Great Plains Regional Medical Center 03/26/26 3 Great Plains Regional Medical Center "1801 W 3rd Street, Elk City, OK 73644" 2210 1184639122 TRUE Corey Lively Description code|1 code|1|type code|2 code|2|type modifiers setting Drug_unit_of_measurement Drug_type_of_measurement standard_charge|gross standard_charge|discounted_cash additional_generic_notes standard_charge|UHC|PPO|negotiated_dollar standard_charge|UHC|PPO|negotiated_percentage standard_charge|UHC|PPO|negotiated_algorithm median_amount|UHC|PPO 10th_percentile|UHC|PPO 90th_percentile|UHC|PPO count|UHC|PPO Standard_charge|UHC|PPO| methodology additional_payer_notes|UHC|PPO Standard_charge|PPO| Standard_charge|PPO|methodology Standard_charge|Blue Cross Blue Shield OK Standard_charge|BCBS|methodology Standard_charge|Healthchoice PPO| Standard_charge|Healthchoice| methodology Standard_charge|min Standard_charge|max DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC 56 DRG 56 LOCAL Inpatient 60288.48 39187.51 14078.47 case rate 48230.78 case rate 20064.96 case rate 11343.31 case rate 9774.98 48230.78 DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC 57 DRG 57 LOCAL Inpatient 37274.64 24228.52 7353.77 case rate 29819.71 case rate 11902.66 case rate 17050 case rate 7103.8 29819.71 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARTION W MCC 64 DRG 64 LOCAL Inpatient 32481.12 21114.03 11596.8 case rate 25984.9 case rate 10027.34 case rate 25052 case rate 8326.84 25984.9 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARTION W CC OR TPA 65 DRG 65 LOCAL Inpatient 31875.04 20718.78 5977.17 case rate 25500.03 case rate 10812.11 case rate 12712 case rate 5116.1 25500.03 NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WO INFARCTION 67 DRG 67 LOCAL Inpatient 113228.71 73598.66 8332.41 case rate 90582.97 case rate 14818.82 case rate 17721 case rate 5116.1 90582.97 TRANSIENT ISCHEMIS WITHOUT THROMBOLYTIC 69 DRG 69 LOCAL Inpatient 32659.95 21228.97 4692.23 case rate 26127.96 case rate 7886.52 case rate 9989 case rate 4342.73 26127.96 NONSPECIFIC CEREBROVASCULAR DISORDERS W MCC 70 DRG 70 LOCAL Inpatient 25818.94 16782.31 10523.57 case rate 20655.15 case rate 17287.22 case rate 22381 case rate 9161.9 22381 NONSPECIFIC CEREBROVASCULAR DISORDERS W CC 71 DRG 71 LOCAL Inpatient 44573.14 28972.54 6286.5 case rate 35658.51 case rate 10376.95 case rate 13280 case rate 6138.88 35658.51 TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC 84 DRG 84 LOCAL Inpatient 20807.53 13524.89 5408.51 case rate 16646.02 case rate 9438.45 case rate 11503 case rate 5116.1 16646.02 OTHER DISORDERS OF NERVOUS SYSTEM W MCC 91 DRG 91 LOCAL Inpatient 22281.03 14482.67 10158.37 case rate 17824.82 case rate 16148.44 case rate 22378 case rate 10158.37 22378 OTHER DISORDERS OF NERVOUS SYSTEM W CC 92 DRG 92 LOCAL Inpatient 37353.95 24280.07 6034.22 case rate 29883.16 case rate 9823.28 case rate 12833 case rate 5670.85 29883.16 PULMONARY EMBOLISM WITHOUT MCC 176 DRG 176 LOCAL Inpatient 24846.21 16150.04 4796.32 case rate 19876.97 case rate 9387.07 case rate 10201 case rate 4429.93 19876.97 RESPIRATORY INFECTIONS AND INFLAMATIONS W MCC 177 DRG 177 LOCAL Inpatient 25069.78 16295.36 10467.11 case rate 20055.82 case rate 19406.44 case rate 21117 case rate 7181.74 21117 RESPIRATORY INFECTIONS AND INFLAMATIONS W CC 178 DRG 178 LOCAL Inpatient 28766.18 18698.02 6392.35 case rate 23012.94 case rate 13581.47 case rate 12341 case rate 5157.32 23012.94 RESPIRATORY INFECTIONS AND INFLAMATIONS WITHOUT CC/MCC 179 DRG 179 LOCAL Inpatient 23323.99 15160.59 4618.73 case rate 18659.19 case rate 9751.98 case rate 9547 case rate 4618.73 18659.19 RESPIRATORY NEOPLASMS W CC 181 DRG 181 LOCAL Inpatient 28987.58 18841.93 6666.98 case rate 23190.06 case rate 12121.82 case rate 13771 case rate 5116.1 23190.06 PULMONARY EDEMA AND RESPIRATORY FAILURE 189 DRG 189 LOCAL Inpatient 57864.09 37611.66 7245.06 case rate 46297.27 case rate 12788.73 case rate 15409 case rate 6107.44 46291.27 CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC 190 DRG 190 LOCAL Inpatient 20500.59 13325.38 6480.56 case rate 16400.47 case