2018 Clinical Diagnostic Laboratory Fee Schedule CPT codes ... Pharmacy/SMAC/Documents/CY 2018... · 2018 Clinical Diagnostic Laboratory Fee Schedule CPT codes, descriptions and other

2018 Clinical Diagnostic Laboratory Fee Schedule

CPT codes, descriptions and other data only are copyright 2016 American Medical Association. All rights reserved.

CPT is a registered trademark of the American Medical Association (AMA).

HCPCS Modifier SHORTDESC Medicare WV Medicaid

36415 Routine venipuncture 3.00 3.00

78267 Breath tst attain/anal c-14 11.06 9.95

78268 Breath test analysis c-14 94.41 84.97

80047 Metabolic panel ionized ca 13.73 12.36

80047 QW Metabolic panel ionized ca 13.73 12.36

80048 Metabolic panel total ca 10.44 9.40

80048 QW Metabolic panel total ca 10.44 9.40

80050 General health panel 50.13 45.12

80051 Electrolyte panel 8.66 7.79

80051 QW Electrolyte panel 8.66 7.79

80053 Comprehen metabolic panel 13.04 11.74

80053 QW Comprehen metabolic panel 13.04 11.74

80055 Obstetric panel 59.02 53.12

80061 Lipid panel 16.53 14.88

80061 QW Lipid panel 16.53 14.88

80069 Renal function panel 10.72 9.65

80069 QW Renal function panel 10.72 9.65

80074 Acute hepatitis panel 58.81 52.93

80076 Hepatic function panel 10.09 9.08

80081 Obstetric panel 92.42 83.18

80150 Assay of amikacin 18.61 16.75

80155 Drug screen quant caffeine 38.57 34.71

80156 Assay carbamazepine total 17.98 16.18

80157 Assay carbamazepine free 16.36 14.72

80158 Assay of cyclosporine 22.28 20.05

80159 Drug screen quant clozapine 22.83 20.55

80162 Assay of digoxin 16.39 14.75

80163 Assay of digoxin free 16.39 14.75

80164 Assay dipropylacetic acid 16.72 15.05

80165 Dipropylacetic acid free 16.72 15.05

80168 Assay of ethosuximide 20.17 18.15

80169 Drug screen quant everolimus 16.96 15.26

80170 Assay of gentamicin 20.22 18.20

80171 Drug screen quant gabapentin 21.67 19.50

80173 Assay of haloperidol 17.98 16.18

80175 Drug screen quan lamotrigine 16.36 14.72

80176 Assay of lidocaine 18.14 16.33

80177 Drug scrn quan levetiracetam 16.36 14.72

80178 Assay of lithium 8.16 7.34

80178 QW Assay of lithium 8.16 7.34

80180 Drug scrn quan mycophenolate 22.28 20.05

80183 Drug scrn quant oxcarbazepin 16.36 14.72

80184 Assay of phenobarbital 15.30 13.77

80185 Assay of phenytoin total 16.36 14.72

80186 Assay of phenytoin free 16.99 15.29

80188 Assay of primidone 20.48 18.43

80190 Assay of procainamide 60.00 54.00

80192 Assay of procainamide 20.68 18.61

80194 Assay of quinidine 18.03 16.23

80195 Assay of sirolimus 16.96 15.26

80197 Assay of tacrolimus 16.96 15.26

80198 Assay of theophylline 17.46 15.71

80199 Drug screen quant tiagabine 27.11 24.40

80200 Assay of tobramycin 19.91 17.92

1 2/8/2018





80201 Assay of topiramate 14.72 13.25

80202 Assay of vancomycin 16.72 15.05

80203 Drug screen quant zonisamide 16.36 14.72

80299 Quantitative assay drug 18.64 16.78

80305 Drug test prsmv dir opt obs 13.46 12.11

80306 Drug test prsmv instrmnt 17.96 16.16

80307 Drug test prsmv chem anlyzr 71.83 64.65

80400 Acth stimulation panel 40.27 36.24



80408 Aldosterone suppression eval 154.94 139.45

80410 Calcitonin stimul panel 33.08 29.77

80412 CRH stimulation panel 801.62 721.46

80414 Testosterone response 63.75 57.38

80415 Estradiol response panel 68.99 62.09

80416 Renin stimulation panel 209.32 188.39

80417 Renin stimulation panel 54.31 48.88

80418 Pituitary evaluation panel 715.43 643.89

80420 Dexamethasone panel 161.88 145.69

80422 Glucagon tolerance panel 56.88 51.19

80424 Glucagon tolerance panel 62.34 56.11

80426 Gonadotropin hormone panel 183.22 164.90

80428 Growth hormone panel 82.35 74.12

80430 Growth hormone panel 129.33 116.40

80432 Insulin suppression panel 166.79 150.11

80434 Insulin tolerance panel 285.03 256.53

80435 Insulin tolerance panel 127.18 114.46

80436 Metyrapone panel 112.55 101.30

80438 TRH stimulation panel 62.24 56.02

80439 TRH stimulation panel 82.98 74.68

80500 Clinical pathology consultation; limited, without review of patient's history and medical records16.29 16.29

80502 Clinical pathology consultation; comprehensive, for a complex diagnostic problem, with review of patient's history and medical records52.35 52.35

81000 Urinalysis nonauto w/scope 4.02 3.62

81001 Urinalysis auto w/scope 3.92 3.53

81002 Urinalysis nonauto w/o scope 3.48 3.13

81002 Urinalysis nonauto w/o scope 3.48 3.13

81003 Urinalysis auto w/o scope 2.77 2.49

81003 QW Urinalysis auto w/o scope 2.77 2.49

81005 Urinalysis 2.67 2.40

81007 Urine screen for bacteria 29.98 26.98

81007 QW Urine screen for bacteria 29.98 26.98

81015 Microscopic exam of urine 3.76 3.38

81020 Urinalysis glass test 4.70 4.23

81025 Urine pregnancy test 8.61 7.75

81050 Volume measurement for timed collection, each3.71 3.34

81099 Unlisted urinalysis procedure Manual/Unlisted Manual/Unlisted

81105 Hpa-1 genotyping 150.89 135.80

81106 Hpa-2 genotyping 150.89 135.80

81107 Hpa-3 genotyping 150.89 135.80

81108 Hpa-4 genotyping 150.89 135.80

81109 Hpa-5 genotyping 150.89 135.80

81110 Hpa-6 genotyping 150.89 135.80

81111 Hpa-9 genotyping 150.89 135.80

81112 Hpa-15 genotyping 150.89 135.80

2 2/8/2018





81120 Idh1 common variants 193.25 173.93

81121 Idh2 common variants 295.79 266.21

81161 Dmd dup/delet analysis 279.00 251.10

81162 Brca1&2 seq & full dup/del 2,252.93 2,027.64

81170 Abl1 gene 300.00 270.00

81175 Asxl1 full gene sequence 707.02 636.32

81176 Asxl1 gene target seq alys 298.64 268.78

81200 ASPA (ASPARTOACYLASE) (EG, CANAVAN DISEASE) GENE ANALYSIS, COMMON VARIANTS (EG, E285A, Y231X)47.25 42.53

81201 APC (adenomatous polyposis coli) (eg, familial adenomatosis polyposis [FAP], attenuated FAP) gene analysis; full gene sequence780.00 702.00

81202 APC (adenomatous polyposis coli) (eg, familial adenomatosis polyposis [FAP], attenuated FAP) gene analysis; known familial variants280.00 252.00

81203 APC (adenomatous polyposis coli) (eg, familial adenomatosis polyposis [FAP], attenuated FAP) gene analysis; duplication/deletion variants200.00 180.00

81205 BCKDHB (BRANCHED-CHAIN KETO ACID DEHYDROGENASE E1, BETA POLYPEPTIDE) (EG, MAPLE SYRUP URINE DISEASE) GENE ANALYSIS, COMMON VARIANTS (EG, R183P, G278S, E422X)94.99 85.49

81206 Bcr/abl1 gene major bp 202.42 182.18

81207 Bcr/abl1 gene minor bp 178.81 160.93

81208 Bcr/abl1 gene other bp 214.62 193.16

81209 BLM (BLOOM SYNDROME, RECQ HELICASE-LIKE) (EG, BLOOM SYNDROME) GENE ANALYSIS, 2281DEL6INS7 VARIANT39.31 35.38

81210 Braf gene 175.40 157.86

81211 Brca1&2 seq & com dup/del 2,395.84 2,156.26

81212 Brca1&2 185&5385&6174 var 440.00 396.00

81213 Brca1&2 uncom dup/del var 553.00 497.70

81214 Brca1 full seq & com dup/del 1,301.42 1,171.28

81215 Brca1 gene known fam variant 375.25 337.73

81216 BRCA2 (BREAST CANCER 2) (EG, HEREDITARY BREAST AND OVARIAN CANCER) GENE ANALYSIS; FULL SEQUENCE ANALYSIS185.12 166.61

81217 Brca2 gene known fam variant 375.25 337.73

81218 CEBPA (CCAAT/enhamcer binding protein [C/EBP], alpha) (eg, acute myeloid leukemia), gene analysis, full gene sequence298.64 268.78

81220 CFTR (CYSTIC FIBROSIS TRANSMEMBRANE CONDUCTANCE REGULATOR) (EG, CYSTIC FIBROSIS) GENE ANALYSIS; COMMON VARIANTS (EG, ACMG/ACOG GUIDELINES)556.60 500.94

81221 CFTR (CYSTIC FIBROSIS TRANSMEMBRANE CONDUCTANCE REGULATOR) (EG, CYSTIC FIBROSIS) GENE ANALYSIS; KNOWN FAMILIAL VARIANTS97.22 87.50

81222 CFTR (CYSTIC FIBROSIS TRANSMEMBRANE CONDUCTANCE REGULATOR) (EG, CYSTIC FIBROSIS) GENE ANALYSIS; DUPLICATION/DELETION VARIANTS435.07 391.56

81223 CFTR (CYSTIC FIBROSIS TRANSMEMBRANE CONDUCTANCE REGULATOR) (EG, CYSTIC FIBROSIS) GENE ANALYSIS; FULL GENE SEQUENCE499.00 449.10

81235 Egfr gene com variants 324.58 292.12

81238 F9 full gene sequence 600.00 540.00

81240 F2 gene 65.69 59.12

81241 F5 gene 75.44 67.90

81242 FANCC (FANCONI ANEMIA, COMPLEMENTATION GROUP C) (EG, FANCONI ANEMIA, TYPE C) GENE ANALYSIS, COMMON VARIANT (EG, IVS4+4A>T)36.62 32.96

81243 FMR1 (FRAGILE X MENTAL RETARDATION 1) (EG, FRAGILE X MENTAL RETARDATION) GENE ANALYSIS; EVALUATION TO DETECT ABNORMAL (EG, EXPANDED) ALLELES57.04 51.34

81244 FMR1 (FRAGILE X MENTAL RETARDATION 1) (EG, FRAGILE X MENTAL RETARDATION) GENE ANALYSIS; CHARACTERIZATION OF ALLELES (EG, EXPANDED SIZE AND METHYLATION STATUS)44.89 40.40

81245 Flt3 gene 165.51 148.96

81246 Flt3 gene analysis 83.00 74.70

81247 G6pd gene alys cmn variant 174.81 157.33

81248 G6pd known familial variant 375.25 337.73

81249 G6pd full gene sequence 600.00 540.00

81252 GJB2 (gap junction protein, beta 2, 26kDa, connexin 26) (eg, nonsyndromic hearing loss) gene analysis; full gene sequence101.12 91.01

81253 GJB2 (gap junction protein, beta 2, 26kDa; connexin 26) (eg, nonsyndromic hearing loss) gene analysis; known familial variants61.52 55.37

81254 GJB6 (gap junction protein, beta 6, 30kDa, connexin 30) (eg, nonsyndromic hearing loss) gene analysis, common variants (eg, 309kb [del(GJB6-D13S1830)] and 232kb [del(GJB6-D13S1854)])35.00 31.50

81255 HEXA (HEXOSAMINIDASE A [ALPHA POLYPEPTIDE]) (EG, TAY-SACHS DISEASE) GENE ANALYSIS, COMMON VARIANTS (EG, 1278INSTATC, 1421+1G>C, G269S)51.45 46.31

