CY19_RATEFINAL

PEIA 2019 Clinical Diagnostic Laboratory

The absence or presence of a CPT Code or fee does not indicate coverage

HCPCS/CPT Modifier Allowance Short Desription

36415 5.00 Routine venipuncture 78267 11.06 Breath tst attain/anal c-14 78268 94.41 Breath test analysis c-14 80047 QW 13.73 Metabolic panel ionized ca 80047 13.73 Metabolic panel ionized ca 80048 QW 10.44 Metabolic panel total ca 80048 9.40 Metabolic panel total ca 80051 QW 8.66 Electrolyte panel 80051 7.79 Electrolyte panel 80053 QW 13.04 Comprehen metabolic panel 80053 11.74 Comprehen metabolic panel 80055 53.12 Obstetric panel 80061 QW 16.53 Lipid panel 80061 14.88 Lipid panel 80069 QW 10.72 Renal function panel 80069 9.65 Renal function panel 80074 52.93 Acute hepatitis panel 80076 9.08 Hepatic function panel 80081 83.18 Obstetric panel 80150 16.75 Assay of amikacin 80155 38.57 Drug assay caffeine 80156 16.18 Assay carbamazepine total 80157 14.73 Assay carbamazepine free 80158 20.06 Drug assay cyclosporine 80159 20.55 Drug assay clozapine 80162 14.75 Assay of digoxin total 80163 14.75 Assay of digoxin free 80164 15.05 Assay dipropylacetic acd tot 80165 15.05 Dipropylacetic acid free 80168 18.15 Assay of ethosuximide 80169 15.26 Drug assay everolimus 80170 18.20 Assay of gentamicin 80171 21.67 Drug screen quant gabapentin 80173 16.18 Assay of haloperidol 80175 14.73 Drug screen quan lamotrigine 80176 16.32 Assay of lidocaine 80177 14.73 Drug scrn quan levetiracetam 80178 QW 8.16 Assay of lithium

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80178 7.35 Assay of lithium 80180 20.06 Drug scrn quan mycophenolate 80183 14.73 Drug scrn quant oxcarbazepin 80184 15.30 Assay of phenobarbital 80185 14.73 Assay of phenytoin total 80186 15.29 Assay of phenytoin free 80188 18.44 Assay of primidone 80190 60.00 Assay of procainamide 80192 18.61 Assay of procainamide 80194 16.22 Assay of quinidine 80195 15.26 Assay of sirolimus 80197 15.26 Assay of tacrolimus 80198 15.71 Assay of theophylline 80199 27.11 Drug screen quant tiagabine 80200 17.92 Assay of tobramycin 80201 13.24 Assay of topiramate 80202 15.05 Assay of vancomycin 80203 14.73 Drug screen quant zonisamide 80299 18.64 Quantitative assay drug 80305 QW 12.60 Drug test prsmv dir opt obs 80305 12.60 Drug test prsmv dir opt obs 80306 17.14 Drug test prsmv instrmnt 80307 64.65 Drug test prsmv chem anlyzr 80400 36.24 Acth stimulation panel 80402 96.62 Acth stimulation panel 80406 86.95 Acth stimulation panel 80408 139.44 Aldosterone suppression eval 80410 29.77 Calcitonin stimul panel 80412 801.62 Crh stimulation panel 80414 57.37 Testosterone response 80415 62.09 Estradiol response panel 80416 209.32 Renin stimulation panel 80417 48.88 Renin stimulation panel 80418 643.84 Pituitary evaluation panel 80420 161.88 Dexamethasone panel 80422 51.19 Glucagon tolerance panel 80424 56.11 Glucagon tolerance panel 80426 164.90 Gonadotropin hormone panel 80428 74.12 Growth hormone panel 80430 129.33 Growth hormone panel 80432 165.61 Insulin suppression panel 80434 285.03 Insulin tolerance panel 80435 114.45 Insulin tolerance panel 80436 101.29 Metyrapone panel

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80438 56.01 Trh stimulation panel 80439 74.68 Trh stimulation panel 81000 4.02 Urinalysis nonauto w/scope 81001 3.52 Urinalysis auto w/scope 81002 3.48 Urinalysis nonauto w/o scope 81003 QW 2.77 Urinalysis auto w/o scope 81003 2.49 Urinalysis auto w/o scope 81005 2.41 Urinalysis 81007 QW 29.98 Urine screen for bacteria 81007 29.98 Urine screen for bacteria 81015 3.39 Microscopic exam of urine 81020 4.70 Urinalysis glass test 81025 8.61 Urine pregnancy test 81050 3.64 Urinalysis volume measure 81105 135.80 Hpa-1 genotyping 81106 135.80 Hpa-2 genotyping 81107 135.80 Hpa-3 genotyping 81108 135.80 Hpa-4 genotyping 81109 135.80 Hpa-5 genotyping 81110 135.80 Hpa-6 genotyping 81111 135.80 Hpa-9 genotyping 81112 135.80 Hpa-15 genotyping 81120 193.25 Idh1 common variants 81121 295.79 Idh2 common variants 81161 279.00 Dmd dup/delet analysis 81162 2,027.64 Brca1&2 gen full seq dup/del 81163 468.00 Brca1&2 gene full seq alys 81164 584.23 Brca1&2 gen ful dup/del alys 81165 282.88 Brca1 gene full seq alys 81166 301.35 Brca1 gene full dup/del alys 81167 282.88 Brca2 gene full dup/del alys 81170 300.00 Abl1 gene 81171 137.00 Aff2 gene detc abnor alleles 81172 274.83 Aff2 gene charac alleles 81173 301.35 Ar gene full gene sequence 81174 185.20 Ar gene known famil variant 81175 676.50 Asxl1 full gene sequence 81176 268.77 Asxl1 gene target seq alys 81177 137.00 Atn1 gene detc abnor alleles 81178 137.00 Atxn1 gene detc abnor allele 81179 137.00 Atxn2 gene detc abnor allele 81180 137.00 Atxn3 gene detc abnor allele 81181 137.00 Atxn7 gene detc abnor allele 81182 137.00 Atxn8os gen detc abnor allel

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81183 137.00 Atxn10 gene detc abnor allel 81184 137.00 Cacna1a gen detc abnor allel 81185 846.27 Cacna1a gene full gene seq 81186 185.20 Cacna1a gen known famil vrnt 81187 137.00 Cnbp gene detc abnor allele 81188 137.00 Cstb gene detc abnor allele 81189 274.83 Cstb gene full gene sequence 81190 185.20 Cstb gene known famil vrnt 81200 47.25 Aspa gene 81201 780.00 Apc gene full sequence 81202 280.00 Apc gene known fam variants 81203 200.00 Apc gene dup/delet variants 81204 137.00 Ar gene charac alleles 81205 94.99 Bckdhb gene 81206 182.18 Bcr/abl1 gene major bp 81207 160.93 Bcr/abl1 gene minor bp 81208 214.62 Bcr/abl1 gene other bp 81209 39.31 Blm gene 81210 175.40 Braf gene 81212 440.00 Brca1&2 185&5385&6174 vrnt 81215 375.25 Brca1 gene known famil vrnt 81216 185.12 Brca2 gene full seq alys 81217 375.25 Brca2 gene known famil vrnt 81218 268.77 Cebpa gene full sequence 81219 135.14 Calr gene com variants 81220 556.60 Cftr gene com variants 81221 97.22 Cftr gene known fam variants 81222 435.07 Cftr gene dup/delet variants 81223 499.00 Cftr gene full sequence 81224 168.75 Cftr gene intron poly t 81225 291.36 Cyp2c19 gene com variants 81226 450.91 Cyp2d6 gene com variants 81227 174.81 Cyp2c9 gene com variants 81228 900.00 Cytogen micrarray copy nmbr 81229 1,160.00 Cytogen m array copy no&snp 81230 174.81 Cyp3a4 gene common variants 81231 174.81 Cyp3a5 gene common variants 81232 174.81 Dpyd gene common variants 81233 175.40 Btk gene common variants 81234 137.00 Dmpk gene detc abnor allele 81235 324.58 Egfr gene com variants 81236 282.88 Ezh2 gene full gene sequence 81237 175.40 Ezh2 gene common variants 81238 600.00 F9 full gene sequence