rate 5519.62 case rate 13783 case rate 5012.26 16400.47 SIMPLE PNEUMONIA AND PLEURISY W MCC 193 DRG 193 LOCAL Inpatient 29434.46 19132.4 7801.38 case rate 23547.57 case rate 14398.33 case rate 16592 case rate 5410.79 23547.57 SIMPLE PNEUMONIA AND PLEURISY W CC 194 DRG 194 LOCAL Inpatient 18166.99 11808.54 4940.99 case rate 14533.59 case rate 9785.54 case rate 10283 case rate 4038.6 14533.59 RESPIRATORY SYSTEM DIAGNOSIS WITH VENTALATOR SUPPORT < 96 HRS 208 DRG 208 LOCAL Inpatient 91549.05 59506.88 15900.32 case rate 73239.24 case rate 24828.75 case rate 33816 case rate 12206.7 73239.24 ACUTE MYOCARDIAL INFARCTION DISCHARGED ALIVE WITH MCC 280 DRG 280 LOCAL Inpatient 30043.6 19528.34 9329.78 case rate 24034.88 case rate 17382.64 case rate 19842 case rate 7440.53 24034.88 HEART FAILURE AND SHOCK WITH MCC 291 DRG 291 LOCAL Inpatient 26157.27 17002.23 7550.27 case rate 20925.82 case rate 15476.29 case rate 16058 case rate 5676.82 20925.82 CARDIAC ARYTHMIA AND CONDUCTION DISORDERS W MCC 308 DRG 308 LOCAL Inpatient 33179.1 21566.41 6895.74 case rate 26543.28 case rate 12462.61 case rate 15036 case rate 6895.74 26543.28 SYNCOPE AND COLLAPSE 312 DRG 312 LOCAL Inpatient 16089.56 10458.21 5078.01 case rate 12871.65 case rate 8352.1 case rate 10800 case rate 3985.61 12871.65 MAJOR SMALL AND LARGE BOWEL PROCEDURES W CC 330 DRG 330 LOCAL Inpatient 76361.52 49634.99 14439.54 case rate 61089.22 case rate 25888.89 case rate 29668 case rate 8594.3 61089.22 GASTROINTESTINAL HEMORRAGE W MCC 377 DRG 377 LOCAL Inpatient 10026.64 6517.32 10455.94 case rate 8021.31 case rate 17973 case rate 22391 case rate 5062.34 22391 "ESOPHAGITIS, GASTROENTERITIS AND MISC DIGESTIVE DISORDERS W MCC" 391 DRG 391 LOCAL Inpatient 25056.83 16286.94 7550.86 case rate 20045.46 case rate 12950.21 case rate 15955 case rate 5937.81 20045.46 "ESOPHAGITIS, GASTROENTERITIS AND MISC DIGESTIVE DISORDERS WO MCC" 392 DRG 392 LOCAL Inpatient 28499.97 18524.98 4631.66 case rate 22799.98 case rate 6129.68 case rate 9825 case rate 4283.03 22799.98 MAJOR HIP AND KNEE JOINT REPLACEMENT OF LOWER EXT WO MCC 470 DRG 470 LOCAL Inpatient 54939.8 35710.87 11243.37 case rate 43951.84 case rate 21541.39 case rate 23534 case rate 9338.65 43951.84 HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT W MCC 480 DRG 480 LOCAL Inpatient 48403.71 31462.41 17422.25 case rate 38722.97 case rate 31666.67 case rate 36882 case rate 14830.2 38722.97 HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT W CC 481 DRG 481 LOCAL Inpatient 47531.81 30895.68 12201.93 case rate 38025.45 case rate 21497.35 case rate 25951 case rate 12201.93 38025.45 HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FX WO MCC 522 DRG 522 LOCAL Inpatient 50514.59 32834.48 12421.28 case rate 40411.67 case rate 12552.52 case rate 26417 case rate 8594.3 40411.67 AFTERCARE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE W MCC 559 DRG 559 LOCAL Inpatient 52520.13 34138.08 10497.1 case rate 42016.1 case rate 1730.11 case rate 23144 case rate 1730.11 42016.1 AFTERCARE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE W CC 560 DRG 560 LOCAL Inpatient 40183.04 26118.98 6442.93 case rate 32146.43 case rate 11295.52 case rate 14159 case rate 6442.93 32146.43 AFTERCARE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WO CC/MCC 561 DRG 561 LOCAL Inpatient 40413.54 26268.8 4558.15 case rate 32330.83 case rate 7980.89 case rate 9758 case rate 4558.15 32330.83 "MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS W MCC" 640 DRG 640 LOCAL Inpatient 30289.19 19687.97 7734.34 case rate 24231.35 case rate 12293.79 case rate 16449 case rate 5620.53 24231.35 RENAL FAILURE W MCC 682 DRG 682 LOCAL Inpatient 43971.62 28581.55 8825.8 case rate 35177.3 case rate 15564.37 case rate 18771 case rate 6758.19 35177.3 RENAL FAILURE W CC 683 DRG 683 LOCAL Inpatient 19870 12915.5 5262.67 case rate 15896 case rate 9743.59 case rate 11266 case rate 3905.36 15896 VAGINAL DELIVERY WITH O/R PROCEDURES EXCEPT STERILIZATION 768 DRG 768 LOCAL Inpatient 11622.24 7554.46 case rate 9297.79 case rate 9661.2 case rate 15235 case rate 5116.1 15235 CESAREAN