81256 Hfe gene 80.69 72.62

81257 HBA1/HBA2 (ALPHA GLOBIN 1 AND ALPHA GLOBIN 2) (EG, ALPHA THALASSEMIA, HB BART HYDROPS FETALIS SYNDROME, HBH DISEASE),102.26 92.03

81258 Hba1/hba2 gene fam vrnt 375.25 337.73

81259 Hba1/hba2 full gene sequence 600.00 540.00

81261 Igh gene rearrange amp meth 244.43 219.99

81262 Igh gene rearrang dir probe 68.55 61.70

81263 Igh vari regional mutation 363.60 327.24

81264 Igk rearrangeabn clonal pop 184.35 165.92

81265 Str markers specimen anal 265.49 238.94

3 2/8/2018





81266 Comparative analysis using Short Tandem Repeat (STR) markers; each additional specimen (eg, additional cord blood donor, additional fetal samples from different cultures, or additional zygosity in multiple birth pregnancies) (List separately in addition to code for primary procedure)304.81 274.33

81267 Chimerism anal no cell selec 256.12 230.51

81268 Chimerism anal w/cell select 321.96 289.76

81269 Hba1/hba2 gene dup/del vrnts 202.40 182.16

81270 Jak2 gene 113.17 101.85

81272 Kit gene targeted seq analys 329.51 296.56

81275 Kras gene 193.25 173.93

81276 Kras gene addl variants 193.25 173.93

81280 Long QT Sydrome Gene Analysis(EG, KCNQ1, KCNH2, SCN5A, KCNE1, KCNE2, KCNJ2, CACNA1C, CAV3, SCN4B, AKAP, SNTA1, AND ANK2); FULL SEQUENCE ANALYSIS416.08 374.47

81288 Mlh1 gene 192.32 173.09

81290 MCOLN1 (MUCOLIPIN 1) (EG, MUCOLIPIDOSIS, TYPE IV) GENE ANALYSIS, COMMON VARIANTS (EG, IVS3-2A>G, DEL6.4KB)39.31 35.38

81291 Mthfr gene 65.34 58.81

81292 Mlh1 gene full seq 675.40 607.86

81293 Mlh1 gene known variants 331.00 297.90

81294 Mlh1 gene dup/delete variant 202.40 182.16

81295 Msh2 gene full seq 381.70 343.53

81296 Msh2 gene known variants 337.73 303.96

81297 Msh2 gene dup/delete variant 213.30 191.97

81298 Msh6 gene full seq 641.85 577.67

81299 Msh6 gene known variants 308.00 277.20

81300 Msh6 gene dup/delete variant 238.00 214.20

81301 Microsatellite instability 357.48 321.73

81310 Npm1 gene 246.52 221.87

81314 Pdgfra gene 329.51 296.56

81315 Pml/raralpha com breakpoints 255.94 230.35

81316 Pml/raralpha 1 breakpoint 255.94 230.35

81317 Pms2 gene full seq analysis 707.02 636.32

81318 Pms2 known familial variants 331.00 297.90

81319 Pms2 gene dup/delet variants 203.50 183.15

81321 Pten gene full sequence 600.00 540.00

81322 Pten gene known fam variant 52.85 47.57

81323 Pten gene dup/delet variant 300.00 270.00

81324 PMP22 (peripheral myelin protein 22) (eg, Charcot-Marie-Tooth, hereditary neuropathy with liability to pressure palsies) gene analysis; duplication/deletion analysis758.36 682.52

81325 PMP22 (peripheral myelin protein 22) (eg, Charcot-Marie-Tooth, hereditary neuropathy with liability to pressure palsies) gene analysis; full sequence analysis769.58 692.62

81326 PMP22 (peripheral myelin protein 22) (eg, Charcot-Marie-Tooth, hereditary neuropathy with liability to pressure palsies) gene analysis; known familial variant52.85 47.57

81331 SNRPN/UBE3A (SMALL NUCLEAR RIBONUCLEOPROTEIN POLYPEPTIDE N AND UBIQUITIN PROTEIN LIGASE E3A) (EG, PRADER-WILLI SYNDROME AND/OR ANGELMAN SYNDROME), METHYLATION ANALYSIS51.07 45.96

81332 Serpina1 gene 53.89 48.50

81334 #REF! 329.51 296.56

81340 Trb@ gene rearrange amplify 257.92 232.13

81341 Trb@ gene rearrange dirprobe 61.22 55.10

81342 Trg gene rearrangement anal 248.76 223.88

81361 Hbb gene com variants 174.81 157.33

81362 Hbb gene known fam variant 375.25 337.73

81363 Hbb gene dup/del variants 202.40 182.16

81364 Hbb full gene sequence 324.58 292.12

81370 Hla i & ii typing lr 496.45 446.81

81371 Hla i & ii type verify lr 404.52 364.07

81372 Hla i typing complete lr 403.59 363.23

81373 Hla i typing 1 locus lr 137.48 123.73

81374 Hla i typing 1 antigen lr 89.81 80.83

81375 Hla ii typing ag equiv lr 272.52 245.27

81376 Hla ii typing 1 locus lr 150.89 135.80

81377 Hla ii type 1 ag equiv lr 113.35 102.02

81378 Hla i & ii typing hr 426.63 383.97

4 2/8/2018





81379 Hla i typing complete hr 414.05 372.65

81380 Hla i typing 1 locus hr 218.83 196.95

81381 Hla i typing 1 allele hr 169.90 152.91

81382 Hla ii typing 1 loc hr 152.69 137.42

81383 Hla ii typing 1 allele hr 134.73 121.26

81401 Molecular Pathology Procedure Level 2 137.00 123.30



81410 Aortic dysfunction/dilation 504.00 453.60

81411 Aortic dysfunction/dilation 1,350.19 1,215.17

81412 Ashkenazi jewish assoc dis 2,448.56 2,203.70

81420 Fetal chrmoml aneuploidy 759.05 683.15

81432 Hrdtry brst ca-rlatd dsordrs 838.33 754.50

81433 Hrdtry brst ca-rlatd dsordrs 541.89 487.70

81434 Hereditary retinal disorders 597.91 538.12

81435 Hereditary colon cancer 722.10 649.89

81436 Hereditary colon ca synd 722.10 649.89

81437 Heredtry nurondcrn tum dsrdr 541.89 487.70

81438 Heredtry nurondcrn tum dsrdr 541.89 487.70

81442 Noonan spectrum disorders 2,143.60 1,929.24

81479 Unlisted molecular pathology procedureManual/Unlisted Manual/Unlisted

81507 Fetal aneuploidy (trisomy 21, 18 and 13) DNA sequence analysis of selected regions using maternal plasma, algorithm reported as a risk score for each trisomy795.00 715.50

