Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 320.00 - Rates for Clinical Laboratory Services › Section 320.05 - Allowable Fees

Current through Register 1525, July 5, 2024
Code
Rate
Description
Organ and Disease Oriented
							 Panels
80047
$12.11
Basic metabolic panel (Calcium, ionized) This panel
							 must include the following: Calcium, ionized (82330) Carbon dioxide
							 (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947)
							 Potassium (84132) Sodium (84295) Urea Nitrogen (BUN) (84520)
80048
$7.46
Basic metabolic panel (Calcium, total) This panel
							 must include the following: Calcium, total (82310) Carbon dioxide (bicarbonate)
							 (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Potassium (84132)
							 Sodium (84295) Urea nitrogen (BUN) (84520)
80050
$17.18
General health panel This panel must include the
							 following: Comprehensive metabolic panel (80053) Blood count, complete (CBC),
							 automated and automated differential WBC count (85025 or 85027 and 85004) or
							 Blood count, complete (CBC), automated (85027) and appropriate manual
							 differential WBC count (85007 or 85009) Thyroid stimulating hormone (TSH)
							 (84443)
80051
$6.18
Electrolyte panel This panel must include the
							 following: Carbon dioxide (bicarbonate) (82374) Chloride (82435) Potassium
							 (84132) Sodium (84295)
80053
$9.31
Comprehensive metabolic panel. This panel must
							 include the following: Albumin (82040) Bilirubin, total (82247) Calcium, total
							 (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine
							 (82565) Glucose (82947) Phosphatase, alkaline (84075) Potassium (84132)
							 Protein, total (84155) Sodium (84295) Transferase, alanine amino (ALT) (SGPT)
							 (84460) Transferase, aspartate amino (AST) (SGOT) (84450) Urea nitrogen (BUN)
							 (84520)
80055
$42.17
Obstetric panel This panel must include the
							 following: Blood count, complete (CBC), automated and automated differential
							 WBC count (85025 or 85027 and 85004) or Blood count, complete (CBC), automated
							 (85027) and appropriate manual differential WBC count (85007 or 85009)
							 Hepatitis B surface antigen (HBsAg) (87340) Antibody, rubella (86762) Syphilis
							 test, non-treponemal antibody; qualitative (
eg.
, VDRL, RPR,
							 ART) (86592) Antibody screen, RBC, each serum technique (86850) Blood typing,
							 ABO (86900) AND Blood typing, Rh (D) (86901)
80061
$11.81
Lipid panel This panel must include the following:
							 Cholesterol, serum, total (82465) Lipoprotein, direct measurement, high density
							 cholesterol (HDL cholesterol) (83718) Triglycerides (84478)
80069
$7.66
Renal function panel This panel must include the
							 following: Albumin (82040) Calcium, total (82310) Carbon dioxide (bicarbonate)
							 (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Phosphorus
							 inorganic (phosphate) (84100) Potassium (84132) Sodium (84295) Urea nitrogen
							 (BUN) (84520)
80074
$42.01
Acute hepatitis panel This panel must include the
							 following: Hepatitis A antibody (HAAb), IgM antibody (86709) Hepatitis B core
							 antibody (HBcAb), IgM antibody (86705) Hepatitis B surface antigen (HBsAg)
							 (87340) Hepatitis C antibody (86803)
80076
$7.21
Hepatic function panel This panel must include the
							 following: Albumin (82040) Bilirubin, total (82247) Bilirubin, direct (82248)
							 Phosphatase, alkaline (84075) Protein, total (84155) Transferase, alanine amino
							 (ALT) (SGPT) (84460) Transferase, aspartate amino (AST) (SGOT)
							 (84450)
80081
$66.03
Obstetric panel (includes HIV testing)
Drug Testing and Therapeutic
							 Assays
80143
$16.44
Acetaminophen
80145
$34.02
Adalimumab
80150
$13.30
Amikacin
80151
$16.44
Amiodarone
80155
$34.02
Caffeine
80156
$12.85
Carbamazepine; total
80157
$11.69
Carbamazepine; free
80158
$15.92
Cyclosporine
80159
$17.77
Clozapine
80161
$16.44
Carbamazepine; -10,11-epoxide
80162
$11.71
Digoxin; total
80163
$11.71
Digoxin; free
80164
$11.94
Valproic acid (dipropylacetic acid);
							 total
80165
$11.94
Valproic acid (dipropylacetic acid); free
80167
$16.44
Felbamate
80168
$14.41
Ethosuximide
80169
$12.11
Everolimus
80170
$14.45
Gentamicin
80171
$19.11
Gabapentin, whole blood, serum, or plasma
80173
$13.92
Haloperidol
80175
$11.69
Lamotrigine
80176
$12.96
Lidocaine
80177
$11.69
Levetiracetam
80178
$5.83
Lithium
80179
$16.44
Salicylate
80180
$15.92
Mycophenolate (mycophenolic acid)
80181
$16.44
Flecainide
80183
$11.69
Oxcarbazepine
80184
$13.49
Phenobarbital
80185
$11.69
Phenytoin; total
80186
$12.14
Phenytoin; free
80187
$23.91
Posaconazole
80188
$14.63
Primidone
80189
$23.91
Itraconazole
80190
$52.92
Procainamide;
80192
$14.77
Procainamide; with metabolites
							 (
e.g.
, n-acetyl procainamide)
80193
$34.02
Leflunomide
80194
$12.88
Quinidine
80195
$12.11
Sirolimus
80197
$12.11
Tacrolimus
80198
$12.47
Theophylline
80199
$23.91
Tiagabine
80200
$14.23
Tobramycin
80201
$10.51
Topiramate
80202
$11.94
Vancomycin
80203
$11.69
Zonisamide
80204
$34.02
Methotrexate
80210
$23.91
Rufinamide
80220
$16.44
Hydroxychloroquine
80230
$34.02
Infliximab
80235
$23.91
Lacosamide
80280
$34.02
Vedolizumab
80285
$23.91
Voriconazole
Evocative Suppression
							 Testing
80299
$16.44
Quantitation of therapeutic drug, not elsewhere
							 specified
80305
$8.92
Drug test(s), presumptive, any number of drug
							 classes, any number of devices or procedures; capable of being read by direct
							 optical observation only (
e.g.
, utilizing immunoassay
							 [
e.g.,
dipsticks, cups, cards, or cartridges]), includes
							 sample validation when performed, per date of service
80306
$11.89
Drug test(s), presumptive, any number of drug
							 classes, any number of devices or procedures; read by instrument assisted
							 direct optical observation (
e.g
, utilizing immunoassay
							 [
e.g.
, dipsticks, cups, cards, or cartridges]), includes
							 sample validation when performed, per date of service
80307
$47.55
Drug test(s), presumptive, any number of drug
							 classes, any number of devices or procedures; by instrument chemistry analyzers
							 (
e.g.
, utilizing immunoassay [
e.g.,
EIA,
							 ELISA, EMIT, FPIA, IA, KIMS, RIA]), chromatography (
e.g
, GC,
							 HPLC), and mass spectrometry either with or without chromatography,
							 (
e.g
, DART, DESI, GC-MS, GC-MS/MS, LC-MS, LC-MS/MS, LDTD,
							 MALDI, TOF) includes sample validation when performed, per date of
							 service
80400
$28.77
ACTH stimulation panel; for adrenal insufficiency
							 This panel must include the following: Cortisol (82533 x 2)
80402
$76.70
ACTH stimulation panel; for 21 hydroxylase deficiency
							 This panel must include the following: Cortisol (82533 x 2) 17
							 hydroxyprogesterone (83498 x 2)
80406
$69.03
ACTH stimulation panel; for 3
							 beta-hydroxydehydrogenase deficiency This panel must include the following:
							 Cortisol (82533 x 2) 17 hydroxypregnenolone (84143 x 2)
80408
$110.69
Aldosterone suppression evaluation panel
							 (
e.g
., saline infusion) This panel must include the following:
							 Aldosterone (82088 x 2) Renin (84244 x 2)
80410
$70.89
Calcitonin stimulation panel (
e.g.
,
							 calcium, pentagastrin) This panel must include the following: Calcitonin (82308
							 x 3)
80412
$707.03
Corticotropic releasing hormone (CRH) stimulation
							 panel This panel must include the following: Cortisol (82533 x 6)
							 Adrenocorticotropic hormone (ACTH) (82024 x 6)
80414
$45.55
Chorionic gonadotropin stimulation panel;
							 testosterone response This panel must include the following: Testosterone
							 (84403 x 2 on 3 pooled blood samples)
80415
$49.29
Chorionic gonadotropin stimulation panel; estradiol
							 response This panel must include the following: Estradiol, total (82670 x 2 on
							 3 pooled blood samples)
80416
$184.62
Renal vein renin stimulation panel
							 (
e.g.
, captopril) This panel must include the following: Renin
							 (84244 x 6)
80417
$38.80
Peripheral vein renin stimulation panel
							 (
e.g
., captopril) This panel must include the following: Renin
							 (84244 x 2)
80418
$511.10
Combined rapid anterior pituitary evaluation panel
							 This panel must include the following: Adrenocorticotropic hormone (ACTH)
							 (82024 x 4) Luteinizing hormone (LH) (83002 x 4) Follicle stimulating hormone
							 (FSH) (83001 x 4) Prolactin (84146 x 4) Human growth hormone (HGH) (83003 x 4)
							 Cortisol (82533 x 4) Thyroid stimulating hormone (TSH) (84443 x 4)
80420
$142.78
Dexamethasone suppression panel, 48 hour This panel
							 must include the following: Free cortisol, urine (82530 x 2) Cortisol (82533 x
							 2) Volume measurement for timed collection (81050 x 2)
80422
$40.63
Glucagon tolerance panel; for insulinoma This panel
							 must include the following: Glucose (82947 x 3) Insulin (83525 x 3)
80424
$44.54
Glucagon tolerance panel; for pheochromocytoma This
							 panel must include the following: Catecholamines, fractionated (82384 x
							 2)
80426
$130.90
Gonadotropin releasing hormone stimulation panel This
							 panel must include the following: Follicle stimulating hormone (FSH) (83001 x
							 4) Luteinizing hormone (LH) (83002 x 4)
80428
$58.83
Growth hormone stimulation panel
							 (
e.g.
, arginine infusion, l-dopa administration) This panel
							 must include the following: Human growth hormone (HGH) (83003 x 4)
80430
$114.07
Growth hormone suppression panel (glucose
							 administration) This panel must include the following: Glucose (82947 x 3)
							 Human growth hormone (HGH) (83003 x 4)
80432
$146.07
Insulin-induced C-peptide suppression panel This
							 panel must include the following: Insulin (83525) C-peptide (84681 x 5) Glucose
							 (82947 x 5)
80434
$251.40
Insulin tolerance panel; for ACTH insufficiency This
							 panel must include the following: Cortisol (82533 x 5) Glucose (82947 x
							 5)
80435
$90.85
Insulin tolerance panel; for growth hormone
							 deficiency This panel must include the following: Glucose (82947 x 5) Human
							 growth hormone (HGH) (83003 x 5)
80436
$80.40
Metyrapone panel This panel must include the
							 following: Cortisol (82533 x 2) 11 deoxycortisol (82634 x 2)
80438
$44.46
Thyrotropin releasing hormone (TRH) stimulation
							 panel; 1 hour This panel must include the following: Thyroid stimulating
							 hormone (TSH) (84443 x 3)
80439
$59.28
Thyrotropin releasing hormone (TRH) stimulation
							 panel; 2 hour This panel must include the following: Thyroid stimulating
							 hormone (TSH) (84443 x 4)
Urinalysis
81000
$3.55
Urinalysis, by dip stick or tablet reagent for
							 bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein,
							 specific gravity, urobilinogen, any number of these constituents;
							 non-automated, with microscopy
81001
$2.80
Urinalysis, by dip stick or tablet reagent for
							 bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein,
							 specific gravity, urobilinogen, any number of these constituents; automated,
							 with microscopy
81002
$3.07
Urinalysis, by dip stick or tablet reagent for
							 bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein,
							 specific gravity, urobilinogen, any number of these constituents;
							 non-automated, without microscopy
81003
$1.98
Urinalysis, by dip stick or tablet reagent for
							 bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein,
							 specific gravity, urobilinogen, any number of these constituents; automated,
							 without microscopy
81005
$1.91
Urinalysis; qualitative or semiquantitative, except
							 immunoassays
81007
$26.44
Urinalysis; bacteriuria screen, except by culture or
							 dipstick
81015
$2.69
Urinalysis; microscopic only
81020
$4.15
Urinalysis; 2 or 3 glass test
81025
$7.59
Urine pregnancy test, by visual color comparison
							 methods
81050
$3.21
Volume measurement for timed collection,
							 each
81099
I.C.
Unlisted urinalysis procedure
Chemistry
82009
$3.99
Ketone body(s) (
e.g
., acetone,
							 acetoacetic acid, beta-hydroxybutyrate); qualitative
82010
$7.21
Ketone body(s) (
e.g
., acetone,
							 acetoacetic acid, beta-hydroxybutyrate); quantitative
82013
$10.84
Acetylcholinesterase
82016
$14.54
Acylcarnitines; qualitative, each
							 specimen
82017
$14.88
Acylcarnitines; quantitative, each
							 specimen
82024
$34.06
Adrenocorticotropic hormone (ACTH)
82030
$22.76
Adenosine, 5-monophosphate, cyclic (cyclic
							 AMP)
82040
$4.37
Albumin; serum, plasma or whole blood
82042
$6.86
Albumin; other source, quantitative, each
							 specimen
82043
$5.10
Albumin; urine (
e.g
., microalbumin),
							 quantitative
82044
$5.49
Albumin; urine (
e.g
., microalbumin),
							 semiquantitative (
e.g
., reagent strip assay)
82045
$29.94
Albumin; ischemia modified
82075
$26.46
Alcohol (ethanol); breath
82077
$15.23
Alcohol (ethanol); any specimen except urine and
							 breath, immunoassay (
e.g
., IA, EIA, ELISA, RIA, EMIT, FPIA)
							 and enzymatic methods (
e.g
., alcohol
							 dehydrogenase)
82085
$8.56
Aldolase
82088
$35.94
Aldosterone
82103
$11.85
Alpha-1-antitrypsin; total
82104
$12.75
Alpha-1-antitrypsin; phenotype
82105
$14.79
Alpha-fetoprotein (AFP); serum
82106
$14.99
Alpha-fetoprotein (AFP); amniotic fluid
82107
$56.81
Alpha-fetoprotein (AFP); AFP-L3 fraction isoform and
							 total AFP (including ratio)
82108
$22.47
Aluminum
82120
$5.28
Amines, vaginal fluid, qualitative
82127
$12.51
Amino acids; single, qualitative, each
							 specimen
82128
$12.23
Amino acids; multiple, qualitative, each
							 specimen
82131
$20.27
Amino acids; single, quantitative, each
							 specimen
82135
$14.51
Aminolevulinic acid, delta (ALA)
82136
$17.30
Amino acids, 2 to 5 amino acids, quantitative, each
							 specimen
82139
$14.88
Amino acids, 6 or more amino acids, quantitative,
							 each specimen
82140
$12.85
Ammonia
82143
$8.25
Amniotic fluid scan (spectrophotometric)
82150
$5.72
Amylase
82154
$25.43
Androstanediol glucuronide
82157
$25.82
Androstenedione
82160
$22.54
Androsterone
82163
$18.10
Angiotensin II
82164
$12.88
Angiotensin I - converting enzyme (ACE)
82172
$18.60
Apolipoprotein, each
82175
$16.73
Arsenic
82180
$8.72
Ascorbic acid (Vitamin C), blood
82190
$14.02
Atomic absorption spectroscopy, each
							 analyte
82232
$14.27
Beta-2 microglobulin
82239
$15.10
Bile acids; total
82240
$23.44
Bile acids; cholylglycine
82247
$4.43
Bilirubin; total
82248
$4.43
Bilirubin; direct
82252
$4.02
Bilirubin; feces, qualitative
82261
$14.88
Biotinidase, each specimen
82270
$3.86
Blood, occult, by peroxidase activity
							 (
e.g.,
guaiac), qualitative; feces, consecutive collected
							 specimens with single determination, for colorectal neoplasm screening
							 (
i.e
, patient was provided three cards or single triple card
							 for consecutive collection)
82271
$4.69
Blood, occult, by peroxidase activity
							 (
e.g
., guaiac), qualitative; other sources
82272
$3.73
Blood, occult, by peroxidase activity
							 (
e.g
., guaiac), qualitative, feces, 1-3 simultaneous
							 determinations, performed for other than colorectal neoplasm
							 screening
82274
$14.04
Blood, occult, by fecal hemoglobin determination by
							 immunoassay, qualitative, feces, 1-3 simultaneous determinations
82286
$4.55
Bradykinin
82300
$20.85
Cadmium
82306
$26.11
Vitamin D; 25 hydroxy, includes fraction(s), if
							 performed
82308
$23.63
Calcitonin
82310
$4.55
Calcium; total
82330
$12.07
Calcium; ionized
82331
$11.77
Calcium; after calcium infusion test
82340
$5.32
Calcium; urine quantitative, timed
							 specimen
82355
$10.21
Calculus; qualitative analysis
82360
$11.35
Calculus; quantitative analysis, chemical
82365
$11.38
Calculus; infrared spectroscopy
82370
$11.04
Calculus; X-ray diffraction
82373
$15.93
Carbohydrate deficient transferrin
82374
$4.30
Carbon dioxide (bicarbonate)
82375
$10.87
Carboxyhemoglobin; quantitative
82376
$12.41
Carboxyhemoglobin; qualitative
82378
$16.72
Carcinoembryonic antigen (CEA)
82379
$14.88
Carnitine (total and free), quantitative, each
							 specimen
82380
$8.13
Carotene
82382
$24.08
Catecholamines; total urine
82383
$25.65
Catecholamines; blood
82384
$22.27
Catecholamines; fractionated
82387
$15.93
Cathepsin-D
82390
$9.47
Ceruloplasmin
82397
$12.45
Chemiluminescent assay
82415
$11.17
Chloramphenicol
82435
$4.06
Chloride; blood
82436
$5.07
Chloride; urine
82438
$4.41
Chloride; other source
82441
$5.30
Chlorinated hydrocarbons, screen
82465
$3.84
Cholesterol, serum or whole blood, total
82480
$6.94
Cholinesterase; serum
82482
$8.65
Cholinesterase; RBC
82485
$18.21
Chondroitin B sulfate, quantitative
82495
$17.89
Chromium
82507
$24.52
Citrate
82523
$16.48
Collagen cross links, any method
82525
$10.95
Copper
82528
$19.86
Corticosterone
82530
$14.74
Cortisol; free
82533
$14.38
Cortisol; total
82540
$4.09
Creatine
82542
$21.25
Column chromatography, includes mass spectrometry, if
							 performed (
e.g
., HPLC, LC, LC/MS, LC/MS-MS, GC, GC/MS-MS,
							 GC/MS, HPLC/MS), non-drug analyte(s) not elsewhere specified, qualitative or
							 quantitative, each specimen
82550
$5.74
Creatine kinase (CK), (CPK); total
82552
$11.81
Creatine kinase (CK), (CPK); isoenzymes
82553
$10.19
Creatine kinase (CK), (CPK); MB fraction
							 only
82554
$10.47
Creatine kinase (CK), (CPK); isoforms
82565
$4.52
Creatinine; blood
82570
$4.57
Creatinine; other source
82575
$8.34
Creatinine; clearance
82585
$12.47
Cryofibrinogen
82595
$5.71
Cryoglobulin, qualitative or semi-quantitative
							 (
e.g
., cryocrit)
82600
$17.11
Cyanide
82607
$13.30
Cyanocobalamin (Vitamin B-12);
82608
$12.63
Cyanocobalamin (Vitamin B-12); unsaturated binding
							 capacity
82610
$16.33
Cystatin C
82615
$8.42
Cystine and homocystine, urine,
							 qualitative
82626
$22.29
Dehydroepiandrosterone (DHEA)
82627
$19.61
Dehydroepiandrosterone-sulfate (DHEA-S)
82633
$27.32
Desoxycorticosterone, 11-
82634
$25.82
Deoxycortisol, 11-
82638
$10.80
Dibucaine number
82642
$25.82
Dihydrotestosterone (DHT)
82652
$33.96
Vitamin D; 1, 25 dihydroxy, includes fraction(s), if
							 performed
82653
$20.26
Elastase, pancreatic (EL-1), fecal;
							 quantitative
82656
$10.17
Elastase, pancreatic (EL-1), fecal, qualitative or
							 semi-quantitative
82657
$19.55
Enzyme activity in blood cells, cultured cells, or
							 tissue, not elsewhere specified; nonradioactive substrate, each
							 specimen
82658
$38.83
Enzyme activity in blood cells, cultured cells, or
							 tissue, not elsewhere specified; radioactive substrate, each
							 specimen
82664
$54.24
Electrophoretic technique, not elsewhere
							 specified
82668
$16.57
Erythropoietin
82670
$24.64
Estradiol; total
82671
$28.49
Estrogens; fractionated
82672
$19.14
Estrogens; total
82677
$21.33
Estriol
82679
$22.01
Estrone
82681
$24.64
Estradiol; free, direct measurement
							 (
e.g
., equilibrium dialysis)
82693
$13.14
Ethylene glycol
82696
$23.14
Etiocholanolone
82705
$4.50
Fat or lipids, feces; qualitative
82710
$14.82
Fat or lipids, feces; quantitative
82715
$20.26
Fat differential, feces, quantitative
82725
$16.56
Fatty acids, nonesterified
82726
$17.42
Very long chain fatty acids
82728
$12.02
Ferritin
82731
$56.81
Fetal fibronectin, cervicovaginal secretions,
							 semi-quantitative
82735
$16.35
Fluoride
82746
$12.97
Folic acid; serum
82747
$15.57
Folic acid; RBC
82757
$15.29
Fructose, semen
82759
$18.95
Galactokinase, RBC
82760
$9.88
Galactose
82775
$18.58
Galactose-1-phosphate uridyl transferase;
							 quantitative
82776
$10.35
Galactose-1-phosphate uridyl transferase;
							 screen
82777
$39.03
Galectin-3
82784
$8.20
Gammaglobulin (immunoglobulin); IgA, IgD, IgG, IgM,
							 each
82785
$14.52
Gammaglobulin (immunoglobulin); IgE
82787
$7.07
Gammaglobulin (immunoglobulin); immunoglobulin
							 subclasses (
e.g
., IgG1, 2, 3, or 4), each
82800
$9.70
Gases, blood, pH only
82803
$22.99
Gases, blood, any combination of pH, pCO2, pO2, CO2,
							 HCO3 (including calculated O2 saturation);
82805
$69.48
Gases, blood, any combination of pH, pCO2, pO2, CO2,
							 HCO3 (including calculated O2 saturation); with O2 saturation, by direct
							 measurement, except pulse oximetry
82810
$8.62
Gases, blood, O2 saturation only, by direct
							 measurement, except pulse oximetry
82820
$11.77
Hemoglobin-oxygen affinity (pO2 for 50% hemoglobin
							 saturation with oxygen)
82930
$5.92
Gastric acid analysis, includes pH if performed, each
							 specimen
82938
$15.60
Gastrin after secretin stimulation
82941
$15.55
Gastrin
82943
$12.60
Glucagon
82945
$3.47
Glucose, body fluid, other than blood
82946
$15.67
Glucagon tolerance test
82947
$3.47
Glucose; quantitative, blood (except reagent
							 strip)
82948
$4.45
Glucose; blood, reagent strip
82950
$4.19
Glucose; post glucose dose (includes
							 glucose)
82951
$11.35
Glucose; tolerance test (GTT), three specimens
							 (includes glucose)
82952
$3.46
Glucose; tolerance test, each additional beyond three
							 specimens (List separately in addition to code for primary
							 procedure)
82955
$8.56
Glucose-6-phosphate dehydrogenase (G6PD);
							 quantitative
82960
$5.34
Glucose-6-phosphate dehydrogenase (G6PD);
							 screen
82962
$2.89
Glucose, blood by glucose monitoring device(s)
							 cleared by the FDA specifically for home use
82963
$18.95
Glucosidase, beta
82965
$11.60
Glutamate dehydrogenase
82977
$6.35
Glutamyltransferase, gamma (GGT)
82978
$13.63
Glutathione
82979
$8.33
Glutathione reductase, RBC
82985
$14.78
Glycated protein
83001
$16.39
Gonadotropin; follicle stimulating hormone
							 (FSH)
83002
$16.33
Gonadotropin; luteinizing hormone (LH)
83003
$14.70
Growth hormone, human (HGH)
							 (somatotropin)
83006
$66.68
Growth stimulation expressed gene 2 (ST2, Interleukin
							 1 receptor like-1)
83009
$59.41
Helicobacter pylori, blood test analysis for urease
							 activity, nonradioactive isotope (
e.g,
C-13)
83010
$11.10
Haptoglobin; quantitative
83012
$23.72
Haptoglobin; phenotypes
83013
$59.41
Helicobacter pylori; breath test analysis for urease
							 activity, nonradioactive isotope (
e.g.,
C-13)
83014
$6.93
Helicobacter pylori; drug administration
83015
$18.47
Heavy metal (
e.g
., arsenic, barium,
							 beryllium, bismuth, antimony, mercury); qualitative, any number of
							 analytes
83018
$19.37
Heavy metal (
e.g
., arsenic, barium,
							 beryllium, bismuth, antimony, mercury); quantitative, each, not elsewhere
							 specified
83020
$11.35
Hemoglobin fractionation and quantitation;
							 electrophoresis (
e.g
., A2, S, C, and/or F)
83021
$15.93
Hemoglobin fractionation and quantitation;
							 chromatography (
e.g
., A2, S, C, and/or F)
83026
$3.54
Hemoglobin; by copper sulfate method,
							 nonautomated
83030
$9.47
Hemoglobin; F (fetal), chemical
83033
$7.06
Hemoglobin; F (fetal), qualitative
83036
$8.56
Hemoglobin; glycosylated (A1C)
83037
$8.56
Hemoglobin; glycosylated (A1C) by device cleared by
							 FDA for home use
83045
$5.72
Hemoglobin; methemoglobin, qualitative
83050
$7.23
Hemoglobin; methemoglobin, quantitative
83051
$6.45
Hemoglobin; plasma
83060
$7.76
Hemoglobin; sulfhemoglobin, quantitative
83065
$7.94
Hemoglobin; thermolabile
83068
$8.35
Hemoglobin; unstable, screen
83069
$3.48
Hemoglobin; urine
83070
$4.19
Hemosiderin, qualitative
83080
$14.88
b-Hexosaminidase, each assay
83088
$26.05
Histamine
83090
$15.81
Homocysteine
83150
$19.77
Homovanillic acid (HVA)
83491
$15.79
Hydroxycorticosteroids, 17- (17-OHCS)
83497
$11.38
Hydroxyindolacetic acid, 5-(HIAA)
83498
$23.96
Hydroxyprogesterone, 17-d
83500
$19.98
Hydroxyproline; free
83505
$21.43
Hydroxyproline; total
83516
$10.17
Immunoassay for analyte other than infectious agent
							 antibody or infectious agent antigen; qualitative or semiquantitative, multiple
							 step method
83518
$8.50
Immunoassay for analyte other than infectious agent
							 antibody or infectious agent antigen; qualitative or semiquantitative, single
							 step method (
e.g
., reagent strip)
83519
$16.23
Immunoassay for analyte other than infectious agent
							 antibody or infectious agent antigen; quantitative, by radioimmunoassay
							 (
e.g
., RIA)
83520
$15.23
Immunoassay for analyte other than infectious agent
							 antibody or infectious agent antigen; quantitative, not otherwise
							 specified
83521
$15.23
Immunoglobulin light chains (
i.e.
