relative Value

88112 Cytopath cell enhance tech 4.54 TC Relative Value Scale

88112 Cytopath cell enhance tech 9.80 General Relative Value

88120 Cytp urne 3-5 probes ea spec 5.03 26 Relative Value

88120 Cytp urne 3-5 probes ea spec 38.90 TC Relative Value Scale

88120 Cytp urne 3-5 probes ea spec 43.93 General Relative Value

88121 Cytp urine 3-5 probes cmptr 4.47 26 Relative Value

88121 Cytp urine 3-5 probes cmptr 32.63 TC Relative Value Scale

88121 Cytp urine 3-5 probes cmptr 37.10 General Relative Value

88125 Forensic cytopathology 1.48 26 Relative Value

88125 Forensic cytopathology 0.94 TC Relative Value Scale

88125 Forensic cytopathology 2.42 General Relative Value

88130 Sex chromatin identification 19.01 General Fee Schedule

88140 Sex chromatin identification 3.65 General Fee Schedule

88141 Cytopath c/v interpret 15.18 General Fee Schedule

88142 Cytopath c/v thin layer 25.61 General Fee Schedule

88143 Cytopath c/v thin layer redo 19.21 General Fee Schedule

88147 Cytopath c/v automated 14.38 General Fee Schedule

88148 Cytopath c/v auto rescreen 19.21 General Fee Schedule

88150 Cytopath c/v manual 13.36 General Fee Schedule

88152 Cytopath c/v auto redo 13.36 General Fee Schedule

88153 Cytopath c/v redo 13.36 General Fee Schedule

88154 Cytopath c/v select 13.36 General Fee Schedule

88155 Cytopath c/v index add-on 7.56 General Fee Schedule

88160 Cytopath smear other source 2.50 26 Relative Value

88160 Cytopath smear other source 2.50 TC Relative Value Scale

88160 Cytopath smear other source 5.00 General Relative Value





Codes and Rates

Procedure


Current






88164 Cytopath tbs c/v manual 13.36 General Fee Schedule

88165 Cytopath tbs c/v redo 13.36 General Fee Schedule

88166 Cytopath tbs c/v auto redo 6.53 General Fee Schedule

88167 Cytopath tbs c/v select 13.36 General Fee Schedule

88172 Cytp dx eval fna 1st ea site 2.50 TC Relative Value Scale

88172 Cytp dx eval fna 1st ea site 5.92 General Relative Value

88172 Cytp dx eval fna 1st ea site 3.38 26 Relative Value

88173 Cytopath eval fna report 6.19 26 Relative Value

88173 Cytopath eval fna report 2.27 TC Relative Value Scale

88173 Cytopath eval fna report 8.46 General Relative Value

88174 Cytopath c/v auto in fluid 13.49 General Fee Schedule

88175 Cytopath c/v auto fluid redo 13.49 General Fee Schedule

88177 Cytp fna eval ea addl 2.06 26 Relative Value

88177 Cytp fna eval ea addl 0.61 TC Relative Value Scale

88177 Cytp fna eval ea addl 2.67 General Relative Value

88182 FLOW CYTOMETRY; CELL CYCLE / DNA ANALYSI 4.04 26 Relative Value

88182 FLOW CYTOMETRY; CELL CYCLE / DNA ANALYSI 8.30 TC Relative Value Scale

88182 FLOW CYTOMETRY; CELL CYCLE / DNA ANALYSI 11.51 General Relative Value

88184 Flowcytometry/ tc 1 marker 4.40 TC Relative Value Scale

88185 Flowcytometry/tc add-on 2.16 TC Relative Value Scale

88187 Flowcytometry/read 2-8 5.97 General Relative Value

88188 Flowcytometry/read 9-15 7.45 General Relative Value

88189 Flowcytometry/read 16 & > 9.81 General Relative Value

88199 UNLISTED CYTOPATHOLOGY PROCEDURE 0 26 Requires manual Price

88199 UNLISTED CYTOPATHOLOGY PROCEDURE 0 Manual Price

88230 Tissue culture lymphocyte 46.59 General Fee Schedule

88233 Tissue culture skin/biopsy 93.18 General Fee Schedule

88235 Tissue culture placenta 93.18 General Fee Schedule

88237 Tissue culture bone marrow 159.60 General Fee Schedule