81519 Oncology breast mrna 3,873.00 3,485.70

81539 Oncology prostate prob score 760.00 684.00

81595 Cardiology hrt trnspl mrna 3,240.00 2,916.00

81599 Unlisted multianalyte assay with algorithmic analysisManual/Unlisted Manual/Unlisted

82009 Test for acetone/ketones 5.58 5.02

82010 Acetone assay 10.09 9.08

82010 QW Acetone assay 10.09 9.08

82013 Acetylcholinesterase assay 13.79 12.41

82016 Acylcarnitines qual 17.13 15.42

82017 Acylcarnitines quant 20.83 18.75

82024 Assay of acth 47.68 42.91

82030 Assay of adp & amp 31.85 28.67

82040 Assay of serum albumin 6.11 5.50

82040 QW Assay of serum albumin 6.11 5.50

82042 Assay of urine albumin 7.78 7.00

82043 Microalbumin quantitative 7.14 6.43

82043 QW Microalbumin quantitative 7.14 6.43

82044 Microalbumin semiquant 6.23 5.61

82044 QW Microalbumin semiquant 6.23 5.61

82045 Albumin ischemia modified 41.90 37.71

82075 Assay of breath ethanol 30.00 27.00

82085 Assay of aldolase 11.99 10.79

82088 Assay of aldosterone 50.31 45.28

82103 Alpha-1-antitrypsin total 16.59 14.93

82104 Alpha-1-antitrypsin pheno 17.86 16.07

82105 Alpha-fetoprotein serum 20.71 18.64

82106 Alpha-fetoprotein amniotic 20.71 18.64

82107 Alpha-fetoprotein l3 79.52 71.57

82108 Assay of aluminum 31.46 28.31

82120 Amines vaginal fluid qual 5.99 5.39

82120 QW Amines vaginal fluid qual 5.99 5.39

82127 Amino acid single qual 17.13 15.42

5 2/8/2018





82128 Amino acids mult qual 17.13 15.42

82131 Amino acids single quant 22.98 20.68

82135 Assay aminolevulinic acid 20.31 18.28

82136 Amino acids quant 2-5 20.83 18.75

82139 Amino acids quan 6 or more 20.83 18.75

82140 Ammonia 17.99 16.19

82143 Amniotic fluid scan 9.35 8.42

82150 Assay of amylase 8.00 7.20

82150 QW Assay of amylase 8.00 7.20

82154 Androstanediol glucuronide 35.60 32.04

82157 Assay of androstenedione 36.14 32.53

82160 Assay of androsterone 30.87 27.78

82163 Assay of angiotensin II 25.34 22.81

82164 Angiotensin I enzyme test 18.03 16.23

82172 Assay of apolipoprotein 21.09 18.98

82175 Assay of arsenic 23.42 21.08

82180 Assay of ascorbic acid 12.20 10.98

82190 Atomic absorption 18.41 16.57

82232 Assay of beta-2 protein 19.97 17.97

82239 Bile acids total 21.14 19.03

82240 Bile acids cholylglycine 32.81 29.53

82247 Bilirubin total 6.19 5.57

82247 QW Bilirubin total 6.19 5.57

82248 Bilirubin direct 6.19 5.57

82252 Fecal bilirubin test 5.63 5.07

82261 Assay of biotinidase 20.83 18.75

82270 Occult blood feces 4.38 3.94

82271 Occult blood other sources 5.32 4.79

82271 QW Occult blood other sources 5.32 4.79

82272 Occult bld feces 1-3 tests 4.23 3.81

82274 Assay test for blood fecal 19.64 17.68

82274 QW Assay test for blood fecal 19.64 17.68

82286 Assay of bradykinin 6.37 5.73

82300 Assay of cadmium 28.58 25.72

82306 Vitamin d 25 hydroxy 36.55 32.90

82308 Assay of calcitonin 33.08 29.77

82310 Assay of calcium 6.37 5.73

82310 QW Assay of calcium 6.37 5.73

82330 Assay of calcium 16.88 15.19

82330 QW Assay of calcium 16.88 15.19

82331 Calcium infusion test 13.34 12.01

82340 Assay of calcium in urine 7.44 6.70

82355 Calculus analysis qual 14.29 12.86

82360 Calculus assay quant 15.89 14.30

82365 Calculus spectroscopy 15.92 14.33

82370 X-ray assay calculus 15.46 13.91

82373 Assay c-d transfer measure 22.29 20.06

82374 Assay blood carbon dioxide 6.03 5.43

82374 QW Assay blood carbon dioxide 6.03 5.43

82375 Assay carboxyhb quant 15.21 13.69

82376 Assay carboxyhb qual 14.07 12.66

82378 Carcinoembryonic antigen 23.41 21.07

82379 Assay of carnitine 20.83 18.75

82380 Assay of carotene 11.39 10.25

6 2/8/2018





82382 Assay urine catecholamines 27.30 24.57

82383 Assay blood catecholamines 30.93 27.84

82384 Assay three catecholamines 31.18 28.06

82387 Assay of cathepsin-d 22.29 20.06

82390 Assay of ceruloplasmin 13.26 11.93

82397 Chemiluminescent assay 17.43 15.69

82415 Assay of chloramphenicol 15.64 14.08

82435 Assay of blood chloride 5.68 5.11

82435 QW Assay of blood chloride 5.68 5.11

82436 Assay of urine chloride 6.21 5.59

82438 Assay other fluid chlorides 6.03 5.43

82441 Test for chlorohydrocarbons 7.42 6.68

82465 Assay bld/serum cholesterol 5.37 4.83

82465 QW Assay bld/serum cholesterol 5.37 4.83

82480 Assay serum cholinesterase 9.72 8.75

82482 Assay rbc cholinesterase 9.81 8.83

82485 Assay chondroitin sulfate 25.50 22.95

82495 Assay of chromium 25.04 22.54

82507 Assay of citrate 34.33 30.90

82523 Collagen crosslinks 23.07 20.76

82523 QW Collagen crosslinks 23.07 20.76

82525 Assay of copper 15.32 13.79

82528 Assay of corticosterone 27.80 25.02

82530 Cortisol free 20.63 18.57

82533 Total cortisol 20.12 18.11

82540 Assay of creatine 5.72 5.15

82542 Column chromotography quant 24.09 21.68

82550 Assay of ck (cpk) 8.04 7.24

82550 QW Assay of ck (cpk) 8.04 7.24

82552 Assay of cpk in blood 16.53 14.88

82553 Creatine mb fraction 14.26 12.83

82554 Creatine isoforms 14.65 13.19

82565 Assay of creatinine 6.33 5.70

82565 QW Assay of creatinine 6.33 5.70

82570 Assay of urine creatinine 6.39 5.75

82570 QW Assay of urine creatinine 6.39 5.75

82575 Creatinine clearance test 11.67 10.50

82585 Assay of cryofibrinogen 14.14 12.73

82595 Assay of cryoglobulin 7.98 7.18

82600 Assay of cyanide 23.95 21.56

82607 Vitamin B-12 18.61 16.75

82608 B-12 binding capacity 17.68 15.91

82610 Cystatin c 18.52 16.67

82615 Test for urine cystines 10.08 9.07

82626 Dehydroepiandrosterone 31.20 28.08

82627 Dehydroepiandrosterone 27.45 24.71

82633 Desoxycorticosterone 38.25 34.43

82634 Deoxycortisol 36.14 32.53

82638 Assay of dibucaine number 15.12 13.61

82652 Vit d 1 25-dihydroxy 47.53 42.78

82656 Pancreatic elastase fecal 14.24 12.82

82657 Enzyme cell activity 22.29 20.06

82658 Enzyme cell activity ra 44.03 39.63

82664 Electrophoretic test 61.50 55.35

7 2/8/2018





82668 Assay of erythropoietin 23.20 20.88

82670 Assay of estradiol 34.49 31.04

82671 Assay of estrogens 39.88 35.89

82672 Assay of estrogen 26.78 24.10

82677 Assay of estriol 29.85 26.87

82679 Assay of estrone 30.81 27.73

82679 QW Assay of estrone 30.81 27.73

82693 Assay of ethylene glycol 18.40 16.56

82696 Assay of etiocholanolone 29.12 26.21

82705 Fats/lipids feces qual 6.29 5.66

82710 Fats/lipids feces quant 20.75 18.68

82715 Assay of fecal fat 22.97 20.67

82725 Assay of blood fatty acids 18.77 16.89

82726 Long chain fatty acids 22.29 20.06

82728 Assay of ferritin 16.83 15.15

82731 Assay of fetal fibronectin 79.52 71.57

82735 Assay of fluoride 22.89 20.60

82746 Assay of folic acid serum 18.15 16.34

82747 Assay of folic acid rbc 21.38 19.24

82757 Assay of semen fructose 21.40 19.26

82759 Assay of rbc galactokinase 26.52 23.87

82760 Assay of galactose 13.82 12.44

82775 Assay galactose transferase 26.01 23.41

82776 Galactose transferase test 11.74 10.57

82784 Assay iga/igd/igg/igm each 11.48 10.33

82785 Assay of ige 20.32 18.29

82787 Igg 1 2 3 or 4 each 9.90 8.91

82800 Blood pH 11.00 9.90

82803 Blood gases any combination 26.07 23.46

82805 Blood gases w/o2 saturation 78.77 70.89

82810 Blood gases o2 sat only 10.77 9.69

82820 Hemoglobin-oxygen affinity 13.34 12.01

82930 Gastric analy w/ph ea spec 6.72 6.05

82938 Gastrin test 21.84 19.66

82941 Assay of gastrin 21.77 19.59

82943 Assay of glucagon 17.64 15.88

82945 Glucose other fluid 4.85 4.37

82946 Glucagon tolerance test 18.61 16.75

82947 Assay glucose blood quant 4.85 4.37

82947 QW Assay glucose blood quant 4.85 4.37

82948 Reagent strip/blood glucose 5.04 4.54

82950 Glucose test 5.86 5.27

82950 QW Glucose test 5.86 5.27

82951 Glucose tolerance test (GTT) 15.89 14.30

82951 QW Glucose tolerance test (GTT) 15.89 14.30

82952 GTT-added samples 4.84 4.36

82952 QW GTT-added samples 4.84 4.36

82955 Assay of g6pd enzyme 11.97 10.77

82960 Test for G6PD enzyme 7.47 6.72

82962 Glucose blood test 3.28 2.95

82963 Assay of glucosidase 26.52 23.87

82965 Assay of gdh enzyme 13.15 11.84

82977 Assay of GGT 8.89 8.00

82977 QW Assay of GGT 8.89 8.00

8 2/8/2018





82978 Assay of glutathione 17.60 15.84

82979 Assay rbc glutathione 11.66 10.49

82985 Assay of glycated protein 18.61 16.75

82985 QW Assay of glycated protein 18.61 16.75

83001 Assay of gonadotropin (fsh) 22.94 20.65

83001 QW Assay of gonadotropin (fsh) 22.94 20.65

83002 Assay of gonadotropin (lh) 22.86 20.57

83002 QW Assay of gonadotropin (lh) 22.86 20.57

83003 Assay growth hormone (hgh) 20.58 18.52

83009 H pylori (c-13) blood 83.16 74.84

83010 Assay of haptoglobin quant 15.53 13.98

83012 Assay of haptoglobins 26.89 24.20

83013 H pylori (c-13) breath 83.16 74.84

83014 H pylori drug admin 9.70 8.73

83015 Heavy metal screen 23.25 20.93

83018 Quantitative screen metals 27.12 24.41

83020 Hemoglobin electrophoresis 15.89 14.30

83020 26 Hemoglobin electrophoresis 12.99 12.99

83021 Hemoglobin chromotography 22.29 20.06

83026 Hemoglobin copper sulfate 4.01 3.61

83030 Fetal hemoglobin chemical 10.74 9.67

83033 Fetal hemoglobin assay qual 8.00 7.20

83036 Glycosylated hemoglobin test 11.99 10.79

83036 QW Glycosylated hemoglobin test 11.99 10.79

83037 Glycosylated hb home device 11.99 10.79

83037 QW Glycosylated hb home device 11.99 10.79

83045 Blood methemoglobin test 6.49 5.84

83050 Blood methemoglobin assay 9.05 8.15

83051 Assay of plasma hemoglobin 9.03 8.13

83060 Blood sulfhemoglobin assay 10.21 9.19

83065 Assay of hemoglobin heat 9.00 8.10

83068 Hemoglobin stability screen 10.45 9.41

83069 Assay of urine hemoglobin 4.88 4.39

83070 Assay of hemosiderin qual 5.86 5.27

83080 Assay of b hexosaminidase 20.83 18.75

83088 Assay of histamine 36.46 32.81

83090 Assay of homocystine 20.83 18.75

83150 Assay of homovanillic acid 23.89 21.50

83491 Assay of corticosteroids 17 21.64 19.48

83497 Assay of 5-hiaa 15.92 14.33

83498 Assay of progesterone 17-d 33.54 30.19

83500 Assay free hydroxyproline 27.96 25.16

83505 Assay total hydroxyproline 30.01 27.01

83516 Immunoassay nonantibody 14.24 12.82

83518 Immunoassay dipstick 10.47 9.42

83519 Ria nonantibody 18.40 16.56

83520 Immunoassay quant nos nonab 17.27 15.54

83525 Assay of insulin 14.11 12.70

83527 Assay of insulin 15.98 14.38

83528 Assay of intrinsic factor 19.82 17.84

83540 Assay of iron 7.99 7.19

83550 Iron binding test 10.79 9.71

83570 Assay of idh enzyme 10.93 9.84

83582 Assay of ketogenic steroids 17.50 15.75

9 2/8/2018





83586 Assay 17- ketosteroids 15.80 14.22

83593 Fractionation ketosteroids 32.47 29.22

83605 Assay of lactic acid 13.19 11.87

83605 QW Assay of lactic acid 13.19 11.87

83615 Lactate (LD) (LDH) enzyme 7.45 6.71

83625 Assay of ldh enzymes 15.80 14.22

83630 Lactoferrin fecal (qual) 24.24 21.82

83631 Lactoferrin fecal (quant) 24.24 21.82

83632 Placental lactogen 24.97 22.47

83633 Test urine for lactose 11.25 10.13

83655 Assay of lead 14.95 13.46

83655 QW Assay of lead 14.95 13.46

83661 L/s ratio fetal lung 27.14 24.43

83662 Foam stability fetal lung 23.35 21.02

83663 Fluoro polarize fetal lung 23.35 21.02

83664 Lamellar bdy fetal lung 23.35 21.02

83670 Assay of lap enzyme 11.31 10.18

83690 Assay of lipase 8.51 7.66

83695 Assay of lipoprotein(a) 15.98 14.38

83698 Assay lipoprotein pla2 46.31 41.68

83700 Lipopro bld electrophoretic 13.90 12.51

83701 Lipoprotein bld hr fraction 33.86 30.47

83704 Lipoprotein bld by nmr 38.95 35.06

83718 Assay of lipoprotein 10.12 9.11

83718 QW Assay of lipoprotein 10.12 9.11

83719 Assay of blood lipoprotein 14.36 12.92

83721 Assay of blood lipoprotein 11.78 10.60

83721 QW Assay of blood lipoprotein 11.78 10.60

83727 Assay of lrh hormone 21.22 19.10

83735 Assay of magnesium 8.27 7.44

83775 Assay malate dehydrogenase 9.10 8.19

83785 Assay of manganese 30.37 27.33

83789 Mass spectrometry quant 24.11 21.70

83825 Assay of mercury 20.07 18.06

83835 Assay of metanephrines 20.92 18.83

83857 Assay of methemalbumin 13.26 11.93

83861 Microfluid analy tears 22.48 20.23

83864 Mucopolysaccharides 28.50 25.65

83872 Assay synovial fluid mucin 7.24 6.52

83873 Assay of csf protein 21.24 19.12

