LABORATORY - TESTING For the Time Period : 10/01/16 and 09/30/2017

IF YOU ARE COVERED BY HEALTH INSURANCE , YOU ARE STRONGLY ENCOURAGED TO CONSULT WITH YOUR HEALTH INSURER TO DETERMINE ACCURATE INFORMATION ABOUT YOUR FINACIAL RESPONSIBILITY FOR A PARTICULAR HEALTH CARE SERVICE PROVIDED AT THIS HEALTHCARE FACILITY. IF YOU ARE NOT COVERED BY HEALTH INSURANCE YOU ARE STRONGLY ENCOURAGED TO CONTACT THE BUSINESS OFFICE AT (719)584-4508 OR TOLL FREE AT 800-543-4046 TO DISCUSS PAYMENT OPTIONS PRIOR TO RECEIVING A HEALTH CARE SERVICE FROM THIS HEALTH CARE FACILITY SINCE POSTED HEALTHCARE SERVICES MAY NOT REFLECT THE ACTUAL AMOUNT OF YOUR FINANCIAL RESPONSIBILITY.

Note: 1. The pricing on this page is for Laboratory testing only. It is not combined pricing with other testing 2. Charging is based on the Length of Stay, amount of supplies used, therapies provided, testing given as well as other care provided 3. This pricing is an average charge and not intended to be the exact charge for any particular patient 4. The average charge shown is an estimate and that actual charges for the service depend on the circumstances at the time the service is provided and the patient. 5. Any discount is negotiated by the insurance provider. Most insurance providers should be able to tell their members what financial responsibility they will have. 6. Patients without insurance are able to receive a discount equal to the insurance provider with the lowest negotiated discount

CPT Description Average Charge 80048 METABOLIC PANEL TOTAL CA $ 1,198.36 80050 GENERAL HEALTH PANEL $ 7,521.00 80051 ELECTROLYTE PANEL $ 471.35 80053 COMPREHEN METABOLIC PANEL $ 1,832.37 80055 OBSTETRIC PANEL $ 1,900.00 80061 LIPID PANEL $ 543.48 80069 RENAL FUNCTION PANEL $ 1,349.52 80074 ACUTE HEPATITIS PANEL $ 2,205.10 80076 HEPATIC FUNCTION PANEL $ 872.14 80156 ASSAY CARBAMAZEPINE TOTAL $ 587.98 80158 DRUG ASSAY CYCLOSPORINE $ 50.00 80159 DRUG ASSAY CLOZAPINE $ 115.50 80162 ASSAY OF DIGOXIN TOTAL $ 395.41 80164 ASSAY DIPROPYLACETIC ACID TOTAL $ 524.28 80169 DRUG ASSAY EVEROLIMUS $ 113.75 80170 ASSAY OF GENTAMICIN $ 1,610.40 80175 DRUG SCREEN QUANTITATIVE LAMOTRIGINE $ 100.22 80177 DRUG SCREEN QUANTIOTATIVE LEVETIRACETAM $ 57.16 80178 ASSAY OF LITHIUM $ 266.08 80183 DRUG SCREEN QUANTITATIVE OXCARBAZEPIN $ 60.00 80184 ASSAY OF PHENOBARBITAL $ 452.08 80185 ASSAY OF PHENYTOIN TOTAL $ 647.72 80186 ASSAY OF PHENYTOIN FREE $ 28.00 80195 ASSAY OF SIROLIMUS $ 97.00 80197 ASSAY OF TACROLIMUS $ 115.21 80198 ASSAY OF