Independent_Labs_Query by afr15630

VIEWS: 26 PAGES: 29

									                                     INDEPENDENT LABORATORIES FEE SCHEDULE
                                               EFFECTIVE 04/01/2005

CODE                                       DESCRIPTION                                MAX FEE   MAX UNITS

0023T   INFECTIOUS AGENT DRUG SUSCEPTIBILITY PHENOTYPE PREDICTION USING GENOTYPIC      72.00        1
80048   BASIC METABOLIC PANEL                                                           7.20        1
80051   ELECTROLYTE PANEL                                                               5.85        2
80053   COMPREHENSIVE METABOLIC PANEL                                                   9.00        1
80055   OBSTETRIC PANEL                                                                40.70        1
80061   LIPID PANEL                                                                     8.55        1
80069   RENAL FUNCTION PANEL                                                            7.20        1
80074   ACUTE HEPATITIS PANEL                                                          41.40        1
80076   HEPATIC FUNCTION PANEL                                                          6.75        1
80100   DRUG SCREEN, QUALITATIVE; MULTIPLE DRUG CLASSES CHROMATOGRAPHIC METHOD, EAC    11.70        5
80101   DRUG SCREEN, QUALITATIVE; SINGLE DRUG CLASS METHOD (EG, IMMUNOASSAY, ENZYME    13.05        1
80102   DRUG, CONFIRMATION, EACH PROCEDURE                                             12.15        1
80150   AMIKACIN                                                                       13.95        1
80152   AMITRIPTYLINE                                                                  16.20        1
80154   BENZODIAZEPINES                                                                16.65        1
80156   CARBAMAZEPINE; TOTAL                                                           13.50        1
80157   CARBAMAZEPINE; FREE                                                             8.55        1
80158   CYCLOSPORINE                                                                   13.95        1
80160   DESIPRAMINE                                                                    16.20        1
80162   DIGOXIN                                                                        12.60        1
80164   DIPROPYLACETIC ACID (VALPROIC ACID)                                            12.60        1
80166   DOXEPIN                                                                        13.95        1
80168   ETHOSUXIMIDE                                                                   13.95        1
80170   GENTAMICIN                                                                     14.85        1
80172   GOLD                                                                           14.40        1
80173   HALOPERIDOL                                                                    12.60        1
80174   IMIPRAMINE                                                                     15.75        1
80176   LIDOCAINE                                                                       9.45        1
80178   LITHIUM                                                                         6.30        1
80182   NORTRIPTYLINE                                                                  12.60        1
80184   PHENOBARBITAL                                                                   9.90        1
80185   PHENYTOIN; TOTAL                                                               12.15        1



                                                         Page 1
CODE                                         DESCRIPTION                              MAX FEE   MAX UNITS

80186   PHENYTOIN; FREE                                                                12.60        1
80188   PRIMIDONE                                                                      13.50        1
80190   PROCAINAMIDE;                                                                  14.85        1
80192   PROCAINAMIDE; WITH METABOLITES (EG, N-ACETYL PROCAINAMIDE)                     14.85        1
80194   QUINIDINE                                                                      13.05        1
80196   SALICYLATE                                                                      6.30        1
80197   TACROLIMUS                                                                     14.40        1
80198   THEOPHYLLINE                                                                   13.05        1
80200   TOBRAMYCIN                                                                     14.40        1
80201   TOPIRAMATE                                                                     12.60        1
80202   VANCOMYCIN                                                                     12.60        2
80299   QUANTITATION OF DRUG, NOT ELSEWHERE SPECIFIED                                  12.60        1
81000   URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOB     2.70        4
81001   URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOB     2.94        4
81002   URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOB     1.80        1
81003   URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOB     2.25        1
81005   URINALYSIS; QUALITATIVE OR SEMIQUANTITATIVE, EXCEPT IMMUNOASSAYS                1.80        1
81007   URINALYSIS; BACTERIURIA SCREEN, EXCEPT BY CULTURE OR DIPSTICK                   1.35        1
81015   URINALYSIS; MICROSCOPIC ONLY                                                    1.80        1
81025   URINE PREGNANCY TEST, BY VISUAL COLOR COMPARISON METHODS                        5.85        1
81050   VOLUME MEASUREMENT FOR TIMED COLLECTION, EACH                                   2.70        1
81099   UNLISTED URINALYSIS PROCEDURE                                                   0.00        1
82000   ACETALDEHYDE, BLOOD                                                            11.25        1
82003   ACETAMINOPHEN                                                                  11.25        1
82009   ACETONE OR OTHER KETONE BODIES, SERUM; QUALITATIVE                              3.15        1
82010   ACETONE OR OTHER KETONE BODIES, SERUM; QUANTITATIVE                             2.70        1
82013   ACETYLCHOLINESTERASE                                                           10.35        1
82017   ACYLCARNITINES; QUANTITATIVE, EACH SPECIMEN (FOR CARNITINE, SEE 82379)          4.05        1
82024   ADRENOCORTICOTROPIC HORMONE (ACTH)                                             33.30        1
82030   ADENOSINE, 5'-MONOPHOSPHATE, CYCLIC (CYCLIC AMP)                                8.10        1
82040   ALBUMIN; SERUM                                                                  2.25        1
82042   ALBUMIN; URINE OR OTHER SOURCE, QUANTITATIVE, EACH SPECIMEN                     0.90        1
82043   ALBUMIN; URINE, MICROALBUMIN, QUANTITATIVE                                      1.35        1
82044   ALBUMIN; URINE, MICROALBUMIN, SEMIQUANTITATIVE (EG, REAGENT STRIP ASSAY)        1.35        1
82045   ALBUMIN; ISCHEMIA MODIFIED                                                     29.88        1



                                                           Page 2
CODE                                         DESCRIPTION                  MAX FEE   MAX UNITS

82055   ALCOHOL (ETHANOL); ANY SPECIMEN EXCEPT BREATH                      10.80        1
82085   ALDOLASE                                                            8.55        1
82088   ALDOSTERONE                                                        35.10        1
82101   ALKALOIDS, URINE, QUANTITATIVE                                      7.65        1
82103   ALPHA-1-ANTITRYPSIN; TOTAL                                         11.70        1
82104   ALPHA-1-ANTITRYPSIN; PHENOTYPE                                     12.60        1
82105   ALPHA-FETOPROTEIN; SERUM                                           13.95        1
82106   ALPHA-FETOPROTEIN; AMNIOTIC FLUID                                  13.95        1
82108   ALUMINUM                                                           24.30        1
82127   AMINO ACIDS; SINGLE, QUALITATIVE, EACH SPECIMEN                    11.70        1
82128   AMINO ACIDS; MULTIPLE, QUALITATIVE, EACH SPECIMEN                  11.25        1
82131   AMINO ACIDS; SINGLE, QUANTITATIVE, EACH SPECIMEN                    4.50        1
82135   AMINOLEVULINIC ACID, DELTA (ALA)                                   15.30        1
82136   AMINO ACIDS, 2 TO 5 AMINO ACIDS, QUANTITATIVE, EACH SPECIMEN        4.05        1
82139   AMINO ACIDS, 6 OR MORE AMINO ACIDS, QUANTITATIVE, EACH SPECIMEN     4.05        1
82140   AMMONIA                                                            11.25        1
82143   AMNIOTIC FLUID SCAN (SPECTROPHOTOMETRIC)                            6.75        1
82145   AMPHETAMINE OR METHAMPHETAMINE                                     13.95        1
82150   AMYLASE                                                             5.40        4
82154   ANDROSTANEDIOL GLUCURONIDE                                         30.15        1
82157   ANDROSTENEDIONE                                                    24.30        1
82160   ANDROSTERONE                                                       25.20        1
82163   ANGIOTENSIN II                                                     16.65        1
82164   ANGIOTENSIN I - CONVERTING ENZYME (ACE)                            11.25        1
82172   APOLIPOPROTEIN, EACH                                                9.90        2
82175   ARSENIC                                                            17.55        1
82180   ASCORBIC ACID (VITAMIN C), BLOOD                                    9.00        1
82205   BARBITURATES, NOT ELSEWHERE SPECIFIED                              10.80        1
82232   BETA-2 MICROGLOBULIN                                               14.85        1
82239   BILE ACIDS; TOTAL                                                  13.95        1
82240   BILE ACIDS; CHOLYLGLYCINE                                          11.25        1
82247   BILIRUBIN; TOTAL                                                    4.05        1
82248   BILIRUBIN; DIRECT                                                   4.05        1
82252   BILIRUBIN; FECES, QUALITATIVE                                       0.90        1
82261   BIOTINIDASE, EACH SPECIMEN                                          4.05        1



                                                           Page 3
CODE                                       DESCRIPTION                                MAX FEE   MAX UNITS

82270   BLOOD, OCCULT, BY PEROXIDASE ACTIVITY (EG, GUAIAC), QUALITATIVE; FECES, 1-3     1.80        1
82273   BLOOD, OCCULT, BY PEROXIDASE ACTIVITY (EG, GUAIAC), QUALITATIVE; OTHER SOUR     1.80        1
82274   BLOOD, OCCULT, BY FECAL HEMOGLOBIN DETERMINATION BY IMMUNOASSAY, QUALITATIV     1.80        1
82286   BRADYKININ                                                                      4.95        1
82300   CADMIUM                                                                         6.30        1
82306   CALCIFEDIOL (25-OH VITAMIN D-3)                                                27.00        1
82307   CALCIFEROL (VITAMIN D)                                                         30.15        1
82308   CALCITONIN                                                                     22.05        1
82310   CALCIUM; TOTAL                                                                  4.05        6
82330   CALCIUM; IONIZED                                                                9.90        1
82340   CALCIUM; URINE QUANTITATIVE, TIMED SPECIMEN                                     5.40        1
82355   CALCULUS; QUALITATIVE ANALYSIS                                                  9.45        1
82360   CALCULUS (STONE); QUANTITATIVE ANALYSIS, CHEMICAL                               5.40        1
82370   CALCULUS (STONE); X-RAY DIFFRACTION                                             9.45        1
82374   CARBON DIOXIDE (BICARBONATE)                                                    3.15        1
82375   CARBON MONOXIDE, (CARBOXYHEMOGLOBIN); QUANTITATIVE                              8.10        1
82376   CARBON MONOXIDE, (CARBOXYHEMOGLOBIN); QUALITATIVE                               3.60        1
82378   CARCINOEMBRYONIC ANTIGEN (CEA)                                                 17.55        1
82379   CARNITINE (TOTAL AND FREE), QUANTITATIVE, EACH SPECIMEN                         4.05        1
82380   CAROTENE                                                                        8.55        1
82382   CATECHOLAMINES; TOTAL URINE                                                    13.05        1
82383   CATECHOLAMINES; BLOOD                                                          22.95        1
82384   CATECHOLAMINES; FRACTIONATED                                                   15.75        1
82390   CERULOPLASMIN                                                                   9.45        1
82397   CHEMILUMINESCENT ASSAY                                                         14.85        1
82435   CHLORIDE; BLOOD                                                                 4.05        1
82436   CHLORIDE; URINE                                                                 1.80        1
82438   CHLORIDE; OTHER SOURCE                                                          3.60        1
82465   CHOLESTEROL, SERUM OR WHOLE BLOOD, TOTAL                                        3.60        1
82480   CHOLINESTERASE; SERUM                                                           6.75        1
82482   CHOLINESTERASE; RBC                                                             5.85        1
82485   CHONDROITIN B SULFATE, QUANTITATIVE                                             9.45        1
82486   CHROMATOGRAPHY, QUALITATIVE; COLUMN (EG, GAS LIQUID OR HPLC), ANALYTE NOT E    11.25        1
82487   CHROMATOGRAPHY, QUALITATIVE; PAPER, 1-DIMENSIONAL, ANALYTE NOT ELSEWHERE SP     9.45        1
82488   CHROMATOGRAPHY, QUALITATIVE; PAPER, 2-DIMENSIONAL, ANALYTE NOT ELSEWHERE SP     9.45        1