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81239 274.83 Dmpk gene charac alleles 81240 65.69 F2 gene 81241 73.37 F5 gene 81242 36.62 Fancc gene 81243 57.04 Fmr1 gene detection 81244 44.89 Fmr1 gene charac alleles 81245 165.51 Flt3 gene 81246 83.00 Flt3 gene analysis 81247 174.81 G6pd gene alys cmn variant 81248 375.25 G6pd known familial variant 81249 600.00 G6pd full gene sequence 81250 58.49 G6pc gene 81251 47.25 Gba gene 81252 101.12 Gjb2 gene full sequence 81253 61.52 Gjb2 gene known fam variants 81254 35.00 Gjb6 gene com variants 81255 51.45 Hexa gene 81256 72.62 Hfe gene 81257 102.26 Hba1/hba2 gene 81258 375.25 Hba1/hba2 gene fam vrnt 81259 600.00 Hba1/hba2 full gene sequence 81260 39.31 Ikbkap gene 81261 219.99 Igh gene rearrange amp meth 81262 68.55 Igh gene rearrang dir probe 81263 327.24 Igh vari regional mutation 81264 172.73 Igk rearrangeabn clonal pop 81265 238.94 Str markers specimen anal 81266 304.81 Str markers spec anal addl 81267 230.51 Chimerism anal no cell selec 81268 289.76 Chimerism anal w/cell select 81269 202.40 Hba1/hba2 gene dup/del vrnts 81270 101.85 Jak2 gene 81271 137.00 Htt gene detc abnor alleles 81272 329.51 Kit gene targeted seq analys 81273 124.87 Kit gene analys d816 variant 81274 274.83 Htt gene charac alleles 81275 193.25 Kras gene variants exon 2 81276 193.25 Kras gene addl variants 81283 73.37 Ifnl3 gene 81284 137.00 Fxn gene detc abnor alleles 81285 274.83 Fxn gene charac alleles 81286 274.83 Fxn gene full gene sequence 81287 124.64 Mgmt gene prmtr mthyltn alys 81288 192.32 Mlh1 gene

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81289 185.20 Fxn gene known famil variant 81290 39.31 Mcoln1 gene 81291 65.34 Mthfr gene 81292 675.40 Mlh1 gene full seq 81293 331.00 Mlh1 gene known variants 81294 202.40 Mlh1 gene dup/delete variant 81295 381.70 Msh2 gene full seq 81296 337.73 Msh2 gene known variants 81297 213.30 Msh2 gene dup/delete variant 81298 641.85 Msh6 gene full seq 81299 308.00 Msh6 gene known variants 81300 238.00 Msh6 gene dup/delete variant 81301 348.56 Microsatellite instability 81302 527.87 Mecp2 gene full seq 81303 120.00 Mecp2 gene known variant 81304 150.00 Mecp2 gene dup/delet variant 81305 175.40 Myd88 gene p.leu265pro vrnt 81306 291.36 Nudt15 gene common variants 81310 246.52 Npm1 gene 81311 295.79 Nras gene variants exon 2&3 81312 137.00 Pabpn1 gene detc abnor allel 81313 255.05 Pca3/klk3 antigen 81314 329.51 Pdgfra gene 81315 230.35 Pml/raralpha com breakpoints 81316 230.35 Pml/raralpha 1 breakpoint 81317 676.50 Pms2 gene full seq analysis 81318 331.00 Pms2 known familial variants 81319 203.50 Pms2 gene dup/delet variants 81320 291.36 Plcg2 gene common variants 81321 600.00 Pten gene full sequence 81322 47.56 Pten gene known fam variant 81323 300.00 Pten gene dup/delet variant 81324 758.36 Pmp22 gene dup/delet 81325 769.58 Pmp22 gene full sequence 81326 47.56 Pmp22 gene known fam variant 81327 192.00 Sept9 gen prmtr mthyltn alys 81328 174.81 Slco1b1 gene com variants 81329 137.00 Smn1 gene dos/deletion alys 81330 47.00 Smpd1 gene common variants 81331 51.07 Snrpn/ube3a gene 81332 48.50 Serpina1 gene 81333 137.00 Tgfbi gene common variants 81334 659.02 Runx1 gene targeted seq alys 81335 174.81 Tpmt gene com variants

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81336 301.35 Smn1 gene full gene sequence 81337 185.20 Smn1 gen nown famil seq vrnt 81340 232.13 Trb@ gene rearrange amplify 81341 55.10 Trb@ gene rearrange dirprobe 81342 223.88 Trg gene rearrangement anal 81343 137.00 Ppp2r2b gen detc abnor allel 81344 137.00 Tbp gene detc abnor alleles 81345 185.20 Tert gene targeted seq alys 81346 174.81 Tyms gene com variants 81350 234.00 Ugt1a1 gene 81355 88.20 Vkorc1 gene 81361 174.81 Hbb gene com variants 81362 375.25 Hbb gene known fam variant 81363 202.40 Hbb gene dup/del variants 81364 324.58 Hbb full gene sequence 81370 446.80 Hla i & ii typing lr 81371 404.52 Hla i & ii type verify lr 81372 403.59 Hla i typing complete lr 81373 127.43 Hla i typing 1 locus lr 81374 80.83 Hla i typing 1 antigen lr 81375 245.27 Hla ii typing ag equiv lr 81376 135.80 Hla ii typing 1 locus lr 81377 102.01 Hla ii type 1 ag equiv lr 81378 383.96 Hla i & ii typing hr 81379 372.65 Hla i typing complete hr 81380 196.94 Hla i typing 1 locus hr 81381 169.90 Hla i typing 1 allele hr 81382 137.42 Hla ii typing 1 loc hr 81383 121.26 Hla ii typing 1 allele hr 81400 63.96 Mopath procedure level 1 81401 137.00 Mopath procedure level 2 81402 150.33 Mopath procedure level 3 81403 185.20 Mopath procedure level 4 81404 274.83 Mopath procedure level 5 81405 301.35 Mopath procedure level 6 81406 282.88 Mopath procedure level 7 81407 846.27 Mopath procedure level 8 81408 2,000.00 Mopath procedure level 9 81410 504.00 Aortic dysfunction/dilation 81411 1,350.19 Aortic dysfunction/dilation 81412 2,448.56 Ashkenazi jewish assoc dis 81413 649.89 Car ion chnnlpath inc 10 gns 81414 649.89 Car ion chnnlpath inc 2 gns 81415 4,780.00 Exome sequence analysis

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81416 12,000.00 Exome sequence analysis 81417 320.00 Exome re-evaluation 81420 759.05 Fetal chrmoml aneuploidy 81422 759.05 Fetal chrmoml microdeltj 81425 5,031.20 Genome sequence analysis 81426 2,709.95 Genome sequence analysis 81427 2,337.65 Genome re-evaluation 81430 1,625.00 Hearing loss sequence analys 81431 679.57 Hearing loss dup/del analys 81432 754.50 Hrdtry brst ca-rlatd dsordrs 81433 487.70 Hrdtry brst ca-rlatd dsordrs 81434 597.91 Hereditary retinal disorders 81435 649.89 Hereditary colon ca dsordrs 81436 649.89 Hereditary colon ca dsordrs 81437 487.70 Heredtry nurondcrn tum dsrdr 81438 487.70 Heredtry nurondcrn tum dsrdr 81439 649.89 Hrdtry cardmypy gene panel 81440 3,324.00 Mitochondrial gene 81442 2,143.60 Noonan spectrum disorders 81443 2,448.56 Genetic tstg severe inh cond 81445 597.91 Targeted genomic seq analys 81448 649.89 Hrdtry perph neurphy panel 81450 759.53 Targeted genomic seq analys 81455 2,919.60 Targeted genomic seq analys 81460 1,287.00 Whole mitochondrial genome 81465 936.00 Whole mitochondrial genome 81470 914.00 X-linked intellectual dblt 81471 914.00 X-linked intellectual dblt 81490 840.65 Autoimmune rheumatoid arthr 81493 1,050.00 Cor artery disease mrna 81500 260.50 Onco (ovar) two proteins 81503 897.00 Onco (ovar) five proteins 81504 520.00 Oncology tissue of origin 81506 74.67 Endo assay seven anal 81507 795.00 Fetal aneuploidy trisom risk 81508 54.30 Ftl cgen abnor two proteins 81509 1,487.37 Ftl cgen abnor 3 proteins 81510 55.54 Ftl cgen abnor three anal 81511 153.50 Ftl cgen abnor four anal 81512 69.52 Ftl cgen abnor five anal 81518 3,873.00 Onc brst mrna 11 genes 81519 3,873.00 Oncology breast mrna 81520 2,789.12 Onc breast mrna 58 genes 81521 3,873.00 Onc breast mrna 70 genes

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81525 3,116.00 Oncology colon mrna 81528 508.87 Oncology colorectal scr 81535 579.46 Oncology gynecologic 81536 177.56 Oncology gynecologic 81538 2,871.00 Oncology lung 81539 760.00 Oncology prostate prob score 81540 3,750.00 Oncology tum unknown origin 81541 3,873.00 Onc prostate mrna 46 genes 81545 3,600.00 Oncology thyroid 81551 2,030.00 Onc prostate 3 genes 81595 3,240.00 Cardiology hrt trnspl mrna 81596 72.19 Nfct ds chrnc hcv 6 assays 82009 5.02 Test for acetone/ketones 82010 QW 10.09 Acetone assay 82010 9.08 Acetone assay 82013 12.41 Acetylcholinesterase assay 82016 16.49 Acylcarnitines qual 82017 18.74 Acylcarnitines quant 82024 42.91 Assay of acth 82030 28.67 Assay of adp & amp 82040 QW 6.11 Assay of serum albumin 82040 5.50 Assay of serum albumin 82042 QW 7.78 Other source albumin quan ea 82042 7.78 Other source albumin quan ea 82043 QW 7.14 Ur albumin quantitative 82043 6.42 Ur albumin quantitative 82044 QW 6.23 Ur albumin semiquantitative 82044 6.23 Ur albumin semiquantitative 82045 37.71 Albumin ischemia modified 82075 30.00 Assay of breath ethanol 82085 10.79 Assay of aldolase 82088 45.28 Assay of aldosterone 82103 14.93 Alpha-1-antitrypsin total 82104 16.07 Alpha-1-antitrypsin pheno 82105 18.64 Alpha-fetoprotein serum 82106 18.64 Alpha-fetoprotein amniotic 82107 71.57 Alpha-fetoprotein l3 82108 28.31 Assay of aluminum 82120 QW 5.99 Amines vaginal fluid qual 82120 5.99 Amines vaginal fluid qual 82127 15.41 Amino acid single qual 82128 15.41 Amino acids mult qual 82131 22.98 Amino acids single quant 82135 18.28 Assay aminolevulinic acid