SECTION W STERILIZATION WO CC/MCC 785 DRG 785 LOCAL Inpatient 19333.59 12566.83 case rate 15466.87 case rate 8865.91 case rate 10835 case rate 3082.14 15466.87 CESAREAN SECTION W STERILIZATION W CC 787 DRG 787 LOCAL Inpatient 18814.93 12229.7 case rate 15051.94 case rate 11336.41 case rate 13146 case rate 3191.75 15051.94 CESAREAN SECTION W STERILIZATION WO CC OR MCC 788 DRG 788 LOCAL Inpatient 19577.36 12725.28 case rate 15661.89 case rate 9444.74 case rate 8692.06 case rate 2847.13 15661.89 NEONATE WITH OTHER SIGNIFICANT PROBLEMS 794 DRG 794 LOCAL Inpatient 10466.58 6803.28 case rate 8373.26 case rate 14092.14 case rate 9265.32 case rate 1541.44 14092.14 NORMAL NEWBORN 795 DRG 795 LOCAL Inpatient 7372.08 4791.85 case rate 5897.66 case rate 8669.8 case rate 6752 case rate 757.98 8669.8 VAGINAL DELIVERY WO STERILIZATION OR D&C WO CC OR MCC 807 DRG 807 LOCAL Inpatient 11116 7225.4 case rate 8892.8 case rate 6438.4 case rate 6212 case rate 1731.24 8892.8 SEPTICEMIA OR SERVE SEPSIS WO MV >96 HOURS W MCC 871 DRG 871 LOCAL Inpatient 34254.5 22265.42 11659.14 case rate 27403.6 case rate 5227.24 case rate 24796 case rate 5227.24 27403.6 ORGANIC DISTURBANCE AND INTELLECTUAL DISABILITY 884 DRG 884 LOCAL Inpatient 39962.29 25975.49 10331.85 case rate 31969.83 case rate 12941.82 case rate 19017 case rate 4664.85 31969.83 DRAIN/ INJ JOINT 20610 CPT 20610 LOCAL Outpatient 3232.1 2035.86 fee schedule 252.73 percent of total billed charge 858.09 fee schedule 487.94 fee schedule 252.73 858.09 RECONSTRUCTION SHOULDER JOINT 23472 CPT 23472 LOCAL Outpatient 57188.28 37172.38 fee schedule 12396.52 percent of total billed charge 20744.07 fee schedule 15550 fee schedule 12396.52 20744.07 TOTAL HIP ARTHROPLASTY 27130 CPT 27130 LOCAL Outpatient 46570.3 30270.69 fee schedule 12564.29 percent of total billed charge 25185.37 fee schedule 18000 fee schedule 12564.29 25185.37 TOTAL KNEE ARTHROPLASTY 27447 CPT 27447 LOCAL Outpatient 41541.15 27001.75 fee schedule 12564.69 percent of total billed charge 20930.95 fee schedule 11196 fee schedule 11196 20930.95 WRIST ENDOSCOPY/SURGERY 29848 CPT 29848 LOCAL Outpatient 5086.68 3306.34 fee schedule 2204.55 percent of total billed charge 2165.83 fee schedule 3062.66 fee schedule 2165.83 3062.66 KNEE ARTHROSCOPY/SURGERY 29881 CPT 29881 LOCAL Outpatient 13341.02 8671.66 fee schedule 2766.95 percent of total billed charge 6534.35 fee schedule 4787.9 fee schedule 2766.95 6534.35 EGD BIOPSY SINGLE/MULTIPLE 43239 CPT 43239 LOCAL Outpatient 9209.38 5986.1 fee schedule 1388.88 percent of total billed charge 3605.48 fee schedule 3908.57 fee schedule 1388.88 3908.57 LAPAROSCOPY APPENDECTOMY 44970 CPT 44970 LOCAL Outpatient 25261.97 16420.28 fee schedule 1288.2 percent of total billed charge 7693.83 fee schedule 8491.35 fee schedule 1288.2 8491.35 DIAGNOSTIC COLONOSCOPY 45378 CPT 45378 LOCAL Outpatient 6111.51 3972.48 fee schedule 772.49 percent of total billed charge 1350.34 fee schedule 3796.22 fee schedule 772.49 3796.22 COLONOSCOPY AND BIOPSY 45380 CPT 45380 LOCAL Outpatient 5893.22 3830.59 fee schedule 1005.6 percent of total billed charge 1716.42 fee schedule 2341.32 fee schedule 1005.6 2341.32 LAPAROSCOPIC CHOLYSTECTOMY 47562 CPT 47562 LOCAL Outpatient 18749.64 12187.27 fee schedule 4105.39 percent of total billed charge 4358.58 fee schedule 6645.42 fee schedule 4105.39 6645.42 FRAGMENTING OF KIDNEY STONE 50590 CPT 50590 LOCAL Outpatient 32396.61 21057.8 fee schedule 2979.32 percent of total billed charge 11981.93 fee schedule 9601.51 fee schedule 2979.32 11981.93 NJX INTERLAMINAR CRV/THRC 62321 CPT 62321 LOCAL Outpatient 8119.11 5277.42 fee schedule 598.95 percent of total billed charge 1271.94 fee schedule 1353.8 fee schedule 598.95 1353.8 NJX INTERLAMINAR LMBR/SAC 62323 CPT 62323 LOCAL Outpatient 3793.89 2466.03 fee schedule 598.95 percent of total billed charge 1271.94 fee schedule 1353.8 fee schedule 598.95 1353.8 INSRT/REDO SPNE N GENERATOR 63685 CPT 63685 LOCAL Outpatient 72718.09 47266.76 fee schedule 26011.24 percent of total billed charge 34707.43 fee schedule 42852.32 fee schedule 26011.24 42852.32 INJ PARAVERT