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CLFS_2015
2015 Clinical Diagnostic Laboratory Fee Schedule CPT codes, descriptions and other data only are copyright 2013 American Medical Association.
All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).
AR
07102
LOC 00
36415 6.00 Routine venipuncture
78267 21.40 Breath tst attain/anal c-14
78268 78.76 Breath test analysis c-14
80047 23.02 Metabolic panel ionized ca
80047 23.02 Metabolic panel ionized ca
80048 23.02 Metabolic panel total ca
80048 23.02 Metabolic panel total ca
80051 19.10 Electrolyte panel
80051 19.10 Electrolyte panel
80053 28.74 Comprehen metabolic panel
80053 28.74 Comprehen metabolic panel
80061 34.62 Lipid panel
80061 34.62 Lipid panel
80069 23.64 Renal function panel
80069 23.64 Renal function panel
80074 129.66 Acute hepatitis panel
80076 22.22 Hepatic function panel
80150 41.02 Assay of amikacin
80155 38.50 Drug screen quant caffeine
80156 39.64 Assay carbamazepine total
80157 36.08 Assay carbamazepine free
80158 49.14 Assay of cyclosporine
80159 50.34 Drug screen quant clozapine
80162 36.14 Assay of digoxin
80163 36.14 Assay of digoxin free
80164 36.88 Assay dipropylacetic acid
80165 36.88 Dipropylacetic acid free
80168 44.48 Assay of ethosuximide
80169 37.38 Drug screen quant everolimus
80170 44.60 Assay of gentamicin
80171 36.08 Drug screen quant gabapentin
80173 39.64 Assay of haloperidol
80175 36.08 Drug screen quan lamotrigine
80176 39.98 Assay of lidocaine
80177 36.08 Drug scrn quan levetiracetam
80178 18.00 Assay of lithium
80178 18.00 Assay of lithium
SHORTDESCHCPCS
Page 1
CLFS_2015
80180 49.14 Drug scrn quan mycophenolate
80183 36.08 Drug scrn quant oxcarbazepin
80184 31.16 Assay of phenobarbital
80185 36.08 Assay of phenytoin total
80186 37.46 Assay of phenytoin free
80188 45.16 Assay of primidone
80190 45.60 Assay of procainamide
80192 45.60 Assay of procainamide
80194 39.74 Assay of quinidine
80195 37.38 Assay of sirolimus
80197 37.38 Assay of tacrolimus
80198 38.50 Assay of theophylline
80199 49.16 Drug screen quant tiagabine
80200 43.88 Assay of tobramycin
80201 32.46 Assay of topiramate
80202 36.88 Assay of vancomycin
80203 36.08 Drug screen quant zonisamide
80299 37.28 Quantitative assay drug
80400 88.78 Acth stimulation panel
80402 236.66 Acth stimulation panel
80406 212.98 Acth stimulation panel
80408 341.56 Aldosterone suppression eval
80410 218.66 Calcitonin stimul panel
80412 536.84 CRH stimulation panel
80414 140.54 Testosterone response
80415 152.10 Estradiol response panel
80416 359.16 Renin stimulation panel
80417 119.72 Renin stimulation panel
80418 1337.28 Pituitary evaluation panel
80420 196.08 Dexamethasone panel
80422 125.40 Glucagon tolerance panel
80424 137.44 Glucagon tolerance panel
80426 403.92 Gonadotropin hormone panel
80428 181.54 Growth hormone panel
80430 213.60 Growth hormone panel
80432 367.70 Insulin suppression panel
80434 275.36 Insulin tolerance panel
80435 280.38 Insulin tolerance panel
80436 248.12 Metyrapone panel
80438 137.20 TRH stimulation panel
80439 182.94 TRH stimulation panel
81000 8.62 Urinalysis nonauto w/scope
81001 8.62 Urinalysis auto w/scope
81002 6.96 Urinalysis nonauto w/o scope
Page 2
CLFS_2015
81003 6.12 Urinalysis auto w/o scope
81003 6.12 Urinalysis auto w/o scope
81005 5.90 Urinalysis
81007 6.98 Urine screen for bacteria
81007 6.98 Urine screen for bacteria
81015 8.28 Microscopic exam of urine
81020 10.04 Urinalysis glass test
81025 17.22 Urine pregnancy test
81050 8.16 Urinalysis volume measure
81161 0.00 Dmd dup/delet analysis
81206 446.26 Bcr/abl1 gene major bp
81207 394.20 Bcr/abl1 gene minor bp
81208 437.76 Bcr/abl1 gene other bp
81210 357.60 Braf gene
81211 4356.08 Brca1&2 seq & com dup/del
81212 352.52 Brca1&2 185&5385&6174 var
81213 1162.52 Brca1&2 uncom dup/del var
81214 2869.08 Brca1 full seq & com dup/del
81215 186.02 Brca1 gene known fam variant
81217 186.02 Brca2 gene known fam variant
81225 582.14 Cyp2c19 gene com variants
81226 900.92 Cyp2d6 gene com variants
81227 349.28 Cyp2c9 gene com variants
81235 658.36 Egfr gene com variants
81240 133.92 F2 gene
81241 166.32 F5 gene
81245 331.02 Flt3 gene
81246 0.00 Flt3 gene analysis
81256 177.90 Hfe gene
81261 538.86 Igh gene rearrange amp meth
81262 118.80 Igh gene rearrang dir probe
81263 801.58 Igh vari regional mutation
81264 406.42 Igk rearrangeabn clonal pop
81265 585.30 Str markers specimen anal
81267 564.64 Chimerism anal no cell selec
81268 709.78 Chimerism anal w/cell select
81270 249.50 Jak2 gene
81275 393.98 Kras gene
81287 0.00 Mgmt gene methylation anal
81288 0.00 Mlh1 gene
81291 118.80 Mthfr gene
81292 1289.24 Mlh1 gene full seq
81293 516.82 Mlh1 gene known variants
81294 380.40 Mlh1 gene dup/delete variant
Page 3
CLFS_2015
81295 302.66 Msh2 gene full seq
81296 258.42 Msh2 gene known variants
81297 302.66 Msh2 gene dup/delete variant
81298 574.22 Msh6 gene full seq
81299 321.68 Msh6 gene known variants
81300 322.56 Msh6 gene dup/delete variant
81301 788.10 Microsatellite instability
81310 493.04 Npm1 gene
81313 0.00 Pca3/klk3 antigen
81315 564.24 Pml/raralpha com breakpoints
81316 860.62 Pml/raralpha 1 breakpoint
81317 1558.68 Pms2 gene full seq analysis
81318 368.30 Pms2 known familial variants
81319 442.22 Pms2 gene dup/delet variants
81321 1198.40 Pten gene full sequence
81322 116.50 Pten gene known fam variant
81323 174.76 Pten gene dup/delet variant
81332 118.80 Serpina1 gene
81340 568.62 Trb@ gene rearrange amplify
81341 134.96 Trb@ gene rearrange dirprobe
81342 548.42 Trg gene rearrangement anal
81370 1094.46 Hla i & ii typing lr
81371 655.08 Hla i & ii type verify lr
81372 601.22 Hla i typing complete lr
81373 303.10 Hla i typing 1 locus lr
81374 198.00 Hla i typing 1 antigen lr
81375 600.80 Hla ii typing ag equiv lr
81376 332.64 Hla ii typing 1 locus lr
81377 249.88 Hla ii type 1 ag equiv lr
81378 940.52 Hla i & ii typing hr
81379 912.80 Hla i typing complete hr
81380 482.42 Hla i typing 1 locus hr
81381 257.42 Hla i typing 1 allele hr
81382 336.62 Hla ii typing 1 loc hr
