Attachment B.xlsx
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Attachment B
| Test Code | Description | Quantity | Unit of Measure | FSS Price | Amount |
| 000315 | CK+Cl+Creat+K+Na+Pheoch CPT: 82570, 83835, 82550, 82435, 82565, 84132, 84295 | 1 | EA | $ 31.49 | $ 31.49 |
| 000372 | Alb+AlP+AST+BUN+Ca+Chol+Glu...; See Individual Test Components; CPT:81003, 84436, 85025, 85652, 86592, 84478, 82040, 82247, 82310, 82465, 82947, 83615, 84075, 84100 | 1 | EA | $ 19.90 | $ 19.90 |
| 000455 | Thyroid Panel Cloned enzyme donor immunoassay (CEDIA) CPT:84436, 84479 | 1 | EA | $ 8.09 | $ 8.09 |
| 000505 | HFP7+3AC see individual tests CPT:80076, 82977, 82465, 83615 | 1 | EA | $ 4.20 | $ 4.20 |
| 000513 | HFP7+3AC+PE CPT:80076, 84165, 84155, 82977, 82465, 83615 | 1 | EA | $ 18.56 | $ 18.56 |
| 000604 | Cl+K+Na CPT:82435, 84132, 84295 | 1 | EA | $ 4.84 | $ 4.84 |
| 000620 | Thyroid Panel With TSH See individual test descriptions CPT: 84436, 84443, 84479 | 1 | EA | $ 10.07 | $ 10.07 |
| 000703 | Renin Activity and Aldosterone Renin: radioimmunoassay (RIA); aldosterone: liquid chromatography/tandem mass spectrometry (LC/MS-MS) CPT:82088, 84244 | 1 | EA | $ 33.65 | $ 33.65 |
| 000810 | Vitamin B12 and Folates Electrochemiluminescence Immunoassay (ECLIA) CPT:82607, 82746 | 1 | EA | $ 15.35 | $ 15.35 |
| 000893 | Alb+AlP+AST+BUN+Ca+Chol+CK+... CPT:82550, 82553, 83625, 82040, 82247, 82310, 82465, 82947, 83615, 84075, 84100, 84155, 84450, 84520, 84550 | 1 | EA | $ 36.63 | $ 36.63 |
| 001016 | Calcium, Serum Colorimetric CPT:82310 | 1 | EA | $ 2.77 | $ 2.77 |
| 001024 | Phosphorus, Serum Colorimetric CPT:84100 | 1 | EA | $ 2.77 | $ 2.77 |
| 001040 | Urea Nitrogen, Serum Enzymatic (urease) CPT:84520 | 1 | EA | $ 2.77 | $ 2.77 |
| 001057 | Uric Acid, Serum Uricase CPT:84550 | 1 | EA | $ 2.77 | $ 2.77 |
| 001065 | Cholesterol, Total Enzymatic CPT:82465 | 1 | EA | $ 2.77 | $ 2.77 |
| 001073 | Protein, Total, Serum Colorimetric CPT:84155 | 1 | EA | $ 2.77 | $ 2.77 |
| 001081 | Albumin, Serum Colorimetric CPT:82040 | 1 | EA | $ 2.77 | $ 2.77 |
| 001099 | Bilirubin, Total Colorimetric CPT:82247 | 1 | EA | $ 2.27 | $ 2.27 |
| 001107 | Alkaline Phosphatase, Serum Kinetic CPT:84075 | 1 | EA | $ 2.77 | $ 2.77 |
| 001115 | Lactic Acid Dehydrogenase (LD) Kinetic CPT:83615 | 1 | EA | $ 2.77 | $ 2.77 |
| 001123 | Aspartate Aminotransferase Kinetic CPT:84450 | 1 | EA | $ 2.77 | $ 2.77 |
| 001149 | Thyroxine (T4) Cloned enzyme donor immunoassay (CEDIA) CPT:84436 | 1 | EA | $ 5.00 | $ 5.00 |
| 001156 | T3 Uptake Cloned enzyme donor immunoassay (CEDIA) CPT:84479 | 1 | EA | $ 5.88 | $ 5.88 |
| 001172 | Triglycerides Enzymatic CPT:84478 | 1 | EA | $ 2.77 | $ 2.77 |
| 001180 | Potassium, Serum Ion-selective electrode (ISE); flame photometer CPT:84132 | 1 | EA | $ 2.77 | $ 2.77 |
| 001198 | Sodium, Serum Ion-selective electrode (ISE); flame photometer CPT:84295 | 1 | EA | $ 3.79 | $ 3.79 |
| 001206 | Chloride, Serum Ion-selective electrode (ISE) CPT:82435 | 1 | EA | $ 4.46 | $ 4.46 |
| 001214 | Bilirubin, Total/Direct, Serum Colorimetric CPT:82247, 82248 | 1 | EA | $ 2.37 | $ 2.37 |
| 001222 | Bilirubin, Direct Colorimetric CPT:82248 | 1 | EA | $ 2.77 | $ 2.77 |
| 001248 | Potassium, Heparin Plasma ISE CPT:84132 | 1 | EA | $ 4.70 | $ 4.70 |
| 001255 | Glucose Fasting and 2hr CPT:82950, 82947 | 1 | EA | $ 5.34 | $ 5.34 |
| 001302 | Glucose, Random CPT:82947 | 1 | EA | $ 1.95 | $ 1.95 |
| 001321 | Iron and Total Iron Binding Capacity (TIBC) Colorimetric CPT:83550, 83540 | 1 | EA | $ 7.43 | $ 7.43 |
| 001339 | Iron, Serum Colorimetric CPT:83540 | 1 | EA | $ 2.77 | $ 2.77 |
| 001362 | Creatine Kinase (CK), Total, Serum Kinetic - 340 nm spectrophotometric CPT:82550 | 1 | EA | $ 2.77 | $ 2.77 |
| 001404 | Lipase, Serum Colorimetric CPT:83690 | 1 | EA | $ 4.20 | $ 4.20 |
| 001407 | Creatinine Plus, Serum Enzymatic CPT:82565 | 1 | EA | $ 6.62 | $ 6.62 |
| 001496 | Immunofixation Reflex, Serum Immunodiffusion against monospecific antisera to immunoglobulin and individual heavy and light chains (IFE) CPT:82784 (x3), 86334 | 1 | EA | $ 30.16 | $ 30.16 |
| 001503 | Vitamin B12 Electrochemiluminescence immunoassay (ECLIA) CPT:82607 | 1 | EA | $ 7.92 | $ 7.92 |
| 001537 | Magnesium, Serum Colorimetric CPT:83735 | 1 | EA | $ 4.46 | $ 4.46 |
| 001545 | Alanine Aminotransferase Kinetic CPT:84460 | 1 | EA | $ 2.77 | $ 2.77 |
| 001578 | Carbon Dioxide, Total Enzymatic CPT:82374 | 1 | EA | $ 2.77 | $ 2.77 |
| 001610 | Fibrinogen, Quantitative The measurement of fibrinogen activity is based on determination of fibrin polymerization function by the Clauss method.(11) This method measures the rate of clot formation after adding a high concentration of thrombin to citrated plasma. The fibrinogen a CPT:85384 | 1 | EA | $ 7.61 | $ 7.61 |
| 001669 | Xylose, Plasma Spectrophotometry CPT:84620 | 1 | EA | $ 8.66 | $ 8.66 |
| 001701 | 5´ Nucleotidase Kinetic - 340 nm CPT:83915 | 1 | EA | $ 5.94 | $ 5.94 |
| 001727 | Phospholipids, Serum Spectrophotometry (4-aminoantipyrine) CPT:84311 | 1 | EA | $ 11.19 | $ 11.19 |
| 001750 | Vitamin A and Carotene High-pressure liquid chromatography (HPLC) with UV detection CPT:82380, 84590 | 1 | EA | $ 24.20 | $ 24.20 |
| 001768 | Immunoglobulins (Quantitative IgA, IgG, IgM), Serum Immunologic CPT:82784 (x3) | 1 | EA | $ 15.58 | $ 15.58 |
| 001776 | Immunoglobulin G, Quantitative, Serum Immunoturbidimetric CPT:82784 | 1 | EA | $ 5.19 | $ 5.19 |
| 001784 | Immunoglobulin A, Quantitative, Serum Immunoturbidimetric CPT:82784 | 1 | EA | $ 5.19 | $ 5.19 |
| 001792 | Immunoglobulin M, Quantitative, Serum Immunoturbidimetric CPT:82784 | 1 | EA | $ 5.19 | $ 5.19 |
| 001818 | Glucose, Plasma Enzymatic CPT:82947 | 1 | EA | $ 2.77 | $ 2.77 |
| 001834 | Complement C4, Serum Immunologic CPT:86160 | 1 | EA | $ 4.46 | $ 4.46 |
| 001859 | CK+LD, Totals+Isoenzymes CPT:82550, 82552, 83625, 83615 | 1 | EA | $ 150.43 | $ 150.43 |
| 001875 | Fructose, Semen Analysis Resorcinol CPT:82757 | 1 | EA | $ 20.90 | $ 20.90 |
| 001909 | Alb+Prot Colorimetric CPT:82040, 84155 | 1 | EA | $ 4.76 | $ 4.76 |
| 001917 | Glucose 6-Phosphate Dehydrogenase (G-6-PD), Kinetic - 340 nm CPT:82955, 85041 | 1 | EA | $ 7.92 | $ 7.92 |
| 001925 | High-Density Lipoprotein Cholesterol (HDLC) Enzymatic CPT:83718 | 1 | EA | $ 4.20 | $ 4.20 |
| 001958 | Gamma Glutamyl Transpeptidase (GGT) Kinetic CPT:82977 | 1 | EA | $ 2.77 | $ 2.77 |
| 001974 | Thyroxine (T4) Free, Direct, Serum Electrochemiluminescence Immunoassay (ECLIA) CPT:84439 | 1 | EA | $ 4.95 | $ 4.95 |
| 001975 | T4F Electrochemiluminescence Immunoassay (ECLIA) CPT:84439 | 1 | EA | $ 6.93 | $ 6.93 |
| 001976 | Thyroxine (T4) Free, Direct, S Electrochemiluminescence Immunoassay (ECLIA) CPT:84439 | 1 | EA | $ 6.93 | $ 6.93 |
| 001977 | Thyroxine (T4) Free, Direct, S Electrochemiluminescence Immunoassay (ECLIA) CPT:84439 | 1 | EA | $ 6.93 | $ 6.93 |
| 002006 | Renin, Plasma Radioimmunoassay (RIA) CPT:84244 | 1 | EA | $ 15.18 | $ 15.18 |
| 002014 | Folate (Folic Acid) Electrochemiluminescence immunoassay (ECLIA) CPT:82746 | 1 | EA | $ 7.43 | $ 7.43 |
| 002022 | Glucose, 2-Hour Postprandial Enzymatic CPT:82950 | 1 | EA | $ 4.68 | $ 4.68 |
| 002048 | Glucose, Cerebrospinal Fluid Enzymatic CPT:82945 | 1 | EA | $ 10.70 | $ 10.70 |