THEOPHYLLINE $ 537.00 80201 ASSAY OF TOPIRAMATE $ 46.00 80202 ASSAY OF VANCOMYCIN $ 672.78 80203 DRUG SCREEN QUANTITATIVE ZONISAMIDE $ 87.00 80299 QUANTITATIVE ASSAY DRUG $ 180.00 81001 URINALYSIS AUTO W/SCOPE $ 291.83 81003 URINALYSIS AUTO W/OUT SCOPE $ 223.41 81025 URINE PREGNANCY TEST $ 358.48 81050 URINALYSIS VOLUME MEASURE $ 187.80 81221 CFTR(CYSTIC FUBROSIS TRANSMEMBRANE) GENE KNOWN FAM VARIANTS $ 225.00 81235 EGFR GENE COM VARIANTS $ 992.25 81240 F2 GENE $ 192.40 81241 F5 GENE $ 262.44 81243 FMR1 GENE DETECTION $ 1,173.00 81270 JAK2 GENE $ 339.50 81332 SERPINA1 GENE $ 336.00 81374 HLA I TYPING 1 ANTIGEN LR $ 191.25 82010 ACETONE ASSAY $ 65.12 82017 ACYLCARNITINES QUANT $ 23.67 82024 ASSAY OF ACTH (ADRENOCORTICOTROPIC) $ 79.57 82040 ASSAY OF SERUM ALBUMIN $ 164.64 82042 ASSAY OF URINE ALBUMIN $ 78.30 82043 MICROALBUMIN QUANTITATIVE $ 20.51 82085 ASSAY OF ALDOLASE $ 32.00 82088 ASSAY OF ALDOSTERONE $ 103.75 82103 ALPHA-1-ANTITRYPSIN TOTAL $ 44.00 82105 ALPHA-FETOPROTEIN SERUM $ 49.00 82139 AMINO ACIDS QUAN 6 OR MORE $ 42.24 82140 ASSAY OF AMMONIA $ 932.66 82150 ASSAY OF AMYLASE $ 453.62 82164 ANGIOTENSIN I ENZYME TEST $ 34.00 82172 ASSAY OF APOLIPOPROTEIN $ 57.00 82175 ASSAY OF ARSENIC $ 67.67 82232 ASSAY OF BETA-2 PROTEIN $ 44.00 82247 BILIRUBIN TOTAL $ 183.98 82248 BILIRUBIN DIRECT $ 176.74 82270 OCCULT BLOOD FECES $ 29.00 82271 OCCULT BLOOD OTHER SOURCES $ 17.00 82272 OCCULT BLOOD FECES 1-3 TESTS $ 19.01 82306 VITAMIN D 25 HYDROXY $ 250.00 82308 ASSAY OF CALCITONIN $ 63.00 82310 ASSAY OF CALCIUM $ 209.52 82330 ASSAY OF CALCIUM $ 170.44 82340 ASSAY OF CALCIUM IN URINE $ 220.40 82365 CALCULUS SPECTROSCOPY $ 41.84 82375 ASSAY CARBOXYHB QUANT $ 420.54 82378 CARCINOEMBRYONIC ANTIGEN $ 237.84 82379 ASSAY OF CARNITINE $ 24.32 82382 ASSAY URINE CATECHOLAMINES $ 35.00 82384 ASSAY THREE CATECHOLAMINES $ 84.00 82390 ASSAY OF CERULOPLASMIN $ 29.00 82397 CHEMILUMINESCENT ASSAY $ 128.00 82436 ASSAY OF URINE CHLORIDE $ 231.20 82465 ASSAY BLD/SERUM CHOLESTEROL $ 121.13 82507 ASSAY OF CITRATE $ 197.00 82525 ASSAY OF COPPER $ 29.00 82530 CORTISOL FREE $ 55.00 82533 TOTAL CORTISOL $ 2,382.34 82550 ASSAY OF CK (CPK) $ 195.24 82553 CREATINE MB FRACTION $ 731.08 82565 ASSAY OF CREATININE $ 130.63 82570 ASSAY OF URINE CREATININE $ 285.21 82575 CREATININE CLEARANCE TEST $ 291.67 82595 ASSAY OF CRYOGLOBULIN $ 23.00 82607 VITAMIN B-12 $ 577.90 82626 DEHYDROEPIANDROSTERONE $ 67.00 82627 DEHYDROEPIANDROSTERONE $ 75.00 82652 VIT D 1 25-DIHYDROXY $ 123.53 82657 ENZYME CELL ACTIVITY $ 