F JNT L/S 64493 CPT 64493 LOCAL Outpatient 3578.91 2326.29 fee schedule 732.92 percent of total billed charge 2063.3 fee schedule 2382.93 fee schedule 732.92 2382.93 DSTRJ NULYT AGT GNCLR NRV 64624 CPT 64624 LOCAL Outpatient 9110.48 5921.81 fee schedule 1670.88 percent of total billed charge 2087.86 fee schedule 2358.65 fee schedule 1670.88 2358.65 ACETAMINOPHEN 100 MG/ML BOTT J0131 HCPCS J0131 LOCAL BOTH 100 GR 7.14 4.64 5.712 percent of total billed charges 5.712 percent of total billed charge 5.712 percent ot total billed charges 5.712 percent of total billed charges 5.71 5.71 AMIODARONE 900MG/18ML J0282 HCPCS J0282 LOCAL BOTH 900 GR 19.3 12.55 15.44 percent of total billed charges 15.44 percent of total billed charge 15.44 percent ot total billed charges 15.44 percent of total billed charges 15.44 15.44 ACYCLOVIR 200 MG/5 ML BOTT J8499 HCPCS J8499 LOCAL BOTH 200 GR 8.49 5.52 6.792 percent of total billed charges 6.792 percent of total billed charge 6.792 percent ot total billed charges 6.792 percent of total billed charges 6.79 6.79 PHENYLEPHRINE 500MCG/5ML J2372 HCPCS J2372 LOCAL BOTH 1 UN 73.54 47.8 58.832 percent of total billed charges 58.832 percent of total billed charge 58.832 percent ot total billed charges 58.832 percent of total billed charges 58.83 58.83 CROMOLYN 20MG/2ML J7631 HCPCS J7631 LOCAL BOTH 500 GR 7.14 4.64 5.712 percent of total billed charges 5.712 percent of total billed charge 5.712 percent ot total billed charges 5.712 percent of total billed charges 5.71 5.71 VANCOMYCIN 1.25 inj J3370 HCPCS J3370 LOCAL BOTH 1 UN 148.68 96.64 118.944 percent of total billed charges 118.944 percent of total billed charge 118.944 percent ot total billed charges 118.944 percent of total billed charges 118.94 118.94 SODIUM CHLORIDE INHALATION J7699 HCPCS J7699 LOCAL BOTH 1 UN 6.81 4.43 5.448 percent of total billed charges 5.448 percent of total billed charge 5.448 percent ot total billed charges 5.448 percent of total billed charges 5.45 5.45 ADJUVANTED 0.5ML INJ-INFU VACC S0195 HCPCS S0195 LOCAL BOTH 1 UN 1158.23 752.85 926.584 percent of total billed charges 926.584 percent of total billed charge 926.584 percent ot total billed charges 926.584 percent of total billed charges 926.58 926.58 hyperhepb 110 units/0.5ml Syr J8540 HCPCS J8540 LOCAL BOTH 1 UN 7.84 5.1 6.272 percent of total billed charges 6.272 percent of total billed charge 6.272 percent ot total billed charges 6.272 percent of total billed charges 6.27 6.27 PREVNAR 13 INJ S0077 HCPCS S0077 LOCAL BOTH 1 UN 64.85 42.15 51.88 percent of total billed charges 51.88 percent of total billed charge 51.88 percent ot total billed charges 51.88 percent of total billed charges 51.88 51.88 DEXAMETHASONE 4 MG TABLET Oral dexamethasone J3770 HCPCS J3770 LOCAL BOTH 4 GR 280.76 182.49 224.608 percent of total billed charges 224.608 percent of total billed charge 224.608 percent ot total billed charges 224.608 percent of total billed charges 224.61 224.61 Clindamycin 6mb/ml inj J2060 HCPCS J2060 LOCAL BOTH 1 UN 61.97 40.28 49.576 percent of total billed charges 49.576 percent of total billed charge 49.576 percent ot total billed charges 49.576 percent of total billed charges 49.58 49.58 vancomycin 1.25g premix J3480 HCPCS J3480 LOCAL BOTH 1 UN 46.45 30.19 37.16 percent of total billed charges 37.16 percent of total billed charge 37.16 percent ot total billed charges 37.16 percent of total billed charges 37.16 37.16 ATIVAN 40MG/10ML VIAL J1980 HCPCS J1980 LOCAL BOTH 40 GR 359.77 233.85 287.816 percent of total billed charges 287.816 percent of total billed charge 287.816 percent ot total billed charges 287.816 percent of total billed charges 287.82 287.82 KCL 10MEQ/50ML Q9966 HCPCS Q9966 LOCAL TB BOTH 1 UN 251.61 163.55 201.288 percent of total billed charges 201.288 percent of total billed charge 201.288 percent ot total billed charges 201.288 percent of total billed charges 201.29 201.29 HYOSCYAMINE 0.5mg/ml inj A9512 HCPCS A9512 LOCAL BOTH 1 UN 193.69 125.9 154.952 percent of total billed charges 154.952 percent of total billed charge 154.952 percent ot total billed