| 002055 | Protein, Total, Cerebrospinal Fluid Spectrophotometry CPT:84157 | 1 | EA | $ 4.70 | $ 4.70 |
| 002063 | Chloride, Cerebrospinal Fluid Ion-selective electrode (ISE) CPT:82438 | 1 | EA | $ 4.76 | $ 4.76 |
| 002139 | Carcinoembryonic Antigen (CEA) Electrochemiluminescence Immunoassay (ECLIA) CPT:82378 | 1 | EA | $ 9.90 | $ 9.90 |
| 002162 | Immunoglobulin D, Quantitative, Serum Immunologic CPT:82784 | 1 | EA | $ 10.89 | $ 10.89 |
| 002170 | Immunoglobulin E, Total Electrochemiluminescence immunoassay (ECLIA) CPT:82785 | 1 | EA | $ 9.90 | $ 9.90 |
| 002173 | Immunoglobulin E, Total CPT:82785 | 1 | EA | $ 9.90 | $ 9.90 |
| 002180 | Angiotensin II Radioimmunoassay (RIA) CPT:82163 | 1 | EA | $ 91.14 | $ 91.14 |
| 002188 | Tri-iodothyronine (T3) Electrochemiluminescence Immunoassay (ECLIA) CPT:84480 | 1 | EA | $ 11.87 | $ 11.87 |
| 002196 | Bilirubin, Amniotic Fluid Scan Spectrophotometry CPT:82143 | 1 | EA | $ 9.15 | $ 9.15 |
| 002238 | Immunoglobulin G Index CSF IgG, CSF albumin, and serum IgG: immunologic; serum albumin: spectrophotometry; ratio and index by calculation CPT:82042, 82784 (x2), 82040 | 1 | EA | $ 28.21 | $ 28.21 |
| 002246 | Protein Electrophoresis, Cerebrospinal Fluid Electrophoresis on agarose media CPT:84166, 84157 | 1 | EA | $ 14.85 | $ 14.85 |
| 002253 | Alpha-Fetoprotein (AFP), Serum, Tumor Marker Electrochemiluminescence immunoassay (ECLIA) CPT:82105 | 1 | EA | $ 8.91 | $ 8.91 |
| 002295 | Immunoglobulins (Quantitative, IgA, IgE, IgG, IgM), IgG, IgA, IgM: Immunologic; IgE: Electrochemiluminescence immunoassay (ECLIA) CPT:82785, 82784 (x3) | 1 | EA | $ 30.29 | $ 30.29 |
| 002311 | Creatine Kinase (CK), MB and Total CK total: kinetic, 340 nm spectrophotometric; CK-MB: immunochemiluminometric assay (ICMA) CPT:82550, 82553 | 1 | EA | $ 26.86 | $ 26.86 |
| 002329 | Urea Nitrogen Clearance Enzymatic (urease) CPT:84545 | 1 | EA | $ 7.43 | $ 7.43 |
| 002402 | Creatine, Serum Enzymatic (creatinase)/spectrophotometry CPT:82540 | 1 | EA | $ 7.79 | $ 7.79 |
| 002428 | Alpha-Fetoprotein (AFP), Amniotic Fluid Immunochemiluminometric assay (ICMA)CPT: 82106 | 1 | EA | $ 46.03 | $ 46.03 |
| 003004 | Creatinine Clearance Colorimetric CPT:82575 | 1 | EA | $ 8.48 | $ 8.48 |
| 003012 | Creatinine, 24-Hour Urine Kinetic CPT:82570 | 1 | EA | $ 5.57 | $ 5.57 |
| 003129 | Prot+CreatU (Random) Spectrophotometric CPT:82570, 84156 | 1 | EA | $ 8.66 | $ 8.66 |
| 003160 | Chloride, Urine Colorimetric; ion-selective electrode (ISE) CPT:82436 | 1 | EA | $ 4.89 | $ 4.89 |
| 003178 | Sodium, Urine Ion-selective electrode (ISE); flame photometer CPT:84300 | 1 | EA | $ 3.21 | $ 3.21 |
| 003186 | Potassium, Urine Ion-selective electrode (ISE); flame photometer CPT:84133 | 1 | EA | $ 5.57 | $ 5.57 |
| 003202 | Coproporphyrin, Urine CPT:84120 | 1 | EA | $ 86.66 | $ 86.66 |
| 003228 | Bile, Qualitative, Urine Reagent strip with Ictotest(R) for confirmation of all positives CPT:81005 | 1 | EA | $ 4.46 | $ 4.46 |
| 003236 | C-Peptide, Urine Electrochemiluminescence immunoassay (ECLIA) CPT:84681 | 1 | EA | $ 22.28 | $ 22.28 |
| 003251 | Phosphorus, Urine Colorimetric CPT:84105 | 1 | EA | $ 3.21 | $ 3.21 |
| 003277 | Protein, Total, Quantitative, 24-Hour Urine Spectrophotometric CPT:84156 | 1 | EA | $ 4.20 | $ 4.20 |
| 003293 | Amylase, Urine Enzymatic CPT:82150 | 1 | EA | $ 6.62 | $ 6.62 |
| 003298 | Amylase, Urine 24hr Enzymatic 82150 | 1 | EA | $ 9.21 | $ 9.21 |
| 003324 | Calcium, 24Hr, Ur w/Creatinine see individual tests CPT:82340, 82570 | 1 | EA | $ 15.81 | $ 15.81 |
| 003368 | Protein Electrophoresis, 24-Hour Urine Electrophoresis on agarose media CPT:84166, 84156 | 1 | EA | $ 17.52 | $ 17.52 |
| 003376 | Glucose, Quantitative, Urine Enzymatic CPT:82945 | 1 | EA | $ 3.21 | $ 3.21 |
| 003384 | Urinalysis (No Micro) Reagent strip CPT:81003 | 1 | EA | $ 3.34 | $ 3.34 |
| 003400 | Magnesium, Urine Atomic absorption spectrometry (AAS) or colorimetric CPT:83735 | 1 | EA | $ 6.23 | $ 6.23 |
| 003418 | Uric Acid, Urine Uricase CPT:84560 | 1 | EA | $ 3.03 | $ 3.03 |
| 003434 | Zinc, Urine Inductively-coupled plasma/mass spectrometry (ICP/MS) CPT:84630, 82570 | 1 | EA | $ 17.82 | $ 17.82 |
| 003442 | Osmolality, Urine Freezing point depression CPT:83935 | 1 | EA | $ 6.18 | $ 6.18 |
| 003475 | Creatine, 24-Hour Urine Enzymatic (creatinase)/spectrophotometry CPT:82540 | 1 | EA | $ 7.79 | $ 7.79 |
| 003524 | Chloride, 24Hr,Ur w/Creatinine Colorimetric; ion-selective electrode (ISE) CPT:82436, 82570 | 1 | EA | $ 15.96 | $ 15.96 |
| 003541 | Urea Nitrogen, 24-Hour Urine Urease CPT:84540 | 1 | EA | $ 3.21 | $ 3.21 |
| 003772 | Urinalysis, Complete (With Microscopic Examination) Reagent strip and light microscopy CPT:81001 | 1 | EA | $ 2.37 | $ 2.37 |
| 003855 | Creatine and Creatinine, 24-Hour Urine Spectrophotometry CPT:82540, 82570 | 1 | EA | $ 13.37 | $ 13.37 |
| 003897 | Amylase Urine Enzymatic CPT:82150 | 1 | EA | $ 8.10 | $ 8.10 |
| 004036 | Pregnancy Test, Urine Enzyme immunoassay (EIA) CPT:81025 | 1 | EA | $ 9.90 | $ 9.90 |
| 004044 | Metanephrines, Pheochromocytoma Evaluation Metanephrines: liquid chromatography/tandem mass spectrometry (LC/MS-MS); creatinine: alkaline picric acid CPT:82570, 83835 | 1 | EA | $ 25.00 | $ 25.00 |
| 004051 | Cortisol Electrochemiluminescence immunoassay (ECLIA) CPT:82533 | 1 | EA | $ 7.92 | $ 7.92 |
| 004100 | DHEA, Serum Liquid chromatography tandem/mass spectrometry (LC/MS-MS) CPT:82626 | 1 | EA | $ 19.80 | $ 19.80 |
| 004110 | Galectin-3 Enzyme Immunoassay (EIA) CPT:82777 | 1 | EA | $ 147.00 | $ 147.00 |
| 004180 | ECP CPT:86849 | 1 | EA | $ 141.05 | $ 141.05 |
| 004220 | Complement C3a Radioimmunoassay (RIA) CPT:86160 | 1 | EA | $ 176.40 | $ 176.40 |
| 004226 | Testosterone, Total, Serum Electrochemiluminescence Immunoassay (ECLIA) CPT:84403 | 1 | EA | $ 10.76 | $ 10.76 |
| 004259 | Thyroid-Stimulating Hormone (TSH), Third Generation Electrochemiluminescence Immunoassay (ECLIA) CPT:84443 | 1 | EA | $ 5.94 | $ 5.94 |
| 004267 | Growth Hormone, Serum, 6 Specimens Immunochemiluminometric assay (ICMA) CPT:83003 (x6) | 1 | EA | $ 46.40 | $ 46.40 |
| 004283 | Luteinizing Hormone (LH), Serum Electrochemiluminescence Immunoassay (ECLIA) CPT:83002 | 1 | EA | $ 9.90 | $ 9.90 |
| 004309 | Follicle-Stimulating Hormone (FSH), Serum Electrochemiluminescence immunoassay (ECLIA) CPT:83001 | 1 | EA | $ 8.91 | $ 8.91 |
| 004330 | Complement C4a Radioimmunoassay (RIA) CPT:86160 | 1 | EA | $ 176.40 | $ 176.40 |
| 004354 | Aldosterone/Renin Ratio See individual test descriptions CPT:82088, 84244 | 1 | EA | $ 25.55 | $ 25.55 |
| 004416 | Human Chorionic Gonadotropin (hCG), Beta Subunit, Electrochemiluminescence immunoassay (ECLIA) CPT:84702 | 1 | EA | $8.91 | $ 8.91 |
| 004432 | Cortisol, Urinary Free by HPLC Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS) CPT:82530 | 1 | EA | $ 12.87 | $ 12.87 |
| 004457 | Thyroxine (T4), Thyroxine-Binding Globulin (TBG) and See individual test descriptions CPT:84436, 84442 | 1 | EA | $ 17.23 | $ 17.23 |
| 004465 | Prolactin Electrochemiluminescence immunoassay (ECLIA) CPT:84146 | 1 | EA | $ 9.90 | $ 9.90 |
| 004556 | Human Chorionic Gonadotropin (hCG), Beta Subunit, Electrochemiluminescence Immunoassay (ECLIA) CPT:84703 | 1 | EA | $ 6.93 | $ 6.93 |