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82136 19.61 Amino acids quant 2-5 82139 18.74 Amino acids quan 6 or more 82140 16.19 Assay of ammonia 82143 9.35 Amniotic fluid scan 82150 QW 8.00 Assay of amylase 82150 7.20 Assay of amylase 82154 32.04 Androstanediol glucuronide 82157 32.53 Assay of androstenedione 82160 27.78 Assay of androsterone 82163 22.80 Assay of angiotensin ii 82164 16.22 Angiotensin i enzyme test 82172 21.09 Assay of apolipoprotein 82175 21.08 Assay of arsenic 82180 10.98 Assay of ascorbic acid 82190 16.56 Atomic absorption 82232 17.97 Assay of beta-2 protein 82239 19.03 Bile acids total 82240 29.53 Bile acids cholylglycine 82247 QW 6.19 Bilirubin total 82247 5.57 Bilirubin total 82248 5.57 Bilirubin direct 82252 5.06 Fecal bilirubin test 82261 18.74 Assay of biotinidase 82270 4.38 Occult blood feces 82271 QW 5.32 Occult blood other sources 82271 5.32 Occult blood other sources 82272 4.23 Occult bld feces 1-3 tests 82274 QW 19.64 Assay test for blood fecal 82274 17.67 Assay test for blood fecal 82286 5.73 Assay of bradykinin 82300 25.72 Assay of cadmium 82306 32.89 Vitamin d 25 hydroxy 82308 29.77 Assay of calcitonin 82310 QW 6.37 Assay of calcium 82310 5.73 Assay of calcium 82330 QW 16.88 Assay of calcium 82330 15.20 Assay of calcium 82331 13.34 Calcium infusion test 82340 6.70 Assay of calcium in urine 82355 12.86 Calculus analysis qual 82360 14.30 Calculus assay quant 82365 14.33 Calculus spectroscopy 82370 13.92 X-ray assay calculus 82373 20.06 Assay c-d transfer measure

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82374 QW 6.03 Assay blood carbon dioxide 82374 5.43 Assay blood carbon dioxide 82375 13.69 Assay carboxyhb quant 82376 14.07 Assay carboxyhb qual 82378 21.07 Carcinoembryonic antigen 82379 18.74 Assay of carnitine 82380 10.25 Assay of carotene 82382 27.30 Assay urine catecholamines 82383 29.08 Assay blood catecholamines 82384 28.06 Assay three catecholamines 82387 20.06 Assay of cathepsin-d 82390 11.93 Assay of ceruloplasmin 82397 15.69 Chemiluminescent assay 82415 14.08 Assay of chloramphenicol 82435 QW 5.68 Assay of blood chloride 82435 5.11 Assay of blood chloride 82436 5.75 Assay of urine chloride 82438 5.43 Assay other fluid chlorides 82441 6.67 Test for chlorohydrocarbons 82465 QW 5.37 Assay bld/serum cholesterol 82465 4.84 Assay bld/serum cholesterol 82480 8.75 Assay serum cholinesterase 82482 9.81 Assay rbc cholinesterase 82485 22.95 Assay chondroitin sulfate 82495 22.53 Assay of chromium 82507 30.89 Assay of citrate 82523 QW 23.07 Collagen crosslinks 82523 20.76 Collagen crosslinks 82525 13.79 Assay of copper 82528 25.02 Assay of corticosterone 82530 18.57 Cortisol free 82533 18.11 Total cortisol 82540 5.15 Assay of creatine 82542 24.09 Col chromotography qual/quan 82550 QW 8.04 Assay of ck (cpk) 82550 7.23 Assay of ck (cpk) 82552 14.88 Assay of cpk in blood 82553 12.83 Creatine mb fraction 82554 13.19 Creatine isoforms 82565 QW 6.33 Assay of creatinine 82565 5.69 Assay of creatinine 82570 QW 6.39 Assay of urine creatinine 82570 5.75 Assay of urine creatinine 82575 10.51 Creatinine clearance test

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82585 14.14 Assay of cryofibrinogen 82595 7.18 Assay of cryoglobulin 82600 21.55 Assay of cyanide 82607 16.75 Vitamin b-12 82608 15.91 B-12 binding capacity 82610 18.52 Cystatin c 82615 9.55 Test for urine cystines 82626 28.08 Dehydroepiandrosterone 82627 24.71 Dehydroepiandrosterone 82633 34.43 Desoxycorticosterone 82634 32.53 Deoxycortisol 82638 13.61 Assay of dibucaine number 82642 32.53 Dihydrotestosterone 82652 42.78 Vit d 1 25-dihydroxy 82656 12.81 Pancreatic elastase fecal 82657 22.17 Enzyme cell activity 82658 44.03 Enzyme cell activity ra 82664 61.50 Electrophoretic test 82668 20.88 Assay of erythropoietin 82670 31.04 Assay of estradiol 82671 35.89 Assay of estrogens 82672 24.11 Assay of estrogen 82677 26.87 Assay of estriol 82679 QW 30.81 Assay of estrone 82679 27.73 Assay of estrone 82693 16.56 Assay of ethylene glycol 82696 26.24 Assay of etiocholanolone 82705 5.66 Fats/lipids feces qual 82710 18.67 Fats/lipids feces quant 82715 22.97 Assay of fecal fat 82725 18.77 Assay of blood fatty acids 82726 20.06 Long chain fatty acids 82728 15.15 Assay of ferritin 82731 71.57 Assay of fetal fibronectin 82735 20.60 Assay of fluoride 82746 16.34 Assay of folic acid serum 82747 19.25 Assay of folic acid rbc 82757 19.26 Assay of semen fructose 82759 23.87 Assay of rbc galactokinase 82760 12.44 Assay of galactose 82775 23.41 Assay galactose transferase 82776 11.74 Galactose transferase test 82777 44.25 Galectin-3 82784 10.34 Assay iga/igd/igg/igm each

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82785 18.29 Assay of ige 82787 8.91 Igg 1 2 3 or 4 each 82800 11.00 Blood ph 82803 26.07 Blood gases any combination 82805 78.77 Blood gases w/o2 saturation 82810 9.77 Blood gases o2 sat only 82820 13.34 Hemoglobin-oxygen affinity 82930 6.71 Gastric analy w/ph ea spec 82938 19.66 Gastrin test 82941 19.59 Assay of gastrin 82943 15.88 Assay of glucagon 82945 4.37 Glucose other fluid 82946 17.77 Glucagon tolerance test 82947 QW 4.85 Assay glucose blood quant 82947 4.37 Assay glucose blood quant 82948 5.04 Reagent strip/blood glucose 82950 QW 5.86 Glucose test 82950 5.27 Glucose test 82951 QW 15.89 Glucose tolerance test (gtt) 82951 14.30 Glucose tolerance test (gtt) 82952 QW 4.84 Gtt-added samples 82952 4.36 Gtt-added samples 82955 10.77 Assay of g6pd enzyme 82960 6.72 Test for g6pd enzyme 82962 3.28 Glucose blood test 82963 23.87 Assay of glucosidase 82965 13.15 Assay of gdh enzyme 82977 QW 8.89 Assay of ggt 82977 8.00 Assay of ggt 82978 15.84 Assay of glutathione 82979 10.49 Assay rbc glutathione 82985 QW 18.61 Assay of glycated protein 82985 16.76 Assay of glycated protein 83001 QW 22.94 Assay of gonadotropin (fsh) 83001 20.65 Assay of gonadotropin (fsh) 83002 QW 22.86 Assay of gonadotropin (lh) 83002 20.57 Assay of gonadotropin (lh) 83003 18.52 Assay growth hormone (hgh) 83006 75.60 Growth stimulation gene 2 83009 74.84 H pylori (c-13) blood 83010 13.97 Assay of haptoglobin quant 83012 26.89 Assay of haptoglobins 83013 74.84 H pylori (c-13) breath 83014 8.73 H pylori drug admin