245.00 82668 ASSAY OF ERYTHROPOIETIN $ 55.00 82670 ASSAY OF ESTRADIOL $ 57.00 82693 ASSAY OF ETHYLENE GLYCOL $ 152.00 82705 FATS/LIPIDS FECES QUALITATIVE $ 19.33 82728 ASSAY OF FERRITIN $ 600.03 82731 ASSAY OF FETAL FIBRONECTIN $ 776.95 82746 ASSAY OF FOLIC ACID SERUM $ 501.13 82784 ASSAY IGA(IMMUNOGLOBULIN/IGD(IMMUNOGLOBULIN D)/IGG(IMMUNGLOBULIN GAMMA)/IGM(IMMUNOGLOBULIIN$ 524.09 M ANTIBODIES) EACH 82785 ASSAY OF IGE $ 47.81 82787 IGG 1 2 3 OR 4 EACH $ 34.00 82800 BLOOD PH $ 488.18 82805 BLOOD GASES W/O2 SATURATION $ 741.23 82941 ASSAY OF GASTRIN $ 36.00 82945 GLUCOSE OTHER FLUID $ 258.12 82947 ASSAY GLUCOSE BLOOD QUANT $ 164.90 82950 GLUCOSE TEST $ 202.00 82951 GLUCOSE TOLERANCE TEST (GTT) $ 424.00 82952 GTT-ADDED SAMPLES $ 357.00 82955 ASSAY OF G6PD ENZYME $ 74.00 82962 GLUCOSE BLOOD TEST $ 308.89 82977 ASSAY OF GGT(GAMMA-GLUTAMYL TRANSPEPTIDASE $ 169.55 83001 ASSAY OF GONADOTROPIN (FSH) $ 38.11 83002 ASSAY OF GONADOTROPIN (LH) $ 38.13 83003 ASSAY GROWTH HORMONE (HGH) $ 102.00 83010 ASSAY OF HAPTOGLOBIN QUANT $ 312.87 83021 HEMOGLOBIN CHROMOTOGRAPHY $ 138.37 83036 GLYCOSYLATED HEMOGLOBIN TEST $ 57.52 83050 BLOOD METHEMOGLOBIN ASSAY $ 975.00 83090 ASSAY OF HOMOCYSTINE $ 174.54 83497 ASSAY OF 5-HIAA (HYDROXYINDOLEACETIC ACID) $ 42.00 83498 ASSAY OF PROGESTERONE 17-D $ 76.00 83516 IMMUNOASSAY NONANTIBODY $ 86.00 83519 RIA NONANTIBODY $ 100.02 83520 IMMUNOASSAY QUANT NOS NONAB $ 111.59 83525 ASSAY OF INSULIN $ 36.30 83540 ASSAY OF IRON $ 446.12 83550 IRON BINDING TEST $ 358.04 83605 ASSAY OF LACTIC ACID $ 244.99 83615 LACTATE (LD - LIPID DROPLETS) (LDH -LACTIC ACID DEHYDROGENASE) ENZYME $ 169.55 83631 LACTOFERRIN FECAL (QUANTITATIVE) $ 170.00 83655 ASSAY OF LEAD $ 28.84 83664 LAMELLAR BODY FETAL LUNG $ 228.00 83690 ASSAY OF LIPASE $ 506.65 83695 ASSAY OF LIPOPROTEIN(A) $ 29.00 83735 ASSAY OF MAGNESIUM $ 462.05 83825 ASSAY OF MERCURY $ 41.67 83835 ASSAY OF METANEPHRINES $ 135.36 83864 MUCOPOLYSACCHARIDES $ 129.00 83873 ASSAY OF CSF PROTEIN $ 35.00 83874 ASSAY OF MYOGLOBIN $ 42.25 83880 ASSAY OF NATRIURETIC PEPTIDE $ 219.69 83883 ASSAY NEPHELOMETRY NOT SPEC $ 46.52 83915 ASSAY OF NUCLEOTIDASE $ 49.00 83916 OLIGOCLONAL BANDS $ 41.00 83919 ORGANIC ACIDS QUAL EACH $ 241.09 83921 ORGANIC ACID SINGLE QUANT $ 174.00 83930 ASSAY OF BLOOD OSMOLALITY $ 216.94 83935 ASSAY OF URINE OSMOLALITY $ 236.61 83945 ASSAY OF OXALATE $ 33.00 83970 ASSAY OF PARATHORMONE $ 153.63 83993 ASSAY FOR CALPROTECTIN FECAL $ 231.25 84030 ASSAY OF BLOOD PKU(PHENYLKETONURIA) $ 613.00 84075 ASSAY