| 004565 | Adult Aldosterone, Supine Liquid chromatography/tandem mass spectrometry (LC/MS-MS) CPT:82088 | 1 | EA | $ 131.57 | $ 131.57 |
| 004593 | TSH Pregnancy CPT:84443 | 1 | EA | $ 18.68 | $ 18.68 |
| 004598 | Ferritin, Serum Electrochemiluminescence immunoassay (ECLIA) CPT:82728 | 1 | EA | $ 6.68 | $ 6.68 |
| 004606 | Estrogens Fractionated, S Radioimmunoassay CPT:82670, 82679 | 1 | EA | $ 67.11 | $ 67.11 |
| 004650 | Adiponectin CPT:83520 | 1 | EA | $ 207.76 | $ 207.76 |
| 004747 | Prostatic Acid Phosphatase (PAP), Serum by EIA Immunochemiluminometric (ICMA) CPT:84066 | 1 | EA | $ 9.41 | $ 9.41 |
| 004770 | Lactic Acid Lactate - pyruvate; spectrophotometry CPT:83605 | 1 | EA | $ 14.42 | $ 14.42 |
| 004788 | Pyruvic Acid, Blood Pyruvate - lactate; spectrophotometry CPT:84210 | 1 | EA | $ 15.35 | $ 15.35 |
| 004861 | Viscosity, Serum Viscometry CPT:85810 | 1 | EA | $ 14.30 | $ 14.30 |
| 004895 | Calcitonin (Thyrocalcitonin), Serum Immunochemiluminometric assay (ICMA) CPT:82308 | 1 | EA | $ 17.82 | $ 17.82 |
| 004900 | Mannose Binding Lectin (MBL) This Enzyme Linked Immunoassay (ELISA) uses microwells coated with the unique monoclonal antibody to capture MBL via an epitope near its carbohydrate-binding site. Bound MBL is detected with the same antibody which has been labeled with biotin. CPT:83520 | 1 | EA | $ 109.03 | $ 109.03 |
| 004903 | Cyclic AMP, Urine Radioimmunoassay (RIA) CPT:82030, 82570 | 1 | EA | $ 42.84 | $ 42.84 |
| 004945 | Ca+Creat+P+PTH Intact Plasma: Electrochemiluminescence Immunoassay (ECLIA) Serum: Colormetric CPT:83970, 82310, 82565, 84100 | 1 | EA | $ 14.35 | $ 14.35 |
| 004984 | Cyclic AMP, Plasma Radioimmunoassay (RIA) CPT:82030 | 1 | EA | $ 98.99 | $ 98.99 |
| 005009 | Complete Blood Count (CBC) With Differential Automated cell counter with mixed technologies CPT:85025 | 1 | EA | $ 2.72 | $ 2.72 |
| 005017 | CBC, No Differential/Platelet Automated cell counter CPT:85014, 85018, 85041, 85048 | 1 | EA | $ 3.96 | $ 3.96 |
| 005025 | White Blood Cell (WBC) Count Automated cell counter CPT:85048 | 1 | EA | $ 2.77 | $ 2.77 |
| 005033 | Red Blood Cell (RBC) Count Automated cell counter CPT:85041 | 1 | EA | $ 3.05 | $ 3.05 |
| 005041 | Hemoglobin Automated cell counter CPT:85018 | 1 | EA | $ 2.77 | $ 2.77 |
| 005058 | Hematocrit Automated cell counter CPT:85014 | 1 | EA | $ 2.77 | $ 2.77 |
| 005199 | Prothrombin Time (PT) Prothrombin time reagent containing thromboplastin and calcium chloride is mixed with the patient plasma and the time to clot formation is measured photo-optically. The calcium chloride overcomes the citrate anticoagulant and allows the tissue factor in t CPT:85610 | 1 | EA | $ 2.72 | $ 2.72 |
| 005200 | Dilute Prothrombin Time Clotting time is measured using a dilute prothrombin time (dPT) reagent consisting of a unique formulation of relipidated recombinant tissue factor and calcium.[8] Samples with extended dPT are tested in a confirmatory assay including excess phospholipid. CPT:85705 | 1 | EA | $ 44.15 | $ 44.15 |
| 005207 | Partial Thromboplastin Time (PTT), Activated The aPTT reagent consisting of silica mixed with synthetic phospholipid is mixed with the patient plasma. The silica provides a negatively-charged particulate surface for the activation of the contact pathway of coagulation. Calcium chloride is then added CPT:85730 | 1 | EA | $ 2.97 | $ 2.97 |
| 005215 | Sedimentation Rate, Westergren Modified Westergren; automated and manual methods are employed. CPT:85652 | 1 | EA | $ 2.77 | $ 2.77 |
| 005223 | Hemoglobin (Hgb) Solubility Sodium hydrosulfite reduction CPT:85660 | 1 | EA | $ 3.96 | $ 3.96 |
| 005231 | Cell Count, Body Fluid Microscopic and macroscopic examination CPT:89051, 89060 | 1 | EA | $ 8.66 | $ 8.66 |
| 005240 | Cell Ct, Serous Fluid Microscopic and Macroscopic evaluation CPT:89051 | 1 | EA | $ 28.76 | $ 28.76 |
| 005249 | Platelet Count Automated cell counter; microscopic exam of peripheral smear if specific criteria is met CPT:85049 | 1 | EA | $ 2.77 | $ 2.77 |
| 005256 | Cell Count, Cerebrospinal Fluid Microscopic and macroscopic examination CPT:89051 | 1 | EA | $ 5.75 | $ 5.75 |
| 005260 | Cell Ct, Amniotic Fluid CPT:89051 | 1 | EA | $ 111.42 | $ 111.42 |
| 005280 | Reticulocyte Count Automated cell counter CPT:85045 | 1 | EA | $ 4.40 | $ 4.40 |
| 005298 | Eosinophil Count Automated cell counter CPT:85048 | 1 | EA | $ 2.77 | $ 2.77 |
| 005300 | Hematopath Consultation, Smear Microscopic examination CPT:85060 | 1 | EA | $ 6.18 | $ 6.18 |
| 005322 | Rh+ABO+Ab Scr CPT:86850, 86900, 86901 | 1 | EA | $ 15.32 | $ 15.32 |
| 005355 | Crystal Examination, Miscellaneous Fluid Polarized light CPT:89060 | 1 | EA | $ 6.87 | $ 6.87 |
| 006002 | A1 RBC Antigen Typing CPT:86905 | 1 | EA | $ 75.41 | $ 75.41 |
| 006010 | C/c RBC Antigen Typing CPT:86905 (x2) | 1 | EA | $ 150.82 | $ 150.82 |
| 006015 | Antibody Screen Antiglobulin test CPT:86850 | 1 | EA | $ 5.31 | $ 5.31 |
| 006018 | E/e RBC Antigen Typing CPT:86905 (x2) | 1 | EA | $ 156.38 | $ 156.38 |
| 006025 | Fya/Fyb RBC Antigen Typing CPT:86905 (x2) | 1 | EA | $ 158.76 | $ 158.76 |
| 006030 | Jka/Jkb RBC Antigen Typing CPT:86905 (x2) | 1 | EA | $ 156.38 | $ 156.38 |
| 006031 | Antistreptolysin O (ASO) Antibodies Latex immunoturbidimetry CPT:86060 | 1 | EA | $ 7.51 | $ 7.51 |
| 006034 | Lea/Leb RBC Antigen Typing CPT:86905 (x2) | 1 | EA | $ 154.00 | $ 154.00 |
| 006040 | S/s RBC Antigen Typing CPT:86905 (x2) | 1 | EA | $ 156.38 | $ 156.38 |
| 006048 | M RBC Antigen Typing CPT:86905 | 1 | EA | $ 75.41 | $ 75.41 |
| 006049 | ABO Grouping and Rho(D) Typing Hemagglutination CPT:86900, 86901 | 1 | EA | $ 7.07 | $ 7.07 |
| 006056 | ABO Grouping Hemagglutination CPT:86900 | 1 | EA | $ 4.82 | $ 4.82 |
| 006060 | N RBC Antigen Typing CPT:86905 | 1 | EA | $ 75.41 | $ 75.41 |
| 006064 | Rh Typing Hemagglutination CPT:86901 | 1 | EA | $ 5.13 | $ 5.13 |
| 006068 | K (Kell) RBC Antigen Typing CPT:86905 | 1 | EA | $ 79.38 | $ 79.38 |
| 006072 | Rapid Plasma Reagin (RPR), Qualitative Test Charcoal flocculation CPT:86592 | 1 | EA | $ 3.96 | $ 3.96 |
| 006096 | k (Cellano) RBC Antigen Typing CPT:86905 | 1 | EA | $ 75.41 | $ 75.41 |
| 006099 | RPR (reflex) Charcoal Flocculation CPT:86592 | 1 | EA | $ 4.38 | $ 4.38 |
| 006189 | Mononucleosis Test, Qualitative Latex agglutination (LA) CPT:86308 | 1 | EA | $ 4.85 | $ 4.85 |
| 006197 | Rubella Antibodies, IgG Chemiluminescent immunoassay (CLIA) CPT:86762 | 1 | EA | $ 7.43 | $ 7.43 |
| 006213 | Antibody Identification Antiglobulin test CPT:86870 | 1 | EA | $ 9.90 | $ 9.90 |
| 006262 | Red Blood Cell (RBC) Antigen Hemagglutination/antiglobulin test CPT:86905 | 1 | EA | $ 15.84 | $ 15.84 |
| 006270 | Coombs', Direct Antiglobulin test CPT:86880 | 1 | EA | $ 3.96 | $ 3.96 |
| 006353 | Cold Agglutinin Titer, Quantitative Hemagglutination CPT:86157 | 1 | EA | $ 7.22 | $ 7.22 |
| 006379 | Treponema pallidum Antibodies (FTA-ABS) Indirect fluorescent antibody (IFA) CPT:86780 | 1 | EA | $ 6.37 | $ 6.37 |
| 006395 | Hepatitis B Surface Antibody Immunochemiluminometric assay (ICMA) CPT:86706 | 1 | EA | $ 6.44 | $ 6.44 |
| 006452 | Complement C3, Serum Immunologic CPT:86160 | 1 | EA | $ 6.93 | $ 6.93 |
