Description CPT Charge Amount From Charge Amount To
36415 Routine venipuncture 36415 $29.00 $29.00
36430 Blood transfusion service 36430 $755.50 $755.50
80047 Metabolic panel ionized ca 80047 $273.00 $273.00
80048 Basic Metabolic Panel 80048 $43.01 $43.01
80051 Electrolyte panel 80051 $43.01 $43.01
80053 Comprehensive Metabolic Panel 80053 $75.28 $75.28
80061 Lipids Blood Test 80061 $130.00 $130.00
80069 Kidney Function Panel 80069 $58.07 $58.07
80074 Acute hepatitis panel 80074 $315.08 $315.08
80074 Acute Hepatits Panel 80074 $315.08 $315.08
80076 Liver Function Blood Panel 80076 $48.39 $48.39
80081 Obstetric Blood Panel With HIV 80081 $767.30 $767.30
80197 Assay of tacrolimus 80197 $91.41 $91.41
80202 Assay of vancomycin 80202 $90.33 $90.33
80307 Drug test prsmv chem anlyzr 80307 $55.00 $433.50
81000 Urinalysis, Manual, Microscope Exam 81000 $16.50 $16.50
81001 Urinalysis, Manual, Microscope Exam 81001 $36.50 $36.50
81002 Urinalysis, Automated 81002 $26.50 $26.50
81003 Urinalysis, Automated 81003 $29.50 $29.50
82040 Assay of serum albumin 82040 $29.50 $29.50
82043 Microalbumin quantitative 82043 $86.50 $86.50
82140 Assay of ammonia 82140 $91.00 $91.00
82150 Assay of amylase 82150 $93.50 $93.50
82247 Bilirubin total 82247 $29.50 $62.00
82248 Bilirubin direct 82248 $29.50 $29.50
82261 Assay of biotinidase 82261 $56.00 $56.00
82306 Vitamin d 25 hydroxy 82306 $196.79 $196.79
82310 Assay of calcium 82310 $29.50 $29.50
82330 Assay of calcium 82330 $70.50 $70.50
82378 Carcinoembryonic antigen 82378 $125.82 $125.82
82533 Total cortisol 82533 $108.62 $108.62
82550 Assay of ck (cpk) 82550 $91.00 $91.00
82565 Assay of creatinine 82565 $29.50 $29.50
82570 Assay of urine creatinine 82570 $67.50 $67.50
82607 Vitamin b-12 82607 $100.01 $100.01
82728 Assay of ferritin 82728 $146.50 $146.50
82746 Assay of folic acid serum 82746 $97.86 $97.86
82760 Assay of galactose 82760 $57.50 $57.50
82776 Galactose transferase test 82776 $79.00 $79.00
82784 Assay iga/igd/igg/igm each 82784 $61.29 $61.29
82803 Blood gases any combination 82803 $105.00 $212.50
82945 Glucose other fluid 82945 $26.50 $26.50
82947 Assay glucose blood quant 82947 $26.50 $62.00
82948 Reagent strip/blood glucose 82948 $26.50 $26.50
83010 Assay of haptoglobin quant 83010 $61.83 $83.88
83020 Hemoglobin electrophoresis 83020 $84.95 $84.95
83036 Glycosylated hemoglobin test 83036 $67.50 $67.50
83498 Assay of progesterone 17-d 83498 $72.50 $168.00
83516 Immunoassay nonantibody 83516 $79.57 $256.00
83540 Assay of iron 83540 $93.50 $222.00
83550 Iron binding test 83550 $118.00 $118.00
83605 Assay of lactic acid 83605 $125.00 $125.00
83615 Lactate (ld) (ldh) enzyme 83615 $36.50 $36.50
83690 Assay of lipase 83690 $91.00 $91.00
83735 Assay of magnesium 83735 $87.50 $87.50
83789 Mass spectrometry qual/quan 83789 $109.69 $556.50
83880 Assay of natriuretic peptide 83880 $152.50 $152.50
83883 Assay nephelometry not spec 83883 $53.00 $125.50
83930 Assay of blood osmolality 83930 $67.50 $67.50
83935 Assay of urine osmolality 83935 $67.50 $79.00
