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All Services Pathology and Laboratory Services

CPT 88305

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 Standard Charge

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CPT 80305

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 Standard Charge

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CPT 84520

Urea nitrogen; quantitative

$58.00 Standard Charge

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CPT 83655

Lead

$26.00 Standard Charge

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CPT 87491

Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique

$55.00 Standard Charge

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CPT 82043

Albumin; urine (eg, microalbumin), quantitative

$77.00 Standard Charge

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CPT G0103

Prostate cancer screening; prostate specific antigen test (psa)

$140.00 Standard Charge

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CPT 83993

Calprotectin, fecal

$394.00 Standard Charge

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CPT 84155

Protein, total, except by refractometry; serum, plasma or whole blood

$50.00 Standard Charge

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CPT P9016

Red blood cells, leukocytes reduced, each unit

$659.00 Standard Charge

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CPT 84481

Triiodothyronine T3; free

$30.00 Standard Charge

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CPT 83615

Lactate dehydrogenase (LD), (LDH);

$9.00 Standard Charge

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CPT 87426

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 Standard Charge

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CPT 85730

Coagulation assessment blood test

$16.00 Standard Charge

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CPT 84146

Prolactin

$33.00 Standard Charge

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CPT 86038

Antinuclear antibodies (ANA);

$39.00 Standard Charge

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CPT 87801

Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; amplified probe(s) technique

$312.00 Standard Charge

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CPT 81025

Urine pregnancy test, by visual color comparison methods

$103.00 Standard Charge

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CPT 82950

Glucose; post glucose dose (includes glucose)

$55.00 Standard Charge

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CPT 82140

Ammonia

$43.00 Standard Charge

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CPT 85027

Complete blood count, automated

$88.00 Standard Charge

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CPT 87081

Culture, presumptive, pathogenic organisms, screening only;

$13.00 Standard Charge

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CPT 87624

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 Standard Charge

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CPT 83516

Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitative, multiple step method

$100.00 Standard Charge

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CPT 84439

Thyroxine; free

$125.00 Standard Charge

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CPT 83880

Natriuretic peptide

$268.00 Standard Charge

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CPT 85379

Fibrin degradation products, D-dimer; quantitative

$174.00 Standard Charge

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CPT 84403

Testosterone; total

$38.00 Standard Charge

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CPT 86900

Blood typing, serologic; ABO

$109.00 Standard Charge

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CPT 83605

Lactate (lactic acid)

$143.00 Standard Charge

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CPT 87186

Susceptibility studies, antimicrobial agent; microdilution or agar dilution (minimum inhibitory concentration [MIC] or breakpoint), each multi-antimicrobial, per plate

$29.00 Standard Charge

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CPT 83690

Lipase

$124.00 Standard Charge

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CPT 86592

Syphilis test, non-treponemal antibody; qualitative (eg, VDRL, RPR, ART)

$11.00 Standard Charge

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CPT 87493

Infectious agent detection by nucleic acid (DNA or RNA); Clostridium difficile, toxin gene(s), amplified probe technique

$202.00 Standard Charge

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CPT 82330

Calcium; ionized

$131.00 Standard Charge

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CPT 82274

Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations

$57.00 Standard Charge

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CPT 86160

Complement; antigen, each component

$16.00 Standard Charge

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CPT 87045

Culture, bacterial; stool, aerobic, with isolation and preliminary examination (eg, KIA, LIA), Salmonella and Shigella species

$42.00 Standard Charge

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CPT 82306

Vitamin D; 25 hydroxy, includes fraction(s), if performed

$39.00 Standard Charge

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CPT 84156

Protein, total, except by refractometry; urine

$12.00 Standard Charge

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CPT 82784

Gammaglobulin (immunoglobulin); IgA, IgD, IgG, IgM, each

$13.00 Standard Charge

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CPT 82607

Cyanocobalamin (Vitamin B-12);

$21.00 Standard Charge

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CPT 80051

Electrolyte panel This panel must include the following: Carbon dioxide (bicarbonate) (82374) Chloride (82435) Potassium (84132) Sodium (84295)

$105.00 Standard Charge

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CPT 85025

Complete blood cell count, with differential white blood cells, automated

$107.00 Standard Charge

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CPT 81002

Manual urinalysis test with examination without using microscope

$26.00 Standard Charge

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CPT 87340

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 Standard Charge

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CPT 82803

Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2 saturation);

$276.00 Standard Charge

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CPT 80074

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 Standard Charge

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CPT 84165

Protein; electrophoretic fractionation and quantitation, serum

$21.00 Standard Charge

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CPT 84443

Blood test, thyroid stimulating hormone (TSH)

$167.00 Standard Charge

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CPT 84132

Potassium; serum, plasma or whole blood

$63.00 Standard Charge

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CPT 80055

Obstetric blood test panel

$182.00 Standard Charge

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CPT 87040

Culture, bacterial; blood, aerobic, with isolation and presumptive identification of isolates (includes anaerobic culture, if appropriate)

$29.00 Standard Charge

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CPT 80053

Blood test, comprehensive group o blood chemicals

$215.00 Standard Charge

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CPT 86235

Extractable nuclear antigen, antibody to, any method (eg, nRNP, SS-A, SS-B, Sm, RNP, Sc170, J01), each antibody

$114.00 Standard Charge

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CPT 87328

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 Standard Charge

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CPT 86901

Blood typing, serologic; Rh (D)