83874 Assay of myoglobin 15.95 14.36

83876 Assay myeloperoxidase 50.86 45.77

83880 Assay of natriuretic peptide 41.90 37.71

83880 QW Assay of natriuretic peptide 41.90 37.71

83883 Assay nephelometry not spec 16.79 15.11

83885 Assay of nickel 30.26 27.23

83915 Assay of nucleotidase 13.77 12.39

83916 Oligoclonal bands 27.39 24.65

83918 Organic acids total quant 23.60 21.24

83919 Organic acids qual each 20.31 18.28

83921 Organic acid single quant 21.21 19.09

83930 Assay of blood osmolality 8.16 7.34

83935 Assay of urine osmolality 8.42 7.58

83937 Assay of osteocalcin 36.85 33.17

10 2/8/2018





83945 Assay of oxalate 15.89 14.30

83950 Oncoprotein her-2/neu 79.52 71.57

83951 Oncoprotein dcp 79.52 71.57

83970 Assay of parathormone 50.96 45.86

83986 Assay ph body fluid nos 4.42 3.98

83986 QW Assay ph body fluid nos 4.42 3.98

83992 Assay for phencyclidine 20.17 18.15

83993 Assay for calprotectin fecal 24.24 21.82

84030 Assay of blood pku 6.79 6.11

84035 Assay of phenylketones 4.52 4.07

84060 Assay acid phosphatase 9.12 8.21

84066 Assay prostate phosphatase 11.93 10.74

84075 Assay alkaline phosphatase 6.39 5.75

84075 QW Assay alkaline phosphatase 6.39 5.75

84078 Assay alkaline phosphatase 9.01 8.11

84080 Assay alkaline phosphatases 18.25 16.43

84081 Assay phosphatidylglycerol 20.39 18.35

84085 Assay of rbc pg6d enzyme 11.66 10.49

84087 Assay phosphohexose enzymes 12.74 11.47

84100 Assay of phosphorus 5.85 5.27

84105 Assay of urine phosphorus 6.39 5.75

84106 Test for porphobilinogen 5.82 5.24

84110 Assay of porphobilinogen 10.42 9.38

84112 Placenta alpha micro ig c/v 98.11 88.30

84119 Test urine for porphyrins 13.36 12.02

84120 Assay of urine porphyrins 18.16 16.34

84126 Assay of feces porphyrins 39.11 35.20

84132 Assay of serum potassium 5.68 5.11

84132 QW Assay of serum potassium 5.68 5.11

84133 Assay of urine potassium 5.32 4.79

84134 Assay of prealbumin 18.01 16.21

84135 Assay of pregnanediol 23.63 21.27

84138 Assay of pregnanetriol 23.37 21.03

84140 Assay of pregnenolone 25.52 22.97

84143 Assay of 17-hydroxypregneno 28.16 25.34

84144 Assay of progesterone 25.76 23.18

84146 Assay of prolactin 23.92 21.53

84150 Assay of prostaglandin 41.77 37.59

84152 Assay of psa complexed 22.71 20.44

84153 Assay of psa total 22.71 20.44

84154 Assay of psa free 22.71 20.44

84155 Assay of protein serum 4.53 4.08

84155 QW Assay of protein serum 4.53 4.08

84156 Assay of protein urine 4.53 4.08

84157 Assay of protein other 4.53 4.08

84157 QW Assay of protein other 4.53 4.08

84160 Assay of protein any source 6.39 5.75

84163 Pappa serum 18.59 16.73

84165 Protein e-phoresis serum 13.26 11.93

84165 26 Protein e-phoresis serum 12.99 12.99

84166 Protein e-phoresis/urine/csf 22.01 19.81

84166 26 Protein e-phoresis/urine/csf 12.99 12.99

84181 Western blot test 21.02 18.92

84181 26 Western blot test 12.99 12.99

11 2/8/2018





84182 Protein western blot test 29.21 26.29

84182 26 Protein western blot test 12.99 12.99

84202 Assay RBC protoporphyrin 17.71 15.94

84203 Test RBC protoporphyrin 10.63 9.57

84206 Assay of proinsulin 26.69 24.02

84207 Assay of vitamin b-6 34.69 31.22

84210 Assay of pyruvate 14.48 13.03

84220 Assay of pyruvate kinase 11.66 10.49

84228 Assay of quinine 14.36 12.92

84233 Assay of estrogen 87.88 79.09

84234 Assay of progesterone 80.10 72.09

84235 Assay of endocrine hormone 71.23 64.11

84238 Assay nonendocrine receptor 45.14 40.63

84244 Assay of renin 27.15 24.44


84255 Assay of selenium 31.52 28.37

84260 Assay of serotonin 38.25 34.43

84270 Assay of sex hormone globul 26.83 24.15

84275 Assay of sialic acid 16.59 14.93

84285 Assay of silica 29.06 26.15

84295 Assay of serum sodium 5.94 5.35

84295 QW Assay of serum sodium 5.94 5.35

84300 Assay of urine sodium 6.00 5.40

84302 Assay of sweat sodium 6.00 5.40

84305 Assay of somatomedin 26.25 23.63

84307 Assay of somatostatin 22.56 20.30

84311 Spectrophotometry 8.63 7.77

84315 Body fluid specific gravity 3.28 2.95

84375 Chromatogram assay sugars 39.00 35.10

84376 Sugars single qual 6.79 6.11

84377 Sugars multiple qual 6.79 6.11

84378 Sugars single quant 14.23 12.81

84379 Sugars multiple quant 14.23 12.81

84392 Assay of urine sulfate 5.86 5.27

84402 Assay of free testosterone 31.45 28.31

84403 Assay of total testosterone 31.87 28.68

84410 Testosterone bioavailable 63.32 56.99


84430 Assay of thiocyanate 14.36 12.92

84432 Assay of thyroglobulin 19.83 17.85

84436 Assay of total thyroxine 8.48 7.63

84437 Assay of neonatal thyroxine 7.98 7.18

84439 Assay of free thyroxine 11.13 10.02

84442 Assay of thyroid activity 18.25 16.43

84443 Assay thyroid stim hormone 20.75 18.68

84443 QW Assay thyroid stim hormone 20.75 18.68

84445 Assay of tsi globulin 62.78 56.50

84446 Assay of vitamin e 17.51 15.76

84449 Assay of transcortin 22.22 20.00

84450 Transferase (AST) (SGOT) 6.39 5.75

84450 QW Transferase (AST) (SGOT) 6.39 5.75

84460 Alanine amino (ALT) (SGPT) 6.54 5.89

84460 QW Alanine amino (ALT) (SGPT) 6.54 5.89

84466 Assay of transferrin 15.76 14.18

12 2/8/2018





84478 Assay of triglycerides 7.09 6.38

84478 QW Assay of triglycerides 7.09 6.38

84479 Assay of thyroid (t3 or t4) 7.98 7.18

84480 Assay triiodothyronine (t3) 17.51 15.76

84481 Free assay (FT-3) 20.92 18.83

84482 T3 reverse 19.46 17.51

84484 Assay of troponin quant 12.47 11.22

84485 Assay duodenal fluid trypsin 8.89 8.00

84488 Test feces for trypsin 9.01 8.11

84490 Assay of feces for trypsin 9.93 8.94

84510 Assay of tyrosine 12.84 11.56

84512 Assay of troponin qual 10.09 9.08

84520 Assay of urea nitrogen 4.88 4.39

84520 QW Assay of urea nitrogen 4.88 4.39

84525 Urea nitrogen semi-quant 5.13 4.62

84540 Assay of urine/urea-n 5.86 5.27

84545 Urea-N clearance test 8.16 7.34

84550 Assay of blood/uric acid 5.58 5.02

84550 QW Assay of blood/uric acid 5.58 5.02

84560 Assay of urine/uric acid 5.86 5.27

84577 Assay of feces/urobilinogen 20.75 18.68

84578 Test urine urobilinogen 4.47 4.02

84580 Assay of urine urobilinogen 10.08 9.07

84583 Assay of urine urobilinogen 6.21 5.59

84585 Assay of urine vma 19.13 17.22

84586 Assay of vip 43.62 39.26

84588 Assay of vasopressin 41.90 37.71

84590 Assay of vitamin a 14.33 12.90

84591 Assay of nos vitamin 17.06 15.35

84597 Assay of vitamin k 16.94 15.25

84600 Assay of volatiles 19.85 17.87

84620 Xylose tolerance test 14.63 13.17

84630 Assay of zinc 14.06 12.65

84681 Assay of c-peptide 25.70 23.13

84702 Chorionic gonadotropin test 18.59 16.73

84703 Chorionic gonadotropin assay 9.29 8.36

84703 QW Chorionic gonadotropin assay 9.29 8.36

84704 Hcg free betachain test 18.59 16.73

84830 Ovulation tests 12.70 11.43

84999 Unlisted chemistry procedure Manual/Unlisted Manual/Unlisted

85002 Bleeding time test 5.57 5.01

85004 Automated diff wbc count 7.98 7.18

85007 Bl smear w/diff wbc count 4.24 3.82

85008 Bl smear w/o diff wbc count 4.24 3.82

85009 Manual diff wbc count b-coat 5.07 4.56

85013 Spun microhematocrit 7.00 6.30

85014 Hematocrit 2.93 2.64

85014 QW Hematocrit 2.93 2.64

85018 Hemoglobin 2.93 2.64

85018 QW Hemoglobin 2.93 2.64

85025 Complete cbc w/auto diff wbc 9.59 8.63

85027 Complete cbc automated 7.98 7.18

85032 Manual cell count each 5.32 4.79

85041 Automated rbc count 3.73 3.36

13 2/8/2018





85044 Manual reticulocyte count 5.32 4.79

85045 Automated reticulocyte count 4.93 4.44

85046 Reticyte/hgb concentrate 6.88 6.19

85048 Automated leukocyte count 3.13 2.82

85049 Automated platelet count 5.53 4.98

85055 Reticulated platelet assay 35.74 32.17

85060 Blood smear, peripheral, interpretation by physician with written report17.66 17.66

85097 Bone marrow, smear interpretation 62.34 62.34

85130 Chromogenic substrate assay 14.68 13.21

85170 Blood clot retraction 16.30 14.67

85175 Blood clot lysis time 20.37 18.33

85210 Clot factor ii prothrom spec 16.03 14.43

85220 Blooc clot factor v test 21.79 19.61

85230 Clot factor vii proconvertin 22.10 19.89

85240 Clot factor viii ahg 1 stage 22.10 19.89

85244 Clot factor viii reltd antgn 25.21 22.69

85245 Clot factor viii vw ristoctn 28.32 25.49

85246 Clot factor viii vw antigen 28.32 25.49

85247 Clot factor viii multimetric 28.32 25.49

85250 Clot factor ix ptc/chrstmas 23.51 21.16

85260 Clot factor x stuart-power 22.10 19.89

85270 Clot factor xi pta 22.10 19.89

85280 Clot factor xii hageman 23.89 21.50

85290 Clot factor xiii fibrin stab 20.17 18.15

85291 Clot factor xiii fibrin scrn 10.98 9.88

85292 Clot factor fletcher fact 23.37 21.03

85293 Clot factor wght kininogen 23.37 21.03

85300 Antithrombin iii activity 14.63 13.17

85301 Antithrombin iii antigen 13.35 12.02

85302 Clot inhibit prot c antigen 14.83 13.35

85303 Clot inhibit prot c activity 17.08 15.37

85305 Clot inhibit prot s total 14.33 12.90

85306 Clot inhibit prot s free 18.92 17.03

85307 Assay activated protein c 18.92 17.03

85335 Factor inhibitor test 15.89 14.30

85337 Thrombomodulin 17.27 15.54

85345 Coagulation time lee & white 5.32 4.79

85347 Coagulation time activated 5.26 4.73

85348 Coagulation time otr method 4.60 4.14

85360 Euglobulin lysis 10.38 9.34

85362 Fibrin degradation products 8.51 7.66

85366 Fibrinogen test 80.46 72.41

85370 Fibrinogen test 14.02 12.62

85378 Fibrin degrade semiquant 9.72 8.75

85379 Fibrin degradation quant 12.56 11.30

85380 Fibrin degradj d-dimer 12.56 11.30

85384 Fibrinogen activity 10.49 9.44

85385 Fibrinogen antigen 14.46 13.01

85390 Fibrinolysins screen i&r 15.48 13.93

85390 26 Fibrinolysins screen i&r 12.99 12.99

85396 Coagulation/fibrinolysis assay, whole blood, including use of any pharmacologic additive(s), as indicated, including interpretation and written report, per day14.70 14.70

85400 Fibrinolytic plasmin 9.51 8.56

85410 Fibrinolytic antiplasmin 9.51 8.56

85415 Fibrinolytic plasminogen 21.22 19.10

14 2/8/2018







85441 Heinz bodies direct 5.18 4.66

85445 Heinz bodies induced 8.42 7.58

85460 Hemoglobin fetal 9.55 8.60

85461 Hemoglobin fetal 9.36 8.42

85475 Hemolysin acid 10.95 9.86

85520 Heparin assay 16.16 14.54

85525 Heparin neutralization 14.62 13.16

85530 Heparin-protamine tolerance 16.16 14.54

85536 Iron stain peripheral blood 7.98 7.18

85540 Wbc alkaline phosphatase 10.62 9.56

85547 RBC mechanical fragility 10.62 9.56

85549 Muramidase 23.15 20.84

85555 RBC osmotic fragility 8.25 7.43

85557 RBC osmotic fragility 16.49 14.84

85576 Blood platelet aggregation 26.52 23.87

85576 26 Blood platelet aggregation 12.99 12.99

85576 QW Blood platelet aggregation 26.52 23.87

85597 Phospholipid pltlt neutraliz 22.19 19.97

85598 Hexagnal phosph pltlt neutrl 22.19 19.97

85610 Prothrombin time 4.85 4.37

85610 QW Prothrombin time 4.85 4.37

85611 Prothrombin test 4.87 4.38

85612 Viper venom prothrombin time 17.49 15.74

85613 Russell viper venom diluted 11.83 10.65

85635 Reptilase test 12.16 10.94

85651 Rbc sed rate nonautomated 4.38 3.94

85652 Rbc sed rate automated 3.33 3.00

85660 RBC sickle cell test 6.80 6.12

85670 Thrombin time plasma 7.12 6.41

85675 Thrombin time titer 8.45 7.61

85705 Thromboplastin inhibition 11.89 10.70

85730 Thromboplastin time partial 7.42 6.68

85732 Thromboplastin time partial 7.98 7.18

85810 Blood viscosity examination 14.41 12.97

85999 Unlisted hematology and coagulation procedureManual/Unlisted Manual/Unlisted

86000 Agglutinins febrile antigen 8.62 7.76

86001 Allergen specific igg 7.82 7.04

86003 Allergen specific IgE 6.44 5.80

86005 Allergen specific IgE 9.84 8.86

86008 Allg spec ige recomb ea 22.14 19.93

86021 WBC antibody identification 18.59 16.73

86022 Platelet antibodies 22.68 20.41

86023 Immunoglobulin assay 15.38 13.84

86038 Antinuclear antibodies 14.92 13.43

86039 Antinuclear antibodies (ANA) 13.78 12.40

86060 Antistreptolysin o titer 9.01 8.11

86063 Antistreptolysin o screen 7.12 6.41

86077 Blood bank physician services; difficult cross match and/or evaluation of irregular anitbody(s), interpretation and written report39.63 39.63