,
							 kappa, lambda), free, each
83525
$10.08
Insulin; total
83527
$11.42
Insulin; free
83528
$17.48
Intrinsic factor
83529
$15.23
Interleukin-6 (IL-6)
83540
$5.71
Iron
83550
$7.71
Iron binding capacity
83570
$7.81
Isocitric dehydrogenase (IDH)
83582
$13.64
Ketogenic steroids, fractionation
83586
$11.29
Ketosteroids, 17- (17-KS); total
83593
$25.14
Ketosteroids, 17- (17-KS); fractionation
83605
$10.20
Lactate (lactic acid)
83615
$5.33
Lactate dehydrogenase (LD), (LDH);
83625
$11.28
Lactate dehydrogenase (LD), (LDH); isoenzymes,
							 separation and quantitation
83630
$17.38
Lactoferrin, fecal; qualitative
83631
$17.31
Lactoferrin, fecal; quantitative
83632
$17.83
Lactogen, human placental (HPL) human chorionic
							 somatomammotropin
83633
$9.92
Lactose, urine, qualitative
83655
$10.68
Lead
83661
$19.40
Fetal lung maturity assessment; lecithin
							 sphingomyelin (L/S) ratio
83662
$16.68
Fetal lung maturity assessment; foam stability
							 test
83663
$16.68
Fetal lung maturity assessment; fluorescence
							 polarization
83664
$17.04
Fetal lung maturity assessment; lamellar body
							 density
83670
$8.65
Leucine aminopeptidase (LAP)
83690
$6.08
Lipase
83695
$12.63
Lipoprotein (a)
83698
$40.85
Lipoprotein-associated phospholipase A2
							 (Lp-PLA2)
83700
$9.93
Lipoprotein, blood; electrophoretic separation and
							 quantitation
83701
$29.86
Lipoprotein, blood; high resolution fractionation and
							 quantitation of lipoproteins, including lipoprotein subclasses when performed
							 (
e.g
., electrophoresis, ultracentrifugation)
83704
$30.16
Lipoprotein, blood; quantitation of lipoprotein
							 particle number(s) (
e.g
., by nuclear magnetic resonance
							 spectroscopy), includes lipoprotein particle subclass(es), when
							 performed
83718
$7.22
Lipoprotein, direct measurement; high density
							 cholesterol (HDL cholesterol)
83719
$11.25
Lipoprotein, direct measurement; VLDL
							 cholesterol
83721
$9.26
Lipoprotein, direct measurement; LDL
							 cholesterol
83722
$30.16
Lipoprotein, direct measurement; small dense LDL
							 cholesterol
83727
$15.16
Luteinizing releasing factor (LRH)
83735
$5.91
Magnesium
83775
$6.50
Malate dehydrogenase
83785
$23.51
Manganese
83789
$21.27
Mass spectrometry and tandem mass spectrometry
							 (
e.g.
, MS, MS/MS, MALDI, MS-TOF, QTOF), non-drug analyte(s)
							 not elsewhere specified, qualitative or quantitative, each specimen
83825
$14.34
Mercury, quantitative
83835
$14.94
Metanephrines
83857
$9.47
Methemalbumin
83861
$19.83
Microfluidic analysis utilizing an integrated
							 collection and analysis device, tear osmolarity
83864
$25.14
Mucopolysaccharides, acid, quantitative
83872
$5.17
Mucin, synovial fluid (Ropes test)
83873
$15.17
Myelin basic protein, cerebrospinal fluid
83874
$11.40
Myoglobin
83876
$44.86
Myeloperoxidase (MPO)
83880
$34.63
Natriuretic peptide
83883
$12.00
Nephelometry, each analyte not elsewhere
							 specified
83885
$21.62
Nickel
83915
$9.83
Nucleotidase 5'-
83916
$24.16
Oligoclonal immune (oligoclonal bands)
83918
$20.82
Organic acids; total, quantitative, each
							 specimen
83919
$14.51
Organic acids; qualitative, each specimen
83921
$18.71
Organic acid, single, quantitative
83930
$5.83
Osmolality; blood
83935
$6.02
Osmolality; urine
83937
$26.33
Osteocalcin (bone g1a protein)
83945
$12.74
Oxalate
83950
$56.81
Oncoprotein; HER-2/neu
83951
$56.81
Oncoprotein; des-gamma-carboxy-prothrombin
							 (DCP)
83970
$36.41
Parathormone (parathyroid hormone)
83986
$3.16
pH; body fluid, not otherwise specified
83987
$3.16
pH; exhaled breath condensate
83992
$15.37
Phencyclidine (PCP)
83993
$17.31
Calprotectin, fecal
84030
$4.85
Phenylalanine (PKU), blood
84035
$3.51
Phenylketones, qualitative
84060
$6.74
Phosphatase, acid; total
84066
$8.52
Phosphatase, acid; prostatic
84075
$4.57
Phosphatase, alkaline;
84078
$7.29
Phosphatase, alkaline; heat stable (total not
							 included)
84080
$13.04
Phosphatase, alkaline; isoenzymes
84081
$14.57
Phosphatidylglycerol
84085
$8.33
Phosphogluconate, 6-, dehydrogenase, RBC
84087
$9.46
Phosphohexose isomerase
84100
$4.18
Phosphorus inorganic (phosphate);
84105
$5.10
Phosphorus inorganic (phosphate); urine
84106
$5.13
Porphobilinogen, urine; qualitative
84110
$7.44
Porphobilinogen, urine; quantitative
84112
$86.53
Evaluation of cervicovaginal fluid for specific
							 amniotic fluid protein(s) (
e.g
., placental alpha
							 microglobulin-1 [PAMG-1], placental protein 12 [PP12], alpha-fetoprotein),
							 qualitative, each specimen
84119
$11.78
Porphyrins, urine; qualitative
84120
$12.97
Porphyrins, urine; quantitation and
							 fractionation
84126
$34.50
Porphyrins, feces, quantitative
84132
$4.20
Potassium; serum, plasma or whole blood
84133
$4.17
Potassium; urine
84134
$12.87
Prealbumin
84135
$18.76
Pregnanediol
84138
$18.57
Pregnanetriol
84140
$18.23
Pregnenolone
84143
$20.12
17-hydroxypregnenolone
84144
$18.40
Progesterone
84145
$24.01
Procalcitonin (PCT)
84146
$17.09
Prolactin
84150
$36.84
Prostaglandin, each
84152
$16.22
Prostate specific antigen (PSA); complexed (direct
							 measurement)
84153
$16.22
Prostate specific antigen (PSA); total
84154
$16.22
Prostate specific antigen (PSA); free
84155
$3.24
Protein, total, except by refractometry; serum,
							 plasma or whole blood
84156
$3.24
Protein, total, except by refractometry;
							 urine
84157
$3.53
Protein, total, except by refractometry; other source
							 (
e.g.
, synovial fluid, cerebrospinal fluid)
84160
$4.95
Protein, total, by refractometry, any
							 source
84163
$13.27
Pregnancy-associated plasma protein-A
							 (PAPP-A)
84165
$9.47
Protein; electrophoretic fractionation and
							 quantitation, serum
84166
$15.73
Protein; electrophoretic fractionation and
							 quantitation, other fluids with concentration (
e.g
., urine,
							 CSF)
84181
$15.02
Protein; Western Blot, with interpretation and
							 report, blood or other body fluid
84182
$25.76
Protein; Western Blot, with interpretation and
							 report, blood or other body fluid, immunological probe for band identification,
							 each
84202
$12.66
Protoporphyrin, RBC; quantitative
84203
$8.59
Protoporphyrin, RBC; screen
84206
$23.54
Proinsulin
84207
$24.78
Pyridoxal phosphate (Vitamin B-6)
84210
$12.77
Pyruvate
84220
$8.33
Pyruvate kinase
84228
$10.26
Quinine
84233
$77.51
Receptor assay; estrogen
84234
$57.22
Receptor assay; progesterone
84235
$62.82
Receptor assay; endocrine, other than estrogen or
							 progesterone (specify hormone)
84238
$32.25
Receptor assay; non-endocrine (specify
							 receptor)
84244
$19.40
Renin
84252
$17.85
Riboflavin (Vitamin B-2)
84255
$22.52
Selenium
84260
$27.32
Serotonin
84270
$19.17
Sex hormone binding globulin (SHBG)
84275
$11.85
Sialic acid
84285
$22.24
Silica
84295
$4.24
Sodium; serum, plasma or whole blood
84300
$4.46
Sodium; urine
84302
$4.29
Sodium; other source
84305
$18.75
Somatomedin
84307
$16.12
Somatostatin
84311
$7.14
Spectrophotometry, analyte not elsewhere
							 specified
84315
$2.89
Specific gravity (except urine)
84375
$34.40
Sugars, chromatographic, TLC or paper
							 chromatography
84376
$4.85
Sugars (mono-, di-, and oligosaccharides); single
							 qualitative, each specimen
84377
$4.85
Sugars (mono-, di-, and oligosaccharides); multiple
							 qualitative, each specimen
84378
$10.17
Sugars (mono-, di-, and oligosaccharides); single
							 quantitative, each specimen
84379
$10.17
Sugars (mono-, di-, and oligosaccharides); multiple
							 quantitative, each specimen
84392
$4.84
Sulfate, urine
84402
$22.46
Testosterone; free
84403
$22.76
Testosterone; total
84410
$45.23
Testosterone; bioavailable, direct measurement
							 (
e.g
., differential precipitation)
84425
$18.72
Thiamine (Vitamin B-1)
84430
$10.26
Thiocyanate
84431
$30.97
Thromboxane metabolite(s), including thromboxane if
							 performed, urine
84432
$14.16
Thyroglobulin
84436
$6.06
Thyroxine; total
84437
$5.71
Thyroxine; requiring elution (
e.g
.,
							 neonatal)
84439
$7.96
Thyroxine; free
84442
$13.04
Thyroxine binding globulin (TBG)
84443
$14.82
Thyroid stimulating hormone (TSH)
84445
$44.86
Thyroid stimulating immune globulins
							 (TSI)
84446
$12.51
Tocopherol alpha (Vitamin E)
84449
$15.88
Transcortin (cortisol binding globulin)
84450
$4.57
Transferase; aspartate amino (AST) (SGOT)
84460
$4.67
Transferase; alanine amino (ALT) (SGPT)
84466
$11.25
Transferrin
84478
$5.06
Triglycerides
84479
$5.71
Thyroid hormone (T3 or T4) uptake or thyroid hormone
							 binding ratio (THBR)
84480
$12.51
Triiodothyronine T3; total (TT-3)
84481
$14.94
Triiodothyronine T3; free
84482
$13.90
Triiodothyronine T3; reverse
84484
$11.00
Troponin, quantitative
84485
$6.35
Trypsin; duodenal fluid
84488
$6.44
Trypsin; feces, qualitative
84490
$8.76
Trypsin; feces, quantitative, 24-hour
							 collection
84510
$9.38
Tyrosine
84512
$8.90
Troponin, qualitative
84520
$3.48
Urea nitrogen; quantitative
84525
$4.52
Urea nitrogen; semiquantitative
							 (
e.g
., reagent strip test)
84540
$4.90
Urea nitrogen, urine
84545
$6.35
Urea nitrogen, clearance
84550
$3.99
Uric acid; blood
84560
$4.48
Uric acid; other source
84577
$14.82
Urobilinogen, feces, quantitative
84578
$3.94
Urobilinogen, urine; qualitative
84580
$8.42
Urobilinogen, urine; quantitative, timed
							 specimen
84583
$5.34
Urobilinogen, urine; semiquantitative
84585
$13.67
Vanillylmandelic acid (VMA), urine
84586
$31.16
Vasoactive intestinal peptide (VIP)
84588
$29.94
Vasopressin (antidiuretic hormone, ADH)
84590
$10.24
Vitamin A
84591
$15.05
Vitamin, not otherwise specified
84597
$12.10
Vitamin K
84600
$15.09
Volatiles (
e.g.
, acetic anhydride,
							 diethylether)
84620
$11.39
Xylose absorption test, blood and/or
							 urine
84630
$10.05
Zinc
84681
$18.35
C-peptide
84702
$13.27
Gonadotropin, chorionic (hCG);
							 quantitative
84703
$6.63
Gonadotropin, chorionic (hCG);
							 qualitative
84704
$13.49
Gonadotropin, chorionic (hCG); free beta
							 chain
84830
$11.20
Ovulation tests, by visual color comparison methods
							 for human luteinizing hormone
84999
$4.34
Unlisted chemistry procedure
Hematology and Coagulation
85002
$4.25
Bleeding time
85004
$5.71
Blood count; automated differential WBC
							 count
85007
$3.35
Blood count; blood smear, microscopic examination
							 with manual differential WBC count
85008
$3.03
Blood count; blood smear, microscopic examination
							 without manual differential WBC count
85009
$4.47
Blood count; manual differential WBC count, buffy
							 coat
85013
$6.17
Blood count; spun microhematocrit
85014
$2.09
Blood count; hematocrit (Hct)
85018
$2.09
Blood count; hemoglobin (Hgb)
85025
$6.85
Blood count; complete (CBC), automated (Hgb, Hct,
							 RBC, WBC and platelet count) and automated differential WBC count
85027
$5.71
Blood count; complete (CBC), automated (Hgb, Hct,
							 RBC, WBC and platelet count)
85032
$3.80
Blood count; manual cell count (erythrocyte,
							 leukocyte, or platelet) each
85041
$2.66
Blood count; red blood cell (RBC),
							 automated
85044
$3.80
Blood count; reticulocyte, manual
85045
$3.52
Blood count; reticulocyte, automated
85046
$4.91
Blood count; reticulocytes, automated, including one
							 or more cellular parameters (
e.g
., reticulocyte hemoglobin
							 content [CHr], immature reticulocyte fraction [IRF], reticulocyte volume [MRV],
							 RNA content), direct measurement
85048
$2.24
Blood count; leukocyte (WBC), automated
85049
$3.95
Blood count; platelet, automated
85055
$31.52
Reticulated platelet assay
85130
$10.49
Chromogenic substrate assay
85170
$14.38
Clot retraction
85175
$17.97
Clot lysis time, whole blood dilution
85210
$11.45
Clotting; factor II, prothrombin,
							 specific
85220
$15.57
Clotting; factor V (AcG or proaccelerin), labile
							 factor
85230
$15.79
Clotting; factor VII (proconvertin, stable
							 factor)
85240
$15.79
Clotting; factor VIII (AHG), 1-stage
85244
$18.01
Clotting; factor VIII related antigen
85245
$20.23
Clotting; factor VIII, VW factor, ristocetin
							 cofactor
85246
$20.23
Clotting; factor VIII, VW factor antigen
85247
$20.23
Clotting; factor VIII, von Willebrand factor,
							 multimetric analysis
85250
$16.79
Clotting; factor IX (PTC or Christmas)
85260
$15.79
Clotting; factor X (Stuart-Prower)
85270
$15.79
Clotting; factor XI (PTA)
85280
$17.07
Clotting; factor XII (Hageman)
85290
$14.41
Clotting; factor XIII (fibrin
							 stabilizing)
85291
$8.04
Clotting; factor XIII (fibrin stabilizing), screen
							 solubility
85292
$16.70
Clotting; prekallikrein assay (Fletcher factor
							 assay)
85293
$16.70
Clotting; high molecular weight kininogen assay
							 (Fitzgerald factor assay)
85300
$10.45
Clotting inhibitors or anticoagulants; antithrombin
							 III, activity
85301
$9.53
Clotting inhibitors or anticoagulants; antithrombin
							 III, antigen assay
85302
$10.59
Clotting inhibitors or anticoagulants; protein C,
							 antigen
85303
$12.21
Clotting inhibitors or anticoagulants; protein C,
							 activity
85305
$10.24
Clotting inhibitors or anticoagulants; protein S,
							 total
85306
$13.51
Clotting inhibitors or anticoagulants; protein S,
							 free
85307
$13.51
Activated Protein C (APC) resistance
							 assay
85335
$11.35
Factor inhibitor test
85337
$15.23
Thrombomodulin
85345
$4.14
Coagulation time; Lee and White
85347
$3.77
Coagulation time; activated
85348
$3.96
Coagulation time; other methods
85360
$7.42
Euglobulin lysis
85362
$6.08
Fibrin(ogen) degradation (split) products (FDP)
							 (FSP); agglutination slide, semiquantitative
85366
$70.97
Fibrin(ogen) degradation (split) products (FDP)
							 (FSP); paracoagulation
85370
$10.96
Fibrin(ogen) degradation (split) products (FDP)
							 (FSP); quantitative
85378
$8.57
Fibrin degradation products, D-dimer; qualitative or
							 semiquantitative
85379
$8.98
Fibrin degradation products, D-dimer;
							 quantitative
85380
$8.98
Fibrin degradation products, D-dimer; ultrasensitive
							 (
e.g.
, for evaluation for venous thromboembolism), qualitative
							 or semiquantitative
85384
$8.57
Fibrinogen; activity
85385
$12.75
Fibrinogen; antigen
85390
$13.65
Fibrinolysins or coagulopathy screen, interpretation
							 and report
85397
$27.22
Coagulation and fibrinolysis, functional activity,
							 not otherwise specified (
e.g
., ADAMTS-13), each
							 analyte
85400
$6.80
Fibrinolytic factors and inhibitors;
							 plasmin
85410
$6.80
Fibrinolytic factors and inhibitors; alpha-2
							 antiplasmin
85415
$15.16
Fibrinolytic factors and inhibitors; plasminogen
							 activator
85420
$5.76
Fibrinolytic factors and inhibitors; plasminogen,
							 except antigenic assay
85421
$8.98
Fibrinolytic factors and inhibitors; plasminogen,
							 antigenic assay
85441
$3.70
Heinz bodies; direct
85445
$6.02
Heinz bodies; induced, acetyl
							 phenylhydrazine
85460
$6.82
Hemoglobin or RBCs, fetal, for fetomaternal
							 hemorrhage; differential lysis (Kleihauer-Betke)
85461
$8.26
Hemoglobin or RBCs, fetal, for fetomaternal
							 hemorrhage; rosette
85475
$7.82
Hemolysin, acid
85520
$11.55
Heparin assay
85525
$10.44
Heparin neutralization
85530
$11.55
Heparin-protamine tolerance test
85536
$6.07
Iron stain, peripheral blood
85540
$7.59
Leukocyte alkaline phosphatase with count
85547
$7.59
Mechanical fragility, RBC
85549
$16.54
Muramidase
85555
$6.59
Osmotic fragility, RBC; unincubated
85557
$11.78
Osmotic fragility, RBC; incubated
85576
$21.97
Platelet, aggregation (in vitro), each
							 agent
85597
$15.86
Phospholipid neutralization; platelet
85598
$15.86
Phospholipid neutralization; hexagonal
							 phospholipid
85610
$3.78
Prothrombin time;
85611
$3.48
Prothrombin time; substitution, plasma fractions,
							 each
85612
$15.43
Russell viper venom time (includes venom);
							 undiluted
85613
$8.45
Russell viper venom time (includes venom);
							 diluted
85635
$8.69
Reptilase test
85651
$3.77
Sedimentation rate, erythrocyte;
							 nonautomated
85652
$2.38
Sedimentation rate, erythrocyte;
							 automated
85660
$4.86
Sickling of RBC, reduction
85670
$5.09
Thrombin time; plasma
85675
$6.04
Thrombin time; titer
85705
$8.49
Thromboplastin inhibition, tissue
85730
$5.30
Thromboplastin time, partial (PTT); plasma or whole
							 blood
85732
$5.71
Thromboplastin time, partial (PTT); substitution,
							 plasma fractions, each
85810
$10.29
Viscosity
85999
I.C.
