Proc Desc PRICE CPT VENIPUNCTURE $ 17.00 36415 CAP BLOOD DRAW $ 17.00 36416 BASIC METABOLIC PANEL $ 60.00 80048 GENERAL HEALTH PANEL $ 276.00 80050 ELECTROLYTE PANEL $ 50.00 80051 COMPREHENSIVE METABOLIC PANEL $ 75.00 80053 LIPID PROFILE $ 95.00 80061 RENAL PROFILE $ 62.00 80069 HEPATIC FUNCTION PANEL $ 58.00 80076 CORD BLOOD DRUG OF ABUSE $ 564.00 80101 CARBAMAZEPINE $ 103.00 80156 DIGOXIN $ 94.00 80162 VALPROIC ACID $ 96.00 80164 GENTAMICIN, PK $ 116.00 80170 GENTAMICIN, TR $ 116.00 80170 LAMOTRIGINE $ 94.00 80175 LITHIUM $ 47.00 80178 MYCOPHENOLIC ACID $ 128.00 80180 PHENOBARBIATL $ 88.00 80184 PHENYTOIN $ 94.00 80185 PRIMIDONE $ 118.00 80188 FK506 (TACROLIMUS) $ 98.00 80197 VANCOMYCIN, PK $ 96.00 80202 VANCOMYCIN, TR $ 96.00 80202 LEGAL DRUG SCREEN $ 140.00 80301 DRUG SCREEN 8 $ 413.00 80307 ETHANOL $ 65.00 80320 SALICYLATES $ 67.00 80329 ACETAMINOPHEN $ 67.00 80329 MVMG - URINALYSIS DIP & MICRO $ 23.00 81000 URINE EXAM $ 23.00 81001 MVMG - URINALYSIS DIP STICK $ 20.00 81002 URINALYSIS $ 16.00 81003 PREGNANCY TEST, UR $ 50.00 81025 PROTHROMBIN 20210 MUTATION $ 378.00 81240 FACTOR V LEIDEN $ 434.00 81241 MTINV $ 376.00 81291 SEVERE COMBINED IMMUNODEFICNCY $ 9.00 81479 KETONES $ 32.00 82009 ORGANIC ACID PROFILE NEWBORN $ 98.00 82016 FATTY ACID PROFILE NEWBORN $ 98.00 82016 ALBUMIN $ 35.00 82040 MICROALBUMIN, UR, RND $ 41.00 82043 ALPHA FETOPROTEIN $ 119.00 82105 QUAD AFP $ 119.00 82105 AMINO ACID PROFILE NEWBORN $ 98.00 82128
AMMONIA $ 103.00 82140 AMYLASE $ 46.00 82150 AMYLASE, FLD $ 46.00 82150 BILE ACIDS $ 122.00 82239 BILIRUBIN, TOT $ 36.00 82247 BILIRUBIN, FLD $ 36.00 82247 BILIRUBIN, DIRECT $ 36.00 82248 BIOTINIDASE DEFICIENCY SCREEN $ 120.00 82261 MVMG - OCCULT BLOOD, STL (SCR) $ 25.00 82270 IFOB (FIT TEST) $ 113.00 82274 VITAMIN D, 25-HYDROXY $ 210.00 82306 CALCITONIN $ 190.00 82308 CALCIUM $ 37.00 82310 CALCIUM, IONIZED $ 97.00 82330 CALCULI,URINARY NO PHOTO $ 91.00 82360 CARCINOEMBYRONIC AG $ 135.00 82378 CATECHOLAMINES, UJR, FRAC $ 179.00 82384 CORTISOL, PM $ 116.00 82533 CORTISOL, AM $ 116.00 82533 CREATINE KINASE $ 46.00 82550 CK-MB FRACTION $ 82.00 82553 CREATININE $ 36.00 82565 CREATININE, UR $ 37.00 82570 CREATININE, UR, RND $ 37.00 82570 CREATININE CLEARANCE $ 67.00 82575 VITAMIN B12 $ 107.00 82607 DHEA $ 179.00 82626 DHEA-SO4 $ 158.00 82627 VITAMIN D, 1 25-DIHYDROXY $ 273.00 82652 ERYTHROPOIETIN $ 133.00 82668 ESTRADIOL $ 198.00 82670 ESTROGENS $ 229.00 82671 ESTRIOL, UNCONJUGATED $ 172.00 82677 QUAD ESTRIOL $ 172.00 82677 ESTRONE $ 177.00 82679 FECAL FAT, QLT $ 36.00 82705 FERRITIN $ 97.00 82728 FIBRONECTIN, FETAL $ 457.00 82731 FOLATE $ 104.00 82746 FOLATE, RBC $ 104.00 82746 GALACOSE SCREEN $ 68.00 82776 IMMUNOGLOBULIN A $ 66.00 82784 IGG4, IGG SUBCLASSES $ 57.00 82787 GLUCOSE, CSF $ 28.00 82945 GLUCOSE, FLD $ 28.00 82945 GLUCOSE $ 28.00 82947 GLUCOSE CHALLENGE, PREG $ 34.00 82950
GLUCOSE TOLERANCE, 3 HR $ 91.00 82951 GLUCOSE TOLERANCE, 2 HR $ 91.00 82951 GAMMA GLUTAMYL TRANSFERASE $ 51.00 82977 FOLLICLE STIM HORMONE $ 132.00 83001 LUTEINIZING HORMONE $ 131.00 83002 HAPTOGLOBIN $ 89.00 83010 HELICOBCTR PYLOR, BREATH TEST $ 478.00 83013 HGB SCREEN NEONATE $ 91.00 83020 ELECTROPHORESIS, HGB $ 128.00 83021 GLYCOSYLTED HGB A1C $ 69.00 83036 HOMOCYSTINE $ 120.00 83090 17 HYDROXYPROGESTERONE $ 193.00 83498 ADRENAL HYPERPLASIA SCREEN $ 193.00 83498 TISSUE TRANSGLUTAMINASE AB,IGA $ 82.00 83516 TISSUE TRANSGLUTAMINASE AB,IGG $ 82.00 83516 TRYPSIN-LIKE IMMUNOREACTIVITY $ 99.00 83520 INSULIN ASSAY $ 81.00 83525 IRON $ 46.00 83540 IRON BINDING CAPACITY $ 62.00 83550 LACTIC ACID, VENOUS $ 76.00 83605 LACTATE DEHYDROGENASE $ 43.00 83615 LD, FLD $ 43.00 83615 LEAD, BLD $ 86.00 83655 LIPASE $ 49.00 83690 HDL CHOLESTEROL $ 58.00 83718 LDL CHOLESTEROL, DIRECT $ 68.00 83721 MAGNESIUM $ 48.00 83735 X-ALD $ 139.00 83789 B-TYPE NATRUIURETIC PEP,NT-PRO $ 241.00 83880 OSMOLALITY $ 47.00 83930 OSMOLALITY, UR, RND $ 48.00 83935 PTH, INTACT, WHOLE MOLECULE $ 293.00 83970 PTH, INTACT, NO CA $ 293.00 83970 ALKALINE PHOSPHATASE $ 37.00 84075 PHOSPHORUS $ 34.00 84100 POTASSIUM $ 33.00 84132 PRE-ALBUMIN $ 104.00 84134 PROGESTERONE $ 148.00 84144 PROLACTIN $ 138.00 84146 PROSTATE SPECIFIC AG $ 131.00 84153 PROTEIN, TOT $ 26.00 84155 PROTEIN, UR, QNT $ 26.00 84156 PROTEIN, UR, RND $ 26.00 84156 PROTEIN, CSF $ 26.00 84157 PROTEIN, FLD $ 26.00 84157 ELECTROPHORESIS, PROTEIN $ 76.00 84165 ELECTROPHORESIS, PROT, UR, R $ 127.00 84166
SEROTONIN $ 220.00 84260 SODIUM $ 34.00 84295 SODIUM, UR, RND $ 35.00 84300 TESTOSTERONE, FREE $ 181.00 84402 TESTOSTERONE, FREE $ 181.00 84402 TESTOSTERONE, TTL (ADULT MALE) $ 183.00 84403 TESTOSTERONE, TOTAL BY LCMSMS $ 183.00 84403 VITAMIN B1 WHOLE BLOOD $ 151.00 84425 THYROXIN (T4) $ 49.00 84436 T4, FREE $ 64.00 84439 TSH SCREEN, NEONATAL $ 119.00 84443 THYROID STIM HORMONE $ 119.00 84443 AST $ 37.00 84450 ALT $ 38.00 84460 TRANSFERRIN $ 91.00 84466 TRIGLYCERIDES $ 