                                                         Page 4
CODE                                       DESCRIPTION                                MAX FEE   MAX UNITS

82489   CHROMATOGRAPHY, QUALITATIVE; THIN LAYER, ANALYTE NOT ELSEWHERE SPECIFIED        9.45        1
82491   CHROMATOGRAPHY, QUANTITATIVE, COLUMN (EG, GAS LIQUID OR HPLC); SINGLE ANALY    13.95        1
82492   CHROMATOGRAPHY, QUANTITATIVE, COLUMN (EG, GAS LIQUID OR HPLC); MULTIPLE ANA    14.85        1
82495   CHROMIUM                                                                        3.60        1
82507   CITRATE                                                                        25.20        1
82520   COCAINE OR METABOLITE                                                          13.95        1
82523   COLLAGEN CROSS LINKS, ANY METHOD                                               16.20        1
82525   COPPER                                                                         10.35        1
82528   CORTICOSTERONE                                                                 20.25        1
82530   CORTISOL; FREE                                                                 15.75        1
82533   CORTISOL; TOTAL                                                                14.85        1
82540   CREATINE                                                                        3.60        1
82541   COLUMN CHROMATOGRAPHY/MASS SPECTROMETRY (EG, GC/MS, OR HPLC/MS), ANALYTE NO    14.85        1
82542   COLUMN CHROMATOGRAPHY/MASS SPECTROMETRY (EG, GC/MS, OR HPLC/MS), ANALYTE NO    14.85        1
82543   COLUMN CHROMATOGRAPHY/MASS SPECTROMETRY (EG, GC/MS, OR HPLC/MS), ANALYTE NO    14.85        1
82544   COLUMN CHROMATOGRAPHY/MASS SPECTROMETRY (EG, GC/MS, OR HPLC/MS), ANALYTE NO    14.85        1
82550   CREATINE KINASE (CK), (CPK); TOTAL                                              5.85        1
82552   CREATINE KINASE (CK), (CPK); ISOENZYMES                                        11.25        1
82553   CREATINE KINASE (CK), (CPK); MB FRACTION ONLY                                   6.30        1
82554   CREATINE KINASE (CK), (CPK); ISOFORMS                                           6.30        1
82565   CREATININE; BLOOD                                                               4.05        1
82570   CREATININE; OTHER SOURCE                                                        4.50        1
82575   CREATININE; CLEARANCE                                                           8.55        1
82585   CRYOFIBRINOGEN                                                                  7.65        1
82595   CRYOGLOBULIN, QUALITATIVE OR SEMI-QUANTITATIVE (EG, CRYOCRIT)                   4.95        1
82607   CYANOCOBALAMIN (VITAMIN B-12);                                                 13.50        1
82608   CYANOCOBALAMIN (VITAMIN B-12); UNSATURATED BINDING CAPACITY                    13.50        1
82615   CYSTINE AND HOMOCYSTINE, URINE, QUALITATIVE                                     5.40        1
82626   DEHYDROEPIANDROSTERONE (DHEA)                                                  23.40        1
82627   DEHYDROEPIANDROSTERONE-SULFATE (DHEA-S)                                        23.40        1
82633   DESOXYCORTICOSTERONE, 11-                                                      27.00        1
82634   DEOXYCORTISOL, 11-                                                             27.00        1
82638   DIBUCAINE NUMBER                                                               11.25        1
82646   DIHYDROCODEINONE                                                               13.05        1
82649   DIHYDROMORPHINONE                                                              23.85        1



                                                         Page 5
CODE                                         DESCRIPTION                              MAX FEE   MAX UNITS

82651   DIHYDROTESTOSTERONE (DHT)                                                      23.85        1
82654   DIMETHADIONE                                                                    9.00        1
82657   ENZYME ACTIVITY IN BLOOD CELLS, CULTURED CELLS, OR TISSUE, NOT ELSEWHERE SP    14.85        1
82658   ENZYME ACTIVITY IN BLOOD CELLS, CULTURED CELLS, OR TISSUE, NOT ELSEWHERE SP    14.85        1
82664   ELECTROPHORETIC TECHNIQUE, NOT ELSEWHERE SPECIFIED                             11.25        1
82666   EPIANDROSTERONE                                                                19.80        1
82668   ERYTHROPOIETIN                                                                 16.65        1
82670   ESTRADIOL                                                                      23.40        1
82671   ESTROGENS; FRACTIONATED                                                        23.85        1
82672   ESTROGENS; TOTAL                                                               19.80        1
82677   ESTRIOL                                                                        25.20        1
82679   ESTRONE                                                                        23.85        1
82690   ETHCHLORVYNOL                                                                  13.05        1
82693   ETHYLENE GLYCOL                                                                 4.50        1
82696   ETIOCHOLANOLONE                                                                22.95        1
82705   FAT OR LIPIDS, FECES; QUALITATIVE                                               4.50        1
82710   FAT OR LIPIDS, FECES; QUANTITATIVE                                             10.35        1
82715   FAT DIFFERENTIAL, FECES, QUANTITATIVE                                          15.75        1
82725   FATTY ACIDS, NONESTERIFIED                                                      5.40        1
82726   VERY LONG CHAIN FATTY ACIDS                                                    14.85        1
82728   FERRITIN                                                                       12.60        1
82731   FETAL FIBRONECTIN, CERVICOVAGINAL SECRETIONS, SEMI-QUANTITATIVE                56.07        1
82735   FLUORIDE                                                                        5.40        1
82742   FLURAZEPAM                                                                     18.45        1
82746   FOLIC ACID; SERUM                                                              13.50        1
82747   FOLIC ACID; RBC                                                                 2.25        1
82757   FRUCTOSE, SEMEN                                                                 8.10        1
82759   GALACTOKINASE, RBC                                                             19.80        1
82760   GALACTOSE                                                                       3.15        1
82775   GALACTOSE-1-PHOSPHATE URIDYL TRANSFERASE; QUANTITATIVE                         19.80        1
82776   GALACTOSE-1-PHOSPHATE URIDYL TRANSFERASE; SCREEN                                7.20        1
82784   GAMMAGLOBULIN; IGA, IGD, IGG, IGM, EACH                                         8.10        4
82785   GAMMAGLOBULIN; IGE                                                             14.40        1
82787   GAMMAGLOBULIN; IMMUNOGLOBULIN SUBCLASSES, (IGG1, 2, 3, OR 4), EACH              3.29        1
82926   GASTRIC ACID, FREE AND TOTAL, EACH SPECIMEN                                     5.40        1



                                                           Page 6
CODE                                        DESCRIPTION                               MAX FEE   MAX UNITS

82928   GASTRIC ACID, FREE OR TOTAL; EACH SPECIMEN                                      3.15        1
82938   GASTRIN AFTER SECRETIN STIMULATION                                             16.20        1
82941   GASTRIN                                                                        15.75        1
82943   GLUCAGON                                                                       12.60        1
82945   GLUCOSE, BODY FLUID, OTHER THAN BLOOD                                           3.15        2
82946   GLUCAGON TOLERANCE TEST                                                        13.95        1
82947   GLUCOSE; QUANTITATIVE, BLOOD (EXCEPT REAGENT STRIP)                             3.15       10
82948   GLUCOSE; BLOOD, REAGENT STRIP                                                   2.70       10
82950   GLUCOSE; POST GLUCOSE DOSE (INCLUDES GLUCOSE)                                   3.60        1
82951   GLUCOSE; TOLERANCE TEST (GTT), THREE SPECIMENS (INCLUDES GLUCOSE)              11.70        1
82952   GLUCOSE; TOLERANCE TEST, EACH ADDITIONAL BEYOND THREE SPECIMENS                 3.60        1
82953   GLUCOSE; TOLBUTAMIDE TOLERANCE TEST                                             3.15        1
82955   GLUCOSE-6-PHOSPHATE DEHYDROGENASE (G6PD); QUANTITATIVE                          8.55        1
82960   GLUCOSE-6-PHOSPHATE DEHYDROGENASE (G6PD); SCREEN                                3.60        1
82962   GLUCOSE, BLOOD BY GLUCOSE MONITORING DEVICE(S) CLEARED BY THE FDA SPECIFICA     2.47        1
82963   GLUCOSIDASE, BETA                                                              19.80        1
82965   GLUTAMATE DEHYDROGENASE                                                         3.15        1
82975   GLUTAMINE (GLUTAMIC ACID AMIDE)                                                12.60        1
82977   GLUTAMYLTRANSFERASE, GAMMA (GGT)                                                6.30        1
82978   GLUTATHIONE                                                                    13.05        1
82979   GLUTATHIONE REDUCTASE, RBC                                                      4.95        1
82980   GLUTETHIMIDE                                                                   11.25        1
82985   GLYCATED PROTEIN                                                               10.35        1
83001   GONADOTROPIN; FOLLICLE STIMULATING HORMONE (FSH)                               17.10        1
83002   GONADOTROPIN; LUTEINIZING HORMONE (LH)                                         17.55        1
83003   GROWTH HORMONE, HUMAN (HGH) (SOMATOTROPIN)                                     14.40        1
83008   GUANOSINE MONOPHOSPHATE (GMP), CYCLIC                                          13.95        1
83009   HELICOBACTER PYLORI, BLOOD TEST ANALYSIS FOR UREASE ACTIVITY, NON-RADIOACTI     0.00        1
83010   HAPTOGLOBIN; QUANTITATIVE                                                       9.90        1
83012   HAPTOGLOBIN; PHENOTYPES                                                        15.75        1
83015   HEAVY METAL (ARSENIC, BARIUM, BERYLLIUM, BISMUTH, ANTIMONY, MERCURY); SCREE    17.10        1
83018   HEAVY METAL (ARSENIC, BARIUM, BERYLLIUM, BISMUTH, ANTIMONY, MERCURY); QUANT    19.80        1
83020   HEMOGLOBIN FRACTIONATION AND QUANTITATION; ELECTROPHORESIS (EG, A2, S, C, A    10.80        1
83021   HEMOGLOBIN FRACTIONATION AND QUANTITATION; CHROMOTOGRAPHY (EG, A2, S, C, AN    14.85        1
83026   HEMOGLOBIN; BY COPPER SULFATE METHOD, NON-AUTOMATED                             2.25        1



                                                          Page 7
CODE                                       DESCRIPTION                                MAX FEE   MAX UNITS

83030   HEMOGLOBIN; F(FETAL), CHEMICAL                                                  7.20        1
83033   HEMOGLOBIN; F (FETAL), QUALITATIVE                                              3.15        1
83036   HEMOGLOBIN; GLYCATED                                                            8.55        1
83045   HEMOGLOBIN; METHEMOGLOBIN, QUALITATIVE                                          1.80        1
83050   HEMOGLOBIN; METHEMOGLOBIN, QUANTITATIVE                                         2.25        1
83051   HEMOGLOBIN; PLASMA                                                              5.40        1
83055   HEMOGLOBIN; SULFHEMOGLOBIN, QUALITATIVE                                         4.05        1
83060   HEMOGLOBIN; SULFHEMOGLOBIN, QUANTITATIVE                                        3.60        1
83065   HEMOGLOBIN; THERMOLABILE                                                        2.70        1
83068   HEMOGLOBIN; UNSTABLE, SCREEN                                                    5.40        1
83069   HEMOGLOBIN; URINE                                                               2.25        1
83070   HEMOSIDERIN; QUALITATIVE                                                        4.05        1
83071   HEMOSIDERIN; QUANTITATIVE                                                       6.30        1
83080   B-HEXOSAMINIDASE, EACH ASSAY                                                    4.05        1
83088   HISTAMINE                                                                      14.40        1
83090   HOMOCYSTINE                                                                     4.05        1
83150   HOMOVANILLIC ACID (HVA)                                                         8.10        1
83491   HYDROXYCORTICOSTEROIDS, 17- (17-OHCS)                                          14.40        1
83497   HYDROXYINDOLACETIC ACID, 5-(HIAA)                                              11.25        1
83498   HYDROXYPROGESTERONE, 17-D                                                      25.20        1
83499   HYDROXYPROGESTERONE, 20- 83500J0 HYDROXYPROLINE;                               23.40        1
83500   HYDROXYPROLINE; FREE                                                           20.25        1
83505   HYDROXYPROLINE; TOTAL                                                          25.65        1
83516   IMMUNOASSAY FOR ANALYTE OTHER THAN INFECTIOUS AGENT ANTIBODY OR INFECTIOUS     12.15        1
83518   IMMUNOASSAY FOR ANALYTE OTHER THAN ANTIBODY OR INFECTIOUS AGENT ANTIGEN, QU     8.55        1
83519   IMMUNOASSAY, ANALYTE, QUANTITATIVE; BY RADIOPHARMACEUTICAL TECHNIQUE (EG, R    12.60        1
83520   IMMUNOASSAY, ANALYTE; NOT OTHERWISE SPECIFIED                                  12.60        1
83525   INSULIN; TOTAL                                                                 10.35        1
83527   INSULIN; FREE                                                                  13.50        1
83528   INTRINSIC FACTOR                                                               14.40        1
83540   IRON                                                                            4.50        1
83550   IRON BINDING CAPACITY                                                           7.65        1
83570   ISOCITRIC DEHYDROGENASE (IDH)                                                   8.10        1
83582   KETOGENIC STEROIDS, FRACTIONATION                                              13.05        1
83586   KETOSTEROIDS, 17- (17-KS); TOTAL                                               11.70        1



