Procedure Current Code Description Pricing Description ... · 80346 Benzodiazepines1-12 16.68...
Transcript of Procedure Current Code Description Pricing Description ... · 80346 Benzodiazepines1-12 16.68...
Pathology and Laboratory
Codes and Rates
Procedure
CodeCode Description
Current
RatePricing Description
80047 Metabolic panel ionized ca 22.46 General Fee Schedule
80048 Metabolic panel total ca 10.91 General Fee Schedule
80050 General health panel 44.49 General Fee Schedule
80051 Electrolyte panel 9.03 General Fee Schedule
80053 Comprehen metabolic panel 13.64 General Fee Schedule
80055 Obstetric panel 31.68 General Fee Schedule
80061 Lipid panel 17.27 General Fee Schedule
80069 Renal function panel 11.19 General Fee Schedule
80074 Acute hepatitis panel 61.40 General Fee Schedule
80076 Hepatic function panel 10.54 General Fee Schedule
80150 Assay of amikacin 19.43 General Fee Schedule
80155 Drug screen quant caffeine 14.84 General Fee Schedule
80156 Assay carbamazepine total 18.77 General Fee Schedule
80157 Assay carbamazepine free 12.82 General Fee Schedule
80158 Assay of cyclosporine 23.27 General Fee Schedule
80159 Drug screen quant clozapine 19.40 General Fee Schedule
80162 Assay of digoxin total 17.11 General Fee Schedule
80163 Assay of digoxin free 17.11 General Fee Schedule
80164 Assay dipropylacetic acd tot 17.45 General Fee Schedule
80165 Dipropylacetic acid free 17.45 General Fee Schedule
80168 Assay of ethosuximide 21.05 General Fee Schedule
80169 Drug screen quant everolimus 14.40 General Fee Schedule
80170 Assay of gentamicin 21.12 General Fee Schedule
80171 Drug screen quant gabapentin 13.91 General Fee Schedule
80173 Assay of haloperidol 18.77 General Fee Schedule
80175 Drug screen quan lamotrigine 13.91 General Fee Schedule
80176 Assay of lidocaine 18.93 General Fee Schedule
80177 Drug scrn quan levetiracetam 13.91 General Fee Schedule
80178 Assay of lithium 8.52 General Fee Schedule
80180 Drug scrn quan mycophenolate 18.93 General Fee Schedule
80183 Drug scrn quant oxcarbazepin 13.91 General Fee Schedule
80184 Assay of phenobarbital 14.70 General Fee Schedule
80185 Assay of phenytoin total 17.07 General Fee Schedule
80186 Assay of phenytoin free 17.76 General Fee Schedule
80188 Assay of primidone 21.39 General Fee Schedule
80190 Assay of procainamide 21.59 General Fee Schedule
80192 Assay of procainamide 21.59 General Fee Schedule
80194 Assay of quinidine 18.82 General Fee Schedule
80195 Assay of sirolimus 13.37 General Fee Schedule
80197 Assay of tacrolimus 17.71 General Fee Schedule
80198 Assay of theophylline 18.25 General Fee Schedule
80199 Drug screen quant tiagabine 19.03 General Fee Schedule
80200 Assay of tobramycin 20.79 General Fee Schedule
80201 Assay of topiramate 15.38 General Fee Schedule
80202 Assay of vancomycin 17.45 General Fee Schedule
80203 Drug screen quant zonisamide 13.91 General Fee Schedule
80299 Quantitative assay drug 17.65 General Fee Schedule
80300 Drug screen non tlc devices 13.61 General Fee Schedule
80301 Drug screen class list a 13.61 General Fee Schedule
80302 Drug screen prsmptv 1 class 13.61 General Fee Schedule
Data for November 2015
Pathology and Laboratory
Codes and Rates
Procedure
CodeCode Description
Current
RatePricing Description
80303 Drug screen one/mult class 15.40 General Fee Schedule
80304 Drug screen one/mult class 15.13 General Fee Schedule
80320 Drug screen quantalcohols 16.68 General Fee Schedule
80321 Alcohols biomarkers 1or 2 16.68 General Fee Schedule
80322 Alcohols biomarkers 3/more 16.68 General Fee Schedule
80323 Alkaloids nos 16.68 General Fee Schedule
80324 Drug screen amphetamines 1/2 16.68 General Fee Schedule
80325 Amphetamines 3or 4 16.68 General Fee Schedule
80326 Amphetamines 5 or more 16.68 General Fee Schedule
80327 Anabolic steroid 1 or 2 16.68 General Fee Schedule
80328 Anabolic steroid 3 or more 16.68 General Fee Schedule
80329 Analgesics non-opioid 1 or 2 16.68 General Fee Schedule
80330 Analgesics non-opioid 3-5 16.68 General Fee Schedule
80331 Analgesics non-opioid 6/more 16.68 General Fee Schedule
80332 Antidepressants class 1 or 2 16.68 General Fee Schedule
80333 Antidepressants class 3-5 16.68 General Fee Schedule
80334 Antidepressants class 6/more 16.68 General Fee Schedule
80335 Antidepressant tricyclic 1/2 16.68 General Fee Schedule
80336 Antidepressant tricyclic 3-5 16.68 General Fee Schedule
80337 Tricyclic & cyclicals 6/more 16.68 General Fee Schedule
80338 Antidepressant not specified 16.68 General Fee Schedule
80339 Antiepileptics nos 1-3 16.68 General Fee Schedule
80340 Antiepileptics nos 4-6 16.68 General Fee Schedule
80341 Antiepileptics nos 7/more 16.68 General Fee Schedule
80342 Antipsychotics nos 1-3 16.68 General Fee Schedule
80343 Antipsychotics nos 4-6 16.68 General Fee Schedule
80344 Antipsychotics nos 7/more 16.68 General Fee Schedule
80345 Drug screening barbiturates 16.68 General Fee Schedule
80346 Benzodiazepines1-12 16.68 General Fee Schedule
80347 Benzodiazepines 13 or more 16.68 General Fee Schedule
80348 Drug screening buprenorphine 16.68 General Fee Schedule
80349 Cannabinoids natural 16.68 General Fee Schedule
80350 Cannabinoids synthetic 1-3 16.68 General Fee Schedule
80351 Cannabinoids synthetic 4-6 16.68 General Fee Schedule
80352 Cannabinoid synthetic 7/more 16.68 General Fee Schedule
80353 Drug screening cocaine 16.68 General Fee Schedule
80354 Drug screening fentanyl 16.68 General Fee Schedule
80355 Gabapentin non-blood 16.68 General Fee Schedule
80356 Heroin metabolite 16.68 General Fee Schedule
80357 Ketamine and norketamine 16.68 General Fee Schedule
80358 Drug screening methadone 16.68 General Fee Schedule
80359 Methylenedioxyamphetamines 16.68 General Fee Schedule
80360 Methylphenidate 16.68 General Fee Schedule
80361 Opiates 1 or more 16.68 General Fee Schedule
80362 Opioids & opiate analogs 1/2 16.68 General Fee Schedule
80363 Opioids & opiate analogs 3/4 16.68 General Fee Schedule
80364 Opioid &opiate analog 5/more 16.68 General Fee Schedule
80365 Drug screening oxycodone 16.68 General Fee Schedule
80366 Drug screening pregabalin 16.68 General Fee Schedule
80367 Drug screening propoxyphene 16.68 General Fee Schedule
Data for November 2015
Pathology and Laboratory
Codes and Rates
Procedure
CodeCode Description
Current
RatePricing Description
80368 Sedative hypnotics 16.68 General Fee Schedule
80369 Skeletal muscle relaxant 1/2 16.68 General Fee Schedule
80370 Skel musc relaxant 3 or more 16.68 General Fee Schedule
80371 Stimulants synthetic 16.68 General Fee Schedule
80372 Drug screening tapentadol 16.68 General Fee Schedule
80373 Drug screening tramadol 16.68 General Fee Schedule
80374 Stereoisomer analysis 16.68 General Fee Schedule
80375 Drug/substance nos 1-3 16.68 General Fee Schedule
80376 Drug/substance nos 4-6 16.68 General Fee Schedule
80377 Drug/substance nos 7/more 16.68 General Fee Schedule
80400 Acth stimulation panel 42.03 General Fee Schedule
80402 Acth stimulation panel 112.06 General Fee Schedule
80406 Acth stimulation panel 80.47 General Fee Schedule
80408 Aldosterone suppression eval 161.77 General Fee Schedule
80410 Calcitonin stimul panel 103.56 General Fee Schedule
80412 Crh stimulation panel 424.83 General Fee Schedule
80414 Testosterone response 66.25 General Fee Schedule
80415 Estradiol response panel 72.05 General Fee Schedule
80416 Renin stimulation panel 170.12 General Fee Schedule
80417 Renin stimulation panel 56.70 General Fee Schedule
80418 Pituitary evaluation panel 747.05 General Fee Schedule
80420 Dexamethasone panel 92.85 General Fee Schedule
80422 Glucagon tolerance panel 59.42 General Fee Schedule
80424 Glucagon tolerance panel 65.11 General Fee Schedule
80426 Gonadotropin hormone panel 191.36 General Fee Schedule
80428 Growth hormone panel 85.95 General Fee Schedule
80430 Growth hormone panel 101.13 General Fee Schedule
80432 Insulin suppression panel 151.41 General Fee Schedule
80434 Insulin tolerance panel 130.34 General Fee Schedule
80435 Insulin tolerance panel 132.74 General Fee Schedule
80436 Metyrapone panel 117.50 General Fee Schedule
80438 Trh stimulation panel 64.95 General Fee Schedule
80439 Trh stimulation panel 86.60 General Fee Schedule
80500 Lab pathology consultation 18.97 General Fee Schedule
80502 Lab pathology consultation 50.08 General Fee Schedule
81000 Urinalysis nonauto w/scope 4.07 General Fee Schedule
81001 Urinalysis auto w/scope 4.07 General Fee Schedule
81002 URINALYSIS NONAUTO W/SCOPE 3.29 General Fee Schedule
81003 Urinalysis auto w/o scope 2.90 General Fee Schedule
81005 URINALYSIS 2.78 General Fee Schedule
81007 Urine screen for bacteria 3.30 General Fee Schedule
81015 MICROSCOPIC EXAM OF URINE 3.90 General Fee Schedule
81020 Urinalysis glass test 4.73 General Fee Schedule
81025 URINE PREGNANCY TEST 8.15 General Fee Schedule
81050 Urinalysis volume measure 3.84 General Fee Schedule
81099 UNLISTED URINALYSIS PROCEDURE 0 Manual Price
81200 Aspa gene 846.84 General Fee Schedule
81201 Apc gene full sequence 1104.19 General Fee Schedule
81202 Apc gene known fam variants 67.44 General Fee Schedule
81203 Apc gene dup/delet variants 526.57 General Fee Schedule
Data for November 2015
Pathology and Laboratory
Codes and Rates
Procedure
CodeCode Description
Current
RatePricing Description
81206 Bcr/abl1 gene major bp 143.48 General Fee Schedule
81207 Bcr/abl1 gene minor bp 143.48 General Fee Schedule
81208 Bcr/abl1 gene other bp 166.64 General Fee Schedule
81209 Blm gene 846.84 General Fee Schedule
81210 Braf gene 165.83 General Fee Schedule
81211 Brca1&2 seq & com dup/del 2958.34 General Fee Schedule
81212 Brca1&2 185&5385&6174 var 186.07 General Fee Schedule
81213 Brca1&2 uncom dup/del var 903.21 General Fee Schedule
81214 Brca1 full seq & com dup/del 1536.81 General Fee Schedule
81215 Brca1 gene known fam variant 96.30 General Fee Schedule
81216 Brca2 gene full sequence 2142.46 General Fee Schedule
81217 Brca2 gene known fam variant 96.20 General Fee Schedule
81220 Cftr gene com variants 1550.66 General Fee Schedule
81221 Cftr gene known fam variants 86.86 General Fee Schedule
81222 Cftr gene dup/delet variants 424.96 General Fee Schedule
81223 Cftr gene full sequence 4055.59 General Fee Schedule
81224 Cftr gene intron poly t 76.28 General Fee Schedule
81228 Cytogen micrarray copy nmbr 662.92 General Fee Schedule
81229 Cytogen m array copy no&snp 2296.26 General Fee Schedule
81235 Egfr gene com variants 250.62 General Fee Schedule
81240 F2 gene 61.65 General Fee Schedule
81241 F5 gene 40.87 General Fee Schedule
81242 Fancc gene 846.84 General Fee Schedule
81243 Fmr1 gene detection 216.01 General Fee Schedule
81244 Fmr1 gene characterization 92.46 General Fee Schedule
81245 Flt3 gene 83.13 General Fee Schedule
81250 G6pc gene 86.74 General Fee Schedule
81251 Gba gene 846.84 General Fee Schedule
81252 Gjb2 gene full sequence 196.20 General Fee Schedule
81253 Gjb2 gene known fam variants 75.33 General Fee Schedule
81254 Gjb6 gene com variants 0 Manual Price