81383 297.02 Hla ii typing 1 allele hr
81410 0.00 Aortic dysfunction/dilation
81411 0.00 Aortic dysfunction/dilation
81415 0.00 Exome sequence analysis
81416 0.00 Exome sequence analysis
81417 0.00 Exome re-evaluation
81420 0.00 Fetal chrmoml aneuploidy
81425 0.00 Genome sequence analysis
81426 0.00 Genome sequence analysis
81427 0.00 Genome re-evaluation
Page 4
CLFS_2015
81430 0.00 Hearing loss sequence analys
81431 0.00 Hearing loss dup/del analys
81435 0.00 Hereditary colon cancer
81436 0.00 Hereditary colon ca synd
81440 0.00 Mitochondrial gene
81445 0.00 Targeted genomic seq analys
81450 0.00 Targeted genomic seq analys
81455 0.00 Targeted genomic seq analys
81460 0.00 Whole mitochondrial genome
81465 0.00 Whole mitochondrial genome
81470 0.00 X-linked intellectual dblt
81471 0.00 X-linked intellectual dblt
82009 12.30 Test for acetone/ketones
82010 19.10 Acetone assay
82010 19.10 Acetone assay
82013 30.40 Acetylcholinesterase assay
82016 36.34 Acylcarnitines qual
82017 45.90 Acylcarnitines quant
82024 45.08 Assay of acth
82030 70.22 Assay of adp & amp
82040 13.46 Assay of serum albumin
82040 13.46 Assay of serum albumin
82042 14.08 Assay of urine albumin
82042 14.08 Assay of urine albumin
82043 15.74 Microalbumin quantitative
82043 15.74 Microalbumin quantitative
82044 5.16 Microalbumin semiquant
82044 5.16 Microalbumin semiquant
82045 92.38 Albumin ischemia modified
82075 20.50 Assay of breath ethanol
82085 26.42 Assay of aldolase
82088 110.92 Assay of aldosterone
82103 36.58 Alpha-1-antitrypsin total
82104 39.36 Alpha-1-antitrypsin pheno
82105 45.66 Alpha-fetoprotein serum
82106 45.66 Alpha-fetoprotein amniotic
82107 175.30 Alpha-fetoprotein l3
82108 23.78 Assay of aluminum
82120 10.24 Amines vaginal fluid qual
82120 10.24 Amines vaginal fluid qual
82127 36.34 Amino acid single qual
82128 36.34 Amino acids mult qual
82131 45.90 Amino acids single quant
82135 44.78 Assay aminolevulinic acid
Page 5
CLFS_2015
82136 45.90 Amino acids quant 2-5
82139 45.90 Amino acids quan 6 or more
82140 23.80 Assay of ammonia
82143 18.14 Amniotic fluid scan
82150 17.64 Assay of amylase
82150 17.64 Assay of amylase
82154 78.48 Androstanediol glucuronide
82157 79.68 Assay of androstenedione
82160 68.06 Assay of androsterone
82163 55.86 Assay of angiotensin II
82164 39.74 Angiotensin I enzyme test
82172 42.18 Assay of apolipoprotein
82175 51.64 Assay of arsenic
82180 26.90 Assay of ascorbic acid
82190 40.56 Atomic absorption
82232 44.04 Assay of beta-2 protein
82239 46.62 Bile acids total
82240 72.34 Bile acids cholylglycine
82247 13.66 Bilirubin total
82247 13.66 Bilirubin total
82248 13.66 Bilirubin direct
82252 7.34 Fecal bilirubin test
82261 45.90 Assay of biotinidase
82270 8.86 Occult blood feces
82271 8.86 Occult blood other sources
82271 8.86 Occult blood other sources
82272 8.86 Occult bld feces 1-3 tests
82272 8.86 Occult bld feces 1-3 tests
82274 43.30 Assay test for blood fecal
82274 43.30 Assay test for blood fecal
82286 18.76 Assay of bradykinin
82300 62.98 Assay of cadmium
82306 80.58 Vitamin d 25 hydroxy
82308 72.90 Assay of calcitonin
82310 14.04 Assay of calcium
82310 14.04 Assay of calcium
82330 35.94 Assay of calcium
82330 35.94 Assay of calcium
82331 14.08 Calcium infusion test
82340 16.42 Assay of calcium in urine
82355 31.50 Calculus analysis qual
82360 35.04 Calculus assay quant
82365 35.10 Calculus spectroscopy
82370 34.10 X-ray assay calculus
Page 6
CLFS_2015
82373 49.16 Assay c-d transfer measure
82374 13.30 Assay blood carbon dioxide
82374 13.30 Assay blood carbon dioxide
82375 33.54 Assay carboxyhb quant
82376 16.30 Assay carboxyhb qual
82378 51.62 Carcinoembryonic antigen
82379 45.90 Assay of carnitine
82380 25.10 Assay of carotene
82382 46.80 Assay urine catecholamines
82383 68.20 Assay blood catecholamines
82384 68.72 Assay three catecholamines
82387 56.64 Assay of cathepsin-d
82390 29.24 Assay of ceruloplasmin
82397 38.44 Chemiluminescent assay
82415 34.48 Assay of chloramphenicol
82435 12.52 Assay of blood chloride
82435 12.52 Assay of blood chloride
82436 13.70 Assay of urine chloride
82438 13.30 Assay other fluid chlorides
82441 14.66 Test for chlorohydrocarbons
82465 11.84 Assay bld/serum cholesterol
82465 11.84 Assay bld/serum cholesterol
82480 21.44 Assay serum cholinesterase
82482 20.90 Assay rbc cholinesterase
82485 13.68 Assay chondroitin sulfate
82486 49.16 Gas/liquid chromatography
82487 43.46 Paper chromatography
82488 58.14 Paper chromatography
82489 50.34 Thin layer chromatography
82491 49.16 Chromotography quant sing
82492 49.16 Chromotography quant mult
82495 19.04 Assay of chromium
82507 75.68 Assay of citrate
82523 50.86 Collagen crosslinks
82523 50.86 Collagen crosslinks
82525 33.78 Assay of copper
82528 61.28 Assay of corticosterone
82530 45.48 Cortisol free
82533 44.38 Total cortisol
82540 12.62 Assay of creatine
82541 49.16 Column chromotography qual
82542 49.16 Column chromotography quant
82543 49.16 Column chromotograph/isotope
82544 49.16 Column chromotograph/isotope
Page 7
CLFS_2015
82550 17.72 Assay of ck (cpk)
82550 17.72 Assay of ck (cpk)
82552 36.46 Assay of cpk in blood
82553 31.44 Creatine mb fraction
82554 32.30 Creatine isoforms
82565 13.94 Assay of creatinine
82565 13.94 Assay of creatinine
82570 14.08 Assay of urine creatinine
82570 14.08 Assay of urine creatinine
82575 25.72 Creatinine clearance test
82585 23.36 Assay of cryofibrinogen
82595 17.62 Assay of cryoglobulin
82600 52.80 Assay of cyanide
82607 41.02 Vitamin B-12
82608 38.96 B-12 binding capacity
82610 37.00 Cystatin c
82615 22.22 Test for urine cystines
82626 68.78 Dehydroepiandrosterone
82627 60.52 Dehydroepiandrosterone
82633 84.32 Desoxycorticosterone
82634 79.68 Deoxycortisol
82638 33.32 Assay of dibucaine number
82652 104.78 Vit d 1 25-dihydroxy
82656 31.40 Pancreatic elastase fecal
82657 49.16 Enzyme cell activity
82658 49.16 Enzyme cell activity ra
82664 93.50 Electrophoretic test
82668 51.16 Assay of erythropoietin
82670 76.04 Assay of estradiol
82671 65.32 Assay of estrogens