Unlisted hematology and coagulation
							 procedure
Immunology
86000
$6.16
Agglutinins, febrile (
e.g.,
Brucella, Francisella, Murine typhus, Q fever, Rocky Mountain spotted fever,
							 scrub typhus), each antigen
86001
$6.90
Allergen specific IgG quantitative or
							 semiquantitative, each allergen
86003
$4.60
Allergen specific IgE; quantitative or
							 semiquantitative, crude allergen extract, each
86005
$7.03
Allergen specific IgE; qualitative, multiallergen
							 screen (
e.g
., disk, sponge, card)
86008
$15.81
Allergen specific IgE; quantitative or
							 semiquantitative, recombinant or purified component, each
86015
$10.17
Actin (smooth muscle) antibody (ASMA),
							 each
86021
$13.27
Antibody identification; leukocyte
							 antibodies
86022
$16.20
Antibody identification; platelet
							 antibodies
86023
$10.99
Antibody identification; platelet associated
							 immunoglobulin assay
86036
$10.63
Antineutrophil cytoplasmic antibody (ANCA); screen,
							 each antibody
86037
$10.63
Antineutrophil cytoplasmic antibody (ANCA); titer,
							 each antibody
86038
$10.66
Antinuclear antibodies (ANA);
86039
$9.84
Antinuclear antibodies (ANA); titer
86051
$10.17
Aquaporin-4 (neuromyelitis optica [NMO]) antibody;
							 enzyme-linked immunosorbent immunoassay (ELISA)
86052
$10.63
Aquaporin-4 (neuromyelitis optica [NMO]) antibody;
							 cell-based immunofluorescence assay (CBA), each
86053
$10.63
Aquaporin-4 (neuromyelitis optica [NMO]) antibody;
							 flow cytometry (
i.e.
, fluorescence-activated cell sorting
							 [FACS]), each
86060
$6.44
Antistreptolysin 0; titer
86063
$5.09
Antistreptolysin 0; screen
86140
$4.57
C-reactive protein;
86141
$11.42
C-reactive protein; high sensitivity
							 (hsCRP)
86146
$22.45
Beta 2 Glycoprotein I antibody, each
86147
$22.45
Cardiolipin (phospholipid) antibody, each Ig
							 class
86148
$14.17
Anti-phosphatidylserine (phospholipid)
							 antibody
86152
$221.19
Cell enumeration using immunologic selection and
							 identification in fluid specimen (
e.g
., circulating tumor
							 cells in blood);
86155
$14.10
Chemotaxis assay, specify method
86156
$7.12
Cold agglutinin; screen
86157
$7.11
Cold agglutinin; titer
86160
$10.58
Complement; antigen, each component
86161
$10.58
Complement; functional activity, each
							 component
86162
$17.92
Complement; total hemolytic (CH50)
86171
$8.83
Complement fixation tests, each antigen
86200
$11.42
Cyclic citrullinated peptide (CCP),
							 antibody
86215
$11.69
Deoxyribonuclease, antibody
86225
$12.12
Deoxyribonucleic acid (DNA) antibody; native or
							 double stranded
86226
$10.68
Deoxyribonucleic acid (DNA) antibody; single
							 stranded
86231
$10.66
Endomysial antibody (EMA), each immunoglobulin (Ig)
							 class
86235
$15.81
Extractable nuclear antigen, antibody to, any method
							 (
e.g
., nRNP, SS-A, SS-B, Sm, RNP, Sc170, J01), each
							 antibody
86255
$10.63
Fluorescent noninfectious agent antibody; screen,
							 each antibody
86256
$10.63
Fluorescent noninfectious agent antibody; titer, each
							 antibody
86258
$10.17
Gliadin (deamidated) (DGP) antibody, each
							 immunoglobulin (Ig) class
86277
$13.88
Growth hormone, human (HGH), antibody
86280
$7.22
Hemagglutination inhibition test (HAI)
86294
$22.55
Immunoassay for tumor antigen, qualitative or
							 semiquantitative (
e.g
., bladder tumor antigen)
86300
$18.35
Immunoassay for tumor antigen, quantitative; CA 15-3
							 (27.29)
86301
$18.35
Immunoassay for tumor antigen, quantitative; CA
							 19-9
86304
$18.35
Immunoassay for tumor antigen, quantitative; CA
							 125
86305
$18.35
Human epididymis protein 4 (HE4)
86308
$4.57
Heterophile antibodies; screening
86309
$5.71
Heterophile antibodies; titer
86310
$6.50
Heterophile antibodies; titers after absorption with
							 beef cells and guinea pig kidney
86316
$18.35
Immunoassay for tumor antigen, other antigen,
							 quantitative (
e.g
., CA 50, 72-4, 549), each
86317
$13.22
Immunoassay for infectious agent antibody,
							 quantitative, not otherwise specified
86318
$15.96
Immunoassay for infectious agent antibody(ies),
							 qualitative or semiquantitative, single-step method (
e.g
.,
							 reagent strip);
86320
$26.39
Immunoelectrophoresis; serum
86325
$20.40
Immunoelectrophoresis; other fluids
							 (
e.g.,
urine, cerebrospinal fluid) with
							 concentration
86327
$26.39
Immunoelectrophoresis; crossed (2-dimensional
							 assay)
86328
$45.23
Immunoassay for infectious agent antibody(ies),
							 qualitative or semiquantitative, single step method (
e.g
.,
							 reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
							 (Coronavirus disease [COVID-19])
86329
$12.39
Immunodiffusion; not elsewhere specified
86331
$10.57
Immunodiffusion; gel diffusion, qualitative
							 (Ouchterlony), each antigen or antibody
86332
$21.49
Immune complex assay
86334
$19.70
Immunofixation electrophoresis; serum
86335
$25.89
Immunofixation electrophoresis; other fluids with
							 concentration (
e.g
., urine, CSF)
86336
$13.75
Inhibin A
86337
$18.88
Insulin antibodies
86340
$13.30
Intrinsic factor antibodies
86341
$20.79
Islet cell antibody
86343
$10.99
Leukocyte histamine release test (LHR)
86344
$9.16
Leukocyte phagocytosis
86352
$119.83
Cellular function assay involving stimulation
							 (
e.g
., mitogen or antigen) and detection of biomarker (e.g.,
							 ATP)
86353
$43.24
Lymphocyte transformation, mitogen (phytomitogen) or
							 antigen induced blastogenesis
86355
$33.28
B cells, total count
86356
$23.62
Mononuclear cell antigen, quantitative
							 (
e.g
., flow cytometry), not otherwise specified, each
							 antigen
86357
$33.28
Natural killer (NK) cells, total count
86359
$33.28
T cells; total count
86360
$41.44
T cells; absolute CD4 and CD8 count, including
							 ratio
86361
$23.62
T cells; absolute CD4 count
86362
$10.63
Myelin oligodendrocyte glycoprotein (MOG-IgG1)
							 antibody; cell-based immunofluorescence assay (CBA), each
86363
$10.63
Myelin oligodendrocyte glycoprotein (MOG-IgG1)
							 antibody; flow cytometry (
i.e.
, fluorescence-activated cell
							 sorting [FACS]), each
86364
$10.17
Tissue transglutaminase, each immunoglobulin (Ig)
							 class
86367
$68.60
Stem cells (
i.e.,
CD34), total
							 count
86376
$12.83
Microsomal antibodies (
e.g
., thyroid
							 or liver-kidney), each
86381
$22.45
Mitochondrial antibody (
e.g.
, M2),
							 each
86382
$14.91
Neutralization test, viral
86384
$12.00
Nitroblue tetrazolium dye test (NTD)
86386
$19.21
Nuclear Matrix Protein 22 (NMP22),
							 qualitative
86403
$10.18
Particle agglutination; screen, each
							 antibody
86406
$9.38
Particle agglutination; titer, each
							 antibody
86408
$42.13
Neutralizing antibody, severe acute respiratory
							 syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]);
							 screen
86409
$105.33
Neutralizing antibody, severe acute respiratory
							 syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]);
							 titer
86413
$51.43
Severe acute respiratory syndrome coronavirus 2
							 (SARS-CoV-2) (Coronavirus disease [COVID-19]) antibody,
							 quantitative
86430
$5.42
Rheumatoid factor; qualitative
86431
$5.00
Rheumatoid factor; quantitative
86480
$54.67
Tuberculosis test, cell mediated immunity antigen
							 response measurement; gamma interferon
86481
$88.20
Tuberculosis test, cell mediated immunity antigen
							 response measurement; enumeration of gamma interferon-producing T-cells in cell
							 suspension
86485
$24.48
Skin test; candida
86590
$11.17
Streptokinase, antibody
86592
$3.77
Syphilis test, non-treponemal antibody; qualitative
							 (
e.g
., VDRL, RPR, ART)
86593
$3.88
Syphilis test, non-treponemal antibody;
							 quantitative
86596
$16.23
Voltage-gated calcium channel antibody,
							 each
86602
$8.98
Antibody; actinomyces
86603
$11.35
Antibody; adenovirus
86606
$13.27
Antibody; Aspergillus
86609
$11.36
Antibody; bacterium, not elsewhere
							 specified
86611
$8.98
Antibody; Bartonella
86612
$11.38
Antibody; Blastomyces
86615
$11.63
Antibody; Bordetella
86617
$13.66
Antibody; Borrelia burgdorferi (Lyme disease)
							 confirmatory test (
e.g
., Western Blot or
							 immunoblot)
86618
$15.02
Antibody; Borrelia burgdorferi (Lyme
							 disease)
86619
$11.80
Antibody; Borrelia (relapsing fever)
86622
$7.88
Antibody; Brucella
86625
$11.57
Antibody; Campylobacter
86628
$10.59
Antibody; Candida
86631
$10.43
Antibody; Chlamydia
86632
$11.18
Antibody; Chlamydia, IgM
86635
$10.12
Antibody; Coccidioides
86638
$10.69
Antibody; Coxiella burnetii (Q fever)
86641
$12.71
Antibody; Cryptococcus
86644
$12.69
Antibody; cytomegalovirus (CMV)
86645
$14.86
Antibody; cytomegalovirus (CMV), IgM
86648
$13.42
Antibody; Diphtheria
86651
$11.63
Antibody; encephalitis, California (La
							 Crosse)
86652
$11.63
Antibody; encephalitis, Eastern equine
86653
$11.63
Antibody; encephalitis, St. Louis
86654
$11.63
Antibody; encephalitis, Western equine
86658
$11.49
Antibody; enterovirus (
e.g
.,
							 coxsackie, echo, polio)
86663
$11.57
Antibody; Epstein-Barr (EB) virus, early antigen
							 (EA)
86664
$13.49
Antibody; Epstein-Barr (EB) virus, nuclear antigen
							 (EBNA)
86665
$16.00
Antibody; Epstein-Barr (EB) virus, viral capsid
							 (VCA)
86666
$8.98
Antibody; Ehrlichia
86668
$12.49
Antibody; Francisella tularensis
86671
$10.80
Antibody; fungus, not elsewhere specified
86674
$12.98
Antibody; Giardia lamblia
86677
$14.86
Antibody; Helicobacter pylori
86682
$11.47
Antibody; helminth, not elsewhere
							 specified
86684
$13.97
Antibody; Haemophilus influenza
86687
$8.02
Antibody; HTLV-I
86688
$12.35
Antibody; HTLV-II
86689
$17.07
Antibody; HTLV or HIV antibody, confirmatory test
							 (
e.g
., Western Blot)
86692
$15.14
Antibody; hepatitis, delta agent
86694
$12.69
Antibody; herpes simplex, nonspecific type
							 test
86695
$11.63
Antibody; herpes simplex, type 1
86696
$17.07
Antibody; herpes simplex, type 2
86698
$12.16
Antibody; histoplasma
86701
$7.84
Antibody; HIV-1
86702
$11.92
Antibody; HIV-2
86703
$12.09
Antibody; HIV-1 and HIV-2, single result
86704
$10.63
Hepatitis B core antibody (HBcAb); total
86705
$10.38
Hepatitis B core antibody (HBcAb); IgM
							 antibody
86706
$9.47
Hepatitis B surface antibody (HBsAb)
86707
$10.20
Hepatitis Be antibody (HBeAb)
86708
$10.93
Hepatitis A antibody (HAAb)
86709
$9.93
Hepatitis A antibody (HAAb), IgM antibody
86710
$11.95
Antibody; influenza virus
86711
$14.90
Antibody; JC (John Cunningham) virus
86713
$13.49
Antibody; Legionella
86717
$10.80
Antibody; Leishmania
86720
$14.29
Antibody; Leptospira
86723
$11.63
Antibody; Listeria monocytogenes
86727
$11.35
Antibody; lymphocytic choriomeningitis
86732
$13.23
Antibody; mucormycosis
86735
$11.51
Antibody; mumps
86738
$11.68
Antibody; mycoplasma
86741
$11.63
Antibody; Neisseria meningitidis
86744
$14.10
Antibody; Nocardia
86747
$13.26
Antibody; parvovirus
86750
$11.63
Antibody; Plasmodium (malaria)
86753
$10.93
Antibody; protozoa, not elsewhere
							 specified
86756
$14.01
Antibody; respiratory syncytial virus
86757
$17.07
Antibody; Rickettsia
86759
$16.08
Antibody; rotavirus
86762
$12.69
Antibody; rubella
86765
$11.36
Antibody; rubeola
86768
$11.63
Antibody; Salmonella
86769
$42.13
Antibody; severe acute respiratory syndrome
							 coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])
86771
$21.59
Antibody; Shigella
86774
$13.05
Antibody; tetanus
86777
$12.69
Antibody; Toxoplasma
86778
$12.71
Antibody; Toxoplasma, IgM
86780
$11.68
Antibody; Treponema pallidum
86784
$11.08
Antibody; Trichinella
86787
$11.36
Antibody; varicella-zoster
86788
$14.86
Antibody; West Nile virus, IgM
86789
$12.69
Antibody; West Nile virus
86790
$11.36
Antibody; virus, not elsewhere specified
86793
$11.63
Antibody; Yersinia
86794
$14.86
Antibody; Zika virus, IgM
86800
$14.03
Thyroglobulin antibody
86803
$12.59
Hepatitis C antibody;
86804
$13.66
Hepatitis C antibody; confirmatory test
							 (
e.g
., immunoblot)
86805
$167.15
Lymphocytotoxicity assay, visual crossmatch; with
							 titration
86806
$41.97
Lymphocytotoxicity assay, visual crossmatch; without
							 titration
86807
$69.37
Serum screening for cytotoxic percent reactive
							 antibody (PRA); standard method
86808
$26.18
Serum screening for cytotoxic percent reactive
							 antibody (PRA); quick method
86812
$22.76
HLA typing; A, B, or C (
e.g
., A10,
							 B7, B27), single antigen
86813
$51.16
HLA typing; A, B, or C, multiple antigens
86816
$26.61
HLA typing; DR/DQ, single antigen
86817
$93.62
HLA typing; DR/DQ, multiple antigens
86821
$32.25
HLA typing; lymphocyte culture, mixed
							 (MLC)
86825
$96.57
Human leukocyte antigen (HLA) crossmatch,
							 non-cytotoxic (
e.g
., using flow cytometry); first serum sample
							 or dilution
86826
$32.22
Human leukocyte antigen (HLA) crossmatch,
							 non-cytotoxic (
e.g
., using flow cytometry); each additional
							 serum sample or sample dilution (List separately in addition to primary
							 procedure)
86828
$56.62
Antibody to human leukocyte antigens (HLA), solid
							 phase assays (
e.g.,
microspheres or beads, ELISA, flow
							 cytometry); qualitative assessment of the presence or absence of antibody(ies)
							 to HLA Class I and Class II HLA antigens
86829
$56.62
Antibody to human leukocyte antigens (HLA), solid
							 phase assays (
e.g
., microspheres or beads, ELISA, Flow
							 cytometry); qualitative assessment of the presence or absence of antibody(ies)
							 to HLA Class I or Class II HLA antigens
86830
$84.25
Antibody to human leukocyte antigens (HLA), solid
							 phase assays (
e.g
., microspheres or beads, ELISA, Flow
							 cytometry); antibody identification by qualitative panel using complete HLA
							 phenotypes, HLA Class I
86831
$72.22
Antibody to human leukocyte antigens (HLA), solid
							 phase assays (
e.g
., microspheres or beads, ELISA, Flow
							 cytometry); antibody identification by qualitative panel using complete HLA
							 phenotypes, HLA Class II
86832
$285.55
Antibody to human leukocyte antigens (HLA), solid
							 phase assays (
e.g
., microspheres or beads, ELISA, Flow
							 cytometry); high definition qualitative panel for identification of antibody
							 specificities (
e.g.,
individual antigen per bead methodology),
							 HLA Class I
86833
$287.36
Antibody to human leukocyte antigens (HLA), solid
							 phase assays (
e.g
., microspheres or beads, ELISA, Flow
							 cytometry); high definition qualitative panel for identification of antibody
							 specificities (
e.g.,
individual antigen per bead methodology),
							 HLA Class II
86834
$315.37
Antibody to human leukocyte antigens (HLA), solid
							 phase assays (
e.g
., microspheres or beads, ELISA, Flow
							 cytometry); semi-quantitative panel (
e.g
., titer), HLA Class
							 I
86835
$284.85
Antibody to human leukocyte antigens (HLA), solid
							 phase assays (
e.g
., microspheres or beads, ELISA, Flow
							 cytometry); semi-quantitative panel (
e.g
., titer), HLA Class
							 II
86849
I.C.
Unlisted immunology procedure
Transformation
86850
$8.62
Antibody screen, RBC, each serum
							 technique
86860
I.C.
Antibody elution (RBC), each elution
86870
I.C.
Antibody identification, RBC antibodies, each panel
							 for each serum technique
86880
$4.75
Antihuman globulin test (Coombs test); direct, each
							 antiserum
86885
$5.05
Antihuman globulin test (Coombs test); indirect,
							 qualitative, each reagent red cell
86886
$4.57
Antihuman globulin test (Coombs test); indirect, each
							 antibody titer
86890
I.C.
Autologous blood or component, collection processing
							 and storage; predeposited
86891
I.C.
Autologous blood or component, collection processing
							 and storage; intra- or post-operative salvage
86900
$2.64
Blood typing, serologic; ABO
86901
$2.64
Blood typing, serologic; Rh (D)
86902
$5.60
Blood typing, serologic; antigen testing of donor
							 blood using reagent serum, each antigen test
86904
$14.41
Blood typing, serologic; antigen screening for
							 compatible unit using patient serum, per unit screened
86905
$3.38
Blood typing, serologic; RBC antigens, other than ABO
							 or Rh (D), each
86906
$6.84
Blood typing, serologic; Rh phenotyping,
							 complete
86920
I.C.
Compatibility test each unit; immediate spin
							 technique
86921
I.C.
Compatibility test each unit; incubation
							 technique
86922
I.C.
Compatibility test each unit; antiglobulin
							 technique
86923
I.C.
Compatibility test each unit; electronic
86927
I.C.
Fresh frozen plasma, thawing, each unit
86930
I.C.
Frozen blood, each unit; freezing (includes
							 preparation)
86931
I.C.
Frozen blood, each unit; thawing
86932
I.C.
Frozen blood, each unit; freezing (includes
							 preparation) and thawing
86940
$7.74
Hemolysins and agglutinins; auto, screen,
							 each
86941
$10.68
Hemolysins and agglutinins; incubated
86945
$23.48
Irradiation of blood product, each unit
86960
I.C.
Volume reduction of blood or blood product
							 (
e.g
., red blood cells or platelets), each unit
86965
$23.48
Pooling of platelets or other blood
							 products
86970
$18.76
Pretreatment of RBCs for use in RBC antibody
							 detection, identification, and/or compatibility testing; incubation with
							 chemical agents or drugs, each
86971
$18.76
Pretreatment of RBCs for use in RBC antibody
							 detection, identification, and/or compatibility testing; incubation with
							 enzymes, each
86976
$18.76
Pretreatment of serum for use in RBC antibody
							 identification; by dilution
86977
$18.76
Pretreatment of serum for use in RBC antibody
							 identification; incubation with inhibitors, each
86978
$18.76
Pretreatment of serum for use in RBC antibody
							 identification; by differential red cell absorption using patient RBCs or RBCs
							 of known phenotype, each absorption
86985
I.C.
Splitting of blood or blood products, each
							 unit
86999
I.C.