| 006460 | Rapid Plasma Reagin (RPR), Quantitation Charcoal flocculation CPT:86593 | 1 | EA | $ 5.14 | $ 5.14 |
| 006478 | Toxoplasma gondii Antibodies, IgG Chemiluminescent immunoassay (CLIA) CPT:86777 | 1 | EA | $ 11.88 | $ 11.88 |
| 006486 | Antiparietal Cell Antibodies, Quantitative Enzyme-linked immunosorbent assay (ELISA) CPT:83516 | 1 | EA | $ 18.56 | $ 18.56 |
| 006490 | Toxoplasma IgG, Reflex IgM Chemiluminescent immunoassay (CLIA) CPT:86778 | 1 | EA | $ 105.84 | $ 105.84 |
| 006510 | Hepatitis B Surface Antigen Immunochemiluminometric assay (ICMA) CPT:87340 | 1 | EA | $ 4.95 | $ 4.95 |
| 006536 | Mononucleosis Test, Qualitative With Reflex to Titer Latex agglutination (LA) CPT:86308 | 1 | EA | $ 5.50 | $ 5.50 |
| 006569 | Mononucleosis Test, Quant CPT:86309 | 1 | EA | $ 9.22 | $ 9.22 |
| 006627 | C-Reactive Protein (CRP), Quantitative Latex immunoturbidimetry CPT:86140 | 1 | EA | $ 5.94 | $ 5.94 |
| 006668 | Anti-Smooth Muscle/Mitochond. Enzyme-linked immunosorbent assay (ELISA) CPT:83516 (x2) | 1 | EA | $ 19.80 | $ 19.80 |
| 006684 | Thyroid Antibodies See individual test descriptions CPT:86376, 86800 | 1 | EA | $ 19.94 | $ 19.94 |
| 006685 | Thyroglobulin Antibody CPT:86800 | 1 | EA | $ 9.79 | $ 9.79 |
| 006718 | Hepatitis B Core Antibody, Total Immunochemiluminometric assay (ICMA) CPT:86704 | 1 | EA | $ 5.94 | $ 5.94 |
| 006734 | Hepatitis A Antibody, IgM Immunochemiluminometric assay (ICMA) CPT:86709 | 1 | EA | $ 7.92 | $ 7.92 |
| 006841 | Mucin Clot Test Precipitation CPT:83872 | 1 | EA | $ 4.02 | $ 4.02 |
| 006981 | Autoimmune Profile See individual tests. CPT:86038, 86160, 86225 | 1 | EA | $ 36.32 | $ 36.32 |
| 007010 | Orotic Acid, Urine Liquid chromatography/tandem mass spectrometry (LC/MS-MS) CPT:83921, 82570 | 1 | EA | $ 176.45 | $ 176.45 |
| 007022 | Serum Coma Overdose Profile Liquid chromatography/tandem mass spectrometry (LC/MS-MS), gas chromatography spectrophotometric and immunoassay CPT:82055, 80196, 84600, 82205 (x2), 82542, 82003, 80154, 80184, 80185, 82010 | 1 | EA | $ 19.80 | $ 19.80 |
| 007034 | Drug Screen (Blood or Serum) Liquid chromatography/tandem mass spectrometry (LC/MS-MS), gas chromatography spectrophotometric and immunoassay CPT:82055, 84600, 82205 (x2), 80154, 82010, 80196, 80184 | 1 | EA | $ 196.00 | $ 196.00 |
| 007039 | Arsenic Exposure Profile, Urine Total arsenic: inductively-coupled plasma-mass spectrometry (ICP-MS): Inorganic arsenic: flow injection atomic absorption spectrometry (FIAS) CPT:82175, 82570 | 1 | EA | $ 34.64 | $ 34.64 |
| 007047 | Methemoglobin, Blood Co-Oximetry CPT:83050 | 1 | EA | $ 17.33 | $ 17.33 |
| 007054 | Ammonia, Plasma Enzymatic CPT:82140 | 1 | EA | $ 10.89 | $ 10.89 |
| 007062 | Volatiles, Blood Gas chromatography (GC) CPT:84600, 82055, 82010 | 1 | EA | $ 14.85 | $ 14.85 |
| 007130 | HBsAg Quantitative, Monitor CPT:82397 | 1 | EA | $ 372.40 | $ 372.40 |
| 007153 | Tobramycin Random, Serum Immunoassay CPT:80200 | 1 | EA | $ 15.02 | $ 15.02 |
| 007154 | Tobramycin (Nebcin®), Serum, Peak Immunoassay CPT:80200 | 1 | EA | $ 17.33 | $ 17.33 |
| 007155 | Tobramycin (Nebcin®), Serum, Trough Immunoassay CPT:80200 | 1 | EA | $ 15.02 | $ 15.02 |
| 007161 | Gentamicin Random, Serum Immunoassay CPT:80170 | 1 | EA | $ 14.85 | $ 14.85 |
| 007162 | Gentamicin (Garamycin®), Serum, Peak Immunoassay CPT:80170 | 1 | EA | $ 14.85 | $ 14.85 |
| 007163 | Gentamicin (Garamycin®), Serum, Trough Immunoassay CPT:80170 | 1 | EA | $ 14.85 | $ 14.85 |
| 007211 | Cholinesterase, Serum Spectrophotometry (Ellman) - kinetic CPT:82480 | 1 | EA | $ 13.61 | $ 13.61 |
| 007245 | Arsenic, Blood Inductively-coupled plasma/mass spectrometry (ICP/MS) CPT:82175 | 1 | EA | $ 38.11 | $ 38.11 |
| 007260 | Valproic Acid (Depakene®), Serum Immunoassay CPT:80164 | 1 | EA | $ 7.73 | $ 7.73 |
| 007336 | Theophylline, Serum Immunoassay CPT:80198 | 1 | EA | $ 14.85 | $ 14.85 |
| 007385 | Digoxin Electrochemiluminescence Immunoassay (ECLIA) CPT:80162 | 1 | EA | $ 12.11 | $ 12.11 |
| 007393 | Nortriptyline (Aventyl®), Serum Liquid chromatography/tandem mass spectrometry (LC/MS-MS) CPT:80182 | 1 | EA | $ 19.69 | $ 19.69 |
| 007401 | Phenytoin (Dilantin®), Serum Immunoassay CPT:80185 | 1 | EA | $ 10.82 | $ 10.82 |
| 007419 | Carbamazepine (Tegretol®), Serum Immunoassay CPT:80156 | 1 | EA | $ 11.97 | $ 11.97 |
| 007443 | Ethosuximide (Zarontin®), Serum Immunoassay CPT:80168 | 1 | EA | $ 17.33 | $ 17.33 |
| 007468 | Imipramine, Serum Liquid chromatography/tandem mass spectrometry (LC/MS-MS) CPT:80174 | 1 | EA | $ 23.57 | $ 23.57 |
| 007476 | Amitriptyline, Serum Liquid chromatography/tandem mass spectrometry (LC/MS-MS) CPT:80152 | 1 | EA | $ 23.57 | $ 23.57 |
| 007492 | Heavy Metals Profile I, Urine Atomic absorption spectrometry (AAS); inductively coupled plasma-mass spectrometry (ICP-MS) CPT:82175, 82570, 83655, 83825 | 1 | EA | $ 44.54 | $ 44.54 |
| 007566 | Digoxin, Random, Serum Electrochemiluminescence Immunoassay (ECLIA) CPT:80162 | 1 | EA | $ 12.36 | $ 12.36 |
| 007682 | Chlordiazepoxide, Serum Liquid chromatography/tandem mass spectrometry (LC/MS-MS) CPT:80154 | 1 | EA | $ 19.80 | $ 19.80 |
| 007740 | Acetaminophen (Tylenol®), Serum Enzymatic CPT:82003 | 1 | EA | $ 20.79 | $ 20.79 |
| 007765 | Desipramine, Serum Liquid chromatography/tandem mass spectrometry (LC/MS-MS) CPT:80160 | 1 | EA | $ 22.28 | $ 22.28 |
| 007781 | Methadone (Dolophine®), Serum Liquid chromatography/mass spectrometry (LC-MS) CPT:83840 | 1 | EA | $ 19.80 | $ 19.80 |
| 007784 | Methadone Peak Level, Serum Liquid chromatography mass spectrometry (LC-MS) CPT:83840 | 1 | EA | $ 114.42 | $ 114.42 |
| 007823 | Phenobarbital (Luminal®), Serum Immunoassay CPT:80184 | 1 | EA | $ 12.87 | $ 12.87 |
| 007831 | Quinidine, Serum Immunoassay CPT:80194 | 1 | EA | $ 14.85 | $ 14.85 |
| 007849 | Salicylate, Serum Immunoassay CPT:80196 | 1 | EA | $ 10.40 | $ 10.40 |
| 007864 | Disopyramide, Serum Immunoassay CPT:80299 | 1 | EA | $ 17.34 | $ 17.34 |
| 007898 | Benzodiazepine Screen, Serum Immunoassay/HPLC CPT:80101 | 1 | EA | $ 17.33 | $ 17.33 |
| 007930 | Clorazepate (Tranxene®), Serum Liquid chromatography/tandem mass spectrometry (LC/MS-MS) CPT:80154 | 1 | EA | $ 19.80 | $ 19.80 |
| 007989 | Diazepam, Serum High-pressure liquid chromatography (HPLC) CPT:80154 | 1 | EA | $ 19.80 | $ 19.80 |
| 008087 | Urine Culture, Comprehensive CPT:87086 | 1 | EA | $ 17.27 | $ 17.27 |
| 008128 | GC (Neisseria gonorrhoeae) Culture Only Culture on selective media; DNA probes for identification CPT:87081 | 1 | EA | $ 6.44 | $ 6.44 |
| 008136 | Fungus Stain KOH/CALCOFLUOR CPT:87206 | 1 | EA | $ 7.01 | $ 7.01 |
| 008144 | Stool Culture Aerobic culture on selective media; detection of EHEC |
Shiga-like toxins by enzyme immunoassay (EIA) CPT:87045, 87046,
| 87427 | 1 | EA | $ 17.93 | $ 17.93 | ||
| 008169 | Beta-Hemolytic Streptococcus Culture, Group A Only, Culture CPT:87081 | 1 | EA | $ 5.05 | $ 5.05 | |
| 008185 | Parasite Examination, Blood Wright stain; microscopic examination of thick and thin peripheral blood smears stained with Romanovsky dye (in particular Giemsa). CPT:87207 | 1 | EA | $ 9.90 | $ 9.90 | |
| 008202 | Viral Identification Conventional tissue culture and shell vial cell cultures; FA confirmation CPT:87253 | 1 | EA | $ 78.89 | $ 78.89 | |