81255 Hexa gene 846.84 General Fee Schedule
81256 Hfe gene 35.92 General Fee Schedule
81257 Hba1/hba2 gene 169.24 General Fee Schedule
81260 Ikbkap gene 846.84 General Fee Schedule
81261 Igh gene rearrange amp meth 116.42 General Fee Schedule
81262 Igh gene rearrang dir probe 45.23 General Fee Schedule
81264 Igk rearrangeabn clonal pop 154.71 General Fee Schedule
81265 Str markers specimen anal 221.13 General Fee Schedule
81266 Str markers spec anal addl 46.66 General Fee Schedule
81267 Chimerism anal no cell selec 42.32 General Fee Schedule
81268 Chimerism anal w/cell select 46.66 General Fee Schedule
81270 Jak2 gene 56.69 General Fee Schedule
81275 Kras gene 307.53 General Fee Schedule
81280 Long qt synd gene full seq 1097.84 General Fee Schedule
81290 Mcoln1 gene 846.84 General Fee Schedule
81292 Mlh1 gene full seq 1097.84 General Fee Schedule
81293 Mlh1 gene known variants 67.44 General Fee Schedule
81294 Mlh1 gene dup/delete variant 144.81 General Fee Schedule
81295 Msh2 gene full seq 926.11 General Fee Schedule
Data for November 2015
Pathology and Laboratory
Codes and Rates
Procedure
CodeCode Description
Current
RatePricing Description
81296 Msh2 gene known variants 67.44 General Fee Schedule
81297 Msh2 gene dup/delete variant 115.22 General Fee Schedule
81298 Msh6 gene full seq 1441.31 General Fee Schedule
81299 Msh6 gene known variants 67.44 General Fee Schedule
81300 Msh6 gene dup/delete variant 122.79 General Fee Schedule
81301 Microsatellite instability 300.01 General Fee Schedule
81302 Mecp2 gene full seq 328.24 General Fee Schedule
81303 Mecp2 gene known variant 108.71 General Fee Schedule
81304 Mecp2 gene dup/delet variant 78.90 General Fee Schedule
81310 Npm1 gene 67.15 General Fee Schedule
81315 Pml/raralpha com breakpoints 79.23 General Fee Schedule
81316 Pml/raralpha 1 breakpoint 327.62 General Fee Schedule
81317 Pms2 gene full seq analysis 1097.84 General Fee Schedule
81318 Pms2 known familial variants 67.44 General Fee Schedule
81319 Pms2 gene dup/delet variants 168.34 General Fee Schedule
81321 Pten gene full sequence 1078.57 General Fee Schedule
81322 Pten gene known fam variant 44.35 General Fee Schedule
81323 Pten gene dup/delet variant 1078.57 General Fee Schedule
81324 Pmp22 gene dup/delet 564.52 General Fee Schedule
81325 Pmp22 gene full sequence 0 Manual Price
81326 Pmp22 gene known fam variant 86.77 General Fee Schedule
81330 Smpd1 gene common variants 846.84 General Fee Schedule
81331 Snrpn/ube3a gene 488.18 General Fee Schedule
81332 Serpina1 gene 54.35 General Fee Schedule
81340 Trb@ gene rearrange amplify 216.46 General Fee Schedule
81341 Trb@ gene rearrange dirprobe 51.38 General Fee Schedule
81342 Trg gene rearrangement anal 137.71 General Fee Schedule
81370 Hla i & ii typing lr 416.63 General Fee Schedule
81371 Hla i & ii type verify lr 15.70 General Fee Schedule
81372 Hla i typing complete lr 228.87 General Fee Schedule
81373 Hla i typing 1 locus lr 15.70 General Fee Schedule
81376 Hla ii typing 1 locus lr 15.70 General Fee Schedule
81378 Hla i & ii typing hr 78.49 General Fee Schedule
81380 Hla i typing 1 locus hr 15.70 General Fee Schedule
81382 Hla ii typing 1 loc hr 15.70 General Fee Schedule
81400 Mopath procedure level 1 57.94 General Fee Schedule
81401 Mopath procedure level 2 195.30 General Fee Schedule
81402 Mopath procedure level 3 54.50 General Fee Schedule
81403 Mopath procedure level 4 313.25 General Fee Schedule
81404 Mopath procedure level 5 334.64 General Fee Schedule
81405 Mopath procedure level 6 462.58 General Fee Schedule
81406 Mopath procedure level 7 1989.57 General Fee Schedule
81407 Mopath procedure level 8 2828.35 General Fee Schedule
81408 Mopath procedure level 9 0 Manual Price
81420 Fetal chrmoml aneuploidy 58.57 General Fee Schedule
81479 Unlisted molecular pathology 0 Manual Price
81507 Fetal aneuploidy trisom risk 58.57 General Fee Schedule
82009 Test for acetone/ketones 5.82 General Fee Schedule
82010 Acetone assay 10.54 General Fee Schedule
82013 ACETYLCHOLINESTERASE ASSAY 14.41 General Fee Schedule
Data for November 2015
Pathology and Laboratory
Codes and Rates
Procedure
CodeCode Description
Current
RatePricing Description
82016 Acylcarnitines qual 17.87 General Fee Schedule
82017 Acylcarnitines quant 3.42 General Fee Schedule
82024 Assay of acth 14.35 General Fee Schedule
82030 Assay of adp & amp 18.27 General Fee Schedule
82040 Assay of serum albumin 6.38 General Fee Schedule
82042 Assay of urine albumin 3.71 General Fee Schedule
82043 Microalbumin quantitative 7.48 General Fee Schedule
82044 Microalbumin semiquant 5.90 General Fee Schedule
82045 Albumin ischemia modified 31.80 General Fee Schedule
82075 Assay of breath ethanol 15.55 General Fee Schedule
82085 Assay of aldolase 12.52 General Fee Schedule
82088 Assay of aldosterone 52.51 General Fee Schedule
82103 Alpha-1-antitrypsin total 17.31 General Fee Schedule
82104 Alpha-1-antitrypsin pheno 18.64 General Fee Schedule
82105 Alpha-fetoprotein serum 21.62 General Fee Schedule
82106 Alpha-fetoprotein amniotic 21.62 General Fee Schedule
82107 Alpha-fetoprotein l3 66.27 General Fee Schedule
82108 Assay of aluminum 32.85 General Fee Schedule
82120 Amines vaginal fluid qual 2.21 General Fee Schedule
82127 Amino acid single qual 17.87 General Fee Schedule
82128 Amino acids mult qual 17.87 General Fee Schedule
82131 Amino acids single quant 3.42 General Fee Schedule
82135 Assay aminolevulinic acid 21.22 General Fee Schedule
82136 Amino acids quant 2-5 3.42 General Fee Schedule
82139 Amino acids quan 6 or more 3.42 General Fee Schedule
82140 ASSAY OF AMMONIA 18.79 General Fee Schedule
82143 AMNIOTIC FLUID SCAN 8.86 General Fee Schedule
82150 ASSAY OF AMYLASE 8.35 General Fee Schedule
82154 ANDROSTANEDIOL GLUCURONIDE 19.21 General Fee Schedule
82157 ASSAY OF ANDROSTENEDIONE 37.74 General Fee Schedule
82160 Assay of androsterone 32.25 General Fee Schedule
82163 ASSAY OF ANGIOTENSIN II 26.46 General Fee Schedule
82164 ANGROTENSIN I-ENZYME TEST 18.82 General Fee Schedule
82172 Assay of apolipoprotein 19.97 General Fee Schedule
82175 ASSAY OF ARSENIC 24.45 General Fee Schedule
82180 ASSAY OF ASCORBIC ACID 12.74 General Fee Schedule
82190 ATOMIC ABSORPTION 19.21 General Fee Schedule
82232 Assay of beta-2 protein 20.86 General Fee Schedule
82239 Bile acids total 10.86 General Fee Schedule
82240 Bile acids cholylglycine 16.48 General Fee Schedule
82247 Bilirubin total 6.47 General Fee Schedule
82248 Bilirubin direct 6.47 General Fee Schedule
82252 FECAL BILIRUBIN TEST 1.78 General Fee Schedule
82261 Assay of biotinidase 3.42 General Fee Schedule
82270 Occult blood feces 4.18 General Fee Schedule
82271 Occult blood other sources 3.16 General Fee Schedule
82272 Occult bld feces 1-3 tests 3.16 General Fee Schedule
82274 Assay test for blood fecal 4.18 General Fee Schedule
82286 ASSAY OF BRADYKININ 8.87 General Fee Schedule
82300 Assay of cadmium 29.82 General Fee Schedule
Data for November 2015
Pathology and Laboratory
Codes and Rates
Procedure
CodeCode Description
Current
RatePricing Description
82306 Vitamin d 25 hydroxy 38.14 General Fee Schedule
82308 ASSAY OF CALCITONIN 34.51 General Fee Schedule
82310 Assay of calcium 6.63 General Fee Schedule
82330 Assay of calcium 17.62 General Fee Schedule
82331 CALCIUM INFUSION TEST 6.66 General Fee Schedule
82340 Assay of calcium in urine 7.76 General Fee Schedule
82355 Calculus analysis qual 14.91 General Fee Schedule
82360 Calculus assay quant 16.60 General Fee Schedule
82365 Calculus spectroscopy 16.62 General Fee Schedule
82370 X-ray assay calculus 16.15 General Fee Schedule
82373 Assay c-d transfer measure 9.28 General Fee Schedule
82374 Assay blood carbon dioxide 3.66 General Fee Schedule
82375 Assay carboxyhb quant 15.89 General Fee Schedule
82376 Assay carboxyhb qual 6.42 General Fee Schedule
82378 CARCINOEMBRYONIC ANTIGEN 24.45 General Fee Schedule
82379 Assay of carnitine 3.42 General Fee Schedule
82380 Assay of carotene 11.88 General Fee Schedule
82382 Assay urine catecholamines 22.15 General Fee Schedule
82383 Assay blood catecholamines 32.31 General Fee Schedule
82384 Assay three catecholamines 32.55 General Fee Schedule
82387 Assay of cathepsin-d 10.41 General Fee Schedule
82390 Assay of ceruloplasmin 13.84 General Fee Schedule
82397 CHEMILUMINESCENT ASSAY 10.41 General Fee Schedule
82415 Assay of chloramphenicol 16.33 General Fee Schedule
82435 Assay of blood chloride 3.60 General Fee Schedule
82436 Assay of urine chloride 6.48 General Fee Schedule
82438 Assay other fluid chlorides 6.30 General Fee Schedule
82441 TEST FOR CHLOROHYDROCARBONS 7.73 General Fee Schedule
82465 Assay bld/serum cholesterol 5.63 General Fee Schedule
82480 Assay serum cholinesterase 10.16 General Fee Schedule
82482 Assay rbc cholinesterase 9.90 General Fee Schedule
82485 Assay chondroitin sulfate 22.89 General Fee Schedule
82486 Gas/liquid chromatography 23.28 General Fee Schedule
82487 CHROMATOGRAPHY--QUALITATIVE--ANALYTE NES 20.57 General Fee Schedule
82488 CHROMATOGRAPHY--QUALITATIVE PAPER 2-DIME 27.55 General Fee Schedule
82489 THIN LAYER CHROMATOGRAPHY 23.85 General Fee Schedule
82491 Chromotography quant sing 23.28 General Fee Schedule
82492 Chromotography quant mult 23.28 General Fee Schedule
82495 Assay of chromium 26.15 General Fee Schedule
82507 Assay of citrate 35.85 General Fee Schedule
82523 Collagen crosslinks 24.10 General Fee Schedule
82525 Assay of copper 15.98 General Fee Schedule
82528 Assay of corticosterone 29.02 General Fee Schedule
82530 Cortisol free 21.55 General Fee Schedule
82533 TOTAL CORTISOL 21.01 General Fee Schedule
82540 Assay of creatine 5.97 General Fee Schedule
82541 Column chromotography qual 23.28 General Fee Schedule
82542 Column chromotography quant 23.28 General Fee Schedule
82543 Column chromotograph/isotope 23.28 General Fee Schedule
82544 Column chromotograph/isotope 23.28 General Fee Schedule
Data for November 2015
Pathology and Laboratory
Codes and Rates
Procedure
CodeCode Description
Current
RatePricing Description
82550 Assay of ck (cpk) 8.40 General Fee Schedule
82552 Assay of cpk in blood 17.27 General Fee Schedule
82553 Creatine mb fraction 14.87 General Fee Schedule
82554 Creatine isoforms 15.30 General Fee Schedule
82565 Assay of creatinine 6.61 General Fee Schedule
82570 Assay of urine creatinine 6.66 General Fee Schedule
82575 CREATININE CLEARANCE TEST 12.18 General Fee Schedule
82585 Assay of cryofibrinogen 9.12 General Fee Schedule
82595 Assay of cryoglobulin 8.35 General Fee Schedule
82600 Assay of cyanide 25.01 General Fee Schedule
82607 VITAMIN B-12 19.43 General Fee Schedule
82608 B-12 BINDING CAPACITY 18.46 General Fee Schedule
82610 Cystatin c 5.82 General Fee Schedule
82615 TEST FOR URINE CYSTINES 10.54 General Fee Schedule
82626 DEHYDROEPIANDROSTERONE 32.57 General Fee Schedule
82627 DEHYDROEPIANDROSTERONE 28.65 General Fee Schedule
82633 DESOXYCORTICOSTERONE 39.93 General Fee Schedule
82634 DESOXYCORTISOL 37.74 General Fee Schedule
82638 Assay of dibucaine number 15.78 General Fee Schedule