ALKALINE PHOSPHATASE $ 122.62 84080 ASSAY ALKALINE PHOSPHATASES $ 50.00 84100 ASSAY OF PHOSPHORUS $ 147.97 84112 EVAL AMNIOTIC FLUID PROTEIN $ 102.08 84132 ASSAY OF SERUM POTASSIUM $ 221.71 84133 ASSAY OF URINE POTASSIUM $ 241.55 84134 ASSAY OF PREALBUMIN $ 270.50 84144 ASSAY OF PROGESTERONE $ 49.19 84145 PROCALCITONIN (PCT) $ 304.12 84146 ASSAY OF PROLACTIN $ 46.12 84153 ASSAY OF PSA TOTAL $ 215.15 84155 ASSAY OF PROTEIN SERUM $ 126.11 84156 ASSAY OF PROTEIN URINE $ 296.42 84157 ASSAY OF PROTEIN OTHER $ 292.55 84165 PROTEIN E-PHORESIS SERUM $ 235.33 84210 ASSAY OF PYRUVATE $ 169.42 84244 ASSAY OF RENIN $ 55.00 84260 ASSAY OF SEROTONIN $ 108.00 84295 ASSAY OF SERUM SODIUM $ 125.46 84300 ASSAY OF URINE SODIUM $ 213.60 84305 ASSAY OF SOMATOMEDIN $ 63.57 84311 SPECTROPHOTOMETRY $ 53.50 84402 ASSAY OF FREE TESTOSTERONE $ 52.00 84403 ASSAY OF TOTAL TESTOSTERONE $ 54.51 84425 ASSAY OF VITAMIN B-1 $ 178.00 84432 ASSAY OF THYROGLOBULIN $ 281.59 84436 ASSAY OF TOTAL THYROXINE $ 359.53 84439 ASSAY OF FREE THYROXINE $ 258.94 84443 ASSAY THYROID STIM HORMONE $ 834.50 84445 ASSAY OF TSI(THYROID STIMULATING IMMUNE) GLOBULIN $ 140.00 84446 ASSAY OF VITAMIN E $ 29.00 84450 TRANSFERASE (AST) (SGOT) $ 149.53 84460 ALANINE AMINO (ALT) (SGPT) $ 130.30 84466 ASSAY OF TRANSFERRIN $ 28.67 84478 ASSAY OF TRIGLYCERIDES $ 123.81 84479 ASSAY OF THYROID (T3 OR T4) $ 356.45 84480 ASSAY TRIIODOTHYRONINE (T3) $ 46.00 84481 FREE ASSAY (FT-3) $ 50.00 84482 T3 REVERSE $ 45.00 84484 ASSAY OF TROPONIN QUANT $ 376.19 84520 ASSAY OF UREA NITROGEN $ 125.26 84540 ASSAY OF URINE/UREA-N $ 241.00 84550 ASSAY OF BLOOD/URIC ACID $ 129.83 84560 ASSAY OF URINE/URIC ACID $ 271.50 84585 ASSAY OF URINE VMA(VANILLYLMANDELIC ACID) $ 31.00 84586 ASSAY OF VIP $ 127.00 84588 ASSAY OF VASOPRESSIN $ 105.00 84590 ASSAY OF VITAMIN A $ 54.00 84600 ASSAY OF VOLATILES $ 90.00 84630 ASSAY OF ZINC $ 60.00 84681 ASSAY OF C-PEPTIDE $ 52.00 84702 CHORIONIC GONADOTROPIN TEST $ 576.24 84703 CHORIONIC GONADOTROPIN ASSAY $ 339.55 85008 BLOOD SMEAR W/OUT DIFF WBC(WHITE BLOOD CELL) COUNT $ 48.00 85014 HEMATOCRIT $ 130.47 85018 HEMOGLOBIN $ 136.99 85025 COMPLETE CBC W/AUTO DIFF WBC (WHITE BLOOD CELL) $ 276.56 85027 COMPLETE CBC AUTOMATED $ 245.80 85045 AUTOMATED RETICULOCYTE COUNT $ 372.97 85048 AUTOMATED LEUKOCYTE COUNT $ 97.85 85049 AUTOMATED PLATELET COUNT $ 85.45 85240 CLOT FACTOR VIII AHG 1 STAGE $ 175.00 85245 CLOT FACTOR VIII VW RISTOCTN $ 160.00 85246 CLOTTING FACTOR VIII VW ANTIGEN $ 126.00 85260 CLOT FACTOR X STUART-POWER $ 