88239 Tissue culture tumor 186.45 General Fee Schedule

88240 Cell cryopreserve/storage 12.76 General Fee Schedule

88241 Frozen cell preparation 12.76 General Fee Schedule

88245 Chromosome analysis 20-25 188.11 General Fee Schedule


88249 Chromosome analysis 100 218.85 General Fee Schedule





88267 Chromosome analys placenta 227.18 General Fee Schedule

88269 Chromosome analys amniotic 210.18 General Fee Schedule

88271 Cytogenetics dna probe 27.07 General Fee Schedule

88272 Cytogenetics 3-5 33.83 General Fee Schedule






Codes and Rates

Procedure


Current


88280 CHROMOSOME KARYOTYPE STUDY 31.73 General Fee Schedule

88283 CHROMOSOME BANDING STUDY 86.68 General Fee Schedule

88285 Chromosome count additional 24.01 General Fee Schedule

88289 Chromosome study additional 43.52 General Fee Schedule

88291 Cyto/molecular report 18.77 General Fee Schedule

88299 UNLISTED CYTOGENETIC STUDY 0 Manual Price

88300 Surgical path gross 0.48 26 Relative Value

88300 Surgical path gross 0.50 TC Relative Value Scale

88300 Surgical path gross 1.80 General Relative Value

88302 Tissue exam by pathologist 0.73 26 Relative Value

88302 Tissue exam by pathologist 1.20 TC Relative Value Scale

88302 Tissue exam by pathologist 4.10 General Relative Value













88311 SURGICAL PATHOLOGY, GROSS AND MICROSCOPI 0.20 26 Relative Value

88311 SURGICAL PATHOLOGY, GROSS AND MICROSCOPI 0.60 TC Relative Value Scale

88311 SURGICAL PATHOLOGY, GROSS AND MICROSCOPI 0.80 General Relative Value

88312 Special stains group 1 0.50 26 Relative Value

88312 Special stains group 1 1.20 TC Relative Value Scale

88312 Special stains group 1 1.70 General Relative Value

88313 Special stains group 2 0.20 26 Relative Value

88313 Special stains group 2 0.60 TC Relative Value Scale

88313 Special stains group 2 0.80 General Relative Value

88314 Histochemical stains add-on 1.20 26 Relative Value

88314 Histochemical stains add-on 3.80 TC Relative Value Scale

88314 Histochemical stains add-on 5.00 General Relative Value

88319 Enzyme histochemistry 2.30 26 Relative Value

88319 Enzyme histochemistry 2.20 TC Relative Value Scale

88319 Enzyme histochemistry 4.50 General Relative Value

88321 Microslide consultation 6.10 General Relative Value

88323 Microslide consultation 6.36 26 Relative Value

88323 Microslide consultation 4.26 TC Relative Value Scale

88323 Microslide consultation 10.62 General Relative Value

88325 Comprehensive review of data 10.20 General Relative Value

88329 Path consult introp 10.45 General Relative Value

88331 Path consult intraop 1 bloc 5.60 26 Relative Value

88331 Path consult intraop 1 bloc 1.75 TC Relative Value Scale

88331 Path consult intraop 1 bloc 7.35 General Relative Value

88332 Path consult intraop addl 2.80 26 Relative Value

88332 Path consult intraop addl 0.88 TC Relative Value Scale



Codes and Rates

Procedure


Current


88332 Path consult intraop addl 3.68 General Relative Value

88333 Intraop cyto path consult 1 5.54 26 Relative Value

88333 Intraop cyto path consult 1 1.85 TC Relative Value Scale

88333 Intraop cyto path consult 1 7.39 General Relative Value

88334 Intraop cyto path consult 2 2.72 26 Relative Value

88334 Intraop cyto path consult 2 1.13 TC Relative Value Scale

88334 Intraop cyto path consult 2 3.85 General Relative Value