Unlisted transfusion medicine procedure
Microbiology
87003
$14.85
Animal inoculation, small animal, with observation
							 and dissection
87015
$5.89
Concentration (any type), for infectious
							 agents
87040
$9.10
Culture, bacterial; blood, aerobic, with isolation
							 and presumptive identification of isolates (includes anaerobic culture, if
							 appropriate)
87045
$8.33
Culture, bacterial; stool, aerobic, with isolation
							 and preliminary examination (
e.g
., KIA, LIA), Salmonella and
							 Shigella species
87046
$8.33
Culture, bacterial; stool, aerobic, additional
							 pathogens, isolation and presumptive identification of isolates, each
							 plate
87070
$7.60
Culture, bacterial; any other source except urine,
							 blood or stool, aerobic, with isolation and presumptive identification of
							 isolates
87071
$8.72
Culture, bacterial; quantitative, aerobic with
							 isolation and presumptive identification of isolates, any source except urine,
							 blood or stool
87073
$8.52
Culture, bacterial; quantitative, anaerobic with
							 isolation and presumptive identification of isolates, any source except urine,
							 blood or stool
87075
$8.35
Culture, bacterial; any source, except blood,
							 anaerobic with isolation and presumptive identification of isolates
87076
$7.13
Culture, bacterial; anaerobic isolate, additional
							 methods required for definitive identification, each isolate
87077
$7.13
Culture, bacterial; aerobic isolate, additional
							 methods required for definitive identification, each isolate
87081
$5.85
Culture, presumptive, pathogenic organisms, screening
							 only;
87084
$23.88
Culture, presumptive, pathogenic organisms, screening
							 only; with colony estimation from density chart
87086
$7.12
Culture, bacterial; quantitative colony count,
							 urine
87088
$7.14
Culture, bacterial; with isolation and presumptive
							 identification of each isolate, urine
87101
$6.80
Culture, fungi (mold or yeast) isolation, with
							 presumptive identification of isolates; skin, hair, or nail
87102
$7.42
Culture, fungi (mold or yeast) isolation, with
							 presumptive identification of isolates; other source (except blood)
87103
$18.05
Culture, fungi (mold or yeast) isolation, with
							 presumptive identification of isolates; blood
87106
$9.10
Culture, fungi, definitive identification, each
							 organism; yeast
87107
$9.10
Culture, fungi, definitive identification, each
							 organism; mold
87109
$13.57
Culture, mycoplasma, any source
87110
$17.29
Culture, chlamydia, any source
87116
$9.53
Culture, tubercle or other acid-fast bacilli
							 (
e.g
., TB, AFB, mycobacteria) any source, with isolation and
							 presumptive identification of isolates
87118
$12.89
Culture, mycobacterial, definitive identification,
							 each isolate
87140
$4.91
Culture, typing; immunofluorescent method, each
							 antiserum
87143
$11.04
Culture, typing; gas liquid chromatography (GLC) or
							 high pressure liquid chromatography (HPLC) method
87147
$4.57
Culture, typing; immunologic method, other than
							 immunofluorescence (
e.g
., agglutination grouping), per
							 antiserum
87149
$17.68
Culture, typing; identification by nucleic acid (DNA
							 or RNA) probe, direct probe technique, per culture or isolate, each organism
							 probed
87150
$30.95
Culture, typing; identification by nucleic acid (DNA
							 or RNA) probe, amplified probe technique, per culture or isolate, each organism
							 probed
87152
$6.83
Culture, typing; identification by pulse field gel
							 typing
87154
$192.33
Culture, typing; identification of blood pathogen and
							 resistance typing, when performed, by nucleic acid (DNA or RNA) probe,
							 multiplexed amplified probe technique including multiplex reverse
							 transcription, when performed, per culture or isolate, 6 or more
							 targets
87158
$6.83
Culture, typing; other methods
87164
$9.47
Dark field examination, any source
							 (
e.g
., penile, vaginal, oral, skin); includes specimen
							 collection
87166
$9.97
Dark field examination, any source
							 (
e.g
., penile, vaginal, oral, skin); without
							 collection
87168
$3.77
Macroscopic examination; arthropod
87169
$3.80
Macroscopic examination; parasite
87172
$3.77
Pinworm exam (
e.g
., cellophane tape
							 prep)
87176
$5.19
Homogenization, tissue, for culture
87177
$7.85
Ova and parasites, direct smears, concentration and
							 identification
87181
$4.19
Susceptibility studies, antimicrobial agent; agar
							 dilution method, per agent (
e.g
., antibiotic gradient
							 strip)
87184
$6.60
Susceptibility studies, antimicrobial agent; disk
							 method, per plate (12 or fewer agents)
87185
$4.19
Susceptibility studies, antimicrobial agent; enzyme
							 detection (
e.g
., beta lactamase), per enzyme
87186
$7.63
Susceptibility studies, antimicrobial agent;
							 microdilution or agar dilution (minimum inhibitory concentration [MIC] or
							 breakpoint), each multi-antimicrobial, per plate
87187
$35.43
Susceptibility studies, antimicrobial agent;
							 microdilution or agar dilution, minimum lethal concentration (MLC), each plate
							 (List separately in addition to code for primary procedure)
87188
$5.86
Susceptibility studies, antimicrobial agent;
							 macrobroth dilution method, each agent
87190
$6.45
Susceptibility studies, antimicrobial agent;
							 mycobacteria, proportion method, each agent
87197
$13.25
Serum bactericidal titer (Schlichter
							 test)
87205
$3.77
Smear, primary source with interpretation; Gram or
							 Giemsa stain for bacteria, fungi, or cell types
87206
$4.75
Smear, primary source with interpretation;
							 fluorescent and/or acid fast stain for bacteria, fungi, parasites, viruses or
							 cell types
87207
$5.28
Smear, primary source with interpretation; special
							 stain for inclusion bodies or parasites (
e.g
., malaria,
							 coccidia, microsporidia, trypanosomes, herpes viruses)
87209
$15.86
Smear, primary source with interpretation; complex
							 special stain (
e.g
., trichrome, iron hemotoxylin) for ova and
							 parasites
87210
$5.13
Smear, primary source with interpretation; wet mount
							 for infectious agents (
e.g
., saline, India ink, KOH
							 preps)
87220
$3.77
Tissue examination by KOH slide of samples from skin,
							 hair, or nails for fungi or ectoparasite ova or mites (
e.g
.,
							 scabies)
87230
$17.41
Toxin or antitoxin assay, tissue culture
							 (
e.g
., Clostridium difficile toxin)
87250
$17.25
Virus isolation; inoculation of embryonated eggs, or
							 small animal, includes observation and dissection
87252
$22.99
Virus isolation; tissue culture inoculation,
							 observation, and presumptive identification by cytopathic effect
87253
$17.82
Virus isolation; tissue culture, additional studies
							 or definitive identification (
e.g
., hemabsorption,
							 neutralization, immunofluorescence stain), each isolate
87254
$17.25
Virus isolation; centrifuge enhanced (shell vial)
							 technique, includes identification with immunofluorescence stain, each
							 virus
87255
$29.86
Virus isolation; including identification by
							 non-immunologic method, other than by cytopathic effect (
e.g
.,
							 virus specific enzymatic activity)
87260
$12.73
Infectious agent antigen detection by
							 immunofluorescent technique; adenovirus
87265
$10.57
Infectious agent antigen detection by
							 immunofluorescent technique; Bordetella pertussis/parapertussis
87267
$11.84
Infectious agent antigen detection by
							 immunofluorescent technique; Enterovirus, direct fluorescent antibody
							 (DFA)
87269
$12.00
Infectious agent antigen detection by
							 immunofluorescent technique; giardia
87270
$10.57
Infectious agent antigen detection by
							 immunofluorescent technique; Chlamydia trachomatis
87271
$11.84
Infectious agent antigen detection by
							 immunofluorescent technique; Cytomegalovirus, direct fluorescent antibody
							 (DFA)
87272
$10.57
Infectious agent antigen detection by
							 immunofluorescent technique; cryptosporidium
87273
$10.57
Infectious agent antigen detection by
							 immunofluorescent technique; Herpes simplex virus type 2
87274
$10.57
Infectious agent antigen detection by
							 immunofluorescent technique; Herpes simplex virus type 1
87275
$10.80
Infectious agent antigen detection by
							 immunofluorescent technique; influenza B virus
87276
$14.17
Infectious agent antigen detection by
							 immunofluorescent technique; influenza A virus
87278
$13.76
Infectious agent antigen detection by
							 immunofluorescent technique; Legionella pneumophila
87279
$14.49
Infectious agent antigen detection by
							 immunofluorescent technique; Parainfluenza virus, each type
87280
$11.84
Infectious agent antigen detection by
							 immunofluorescent technique; respiratory syncytial virus
87281
$10.57
Infectious agent antigen detection by
							 immunofluorescent technique; Pneumocystis carinii
87283
$53.63
Infectious agent antigen detection by
							 immunofluorescent technique; Rubeola
87285
$10.74
Infectious agent antigen detection by
							 immunofluorescent technique; Treponema pallidum
87290
$11.84
Infectious agent antigen detection by
							 immunofluorescent technique; Varicella zoster virus
87299
$14.20
Infectious agent antigen detection by
							 immunofluorescent technique; not otherwise specified, each organism
87300
$10.57
Infectious agent antigen detection by
							 immunofluorescent technique, polyvalent for multiple organisms, each polyvalent
							 antiserum
87301
$10.57
Infectious agent antigen detection by immunoassay
							 technique, (
e.g
., enzyme immunoassay [EIA], enzyme-linked
							 immunosorbent assay [ELISA], fluorescence immunoassay [FIA],
							 immunochemiluminometric assay [IMCA]) qualitative or semiquantitative;
							 adenovirus enteric types 40/41
87305
$10.57
Infectious agent antigen detection by immunoassay
							 technique, (
e.g
., enzyme immunoassay [EIA], enzyme-linked
							 immunosorbent assay [ELISA], fluorescence immunoassay [FIA],
							 immunochemiluminometric assay [IMCA]) qualitative or semiquantitative;
							 Aspergillus
87320
$13.23
Infectious agent antigen detection by immunoassay
							 technique, (
e.g
., enzyme immunoassay [EIA], enzyme-linked
							 immunosorbent assay [ELISA], fluorescence immunoassay [FIA],
							 immunochemiluminometric assay [IMCA]) qualitative or semiquantitative;
							 Chlamydia trachomatis
87324
$10.57
Infectious agent antigen detection by immunoassay
							 technique, (
e.g
., enzyme immunoassay [EIA], enzyme-linked
							 immunosorbent assay [ELISA], fluorescence immunoassay [FIA],
							 immunochemiluminometric assay [IMCA]) qualitative or semiquantitative;
							 Clostridium difficile toxin(s)
87327
$11.84
Infectious agent antigen detection by immunoassay
							 technique, (
e.g
., enzyme immunoassay [EIA], enzyme-linked
							 immunosorbent assay [ELISA], fluorescence immunoassay [FIA],
							 immunochemiluminometric assay [IMCA]) qualitative or semiquantitative;
							 Cryptococcus neoformans
87328
$12.19
Infectious agent antigen detection by immunoassay
							 technique, (
e.g
., enzyme immunoassay [EIA], enzyme-linked
							 immunosorbent assay [ELISA], fluorescence immunoassay [FIA],
							 immunochemiluminometric assay [IMCA]) qualitative or semiquantitative;
							 cryptosporidium
87329
$10.57
Infectious agent antigen detection by immunoassay
							 technique, (
e.g.,
enzyme immunoassay [EIA], enzyme-linked
							 immunosorbent assay [ELISA], fluorescence immunoassay [FIA],
							 immunochemiluminometric assay [IMCA]) qualitative or semiquantitative;
							 giardia
87332
$10.57
Infectious agent antigen detection by immunoassay
							 technique, (
e.g
., enzyme immunoassay [EIA], enzyme-linked
							 immunosorbent assay [ELISA], fluorescence immunoassay [FIA],
							 immunochemiluminometric assay [IMCA]) qualitative or semiquantitative;
							 cytomegalovirus
87335
$11.17
Infectious agent antigen detection by immunoassay
							 technique, (
e.g
., enzyme immunoassay [EIA], enzyme-linked
							 immunosorbent assay [ELISA], fluorescence immunoassay [FIA],
							 immunochemiluminometric assay [IMCA]) qualitative or semiquantitative;
							 Escherichia coli 0157
87336
$14.11
Infectious agent antigen detection by immunoassay
							 technique, (
e.g
., enzyme immunoassay [EIA], enzyme-linked
							 immunosorbent assay [ELISA], fluorescence immunoassay [FIA],
							 immunochemiluminometric assay [IMCA]) qualitative or semiquantitative;
							 Entamoeba histolytica dispar group
87337
$10.57
Infectious agent antigen detection by immunoassay
							 technique, (
e.g
., enzyme immunoassay [EIA], enzyme-linked
							 immunosorbent assay [ELISA], fluorescence immunoassay [FIA],
							 immunochemiluminometric assay [IMCA]) qualitative or semiquantitative;
							 Entamoeba histolytica group
87338
$12.68
Infectious agent antigen detection by immunoassay
							 technique, (
e.g
., enzyme immunoassay [EIA], enzyme-linked
							 immunosorbent assay [ELISA], fluorescence immunoassay [FIA],
							 immunochemiluminometric assay [IMCA]) qualitative or semiquantitative;
							 Helicobacter pylori, stool
87339
$14.11
Infectious agent antigen detection by immunoassay
							 technique, (
e.g
., enzyme immunoassay [EIA], enzyme-linked
							 immunosorbent assay [ELISA], fluorescence immunoassay [FIA],
							 immunochemiluminometric assay [IMCA]) qualitative or semiquantitative;
							 Helicobacter pylori
87340
$9.11
Infectious agent antigen detection by immunoassay
							 technique, (
e.g
., enzyme immunoassay [EIA], enzyme-linked
							 immunosorbent assay [ELISA], fluorescence immunoassay [FIA],
							 immunochemiluminometric assay [IMCA]) qualitative or semiquantitative;
							 hepatitis B surface antigen (HBsAg)
87341
$9.11
Infectious agent antigen detection by immunoassay
							 technique, (
e.g
., enzyme immunoassay [EIA], enzyme-linked
							 immunosorbent assay [ELISA], fluorescence immunoassay [FIA],
							 immunochemiluminometric assay [IMCA]) qualitative or semiquantitative;
							 hepatitis B surface antigen (HBsAg) neutralization
87350
$10.17
Infectious agent antigen detection by immunoassay
							 technique, (
e.g
., enzyme immunoassay [EIA], enzyme-linked
							 immunosorbent assay [ELISA], fluorescence immunoassay [FIA],
							 immunochemiluminometric assay [IMCA]) qualitative or semiquantitative;
							 hepatitis Be antigen (HBeAg)
87380
$16.19
Infectious agent antigen detection by immunoassay
							 technique, (
e.g
., enzyme immunoassay [EIA], enzyme-linked
							 immunosorbent assay [ELISA], fluorescence immunoassay [FIA],
							 immunochemiluminometric assay [IMCA]) qualitative or semiquantitative;
							 hepatitis, delta agent
87385
$11.69
Infectious agent antigen detection by immunoassay
							 technique, (
e.g
., enzyme immunoassay [EIA], enzyme-linked
							 immunosorbent assay [ELISA], fluorescence immunoassay [FIA],
							 immunochemiluminometric assay [IMCA]) qualitative or semiquantitative;
							 Histoplasma capsulatum
87389
$21.24
Infectious agent antigen detection by immunoassay
							 technique, (
e.g
., enzyme immunoassay [EIA], enzyme-linked
							 immunosorbent assay [ELISA], fluorescence immunoassay [FIA],
							 immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; HIV-1
							 antigen(s), with HIV-1 and HIV-2 antibodies, single result
87390
$21.22
Infectious agent antigen detection by immunoassay
							 technique, (
e.g
., enzyme immunoassay [EIA], enzyme-linked
							 immunosorbent assay [ELISA], fluorescence immunoassay [FIA],
							 immunochemiluminometric assay [IMCA]) qualitative or semiquantitative;
							 HIV-1
87391
$19.32
Infectious agent antigen detection by immunoassay
							 technique, (
e.g
., enzyme immunoassay [EIA], enzyme-linked
							 immunosorbent assay [ELISA], fluorescence immunoassay [FIA],
							 immunochemiluminometric assay [IMCA]) qualitative or semiquantitative;
							 HIV-2
87400
$12.46
Infectious agent antigen detection by immunoassay
							 technique, (
e.g
., enzyme immunoassay [EIA], enzyme-linked
							 immunosorbent assay [ELISA], fluorescence immunoassay [FIA],
							 immunochemiluminometric assay [IMCA]) qualitative or semiquantitative;
							 Influenza, A or B, each
87420
$12.27
Infectious agent antigen detection by immunoassay
							 technique, (
e.g
., enzyme immunoassay [EIA], enzyme-linked
							 immunosorbent assay [ELISA], fluorescence immunoassay [FIA],
							 immunochemiluminometric assay [IMCA]) qualitative or semiquantitative;
							 respiratory syncytial virus
87425
$10.57
Infectious agent antigen detection by immunoassay
							 technique, (
e.g
., enzyme immunoassay [EIA], enzyme-linked
							 immunosorbent assay [ELISA], fluorescence immunoassay [FIA],
							 immunochemiluminometric assay [IMCA]) qualitative or semiquantitative;
							 rotavirus
87426
$35.33
Infectious agent antigen detection by immunoassay
							 technique, (
e.g
., enzyme immunoassay [EIA], enzyme-linked
							 immunosorbent assay [ELISA], fluorescence immunoassay [FIA],
							 immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe
							 acute respiratory syndrome coronavirus (
e.g
., SARS-CoV,
							 SARS-CoV-2 [COVID-19])
87427
$10.57
Infectious agent antigen detection by immunoassay
							 technique, (
e.g
., enzyme immunoassay [EIA], enzyme-linked
							 immunosorbent assay [ELISA], fluorescence immunoassay [FIA],
							 immunochemiluminometric assay [IMCA]) qualitative or semiquantitative;
							 Shiga-like toxin
87428
$63.59
Infectious agent antigen detection by immunoassay
							 technique, (
e.g
., enzyme immunoassay [EIA], enzyme-linked
							 immunosorbent assay [ELISA], fluorescence immunoassay [FIA],
							 immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe
							 acute respiratory syndrome coronavirus (
e.g
., SARS-CoV,
							 SARS-CoV-2 [COVID-19]) and influenza virus types A and B
87430
$14.83
Infectious agent antigen detection by immunoassay
							 technique, (
e.g
., enzyme immunoassay [EIA], enzyme-linked
							 immunosorbent assay [ELISA], fluorescence immunoassay [FIA],
							 immunochemiluminometric assay [IMCA]) qualitative or semiquantitative;
							 Streptococcus, group A
87449
$10.57
Infectious agent antigen detection by immunoassay
							 technique, (
e.g
., enzyme immunoassay [EIA], enzyme-linked
							 immunosorbent assay [ELISA], fluorescence immunoassay [FIA],
							 immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; not
							 otherwise specified, each organism
87451
$9.27
Infectious agent antigen detection by immunoassay
							 technique, (
e.g
., enzyme immunoassay [EIA], enzyme-linked
							 immunosorbent assay [ELISA], fluorescence immunoassay [FIA],
							 immunochemiluminometric assay [IMCA]) qualitative or semiquantitative;
							 polyvalent for multiple organisms, each polyvalent antiserum
87471
$30.95
Infectious agent detection by nucleic acid (DNA or
							 RNA); Bartonella henselae and Bartonella quintana, amplified probe
							 technique
87472
$37.78
Infectious agent detection by nucleic acid (DNA or
							 RNA); Bartonella henselae and Bartonella quintana, quantification
87475
$17.68
Infectious agent detection by nucleic acid (DNA or
							 RNA); Borrelia burgdorferi, direct probe technique
87476
$30.95
Infectious agent detection by nucleic acid (DNA or
							 RNA); Borrelia burgdorferi, amplified probe technique
87480
$17.68
Infectious agent detection by nucleic acid (DNA or
							 RNA); Candida species, direct probe technique
87481
$30.95
Infectious agent detection by nucleic acid (DNA or
							 RNA); Candida species, amplified probe technique
87482
$49.16
Infectious agent detection by nucleic acid (DNA or
							 RNA); Candida species, quantification
87483
$367.60
Infectious agent detection by nucleic acid (DNA or
							 RNA); central nervous system pathogen (
e.g
., Neisseria
							 meningitidis, Streptococcus pneumoniae, Listeria, Haemophilus influenzae, E.
							 coli, Streptococcus agalactiae, enterovirus, human parechovirus, herpes simplex
							 virus type 1 and 2, human herpesvirus 6, cytomegalovirus, varicella zoster
							 virus, Cryptococcus), includes multiplex reverse transcription, when performed,
							 and multiplex amplified probe technique, multiple types or subtypes, 12-25
							 targets
87485
$17.68
Infectious agent detection by nucleic acid (DNA or
							 RNA); Chlamydia pneumoniae, direct probe technique
87486
$30.95
Infectious agent detection by nucleic acid (DNA or
							 RNA); Chlamydia pneumoniae, amplified probe technique
87487
$37.78
Infectious agent detection by nucleic acid (DNA or
							 RNA); Chlamydia pneumoniae, quantification
87490
$20.07
Infectious agent detection by nucleic acid (DNA or
							 RNA); Chlamydia trachomatis, direct probe technique
87491
$30.95
Infectious agent detection by nucleic acid (DNA or
							 RNA); Chlamydia trachomatis, amplified probe technique
87492
$47.16
Infectious agent detection by nucleic acid (DNA or
							 RNA); Chlamydia trachomatis, quantification
87493
$32.87
Infectious agent detection by nucleic acid (DNA or
							 RNA); Clostridium difficile, toxin gene(s), amplified probe
							 technique
87495
$26.49
Infectious agent detection by nucleic acid (DNA or
							 RNA); cytomegalovirus, direct probe technique
87496
$30.95
Infectious agent detection by nucleic acid (DNA or
							 RNA); cytomegalovirus, amplified probe technique
87497
$37.78
Infectious agent detection by nucleic acid (DNA or
							 RNA); cytomegalovirus, quantification
87498
$30.95
Infectious agent detection by nucleic acid (DNA or
							 RNA); enterovirus, amplified probe technique, includes reverse transcription
							 when performed
87500
$30.95
Infectious agent detection by nucleic acid (DNA or
							 RNA); vancomycin resistance (
e.g
., enterococcus species van A,
							 van B), amplified probe technique
87501
$45.26
Infectious agent detection by nucleic acid (DNA or
							 RNA); influenza virus, includes reverse transcription, when performed, and
							 amplified probe technique, each type or subtype
87502
$84.50
Infectious agent detection by nucleic acid (DNA or
							 RNA); influenza virus, for multiple types or sub-types, includes multiplex
							 reverse transcription, when performed, and multiplex amplified probe technique,
							 first 2 types or sub-types
87503
$25.77
Infectious agent detection by nucleic acid (DNA or
							 RNA); influenza virus, for multiple types or sub-types, includes multiplex
							 reverse transcription, when performed, and multiplex amplified probe technique,
							 each additional influenza virus type or sub-type beyond 2 (List separately in
							 addition to code for primary procedure)
87505
$113.15
Infectious agent detection by nucleic acid (DNA or
							 RNA); gastrointestinal pathogen (
e.g
., Clostridium difficile,
							 E. coli, Salmonella, Shigella, norovirus, Giardia), includes multiplex reverse
							 transcription, when performed, and multiplex amplified probe technique,
							 multiple types or subtypes, 3-5 targets
87506
$231.96
Infectious agent detection by nucleic acid (DNA or
							 RNA); gastrointestinal pathogen (
e.g.,
Clostridium difficile,
							 E. coli, Salmonella, Shigella, norovirus, Giardia), includes multiplex reverse
							 transcription, when performed, and multiplex amplified probe technique,
							 multiple types or subtypes, 6-11 targets
87507
$367.60
Infectious agent detection by nucleic acid (DNA or
							 RNA); gastrointestinal pathogen (
e.g
., Clostridium difficile,
							 E. coli, Salmonella, Shigella, norovirus, Giardia), includes multiplex reverse
							 transcription, when performed, and multiplex amplified probe technique,
							 multiple types or subtypes, 12-25 targets
87510
$17.68
Infectious agent detection by nucleic acid (DNA or
							 RNA); Gardnerella vaginalis, direct probe technique
87511
$30.95
Infectious agent detection by nucleic acid (DNA or
							 RNA); Gardnerella vaginalis, amplified probe technique
87512
$36.83
Infectious agent detection by nucleic acid (DNA or
							 RNA); Gardnerella vaginalis, quantification
87516
$30.95
Infectious agent detection by nucleic acid (DNA or
							 RNA); hepatitis B virus, amplified probe technique
87517
$37.78
Infectious agent detection by nucleic acid (DNA or
							 RNA); hepatitis B virus, quantification
87520
$27.54
Infectious agent detection by nucleic acid (DNA or
							 RNA); hepatitis C, direct probe technique
87521
$30.95
Infectious agent detection by nucleic acid (DNA or
							 RNA); hepatitis C, amplified probe technique, includes reverse transcription
							 when performed
87522
$37.78
Infectious agent detection by nucleic acid (DNA or
							 RNA); hepatitis C, quantification, includes reverse transcription when
							 performed
87525
$26.28
Infectious agent detection by nucleic acid (DNA or
							 RNA); hepatitis G, direct probe technique
87526
$34.63
Infectious agent detection by nucleic acid (DNA or
							 RNA); hepatitis G, amplified probe technique
87527
$36.83
Infectious agent detection by nucleic acid (DNA or
							 RNA); hepatitis G, quantification
87528
$17.68
Infectious agent detection by nucleic acid (DNA or
							 RNA); Herpes simplex virus, direct probe technique
87529
$30.95
Infectious agent detection by nucleic acid (DNA or
							 RNA); Herpes simplex virus, amplified probe technique
87530
$37.78
Infectious agent detection by nucleic acid (DNA or
							 RNA); Herpes simplex virus, quantification
87531
$51.16
Infectious agent detection by nucleic acid (DNA or
							 RNA); Herpes virus-6, direct probe technique
87532
$30.95
Infectious agent detection by nucleic acid (DNA or
							 RNA); Herpes virus-6, amplified probe technique
87533
$36.83
Infectious agent detection by nucleic acid (DNA or
							 RNA); Herpes virus-6, quantification
87534
$19.33
Infectious agent detection by nucleic acid (DNA or
							 RNA); HIV-1, direct probe technique
87535
$30.95
Infectious agent detection by nucleic acid (DNA or
							 RNA); HIV-1, amplified probe technique, includes reverse transcription when
							 performed
87536
$75.06
Infectious agent detection by nucleic acid (DNA or
							 RNA); HIV-1, quantification, includes reverse transcription when
							 performed
87537
$19.33
Infectious agent detection by nucleic acid (DNA or
							 RNA); HIV-2, direct probe technique
87538
$30.95
Infectious agent detection by nucleic acid (DNA or
							 RNA); HIV-2, amplified probe technique, includes reverse transcription when
							 performed
87539
$51.70
Infectious agent detection by nucleic acid (DNA or
							 RNA); HIV-2, quantification, includes reverse transcription when
							 performed
87540
$17.68
Infectious agent detection by nucleic acid (DNA or
							 RNA); Legionella pneumophila, direct probe technique
87541
$30.95
Infectious agent detection by nucleic acid (DNA or
							 RNA); Legionella pneumophila, amplified probe technique
87542
$36.83
Infectious agent detection by nucleic acid (DNA or
							 RNA); Legionella pneumophila, quantification
87550
$17.68
Infectious agent detection by nucleic acid (DNA or
							 RNA); Mycobacteria species, direct probe technique
87551
$42.55
Infectious agent detection by nucleic acid (DNA or
							 RNA); Mycobacteria species, amplified probe technique
87552
$37.78
Infectious agent detection by nucleic acid (DNA or
							 RNA); Mycobacteria species, quantification
87555
$23.71
Infectious agent detection by nucleic acid (DNA or
							 RNA); Mycobacteria tuberculosis, direct probe technique
87556
$36.76
Infectious agent detection by nucleic acid (DNA or
							 RNA); Mycobacteria tuberculosis, amplified probe technique
87557
$37.78
Infectious agent detection by nucleic acid (DNA or
							 RNA); Mycobacteria tuberculosis, quantification
87560
$24.07
Infectious agent detection by nucleic acid (DNA or
							 RNA); Mycobacteria avium-intracellulare, direct probe technique
87561
$30.95
Infectious agent detection by nucleic acid (DNA or
							 RNA); Mycobacteria avium-intracellulare, amplified probe technique
87562
$37.78
Infectious agent detection by nucleic acid (DNA or
							 RNA); Mycobacteria avium-intracellulare, quantification
87563
$30.95
Infectious agent detection by nucleic acid (DNA or
							 RNA); Mycoplasma genitalium, amplified probe technique
87580
$17.68
Infectious agent detection by nucleic acid (DNA or
							 RNA); Mycoplasma pneumoniae, direct probe technique
87581
$30.95
Infectious agent detection by nucleic acid (DNA or
							 RNA); Mycoplasma pneumoniae, amplified probe technique
87582
$266.91
Infectious agent detection by nucleic acid (DNA or
							 RNA); Mycoplasma pneumoniae, quantification
87590
$23.71
Infectious agent detection by nucleic acid (DNA or
							 RNA); Neisseria gonorrhoeae, direct probe technique
87591
$30.95
Infectious agent detection by nucleic acid (DNA or
							 RNA); Neisseria gonorrhoeae, amplified probe technique
87592
$37.78
Infectious agent detection by nucleic acid (DNA or
							 RNA); Neisseria gonorrhoeae, quantification
87623
$30.95
Infectious agent detection by nucleic acid (DNA or
							 RNA); Human Papillomavirus (HPV), low-risk types (
e.g
., 6, 11,
							 42, 43, 44)
87624
$30.95
Infectious agent detection by nucleic acid (DNA or
							 RNA); Human Papillomavirus (HPV), high-risk types (
e.g
., 16,
							 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68)
87625
$35.77
Infectious agent detection by nucleic acid (DNA or
							 RNA); Human Papillomavirus (HPV), types 16 and 18 only, includes type 45, if
							 performed
87631
$125.80
Infectious agent detection by nucleic acid (DNA or
							 RNA); respiratory virus (
e.g.,
adenovirus, influenza virus,
							 coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus,
							 rhinovirus), includes multiplex reverse transcription, when performed, and
							 multiplex amplified probe technique, multiple types or subtypes, 3-5
							 targets
87632
$192.33
Infectious agent detection by nucleic acid (DNA or
							 RNA); respiratory virus (
e.g
., adenovirus, influenza virus,
							 coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus,
							 rhinovirus), includes multiplex reverse transcription, when performed, and
							 multiplex amplified probe technique, multiple types or subtypes, 6-11
							 targets
87633
$367.60
Infectious agent detection by nucleic acid (DNA or
							 RNA); respiratory virus (
e.g
., adenovirus, influenza virus,
							 coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus,
							 rhinovirus), includes multiplex reverse transcription, when performed, and
							 multiplex amplified probe technique, multiple types or subtypes, 12-25
							 targets
87634
$61.92
Infectious agent detection by nucleic acid (DNA or
							 RNA); respiratory syncytial virus, amplified probe technique
87635
$51.31
Infectious agent detection by nucleic acid (DNA or
							 RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus
							 disease [COVID-19]), amplified probe technique
87636
$142.63
Infectious agent detection by nucleic acid (DNA or
							 RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus
							 disease [COVID-19]) and influenza virus types A and B, multiplex amplified
							 probe technique
87637
$142.63
Infectious agent detection by nucleic acid (DNA or
							 RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus
							 disease [COVID-19]), influenza virus types A and B, and respiratory syncytial
							 virus, multiplex amplified probe technique
87640
$30.95
Infectious agent detection by nucleic acid (DNA or
							 RNA); Staphylococcus aureus, amplified probe technique
87641
$30.95
Infectious agent detection by nucleic acid (DNA or
							 RNA); Staphylococcus aureus, methicillin resistant, amplified probe
							 technique
87650
$17.68
Infectious agent detection by nucleic acid (DNA or
							 RNA); Streptococcus, group A, direct probe technique
87651
$30.95
Infectious agent detection by nucleic acid (DNA or
							 RNA); Streptococcus, group A, amplified probe technique
87652
$36.83
Infectious agent detection by nucleic acid (DNA or
							 RNA); Streptococcus, group A, quantification
87653
$30.95
Infectious agent detection by nucleic acid (DNA or
							 RNA); Streptococcus, group B, amplified probe technique
87660
$17.68
Infectious agent detection by nucleic acid (DNA or
							 RNA); Trichomonas vaginalis, direct probe technique
87661
$30.95
Infectious agent detection by nucleic acid (DNA or
							 RNA); Trichomonas vaginalis, amplified probe technique
87662
$45.26
Infectious agent detection by nucleic acid (DNA or
							 RNA); Zika virus, amplified probe technique
87797
$26.49
Infectious agent detection by nucleic acid (DNA or
							 RNA), not otherwise specified; direct probe technique, each
							 organism
87798
$30.95
Infectious agent detection by nucleic acid (DNA or
							 RNA), not otherwise specified; amplified probe technique, each
							 organism
87799
$37.78
Infectious agent detection by nucleic acid (DNA or
							 RNA), not otherwise specified; quantification, each organism
87800
$38.52
Infectious agent detection by nucleic acid (DNA or
							 RNA), multiple organisms; direct probe(s) technique
87801
$61.92
Infectious agent detection by nucleic acid (DNA or
							 RNA), multiple organisms; amplified probe(s) technique
87802
$11.23
Infectious agent antigen detection by immunoassay
							 with direct optical (
i.e.