                                                         Page 8
CODE                                       DESCRIPTION                                MAX FEE   MAX UNITS

83593   KETOSTEROIDS, 17- (17-KS); FRACTIONATION                                       23.85        1
83605   LACTATE (LACTIC ACID)                                                           9.45        4
83615   LACTATE DEHYDROGENASE (LD), (LDH);                                              4.50        1
83625   LACTATE DEHYDROGENASE (LD), (LDH); ISOENZYMES, SEPARATION AND QUANTITATION      9.45        1
83630   LACTOFERRIN, FECAL, QUALITATIVE                                                10.15        1
83632   LACTOGEN, HUMAN PLACENTAL (HPL) HUMAN CHORIONIC SOMATOMAMMOTROPIN              18.45        1
83633   LACTOSE, URINE; QUALITATIVE                                                     4.95        1
83634   LACTOSE, URINE; QUANTITATIVE                                                    4.95        1
83655   LEAD                                                                            9.45        1
83661   FETAL LUNG MATURITY ASSESSMENT; LECITHIN SPHINGOMYELIN (L/S) RATIO             13.05        1
83690   LIPASE                                                                          6.30        1
83715   LIPOPROTEIN, BLOOD; ELECTROPHORETIC SEPARATION AND QUANTITATION                 9.90        1
83716   LIPOPROTEIN, BLOOD; HIGH RESOLUTION FRACTIONATION AND QUANTITATION OF LIPOP    10.35        1
83718   LIPOPROTEIN, DIRECT MEASUREMENT; HIGH DENSITY CHOLESTEROL (HDL CHOLESTEROL)     5.40        1
83719   LIPOPROTEIN, DIRECT MEASUREMENT; DIRECT MEASUREMENT, VLDL CHOLESTEROL          11.70        1
83721   LIPOPROTEIN, DIRECT MEASUREMENT; DIRECT MEASUREMENT, LDL CHOLESTEROL            9.90        1
83727   LUTEINIZING RELEASING FACTOR (LRH)                                             15.75        1
83735   MAGNESIUM                                                                       5.85        1
83775   MALATE DEHYDROGENASE                                                            6.75        1
83785   MANGANESE                                                                      22.05        1
83788   MASS SPECTROMETRY AND TANDEM MASS SPECTROMETRY (MS, MS/ MS), ANALYTE NOT EL    14.85        1
83789   MASS SPECTROMETRY AND TANDEM MASS SPECTROMETRY (MS, MS/ MS), ANALYTE NOT EL    14.85        1
83805   MEPROBAMATE                                                                    15.75        1
83825   MERCURY, QUANTITATIVE                                                          14.40        1
83835   METANEPHRINES                                                                  15.75        1
83840   METHADONE                                                                      14.85        1
83857   METHEMALBUMIN                                                                   9.45        1
83858   METHSUXIMIDE                                                                    8.55        1
83864   MUCOPOLYSACCHARIDES, ACID; QUANTITATIVE                                        14.40        1
83866   MUCOPOLYSACCHARIDES, ACID; SCREEN                                               7.20        1
83872   MUCIN, SYNOVIAL FLUID (ROPES TEST)                                              4.95        1
83873   MYELIN BASIC PROTEIN, CEREBROSPINAL FLUID                                      15.30        1
83874   MYOGLOBIN                                                                      11.70        1
83883   NEPHELOMETRY, EACH ANALYTE NOT ELSEWHERE SPECIFIED                             13.95        1
83885   NICKEL                                                                          3.60        1



                                                         Page 9
CODE                                       DESCRIPTION                                MAX FEE   MAX UNITS

83887   NICOTINE                                                                       22.05        1
83890   MOLECULAR DIAGNOSTICS; MOLECULAR ISOLATION OR EXTRACTION                        1.80        1
83891   MOLECULAR DIAGNOSTICS; ISOLATION OR EXTRACTION OF HIGHLY PURIFIED NUCLEIC A     1.80        1
83892   NUCLEAR MOLECULAR DIAGNOSTICS; ENZYMATIC DIGESTION                              1.80        1
83893   MOLECULAR DIAGNOSTICS; DOT/SLOT BLOT PRODUCTION                                 1.80        1
83894   MOLECULAR DIAGNOSTICS; SEPARATION BY GEL ELECTROPHORESIS (EG, AGAROSE, POLY     1.80        1
83896   NUCLEAR MOLECULAR DIAGNOSTICS; NUCLEIC ACID PROBE, EACH                         1.80        3
83897   MOLECULAR DIAGNOSTICS; NUCLEIC ACID TRANSFER (EG, SOUTHERN, NORTHERN)           1.80        1
83898   MOLECULAR DIAGNOSTICS; AMPLIFICATION OF PATIENT NUCLEIC ACID (EG, PCR, LCR)     1.80        1
83901   MOLECULAR DIAGNOSTICS; AMPLIFICATION OF PATIENT NUCLEIC ACID, MULTIPLEX, EA    14.40        1
83902   MOLECULAR DIAGNOSTICS; REVERSE TRANSCRIPTION                                    9.45        1
83903   MOLECULAR DIAGNOSTICS; MUTATION SCANNING, BY PHYSICAL PROPERTIES (EG, SINGL    14.40        1
83904   MOLECULAR DIAGNOSTICS; MUTATION IDENTIFICATION BY SEQUENCING, SINGLE SEGMEN    14.40        1
83905   MOLECULAR DIAGNOSTICS; MUTATION IDENTIFICATION BY ALLELE SPECIFIC TRANSCRIP    14.40        1
83906   MOLECULAR DIAGNOSTICS; MUTATION IDENTIFICATION BY ALLELE SPECIFIC TRANSLATI    14.40        1
83912   NUCLEAR MOLECULAR DIAGNOSTICS; INTERPRETATION AND REPORT                        9.16        1
83915   NUCLEOTIDASE 5'- 83916J0 OLIGOCLONAL IMMUNOGLOBULIN (OLIGOCLONAL BANDS)         8.55        1
83916   OLIGOCLONAL IMMUNE (OLIGOCLONAL BANDS)                                         13.05        1
83918   ORGANIC ACIDS; TOTAL, QUANTITATIVE, EACH SPECIMEN                               9.90        1
83919   ORGANIC ACIDS; QUALITATIVE, EACH SPECIMEN                                      13.05        1
83921   ORGANIC ACID, SINGLE, QUANTITATIVE                                             13.05        1
83925   OPIATES, (EG, MORPHINE, MEPERIDINE)                                            15.30        1
83930   OSMOLALITY; BLOOD                                                               5.85        1
83935   OSMOLALITY; URINE                                                               6.30        1
83937   OSTEOCALCIN (BONE G1A PROTEIN)                                                 16.65        1
83945   OXALATE                                                                        11.70        1
83950   ONCOPROTEIN, HER-2/NEU                                                         55.80        1
83970   PARATHORMONE (PARATHYROID HORMONE)                                             36.45        1
83986   PH, BODY FLUID, EXCEPT BLOOD                                                    3.15        1
83992   PHENCYCLIDINE (PCP)                                                            13.50        1
84022   PHENOTHIAZINE                                                                   9.45        1
84030   PHENYLALANINE (PKU), BLOOD                                                      3.60        1
84035   PHENYLKETONES, QUALITATIVE                                                      3.60        1
84060   PHOSPHATASE, ACID; TOTAL                                                        5.40        1
84066   PHOSPHATASE, ACID; PROSTATIC                                                    9.00        1



                                                         Page 10
CODE                                       DESCRIPTION                               MAX FEE   MAX UNITS

84075   PHOSPHATASE, ALKALINE;                                                         4.50        1
84078   PHOSPHATASE, ALKALINE; HEAT STABLE (TOTAL NOT INCLUDED)                        6.30        1
84080   PHOSPHATASE, ALKALINE; ISOENZYMES                                             13.95        1
84085   PHOSPHOGLUCONATE, 6-, DEHYDROGENASE, RBC                                       5.85        1
84087   PHOSPHOHEXOSE ISOMERASE                                                        4.95        1
84100   PHOSPHORUS INORGANIC (PHOSPHATE);                                              3.60        1
84105   PHOSPHORUS INORGANIC (PHOSPHATE); URINE                                        3.15        1
84106   PORPHOBILINOGEN, URINE; QUALITATIVE                                            3.60        1
84110   PORPHOBILINOGEN, URINE; QUANTITATIVE                                           7.20        1
84119   PORPHYRINS, URINE; QUALITATIVE                                                 7.65        1
84120   PORPHYRINS, URINE; QUANTITATION AND FRACTIONATION                             12.60        1
84126   PORPHYRINS, FECES; QUANTITATIVE                                               23.85        1
84127   PORPHYRINS, FECES; QUALITATIVE                                                11.25        1
84132   POTASSIUM; SERUM                                                               3.60        8
84133   POTASSIUM; URINE                                                               3.60        1
84134   PREALBUMIN                                                                    13.50        1
84135   PREGNANEDIOL                                                                  19.35        1
84138   PREGNANETRIOL                                                                 18.90        1
84140   PREGNENOLONE                                                                  13.50        1
84143   17-HYDROXYPREGNENOLONE                                                        23.85        1
84144   PROGESTERONE                                                                  19.35        1
84146   PROLACTIN                                                                     17.55        1
84150   PROSTAGLANDIN, EACH                                                           21.60        1
84152   PROSTATE SPECIFIC ANTIGEN (PSA); COMPLEXED (DIRECT MEASUREMENT)               15.75        1
84153   PROSTATE SPECIFIC ANTIGEN (PSA); TOTAL                                        19.35        1
84154   PROSTATE SPECIFIC ANTIGEN (PSA); FREE                                         15.75        1
84155   PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; SERUM                                 3.60        1
84156   PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; URINE                                 3.15        1
84157   PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; OTHER SOURCE (EG, SYNOVIAL FLUID,     3.15        1
84160   PROTEIN, TOTAL, BY REFRACTOMETRY, ANY SOURCE                                   4.50        1
84163   PREGNANCY-ASSOCIATED PLASMA PROTEIN-A (PAPP-A)                                 0.00        1
84165   PROTEIN; ELECTROPHORETIC FRACTIONATION AND QUANTITATION, SERUM                 9.00        1
84166   PROTEIN; ELECTROPHORETIC FRACTIONATION AND QUANTITATION, OTHER FLUIDS WITH     0.00        1
84181   PROTEIN; WESTERN BLOT, WITH INTERPRETATION AND REPORT, BLOOD OR OTHER BODY    14.40        1
84182   PROTEIN; WESTERN BLOT, WITH INTERPRETATION AND REPORT, BLOOD OR OTHER BODY    15.30        1