94.00 85300 ANTITHROMBIN III ACTIVITY $ 159.00 85301 ANTITHROMBIN III ANTIGEN $ 177.00 85303 CLOT INHIBIT PROT C ACTIVITY $ 154.00 85306 CLOT INHIBIT PROT S FREE $ 64.05 85307 ASSAY ACTIVATED PROTEIN COUNT $ 126.00 85347 COAGULATION TIME ACTIVATED $ 821.91 85379 FIBRIN DEGRADATION QUANT $ 116.10 85384 FIBRINOGEN ACTIVITY $ 712.92 85460 HEMOGLOBIN FETAL $ 156.29 85520 HEPARIN ASSAY $ 185.33 85576 BLOOD PLATELET AGGREGATION $ 302.78 85597 PHOSPHOLIPID PLTLT NEUTRALIZ $ 47.00 85598 HEXAGNAL PHOSPH PLTLT NEUTRL $ 67.80 85610 PROTHROMBIN TIME $ 277.83 85613 RUSSELL VIPER VENOM DILUTED $ 101.50 85652 RBC(RED BLOOD CELL)SED RATE AUTOMATED $ 469.78 85660 RBC(RED BLOOD CELL) SICKLE CELL TEST $ 13.61 85670 THROMBIN TIME PLASMA $ 129.70 85730 THROMBOPLASTIN TIME PARTIAL $ 260.07 85732 THROMBOPLASTIN TIME PARTIAL PTT $ 32.00 85810 BLOOD VISCOSITY EXAMINATION $ 24.00 86001 ALLERGEN SPECIFIC IGG $ 37.00 86003 ALLERGEN SPECIFIC IGE (IMMUNOGLOBULIN) $ 182.68 86038 ANTINUCLEAR ANTIBODIES $ 49.78 86060 ANTISTREPTOLYSIN O TITER $ 388.67 86140 C-REACTIVE PROTEIN $ 206.73 86146 BETA-2 GLYCOPROTEIN ANTIBODY $ 217.04 86147 CARDIOLIPIN ANTIBODY EA IG $ 143.38 86148 ANTI-PHOSPHOLIPID ANTIBODY $ 99.00 86156 COLD AGGLUTININ SCREEN $ 43.50 86160 COMPLEMENT ANTIGEN $ 573.57 86162 COMPLEMENT TOTAL (CH50) $ 42.00 86200 CCP ANTIBODY $ 109.20 86225 DNA ANTIBODY NATIVE $ 28.33 86235 NUCLEAR ANTIGEN ANTIBODY $ 416.58 86255 FLUORESCENT ANTIBODY SCREEN $ 46.22 86256 FLUORESCENT ANTIBODY TITER $ 263.59 86300 IMMUNOASSAY TUMOR CA 15-3 $ 50.00 86301 IMMUNOASSAY TUMOR CA 19-9 $ 61.00 86304 IMMUNOASSAY TUMOR CA 125 $ 58.00 86308 HETEROPHILE ANTIBODY SCREEN $ 190.92 86316 IMMUNOASSAY TUMOR OTHER $ 165.00 86317 IMMUNOASSAY INFECTIOUS AGENT $ 64.45 86331 IMMUNODIFFUSION OUCHTERLONY $ 29.00 86334 IMMUNOFIX E-PHORESIS SERUM $ 78.00 86335 IMMUNFIX E-PHORSIS/URINE/CSF(COLONY STIMULATING FACTOR) $ 140.94 86336 INHIBIN A $ 70.00 86337 INSULIN ANTIBODIES $ 44.00 86340 INTRINSIC FACTOR ANTIBODY $ 31.00 86341 ISLET CELL ANTIBODY $ 135.00 86355 B CELLS TOTAL COUNT $ 54.00 86357 NK(NATURAL KILLER)CELLS TOTAL COUNT $ 76.00 86359 T CELLS TOTAL COUNT $ 54.00 86360 T CELL ABSOLUTE COUNT/RATIO $ 146.00 86361 T CELL ABSOLUTE COUNT $ 38.00 86376 MICROSOMAL ANTIBODY EACH $ 47.00 86431 RHEUMATOID FACTOR QUANT $ 166.66 86480 TB TEST CELL IMMUN MEASURE $ 237.00 86592 SYPHILIS TEST NON-TREP QUAL $ 276.80 86593 SYPHILIS TEST NON-TREP QUANT $ 50.00 86602 ANTINOMYCES ANTIBODY $ 47.17 86603 ADENOVIRUS ANTIBODY $ 68.94 86606 ASPERGILLUS