36C26318Q0590-002.xlsx
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36C26318Q0590 S02 Attachment 1 - CPT Code Listing - Local Reference Lab.xlsx
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Text version
Base Period
| CLIN | CPT Code | Description | Estimated QTY | Price Per Test | Estimated Total |
| 0001 | 80051 | Electrolyte panel | 2 | $0.00 | |
| 0002 | 80053 | CMP | 2 | $0.00 | |
| 0003 | 80158 | Cyclosporin | 12 | $0.00 | |
| 0004 | 80184 | Phenobarbital | 12 | $0.00 | |
| 0005 | 80197 | Tacrolimus | 20 | $0.00 | |
| 0006 | 80198 | Theophylline | 8 | $0.00 | |
| 0007 | 81003 | UA, macroscopic | 3 | $0.00 | |
| 0008 | 82009 | Ketones | 5 | $0.00 | |
| 0009 | 82010 | Acetone | 10 | $0.00 | |
| 0010 | 82040 | Albumin | 6 | $0.00 | |
| 0011 | 82042 | Albumin, body fluid | 12 | $0.00 | |
| 0012 | 82150 | Amylase, body fluid | 12 | $0.00 | |
| 0013 | 82247 | Total Bilirubin | 6 | $0.00 | |
| 0014 | 82248 | Direct Bilirubin | 6 | $0.00 | |
| 0015 | 82330 | Ionized Calcium | 36 | $0.00 | |
| 0016 | 82374 | CO2 | 6 | $0.00 | |
| 0017 | 82435 | Chloride | 6 | $0.00 | |
| 0018 | 82465 | Cholesterol | 6 | $0.00 | |
| 0019 | 82533 | Cortisol | 25 | $0.00 | |
| 0020 | 82550 | CK | 3 | $0.00 | |
| 0021 | 82565 | Creatinine | 6 | $0.00 | |
| 0022 | 82570 | Creatinine, urine | 5 | $0.00 | |
| 0023 | 82607 | Vitamin B12 | 3 | $0.00 | |
| 0024 | 82945 | Glucose, body fluid | 5 | $0.00 | |
| 0025 | 82947 | Glucose, serum/plasma | 6 | $0.00 | |
| 0026 | 82977 | GGTP | 6 | $0.00 | |
| 0027 | 83051 | Hemoglobin, plasma | 5 | $0.00 | |
| 0028 | 83605 | Lactic Acid | 3 | $0.00 | |
| 0029 | 83615 | LDH | 5 | $0.00 | |
| 0030 | 83690 | Lipase | 6 | $0.00 | |
| 0031 | 83718 | HDL | 6 | $0.00 | |
| 0032 | 83721 | LDL | 6 | $0.00 | |
| 0033 | 83735 | Magnesium | 6 | $0.00 | |
| 0034 | 83930 | Osmolality, serum | 100 | $0.00 | |
| 0035 | 83935 | Osmolality, urine | 100 | $0.00 | |
| 0036 | 83970 | PTH-intact | 3 | $0.00 | |
| 0037 | 84075 | Alkaline Phosphatase | 6 | $0.00 | |
| 0038 | 84100 | Phosphorus | 6 | $0.00 | |
| 0039 | 84132 | Potassium | 6 | $0.00 | |
| 0040 | 84134 | Prealbumin | 3 | $0.00 | |
| 0041 | 84156 | Total Protein, urine | 5 | $0.00 | |
| 0042 | 84157 | Total Protein, body fluid | 6 | $0.00 | |
| 0043 | 84295 | Sodium | 6 | $0.00 | |
| 0044 | 84300 | Sodium, urine | 10 | $0.00 | |
| 0045 | 84439 | Free T4 unbound | 5 | $0.00 | |
| 0046 | 84443 | TSH, highly sensitive | 5 | $0.00 | |
| 0047 | 84450 | AST | 6 | $0.00 | |
| 0048 | 84460 | ALT | 6 | $0.00 | |
| 0049 | 84478 | Triglycerides, body fluid | 5 | $0.00 | |
| 0050 | 84484 | Troponin | 5 | $0.00 | |
| 0051 | 84520 | BUN | 6 | $0.00 | |
| 0052 | 84702 | Pregnancy test | 5 | $0.00 | |
| 0053 | 85027 | Hemogram | 6 | $0.00 | |
| 0054 | 85379 | D-Dimer | 5 | $0.00 | |
| 0055 | 85610 | Protime | 5 | $0.00 | |
| 0056 | 85730 | APTT | 5 | $0.00 | |
| 0057 | 86022 | Heparin Induced Thrombocytopenia | 5 | $0.00 | |