41.00 84478 T3 UPTAKE $ 46.00 84479 T3, BYICMA, TBG CORRECTED $ 101.00 84480 T3, FREE $ 120.00 84481 REVERSE T3 $ 112.00 84482 TROPONIN-I $ 72.00 84484 UREA NITROGEN $ 28.00 84520 URIC ACID $ 32.00 84550 C-PEPTIDE $ 148.00 84681 QUAD HCG $ 107.00 84702 HCG, BETA, QNT (PREGNANCY) $ 107.00 84702 PREG TEST, HCG QLT $ 53.00 84703 DIFFERENTIAL, MANUAL $ 24.00 85007 RBC MORPHOLOGY $ 24.00 85008 CBC, PLT & AUTO DIFF $ 55.00 85025 HEMOGRAM WITH PLATLET $ 46.00 85027 RETIC, HCT CORRECTED $ 31.00 85044 PLATELET COUNT $ 32.00 85049 SLIDE REVIEW PATHOLOGIST $ 147.00 85060 PERIPHERAL BLOOD SMEAR $ 146.80 85060 FACTOR V $ 125.00 85220 ANTITHROMBIN III ACTIVITY $ 84.00 85300 ANTITHROMBIN III AG $ 77.00 85301 PROTEIN C ACTIVITY $ 98.00 85303 PROTEIN S ACTIVITY $ 109.00 85306 DIMER TEST $ 72.00 85379 FIBRINOGEN $ 60.00 85384 ROSETTE TEST $ 54.00 85461 PROTHROMBIN TIME $ 28.00 85610 MVMG - PT $ 28.00 85610 LUPUS, DRVTT $ 68.00 85613 SEDIMENTATION RATE $ 25.00 85651
THROMBIN TIME $ 41.00 85670 PTT $ 43.00 85730 ANTINUCLEAR FA AB SCREEN $ 86.00 86038 ASO $ 52.00 86060 C-REACTIVE PROTEIN, QNT $ 37.00 86140 CRP, HIGH SENSITIVITY $ 92.00 86141 CARDIOLIPIN AB, IGG $ 181.00 86147 CARDIOLIPIN AB, IGM $ 181.00 86147 C3 $ 85.00 86160 C4 $ 85.00 86160 DNA DOUBLE STRAND AB (CRITH) $ 98.00 86225 BANAMP1 $ 98.00 86225 ANCA, TOT $ 86.00 86255 CANCER AG 125 $ 148.00 86304 INFECT MONO, DIFF $ 37.00 86308 PRENATAL RISK PRF $ 111.00 86336 THROID PEROXIDASE AB $ 103.00 86376 RHEUMATOID FACTOR, QNT $ 40.00 86431 TBGOLD $ 440.00 86480 TREP TREPONEMA PALLIDUM REFLEX $ 30.00 86592 RPRTP RPR TITER $ 31.00 86593 B. BURGDORFERI AB, IGG & IGM $ 110.00 86617 CYTOMEGALOVIRUS AB, IGG $ 102.00 86644 CYTOMEGALOVIRUS AB, IGM $ 120.00 86645 EBV EARLY ANTIGEN, AB $ 93.00 86663 EBV NUCLEAR AB $ 109.00 86664 EBV CAPSID AB, IGG $ 129.00 86665 EBV CAPSID AB, IGM $ 93.00 86665 HELICOBACTER PYLORI AB, IGG $ 103.00 86677 HSV AB, IGM $ 102.00 86694 HSV 1 AB, IGG $ 94.00 86695 HSV 2 AB, IGG $ 137.00 86696 HIV 1/HIV 2 ABS $ 97.00 86703 HEPATITIS B CORE AB, TOT $ 86.00 86704 HEPATITIS B CORE AB, IGM $ 84.00 86705 HEPATITIS B SURF AB $ 76.00 86706 HEPATITIS B SURF AB, QNT $ 76.00 86706 HEPATITIS A VIRUS, TOT $ 88.00 86708 HEPATITIS A AB, IGM $ 80.00 86709 MUMPS VIRUS AB, IGG $ 93.00 86735 PARVOVIRUS B19 AB, IGG $ 107.00 86747 PARVOVIRUS B19 AB, IGM $ 107.00 86747 RUBELLA AB, IGG $ 102.00 86762 RUBELLA AB, IGM $ 102.00 86762 RUBEOLA (MEASLES) AB, IGG $ 91.00 86765 TOXOPLASMA GONDIT AB, IGG $ 102.00 86777 TOXOPLASMA GONDIT AB, IGM $ 102.00 86778