$85.00 Standard Charge

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CPT 86308

Heterophile antibodies; screening

$90.00 Standard Charge

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CPT 87077

Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate

$83.00 Standard Charge

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CPT 84550

Uric acid; blood

$68.00 Standard Charge

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CPT 80048

Basic metabolic panel

$158.00 Standard Charge

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CPT 82565

Creatinine; blood

$65.00 Standard Charge

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CPT 86140

C-reactive protein;

$91.00 Standard Charge

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CPT 84480

Triiodothyronine T3; total (TT-3)

$32.00 Standard Charge

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CPT 87150

Culture, typing; identification by nucleic acid (DNA or RNA) probe, amplified probe technique, per culture or isolate, each organism probed

$1,123.00 Standard Charge

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CPT 83001

Gonadotropin; follicle stimulating hormone (FSH)

$30.00 Standard Charge

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CPT 86803

Hepatitis C antibody;

$20.00 Standard Charge

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CPT 85610

Blood test, clotting time

$7.00 Standard Charge

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CPT 80061

Blood test, lipids (cholesterol and triglycerides)

$155.00 Standard Charge

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CPT 83735

Magnesium

$95.00 Standard Charge

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CPT 85018

Blood count; hemoglobin (Hgb)

$43.00 Standard Charge

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CPT 86762

Antibody; rubella

$20.00 Standard Charge

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CPT 87086

Culture, bacterial; quantitative colony count, urine

$18.00 Standard Charge

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CPT 84145

Procalcitonin (PCT)

$561.00 Standard Charge

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CPT 87400

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 Standard Charge

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CPT 86200

Cyclic citrullinated peptide (CCP), antibody

$53.00 Standard Charge

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CPT 83883

Nephelometry, each analyte not elsewhere specified

$38.00 Standard Charge

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CPT 85045

Blood count; reticulocyte, automated

$13.00 Standard Charge

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CPT 87591

Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, amplified probe technique

$55.00 Standard Charge

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CPT 83036

Hemoglobin; glycosylated (A1C)

$105.00 Standard Charge

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CPT 85652

Sedimentation rate, erythrocyte; automated

$58.00 Standard Charge

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CPT 86003

Allergen specific IgE; quantitative or semiquantitative, crude allergen extract, each

$16.00 Standard Charge

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CPT 84450

Transferase; aspartate amino (AST) (SGOT)

$65.00 Standard Charge

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CPT 82728

Ferritin

$17.00 Standard Charge

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CPT 87880

Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Streptococcus, group A

$105.00 Standard Charge

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CPT 82785

Gammaglobulin (immunoglobulin); IgE

$22.00 Standard Charge

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CPT 82947

Glucose; quantitative, blood (except reagent strip)

$55.00 Standard Charge

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CPT 82150

Amylase

$111.00 Standard Charge

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CPT 87329

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 Standard Charge

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CPT 80076

Liver function blood test panel

$164.00 Standard Charge

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CPT 84153

PSA (prostate specific antigen)

$23.00 Standard Charge

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CPT 87210

Smear, primary source with interpretation; wet mount for infectious agents (eg, saline, India ink, KOH preps)

$78.00 Standard Charge

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CPT 87522

Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, quantification, includes reverse transcription when performed

$339.00 Standard Charge

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CPT 87147

Culture, typing; immunologic method, other than immunofluorescence (eg, agglutination grouping), per antiserum

$68.00 Standard Charge

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CPT 81001

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 Standard Charge

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CPT 86141

C-reactive protein; high sensitivity (hsCRP)

$32.00 Standard Charge

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CPT 87205

Smear, primary source with interpretation; Gram or Giemsa stain for bacteria, fungi, or cell types

$20.00 Standard Charge

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CPT 86706

Hepatitis B surface antibody (HBsAb)

$18.00 Standard Charge

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CPT 84460

Transferase; alanine amino (ALT) (SGPT)

$63.00 Standard Charge

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CPT 82550

Creatine kinase (CK), (CPK); total

$96.00 Standard Charge

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CPT 82533

Cortisol; total

$24.00 Standard Charge

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CPT 87389

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 Standard Charge

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CPT 80069

Kidney function panel test

$159.00 Standard Charge

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CPT 83970

Parathormone (parathyroid hormone)

$33.00 Standard Charge

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CPT 82570

Creatinine; other source

$12.00 Standard Charge

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CPT 84100

Phosphorus inorganic (phosphate);

$66.00 Standard Charge

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CPT 82746

Folic acid; serum

$20.00 Standard Charge

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CPT 83550

Iron binding capacity

$9.00 Standard Charge

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CPT 86256

Fluorescent noninfectious agent antibody; titer, each antibody

$149.00 Standard Charge

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CPT 83540

Iron

$9.00 Standard Charge

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CPT 80050

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 Standard Charge

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CPT 84702

Gonadotropin, chorionic (hCG); quantitative

$24.00 Standard Charge

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CPT 87070

Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates

$37.00 Standard Charge

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CPT 84144

Progesterone

$32.00 Standard Charge

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CPT 81003

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 Standard Charge

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CPT 85014

Blood count; hematocrit (Hct)

$44.00 Standard Charge

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CPT 84484

Troponin, quantitative

$113.00 Standard Charge

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CPT 82948

Glucose; blood, reagent strip

$26.00 Standard Charge

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CPT 86850

Antibody screen, RBC, each serum technique

$147.00 Standard Charge

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CPT 82553

Creatine kinase (CK), (CPK); MB fraction only

$200.00 Standard Charge

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