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Internal Hcpcs Code Description Charge Charge Number Lab 10001 84060 Acid Phosphatase #829642 68.5 10002 82040 Albumin Sera 69.5

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Internal Hcpcs Code Description Charge Charge Number Lab 10001 84060 Acid Phosphatase #829642 68.5 10002 82040 Albumin Sera 69.5 INTERNAL HCPCS CODE DESCRIPTION CHARGE CHARGE NUMBER LAB 10001 84060 ACID PHOSPHATASE #829642 68.5 10002 82040 ALBUMIN SERA 69.5 10003 84075 ALKALINE PHOSPHATASE 52.5 10004 82150 AMYLASE 7 80.5 10009 82088 ALDOSTERONE, SERUM #004374 498 10011 86060 ASO TITER #006031 119.5 10013 84600 ALCOHOL, METHYL #017699 219 10014 87116 AFB CULTURE AND SMEAR/ #183753 165 10015 86901 BLOOD TYPING-RH (D) 23 10016 87206 ACID FAST STAIN #008618 73 10017 82247 TOTAL BILIRUBIN 50.5 10018 86900 BLOOD TYPING-ABO 23 10019 85002 BLEEDING TIME 50.5 10020 84520 BUN 43.5 10022 82607 VITAMIN B-12 115 10026 82310 CALCIUM,TOTAL 39 10027 85025 CBC W/COMP DIFF 69.5 10028 82380 CAROTENE #001529 138.5 10029 82435 CHLORIDE SERUM 80.5 10030 82465 CHOLESTEROL 50.5 10032 82550 CPK, TOTAL 67.5 10033 82565 CREATININE 44.5 10034 82575 CREATININE CLEARANCE #003004 80.5 10035 82378 CEA #002139 169 10036 87070 CULTURE SPUTUM & GRAM STAIN 51.5 10037 82552 CPK ISOENZYMES #002154 123.5 10038 82355 CALCULUS ANALYSIS #120790 142 10039 82382 CATECHOLAMINES,RANDOM URINE #316203 179.5 10040 82533 CORTISOL,TOTAL 175.5 10041 85007 DIFFERENTIAL 22 10044 80162 DIGOXIN/LANOXIN LEVEL 152 10045 80185 DILANTIN, QUANT 105.5 10048 P9016 PRBC'S 326.5 10050 36430 BLOOD ADMINISTRATION 262.5 10051 86022 PLATELETS APHERESIS 1112 10054 83700 ELECTROPHORESIS, LIPOPROTEIN #235036 165 10055 83020 ELECTROPHORESIS, HEMOGLOBIN 82.5 10056 80307 ETHANOL, QUANT. 173.5 10057 87106 FUNGAL ID #390 167 10058 86780 FTA-ABS #006379 118 10059 82746 FOLATE (FOLIC ACID) SERUM 68.5 10062 82941 GASTRIN SERUM #004390 95.5 10063 87205 GRAM STAIN 42 10064 85014 HCT 28 10065 85018 HEMOGLOBIN 28 10066 84702 HCG, QUANT. #004416 185 10067 81025 HCG,BETA SCREEN SERUM 98 10068 86812 HLA-B27 ANTIGEN #006924 336 10069 86694 HERPES SIMPLEX I &II IGM #165180 85.5 10070 83491 17-HYDROXYCORTICOSTEROIDS 24UR #806730 151 10071 80074 HEPATITIS PANEL 4 #303744 321 10072 83010 HAPTOGLOBIN #001628 60.5 10073 86320 IMMUNOELECTROPHORESIS SERUM #001495 230.5 10074 83540 IRON #001339 59 10075 83550 IRON BINDING CAP. #001321 86.5 10076 83525 INSULIN 118 10077 87220 KOH PREP 28 10078 83582 17 KETOSTEROIDS 24 HR URINE #806813 149 10079 83615 LDH SERA 54 10080 85345 LEE-WHITE CLOTTING TIME 32 10081 83690 LIPASE 77.5 10082 82150 AMYLASE FLUID #088062 80.5 10086 80178 LITHIUM #007708 80.5 10087 83655 ADULT LEAD, BLOOD #007625 118 10093 86308 MONO TEST 63.5 10095 87210 N/S PREP 28 10096 82270 OCCULT BLOOD 33 10097 83930 OSMOLALITY (SERUM) #002071 89 10098 83935 OSMOLALITY (URINE) #003434 89 10099 84030 PKU 72 10100 85049 PLATELET COUNT 56 10101 84132 POTASSIUM 48 10103 85610 PROTIME 54 10104 85730 PTT 57 10105 80184 PHENOBARBITAL #007823 78.5 10106 84100 PHOSPHORUS 52.5 10107 84156 PROTEIN, TOTAL URINE #003129 68.5 10108 84165 PROTEIN ELECTROPHORESIS 24 HR UR #267245 119.5 10109 83970 PARATHYROID HORMONE & CAL. #054601 464 10111 84146 PROLACTIN #004465 132 10112 80192 PROCAINAMIDE #007252 98 10116 86430 RA TEST #006502 57 10117 85045 RETICULOCYTE COUNT #005280 50.5 10118 84244 RENIN, RIA #002006 251 10119 86762 RUBELLA IGG,IGM #262303 52.5 10120 85652 SED RATE AUTOMATED 41 10121 84450 SGOT / AST 67.5 10122 84460 SGPT / ALT 80.5 10123 84295 SODIUM 57 10124 82945 GLUCOSE/SPINAL FLUID 50.5 10125 G0480 SALICYLATES 115 10126 89051 CELL COUNT SEROUS FLD #005240 48 10127 84479 T3 74 10128 84436 T4 80.5 10131 84155 PROTEIN, TOTAL 60.5 10132 84478 TRIGLYCERIDES 74 10133 80198 THEOPHYLLINE (AMINOPHYLLINE 110 10134 80156 TEGRETOL 161 10135 81001 URINALYSIS AUTO W/MIC 44.5 10136 84550 URIC ACID 56 10140 G6031 VALIUM, QUANT. #007989 202 10141 84585 VMA 24 HOUR URINE #004143 95.5 10142 86592 VDRL (RPR) #012005 57 10143 85048 WBC 24 10144 80168 ZARONTIN LEVEL #007443 185 10147 80061 LIPID PANEL 238 10150 84403 TESTOSTERONE 176.5 10152 93010 EKG WITH PROF FEE 62.5 10153 84157 PROTEIN SPINAL FLUID #002055 63.5 10154 80170 GENTAMICIN PEAK 110 10155 86038 ANA SCREEN #164947 75 10156 86160 COMPLEMENT C-3 #006452 75 10157 86160 COMPLEMENT COMPONENT C4 #001834 75 10159 86235 SMRNP ANTIBODY #006338 98 10164 86376 THYROID ANTIBODIES #006684 69.5 10165 84300 URINE NA+-24 HOUR #003178 42 10166 84133 URINE K+ 24 HR #003186 42 10167 86376 THYROID PEROXIDASE #006676 91 10168 87340 HBsAg #006510 48 10169 85303 PROTEIN C ACTIVITY #117705 104.5 10170 86870 ANTIBODY INDENTIFICATION PANEL 99 10173 82105 MATERNAL TRIPLE TEST (AFP) #010801 241 10174 88262 CHROMOSOME BLOOD#511035 491.5 10175 86147 CARDIOLIPIN ANTIBODIES #161950 93 10177 81050 VOL./TIMED COLLECTION 21 10178 82128 AMINO ACID MSUD #700190 65 10179 87634 RSV BY ALERE i 115 10180 83615 LDH FLUID #100156 39 10181 82945 GLUCOSE FLUID(QUANT)17425 50.5 10182 