86078 Blood bank physician services; investigation of transfusion reaction including suspicion of transmissible disease, interpretation and written report39.63 39.63

86079 Blood bank physician services; authorization for deviation from standard blood banking procedures (eg, use of outdated blood, transfusion of Rh incompatible units), with written report39.41 39.41

86140 C-reactive protein 6.39 5.75

86141 C-reactive protein hs 15.98 14.38

15 2/8/2018





86146 Beta-2 glycoprotein antibody 31.42 28.28

86147 Cardiolipin antibody ea ig 31.42 28.28

86148 Anti-phospholipid antibody 19.84 17.86

86152 Cell enumeration & id 303.34 273.01

86153 26 Cell enumeration using immunologic selection and identification in fluid specimen (eg, circulating tumor cells in blood); physician interpretation and report, when required24.48 24.48

86155 Chemotaxis assay 19.74 17.77

86156 Cold agglutinin screen 8.27 7.44

86157 Cold agglutinin titer 9.95 8.96

86160 Complement antigen 14.81 13.33

86161 Complement/function activity 14.81 13.33

86162 Complement total (ch50) 25.09 22.58

86171 Complement fixation each 12.36 11.12

86200 Ccp antibody 15.98 14.38

86215 Deoxyribonuclease antibody 16.35 14.72

86225 Dna antibody native 16.97 15.27

86226 Dna antibody single strand 14.95 13.46

86235 Nuclear antigen antibody 22.14 19.93

86255 Fluorescent antibody screen 14.88 13.39

86255 26 Fluorescent antibody screen 12.99 12.99

86256 Fluorescent antibody titer 14.88 13.39

86256 26 Fluorescent antibody titer 12.99 12.99

86277 Growth hormone antibody 19.43 17.49

86280 Hemagglutination inhibition 10.12 9.11

86294 Immunoassay tumor qual 25.57 23.01

86294 QW Immunoassay tumor qual 25.57 23.01

86300 Immunoassay tumor ca 15-3 25.70 23.13

86301 Immunoassay tumor ca 19-9 25.70 23.13

86304 Immunoassay tumor ca 125 25.70 23.13

86308 Heterophile antibody screen 6.39 5.75

86308 QW Heterophile antibody screen 6.39 5.75

86309 Heterophile antibody titer 7.98 7.18

86310 Heterophile antibody absrbj 9.10 8.19

86316 Immunoassay tumor other 25.70 23.13

86317 Immunoassay infectious agent 18.50 16.65

86318 Immunoassay infectious agent 18.09 16.28

86318 QW Immunoassay infectious agent 18.09 16.28

86320 Serum immunoelectrophoresis 29.92 26.93

86320 26 Serum immunoelectrophoresis 12.99 12.99

86325 Other immunoelectrophoresis 27.61 24.85

86325 26 Other immunoelectrophoresis 12.99 12.99

86327 Immunoelectrophoresis assay 29.92 26.93

86327 26 Immunoelectrophoresis assay 14.73 14.73

86329 Immunodiffusion nes 17.34 15.61

86331 Immunodiffusion ouchterlony 14.79 13.31

86332 Immune complex assay 30.09 27.08

86334 Immunofix e-phoresis serum 27.59 24.83

86334 26 Immunofix e-phoresis serum 12.99 12.99

86335 Immunfix e-phorsis/urine/csf 36.23 32.61

86335 26 Immunfix e-phorsis/urine/csf 12.99 12.99

86336 Inhibin A 19.24 17.32

86337 Insulin antibodies 26.43 23.79

86340 Intrinsic factor antibody 18.61 16.75

86341 Islet cell antibody 24.43 21.99

86343 Leukocyte histamine release 15.38 13.84

16 2/8/2018





86344 Leukocyte phagocytosis 10.39 9.35

86353 Lymphocyte transformation 60.53 54.48

86355 B cells total count 46.58 41.92

86356 Mononuclear cell antigen 33.06 29.75

86357 Nk cells total count 46.58 41.92

86359 T cells total count 46.58 41.92

86360 T cell absolute count/ratio 58.01 52.21

86361 T cell absolute count 33.06 29.75

86367 Stem cells total count 77.78 70.00

86376 Microsomal antibody each 17.96 16.16

86382 Neutralization test viral 20.88 18.79

86384 Nitroblue tetrazolium dye 14.06 12.65

86386 Nuclear matrix protein 22 21.78 19.60

86403 Particle agglut antbdy scrn 12.58 11.32

86406 Particle agglut antbdy titr 13.13 11.82

86430 Rheumatoid factor test qual 7.00 6.30

86431 Rheumatoid factor quant 7.00 6.30

86480 Tb test cell immun measure 76.52 68.87

86481 Tb ag response t-cell susp 100.00 90.00

86485 Skin test; candida 6.18 5.56

86486 Skin test; unlisted antigen, each 3.30 3.30

86490 Skin test; coccidioidomycosis 57.80 57.80

86510 Skin test; histoplasmosis 4.20 4.20

86580 Skin test; tuberculosis, intradermal 5.34 5.34

86590 Streptokinase antibody 13.64 12.28

86592 Syphilis test non-trep qual 5.27 4.74

86593 Syphilis test non-trep quant 5.44 4.90

86602 Antinomyces antibody 12.56 11.30

86603 Adenovirus antibody 15.89 14.30

86606 Aspergillus antibody 18.59 16.73

86609 Bacterium antibody 15.90 14.31

86611 Bartonella antibody 12.56 11.30

86612 Blastomyces antibody 15.93 14.34

86615 Bordetella antibody 16.28 14.65

86617 Lyme disease antibody 19.13 17.22

86618 Lyme disease antibody 21.02 18.92

86618 QW Lyme disease antibody 21.02 18.92

86619 Borrelia antibody 16.52 14.87

86622 Brucella antibody 11.03 9.93

86625 Campylobacter antibody 16.20 14.58

86628 Candida antibody 14.82 13.34

86631 Chlamydia antibody 14.60 13.14

86632 Chlamydia igm antibody 15.66 14.09

86635 Coccidioides antibody 14.17 12.75

86638 Q fever antibody 14.97 13.47

86641 Cryptococcus antibody 17.79 16.01

86644 CMV antibody 17.77 15.99

86645 Cmv antibody igm 20.80 18.72

86648 Diphtheria antibody 18.77 16.89

86651 Encephalitis californ antbdy 16.28 14.65

86652 Encephaltis east eqne anbdy 16.28 14.65

86653 Encephaltis st louis antbody 16.28 14.65

86654 Encephaltis west eqne antbdy 16.28 14.65

86658 Enterovirus antibody 16.08 14.47

17 2/8/2018





86663 Epstein-barr antibody 16.20 14.58

86664 Epstein-barr nuclear antigen 18.88 16.99

86665 Epstein-barr capsid vca 22.40 20.16

86666 Ehrlichia antibody 12.56 11.30

86668 Francisella tularensis 14.16 12.74

86671 Fungus nes antibody 15.13 13.62

86674 Giardia lamblia antibody 18.17 16.35

86677 Helicobacter pylori antibody 17.91 16.12

86682 Helminth antibody 16.06 14.45

86684 Hemophilus influenza antibdy 19.56 17.60

86687 Htlv-i antibody 10.36 9.32

86688 Htlv-ii antibody 17.29 15.56

86689 Htlv/hiv confirmj antibody 23.90 21.51

86692 Hepatitis delta agent antbdy 21.19 19.07

86694 Herpes simplex nes antbdy 17.77 15.99

86695 Herpes simplex type 1 test 16.28 14.65

86696 Herpes simplex type 2 test 23.90 21.51

86698 Histoplasma antibody 15.43 13.89

86701 Hiv-1antibody 10.97 9.87

86701 QW Hiv-1antibody 10.97 9.87

86702 Hiv-2 antibody 16.69 15.02

86703 Hiv-1/hiv-2 1 result antbdy 16.92 15.23

86703 QW Hiv-1/hiv-2 1 result antbdy 18.80 16.92

86704 Hep b core antibody total 14.88 13.39

86705 Hep b core antibody igm 14.54 13.09

86706 Hep b surface antibody 13.26 11.93

86707 Hepatitis be antibody 14.28 12.85

86708 Hepatitis a total antibody 15.29 13.76

86709 Hepatitis a igm antibody 13.90 12.51

86710 Influenza virus antibody 16.73 15.06

86711 John cunningham antibody 17.77 15.99

86713 Legionella antibody 18.89 17.00

86717 Leishmania antibody 15.12 13.61

86720 Leptospira antibody 16.28 14.65

86723 Listeria monocytogenes 16.28 14.65

86727 Lymph choriomeningitis ab 15.89 14.30

86732 Mucormycosis antibody 16.28 14.65

86735 Mumps antibody 16.11 14.50

86738 Mycoplasma antibody 16.34 14.71

86741 Neisseria meningitidis 16.28 14.65

86744 Nocardia antibody 16.28 14.65

86747 Parvovirus antibody 18.56 16.70

86750 Malaria antibody 16.28 14.65

86753 Protozoa antibody nos 15.29 13.76

86756 Respiratory virus antibody 15.91 14.32

86757 Rickettsia antibody 23.90 21.51

86759 Rotavirus antibody 18.23 16.41

86762 Rubella antibody 17.77 15.99

86765 Rubeola antibody 15.90 14.31

86768 Salmonella antibody 16.28 14.65

86771 Shigella antibody 24.48 22.03

86774 Tetanus antibody 18.27 16.44

86777 Toxoplasma antibody 17.77 15.99

86778 Toxoplasma antibody igm 17.78 16.00

18 2/8/2018





86780 Treponema pallidum 16.34 14.71

86784 Trichinella antibody 15.51 13.96

86787 Varicella-zoster antibody 15.90 14.31

86788 West nile virus ab igm 20.80 18.72

86789 West nile virus antibody 17.77 15.99

86790 Virus antibody nos 15.90 14.31

86793 Yersinia antibody 16.28 14.65

86794 Zika virus igm antibody 20.80 18.72

86800 Thyroglobulin antibody 19.64 17.68

86803 Hepatitis c ab test 17.61 15.85

86804 Hep c ab test confirm 19.13 17.22

86805 Lymphocytotoxicity assay 189.51 170.56

86806 Lymphocytotoxicity assay 58.75 52.88

86807 Cytotoxic antibody screening 78.65 70.79

86808 Cytotoxic antibody screening 36.64 32.98

86812 Hla typing a b or c 31.86 28.67

86813 Hla typing a b or c 71.60 64.44

86816 Hla typing dr/dq 34.39 30.95

86817 Hla typing dr/dq 106.14 95.53

86821 Lymphocyte culture mixed 45.14 40.63

86825 Hla x-math non-cytotoxic 109.49 98.54

86826 Hla x-match noncytotoxc addl 36.53 32.88

86828 Hla class i&ii antibody qual 64.19 57.77

86829 Hla class i/ii antibody qual 64.19 57.77

86830 Hla class i phenotype qual 99.68 89.71

86831 Hla class ii phenotype qual 85.44 76.90

86832 Hla class i high defin qual 323.75 291.38

86833 Hla class ii high defin qual 325.80 293.22

86834 Hla class i semiquant panel 441.43 397.29

86835 Hla class ii semiquant panel 398.72 358.85

86849 Unlisted immunology procedure Manual/Unlisted Manual/Unlisted

86850 Rbc antibody screen 9.77 8.79

86860 Antibody elution, (RBC), each elution 29.96 26.96

86870 Antibody identification, RBC antibodies, each panel for each serum technique25.09 22.58

86880 Coombs test direct 6.65 5.99

86885 Coombs test indirect qual 7.07 6.36

86886 Coombs test indirect titer 6.39 5.75

86890 Autologous blood or component, collection processing and storage; predeposited49.24 44.32

86891 Autologous blood or component, collection processing and storage; intra-or postoperative salvage21.31 19.18

86900 Blood typing abo 3.69 3.32

86901 Blood typing rh (d) 3.69 3.32

86902 Blood type antigen donor ea 6.35 5.72

86904 Blood typing patient serum 16.34 14.71

86905 Blood typing rbc antigens 4.73 4.26

86906 Blood typing rh phenotype 9.57 8.61

86920 Compatibility test each unit; immediate spin technique23.83 21.45

86921 Compatibility test each unit; incubation technique23.83 21.45

86922 Compatibility test each unit; antiglobulin technique23.83 21.45

86923 Compatibility test each unit; electronic 12.91 11.62

86927 Fresh frozen plasma, thawing, each unit 9.76 8.78

86930 Frozen blood, each unit; freezing (includes preparation)23.83 21.45

86931 Frozen blood, each unit; thawing 35.96 32.36

86932 Frozen blood, each unit; freezing (includes preparation) and thawing47.65 42.89

86940 Hemolysins/agglutinins auto 10.13 9.12

19 2/8/2018





86941 Hemolysins/agglutinins 14.95 13.46

86945 Irradiation of blood product, each unit 11.71 10.54

86950 Leukocyte transfusion 31.76 28.58

86960 Volume reduction of blood or blood products (eg, red blood cells or platelets), each unit12.91 11.62

86965 Pooling of platelets or other blood products 16.03 14.43

86970 Pretreatment of RBCs for use in RBC antibody detection, identification, and/or compatibility testing; incubation with chemical agents or drugs, each16.03 14.43

