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Level IV - Surgical pathology, gross and microscopic examination Abortion - spontaneous/missed Artery, biopsy Bone marrow, biopsy Bone exostosis Brain/meninges, other than for tumor resection Breast, biopsy, not requiring microscopic evaluation of surgical margins Breast, reduction mammoplasty Bronchus, biopsy Cell block, any source Cervix, biopsy Colon, biopsy Duodenum, biopsy Endocervix, curettings/biopsy Endometrium, curettings/biopsy Esophagus, biopsy Extremity, amputation, traumatic Fallopian tube, biopsy Fallopian tube, ectopic pregnancy Femoral head, fracture Fingers/toes, amputation, non-traumatic Gingiva/oral mucosa, biopsy Heart valve Joint, resection Kidney, biopsy Larynx, biopsy Leiomyoma(s), uterine myomectomy - without uterus Lip, biopsy/wedge resection Lung, transbronchial biopsy Lymph node, biopsy Muscle, biopsy Nasal mucosa, biopsy Nasopharynx/oropharynx, biopsy Nerve, biopsy Odontogenic/dental cyst Omentum, biopsy Ovary with or without tube, non-neoplastic Ovary, biopsy/wedge resection Pa...
$193.00 See All Rates |
Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; capable of being read by direct optical observation only (eg, utilizing immunoassay [eg, dipsticks, cups, cards, or cartridges]), includes sample validation when performed, per date of service
$62.00 See All Rates |
Urea nitrogen; quantitative
$58.00 See All Rates |
Lead
$26.00 See All Rates |
Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique
$55.00 See All Rates |
Albumin; urine (eg, microalbumin), quantitative
$77.00 See All Rates |
Prostate cancer screening; prostate specific antigen test (psa)
$140.00 See All Rates |
Calprotectin, fecal
$394.00 See All Rates |
Protein, total, except by refractometry; serum, plasma or whole blood
$50.00 See All Rates |
Red blood cells, leukocytes reduced, each unit
$659.00 See All Rates |
Triiodothyronine T3; free
$30.00 See All Rates |
Lactate dehydrogenase (LD), (LDH);
$9.00 See All Rates |
Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]), qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19])
$155.00 See All Rates |
Coagulation assessment blood test
$16.00 See All Rates |
Prolactin
$33.00 See All Rates |
Antinuclear antibodies (ANA);
$39.00 See All Rates |
Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; amplified probe(s) technique
$312.00 See All Rates |
Urine pregnancy test, by visual color comparison methods
$103.00 See All Rates |
Glucose; post glucose dose (includes glucose)
$55.00 See All Rates |
Ammonia
$43.00 See All Rates |
Complete blood count, automated
$88.00 See All Rates |
Culture, presumptive, pathogenic organisms, screening only;
$13.00 See All Rates |
Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), high-risk types (eg, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68)
$118.00 See All Rates |
Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitative, multiple step method
$100.00 See All Rates |
Thyroxine; free
$125.00 See All Rates |
Natriuretic peptide
$268.00 See All Rates |
Fibrin degradation products, D-dimer; quantitative
$174.00 See All Rates |
Testosterone; total
$38.00 See All Rates |
Blood typing, serologic; ABO
$109.00 See All Rates |
Lactate (lactic acid)
$143.00 See All Rates |
Susceptibility studies, antimicrobial agent; microdilution or agar dilution (minimum inhibitory concentration [MIC] or breakpoint), each multi-antimicrobial, per plate
$29.00 See All Rates |
Lipase
$124.00 See All Rates |
Syphilis test, non-treponemal antibody; qualitative (eg, VDRL, RPR, ART)
$11.00 See All Rates |
Infectious agent detection by nucleic acid (DNA or RNA); Clostridium difficile, toxin gene(s), amplified probe technique
$202.00 See All Rates |
Calcium; ionized
$131.00 See All Rates |
Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations
$57.00 See All Rates |
Complement; antigen, each component
$16.00 See All Rates |
Culture, bacterial; stool, aerobic, with isolation and preliminary examination (eg, KIA, LIA), Salmonella and Shigella species
$42.00 See All Rates |
Vitamin D; 25 hydroxy, includes fraction(s), if performed
$39.00 See All Rates |
Protein, total, except by refractometry; urine
$12.00 See All Rates |
Gammaglobulin (immunoglobulin); IgA, IgD, IgG, IgM, each
$13.00 See All Rates |
Cyanocobalamin (Vitamin B-12);
$21.00 See All Rates |
Electrolyte panel This panel must include the following: Carbon dioxide (bicarbonate) (82374) Chloride (82435) Potassium (84132) Sodium (84295)
$105.00 See All Rates |
Complete blood cell count, with differential white blood cells, automated
$107.00 See All Rates |
Manual urinalysis test with examination without using microscope
$26.00 See All Rates |
Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]), qualitative or semiquantitative; hepatitis B surface antigen (HBsAg)
$13.00 See All Rates |
Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2 saturation);
$276.00 See All Rates |
Acute hepatitis panel This panel must include the following: Hepatitis A antibody (HAAb), IgM antibody (86709) Hepatitis B core antibody (HBcAb), IgM antibody (86705) Hepatitis B surface antigen (HBsAg) (87340) Hepatitis C antibody (86803)
$82.00 See All Rates |
Protein; electrophoretic fractionation and quantitation, serum
$21.00 See All Rates |
Blood test, thyroid stimulating hormone (TSH)
$167.00 See All Rates |
Potassium; serum, plasma or whole blood