charges 154.952 percent of total billed charges 154.95 154.95 POLIOVIRUS VACCINE A9579 HCPCS A9579 LOCAL BOTH 1 UN 94.52 61.44 75.616 percent of total billed charges 75.616 percent of total billed charge 75.616 percent ot total billed charges 75.616 percent of total billed charges 75.62 75.62 "DTAP/HIB VACCINE, IM" J7060 HCPCS J7060 LOCAL BOTH 1 UN 111.88 72.72 89.504 percent of total billed charges 89.504 percent of total billed charge 89.504 percent ot total billed charges 89.504 percent of total billed charges 89.5 89.5 iopamidol M 200 10ml inj J7070 HCPCS J7070 LOCAL TB BOTH 200 ML 81.27 52.83 65.016 percent of total billed charges 65.016 percent of total billed charge 65.016 percent ot total billed charges 65.016 percent of total billed charges 65.02 65.02 TC -99M** J7042 HCPCS J7042 LOCAL BOTH 1 UN 81.27 52.83 65.016 percent of total billed charges 65.016 percent of total billed charge 65.016 percent ot total billed charges 65.016 percent of total billed charges 65.02 65.02 MRI 10 ML GADOLINIUM INJ GADOLINIUM BASED MRI CONTR J7121 HCPCS J7121 LOCAL TB BOTH 1 UN 81.27 52.83 65.016 percent of total billed charges 65.016 percent of total billed charge 65.016 percent ot total billed charges 65.016 percent of total billed charges 65.02 65.02 DEXTROSE 5% 250ML AVIVA J7120 HCPCS J7120 LOCAL TB BOTH 250 ML 81.27 52.83 65.016 percent of total billed charges 65.016 percent of total billed charge 65.016 percent ot total billed charges 65.016 percent of total billed charges 65.02 65.02 "DEXTROSE 5%-WATER 1000 ML BAG INFUSION D 5 W, 1000cc" J7050 HCPCS J7050 LOCAL BOTH 1 UN 56.24 36.56 44.992 percent of total billed charges 44.992 percent of total billed charge 44.992 percent ot total billed charges 44.992 percent of total billed charges 44.99 44.99 DEXTROSE 5%-NORMAL SALINE 1000 5% dextrose/normal saline J7030 HCPCS J7030 LOCAL BOTH 1 UN 80.79 52.51 64.632 percent of total billed charges 64.632 percent of total billed charge 64.632 percent ot total billed charges 64.632 percent of total billed charges 64.63 64.63 DEXTROSE 5%-LACT RINGERS 1000 C1894 HCPCS C1894 LOCAL BOTH 1 UN 1137.41 739.32 909.928 percent of total billed charges 909.928 percent of total billed charge 909.928 percent ot total billed charges 909.928 percent of total billed charges 909.93 909.93 "RINGERS SOLN,LACTATED 1000 ML" A4850 HCPCS A4850 LOCAL BOTH 1 UN 1440.02 936.01 1152.016 percent of total billed charges 1152.016 percent of total billed charge 1152.016 percent ot total billed charges 1152.016 percent of total billed charges 1152.02 1152.02 SODIUM CHLORIDE 0.9% 50 ML BAG A6203 HCPCS A6203 LOCAL BOTH 1 UN 4.76 3.09 3.808 percent of total billed charges 3.808 percent of total billed charge 3.808 percent ot total billed charges 3.808 percent of total billed charges 3.81 3.81 SODIUM CHLORIDE 0.9% 1000 ML B E0218 HCPCS E0218 LOCAL BOTH 1 UN 8.92 5.8 7.136 percent of total billed charges 7.136 percent of total billed charge 7.136 percent ot total billed charges 7.136 percent of total billed charges 7.14 7.14 "AVONEX 30MCG INJ INTERFERON BETA 1a,1mcg" J1826 HCPCS J1826 LOCAL TB BOTH 30 GR 40.67 26.44 32.536 percent of total billed charges 32.536 percent of total billed charge 32.536 percent ot total billed charges 32.536 percent of total billed charges 32.54 32.54 ARANESP 60MCG/0.3ML VIAL IN DARBEPOETIN 1 MICROGRAM J0881 HCPCS J0881 LOCAL BOTH 60 GR 6.49 4.22 5.192 percent of total billed charges 5.192 percent of total billed charge 5.192 percent ot total billed charges 5.192 percent of total billed charges 5.19 5.19 PEPCID COMPLETE J3490 HCPCS J3490 LOCAL BOTH 1 UN 267.46 173.85 213.968 percent of total billed charges 213.968 percent of total billed charge 213.968 percent ot total billed charges 213.968 percent of total billed charges 213.97 213.97 MIDAZOLAM HCL 50MG/10ML VIAL J2250 HCPCS J2250 LOCAL BOTH 50 GR 56.56 36.76 45.248 percent of total billed charges 45.248 percent of total billed charge 45.248 percent ot total billed charges 45.248 percent of total billed charges 45.25 45.25 FENTANYL 500MCG-10ML INJ FENTANYL CITRATE 0.1MG J3010 HCPCS J3010 LOCAL TB BOTH 