| 008243 | Varicella-Zoster Virus (VZV) Culture Inoculation of specimens into cell cultures, incubation of cultures, observation of characteristics cytopathic effect, and identification by fluorescent monoclonal antibody CPT:87252, 87254 | 1 | EA | $ 35.85 | $ 35.85 | |
| 008244 | Viral Identification CPT:87253 | 1 | EA | $ 87.36 | $ 87.36 | |
| 008300 | Blood Culture, Routine Culture CPT:87040 | 1 | EA | $ 10.40 | $ 10.40 | |
| 008334 | Genital Culture, Routine Culture CPT:87070 | 1 | EA | $ 12.38 | $ 12.38 | |
| 008342 | Upper Respiratory Culture, Routine Culture CPT:87070 | 1 | EA | $ 10.76 | $ 10.76 | |
| 008474 | Organism Identification, Mold Standard identification including DNA probes CPT:87107 | 1 | EA | $ 21.16 | $ 21.16 | |
| 008482 | Fungus (Mycology) Culture Culture CPT:87101 | 1 | EA | $ 9.08 | $ 9.08 | |
| 008540 | Gram's Stain GRAM STAIN CPT:87205 | 1 | EA | $ 4.82 | $ 4.82 | |
| 008557 | Environmental Culture Culture (aerobic), bacterial Test Not Coded | 1 | EA | $ 6.62 | $ 6.62 | |
| 008581 | Eosinophil Count, Nasal Hansel stain and microscopic examination of smear of nasal secretions CPT:89190 | 1 | EA | $ 5.19 | $ 5.19 | |
| 008618 | Acid Fast Smear Fluorescent Stain (Direct Kinyoun stain for bone marrow ONLY). CPT:87206 | 1 | EA | $ 24.75 | $ 24.75 | |
| 008649 | Aerobic Bacterial Culture, General Culture CPT:87070 | 1 | EA | $ 9.89 | $ 9.89 | |
| 008656 | White Blood Cells (WBC), Stool Simple stain CPT:89055 | 1 | EA | $ 5.57 | $ 5.57 | |
| 008664 | Organism Identification, Bacteria Standard identification only CPT:87077 | 1 | EA | $ 9.15 | $ 9.15 | |
| 008681 | Susceptibility, Aer + Anaerob; Routed to BN used for reflexing ONLY. No method listed.; CPT:87186 | 1 | EA | $ 80.25 | $ 80.25 | |
| 008690 | M tuberculosis Detection, PCR reflex test CPT:87556 | 1 | EA | $ 288.12 | $ 288.12 | |
| 008694 | AFB ID by DNA Probe Rflx AST Micro CPT:87149 | 1 | EA | $ 107.56 | $ 107.56 | |
| 008722 | Salmonella/Shigella Screen Culture CPT:87045 | 1 | EA | $ 9.34 | $ 9.34 | |
| 008848 | Urine Culture, Routine Culture CPT:87086 | 1 | EA | $ 7.92 | $ 7.92 | |
| 008851 | Urine Culture,Prenatal, W/GBS CPT:87086 | 1 | EA | $ 58.80 | $ 58.80 | |
| 008900 | Anaerobic Cult, Extended Incub CPT:87073 | 1 | EA | $ 15.80 | $ 15.80 | |
| 008904 | Anaerobic Culture Anaerobic culture CPT:87075 | 1 | EA | $ 15.80 | $ 15.80 | |
| 009100 | Gynecologic Pap Smear, 1 Slide Pap stained: microscopic examination CPT:88164 | 1 | EA | $ 14.85 | $ 14.85 | |
| 009126 | Miscellaneous Smear Cytology Pap stained: microscopic examination CPT:88161 | 1 | EA | $ 53.70 | $ 53.70 | |
| 009134 | Breast Discharge Cytology Pap stained: microscopic examination CPT:88161 | 1 | EA | $ 53.70 | $ 53.70 | |
| 009165 | Anal Cyto,LBP+cobas HPV,Rectal; N/A; CPT:88112, 87624 | 1 | EA | $ 192.53 | $ 192.53 | |
| 009191 | Gynecologic Pap Smear, 2 Slides Pap stained: microscopic examination CPT:88164 | 1 | EA | $ 29.69 | $ 29.69 | |
| 009209 | Gynecologic Pap Smear and Maturation Index Pap stained: microscopic examination CPT:88164, 88155 | 1 | EA | $ 16.34 | $ 16.34 | |
| 009365 | Needle Aspiration Cytology With Radiologic Guidance The fluid will be centrifuged, supernatant poured off, and diagnostic cells aspirated from the remaining material. Filters, monolayers, and/or cytospins will be made along with a cell block, if applicable. Microscopic examination is performed. CPT:88172, 88173 | 1 | EA | $ 193.52 | $ 193.52 | |
| 009876 | Ductal Lavage Cytology CPT:88112 | 1 | EA | $ 49.00 | $ 49.00 | |
| 010170 | Zinc Protoporphyrin (ZPP) CPT:84202 | 1 | EA | $ 8.47 | $ 8.47 | |
| 010272 | Epstein-Barr Virus (EBV) Nuclear Antigen, IgG Chemiluminescent immunoassay (CLIA) CPT:86664 | 1 | EA | $ 15.84 | $ 15.84 | |
| 010390 | T3Free Electrochemiluminescence Immunoassay (ECLIA) CPT:84481 | 1 | EA | $ 38.59 | $ 38.59 | |
| 010421 | Melanocyte Stimulating Hormone CPT:83519 | 1 | EA | $ 104.62 | $ 104.62 | |
| 010423 | APCA+IF Ab CPT:86340, 83516 | 1 | EA | $ 30.44 | $ 30.44 | |
| 010424 | APCA+IF Ab CPT:83516, 86340 | 1 | EA | $ 30.44 | $ 30.44 | |
| 010447 | ADH Radioimmunoassay (RIA) CPT:84588 | 1 | EA | $ 103.28 | $ 103.28 | |
| 010505 | Copeptin; The ThermoFisher/BRAHMS KRYPTOR assay employs Time-Resolved Amplified Cryptate Emission Cryptate Emission (TRACE) technology based on a non-radioactive energy transfer between a donor (europium cryptate) and an acceptor (XL665) in a sandwich immunofluorescent format using two mouse monoclonal antibodies.[6]; CPT:84588 | 1 | EA | $ 200.00 | $ 200.00 | |
| 010801 | Alpha-Fetoprotein (AFP), Maternal Serum (MS-AFP) Immunochemiluminometric assay (ICMA) CPT:82105 | 1 | EA | $ 12.11 | $ 12.11 | |
| 010848 | Aldosterone LCMS (8 Specimens) CPT:82088 (x8) | 1 | EA | $ 219.03 | $ 219.03 | |
| 012005 | Rapid Plasma Reagin (RPR) Test With Reflex to Charcoal flocculation and agglutination CPT:86592 | 1 | EA | $ 3.96 | $ 3.96 | |
| 012021 | RPR Qn+TP Abs Charcoal flocculation and agglutination CPT:86593, 86780 | 1 | EA | $ 10.33 | $ 10.33 | |
| 012229 | Albumin, Cerebrospinal Fluid Immunologic CPT:82042 | 1 | EA | $ 10.37 | $ 10.37 | |
| 012393 | Muscle Fiber, Stool Microscopic exam CPT:89160 | 1 | EA | $ 1.46 | $ 1.46 | |
| 012580 | Antichromatin Antibodies Multiplex flow immunoassay CPT:86235 | 1 | EA | $ 19.67 | $ 19.67 | |
| 012682 | Sjogren's Anti-SS-A CPT:86235 | 1 | EA | $ 11.25 | $ 11.25 | |
| 012690 | Sjogren's Anti-SS-B Multiplex flow immunoassay CPT:86235 | 1 | EA | $ 11.25 | $ 11.25 | |
| 012700 | Antiribosomal P Antibodies Multiplex flow immunoassay CPT:83516 | 1 | EA | $ 89.84 | $ 89.84 | |
| 012898 | Uric Acid, Urine Uricase CPT:84560 | 1 | EA | $ 3.21 | $ 3.21 | |
| 013037 | pH, Urine Electrochemical (pH meter) CPT:83986 | 1 | EA | $ 4.02 | $ 4.02 | |
| 013326 | Sodium, Urine Ion-selective electrode (ISE) CPT:84300 | 1 | EA | $ 3.21 | $ 3.21 | |
| 013330 | Sodium Fractional Excretion Urine Sodium (ISE) & Serum Creatinine (colorimetric) CPT:82570, 84300, 82565, 84295 | 1 | EA | $ 22.54 | $ 22.54 | |
| 013334 | Potassium, Urine Ion-selective electrode (ISE); flame photometer CPT:84133 | 1 | EA | $ 3.21 | $ 3.21 | |
| 013508 | Urea Nitrogen, U Urease CPT:84540 | 1 | EA | $ 3.21 | $ 3.21 | |
| 013510 | Urea Fractional Excretion CPT:84540, 82570, 84520, 82565 | 1 | EA | $ 5.80 | $ 5.80 | |
| 013656 | Chloride, Urine Colorimetric; ion-selective electrode (ISE) CPT:82436 | 1 | EA | $ 5.40 | $ 5.40 | |
| 013664 | Protein,Total,Urine Coomassie blue; colorimetric CPT:84156 | 1 | EA | $ 4.20 | $ 4.20 | |
| 013672 | Creatinine, Random Urine Kinetic CPT:82570 | 1 | EA | $ 5.69 | $ 5.69 | |
| 013706 | Calcium, Random Urine Colorimetric CPT:82340 | 1 | EA | $ 3.21 | $ 3.21 | |
| 013730 | Magnesium, U Atomic absorption spectrometry (AAS) or colorimetric CPT:83735 | 1 | EA | $ 7.72 | $ 7.72 | |
| 014319 | Insulin (8 Specimens) CPT:83525 (x8) | 1 | EA | $ 88.69 | $ 88.69 | |
| 014357 | Insulin, 1 hour (60 min) Electrochemiluminescence Immunoassay (ECLIA) CPT:83525 | 1 | EA | $ 17.52 | $ 17.52 | |
| 014548 | Respiratory Syncytial Virus (RSV) by Immunoassay Immunoassay CPT:87807 | 1 | EA | $ 15.89 | $ 15.89 | |
| 014634 | Insulin (34 Specimens) CPT:83525 (x34) | 1 | EA | $ 501.50 | $ 501.50 | |