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83015 20.94 Heavy metal qual any anal 83018 24.41 Heavy metal quant each nes 83020 14.30 Hemoglobin electrophoresis 83021 20.06 Hemoglobin chromotography 83026 4.01 Hemoglobin copper sulfate 83030 10.74 Fetal hemoglobin chemical 83033 8.00 Fetal hemoglobin assay qual 83036 QW 11.99 Glycosylated hemoglobin test 83036 10.79 Glycosylated hemoglobin test 83037 QW 11.99 Glycosylated hb home device 83037 10.79 Glycosylated hb home device 83045 6.49 Blood methemoglobin test 83050 8.20 Blood methemoglobin assay 83051 8.12 Assay of plasma hemoglobin 83060 9.19 Blood sulfhemoglobin assay 83065 9.00 Assay of hemoglobin heat 83068 9.47 Hemoglobin stability screen 83069 4.39 Assay of urine hemoglobin 83070 5.27 Assay of hemosiderin qual 83080 18.74 Assay of b hexosaminidase 83088 32.81 Assay of histamine 83090 18.74 Assay of homocystine 83150 22.41 Assay of homovanillic acid 83491 19.47 Assay of corticosteroids 17 83497 14.33 Assay of 5-hiaa 83498 30.19 Assay of progesterone 17-d 83500 25.17 Assay free hydroxyproline 83505 27.01 Assay total hydroxyproline 83516 QW 14.24 Immunoassay nonantibody 83516 12.81 Immunoassay nonantibody 83518 QW 10.47 Immunoassay dipstick 83518 9.64 Immunoassay dipstick 83519 18.40 Ria nonantibody 83520 QW 17.27 Immunoassay quant nos nonab 83520 17.27 Immunoassay quant nos nonab 83525 12.70 Assay of insulin 83527 14.39 Assay of insulin 83528 19.82 Assay of intrinsic factor 83540 7.19 Assay of iron 83550 9.71 Iron binding test 83570 9.83 Assay of idh enzyme 83582 15.75 Assay of ketogenic steroids 83586 14.22 Assay 17- ketosteroids 83593 29.22 Fractionation ketosteroids

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83605 QW 13.19 Assay of lactic acid 83605 11.87 Assay of lactic acid 83615 6.71 Lactate (ld) (ldh) enzyme 83625 14.22 Assay of ldh enzymes 83630 21.81 Lactoferrin fecal (qual) 83631 21.81 Lactoferrin fecal (quant) 83632 22.47 Placental lactogen 83633 11.25 Test urine for lactose 83655 QW 14.95 Assay of lead 83655 13.45 Assay of lead 83661 24.43 L/s ratio fetal lung 83662 21.01 Foam stability fetal lung 83663 21.01 Fluoro polarize fetal lung 83664 21.01 Lamellar bdy fetal lung 83670 10.18 Assay of lap enzyme 83690 7.65 Assay of lipase 83695 14.39 Assay of lipoprotein(a) 83698 46.31 Assay lipoprotein pla2 83700 12.51 Lipopro bld electrophoretic 83701 33.86 Lipoprotein bld hr fraction 83704 35.06 Lipoprotein bld quan part 83718 QW 10.12 Assay of lipoprotein 83718 9.10 Assay of lipoprotein 83719 12.93 Assay of blood lipoprotein 83721 QW 11.78 Assay of blood lipoprotein 83721 10.60 Assay of blood lipoprotein 83722 35.06 Lipoprtn dir meas sd ldl chl 83727 19.10 Assay of lrh hormone 83735 7.44 Assay of magnesium 83775 8.19 Assay malate dehydrogenase 83785 27.33 Assay of manganese 83789 24.11 Mass spectrometry qual/quan 83825 18.06 Assay of mercury 83835 18.82 Assay of metanephrines 83857 11.93 Assay of methemalbumin 83861 QW 22.48 Microfluid analy tears 83861 22.48 Microfluid analy tears 83864 28.50 Mucopolysaccharides 83872 6.51 Assay synovial fluid mucin 83873 19.12 Assay of csf protein 83874 14.35 Assay of myoglobin 83876 50.86 Assay myeloperoxidase 83880 QW 41.90 Assay of natriuretic peptide 83880 39.26 Assay of natriuretic peptide

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83883 15.11 Assay nephelometry not spec 83885 27.23 Assay of nickel 83915 12.39 Assay of nucleotidase 83916 27.39 Oligoclonal bands 83918 23.60 Organic acids total quant 83919 18.28 Organic acids qual each 83921 21.21 Organic acid single quant 83930 7.35 Assay of blood osmolality 83935 7.57 Assay of urine osmolality 83937 33.16 Assay of osteocalcin 83945 14.45 Assay of oxalate 83950 71.57 Oncoprotein her-2/neu 83951 71.57 Oncoprotein dcp 83970 45.86 Assay of parathormone 83986 QW 4.42 Assay ph body fluid nos 83986 3.98 Assay ph body fluid nos 83987 3.98 Exhaled breath condensate 83993 21.81 Assay for calprotectin fecal 84030 6.11 Assay of blood pku 84035 4.07 Assay of phenylketones 84060 8.21 Assay acid phosphatase 84066 10.73 Assay prostate phosphatase 84075 QW 6.39 Assay alkaline phosphatase 84075 5.75 Assay alkaline phosphatase 84078 8.26 Assay alkaline phosphatase 84080 16.43 Assay alkaline phosphatases 84081 18.35 Assay phosphatidylglycerol 84085 10.49 Assay of rbc pg6d enzyme 84087 11.47 Assay phosphohexose enzymes 84100 5.27 Assay of phosphorus 84105 5.78 Assay of urine phosphorus 84106 5.82 Test for porphobilinogen 84110 9.38 Assay of porphobilinogen 84112 98.11 Eval amniotic fluid protein 84119 13.36 Test urine for porphyrins 84120 16.35 Assay of urine porphyrins 84126 39.11 Assay of feces porphyrins 84132 QW 5.68 Assay of serum potassium 84132 5.11 Assay of serum potassium 84133 4.79 Assay of urine potassium 84134 16.21 Assay of prealbumin 84135 21.27 Assay of pregnanediol 84138 21.05 Assay of pregnanetriol 84140 22.97 Assay of pregnenolone

Page 16 CY19_RATEFINAL

84143 25.34 Assay of 17-hydroxypregneno 84144 23.18 Assay of progesterone 84145 29.77 Procalcitonin (pct) 84146 21.53 Assay of prolactin 84150 41.77 Assay of prostaglandin 84152 20.44 Assay of psa complexed 84153 20.44 Assay of psa total 84154 20.44 Assay of psa free 84155 QW 4.53 Assay of protein serum 84155 4.07 Assay of protein serum 84156 4.07 Assay of protein urine 84157 QW 4.53 Assay of protein other 84157 4.07 Assay of protein other 84160 5.75 Assay of protein any source 84163 16.73 Pappa serum 84165 11.93 Protein e-phoresis serum 84166 19.81 Protein e-phoresis/urine/csf 84181 18.92 Western blot test 84182 29.21 Protein western blot test 84202 15.94 Assay rbc protoporphyrin 84203 9.74 Test rbc protoporphyrin 84206 26.69 Assay of proinsulin 84207 31.22 Assay of vitamin b-6 84210 14.48 Assay of pyruvate 84220 10.49 Assay of pyruvate kinase 84228 12.93 Assay of quinine 84233 87.88 Assay of estrogen 84234 72.09 Assay of progesterone 84235 71.23 Assay of endocrine hormone 84238 40.63 Assay nonendocrine receptor 84244 24.44 Assay of renin 84252 22.49 Assay of vitamin b-2 84255 28.37 Assay of selenium 84260 34.43 Assay of serotonin 84270 24.15 Assay of sex hormone globul 84275 14.93 Assay of sialic acid 84285 26.15 Assay of silica 84295 QW 5.94 Assay of serum sodium 84295 5.35 Assay of serum sodium 84300 5.40 Assay of urine sodium 84302 5.40 Assay of sweat sodium 84305 23.63 Assay of somatomedin 84307 20.31 Assay of somatostatin 84311 8.10 Spectrophotometry

Page 17 CY19_RATEFINAL

84315 3.28 Body fluid specific gravity 84375 39.00 Chromatogram assay sugars 84376 6.11 Sugars single qual 84377 6.11 Sugars multiple qual 84378 12.81 Sugars single quant 84379 12.81 Sugars multiple quant 84392 5.49 Assay of urine sulfate 84402 28.30 Assay of free testosterone 84403 28.68 Assay of total testosterone 84410 56.98 Testosterone bioavailable 84425 23.59 Assay of vitamin b-1 84430 12.93 Assay of thiocyanate 84431 35.11 Thromboxane urine 84432 17.84 Assay of thyroglobulin 84436 7.63 Assay of total thyroxine 84437 7.18 Assay of neonatal thyroxine 84439 10.02 Assay of free thyroxine 84442 16.43 Assay of thyroid activity 84443 QW 20.75 Assay thyroid stim hormone 84443 18.67 Assay thyroid stim hormone 84445 56.51 Assay of tsi globulin 84446 15.75 Assay of vitamin e 84449 20.00 Assay of transcortin 84450 QW 6.39 Transferase (ast) (sgot) 84450 5.75 Transferase (ast) (sgot) 84460 QW 6.54 Alanine amino (alt) (sgpt) 84460 5.89 Alanine amino (alt) (sgpt) 84466 14.18 Assay of transferrin 84478 QW 7.09 Assay of triglycerides 84478 6.38 Assay of triglycerides 84479 7.18 Assay of thyroid (t3 or t4) 84480 15.75 Assay triiodothyronine (t3) 84481 18.82 Free assay (ft-3) 84482 17.51 T3 reverse 84484 12.47 Assay of troponin quant 84485 8.00 Assay duodenal fluid trypsin 84488 8.11 Test feces for trypsin 84490 9.93 Assay of feces for trypsin 84510 11.56 Assay of tyrosine 84512 10.09 Assay of troponin qual 84520 QW 4.88 Assay of urea nitrogen 84520 4.39 Assay of urea nitrogen 84525 5.13 Urea nitrogen semi-quant 84540 5.56 Assay of urine/urea-n