| 0058 | 86140 | CRP | 6 | $0.00 | |
| 0059 | 86308 | Mononucleosis Screen | 5 | $0.00 | |
| 0060 | 86695 | Herpes Type 1 | 3 | $0.00 | |
| 0061 | 86696 | Herpes Type 2 | 3 | $0.00 | |
| 0062 | 86705 | Hepatitis B Surface Antibody | 20 | $0.00 | |
| 0063 | 86850 | Blood Bank Antibody Screen | 6 | $0.00 | |
| 0064 | 86870 | Blood Bank Antibody ID | 3 | $0.00 | |
| 0065 | 86880 | Coombs | 6 | $0.00 | |
| 0066 | 87015 | Acid Fast -AFB Concentrate | 1 | $0.00 | |
| 0067 | 87076 | Microbiology Culture, Anaerobic | 5 | $0.00 | |
| 0068 | 87077 | Microbiology Culture, Aerobic | 10 | $0.00 | |
| 0069 | 87116 | Acid Fast Culture | 1 | $0.00 | |
| 0070 | 87169 | Parasite Identification | 2 | $0.00 | |
| 0071 | 87172 | Pinworm Exam | 5 | $0.00 | |
| 0072 | 87181 | Lab Agar Dilution | 10 | $0.00 | |
| 0073 | 87186 | Microbiology, gram pos | 5 | $0.00 | |
| 0074 | 87186 | Microbiologoy, gram neg | 10 | $0.00 | |
| 0075 | 87186 | Antimicrobial Susceptibility | 8 | $0.00 | |
| 0076 | 87206 | Acid Fast Stain | 1 | $0.00 | |
| 0077 | 87324 | C. Difficile | 5 | $0.00 | |
| 0078 | 87340 | Hepatitis B Surface Antigen | 20 | $0.00 | |
| 0079 | 87341 | Hepatitis Confirmation | 5 | $0.00 | |
| 0080 | 87406 | Fungus ID | 5 | $0.00 | |
| 0081 | 87502 | Influenza PCR | 2 | $0.00 | |
| 0082 | 87529 | Herpes Simplex DNA Probe | 3 | $0.00 | |
| 0083 | 87651 | Group A Strep | 3 | $0.00 | |
| 0084 | 87798 | Infectious Agent AMP | 3 | $0.00 | |
| 0085 | 88342 | Immunohistochemical stain, various markers | 5 | $0.00 | |
| 0086 | 89051 | Cell Count, body fluid | 1 | $0.00 | |
| 0087 | 88108 | Differential, body fluid | 1 | $0.00 | |
| 0088 | 89060 | Crystals, body fluid | 1 | $0.00 | |
| 0089 | 88305 | Tissue Exam | 1 | $0.00 | |
| 0090 | 88311 | Decalcify Tissue | 1 | $0.00 | |
| 0091 | 85384 | Fibrinogen | 2 | $0.00 | |
| 0092 | 85520 | Anti-XA | 2 | $0.00 | |
| Estimated Total | $0.00 |
Option One
| CLIN | CPT Code | Description | Estimated QTY | Price Per Test | Estimated Total |
| 1001 | 80051 | Electrolyte panel | 2 | $0.00 | |
| 1002 | 80053 | CMP | 2 | $0.00 | |
| 1003 | 80158 | Cyclosporin | 12 | $0.00 | |
| 1004 | 80184 | Phenobarbital | 12 | $0.00 | |
| 1005 | 80197 | Tacrolimus | 20 | $0.00 | |
| 1006 | 80198 | Theophylline | 8 | $0.00 | |
| 1007 | 81003 | UA, macroscopic | 3 | $0.00 | |
| 1008 | 82009 | Ketones | 5 | $0.00 | |
| 1009 | 82010 | Acetone | 10 | $0.00 | |
| 1010 | 82040 | Albumin | 6 | $0.00 | |
| 1011 | 82042 | Albumin, body fluid | 12 | $0.00 | |
| 1012 | 82150 | Amylase, body fluid | 12 | $0.00 | |
| 1013 | 82247 | Total Bilirubin | 6 | $0.00 | |
| 1014 | 82248 | Direct Bilirubin | 6 | $0.00 | |
| 1015 | 82330 | Ionized Calcium | 36 | $0.00 | |
| 1016 | 82374 | CO2 | 6 | $0.00 | |
| 1017 | 82435 | Chloride | 6 | $0.00 | |
| 1018 | 82465 | Cholesterol | 6 | $0.00 | |
| 1019 | 82533 | Cortisol | 25 | $0.00 | |
| 1020 | 82550 | CK | 3 | $0.00 | |