86971 Pretreatment of RBCs for use in RBC antibody detection, identification, and/or compatibility testing; incubation with enzymes, each19.51 17.56

86972 Pretreatment of RBCs for use in RBC antibody detection, identification, and/or compatibility testing; by density gradient separation16.03 14.43

86975 Pretreatment of serum for use in RBC antibody identification; incubation with drugs, each16.03 14.43

86976 Pretreatment of serum for use in RBC antibody identification; by dilution16.03 14.43

86977 Pretreatment of serum for use in RBC antibody identification; incubation with inhibitors, each16.03 14.43

86978 Pretreatment of serum for use in RBC antibody identification; by differential red cell absorption using patient RBCs or RBCs of known phenotype, each absorption19.51 17.56

86985 Splitting of blood or blood products, each unit24.59 22.13

86999 Unlisted transfusion medicine procedureManual/Unlisted Manual/Unlisted

87003 Small animal inoculation 20.79 18.71

87015 Specimen infect agnt concntj 8.24 7.42

87040 Blood culture for bacteria 12.74 11.47

87045 Feces culture aerobic bact 11.66 10.49

87046 Stool cultr aerobic bact ea 11.66 10.49

87070 Culture othr specimn aerobic 10.64 9.58

87071 Culture aerobic quant other 11.66 10.49

87073 Culture bacteria anaerobic 11.66 10.49

87075 Cultr bacteria except blood 11.69 10.52

87076 Culture anaerobe ident each 9.97 8.97

87077 Culture aerobic identify 9.97 8.97

87077 QW Culture aerobic identify 9.97 8.97

87081 Culture screen only 8.18 7.36

87084 Culture of specimen by kit 27.07 24.36

87086 Urine culture/colony count 9.96 8.96

87088 Urine bacteria culture 9.99 8.99

87101 Skin fungi culture 9.51 8.56

87102 Fungus isolation culture 10.38 9.34

87103 Blood fungus culture 20.46 18.41

87106 Fungi identification yeast 12.74 11.47

87107 Fungi identification mold 12.74 11.47

87109 Mycoplasma 19.00 17.10

87110 Chlamydia culture 24.19 21.77

87116 Mycobacteria culture 13.34 12.01

87118 Mycobacteric identification 14.61 13.15

87140 Culture type immunofluoresc 6.88 6.19

87143 Culture typing glc/hplc 15.46 13.91

87147 Culture type immunologic 6.39 5.75

87149 Dna/rna direct probe 24.76 22.28

87150 Dna/rna amplified probe 43.33 39.00

87152 Culture type pulse field gel 7.74 6.97

87153 Dna/rna sequencing 142.42 128.18

87158 Culture typing added method 7.74 6.97

87164 Dark field examination 13.26 11.93

87164 26 Dark field examination 12.99 12.99

87166 Dark field examination 13.95 12.56

87168 Macroscopic exam arthropod 5.27 4.74

87169 Macroscopic exam parasite 5.27 4.74

87172 Pinworm exam 5.27 4.74

87176 Tissue homogenization cultr 7.26 6.53

20 2/8/2018





87177 Ova and parasites smears 10.99 9.89

87181 Microbe susceptible diffuse 5.86 5.27

87184 Microbe susceptible disk 8.51 7.66

87185 Microbe susceptible enzyme 5.86 5.27

87186 Microbe susceptible mic 10.67 9.60

87187 Microbe susceptible mlc 40.17 36.15

87188 Microbe suscept macrobroth 8.20 7.38

87190 Microbe suscept mycobacteri 7.31 6.58

87197 Bactericidal level serum 18.55 16.70

87205 Smear gram stain 5.27 4.74

87206 Smear fluorescent/acid stai 6.65 5.99

87207 Smear special stain 7.40 6.66

87207 26 Smear special stain 12.99 12.99

87209 Smear complex stain 22.19 19.97

87210 Smear wet mount saline/ink 5.82 5.24

87210 QW Smear wet mount saline/ink 5.82 5.24

87220 Tissue exam for fungi 5.27 4.74

87230 Assay toxin or antitoxin 24.37 21.93

87250 Virus inoculate eggs/animal 24.15 21.74

87252 Virus inoculation tissue 32.18 28.96

87253 Virus inoculate tissue addl 24.94 22.45

87254 Virus inoculation shell via 24.15 21.74

87255 Genet virus isolate hsv 41.81 37.63

87260 Adenovirus ag if 14.80 13.32

87265 Pertussis ag if 14.80 13.32

87267 Enterovirus antibody dfa 14.80 13.32

87269 Giardia ag if 14.80 13.32

87270 Chlamydia trachomatis ag if 14.80 13.32

87271 Cytomegalovirus dfa 14.80 13.32

87272 Cryptosporidium ag if 14.80 13.32

87273 Herpes simplex 2 ag if 14.80 13.32

87274 Herpes simplex 1 ag if 14.80 13.32

87275 Influenza b ag if 14.80 13.32

87276 Influenza a ag if 16.07 14.46

87278 Legion pneumophilia ag if 15.60 14.04

87279 Parainfluenza ag if 16.43 14.79

87280 Respiratory syncytial ag if 14.80 13.32

87281 Pneumocystis carinii ag if 14.80 13.32

87283 Rubeola ag if 60.80 54.72

87285 Treponema pallidum ag if 14.80 13.32

87290 Varicella zoster ag if 14.80 13.32

87299 Antibody detection nos if 16.10 14.49

87300 Ag detection polyval if 14.80 13.32

87301 Adenovirus ag eia 14.80 13.32

87305 Aspergillus ag eia 14.80 13.32

87320 Chylmd trach ag eia 15.00 13.50

87324 Clostridium ag eia 14.80 13.32

87327 Cryptococcus neoform ag eia 14.80 13.32

87328 Cryptosporidium ag eia 14.80 13.32

87329 Giardia ag eia 14.80 13.32

87332 Cytomegalovirus ag eia 14.80 13.32

87335 E coli 0157 ag eia 14.80 13.32

87336 Entamoeb hist dispr ag eia 16.00 14.40

87337 Entamoeb hist group ag eia 14.80 13.32

21 2/8/2018





87338 Hpylori stool eia 17.76 15.98

87339 H pylori ag eia 16.00 14.40

87340 Hepatitis b surface ag eia 12.75 11.48

87341 Hepatitis b surface ag eia 12.75 11.48

87350 Hepatitis be ag eia 14.23 12.81

87380 Hepatitis delta ag eia 20.26 18.23

87385 Histoplasma capsul ag eia 14.80 13.32

87389 Hiv-1 ag w/hiv-1 & hiv-2 ab 29.73 26.76

87390 Hiv-1 ag eia 24.06 21.65

87391 Hiv-2 ag eia 21.90 19.71

87400 Influenza a/b ag eia 14.80 13.32

87420 Resp syncytial ag eia 14.80 13.32

87425 Rotavirus ag eia 14.80 13.32

87427 Shiga-like toxin ag eia 14.80 13.32

87430 Strep a ag eia 16.81 15.13

87449 Ag detect nos eia mult 14.80 13.32

87449 QW Ag detect nos eia mult 14.80 13.32

87450 Ag detect nos eia single 11.84 10.66

87451 Ag detect polyval eia mult 11.84 10.66

87471 Bartonella dna amp probe 43.33 39.00

87472 Bartonella dna quant 52.88 47.59

87475 Lyme dis dna dir probe 24.76 22.28

87476 Lyme dis dna amp probe 43.33 39.00

87480 Candida dna dir probe 24.76 22.28

87481 Candida dna amp probe 43.33 39.00

87482 Candida dna quant 55.74 50.17

87483 Cns dna amp probe type 12-25 514.55 463.10

87485 Chylmd pneum dna dir probe 24.76 22.28

87486 Chylmd pneum dna amp probe 43.33 39.00

87487 Chylmd pneum dna quant 52.88 47.59

87490 Chylmd trach dna dir probe 24.76 22.28

87491 Chylmd trach dna amp probe 43.33 39.00

87492 Chylmd trach dna quant 53.47 48.12

87493 C diff amplified probe 43.33 39.00

87495 Cytomeg dna dir probe 30.03 27.03

87496 Cytomeg dna amp probe 43.33 39.00

87497 Cytomeg dna quant 52.88 47.59

87498 Enterovirus probe&revrs trns 43.33 39.00

87500 Vanomycin dna amp probe 43.33 39.00

87501 Influenza dna amp prob 1+ 63.35 57.02

87502 Influenza dna amp probe 105.06 94.55

87503 Influenza dna amp prob addl 29.22 26.30

87505 Nfct agent detection gi 158.38 142.54

87506 Iadna-dna/rna probe tq 6-11 263.49 237.14

87507 Iadna-dna/rna probe tq 12-25 514.55 463.10

87510 Gardner vag dna dir probe 24.76 22.28

87511 Gardner vag dna amp probe 43.33 39.00

87512 Gardner vag dna quant 51.55 46.40

87516 Hepatitis b dna amp probe 43.33 39.00

87517 Hepatitis b dna quant 52.88 47.59

87520 Hepatitis c rna dir probe 31.22 28.10

87521 Hepatitis c probe&rvrs trnsc 43.33 39.00

87522 Hepatitis c revrs trnscrpj 52.88 47.59

87525 Hepatitis g dna dir probe 29.80 26.82

22 2/8/2018





87526 Hepatitis g dna amp probe 43.33 39.00

87527 Hepatitis g dna quant 51.55 46.40

87528 Hsv dna dir probe 24.76 22.28

87529 Hsv dna amp probe 43.33 39.00

87530 Hsv dna quant 52.88 47.59

87531 Hhv-6 dna dir probe 58.00 52.20

87532 Hhv-6 dna amp probe 43.33 39.00

87533 Hhv-6 dna quant 51.55 46.40

87534 Hiv-1 dna dir probe 24.76 22.28

87535 Hiv-1 probe&reverse trnscrpj 43.33 39.00

87536 Hiv-1 quant&revrse trnscrpj 105.06 94.55

87537 Hiv-2 dna dir probe 24.76 22.28

87538 Hiv-2 probe&revrse trnscripj 43.33 39.00

87539 Hiv-2 quant&revrse trnscripj 58.62 52.76

87540 Legion pneumo dna dir prob 24.76 22.28

87541 Legion pneumo dna amp prob 43.33 39.00

87542 Legion pneumo dna quant 51.55 46.40

87550 Mycobacteria dna dir probe 24.76 22.28

87551 Mycobacteria dna amp probe 48.24 43.42

87552 Mycobacteria dna quant 52.88 47.59

87555 M.tuberculo dna dir probe 26.88 24.19

87556 M.tuberculo dna amp probe 43.33 39.00

87557 M.tuberculo dna quant 52.88 47.59

87560 M.avium-intra dna dir prob 27.29 24.56

87561 M.avium-intra dna amp prob 43.33 39.00

87562 M.avium-intra dna quant 52.88 47.59

87580 M.pneumon dna dir probe 24.76 22.28

87581 M.pneumon dna amp probe 43.33 39.00

87582 M.pneumon dna quant 302.62 272.36

87590 N.gonorrhoeae dna dir prob 26.88 24.19

87591 N.gonorrhoeae dna amp prob 43.33 39.00

87592 N.gonorrhoeae dna quant 52.88 47.59

87623 Hpv low-risk types 43.33 39.00

87624 Hpv high-risk types 43.33 39.00

87625 Hpv types 16 & 18 only 43.33 39.00

87631 Resp virus 3-11 targets 158.38 142.54



87634 Rsv dna/rna amp probe 86.66 77.99

87640 Staph a dna amp probe 43.33 39.00

87641 Mr-staph dna amp probe 43.33 39.00

87650 Strep a dna dir probe 24.76 22.28

87651 Strep a dna amp probe 43.33 39.00

87652 Strep a dna quant 51.55 46.40

87653 Strep b dna amp probe 43.33 39.00

87660 Trichomonas vagin dir probe 24.76 22.28

87661 Trichomonas vaginalis amplif 43.33 39.00

87662 Zika virus dna/rna amp probe 63.35 57.02

87797 Detect agent nos dna dir 30.03 27.03

87798 Detect agent nos dna amp 43.33 39.00

87799 Detect agent nos dna quant 52.88 47.59

87800 Detect agnt mult dna direc 49.53 44.58

87801 Detect agnt mult dna ampli 86.66 77.99

87802 Strep b assay w/optic 14.80 13.32

23 2/8/2018





87803 Clostridium toxin a w/optic 16.00 14.40

87804 Influenza assay w/optic 16.55 14.90

87804 QW Influenza assay w/optic 16.55 14.90

87806 Hiv antigen w/hiv antibodies 32.77 29.49

87807 Rsv assay w/optic 14.80 13.32

87807 QW Rsv assay w/optic 14.80 13.32

87808 Trichomonas assay w/optic 15.29 13.76

87808 QW Trichomonas assay w/optic 15.29 13.76