1 UN 13.95 9.07 11.16 percent of total billed charges 11.16 percent of total billed charge 11.16 percent ot total billed charges 11.16 percent of total billed charges 11.16 11.16 ALKERAN 2MG Melphalan oral 2 MG J8600 HCPCS J8600 LOCAL BOTH 2 GM 6912.3 4493 5529.84 percent of total billed charges 5529.84 percent of total billed charge 5529.84 percent ot total billed charges 5529.84 percent of total billed charges 5529.84 5529.84 TAXOTERE 80MG/8ML VIAL J9171 HCPCS J9171 LOCAL BOTH 80 GM 408.96 265.82 327.168 percent of total billed charges 327.168 percent of total billed charge 327.168 percent ot total billed charges 327.168 percent of total billed charges 327.17 327.17 ALTEPLASE 2 MG VIAL Alteplase recombinant J2997 HCPCS J2997 LOCAL TB BOTH 2 GR 774.2 503.23 619.36 percent of total billed charges 619.36 percent of total billed charge 619.36 percent ot total billed charges 619.36 percent of total billed charges 619.36 619.36 "ACETADOTE 30ML INJECTION,ACETYLCYSTEINE 100MG" J0132 HCPCS J0132 LOCAL BOTH 30 ML 175.1 113.82 140.08 percent of total billed charges 140.08 percent of total billed charge 140.08 percent ot total billed charges 140.08 percent of total billed charges 140.08 140.08 ACETAZOLAMIDE SOD 500 MG/VIAL Acetazolamid sodium injectio J1120 HCPCS J1120 LOCAL BOTH 500 GM 5.13 3.33 4.104 percent of total billed charges 4.104 percent of total billed charge 4.104 percent ot total billed charges 4.104 percent of total billed charges 4.1 4.1 OXYTOCIN 100 UNIT/10 ML INJ OXYTOCIN UP TO 10 UNITS J2590 HCPCS J2590 LOCAL TB BOTH 1 UN 466.13 302.98 372.904 percent of total billed charges 372.904 percent of total billed charge 372.904 percent ot total billed charges 372.904 percent of total billed charges 372.9 372.9 TRASTUZUMAB 440MG/21ML VIAL INJ TRASTUZUMAB 10MG J9355 HCPCS J9355 LOCAL BOTH 1 UN 8827.78 5738.06 7062.224 percent of total billed charges 7062.224 percent of total billed charge 7062.224 percent ot total billed charges 7062.224 percent of total billed charges 7062.22 7062.22 Tocilizumab 400mg inj EUA Q0249 HCPCS Q0249 LOCAL TB BOTH 400 GM 138.16 89.8 110.528 percent of total billed charges 110.528 percent of total billed charge 110.528 percent ot total billed charges 110.528 percent of total billed charges 110.53 110.53 "BICILLIN LA 600,000 UNITS-1ML Penicillin g benzathine inj" J0561 HCPCS J0561 LOCAL BOTH 1 UN 246.1 159.97 196.88 percent of total billed charges 196.88 percent of total billed charge 196.88 percent ot total billed charges 196.88 percent of total billed charges 196.88 196.88 CARNITOR 1000MG INJ J1955 HCPCS J1955 LOCAL BOTH 1 UN 53.54 34.8 42.832 percent of total billed charges 42.832 percent of total billed charge 42.832 percent ot total billed charges 42.832 percent of total billed charges 42.83 42.83 ACETYLCYSTEINE 20% 4ML VIAL Acetylcysteine non-comp unit J7608 HCPCS J7608 LOCAL TB BOTH 1 UN 221.87 144.22 177.496 percent of total billed charges 177.496 percent of total billed charge 177.496 percent ot total billed charges 177.496 percent of total billed charges 177.5 177.5 ACYCLOVIR 7MG/ML IVPB J0133 HCPCS J0133 LOCAL BOTH 7 GM 1941.02 1261.66 1552.816 percent of total billed charges 1552.816 percent of total billed charge 1552.816 percent ot total billed charges 1552.816 percent of total billed charges 1552.82 1552.82 OCTREOTIDE ACETATE 0.2 MG/ML 5 J2354 HCPCS J2354 LOCAL BOTH 1 UN 48.72 31.67 38.976 percent of total billed charges 38.976 percent of total billed charge 38.976 percent ot total billed charges 38.976 percent of total billed charges 38.98 38.98 DEXAMETHASONE 20MG/5ML INJ J1100 HCPCS J1100 LOCAL TB BOTH 20 GR 193.69 125.9 154.952 percent of total billed charges 154.952 percent of total billed charge 154.952 percent ot total billed charges 154.952 percent of total billed charges 154.95 154.95 FOSPHENYTOIN 500MG PE/10 ML Q2009 HCPCS Q2009 LOCAL BOTH 1 UN 1499.66 974.78 1199.728 percent of total billed charges 1199.728 percent of total billed charge 1199.728 percent ot total billed charges 1199.728 percent of total billed charges 1199.73 1199.73 daptomycin 350mg inj J0878 HCPCS J0878 LOCAL