82248 DIRECT BILIRUBIN 60.5 10183 82948 GLUCOMETER SUPPLY 38 10184 G0480 ACETAMINOPHEN LEVEL (TYLENOL) 150 10185 84202 PROTOPORPHRIN,RBC;QUANT #010165 91 10189 86022 PLATELET ANTIBODY #014086 233 10190 85220 FACTOR V 302 10191 82784 IMMUNOGLOBULIN A #001784 65 10192 82103 ALHPA 1 ANTITRYPSIN #001982 92 10193 84260 SEROTONIN #120204 208 10195 86225 DOUBLE STRAIN DNA AB #096339 59 10196 86235 ENA 1 OF 2 99 10197 84154 FREE PSA #480947 115 10198 82010 KETONE SERUM 806443 279.5 10201 86317 TETANUS AB #163691 47 10203 87522 HEP C GENOTYPE #550475 651 10204 87177 CRYPTOSPORIDIUM #183020 33.5 11000 87177 OVA & PARASITES #008623 104.5 11001 82104 ALPHA-1-ANTITRYPSIN PHENOTYPE #095653 86.5 11002 82693 ETHYLENE GLYCOL #071654 90 11003 85305 PROTEIN S AG #164517 69.5 11010 80173 HALDOL LEVEL #070482 254 11021 86701 HIV-1/2 DIFFERENTIAL #083904 167 11023 82672 ESTROGEN, TOTAL #004549 75 11024 80188 MYSOLINE #007856 104.5 11025 84144 PROGESTERONE 154 11026 80299 NORPACE #007864 155.5 11027 82140 AMMONIA #007054 132 11028 G0480 THC #791566 147 11029 84066 PROSTATIC ACID PHOS. #004747 105.5 11030 83735 MAGNESIUM 65 11031 80299 COUMADIN #071423 173.5 11032 86757 ROCKY MOUNTAIN FEVER G,M #247494 151 11033 86735 MUMPS VIRUS AB, IGG #096552 118 11034 83718 HDL CHOLESTEROL 65 11035 82570 URINE CREATININE/RANDOM #013672 52.5 11036 36415 VENIPUNCTURE, ROUTINE 20 11038 82375 CARBON MONOXIDE BLOOD #007187 80.5 11039 82374 CARBON DIOXIDE 56 11040 86850 ANTIBODY SCREENING RBC EACH SERUM TECHNI 50.5 11041 86337 INSULIN ANTIBODY #141598 91 11042 82670 ESTRADIOL #4021 95.5 11043 84153 PSA PROSTATE SPECIFIC ANTIGEN 168 11044 PHLEBOTOMY BAGS (DISP.) LAB SUPPLIES 39 11045 G6030 AMITRYPTYLINE #007476 136 11048 80154 DIAZEPAM #007989 149 11049 86663 EPSTEIN-BARR ANTIBODIES, ACUTE #219311 261.5 11050 82728 FERRITIN 39 11052 86713 LEGIONELLA, TOTAL ANTIBODY #164616 309.5 11053 86738 MYCOPLASMA PNEUMONIAE AB #163758 145 11054 G6037 NORTRIPTYLINE #007393 176.5 11055 89060 CRYSTALS #133005 94.5 11056 87324 CLOSTRIDIUM DIFF. TOXIN 086207 193.5 11057 83001 FSH 123.5 11058 83002 LH 142 11060 82977 GGT 56 11061 86317 RUBELLA TITER INDEX 86.5 11063 85660 SICKLE CELL SCREEN #005223 49.5 11065 80164 DEPEKENE (VALPROIC ACID) 135 11066 80194 QUINIDINE #007831 134 11069 82525 COPPER #001586 117 11070 82390 CERULOPLASMIN #001560 107 11072 G6032 DESIPRAMINE #007765 208 11073 G6036 IMIPRAMINE #007468 105.5 11074 85230 COAG FACTOR VII #800599 312.5 11075 85260 COAG FACTOR X #086306 312.5 11077 84600 ISOPROPYL