| 015057 | Antithrombin III Antigen (Immunologic) Automated (LIATEST) Enzyme Immunoassay (EIA) CPT:85301 | 1 | EA | $ 13.86 | $ 13.86 | |
| 015173 | Differential and Total WBC Count Automated cell counter CPT:85048, 85004 | 1 | EA | $ 3.71 | $ 3.71 | |
| 015230 | Thrombin Time Human thrombin is mixed with the patient sample and clotting time is determined photometrically. CPT:85670 | 1 | EA | $ 19.80 | $ 19.80 | |
| 015400 | C6 B. burgdorferi (Lyme) Enzyme-linked immunosorbent assay (ELISA) CPT:86618 | 1 | EA | $ 45.08 | $ 45.08 | |
| 015594 | Antithrombin III (Functional/Immunologic) AT antigen: Automated (LIATEST) enzyme immunoassay (EIA) AT activity: The patient plasma is mixed with heparin and thrombin. The extent of thrombin inhibition is proportional to the AT concentration of the patient sample. Residual thrombin activity is mea CPT:85300, 85301 | 1 | EA | $ 40.58 | $ 40.58 | |
| 015602 | Bilirubin, Total, Neonatal CPT:82247 | 1 | EA | $ 2.74 | $ 2.74 | |
| 015610 | Parathyroid Hormone (PTH), Intact Electrochemiluminescence immunoassay (ECLIA) CPT:83970 | 1 | EA | $ 11.88 | $ 11.88 | |
| 015795 | Aldosterone LCMS (6 Specimens) CPT:82088 (x6) | 1 | EA | $ 164.28 | $ 164.28 | |
| 015796 | Aldosterone LCMS (7 Specimens) CPT:82088 (x7) | 1 | EA | $ 191.65 | $ 191.65 | |
| 015797 | Calcitonin, Serum (7 Spec) CPT:82308 (x7) | 1 | EA | $ 237.95 | $ 237.95 | |
| 015798 | C-Peptide (5 Specimens) CPT:84681 (x5) | 1 | EA | $ 94.33 | $ 94.33 | |
| 015801 | C-Peptide (7 Specimen) CPT:84681 (x7) | 1 | EA | $ 132.06 | $ 132.06 | |
| 015804 | C-Peptide (8 Specimen) CPT:84681 (x8) | 1 | EA | $ 150.92 | $ 150.92 | |
| 016125 | ENA+DNA/DS+AMA+ASMA+SjoSSA+... See individual test CPT:86225, 86235 (x4), 83516 (x2) | 1 | EA | $ 713.25 | $ 713.25 | |
| 016188 | Murine Typhus Antibodies, IgG Indirect fluorescent antibody (IFA) CPT:86757 | 1 | EA | $ 30.14 | $ 30.14 | |
| 016220 | ENA+DNA/DS see individual tests CPT:86225, 86235 (x2) | 1 | EA | $ 42.76 | $ 42.76 | |
| 016261 | FTA/RPR Quant Profile Charcoal flocculation and Indirect fluorescent antibody (IFA) CPT:86593, 86780 | 1 | EA | $ 19.98 | $ 19.98 | |
| 016353 | RNP Antibodies Multiplex flow immunoassay CPT:86235 | 1 | EA | $ 11.25 | $ 11.25 | |
| 016360 | Smith Antibodies Multiplex flow immunoassay CPT:86235 | 1 | EA | $ 11.25 | $ 11.25 | |
| 016592 | Rocky Mountain Spotted Fever (RMSF), IgG Enzyme immunoassay (EIA) with indirect fluorescent antibody (IFA) titer on positives CPT:86757 | 1 | EA | $ 20.11 | $ 20.11 | |
| 016667 | Rocky Mountain Spotted Fever (RMSF), IgM Enzyme immunoassay (EIA) CPT:86757 | 1 | EA | $ 25.46 | $ 25.46 | |
| 016691 | Fats, Neutral see individual tests CPT:82705 | 1 | EA | $ 9.84 | $ 9.84 | |
| 016865 | Citric Acid (Citrate), Urine Spectrophotometry (kinetic at 340 nm) CPT:82507 | 1 | EA | $ 17.82 | $ 17.82 | |
| 016873 | Apolipoprotein A-1 Immunologic CPT:82172 | 1 | EA | $ 10.14 | $ 10.14 | |
| 016881 | Hepatitis B Core Antibody, IgM Immunochemiluminometric assay (ICMA) CPT:86705 | 1 | EA | $ 7.43 | $ 7.43 | |
| 016931 | Prealbumin Immunologic CPT:84134 | 1 | EA | $ 9.65 | $ 9.65 | |
| 017100 | Integrated 1 Enzyme Immunoassay (EIA) CPT:84163 | 1 | EA | $ 101.47 | $ 101.47 | |
| 017170 | Integrated 2 Chemiluminescent immunoassay CPT:82105, 82677, 84702, 86336 | 1 | EA | $ 266.78 | $ 266.78 | |
| 017200 | Serum Integrated 1 Enzyme Immunoassay (EIA) CPT:84163 | 1 | EA | $ 101.47 | $ 101.47 | |
| 017270 | Serum Integrated 2 Chemiluminescent immunoassay CPT:82105, 82677, 84702, 86336 | 1 | EA | $ 266.78 | $ 266.78 | |
| 017319 | Alpha-Fetoprotein (AFP) Tetra Profile Immunochemiluminometric assay (ICMA) CPT:82105, 82677, 84702, 86336 | 1 | EA | $ 63.36 | $ 63.36 | |
| 017422 | Add On: hCG,uE3,Inhibin See individual tests. CPT:84702, 82677, 86336 | 1 | EA | $ 208.12 | $ 208.12 | |
| 017500 | First Trimester Screen w/NT PAPP-A: enzyme immunoassay (EIA); hCG and DIA: immunochemiluminometric assay (ICMA) CPT:84702, 86336, 84163 | 1 | EA | $ 168.03 | $ 168.03 | |
| 017665 | Acetone Gas chromatography(GC) CPT:82010 | 1 | EA | $ 44.99 | $ 44.99 | |
| 017700 | Sequential 1 hCG: chemiluminescent immunoassay (CLIA); PAPP-A: enzyme immunoassay (EIA) CPT:84702, 84163 | 1 | EA | $ 74.24 | $ 74.24 | |
| 017750 | Sequential 2 Chemiluminescent immunoassay (CLIA) CPT:82105, 84702, 82677, 86336 | 1 | EA | $ 75.23 | $ 75.23 | |
| 017996 | Ethanol, Blood Gas chromatography (GC) CPT:82055 | 1 | EA | $ 17.33 | $ 17.33 | |
| 019292 | A1A Phenotype Confirmation confirmation test CPT:82104 | 1 | EA | $ 58.80 | $ 58.80 | |
| 019505 | Uric Acid, Body Fluid Uricase CPT:84560 | 1 | EA | $ 3.21 | $ 3.21 | |
| 019588 | Protein, Total, Body Fluid Electrochemiluminescence Immunoassay (ECLIA) CPT:84157 | 1 | EA | $ 4.20 | $ 4.20 | |
| 019745 | T4,Free(Direct) CPT:84439 | 1 | EA | $ 16.42 | $ 16.42 | |
| 019845 | Calcitonin, Serum (8 Spec) CPT:82308 (x8) | 1 | EA | $ 271.95 | $ 271.95 | |
| 020321 | Prothrombin Time (PT) and Partial Thromboplastin see individual tests CPT:85610, 85730 | 1 | EA | $ 5.45 | $ 5.45 | |
| 023358 | LP+Chol/HDL+CHD Risk CPT:80061 | 1 | EA | $ 13.66 | $ 13.66 | |
| 023374 | Xylose Tolerance Test (Fasting, 1-, 2-, 3-, 4-, and Spectrophotometry CPT:84620 | 1 | EA | $ 29.69 | $ 29.69 | |
| 023804 | Lactate and Pyruvate Spectrophotometry CPT:83605, 84210 | 1 | EA | $ 27.99 | $ 27.99 | |
| 024026 | Thyroxine (T4) and Thyroid-Stimulating Hormone (TSH), See individual test description CPT:84436, 84443 | 1 | EA | $ 15.72 | $ 15.72 | |
| 024091 | Cortisol, 6 Specimens Electrochemiluminescence immunoassay (ECLIA) CPT:82533 (x6) | 1 | EA | $ 47.51 | $ 47.51 | |
| 024109 | Prolactin, 6 Specimens Electrochemiluminescence immunoassay (ECLIA) CPT:84146 (x6) | 1 | EA | $ 59.40 | $ 59.40 | |
| 024265 | Cortisol, 2 Specimens Electrochemiluminescence immunoassay (ECLIA) CPT:82533 (x2) | 1 | EA | $ 15.84 | $ 15.84 | |
| 024778 | BUN+Creat Calculation CPT:82565, 84520 | 1 | EA | $ 2.80 | $ 2.80 | |
| 025239 | Glu+Hb A1c CPT:83036, 82947 | 1 | EA | $ 14.70 | $ 14.70 | |
| 026781 | Calcitonin (Thyrocalcitonin), Serum, 3 Specimens Immunochemiluminometric assay (ICMA) CPT:82308 (x3) | 1 | EA | $ 49.89 | $ 49.89 | |
| 026799 | Calcitonin (Thyrocalcitonin), Serum, 4 Specimens Immunochemiluminometric assay (ICMA) CPT:82308 (x4) | 1 | EA | $ 55.23 | $ 55.23 | |
| 026807 | Calcitonin (Thyrocalcitonin), Serum, 5 Specimens Immunochemiluminometric assay (ICMA) CPT:82308 (x5) | 1 | EA | $ 60.58 | $ 60.58 | |
| 026815 | Calcitonin (Thyrocalcitonin), Serum, 6 Specimens Immunochemiluminometric assay (ICMA) CPT:82308 (x6) | 1 | EA | $ 65.92 | $ 65.92 | |
| 026872 | Prolactin, 2 Specimens Electrochemiluminescence immunoassay (ECLIA) CPT:84146 (x2) | 1 | EA | $ 19.80 | $ 19.80 | |
| 026880 | Prolactin, 4 Specimens Electrochemiluminescence immunoassay (ECLIA) CPT:84146 (x4) | 1 | EA | $ 39.59 | $ 39.59 | |
| 026898 | Growth Hormone, Serum, 2 Specimens Immunochemiluminometric assay (ICMA) CPT:83003 (x2) | 1 | EA | $ 25.62 | $ 25.62 | |
| 026948 | Cortisol, 4 Specimens Electrochemiluminescence immunoassay (ECLIA) CPT:82533 (x4) | 1 | EA | $ 31.67 | $ 31.67 | |
| 026955 | Luteinizing Hormone (LH), Serum, 4 Specimens Electrochemiluminescence Immunoassay (ECLIA) CPT:83002 (x4) | 1 | EA | $ 21.78 | $ 21.78 | |