82672 59.06 Assay of estrogen
82677 65.82 Assay of estriol
82679 67.92 Assay of estrone
82679 67.92 Assay of estrone
82693 40.54 Assay of ethylene glycol
82696 64.18 Assay of etiocholanolone
82705 13.86 Fats/lipids feces qual
82710 31.68 Fats/lipids feces quant
82715 46.84 Assay of fecal fat
82725 36.24 Assay of blood fatty acids
82726 49.16 Long chain fatty acids
82728 37.08 Assay of ferritin
82731 175.30 Assay of fetal fibronectin
82735 50.46 Assay of fluoride
Page 8
CLFS_2015
82746 40.02 Assay of folic acid serum
82747 47.14 Assay of folic acid rbc
82757 47.20 Assay of semen fructose
82759 58.48 Assay of rbc galactokinase
82760 22.04 Assay of galactose
82775 57.34 Assay galactose transferase
82776 17.46 Galactose transferase test
82777 59.86 Galectin-3
82784 15.70 Assay iga/igd/igg/igm each
82785 44.06 Assay of ige
82787 21.82 Igg 1 2 3 or 4 each
82800 23.02 Blood pH
82803 52.66 Blood gases any combination
82805 77.24 Blood gases w/o2 saturation
82810 23.76 Blood gases o2 sat only
82820 27.18 Hemoglobin-oxygen affinity
82930 10.16 Gastric analy w/ph ea spec
82938 48.16 Gastrin test
82941 48.00 Assay of gastrin
82943 38.88 Assay of glucagon
82945 10.68 Glucose other fluid
82946 41.02 Glucagon tolerance test
82947 10.68 Assay glucose blood quant
82947 10.68 Assay glucose blood quant
82948 8.62 Reagent strip/blood glucose
82950 12.92 Glucose test
82950 12.92 Glucose test
82951 35.04 Glucose tolerance test (GTT)
82951 35.04 Glucose tolerance test (GTT)
82952 10.68 GTT-added samples
82952 10.68 GTT-added samples
82955 26.38 Assay of g6pd enzyme
82960 16.48 Test for G6PD enzyme
82962 6.38 Glucose blood test
82963 58.48 Assay of glucosidase
82965 19.04 Assay of gdh enzyme
82977 19.60 Assay of GGT
82977 19.60 Assay of GGT
82978 38.80 Assay of glutathione
82979 15.70 Assay rbc glutathione
82985 41.02 Assay of glycated protein
82985 41.02 Assay of glycated protein
83001 50.58 Assay of gonadotropin (fsh)
83001 50.58 Assay of gonadotropin (fsh)
Page 9
CLFS_2015
83002 50.40 Assay of gonadotropin (lh)
83002 50.40 Assay of gonadotropin (lh)
83003 45.40 Assay growth hormone (hgh)
83006 59.86 Growth stimulation gene 2
83009 78.76 H pylori (c-13) blood
83010 34.24 Assay of haptoglobin quant
83012 46.80 Assay of haptoglobins
83013 78.76 H pylori (c-13) breath
83014 21.40 H pylori drug admin
83015 51.26 Heavy metal screen
83018 59.60 Quantitative screen metals
83020 35.04 Hemoglobin electrophoresis
83021 49.16 Hemoglobin chromotography
83026 6.44 Hemoglobin copper sulfate
83030 22.50 Fetal hemoglobin chemical
83033 15.46 Fetal hemoglobin assay qual
83036 26.42 Glycosylated hemoglobin test
83036 26.42 Glycosylated hemoglobin test
83037 26.42 Glycosylated hb home device
83037 26.42 Glycosylated hb home device
83045 13.48 Blood methemoglobin test
83050 15.74 Blood methemoglobin assay
83051 19.90 Assay of plasma hemoglobin
83060 22.50 Blood sulfhemoglobin assay
83065 18.76 Assay of hemoglobin heat
83068 23.02 Hemoglobin stability screen
83069 10.74 Assay of urine hemoglobin
83070 9.12 Assay of hemosiderin qual
83080 45.90 Assay of b hexosaminidase
83088 75.94 Assay of histamine
83090 45.90 Assay of homocystine
83150 24.56 Assay of homovanillic acid
83491 47.68 Assay of corticosteroids 17
83497 35.10 Assay of 5-hiaa
83498 73.94 Assay of progesterone 17-d
83499 68.62 Assay of progesterone 20-
83500 61.64 Assay free hydroxyproline
83505 66.18 Assay total hydroxyproline
83516 31.40 Immunoassay nonantibody
83516 31.40 Immunoassay nonantibody
83518 12.48 Immunoassay dipstick
83518 12.48 Immunoassay dipstick
83519 24.52 Ria nonantibody
83520 35.24 Immunoassay quant nos nonab
Page 10
CLFS_2015
83520 35.24 Immunoassay quant nos nonab
83525 31.10 Assay of insulin
83527 35.24 Assay of insulin
83528 43.30 Assay of intrinsic factor
83540 17.62 Assay of iron
83550 23.80 Iron binding test
83570 24.08 Assay of idh enzyme
83582 38.56 Assay of ketogenic steroids
83586 34.86 Assay 17- ketosteroids
83593 71.58 Fractionation ketosteroids
83605 29.06 Assay of lactic acid
83605 29.06 Assay of lactic acid
83615 16.42 Lactate (LD) (LDH) enzyme
83625 34.84 Assay of ldh enzymes
83630 53.42 Lactoferrin fecal (qual)
83631 53.42 Lactoferrin fecal (quant)
83632 55.02 Placental lactogen
83633 14.96 Test urine for lactose
83655 32.94 Assay of lead
83655 32.94 Assay of lead
83661 59.84 L/s ratio fetal lung
83662 51.48 Foam stability fetal lung
83663 51.48 Fluoro polarize fetal lung
83664 51.48 Lamellar bdy fetal lung
83670 24.94 Assay of lap enzyme
83690 18.76 Assay of lipase
83695 35.24 Assay of lipoprotein(a)
83698 92.38 Assay lipoprotein pla2
83700 30.64 Lipopro bld electrophoretic
83701 66.32 Lipoprotein bld hr fraction
83704 85.86 Lipoprotein bld by nmr
83718 22.28 Assay of lipoprotein
83718 22.28 Assay of lipoprotein
83719 31.68 Assay of blood lipoprotein
83721 25.98 Assay of blood lipoprotein
83721 25.98 Assay of blood lipoprotein
83727 46.80 Assay of lrh hormone
83735 18.22 Assay of magnesium
83775 20.06 Assay malate dehydrogenase
83785 66.94 Assay of manganese
83788 49.16 Mass spectrometry qual
83789 49.16 Mass spectrometry quant
83825 44.24 Assay of mercury
83835 41.00 Assay of metanephrines
Page 11
CLFS_2015
83857 29.24 Assay of methemalbumin
83861 44.96 Microfluid analy tears
83861 44.96 Microfluid analy tears
83864 54.20 Mucopolysaccharides
83872 14.20 Assay synovial fluid mucin
83873 46.82 Assay of csf protein
83874 35.16 Assay of myoglobin
83876 92.38 Assay myeloperoxidase
83880 92.38 Assay of natriuretic peptide
83880 92.38 Assay of natriuretic peptide
83883 37.00 Assay nephelometry not spec
83885 66.68 Assay of nickel
83915 30.36 Assay of nucleotidase
83916 54.74 Oligoclonal bands
83918 44.78 Organic acids total quant
83919 44.78 Organic acids qual each
83921 44.78 Organic acid single quant
83930 18.00 Assay of blood osmolality
83935 18.56 Assay of urine osmolality
83937 81.24 Assay of osteocalcin
83945 35.04 Assay of oxalate
83950 175.30 Oncoprotein her-2/neu
83951 175.30 Oncoprotein dcp
83970 112.34 Assay of parathormone