, visual) observation; Streptococcus,
							 group B
87803
$14.11
Infectious agent antigen detection by immunoassay
							 with direct optical (
i.e.
, visual) observation; Clostridium
							 difficile toxin A
87804
$14.60
Infectious agent antigen detection by immunoassay
							 with direct optical (
i.e.
, visual) observation;
							 Influenza
87806
$28.90
Infectious agent antigen detection by immunoassay
							 with direct optical (
i.e.
, visual) observation; HIV-1
							 antigen(s), with HIV-1 and HIV-2 antibodies
87807
$11.55
Infectious agent antigen detection by immunoassay
							 with direct optical (
i.e.
, visual) observation; respiratory
							 syncytial virus
87808
$13.49
Infectious agent antigen detection by immunoassay
							 with direct optical (
i.e.
, visual) observation; Trichomonas
							 vaginalis
87809
$19.19
Infectious agent antigen detection by immunoassay
							 with direct optical (
i.e.
, visual) observation;
							 adenovirus
87810
$31.13
Infectious agent antigen detection by immunoassay
							 with direct optical (
i.e.
, visual) observation; Chlamydia
							 trachomatis
87811
$41.38
Infectious agent antigen detection by immunoassay
							 with direct optical
(i.e.
, visual) observation; severe acute
							 respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease
							 [COVID-19])
87850
$21.66
Infectious agent antigen detection by immunoassay
							 with direct optical (
i.e.
, visual) observation; Neisseria
							 gonorrhoeae
87880
$14.58
Infectious agent antigen detection by immunoassay
							 with direct optical (
i.e.
, visual) observation; Streptococcus,
							 group A
87899
$14.17
Infectious agent antigen detection by immunoassay
							 with direct optical (
i.e.
, visual) observation; not otherwise
							 specified
87900
$114.97
Infectious agent drug susceptibility phenotype
							 prediction using regularly updated genotypic bioinformatics
87901
$227.07
Infectious agent genotype analysis by nucleic acid
							 (DNA or RNA); HIV-1, reverse transcriptase and protease regions
87902
$227.07
Infectious agent genotype analysis by nucleic acid
							 (DNA or RNA); Hepatitis C virus
87903
$431.00
Infectious agent phenotype analysis by nucleic acid
							 (DNA or RNA) with drug resistance tissue culture analysis, HIV 1; first through
							 10 drugs tested
87904
$22.99
Infectious agent phenotype analysis by nucleic acid
							 (DNA or RNA) with drug resistance tissue culture analysis, HIV 1; each
							 additional drug tested (List separately in addition to code for primary
							 procedure)
87905
$10.78
Infectious agent enzymatic activity other than virus
							 (
e.g.,
sialidase activity in vaginal fluid)
87906
$113.54
Infectious agent genotype analysis by nucleic acid
							 (DNA or RNA); HIV-1, other region (
e.g
., integrase,
							 fusion)
87910
$227.07
Infectious agent genotype analysis by nucleic acid
							 (DNA or RNA); cytomegalovirus
87912
$227.07
Infectious agent genotype analysis by nucleic acid
							 (DNA or RNA); Hepatitis B virus
87999
I.C.
Unlisted microbiology procedure
Anatomic Pathology
88000
I.C.
Necropsy (autopsy), gross examination only; without
							 CNS
88005
I.C.
Necropsy (autopsy), gross examination only; with
							 brain
88007
I.C.
Necropsy (autopsy), gross examination only; with
							 brain and spinal cord
88012
I.C.
Necropsy (autopsy), gross examination only; infant
							 with brain
88014
I.C.
Necropsy (autopsy), gross examination only; stillborn
							 or newborn with brain
88016
I.C.
Necropsy (autopsy), gross examination only; macerated
							 stillborn
88020
I.C.
Necropsy (autopsy), gross and microscopic; without
							 CNS
88025
I.C.
Necropsy (autopsy), gross and microscopic; with
							 brain
88027
I.C.
Necropsy (autopsy), gross and microscopic; with brain
							 and spinal cord
88028
I.C.
Necropsy (autopsy), gross and microscopic; infant
							 with brain
88029
I.C.
Necropsy (autopsy), gross and microscopic; stillborn
							 or newborn with brain
88036
I.C.
Necropsy (autopsy), limited, gross and/or
							 microscopic; regional
88037
I.C.
Necropsy (autopsy), limited, gross and/or
							 microscopic; single organ
88040
I.C.
Necropsy (autopsy); forensic examination
88045
I.C.
Necropsy (autopsy); coroner's call
88099
I.C.
Unlisted necropsy (autopsy) procedure
Cytopathology
88130
$15.86
Sex chromatin identification; Barr bodies
88140
$7.05
Sex chromatin identification; peripheral blood smear,
							 polymorphonuclear drumsticks
88142
$17.87
Cytopathology, cervical or vaginal (any reporting
							 system), collected in preservative fluid, automated thin layer preparation;
							 manual screening under physician supervision
88143
$20.32
Cytopathology, cervical or vaginal (any reporting
							 system), collected in preservative fluid, automated thin layer preparation;
							 with manual screening and rescreening under physician supervision
88147
$44.59
Cytopathology smears, cervical or vaginal; screening
							 by automated system under physician supervision
88148
$14.11
Cytopathology smears, cervical or vaginal; screening
							 by automated system with manual rescreening under physician
							 supervision
88150
$13.36
Cytopathology, slides, cervical or vaginal; manual
							 screening under physician supervision
88152
$24.38
Cytopathology, slides, cervical or vaginal; with
							 manual screening and computer-assisted rescreening under physician
							 supervision
88153
$21.19
Cytopathology, slides, cervical or vaginal; with
							 manual screening and rescreening under physician supervision
88155
$12.92
Cytopathology, slides, cervical or vaginal,
							 definitive hormonal evaluation (
e.g.,
maturation index,
							 karyopyknotic index, estrogenic index) (List separately in addition to code[s]
							 for other technical and interpretation services)
88164
$13.36
Cytopathology, slides, cervical or vaginal (the
							 Bethesda System); manual screening under physician supervision
88165
$37.24
Cytopathology, slides, cervical or vaginal (the
							 Bethesda System); with manual screening and rescreening under physician
							 supervision
88166
$13.36
Cytopathology, slides, cervical or vaginal (the
							 Bethesda System); with manual screening and computer-assisted rescreening under
							 physician supervision
88167
$13.36
Cytopathology, slides, cervical or vaginal (the
							 Bethesda System); with manual screening and computer-assisted rescreening using
							 cell selection and review under physician supervision
88174
$22.38
Cytopathology, cervical or vaginal (any reporting
							 system), collected in preservative fluid, automated thin layer preparation;
							 screening by automated system, under physician supervision
88175
$23.47
Cytopathology, cervical or vaginal (any reporting
							 system), collected in preservative fluid, automated thin layer preparation;
							 with screening by automated system and manual rescreening or review, under
							 physician supervision
Cytogenic Studies
88230
$102.74
Tissue culture for non-neoplastic disorders;
							 lymphocyte
88233
$124.12
Tissue culture for non-neoplastic disorders; skin or
							 other solid tissue biopsy
88235
$132.56
Tissue culture for non-neoplastic disorders; amniotic
							 fluid or chorionic villus cells
88237
$126.79
Tissue culture for neoplastic disorders; bone marrow,
							 blood cells
88239
$130.11
Tissue culture for neoplastic disorders; solid
							 tumor
88240
$11.53
Cryopreservation, freezing and storage of cells, each
							 cell line
88241
$10.66
Thawing and expansion of frozen cells, each
							 aliquot
88245
$152.74
Chromosome analysis for breakage syndromes; baseline
							 Sister Chromatid Exchange (SCE), 20-25 cells
88248
$152.74
Chromosome analysis for breakage syndromes; baseline
							 breakage, score 50-100 cells, count 20 cells, 2 karyotypes
							 (
e.g
., for ataxia telangiectasia, Fanconi anemia, fragile
							 X)
88249
$152.74
Chromosome analysis for breakage syndromes; score 100
							 cells, clastogen stress (
e.g
., diepoxybutane, mitomycin C,
							 ionizing radiation, UV radiation)
88261
$233.15
Chromosome analysis; count 5 cells, 1 karyotype, with
							 banding
88262
$110.68
Chromosome analysis; count 15-20 cells, 2 karyotypes,
							 with banding
88263
$132.56
Chromosome analysis; count 45 cells for mosaicism, 2
							 karyotypes, with banding
88264
$127.55
Chromosome analysis; analyze 20-25 cells
88267
$166.32
Chromosome analysis, amniotic fluid or chorionic
							 villus, count 15 cells, 1 karyotype, with banding
88269
$153.17
Chromosome analysis, in situ for amniotic fluid
							 cells, count cells from 6-12 colonies, 1 karyotype, with banding
88271
$18.89
Molecular cytogenetics; DNA probe, each
							 (
e.g.,
FISH)
88272
$35.90
Molecular cytogenetics; chromosomal in situ
							 hybridization, analyze 3-5 cells (
e.g
., for derivatives and
							 markers)
88273
$30.70
Molecular cytogenetics; chromosomal in situ
							 hybridization, analyze 10-30 cells (
e.g
., for
							 microdeletions)
88274
$37.38
Molecular cytogenetics; interphase in situ
							 hybridization, analyze 25-99 cells
88275
$45.15
Molecular cytogenetics; interphase in situ
							 hybridization, analyze 100-300 cells
88280
$29.52
Chromosome analysis; additional karyotypes, each
							 study
88283
$60.51
Chromosome analysis; additional specialized banding
							 technique (
e.g
., NOR, C-banding)
88285
$23.73
Chromosome analysis; additional cells counted, each
							 study
88289
$30.37
Chromosome analysis; additional high resolution
							 study
88371
$19.61
Protein analysis of tissue by Western Blot, with
							 interpretation and report;
88372
$23.13
Protein analysis of tissue by Western Blot, with
							 interpretation and report; immunological probe for band identification,
							 each
In vivo
,
							 (
e.g
., Transcutaneous) Laboratory
							 Procedures
88720
$4.43
Bilirubin, total, transcutaneous
88738
$4.43
Hemoglobin (Hgb), quantitative,
							 transcutaneous
88740
$8.26
Hemoglobin, quantitative, transcutaneous, per day;
							 carboxyhemoglobin
88741
$8.26
Hemoglobin, quantitative, transcutaneous, per day;
							 methemoglobin
Other Procedures
89050
$4.16
Cell count, miscellaneous body fluids
							 (
e.g
., cerebrospinal fluid, joint fluid), except
							 blood;
89051
$4.94
Cell count, miscellaneous body fluids
							 (
e.g
., cerebrospinal fluid, joint fluid), except blood; with
							 differential count
89055
$3.77
Leukocyte assessment, fecal, qualitative or
							 semiquantitative
89060
$6.47
Crystal identification by light microscopy with or
							 without polarizing lens analysis, tissue or any body fluid (except
							 urine)
89125
$5.19
Fat stain, feces, urine, or respiratory
							 secretions
89160
$4.28
Meat fibers, feces
89190
$5.11
Nasal smear for eosinophils
Reproductive Medicine
							 Procedures
89250
I.C.
Culture of oocyte(s)/embryo(s), less than four
							 days;
89251
I.C.
Culture of oocyte(s)/embryo(s), less than four days;
							 with co-culture of oocyte(s)/embryos
89253
I.C.
Assisted embryo hatching, microtechniques (any
							 method)
89254
I.C.
Oocyte identification from follicular
							 fluid
89255
I.C.
Preparation of embryo for transfer (any
							 method)
89257
I.C.
Sperm identification from aspiration (other than
							 seminal fluid)
89258
I.C.
Cryopreservation; embryo(s)
89259
I.C.
Cryopreservation; sperm
89264
I.C.
Sperm identification from testis tissue, fresh or
							 cryopreserved
89268
I.C.
Insemination of oocytes
89272
I.C.
Extended culture of oocyte(s)/embryo(s), 4-7
							 days
89280
I.C.
Assisted oocyte fertilization, microtechnique; less
							 than or equal to ten oocytes
89281
I.C.
Assisted oocyte fertilization, microtechnique;
							 greater than ten oocytes
89290
I.C.
Biopsy, oocyte polar body or embryo blastomere,
							 microtechnique (for pre-implantation genetic diagnosis); less than or equal to
							 five embryos
89291
I.C.
Biopsy, oocyte polar body or embryo blastomere,
							 microtechnique (for pre-implantation genetic diagnosis); greater than five
							 embryos
89300
$8.68
Semen analysis; presence and/or motility of sperm
							 including Huhner test (post coital)
89310
$7.59
Semen analysis; motility and count (not including
							 Huhner test)
89320
$10.86
Semen analysis; volume, count, motility, and
							 differential
89321
$10.63
Semen analysis; sperm presence and motility of sperm,
							 if performed
89322
$13.67
Semen analysis; volume, count, motility, and
							 differential using strict morphologic criteria (
e.g
.,
							 Kruger)
89325
$9.41
Sperm antibodies
89329
$17.28
Sperm evaluation; hamster penetration
							 test
89330
$9.16
Sperm evaluation; cervical mucus penetration test,
							 with or without spinnbarkeit test
89331
$17.28
Sperm evaluation, for retrograde ejaculation, urine
							 (sperm concentration, motility, and morphology, as indicated)
89335
I.C.
Cryopreservation, reproductive tissue,
							 testicular
89342
I.C.
Storage (per year); embryo(s)
89343
I.C.
Storage (per year); sperm/semen
89344
I.C.
Storage (per year); reproductive tissue,
							 testicular/ovarian
89346
I.C.
Storage (per year); oocyte(s)
89352
I.C.
Thawing of cryopreserved; embryo(s)
89353
I.C.
Thawing of cryopreserved; sperm/semen, each
							 aliquot
89354
I.C.
Thawing of cryopreserved; reproductive tissue,
							 testicular/ovarian
89356
I.C.
Thawing of cryopreserved; oocytes, each
							 aliquot
89398
I.C.
Unlisted reproductive medicine laboratory
							 procedure
Other Pathology and
							 Laboratory
36415
$2.65
Collection of venous blood by
							 venipuncture
78267
$9.75
Urea breath test, C-14 (isotopic); acquisition for
							 analysis
78268
$83.27
Urea breath test, C-14 (isotopic);
							 analysis
81105
$107.80
Human Platelet Antigen 1 genotyping (HPA-1), ITGB3
							 (integrin, beta 3 [platelet glycoprotein IIIa], antigen CD61 [GPIIIa])
							 (
e.g
., neonatal alloimmune thrombocytopenia [NAIT],
							 post-transfusion purpura), gene analysis, common variant, HPA-1a/b
							 (L33P)
81106
$107.80
Human Platelet Antigen 2 genotyping (HPA-2), GP1BA
							 (glycoprotein Ib [platelet], alpha polypeptide [GPIba]) (
e.g
.,
							 neonatal alloimmune thrombocytopenia [NAIT], post-transfusion purpura), gene
							 analysis, common variant, HPA-2a/b (T145M)
81107
$107.80
Human Platelet Antigen 3 genotyping (HPA-3), ITGA2B
							 (integrin, alpha 2b [platelet glycoprotein IIb of IIb/IIIa complex], antigen
							 CD41 [GPIIb]) (
e.g
., neonatal alloimmune thrombocytopenia
							 [NAIT], post-transfusion purpura), gene analysis, common variant, HPA-3a/b
							 (I843S)
81108
$107.80
Human Platelet Antigen 4 genotyping (HPA-4), ITGB3
							 (integrin, beta 3 [platelet glycoprotein IIIa], antigen CD61 [GPIIIa])
							 (
e.g
., neonatal alloimmune thrombocytopenia [NAIT],
							 post-transfusion purpura), gene analysis, common variant, HPA-4a/b
							 (R143Q)
81109
$107.80
Human Platelet Antigen 5 genotyping (HPA-5), ITGA2
							 (integrin, alpha 2 [CD49B, alpha 2 subunit of VLA-2 receptor] [GPIa])
							 (
e.g.,
neonatal alloimmune thrombocytopenia [NAIT],
							 post-transfusion purpura), gene analysis, common variant
							 (
e.g.,
HPA-5a/b (K505E))
81110
$107.80
Human Platelet Antigen 6 genotyping (HPA-6w), ITGB3
							 (integrin, beta 3 [platelet glycoprotein IIIa, antigen CD61] [GPIIIa])
							 (
e.g
., neonatal alloimmune thrombocytopenia [NAIT],
							 post-transfusion purpura), gene analysis, common variant, HPA-6a/b
							 (R489Q)
81111
$107.80
Human Platelet Antigen 9 genotyping (HPA-9w), ITGA2B
							 (integrin, alpha 2b [platelet glycoprotein IIb of IIb/IIIa complex, antigen
							 CD41] [GPIIb]) (
e.g
., neonatal alloimmune thrombocytopenia
							 [NAIT], post-transfusion purpura), gene analysis, common variant, HPA-9a/b
							 (V837M)
81112
$107.80
Human Platelet Antigen 15 genotyping (HPA-15), CD109
							 (CD109 molecule) (
e.g
., neonatal alloimmune thrombocytopenia
							 [NAIT], post-transfusion purpura), gene analysis, common variant, HPA-15a/b
							 (S682Y)
81120
$170.45
IDH1 (isocitrate dehydrogenase 1 [NADP+], soluble)
							 (
e.g
., glioma), common variants (
e.g
., R132H,
							 R132C)
81121
$260.89
IDH2 (isocitrate dehydrogenase 2 [NADP+],
							 mitochondrial) (
e.g
., glioma), common variants
							 (
e.g
., R140W, R172M)
81161
$246.08
DMD (dystrophin) (
e.g
.,
							 Duchenne/Becker muscular dystrophy) deletion analysis, and duplication
							 analysis, if performed
81162
$1,609.54
BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2,
							 DNA repair associated) (
e.g
., hereditary breast and ovarian
							 cancer) gene analysis; full sequence analysis and full duplication/deletion
							 analysis (
i.e.
, detection of large gene
							 rearrangements)
81163
$412.78
BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2,
							 DNA repair associated) (
e.g
., hereditary breast and ovarian
							 cancer) gene analysis; full sequence analysis
81164
$515.29
BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2,
							 DNA repair associated) (
e.g
., hereditary breast and ovarian
							 cancer) gene analysis; full duplication/deletion analysis
							 (
i.e.