ANTIBODY $ 24.11 86609 BACTERIUM ANTIBODY $ 822.89 86611 BARTONELLA ANTIBODY $ 34.73 86612 BLASTOMYCES ANTIBODY $ 44.00 86618 LYME DISEASE ANTIBODY $ 29.17 86625 CAMPYLOBACTER ANTIBODY $ 85.00 86631 CHLAMYDIA ANTIBODY $ 119.00 86632 CHLAMYDIA IGM ANTIBODY $ 26.42 86635 COCCIDIOIDES ANTIBODY $ 110.00 86644 CMV(CYTOMEGALOVIRUS) ANTIBODY $ 30.00 86645 CMV (CYTOMEGALOVIRUS) ANTIBODY IGM $ 30.00 86658 ENTEROVIRUS ANTIBODY $ 328.50 86663 EPSTEIN-BARR ANTIBODY $ 30.00 86664 EPSTEIN-BARR NUCLEAR ANTIGEN $ 30.00 86665 EPSTEIN-BARR CAPSID VCA $ 45.24 86668 FRANCISELLA TULARENSIS $ 100.00 86671 FUNGUS NES ANTIBODY $ 17.00 86677 HELICOBACTER PYLORI ANTIBODY $ 164.98 86689 HTLV(RETROVIRUS)/HIV CONFIRMJ ANTIBODY - ROMAN NUMERAL TO INDICATE TYPE $ 52.00 86694 HERPES SIMPLEX NES ANTBDY $ 149.00 86695 HERPES SIMPLEX TYPE 1 TEST $ 30.00 86696 HERPES SIMPLEX TYPE 2 TEST $ 40.00 86698 HISTOPLASMA ANTIBODY $ 105.00 86701 HIV-1ANTIBODY $ 571.00 86702 HIV-2 ANTIBODY $ 117.00 86704 HEP B CORE ANTIBODY TOTAL $ 23.29 86705 HEP B CORE ANTIBODY IGM $ 166.13 86706 HEP B SURFACE ANTIBODY $ 518.11 86708 HEPATITIS A ANTIBODY $ 20.00 86709 HEPATITIS A IGM ANTIBODY $ 568.90 86713 LEGIONELLA ANTIBODY $ 109.60 86720 LEPTOSPIRA ANTIBODY $ 20.00 86735 MUMPS ANTIBODY $ 64.60 86738 MYCOPLASMA ANTIBODY $ 63.20 86747 PARVOVIRUS ANTIBODY $ 183.00 86757 RICKETTSIA ANTIBODY $ 74.00 86762 RUBELLA ANTIBODY $ 304.07 86765 RUBEOLA ANTIBODY $ 80.00 86768 SALMONELLA ANTIBODY $ 20.00 86777 TOXOPLASMA ANTIBODY $ 29.00 86780 TREPONEMA PALLIDUM $ 35.00 86787 VARICELLA-ZOSTER ANTIBODY $ 51.40 86788 WEST NILE VIRUS AB IGM $ 78.13 86789 WEST NILE VIRUS ANTIBODY $ 78.13 86790 VIRUS ANTIBODY NOS $ 184.50 86800 THYROGLOBULIN ANTIBODY $ 55.38 86849 IMMUNOLOGY PROCEDURE $ 200.00 86850 RBC (RED BLOOD CELLS)ANTIBODY SCREEN $ 420.75 86870 RBC(RED BLLOD CELL)ANTIBODY IDENTIFICATION $ 502.36 86880 COOMBS TEST DIRECT $ 266.60 86900 BLOOD TYPING SEROLOGIC ABO $ 210.35 86901 BLOOD TYPING SEROLOGIC RH(D) $ 210.35 86902 BLOOD TYPE ANTIGEN DONOR EA $ 252.19 86905 BLOOD TYPING RBC(RED BLOOD CELL) ANTIGENS $ 272.29 86906 BLOOD TYPING SEROLOGIC RH PHENOTYPING $ 105.00 86920 COMPATIBILITY TEST SPIN $ 312.42 86921 COMPATIBILITY TEST INCUBATE $ 132.86 86922 COMPATIBILITY TEST ANTIGLOB $ 199.55 86978 RBC(RED BLOOD CELL) PRETREATMENT SERUM $ 225.00 87015 SPECIMEN FOR INFECTIOUS AGENTS CONCENTRATION $ 42.23 87040 BLOOD CULTURE FOR BACTERIA $ 1,366.51 87045 FECES CULTURE AEROBIC BACTERIA $ 528.50 87046 STOOL CULTR AEROBIC BACT EA $ 306.64 