83986 9.74 Assay ph body fluid nos
83986 9.74 Assay ph body fluid nos
83987 43.22 Exhaled breath condensate
83992 37.98 Assay for phencyclidine
83993 53.42 Assay for calprotectin fecal
84030 14.90 Assay of blood pku
84035 6.56 Assay of phenylketones
84060 20.10 Assay acid phosphatase
84061 21.52 Phosphatase forensic exam
84066 26.30 Assay prostate phosphatase
84075 14.08 Assay alkaline phosphatase
84075 14.08 Assay alkaline phosphatase
84078 12.90 Assay alkaline phosphatase
84080 40.24 Assay alkaline phosphatases
84081 44.96 Assay phosphatidylglycerol
84085 17.46 Assay of rbc pg6d enzyme
84087 28.10 Assay phosphohexose enzymes
84100 12.90 Assay of phosphorus
84105 14.08 Assay of urine phosphorus
84106 11.64 Test for porphobilinogen
Page 12
CLFS_2015
84110 17.46 Assay of porphobilinogen
84112 175.30 Placenta alpha micro ig c/v
84119 23.44 Test urine for porphyrins
84120 36.38 Assay of urine porphyrins
84126 69.32 Assay of feces porphyrins
84132 12.52 Assay of serum potassium
84132 12.52 Assay of serum potassium
84133 11.70 Assay of urine potassium
84134 39.68 Assay of prealbumin
84135 52.06 Assay of pregnanediol
84138 51.54 Assay of pregnanetriol
84140 56.26 Assay of pregnenolone
84143 62.10 Assay of 17-hydroxypregneno
84144 56.78 Assay of progesterone
84145 72.90 Procalcitonin (pct)
84146 52.74 Assay of prolactin
84150 67.92 Assay of prostaglandin
84152 50.06 Assay of psa complexed
84153 50.06 Assay of psa total
84154 50.06 Assay of psa free
84155 9.98 Assay of protein serum
84155 9.98 Assay of protein serum
84156 9.98 Assay of protein urine
84157 9.98 Assay of protein other
84157 9.98 Assay of protein other
84160 14.08 Assay of protein any source
84163 22.00 Pappa serum
84165 29.22 Protein e-phoresis serum
84166 48.54 Protein e-phoresis/urine/csf
84181 46.36 Western blot test
84182 48.98 Protein western blot test
84202 39.04 Assay RBC protoporphyrin
84203 17.46 Test RBC protoporphyrin
84206 48.48 Assay of proinsulin
84207 76.48 Assay of vitamin b-6
84210 29.54 Assay of pyruvate
84220 11.70 Assay of pyruvate kinase
84228 31.68 Assay of quinine
84233 175.30 Assay of estrogen
84234 176.58 Assay of progesterone
84235 142.46 Assay of endocrine hormone
84238 99.54 Assay nonendocrine receptor
84244 59.86 Assay of renin
84252 55.08 Assay of vitamin b-2
Page 13
CLFS_2015
84255 69.48 Assay of selenium
84260 84.32 Assay of serotonin
84270 59.16 Assay of sex hormone globul
84275 36.58 Assay of sialic acid
84285 64.08 Assay of silica
84295 13.10 Assay of serum sodium
84295 13.10 Assay of serum sodium
84300 13.24 Assay of urine sodium
84302 13.24 Assay of sweat sodium
84305 57.86 Assay of somatomedin
84307 49.76 Assay of somatostatin
84311 17.98 Spectrophotometry
84315 3.56 Body fluid specific gravity
84375 53.36 Chromatogram assay sugars
84376 14.96 Sugars single qual
84377 14.96 Sugars multiple qual
84378 31.38 Sugars single quant
84379 31.38 Sugars multiple quant
84392 12.92 Assay of urine sulfate
84402 69.30 Assay of free testosterone
84403 70.26 Assay of total testosterone
84425 57.78 Assay of vitamin b-1
84430 31.68 Assay of thiocyanate
84431 45.74 Thromboxane urine
84432 43.72 Assay of thyroglobulin
84436 16.96 Assay of total thyroxine
84437 17.62 Assay of neonatal thyroxine
84439 24.54 Assay of free thyroxine
84442 40.24 Assay of thyroid activity
84443 45.74 Assay thyroid stim hormone
84443 45.74 Assay thyroid stim hormone
84445 138.40 Assay of tsi globulin
84446 38.58 Assay of vitamin e
84449 48.98 Assay of transcortin
84450 14.08 Transferase (AST) (SGOT)
84450 14.08 Transferase (AST) (SGOT)
84460 14.42 Alanine amino (ALT) (SGPT)
84460 14.42 Alanine amino (ALT) (SGPT)
84466 34.76 Assay of transferrin
84478 15.64 Assay of triglycerides
84478 15.64 Assay of triglycerides
84479 17.62 Assay of thyroid (t3 or t4)
84480 38.58 Assay triiodothyronine (t3)
84481 46.10 Free assay (FT-3)
Page 14
CLFS_2015
84482 42.90 T3 reverse
84484 26.78 Assay of troponin quant
84485 14.42 Assay duodenal fluid trypsin
84488 14.94 Test feces for trypsin
84490 17.98 Assay of feces for trypsin
84510 17.46 Assay of tyrosine
84512 20.96 Assay of troponin qual
84520 10.74 Assay of urea nitrogen
84520 10.74 Assay of urea nitrogen
84525 10.24 Urea nitrogen semi-quant
84540 12.92 Assay of urine/urea-n
84545 16.74 Urea-N clearance test
84550 12.30 Assay of blood/uric acid
84550 12.30 Assay of blood/uric acid
84560 12.92 Assay of urine/uric acid
84577 33.96 Assay of feces/urobilinogen
84578 7.84 Test urine urobilinogen
84580 19.32 Assay of urine urobilinogen
84583 13.70 Assay of urine urobilinogen
84585 42.18 Assay of urine vma
84586 96.18 Assay of vip
84588 92.38 Assay of vasopressin
84590 29.06 Assay of vitamin a
84591 29.06 Assay of nos vitamin
84597 37.32 Assay of vitamin k
84600 42.02 Assay of volatiles
84620 32.24 Xylose tolerance test
84630 31.00 Assay of zinc
84681 56.64 Assay of c-peptide
84702 22.00 Chorionic gonadotropin test
84703 20.46 Chorionic gonadotropin assay
84703 20.46 Chorionic gonadotropin assay
84704 22.00 Hcg free betachain test
84830 27.30 Ovulation tests
85002 12.26 Bleeding time test
85004 17.62 Automated diff wbc count
85007 9.36 Bl smear w/diff wbc count
85008 9.36 Bl smear w/o diff wbc count
85009 10.12 Manual diff wbc count b-coat
85013 6.46 Spun microhematocrit
85014 6.46 Hematocrit
85014 6.46 Hematocrit
85018 6.46 Hemoglobin
85018 6.46 Hemoglobin
Page 15
CLFS_2015
85025 21.16 Complete cbc w/auto diff wbc
85027 17.62 Complete cbc automated
85032 11.70 Manual cell count each
85041 8.22 Automated rbc count
85044 11.70 Manual reticulocyte count
85045 10.88 Automated reticulocyte count
85046 15.18 Reticyte/hgb concentrate
85048 6.92 Automated leukocyte count
85049 12.18 Automated platelet count
85055 54.80 Reticulated platelet assay
85130 16.96 Chromogenic substrate assay
85170 9.84 Blood clot retraction
85175 12.38 Blood clot lysis time
85210 17.46 Clot factor ii prothrom spec
85220 48.02 Blooc clot factor v test
85230 48.74 Clot factor vii proconvertin
85240 48.74 Clot factor viii ahg 1 stage
85244 55.58 Clot factor viii reltd antgn