                                                         Page 11
CODE                                      DESCRIPTION                                 MAX FEE   MAX UNITS

84202   PROTOPORPHYRIN, RBC; QUANTITATIVE                                               4.95        1
84203   PROTOPORPHYRIN, RBC; SCREEN                                                     4.95        1
84206   PROINSULIN                                                                      8.55        1
84207   PYRIDOXAL PHOSPHATE (VITAMIN B-6)                                              12.60        1
84210   PYRUVATE                                                                        9.90        1
84220   PYRUVATE KINASE                                                                 3.15        1
84228   QUININE                                                                         3.60        1
84233   RECEPTOR ASSAY; ESTROGEN                                                       37.35        1
84234   RECEPTOR ASSAY; PROGESTERONE                                                   11.70        1
84235   RECEPTOR ASSAY; ENDOCRINE, OTHER THAN ESTROGEN OR PROGESTERONE (SPECIFY HOR    49.05        1
84244   RENIN                                                                          16.65        1
84252   RIBOFLAVIN (VITAMIN B-2)                                                        8.10        1
84255   SELENIUM                                                                       23.85        1
84260   SEROTONIN                                                                       9.90        1
84270   SEX HORMONE BINDING GLOBULIN (SHBG)                                             6.30        1
84275   SIALIC ACID                                                                     4.50        1
84285   SILICA                                                                         22.05        1
84295   SODIUM; SERUM                                                                   3.60        1
84300   SODIUM; URINE                                                                   3.60        1
84302   SODIUM; OTHER SOURCE                                                            4.05        1
84305   SOMATOMEDIN                                                                    15.75        1
84307   SOMATOSTATIN                                                                    7.20        1
84311   SPECTROPHOTOMETRY, ANALYTE NOT ELSEWHERE SPECIFIED                              5.85        1
84315   SPECIFIC GRAVITY (EXCEPT URINE)                                                 1.80        1
84375   SUGARS, CHROMATOGRAPHIC, TLC OR PAPER CHROMATOGRAPHY                            5.40        1
84376   SUGARS (MON-, DI, AND OLIGOSACCHARIDES); SINGLE QUALITATIVE, EACH SPECIMEN      4.50        1
84377   SUGARS (MON-, DI, AND OLIGOSACCHARIDES); MULTIPLE QUALITATIVE, EACH SPECIME     4.50        1
84378   SUGARS (MON-, DI, AND OLIGOSACCHARIDES); SINGLE QUANTITATIVE, EACH SPECIMEN     6.75        1
84379   SUGARS (MON-, DI, AND OLIGOSACCHARIDES); MULTIPLE QUANTITATIVE, EACH SPECIM     6.75        1
84402   TESTOSTERONE; FREE                                                             24.75        1
84403   TESTOSTERONE; TOTAL                                                            20.25        1
84425   THIAMINE (VITAMIN B-1)                                                          5.40        1
84430   THIOCYANATE                                                                    10.35        1
84432   THYROGLOBULIN                                                                  12.60        1
84436   THYROXINE; TOTAL                                                                6.30        1



                                                        Page 12
CODE                                        DESCRIPTION                             MAX FEE   MAX UNITS

84437   THYROXINE; REQUIRING ELUTION (EG, NEONATAL)                                   3.60        1
84439   THYROXINE; FREE                                                               6.30        1
84442   THYROXINE BINDING GLOBULIN (TBG)                                              9.90        1
84443   THYROID STIMULATING HORMONE (TSH)                                            15.75        1
84445   THYROID STIMULATING IMMUNE GLOBULINS (TSI)                                   11.25        1
84446   TOCOPHEROL ALPHA (VITAMIN E)                                                 11.25        1
84449   TRANSCORTIN (CORTISOL BINDING GLOBULIN)                                      12.15        1
84450   TRANSFERASE; ASPARTATE AMINO (AST) (SGOT)                                     4.50        1
84460   TRANSFERASE; ALANINE AMINO (ALT) (SGPT)                                       3.60        1
84466   TRANSFERRIN                                                                  13.50        1
84478   TRIGLYCERIDES                                                                 5.40        1
84479   THYROID HORMONE (T3 OR T4) UPTAKE OR THYROID HORMONE BINDING RATIO (THBR)     5.40        1
84480   TRIIODOTHYRONINE T3; TOTAL (TT-3)                                            10.35        1
84481   TRIIODOTHYRONINE T3; FREE                                                    10.35        1
84484   TROPONIN, QUANTITATIVE                                                        9.45        1
84485   TRYPSIN; DUODENAL FLUID                                                       4.50        1
84488   TRYPSIN; FECES, QUALITATIVE                                                   4.50        1
84490   TRYPSIN; FECES, QUANTITATIVE, 24-HOUR COLLECTION                              4.50        1
84510   TYROSINE                                                                      5.40        1
84512   TROPONIN, QUALITATIVE                                                         4.50        1
84520   UREA NITROGEN; QUANTITATIVE                                                   3.15        1
84525   UREA NITROGEN; SEMIQUANTITATIVE (EG, REAGENT STRIP TEST)                      1.80        1
84540   UREA NITROGEN, URINE                                                          3.60        1
84545   UREA NITROGEN, CLEARANCE                                                      5.40        1
84550   URIC ACID; BLOOD                                                              3.60        1
84560   URIC ACID; OTHER SOURCE                                                       4.05        1
84577   UROBILINOGEN, FECES, QUANTITATIVE                                            11.25        1
84578   UROBILINOGEN, URINE; QUALITATIVE                                              2.70        1
84580   UROBILINOGEN, URINE; QUANTITATIVE, TIMED SPECIMEN                             6.30        1
84583   UROBILINOGEN, URINE; SEMIQUANTITATIVE                                         4.50        1
84585   VANILLYLMANDELIC ACID (VMA), URINE                                           11.25        1
84586   VASOACTIVE INTESTINAL PEPTIDE (VIP)                                          15.75        1
84588   VASOPRESSIN (ANTIDIURETIC HORMONE, ADH)                                      23.85        1
84590   VITAMIN A                                                                    11.25        1
84597   VITAMIN K                                                                     4.50        1



                                                          Page 13
CODE                                       DESCRIPTION                                MAX FEE   MAX UNITS

84600   VOLATILES (EG, ACETIC ANHYDRIDE, CARBON TETRACHLORIDE, DICHLOROETHANE, DICH    15.75        1
84620   XYLOSE ABSORPTION TEST, BLOOD AND/OR URINE                                     10.35        1
84630   ZINC                                                                           10.35        1
84681   C-PEPTIDE                                                                      13.50        1
84702   GONADOTROPIN, CHORIONIC (HCG); QUANTITATIVE                                    13.95        1
84703   GONADOTROPIN, CHORIONIC (HCG); QUALITATIVE                                      6.30        1
84999   UNLISTED CHEMISTRY PROCEDURE                                                    0.00        1
85002   BLEEDING TIME                                                                   4.05        1
85004   BLOOD COUNT; AUTOMATED DIFFERENTIAL WBC COUNT                                   5.40        1
85007   BLOOD COUNT; BLOOD SMEAR, MICROSCOPIC EXAMINATION WITH MANUAL DIFFERENTIAL      3.15       10
85008   BLOOD COUNT; BLOOD SMEAR, MICROSCOPIC EXAMINATION WITHOUT MANUAL DIFFERENTI     2.70        1
85009   BLOOD COUNT; MANUAL DIFFERENTIAL WBC COUNT, BUFFY COAT                          3.15        6
85013   BLOOD COUNT; SPUN MICROHEMATOCRIT                                               2.25        1
85014   BLOOD COUNT; HEMATOCRIT (HCT)                                                   1.80       10
85018   BLOOD COUNT; HEMOGLOBIN (HGB)                                                   1.80       10
85025   BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COU     7.20        4
85027   BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COU     5.40        1
85032   BLOOD COUNT; MANUAL CELL COUNT (ERYTHROCYTE, LEUKOCYTE, OR PLATELET) EACH       3.60        1
85041   BLOOD COUNT; RED BLOOD CELL (RBC), AUTOMATED                                    1.80        1
85044   BLOOD COUNT; RETICULOCYTE, MANUAL                                               3.60        4
85045   BLOOD COUNT; RETICULOCYTE, AUTOMATED                                            3.60        1
85046   BLOOD COUNT; RETICULOCYTES, AUTOMATED, INCLUDING ONE OR MORE CELLULAR PARAM     4.50        1
85048   BLOOD COUNT; LEUKOCYTE (WBC), AUTOMATED                                         1.80        1
85049   BLOOD COUNT; PLATELET, AUTOMATED                                                3.60        1
85055   RETICULATED PLATELET ASSAY                                                      3.60        1
85060   BLOOD SMEAR, PERIPHERAL, INTERPRETATION BY PHYSICIAN WITH WRITTEN REPORT       11.03        1
85130   CHROMOGENIC SUBSTRATE ASSAY                                                    12.15        1
85170   CLOT RETRACTION                                                                 3.15        1
85175   CLOT LYSIS TIME, WHOLE BLOOD DILUTION                                           3.60        1
85210   CLOTTING; FACTOR II, PROTHROMBIN, SPECIFIC                                      3.60        1
85220   CLOTTING; FACTOR V (ACG OR PROACCELERIN), LABILE FACTOR                        15.75        1
85230   CLOTTING; FACTOR VII (PROCONVERTIN, STABLE FACTOR)                             15.75        1
85240   CLOTTING; FACTOR VIII (AHG), ONE STAGE                                         16.20        1
85244   CLOTTING; FACTOR VIII RELATED ANTIGEN                                          18.45        1
85245   CLOTTING; FACTOR VIII, VW FACTOR, RISTOCETIN COFACTOR                          20.70        1



                                                         Page 14
CODE                                        DESCRIPTION                               MAX FEE   MAX UNITS

85246   CLOTTING; FACTOR VIII, VW FACTOR ANTIGEN                                       20.70        1
85247   CLOTTING; FACTOR VIII, VON WILLEBRAND'S FACTOR, MULTIMETRIC ANALYSIS           20.70        1
85250   CLOTTING; FACTOR IX (PTC OR CHRISTMAS)                                         16.65        1
85260   CLOTTING; FACTOR X (STUART-PROWER)                                             16.65        1
85270   CLOTTING; FACTOR XI (PTA)                                                      16.65        1
85280   CLOTTING; FACTOR XII (HAGEMAN)                                                 16.65        1
85290   CLOTTING; FACTOR XIII (FIBRIN STABILIZING)                                     14.85        1
85291   CLOTTING; FACTOR XIII (FIBRIN STABILIZING), SCREEN SOLUBILITY                   8.10        1
85300   CLOTTING INHIBITORS OR ANTICOAGULANTS; ANTITHROMBIN III, ACTIVITY               3.60        1
85301   CLOTTING INHIBITORS OR ANTICOAGULANTS; ANTITHROMBIN III, ANTIGEN ASSAY          9.45        1
85302   CLOTTING INHIBITORS OR ANTICOAGULANTS; PROTEIN C, ANTIGEN                      11.70        1
85303   CLOTTING INHIBITORS OR ANTICOAGULANTS; PROTEIN C, ACTIVITY                     11.70        1
85305   CLOTTING INHIBITORS OR ANTICOAGULANTS; PROTEIN S, TOTAL                        10.80        1
85306   CLOTTING INHIBITORS OR ANTICOAGULANTS; PROTEIN S, FREE                         11.25        1
85307   ACTIVATED PROTEIN C (APC) RESISTANCE ASSAY                                     13.05        1
85335   FACTOR INHIBITOR TEST                                                          10.80        1
85337   THROMBOMODULIN                                                                  9.45        1
85360   EUGLOBULIN LYSIS                                                                4.95        1
85362   FIBRIN(OGEN) DEGRADATION (SPLIT) PRODUCTS (FDP)(FSP); AGGLUTINATION SLIDE,      6.30        1
85366   FIBRIN(OGEN) DEGRADATION (SPLIT) PRODUCTS (FDP)(FSP); PARACOAGULATION           7.20        1
85370   FIBRIN(OGEN) DEGRADATION (SPLIT) PRODUCTS (FDP)(FSP); QUANTITATIVE              6.30        1
85378   FIBRIN DEGRADATION PRODUCTS, D-DIMER; QUALITATIVE OR SEMIQUANTITATIVE           6.30        1
85379   FIBRIN DEGRADATION PRODUCTS, D-DIMER; QUANTITATIVE                              6.30        1
85380   FIBRIN DEGRADATION PRODUCTS, D-DIMER; ULTRASENSITIVE (EG, FOR EVALUATION FO     8.55        1
85384   FIBRINOGEN; ACTIVITY                                                            7.20        1
85385   FIBRINOGEN; ANTIGEN                                                             7.20        1
85390   FIBRINOLYSINS OR COAGULOPATHY SCREEN, INTERPRETATION AND REPORT                 4.05        1
85396   COAGULATION/FIBRINOLYSIS ASSAY, WHOLE BLOOD (EG, VISCOELASTIC CLOT ASSESSME     9.67        1
85400   FIBRINOLYTIC FACTORS AND INHIBITORS; PLASMIN                                    7.65        1
85410   FIBRINOLYTIC FACTORS AND INHIBITORS; ALPHA-2 ANTIPLASMIN                        7.20        1
85415   FIBRINOLYTIC FACTORS AND INHIBITORS; PLASMINOGEN ACTIVATOR                      7.65        1
85420   FIBRINOLYTIC FACTORS AND INHIBITORS; PLASMINOGEN, EXCEPT ANTIGENIC ASSAY        5.85        1
85441   HEINZ BODIES; DIRECT                                                            3.15        1
85445   HEINZ BODIES; INDUCED, ACETYL PHENYLHYDRAZINE                                   6.30        1
85460   HEMOGLOBIN OR RBCS, FETAL, FOR FETOMATERNAL HEMORRHAGE; DIFFERENTIAL LYSIS      7.20        1