$63.00 See All Rates |
Obstetric blood test panel
$182.00 See All Rates |
Culture, bacterial; blood, aerobic, with isolation and presumptive identification of isolates (includes anaerobic culture, if appropriate)
$29.00 See All Rates |
Blood test, comprehensive group o blood chemicals
$215.00 See All Rates |
Extractable nuclear antigen, antibody to, any method (eg, nRNP, SS-A, SS-B, Sm, RNP, Sc170, J01), each antibody
$114.00 See All Rates |
Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]), qualitative or semiquantitative; cryptosporidium
$206.00 See All Rates |
Blood typing, serologic; Rh (D)
$85.00 See All Rates |
Heterophile antibodies; screening
$90.00 See All Rates |
Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate
$83.00 See All Rates |
Uric acid; blood
$68.00 See All Rates |
Basic metabolic panel
$158.00 See All Rates |
Creatinine; blood
$65.00 See All Rates |
C-reactive protein;
$91.00 See All Rates |
Triiodothyronine T3; total (TT-3)
$32.00 See All Rates |
Culture, typing; identification by nucleic acid (DNA or RNA) probe, amplified probe technique, per culture or isolate, each organism probed
$1,123.00 See All Rates |
Gonadotropin; follicle stimulating hormone (FSH)
$30.00 See All Rates |
Hepatitis C antibody;
$20.00 See All Rates |
Blood test, clotting time
$7.00 See All Rates |
Blood test, lipids (cholesterol and triglycerides)
$155.00 See All Rates |
Magnesium
$95.00 See All Rates |
Blood count; hemoglobin (Hgb)
$43.00 See All Rates |
Antibody; rubella
$20.00 See All Rates |
Culture, bacterial; quantitative colony count, urine
$18.00 See All Rates |
Procalcitonin (PCT)
$561.00 See All Rates |
Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]), qualitative or semiquantitative; Influenza, A or B, each
$98.00 See All Rates |
Cyclic citrullinated peptide (CCP), antibody
$53.00 See All Rates |
Nephelometry, each analyte not elsewhere specified
$38.00 See All Rates |
Blood count; reticulocyte, automated
$13.00 See All Rates |
Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, amplified probe technique
$55.00 See All Rates |
Hemoglobin; glycosylated (A1C)
$105.00 See All Rates |
Sedimentation rate, erythrocyte; automated
$58.00 See All Rates |
Allergen specific IgE; quantitative or semiquantitative, crude allergen extract, each
$16.00 See All Rates |
Transferase; aspartate amino (AST) (SGOT)
$65.00 See All Rates |
Ferritin
$17.00 See All Rates |
Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Streptococcus, group A
$105.00 See All Rates |
Gammaglobulin (immunoglobulin); IgE
$22.00 See All Rates |
Glucose; quantitative, blood (except reagent strip)
$55.00 See All Rates |
Amylase
$111.00 See All Rates |
Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]), qualitative or semiquantitative; giardia
$45.00 See All Rates |
Liver function blood test panel
$164.00 See All Rates |
PSA (prostate specific antigen)
$23.00 See All Rates |
Smear, primary source with interpretation; wet mount for infectious agents (eg, saline, India ink, KOH preps)
$78.00 See All Rates |
Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, quantification, includes reverse transcription when performed
$339.00 See All Rates |
Culture, typing; immunologic method, other than immunofluorescence (eg, agglutination grouping), per antiserum
$68.00 See All Rates |
Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, with microscopy
$69.00 See All Rates |
C-reactive protein; high sensitivity (hsCRP)
$32.00 See All Rates |
Smear, primary source with interpretation; Gram or Giemsa stain for bacteria, fungi, or cell types
$20.00 See All Rates |
Hepatitis B surface antibody (HBsAb)
$18.00 See All Rates |
Transferase; alanine amino (ALT) (SGPT)
$63.00 See All Rates |
Creatine kinase (CK), (CPK); total
$96.00 See All Rates |
Cortisol; total
$24.00 See All Rates |
Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]), qualitative or semiquantitative; HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies, single result
$84.00 See All Rates |
Kidney function panel test
$159.00 See All Rates |
Parathormone (parathyroid hormone)
$33.00 See All Rates |
Creatinine; other source
$12.00 See All Rates |
Phosphorus inorganic (phosphate);
$66.00 See All Rates |
Folic acid; serum
$20.00 See All Rates |
Iron binding capacity
$9.00 See All Rates |
Fluorescent noninfectious agent antibody; titer, each antibody
$149.00 See All Rates |
Iron
$9.00 See All Rates |
General health panel This panel must include the following: Comprehensive metabolic panel (80053) Blood count, complete (CBC), automated and automated differential WBC count (85025 or 85027 and 85004) OR Blood count, complete (CBC), automated (85027) and appropriate manual differential WBC count (85007 or 85009) Thyroid stimulating hormone (TSH) (84443)
$318.00 See All Rates |
Gonadotropin, chorionic (hCG); quantitative
$24.00 See All Rates |
Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates
$37.00 See All Rates |
Progesterone
$32.00 See All Rates |
Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, without microscopy
$38.00 See All Rates |
Blood count; hematocrit (Hct)
$44.00 See All Rates |
Troponin, quantitative
$113.00 See All Rates |
Glucose; blood, reagent strip
$26.00 See All Rates |
Antibody screen, RBC, each serum technique
$147.00 See All Rates |
Creatine kinase (CK), (CPK); MB fraction only
$200.00 See All Rates |