85245 62.44 Clot factor viii vw ristoctn
85246 62.44 Clot factor viii vw antigen
85247 62.44 Clot factor viii multimetric
85250 51.82 Clot factor ix ptc/chrstmas
85260 48.74 Clot factor x stuart-power
85270 48.74 Clot factor xi pta
85280 52.66 Clot factor xii hageman
85290 44.48 Clot factor xiii fibrin stab
85291 24.22 Clot factor xiii fibrin scrn
85292 51.54 Clot factor fletcher fact
85293 51.54 Clot factor wght kininogen
85300 32.26 Antithrombin iii activity
85301 29.42 Antithrombin iii antigen
85302 32.70 Clot inhibit prot c antigen
85303 37.64 Clot inhibit prot c activity
85305 31.58 Clot inhibit prot s total
85306 41.70 Clot inhibit prot s free
85307 41.70 Assay activated protein c
85335 35.04 Factor inhibitor test
85337 28.38 Thrombomodulin
85345 11.70 Coagulation time lee & white
85347 10.90 Coagulation time activated
85348 10.14 Coagulation time otr method
85360 22.86 Euglobulin lysis
85362 18.76 Fibrin degradation products
85366 23.44 Fibrinogen test
Page 16
CLFS_2015
85370 30.90 Fibrinogen test
85378 19.42 Fibrin degrade semiquant
85379 27.70 Fibrin degradation quant
85380 27.70 Fibrin degradj d-dimer
85384 23.12 Fibrinogen activity
85385 23.12 Fibrinogen antigen
85390 14.08 Fibrinolysins screen i&r
85397 62.44 Clotting funct activity
85400 24.08 Fibrinolytic plasmin
85410 20.98 Fibrinolytic antiplasmin
85415 46.80 Fibrinolytic plasminogen
85420 17.46 Fibrinolytic plasminogen
85421 27.72 Fibrinolytic plasminogen
85441 11.44 Heinz bodies direct
85445 18.56 Heinz bodies induced
85460 21.06 Hemoglobin fetal
85461 16.62 Hemoglobin fetal
85475 24.16 Hemolysin acid
85520 21.22 Heparin assay
85525 31.16 Heparin neutralization
85530 38.58 Heparin-protamine tolerance
85536 17.62 Iron stain peripheral blood
85540 23.42 Wbc alkaline phosphatase
85547 18.22 RBC mechanical fragility
85549 51.04 Muramidase
85555 18.18 RBC osmotic fragility
85557 36.36 RBC osmotic fragility
85576 58.48 Blood platelet aggregation
85576 58.48 Blood platelet aggregation
85597 48.92 Phospholipid pltlt neutraliz
85598 48.92 Hexagnal phosph pltlt neutrl
85610 10.70 Prothrombin time
85610 10.70 Prothrombin time
85611 10.72 Prothrombin test
85612 15.70 Viper venom prothrombin time
85613 15.70 Russell viper venom diluted
85635 26.78 Reptilase test
85651 9.64 Rbc sed rate nonautomated
85652 7.36 Rbc sed rate automated
85660 15.00 RBC sickle cell test
85670 15.70 Thrombin time plasma
85675 18.64 Thrombin time titer
85705 26.20 Thromboplastin inhibition
85730 16.34 Thromboplastin time partial
Page 17
CLFS_2015
85732 17.62 Thromboplastin time partial
85810 31.78 Blood viscosity examination
86000 4.28 Agglutinins febrile antigen
86001 14.20 Allergen specific igg
86003 14.20 Allergen specific IgE
86005 21.70 Allergen specific IgE
86021 40.98 WBC antibody identification
86022 50.00 Platelet antibodies
86023 33.90 Immunoglobulin assay
86038 32.90 Antinuclear antibodies
86039 30.38 Antinuclear antibodies (ANA)
86060 19.88 Antistreptolysin o titer
86063 15.70 Antistreptolysin o screen
86140 14.08 C-reactive protein
86141 35.24 C-reactive protein hs
86146 69.24 Beta-2 glycoprotein antibody
86147 69.24 Cardiolipin antibody ea ig
86148 31.64 Anti-phospholipid antibody
86152 668.74 Cell enumeration & id
86155 43.52 Chemotaxis assay
86156 18.24 Cold agglutinin screen
86157 21.94 Cold agglutinin titer
86160 32.66 Complement antigen
86161 32.66 Complement/function activity
86162 55.30 Complement total (ch50)
86171 27.24 Complement fixation each
86185 23.80 Counterimmunoelectrophoresis
86200 35.24 Ccp antibody
86215 33.16 Deoxyribonuclease antibody
86225 37.38 Dna antibody native
86226 32.96 Dna antibody single strand
86235 48.82 Nuclear antigen antibody
86243 55.84 Fc receptor
86255 32.80 Fluorescent antibody screen
86256 32.80 Fluorescent antibody titer
86277 42.84 Growth hormone antibody
86280 22.28 Hemagglutination inhibition
86294 31.44 Immunoassay tumor qual
86294 31.44 Immunoassay tumor qual
86300 56.64 Immunoassay tumor ca 15-3
86301 56.64 Immunoassay tumor ca 19-9
86304 56.64 Immunoassay tumor ca 125
86305 56.64 Human epididymis protein 4
86308 14.08 Heterophile antibody screen
Page 18
CLFS_2015
86308 14.08 Heterophile antibody screen
86309 17.62 Heterophile antibody titer
86310 20.06 Heterophile antibody absrbj
86316 56.64 Immunoassay tumor other
86317 40.80 Immunoassay infectious agent
86318 35.24 Immunoassay infectious agent
86318 35.24 Immunoassay infectious agent
86320 61.00 Serum immunoelectrophoresis
86325 60.88 Other immunoelectrophoresis
86327 61.76 Immunoelectrophoresis assay
86329 38.22 Immunodiffusion nes
86331 30.90 Immunodiffusion ouchterlony
86332 66.34 Immune complex assay
86334 60.82 Immunofix e-phoresis serum
86335 79.88 Immunfix e-phorsis/urine/csf
86336 42.42 Inhibin A
86337 58.26 Insulin antibodies
86340 41.02 Intrinsic factor antibody
86341 53.84 Islet cell antibody
86343 33.92 Leukocyte histamine release
86344 21.74 Leukocyte phagocytosis
86352 369.78 Cell function assay w/stim
86353 124.10 Lymphocyte transformation
86355 102.68 B cells total count
86356 54.80 Mononuclear cell antigen
86357 102.68 Nk cells total count
86359 102.68 T cells total count
86360 109.56 T cell absolute count/ratio
86361 54.80 T cell absolute count
86367 102.68 Stem cells total count
86376 39.60 Microsomal antibody each
86378 53.60 Migration inhibitory factor
86382 46.02 Neutralization test viral
86384 26.86 Nitroblue tetrazolium dye
86386 43.46 Nuclear matrix protein 22
86386 43.46 Nuclear matrix protein 22
86403 27.74 Particle agglut antbdy scrn
86406 28.94 Particle agglut antbdy titr
86430 15.44 Rheumatoid factor test qual
86431 15.44 Rheumatoid factor quant
86480 168.70 Tb test cell immun measure
86481 203.92 Tb ag response t-cell susp
86590 26.86 Streptokinase antibody
86592 11.62 Syphilis test non-trep qual
Page 19
CLFS_2015
86593 11.98 Syphilis test non-trep quant
86602 27.70 Antinomyces antibody
86603 35.02 Adenovirus antibody
86606 40.98 Aspergillus antibody
86609 35.06 Bacterium antibody
86611 27.70 Bartonella antibody