                                                          Page 15
CODE                                          DESCRIPTION                             MAX FEE   MAX UNITS

85461   HEMOGLOBIN OR RBCS, FETAL, FOR FETOMATERNAL HEMORRHAGE; ROSETTE                 6.75        1
85475   HEMOLYSIN, ACID                                                                 8.10        1
85520   HEPARIN ASSAY                                                                   6.30        1
85525   HEPARIN NEUTRALIZATION                                                          7.65        1
85530   HEPARIN-PROTAMINE TOLERANCE TEST                                                6.30        1
85536   IRON STAIN, PERIPHERAL BLOOD                                                    5.40        1
85540   LEUKOCYTE ALKALINE PHOSPHATASE WITH COUNT                                       7.20        1
85547   MECHANICAL FRAGILITY, RBC                                                       7.65        1
85549   MURAMIDASE                                                                     17.10        1
85555   OSMOTIC FRAGILITY, RBC; UNINCUBATED                                             4.50        1
85557   OSMOTIC FRAGILITY, RBC; INCUBATED                                              12.15        1
85576   PLATELET; AGGREGATION (IN VITRO), EACH AGENT                                   18.45        1
85597   PLATELET NEUTRALIZATION                                                        18.90        1
85610   PROTHROMBIN TIME;                                                               3.15        1
85611   PROTHROMBIN TIME; SUBSTITUTION, PLASMA FRACTIONS, EACH                          3.60        1
85612   RUSSELL VIPER VENOM TIME (INCLUDES VENOM); UNDILUTED                            7.65        1
85613   RUSSELL VIPER VENOM TIME (INCLUDES VENOM); DILUTED                              7.20        1
85635   REPTILASE TEST                                                                  9.00        1
85651   SEDIMENTATION RATE, ERYTHROCYTE, NON-AUTOMATED                                  3.15        1
85652   SEDIMENTATION RATE, ERYTHROCYTE; AUTOMATED                                      2.70        1
85660   SICKLING OF RBC, REDUCTION                                                      3.60        1
85670   THROMBIN TIME; PLASMA                                                           3.60        1
85675   THROMBIN TIME; TITER                                                            3.15        1
85705   THROMBOPLASTIN INHIBITION; TISSUE                                               6.30        1
85730   THROMBOPLASTIN TIME, PARTIAL (PTT); PLASMA OR WHOLE BLOOD                       4.95        1
85732   THROMBOPLASTIN TIME, PARTIAL (PTT); SUBSTITUTION, PLASMA FRACTIONS, EACH        4.95        1
85999   UNLISTED HEMATOLOGY AND COAGULATION PROCEDURE                                   0.00        1
86000   AGGLUTININS, FEBRILE (EG, BRUCELLA, FRANCISELLA, MURINE TYPHUS, Q FEVER, RO     6.30        1
86001   ALLERGEN SPECIFIC IGG QUANTITATIVE OR SEMIQUANTITATIVE, EACH ALLERGEN           4.50       12
86003   ALLERGEN SPECIFIC IGE; QUANTITATIVE OR SEMIQUANTITATIVE, EACH ALLERGEN          5.40       12
86005   ALLERGEN SPECIFIC IGE; QUALITATIVE, MULTIALLERGEN SCREEN (DIPSTICK, PADDLE      8.10        1
86021   ANTIBODY IDENTIFICATION; LEUKOCYTE ANTIBODIES                                   9.45        1
86022   ANTIBODY IDENTIFICATION; PLATELET ANTIBODIES                                   15.75        1
86023   ANTIBODY IDENTIFICATION; PLATELET ASSOCIATED IMMUNOGLOBULIN ASSAY               8.10        1
86038   ANTINUCLEAR ANTIBODIES (ANA);                                                  11.25        1



                                                            Page 16
CODE                                       DESCRIPTION                                MAX FEE   MAX UNITS

86039   ANTINUCLEAR ANTIBODIES (ANA); TITER                                            11.70        1
86060   ANTISTREPTOLYSIN 0; TITER                                                       5.40        1
86063   ANTISTREPTOLYSIN 0; SCREEN                                                      4.50        1
86064   B CELLS, TOTAL COUNT                                                            2.81        1
86140   C-REACTIVE PROTEIN                                                              4.50        1
86141   C-REACTIVE PROTEIN; HIGH SENSITIVITY (HSCRP)                                   11.25        1
86146   BETA 2 GLYCOPROTEIN I ANTIBODY, EACH                                           14.40        1
86147   CARDIOLIPIN (PHOSPHOLIPID) ANTIBODY, EACH IG CLASS                             13.50        1
86148   ANTI-PHOSPHATIDYLSERINE (PHOSPHOLIPID) ANTIBODY                                14.40        1
86155   CHEMOTAXIS ASSAY, SPECIFY METHOD                                               10.35        1
86156   COLD AGGLUTININ; SCREEN                                                         6.30        1
86157   COLD AGGLUTININ; TITER                                                          6.30        1
86160   COMPLEMENT; ANTIGEN, EACH COMPONENT                                            10.80        1
86161   COMPLEMENT; FUNCTIONAL ACTIVITY, EACH COMPONENT                                10.80        1
86162   COMPLEMENT; TOTAL HEMOLYTIC (CH50)                                             15.75        1
86171   COMPLEMENT FIXATION TESTS, EACH ANTIGEN                                         8.55        1
86185   COUNTERIMMUNOELECTROPHORESIS, EACH ANTIGEN                                      7.65        1
86215   DEOXYRIBONUCLEASE, ANTIBODY                                                    12.15        1
86225   DEOXYRIBONUCLEIC ACID (DNA) ANTIBODY; NATIVE OR DOUBLE STRANDED                12.60        1
86226   DEOXYRIBONUCLEIC ACID (DNA) ANTIBODY; SINGLE STRANDED                          12.60        1
86235   EXTRACTABLE NUCLEAR ANTIGEN, ANTIBODY TO, ANY METHOD (EG, NRNP, SS-A, SS-B,    15.75        1
86243   FC RECEPTOR                                                                    18.90        1
86255   FLUORESCENT NONINFECTIOUS AGENT ANTIBODY; SCREEN, EACH ANTIBODY                10.35        1
86256   FLUORESCENT ANTIBODY; TITER, EACH ANTIBODY                                     10.35        1
86277   GROWTH HORMONE, HUMAN (HGH), ANTIBODY                                          14.40        1
86280   HEMAGGLUTINATION INHIBITION TEST (HAI)                                          7.20        1
86294   IMMUNOASSAY FOR TUMOR ANTIGEN, QUALITATIVE OR SEMIQUANTITATIVE (EG, BLADDER    17.55        1
86300   IMMUNOASSAY FOR TUMOR ANTIGEN, QUANTITATIVE; CA 15-3 (27.29)                   17.55        1
86301   IMMUNOASSAY FOR TUMOR ANTIGEN, QUANTITATIVE; CA 19-9                           17.55        1
86304   IMMUNOASSAY FOR TUMOR ANTIGEN, QUANTITATIVE; CA 125                            17.55        1
86308   HETEROPHILE ANTIBODIES; SCREENING                                               4.50        1
86309   HETEROPHILE ANTIBODIES; TITER                                                   5.85        1
86310   HETEROPHILE ANTIBODIES; TITERS AFTER ABSORPTION WITH BEEF CELLS AND GUINEA      4.95        1
86316   IMMUNOASSAY FOR TUMOR ANTIGEN; OTHER ANTIGEN, QUANTITATIVE (EG, CA 50, 72-4    14.40        1
86317   IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY, QUANTITATIVE, NOT OTHERWISE SPEC    13.50        1



                                                         Page 17
CODE                                      DESCRIPTION                                 MAX FEE   MAX UNITS

86318   IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY, QUALITATIVE OR SEMIQUANTITATIVE,    12.60        1
86320   IMMUNOELECTROPHORESIS; SERUM                                                   19.35        1
86325   IMMUNOELECTROPHORESIS; OTHER FLUIDS (EG, URINE, CEREBROSPINAL FLUID) WITH C    19.35        1
86327   IMMUNOELECTROPHORESIS; CROSSED (2-DIMENSIONAL ASSAY)                           19.35        1
86329   IMMUNODIFFUSION; NOT ELSEWHERE SPECIFIED                                       13.05        1
86331   IMMUNODIFFUSION; GEL DIFFUSION, QUALITATIVE (OUCHTERLONY), EACH ANTIGEN OR     10.80        1
86332   IMMUNE COMPLEX ASSAY                                                           12.60        1
86334   IMMUNOFIXATION ELECTROPHORESIS; SERUM                                          19.35        1
86337   INSULIN ANTIBODIES                                                             19.35        1
86340   INTRINSIC FACTOR ANTIBODIES                                                    13.50        1
86341   ISLET CELL ANTIBODY                                                            20.70        1
86343   LEUKOCYTE HISTAMINE RELEASE TEST (LHR)                                         11.25        1
86344   LEUKOCYTE PHAGOCYTOSIS                                                          7.20        1
86353   LYMPHOCYTE TRANSFORMATION, MITOGEN (PHYTOMITOGEN) OR ANTIGEN INDUCED BLASTO    45.90        1
86359   T CELLS; TOTAL COUNT                                                            2.25        1
86360   T CELLS; ABSOLUTE CD4 AND CD8 COUNT, INCLUDING RATIO                            5.40        1
86361   T CELLS; ABSOLUTE CD4 COUNT                                                     3.60        1
86376   MICROSOMAL ANTIBODIES (EG, THYROID OR LIVER-KIDNEY), EACH                       8.55        1
86378   MIGRATION INHIBITORY FACTOR TEST (MIF)                                         15.75        1
86379   NATURAL KILLER (NK) CELLS, TOTAL COUNT                                          2.81        1
86382   NEUTRALIZATION TEST, VIRAL                                                     13.50        1
86403   PARTICLE AGGLUTINATION; SCREEN, EACH ANTIBODY                                   9.90        1
86406   PARTICLE AGGLUTINATION; TITER, EACH ANTIBODY                                   11.25        5
86430   RHEUMATOID FACTOR; QUALITATIVE                                                  4.95        1
86431   RHEUMATOID FACTOR; QUANTITATIVE                                                 4.95        1
86590   STREPTOKINASE, ANTIBODY                                                         5.40        1
86592   SYPHILIS TEST; QUALITATIVE (EG, VDRL, RPR, ART)                                 3.60        1
86593   SYPHILIS TEST; QUANTITATIVE                                                     4.05        1
86602   ANTIBODY; ACTINOMYCES                                                           4.50        1
86603   ANTIBODY; ADENOVIRUS                                                           13.50        1
86606   ANTIBODY; ASPERGILLUS                                                          11.25        1
86611   ANTIBODY; BARTONELLA                                                            4.29        1
86612   ANTIBODY; BLASTOMYCES                                                          11.25        1
86615   ANTIBODY; BORDETELLA                                                            9.00        1
86617   ANTIBODY; BORRELIA BURGDORFERI (LYME DISEASE) CONFIRMATORY TEST (EG, WESTER    16.20        1