BOTH 1 UN 199.43 129.63 159.544 percent of total billed charges 159.544 percent of total billed charge 159.544 percent ot total billed charges 159.544 percent of total billed charges 159.54 159.54 DELESTROGEN 20MG/ML Estradiol valerate 10 MG inj J1380 HCPCS J1380 LOCAL TB BOTH 20 GR 20.28 13.18 16.224 percent of total billed charges 16.224 percent of total billed charge 16.224 percent ot total billed charges 16.224 percent of total billed charges 16.22 16.22 "SODIUM CHLORIDE 0.9% 20ML INJ STERILE WTR, SALINE DEX 10ML" A4216 HCPCS A4216 LOCAL BOTH 1 UN 56.24 36.56 44.992 percent of total billed charges 44.992 percent of total billed charge 44.992 percent ot total billed charges 44.992 percent of total billed charges 44.99 44.99 ARIMIDLEX 1MG TABLET J8999 HCPCS J8999 LOCAL BOTH 1 UN 2696.56 1752.76 2157.248 percent of total billed charges 2157.248 percent of total billed charge 2157.248 percent ot total billed charges 2157.248 percent of total billed charges 2157.25 2157.25 NESIRITIDE 1.5 MG/VIAL Nesiritide injection J2325 HCPCS J2325 LOCAL TB BOTH 1 UN 264.75 172.09 211.8 percent of total billed charges 211.8 percent of total billed charge 211.8 percent ot total billed charges 211.8 percent of total billed charges 211.8 211.8 ADENOSINE 6 MG/2ML VIAL PER1MG Injection adenosine 6 MG J0153 HCPCS J0153 LOCAL TB BOTH 6 GR 1687.25 1096.71 1349.8 percent of total billed charges 1349.8 percent of total billed charge 1349.8 percent ot total billed charges 1349.8 percent of total billed charges 1349.8 1349.8 OTIPRIO 60MG PER 6MG J7342 HCPCS J7342 LOCAL BOTH 1 UN 4527.26 2942.72 3621.808 percent of total billed charges 3621.808 percent of total billed charge 3621.808 percent ot total billed charges 3621.808 percent of total billed charges 3621.81 3621.81 FOMEPIZOLE 1.5G/1.5ML INJ J1451 HCPCS J1451 LOCAL BOTH 1 UN 20.28 13.18 16.224 percent of total billed charges 16.224 percent of total billed charge 16.224 percent ot total billed charges 16.224 percent of total billed charges 16.22 16.22 LIDOCAINE 2% 2ML INJ INJ LIDOCAINE HCL 10MG J2001 HCPCS J2001 LOCAL BOTH 1 UN 400.16 260.1 320.128 percent of total billed charges 320.128 percent of total billed charge 320.128 percent ot total billed charges 320.128 percent of total billed charges 320.13 320.13 VENOFER(IRON SUC/COM)100MG/5ML J1756 HCPCS J1756 LOCAL BOTH 1 UN 854.06 555.14 683.248 percent of total billed charges 683.248 percent of total billed charge 683.248 percent ot total billed charges 683.248 percent of total billed charges 683.25 683.25 SYNERCID 500MG INJ Quinupristin/dalfopristin J2770 HCPCS J2770 LOCAL BOTH 1 UN 856.55 556.76 685.24 percent of total billed charges 685.24 percent of total billed charge 685.24 percent ot total billed charges 685.24 percent of total billed charges 685.24 685.24 FLUPHENAZINE 125MG/5ML VIAL J2680 HCPCS J2680 LOCAL TB BOTH 1 UN 43.04 27.98 34.432 percent of total billed charges 34.432 percent of total billed charge 34.432 percent ot total billed charges 34.432 percent of total billed charges 34.43 34.43 CELLCEPT 500MG TABLET Mycophenolate mofetil oral J7517 HCPCS J7517 LOCAL TB BOTH 500 GR 309.74 201.33 247.792 percent of total billed charges 247.792 percent of total billed charge 247.792 percent ot total billed charges 247.792 percent of total billed charges 247.79 247.79 ALBUMIN HUMAN 25% 50ML VIAL Albumin (human) 25% 50ml P9047 HCPCS P9047 LOCAL TB BOTH 1 UN 185.54 120.6 148.432 percent of total billed charges 148.432 percent of total billed charge 148.432 percent ot total billed charges 148.432 percent of total billed charges 148.43 148.43 ALBUMIN 5% 50ML VIAL PLASMA CYROPECIPITATE RED EA U P9041 HCPCS P9041 LOCAL BOTH 1 UN 1.08 0.7 0.864 percent of total billed charges 0.864 percent of total billed charge 0.864 percent ot total billed charges 0.864 percent of total billed charges 0.86 0.86 SOTROVIMAB 500MG/8ML Q0247 HCPCS Q0247 LOCAL BOTH 1 UN 76.19 49.52 60.952 percent of total billed charges 60.952 percent of total billed charge 60.952 percent ot total billed charges 60.952 percent of total billed charges 60.95 60.95 TRIAMCINOLONE ACETONIDE 