| 1021 | 82565 | Creatinine | 6 | $0.00 | |
| 1022 | 82570 | Creatinine, urine | 5 | $0.00 | |
| 1023 | 82607 | Vitamin B12 | 3 | $0.00 | |
| 1024 | 82945 | Glucose, body fluid | 5 | $0.00 | |
| 1025 | 82947 | Glucose, serum/plasma | 6 | $0.00 | |
| 1026 | 82977 | GGTP | 6 | $0.00 | |
| 1027 | 83051 | Hemoglobin, plasma | 5 | $0.00 | |
| 1028 | 83605 | Lactic Acid | 3 | $0.00 | |
| 1029 | 83615 | LDH | 5 | $0.00 | |
| 1030 | 83690 | Lipase | 6 | $0.00 | |
| 1031 | 83718 | HDL | 6 | $0.00 | |
| 1032 | 83721 | LDL | 6 | $0.00 | |
| 1033 | 83735 | Magnesium | 6 | $0.00 | |
| 1034 | 83930 | Osmolality, serum | 100 | $0.00 | |
| 1035 | 83935 | Osmolality, urine | 100 | $0.00 | |
| 1036 | 83970 | PTH-intact | 3 | $0.00 | |
| 1037 | 84075 | Alkaline Phosphatase | 6 | $0.00 | |
| 1038 | 84100 | Phosphorus | 6 | $0.00 | |
| 1039 | 84132 | Potassium | 6 | $0.00 | |
| 1040 | 84134 | Prealbumin | 3 | $0.00 | |
| 1041 | 84156 | Total Protein, urine | 5 | $0.00 | |
| 1042 | 84157 | Total Protein, body fluid | 6 | $0.00 | |
| 1043 | 84295 | Sodium | 6 | $0.00 | |
| 1044 | 84300 | Sodium, urine | 10 | $0.00 | |
| 1045 | 84439 | Free T4 unbound | 5 | $0.00 | |
| 1046 | 84443 | TSH, highly sensitive | 5 | $0.00 | |
| 1047 | 84450 | AST | 6 | $0.00 | |
| 1048 | 84460 | ALT | 6 | $0.00 | |
| 1049 | 84478 | Triglycerides, body fluid | 5 | $0.00 | |
| 1050 | 84484 | Troponin | 5 | $0.00 | |
| 1051 | 84520 | BUN | 6 | $0.00 | |
| 1052 | 84702 | Pregnancy test | 5 | $0.00 | |
| 1053 | 85027 | Hemogram | 6 | $0.00 | |
| 1054 | 85379 | D-Dimer | 5 | $0.00 | |
| 1055 | 85610 | Protime | 5 | $0.00 | |
| 1056 | 85730 | APTT | 5 | $0.00 | |
| 1057 | 86022 | Heparin Induced Thrombocytopenia | 5 | $0.00 | |
| 1058 | 86140 | CRP | 6 | $0.00 | |
| 1059 | 86308 | Mononucleosis Screen | 5 | $0.00 | |
| 1060 | 86695 | Herpes Type 1 | 3 | $0.00 | |
| 1061 | 86696 | Herpes Type 2 | 3 | $0.00 | |
| 1062 | 86705 | Hepatitis B Surface Antibody | 20 | $0.00 | |
| 1063 | 86850 | Blood Bank Antibody Screen | 6 | $0.00 | |
| 1064 | 86870 | Blood Bank Antibody ID | 3 | $0.00 | |
| 1065 | 86880 | Coombs | 6 | $0.00 | |
| 1066 | 87015 | Acid Fast -AFB Concentrate | 1 | $0.00 | |
| 1067 | 87076 | Microbiology Culture, Anaerobic | 5 | $0.00 | |
| 1068 | 87077 | Microbiology Culture, Aerobic | 10 | $0.00 | |
| 1069 | 87116 | Acid Fast Culture | 1 | $0.00 | |
| 1070 | 87169 | Parasite Identification | 2 | $0.00 | |
| 1071 | 87172 | Pinworm Exam | 5 | $0.00 | |
| 1072 | 87181 | Lab Agar Dilution | 10 | $0.00 | |
| 1073 | 87186 | Microbiology, gram pos | 5 | $0.00 | |
| 1074 | 87186 | Microbiologoy, gram neg | 10 | $0.00 | |
| 1075 | 87186 | Antimicrobial Susceptibility | 8 | $0.00 | |
| 1076 | 87206 | Acid Fast Stain | 1 | $0.00 | |
| 1077 | 87324 | C. Difficile | 5 | $0.00 | |
| 1078 | 87340 | Hepatitis B Surface Antigen | 20 | $0.00 | |
| 1079 | 87341 | Hepatitis Confirmation | 5 | $0.00 | |