88341 Immunohisto antibody slide 5.22 26 Relative Value

88341 Immunohisto antibody slide 1.22 TC Relative Value Scale

88341 Immunohisto antibody slide 6.44 General Relative Value

88342 Immunohisto antibody stain 3.82 26 Relative Value

88342 Immunohisto antibody stain 2.89 TC Relative Value Scale

88342 Immunohisto antibody stain 6.71 General Relative Value

88344 Immunohisto antibody slide 3.82 26 Relative Value

88344 Immunohisto antibody slide 2.89 TC Relative Value Scale

88344 Immunohisto antibody slide 6.71 General Relative Value

88346 IMMUNOFLUORESCENT STUDY EACH ANTIBODY 4.08 26 Relative Value

88346 IMMUNOFLUORESCENT STUDY EACH ANTIBODY 2.60 TC Relative Value Scale

88346 IMMUNOFLUORESCENT STUDY EACH ANTIBODY 6.67 General Relative Value

88347 INDIRECT METHOD 3.94 26 Relative Value

88347 INDIRECT METHOD 3.84 TC Relative Value Scale

88347 INDIRECT METHOD 7.78 General Relative Value

88348 Electron microscopy 8.45 26 Relative Value

88348 Electron microscopy 4.33 TC Relative Value Scale

88348 Electron microscopy 14.39 General Relative Value

88355 Analysis skeletal muscle 9.03 26 Relative Value

88355 Analysis skeletal muscle 8.49 TC Relative Value Scale

88355 Analysis skeletal muscle 17.51 General Relative Value

88356 Analysis nerve 14.58 26 Relative Value

88356 Analysis nerve 8.94 TC Relative Value Scale

88356 Analysis nerve 23.52 General Relative Value

88358 Analysis tumor 5.14 26 Relative Value

88358 Analysis tumor 2.28 TC Relative Value Scale

88358 Analysis tumor 8.68 General Relative Value

88360 Tumor immunohistochem/manual 5.31 26 Relative Value

88360 Tumor immunohistochem/manual 4.20 TC Relative Value Scale

88360 Tumor immunohistochem/manual 9.51 General Relative Value

88361 Tumor immunohistochem/comput 4.35 26 Relative Value

88361 Tumor immunohistochem/comput 6.82 TC Relative Value Scale

88361 Tumor immunohistochem/comput 11.17 General Relative Value

88362 NERVE TEASING PREPARATION 12.11 26 Relative Value

88362 NERVE TEASING PREPARATION 4.17 TC Relative Value Scale

88362 NERVE TEASING PREPARATION 16.85 General Relative Value

88363 Xm archive tissue molec anal 3.65 General Relative Value

88364 Insitu hybridization (fish) 2.56 26 Relative Value

88364 Insitu hybridization (fish) 6.64 TC Relative Value Scale

88364 Insitu hybridization (fish) 9.13 General Relative Value






Codes and Rates

Procedure


Current





88367 Insitu hybridization auto 6.20 26 Relative Value

88367 Insitu hybridization auto 11.91 TC Relative Value Scale

88367 Insitu hybridization auto 18.11 General Relative Value

88368 Insitu hybridization manual 6.73 26 Relative Value

88368 Insitu hybridization manual 9.70 TC Relative Value Scale

88368 Insitu hybridization manual 16.43 General Relative Value

88369 M/phmtrc alysishquant/semiq 2.35 26 Relative Value

88369 M/phmtrc alysishquant/semiq 4.61 TC Relative Value Scale

88369 M/phmtrc alysishquant/semiq 6.96 General Relative Value

88371 Protein western blot tissue 12.68 26 Fee Schedule

88371 Protein western blot tissue 28.08 General Fee Schedule

88372 PROTEIN ANALYSIS W/PROBE 13.19 26 Fee Schedule

88372 PROTEIN ANALYSIS W/PROBE 13.45 General Fee Schedule

88373 M/phmtrc alys ishquant/semiq 1.98 26 Relative Value

88373 M/phmtrc alys ishquant/semiq 3.73 TC Relative Value Scale

88373 M/phmtrc alys ishquant/semiq 5.71 General Relative Value