86612 35.12 Blastomyces antibody
86615 35.90 Bordetella antibody
86617 42.16 Lyme disease antibody
86618 46.36 Lyme disease antibody
86618 46.36 Lyme disease antibody
86619 36.42 Borrelia antibody
86622 24.32 Brucella antibody
86625 35.72 Campylobacter antibody
86628 32.68 Candida antibody
86631 32.18 Chlamydia antibody
86632 34.54 Chlamydia igm antibody
86635 31.22 Coccidioides antibody
86638 33.00 Q fever antibody
86641 39.22 Cryptococcus antibody
86644 39.16 CMV antibody
86645 45.86 Cmv antibody igm
86648 41.38 Diphtheria antibody
86651 35.90 Encephalitis californ antbdy
86652 35.90 Encephaltis east eqne anbdy
86653 35.90 Encephaltis st louis antbody
86654 35.90 Encephaltis west eqne antbdy
86658 35.46 Enterovirus antibody
86663 35.72 Epstein-barr antibody
86664 41.64 Epstein-barr nuclear antigen
86665 49.38 Epstein-barr capsid vca
86666 27.70 Ehrlichia antibody
86668 28.32 Francisella tularensis
86671 33.36 Fungus nes antibody
86674 40.06 Giardia lamblia antibody
86677 39.48 Helicobacter pylori antibody
86682 35.40 Helminth antibody
86684 39.94 Hemophilus influenza antibdy
86687 22.84 Htlv-i antibody
86688 38.12 Htlv-ii antibody
86689 52.68 Htlv/hiv confirmj antibody
86692 46.70 Hepatitis delta agent antbdy
86694 39.16 Herpes simplex nes antbdy
86695 25.78 Herpes simplex type 1 test
Page 20
CLFS_2015
86696 52.68 Herpes simplex type 2 test
86698 34.02 Histoplasma antibody
86701 24.18 Hiv-1antibody
86701 24.18 Hiv-1antibody
86702 36.78 Hiv-2 antibody
86703 37.32 Hiv-1/hiv-2 1 result antbdy
86704 32.80 Hep b core antibody total
86705 32.06 Hep b core antibody igm
86706 29.24 Hep b surface antibody
86707 31.50 Hepatitis be antibody
86708 33.72 Hepatitis a total antibody
86709 30.64 Hepatitis a igm antibody
86710 36.88 Influenza virus antibody
86711 39.16 John cunningham antibody
86713 41.64 Legionella antibody
86717 33.34 Leishmania antibody
86720 35.90 Leptospira antibody
86723 35.90 Listeria monocytogenes
86727 35.02 Lymph choriomeningitis ab
86729 32.52 Lympho venereum antibody
86732 35.90 Mucormycosis antibody
86735 35.52 Mumps antibody
86738 36.04 Mycoplasma antibody
86741 35.90 Neisseria meningitidis
86744 35.90 Nocardia antibody
86747 40.92 Parvovirus antibody
86750 35.90 Malaria antibody
86753 33.72 Protozoa antibody nos
86756 35.08 Respiratory virus antibody
86757 52.68 Rickettsia antibody
86759 35.90 Rotavirus antibody
86762 39.16 Rubella antibody
86765 35.06 Rubeola antibody
86768 35.90 Salmonella antibody
86771 35.90 Shigella antibody
86774 40.28 Tetanus antibody
86777 39.16 Toxoplasma antibody
86778 39.20 Toxoplasma antibody igm
86780 35.94 Treponema pallidum
86784 34.18 Trichinella antibody
86787 35.06 Varicella-zoster antibody
86788 45.86 West nile virus ab igm
86789 39.16 West nile virus antibody
86790 35.06 Virus antibody nos
Page 21
CLFS_2015
86793 35.90 Yersinia antibody
86800 43.30 Thyroglobulin antibody
86803 38.84 Hepatitis c ab test
86803 38.84 Hepatitis c ab test
86804 42.16 Hep c ab test confirm
86805 142.32 Lymphocytotoxicity assay
86806 129.52 Lymphocytotoxicity assay
86807 63.30 Cytotoxic antibody screening
86808 63.30 Cytotoxic antibody screening
86812 70.24 Hla typing a b or c
86813 157.84 Hla typing a b or c
86816 75.82 Hla typing dr/dq
86817 175.24 Hla typing dr/dq
86821 153.66 Lymphocyte culture mixed
86822 99.50 Lymphocyte culture primed
86825 164.42 Hla x-math non-cytotoxic
86826 54.80 Hla x-match noncytotoxc addl
86828 63.30 Hla class i&ii antibody qual
86829 63.30 Hla class i/ii antibody qual
86830 219.74 Hla class i phenotype qual
86831 188.36 Hla class ii phenotype qual
86832 345.32 Hla class i high defin qual
86833 313.94 Hla class ii high defin qual
86834 973.18 Hla class i semiquant panel
86835 878.98 Hla class ii semiquant panel
86880 14.66 Coombs test direct
86885 15.58 Coombs test indirect qual
86886 14.08 Coombs test indirect titer
86900 8.12 Blood typing abo
86901 8.12 Blood typing rh (d)
86902 10.40 Blood type antigen donor ea
86904 25.88 Blood typing patient serum
86905 10.40 Blood typing rbc antigens
86906 21.10 Blood typing rh phenotype
86940 22.32 Hemolysins/agglutinins auto
86941 30.64 Hemolysins/agglutinins
87003 45.82 Small animal inoculation
87015 18.18 Specimen infect agnt concntj
87040 28.10 Blood culture for bacteria
87045 25.70 Feces culture aerobic bact
87046 25.70 Stool cultr aerobic bact ea
87070 23.44 Culture othr specimn aerobic
87071 25.70 Culture aerobic quant other
87073 25.70 Culture bacteria anaerobic
Page 22
CLFS_2015
87075 23.80 Cultr bacteria except blood
87076 22.00 Culture anaerobe ident each
87077 22.00 Culture aerobic identify
87077 22.00 Culture aerobic identify
87081 18.04 Culture screen only
87084 23.44 Culture of specimen by kit
87086 21.98 Urine culture/colony count
87088 22.04 Urine bacteria culture
87101 15.70 Skin fungi culture
87102 22.86 Fungus isolation culture
87103 24.54 Blood fungus culture
87106 22.26 Fungi identification yeast
87107 22.26 Fungi identification mold
87109 41.88 Mycoplasma
87110 53.32 Chlamydia culture
87116 29.40 Mycobacteria culture
87118 29.80 Mycobacteric identification
87140 15.18 Culture type immunofluoresc
87143 34.10 Culture typing glc/hplc
87147 14.08 Culture type immunologic
87149 54.58 Dna/rna direct probe
87150 95.52 Dna/rna amplified probe
87152 14.24 Culture type pulse field gel
87153 313.96 Dna/rna sequencing
87158 14.24 Culture typing added method
87164 29.24 Dark field examination
87166 30.74 Dark field examination
87168 11.62 Macroscopic exam arthropod
87169 11.62 Macroscopic exam parasite
87172 11.62 Pinworm exam
87176 14.94 Tissue homogenization cultr
87177 24.22 Ova and parasites smears
87181 12.92 Microbe susceptible diffuse
87184 18.78 Microbe susceptible disk
87185 12.92 Microbe susceptible enzyme
87186 15.70 Microbe susceptible mic
87187 15.70 Microbe susceptible mlc
87188 12.64 Microbe suscept macrobroth
87190 15.38 Microbe suscept mycobacteri
87197 30.12 Bactericidal level serum
87205 11.62 Smear gram stain
87206 14.66 Smear fluorescent/acid stai
87207 16.30 Smear special stain