87070 CULTURE OTHR SPECIMN AEROBIC $ 665.53 87071 CULTURE AEROBIC QUANT OTHER $ 115.56 87073 CULTURE BACTERIA ANAEROBIC $ 199.15 87075 CULTR BACTERIA EXCEPT BLOOD $ 864.11 87076 CULTURE ANAEROBE ADDITIONAL METHODS IDENT EACH ISOLATE $ 274.56 87077 CULTURE AEROBIC IDENTIFY $ 183.04 87081 CULTURE SCREEN ONLY $ 222.98 87086 URINE CULTURE/COLONY COUNT $ 456.32 87102 FUNGUS ISOLATION CULTURE $ 474.37 87106 FUNGI IDENTIFICATION YEAST $ 197.50 87107 FUNGI IDENTIFICATION MOLD $ 197.00 87109 MYCOPLASMA $ 103.00 87110 CHLAMYDIA CULTURE $ 57.38 87116 MYCOBACTERIA CULTURE $ 102.93 87140 CULTURE TYPE IMMUNOFLUORESC $ 17.50 87143 CULTURE TYPING GLC/HPLC $ 449.67 87147 CULTURE TYPE IMMUNOLOGIC $ 205.87 87172 PINWORM EXAM $ 147.00 87176 TISSUE HOMOGENIZATION CULTR $ 141.11 87177 OVA AND PARASITES SMEARS $ 27.11 87184 MICROBE SUSCEPTIBLE DISK $ 336.30 87186 MICROBE SUSCEPTIBLE MIC $ 491.86 87188 MICROBE SUSCEPT MACROBROTH $ 111.00 87205 SMEAR GRAM STAIN $ 283.95 87206 SMEAR FLUORESCENT/ACID STAIN $ 288.23 87207 SMEAR SPECIAL STAIN $ 191.00 87252 VIRUS INOCULATION TISSUE $ 71.00 87254 VIRUS INOCULATION SHELL VIA $ 103.88 87255 GENET VIRUS ISOLATE HSV (HERPES SIMPLEX VIRUS) $ 62.00 87324 CLOSTRIDIUM AG(ANTIGEN) IA(ANTIBODIES) $ 56.75 87328 CRYPTOSPORIDIUM AG(ANTIGEN) IA(ANTIBODIES) $ 141.71 87329 GIARDIA AG(ANTIGEN) IA(ANTIBODIES) $ 141.71 87338 HPYLORI STOOL IA $ 136.80 87340 HEPATITIS B SURFACE AG IA $ 578.19 87350 HEPATITIS BE AG IA $ 26.00 87380 HEPATITIS DELTA AG(ANTIGEN) IA (STATE/CONDITION) $ 50.00 87389 HIV-1 AG(ANTIGEN) W/HIV-1 HIV-2 AB(ANTIBODIES) $ 72.28 87420 RESP SYNCYTIAL AG(ANTIGEN) IA(ANTIBODIES) $ 320.55 87425 ROTAVIRUS AG IA $ 125.64 87427 SHIGA-LIKE TOXIN AG(ANTIGEN) IA(ANTIBODIES) $ 31.46 87449 AG (ANTIGEN)DETECT NOS(NOT OTHERWISE SPECIFIED) IA(ANTIBODIES) MULT $ 52.77 87476 LYME DIS DNA AMP PROBE $ 272.00 87486 CHYLMD PNEUM DNA AMP PROBE $ 306.00 87491 CHYLMD TRACH DNA AMP PROBE $ 447.89 87493 C DIFF AMPLIFIED PROBE $ 151.37 87497 CYTOMEG DNA QUANT $ 409.43 87498 ENTEROVIRUS PROBEREVRS TRNS $ 309.00 87517 HEPATITIS B DNA QUANT $ 110.35 87521 HEPATITIS C PROBERVRS TRNSC $ 510.00 87529 HSV(HERPES SIMPLEX VIRUS)DNA AMP PROBE $ 559.41 87532 HHV-6 DNA AMP PROBE $ 171.60 87536 HIV-1 QUANTREVRSE TRNSCRPJ $ 348.00 87556 M.TUBERCULO DNA AMP PROBE $ 647.00 87591 N.GONORRHOEAE DNA AMP PROB $ 469.55 87631 RESP VIRUS 3-5 TARGETS $ 440.85 87633 RESP VIRUS 12-25 TARGETS $ 935.49 87798 DETECT INFECTIOUS AGENT NOS(NOT OTHERWISE SPECIFIED) DNA AMPLIFIED PROBE TECHNIQUE$ 207.42 