TPPAP TREPONEMA PALLIDUM AB $ 94.00 86780 VARICELLA ZOSTER AB, IGG $ 91.00 86787 THYROGLOBULIN $ 113.00 86800 THYROGLOBULIN AB $ 113.00 86800 HEP C ANTIBODY TOTAL $ 101.00 86803 ABS RBC 1ST SERUM TECHNIQUE $ 56.00 86850 ABS RBC 2ND SERUM TECHNIQUE $ 56.00 86850 ABS RBC 3RD SERUM TECHNIQUE $ 56.00 86850 ANTIBODY IDENT $ 266.00 86870 COOMBS, DIRECT $ 38.00 86880 ANTIBODY D TITER $ 37.00 86886 ABO BLOOD GROUP $ 21.00 86900 RH (D) $ 21.00 86901 ANTIGEN TYPING UNITS $ 37.00 86902 ANITGEN TYPING PATIENT $ 27.00 86905 CROSSMATCH IMMEDIATE SPIN $ 216.00 86920 CROSSMATCH INCUBATION $ 195.00 86921 CROSSMATCH ANTIGLOBULIN $ 230.00 86922 RBC PRE WARM $ 180.00 86970 CULTURE, BLOOD $ 73.00 87040 CULTURE, STOOL $ 67.00 87046 CULTURE,ROUTINE $ 61.00 87070 CULTURE, ANAEROBIC $ 67.00 87075 BACTERIA ID $ 57.00 87077 HELICO PYLORI SCREEN $ 57.00 87077 CULTURE BETA STREP B SCREEN $ 47.00 87081 CULTURE,MRSA $ 47.00 87081 CULTURE, URINARY $ 57.00 87088 GBS LM PCR $ 224.20 87150 OP CONCENTRATION $ 63.00 87177 BETA LACTAMASE PRODUCTION $ 34.00 87185 SUSCEPT, GRAM NEGATIVE $ 61.00 87186 SUSCEPT, GRAM POSITIVE $ 61.00 87186 GRAM STAIN $ 30.00 87205 WET MOUNT $ 33.00 87210 MVMG - WET MOUNT & KOH PREP $ 33.00 87210 KOH PREPARATION $ 30.00 87220 CULTURE, VIRAL $ 185.00 87252 GIARDIA AG, EIA $ 85.00 87329 HELICOBACTER PYLORI STOOL AG $ 102.00 87338 HEPATITIS B SURF AG $ 73.00 87340 MVMG - INFLUENZA SCREEN $ 85.00 87400 RESPIRATORY VIRAL SCREEN $ 85.00 87420 LEGIONELLA PNEUMOPHILA AG, URI $ 85.00 87449 CANDIDA ORGANISM $ 249.15 87481 CHLAMYDIA TRACHOMATIS PCR $ 249.00 87491 CHLAMYDIA TRACHOMATIS $ 249.15 87491
CLOSTRIDIUM DIFFICILE DNA $ 249.00 87493 FLU A & B MOLECULAR $ 604.00 87502 GRADNERELLA VAGINALIS $ 249.15 87511 HEPATITIS C, RNA QNT $ 304.00 87522 HEPATITIS C RNA, PCR, RT, QNT $ 304.00 87522 HERPES SIMPLEX VIRUS $ 249.15 87529 NEISSERIA GONORRHOEAE PCR $ 249.00 87591 NEISSERIA GONORRHOEAE $ 249.15 87591 HPV - HIGH RISK PANEL $ 249.15 87624 HPV - 16 & 18 GENOTYPING $ 249.15 87625 BSAPCR $ 249.00 87651 GROUP BETA STREPTOCOCCUS $ 249.15 87653 TRICHOMONAS VAGINALIS $ 249.15 87661 NOROVIRUS DETECT,REAL TIME PCR $ 249.00 87798 INFECT AGENT NUCL AMPLIF PROBE $ 249.15 87798 HIV 1/2 AG/AB COMBO $ 188.00 87806 GROUP A STREP RAPID SCREEN $ 95.00 87880 MVMG - GROUP A STREP RAPID SCR $ 95.00 87880 SHIGATOXIN 1 CHARGE $ 92.00 87899 SHIGATOXIN 2 