87809 Adenovirus assay w/optic 21.76 19.58

87809 QW Adenovirus assay w/optic 21.76 19.58

87810 Chylmd trach assay w/optic 35.29 31.76

87850 N. gonorrhoeae assay w/optic 24.56 22.10

87880 Strep a assay w/optic 16.53 14.88

87880 QW Strep a assay w/optic 16.53 14.88

87899 Agent nos assay w/optic 16.07 14.46

87899 QW Agent nos assay w/optic 16.07 14.46

87900 Phenotype infect agent drug 160.92 144.83

87901 Genotype dna hiv reverse t 317.84 286.06

87902 Genotype dna/rna hep c 317.84 286.06

87903 Phenotype dna hiv w/culture 603.28 542.95

87904 Phenotype dna hiv w/clt add 32.18 28.96

87906 Genotype dna/rna hiv 158.92 143.03

87910 Genotype cytomegalovirus 317.84 286.06

87912 Genotype dna hepatitis b 317.84 286.06

87999 Unlisted microbiology procedureManual/Unlisted Manual/Unlisted

88104 Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation48.63 48.63

88104 26 Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation20.58 20.58

88104 TC Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation28.05 28.05

88106 Cytopathology, fluids, washings or brushings, except cervical or vaginal; simple filter method with interpretation42.86 42.86

88106 26 Cytopathology, fluids, washings or brushings, except cervical or vaginal; simple filter method with interpretation14.13 14.13

88106 TC Cytopathology, fluids, washings or brushings, except cervical or vaginal; simple filter method with interpretation28.73 28.73

88108 Cytopathology, concentration technique, smears and interpretation40.79 40.79

88108 26 Cytopathology, concentration technique, smears and interpretation16.38 16.38

88108 TC Cytopathology, concentration technique, smears and interpretation24.42 24.42

88112 Cytopathology, selective cellular enhancement technique with interpretation, except cervical or vaginal46.14 46.14

88112 26 Cytopathology, selective cellular enhancement technique with interpretation, except cervical or vaginal20.36 20.36

88112 TC Cytopathology, selective cellular enhancement technique with interpretation, except cervical or vaginal25.78 25.78

88120 Cytopathology, in situ hybridization (eg, FISH)413.97 413.97

88120 26 Cytopathology, in situ hybridization (eg, FISH)42.20 42.20

88120 TC Cytopathology, in situ hybridization (eg, FISH)371.78 371.78

88121 Cytopathology, in situ hybridization (eg, FISH), urinary tract specimen with morphometric analysis, 3-5 molecular probes, each specimen; using computer-assisted technology345.03 345.03

88121 26 Cytopathology, in situ hybridization (eg, FISH), urinary tract specimen with morphometric analysis, 3-5 molecular probes, each specimen; using computer-assisted technology36.05 36.05

88121 TC Cytopathology, in situ hybridization (eg, FISH), urinary tract specimen with morphometric analysis, 3-5 molecular probes, each specimen; using computer-assisted technology308.98 308.98

88125 Cytopathology, forensic (eg, sperm) 18.24 18.24

88125 26 Cytopathology, forensic (eg, sperm) 10.18 10.18

88125 TC Cytopathology, forensic (eg, sperm) 8.07 8.07

88130 Sex chromatin identification 22.19 19.97

88140 Sex chromatin identification 9.86 8.87

88141 Cytopathology, cervical or vaginal (any reporting system), requiring interpretation by physician22.34 22.34

88142 Cytopath c/v thin layer 25.01 22.51

88143 Cytopath c/v thin layer redo 25.01 22.51

88147 Cytopath c/v automated 50.56 45.50

88148 Cytopath c/v auto rescreen 18.76 16.88

88150 Cytopath c/v manual 14.65 13.19

24 2/8/2018





88152 Cytopath c/v auto redo 27.64 24.88

88153 Cytopath c/v redo 24.03 21.63

88155 Cytopath c/v index add-on 14.65 13.19

88160 Cytopathology, smears, any other source; screening and interpretation48.46 48.46

88160 26 Cytopathology, smears, any other source; screening and interpretation18.82 18.82

88160 TC Cytopathology, smears, any other source; screening and interpretation29.64 29.64

88161 Cytopathology, smears, any other source; preparation, screening and interpretation44.15 44.15

88161 26 Cytopathology, smears, any other source; preparation, screening and interpretation18.14 18.14

88161 TC Cytopathology, smears, any other source; preparation, screening and interpretation26.01 26.01

88162 Cytopathology, smears, any other source; extended study involving over 5 slides and/or multiple stains65.11 65.11

88162 26 Cytopathology, smears, any other source; extended study involving over 5 slides and/or multiple stains28.09 28.09

88162 TC Cytopathology, smears, any other source; extended study involving over 5 slides and/or multiple stains37.02 37.02

88164 Cytopath tbs c/v manual 14.65 13.19

88165 Cytopath tbs c/v redo 42.22 38.00

88166 Cytopath tbs c/v auto redo 14.65 13.19

88167 Cytopath tbs c/v select 14.65 13.19

88172 Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy of specimen(s)39.59 39.59

88172 26 Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy of specimen(s)26.30 26.30

88172 TC Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy of specimen(s)13.29 13.29

88173 Cytopathology, evaluation of fine needle aspirate; interpretation and report104.30 104.30

88173 26 Cytopathology, evaluation of fine needle aspirate; interpretation and report51.60 51.60

88173 TC Cytopathology, evaluation of fine needle aspirate; interpretation and report52.69 52.69

88174 Cytopath c/v auto in fluid 26.38 23.74

88175 Cytopath c/v auto fluid redo 32.71 29.44

88177 Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy for diagnosis, each separate additional evaluation episode, same site (list sperately in addition to code for primary procedure)21.09 21.09

88177 26 Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy for diagnosis, each separate additional evaluation episode, same site (list sperately in addition to code for primary procedure16.09 16.09

88177 TC Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy for diagnosis, each separate additional evaluation episode, same site (list sperately in addition to code for primary procedure5.00 5.00

88182 Flow cytometry, cell cycle or DNA analysis 87.29 87.29

88182 26 Flow cytometry, cell cycle or DNA analysis 28.12 28.12

88182 TC Flow cytometry, cell cycle or DNA analysis 59.17 59.17

88184 Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; first marker43.16 43.16

88185 each additional marker (List separately in addition to code for first marker)19.30 19.30

88187 Flow cytometry, interpretation; 2 to 8 markers33.03 33.03

88188 Flow cytometry, interpretation; 9 to 15 markers46.18 46.18

88189 Flow cytometry, interpretation; 16 or more markers61.94 61.94

88199 Unlisted cytopathology procedureManual/Unlisted Manual/Unlisted

88199 26 Unlisted cytopathology procedureManual/Unlisted Manual/Unlisted

88199 TC Unlisted cytopathology procedureManual/Unlisted Manual/Unlisted

88230 Tissue culture lymphocyte 143.82 129.44

88233 Tissue culture skin/biopsy 173.74 156.37

88235 Tissue culture placenta 181.81 163.63

88237 Tissue culture bone marrow 155.93 140.34

88239 Tissue culture tumor 182.12 163.91

88240 Cell cryopreserve/storage 13.07 11.76

88241 Frozen cell preparation 12.47 11.22

88245 Chromosome analysis 20-25 213.80 192.42


88249 Chromosome analysis 100 213.80 192.42





88267 Chromosome analys placenta 221.95 199.76

88269 Chromosome analys amniotic 205.34 184.81

25 2/8/2018





88271 Cytogenetics dna probe 26.44 23.80

88272 Cytogenetics 3-5 40.70 36.63

88273 Cytogenetics 10-30 39.66 35.69

88274 Cytogenetics 25-99 42.98 38.68

88275 Cytogenetics 100-300 51.19 46.07

88280 Chromosome karyotype study 33.47 30.12

88283 Chromosome banding study 84.69 76.22

88285 Chromosome count additional 26.91 24.22

88289 Chromosome study additional 42.51 38.26

88291 Cytogenetics and molecular cytogenetics, interpretation and report23.08 23.08

88299 Unlisted cytogenetic study Manual/Unlisted Manual/Unlisted

88300 Level I-Surgical pathology, gross examination only11.14 11.14

88300 26 Level I-Surgical pathology, gross examination only3.30 3.30

88300 TC Level I-Surgical pathology, gross examination only7.84 7.84

88302 Level II- Surgical pathology, gross and microscopic examination20.59 20.59

88302 26 Level II- Surgical pathology, gross and microscopic examination5.26 5.26

88302 TC Level II- Surgical pathology, gross and microscopic examination15.33 15.33

88304 Level III- Surgical pathology, gross and microscopic examination27.21 27.21

88304 26 Level III- Surgical pathology, gross and microscopic examination8.47 8.47

88304 TC Level III -Surgical pathology, gross and microscopic examination18.74 18.74

88305 Level IV- Surgical pathology, gross and microscopic examination46.80 46.80

88305 26 Level IV- Surgical pathology, gross and microscopic examination27.61 27.61

88305 TC Level IV -Surgical pathology, gross and microscopic examination19.19 19.19

88307 Level V- Surgical pathology, gross and microscopic examination175.62 175.62

88307 26 Level V- Surgical pathology, gross and microscopic examination60.47 60.47

88307 TC Level V- Surgical pathology, gross and microscopic examination115.15 115.15

88309 Level VI- Surgical pathology, gross and microscopic examination267.92 267.92

88309 26 Level VI- Surgical pathology, gross and microscopic examination107.24 107.24

88309 TC Level VI- Surgical pathology, gross and microscopic examination160.69 160.69

88311 Decalcification procedure (List separately in addition to code for surgical pathology examination)15.23 15.23

88311 26 Decalcification procedure (List separately in addition to code for surgical pathology examination)9.21 9.21

88311 TC Decalcification procedure (List separately in addition to code for surgical pathology examination)6.02 6.02

88312 Special stains (List separately in addition to code for primary service); Group I for microorganisms, each64.47 64.47

88312 26 Special stains (List separately in addition to code for primary service); Group I for microorganisms, each19.39 19.39