82652 Vit d 1 25-dihydroxy 49.62 General Fee Schedule
82656 Pancreatic elastase fecal 11.26 General Fee Schedule
82657 Enzyme cell activity 23.28 General Fee Schedule
82658 Enzyme cell activity ra 23.28 General Fee Schedule
82664 ELECTROPHORETIC TEST 44.29 General Fee Schedule
82668 Assay of erythropoietin 24.21 General Fee Schedule
82670 Assay of estradiol 36.03 General Fee Schedule
82671 Assay of estrogens 41.64 General Fee Schedule
82672 Assay of estrogen 27.96 General Fee Schedule
82677 Assay of estriol 31.18 General Fee Schedule
82679 Assay of estrone 32.19 General Fee Schedule
82693 Assay of ethylene glycol 19.20 General Fee Schedule
82696 Assay of etiocholanolone 30.39 General Fee Schedule
82705 Fats/lipids feces qual 6.58 General Fee Schedule
82710 Fats/lipids feces quant 21.65 General Fee Schedule
82715 Assay of fecal fat 12.82 General Fee Schedule
82725 Assay of blood fatty acids 17.16 General Fee Schedule
82726 Long chain fatty acids 23.28 General Fee Schedule
82728 Assay of ferritin 17.57 General Fee Schedule
82731 Assay of fetal fibronectin 83.02 General Fee Schedule
82735 Assay of fluoride 23.92 General Fee Schedule
82746 Assay of folic acid serum 18.94 General Fee Schedule
82747 Assay of folic acid rbc 22.18 General Fee Schedule
82757 Assay of semen fructose 10.07 General Fee Schedule
82759 Assay of rbc galactokinase 20.06 General Fee Schedule
82760 Assay of galactose 14.44 General Fee Schedule
82775 ASSAY GALACTOSE TRANSFERASE 27.15 General Fee Schedule
82776 GALACTOSE TRANSFERASE TEST 7.36 General Fee Schedule
82784 Assay iga/igd/igg/igm each 7.36 General Fee Schedule
82785 Assay of ige 21.23 General Fee Schedule
82787 Igg 1 2 3 or 4 each 5.93 General Fee Schedule
Data for November 2015
Pathology and Laboratory
Codes and Rates
Procedure
CodeCode Description
Current
RatePricing Description
82800 BLOOD PH 10.91 General Fee Schedule
82803 Blood gases any combination 24.94 General Fee Schedule
82805 Blood gases w/o2 saturation 36.57 General Fee Schedule
82810 Blood gases o2 sat only 11.26 General Fee Schedule
82820 HEMOGLOBIN-OXYGEN AFFINITY 12.49 General Fee Schedule
82930 Gastric analy w/ph ea spec 5.97 General Fee Schedule
82938 GASTIN TEST 22.84 General Fee Schedule
82941 ASSAY OF GASTIN 22.75 General Fee Schedule
82943 Assay of glucagon 18.41 General Fee Schedule
82945 Glucose other fluid 5.06 General Fee Schedule
82946 Glucagon tolerance test 17.20 General Fee Schedule
82947 Assay glucose blood quant 5.06 General Fee Schedule
82948 REAGENT STRIP/BLOOD GLUCOSE 4.08 General Fee Schedule
82950 GLUCOSE TEST 6.10 General Fee Schedule
82951 GLUCOSE TOLERANCE TEST (GTT) 8.28 General Fee Schedule
82952 GTT-added samples 5.06 General Fee Schedule
82955 Assay of g6pd enzyme 12.50 General Fee Schedule
82960 TEST FOR G6PD ENZYME 7.80 General Fee Schedule
82962 GLUCOSE BLOOD TEST 2.34 General Fee Schedule
82963 Assay of glucosidase 27.71 General Fee Schedule
82965 Assay of gdh enzyme 9.96 General Fee Schedule
82977 ASSAY OF GGT 9.28 General Fee Schedule
82978 Assay of glutathione 13.74 General Fee Schedule
82979 Assay rbc glutathione 8.87 General Fee Schedule
82985 Assay of glycated protein 19.43 General Fee Schedule
83001 Assay of gonadotropin (fsh) 23.97 General Fee Schedule
83002 Assay of gonadotropin (lh) 23.89 General Fee Schedule
83003 Assay growth hormone (hgh) 21.49 General Fee Schedule
83009 H pylori (c-13) blood 65.69 General Fee Schedule
83010 Assay of haptoglobin quant 8.55 General Fee Schedule
83012 Assay of haptoglobins 22.15 General Fee Schedule
83013 H pylori (c-13) breath 86.82 General Fee Schedule
83014 H pylori drug admin 10.13 General Fee Schedule
83015 HEAVY METAL SCREEN 24.27 General Fee Schedule
83018 Quantitative screen metals 28.30 General Fee Schedule
83020 Hemoglobin electrophoresis 13.19 26 Fee Schedule
83021 Hemoglobin chromotography 23.28 General Fee Schedule
83026 Hemoglobin copper sulfate 3.05 General Fee Schedule
83030 Fetal hemoglobin chemical 8.06 General Fee Schedule
83030 Fetal hemoglobin chemical 7.75 26 Fee Schedule
83033 Fetal hemoglobin assay qual 7.68 General Fee Schedule
83036 Glycosylated hemoglobin test 12.52 General Fee Schedule
83037 Glycosylated hb home device 15.52 General Fee Schedule
83045 BLOOD METHEMOGLOBIN TEST 6.38 General Fee Schedule
83050 BLOOD METHEMOGLOBIN ASSAY 9.44 General Fee Schedule
83051 Assay of plasma hemoglobin 4.55 General Fee Schedule
83060 HEMOGLOBIN-- 10.66 General Fee Schedule
83065 Assay of hemoglobin heat 8.87 General Fee Schedule
83068 HEMOGLOBIN STABILITY SCREEN 10.91 General Fee Schedule
83069 Assay of urine hemoglobin 5.09 General Fee Schedule
Data for November 2015
Pathology and Laboratory
Codes and Rates
Procedure
CodeCode Description
Current
RatePricing Description
83070 Assay of hemosiderin qual 6.13 General Fee Schedule
83080 Assay of b hexosaminidase 3.43 General Fee Schedule
83088 Assay of histamine 38.06 General Fee Schedule
83090 Assay of homocystine 21.74 General Fee Schedule
83150 Assay of homovanillic acid 24.94 General Fee Schedule
83491 Assay of corticosteroids 17 22.58 General Fee Schedule
83497 Assay of 5-hiaa 16.62 General Fee Schedule
83498 Assay of progesterone 17-d 35.02 General Fee Schedule
83499 Assay of progesterone 20- 32.48 General Fee Schedule
83500 Assay free hydroxyproline 29.21 General Fee Schedule
83505 Assay total hydroxyproline 31.33 General Fee Schedule
83516 Immunoassay nonantibody 14.87 General Fee Schedule
83518 Immunoassay dipstick 10.92 General Fee Schedule
83519 Ria nonantibody 17.42 General Fee Schedule
83520 Immunoassay quant nos nonab 16.70 General Fee Schedule
83525 ASSAY OF INSULIN 14.75 General Fee Schedule
83527 ASSAY OF INSULIN 16.32 General Fee Schedule
83528 Assay of intrinsic factor 20.49 General Fee Schedule
83540 Assay of iron 8.35 General Fee Schedule
83550 IRON BINDING TEST 11.28 General Fee Schedule
83570 Assay of idh enzyme 11.41 General Fee Schedule
83582 Assay of ketogenic steroids 18.28 General Fee Schedule
83586 Assay 17- ketosteroids 16.50 General Fee Schedule
83593 Fractionation ketosteroids 33.90 General Fee Schedule
83605 Assay of lactic acid 1.78 General Fee Schedule
83615 LACTATE (LD) (LDH) ENZYME 7.77 General Fee Schedule
83625 Assay of ldh enzymes 7.66 General Fee Schedule
83630 Lactoferrin fecal (qual) 19.14 General Fee Schedule
83631 Lactoferrin fecal (quant) 26.94 General Fee Schedule
83632 PLACENTAL LACTOGEN 26.05 General Fee Schedule
83633 TEST URINE FOR LACTOSE 7.11 General Fee Schedule
83655 Assay of lead 15.60 General Fee Schedule
83661 L/s ratio fetal lung 12.82 General Fee Schedule
83662 Foam stability fetal lung 24.83 General Fee Schedule
83663 Fluoro polarize fetal lung 12.19 General Fee Schedule
83664 Lamellar bdy fetal lung 6.10 General Fee Schedule
83670 Assay of lap enzyme 11.81 General Fee Schedule
83690 Assay of lipase 8.87 General Fee Schedule
83695 Assay of lipoprotein(a) 12.61 General Fee Schedule
83698 Assay lipoprotein pla2 33.55 General Fee Schedule
83700 Lipopro bld electrophoretic 13.55 General Fee Schedule
83701 Lipoprotein bld hr fraction 24.17 General Fee Schedule
83704 Lipoprotein bld by nmr 30.73 General Fee Schedule
83718 Assay of lipoprotein 10.55 General Fee Schedule
83719 Assay of blood lipoprotein 14.99 General Fee Schedule
83721 Assay of blood lipoprotein 12.30 General Fee Schedule
83727 Assay of lrh hormone 22.15 General Fee Schedule
83735 Assay of magnesium 8.65 General Fee Schedule
83775 Assay malate dehydrogenase 9.52 General Fee Schedule
83785 ASSAY OF MANGANESE 31.70 General Fee Schedule
Data for November 2015
Pathology and Laboratory
Codes and Rates
Procedure
CodeCode Description
Current
RatePricing Description
83788 Mass spectrometry qual 23.28 General Fee Schedule
83789 Mass spectrometry quant 23.28 General Fee Schedule
83825 Assay of mercury 20.96 General Fee Schedule
83835 Assay of metanephrines 21.85 General Fee Schedule
83857 Assay of methemalbumin 13.84 General Fee Schedule
83861 Microfludic analysis tear osmolarity 18.36 General Fee Schedule
83864 MUCOPLOYSACCHARIDES 25.66 General Fee Schedule
83872 ASSAY SYNOVIAL FLUID MUCIN 7.59 General Fee Schedule
83873 Assay of csf protein 22.17 General Fee Schedule
83874 Assay of myoglobin 16.64 General Fee Schedule
83876 Assay myeloperoxidase 12.63 General Fee Schedule
83880 Assay of natriuretic peptide 42.48 General Fee Schedule
83883 Assay nephelometry not spec 7.31 General Fee Schedule
83885 Assay of nickel 31.59 General Fee Schedule
83915 Assay of nucleotidase 14.38 General Fee Schedule
83916 Oligoclonal bands 25.93 General Fee Schedule
83918 Organic acids total quant 21.22 General Fee Schedule
83919 Organic acids qual each 21.22 General Fee Schedule
83921 Organic acid single quant 21.22 General Fee Schedule
83930 Assay of blood osmolality 8.52 General Fee Schedule
83935 Assay of urine osmolality 8.78 General Fee Schedule
83937 Assay of osteocalcin 19.21 General Fee Schedule
83945 Assay of oxalate 16.60 General Fee Schedule
83950 Oncoprotein her-2/neu 83.02 General Fee Schedule
83951 Oncoprotein dcp 69.24 General Fee Schedule
83970 ASSAY OF PARATHORMONE 53.21 General Fee Schedule
83986 Assay ph body fluid nos 4.61 General Fee Schedule
83987 Exhaled breath condensate 17.45 General Fee Schedule
83992 ASSAY FOR PHENCYCLIDINE 18.93 General Fee Schedule
83993 Assay for calprotectin fecal 20.19 General Fee Schedule
84030 Assay of blood pku ** 7.11 General Fee Schedule
84035 Assay of phenylketones 3.95 General Fee Schedule
84060 ASSAY ACID PHOSPHATASE 9.53 General Fee Schedule
84061 Phosphatase forensic exam 10.21 General Fee Schedule
84066 ASSAY PROSTATE PHOSPHATASE 12.45 General Fee Schedule
84075 PHOSPHATASE, ALKALINE 6.66 General Fee Schedule
84078 ASSAY ALKALINE PHOSPATASE 9.42 General Fee Schedule
84080 ASSAY ALKALINE PHOSPHATASES 19.04 General Fee Schedule
84081 Assay phosphatidylglycerol 21.32 General Fee Schedule
84085 Assay of rbc pg6d enzyme 8.69 General Fee Schedule
84087 ASSAY PHOSPHOHEXOSE ENZYMES 13.31 General Fee Schedule
84100 Assay of phosphorus 6.13 General Fee Schedule
84105 Assay of urine phosphorus 6.66 General Fee Schedule
84106 TEST FOR PORPHOBILINOGEN 5.50 General Fee Schedule
84110 Assay of porphobilinogen 10.89 General Fee Schedule
84112 Eval amniotic fluid protein 70.55 General Fee Schedule
84119 TEST URINE FOR PORPHYRINS 11.10 General Fee Schedule
84120 Assay of urine porphyrins 18.95 General Fee Schedule
84126 Assay of feces porphyrins 32.83 General Fee Schedule
84132 Assay of serum potassium 5.92 General Fee Schedule
Data for November 2015
Pathology and Laboratory
Codes and Rates
Procedure
CodeCode Description
Current
RatePricing Description
84133 Assay of urine potassium 5.56 General Fee Schedule
84134 Assay of prealbumin 7.31 General Fee Schedule
84135 Assay of pregnanediol 24.66 General Fee Schedule
84138 Assay of pregnanetriol 24.39 General Fee Schedule
84140 Assay of pregnenolone 19.21 General Fee Schedule
84143 Assay of 17-hydroxypregneno 19.21 General Fee Schedule
84144 Assay of progesterone 20.06 General Fee Schedule