CHARGE $ 92.00 87899 NON-GYN FLUID,WASHIES OR BRUSH $ 257.20 88104 NON-GYN CENCENTR TECHN W/INTER $ 223.68 88108 NON-GYN CELL ENH TECH & INTERP $ 236.27 88112 CELLULAR ENHANCEMENT ISH MANUA $ 3,188.20 88120 CELLULAR ENH ISH COMPUTER ASSI $ 2,541.06 88121 NON GYN SMEARS,OTHER SOURCE $ 271.86 88160 NON GYN SMEARS,OTHER SOURCE >5 $ 338.56 88162 NON GYN RAPID ASSESS FNA FIRST $ 121.15 88172 NON GYN CYTO FINE NDL ASPIR EV $ 483.00 88173 LIQ BASE PAP SMEAR AUTO SCREEN $ 188.08 88175 NON GYN RAPID ASSESS FNA ADDTL $ 46.06 88177 FLOW CYTOMETRY 1 MARKER $ 395.08 88184 FLOW CYTOMETRY EA ADDT MARKER $ 177.91 88185 TISSUE EXAM LEVEL 1 $ 70.96 88300 TISSUE EXAM LEVEL II $ 140.01 88302 TISSUE EXAM LEVEL III $ 171.41 88304 TISSUE EXAM LEVEL IV $ 175.55 88305 TISSUE EXAM LEVEL V $ 1,058.46 88307 TISSUE EXAM LEVEL VI $ 1,476.83 88309 DECALCIFICATION $ 54.17 88311 SPECIAL STAIN GROUP 1 $ 414.12 88312 O & P, TRICHROME STAIN $ 345.06 88313 SPECIAL STAIN GROUP II $ 345.06 88313 CONSULT REFER MATER W/SLID PRE $ 194.41 88323 IMMUNOCYTOCHEM STAIN ADDL ANTI $ 376.68 88341 IMMUNOCYTOCHEN STAIN 1ST ANTIB $ 430.91 88342 IMMUNOCYTOCHEM STAIN COCKTAIL $ 799.19 88344
IMMUNOFLOURESCENT STUDY/DIRECT $ 336.72 88346 IMMUNOFLUOR ANTB ADDL STAIN $ 253.23 88350 MANUAL QUANT IMMUNOSHISTCH IHC $ 520.89 88360 COMPU QUANT IMMUNOHISTCHEM IHC $ 573.16 88361 IN-SITU HYBRIDIZAT ADDL PROBE $ 571.09 88364 IN-SITU HYBRIDIZAT 1ST PROBE $ 797.12 88365 IN-SITU HYBRIDIZ MULT PROB 1SL $ 1,178.00 88366 COMP ASSIST MORPHOMET ANLY 1PR $ 424.58 88367 MANUAL MORPHOMET ANLYS 1 PROBE $ 464.37 88368 MANUAL MORPHOMET ANLYS ADD PRO $ 451.84 88369 COMP ASSIST MORPHOMET ADD PROB $ 299.29 88373 COMP ASST MORPHOMET MULT PROB $ 1,774.45 88374 MANUAL MORPHOMET MULT PROB 1SL $ 2,037.86 88377 MICRODISSECTION MANUAL $ 572.99 88381 MACROSCOPIC EXAM DISSECT/PREP $ 35.36 88387 TISS PREP FROZ SECT/INTRA CONS $ 58.36 88388 CELL COUNT, CSF $ 34.00 89050 CELL COUNT, FLD $ 34.00 89050 CELL COUNT & DIFFERENTIAL, FLD $ 39.00 89051 CELL COUNT & DIFERNETIAL, CSF $ 39.00 89051 FECAL LEUKOCYTE SMEAR $ 30.00 89055 CRYSTALS, FLD $ 51.00 89060 CHAIN OF CUSTODY $ 35.00 99001 THERAPEUTIC PHLEBOTOMY $ 603.00 99195 PSAS $ 131.00 G0103 TRANSFUSION RBC LEUCOR $ 611.00 P9016 TRANSFUSION FROZEN PLASMA $ 272.00 P9017 TRANSFUSION PLT PHERESIS LR $ 1,076.00 P9035 TRANSFUSION LR RBC IRRADIATED $ 573.00 P9040 TRANSFUSION PLT PH LR/CME-/IRR $ 913.00 P9053 TRANSFUSION RBC LR/IRR/CMU- $ 709.00 P9058