ALCHOL (BLOOD) #017681 145 11079 P9017 PLASMA-FRESH FROZEN 99 11080 85384 FIBRINOGEN #001610 99 11081 83921 METHYLMALONIC ACID #706961 86.5 11083 86603 ADENOVIRUS ANTIBODIES #096065 173.5 11084 G0480 TRICYCLIC SCREEN #007690 47 11085 80346 KLONOPIN #071712 51.5 11086 84120 PORPHYRINS,TOTAL #823239 65 11087 89190 NASAL SMEAR FOR EOSINOPHILS 48 11088 86603 A-TYPICAL PNEUMONIA ANTIBODY PANEL 340 11089 80150 AMIKACIN #007203 126 11090 G0404 EKG INITIAL PREVENTIVE SCREENING EXAM 137.5 11091 G0403 EKG PRO FEE INITIAL PREVENTIVE SCREENING 62.5 11093 80069 RENAL FUNCTION PANEL 48 11094 86618 LYME AB #258004 116 11095 PATERNAL DNA 939 11200 82175 ARSENIC BLOOD #007245 92 11201 83655 LEAD ADULT #007625 92 11202 83825 MERCURY #810259 92 11203 86325 IMMUNOELECTROPHORESIS-URINE #123034 188 11204 84560 URIC ACID-24 HR URINE #003418 32 11205 82340 CALCIUM-24 HR URINE #003269 32 11206 83945 OXALATE-24 HR URINE #003970 72 11209 82530 CORTISOL URINE FREE RANDOM 147 11210 82626 DHEA-SERUM #004100 74 11211 84105 URINE PHOSPHATE- 24HR #003251 41 11212 86140 C-REACTIVE PROTEIN #006627 86.5 11213 80299 FELBAMATE-SELBATOL #716530 139.5 11214 85305 PROTEIN-S-TOTAL #164517 258 11218 87102 CULTURE, FUNGAL #188243 136 11220 84022 PROLIXIN - (FLUPHENAZINE) #706887 160 11221 84630 ZINC #001800 76 11223 84540 URINE 24HR UREA NITROGEN #003541 50.5 11224 87252 CULTURE VIRAL #008573 525.5 11225 87101 FUNGAL CULTURE SKIN/HAIR/NAIL #008482 91 11226 82043 24 MICROALB/CREAT RATIO #140095 51.5 11227 80200 TOBRAMYCIN PEAK 52.5 11228 83835 METANEPHRINES TOTAL 24UR #004234 61.5 11230 82383 CATECHOLAMINES PLASMA #084152 161 11232 87088 CULTURE URINE 72 11233 87101 FUNGUS (MYCOLOGY) CULTURE #008482 54 11236 82705 FECAL FAT #001677 87.5 11237 89055 FECAL WBC #008656 38 11238 80299 NEURONTIN LEVEL #716811 189 11239 86706 HEPATITIS B SURFACE ANTIBODY #006530 60.5 11240 86003 COLLECTION FEE 25 11243 86304 CA 125 #002303 147 11245 80202 VANCOMYCIN PEAK 109 11247 86255 MITOCHONDRIAL AB #006650 33.5 11253 86255 SMOOTH MUSCLE AB #006643 33.5 11254 87651 RAPID STREP A 98 11255 G6034 DOXEPIN LEVEL #007609 102.5 11256 82553 CK-MB 91 11257 85240 VON WILLEBRAND PANEL #500247 132 11301 83036 HEMOGLOBIN A1C 95.5 11302 82379 CARNITINE TOTAL AND FREE #706500 49.5 11303 82384 CATECHOLAMINES F&T 24UR #004176 169 11304 85245 COAG.FACTOR VIII #086264 302 11305 85250 COAG.FACTOR IX #086298 302 11306 85270 COAG.FACTO XI #086314 302 11307 85280 COAG.FACTO XII #086322 302 11308
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