84145 Procalcitonin (pct) 21.40 General Fee Schedule
84146 Assay of prolactin 24.98 General Fee Schedule
84150 ASSAY OF PROSTAGLANDIN 32.19 General Fee Schedule
84152 Assay of psa complexed 23.71 General Fee Schedule
84153 Assay of psa total 23.71 General Fee Schedule
84154 Assay of psa free 23.71 General Fee Schedule
84155 Assay of protein serum 4.71 General Fee Schedule
84156 Assay of protein urine 4.89 General Fee Schedule
84157 Assay of protein other 4.89 General Fee Schedule
84160 Assay of protein any source 6.66 General Fee Schedule
84163 Pappa serum 14.68 General Fee Schedule
84165 Protein e-phoresis serum 13.45 26 Fee Schedule
84166 Protein e-phoresis/urine/csf 11.69 26 Fee Schedule
84181 WESTERN BLOT TEST 12.93 26 Fee Schedule
84182 Protein western blot test 12.93 26 Fee Schedule
84202 ASSAY RBC PROTOPORPYRIN 18.49 General Fee Schedule
84203 TEST RBC PROTOPORPHYRIN 11.09 General Fee Schedule
84206 ASSAY OF PROINSULIN 22.89 General Fee Schedule
84207 Assay of vitamin b-6 36.21 General Fee Schedule
84210 Assay of pyruvate 13.99 General Fee Schedule
84220 Assay of pyruvate kinase 12.16 General Fee Schedule
84228 Assay of quinine 14.99 General Fee Schedule
84233 Assay of estrogen 83.02 General Fee Schedule
84234 Assay of progesterone 83.63 General Fee Schedule
84235 Assay of endocrine hormone 67.45 General Fee Schedule
84238 Assay nonendocrine receptor 47.12 General Fee Schedule
84244 ASSAY OF RENIN 28.35 General Fee Schedule
84252 Assay of vitamin b-2 26.08 General Fee Schedule
84255 Assay of selenium 32.91 General Fee Schedule
84260 Assay of serotonin 23.98 General Fee Schedule
84270 Assay of sex hormone globul 28.02 General Fee Schedule
84275 Assay of sialic acid 17.31 General Fee Schedule
84285 Assay of silica 30.35 General Fee Schedule
84295 Assay of serum sodium 6.21 General Fee Schedule
84300 Assay of urine sodium 6.26 General Fee Schedule
84302 Assay of sweat sodium 6.33 General Fee Schedule
84305 Assay of somatomedin 25.29 General Fee Schedule
84307 Assay of somatostatin 23.58 General Fee Schedule
84311 SPECTROPHOTOMETRY 9.01 General Fee Schedule
84315 BODY FLUID SPECIFIC GRAVITY 3.23 General Fee Schedule
84375 Chromatogram assay sugars 3.08 General Fee Schedule
84376 Sugars single qual 7.11 General Fee Schedule
84377 Sugars multiple qual 7.11 General Fee Schedule
Data for November 2015
Pathology and Laboratory
Codes and Rates
Procedure
CodeCode Description
Current
RatePricing Description
84378 Sugars single quant 14.84 General Fee Schedule
84379 Sugars multiple quant 14.84 General Fee Schedule
84392 Assay of urine sulfate 6.13 General Fee Schedule
84402 Assay of free testosterone 32.82 General Fee Schedule
84403 Assay of total testosterone 33.29 General Fee Schedule
84425 Assay of vitamin b-1 27.36 General Fee Schedule
84430 Assay of thiocyanate 14.99 General Fee Schedule
84431 Thromboxane urine 14.29 General Fee Schedule
84432 Assay of thyroglobulin 19.71 General Fee Schedule
84436 Assay of total thyroxine 8.86 General Fee Schedule
84437 Assay of neonatal thyroxine 8.35 General Fee Schedule
84439 Assay of free thyroxine 10.52 General Fee Schedule
84442 Assay of thyroid activity 14.97 General Fee Schedule
84443 THYROID STIM HORMONE 21.65 General Fee Schedule
84445 Assay of tsi globulin 65.56 General Fee Schedule
84446 Assay of vitamin e 18.29 General Fee Schedule
84449 Assay of transcortin 19.21 General Fee Schedule
84450 TRANSFERASE, ASPARTATE AMINO (AST) (SGOT 6.65 General Fee Schedule
84460 ALANINE AMINO (ALT) (SGPT) 6.81 General Fee Schedule
84466 84478 16.45 General Fee Schedule
84478 Assay of triglycerides 7.42 General Fee Schedule
84479 Assay of thyroid (t3 or t4) 8.35 General Fee Schedule
84480 Assay triiodothyronine (t3) 18.29 General Fee Schedule
84481 FREE ASSAY (FT-3) 21.85 General Fee Schedule
84482 T3 reverse 20.32 General Fee Schedule
84484 Assay of troponin quant 8.64 General Fee Schedule
84485 ASSAY DUODENAL FLUID TRYPSIN 5.50 General Fee Schedule
84488 TRYPSIN FECES FOR TRYPSIN 5.50 General Fee Schedule
84490 Assay of feces for trypsin 7.36 General Fee Schedule
84510 Assay of tyrosine 13.42 General Fee Schedule
84512 Assay of troponin qual 9.92 General Fee Schedule
84520 Assay of urea nitrogen 5.09 General Fee Schedule
84525 UREA NITROGEN SEMI-QUANT 2.21 General Fee Schedule
84540 Assay of urine/urea-n 6.13 General Fee Schedule
84545 UREA-N CLEARANCE TEST 8.51 General Fee Schedule
84550 Assay of blood/uric acid 5.82 General Fee Schedule
84560 Assay of urine/uric acid 6.13 General Fee Schedule
84577 Assay of feces/urobilinogen 16.07 General Fee Schedule
84578 TEST URINE UROBILINOGEN 1.78 General Fee Schedule
84580 Assay of urine urobilinogen 9.10 General Fee Schedule
84583 Assay of urine urobilinogen 6.46 General Fee Schedule
84585 Assay of urine vma 19.89 General Fee Schedule
84586 Assay of vip 19.12 General Fee Schedule
84588 Assay of vasopressin 41.84 General Fee Schedule
84590 Assay of vitamin a 14.88 General Fee Schedule
84591 Assay of nos vitamin 15.67 General Fee Schedule
84597 Assay of vitamin k 17.59 General Fee Schedule
84600 Assay of volatiles 20.63 General Fee Schedule
84620 XYLOSE TOLERANCE TEST 15.20 General Fee Schedule
84630 Assay of zinc 14.62 General Fee Schedule
Data for November 2015
Pathology and Laboratory
Codes and Rates
Procedure
CodeCode Description
Current
RatePricing Description
84681 Assay of c-peptide 22.41 General Fee Schedule
84702 CHORIONIC GONADOTROPIN TEST 19.40 General Fee Schedule
84703 CHORIONIC GONADOTROPIN ASSAY 8.99 General Fee Schedule
84704 Hcg free betachain test 15.49 General Fee Schedule
84830 OVULATION TESTS 12.94 General Fee Schedule
84999 UNLISTED CHEMISTRY PROCEDURE 0 Manual Price
85002 BLEEDING TIME TEST 5.79 General Fee Schedule
85004 Automated diff wbc count 6.49 General Fee Schedule
85007 Bl smear w/diff wbc count 4.45 General Fee Schedule
85008 Bl smear w/o diff wbc count 4.45 General Fee Schedule
85009 Manual diff wbc count b-coat 4.78 General Fee Schedule
85013 Spun microhematocrit 3.05 General Fee Schedule
85014 Hematocrit 3.05 General Fee Schedule
85018 Hemoglobin 3.05 General Fee Schedule
85025 Complete cbc w/auto diff wbc 9.10 General Fee Schedule
85027 Complete cbc automated 6.42 General Fee Schedule
85032 Manual cell count each 5.62 General Fee Schedule
85041 Automated rbc count 3.87 General Fee Schedule
85044 Manual reticulocyte count 5.56 General Fee Schedule
85045 Automated reticulocyte count 5.16 General Fee Schedule
85046 Reticyte/hgb concentrate 7.20 General Fee Schedule
85048 Automated leukocyte count 3.28 General Fee Schedule
85049 Automated platelet count 6.15 General Fee Schedule
85055 Reticulated platelet assay 24.19 General Fee Schedule
85060 Blood smear interpretation 16.42 General Fee Schedule
85097 Bone marrow interpretation 4.30 General Relative Value
85130 CHROMOGENIC SUBSTRATE ASSAY 9.10 General Fee Schedule
85170 BLOOD CLOT RETRACTION 4.66 General Fee Schedule
85175 BLOOD CLOT LYSIS TIME 5.85 General Fee Schedule
85210 Clot factor ii prothrom spec 16.75 General Fee Schedule
85220 Blooc clot factor v test 22.76 General Fee Schedule
85230 Clot factor vii proconvertin 23.07 General Fee Schedule
85240 Clot factor viii ahg 1 stage 23.07 General Fee Schedule
85244 Clot factor viii reltd antgn 26.31 General Fee Schedule
85245 Clot factor viii vw ristoctn 29.60 General Fee Schedule
85246 Clot factor viii vw antigen 29.60 General Fee Schedule
85247 Clot factor viii multimetric 29.60 General Fee Schedule
85250 Clot factor ix ptc/chrstmas 24.53 General Fee Schedule
85260 Clot factor x stuart-power 23.07 General Fee Schedule
85270 Clot factor xi pta 23.07 General Fee Schedule
85280 Clot factor xii hageman 24.94 General Fee Schedule
85290 Clot factor xiii fibrin stab 21.05 General Fee Schedule
85291 Clot factor xiii fibrin scrn 11.47 General Fee Schedule
85292 Clot factor fletcher fact 24.40 General Fee Schedule
85293 Clot factor wght kininogen 24.40 General Fee Schedule
85300 Antithrombin iii activity 15.28 General Fee Schedule
85301 Antithrombin iii antigen 13.94 General Fee Schedule
85302 Clot inhibit prot c antigen 15.50 General Fee Schedule
85303 Clot inhibit prot c activity 17.82 General Fee Schedule
85305 Clot inhibit prot s total 14.94 General Fee Schedule
Data for November 2015
Pathology and Laboratory
Codes and Rates
Procedure
CodeCode Description
Current
RatePricing Description
85306 Clot inhibit prot s free 19.77 General Fee Schedule
85307 Assay activated protein c 19.77 General Fee Schedule
85335 FACTOR INHIBITOR TEST 11.86 General Fee Schedule
85337 THROMBOMODULIN 13.45 General Fee Schedule
85345 Coagulation time lee & white 5.56 General Fee Schedule
85347 Coagulation time activated 5.51 General Fee Schedule
85348 Coagulation time otr method 4.78 General Fee Schedule
85360 EUGLOBULIN LYSIS 5.98 General Fee Schedule
85362 FIBRIN DEGRADATION PRODUCTS 8.87 General Fee Schedule
85366 FIBRINOGEN TEST 11.10 General Fee Schedule
85370 FIBRINOGEN TEST 14.65 General Fee Schedule
85378 Fibrin degrade semiquant 9.20 General Fee Schedule
85379 Fibrin degradation quant 10.43 General Fee Schedule
85380 Fibrin degradj d-dimer 10.55 General Fee Schedule
85384 Fibrinogen activity 10.94 General Fee Schedule
85385 Fibrinogen antigen 10.94 General Fee Schedule
85390 Fibrinolysins screen i&r 12.21 26 Fee Schedule
85396 Clotting assay whole blood 17.30 General Fee Schedule
85397 Clotting funct activity 24.67 General Fee Schedule
85400 FIBRINOLYTIC PLASMIN 11.41 General Fee Schedule
85410 FIBRINOLYTIC ANTIPLASMIN 9.12 General Fee Schedule
85415 FIBRINOLYTIC PLASMINOGEN 22.15 General Fee Schedule
85420 FIBRINOLYTIC PLASMINOGEN 8.43 General Fee Schedule
85421 FIBRINOLYTIC PLASMINOGEN 13.13 General Fee Schedule
85441 Heinz bodies direct 5.43 General Fee Schedule
85445 Heinz bodies induced 8.78 General Fee Schedule
85460 Hemoglobin fetal 9.97 General Fee Schedule
85461 Hemoglobin fetal 8.56 General Fee Schedule
85475 Hemolysin acid 11.45 General Fee Schedule
85520 HEPARIN ASSAY 13.74 General Fee Schedule
85525 Heparin neutralization 15.28 General Fee Schedule
85530 HEPARIN-PROTAMINE TOLERANCE 18.29 General Fee Schedule
85536 Iron stain peripheral blood 8.35 General Fee Schedule
85540 Wbc alkaline phosphatase 11.08 General Fee Schedule
85547 RBC mechanical fragility 11.08 General Fee Schedule
85549 MURAMIDASE 24.17 General Fee Schedule
85555 RBC osmotic fragility 8.63 General Fee Schedule
85557 RBC osmotic fragility 17.23 General Fee Schedule
85576 Blood platelet aggregation 13.21 26 Fee Schedule
85597 Phospholipid pltlt neutraliz 19.83 General Fee Schedule
85598 Hexagnal phosph pltlt neutrl 16.83 General Fee Schedule
85610 PROTHROMBIN TIME-- 5.07 General Fee Schedule
85611 PROTHROMBIN TEST 5.09 General Fee Schedule
85612 VIPER VENOM PROTHROMBIN TIME 12.34 General Fee Schedule
85613 Russell viper venom diluted 12.34 General Fee Schedule
85635 REPTILASE TEST 12.70 General Fee Schedule
85651 Rbc sed rate nonautomated 4.59 General Fee Schedule