                                                        Page 18
CODE                                        DESCRIPTION                        MAX FEE   MAX UNITS

86618   ANTIBODY; BORELLA BURGDORFERI (LYME DISEASE)                            11.70        1
86619   ANTIBODY; BORRELIA (RELAPSING FEVER)                                     9.00        1
86622   ANTIBODY; BRUCELLA                                                       6.30        1
86625   ANTIBODY; CAMPYLOBACTER                                                 13.50        1
86628   ANTIBODY; CANDIDA                                                        4.95        1
86631   ANTIBODY; CHLAMYDIA                                                      7.65        1
86632   ANTIBODY; CHLAMYDIA, IGM                                                11.25        1
86635   ANTIBODY; COCCIDIOIDES                                                   9.00        1
86638   ANTIBODY; COXIELLA BRUNETII (Q FEVER)                                   12.60        1
86641   ANTIBODY; CRYPTOCOCCUS                                                   6.75        1
86644   ANTIBODY; CYTOMEGALOVIRUS (CMV)                                         13.05        1
86645   ANTIBODY; CYTOMEGALOVIRUS (CMV), IGM                                    11.25        1
86648   ANTIBODY; DIPHTHERIA                                                     9.90        1
86651   ANTIBODY; ENCEPHALITIS, CALIFORNIA (LA CROSSE)                           9.90        1
86652   ANTIBODY; ENCEPHALITIS, EASTERN EQUINE                                  13.95        1
86653   ANTIBODY; ENCEPHALITIS, ST. LOUIS                                       13.95        1
86654   ANTIBODY; ENCEPHALITIS, WESTERN EQUINE                                  13.95        1
86658   ANTIBODY; ENTEROVIRUS (EG, COXSACKIE, ECHO, POLIO)                       9.00        1
86663   ANTIBODY; EPSTEIN-BARR (EB) VIRUS, EARLY ANTIGEN (EA)                   12.60        1
86664   ANTIBODY; EPSTEIN-BARR (EB) VIRUS, NUCLEAR ANTIGEN (EBNA)               15.75        1
86665   ANTIBODY; EPSTEIN-BARR (EB) VIRUS, VIRAL CAPSID (VCA)                   12.60        1
86666   ANTIBODY; EHRLICHIA                                                      4.29        1
86668   ANTIBODY; FRANCISELLA TULARENSIS                                         6.30        1
86674   ANTIBODY; GIARDIA LAMBLIA                                                6.30        1
86677   ANTIBODY; HELICOBACTER PYLORI                                           14.85        1
86684   ANTIBODY; HEMOPHILUS INFLUENZA                                          14.85        1
86687   ANTIBODY; HTLV I                                                         8.10        1
86688   ANTIBODY; HTLV-II                                                       13.95        1
86689   ANTIBODY; HTLV OR HIV ANTIBODY, CONFIRMATORY TEST (EG, WESTERN BLOT)    13.05        1
86692   ANTIBODY; HEPATITIS, DELTA AGENT                                        10.80        1
86694   ANTIBODY; HERPES SIMPLEX, NON-SPECIFIC TYPE TEST                        13.05        1
86695   ANTIBODY; HERPES SIMPLEX, TYPE I                                        11.25        1
86696   ANTIBODY; HERPES SIMPLEX, TYPE 2                                        16.65        1
86698   ANTIBODY; HISTOPLASMA                                                    9.00        1
86701   ANTIBODY; HIV-1                                                          9.00        1



                                                          Page 19
CODE                                        DESCRIPTION                 MAX FEE   MAX UNITS

86702   ANTIBODY; HIV-2                                                  13.05        1
86703   ANTIBODY; HIV-1 AND HIV-2, SINGLE ASSAY                           8.55        1
86704   HEPATITIS B CORE ANTIBODY (HBCAB), TOTAL                         10.35        1
86705   HEPATITIS B CORE ANTIBODY (HBCAB); IGM ANTIBODY                   9.90        1
86706   HEPATITIS B SURFACE ANTIBODY (HBSAB)                              9.00        1
86707   HEPATITIS BE ANTIBODY (HBEAB)                                     9.90        1
86708   HEPATITIS A ANTIBODY (HAAB), TOTAL                               10.35        1
86709   HEPATITIS A ANTIBODY (HAAB); IGM ANTIBODY                         9.45        1
86710   ANTIBODY; INFLUENZA VIRUS                                         9.90        1
86713   ANTIBODY; LEGIONELLA                                             15.75        1
86717   ANTIBODY; LEISHMANIA                                              8.10        1
86720   ANTIBODY; LEPTOSPIRA                                             10.80        1
86723   ANTIBODY; LISTERIA MONOCYTOGENES                                 13.95        1
86727   ANTIBODY; LYMPHOCYTIC CHORIOMENINGITIS                           11.25        1
86729   ANTIBODY; LYMPHOGRANULOMA VENEREUM                               12.60        1
86732   ANTIBODY; MUCORMYCOSIS                                           13.05        1
86735   ANTIBODY; MUMPS                                                  11.25        1
86738   ANTIBODY; MYCOPLASMA                                              9.00        1
86741   ANTIBODY; NEISSERIA MENINGITIDIS                                 13.95        1
86744   ANTIBODY; NOCARDIA                                               13.05        1
86747   ANTIBODY; PARVOVIRUS                                             14.40        1
86750   ANTIBODY; PLASMODIUM (MALARIA)                                    5.85        1
86756   ANTIBODY; RESPIRATORY SYNCYTIAL VIRUS                            11.25        1
86757   ANTIBODY; RICKETTSIA                                             16.65        1
86759   ANTIBODY; ROTAVIRUS                                              13.95        1
86762   ANTIBODY; RUBELLA                                                13.05        1
86765   ANTIBODY; RUBEOLA                                                11.70        1
86768   ANTIBODY; SALMONELLA                                              9.45        1
86771   ANTIBODY; SHIGELLA                                                9.00        1
86774   ANTIBODY; TETANUS                                                14.40        1
86777   ANTIBODY; TOXOPLASMA                                             13.05        1
86778   ANTIBODY; TOXOPLASMA, IGM                                        11.25        1
86781   ANTIBODY; TREPONEMA PALLIDUM, CONFIRMATORY TEST (EG, FTA-ABS)    12.15        1
86784   ANTIBODY; TRICHINELLA                                             4.95        1
86787   ANTIBODY; VARICELLA-ZOSTER                                       13.50        1



                                                          Page 20
CODE                                       DESCRIPTION                                MAX FEE   MAX UNITS

86793   ANTIBODY; YERSINIA                                                              9.00        1
86800   THYROGLOBULIN ANTIBODY                                                         14.40        1
86803   HEPATITIS C ANTIBODY;                                                          12.15        1
86804   HEPATITIS C ANTIBODY; CONFIRMATORY TEST (EG, IMMUNOBLOT)                       13.05        1
86805   LYMPHOCYTOTOXICITY ASSAY, VISUAL CROSSMATCH; WITH TITRATION                    49.05        1
86806   LYMPHOCYTOTOXICITY ASSAY, VISUAL CROSSMATCH; WITHOUT TITRATION                 44.55        1
86807   SERUM SCREENING FOR CYTOTOXIC PERCENT REACTIVE ANTIBODY (PRA); STANDARD MET    36.90        1
86808   SERUM SCREENING FOR CYTOTOXIC PERCENT REACTIVE ANTIBODY (PRA); QUICK METHOD    27.45        1
86812   HLA TYPING; A, B, OR C (EG, A10, B7, B27), SINGLE ANTIGEN                      19.35        1
86813   HLA TYPING; A, B, OR C, MULTIPLE ANTIGENS                                      54.45        1
86816   HLA TYPING; DR/DQ, SINGLE ANTIGEN                                              25.20        1
86817   HLA TYPING; DR/DQ, MULTIPLE ANTIGENS                                           60.30        1
86821   HLA TYPING; LYMPHOCYTE CULTURE, MIXED (MLC)                                    52.65        1
86822   HLA TYPING; LYMPHOCYTE CULTURE, PRIMED (PLC)                                   32.40        1
86850   ANTIBODY SCREEN, RBC, EACH SERUM TECHNIQUE                                     10.35        1
86860   ANTIBODY ELUTION (RBC), EACH ELUTION                                           13.05        1
86870   ANTIBODY IDENTIFICATION, RBC ANTIBODIES, EACH PANEL FOR EACH SERUM TECHNIQU     7.06        1
86880   ANTIHUMAN GLOBULIN TEST (COOMBS TEST); DIRECT, EACH ANTISERUM                   4.95        1
86885   ANTIHUMAN GLOBULIN TEST (COOMBS TEST); INDIRECT, QUALITATIVE, EACH ANTISERU     4.95        1
86886   ANTIHUMAN GLOBULIN TEST (COOMBS TEST); INDIRECT, TITER, EACH ANTISERUM          4.50        1
86900   BLOOD TYPING; ABO                                                               2.70        1
86901   BLOOD TYPING; RH (D)                                                            2.70        1
86905   BLOOD TYPING; RBC ANTIGENS, OTHER THAN ABO OR RH (D), EACH                      3.15        1
86906   BLOOD TYPING; RH PHENOTYPING, COMPLETE                                          6.30        1
86910   BLOOD TYPING, FOR PATERNITY TESTING, PER INDIVIDUAL, ABO, RH AND MN;           18.00        1
86940   HEMOLYSINS AND AGGLUTININS, AUTO, SCREEN, EACH;                                 7.20        1
87015   CONCENTRATION (ANY TYPE), FOR INFECTIOUS AGENTS                                 5.85        1
87040   CULTURE, BACTERIAL; BLOOD, AEROBIC, WITH ISOLATION AND PRESUMPTIVE IDENTIFI     9.45        3
87045   CULTURE, BACTERIAL; STOOL, AEROBIC, WITH ISOLATION AND PRELIMINARY EXAMINAT     8.55        3
87046   CULTURE, BACTERIAL; STOOL, AEROBIC, ADDITIONAL PATHOGENS, ISOLATION AND PRE     1.80        1
87070   CULTURE, BACTERIAL; ANY OTHER SOURCE EXCEPT URINE, BLOOD OR STOOL, AEROBIC,     7.65        3
87071   CULTURE, BACTERIAL; QUANTITATIVE, AEROBIC WITH ISOLATION AND PRESUMPTIVE ID     4.05        1
87073   CULTURE, BACTERIAL; QUANTITATIVE, ANAEROBIC WITH ISOLATION AND PRESUMPTIVE      4.05        1
87075   CULTURE, BACTERIAL; ANY SOURCE, EXCEPT BLOOD, ANAEROBIC WITH ISOLATION AND      8.55        1
87076   CULTURE, BACTERIAL; ANAEROBIC ISOLATE, ADDITIONAL METHODS REQUIRED FOR DEFI     8.54        1