Page 18 CY19_RATEFINAL

84545 7.35 Urea-n clearance test 84550 QW 5.58 Assay of blood/uric acid 84550 5.02 Assay of blood/uric acid 84560 5.27 Assay of urine/uric acid 84577 18.67 Assay of feces/urobilinogen 84578 4.47 Test urine urobilinogen 84580 9.55 Assay of urine urobilinogen 84583 6.05 Assay of urine urobilinogen 84585 17.22 Assay of urine vma 84586 39.26 Assay of vip 84588 37.71 Assay of vasopressin 84590 12.90 Assay of vitamin a 84591 17.06 Assay of nos vitamin 84597 15.24 Assay of vitamin k 84600 17.87 Assay of volatiles 84620 13.16 Xylose tolerance test 84630 12.65 Assay of zinc 84681 23.13 Assay of c-peptide 84702 16.73 Chorionic gonadotropin test 84703 QW 9.29 Chorionic gonadotropin assay 84703 8.36 Chorionic gonadotropin assay 84704 16.73 Hcg free betachain test 84830 12.70 Ovulation tests 85002 5.01 Bleeding time test 85004 7.18 Automated diff wbc count 85007 3.82 Bl smear w/diff wbc count 85008 3.82 Bl smear w/o diff wbc count 85009 5.07 Manual diff wbc count b-coat 85013 7.00 Spun microhematocrit 85014 QW 2.93 Hematocrit 85014 2.63 Hematocrit 85018 QW 2.93 Hemoglobin 85018 2.63 Hemoglobin 85025 QW 8.63 Complete cbc w/auto diff wbc 85025 8.63 Complete cbc w/auto diff wbc 85027 7.18 Complete cbc automated 85032 4.79 Manual cell count each 85041 3.35 Automated rbc count 85044 4.79 Manual reticulocyte count 85045 4.44 Automated reticulocyte count 85046 6.19 Reticyte/hgb concentrate 85048 2.82 Automated leukocyte count 85049 4.97 Automated platelet count 85055 35.74 Reticulated platelet assay

Page 19 CY19_RATEFINAL

85130 13.21 Chromogenic substrate assay 85170 16.30 Blood clot retraction 85175 20.37 Blood clot lysis time 85210 14.43 Clot factor ii prothrom spec 85220 19.61 Blooc clot factor v test 85230 19.89 Clot factor vii proconvertin 85240 19.89 Clot factor viii ahg 1 stage 85244 22.69 Clot factor viii reltd antgn 85245 25.49 Clot factor viii vw ristoctn 85246 25.49 Clot factor viii vw antigen 85247 25.49 Clot factor viii multimetric 85250 21.16 Clot factor ix ptc/chrstmas 85260 19.89 Clot factor x stuart-power 85270 19.89 Clot factor xi pta 85280 21.50 Clot factor xii hageman 85290 18.15 Clot factor xiii fibrin stab 85291 9.88 Clot factor xiii fibrin scrn 85292 21.04 Clot factor fletcher fact 85293 21.04 Clot factor wght kininogen 85300 13.17 Antithrombin iii activity 85301 12.01 Antithrombin iii antigen 85302 13.35 Clot inhibit prot c antigen 85303 15.37 Clot inhibit prot c activity 85305 12.90 Clot inhibit prot s total 85306 17.03 Clot inhibit prot s free 85307 17.03 Assay activated protein c 85335 14.30 Factor inhibitor test 85337 17.27 Thrombomodulin 85345 4.79 Coagulation time lee & white 85347 4.73 Coagulation time activated 85348 4.49 Coagulation time otr method 85360 9.34 Euglobulin lysis 85362 7.65 Fibrin degradation products 85366 80.46 Fibrinogen test 85370 12.62 Fibrinogen test 85378 9.72 Fibrin degrade semiquant 85379 11.31 Fibrin degradation quant 85380 11.31 Fibrin degradj d-dimer 85384 9.72 Fibrinogen activity 85385 14.46 Fibrinogen antigen 85390 15.48 Fibrinolysins screen i&r 85397 30.86 Clotting funct activity 85400 8.56 Fibrinolytic plasmin 85410 8.56 Fibrinolytic antiplasmin

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85415 19.10 Fibrinolytic plasminogen 85420 7.26 Fibrinolytic plasminogen 85421 11.32 Fibrinolytic plasminogen 85441 4.67 Heinz bodies direct 85445 7.57 Heinz bodies induced 85460 8.59 Hemoglobin fetal 85461 9.36 Hemoglobin fetal 85475 9.86 Hemolysin acid 85520 14.55 Heparin assay 85525 13.15 Heparin neutralization 85530 14.55 Heparin-protamine tolerance 85536 7.18 Iron stain peripheral blood 85540 9.56 Wbc alkaline phosphatase 85547 9.56 Rbc mechanical fragility 85549 20.83 Muramidase 85555 7.47 Rbc osmotic fragility 85557 14.84 Rbc osmotic fragility 85576 QW 26.52 Blood platelet aggregation 85576 24.91 Blood platelet aggregation 85597 19.97 Phospholipid pltlt neutraliz 85598 19.97 Hexagnal phosph pltlt neutrl 85610 QW 4.85 Prothrombin time 85610 4.37 Prothrombin time 85611 4.38 Prothrombin test 85612 17.49 Viper venom prothrombin time 85613 10.64 Russell viper venom diluted 85635 10.94 Reptilase test 85651 4.27 Rbc sed rate nonautomated 85652 3.00 Rbc sed rate automated 85660 6.12 Rbc sickle cell test 85670 6.41 Thrombin time plasma 85675 7.61 Thrombin time titer 85705 10.70 Thromboplastin inhibition 85730 6.67 Thromboplastin time partial 85732 7.18 Thromboplastin time partial 85810 12.97 Blood viscosity examination 86000 7.76 Agglutinins febrile antigen 86001 7.82 Allergen specific igg 86003 5.80 Allg spec ige crude xtrc ea 86005 8.85 Allg spec ige multiallg scr 86008 19.93 Allg spec ige recomb ea 86021 16.73 Wbc antibody identification 86022 20.41 Platelet antibodies 86023 13.84 Immunoglobulin assay

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86038 13.43 Antinuclear antibodies 86039 12.40 Antinuclear antibodies (ana) 86060 8.11 Antistreptolysin o titer 86063 6.41 Antistreptolysin o screen 86140 5.75 C-reactive protein 86141 14.39 C-reactive protein hs 86146 28.28 Beta-2 glycoprotein antibody 86147 28.28 Cardiolipin antibody ea ig 86148 17.85 Anti-phospholipid antibody 86152 273.00 Cell enumeration & id 86155 17.76 Chemotaxis assay 86156 8.07 Cold agglutinin screen 86157 8.96 Cold agglutinin titer 86160 13.33 Complement antigen 86161 13.33 Complement/function activity 86162 22.58 Complement total (ch50) 86171 11.12 Complement fixation each 86200 14.39 Ccp antibody 86215 14.72 Deoxyribonuclease antibody 86225 15.27 Dna antibody native 86226 13.45 Dna antibody single strand 86235 19.93 Nuclear antigen antibody 86255 13.39 Fluorescent antibody screen 86256 13.39 Fluorescent antibody titer 86277 17.49 Growth hormone antibody 86280 9.10 Hemagglutination inhibition 86294 QW 25.57 Immunoassay tumor qual 86294 25.57 Immunoassay tumor qual 86300 23.13 Immunoassay tumor ca 15-3 86301 23.13 Immunoassay tumor ca 19-9 86304 23.13 Immunoassay tumor ca 125 86305 23.13 Human epididymis protein 4 86308 QW 6.39 Heterophile antibody screen 86308 5.75 Heterophile antibody screen 86309 7.18 Heterophile antibody titer 86310 8.19 Heterophile antibody absrbj 86316 23.13 Immunoassay tumor other 86317 16.65 Immunoassay infectious agent 86318 QW 18.09 Immunoassay infectious agent 86318 18.09 Immunoassay infectious agent 86320 29.92 Serum immunoelectrophoresis 86325 24.85 Other immunoelectrophoresis 86327 29.92 Immunoelectrophoresis assay 86329 15.61 Immunodiffusion nes