, detection of large gene rearrangements)
81165
$249.50
BRCA1 (BRCA1, DNA repair associated)
							 (
e.g
., hereditary breast and ovarian cancer) gene analysis;
							 full sequence analysis
81166
$265.79
BRCA1 (BRCA1, DNA repair associated)
							 (
e.g
., hereditary breast and ovarian cancer) gene analysis;
							 full duplication/deletion analysis (
i.e.
, detection of large
							 gene rearrangements)
Other Pathology and
							 Laboratory
81167
$249.50
BRCA2 (BRCA2, DNA repair associated)
							 (
e.g.,
hereditary breast and ovarian cancer) gene analysis;
							 full duplication/deletion analysis (
i.e.
, detection of large
							 gene rearrangements)
81168
$182.85
CCND1/IGH (t(11;14)) (
e.g
., mantle
							 cell lymphoma) translocation analysis, major breakpoint, qualitative and
							 quantitative, if performed
81170
$264.60
ABL1 (ABL proto-oncogene 1, non-receptor tyrosine
							 kinase) (
e.g
., acquired imatinib tyrosine kinase inhibitor
							 resistance), gene analysis, variants in the kinase domain
81171
$120.83
AFF2 (AF4/FMR2 family, member 2 [FMR2])
							 (
e.g
., fragile X mental retardation 2 [FRAXE]) gene analysis;
							 evaluation to detect abnormal (
e.g
., expanded)
							 alleles
81172
$242.40
AFF2 (AF4/FMR2 family, member 2 [FMR2])
							 (
e.g
., fragile X mental retardation 2 [FRAXE]) gene analysis;
							 characterization of alleles (
e.g
., expanded size and
							 methylation status)
81173
$265.79
AR (androgen receptor) (
e.g
., spinal
							 and bulbar muscular atrophy, Kennedy disease, X chromosome inactivation) gene
							 analysis; full gene sequence
81174
$163.35
AR (androgen receptor) (
e.g
., spinal
							 and bulbar muscular atrophy, Kennedy disease, X chromosome inactivation) gene
							 analysis; known familial variant
81175
$596.67
ASXL1 (additional sex combs like 1, transcriptional
							 regulator) (
e.g
., myelodysplastic syndrome, myeloproliferative
							 neoplasms, chronic myelomonocytic leukemia), gene analysis; full gene
							 sequence
81176
$213.36
ASXL1 (additional sex combs like 1, transcriptional
							 regulator) (
e.g
., myelodysplastic syndrome, myeloproliferative
							 neoplasms, chronic myelomonocytic leukemia), gene analysis; targeted sequence
							 analysis (
e.g
., exon 12)
81177
$120.83
ATN1 (atrophin 1) (
e.g
.,
							 dentatorubral-pallidoluysian atrophy) gene analysis, evaluation to detect
							 abnormal (
e.g.,
expanded) alleles
81178
$120.83
ATXN1 (ataxin 1) (
e.g
.,
							 spinocerebellar ataxia) gene analysis, evaluation to detect abnormal
							 (
e.g
., expanded) alleles
81179
$120.83
ATXN2 (ataxin 2) (
e.g
.,
							 spinocerebellar ataxia) gene analysis, evaluation to detect abnormal
							 (
e.g
., expanded) alleles
81180
$120.83
ATXN3 (ataxin 3) (
e.g
.,
							 spinocerebellar ataxia, Machado-Joseph disease) gene analysis, evaluation to
							 detect abnormal (
e.g.,
expanded) alleles
81181
$120.83
ATXN7 (ataxin 7) (
e.g
.,
							 spinocerebellar ataxia) gene analysis, evaluation to detect abnormal
							 (
e.g
., expanded) alleles
81182
$120.83
ATXN8OS (ATXN8 opposite strand [non-protein coding])
							 (
e.g
., spinocerebellar ataxia) gene analysis, evaluation to
							 detect abnormal (
e.g
., expanded) alleles
81183
$120.83
ATXN10 (ataxin 10) (
e.g.,
spinocerebellar ataxia) gene analysis, evaluation to detect abnormal
							 (
e.g
., expanded) alleles
81184
$120.83
CACNA1A (calcium voltage-gated channel subunit alpha1
							 A) (
e.g
., spinocerebellar ataxia) gene analysis; evaluation to
							 detect abnormal (
e.g
., expanded) alleles
81185
$746.41
CACNA1A (calcium voltage-gated channel subunit alpha1
							 A) (
e.g.,
spinocerebellar ataxia) gene analysis; full gene
							 sequence
81186
$163.35
CACNA1A (calcium voltage-gated channel subunit alpha1
							 A) (
e.g.,
spinocerebellar ataxia) gene analysis; known
							 familial variant
81187
$120.83
CNBP (CCHC-type zinc finger nucleic acid binding
							 protein) (
e.g.,
myotonic dystrophy type 2) gene analysis,
							 evaluation to detect abnormal (
e.g.,
expanded)
							 alleles
81188
$120.83
CSTB (cystatin B) (
e.g.,
Unverricht-Lundborg disease) gene analysis; evaluation to detect abnormal
							 (
e.g
., expanded) alleles
81189
$242.40
CSTB (cystatin B) (
e.g
.,
							 Unverricht-Lundborg disease) gene analysis; full gene sequence
81190
$163.35
CSTB (cystatin B) (
e.g
.,
							 Unverricht-Lundborg disease) gene analysis; known familial
							 variant(s)
81191
$182.85
NTRK1 (neurotrophic receptor tyrosine kinase 1)
							 (
e.g
., solid tumors) translocation analysis
81192
$182.85
NTRK2 (neurotrophic receptor tyrosine kinase 2)
							 (
e.g
., solid tumors) translocation analysis
81193
$182.85
NTRK3 (neurotrophic receptor tyrosine kinase 3)
							 (
e.g
., solid tumors) translocation analysis
81194
$457.12
NTRK (neurotrophic-tropomyosin receptor tyrosine
							 kinase 1, 2, and 3) (
e.g
., solid tumors) translocation
							 analysis
81200
$41.67
ASPA (aspartoacylase) (
e.g
., Canavan
							 disease) gene analysis, common variants (
e.g
., E285A,
							 Y231X)
81201
$687.96
APC (adenomatous polyposis coli)
							 (
e.g
., familial adenomatosis polyposis [FAP], attenuated FAP)
							 gene analysis; full gene sequence
81202
$246.96
APC (adenomatous polyposis coli)
							 (
e.g
., familial adenomatosis polyposis [FAP], attenuated FAP)
							 gene analysis; known familial variants
81203
$176.40
APC (adenomatous polyposis coli)
							 (
e.g
., familial adenomatosis polyposis [FAP], attenuated FAP)
							 gene analysis; duplication/deletion variants
81204
$120.83
AR (androgen receptor) (
e.g
., spinal
							 and bulbar muscular atrophy, Kennedy disease, X chromosome inactivation) gene
							 analysis; characterization of alleles (
e.g
., expanded size or
							 methylation status)
81205
$83.78
BCKDHB (branched-chain keto acid dehydrogenase E1,
							 beta polypeptide) (
e.g
., maple syrup urine disease) gene
							 analysis, common variants (
e.g
., R183P, G278S,
							 E422X)
81206
$144.61
BCR/ABL1 (t(9;22)) (
e.g
., chronic
							 myelogenous leukemia) translocation analysis; major breakpoint, qualitative or
							 quantitative
81207
$127.75
BCR/ABL1 (t(9;22)) (
e.g.,
chronic
							 myelogenous leukemia) translocation analysis; minor breakpoint, qualitative or
							 quantitative
81208
$189.29
BCR/ABL1 (t(9;22)) (
e.g
., chronic
							 myelogenous leukemia) translocation analysis; other breakpoint, qualitative or
							 quantitative
81209
$34.67
BLM (Bloom syndrome, RecQ helicase-like)
							 (
e.g
., Bloom syndrome) gene analysis, 2281del6ins7
							 variant
81210
$154.70
BRAF (B-Raf proto-oncogene, serine/threonine kinase)
							 (
e.g
., colon cancer, melanoma), gene analysis, V600
							 variant(s)
81212
$388.08
BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2,
							 DNA repair associated) (
e.g
., hereditary breast and ovarian
							 cancer) gene analysis; 185delAG, 5385insC, 6174delT variants
81215
$330.97
BRCA1 (BRCA1, DNA repair associated)
							 (
e.g
., hereditary breast and ovarian cancer) gene analysis;
							 known familial variant
81216
$163.28
BRCA2 (BRCA2, DNA repair associated)
							 (
e.g
., hereditary breast and ovarian cancer) gene analysis;
							 full sequence analysis
81217
$330.97
BRCA2 (BRCA2, DNA repair associated)
							 (
e.g
., hereditary breast and ovarian cancer) gene analysis;
							 known familial variant
81218
$213.36
CEBPA (CCAAT/enhancer binding protein [C/EBP], alpha)
							 (
e.g
., acute myeloid leukemia), gene analysis, full gene
							 sequence
81219
$107.28
CALR (calreticulin) (
e.g
.,
							 myeloproliferative disorders), gene analysis, common variants in exon
							 9
81220
$490.92
CFTR (cystic fibrosis transmembrane conductance
							 regulator) (
e.g
., cystic fibrosis) gene analysis; common
							 variants (
e.g.,
ACMG/ACOG guidelines)
81221
$85.75
CFTR (cystic fibrosis transmembrane conductance
							 regulator) (
e.g
., cystic fibrosis) gene analysis; known
							 familial variants
81222
$383.73
CFTR (cystic fibrosis transmembrane conductance
							 regulator) (
e.g
., cystic fibrosis) gene analysis;
							 duplication/deletion variants
81223
$440.12
CFTR (cystic fibrosis transmembrane conductance
							 regulator) (
e.g
., cystic fibrosis) gene analysis; full gene
							 sequence
81224
$148.84
CFTR (cystic fibrosis transmembrane conductance
							 regulator) (
e.g
., cystic fibrosis) gene analysis; intron 8
							 poly-T analysis (
e.g.,
male infertility)
81225
$256.98
CYP2C19 (cytochrome P450, family 2, subfamily C,
							 polypeptide 19) (
e.g
., drug metabolism), gene analysis, common
							 variants (
e.g.,
*2, *3, *4, *8, *17)
81226
$397.70
CYP2D6 (cytochrome P450, family 2, subfamily D,
							 polypeptide 6) (
e.g
., drug metabolism), gene analysis, common
							 variants (
e.g
., *2, *3, *4, *5, *6, *9, *10, *17, *19, *29,
							 *35, *41, *1XN, *2XN, *4XN)
81227
$154.18
CYP2C9 (cytochrome P450, family 2, subfamily C,
							 polypeptide 9) (
e.g
., drug metabolism), gene analysis, common
							 variants (
e.g
., *2, *3, *5, *6)
81228
$793.80
Cytogenomic constitutional (genome-wide) microarray
							 analysis; interrogation of genomic regions for copy number variants
							 (
e.g
., bacterial artificial chromosome [BAC] or oligo-based
							 comparative genomic hybridization [CGH] microarray analysis)
81229
$1,023.12
Cytogenomic constitutional (genome-wide) microarray
							 analysis; interrogation of genomic regions for copy number and single
							 nucleotide polymorphism (SNP) variants for chromosomal
							 abnormalities
81230
$154.18
CYP3A4 (cytochrome P450 family 3 subfamily A member
							 4) (
e.g
., drug metabolism), gene analysis, common variant(s)
							 (
e.g
., *2, *22)
81231
$154.18
CYP3A5 (cytochrome P450 family 3 subfamily A member
							 5) (
e.g
., drug metabolism), gene analysis, common variants
							 (
e.g
., *2, *3, *4, *5, *6, *7)
81232
$154.18
DPYD (dihydropyrimidine dehydrogenase)
							 (
e.g
., 5-fluorouracil/5-FU and capecitabine drug metabolism),
							 gene analysis, common variant(s) (
e.g
., *2A, *4, *5,
							 *6)
81233
$154.70
BTK (Bruton's tyrosine kinase)
							 (
e.g
., chronic lymphocytic leukemia) gene analysis, common
							 variants (
e.g
., C481S, C481R, C481F)
81234
$120.83
DMPK (DM1 protein kinase) (
e.g
.,
							 myotonic dystrophy type 1) gene analysis; evaluation to detect abnormal
							 (expanded) alleles
81235
$286.28
EGFR (epidermal growth factor receptor)
							 (
e.g
., non-small cell lung cancer) gene analysis, common
							 variants (
e.g.,
exon 19 LREA deletion, L858R, T790M, G719A,
							 G719S, L861Q)
81236
$249.50
EZH2 (enhancer of zeste 2 polycomb repressive complex
							 2 subunit) (
e.g
., myelodysplastic syndrome, myeloproliferative
							 neoplasms) gene analysis, full gene sequence
81237
$154.70
EZH2 (enhancer of zeste 2 polycomb repressive complex
							 2 subunit) (
e.g
., diffuse large B-cell lymphoma) gene
							 analysis, common variant(s) (
e.g
., codon 646)
81238
$529.20
F9 (coagulation factor IX) (
e.g
.,
							 hemophilia B), full gene sequence
81239
$242.40
DMPK (DM1 protein kinase) (
e.g
.,
							 myotonic dystrophy type 1) gene analysis; characterization of alleles
							 (
e.g
., expanded size)
81240
$57.94
F2 (prothrombin, coagulation factor II)
							 (
e.g
., hereditary hypercoagulability) gene analysis,
							 20210G>A variant
81241
$64.71
F5 (coagulation factor V) (
e.g
.,
							 hereditary hypercoagulability) gene analysis, Leiden variant
81242
$32.30
FANCC (Fanconi anemia, complementation group C)
							 (
e.g
., Fanconi anemia, type C) gene analysis, common variant
							 (
e.g
., IVS4+4A>T)
81243
$50.31
FMR1 (fragile X mental retardation 1)
							 (
e.g
., fragile X mental retardation) gene analysis; evaluation
							 to detect abnormal (
e.g
., expanded) alleles
81244
$39.59
FMR1 (fragile X mental retardation 1)
							 (
e.g
., fragile X mental retardation) gene analysis;
							 characterization of alleles (
e.g
., expanded size and promoter
							 methylation status)
81245
$145.98
FLT3 (fms-related tyrosine kinase 3)
							 (
e.g
., acute myeloid leukemia), gene analysis; internal tandem
							 duplication (ITD) variants (
i.e
., exons 14, 15)
81246
$73.21
FLT3 (fms-related tyrosine kinase 3)
							 (
e.g
., acute myeloid leukemia), gene analysis; tyrosine kinase
							 domain (TKD) variants (
e.g
., D835, I836)
81247
$154.18
G6PD (glucose-6-phosphate dehydrogenase)
							 (
e.g
., hemolytic anemia, jaundice), gene analysis; common
							 variant(s) (
e.g
., A, A-)
81248
$330.97
G6PD (glucose-6-phosphate dehydrogenase)
							 (
e.g
., hemolytic anemia, jaundice), gene analysis; known
							 familial variant(s)
81249
$529.20
G6PD (glucose-6-phosphate dehydrogenase)
							 (
e.g
., hemolytic anemia, jaundice), gene analysis; full gene
							 sequence
81250
$51.59
G6PC (glucose-6-phosphatase, catalytic subunit)
							 (
e.g
., Glycogen storage disease, type 1a, von Gierke disease)
							 gene analysis, common variants (
e.g
., R83C, Q347X)
81251
$41.67
GBA (glucosidase, beta, acid) (
e.g
.,
							 Gaucher disease) gene analysis, common variants (
e.g
., N370S,
							 84GG, L444P, IVS2+1G>A)
81252
$89.19
GJB2 (gap junction protein, beta 2, 26kDa, connexin
							 26) (
e.g
., nonsyndromic hearing loss) gene analysis; full gene
							 sequence
81253
$54.26
GJB2 (gap junction protein, beta 2, 26kDa, connexin
							 26) (
e.g
., nonsyndromic hearing loss) gene analysis; known
							 familial variants
81254
$30.87
GJB6 (gap junction protein, beta 6, 30kDa, connexin
							 30) (
e.g
., nonsyndromic hearing loss) gene analysis, common
							 variants (
e.g
., 309kb [del(GJB6-D13S1830)] and 232kb
							 [del(GJB6-D13S1854)])
81255
$45.38
HEXA (hexosaminidase A [alpha polypeptide])
							 (
e.g
., Tay-Sachs disease) gene analysis, common variants
							 (
e.g
., 1278insTATC, 1421+1G>C, G269S)
81256
$57.65
HFE (hemochromatosis) (
e.g
.,
							 hereditary hemochromatosis) gene analysis, common variants
							 (
e.g
., C282Y, H63D)
81257
$90.19
HBA1/HBA2 (alpha globin 1 and alpha globin 2)
							 (
e.g
., alpha thalassemia, Hb Bart hydrops fetalis syndrome,
							 HbH disease), gene analysis; common deletions or variant
							 (
e.g
., Southeast Asian, Thai, Filipino, Mediterranean,
							 alpha3.7, alpha4.2, alpha20.5, Constant Spring)
81258
$330.97
HBA1/HBA2 (alpha globin 1 and alpha globin 2)
							 (
e.g
., alpha thalassemia, Hb Bart hydrops fetalis syndrome,
							 HbH disease), gene analysis; known familial variant
81259
$529.20
HBA1/HBA2 (alpha globin 1 and alpha globin 2)
							 (
e.g.,
alpha thalassemia, Hb Bart hydrops fetalis syndrome,
							 HbH disease), gene analysis; full gene sequence
81260
$34.67
IKBKAP (inhibitor of kappa light polypeptide gene
							 enhancer in B-cells, kinase complex-associated protein) (
e.g
.,
							 familial dysautonomia) gene analysis, common variants (
e.g
.,
							 2507+6T>C, R696P)
81261
$174.63
IGH@ (Immunoglobulin heavy chain locus)
							 (
e.g.,
leukemias and lymphomas, B-cell), gene rearrangement
							 analysis to detect abnormal clonal population(s); amplified methodology
							 (
e.g.,
polymerase chain reaction)
81262
$60.46
IGH@ (Immunoglobulin heavy chain locus)
							 (
e.g.,
leukemias and lymphomas, B-cell), gene rearrangement
							 analysis to detect abnormal clonal population(s); direct probe methodology
							 (e.g., Southern blot)
81263
$259.77
IGH@ (Immunoglobulin heavy chain locus) (e.g.,
							 leukemia and lymphoma, B-cell), variable region somatic mutation
							 analysis
81264
$152.35
IGK@ (Immunoglobulin kappa light chain locus)
							 (
e.g.,
leukemia and lymphoma, B-cell), gene rearrangement
							 analysis, evaluation to detect abnormal clonal population(s)
81265
$205.57
Comparative analysis using Short Tandem Repeat (STR)
							 markers; patient and comparative specimen (
e.g
.,
							 pre-transplant recipient and donor germline testing, post-transplant
							 non-hematopoietic recipient germline [
e.g.,
buccal swab or
							 other germline tissue sample] and donor testing, twin zygosity testing, or
							 maternal cell contamination of fetal cells)
81266
$268.84
Comparative analysis using Short Tandem Repeat (STR)
							 markers; each additional specimen (
e.g
., additional cord blood
							 donor, additional fetal samples from different cultures, or additional zygosity
							 in multiple birth pregnancies). (List separately in addition to code for
							 primary procedure)
81267
$182.98
Chimerism (engraftment) analysis, post
							 transplantation specimen (
e.g
., hematopoietic stem cell),
							 includes comparison to previously performed baseline analyses; without cell
							 selection
81268
$230.02
Chimerism (engraftment) analysis, post
							 transplantation specimen (
e.g
., hematopoietic stem cell),
							 includes comparison to previously performed baseline analyses; with cell
							 selection (
e.g
., CD3, CD33), each cell type
81269
$178.52
HBA1/HBA2 (alpha globin 1 and alpha globin 2)
							 (
e.g
., alpha thalassemia, Hb Bart hydrops fetalis syndrome,
							 HbH disease), gene analysis; duplication/deletion variants
81270
$80.84
JAK2 (Janus kinase 2) (
e.g
.,
							 myeloproliferative disorder) gene analysis, p.Val617Phe (V617F)
							 variant
81271
$120.83
HTT (huntingtin) (
e.g
., Huntington
							 disease) gene analysis; evaluation to detect abnormal (
e.g
.,
							 expanded) alleles
81272
$290.63
KIT (v-kit Hardy-Zuckerman 4 feline sarcoma viral
							 oncogene homolog) (
e.g.,
gastrointestinal stromal tumor
							 [GIST], acute myeloid leukemia, melanoma), gene analysis, targeted sequence
							 analysis (
e.g
., exons 8, 11, 13, 17, 18)
81273
$110.14
KIT (v-kit Hardy-Zuckerman 4 feline sarcoma viral
							 oncogene homolog) (
e.g.,
mastocytosis), gene analysis, D816
							 variant(s)
81274
$242.40
HTT (huntingtin) (
e.g.,
Huntington
							 disease) gene analysis; characterization of alleles (
e.g.,
expanded size)
81275
$170.45
KRAS (Kirsten rat sarcoma viral oncogene homolog)
							 (
e.g.,
carcinoma) gene analysis; variants in exon 2
							 (
e.g.,
codons 12 and 13)
81276
$170.45
KRAS (Kirsten rat sarcoma viral oncogene homolog)
							 (
e.g.,
carcinoma) gene analysis; additional variant(s)
							 (
e.g.,
codon 61, codon 146)
81277
$1,023.12
Cytogenomic neoplasia (genome-wide) microarray
							 analysis, interrogation of genomic regions for copy number and
							 loss-of-heterozygosity variants for chromosomal abnormalities
81278
$182.85
IGH@/BCL2 (t(14;18)) (
e.g.,
follicular lymphoma) translocation analysis, major breakpoint region (MBR) and
							 minor cluster region (mcr) breakpoints, qualitative or quantitative
81279
$163.35
JAK2 (Janus kinase 2) (
e.g.,
myeloproliferative disorder) targeted sequence analysis (
e.g.,
exons 12 and 13)
81283
$64.71
IFNL3 (interferon, lambda 3) (
e.g.,
drug response), gene analysis, rs12979860 variant
81284
$120.83
FXN (frataxin) (
e.g.,
Friedreich
							 ataxia) gene analysis; evaluation to detect abnormal (expanded)
							 alleles
81285
$242.40
FXN (frataxin) (
e.g.,
Friedreich
							 ataxia) gene analysis; characterization of alleles (
e.g.,
expanded size)
81286
$242.40
FXN (frataxin) (
e.g.,
Friedreich
							 ataxia) gene analysis; full gene sequence
81287
$109.93
MGMT (O-6-methylguanine-DNA methyltransferase)
							 (
e.g.,
glioblastoma multiforme) promoter methylation
							 analysis
81288
$169.63
MLH1 (mutL homolog 1, colon cancer, nonpolyposis type
							 2) (
e.g.,
hereditary non-polyposis colorectal cancer, Lynch
							 syndrome) gene analysis; promoter methylation analysis
81289
$163.35
FXN (frataxin) (
e.g.,
Friedreich
							 ataxia) gene analysis; known familial variant(s)
81290
$34.67
MCOLN1 (mucolipin 1) (
e.g.,
Mucolipidosis, type IV) gene analysis, common variants (
e.g.,
IVS3-2A>G, del6.4kb)
81291
$57.63
MTHFR (5,10-methylenetetrahydrofolate reductase)
							 (
e.g.,
hereditary hypercoagulability) gene analysis, common
							 variants (
e.g.,
677T, 1298C)
81292
$595.70
MLH1 (mutL homolog 1, colon cancer, nonpolyposis type
							 2) (
e.g.,
hereditary non-polyposis colorectal cancer, Lynch
							 syndrome) gene analysis; full sequence analysis
81293
$291.94
MLH1 (mutL homolog 1, colon cancer, nonpolyposis type
							 2) (
e.g.,
hereditary non-polyposis colorectal cancer, Lynch
							 syndrome) gene analysis; known familial variants
81294
$178.52
MLH1 (mutL homolog 1, colon cancer, nonpolyposis type
							 2) (
e.g.,
hereditary non-polyposis colorectal cancer, Lynch
							 syndrome) gene analysis; duplication/deletion variants
81295
$336.66
MSH2 (mutS homolog 2, colon cancer, nonpolyposis type
							 1) (
e.g.,
hereditary non-polyposis colorectal cancer, Lynch
							 syndrome) gene analysis; full sequence analysis
81296
$297.88
MSH2 (mutS homolog 2, colon cancer, nonpolyposis type
							 1) (
e.g.,
hereditary non-polyposis colorectal cancer, Lynch
							 syndrome) gene analysis; known familial variants
81297
$188.13
MSH2 (mutS homolog 2, colon cancer, nonpolyposis type
							 1) (
e.g.,
hereditary non-polyposis colorectal cancer, Lynch
							 syndrome) gene analysis; duplication/deletion variants
81298
$566.11
MSH6 (mutS homolog 6 [E. coli])
							 (
e.g.,
hereditary non-polyposis colorectal cancer, Lynch
							 syndrome) gene analysis; full sequence analysis
81299
$271.66
MSH6 (mutS homolog 6 [E. coli])
							 (
e.g.,
hereditary non-polyposis colorectal cancer, Lynch
							 syndrome) gene analysis; known familial variants
81300
$209.92
MSH6 (mutS homolog 6 [E. coli])
							 (
e.g.,
hereditary non-polyposis colorectal cancer, Lynch
							 syndrome) gene analysis; duplication/deletion variants
81301
$307.43
Microsatellite instability analysis
							 (
e.g.,
hereditary non-polyposis colorectal cancer, Lynch
							 syndrome) of markers for mismatch repair deficiency (
e.g.,
BAT25, BAT26), includes comparison of neoplastic and normal tissue, if
							 performed
81302
$465.58
MECP2 (methyl CpG binding protein 2)
							 (
e.g.,
Rett syndrome) gene analysis; full sequence
							 analysis
81303
$105.84
MECP2 (methyl CpG binding protein 2)
							 (
e.g.,
Rett syndrome) gene analysis; known familial
							 variant
81304
$132.30
MECP2 (methyl CpG binding protein 2)
							 (
e.g.,
Rett syndrome) gene analysis; duplication/deletion
							 variants
81305
$154.70
MYD88 (myeloid differentiation primary response 88)
							 (
e.g.,
Waldenstrom's macroglobulinemia, lymphoplasmacytic
							 leukemia) gene analysis, p.Leu265Pro (L265P) variant
81306
$256.98
NUDT15 (nudix hydrolase 15) (
e.g.,
drug metabolism) gene analysis, common variant(s) (
e.g.,
*2,
							 *3, *4, *5, *6)
81307
$596.67
PALB2 (partner and localizer of BRCA2)
							 (
e.g.,
breast and pancreatic cancer) gene analysis; full gene
							 sequence
81308
$265.79
PALB2 (partner and localizer of BRCA2)
							 (
e.g.,
breast and pancreatic cancer) gene analysis; known
							 familial variant
81309
$242.40
PIK3CA (phosphatidylinositol-4, 5-biphosphate
							 3-kinase, catalytic subunit alpha) (
e.g.,
colorectal and
							 breast cancer) gene analysis, targeted sequence analysis
							 (
e.g.,
exons 7, 9, 20)
81310
$217.43
NPM1 (nucleophosmin) (
e.g.,
acute
							 myeloid leukemia) gene analysis, exon 12 variants
81311
$260.89
NRAS (neuroblastoma RAS viral [v-ras] oncogene
							 homolog) (
e.g.,
colorectal carcinoma), gene analysis, variants
							 in exon 2 (
e.g.,
codons 12 and 13) and exon 3
							 (
e.g.,
codon 61)
81312
$120.83
PABPN1 (poly[A] binding protein nuclear 1)
							 (
e.g.,
oculopharyngeal muscular dystrophy) gene analysis,
							 evaluation to detect abnormal (
e.g.,
expanded)
							 alleles
81313
$224.95
PCA3/KLK3 (prostate cancer antigen 3 [non-protein
							 coding]/kallikrein-related peptidase 3 [prostate specific antigen]) ratio
							 (
e.g.,
prostate cancer)
81314
$290.63
PDGFRA (platelet-derived growth factor receptor,
							 alpha polypeptide) (
e.g.,
gastrointestinal stromal tumor
							 [GIST]), gene analysis, targeted sequence analysis (
e.g.,
exons 12, 18)
81315
$182.85
PML/RARalpha, (t(15;17)), (promyelocytic
							 leukemia/retinoic acid receptor alpha) (
e.g.,
promyelocytic
							 leukemia) translocation analysis; common breakpoints (
e.g.,
intron 3 and intron 6), qualitative or quantitative
81316
$182.85
PML/RARalpha, (t(15;17)), (promyelocytic
							 leukemia/retinoic acid receptor alpha) (
e.g.,
promyelocytic
							 leukemia) translocation analysis; single breakpoint (
e.g.,
intron 3, intron 6 or exon 6), qualitative or quantitative
81317
$596.67
PMS2 (postmeiotic segregation increased 2 [S.