                                                         Page 21
CODE                                       DESCRIPTION                                MAX FEE   MAX UNITS

87077   CULTURE, BACTERIAL; AEROBIC ISOLATE, ADDITIONAL METHODS REQUIRED FOR DEFINI     6.75        1
87081   CULTURE, PRESUMPTIVE, PATHOGENIC ORGANISMS, SCREENING ONLY;                     4.95        1
87084   CULTURE, PRESUMPTIVE, PATHOGENIC ORGANISMS, SCREENING ONLY, BY COMMERCIAL K     7.65        1
87086   CULTURE, BACTERIAL; QUANTITATIVE COLONY COUNT, URINE                            7.20        1
87088   CULTURE, BACTERIAL; WITH ISOLATION AND PRESUMPTIVE IDENTIFICATION OF ISOLAT     7.20        1
87101   CULTURE, FUNGI (MOLD OR YEAST) ISOLATION, WITH PRESUMPTIVE IDENTIFICATION O     7.20        1
87102   CULTURE, FUNGI, ISOLATION (WITH OR WITHOUT PRESUMPTIVE IDENTIFICATION); OTH     7.65        1
87103   CULTURE, FUNGI, ISOLATION (WITH OR WITHOUT PRESUMPTIVE IDENTIFICATION); BLO     8.10        1
87106   CULTURE, FUNGI, DEFINITIVE IDENTIFICATION, EACH ORGANISM; YEAST                 9.45        1
87107   CULTURE, FUNGI, DEFINITIVE IDENTIFICATION, EACH ORGANISM; MOLD                  8.55        1
87109   CULTURE, MYCOPLASMA, ANY SOURCE                                                13.95        1
87110   CULTURE, CHLAMYDIA, ANY SOURCE                                                 12.60        1
87116   CULTURE, TUBERCLE OR OTHER ACID-FAST BACILLI (EG, TB, AFB, MYCOBACTERIA) AN     9.45        1
87118   CULTURE, MYCOBACTERIAL, DEFINITIVE IDENTIFICATION, EACH ISOLATE                 9.90        1
87140   CULTURE, TYPING; IMMUNOFLUORESCENT METHOD, EACH ANTISERUM                       4.95        1
87143   CULTURE, TYPING; GAS LIQUID CHROMATOGRAPHY (GLC) OR HIGH PRESSURE LIQUID CH    11.25        1
87147   CULTURE, TYPING; IMMUNOLOGIC METHOD, OTHER THAN IMMUNOFLUORESENCE (EG, AGGL     4.05       10
87149   CULTURE, TYPING; IDENTIFICATION BY NUCLEIC ACID PROBE                          10.80        1
87152   CULTURE, TYPING; IDENTIFICATION BY PULSE FIELD GEL TYPING                       4.50        1
87158   CULTURE, TYPING; OTHER METHODS                                                  4.50        1
87164   DARK FIELD EXAMINATION, ANY SOURCE (EG, PENILE, VAGINAL, ORAL, SKIN); INCLU     9.00        1
87166   DARK FIELD EXAMINATION, ANY SOURCE (EG, PENILE, VAGINAL, ORAL, SKIN); WITHO    10.35        1
87168   MACROSCOPIC EXAMINATION; ARTHROPOD                                              3.60        1
87169   MACROSCOPIC EXAMINATION; PARASITE                                               3.60        1
87176   HOMOGENIZATION, TISSUE, FOR CULTURE                                             4.95        1
87177   OVA AND PARASITES, DIRECT SMEARS, CONCENTRATION AND IDENTIFICATION              8.10        1
87181   SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; AGAR DILUTION METHOD, PER AGEN     0.45        1
87184   SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; DISK METHOD, PER PLATE (12 OR      6.30        1
87185   SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; ENZYME DETECTION (EG, BETA LAC     0.45        1
87186   SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; MICRODILUTION OR AGAR DILUTION     7.65        1
87187   SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; MICRODILUTION OR AGAR DILUTION     8.10        1
87188   SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; MACROBROTH DILUTION METHOD, EA     3.60        1
87190   SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; MYCOBACTERIA, PROPORTION METHO     4.50       10
87197   SERUM BACTERICIDAL TITER (SCHLICTER TEST)                                      13.50        1
87205   SMEAR, PRIMARY SOURCE WITH INTERPRETATION; GRAM OR GIEMSA STAIN FOR BACTERI     3.60        1



                                                         Page 22
CODE                                      DESCRIPTION                                 MAX FEE   MAX UNITS

87206   SMEAR, PRIMARY SOURCE WITH INTERPRETATION; FLUORESCENT AND/OR ACID FAST STA     4.50        1
87207   SMEAR, PRIMARY SOURCE WITH INTERPRETATION; SPECIAL STAIN FOR INCLUSION BODI     4.95        1
87210   SMEAR, PRIMARY SOURCE WITH INTERPRETATION; WET MOUNT FOR INFECTIOUS AGENTS      3.60        1
87220   TISSUE EXAMINATION BY KOH SLIDE OF SAMPLES FROM SKIN, HAIR, OR NAILS FOR FU     3.60        1
87230   TOXIN OR ANTITOXIN ASSAY, TISSUE CULTURE (EG, CLOSTRIDIUM DIFFICILE TOXIN)     17.10        1
87252   VIRUS ISOLATION; TISSUE CULTURE INOCULATION, OBSERVATION, AND PRESUMPTIVE I    20.25        1
87253   VIRUS ISOLATION; TISSUE CULTURE, ADDITIONAL STUDIES OR DEFINITIVE IDENTIFIC    16.65        1
87254   VIRUS ISOLATION; CENTRIFUGE ENHANCED (SHELL VIAL) TECHNIQUE, INCLUDES IDENT     4.05        1
87255   VIRUS ISOLATION; INCLUDING IDENTIFICATION BY NON-IMMUNOLOGIC METHOD, OTHER     29.70        1
87260   INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; ADENOVIR    10.35        1
87265   INFECTIOUS AGENT ANTIGEN DETECTION BY DIRECT FLUORESCENT ANTIBODY TECHNIQUE    10.35        1
87267   INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; ENTEROVI    10.35        1
87269   INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; GIARDIA     10.80        1
87270   INFECTIOUS AGENT ANTIGEN DETECTION BY DIRECT FLUORESCENT ANTIBODY TECHNIQUE    10.35        1
87271   INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; CYTOMEGA    10.35        1
87272   INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; CRYPTOSP    10.35        1
87273   INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; HERPES S    10.35        1
87274   INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; HERPES S    10.35        1
87275   INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; INFLUENZ    10.35        1
87276   INFECTIOUS AGENT ANTIGEN DETECTION BY DIRECT FLUORESCENT ANTIBODY TECHNIQUE    10.35        1
87277   INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; LEGIONEL    10.35        1
87278   INFECTIOUS AGENT ANTIGEN DETECTION BY DIRECT FLUORESCENT ANTIBODY TECHNIQUE    10.35        1
87279   INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; PARAINFL    10.35        1
87280   INFECTIOUS AGENT ANTIGEN DETECTION BY DIRECT FLUORESCENT ANTIBODY TECHNIQUE    10.35        1
87281   INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; PNEUMOCY    10.35        1
87283   INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; RUBEOLA     10.35        1
87285   INFECTIOUS AGENT ANTIGEN DETECTION BY DIRECT FLUORESCENT ANTIBODY TECHNIQUE    10.35        1
87290   INFECTIOUS AGENT ANTIGEN DETECTION BY DIRECT FLUORESCENT ANTIBODY TECHNIQUE    10.35        1
87299   INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; NOT OTHE    10.35        1
87300   INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE, POLYVALE     4.95        1
87301   INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITA    10.35        1
87320   INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITA    10.35        1
87324   INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITA    10.35        1
87327   INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITA    10.35        1
87328   INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITA    10.35        1



                                                        Page 23
CODE                                       DESCRIPTION                                MAX FEE   MAX UNITS

87329   INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITA    10.80        1
87332   INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITA    10.35        1
87335   INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITA    10.35        1
87336   INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITA    10.35        1
87337   INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITA    10.35        1
87340   INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITA     8.55        1
87341   INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITA     8.55        1
87350   INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITA     9.90        1
87380   INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITA    13.95        1
87385   INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITA    10.35        1
87390   INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITA     9.45        1
87400   INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITA     4.95        1
87420   INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITA    10.35        1
87425   INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITA    10.35        1
87427   INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITA    10.35        1
87430   INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITA    10.35        1
87449   INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE QUALITAT    10.35        1
87450   INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE QUALITAT     8.10        1
87451   INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE QUALITAT     8.10        1
87470   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); BARTONELLA HENSELA    10.80        1
87471   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); BARTONELLA HENSELA    25.65        1
87472   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); BARTONELLA HENSELA    40.50        1
87475   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); BORRELIA BURGDORFE    10.80        1
87476   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); BORRELIA BURGDORFE    25.65        1
87477   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); BORRELIA BURGDORFE    40.50        1
87480   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CANDIDA SPECIES, D    10.80        1
87481   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CANDIDA SPECIES, A    25.65        1
87482   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CANDIDA SPECIES, Q    40.50        1
87485   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA PNEUMONI    10.80        1
87486   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA PNEUMONI    25.65        1
87487   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA PNEUMONI    40.50        1
87490   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA TRACHOMA    10.80        1
87491   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA TRACHOMA    25.65        1
87492   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA TRACHOMA    36.90        1
87495   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CYTOMEGALOVIRUS, D    10.80        1



                                                         Page 24
CODE                                        DESCRIPTION                               MAX FEE   MAX UNITS

87496   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CYTOMEGALOVIRUS, A     25.65       1
87497   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CYTOMEGALOVIRUS, Q     40.50       1
87510   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); GARDNERELLA VAGINA     10.80       1
87511   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); GARDNERELLA VAGINA     25.65       1
87512   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); GARDNERELLA VAGINA     40.50       1
87515   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HEPATITIS B VIRUS,     10.80       1
87516   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HEPATITIS B VIRUS,     25.65       1
87517   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HEPATITIS B VIRUS,     40.50       1
87520   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HEPATITIS C, DIREC     10.80       1
87521   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HEPATITIS C, AMPLI     25.65       1
87522   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HEPATITIS C, QUANT     40.50       1
87525   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HEPATITIS G, DIREC     10.80       1
87526   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HEPATITIS G, AMPLI     25.65       1
87527   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HEPATITIS G, QUANT     40.50       1
87528   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HERPES SIMPLEX VIR     10.80       1
87529   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HERPES SIMPLEX VIR     25.65       1
87530   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HERPES SIMPLEX VIR     40.50       1
87531   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HERPES VIRUS-6, DI     10.80       1
87532   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HERPES VIRUS-6, AM     25.65       1
87533   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HERPES VIRUS-6, QU     40.50       1
87534   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HIV-1, DIRECT PROB     10.80       1
87535   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HIV-1, AMPLIFIED P     25.65       1
87536   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HIV-1, QUANTIFICAT    117.00       1
87539   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HIV-2, QUANTIFICAT     40.50       1
87540   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); LEGIONELLA PNEUMOP     10.80       1
87541   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); LEGIONELLA PNEUMOP     25.65       1
87542   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); LEGIONELLA PNEUMOP     40.50       1
87550   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOBACTERIA SPECI     10.80       1
87551   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOBACTERIA SPECI     25.65       1
87552   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOBACTERIA SPECI     40.50       1
87555   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOBACTERIA TUBER     10.80       1
87556   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOBACTERIA TUBER     25.65       1
87557   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOBACTERIA TUBER     40.50       1
87560   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOBACTERIA AVIUM     10.80       1
87561   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOBACTERIA AVIUM     25.65       1



                                                          Page 25
CODE                                       DESCRIPTION                                MAX FEE   MAX UNITS

87562   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOBACTERIA AVIUM     40.50       1
87580   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOPLASMA PNEUMON     10.80       1
87581   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOPLASMA PNEUMON     25.65       1
87582   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOPLASMA PNEUMON     40.50       1
87590   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); NEISSERIA GONORRHO     10.80       1
87591   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); NEISSERIA GONORRHO     25.65       1
87592   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); NEISSERIA GONORRHO     40.50       1
87620   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); PAPILLOMAVIRUS, HU     10.80       1
87621   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); PAPILLOMAVIRUS, HU     25.65       2
87622   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); PAPILLOMAVIRUS, HU     40.50       1
87650   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STREPTOCOCCUS, GRO     10.80       1
87651   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STREPTOCOCCUS, GRO     25.65       1
87652   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STREPTOCOCCUS, GRO     40.50       1
87660   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); TRICHOMONAS VAGINA     11.25       1
87797   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), NOT OTHERWISE SPEC     10.80       1
87798   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), NOT OTHERWISE SPEC     25.65       1
87799   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), NOT OTHERWISE SPEC     40.50       1
87800   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), MULTIPLE ORGANISMS     10.80       1
87801   INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), MULTIPLE ORGANISMS     25.65       1
87802   INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSER     10.35       1
87803   INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSER     10.35       1
87804   INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSER     10.35       1
87807   INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSER     10.55       1
87810   INFECTIOUS AGENT DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION;      10.35       1
87850   INFECTIOUS AGENT DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION;      10.35       1
87880   INFECTIOUS AGENT DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION;      10.35       1
87899   INFECTIOUS AGENT DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION;      10.35       1
87901   INFECTIOUS AGENT GENOTYPE ANALYSIS BY NUCLEIC ACID (DNA OR RNA), HIV 1, REV    320.20       1
87903   INFECTIOUS AGENT PHENOTYPE ANALYSIS BY NUCLEIC ACID (DNA OR RNA) WITH DRUG     607.50       1
87904   INFECTIOUS AGENT PHENOTYPE ANALYSIS BY NUCLEIC ACID (DNA OR RNA) WITH DRUG      32.41       5
87999   UNLISTED MICROBIOLOGY PROCEDURE                                                  0.00       1
88104   CYTOPATHOLOGY, FLUIDS, WASHINGS OR BRUSHINGS, EXCEPT CERVICAL OR VAGINAL; S     24.62       1
88106   CYTOPATHOLOGY, FLUIDS, WASHINGS OR BRUSHINGS, EXCEPT CERVICAL OR VAGINAL; F     33.11       1
88107   CYTOPATHOLOGY, FLUIDS, WASHINGS OR BRUSHINGS, EXCEPT CERVICAL OR VAGINAL; S     39.89       1
88108   CYTOPATHOLOGY, CONCENTRATION TECHNIQUE, SMEARS AND INTERPRETATION (EG, SACC     30.72       6