| 026971 | Luteinizing Hormone (LH), Serum, 2 Specimens Electrochemiluminescence Immunoassay (ECLIA) CPT:83002 (x2) | 1 | EA | $ 13.86 | $ 13.86 | |
| 027011 | Thyroid Profile II (Comprehensive) See individual test descriptions CPT:84480, 84436, 84443, 84479 | 1 | EA | $ 26.25 | $ 26.25 | |
| 027383 | Thyroid Stim.Horm(TSH 2 Spec) CPT:84443 (x2) | 1 | EA | $ 30.38 | $ 30.38 | |
| 027623 | CMP12+LP+6AC CPT:80061, 82977, 82040, 82247, 82310, 82435, 82565, 82947, 83540, 83615, 84075, 84100, 84132, 84155, 84295, 84450, 84460, 84520, 84550 | 1 | EA | $ 9.51 | $ 9.51 | |
| 028142 | Complete Blood Count (CBC) Without Differential Automated cell counter CPT:85027 | 1 | EA | $ 2.68 | $ 2.68 | |
| 028290 | Cholinesterase, Serum and RBC Spectrophotometry (Ellman) - kinetic CPT:82480, 82482 | 1 | EA | $ 19.89 | $ 19.89 | |
| 028472 | Prolactin, 3 Specimens Electrochemiluminescence immunoassay (ECLIA) CPT:84146 (x3) | 1 | EA | $ 29.69 | $ 29.69 | |
| 028480 | Follicle-Stimulating Hormone (FSH) and Luteinizing Electrochemiluminescence Immunoassay (ECLIA) CPT:83001, 83002 | 1 | EA | $ 12.87 | $ 12.87 | |
| 028498 | Cortisol, 3 Specimens Electrochemiluminescence immunoassay (ECLIA) CPT:82533 (x3) | 1 | EA | $ 23.76 | $ 23.76 | |
| 028928 | Hepatitis Profile V (Hepatitis A Profile) Immunochemiluminometric assay (ICMA) CPT:86709, 86708 | 1 | EA | $ 13.84 | $ 13.84 | |
| 030387 | Prenatal Profile I (Without Hepatitis B Surface see individual tests CPT:85025, 86592, 86762, 86850, 86900, 86901 | 1 | EA | $ 15.14 | $ 15.14 | |
| 030577 | Anemia Profile A See individual tests. CPT:83550, 85025, 85045, 83540 | 1 | EA | $ 16.28 | $ 16.28 | |
| 030825 | Fe+TIBC+Fer Colorimetric CPT:82728, 83550, 83540 | 1 | EA | $ 21.96 | $ 21.96 | |
| 031088 | Hgb+Hct Automated cell counter CPT:85014, 85018 | 1 | EA | $ 2.83 | $ 2.83 | |
| 031138 | Amenorrhea Profile Electrochemiluminescence Immunoassay (ECLIA) CPT:83001, 83002, 84146 | 1 | EA | $ 34.90 | $ 34.90 | |
| 032185 | CMP12+LP+TP+5AC+CBC/D/Plt+R... CPT:80061, 82985, 85025, 86592, 84436, 84479, 82977, 82040, 82247, 82310, 82435, 82565, 82947, 83615, 84075, 84100, 84132, 84155, 84295, 84450, 84460, 84520, 84550 | 1 | EA | $ 44.04 | $ 44.04 | |
| 032714 | Cell Ct+Cryst+Mucin(Synovial) Microscopic Exam CPT:83872, 89051, 89060 | 1 | EA | $ 17.01 | $ 17.01 | |
| 033852 | C4+C3 Immunologic CPT:86160 (x2) | 1 | EA | $ 13.86 | $ 13.86 | |
| 033969 | LP without VLDL+Chol/HDL+CH... CPT:80061 | 1 | EA | $ 13.66 | $ 13.66 | |
| 034298 | Anticonvulsant Drugs, Serum CPT:80156, 80164, 80184, 80185, 80188 | 1 | EA | $ 351.70 | $ 351.70 | |
| 034934 | Gastrin, Serum, 7 Specimens Immunochemiluminometric assay (ICMA) CPT:82941 (x7) | 1 | EA | $ 77.74 | $ 77.74 | |
| 035113 | Testicular Function Profile II Electrochemiluminescence Immunoassay (ECLIA) CPT:83001, 83002, 84402, 84403 | 1 | EA | $ 44.17 | $ 44.17 | |
| 035527 | Aerobic Culture + Gram Stain Culture; Stain CPT:87070, 87205 | 1 | EA | $ 18.81 | $ 18.81 | |
| 035741 | Testicular Function Profile I Electrochemiluminescence immunoassay (ECLIA) CPT:83001, 83002, 84146, 84403 | 1 | EA | $ 56.98 | $ 56.98 | |
| 037215 | HBV Evaluation Profile CPT:87340, 86704, 86706 | 1 | EA | $ 17.34 | $ 17.34 | |
| 037267 | CMP12+LP+5AC see individual tests CPT:80061, 82977, 82040, 82247, 82310, 82435, 82565, 82947, 83615, 84075, 84100, 84132, 84155, 84295, 84450, 84460, 84520, 84550 | 1 | EA | $ 16.28 | $ 16.28 | |
| 038120 | Prenat Infect Dis Ab, IgG, Qn CPT:86762, 86777, 86644, 86696, 86695 | 1 | EA | $ 21.56 | $ 21.56 | |
| 038164 | Prenat Infect Dis Ab, IgG, Qn CPT:86762, 86644, 86695, 86777, 86696 | 1 | EA | $ 21.56 | $ 21.56 | |
| 038170 | Lead Standard Profile, Blood CPT:83655, 84202 | 1 | EA | $ 16.34 | $ 16.34 | |
| 038171 | Lead Standard Profile CPT:84202, 83655 | 1 | EA | $ 16.34 | $ 16.34 | |
| 038695 | Renin, Plasma, 3 Specimens Radioimmunoassay CPT:84244 (x3) | 1 | EA | $ 50.49 | $ 50.49 | |
| 038703 | Renin, Plasma, 5 Specimens Radioimmunoassay CPT:84244 (x5) | 1 | EA | $ 77.82 | $ 77.82 | |
| 038745 | Gastrin, Serum, 3 Specimens Immunochemiluminometric assay (ICMA) CPT:82941 (x3) | 1 | EA | $ 31.18 | $ 31.18 | |
| 038752 | Gastrin, Serum, 5 Specimens Immunochemiluminometric assay (ICMA) CPT:82941 (x5) | 1 | EA | $ 55.54 | $ 55.54 | |
| 038836 | Growth Hormone, Serum, 5 Specimens Immunochemiluminometric assay (ICMA) CPT:83003 (x5) | 1 | EA | $ 41.21 | $ 41.21 | |
| 038844 | Growth Hormone, Serum, 3 Specimens Immunochemiluminometric assay (ICMA) CPT:83003 (x3) | 1 | EA | $ 30.68 | $ 30.68 | |
| 038869 | Growth Hormone, Serum, 7 Specimens Immunochemiluminometric assay (ICMA) CPT:83003 (x7) | 1 | EA | $ 51.61 | $ 51.61 | |
| 038901 | Adrenocorticotropic Hormone (ACTH), Plasma, 7 Specimens Electrochemiluminescence immunoassay (ECLIA) CPT:82024 (x7) | 1 | EA | $ 139.99 | $ 139.99 | |
| 038919 | Adrenocorticotropic Hormone (ACTH), Plasma, 5 Specimens Electrochemiluminescence immunoassay (ECLIA) CPT:82024 (x5) | 1 | EA | $ 108.90 | $ 108.90 | |
| 038927 | Adrenocorticotropic Hormone (ACTH), Plasma, 3 Specimens Electrochemiluminescence immunoassay (ECLIA) CPT:82024 (x3) | 1 | EA | $ 65.34 | $ 65.34 | |
| 038935 | Follicle-Stimulating Hormone (FSH), Serum, 3 Specimens Electrochemiluminescence immunoassay (ECLIA) CPT:83001 (x3) | 1 | EA | $ 14.85 | $ 14.85 | |
| 038943 | Follicle-Stimulating Hormone (FSH), Serum, 5 Specimens Electrochemiluminescence immunoassay (ECLIA) CPT:83001 (x5) | 1 | EA | $ 29.69 | $ 29.69 | |
| 039022 | Androstenedione, 2 Specimens Liquid chromatography/tandem mass spectrometry (LC/MS-MS) CPT:82157 (x2) | 1 | EA | $ 279.79 | $ 279.79 | |
| 039023 | Androstenedione LCMS (3 Spec) CPT:82157 (x3) | 1 | EA | $ 377.72 | $ 377.72 | |
| 039214 | Cortisol, 7 Specimens Electrochemiluminescence immunoassay (ECLIA) CPT:82533 (x7) | 1 | EA | $ 55.44 | $ 55.44 | |
| 039222 | Cortisol, 5 Specimens Electrochemiluminescence immunoassay (ECLIA) CPT:82533 (x5) | 1 | EA | $ 39.59 | $ 39.59 | |
| 039230 | Luteinizing Hormone (LH), Serum, 3 Specimens Electrochemiluminescence Immunoassay (ECLIA) CPT:83002 (x3) | 1 | EA | $ 17.82 | $ 17.82 | |
| 039248 | Luteinizing Hormone (LH), Serum, 5 Specimens Electrochemiluminescence Immunoassay (ECLIA) CPT:83002 (x5) | 1 | EA | $ 25.73 | $ 25.73 | |
| 039438 | Gastrin, Serum, 4 Specimens Immunochemiluminometric assay (ICMA) CPT:82941 (x4) | 1 | EA | $ 41.57 | $ 41.57 | |
| 039446 | Prolactin, 7 Specimens Electrochemiluminescence immunoassay (ECLIA) CPT:84146 (x7) | 1 | EA | $ 69.30 | $ 69.30 | |
| 039453 | Prolactin, 5 Specimens Electrochemiluminescence immunoassay (ECLIA) CPT:84146 (x5) | 1 | EA | $ 49.50 | $ 49.50 | |
| 039719 | T4+T3 CPT:84436, 84480 | 1 | EA | $ 26.65 | $ 26.65 | |
| 042077 | Anemia Profile B See individual tests. CPT:82607, 82728, 82746, 83550, 85025, 85045, 83540 | 1 | EA | $ 40.42 | $ 40.42 | |
| 042580 | Heavy Metals Profile I, Blood Atomic absorption spectrometry (AAS); inductively-coupled plasma/mass spectrometry (ICP/MS) CPT:82175, 83655, 83825 | 1 | EA | $ 59.40 | $ 59.40 | |
| 043083 | Uric A+RA Qn+CRP+ASO see individual tests CPT:86060, 86140, 86431, 84550 | 1 | EA | $ 20.67 | $ 20.67 | |