85652 Rbc sed rate automated 3.48 General Fee Schedule
85660 RBC SICKLE CELL TEST 7.13 General Fee Schedule
85670 Thrombin time plasma 7.43 General Fee Schedule
Data for November 2015
Pathology and Laboratory
Codes and Rates
Procedure
CodeCode Description
Current
RatePricing Description
85675 Thrombin time titer 8.80 General Fee Schedule
85705 THROMBOPLASTIN INHIBITION 8.96 General Fee Schedule
85730 Thromboplastin time partial 7.70 General Fee Schedule
85732 Thromboplastin time partial 8.32 General Fee Schedule
85810 BLOOD VISCOSITY EXAMINATION 15.03 General Fee Schedule
85999 UNLISTED HEMATOLOGY PROCEDURE 0 26 Requires manual Price
85999 UNLISTED HEMATOLOGY PROCEDURE 0 Manual Price
86000 Agglutinins febrile antigen 9.00 General Fee Schedule
86001 Allergen specific igg 6.16 General Fee Schedule
86003 ALLERGEN SPECIFIC IGE 6.16 General Fee Schedule
86005 ALLERGEN SPECIFIC IgE 8.98 General Fee Schedule
86021 WBC ANTIBODY IDENTIFICATION 19.40 General Fee Schedule
86022 Platelet antibodies 23.68 General Fee Schedule
86023 Immunoglobulin assay 16.04 General Fee Schedule
86038 ANTINUCLEAR ANTIBODIES 15.59 General Fee Schedule
86039 ANTINUCLEAR ANTIBODIES (ANA) 14.40 General Fee Schedule
86060 Antistreptolysin o titer 7.27 General Fee Schedule
86063 Antistreptolysin o screen 4.60 General Fee Schedule
86077 Phys blood bank serv xmatch 36.14 General Fee Schedule
86078 Phys blood bank serv reactj 36.90 General Fee Schedule
86079 Phys blood bank serv authrj 36.65 General Fee Schedule
86140 C-REACTIVE PROTEIN 6.66 General Fee Schedule
86141 C-reactive protein hs 16.70 General Fee Schedule
86146 Beta-2 glycoprotein antibody 19.71 General Fee Schedule
86147 Cardiolipin antibody ea ig 19.71 General Fee Schedule
86148 Anti-phospholipid antibody 20.31 General Fee Schedule
86155 CHEMOTAXIS ASSAY 19.67 General Fee Schedule
86156 Cold agglutinin screen 8.48 General Fee Schedule
86157 Cold agglutinin titer 10.18 General Fee Schedule
86160 Complement antigen 15.18 General Fee Schedule
86161 COMPLEMENT/FUNCTION ACTIVITY 15.18 General Fee Schedule
86162 Complement total (ch50) 25.69 General Fee Schedule
86171 Complement fixation each 12.67 General Fee Schedule
86185 COUNTERIMMUNOELECTROPHORESIS 11.33 General Fee Schedule
86200 Ccp antibody 12.36 General Fee Schedule
86215 Deoxyribonuclease antibody 16.74 General Fee Schedule
86225 Dna antibody native 17.37 General Fee Schedule
86226 Dna antibody single strand 15.31 General Fee Schedule
86235 NUCLEAR ANTIGEN ANTIBODY 18.85 General Fee Schedule
86243 FC RECEPTOR 25.93 General Fee Schedule
86255 Fluorescent antibody screen 13.19 26 Fee Schedule
86256 Fluorescent antibody titer 13.41 26 Fee Schedule
86277 GROWTH HORMONE ANTIBODY 19.89 General Fee Schedule
86280 HEMAGGLUTINATION INHIBITION 10.34 General Fee Schedule
86294 Immunoassay tumor qual 24.78 General Fee Schedule
86300 Immunoassay tumor ca 15-3 26.30 General Fee Schedule
86301 Immunoassay tumor ca 19-9 26.30 General Fee Schedule
86304 Immunoassay tumor ca 125 26.30 General Fee Schedule
86305 Human epididymis protein 4 (HE4) 22.52 General Fee Schedule
86308 Heterophile antibody screen 6.53 General Fee Schedule
Data for November 2015
Pathology and Laboratory
Codes and Rates
Procedure
CodeCode Description
Current
RatePricing Description
86309 Heterophile antibody titer 8.19 General Fee Schedule
86310 Heterophile antibody absrbj 9.33 General Fee Schedule
86316 Immunoassay tumor other 26.30 General Fee Schedule
86317 Immunoassay infectious agent 18.94 General Fee Schedule
86318 Immunoassay infectious agent 16.37 General Fee Schedule
86320 SERUM IMMUNOELECTROPHORESIS 13.45 26 Fee Schedule
86325 Other immunoelectrophoresis 13.45 26 Fee Schedule
86327 IMMUNOELECTROPHORESIS ASSAY 15.42 26 Fee Schedule
86329 Immunodiffusion nes 17.74 General Fee Schedule
86331 IMMUNODIFFUSION OUCHTERLONY 15.16 General Fee Schedule
86332 IMMUNE COMPLEX ASSAY 21.77 General Fee Schedule
86334 Immunofix e-phoresis serum 13.45 26 Fee Schedule
86335 IMMUNOFIXATION ELECTROPHORESIS 16.64 26 Fee Schedule
86336 Inhibin A 16.50 General Fee Schedule
86337 INSULIN ANTIBODIES 27.06 General Fee Schedule
86340 INTRINSIC FACTOR ANTIBODIES 19.04 General Fee Schedule
86341 ISLET CELL ANTIBODY 16.97 General Fee Schedule
86343 LEUKOCYTE HISTAMINE RELEASE 15.74 General Fee Schedule
86344 LEUKOCYTE PHAGOCYTOSIS 10.11 General Fee Schedule
86352 Cell function assay w/stim 73.51 General Fee Schedule
86353 LYMPHO TRANSFORM 61.95 General Fee Schedule
86355 B cells total count 16.95 General Fee Schedule
86356 Mononuclear cell antigen 18.26 General Fee Schedule
86357 Nk cells total count 23.88 General Fee Schedule
86359 T cells total count 22.44 General Fee Schedule
86360 T cell absolute count/ratio 44.87 General Fee Schedule
86361 T cell absolute count 22.86 General Fee Schedule
86367 Stem cells total count 16.95 General Fee Schedule
86376 Microsomal antibody each 18.39 General Fee Schedule
86378 MIGRATION INHIBITORY FACTOR 24.89 General Fee Schedule
86382 Neutralization test viral 21.37 General Fee Schedule
86384 NITROBLUE TETRAZOLIUM DYE 14.39 General Fee Schedule
86386 Nuclear matrix protein 22 0 Manual Price
86403 Particle agglut antbdy scrn 8.81 General Fee Schedule
86406 Particle agglut antbdy titr 13.45 General Fee Schedule
86430 Rheumatoid factor test qual 7.19 General Fee Schedule
86431 Rheumatoid factor quant 7.19 General Fee Schedule
86480 Tb test cell immun measure 83.35 General Fee Schedule
86481 Tb ag response t-cell susp 66.56 General Fee Schedule
86486 Skin test nos antigen 3.56 General Fee Schedule
86490 SKIN TEST-- 0.93 General Relative Value
86510 SKIN TEST-- 0.99 General Relative Value
86580 SKIN TEST-- 0.80 General Relative Value
86590 Streptokinase antibody 13.47 General Fee Schedule
86592 Syphilis test non-trep qual 5.42 General Fee Schedule
86593 Syphilis test non-trep quant 5.56 General Fee Schedule
86602 ACTINOMYCES ANTIBODY 12.85 General Fee Schedule
86603 Adenovirus antibody 14.19 General Fee Schedule
86606 ASPIRGILLUS ANTIBODY 17.79 General Fee Schedule
86609 Bacterium antibody 16.29 General Fee Schedule
Data for November 2015
Pathology and Laboratory
Codes and Rates
Procedure
CodeCode Description
Current
RatePricing Description
86611 Bartonella antibody 12.85 General Fee Schedule
86612 Blastomyces antibody 14.19 General Fee Schedule
86615 BORDETELLA ANTIBODY 16.67 General Fee Schedule
86617 LYME DISEASE ANTIBODY 19.57 General Fee Schedule
86618 LYME DISEASE ANTIBODY 21.52 General Fee Schedule
86619 BORRELIA ANTIBODY 16.91 General Fee Schedule
86622 Brucella antibody 10.34 General Fee Schedule
86625 Campylobacter antibody 16.58 General Fee Schedule
86628 Candida antibody 15.19 General Fee Schedule
86631 Chlamydia antibody 14.94 General Fee Schedule
86632 Chlamydia igm antibody 16.07 General Fee Schedule
86635 Coccidioides antibody 14.19 General Fee Schedule
86638 Q FEVER ANTIBODY 14.19 General Fee Schedule
86641 CRYPTOCOCCUS ANTIBODY 8.81 General Fee Schedule
86644 CMV ANTIBODY 18.20 General Fee Schedule
86645 Cmv antibody igm 18.05 General Fee Schedule
86648 DIPTHERIA ANTIBODY 19.24 General Fee Schedule
86651 Encephalitis californ antbdy 16.67 General Fee Schedule
86652 Encephaltis east eqne anbdy 16.67 General Fee Schedule
86653 Encephaltis st louis antbody 16.67 General Fee Schedule
86654 Encephaltis west eqne antbdy 16.67 General Fee Schedule
86658 Enterovirus antibody 14.19 General Fee Schedule
86663 EPSTEIN-BARR ANTIBODY 16.58 General Fee Schedule
86664 Epstein-barr nuclear antigen 18.05 General Fee Schedule
86665 Epstein-barr capsid vca 18.05 General Fee Schedule
86666 Ehrlichia antibody 12.85 General Fee Schedule
86668 FRANCISELLA TULARENSIS 9.87 General Fee Schedule
86671 Fungus nes antibody 14.19 General Fee Schedule
86674 Giardia lamblia antibody 18.05 General Fee Schedule
86677 Helicobacter pylori antibody 18.34 General Fee Schedule
86682 Helminth antibody 13.09 General Fee Schedule
86684 Hemophilus influenza antibdy 8.81 General Fee Schedule
86687 Htlv-i antibody 10.60 General Fee Schedule
86688 Htlv-ii antibody 12.61 General Fee Schedule
86689 Htlv/hiv confirmj antibody 24.46 General Fee Schedule
86692 Hepatitis delta agent antbdy 21.68 General Fee Schedule
86694 Herpes simplex nes antbdy 18.20 General Fee Schedule
86695 Herpes simplex type 1 test 16.67 General Fee Schedule
86696 Herpes simplex type 2 test 24.46 General Fee Schedule
86698 Histoplasma antibody 14.19 General Fee Schedule
86701 Hiv-1antibody 11.25 General Fee Schedule
86702 Hiv-2 antibody 12.61 General Fee Schedule
86703 Hiv-1/hiv-2 1 result antbdy 12.61 General Fee Schedule
86704 Hep b core antibody total 15.25 General Fee Schedule
86705 Hep b core antibody igm 14.87 General Fee Schedule
86706 Hep b surface antibody 13.57 General Fee Schedule
86707 Hepatitis be antibody 14.61 General Fee Schedule
86708 Hepatitis a total antibody 15.64 General Fee Schedule
86709 Hepatitis a igm antibody 14.22 General Fee Schedule
86710 Influenza virus antibody 17.13 General Fee Schedule
Data for November 2015
Pathology and Laboratory
Codes and Rates
Procedure
CodeCode Description
Current
RatePricing Description
86713 Legionella antibody 18.05 General Fee Schedule
86717 Leishmania antibody 15.48 General Fee Schedule
86720 Leptospira antibody 16.67 General Fee Schedule
86723 Listeria monocytogenes 16.67 General Fee Schedule
86727 Lymph choriomeningitis ab 14.19 General Fee Schedule
86729 Lympho venereum antibody 15.10 General Fee Schedule
86732 Mucormycosis antibody 16.67 General Fee Schedule
86735 Mumps antibody 16.49 General Fee Schedule
86738 Mycoplasma antibody 16.73 General Fee Schedule
86741 NEISSERIA MENINGITIDIS 16.67 General Fee Schedule
86744 Nocardia antibody 16.67 General Fee Schedule
86747 Parvovirus antibody 18.99 General Fee Schedule
86750 Malaria antibody 16.67 General Fee Schedule
86753 Protozoa antibody nos 13.09 General Fee Schedule
86756 Respiratory virus antibody 16.29 General Fee Schedule
86757 Rickettsia antibody 24.46 General Fee Schedule
86759 Rotavirus antibody 16.67 General Fee Schedule
86762 Rubella antibody 18.20 General Fee Schedule
86765 Rubeola antibody 16.29 General Fee Schedule
86768 Salmonella antibody 16.67 General Fee Schedule
86771 Shigella antibody 16.67 General Fee Schedule
86774 Tetanus antibody 18.68 General Fee Schedule
86777 Toxoplasma antibody 18.20 General Fee Schedule
86778 Toxoplasma antibody igm 18.05 General Fee Schedule
86780 Treponema pallidum 14.33 General Fee Schedule
86784 Trichinella antibody 8.04 General Fee Schedule
86787 Varicella-zoster antibody 16.29 General Fee Schedule
86788 West nile virus ab igm 14.41 General Fee Schedule
86789 West nile virus antibody 14.51 General Fee Schedule
86790 Virus antibody nos 16.29 General Fee Schedule
86793 Yersinia antibody 16.67 General Fee Schedule
86800 THYROGLOBULIN ANTIBODY 20.09 General Fee Schedule
86803 HEPATITIS C AB TEST 18.04 General Fee Schedule
86804 Hep c ab test confirm 19.57 General Fee Schedule
86805 LYMPHOCYTOXICITY ASSAY 66.08 General Fee Schedule