| 1080 | 87406 | Fungus ID | 5 | $0.00 | |
| 1081 | 87502 | Influenza PCR | 2 | $0.00 | |
| 1082 | 87529 | Herpes Simplex DNA Probe | 3 | $0.00 | |
| 1083 | 87651 | Group A Strep | 3 | $0.00 | |
| 1084 | 87798 | Infectious Agent AMP | 3 | $0.00 | |
| 1085 | 88342 | Immunohistochemical stain, various markers | 5 | $0.00 | |
| 1086 | 89051 | Cell Count, body fluid | 1 | $0.00 | |
| 1087 | 88108 | Differential, body fluid | 1 | $0.00 | |
| 1088 | 89060 | Crystals, body fluid | 1 | $0.00 | |
| 1089 | 88305 | Tissue Exam | 1 | $0.00 | |
| 1090 | 88311 | Decalcify Tissue | 1 | $0.00 | |
| 1091 | 85384 | Fibrinogen | 2 | $0.00 | |
| 1092 | 85520 | Anti-XA | 2 | $0.00 | |
| Estimated Total | $0.00 |
Option Two
| CLIN | CPT Code | Description | Estimated QTY | Price Per Test | Estimated Total |
| 2001 | 80051 | Electrolyte panel | 2 | $0.00 | |
| 2002 | 80053 | CMP | 2 | $0.00 | |
| 2003 | 80158 | Cyclosporin | 12 | $0.00 | |
| 2004 | 80184 | Phenobarbital | 12 | $0.00 | |
| 2005 | 80197 | Tacrolimus | 20 | $0.00 | |
| 2006 | 80198 | Theophylline | 8 | $0.00 | |
| 2007 | 81003 | UA, macroscopic | 3 | $0.00 | |
| 2008 | 82009 | Ketones | 5 | $0.00 | |
| 2009 | 82010 | Acetone | 10 | $0.00 | |
| 2010 | 82040 | Albumin | 6 | $0.00 | |
| 2011 | 82042 | Albumin, body fluid | 12 | $0.00 | |
| 2012 | 82150 | Amylase, body fluid | 12 | $0.00 | |
| 2013 | 82247 | Total Bilirubin | 6 | $0.00 | |
| 2014 | 82248 | Direct Bilirubin | 6 | $0.00 | |
| 2015 | 82330 | Ionized Calcium | 36 | $0.00 | |
| 2016 | 82374 | CO2 | 6 | $0.00 | |
| 2017 | 82435 | Chloride | 6 | $0.00 | |
| 2018 | 82465 | Cholesterol | 6 | $0.00 | |
| 2019 | 82533 | Cortisol | 25 | $0.00 | |
| 2020 | 82550 | CK | 3 | $0.00 | |
| 2021 | 82565 | Creatinine | 6 | $0.00 | |
| 2022 | 82570 | Creatinine, urine | 5 | $0.00 | |
| 2023 | 82607 | Vitamin B12 | 3 | $0.00 | |
| 2024 | 82945 | Glucose, body fluid | 5 | $0.00 | |
| 2025 | 82947 | Glucose, serum/plasma | 6 | $0.00 | |
| 2026 | 82977 | GGTP | 6 | $0.00 | |
| 2027 | 83051 | Hemoglobin, plasma | 5 | $0.00 | |
| 2028 | 83605 | Lactic Acid | 3 | $0.00 | |
| 2029 | 83615 | LDH | 5 | $0.00 | |
| 2030 | 83690 | Lipase | 6 | $0.00 | |
| 2031 | 83718 | HDL | 6 | $0.00 | |
| 2032 | 83721 | LDL | 6 | $0.00 | |
| 2033 | 83735 | Magnesium | 6 | $0.00 | |
| 2034 | 83930 | Osmolality, serum | 100 | $0.00 | |
| 2035 | 83935 | Osmolality, urine | 100 | $0.00 | |
| 2036 | 83970 | PTH-intact | 3 | $0.00 | |
| 2037 | 84075 | Alkaline Phosphatase | 6 | $0.00 | |
| 2038 | 84100 | Phosphorus | 6 | $0.00 | |
| 2039 | 84132 | Potassium | 6 | $0.00 | |
| 2040 | 84134 | Prealbumin | 3 | $0.00 | |
| 2041 | 84156 | Total Protein, urine | 5 | $0.00 | |
| 2042 | 84157 | Total Protein, body fluid | 6 | $0.00 | |
| 2043 | 84295 | Sodium | 6 | $0.00 | |
| 2044 | 84300 | Sodium, urine | 10 | $0.00 | |
| 2045 | 84439 | Free T4 unbound | 5 | $0.00 | |
| 2046 | 84443 | TSH, highly sensitive | 5 | $0.00 | |