83970 Assay of parathormone 83970 $205.00 $205.00
84030 Assay of blood pku 84030 $30.00 $168.00
84075 Assay alkaline phosphatase 84075 $34.50 $34.50
84100 Assay of phosphorus 84100 $29.50 $29.50
84132 Assay of serum potassium 84132 $29.50 $29.50
84134 Assay of prealbumin 84134 $133.00 $133.00
84145 Procalcitonin (pct) 84145 $305.50 $305.50
84153 PSA (Prostate Specific Antigen) 84153 $174.00 $174.00
84154 PSA (Prostate Specific Antigen) 84154 $122.59 $122.59
84155 Assay of protein serum 84155 $29.50 $29.50
84156 Assay of protein urine 84156 $29.50 $29.50
84157 Assay of protein other 84157 $29.50 $29.50
84165 Protein e-phoresis serum 84165 $70.98 $70.98
84295 Assay of serum sodium 84295 $29.50 $29.50
84300 Assay of urine sodium 84300 $58.50 $58.50
84403 Assay of total testosterone 84403 $153.00 $184.00
84436 Assay of total thyroxine 84436 $66.00 $68.50
84439 Assay of free thyroxine 84439 $53.77 $53.77
84443 Thyroid Simulating Hormone (TSH) Blood Test 84443 $56.00 $125.00
84450 Transferase (ast) (sgot) 84450 $34.50 $62.00
84460 Alanine amino (alt) (sgpt) 84460 $34.50 $62.00
84478 Assay of triglycerides 84478 $29.50 $68.50
84484 Assay of troponin quant 84484 $58.07 $58.07
84520 Assay of urea nitrogen 84520 $26.50 $26.50
84550 Assay of blood/uric acid 84550 $29.50 $29.50
84702 Chorionic gonadotropin test 84702 $75.50 $171.50
84703 Chorionic gonadotropin assay 84703 $93.50 $93.50
85014 Hematocrit 85014 $29.00 $29.00
85018 Hemoglobin 85018 $23.00 $23.00
85025 Complete Blood Count (CBC), With Differential, Automated 85025 $48.39 $48.39
85027 Complete Blood Count (CBC), Automated 85027 $51.00 $59.50
85046 Reticyte/hgb concentrate 85046 $65.50 $65.50
85049 Automated platelet count 85049 $51.00 $51.00
85347 Coagulation time activated 85347 $51.00 $79.00
85379 Fibrin degradation quant 85379 $105.00 $105.00
85384 Fibrinogen activity 85384 $54.00 $81.00
85390 Fibrinolysins screen i&r 85390 $43.00 $71.00
85525 Heparin neutralization 85525 $68.50 $68.50
85576 Blood platelet aggregation 85576 $90.50 $188.00
85610 Clotting Time Blood Test 85610 $51.00 $82.50
85651 Rbc sed rate nonautomated 85651 $45.50 $45.50
85670 Thrombin time plasma 85670 $82.50 $82.50
85730 Coagulation Assessment Blood Test 85730 $78.00 $82.50
86003 Allergen specific ige 86003 $28.00 $28.00
86038 Antinuclear antibodies 86038 $80.65 $80.65
86140 C-reactive protein 86140 $68.50 $68.50
86160 Complement antigen 86160 $79.57 $79.57
86235 Nuclear antigen antibody 86235 $90.50 $153.00
86255 Fluorescent antibody screen 86255 $38.18 $79.57
86300 Immunoassay tumor ca 15-3 86300 $107.00 $131.00
86317 Immunoassay infectious agent 86317 $24.00 $72.56
86334 Immunofix e-phoresis serum 86334 $178.50 $178.50
86360 T cell absolute count/ratio 86360 $301.00 $301.00
86430 Rheumatoid factor test qual 86430 $72.00 $72.00
86480 Tb test cell immun measure 86480 $207.00 $207.00
86592 Syphilis test non-trep qual 86592 $67.50 $67.50
86618 Lyme disease antibody 86618 $112.91 $112.91
86704 Hep b core antibody total 86704 $79.57 $79.57