88312 TC Special stains (list separately in addition to code for primary service); Group I for microorganisms (eg, Gridley, acid fast, methenamine silver), each45.08 45.08

88313 Group II, all other, except immunocytochemistry and immunoperoxidase stains, each46.35 46.35

88313 26 Group II, all other, except immunocytochemistry and immunoperoxidase stains, each8.76 8.76

88313 TC Special stains (list separately in addition to code for primary service); Group II, all other, (eg, iron, trichrome), except immunocytochemistry and immunoperoxidase stains, each37.59 37.59

88314 histochemical staining with frozen section(s)56.49 56.49

88314 26 histochemical staining with frozen section(s)16.41 16.41

88314 TC Special stains; histochemical staining with frozen section(s)40.09 40.09

88319 Determinative histochemistry or cytochemistry to identify enzyme constituents, each58.54 58.54

88319 26 Determinative histochemistry or cytochemistry to identify enzyme constituents, each19.36 19.36

88319 TC Determinative histochemistry or cytochemistry to identify enzyme constituents, each39.18 39.18

88321 Consultation and report on referred slides prepared elsewhere71.95 71.95

88323 Consultation and report on referred material requiring preparation of slides84.56 84.56

88323 26 Consultation and report on referred material requiring preparation of slides63.32 63.32

88323 TC Consultation and report on referred material requiring preparation of slides21.24 21.24

88325 Consultation, comprehensive, with review of records and specimens, with report on referred material129.55 129.55

88329 Pathology consultation during surgery 36.01 36.01

88331 Pathology consultation during surgery; first tissue block, with frozen section(s), single specimen66.81 66.81

88331 26 Pathology consultation during surgery; first tissue block, with frozen section(s), single specimen45.80 45.80

88331 TC Pathology consultation during surgery; first tissue block, with frozen section(s), single specimen21.01 21.01

88332 Pathology consultation during surgery; each additional tissue block with frozen section(s)36.23 36.23

26 2/8/2018





88332 26 Pathology consultation during surgery; each additional tissue block with frozen section(s)22.49 22.49

88332 TC Pathology consultation during surgery; each additional tissue block with frozen section(s)13.74 13.74

88333 Pathology consultation during surgery; cytologic examination, initial site61.84 61.84

88333 26 Pathology consultation during surgery; cytologic examination, initial site45.83 45.83

88333 TC Pathology consultation during surgery; cytologic examination, initial site16.01 16.01

88334 Pathology consultation during surgery; cytologic examination, each additional site38.22 38.22

88334 26 Pathology consultation during surgery; cytologic examination, each additional site28.00 28.00

88334 TC Pathology consultation during surgery; cytologic examination, each additional site10.22 10.22

88341 Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure61.46 61.46

88341 26 Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure20.58 20.58

88341 TC Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure40.88 40.88

88342 Immunohistochemistry (including tissue immunoperoxidase), each antibody72.77 72.77

88342 26 Immunohistochemistry (including tissue immunoperoxidase), each antibody25.87 25.87

88342 TC Immunohistochemistry (including tissue immunoperoxidase), each antibody46.90 46.90

88344 Immunohistochemistry or immunocytochemistry, per specimen; each multiplex antibody stain procedure115.22 115.22

88344 26 Immunohistochemistry or immunocytochemistry, per specimen; each multiplex antibody stain procedure28.35 28.35

88344 TC Immunohistochemistry or immunocytochemistry, per specimen; each multiplex antibody stain procedure86.87 86.87

88346 Immunofluorescence, per specimen; initial single antibody stain procedure62.78 62.78

88346 26 Immunofluorescence, per specimen; initial single antibody stain procedure26.10 26.10

88346 TC Immunofluorescence, per specimen; initial single antibody stain procedure36.68 36.68

88348 Electron microscopy; diagnostic 228.76 228.76

88348 26 Electron microscopy; diagnostic 55.13 55.13

88348 TC Electron microscopy; diagnostic 173.64 173.64

88350 Immunofluorescence, per specimen; each additional single antibody stain procedure48.38 48.38

88350 26 Immunofluorescence, per specimen; each additional single antibody stain procedure20.90 20.90

88350 TC Immunofluorescence, per specimen; each additional single antibody stain procedure27.48 27.48

88355 Morphometric analysis; skeletal muscle 90.29 90.29

88355 26 Morphometric analysis; skeletal muscle 59.51 59.51

88355 TC Morphometric analysis; skeletal muscle 30.78 30.78

88356 Morphometric analysis; nerve 151.19 151.19

88356 26 Morphometric analysis; nerve 90.43 90.43

88356 TC Morphometric analysis; nerve 60.76 60.76

88358 Morphometric analysis; tumor 64.18 64.18

88358 26 Morphometric analysis; tumor 33.86 33.86

88358 TC Morphometric analysis; tumor 30.32 30.32

88360 Morphometric analysis, tumor immunohistochemistry, quantitative or semiquantitative, each antibody; manual88.88 88.88

88360 26 Morphometric analysis, tumor immunohistochemistry, quantitative or semiquantitative, each antibody; manual32.21 32.21

88360 TC Morphometric analysis, tumor immunohistochemistry, quantitative or semiquantitative, each antibody; manual56.67 56.67

88361 Morphometric analysis, tumor immunohistochemistry, quantitative or semiquantitative, each antibody; using computer-assisted technology96.66 96.66

88361 26 Morphometric analysis, tumor immunohistochemistry, quantitative or semiquantitative, each antibody; using computer-assisted technology34.32 34.32

88361 TC Morphometric analysis, tumor immunohistochemistry, quantitative or semiquantitative, each antibody; using computer-assisted technology62.34 62.34

88362 Nerve teasing preparations 141.99 141.99

88362 26 Nerve teasing preparations 80.21 80.21

88362 TC Nerve teasing preparations 61.78 61.78

88363 Examination and selection of retrieved archival (ie, previously diagnosed) tissue (s) for molecular analysis (eg, KRAS mutational analysis)16.74 16.74

88364 In situ hybridization (eg, FISH), per specimen; each additional single probe stain procedure87.54 87.54

88364 26 In situ hybridization (eg, FISH), per specimen; each additional single probe stain procedure25.42 25.42

88364 TC In situ hybridization (eg, FISH), per specimen; each additional single probe stain procedure62.12 62.12

88365 In situ hybridization, each probe 118.71 118.71

88365 26 In situ hybridization, each probe 32.07 32.07

88365 TC In situ hybridization, each probe 86.64 86.64

88366 In situ hybridization (eg, FISH), per specimen; each multiplex probe stain procedure173.24 173.24

88366 26 In situ hybridization (eg, FISH), per specimen; each multiplex probe stain procedure45.26 45.26

88366 TC In situ hybridization (eg, FISH), per specimen; each multiplex probe stain procedure127.98 127.98

27 2/8/2018





88367 Morphmetric analysis, in situ hybridization (quantitative or semi-quantitative) each probe; using computer-assisted technology71.38 71.38

88367 26 Morphmetric analysis, in situ hybridization (quantitative or semi-quantitative) each probe; using computer-assisted technology25.16 25.16

88367 TC Morphmetric analysis, in situ hybridization (quantitative or semi-quantitative) each probe; using computer-assisted technology46.22 46.22

88368 Morphmetric analysis, in situ hybridization (quantitative or semi-quantitative) each probe; manual80.79 80.79

88368 26 Morphmetric analysis, in situ hybridization (quantitative or semi-quantitative) each probe; manual30.25 30.25

88368 TC Morphmetric analysis, in situ hybridization (quantitative or semi-quantitative) each probe; manual50.53 50.53

88369 Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), manual, per specimen; each additional single probe stain procedure72.66 72.66

88369 26 Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), manual, per specimen; each additional single probe stain procedure23.49 23.49

88369 TC Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), manual, per specimen; each additional single probe stain procedure49.17 49.17

88371 Protein western blot tissue 27.44 24.70

88371 26 Protein western blot tissue 12.99 12.99

88372 Protein analysis w/probe 28.08 25.27

88372 26 Protein analysis w/probe 12.99 12.99

88373 Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), using computer-assisted technology, per specimen; each additional single probe stain procedure52.44 52.44

88373 26 Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), using computer-assisted technology, per specimen; each additional single probe stain procedure19.96 19.96

88373 TC Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), using computer-assisted technology, per specimen; each additional single probe stain procedure32.48 32.48

88374 Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), using computer-assisted technology, per specimen; each multiplex probe stain procedure224.57 224.57

88374 26 Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), using computer-assisted technology, per specimen; each multiplex probe stain procedure31.87 31.87

88374 TC Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), using computer-assisted technology, per specimen; each multiplex probe stain procedure192.70 192.70

88377 Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), manual, per specimen; each multiplex probe stain procedure267.95 267.95

88377 26 Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), manual, per specimen; each multiplex probe stain procedure46.52 46.52

88377 TC Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), manual, per specimen; each multiplex probe stain procedure221.43 221.43

88380 Microdissection; laser capture 92.10 92.10

88380 26 Microdissection; laser capture 39.86 39.86

88380 TC Microdissection; laser capture 52.24 52.24

88381 Microdissection; manual 80.69 80.69

88381 26 Microdissection; manual 18.23 18.23

88381 TC Microdissection; manual 62.46 62.46

88387 Macroscopic examination, dissection, and preparation of tissue for non-microscopic analytical studies (eg, nucleic acid-based molecular studies); each tissue preparation (eg, a single lymph node)24.62 24.62

88387 26 Macroscopic examination, dissection, and preparation of tissue for non-microscopic analytical studies (eg, nucleic acid-based molecular studies); each tissue preparation (eg, a single lymph node)20.65 20.65

88387 TC Macroscopic examination, dissection, and preparation of tissue for non-microscopic analytical studies (eg, nucleic acid-based molecular studies); each tissue preparation (eg, a single lymph node)3.98 3.98

88388 Macroscopic examination, dissection, and preparation of tissue for non-microscopic analytical studies; in conjuction with a touch imprint, intraoperative consultation, or frozen section, each tissue preparation (eg, a single lymph node) (List separately in addition to code for primary procedure)23.79 23.79

88388 26 Macroscopic examination, dissection, and preparation of tissue for non-microscopic analytical studies; in conjuction with a touch imprint, intraoperative consultation, or frozen section, each tissue preparation (eg, a single lymph node) (List separately in addition to code for primary procedure)17.31 17.31

88388 TC Macroscopic examination, dissection, and preparation of tissue for non-microscopic analytical studies; in conjuction with a touch imprint, intraoperative consultation, or frozen section, each tissue preparation (eg, a single lymph node) (List separately in addition to code for primary procedure)6.48 6.48

88399 Unlisted surgical pathology procedureManual/Unlisted Manual/Unlisted

88399 26 Unlisted surgical pathology procedureManual/Unlisted Manual/Unlisted

88399 TC Unlisted surgical pathology procedureManual/Unlisted Manual/Unlisted

88720 Bilirubin total transcut 6.19 5.57

88738 Hgb quant transcutaneous 6.19 5.57

88740 Transcutaneous carboxyhb 9.37 8.43

88741 Transcutaneous methb 9.37 8.43

89049 Caffeine halothane contracture test (CHCT) for malignant hyperthermia susceptibility, including interpretation and report162.03 162.03

89050 Body fluid cell count 5.83 5.25

89051 Body fluid cell count 6.80 6.12

89055 Leukocyte assessment fecal 5.27 4.74

89060 Exam synovial fluid crystals 8.83 7.95

89060 26 Exam synovial fluid crystals 12.99 12.99

89125 Specimen fat stain 5.88 5.29

89160 Exam feces for meat fibers 4.85 4.37

89190 Nasal smear for eosinophils 5.86 5.27

89220 Sputum, obtaining specimen, aerosol induced technique (separate procedure)10.56 10.56

89230 Sweat collection by iontophoresis 2.39 2.39

89240 Unlisted miscellaneous pathology testManual/Unlisted Manual/Unlisted

89310 Semen analysis w/count 10.63 9.57

28 2/8/2018





0008M Onc breast risk score 3,443.36 3,099.02

0009M Fetal aneuploidy trisom risk 602.10 541.89

G0480 Drug test def 1-7 classes 114.43 102.99



G0483 Drug test def 22+ classes 246.92 222.23

G0659 Drug test def simple all cl 71.83 64.65

P7001 Culture, bacterial, urine; quantitative, sensitivity study16.67 15.00

P9612 Catheterize for urine spec 3.00 2.70

29 2/8/2018