86806 LYMPHOCYTOTOXICITY ASSAY 60.13 General Fee Schedule
86807 CYTOTOXIC ANTIBODY SCREENING 50.02 General Fee Schedule
86808 CYTOTOXIC ANTIBODY SCREENING 37.51 General Fee Schedule
86812 Hla typing a b or c 32.61 General Fee Schedule
86813 Hla typing a b or c 40.35 General Fee Schedule
86816 Hla typing dr/dq 35.21 General Fee Schedule
86817 Hla typing dr/dq 81.36 General Fee Schedule
86821 Lymphocyte culture mixed 71.34 General Fee Schedule
86822 Lymphocyte culture primed 46.19 General Fee Schedule
86825 Hla x-math non-cytotoxic 58.75 General Fee Schedule
86826 Hla x-match noncytotoxc addl 19.59 General Fee Schedule
86830 Hla class i phenotype qual 48.79 General Fee Schedule
86831 Hla class ii phenotype qual 48.79 General Fee Schedule
86832 Hla class i high defin qual 48.79 General Fee Schedule
86833 Hla class ii high defin qual 48.79 General Fee Schedule
Data for November 2015
Pathology and Laboratory
Codes and Rates
Procedure
CodeCode Description
Current
RatePricing Description
86849 UNLISTED IMMUNOLOGY 0 Manual Price
86850 ANTIBODY SCREEN RBC EACH SERU TECHNIQUE 7.33 General Fee Schedule
86860 ANTIBODY ELUTION (RBC) EACH ELUTION 26.25 General Fee Schedule
86870 ANTI-IDENT RBC ANTI EACH PANEL FOR EA TE 19.99 General Fee Schedule
86880 Coombs test direct 6.78 General Fee Schedule
86885 Coombs test indirect qual 7.24 General Fee Schedule
86886 Coombs test indirect titer 6.53 General Fee Schedule
86890 AUTO BLOOD OR COM COLLECT PROCESS STORAG 75.45 General Fee Schedule
86900 Blood typing serologic abo 3.75 General Fee Schedule
86901 Blood typing serologic rh(d) 5.06 General Fee Schedule
86902 Blood type antigen donor ea 4.11 General Fee Schedule
86904 Blood typing patient serum 12.01 General Fee Schedule
86905 Blood typing rbc antigens 4.82 General Fee Schedule
86906 Bld typing serologic rh phnt 8.12 General Fee Schedule
86910 Blood typing paternity test 23.28 General Fee Schedule
86911 Blood typing antigen system 6.60 General Fee Schedule
86920 Compatibility test spin 11.70 General Fee Schedule
86921 Compatibility test incubate 13.59 General Fee Schedule
86922 Compatibility test antiglob 14.63 General Fee Schedule
86923 Compatibility test electric 7.06 General Fee Schedule
86927 Plasma fresh frozen 13.68 General Fee Schedule
86930 Frozen blood prep 36.57 General Fee Schedule
86931 Frozen blood thaw 54.87 General Fee Schedule
86932 Frozen blood freeze/thaw 73.15 General Fee Schedule
86940 Hemolysins/agglutinins auto 10.35 General Fee Schedule
86941 HEMOLYSINS/AGGLUTININS 15.31 General Fee Schedule
86945 IRRADIATION OF BLOOD PRODUCT 25.39 General Fee Schedule
86950 LEUKOCYTE TRANSFUSION 49.57 General Fee Schedule
86960 Vol reduction of blood/prod 24.17 General Fee Schedule
86965 POOLING OF PLATELETS OR OT BLOOD PRODUCT 7.06 General Fee Schedule
86970 Rbc pretx incubatj w/chemicl 3.52 General Fee Schedule
86971 Rbc pretx incubatj w/enzymes 3.62 General Fee Schedule
86972 Rbc pretx incubatj w/density 4.03 General Fee Schedule
86975 Rbc serum pretx incubj drugs 25.18 General Fee Schedule
86976 Rbc serum pretx id dilution 26.19 General Fee Schedule
86977 Rbc serum pretx incubj/inhib 16.62 General Fee Schedule
86978 Rbc pretreatment serum 25.39 General Fee Schedule
86985 SPLITTING OF BLOOD OR BLOOD PRO EACH UNI 5.47 General Fee Schedule
86999 UNLISTED TRANSFUSION MEDICINE PROCEDURE 0 26 Requires manual Price
86999 UNLISTED TRANSFUSION MEDICINE PROCEDURE 0 Manual Price
87003 Small animal inoculation 21.29 General Fee Schedule
87015 Specimen infect agnt concntj 6.26 26 Fee Schedule
87015 Specimen infect agnt concntj 8.44 General Fee Schedule
87040 Blood culture for bacteria 13.04 General Fee Schedule
87045 Feces culture aerobic bact 11.92 General Fee Schedule
87046 Stool cultr aerobic bact ea 2.98 General Fee Schedule
87070 Culture othr specimn aerobic 10.87 General Fee Schedule
87071 Culture aerobic quant other 5.97 General Fee Schedule
87073 Culture bacteria anaerobic 5.97 General Fee Schedule
87075 Cultr bacteria except blood 8.86 26 Fee Schedule
Data for November 2015
Pathology and Laboratory
Codes and Rates
Procedure
CodeCode Description
Current
RatePricing Description
87075 Cultr bacteria except blood 9.05 General Fee Schedule
87076 Culture anaerobe ident each 6.64 26 Fee Schedule
87076 Culture anaerobe ident each 6.77 General Fee Schedule
87077 Culture aerobic identify 8.93 General Fee Schedule
87081 Culture screen only 8.38 General Fee Schedule
87084 CULTURE OF SPECIMEN BY KIT 10.87 General Fee Schedule
87086 Urine culture/colony count 10.20 General Fee Schedule
87088 Urine bacteria culture 10.22 General Fee Schedule
87101 Skin fungi culture 9.75 General Fee Schedule
87102 FUNGUS ISOLATION CULTURE 10.61 General Fee Schedule
87103 BLOOD FUNGUS CLUTRUE 11.41 General Fee Schedule
87106 Fungi identification yeast 13.04 General Fee Schedule
87107 Fungi identification mold 13.04 General Fee Schedule
87109 Mycoplasma 19.46 General Fee Schedule
87110 Chlamydia culture 24.76 General Fee Schedule
87116 Mycobacteria culture 13.65 General Fee Schedule
87118 Mycobacteric identification 13.83 General Fee Schedule
87140 Culture type immunofluoresc 7.05 General Fee Schedule
87143 Culture typing glc/hplc 15.83 General Fee Schedule
87147 Culture type immunologic 6.53 General Fee Schedule
87149 Dna/rna direct probe 25.33 General Fee Schedule
87150 Dna/rna amplified probe 37.97 General Fee Schedule
87152 Culture type pulse field gel 6.60 General Fee Schedule
87153 Dna/rna sequencing 124.81 General Fee Schedule
87158 Culture typing added method 6.60 General Fee Schedule
87164 Dark field examination 11.98 26 Fee Schedule
87166 Dark field examination 14.27 General Fee Schedule
87168 Macroscopic exam arthropod 5.42 General Fee Schedule
87169 Macroscopic exam parasite 5.42 General Fee Schedule
87172 Pinworm exam 5.42 General Fee Schedule
87176 Tissue homogenization cultr 7.46 General Fee Schedule
87177 OVA AND PARASITES SMEARS 11.27 General Fee Schedule
87181 Microbe susceptible diffuse 6.01 General Fee Schedule
87184 Microbe susceptible disk 8.71 General Fee Schedule
87185 Microbe susceptible enzyme 6.01 General Fee Schedule
87186 Microbe susceptible mic 10.90 General Fee Schedule
87187 Microbe susceptible mlc 13.11 General Fee Schedule
87188 Microbe suscept macrobroth 8.39 General Fee Schedule
87190 Microbe suscept mycobacteri 5.39 General Fee Schedule
87197 Bactericidal level serum 18.98 General Fee Schedule
87205 Smear gram stain 4.00 26 Fee Schedule
87205 Smear gram stain 5.42 General Fee Schedule
87206 Smear fluorescent/acid stai 5.04 26 Fee Schedule
87206 Smear fluorescent/acid stai 5.14 General Fee Schedule
87207 Smear special stain 13.69 26 Fee Schedule
87209 Smear complex stain 16.35 General Fee Schedule
87210 Smear wet mount saline/ink 4.00 26 Fee Schedule
87210 Smear wet mount saline/ink 4.08 General Fee Schedule
87220 Tissue exam for fungi 5.42 General Fee Schedule
87230 Assay toxin or antitoxin 24.95 General Fee Schedule
Data for November 2015
Pathology and Laboratory
Codes and Rates
Procedure
CodeCode Description
Current
RatePricing Description
87250 Virus inoculate eggs/animal 18.32 26 Fee Schedule
87250 Virus inoculate eggs/animal 26.01 General Fee Schedule
87252 Virus inoculation tissue 32.94 General Fee Schedule
87253 Virus inoculate tissue addl 18.93 26 Fee Schedule
87253 Virus inoculate tissue addl 19.32 General Fee Schedule
87254 Virus inoculation shell via 6.18 General Fee Schedule
87255 Genet virus isolate hsv 29.56 General Fee Schedule
87260 Adenovirus ag if 15.18 General Fee Schedule
87265 Pertussis ag if 15.18 General Fee Schedule
87267 Enterovirus antibody dfa 15.34 General Fee Schedule
87269 Giardia ag if 15.72 General Fee Schedule
87270 Chlamydia trachomatis ag if 15.18 General Fee Schedule
87271 Cytomegalovirus dfa 15.34 General Fee Schedule
87272 Cryptosporidium ag if 15.18 General Fee Schedule
87273 Herpes simplex 2 ag if 15.18 General Fee Schedule
87274 Herpes simplex 1 ag if 15.18 General Fee Schedule
87275 Influenza b ag if 15.18 General Fee Schedule
87276 Influenza a ag if 15.18 General Fee Schedule
87277 Legionella micdadei ag if 15.18 General Fee Schedule
87278 Legion pneumophilia ag if 15.18 General Fee Schedule
87279 Parainfluenza ag if 15.18 General Fee Schedule
87280 Respiratory syncytial ag if 15.18 General Fee Schedule
87281 Pneumocystis carinii ag if 15.18 General Fee Schedule
87283 Rubeola ag if 15.18 General Fee Schedule
87285 Treponema pallidum ag if 15.18 General Fee Schedule
87290 Varicella zoster ag if 15.18 General Fee Schedule
87299 Antibody detection nos if 15.18 General Fee Schedule
87300 Ag detection polyval if 7.57 General Fee Schedule
87301 Adenovirus ag eia 15.18 General Fee Schedule
87305 Aspergillus ag eia 12.11 General Fee Schedule
87320 Chylmd trach ag eia 15.18 General Fee Schedule
87324 Clostridium ag eia 15.18 General Fee Schedule
87327 Cryptococcus neoform ag eia 15.18 General Fee Schedule
87328 Cryptosporidium ag eia 15.18 General Fee Schedule
87329 Giardia ag eia 15.72 General Fee Schedule
87332 Cytomegalovirus ag eia 15.18 General Fee Schedule
87335 E coli 0157 ag eia 15.18 General Fee Schedule
87336 Entamoeb hist dispr ag eia 15.18 General Fee Schedule
87337 Entamoeb hist group ag eia 15.18 General Fee Schedule
87338 Hpylori stool eia 15.18 General Fee Schedule
87339 H pylori ag eia 15.18 General Fee Schedule
87340 Hepatitis b surface ag eia 13.04 General Fee Schedule
87341 Hepatitis b surface ag eia 13.04 General Fee Schedule
87350 Hepatitis be ag eia 14.55 General Fee Schedule
87380 Hepatitis delta ag eia 20.74 General Fee Schedule
87385 Histoplasma capsul ag eia 15.18 General Fee Schedule
87389 Hiv-1 ag w/hiv-1 & hiv-2 ab 22.20 General Fee Schedule
87390 Hiv-1 ag eia 22.31 General Fee Schedule
87391 Hiv-2 ag eia 22.31 General Fee Schedule
87400 Influenza a/b ag eia 15.18 General Fee Schedule
Data for November 2015
Pathology and Laboratory
Codes and Rates
Procedure
CodeCode Description
Current
RatePricing Description
87420 Resp syncytial ag eia 15.18 General Fee Schedule
87425 Rotavirus ag eia 15.18 General Fee Schedule
87427 Shiga-like toxin ag eia 15.18 General Fee Schedule
87430 Strep a ag eia 15.18 General Fee Schedule
87449 Ag detect nos eia mult 15.18 General Fee Schedule
87450 Ag detect nos eia single 12.12 General Fee Schedule
87451 Ag detect polyval eia mult 12.12 General Fee Schedule
87470 Bartonella dna dir probe 25.33 General Fee Schedule
87471 Bartonella dna amp probe 44.36 General Fee Schedule
87472 Bartonella dna quant 54.14 General Fee Schedule
87475 Lyme dis dna dir probe 25.33 General Fee Schedule
87476 Lyme dis dna amp probe 44.36 General Fee Schedule
87477 Lyme dis dna quant 52.75 General Fee Schedule
87480 Candida dna dir probe 25.33 General Fee Schedule
87481 Candida dna amp probe 44.36 General Fee Schedule
87482 Candida dna quant 54.14 General Fee Schedule
87485 Chylmd pneum dna dir probe 25.33 General Fee Schedule
87486 Chylmd pneum dna amp probe 44.36 General Fee Schedule
87487 Chylmd pneum dna quant 54.14 General Fee Schedule