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86331 13.31 Immunodiffusion ouchterlony 86332 27.08 Immune complex assay 86334 24.83 Immunofix e-phoresis serum 86335 32.61 Immunfix e-phorsis/urine/csf 86336 17.32 Inhibin a 86337 23.79 Insulin antibodies 86340 16.75 Intrinsic factor antibody 86341 23.57 Islet cell antibody 86343 13.84 Leukocyte histamine release 86344 10.39 Leukocyte phagocytosis 86352 150.96 Cell function assay w/stim 86353 54.47 Lymphocyte transformation 86355 41.92 B cells total count 86356 29.75 Mononuclear cell antigen 86357 41.92 Nk cells total count 86359 41.92 T cells total count 86360 52.20 T cell absolute count/ratio 86361 29.75 T cell absolute count 86367 77.78 Stem cells total count 86376 16.17 Microsomal antibody each 86382 18.79 Neutralization test viral 86384 13.61 Nitroblue tetrazolium dye 86386 QW 21.78 Nuclear matrix protein 22 86386 21.78 Nuclear matrix protein 22 86403 11.54 Particle agglut antbdy scrn 86406 11.82 Particle agglut antbdy titr 86430 6.30 Rheumatoid factor test qual 86431 6.30 Rheumatoid factor quant 86480 68.87 Tb test cell immun measure 86481 100.00 Tb ag response t-cell susp 86590 12.66 Streptokinase antibody 86592 4.75 Syphilis test non-trep qual 86593 4.89 Syphilis test non-trep quant 86602 11.31 Antinomyces antibody 86603 14.30 Adenovirus antibody 86606 16.73 Aspergillus antibody 86609 14.31 Bacterium antibody 86611 11.31 Bartonella antibody 86612 14.34 Blastomyces antibody 86615 14.65 Bordetella antibody 86617 17.21 Lyme disease antibody 86618 QW 21.02 Lyme disease antibody 86618 18.92 Lyme disease antibody 86619 14.86 Borrelia antibody

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86622 9.92 Brucella antibody 86625 14.58 Campylobacter antibody 86628 13.34 Candida antibody 86631 13.14 Chlamydia antibody 86632 14.09 Chlamydia igm antibody 86635 12.75 Coccidioides antibody 86638 13.47 Q fever antibody 86641 16.01 Cryptococcus antibody 86644 15.99 Cmv antibody 86645 18.72 Cmv antibody igm 86648 16.90 Diphtheria antibody 86651 14.65 Encephalitis californ antbdy 86652 14.65 Encephaltis east eqne anbdy 86653 14.65 Encephaltis st louis antbody 86654 14.65 Encephaltis west eqne antbdy 86658 14.47 Enterovirus antibody 86663 14.58 Epstein-barr antibody 86664 16.99 Epstein-barr nuclear antigen 86665 20.16 Epstein-barr capsid vca 86666 11.31 Ehrlichia antibody 86668 14.16 Francisella tularensis 86671 13.62 Fungus nes antibody 86674 16.35 Giardia lamblia antibody 86677 16.85 Helicobacter pylori antibody 86682 14.45 Helminth antibody 86684 17.60 Hemophilus influenza antibdy 86687 9.32 Htlv-i antibody 86688 15.56 Htlv-ii antibody 86689 21.51 Htlv/hiv confirmj antibody 86692 19.07 Hepatitis delta agent antbdy 86694 15.99 Herpes simplex nes antbdy 86695 14.65 Herpes simplex type 1 test 86696 21.51 Herpes simplex type 2 test 86698 13.88 Histoplasma antibody 86701 QW 10.97 Hiv-1antibody 86701 9.87 Hiv-1antibody 86702 15.02 Hiv-2 antibody 86703 15.23 Hiv-1/hiv-2 1 result antbdy 86704 13.39 Hep b core antibody total 86705 13.08 Hep b core antibody igm 86706 11.93 Hep b surface antibody 86707 12.85 Hepatitis be antibody 86708 13.76 Hepatitis a antibody 86709 12.51 Hepatitis a igm antibody

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86710 15.06 Influenza virus antibody 86711 16.89 John cunningham antibody 86713 17.00 Legionella antibody 86717 13.61 Leishmania antibody 86720 16.20 Leptospira antibody 86723 14.65 Listeria monocytogenes 86727 14.30 Lymph choriomeningitis ab 86732 15.00 Mucormycosis antibody 86735 14.50 Mumps antibody 86738 14.71 Mycoplasma antibody 86741 14.65 Neisseria meningitidis 86744 15.99 Nocardia antibody 86747 16.70 Parvovirus antibody 86750 14.65 Malaria antibody 86753 13.76 Protozoa antibody nos 86756 15.89 Respiratory virus antibody 86757 21.51 Rickettsia antibody 86759 18.23 Rotavirus antibody 86762 15.99 Rubella antibody 86765 14.31 Rubeola antibody 86768 14.65 Salmonella antibody 86771 24.48 Shigella antibody 86774 16.44 Tetanus antibody 86777 15.99 Toxoplasma antibody 86778 16.01 Toxoplasma antibody igm 86780 QW 16.34 Treponema pallidum 86780 14.71 Treponema pallidum 86784 13.96 Trichinella antibody 86787 14.31 Varicella-zoster antibody 86788 18.72 West nile virus ab igm 86789 15.99 West nile virus antibody 86790 14.31 Virus antibody nos 86793 14.65 Yersinia antibody 86794 18.72 Zika virus igm antibody 86800 17.67 Thyroglobulin antibody 86803 QW 17.61 Hepatitis c ab test 86803 15.85 Hepatitis c ab test 86804 17.21 Hep c ab test confirm 86805 189.51 Lymphocytotoxicity assay 86806 52.88 Lymphocytotoxicity assay 86807 78.65 Cytotoxic antibody screening 86808 32.98 Cytotoxic antibody screening 86812 28.67 Hla typing a b or c 86813 64.44 Hla typing a b or c

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86816 30.95 Hla typing dr/dq 86817 106.14 Hla typing dr/dq 86821 40.62 Lymphocyte culture mixed 86825 109.49 Hla x-math non-cytotoxic 86826 36.53 Hla x-match noncytotoxc addl 86828 64.19 Hla class i&ii antibody qual 86829 64.19 Hla class i/ii antibody qual 86830 95.52 Hla class i phenotype qual 86831 81.88 Hla class ii phenotype qual 86832 323.75 Hla class i high defin qual 86833 325.80 Hla class ii high defin qual 86834 397.29 Hla class i semiquant panel 86835 358.85 Hla class ii semiquant panel 86850 9.77 Rbc antibody screen 86880 5.99 Coombs test direct 86885 6.36 Coombs test indirect qual 86886 5.75 Coombs test indirect titer 86900 3.32 Blood typing serologic abo 86901 3.32 Blood typing serologic rh(d) 86902 6.35 Blood type antigen donor ea 86904 16.34 Blood typing patient serum 86905 4.25 Blood typing rbc antigens 86906 8.61 Bld typing serologic rh phnt 86940 9.11 Hemolysins/agglutinins auto 86941 13.45 Hemolysins/agglutinins 87003 18.71 Small animal inoculation 87015 7.42 Specimen infect agnt concntj 87040 11.47 Blood culture for bacteria 87045 10.49 Feces culture aerobic bact 87046 10.49 Stool cultr aerobic bact ea 87070 9.57 Culture othr specimn aerobic 87071 10.49 Culture aerobic quant other 87073 10.49 Culture bacteria anaerobic 87075 10.52 Cultr bacteria except blood 87076 8.97 Culture anaerobe ident each 87077 QW 9.97 Culture aerobic identify 87077 8.97 Culture aerobic identify 87081 7.36 Culture screen only 87084 27.07 Culture of specimen by kit 87086 8.97 Urine culture/colony count 87088 8.99 Urine bacteria culture 87101 8.56 Skin fungi culture 87102 9.34 Fungus isolation culture 87103 20.46 Blood fungus culture

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87106 11.47 Fungi identification yeast 87107 11.47 Fungi identification mold 87109 17.10 Mycoplasma 87110 21.77 Chlamydia culture 87116 12.00 Mycobacteria culture 87118 14.61 Mycobacteric identification 87140 6.19 Culture type immunofluoresc 87143 13.92 Culture typing glc/hplc 87147 5.75 Culture type immunologic 87149 22.28 Dna/rna direct probe 87150 38.99 Dna/rna amplified probe 87152 7.74 Culture type pulse field gel 87153 128.17 Dna/rna sequencing 87158 7.74 Culture typing added method 87164 11.93 Dark field examination 87166 12.56 Dark field examination 87168 4.75 Macroscopic exam arthropod 87169 4.75 Macroscopic exam parasite 87172 4.75 Pinworm exam 87176 6.54 Tissue homogenization cultr 87177 9.89 Ova and parasites smears 87181 5.27 Microbe susceptible diffuse 87184 7.66 Microbe susceptible disk 87185 5.27 Microbe susceptible enzyme 87186 9.61 Microbe susceptible mic 87187 40.17 Microbe susceptible mlc 87188 7.38 Microbe suscept macrobroth 87190 7.31 Microbe suscept mycobacteri 87197 16.69 Bactericidal level serum 87205 4.75 Smear gram stain 87206 5.99 Smear fluorescent/acid stai 87207 6.66 Smear special stain 87209 19.97 Smear complex stain 87210 QW 5.82 Smear wet mount saline/ink 87210 5.82 Smear wet mount saline/ink 87220 4.75 Tissue exam for fungi 87230 21.93 Assay toxin or antitoxin 87250 21.73 Virus inoculate eggs/animal 87252 28.97 Virus inoculation tissue 87253 22.45 Virus inoculate tissue addl 87254 21.73 Virus inoculation shell via 87255 37.62 Genet virus isolate hsv 87260 14.43 Adenovirus ag if 87265 13.32 Pertussis ag if