| 2047 | 84450 | AST | 6 | $0.00 | |
| 2048 | 84460 | ALT | 6 | $0.00 | |
| 2049 | 84478 | Triglycerides, body fluid | 5 | $0.00 | |
| 2050 | 84484 | Troponin | 5 | $0.00 | |
| 2051 | 84520 | BUN | 6 | $0.00 | |
| 2052 | 84702 | Pregnancy test | 5 | $0.00 | |
| 2053 | 85027 | Hemogram | 6 | $0.00 | |
| 2054 | 85379 | D-Dimer | 5 | $0.00 | |
| 2055 | 85610 | Protime | 5 | $0.00 | |
| 2056 | 85730 | APTT | 5 | $0.00 | |
| 2057 | 86022 | Heparin Induced Thrombocytopenia | 5 | $0.00 | |
| 2058 | 86140 | CRP | 6 | $0.00 | |
| 2059 | 86308 | Mononucleosis Screen | 5 | $0.00 | |
| 2060 | 86695 | Herpes Type 1 | 3 | $0.00 | |
| 2061 | 86696 | Herpes Type 2 | 3 | $0.00 | |
| 2062 | 86705 | Hepatitis B Surface Antibody | 20 | $0.00 | |
| 2063 | 86850 | Blood Bank Antibody Screen | 6 | $0.00 | |
| 2064 | 86870 | Blood Bank Antibody ID | 3 | $0.00 | |
| 2065 | 86880 | Coombs | 6 | $0.00 | |
| 2066 | 87015 | Acid Fast -AFB Concentrate | 1 | $0.00 | |
| 2067 | 87076 | Microbiology Culture, Anaerobic | 5 | $0.00 | |
| 2068 | 87077 | Microbiology Culture, Aerobic | 10 | $0.00 | |
| 2069 | 87116 | Acid Fast Culture | 1 | $0.00 | |
| 2070 | 87169 | Parasite Identification | 2 | $0.00 | |
| 2071 | 87172 | Pinworm Exam | 5 | $0.00 | |
| 2072 | 87181 | Lab Agar Dilution | 10 | $0.00 | |
| 2073 | 87186 | Microbiology, gram pos | 5 | $0.00 | |
| 2074 | 87186 | Microbiologoy, gram neg | 10 | $0.00 | |
| 2075 | 87186 | Antimicrobial Susceptibility | 8 | $0.00 | |
| 2076 | 87206 | Acid Fast Stain | 1 | $0.00 | |
| 2077 | 87324 | C. Difficile | 5 | $0.00 | |
| 2078 | 87340 | Hepatitis B Surface Antigen | 20 | $0.00 | |
| 2079 | 87341 | Hepatitis Confirmation | 5 | $0.00 | |
| 2080 | 87406 | Fungus ID | 5 | $0.00 | |
| 2081 | 87502 | Influenza PCR | 2 | $0.00 | |
| 2082 | 87529 | Herpes Simplex DNA Probe | 3 | $0.00 | |
| 2083 | 87651 | Group A Strep | 3 | $0.00 | |
| 2084 | 87798 | Infectious Agent AMP | 3 | $0.00 | |
| 2085 | 88342 | Immunohistochemical stain, various markers | 5 | $0.00 | |
| 2086 | 89051 | Cell Count, body fluid | 1 | $0.00 | |
| 2087 | 88108 | Differential, body fluid | 1 | $0.00 | |
| 2088 | 89060 | Crystals, body fluid | 1 | $0.00 | |
| 2089 | 88305 | Tissue Exam | 1 | $0.00 | |
| 2090 | 88311 | Decalcify Tissue | 1 | $0.00 | |
| 2091 | 85384 | Fibrinogen | 2 | $0.00 | |
| 2092 | 85520 | Anti-XA | 2 | $0.00 | |
| Estimated Total | $0.00 |
Option Three
| CLIN | CPT Code | Description | Estimated QTY | Price Per Test | Estimated Total |
| 3001 | 80051 | Electrolyte panel | 2 | $0.00 | |
| 3002 | 80053 | CMP | 2 | $0.00 | |
| 3003 | 80158 | Cyclosporin | 12 | $0.00 | |
| 3004 | 80184 | Phenobarbital | 12 | $0.00 | |
| 3005 | 80197 | Tacrolimus | 20 | $0.00 | |
| 3006 | 80198 | Theophylline | 8 | $0.00 | |
| 3007 | 81003 | UA, macroscopic | 3 | $0.00 | |
| 3008 | 82009 | Ketones | 5 | $0.00 | |
| 3009 | 82010 | Acetone | 10 | $0.00 | |
| 3010 | 82040 | Albumin | 6 | $0.00 | |