							 cerevisiae]) (
e.g.,
hereditary non-polyposis colorectal
							 cancer, Lynch syndrome) gene analysis; full sequence analysis
81318
$291.94
PMS2 (postmeiotic segregation increased 2 [S.
							 cerevisiae]) (
e.g.,
hereditary non-polyposis colorectal
							 cancer, Lynch syndrome) gene analysis; known familial variants
81319
$179.49
PMS2 (postmeiotic segregation increased 2 [S.
							 cerevisiae]) (
e.g.,
hereditary non-polyposis colorectal
							 cancer, Lynch syndrome) gene analysis; duplication/deletion
							 variants
81320
$256.98
PLCG2 (phospholipase C gamma 2)
							 (
e.g.,
chronic lymphocytic leukemia) gene analysis, common
							 variants (
e.g.,
R665W, S707F, L845F)
81321
$529.20
PTEN (phosphatase and tensin homolog)
							 (
e.g.,
Cowden syndrome, PTEN hamartoma tumor syndrome) gene
							 analysis; full sequence analysis
81322
$41.10
PTEN (phosphatase and tensin homolog)
							 (
e.g.,
Cowden syndrome, PTEN hamartoma tumor syndrome) gene
							 analysis; known familial variant
81323
$264.60
PTEN (phosphatase and tensin homolog)
							 (
e.g.,
Cowden syndrome, PTEN hamartoma tumor syndrome) gene
							 analysis; duplication/deletion variant
81324
$668.87
PMP22 (peripheral myelin protein 22)
							 (
e.g.,
Charcot-Marie-Tooth, hereditary neuropathy with
							 liability to pressure palsies) gene analysis; duplication/deletion
							 analysis
81325
$678.77
PMP22 (peripheral myelin protein 22)
							 (
e.g.,
Charcot-Marie-Tooth, hereditary neuropathy with
							 liability to pressure palsies) gene analysis; full sequence
							 analysis
81326
$41.10
PMP22 (peripheral myelin protein 22)
							 (
e.g.,
Charcot-Marie-Tooth, hereditary neuropathy with
							 liability to pressure palsies) gene analysis; known familial
							 variant
81327
$169.34
SEPT9 (Septin9) (
e.g.,
colorectal
							 cancer) promoter methylation analysis
81328
$154.18
SLCO1B1 (solute carrier organic anion transporter
							 family, member 1B1) (
e.g.,
adverse drug reaction), gene
							 analysis, common variant(s) (
e.g.,
*5)
81329
$120.83
SMN1 (survival of motor neuron 1, telomeric)
							 (
e.g.,
spinal muscular atrophy) gene analysis; dosage/deletion
							 analysis (
e.g.,
carrier testing), includes SMN2 (survival of
							 motor neuron 2, centromeric) analysis, if performed
81330
$41.45
SMPD1(sphingomyelin phosphodiesterase 1, acid
							 lysosomal) (
e.g.,
Niemann-Pick disease, Type A) gene analysis,
							 common variants (
e.g.,
R496L, L302P, fsP330)
81331
$45.04
SNRPN/UBE3A (small nuclear ribonucleoprotein
							 polypeptide N and ubiquitin protein ligase E3A) (
e.g.,
Prader-Willi syndrome and/or Angelman syndrome), methylation
							 analysis
81332
$38.50
SERPINA1 (serpin peptidase inhibitor, clade A,
							 alpha-1 antiproteinase, antitrypsin, member 1) (
e.g.,
alpha-1-antitrypsin deficiency), gene analysis, common variants
							 (
e.g.,
*S and *Z)
81333
$120.83
TGFBI (transforming growth factor beta-induced)
							 (
e.g.,
corneal dystrophy) gene analysis, common variants
							 (
e.g.,
R124H, R124C, R124L, R555W, R555Q)
81334
$290.63
RUNX1 (runt related transcription factor 1)
							 (
e.g.,
acute myeloid leukemia, familial platelet disorder with
							 associated myeloid malignancy), gene analysis, targeted sequence analysis
							 (
e.g.,
exons 3-8)
81335
$154.18
TPMT (thiopurine S-methyltransferase)
							 (
e.g.,
drug metabolism), gene analysis, common variants
							 (
e.g.,
*2, *3)
81336
$265.79
SMN1 (survival of motor neuron 1, telomeric)
							 (
e.g.,
spinal muscular atrophy) gene analysis; full gene
							 sequence
81337
$163.35
SMN1 (survival of motor neuron 1, telomeric)
							 (
e.g.,
spinal muscular atrophy) gene analysis; known familial
							 sequence variant(s)
81338
$132.59
MPL (MPL proto-oncogene, thrombopoietin receptor)
							 (
e.g.,
myeloproliferative disorder) gene analysis; common
							 variants (
e.g.,
W515A, W515K, W515L, W515R)
81339
$163.35
MPL (MPL proto-oncogene, thrombopoietin receptor)
							 (
e.g.,
myeloproliferative disorder) gene analysis; sequence
							 analysis, exon 10
81340
$184.27
TRB@ (T cell antigen receptor, beta)
							 (
e.g.,
leukemia and lymphoma), gene rearrangement analysis to
							 detect abnormal clonal population(s); using amplification methodology
							 (
e.g.,
polymerase chain reaction)
81341
$43.74
TRB@ (T cell antigen receptor, beta)
							 (
e.g.,
leukemia and lymphoma), gene rearrangement analysis to
							 detect abnormal clonal population(s); using direct probe methodology
							 (
e.g.,
Southern blot)
81342
$177.72
TRG@ (T cell antigen receptor, gamma)
							 (
e.g.,
leukemia and lymphoma), gene rearrangement analysis,
							 evaluation to detect abnormal clonal population(s)
81343
$120.83
PPP2R2B (protein phosphatase 2 regulatory subunit
							 Bbeta) (
e.g.,
spinocerebellar ataxia) gene analysis,
							 evaluation to detect abnormal (
e.g.,
expanded)
							 alleles
81344
$120.83
TBP (TATA box binding protein)
							 (
e.g.,
spinocerebellar ataxia) gene analysis, evaluation to
							 detect abnormal (
e.g.,
expanded) alleles
81345
$163.35
TERT (telomerase reverse transcriptase)
							 (
e.g.,
thyroid carcinoma, glioblastoma multiforme) gene
							 analysis, targeted sequence analysis (
e.g.,
promoter
							 region)
81346
$154.18
TYMS (thymidylate synthetase) (
e.g.,
5-fluorouracil/5-FU drug metabolism), gene analysis, common variant(s)
							 (
e.g.,
tandem repeat variant)
81347
$170.45
SF3B1 (splicing factor [3b] subunit B1)
							 (
e.g.,
myelodysplastic syndrome/acute myeloid leukemia) gene
							 analysis, common variants (
e.g.,
A672T, E622D, L833F, R625C,
							 R625L)
81348
$154.70
SRSF2 (serine and arginine-rich splicing factor 2)
							 (
e.g.,
myelodysplastic syndrome, acute myeloid leukemia) gene
							 analysis, common variants (
e.g.,
P95H, P95L)
81349
$0
Cytogenomic (genome-wide) analysis for constitutional
							 chromosomal abnormalities; interrogation of genomic regions for copy number and
							 loss-of-heterozygosity variants, low-pass sequencing analysis
81350
$206.39
UGT1A1 (UDP glucuronosyltransferase 1 family,
							 polypeptide A1) (
e.g.,
drug metabolism, hereditary
							 unconjugated hyperbilirubinemia [Gilbert syndrome]) gene analysis, common
							 variants (
e.g.,
*28, *36, *37)
81351
$566.11
TP53 (tumor protein 53) (
e.g.,
Li-Fraumeni syndrome) gene analysis; full gene sequence
81352
$290.63
TP53 (tumor protein 53) (
e.g.,
Li-Fraumeni syndrome) gene analysis; targeted sequence analysis
							 (
e.g.,
4 oncology)
81353
$271.66
TP53 (tumor protein 53) (
e.g.,
Li-Fraumeni syndrome) gene analysis; known familial variant
81355
$77.79
VKORC1 (vitamin K epoxide reductase complex, subunit
							 1) (
e.g.,
warfarin metabolism), gene analysis, common
							 variant(s) (
e.g.,
-1639G>A, c.173+1000C>T)
81357
$170.45
U2AF1 (U2 small nuclear RNA auxiliary factor 1)
							 (
e.g.,
myelodysplastic syndrome, acute myeloid leukemia) gene
							 analysis, common variants (
e.g.,
S34F, S34Y, Q157R,
							 Q157P)
81360
$170.45
ZRSR2 (zinc finger CCCH-type, RNA binding motif and
							 serine/arginine-rich 2) (
e.g.,
myelodysplastic syndrome, acute
							 myeloid leukemia) gene analysis, common variant(s) (
e.g.,
E65fs, E122fs, R448fs)
81361
$154.18
HBB (hemoglobin, subunit beta)
							 (
e.g.,
sickle cell anemia, beta thalassemia,
							 hemoglobinopathy); common variant(s) (
e.g.,
HbS, HbC,
							 HbE)
81362
$330.97
HBB (hemoglobin, subunit beta)
							 (
e.g.,
sickle cell anemia, beta thalassemia,
							 hemoglobinopathy); known familial variant(s)
81363
$178.52
HBB (hemoglobin, subunit beta)
							 (
e.g.,
sickle cell anemia, beta thalassemia,
							 hemoglobinopathy); duplication/deletion variant(s)
81364
$286.28
HBB (hemoglobin, subunit beta)
							 (
e.g.,
sickle cell anemia, beta thalassemia,
							 hemoglobinopathy); full gene sequence
81370
$354.67
HLA Class I and II typing, low resolution
							 (
e.g.,
antigen equivalents); HLA-A, -B, -C, -DRB1/3/4/5, and
							 -DQB1
81371
$356.79
HLA Class I and II typing, low resolution
							 (
e.g.,
antigen equivalents); HLA-A, -B, and -DRB1
							 (
e.g.,
verification typing)
81372
$355.97
HLA Class I typing, low resolution
							 (
e.g.,
antigen equivalents); complete (
i.e.
,
							 HLA-A, -B, and -C)
81373
$112.39
HLA Class I typing, low resolution
							 (
e.g.,
antigen equivalents); one locus (
e.g.,
HLA-A, -B, or -C), each
81374
$65.56
HLA Class I typing, low resolution
							 (
e.g.,
antigen equivalents); one antigen equivalent
							 (
e.g.,
B*27), each
81375
$194.69
HLA Class II typing, low resolution
							 (
e.g.,
antigen equivalents); HLA-DRB1/3/4/5 and
							 -DQB1
81376
$107.80
HLA Class II typing, low resolution
							 (
e.g.,
antigen equivalents); one locus (
e.g.,
HLA-DRB1, -DRB3/4/5, -DQB1, -DQA1, -DPB1, or -DPA1), each
81377
$83.56
HLA Class II typing, low resolution
							 (
e.g.,
antigen equivalents); one antigen equivalent,
							 each
81378
$304.79
HLA Class I and II typing, high resolution
							 (
i.e
., alleles or allele groups), HLA-A, -B, -C, and
							 -DRB1
81379
$295.81
HLA Class I typing, high resolution
							 (
i.e.
, alleles or allele groups); complete
							 (
i.e.
HLA-A, -B, and -C)
81380
$156.33
HLA Class I typing, high resolution
							 (
i.e
., alleles or allele groups); one locus
							 (
e.g.,
HLA-A, -B, or -C), each
81381
$149.85
HLA Class I typing, high resolution
							 (
i.e.
, alleles or allele groups); one allele or allele group
							 (
e.g.,
B*57:01P), each
81382
$109.09
HLA Class II typing, high resolution
							 (
i.e.,
alleles or allele groups); one locus
							 (
e.g.,
HLA-DRB1, -DRB3/4/5, -DQB1, -DQA1, -DPB1, or -DPA1),
							 each
81383
$96.25
HLA Class II typing, high resolution
							 (
i.e.,
alleles or allele groups); one allele or allele group
							 (
e.g.,
HLA-DQB1*06:02P), each
81400
$56.41
Molecular Pathology Procedure Level 1
81401
$120.83
Molecular Pathology Procedure Level 2
81402
$132.59
Molecular Pathology Procedure Level 3
81403
$163.35
Molecular Pathology Procedure Level 4
81404
$242.40
Molecular Pathology Procedure Level 5
81405
$265.79
Molecular Pathology Procedure Level 6
81406
$249.50
Molecular Pathology Procedure Level 7
81407
$746.41
Molecular Pathology Procedure Level 8
81408
$1,764.00
Molecular Pathology Procedure Level 9
81410
$444.53
Aortic dysfunction or dilation
							 (
e.g.,
Marfan syndrome, Loeys Dietz syndrome, Ehler Danlos
							 syndrome type IV, arterial tortuosity syndrome); genomic sequence analysis
							 panel, must include sequencing of at least 9 genes, including FBN1, TGFBR1,
							 TGFBR2, COL3A1, MYH11, ACTA2, SLC2A10, SMAD3, and MYLK
81411
$1,190.87
Aortic dysfunction or dilation
							 (
e.g.,
Marfan syndrome, Loeys Dietz syndrome, Ehler Danlos
							 syndrome type IV, arterial tortuosity syndrome); duplication/deletion analysis
							 panel, must include analyses for TGFBR1, TGFBR2, MYH11, and COL3A1
81412
$2,159.63
Ashkenazi Jewish associated disorders
							 (
e.g.,
Bloom syndrome, Canavan disease, cystic fibrosis,
							 familial dysautonomia, Fanconi anemia group C, Gaucher disease, Tay-Sachs
							 disease), genomic sequence analysis panel, must include sequencing of at least
							 9 genes, including ASPA, BLM, CFTR, FANCC, GBA, HEXA, IKBKAP, MCOLN1, and
							 SMPD1
81413
$515.88
Cardiac ion channelopathies (
e.g.,
Brugada syndrome, long QT syndrome, short QT syndrome, catecholaminergic
							 polymorphic ventricular tachycardia); genomic sequence analysis panel, must
							 include sequencing of at least test genes, including ANK2, CASQ2, CAV3, KCNE1,
							 KCNE2, KCNH2, KCNJ2, KCNQ1, RYR2, and SCN5A
81414
$515.88
Cardiac ion channelopathies (
e.g.,
Brugada syndrome, long QT syndrome, short QT syndrome, catecholaminergic
							 polymorphic ventricular tachycardia); duplication/deletion gene analysis panel,
							 must include analysis of at least two genes, including KCNH2 and
							 KCNQ1
81415
$4,215.96
Exome (
e.g.,
unexplained
							 constitutional or heritable disorder or syndrome); sequence
							 analysis
81416
$10,584.00
Exome (
e.g.,
unexplained
							 constitutional or heritable disorder or syndrome); sequence analysis, each
							 comparator exome (
e.g.,
parents, siblings) (List separately in
							 addition to code for primary procedure)
81417
$282.24
Exome (
e.g.,
unexplained
							 constitutional or heritable disorder or syndrome); reevaluation of previously
							 obtained exome sequence (
e.g.,
updated knowledge or unrelated
							 condition/syndrome)
81419
$2,159.63
Epilepsy genomic sequence analysis panel, must
							 include analyses for ALDH7A1, CACNA1A, CDKL5, CHD2, GABRG2, GRIN2A, KCNQ2,
							 MECP2, PCDH19, POLG, PRRT2, SCN1A, SCN1B, SCN2A, SCN8A, SLC2A1, SLC9A6, STXBP1,
							 SYNGAP1, TCF4, TPP1, TSC1, TSC2, and ZEB2
81420
$669.48
Fetal chromosomal aneuploidy (
e.g.,
trisomy 21, monosomy X) genomic sequence analysis panel, circulating cell-free
							 fetal DNA in maternal blood, must include analysis of chromosomes 13, 18, and
							 21
81422
$669.48
Fetal chromosomal microdeletion(s) genomic sequence
							 analysis (
e.g.,
DiGeorge syndrome, Cri-du-chat syndrome),
							 circulating cell-free fetal DNA in maternal blood
81425
$4,437.52
Genome (
e.g.,
unexplained
							 constitutional or heritable disorder or syndrome); sequence
							 analysis
81426
$2,390.18
Genome (
e.g.,
unexplained
							 constitutional or heritable disorder or syndrome); sequence analysis, each
							 comparator genome (
e.g.,
parents, siblings) (List separately
							 in addition to code for primary procedure)
81427
$2,061.81
Genome (
e.g.,
unexplained
							 constitutional or heritable disorder or syndrome); reevaluation of previously
							 obtained genome sequence (
e.g.,
updated knowledge or unrelated
							 condition/syndrome)
81430
$1,433.25
Hearing loss (
e.g.,
nonsyndromic
							 hearing loss, Usher syndrome, Pendred syndrome); genomic sequence analysis
							 panel, must include sequencing of at least 60 genes, including CDH23, CLRN1,
							 GJB2, GPR98, MTRNR1, MYO7A, MYO15A, PCDH15, OTOF, SLC26A4, TMC1, TMPRSS3,
							 USH1C, USH1G, USH2A, and WFS1
81431
$599.38
Hearing loss (
e.g.,
nonsyndromic
							 hearing loss, Usher syndrome, Pendred syndrome); duplication/deletion analysis
							 panel, must include copy number analyses for STRC and DFNB1 deletions in GJB2
							 and GJB6 genes
81432
$598.92
Hereditary breast cancer-related disorders
							 (
e.g.,
hereditary breast cancer, hereditary ovarian cancer,
							 hereditary endometrial cancer); genomic sequence analysis panel, must include
							 sequencing of at least ten genes, always including BRCA1, BRCA2, CDH1, MLH1,
							 MSH2, MSH6, PALB2, PTEN, STK11, and TP53
81433
$387.14
Hereditary breast cancer-related disorders
							 (
e.g.,
hereditary breast cancer, hereditary ovarian cancer,
							 hereditary endometrial cancer); duplication/deletion analysis panel, must
							 include analyses for BRCA1, BRCA2, MLH1, MSH2, and STK11
81434
$527.36
Hereditary retinal disorders (
e.g.,
retinitis pigmentosa, Leber congenital amaurosis, cone-rod dystrophy), genomic
							 sequence analysis panel, must include sequencing of at least 15 genes,
							 including ABCA4, CNGA1, CRB1, EYS, PDE6A, PDE6B, PRPF31, PRPH2, RDH12, RHO,
							 RP1, RP2, RPE65, RPGR, and USH2A
81435
$515.88
Hereditary colon cancer disorders
							 (
e.g.,
Lynch syndrome, PTEN hamartoma syndrome, Cowden
							 syndrome, familial adenomatosis polyposis); genomic sequence analysis panel,
							 must include sequencing of at least ten genes, including APC, BMPR1A, CDH1,
							 MLH1, MSH2, MSH6, MUTYH, PTEN, SMAD4, and STK11
81436
$515.88
Hereditary colon cancer disorders
							 (
e.g.,
Lynch syndrome, PTEN hamartoma syndrome, Cowden
							 syndrome, familial adenomatosis polyposis); duplication/deletion analysis
							 panel, must include analysis of at least five genes, including MLH1, MSH2,
							 EPCAM, SMAD4, and STK11
81437
$387.14
Hereditary neuroendocrine tumor disorders
							 (
e.g.,
medullary thyroid carcinoma, parathyroid carcinoma,
							 malignant pheochromocytoma or paraganglioma); genomic sequence analysis panel,
							 must include sequencing of at least six genes, including MAX, SDHB, SDHC, SDHD,
							 TMEM127, and VHL
81438
$387.14
Hereditary neuroendocrine tumor disorders
							 (
e.g.,
medullary thyroid carcinoma, parathyroid carcinoma,
							 malignant pheochromocytoma or paraganglioma); duplication/deletion analysis
							 panel, must include analyses for SDHB, SDHC, SDHD, and VHL
81439
$515.88
Hereditary cardiomyopathy (
e.g.,
hypertrophic cardiomyopathy, dilated cardiomyopathy, arrhythmogenic right
							 ventricular cardiomyopathy), genomic sequence analysis panel, must include
							 sequencing of at least five cardiomyopathy-related genes
							 (
e.g.,
DSG2, MYBPC3, MYH7, PKP2, TTN)
81440
$2,931.77
Nuclear encoded mitochondrial genes
							 (
e.g.,
neurologic or myopathic phenotypes), genomic sequence
							 panel, must include analysis of at least 100 genes, including BCS1L, C10orf2,
							 COQ2, COX10, DGUOK, MPV17, OPA1, PDSS2, POLG, POLG2, RRM2B, SCO1, SCO2,
							 SLC25A4, SUCLA2, SUCLG1, TAZ, TK2, and TYMP
81442
$1,890.66
Noonan spectrum disorders (
e.g.,
Noonan syndrome, cardio-facio-cutaneous syndrome, Costello syndrome, LEOPARD
							 syndrome, Noonan-like syndrome), genomic sequence analysis panel, must include
							 sequencing of at least 12 genes, including BRAF, CBL, HRAS, KRAS, MAP2K1,
							 MAP2K2, NRAS, PTPN11, RAF1, RIT1, SHOC2, and SOS1
81443
$2,159.63
Genetic testing for severe inherited conditions
							 (
e.g.,
cystic fibrosis, Ashkenazi Jewish-associated disorders
							 [
e.g.,
Bloom syndrome, Canavan disease, Fanconi anemia type C,
							 mucolipidosis type VI, Gaucher disease, Tay-Sachs disease], beta
							 hemoglobinopathies, phenylketonuria, galactosemia), genomic sequence analysis
							 panel, must include sequencing of at least 15 genes (
e.g.,
ACADM, ARSA, ASPA, ATP7B, BCKDHA, BCKDHB, BLM, CFTR, DHCR7, FANCC, G6PC, GAA,
							 GALT, GBA, GBE1, HBB, HEXA, IKBKAP, MCOLN1, PAH)
81445
$527.36
Targeted genomic sequence analysis panel, solid organ
							 neoplasm, DNA analysis, and RNA analysis when performed, 5-50 genes
							 (
e.g.,
ALK, BRAF, CDKN2A, EGFR, ERBB2, KIT, KRAS, NRAS, MET,
							 PDGFRA, PDGFRB, PGR, PIK3CA, PTEN, RET), interrogation for sequence variants
							 and copy number variants or rearrangements, if performed
81448
$515.88
Hereditary peripheral neuropathies
							 (
e.g.,
Charcot-Marie-Tooth, spastic paraplegia), genomic
							 sequence analysis panel, must include sequencing of at least 5 peripheral
							 neuropathy-related genes (
e.g.,
BSCL2, GJB1, MFN2, MPZ, REEP1,
							 SPAST, SPG11, SPTLC1)
81450
$669.91
Targeted genomic sequence analysis panel,
							 hematolymphoid neoplasm or disorder, DNA analysis, and RNA analysis when
							 performed, 5-50 genes (
e.g.,
BRAF, CEBPA, DNMT3A, EZH2, FLT3,
							 IDH1, IDH2, JAK2, KRAS, KIT, MLL, NRAS, NPM1, NOTCH1), interrogation for
							 sequence variants, and copy number variants or rearrangements, or isoform
							 expression or mRNA expression levels, if performed
81455
$2,575.09
Targeted genomic sequence analysis panel, solid organ
							 or hematolymphoid neoplasm, DNA analysis, and RNA analysis when performed, 51
							 or greater genes (
e.g.,
ALK, BRAF, CDKN2A, CEBPA, DNMT3A,
							 EGFR, ERBB2, EZH2, FLT3, IDH1, IDH2, JAK2, KIT, KRAS, MLL, NPM1, NRAS, MET,
							 NOTCH1, PDGFRA, PDGFRB, PGR, PIK3CA, PTEN, RET), interrogation for sequence
							 variants and copy number variants or rearrangements, if performed
81460
$1,135.13
Whole mitochondrial genome (
e.g.,
Leigh syndrome, mitochondrial encephalomyopathy, lactic acidosis, and
							 stroke-like episodes [MELAS], myoclonic epilepsy with ragged-red fibers
							 [MERFF], neuropathy, ataxia, and retinitis pigmentosa [NARP], Leber hereditary
							 optic neuropathy [LHON]), genomic sequence, must include sequence analysis of
							 entire mitochondrial genome with heteroplasmy detection
81465
$825.55
Whole mitochondrial genome large deletion analysis
							 panel (
e.g.,
Kearns-Sayre syndrome, chronic progressive
							 external ophthalmoplegia), including heteroplasmy detection, if
							 performed
81470
$806.15
X-linked intellectual disability (XLID)
							 (
e.g.,
syndromic and non-syndromic XLID); genomic sequence
							 analysis panel, must include sequencing of at least 60 genes, including ARX,
							 ATRX, CDKL5, FGD1, FMR1, HUWE1, IL1RAPL, KDM5C, L1CAM, MECP2, MED12, MID1,
							 OCRL, RPS6KA3, and SLC16A2
81471
$806.15
X-linked intellectual disability (XLID)
							 (
e.g.,
syndromic and non-syndromic XLID); duplication/deletion
							 gene analysis, must include analysis of at least 60 genes, including ARX, ATRX,
							 CDKL5, FGD1, FMR1, HUWE1, IL1RAPL, KDM5C, L1CAM, MECP2, MED12, MID1, OCRL,
							 RPS6KA3, and SLC16A2
81479
I.C.