87490 Chylmd trach dna dir probe 25.33 General Fee Schedule
87491 Chylmd trach dna amp probe 44.36 General Fee Schedule
87492 Chylmd trach dna quant 44.17 General Fee Schedule
87493 C diff amplified probe 37.97 General Fee Schedule
87495 Cytomeg dna dir probe 25.33 General Fee Schedule
87496 Cytomeg dna amp probe 44.36 General Fee Schedule
87497 Cytomeg dna quant 54.14 General Fee Schedule
87498 Enterovirus probe&revrs trns 35.41 General Fee Schedule
87500 Vanomycin dna amp probe 35.41 General Fee Schedule
87501 Influenza dna amp prob 1+ 55.11 General Fee Schedule
87502 Influenza dna amp probe 91.37 General Fee Schedule
87503 Influenza dna amp prob addl 22.31 General Fee Schedule
87510 Gardner vag dna dir probe 25.33 General Fee Schedule
87511 Gardner vag dna amp probe 44.36 General Fee Schedule
87512 Gardner vag dna quant 52.75 General Fee Schedule
87515 Hepatitis b dna dir probe 25.33 General Fee Schedule
87516 Hepatitis b dna amp probe 44.36 General Fee Schedule
87517 Hepatitis b dna quant 54.14 General Fee Schedule
87520 Hepatitis c rna dir probe 25.33 General Fee Schedule
87521 Hepatitis c probe&rvrs trnsc 44.36 General Fee Schedule
87522 Hepatitis c revrs trnscrpj 54.14 General Fee Schedule
87525 Hepatitis g dna dir probe 25.33 General Fee Schedule
87526 Hepatitis g dna amp probe 44.36 General Fee Schedule
87527 Hepatitis g dna quant 52.75 General Fee Schedule
87528 Hsv dna dir probe 25.33 General Fee Schedule
87529 Hsv dna amp probe 44.36 General Fee Schedule
87530 Hsv dna quant 54.14 General Fee Schedule
87531 Hhv-6 dna dir probe 25.33 General Fee Schedule
87532 Hhv-6 dna amp probe 44.36 General Fee Schedule
87533 Hhv-6 dna quant 52.75 General Fee Schedule
87534 Hiv-1 dna dir probe 25.33 General Fee Schedule
Data for November 2015
Pathology and Laboratory
Codes and Rates
Procedure
CodeCode Description
Current
RatePricing Description
87535 Hiv-1 probe&reverse trnscrpj 44.36 General Fee Schedule
87536 Hiv-1 quant&revrse trnscrpj 107.54 General Fee Schedule
87537 Hiv-2 dna dir probe 25.33 General Fee Schedule
87538 Hiv-2 probe&revrse trnscripj 44.36 General Fee Schedule
87539 Hiv-2 quant&revrse trnscripj 54.14 General Fee Schedule
87540 Legion pneumo dna dir prob 25.33 General Fee Schedule
87541 Legion pneumo dna amp prob 44.36 General Fee Schedule
87542 Legion pneumo dna quant 52.75 General Fee Schedule
87550 Mycobacteria dna dir probe 25.33 General Fee Schedule
87551 Mycobacteria dna amp probe 44.36 General Fee Schedule
87552 Mycobacteria dna quant 54.14 General Fee Schedule
87555 M.tuberculo dna dir probe 25.33 General Fee Schedule
87556 M.tuberculo dna amp probe 44.36 General Fee Schedule
87557 M.tuberculo dna quant 54.14 General Fee Schedule
87560 M.avium-intra dna dir prob 25.33 General Fee Schedule
87561 M.avium-intra dna amp prob 44.36 General Fee Schedule
87562 M.avium-intra dna quant 54.14 General Fee Schedule
87580 M.pneumon dna dir probe 25.33 General Fee Schedule
87581 M.pneumon dna amp probe 44.36 General Fee Schedule
87582 M.pneumon dna quant 52.75 General Fee Schedule
87590 N.gonorrhoeae dna dir prob 25.33 General Fee Schedule
87591 N.gonorrhoeae dna amp prob 44.36 General Fee Schedule
87592 N.gonorrhoeae dna quant 54.14 General Fee Schedule
87623 Hpv low-risk types 44.36 General Fee Schedule
87624 Hpv high-risk types 44.36 General Fee Schedule
87625 Hpv types 16 & 18 only 44.36 General Fee Schedule
87631 Resp virus 3-5 targets 91.37 General Fee Schedule
87633 Resp virus 12-25 targets 481.52 General Fee Schedule
87640 Staph a dna amp probe 35.41 General Fee Schedule
87641 Mr-staph dna amp probe 35.41 General Fee Schedule
87650 Strep a dna dir probe 25.33 General Fee Schedule
87651 Strep a dna amp probe 44.36 General Fee Schedule
87652 Strep a dna quant 52.75 General Fee Schedule
87653 Strep b dna amp probe 35.41 General Fee Schedule
87660 Trichomonas vagin dir probe 26.28 General Fee Schedule
87661 Trichomonas vaginalis amplif 36.08 General Fee Schedule
87797 Detect agent nos dna dir 25.33 General Fee Schedule
87798 Detect agent nos dna amp 44.36 General Fee Schedule
87799 Detect agent nos dna quant 54.14 General Fee Schedule
87800 Detect agnt mult dna direc 25.38 General Fee Schedule
87801 Detect agnt mult dna ampli 44.36 General Fee Schedule
87802 Strep b assay w/optic 15.18 General Fee Schedule
87803 Clostridium toxin a w/optic 15.18 General Fee Schedule
87804 Influenza assay w/optic 15.18 General Fee Schedule
87806 Hiv antigen w/hiv antibodies 24.70 General Fee Schedule
87807 Rsv assay w/optic 11.47 General Fee Schedule
87808 Trichomonas assay w/optic 1.53 General Relative Value
87809 Adenovirus assay w/optic 12.11 General Fee Schedule
87810 Chylmd trach assay w/optic 15.18 General Fee Schedule
87850 N.GONORRHOEAE ASSAY W/OPTIC 15.18 General Fee Schedule
Data for November 2015
Pathology and Laboratory
Codes and Rates
Procedure
CodeCode Description
Current
RatePricing Description
87880 STREP A ASSAY W/OPTIC 15.18 General Fee Schedule
87899 AGENT NOS ASSAY W/OPTIC 15.18 General Fee Schedule
87900 Phenotype infect agent drug 124.45 General Fee Schedule
87901 Genotype dna hiv reverse t 325.34 General Fee Schedule
87902 Genotype dna/rna hep c 325.34 General Fee Schedule
87903 Phenotype dna hiv w/culture 617.52 General Fee Schedule
87904 Phenotype dna hiv w/clt add 32.94 General Fee Schedule
87905 Sialidase enzyme assay 5.54 General Fee Schedule
87906 Genotype dna/rna hiv 138.23 General Fee Schedule
87910 Genotype cytomegalovirus 265.41 General Fee Schedule
87912 Genotype dna hepatitis b 265.41 General Fee Schedule
87999 Microbiology procedure 0 Manual Price
88104 Cytopath fl nongyn smears 2.50 26 Relative Value
88104 Cytopath fl nongyn smears 2.50 TC Relative Value Scale
88104 Cytopath fl nongyn smears 5.00 General Relative Value
88106 Cytopath fl nongyn filter 2.50 26 Relative Value
88106 Cytopath fl nongyn filter 2.50 TC Relative Value Scale
88106 Cytopath fl nongyn filter 5.00 General Relative Value
88108 Cytopath concentrate tech 3.00 26 Relative Value
88108 Cytopath concentrate tech 2.00 TC Relative Value Scale
88108 Cytopath concentrate tech 5.00 General Relative Value
88112 Cytopath cell enhance tech 5.25 26 Relative Value
88112 Cytopath cell enhance tech 4.54 TC Relative Value Scale
88112 Cytopath cell enhance tech 9.80 General Relative Value
88120 Cytp urne 3-5 probes ea spec 5.03 26 Relative Value
88120 Cytp urne 3-5 probes ea spec 38.90 TC Relative Value Scale
88120 Cytp urne 3-5 probes ea spec 43.93 General Relative Value
88121 Cytp urine 3-5 probes cmptr 4.47 26 Relative Value
88121 Cytp urine 3-5 probes cmptr 32.63 TC Relative Value Scale
88121 Cytp urine 3-5 probes cmptr 37.10 General Relative Value
88125 Forensic cytopathology 1.48 26 Relative Value
88125 Forensic cytopathology 0.94 TC Relative Value Scale
88125 Forensic cytopathology 2.42 General Relative Value
88130 Sex chromatin identification 19.01 General Fee Schedule
88140 Sex chromatin identification 3.65 General Fee Schedule
88141 Cytopath c/v interpret 15.18 General Fee Schedule
88142 Cytopath c/v thin layer 25.61 General Fee Schedule
88143 Cytopath c/v thin layer redo 19.21 General Fee Schedule
88147 Cytopath c/v automated 14.38 General Fee Schedule
88148 Cytopath c/v auto rescreen 19.21 General Fee Schedule
88150 Cytopath c/v manual 13.36 General Fee Schedule
88152 Cytopath c/v auto redo 13.36 General Fee Schedule
88153 Cytopath c/v redo 13.36 General Fee Schedule
88154 Cytopath c/v select 13.36 General Fee Schedule
88155 Cytopath c/v index add-on 7.56 General Fee Schedule
88160 Cytopath smear other source 2.50 26 Relative Value
88160 Cytopath smear other source 2.50 TC Relative Value Scale
88160 Cytopath smear other source 5.00 General Relative Value
88161 Cytopath smear other source 2.50 26 Relative Value
88161 Cytopath smear other source 2.50 TC Relative Value Scale
Data for November 2015
Pathology and Laboratory
Codes and Rates
Procedure
CodeCode Description
Current
RatePricing Description
88161 Cytopath smear other source 5.00 General Relative Value
88162 Cytopath smear other source 4.53 General Relative Value
88162 Cytopath smear other source 3.16 26 Relative Value
88162 Cytopath smear other source 1.37 TC Relative Value Scale
88164 Cytopath tbs c/v manual 13.36 General Fee Schedule
88165 Cytopath tbs c/v redo 13.36 General Fee Schedule
88166 Cytopath tbs c/v auto redo 6.53 General Fee Schedule
88167 Cytopath tbs c/v select 13.36 General Fee Schedule
88172 Cytp dx eval fna 1st ea site 2.50 TC Relative Value Scale
88172 Cytp dx eval fna 1st ea site 5.92 General Relative Value
88172 Cytp dx eval fna 1st ea site 3.38 26 Relative Value
88173 Cytopath eval fna report 6.19 26 Relative Value
88173 Cytopath eval fna report 2.27 TC Relative Value Scale
88173 Cytopath eval fna report 8.46 General Relative Value
88174 Cytopath c/v auto in fluid 13.49 General Fee Schedule
88175 Cytopath c/v auto fluid redo 13.49 General Fee Schedule
88177 Cytp fna eval ea addl 2.06 26 Relative Value
88177 Cytp fna eval ea addl 0.61 TC Relative Value Scale
88177 Cytp fna eval ea addl 2.67 General Relative Value
88182 FLOW CYTOMETRY; CELL CYCLE / DNA ANALYSI 4.04 26 Relative Value
88182 FLOW CYTOMETRY; CELL CYCLE / DNA ANALYSI 8.30 TC Relative Value Scale
88182 FLOW CYTOMETRY; CELL CYCLE / DNA ANALYSI 11.51 General Relative Value
88184 Flowcytometry/ tc 1 marker 4.40 TC Relative Value Scale
88185 Flowcytometry/tc add-on 2.16 TC Relative Value Scale
88187 Flowcytometry/read 2-8 5.97 General Relative Value
88188 Flowcytometry/read 9-15 7.45 General Relative Value
88189 Flowcytometry/read 16 & > 9.81 General Relative Value
88199 UNLISTED CYTOPATHOLOGY PROCEDURE 0 26 Requires manual Price
88199 UNLISTED CYTOPATHOLOGY PROCEDURE 0 Manual Price
88230 Tissue culture lymphocyte 46.59 General Fee Schedule
88233 Tissue culture skin/biopsy 93.18 General Fee Schedule
88235 Tissue culture placenta 93.18 General Fee Schedule
88237 Tissue culture bone marrow 159.60 General Fee Schedule
88239 Tissue culture tumor 186.45 General Fee Schedule
88240 Cell cryopreserve/storage 12.76 General Fee Schedule
88241 Frozen cell preparation 12.76 General Fee Schedule
88245 Chromosome analysis 20-25 188.11 General Fee Schedule
88248 Chromosome analysis 50-100 218.85 General Fee Schedule
88249 Chromosome analysis 100 218.85 General Fee Schedule
88261 Chromosome analysis 5 222.34 General Fee Schedule
88262 Chromosome analysis 15-20 157.51 General Fee Schedule
88263 Chromosome analysis 45 189.90 General Fee Schedule
88264 Chromosome analysis 20-25 157.51 General Fee Schedule
88267 Chromosome analys placenta 227.18 General Fee Schedule
88269 Chromosome analys amniotic 210.18 General Fee Schedule
88271 Cytogenetics dna probe 27.07 General Fee Schedule
88272 Cytogenetics 3-5 33.83 General Fee Schedule
88273 Cytogenetics 10-30 40.60 General Fee Schedule
88274 Cytogenetics 25-99 44.00 General Fee Schedule
88275 Cytogenetics 100-300 50.76 General Fee Schedule
Data for November 2015
Pathology and Laboratory
Codes and Rates