| 3011 | 82042 | Albumin, body fluid | 12 | $0.00 | |
| 3012 | 82150 | Amylase, body fluid | 12 | $0.00 | |
| 3013 | 82247 | Total Bilirubin | 6 | $0.00 | |
| 3014 | 82248 | Direct Bilirubin | 6 | $0.00 | |
| 3015 | 82330 | Ionized Calcium | 36 | $0.00 | |
| 3016 | 82374 | CO2 | 6 | $0.00 | |
| 3017 | 82435 | Chloride | 6 | $0.00 | |
| 3018 | 82465 | Cholesterol | 6 | $0.00 | |
| 3019 | 82533 | Cortisol | 25 | $0.00 | |
| 3020 | 82550 | CK | 3 | $0.00 | |
| 3021 | 82565 | Creatinine | 6 | $0.00 | |
| 3022 | 82570 | Creatinine, urine | 5 | $0.00 | |
| 3023 | 82607 | Vitamin B12 | 3 | $0.00 | |
| 3024 | 82945 | Glucose, body fluid | 5 | $0.00 | |
| 3025 | 82947 | Glucose, serum/plasma | 6 | $0.00 | |
| 3026 | 82977 | GGTP | 6 | $0.00 | |
| 3027 | 83051 | Hemoglobin, plasma | 5 | $0.00 | |
| 3028 | 83605 | Lactic Acid | 3 | $0.00 | |
| 3029 | 83615 | LDH | 5 | $0.00 | |
| 3030 | 83690 | Lipase | 6 | $0.00 | |
| 3031 | 83718 | HDL | 6 | $0.00 | |
| 3032 | 83721 | LDL | 6 | $0.00 | |
| 3033 | 83735 | Magnesium | 6 | $0.00 | |
| 3034 | 83930 | Osmolality, serum | 100 | $0.00 | |
| 3035 | 83935 | Osmolality, urine | 100 | $0.00 | |
| 3036 | 83970 | PTH-intact | 3 | $0.00 | |
| 3037 | 84075 | Alkaline Phosphatase | 6 | $0.00 | |
| 3038 | 84100 | Phosphorus | 6 | $0.00 | |
| 3039 | 84132 | Potassium | 6 | $0.00 | |
| 3040 | 84134 | Prealbumin | 3 | $0.00 | |
| 3041 | 84156 | Total Protein, urine | 5 | $0.00 | |
| 3042 | 84157 | Total Protein, body fluid | 6 | $0.00 | |
| 3043 | 84295 | Sodium | 6 | $0.00 | |
| 3044 | 84300 | Sodium, urine | 10 | $0.00 | |
| 3045 | 84439 | Free T4 unbound | 5 | $0.00 | |
| 3046 | 84443 | TSH, highly sensitive | 5 | $0.00 | |
| 3047 | 84450 | AST | 6 | $0.00 | |
| 3048 | 84460 | ALT | 6 | $0.00 | |
| 3049 | 84478 | Triglycerides, body fluid | 5 | $0.00 | |
| 3050 | 84484 | Troponin | 5 | $0.00 | |
| 3051 | 84520 | BUN | 6 | $0.00 | |
| 3052 | 84702 | Pregnancy test | 5 | $0.00 | |
| 3053 | 85027 | Hemogram | 6 | $0.00 | |
| 3054 | 85379 | D-Dimer | 5 | $0.00 | |
| 3055 | 85610 | Protime | 5 | $0.00 | |
| 3056 | 85730 | APTT | 5 | $0.00 | |
| 3057 | 86022 | Heparin Induced Thrombocytopenia | 5 | $0.00 | |
| 3058 | 86140 | CRP | 6 | $0.00 | |
| 3059 | 86308 | Mononucleosis Screen | 5 | $0.00 | |
| 3060 | 86695 | Herpes Type 1 | 3 | $0.00 | |
| 3061 | 86696 | Herpes Type 2 | 3 | $0.00 | |
| 3062 | 86705 | Hepatitis B Surface Antibody | 20 | $0.00 | |
| 3063 | 86850 | Blood Bank Antibody Screen | 6 | $0.00 | |
| 3064 | 86870 | Blood Bank Antibody ID | 3 | $0.00 | |
| 3065 | 86880 | Coombs | 6 | $0.00 | |
| 3066 | 87015 | Acid Fast -AFB Concentrate | 1 | $0.00 | |
| 3067 | 87076 | Microbiology Culture, Anaerobic | 5 | $0.00 | |
| 3068 | 87077 | Microbiology Culture, Aerobic | 10 | $0.00 | |
| 3069 | 87116 | Acid Fast Culture | 1 | $0.00 | |
| 3070 | 87169 | Parasite Identification | 2 | $0.00 | |
| 3071 | 87172 | Pinworm Exam | 5 | $0.00 | |