                                                         Page 26
CODE                                      DESCRIPTION                                 MAX FEE   MAX UNITS

88112   CYTOPATHOLOGY, SELECTIVE CELLULAR ENHANCEMENT TECHNIQUE WITH INTERPRETATION     54.15       1
88141   CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM); REQUIRING INTERP     10.01       1
88142   CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED IN PRE     15.30       1
88143   CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED IN PRE      9.00       1
88147   CYTOPATHOLOGY SMEARS, CERVICAL OR VAGINAL; SCREENING BY AUTOMATED SYSTEM UN      9.19       1
88148   CYTOPATHOLOGY SMEARS, CERVICAL OR VAGINAL; SCREENING BY AUTOMATED SYSTEM WI      9.19       1
88150   CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL; MANUAL SCREENING UNDER PHYSICIA      9.00       1
88152   CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL; WITH MANUAL SCREENING AND COMPU      9.00       1
88153   CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL; WITH MANUAL SCREENING AND RESCR      9.00       1
88154   CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL; WITH MANUAL SCREENING AND COMPU      9.00       1
88155   CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL, DEFINITIVE HORMONAL EVALUATION       4.95       1
88160   CYTOPATHOLOGY, SMEARS, ANY OTHER SOURCE; SCREENING AND INTERPRETATION           23.26       1
88161   CYTOPATHOLOGY, SMEARS, ANY OTHER SOURCE; PREPARATION, SCREENING AND INTERPR     25.12       1
88162   CYTOPATHOLOGY, SMEARS, ANY OTHER SOURCE; EXTENDED STUDY INVOLVING OVER 5 SL     31.06       1
88164   CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL (THE BETHESDA SYSTEM); MANUAL SC      9.00       1
88165   CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL (THE BETHESDA SYSTEM); WITH MANU      9.00       1
88166   CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL (THE BETHESDA SYSTEM); WITH MANU      9.00       1
88167   CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL (THE BETHESDA SYSTEM); WITH MANU      9.00       1
88172   CYTOPATHOLOGY, EVALUATION OF FINE NEEDLE ASPIRATE; IMMEDIATE CYTOHISTOLOGIC     23.26       1
88173   EVALUATION OF FINE NEEDLE ASPIRATE WITH OR WITHOUT PREPARATION OF SMEARS; I     61.11       1
88174   CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED IN PRE     18.45       1
88175   CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED IN PRE     21.60       1
88182   FLOW CYTOMETRY; CELL CYCLE OR DNA ANALYSIS                                      47.87       1
88184   FLOW CYTOMETRY, CELL SURFACE, CYTOPLASMIC, OR NUCLEAR MARKER, TECHNICAL COM     22.75       1
88185   FLOW CYTOMETRY, CELL SURFACE, CYTOPLASMIC, OR NUCLEAR MARKER, TECHNICAL COM     11.20       1
88187   FLOW CYTOMETRY, INTERPRETATION; 2 TO 8 MARKERS                                  30.90       1
88188   FLOW CYTOMETRY, INTERPRETATION; 9 TO 15 MARKERS                                 38.53       1
88189   FLOW CYTOMETRY, INTERPRETATION; 16 OR MORE MARKERS                              50.76       1
88199   UNLISTED CYTOPATHOLOGY PROCEDURE                                                 0.00       1
88230   TISSUE CULTURE FOR NON-NEOPLASTIC DISORDERS; LYMPHOCYTE                        109.35       1
88233   TISSUE CULTURE FOR CHROMOSOME ANALYSIS; SKIN OR OTHER SOLID TISSUE BIOPSY      133.20       1
88235   TISSUE CULTURE FOR CHROMOSOME ANALYSIS; AMNIOTIC FLUID OR CHORIONIC VILLUS     138.60       1
88237   TISSUE CULTURE FOR NEOPLASTIC DISORDERS; BONE MARROW, BLOOD CELLS              118.35       1
88239   TISSUE CULTURE FOR NEOPLASTIC DISORDERS; SOLID TUMOR                           138.60       1
88245   CHROMOSOME ANALYSIS FOR BREAKAGE SYNDROMES; BASELINE SISTER CHROMATID EXCHA     96.75       1



                                                        Page 27
CODE                                      DESCRIPTION                                 MAX FEE   MAX UNITS

88248   CHROMOSOME ANALYSIS FOR BREAKAGE SYNDROMES; BASELINE BREAKAGE, SCORE 50-100    129.15       1
88249   CHROMOSOME ANALYSIS FOR BREAKAGE SYNDROMES; SCORE 100 CELLS, CLASTOGEN STRE    150.75       1
88261   CHROMOSOME ANALYSIS; COUNT 5 CELLS, 1 KARYOTYPE, WITH BANDING                  122.85       1
88262   CHROMOSOME ANALYSIS; COUNT 15-20 CELLS, 2 KARYOTYPES, WITH BANDING             116.55       1
88263   CHROMOSOME ANALYSIS; COUNT 45 CELLS FOR MOSAICISM, 2 KARYOTYPES, WITH BANDI     96.75       1
88264   CHROMOSOME ANALYSIS; ANALYZE 20-25 CELLS                                       108.45       1
88267   CHROMOSOME ANALYSIS, AMNIOTIC FLUID OR CHORIONIC VILLUS, COUNT 15 CELLS, 1     153.00       1
88269   CHROMOSOME ANALYSIS, IN SITU FOR AMNIOTIC FLUID CELLS, COUNT CELLS FROM 6-1     96.75       1
88271   MOLECULAR CYTOGENETICS; DNA PROBE, EACH (EG, FISH)                              12.60       1
88272   MOLECULAR CYTOGENETICS; CHROMOSOMAL IN SITU HYBRIDIZATION, ANALYZE 3-5 CELL     22.05       1
88273   MOLECULAR CYTOGENETICS; CHROMOSOMAL IN SITU HYBRIDIZATION, ANALYZE 10-30 CE     28.35       1
88275   MOLECULAR CYTOGENETICS; INTERPHASE IN SITU HYBRIDIZATION, ANALYZE 100-300 C     42.46       1
88280   CHROMOSOME ANALYSIS; ADDITIONAL KARYOTYPES, EACH STUDY                          19.35       1
88283   CHROMOSOME ANALYSIS; ADDITIONAL SPECIALIZED BANDING TECHNIQUE (EG, NOR, C-B     64.35       1
88285   CHROMOSOME ANALYSIS; ADDITIONAL CELLS COUNTED, EACH STUDY                        3.60       1
88289   CHROMOSOME ANALYSIS; ADDITIONAL HIGH RESOLUTION STUDY                           25.20       1
88291   CYTOGENETICS AND MOLECULAR CYTOGENETICS, INTERPRETATION AND REPORT              12.05       1
88299   UNLISTED CYTOGENETIC STUDY                                                       0.00       1
88300   LEVEL I - SURGICAL PATHOLOGY, GROSS EXAMINATION ONLY                             9.34       4
88302   LEVEL II - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION                20.20       4
88304   LEVEL III - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION               26.65       6
88305   LEVEL IV - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION                46.35      10
88307   LEVEL V - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION                 82.51       7
88309   LEVEL VI - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION               115.61       3
88311   DECALCIFICATION PROCEDURE (LIST SEPARATELY IN ADDITION TO CODE FOR SURGICAL      8.31       5
88312   SPECIAL STAINS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY SERVICE); G     35.47       6
88313   SPECIAL STAINS (LIST SEPARATELY IN ADDITION TO CODE FOR SURGICAL PATHOLOGY      25.63       6
88314   SPECIAL STAINS (LIST SEPARATELY IN ADDITION TO CODE FOR SURGICAL PATHOLOGY      43.29       1
88321   CONSULTATION AND REPORT ON REFERRED SLIDES PREPARED ELSEWHERE                   36.33       1
88323   CONSULTATION AND REPORT ON REFERRED MATERIAL REQUIRING PREPARATION OF SLIDE     54.33       1
88325   CONSULTATION, COMPREHENSIVE, WITH REVIEW OF RECORDS AND SPECIMENS, WITH REP     88.96       1
88329   PATHOLOGY CONSULTATION DURING SURGERY;                                          22.91       1
88331   PATHOLOGY CONSULTATION DURING SURGERY; FIRST TISSUE BLOCK, WITH FROZEN SECT     40.23       5
88332   PATHOLOGY CONSULTATION DURING SURGERY; EACH ADDITIONAL TISSUE BLOCK WITH FR     18.50       5
88342   IMMUNOHISTOCHEMISTRY (INCLUDING TISSUE IMMUNOPEROXIDASE), EACH ANTIBODY         40.06       5



                                                        Page 28
CODE                                       DESCRIPTION                                MAX FEE   MAX UNITS

88346   IMMUNOFLUORESCENT STUDY, EACH ANTIBODY; DIRECT METHOD                           42.10       1
88347   IMMUNOFLUORESCENT STUDY, EACH ANTIBODY; INDIRECT METHOD                         36.83       1
88360   MORPHOMETRIC ANALYSIS, TUMOR IMMUNOHISTOCHEMISTRY (EG, HER-2/NEU, ESTROGEN      49.40       2
88361   MORPHOMETRIC ANALYSIS, TUMOR IMMUNOHISTOCHEMISTRY (EG, HER-2/NEU, ESTROGEN      74.36       2
88362   NERVE TEASING PREPARATIONS                                                     119.17       1
88365   IN SITU HYBRIDIZATION (EG, FISH), EACH PROBE                                    57.38       1
88367   MORPHOMETRIC ANALYSIS, IN SITU HYBRIDIZATION, (QUANTITATIVE OR SEMI-QUANTIT     93.88       2
88368   MORPHOMETRIC ANALYSIS, IN SITU HYBRIDIZATION, (QUANTITATIVE OR SEMI-QUANTIT     85.22       2
88371   PROTEIN ANALYSIS OF TISSUE BY WESTERN BLOT, WITH INTERPRETATION AND REPORT;     19.35       1
88372   PROTEIN ANALYSIS OF TISSUE BY WESTERN BLOT, WITH INTERPRETATION AND REPORT;     19.80       1
88380   MICRODISSECTION (EG, MECHANICAL, LASER CAPTURE)                                 19.13       1
88399   UNLISTED SURGICAL PATHOLOGY PROCEDURE                                            0.00       1
89050   CELL COUNT, MISCELLANEOUS BODY FLUIDS (EG, CEREBROSPINAL FLUID, JOINT FLUID      4.05       1
89051   CELL COUNT, MISCELLANEOUS BODY FLUIDS (EG, CSF, JOINT FLUID), EXCEPT BLOOD;      4.95       1
89055   LEUKOCYTE ASSESSMENT, FECAL, QUALITATIVE OR SEMIQUANTITATIVE                     3.60       1
89060   CRYSTAL IDENTIFICATION BY LIGHT MICROSCOPY WITH OR WITHOUT POLARIZING LENS       5.85       1
89100   DUODENAL INTUBATION AND ASPIRATION; SINGLE SPECIMEN (EG, SIMPLE BILE STUDY      41.76       1
89105   DUODENAL INTUBATION AND ASPIRATION; COLLECTION OF MULTIPLE FRACTIONAL SPECI     46.51       1
89125   FAT STAIN, FECES, URINE, OR RESPIRATORY SECRETIONS                               3.60       1
89160   MEAT FIBERS, FECES                                                               3.15       1
89190   NASAL SMEAR FOR EOSINOPHILS                                                      4.05       1
89220   SPUTUM, OBTAINING SPECIMEN, AEROSOL INDUCED TECHNIQUE (SEPARATE PROCEDURE)       6.95       1
89225   STARCH GRANULES, FECES                                                           2.70       1
89230   SWEAT COLLECTION BY IONTOPHORESIS                                                2.20       1
89240   UNLISTED MISCELLANEOUS PATHOLOGY TEST                                            0.00       1
89321   SEMEN ANALYSIS, PRESENCE AND/OR MOTILITY OF SPERM                               10.35       1




                                                         Page 29

								
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