Procedure
CodeCode Description
Current
RatePricing Description
88280 CHROMOSOME KARYOTYPE STUDY 31.73 General Fee Schedule
88283 CHROMOSOME BANDING STUDY 86.68 General Fee Schedule
88285 Chromosome count additional 24.01 General Fee Schedule
88289 Chromosome study additional 43.52 General Fee Schedule
88291 Cyto/molecular report 18.77 General Fee Schedule
88299 UNLISTED CYTOGENETIC STUDY 0 Manual Price
88300 Surgical path gross 0.48 26 Relative Value
88300 Surgical path gross 0.50 TC Relative Value Scale
88300 Surgical path gross 1.80 General Relative Value
88302 Tissue exam by pathologist 0.73 26 Relative Value
88302 Tissue exam by pathologist 1.20 TC Relative Value Scale
88302 Tissue exam by pathologist 4.10 General Relative Value
88304 Tissue exam by pathologist 1.23 26 Relative Value
88304 Tissue exam by pathologist 1.60 TC Relative Value Scale
88304 Tissue exam by pathologist 5.20 General Relative Value
88305 Tissue exam by pathologist 4.24 26 Relative Value
88305 Tissue exam by pathologist 2.20 TC Relative Value Scale
88305 Tissue exam by pathologist 7.30 General Relative Value
88307 Tissue exam by pathologist 7.10 26 Relative Value
88307 Tissue exam by pathologist 3.00 TC Relative Value Scale
88307 Tissue exam by pathologist 10.10 General Relative Value
88309 Tissue exam by pathologist 9.40 26 Relative Value
88309 Tissue exam by pathologist 4.00 TC Relative Value Scale
88309 Tissue exam by pathologist 13.40 General Relative Value
88311 SURGICAL PATHOLOGY, GROSS AND MICROSCOPI 0.20 26 Relative Value
88311 SURGICAL PATHOLOGY, GROSS AND MICROSCOPI 0.60 TC Relative Value Scale
88311 SURGICAL PATHOLOGY, GROSS AND MICROSCOPI 0.80 General Relative Value
88312 Special stains group 1 0.50 26 Relative Value
88312 Special stains group 1 1.20 TC Relative Value Scale
88312 Special stains group 1 1.70 General Relative Value
88313 Special stains group 2 0.20 26 Relative Value
88313 Special stains group 2 0.60 TC Relative Value Scale
88313 Special stains group 2 0.80 General Relative Value
88314 Histochemical stains add-on 1.20 26 Relative Value
88314 Histochemical stains add-on 3.80 TC Relative Value Scale
88314 Histochemical stains add-on 5.00 General Relative Value
88319 Enzyme histochemistry 2.30 26 Relative Value
88319 Enzyme histochemistry 2.20 TC Relative Value Scale
88319 Enzyme histochemistry 4.50 General Relative Value
88321 Microslide consultation 6.10 General Relative Value
88323 Microslide consultation 6.36 26 Relative Value
88323 Microslide consultation 4.26 TC Relative Value Scale
88323 Microslide consultation 10.62 General Relative Value
88325 Comprehensive review of data 10.20 General Relative Value
88329 Path consult introp 10.45 General Relative Value
88331 Path consult intraop 1 bloc 5.60 26 Relative Value
88331 Path consult intraop 1 bloc 1.75 TC Relative Value Scale
88331 Path consult intraop 1 bloc 7.35 General Relative Value
88332 Path consult intraop addl 2.80 26 Relative Value
88332 Path consult intraop addl 0.88 TC Relative Value Scale
Data for November 2015
Pathology and Laboratory
Codes and Rates
Procedure
CodeCode Description
Current
RatePricing Description
88332 Path consult intraop addl 3.68 General Relative Value
88333 Intraop cyto path consult 1 5.54 26 Relative Value
88333 Intraop cyto path consult 1 1.85 TC Relative Value Scale
88333 Intraop cyto path consult 1 7.39 General Relative Value
88334 Intraop cyto path consult 2 2.72 26 Relative Value
88334 Intraop cyto path consult 2 1.13 TC Relative Value Scale
88334 Intraop cyto path consult 2 3.85 General Relative Value
88341 Immunohisto antibody slide 5.22 26 Relative Value
88341 Immunohisto antibody slide 1.22 TC Relative Value Scale
88341 Immunohisto antibody slide 6.44 General Relative Value
88342 Immunohisto antibody stain 3.82 26 Relative Value
88342 Immunohisto antibody stain 2.89 TC Relative Value Scale
88342 Immunohisto antibody stain 6.71 General Relative Value
88344 Immunohisto antibody slide 3.82 26 Relative Value
88344 Immunohisto antibody slide 2.89 TC Relative Value Scale
88344 Immunohisto antibody slide 6.71 General Relative Value
88346 IMMUNOFLUORESCENT STUDY EACH ANTIBODY 4.08 26 Relative Value
88346 IMMUNOFLUORESCENT STUDY EACH ANTIBODY 2.60 TC Relative Value Scale
88346 IMMUNOFLUORESCENT STUDY EACH ANTIBODY 6.67 General Relative Value
88347 INDIRECT METHOD 3.94 26 Relative Value
88347 INDIRECT METHOD 3.84 TC Relative Value Scale
88347 INDIRECT METHOD 7.78 General Relative Value
88348 Electron microscopy 8.45 26 Relative Value
88348 Electron microscopy 4.33 TC Relative Value Scale
88348 Electron microscopy 14.39 General Relative Value
88355 Analysis skeletal muscle 9.03 26 Relative Value
88355 Analysis skeletal muscle 8.49 TC Relative Value Scale
88355 Analysis skeletal muscle 17.51 General Relative Value
88356 Analysis nerve 14.58 26 Relative Value
88356 Analysis nerve 8.94 TC Relative Value Scale
88356 Analysis nerve 23.52 General Relative Value
88358 Analysis tumor 5.14 26 Relative Value
88358 Analysis tumor 2.28 TC Relative Value Scale
88358 Analysis tumor 8.68 General Relative Value
88360 Tumor immunohistochem/manual 5.31 26 Relative Value
88360 Tumor immunohistochem/manual 4.20 TC Relative Value Scale
88360 Tumor immunohistochem/manual 9.51 General Relative Value
88361 Tumor immunohistochem/comput 4.35 26 Relative Value
88361 Tumor immunohistochem/comput 6.82 TC Relative Value Scale
88361 Tumor immunohistochem/comput 11.17 General Relative Value
88362 NERVE TEASING PREPARATION 12.11 26 Relative Value
88362 NERVE TEASING PREPARATION 4.17 TC Relative Value Scale
88362 NERVE TEASING PREPARATION 16.85 General Relative Value
88363 Xm archive tissue molec anal 3.65 General Relative Value
88364 Insitu hybridization (fish) 2.56 26 Relative Value
88364 Insitu hybridization (fish) 6.64 TC Relative Value Scale
88364 Insitu hybridization (fish) 9.13 General Relative Value
88365 Insitu hybridization (fish) 4.60 26 Relative Value
88365 Insitu hybridization (fish) 6.50 TC Relative Value Scale
88365 Insitu hybridization (fish) 11.10 General Relative Value
Data for November 2015
Pathology and Laboratory
Codes and Rates
Procedure
CodeCode Description
Current
RatePricing Description
88366 Insitu hybridization (fish) 5.91 26 Relative Value
88366 Insitu hybridization (fish) 8.19 TC Relative Value Scale
88366 Insitu hybridization (fish) 14.11 General Relative Value
88367 Insitu hybridization auto 6.20 26 Relative Value
88367 Insitu hybridization auto 11.91 TC Relative Value Scale
88367 Insitu hybridization auto 18.11 General Relative Value
88368 Insitu hybridization manual 6.73 26 Relative Value
88368 Insitu hybridization manual 9.70 TC Relative Value Scale
88368 Insitu hybridization manual 16.43 General Relative Value
88369 M/phmtrc alysishquant/semiq 2.35 26 Relative Value
88369 M/phmtrc alysishquant/semiq 4.61 TC Relative Value Scale
88369 M/phmtrc alysishquant/semiq 6.96 General Relative Value
88371 Protein western blot tissue 12.68 26 Fee Schedule
88371 Protein western blot tissue 28.08 General Fee Schedule
88372 PROTEIN ANALYSIS W/PROBE 13.19 26 Fee Schedule
88372 PROTEIN ANALYSIS W/PROBE 13.45 General Fee Schedule
88373 M/phmtrc alys ishquant/semiq 1.98 26 Relative Value
88373 M/phmtrc alys ishquant/semiq 3.73 TC Relative Value Scale
88373 M/phmtrc alys ishquant/semiq 5.71 General Relative Value
88374 M/phmtrc alys ishquant/semiq 4.23 26 Relative Value
88374 M/phmtrc alys ishquant/semiq 15.10 TC Relative Value Scale
88374 M/phmtrc alys ishquant/semiq 19.33 General Relative Value
88377 M/phmtrc alys ishquant/semiq 6.14 26 Relative Value
88377 M/phmtrc alys ishquant/semiq 14.04 TC Relative Value Scale
88377 M/phmtrc alys ishquant/semiq 20.19 General Relative Value
88380 Microdissection laser 15.88 General Relative Value
88381 Microdissection manual 33.50 26 Fee Schedule
88381 Microdissection manual 100.71 TC Fee Schedule
88381 Microdissection manual 134.67 General Fee Schedule
88387 Tiss exam molecular study 2.32 26 Relative Value
88387 Tiss exam molecular study 0.58 TC Relative Value Scale
88387 Tiss exam molecular study 2.91 General Relative Value
88388 Tiss ex molecul study add-on 1.44 26 Relative Value
88388 Tiss ex molecul study add-on 0.29 TC Relative Value Scale
88388 Tiss ex molecul study add-on 1.72 General Relative Value
88399 UNLISTED SURGICAL PATHOLOGY PROCEDURE 0 26 Requires manual Price
88399 UNLISTED SURGICAL PATHOLOGY PROCEDURE 0 TC Requires Manual Price
88399 UNLISTED SURGICAL PATHOLOGY PROCEDURE 0 Manual Price
88720 Bilirubin total transcut 5.30 General Fee Schedule
88738 Hgb quant transcutaneous 5.44 General Fee Schedule
88740 Transcutaneous carboxyhb 5.28 General Fee Schedule
88741 Transcutaneous methb 5.28 General Fee Schedule
88749 In vivo lab service 0 Manual Price
89049 Chct for mal hyperthermia 15.84 General Relative Value
89050 Body fluid cell count 5.37 General Fee Schedule
89051 BODY FLUID CELL COUNT 6.94 General Fee Schedule
89055 Leukocyte count, fecal 5.45 General Fee Schedule
89060 Exam synovial fluid crystals 1.15 26 Relative Value
89125 Specimen fat stain 5.72 General Fee Schedule
89160 EXAM FECES FOR MEAT FIBERS 4.73 General Fee Schedule
Data for November 2015
Pathology and Laboratory
Codes and Rates
Procedure
CodeCode Description
Current
RatePricing Description
89190 NASAL SMEAR FOR EOSINOPHILS 4.73 General Fee Schedule
89230 Collect sweat for test 2.41 General Fee Schedule
89240 Pathology lab procedure 0 Manual Price
89300 Semen analysis w/huhner 11.85 General Fee Schedule
89310 Semen analysis w/count 8.47 General Fee Schedule
89320 Semen anal vol/count/mot 16.04 General Fee Schedule
89321 Semen anal sperm detection 16.04 General Fee Schedule
89322 Semen anal strict criteria 15.62 General Fee Schedule
89325 SPERM ANTIBODY TEST 10.38 General Fee Schedule
89329 SPERM EVALUATION TEST 27.88 General Fee Schedule
89330 Evaluation cervical mucus 13.18 General Fee Schedule
89331 Retrograde ejaculation anal 19.76 General Fee Schedule
89398 Unlisted reprod med lab proc 0 Manual Price
G0416 Prostate biopsy, any mthd 57.02 General Relative Value
G0432 EIA HIV-1/HIV-2 screen 10.72 General Fee Schedule
G0433 ELISA HIV-1/HIV-2 screen 10.72 General Fee Schedule
G0435 Oral HIV-1/HIV-2 screen 12.89 General Fee Schedule
P3000 SCREEN PAP BY TECH W/ MD SUPV 14.35 General Fee Schedule
P3001 Screening pap smear by phys 7.02 General Fee Schedule
P7001 URINE CULTURE AND SENSITIVITY W/W/OUT 16.37 General Fee Schedule
P9041 Albumin (human),5%, 50ml 2.44 General Fee Schedule
P9043 Plasma protein fract,5%,50ml 14.95 General Fee Schedule
P9045 Albumin (human), 5%, 250 ml 8.81 General Fee Schedule
P9046 Albumin (human), 25%, 20 ml 27.09 General Fee Schedule
P9047 Albumin (human), 25%, 50ml 13.29 General Fee Schedule
P9048 Plasmaprotein fract,5%,250ml 397.43 General Fee Schedule
P9050 Granulocytes, pheresis unit 20.88 General Fee Schedule
P9612 Catheterize for urine spec 2.96 General Fee Schedule
P9615 Urine specimen collect mult 2.96 General Fee Schedule
** Age 0-2
Data for November 2015