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87267 13.42 Enterovirus antibody dfa 87269 13.61 Giardia ag if 87270 13.32 Chlamydia trachomatis ag if 87271 13.42 Cytomegalovirus dfa 87272 13.32 Cryptosporidium ag if 87273 13.32 Herpes simplex 2 ag if 87274 13.32 Herpes simplex 1 ag if 87275 13.32 Influenza b ag if 87276 16.07 Influenza a ag if 87278 15.60 Legion pneumophilia ag if 87279 16.43 Parainfluenza ag if 87280 13.42 Respiratory syncytial ag if 87281 13.32 Pneumocystis carinii ag if 87283 60.80 Rubeola ag if 87285 13.32 Treponema pallidum ag if 87290 13.42 Varicella zoster ag if 87299 16.10 Antibody detection nos if 87300 13.32 Ag detection polyval if 87301 13.32 Adenovirus ag ia 87305 13.32 Aspergillus ag ia 87320 15.00 Chylmd trach ag ia 87324 13.32 Clostridium ag ia 87327 13.42 Cryptococcus neoform ag ia 87328 13.82 Cryptosporidium ag ia 87329 13.32 Giardia ag ia 87332 13.32 Cytomegalovirus ag ia 87335 13.32 E coli 0157 ag ia 87336 16.00 Entamoeb hist dispr ag ia 87337 13.32 Entamoeb hist group ag ia 87338 QW 17.76 Hpylori stool ia 87338 15.98 Hpylori stool ia 87339 16.00 H pylori ag ia 87340 11.48 Hepatitis b surface ag ia 87341 11.48 Hepatitis b surface ag ia 87350 12.81 Hepatitis be ag ia 87380 18.36 Hepatitis delta ag ia 87385 13.32 Histoplasma capsul ag ia 87389 QW 29.73 Hiv-1 ag w/hiv-1 & hiv-2 ab 87389 26.75 Hiv-1 ag w/hiv-1 & hiv-2 ab 87390 24.06 Hiv-1 ag ia 87391 21.90 Hiv-2 ag ia 87400 14.13 Influenza a/b ag ia 87420 13.91 Resp syncytial ag ia 87425 13.32 Rotavirus ag ia

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87427 13.32 Shiga-like toxin ag ia 87430 16.81 Strep a ag ia 87449 QW 14.80 Ag detect nos ia mult 87449 13.32 Ag detect nos ia mult 87450 10.66 Ag detect nos ia single 87451 10.66 Ag detect polyval ia mult 87471 38.99 Bartonella dna amp probe 87472 47.60 Bartonella dna quant 87475 22.28 Lyme dis dna dir probe 87476 38.99 Lyme dis dna amp probe 87480 22.28 Candida dna dir probe 87481 38.99 Candida dna amp probe 87482 55.74 Candida dna quant 87483 463.09 Cns dna amp probe type 12-25 87485 22.28 Chylmd pneum dna dir probe 87486 38.99 Chylmd pneum dna amp probe 87487 47.60 Chylmd pneum dna quant 87490 22.75 Chylmd trach dna dir probe 87491 38.99 Chylmd trach dna amp probe 87492 53.47 Chylmd trach dna quant 87493 38.99 C diff amplified probe 87495 30.03 Cytomeg dna dir probe 87496 38.99 Cytomeg dna amp probe 87497 47.60 Cytomeg dna quant 87498 38.99 Enterovirus probe&revrs trns 87500 38.99 Vanomycin dna amp probe 87501 57.02 Influenza dna amp prob 1+ 87502 QW 105.06 Influenza dna amp probe 87502 95.80 Influenza dna amp probe 87503 29.22 Influenza dna amp prob addl 87505 142.54 Nfct agent detection gi 87506 262.99 Iadna-dna/rna probe tq 6-11 87507 463.09 Iadna-dna/rna probe tq 12-25 87510 22.28 Gardner vag dna dir probe 87511 38.99 Gardner vag dna amp probe 87512 46.40 Gardner vag dna quant 87516 38.99 Hepatitis b dna amp probe 87517 47.60 Hepatitis b dna quant 87520 31.22 Hepatitis c rna dir probe 87521 38.99 Hepatitis c probe&rvrs trnsc 87522 47.60 Hepatitis c revrs trnscrpj 87525 29.80 Hepatitis g dna dir probe 87526 39.26 Hepatitis g dna amp probe 87527 46.40 Hepatitis g dna quant

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87528 22.28 Hsv dna dir probe 87529 38.99 Hsv dna amp probe 87530 47.60 Hsv dna quant 87531 58.00 Hhv-6 dna dir probe 87532 38.99 Hhv-6 dna amp probe 87533 46.40 Hhv-6 dna quant 87534 22.28 Hiv-1 dna dir probe 87535 38.99 Hiv-1 probe&reverse trnscrpj 87536 94.55 Hiv-1 quant&revrse trnscrpj 87537 22.28 Hiv-2 dna dir probe 87538 38.99 Hiv-2 probe&revrse trnscripj 87539 58.62 Hiv-2 quant&revrse trnscripj 87540 22.28 Legion pneumo dna dir prob 87541 38.99 Legion pneumo dna amp prob 87542 46.40 Legion pneumo dna quant 87550 22.28 Mycobacteria dna dir probe 87551 48.24 Mycobacteria dna amp probe 87552 47.60 Mycobacteria dna quant 87555 26.88 M.tuberculo dna dir probe 87556 41.68 M.tuberculo dna amp probe 87557 47.60 M.tuberculo dna quant 87560 27.29 M.avium-intra dna dir prob 87561 38.99 M.avium-intra dna amp prob 87562 47.60 M.avium-intra dna quant 87580 22.28 M.pneumon dna dir probe 87581 38.99 M.pneumon dna amp probe 87582 302.62 M.pneumon dna quant 87590 26.88 N.gonorrhoeae dna dir prob 87591 38.99 N.gonorrhoeae dna amp prob 87592 47.60 N.gonorrhoeae dna quant 87623 38.99 Hpv low-risk types 87624 38.99 Hpv high-risk types 87625 40.55 Hpv types 16 & 18 only 87631 QW 158.38 Resp virus 3-5 targets 87631 142.63 Resp virus 3-5 targets 87632 237.14 Resp virus 6-11 targets 87633 QW 463.09 Resp virus 12-25 targets 87633 463.09 Resp virus 12-25 targets 87634 QW 86.66 Rsv dna/rna amp probe 87634 77.99 Rsv dna/rna amp probe 87640 38.99 Staph a dna amp probe 87641 38.99 Mr-staph dna amp probe 87650 QW 24.76 Strep a dna dir probe 87650 22.28 Strep a dna dir probe

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87651 QW 43.33 Strep a dna amp probe 87651 38.99 Strep a dna amp probe 87652 46.40 Strep a dna quant 87653 38.99 Strep b dna amp probe 87660 22.28 Trichomonas vagin dir probe 87661 38.99 Trichomonas vaginalis amplif 87662 57.02 Zika virus dna/rna amp probe 87797 30.03 Detect agent nos dna dir 87798 38.99 Detect agent nos dna amp 87799 47.60 Detect agent nos dna quant 87800 44.57 Detect agnt mult dna direc 87801 QW 77.99 Detect agnt mult dna ampli 87801 77.99 Detect agnt mult dna ampli 87802 13.32 Strep b assay w/optic 87803 16.00 Clostridium toxin a w/optic 87804 QW 16.55 Influenza assay w/optic 87804 16.55 Influenza assay w/optic 87806 QW 32.77 Hiv antigen w/hiv antibodies 87806 32.77 Hiv antigen w/hiv antibodies 87807 QW 14.80 Rsv assay w/optic 87807 13.32 Rsv assay w/optic 87808 QW 15.29 Trichomonas assay w/optic 87808 15.29 Trichomonas assay w/optic 87809 QW 21.76 Adenovirus assay w/optic 87809 21.76 Adenovirus assay w/optic 87810 35.29 Chylmd trach assay w/optic 87850 24.56 N. gonorrhoeae assay w/optic 87880 QW 16.53 Strep a assay w/optic 87880 16.53 Strep a assay w/optic 87899 QW 16.07 Agent nos assay w/optic 87899 16.07 Agent nos assay w/optic 87900 144.83 Phenotype infect agent drug 87901 286.05 Genotype dna hiv reverse t 87902 286.05 Genotype dna/rna hep c 87903 542.95 Phenotype dna hiv w/culture 87904 28.97 Phenotype dna hiv w/clt add 87905 QW 15.08 Sialidase enzyme assay 87905 13.58 Sialidase enzyme assay 87906 143.03 Genotype dna/rna hiv 87910 286.05 Genotype cytomegalovirus 87912 286.05 Genotype dna hepatitis b 88130 19.97 Sex chromatin identification 88140 8.88 Sex chromatin identification 88142 22.51 Cytopath c/v thin layer