| 3072 | 87181 | Lab Agar Dilution | 10 | $0.00 | |
| 3073 | 87186 | Microbiology, gram pos | 5 | $0.00 | |
| 3074 | 87186 | Microbiologoy, gram neg | 10 | $0.00 | |
| 3075 | 87186 | Antimicrobial Susceptibility | 8 | $0.00 | |
| 3076 | 87206 | Acid Fast Stain | 1 | $0.00 | |
| 3077 | 87324 | C. Difficile | 5 | $0.00 | |
| 3078 | 87340 | Hepatitis B Surface Antigen | 20 | $0.00 | |
| 3079 | 87341 | Hepatitis Confirmation | 5 | $0.00 | |
| 3080 | 87406 | Fungus ID | 5 | $0.00 | |
| 3081 | 87502 | Influenza PCR | 2 | $0.00 | |
| 3082 | 87529 | Herpes Simplex DNA Probe | 3 | $0.00 | |
| 3083 | 87651 | Group A Strep | 3 | $0.00 | |
| 3084 | 87798 | Infectious Agent AMP | 3 | $0.00 | |
| 3085 | 88342 | Immunohistochemical stain, various markers | 5 | $0.00 | |
| 3086 | 89051 | Cell Count, body fluid | 1 | $0.00 | |
| 3087 | 88108 | Differential, body fluid | 1 | $0.00 | |
| 3088 | 89060 | Crystals, body fluid | 1 | $0.00 | |
| 3089 | 88305 | Tissue Exam | 1 | $0.00 | |
| 3090 | 88311 | Decalcify Tissue | 1 | $0.00 | |
| 3091 | 85384 | Fibrinogen | 2 | $0.00 | |
| 3092 | 85520 | Anti-XA | 2 | $0.00 | |
| Estimated Total | $0.00 |
Option Four
| CLIN | CPT Code | Description | Estimated QTY | Price Per Test | Estimated Total |
| 4001 | 80051 | Electrolyte panel | 2 | $0.00 | |
| 4002 | 80053 | CMP | 2 | $0.00 | |
| 4003 | 80158 | Cyclosporin | 12 | $0.00 | |
| 4004 | 80184 | Phenobarbital | 12 | $0.00 | |
| 4005 | 80197 | Tacrolimus | 20 | $0.00 | |
| 4006 | 80198 | Theophylline | 8 | $0.00 | |
| 4007 | 81003 | UA, macroscopic | 3 | $0.00 | |
| 4008 | 82009 | Ketones | 5 | $0.00 | |
| 4009 | 82010 | Acetone | 10 | $0.00 | |
| 4010 | 82040 | Albumin | 6 | $0.00 | |
| 4011 | 82042 | Albumin, body fluid | 12 | $0.00 | |
| 4012 | 82150 | Amylase, body fluid | 12 | $0.00 | |
| 4013 | 82247 | Total Bilirubin | 6 | $0.00 | |
| 4014 | 82248 | Direct Bilirubin | 6 | $0.00 | |
| 4015 | 82330 | Ionized Calcium | 36 | $0.00 | |
| 4016 | 82374 | CO2 | 6 | $0.00 | |
| 4017 | 82435 | Chloride | 6 | $0.00 | |
| 4018 | 82465 | Cholesterol | 6 | $0.00 | |
| 4019 | 82533 | Cortisol | 25 | $0.00 | |
| 4020 | 82550 | CK | 3 | $0.00 | |
| 4021 | 82565 | Creatinine | 6 | $0.00 | |
| 4022 | 82570 | Creatinine, urine | 5 | $0.00 | |
| 4023 | 82607 | Vitamin B12 | 3 | $0.00 | |
| 4024 | 82945 | Glucose, body fluid | 5 | $0.00 | |
| 4025 | 82947 | Glucose, serum/plasma | 6 | $0.00 | |
| 4026 | 82977 | GGTP | 6 | $0.00 | |
| 4027 | 83051 | Hemoglobin, plasma | 5 | $0.00 | |
| 4028 | 83605 | Lactic Acid | 3 | $0.00 | |
| 4029 | 83615 | LDH | 5 | $0.00 | |
| 4030 | 83690 | Lipase | 6 | $0.00 | |
| 4031 | 83718 | HDL | 6 | $0.00 | |
| 4032 | 83721 | LDL | 6 | $0.00 | |
| 4033 | 83735 | Magnesium | 6 | $0.00 | |
| 4034 | 83930 | Osmolality, serum | 100 | $0.00 | |
| 4035 | 83935 | Osmolality, urine | 100 | $0.00 | |
| 4036 | 83970 | PTH-intact | 3 | $0.00 | |