| 045849 | Hepatitis Profile III (Patient Management) See individual tests. CPT:87340, 87350, 86707 | 1 | EA | $ 21.78 | $ 21.78 | |
| 045997 | Growth Hormone, Serum, 4 Specimens Immunochemiluminometric assay (ICMA) CPT:83003 (x4) | 1 | EA | $ 36.02 | $ 36.02 | |
| 046300 | Lactose Tolerance Test Enzymatic CPT:82951, 82952 (x2) | 1 | EA | $ 8.91 | $ 8.91 | |
| 046938 | Hepatitis Profile II (Diagnostic Follow-up) See individual tests. CPT:86706, 87350, 86707 | 1 | EA | $ 17.82 | $ 17.82 | |
| 048249 | Calcitonin (Thyrocalcitonin), Serum, 2 Specimens Immunochemiluminometric assay (ICMA) CPT:82308 (x2) | 1 | EA | $ 35.63 | $ 35.63 | |
| 048462 | Hirsutism Profile See individual test descriptions. CPT:82157, 82627, 84403 | 1 | EA | $ 62.73 | $ 62.73 | |
| 048827 | CMP12+LP+TP+TSH+6AC+CBC/D/Plt Automated cell counter with mixed technologies CPT:80061, 85025, 84436, 84443, 84479, 82977, 82040, 82247, 82310, 82435, 82565, 82947, 83540, 83615, 84075, 84100, 84132, 84155, 84295, 84450, 84460, 84520, 84550 | 1 | EA | $ 27.20 | $ 27.20 | |
| 049213 | C3+C4+CompT Immunologic CPT:86160 (x2), 86162 | 1 | EA | $ 19.80 | $ 19.80 | |
| 049510 | Renin, Plasma, 4 Specimens Radioimmunoassay CPT:84244 (x4) | 1 | EA | $ 64.95 | $ 64.95 | |
| 049528 | Renin, Plasma, 6 Specimens Radioimmunoassay CPT:84244 (x6) | 1 | EA | $ 90.70 | $ 90.70 | |
| 049684 | Fecal Fat and Muscle Fibers, Qualitative Microscopic examination following staining with Oil Red O. Only fibers with identifiable cross striations are counted. CPT:82705, 89160 | 1 | EA | $ 11.13 | $ 11.13 | |
| 052311 | Chromosome Microarray (CMA) Whole genome SNP-based copy number microarray analysis targeting 2.695 million copy number and allele-specific genome sites CPT:81229 | 1 | EA | $ 2,057.79 | $ 2,057.79 | |
| 052373 | Scleroderma Diagnostic Profile See individual tests. CPT:86038, 86235 | 1 | EA | $ 11.88 | $ 11.88 | |
| 052985 | HBcAb+HBsAb Test Not Coded | 1 | EA | $ 12.39 | $ 12.39 | |
| 053272 | Aldosterone LCMS (3 Specimens) Liquid chromatography/tandem mass spectrometry (LC/MS-MS) CPT:82088 (x3) | 1 | EA | $ 188.98 | $ 188.98 | |
| 053686 | Renin, Plasma, 2 Specimens Radioimmunoassay CPT:84244 (x2) | 1 | EA | $ 33.65 | $ 33.65 | |
| 054130 | Glucose/Insulin Resp (5 Spec) CPT:82951, 82952 (x2), 83525 (x5) | 1 | EA | $ 82.57 | $ 82.57 | |
| 054262 | EBVCA(IgG/M) Chemiluminescent immunoassay (CLIA) CPT:86665 (x2) | 1 | EA | $ 34.53 | $ 34.53 | |
| 054601 | Ca+PTH Intact Plasma: Electrochemiluminescence immunoassay (ECLIA) Serum: Colormetric CPT:83970, 82310 | 1 | EA | $ 15.59 | $ 15.59 | |
| 054619 | LUPUS PROFILE CPT:86038, 86225, 86235 (x2) | 1 | EA | $ 40.67 | $ 40.67 | |
| 056499 | Systemic Lupus Erythematosus (SLE) Profile A See individual tests. CPT:86225, 86235 (x5), 86431 | 1 | EA | $ 31.79 | $ 31.79 | |
| 057844 | Rash Profile A Complement Fixation CPT:86603, 86762, 86765 | 1 | EA | $ 29.82 | $ 29.82 | |
| 057877 | Respiratory Infection Profile B (Pneumonia) Complement Fixation, Enzyme immunoassay (EIA) CPT:86603, 86710 (x3), 86738 (x2) | 1 | EA | $ 85.07 | $ 85.07 | |
| 058008 | Rh-hr Genotype With ABO Grouping Hemagglutination CPT:86900, 86906 | 1 | EA | $ 10.14 | $ 10.14 | |
| 058099 | Calcium+Calcium, Ionized Cal Total - Colorimetric; CA++ - Ion-Selective Electrode CPT:82330, 82310 | 1 | EA | $ 21.37 | $ 21.37 | |
| 058198 | Very Low Density Lipoprotein (VLDL) (Includes Triglycerides) | |||||
| (Calculation) CPT:84478 | 1 | EA | $ 4.66 | $ 4.66 | ||
| 058495 | Measles, Mumps, Rubella (MMR) Immunity Profile Chemiluminescent immunoassay (CLIA) CPT:86735, 86762, 86765 | 1 | EA | $ 25.62 | $ 25.62 | |
| 058503 | Respiratory Infection Profile A (Atypical Pneumonia) see individual tests CPT:86603, 86631, 86713, 86738 (x2) | 1 | EA | $ 87.92 | $ 87.92 | |
| 058537 | Hepatitis Profile IV (Hepatitis A and B Immune Status) See individual tests. CPT:86704, 86706, 86708, 86709 | 1 | EA | $ 31.18 | $ 31.18 | |
| 058545 | Hepatitis Profile VI (Hepatitis B Profile) See individual tests. CPT:87340, 86704, 86706, 87350, 86707, 86705 | 1 | EA | $ 44.54 | $ 44.54 | |
| 058552 | Hepatitis Profile VII (Hepatitis A and B Profile) See individual tests. CPT:87340, 86704, 86705, 86706, 87350, 86707, 86708, 86709 | 1 | EA | $ 44.47 | $ 44.47 | |
| 058560 | Hepatitis Profile I (Diagnostic) Immunochemiluminometric assay (ICMA) CPT:87340, 86705, 86709 | 1 | EA | $ 22.72 | $ 22.72 | |
| 058669 | Respiratory Infection Profile D (Croup) Complement fixation (CF) CPT:86710 (x3), 86756 | 1 | EA | $ 31.24 | $ 31.24 | |
| 058867 | CMP12+8AC see individual tests CPT:82977, 84478, 82040, 82247, 82310, 82435, 82465, 82565, 82947, 83540, 83615, 84075, 84100, 84132, 84155, 84295, 84450, 84460, 84520, 84550 | 1 | EA | $ 4.17 | $ 4.17 | |
| 058925 | Testicular Function Profile III Cloned enzyme donor immunoassay (CEDIA)+Electrochemiluminescence Immunoassay (ECLIA) CPT:83001, 83002, 84146, 84403, 84436, 84443, 84479 | 1 | EA | $ 66.45 | $ 66.45 | |
| 059360 | Creat+CreatU+Amy+Amy U CPT:82570, 82150 (x2), 82565 | 1 | EA | $ 24.01 | $ 24.01 | |
| 059980 | Sodium and Potassium (Urine) CPT:84133, 84300 | 1 | EA | $ 10.17 | $ 10.17 | |
| 062448 | Allergen Profile, Mold Thermo Fisher ImmunoCAP(R) CPT:86003 (x12) | 1 | EA | $ 55.44 | $ 55.44 | |
| 062554 | Regional Panel 6 CPT:86003 (x26) | 1 | EA | $ 180.14 | $ 180.14 | |
| 062562 | Regional Panel 7 CPT:86003 (x24) | 1 | EA | $ 330.75 | $ 330.75 | |
| 062570 | Regional Panel 8 CPT:86003 (x21) | 1 | EA | $ 145.53 | $ 145.53 | |
| 062588 | Regional Panel 9 CPT:86003 (x22) | 1 | EA | $ 152.43 | $ 152.43 | |
| 062596 | Regional Panel 10 CPT:86003 (x26) | 1 | EA | $ 180.14 | $ 180.14 | |
| 062828 | IgE+Allergens(10) Electrochemiluminescence immunoassay (ECLIA); Thermo Fisher ImmunoCAP(R) CPT:82785, 86003 (x10) | 1 | EA | $ 79.20 | $ 79.20 | |
| 064881 | GX02-IgE Grass Screen Thermo Fisher ImmunoCAP(R) CPT:86005 | 1 | EA | $ 6.93 | $ 6.93 | |
| 067124 | Penicillin Panel Thermo Fisher ImmunoCAP(R) CPT:86003 (x2) | 1 | EA | $ 13.86 | $ 13.86 | |
| 070001 | Testosterone, Total, LC/MS Liquid chromatography/tandem mass spectrometry (LC/MS-MS) CPT:84403 | 1 | EA | $ 20.00 | $ 20.00 | |
| 070021 | Leflunomide Metabolite (ARAVA) Liquid Chromatography Tandem Mass Spectrometry (LCMSMS) CPT:82542 | 1 | EA | $ 173.48 | $ 173.48 | |
| 070029 | Zinc, RBC CPT:84630 | 1 | EA | $ 90.65 | $ 90.65 | |
| 070032 | Zinc, Whole Blood Inductively-coupled plasma/mass spectrometry (ICP/MS) CPT:84630 | 1 | EA | $ 79.87 | $ 79.87 | |
| 070034 | Iodine, Serum or Plasma Inductively-coupled plasma/mass spectrometry (ICP/MS) CPT:83789 | 1 | EA | $ 60.27 | $ 60.27 | |
| 070037 | 17-OH Progesterone LCMS 2 Spec Liquid chromatography/tandem mass spectrometry (LC/MS-MS) CPT:83498 (x2) | 1 | EA | $ 178.18 | $ 178.18 | |
| 070045 | Nicotine and Metabolite, Ur Qn Liquid chromatography/tandem mass spectrometry (LC/MS-MS) CPT:83887 | 1 | EA | $ 78.40 | $ 78.40 | |
| 070078 | 17-OH Progesterone LCMS 3 Spec CPT:83498 (x3) | 1 | EA | $ 357.95 | $ 357.95 | |
| 070083 | 17-OH Progesterone LCMS 4 Spec CPT:83498 (x4) | 1 | EA | $ 388.08 | $ 388.08 |
This is the start of the file's text. The full file is on GovTribe.
File details come from the government source that posted it. Updated .