Unlisted molecular pathology procedure
81490
$741.45
Autoimmune (rheumatoid arthritis), analysis of 12
							 biomarkers using immunoassays, utilizing serum, prognostic algorithm reported
							 as a disease activity score
81493
$926.10
Coronary artery disease, mRNA, gene expression
							 profiling by real-time RT-PCR of 23 genes, utilizing whole peripheral blood,
							 algorithm reported as a risk score
81500
$229.76
Oncology (ovarian), biochemical assays of two
							 proteins (CA-125 and HE4), utilizing serum, with menopausal status, algorithm
							 reported as a risk score
81503
$791.15
Oncology (ovarian), biochemical assays of five
							 proteins (CA-125, apolipoprotein A1, beta-2 microglobulin, transferrin, and
							 pre-albumin), utilizing serum, algorithm reported as a risk score
81506
$60.79
Endocrinology (type 2 diabetes), biochemical assays
							 of seven analytes (glucose, HbA1c, insulin, hs-CRP, adiponectin, ferritin,
							 interleukin 2-receptor alpha), utilizing serum or plasma, algorithm reporting a
							 risk score
81508
$47.89
Fetal congenital abnormalities, biochemical assays of
							 two proteins (PAPP-A, hCG [any form]), utilizing maternal serum, algorithm
							 reported as a risk score
81509
$1,311.86
Fetal congenital abnormalities, biochemical assays of
							 three proteins (PAPP-A, hCG [any form], DIA), utilizing maternal serum,
							 algorithm reported as a risk score
81510
$48.99
Fetal congenital abnormalities, biochemical assays of
							 three analytes (AFP, uE3, hCG [any form]), utilizing maternal serum, algorithm
							 reported as a risk score
81511
$135.39
Fetal congenital abnormalities, biochemical assays of
							 four analytes (AFP, uE3, hCG [any form], DIA) utilizing maternal serum,
							 algorithm reported as a risk score (may include additional results from
							 previous biochemical testing)
81512
$61.32
Fetal congenital abnormalities, biochemical assays of
							 five analytes (AFP, uE3, total hCG, hyperglycosylated hCG, DIA) utilizing
							 maternal serum, algorithm reported as a risk score
81513
$125.80
Infectious disease, bacterial vaginosis, quantitative
							 real-time amplification of RNA markers for Atopobium vaginae, Gardnerella
							 vaginalis, and Lactobacillus species, utilizing vaginal-fluid specimens,
							 algorithm reported as a positive or negative result for bacterial
							 vaginosis
81514
$231.96
Infectious disease, bacterial vaginosis and
							 vaginitis, quantitative real-time amplification of DNA markers for Gardnerella
							 vaginalis, Atopobium vaginae, Megasphaera type 1, Bacterial Vaginosis
							 Associated Bacteria-2 (BVAB-2), and Lactobacillus species (L. crispatus and L.
							 jensenii), utilizing vaginal-fluid specimens, algorithm reported as a positive
							 or negative for high likelihood of bacterial vaginosis, includes separate
							 detection of Trichomonas vaginalis and/or Candida species (C. albicans, C.
							 tropicalis, C. parapsilosis, C. dubliniensis), Candida glabrata, Candida
							 krusei, when reported
81518
$3,415.99
Oncology (breast), mRNA, gene expression profiling by
							 real-time RT-PCR of 11 genes (7 content and 4 housekeeping), utilizing
							 formalin-fixed paraffin-embedded tissue, algorithms reported as percentage risk
							 for metastatic recurrence and likelihood of benefit from extended endocrine
							 therapy
81519
$3,415.99
Oncology (breast), mRNA, gene expression profiling by
							 real-time RT-PCR of 21 genes, utilizing formalin-fixed paraffin embedded
							 tissue, algorithm reported as recurrence score
81520
$2,214.01
Oncology (breast), mRNA gene expression profiling by
							 hybrid capture of 58 genes (50 content and 8 housekeeping), utilizing
							 formalin-fixed paraffin-embedded tissue, algorithm reported as a recurrence
							 risk score
81521
$3,415.99
Oncology (breast), mRNA, microarray gene expression
							 profiling of 70 content genes and 465 housekeeping genes, utilizing fresh
							 frozen or formalin-fixed paraffin-embedded tissue, algorithm reported as index
							 related to risk of distant metastasis
81522
$3,415.99
Oncology (breast), mRNA, gene expression profiling by
							 RT-PCR of 12 genes (8 content and 4 housekeeping), utilizing formalin-fixed
							 paraffin-embedded tissue, algorithm reported as recurrence risk
							 score
81523
$3,415.99
Oncology (breast), mRNA, next-generation sequencing
							 gene expression profiling of 70 content genes and 31 housekeeping genes,
							 utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as index
							 related to risk to distant metastasis
81525
$2,748.31
Oncology (colon), mRNA, gene expression profiling by
							 real-time RT-PCR of 12 genes (7 content and 5 housekeeping), utilizing
							 formalin-fixed paraffin-embedded tissue, algorithm reported as a recurrence
							 score
81528
$448.82
Oncology (colorectal) screening, quantitative
							 real-time target and signal amplification of 10 DNA markers (KRAS mutations,
							 promoter methylation of NDRG4 and BMP3) and fecal hemoglobin, utilizing stool,
							 algorithm reported as a positive or negative result
81529
$6,344.23
Oncology (cutaneous melanoma), mRNA, gene expression
							 profiling by real-time RT-PCR of 31 genes (28 content and 3 housekeeping),
							 utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as
							 recurrence risk, including likelihood of sentinel lymph node
							 metastasis
81535
$511.08
Oncology (gynecologic), live tumor cell culture and
							 chemotherapeutic response by DAPI stain and morphology, predictive algorithm
							 reported as a drug response score; first single drug or drug
							 combination
81536
$156.61
Oncology (gynecologic), live tumor cell culture and
							 chemotherapeutic response by DAPI stain and morphology, predictive algorithm
							 reported as a drug response score; each additional single drug or drug
							 combination (List separately in addition to code for primary
							 procedure)
81538
$2,532.22
Oncology (lung), mass spectrometric 8-protein
							 signature, including amyloid A, utilizing serum, prognostic and predictive
							 algorithm reported as good versus poor overall survival
81539
$670.32
Oncology (high-grade prostate cancer), biochemical
							 assay of four proteins (Total PSA, Free PSA, Intact PSA, and human kallikrein-2
							 [hK2]), utilizing plasma or serum, prognostic algorithm reported as a
							 probability score
81540
$3,307.50
Oncology (tumor of unknown origin), mRNA, gene
							 expression profiling by real-time RT-PCR of 92 genes (87 content and 5
							 housekeeping) to classify tumor into main cancer type and subtype, utilizing
							 formalin-fixed paraffin-embedded tissue, algorithm reported as a probability of
							 a predicted main cancer type and subtype
81541
$3,415.99
Oncology (prostate), mRNA gene expression profiling
							 by real-time RT-PCR of 46 genes (31 content and 15 housekeeping), utilizing
							 formalin-fixed paraffin-embedded tissue, algorithm reported as a
							 disease-specific mortality risk score
81542
$3,415.99
Oncology (prostate), mRNA, microarray gene expression
							 profiling of 22 content genes, utilizing formalin-fixed paraffin-embedded
							 tissue, algorithm reported as metastasis risk score
81546
$3,175.20
Oncology (thyroid), mRNA, gene expression analysis of
							 10,196 genes, utilizing fine needle aspirate, algorithm reported as a
							 categorical result (
e.g.,
benign or suspicious)
81551
$1,790.46
Oncology (prostate), promoter methylation profiling
							 by real-time PCR of 3 genes (GSTP1, APC, RASSF1), utilizing formalin-fixed
							 paraffin-embedded tissue, algorithm reported as a likelihood of prostate cancer
							 detection on repeat biopsy
81552
$6,858.43
Oncology (uveal melanoma), mRNA, gene expression
							 profiling by real-time RT-PCR of 15 genes (12 content and 3 housekeeping),
							 utilizing fine needle aspirate or formalin-fixed paraffin-embedded tissue,
							 algorithm reported as risk of metastasis
81554
$4,851.00
Pulmonary disease (idiopathic pulmonary fibrosis
							 [IPF]), mRNA, gene expression analysis of 190 genes, utilizing transbronchial
							 biopsies, diagnostic algorithm reported as categorical result
							 (
e.g.,
positive or negative for high probability of usual
							 interstitial pneumonia [UIP])
81560
$0
Transplantation medicine (allograft rejection,
							 pediatric liver and small bowel), measurement of donor and third-party-induced
							 CD154+T-cytotoxic memory cells, utilizing whole peripheral blood, algorithm
							 reported as a rejection risk score
81595
$2,857.68
Cardiology (heart transplant), mRNA, gene expression
							 profiling by real-time quantitative PCR of 20 genes (11 content and 9
							 housekeeping), utilizing subfraction of peripheral blood, algorithm reported as
							 a rejection risk score
81596
$63.67
Infectious disease, chronic hepatitis C virus (HCV)
							 infection, six biochemical assays (ALT, A2-macroglobulin, apolipoprotein A-1,
							 total bilirubin, GGT, and haptoglobin) utilizing serum, prognostic algorithm
							 reported as scores for fibrosis and necroinflammatory activity in
							 liver
81599
I.C.
Unlisted multianalyte assay with algorithmic
							 analysis
G0027
$5.73
Semen analysis; presence and/or motility of sperm
							 excluding Huhner
G0103
$17.03
Prostate cancer screening; prostate specific antigen
							 test (PSA)
G0123
$17.87
creening cytopathology, cervical or vaginal (any
							 reporting system), collected in preservative fluid, automated thin layer
							 preparation, screening by cytotechnologist under physician
							 supervision
G0143
$23.86
Screening cytopathology, cervical or vaginal (any
							 reporting system), collected in preservative fluid, automated thin layer
							 preparation, with manual screening and rescreening by cytotechnologist under
							 physician supervision
G0144
$38.78
Screening cytopathology, cervical or vaginal (any
							 reporting system), collected in preservative fluid, automated thin layer
							 preparation, with screening by automated system, under physician
							 supervision
G0145
$23.36
Screening cytopathology, cervical or vaginal (any
							 reporting system), collected in preservative fluid, automated thin layer
							 preparation, with screening by automated system and manual rescreening under
							 physician supervision
G0147
$13.36
Screening cytopathology smears, cervical or vaginal,
							 performed by automated system under physician supervision
G0148
$28.17
Screening cytopathology smears, cervical or vaginal,
							 performed by automated system with manual rescreening
G0306
$6.85
Complete CBC, automated (HgB, HCT, RBC, WBC, without
							 platelet count) and automated WBC differential count
G0307
$5.71
Complete CBC, automated (HgB, HCT, RBC, WBC; without
							 platelet count)
G0328
$15.92
Colorectal cancer screening; fecal occult blood test,
							 immunoassay, one to three simultaneous determinations
G0432
$17.26
Infectious agent antibody detection by enzyme
							 immunoassay (EIA) technique, HIV-1 and/or HIV-2, screening
G0433
$16.13
Infectious agent antibody detection by enzyme-linked
							 immunosorbent assay (ELISA) technique, HIV-1 and/or HIV-2,
							 screening
G0435
$10.57
Infectious agent antibody detection by rapid antibody
							 test, HIV-1 and/or HIV-2, screening
G0480
$59.69
Drug test(s), definitive, utilizing (1) drug
							 identification methods able to identify individual drugs and distinguish
							 between structural isomers (but not necessarily stereoisomers), including, but
							 not limited to, GC/MS (any type, single or tandem) and LC/MS (any type, single
							 or tandem and excluding immunoassays (
e.g.
, IA, EIA, ELISA,
							 EMIT, FPIA) and enzymatic methods (
e.g.,
alcohol
							 dehydrogenase)), (2) stable isotope or other universally recognized internal
							 standards in all samples (
e.g.,
to control for matrix effects,
							 interferences and variations in signal strength), and (3) method or
							 drug-specific calibration and matrix-matched quality control material
							 (
e.g.,
to control for instrument variations and mass spectral
							 drift); qualitative or quantitative, all sources, includes specimen validity
							 testing, per day; 1-7 drug class(es), including metabolite(s) if
							 performed
G0481
$91.84
Drug test(s), definitive, utilizing (1) drug
							 identification methods able to identify individual drugs and distinguish
							 between structural isomers (but not necessarily stereoisomers), including, but
							 not limited to, GC/MS (any type, single or tandem) and LC/MS (any type, single
							 or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and
							 enzymatic methods (
e.g.,
alcohol dehydrogenase)), (2) stable
							 isotope or other universally recognized internal standards in all samples
							 (
e.g.,
to control for matrix effects, interferences and
							 variations in signal strength), and (3) method or drug-specific calibration and
							 matrix-matched quality control material
(e.g.,
to control for
							 instrument variations and mass spectral drift); qualitative or quantitative,
							 all sources, includes specimen validity testing, per day; 8-14 drug class(es),
							 including metabolite(s) if performed
G0482
$123.97
Drug test(s), definitive, utilizing (1) drug
							 identification methods able to identify individual drugs and distinguish
							 between structural isomers (but not necessarily stereoisomers), including, but
							 not limited to, GC/MS (any type, single or tandem) and LC/MS (any type, single
							 or tandem and excluding immunoassays (
e.g.
, IA, EIA, ELISA,
							 EMIT, FPIA) and enzymatic methods (
e.g.,
alcohol
							 dehydrogenase)), (2) stable isotope or other universally recognized internal
							 standards in all samples (
e.g.,
to control for matrix effects,
							 interferences and variations in signal strength), and (3) method or
							 drug-specific calibration and matrix-matched quality control material
							 (
e.g.,
to control for instrument variations and mass spectral
							 drift); qualitative or quantitative, all sources, includes specimen validity
							 testing, per day; 15-21 drug class(es), including metabolite(s) if
							 performed
G0483
$160.71
Drug test(s), definitive, utilizing (1) drug
							 identification methods able to identify individual drugs and distinguish
							 between structural isomers (but not necessarily stereoisomers), including, but
							 not limited to, GC/MS (any type, single or tandem) and LC/MS (any type, single
							 or tandem and excluding immunoassays (
e.g.,
IA, EIA, ELISA,
							 EMIT, FPIA) and enzymatic methods (
e.g.,
alcohol
							 dehydrogenase)), (2) stable isotope or other universally recognized internal
							 standards in all samples (
e.g.,
to control for matrix effects,
							 interferences and variations in signal strength), and (3) method or
							 drug-specific calibration and matrix-matched quality control material
							 (
e.g.,
to control for instrument variations and mass spectral
							 drift); qualitative or quantitative, all sources, includes specimen validity
							 testing, per day; 22 or more drug class(es), including metabolite(s) if
							 performed
G2023
$23.46
Specimen collection for Severe Acute Respiratory
							 Syndrome Coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any
							 specimen source
G2023 CG
$44.27
Specimen collection for Severe Acute Respiratory
							 Syndrome Coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any
							 specimen source. [Used when provider 1) has a qualified ordering clinician
							 present at the specimen collection site available to order medically necessary
							 COVID-19 diagnostic tests; and 2) ensures the test results are provided to the
							 patient (along with any initial follow-up counseling, as appropriate), either
							 directly or through the patient's ordering clinician.]
G2024
$25.46
Specimen collection for Severe Acute Respiratory
							 Syndrome Coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) from an
							 individual in a SNF or by a laboratory on behalf of a HHA, any specimen
							 source
G2024 CG
$46.27
Specimen collection for Severe Acute Respiratory
							 Syndrome Coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), from an
							 individual in a SNF or by a laboratory on behalf of a HHA, any specimen source.
							 [Used when provider 1) has a qualified ordering clinician present at the
							 specimen collection site available to order medically necessary COVID-19
							 diagnostic tests; and 2) ensures the test results are provided to the patient
							 (along with any initial follow-up counseling, as appropriate), either directly
							 or through the patient's ordering clinician.]
G9143
$106.48
Warfarin responsiveness testing by genetic technique
							 using any method, any number of specimen(s)
P2028
$4.37
Cephalin floculation, blood
P2029
$4.37
Congo red, blood
P2031
$4.37
Hair analysis (excluding arsenic)
P2033
$4.37
Thymol turbidity, blood
P2038
$4.37
Mucoprotein, blood (seromucoid) (medical necessity
							 procedure)
P9604
$4.65
Travel allowance, one way in connection with
							 medically necessary laboratory specimen collection drawn from homebound or
							 nursing homebound patient; prorated trip charge
P9612
$2.65
Catheterization for collection of specimen, single
							 patient, all places of service
P9615
$2.65
Catheterization for collection of specimen(s)
							 (multiple patients)
Q0111
$13.36
Wet mounts, including preparations of vaginal,
							 cervical or skin specimens
Q0112
$5.14
All potassium hydroxide (KOH)
							 preparations
Q0113
$3.77
Pinworm examinations
Q0114
$8.59
Fern test
Q0115
$22.05
Postcoital direct, qualitative examinations of
							 vaginal or cervical mucous
U0002
$51.31
2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV
							 (COVID-19), any technique, multiple types or subtypes (includes all targets),
							 non-CDC
U0003
$75.00
Infectious agent detection by nucleic acid (DNA or
							 RNA); Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) (Coronavirus
							 disease [COVID-19]), amplified probe technique, making use of high throughput
							 technologies as described by CMS-2020-01-R
U0004
$75.00
2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV
							 (COVID-19), any technique, multiple types or subtypes (includes all targets),
							 non-CDC, making use of high throughput technologies as described by
							 CMS-2020-01-R
U0005
$25.00
Infectious agent detection by nucleic acid (DNA or
							 RNA); Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) (Coronavirus
							 disease [COVID-19]), amplified probe technique, CDC or non-CDC, making use of
							 high throughput technologies, completed within two calendar days from date of
							 specimen collection (list separately in addition to either HCPCS code U0003 or
							 U0004) as described by CMS-2020-01-R2