88380 Microdissection laser 15.88 General Relative Value

88381 Microdissection manual 33.50 26 Fee Schedule

88381 Microdissection manual 100.71 TC Fee Schedule

88381 Microdissection manual 134.67 General Fee Schedule

88387 Tiss exam molecular study 2.32 26 Relative Value

88387 Tiss exam molecular study 0.58 TC Relative Value Scale

88387 Tiss exam molecular study 2.91 General Relative Value

88388 Tiss ex molecul study add-on 1.44 26 Relative Value

88388 Tiss ex molecul study add-on 0.29 TC Relative Value Scale

88388 Tiss ex molecul study add-on 1.72 General Relative Value

88399 UNLISTED SURGICAL PATHOLOGY PROCEDURE 0 26 Requires manual Price

88399 UNLISTED SURGICAL PATHOLOGY PROCEDURE 0 TC Requires Manual Price

88399 UNLISTED SURGICAL PATHOLOGY PROCEDURE 0 Manual Price

88720 Bilirubin total transcut 5.30 General Fee Schedule

88738 Hgb quant transcutaneous 5.44 General Fee Schedule

88740 Transcutaneous carboxyhb 5.28 General Fee Schedule

88741 Transcutaneous methb 5.28 General Fee Schedule

88749 In vivo lab service 0 Manual Price

89049 Chct for mal hyperthermia 15.84 General Relative Value

89050 Body fluid cell count 5.37 General Fee Schedule

89051 BODY FLUID CELL COUNT 6.94 General Fee Schedule

89055 Leukocyte count, fecal 5.45 General Fee Schedule

89060 Exam synovial fluid crystals 1.15 26 Relative Value

89125 Specimen fat stain 5.72 General Fee Schedule

89160 EXAM FECES FOR MEAT FIBERS 4.73 General Fee Schedule



Codes and Rates

Procedure


Current


89190 NASAL SMEAR FOR EOSINOPHILS 4.73 General Fee Schedule

89230 Collect sweat for test 2.41 General Fee Schedule

89240 Pathology lab procedure 0 Manual Price

89300 Semen analysis w/huhner 11.85 General Fee Schedule

89310 Semen analysis w/count 8.47 General Fee Schedule

89320 Semen anal vol/count/mot 16.04 General Fee Schedule

89321 Semen anal sperm detection 16.04 General Fee Schedule

89322 Semen anal strict criteria 15.62 General Fee Schedule

89325 SPERM ANTIBODY TEST 10.38 General Fee Schedule

89329 SPERM EVALUATION TEST 27.88 General Fee Schedule

89330 Evaluation cervical mucus 13.18 General Fee Schedule

89331 Retrograde ejaculation anal 19.76 General Fee Schedule

89398 Unlisted reprod med lab proc 0 Manual Price

G0416 Prostate biopsy, any mthd 57.02 General Relative Value

G0432 EIA HIV-1/HIV-2 screen 10.72 General Fee Schedule

G0433 ELISA HIV-1/HIV-2 screen 10.72 General Fee Schedule

G0435 Oral HIV-1/HIV-2 screen 12.89 General Fee Schedule

P3000 SCREEN PAP BY TECH W/ MD SUPV 14.35 General Fee Schedule

P3001 Screening pap smear by phys 7.02 General Fee Schedule

P7001 URINE CULTURE AND SENSITIVITY W/W/OUT 16.37 General Fee Schedule

P9041 Albumin (human),5%, 50ml 2.44 General Fee Schedule

P9043 Plasma protein fract,5%,50ml 14.95 General Fee Schedule

P9045 Albumin (human), 5%, 250 ml 8.81 General Fee Schedule

P9046 Albumin (human), 25%, 20 ml 27.09 General Fee Schedule

P9047 Albumin (human), 25%, 50ml 13.29 General Fee Schedule

P9048 Plasmaprotein fract,5%,250ml 397.43 General Fee Schedule

P9050 Granulocytes, pheresis unit 20.88 General Fee Schedule

P9612 Catheterize for urine spec 2.96 General Fee Schedule

P9615 Urine specimen collect mult 2.96 General Fee Schedule

** Age 0-2


procedure current code description pricing description ... · 80346 benzodiazepines1-12 16.68...

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