87209 48.92 Smear complex stain
Page 23
CLFS_2015
87210 11.62 Smear wet mount saline/ink
87210 11.62 Smear wet mount saline/ink
87220 9.40 Tissue exam for fungi
87230 53.74 Assay toxin or antitoxin
87250 53.24 Virus inoculate eggs/animal
87252 70.96 Virus inoculation tissue
87253 54.98 Virus inoculate tissue addl
87254 53.24 Virus inoculation shell via
87255 92.16 Genet virus isolate hsv
87260 24.52 Adenovirus ag if
87265 24.52 Pertussis ag if
87267 24.52 Enterovirus antibody dfa
87269 24.52 Giardia ag if
87270 24.52 Chlamydia trachomatis ag if
87271 24.52 Cytomegalovirus dfa
87272 24.52 Cryptosporidium ag if
87273 24.52 Herpes simplex 2 ag if
87274 24.52 Herpes simplex 1 ag if
87275 24.52 Influenza b ag if
87276 24.52 Influenza a ag if
87277 24.52 Legionella micdadei ag if
87278 24.52 Legion pneumophilia ag if
87279 24.52 Parainfluenza ag if
87280 24.52 Respiratory syncytial ag if
87281 24.52 Pneumocystis carinii ag if
87283 24.52 Rubeola ag if
87285 24.52 Treponema pallidum ag if
87290 24.52 Varicella zoster ag if
87299 24.52 Antibody detection nos if
87300 24.52 Ag detection polyval if
87301 24.52 Adenovirus ag eia
87305 24.52 Aspergillus ag eia
87320 24.52 Chylmd trach ag eia
87324 24.52 Clostridium ag eia
87327 24.52 Cryptococcus neoform ag eia
87328 24.52 Cryptosporidium ag eia
87329 24.52 Giardia ag eia
87332 24.52 Cytomegalovirus ag eia
87335 24.52 E coli 0157 ag eia
87336 24.52 Entamoeb hist dispr ag eia
87337 24.52 Entamoeb hist group ag eia
87338 12.48 Hpylori stool eia
87339 24.52 H pylori ag eia
87340 28.12 Hepatitis b surface ag eia
Page 24
CLFS_2015
87341 28.12 Hepatitis b surface ag eia
87350 31.38 Hepatitis be ag eia
87380 44.66 Hepatitis delta ag eia
87385 24.52 Histoplasma capsul ag eia
87389 65.54 Hiv-1 ag w/hiv-1 & hiv-2 ab
87390 48.02 Hiv-1 ag eia
87391 48.02 Hiv-2 ag eia
87400 24.52 Influenza a/b ag eia
87420 24.52 Resp syncytial ag eia
87425 24.52 Rotavirus ag eia
87427 24.52 Shiga-like toxin ag eia
87430 24.52 Strep a ag eia
87449 24.52 Ag detect nos eia mult
87449 24.52 Ag detect nos eia mult
87450 12.48 Ag detect nos eia single
87451 12.48 Ag detect polyval eia mult
87470 54.58 Bartonella dna dir probe
87471 95.52 Bartonella dna amp probe
87472 116.58 Bartonella dna quant
87475 54.58 Lyme dis dna dir probe
87476 95.52 Lyme dis dna amp probe
87477 44.82 Lyme dis dna quant
87480 54.58 Candida dna dir probe
87481 95.52 Candida dna amp probe
87482 44.82 Candida dna quant
87485 54.58 Chylmd pneum dna dir probe
87486 95.52 Chylmd pneum dna amp probe
87487 116.58 Chylmd pneum dna quant
87490 54.58 Chylmd trach dna dir probe
87491 95.52 Chylmd trach dna amp probe
87492 44.82 Chylmd trach dna quant
87493 95.52 C diff amplified probe
87495 54.58 Cytomeg dna dir probe
87496 95.52 Cytomeg dna amp probe
87497 116.58 Cytomeg dna quant
87498 95.52 Enterovirus probe&revrs trns
87500 95.52 Vanomycin dna amp probe
87501 139.66 Influenza dna amp prob 1+
87502 231.60 Influenza dna amp probe
87503 56.52 Influenza dna amp prob addl
87505 349.16 Nfct agent detection gi
87506 580.90 Iadna-dna/rna probe tq 6-11
87507 1134.36 Iadna-dna/rna probe tq 12-25
87510 54.58 Gardner vag dna dir probe
Page 25
CLFS_2015
87511 95.52 Gardner vag dna amp probe
87512 44.82 Gardner vag dna quant
87515 54.58 Hepatitis b dna dir probe
87516 95.52 Hepatitis b dna amp probe
87517 116.58 Hepatitis b dna quant
87520 54.58 Hepatitis c rna dir probe
87521 95.52 Hepatitis c probe&rvrs trnsc
87522 116.58 Hepatitis c revrs trnscrpj
87525 54.58 Hepatitis g dna dir probe
87526 95.52 Hepatitis g dna amp probe
87527 44.82 Hepatitis g dna quant
87528 54.58 Hsv dna dir probe
87529 95.52 Hsv dna amp probe
87530 116.58 Hsv dna quant
87531 54.58 Hhv-6 dna dir probe
87532 95.52 Hhv-6 dna amp probe
87533 44.82 Hhv-6 dna quant
87534 54.58 Hiv-1 dna dir probe
87535 95.52 Hiv-1 probe&reverse trnscrpj
87536 231.60 Hiv-1 quant&revrse trnscrpj
87537 54.58 Hiv-2 dna dir probe
87538 95.52 Hiv-2 probe&revrse trnscripj
87539 44.82 Hiv-2 quant&revrse trnscripj
87540 54.58 Legion pneumo dna dir prob
87541 95.52 Legion pneumo dna amp prob
87542 44.82 Legion pneumo dna quant
87550 54.58 Mycobacteria dna dir probe
87551 95.52 Mycobacteria dna amp probe
87552 116.58 Mycobacteria dna quant
87555 54.58 M.tuberculo dna dir probe
87556 95.52 M.tuberculo dna amp probe
87557 116.58 M.tuberculo dna quant
87560 54.58 M.avium-intra dna dir prob
87561 95.52 M.avium-intra dna amp prob
87562 116.58 M.avium-intra dna quant
87580 54.58 M.pneumon dna dir probe
87581 95.52 M.pneumon dna amp probe
87582 44.82 M.pneumon dna quant
87590 54.58 N.gonorrhoeae dna dir prob
87591 95.52 N.gonorrhoeae dna amp prob
87592 44.82 N.gonorrhoeae dna quant
87623 95.52 Hpv low-risk types
87624 95.52 Hpv high-risk types
87625 95.52 Hpv types 16 & 18 only
Page 26
CLFS_2015
87631 349.16 Resp virus 3-11 targets
87632 580.90 Resp virus 6-11 targets
87633 1134.36 Resp virus 12-25 targets
87640 95.52 Staph a dna amp probe
87641 95.52 Mr-staph dna amp probe
87650 54.58 Strep a dna dir probe
87651 95.52 Strep a dna amp probe
87652 44.82 Strep a dna quant
87653 95.52 Strep b dna amp probe
87660 54.58 Trichomonas vagin dir probe
87661 95.52 Trichomonas vaginalis amplif
87797 54.58 Detect agent nos dna dir
87798 95.52 Detect agent nos dna amp
87799 116.58 Detect agent nos dna quant
87800 109.18 Detect agnt mult dna direc
87801 191.04 Detect agnt mult dna ampli
87802 24.52 Strep b assay w/optic
87803 24.52 Clostridium toxin a w/optic
87804 24.52 Influenza assay w/optic
87804 24.52 Influenza assay w/optic
87806 65.54 Hiv antigen w/hiv antibodies
87807 24.52 Rsv assay w/optic
87807 24.52 Rsv assay w/optic
87808 24.52 Trichomonas assay w/optic
87808 24.52 Trichomonas assay w/optic
87809 24.52 Adenovirus assay w/optic
87809 24.52 Adenovirus assay w/optic
87810 24.52 Chylmd trach assay w/optic
87850 24.52 N. gonorrhoeae assay w/optic
87880 24.52 Strep a assay w/optic
87880 24.52 Strep a assay w/optic
87899 24.52 Agent nos assay w/optic
87899 24.52 Agent nos assay w/optic