86706 Hep b surface antibody 86706 $115.50 $115.50
86762 Rubella antibody 86762 $159.50 $159.50
86787 Varicella-zoster antibody 86787 $167.50 $167.50
86803 Hepatitis c ab test 86803 $133.00 $133.00
86850 Rbc antibody screen 86850 $25.80 $25.80
86870 Rbc antibody identification 86870 $319.00 $319.00
86880 Coombs test direct 86880 $99.00 $99.00
86900 Blood typing serologic abo 86900 $54.00 $54.00
86901 Blood typing serologic rh(d) 86901 $54.00 $54.00
86902 Blood type antigen donor ea 86902 $82.50 $82.50
86920 Compatibility test spin 86920 $165.50 $245.00
86922 Compatibility test antiglob 86922 $178.00 $178.00
87015 Specimen infect agnt concntj 87015 $51.00 $51.00
87040 Blood culture for bacteria 87040 $68.82 $68.82
87070 Culture othr specimn aerobic 87070 $40.87 $57.00
87075 Cultr bacteria except blood 87075 $62.37 $62.37
87077 Culture aerobic identify 87077 $107.00 $132.00
87086 Urine culture/colony count 87086 $94.00 $94.00
87088 Urine bacteria culture 87088 $40.50 $40.50
87102 Fungus isolation culture 87102 $55.92 $55.92
87116 Mycobacteria culture 87116 $72.05 $72.05
87149 Dna/rna direct probe 87149 $90.00 $90.00
87176 Tissue homogenization cultr 87176 $36.50 $36.50
87186 Microbe susceptible mic 87186 $90.00 $188.00
87205 Smear gram stain 87205 $59.00 $59.00
87206 Smear fluorescent/acid stai 87206 $59.00 $82.50
87340 Hepatitis b surface ag ia 87340 $118.00 $118.00
87389 Hiv-1 ag w/hiv-1 & hiv-2 ab 87389 $189.50 $189.50
87449 Ag detect nos ia mult 87449 $94.00 $270.00
87480 Candida dna dir probe 87480 $78.00 $78.00
87491 Chylmd trach dna amp probe 87491 $245.50 $245.50
87493 C diff amplified probe 87493 $233.35 $233.35
87506 Iadna-dna/rna probe tq 6-11 87506 $524.00 $524.00
87510 Gardner vag dna dir probe 87510 $78.00 $78.00
87522 Hepatitis c revrs trnscrpj 87522 $188.19 $188.19
87536 Hiv-1 quant&revrse trnscrpj 87536 $555.50 $555.50
87591 N.gonorrhoeae dna amp prob 87591 $245.50 $245.50
87624 Hpv high-risk types 87624 $296.50 $296.50
87631 Resp virus 3-5 targets 87631 $674.50 $674.50
87641 Mr-staph dna amp probe 87641 $204.00 $204.00
87660 Trichomonas vagin dir probe 87660 $78.00 $78.00
88112 Cytopath cell enhance tech 88112 $81.00 $81.00
88173 Cytopath eval fna report 88173 $178.00 $178.00
88185 Flowcytometry/tc add-on 88185 $115.50 $115.50
88304 Tissue exam by pathologist 88304 $127.50 $877.50
88305 Tissue exam by pathologist 88305 $138.50
88307 Tissue exam by pathologist 88307 $435.00
88311 Decalcify tissue 88311 $29.50 $29.50
88312 Special stains group 1 88312 $178.00 $178.00
88313 Special stains group 2 88313 $64.00 $294.00
88331 Path consult intraop 1 bloc 88331 $232.50 $232.50
88341 Immunohisto antb addl slide 88341 $295.50 $295.50
88342 Immunohisto antb 1st stain 88342 $295.50 $295.50
88360 Tumor immunohistochem/manual 88360 $295.50 $523.00
89050 Body fluid cell count 89050 $65.50 $105.00
G0103 Psa screening G0103 $174.00 $174.00
G0123 Screen cerv/vag thin layer G0123 $131.00 $131.00
G0475 Hiv combination assay G0475 $189.50 $189.50
G0480 Drug test prsmv chem anlyzr G0480 $75.00 $518.50