| 4037 | 84075 | Alkaline Phosphatase | 6 | $0.00 | |
| 4038 | 84100 | Phosphorus | 6 | $0.00 | |
| 4039 | 84132 | Potassium | 6 | $0.00 | |
| 4040 | 84134 | Prealbumin | 3 | $0.00 | |
| 4041 | 84156 | Total Protein, urine | 5 | $0.00 | |
| 4042 | 84157 | Total Protein, body fluid | 6 | $0.00 | |
| 4043 | 84295 | Sodium | 6 | $0.00 | |
| 4044 | 84300 | Sodium, urine | 10 | $0.00 | |
| 4045 | 84439 | Free T4 unbound | 5 | $0.00 | |
| 4046 | 84443 | TSH, highly sensitive | 5 | $0.00 | |
| 4047 | 84450 | AST | 6 | $0.00 | |
| 4048 | 84460 | ALT | 6 | $0.00 | |
| 4049 | 84478 | Triglycerides, body fluid | 5 | $0.00 | |
| 4050 | 84484 | Troponin | 5 | $0.00 | |
| 4051 | 84520 | BUN | 6 | $0.00 | |
| 4052 | 84702 | Pregnancy test | 5 | $0.00 | |
| 4053 | 85027 | Hemogram | 6 | $0.00 | |
| 4054 | 85379 | D-Dimer | 5 | $0.00 | |
| 4055 | 85610 | Protime | 5 | $0.00 | |
| 4056 | 85730 | APTT | 5 | $0.00 | |
| 4057 | 86022 | Heparin Induced Thrombocytopenia | 5 | $0.00 | |
| 4058 | 86140 | CRP | 6 | $0.00 | |
| 4059 | 86308 | Mononucleosis Screen | 5 | $0.00 | |
| 4060 | 86695 | Herpes Type 1 | 3 | $0.00 | |
| 4061 | 86696 | Herpes Type 2 | 3 | $0.00 | |
| 4062 | 86705 | Hepatitis B Surface Antibody | 20 | $0.00 | |
| 4063 | 86850 | Blood Bank Antibody Screen | 6 | $0.00 | |
| 4064 | 86870 | Blood Bank Antibody ID | 3 | $0.00 | |
| 4065 | 86880 | Coombs | 6 | $0.00 | |
| 4066 | 87015 | Acid Fast -AFB Concentrate | 1 | $0.00 | |
| 4067 | 87076 | Microbiology Culture, Anaerobic | 5 | $0.00 | |
| 4068 | 87077 | Microbiology Culture, Aerobic | 10 | $0.00 | |
| 4069 | 87116 | Acid Fast Culture | 1 | $0.00 | |
| 4070 | 87169 | Parasite Identification | 2 | $0.00 | |
| 4071 | 87172 | Pinworm Exam | 5 | $0.00 | |
| 4072 | 87181 | Lab Agar Dilution | 10 | $0.00 | |
| 4073 | 87186 | Microbiology, gram pos | 5 | $0.00 | |
| 4074 | 87186 | Microbiologoy, gram neg | 10 | $0.00 | |
| 4075 | 87186 | Antimicrobial Susceptibility | 8 | $0.00 | |
| 4076 | 87206 | Acid Fast Stain | 1 | $0.00 | |
| 4077 | 87324 | C. Difficile | 5 | $0.00 | |
| 4078 | 87340 | Hepatitis B Surface Antigen | 20 | $0.00 | |
| 4079 | 87341 | Hepatitis Confirmation | 5 | $0.00 | |
| 4080 | 87406 | Fungus ID | 5 | $0.00 | |
| 4081 | 87502 | Influenza PCR | 2 | $0.00 | |
| 4082 | 87529 | Herpes Simplex DNA Probe | 3 | $0.00 | |
| 4083 | 87651 | Group A Strep | 3 | $0.00 | |
| 4084 | 87798 | Infectious Agent AMP | 3 | $0.00 | |
| 4085 | 88342 | Immunohistochemical stain, various markers | 5 | $0.00 | |
| 4086 | 89051 | Cell Count, body fluid | 1 | $0.00 | |
| 4087 | 88108 | Differential, body fluid | 1 | $0.00 | |
| 4088 | 89060 | Crystals, body fluid | 1 | $0.00 | |
| 4089 | 88305 | Tissue Exam | 1 | $0.00 | |
| 4090 | 88311 | Decalcify Tissue | 1 | $0.00 | |
| 4091 | 85384 | Fibrinogen | 2 | $0.00 | |
| 4092 | 85520 | Anti-XA | 2 | $0.00 | |
| Estimated Total | $0.00 |
File details come from the government source that posted it.