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88143 23.04 Cytopath c/v thin layer redo 88147 50.56 Cytopath c/v automated 88148 16.88 Cytopath c/v auto rescreen 88150 14.99 Cytopath c/v manual 88152 27.64 Cytopath c/v auto redo 88153 24.03 Cytopath c/v redo 88155 14.65 Cytopath c/v index add-on 88164 14.99 Cytopath tbs c/v manual 88165 42.22 Cytopath tbs c/v redo 88166 14.99 Cytopath tbs c/v auto redo 88167 14.99 Cytopath tbs c/v select 88174 25.37 Cytopath c/v auto in fluid 88175 29.44 Cytopath c/v auto fluid redo 88230 129.44 Tissue culture lymphocyte 88233 156.36 Tissue culture skin/biopsy 88235 163.63 Tissue culture placenta 88237 143.75 Tissue culture bone marrow 88239 163.91 Tissue culture tumor 88240 13.07 Cell cryopreserve/storage 88241 12.09 Frozen cell preparation 88245 192.42 Chromosome analysis 20-25 88248 192.42 Chromosome analysis 50-100 88249 192.42 Chromosome analysis 100 88261 264.34 Chromosome analysis 5 88262 138.49 Chromosome analysis 15-20 88263 166.99 Chromosome analysis 45 88264 144.61 Chromosome analysis 20-25 88267 199.75 Chromosome analys placenta 88269 184.81 Chromosome analys amniotic 88271 23.80 Cytogenetics dna probe 88272 40.70 Cytogenetics 3-5 88273 35.70 Cytogenetics 10-30 88274 42.38 Cytogenetics 25-99 88275 51.19 Cytogenetics 100-300 88280 33.47 Chromosome karyotype study 88283 76.22 Chromosome banding study 88285 26.91 Chromosome count additional 88289 38.26 Chromosome study additional 88371 24.70 Protein western blot tissue 88372 26.22 Protein analysis w/probe 88720 5.57 Bilirubin total transcut 88738 5.57 Hgb quant transcutaneous 88740 9.37 Transcutaneous carboxyhb 88741 9.37 Transcutaneous methb

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89050 5.25 Body fluid cell count 89051 6.12 Body fluid cell count 89055 4.75 Leukocyte assessment fecal 89060 7.95 Exam synovial fluid crystals 89125 5.88 Specimen fat stain 89160 4.85 Exam feces for meat fibers 89190 5.79 Nasal smear for eosinophils 89300 QW 11.03 Semen analysis w/huhner 89300 9.92 Semen analysis w/huhner 89310 9.57 Semen analysis w/count 89320 13.39 Semen anal vol/count/mot 89321 QW 14.88 Semen anal sperm detection 89321 13.39 Semen anal sperm detection 89322 17.22 Semen anal strict criteria 89325 11.86 Sperm antibody test 89329 21.76 Sperm evaluation test 89330 10.99 Evaluation cervical mucus 89331 21.76 Retrograde ejaculation anal 0001U 720.00 Rbn dna hea 35 ag 11 bld grp 0002M 503.40 Liver dis 10 assays w/ash 0002U 25.00 Onc clrct 3 ur metab alg plp 0003M 503.40 Liver dis 10 assays w/nash 0003U 950.00 Onc ovar 5 prtn ser alg scor 0004M 79.00 Scoliosis dna alys 0005U 760.00 Onco prst8 3 gene ur alg 0006M 150.00 Onc hep gene risk classifier 0006U 246.92 Detc ia meds 120+ analytes 0007M 375.00 Onc gastro 51 gene nomogram 0007U 114.43 Rx test prsmv ur w/def conf 0008U 597.91 Hpylori detcj abx rstnc dna 0009M 132.86 Fetal aneuploidy trisom risk 0009U 107.00 Onc brst ca erbb2 amp/nonamp 0010U 427.26 Nfct ds strn typ whl gen seq 0011M 760.00 Onc prst8 ca mrna 12 gen alg 0011U 114.43 Rx mntr lc-ms/ms oral fluid 0012M 760.00 Onc mrna 5 gen rsk urthl ca 0012U 2,515.60 Germln do gene reargmt detcj 0013M 760.00 Onc mrna 5 gen recr urthl ca 0013U 2,515.60 Onc sld org neo gene reargmt 0014U 2,515.60 Hem hmtlmf neo gene reargmt 0016U 182.18 Onc hmtlmf neo rna bcr/abl1 0017U 101.85 Onc hmtlmf neo jak2 mut dna 0018U 0.00 Onc thyr 10 microrna seq alg 0019U 0.00 Onc rna tiss predict alg

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0021U 0.00 Onc prst8 detcj 8 autoantb 0022U 0.00 Trgt gen seq dna&rna 23 gene 0023U 0.00 Onc aml dna detcj/nondetcj 0024U 35.06 Glyca nuc mr spectrsc quan 0025U 95.30 Tenofovir liq chrom ur quan 0026U 3,600.00 Onc thyr dna&mrna 112 genes 0027U 150.52 Jak2 gene trgt seq alys 0029U 0.00 Rx metab advrs trgt seq alys 0030U 0.00 Rx metab warf trgt seq alys 0031U 174.81 Cyp1a2 gene 0032U 174.81 Comt gene 0033U 349.62 Htr2a htr2c genes 0034U 466.17 Tpmt nudt15 genes 0035U 0.00 Neuro csf prion prtn qual 0036U 4,780.00 Xome tum & nml spec seq alys 0037U 3,500.00 Trgt gen seq dna 324 genes 0038U 32.89 Vitamin d srm microsamp quan 0039U 15.27 Dna antb 2strand hi avidity 0040U 455.45 Bcr/abl1 gene major bp quan 0041U 0.00 B brgdrferi antb 5 prtn igm 0042U 0.00 B brgdrferi antb 12 prtn igg 0043U 0.00 Tbrf b grp antb 4 prtn igm 0044U 0.00 Tbrf b grp antb 4 prtn igg 0045U 3,873.00 Onc brst dux carc is 12 gene 0046U 165.51 Flt3 gene itd variants quan 0047U 3,873.00 Onc prst8 mrna 17 gene alg 0048U 0.00 Onc sld org neo dna 468 gene 0049U 246.52 Npm1 gene analysis quan 0050U 0.00 Trgt gen seq dna 194 genes 0051U 205.63 Rx mntr lc-ms/ms ur 31 pnl 0052U 33.86 Lpoprtn bld w/5 maj classes 0053U 0.00 Onc prst8 ca fish alys 4 gen 0054U 165.52 Rx mntr 14+ drugs & sbsts 0055U 0.00 Card hrt trnspl 96 dna seq 0056U 0.00 Hem aml dna gene reargmt 0057U 0.00 Onc sld org neo mrna 51 gene 0058U 358.85 Onc merkel cll carc srm quan 0059U 358.85 Onc merkel cll carc srm +/- 0060U 759.05 Twn zyg gen seq alys chrms2 0061U 27.85 Tc meas 5 bmrk sfdi m-s alys G0027 7.23 Semen analysis G0103 20.44 Psa screening G0123 22.51 Screen cerv/vag thin layer G0143 27.05 Scr c/v cyto,thinlayer,rescr

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G0144 43.97 Scr c/v cyto,thinlayer,rescr G0145 29.44 Scr c/v cyto,thinlayer,rescr G0147 14.99 Scr c/v cyto, automated sys G0148 31.94 Scr c/v cyto, autosys, rescr G0306 8.63 Cbc/diffwbc w/o platelet G0307 7.18 Cbc without platelet G0328 QW 19.64 Fecal blood scrn immunoassay G0328 18.05 Fecal blood scrn immunoassay G0432 19.57 Eia hiv-1/hiv-2 screen G0433 QW 18.29 Elisa hiv-1/hiv-2 screen G0433 18.29 Elisa hiv-1/hiv-2 screen G0435 13.32 Oral hiv-1/hiv-2 screen G0471 5.00 Ven blood coll snf/hha G0472 QW 46.35 Hep c screen high risk/other G0472 46.35 Hep c screen high risk/other G0475 QW 26.75 Hiv combination assay G0475 26.75 Hiv combination assay G0476 38.99 Hpv combo assay ca screen G0480 114.43 Drug test def 1-7 classes G0481 156.59 Drug test def 8-14 classes G0482 198.74 Drug test def 15-21 classes G0483 246.92 Drug test def 22+ classes G0499 31.41 Hepb screen high risk indiv G0659 64.65 Drug test def simple all cl G9143 134.13 Warfarin respon genetic test P2028 5.50 Cephalin floculation test P2029 5.50 Congo red blood test P2031 5.50 Hair analysis P2033 5.50 Blood thymol turbidity P2038 5.50 Blood mucoprotein P3000 14.99 Screen pap by tech w md supv P9612 3.00 Catheterize for urine spec P9615 3.00 Urine specimen collect mult Q0111 14.99 Wet mounts/ w preparations Q0112 5.83 Potassium hydroxide preps Q0113 4.75 Pinworm examinations Q0114 9.74 Fern test Q0115 25.00 Post-coital mucous exam

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