87900 354.76 Phenotype infect agent drug
87901 700.70 Genotype dna hiv reverse t
87902 700.70 Genotype dna/rna hep c
87903 1329.96 Phenotype dna hiv w/culture
87904 70.96 Phenotype dna hiv w/clt add
87905 33.26 Sialidase enzyme assay
87905 33.26 Sialidase enzyme assay
87906 350.36 Genotype dna/rna hiv
87910 700.70 Genotype cytomegalovirus
87912 700.70 Genotype dna hepatitis b
88130 40.96 Sex chromatin identification
Page 27
CLFS_2015
88140 21.76 Sex chromatin identification
88142 41.10 Cytopath c/v thin layer
88143 37.44 Cytopath c/v thin layer redo
88147 28.76 Cytopath c/v automated
88148 28.76 Cytopath c/v auto rescreen
88150 28.76 Cytopath c/v manual
88152 28.76 Cytopath c/v auto redo
88153 28.76 Cytopath c/v redo
88154 28.76 Cytopath c/v select
88155 16.30 Cytopath c/v index add-on
88164 28.76 Cytopath tbs c/v manual
88165 28.76 Cytopath tbs c/v redo
88166 28.76 Cytopath tbs c/v auto redo
88167 28.76 Cytopath tbs c/v select
88174 39.72 Cytopath c/v auto in fluid
88175 50.08 Cytopath c/v auto fluid redo
88230 173.94 Tissue culture lymphocyte
88233 173.94 Tissue culture skin/biopsy
88235 173.94 Tissue culture placenta
88237 173.94 Tissue culture bone marrow
88239 173.94 Tissue culture tumor
88240 27.48 Cell cryopreserve/storage
88241 27.48 Frozen cell preparation
88245 173.94 Chromosome analysis 20-25
88248 471.34 Chromosome analysis 50-100
88249 471.34 Chromosome analysis 100
88261 481.02 Chromosome analysis 5
88262 339.24 Chromosome analysis 15-20
88263 173.94 Chromosome analysis 45
88264 339.24 Chromosome analysis 20-25
88267 489.28 Chromosome analys placenta
88269 452.68 Chromosome analys amniotic
88271 58.28 Cytogenetics dna probe
88272 72.88 Cytogenetics 3-5
88273 87.46 Cytogenetics 10-30
88274 94.74 Cytogenetics 25-99
88275 109.30 Cytogenetics 100-300
88280 68.30 Chromosome karyotype study
88283 75.94 Chromosome banding study
88285 51.72 Chromosome count additional
88289 93.72 Chromosome study additional
88371 60.48 Protein western blot tissue
88372 61.90 Protein analysis w/probe
88720 13.66 Bilirubin total transcut
Page 28
CLFS_2015
88738 13.66 Hgb quant transcutaneous
88740 13.66 Transcutaneous carboxyhb
88741 13.66 Transcutaneous methb
89050 12.86 Body fluid cell count
89051 14.98 Body fluid cell count
89055 11.62 Leukocyte assessment fecal
89060 19.48 Exam synovial fluid crystals
89125 11.76 Specimen fat stain
89160 10.04 Exam feces for meat fibers
89190 12.92 Nasal smear for eosinophils
89300 24.28 Semen analysis w/huhner
89300 24.28 Semen analysis w/huhner
89310 23.42 Semen analysis w/count
89320 32.80 Semen anal vol/count/mot
89321 32.80 Semen anal sperm detection
89321 32.80 Semen anal sperm detection
89322 42.18 Semen anal strict criteria
89325 29.06 Sperm antibody test
89329 57.06 Sperm evaluation test
89330 26.92 Evaluation cervical mucus
89331 53.32 Retrograde ejaculation anal
ATP02 12.30 Auto.Test Panel Pricing Code, 1-2 Tests
ATP03 18.08 Auto.Test Panel Pricing Code, 3 Tests
ATP04 19.10 Auto.Test Panel Pricing Code, 4 Tests
ATP05 21.30 Auto.Test Panel Pricing Code, 5 Tests
ATP06 21.34 Auto.Test Panel Pricing Code, 6 Tests
ATP07 22.22 Auto.Test Panel Pricing Code, 7 Tests
ATP08 23.02 Auto.Test Panel Pricing Code, 8 Tests
ATP09 23.64 Auto.Test Panel Pricing Code, 9 Tests
ATP10 23.64 Auto.Test Panel Pricing Code, 10 Tests
ATP11 24.06 Auto.Test Panel Pricing Code, 11 Tests
ATP12 24.56 Auto.Test Panel Pricing Code, 12 Tests
ATP16 28.74 Auto Test Panel Pricing Code 13-16 Test
ATP18 28.96 Auto Test Panel Pricing Code, 17-18 Test
ATP19 30.14 Auto Test Panel Pricing Code, 19 Tests
ATP20 31.06 Auto Test Panel Pricing Code, 20 Tests
ATP21 32.08 Auto Test Panel Pricing Code, 21 Tests
ATP22 33.02 Auto.Test Panel Pricing Code, 22+ Tests
ATP23 33.02 Auto.Test Panel Pricing Code, 23+ Tests
G0027 17.70 Semen analysis
G0103 50.06 PSA screening
G0123 41.10 Screen cerv/vag thin layer
G0143 37.44 Scr c/v cyto,thinlayer,rescr
G0144 39.72 Scr c/v cyto,thinlayer,rescr
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CLFS_2015
G0145 50.08 Scr c/v cyto,thinlayer,rescr
G0147 28.76 Scr c/v cyto, automated sys
G0148 28.76 Scr c/v cyto, autosys, rescr
G0306 21.16 CBC/diffwbc w/o platelet
G0307 17.62 CBC without platelet
G0328 43.30 Fecal blood scrn immunoassay
G0328 43.30 Fecal blood scrn immunoassay
G0431 197.92 Drug screen multiple class
G0432 37.32 EIA HIV-1/HIV-2 screen
G0433 37.32 ELISA HIV-1/HIV-2 screen
G0433 37.32 ELISA HIV-1/HIV-2 screen
G0434 39.58 Drug screen multi drug class
G0434 39.58 Drug screen multi drug class
G0435 24.52 Oral HIV-1/HIV-2 screen
G0464 985.44 Colorec ca scr, sto bas dna
G0471 10.00 Ven blood coll SNF/HHA
G6030 48.72 Assay of amitriptyline
G6031 50.34 Assay of benzodiazepines
G6032 46.84 Assay of desipramine
G6034 42.18 Assay of doxepin
G6035 44.32 Assay of gold
G6036 46.84 Assay of imipramine
G6037 36.88 Assay of nortiptyline
G6038 19.32 Assay of salicylate
G6039 55.08 Assay of acetaminophen
G6040 27.02 Assay of ethanol
G6041 81.70 Assay of urine alkaloids
G6042 42.30 Assay of amphetamines
G6043 31.16 Assay of barbiturates
G6044 41.24 Assay of cocaine
G6045 56.20 Assay of dihydrocodeinone
G6046 69.96 Assay of dihydromorphinone
G6047 70.26 Assay of dihydrotestosterone
G6048 37.70 Assay of dimethadione
G6049 58.48 Asssay of epiandrosterone
G6050 47.04 Assay of ethchlorvynol
G6051 53.88 Assay of flurazepam
G6052 47.96 Assay of meprobamate
G6053 44.44 Assay of methadone
G6054 40.32 Assay of methsuximide
G6055 64.46 Assay of nicotine
G6056 52.96 Assay of opiates
G6057 42.38 Assay of phenothiazine
G6058 36.06 Drug confirmation
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CLFS_2015
G9143 328.54 Warfarin respon genetic test
P2038 13.70 Blood mucoprotein
P3000 28.76 Screen pap by tech w md supv
P9612 6.00 Catheterize for urine spec
P9615 6.00 Urine specimen collect mult
Q0111 11.62 Wet mounts/ w preparations
Q0112 9.40 Potassium hydroxide preps
Q0113 14.72 Pinworm examinations
Q0114 19.48 Fern test
Q0115 26.92 Post-coital mucous exam
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