87799 DETECT AGENT NOS DNA QUANT $ 354.63 87800 DETECTION OF INFECTIOUS AGNT MULTIPLE ORGS BY DIRECT PROBE TECHNIQUE -DNA $ 119.82 87804 INFLUENZA ASSAY W/OPTIC $ 269.50 87880 STREP A ASSAY W/OPTIC $ 130.15 87899 AGENT NOS ASSAY W/OPTIC $ 198.00 87901 GENOTYPE DNA HIV REVERSE T $ 526.00 87902 GENOTYPE DNA/RNA HEP C $ 526.00 88104 CYTOPATH FL NONGYN SMEARS $ 493.27 88108 CYTOPATH CONCENTRATE TECH $ 196.83 88160 CYTOPATH SMEAR OTHER SOURCE $ 175.00 88161 CYTOPATH SMEAR OTHER SOURCE $ 563.27 88162 CYTOPATH SMEAR OTHER SOURCE $ 787.65 88172 CYTP DX EVAL FNA 1ST EA SITE $ 174.65 88177 CYTOPATHOLOGY FNA(FINE NEEDLE ASPIRATION) EACH ADDL EVALUATION EPISODE $ 77.00 88184 FLOWCYTOMETRY/ TC 1 MARKER $ 321.25 88185 FLOWCYTOMETRY/TC ADD-ON $ 615.30 88233 TISSUE CULTURE SKIN/BIOPSY $ 680.00 88262 CHROMOSOME ANALYSIS 15-20 $ 550.00 88264 CHROMOSOME ANALYSIS 20-25 $ 177.00 88271 CYTOGENETICS DNA PROBE $ 74.78 88274 CYTOGENETICS 25-99 $ 125.00 88275 CYTOGENETICS 100-300 $ 85.00 88291 CYTOPATHOLOGY/MOLECULAR REPORT $ 35.00 88300 SURGICAL PATH GROSS $ 480.94 88302 TISSUE EXAM BY PATHOLOGIST $ 413.27 88304 TISSUE EXAM BY PATHOLOGIST $ 1,048.55 88305 TISSUE EXAM BY PATHOLOGIST $ 917.44 88307 TISSUE EXAM BY PATHOLOGIST $ 1,992.31 88309 TISSUE EXAM BY PATHOLOGIST $ 2,639.79 88311 DECALCIFY TISSUE $ 290.40 88312 SPECIAL STAINS GROUP 1 $ 269.38 88313 SPECIAL STAINS GROUP 2 $ 396.82 88314 HISTOCHEMICAL STAINS ADD-ON $ 1,199.45 88319 ENZYME HISTOCHEMISTRY $ 683.27 88323 MICROSLIDE CONSULTATION $ 155.00 88325 COMPREHENSIVE REVIEW OF DATA $ 592.00 88331 PATH CONSULT INTRAOP 1 BLOC $ 1,124.77 88332 PATH CONSULT WITH FROZENSECTIONS EACH ADDL TISSUE BLOCK $ 907.04 88333 INTRAOP CYTO PATH CONSULT 1 $ 971.00 88341 IMMUNOHISTO ANTB ADDL SLIDE $ 721.36 88342 IMMUNOHISTO ANTB 1ST STAIN $ 2,813.48 88346 IMMUNOFLUOR ANTIBODY 1ST STAIN $ 210.33 88348 ELECTRON MICROSCOPY $ 482.00 88350 IMMUNOFLUOR ANTB ADDL STAIN $ 290.00 88360 TUMOR IMMUNOHISTOCHEM/MANUAL $ 1,485.54 88361 TUMOR IMMUNOHISTOCHEM/COMPUT $ 268.73 88363 XM (CROSS MATCH) ARCHIVE TISSUE MOLECULAR ANALYSIS -ARCHIVAL TISSUE $ 149.81 88365 INSITU HYBRIDIZATION (FISH) $ 493.00 88377 M/PHMTRC ALYS ISHQUANT/SEMIQ $ 573.91 88381 MICRODISSECTION MANUAL $ 361.88 88720 BILIRUBIN TOTAL TRANSCUT $ 103.00 89050 BODY FLUID CELL COUNT $ 85.25 89051 BODY FLUID CELL COUNT $ 372.56 89055 LEUKOCYTE ASSESSMENT FECAL $ 213.02 89060 EXAM SYNOVIAL FLUID CRYSTALS $ 210.20 89320 SEMEN ANALYSIS VOLUME/COUNT/MOTILITY $ 398.50 89321 SEMEN ANAL SPERM DETECTION $ 261.86