40MG J3301 HCPCS J3301 LOCAL BOTH 1 UN 488.84 317.75 391.072 percent of total billed charges 391.072 percent of total billed charge 391.072 percent ot total billed charges 391.072 percent of total billed charges 391.07 391.07 PROPOFOL 1000MG-100ML PROPOFOL 1000MG-100ML J2704 HCPCS J2704 LOCAL BOTH 1 UN 2376 1544.4 1900.8 percent of total billed charges 1900.8 percent of total billed charge 1900.8 percent ot total billed charges 1900.8 percent of total billed charges 1900.8 1900.8 RISPERDAL CONSTA 37.5MG Risperidone long acting J2794 HCPCS J2794 LOCAL TB BOTH 1 UN 89.44 58.14 71.552 percent of total billed charges 71.552 percent of total billed charge 71.552 percent ot total billed charges 71.552 percent of total billed charges 71.55 71.55 "EPOETIN ALFA 20,000 UNITS-ML Epoetin alfa non-esrd" J0885 HCPCS J0885 LOCAL BOTH 1 UN 160.99 104.64 128.792 percent of total billed charges 128.792 percent of total billed charge 128.792 percent ot total billed charges 128.792 percent of total billed charges 128.79 128.79 MRI HEAD/BRAIN W/O CONTRAST 70551 CPT 70551 LOCAL TC BOTH 2924.7 1901.06 225.32 fee schedule 2339.76 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2339.76 MRI HEAD/BRAIN W/CONTRAST 70552 CPT 70552 LOCAL TC BOTH 2924.7 1901.06 225.32 fee schedule 2339.76 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2339.76 MRI HEAD/BRAIN W/WO 70553 CPT 70553 LOCAL TC BOTH 2924.7 1901.06 225.32 fee schedule 2339.76 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2339.76 MRA HEAD 70544 CPT 70544 LOCAL TC BOTH 2230.11 1449.57 225.32 fee schedule 1784.09 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1784.09 MRA HEAD W CONTRAST 70545 CPT 70545 LOCAL TC BOTH 2230.11 1449.57 225.32 fee schedule 1784.09 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1784.09 MRA HEAD W/WO 70546 CPT 70546 LOCAL TC BOTH 2787.95 1812.17 225.32 fee schedule 2230.36 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2230.36 MRA NECK 70547 CPT 70547 LOCAL TC BOTH 2439.27 1585.53 225.32 fee schedule 1951.42 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1951.42 MRA NECK W CONTRAST 70548 CPT 70548 LOCAL TC BOTH 2439.27 1585.53 225.32 fee schedule 1951.42 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1951.42 MRA NECK W/WO 70549 CPT 70549 LOCAL TC BOTH 2787.95 1812.17 225.32 fee schedule 2230.36 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2230.36 MRI CERVICAL 72141 CPT 72141 LOCAL TC BOTH 2439.27 1585.53 225.32 fee schedule 1951.42 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1951.42 MRI CERVICAL W/CONTRAST 72142 CPT 72142 LOCAL TC BOTH 2439.27 1585.53 225.32 fee schedule 1951.42 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1951.42 MRI CERVICAL W/WO CONTRAST 72156 CPT 72156 LOCAL TC BOTH 2787.95 1812.17 225.32 fee schedule 2230.36 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2230.36 MRI THORACIC 72146 CPT 72146 LOCAL TC BOTH 2439.27 1585.53 225.32 fee schedule 1951.42 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1951.42 MRI THORACIC W/ CONTRAST 72147 CPT 72147 LOCAL TC BOTH 2439.27 1585.53 225.32 fee schedule 1951.42 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1951.42 MRI THORACIC W/WO CONTRAST 72157 CPT 72157 LOCAL TC BOTH 2787.95 1812.17 225.32 fee schedule 2230.36 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2230.36 MRI LUMBAR 72148 CPT 72148 LOCAL TC BOTH 2439.27 1585.53 225.32 fee schedule 1951.42 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1951.42 MRI LUMBAR W/CONTRAST 72149 CPT 72149 LOCAL TC BOTH 2439.27 1585.53 225.32 fee schedule 1951.42 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1951.42 MRI LUMBAR W/WO CONTRAST 72158 CPT 72158 LOCAL TC BOTH 2787.95 1812.17 225.32 fee schedule 2230.36 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2230.36 MRI SACRAL 72195 CPT 72195 LOCAL TC BOTH 2439.27 1585.53 225.32 fee schedule 1951.42 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1951.42 MRI SACRAL W/WO CONTRAST 72197 CPT 72197 LOCAL TC BOTH 2787.95 1812.17 225.32 fee schedule 2230.36 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2230.36 MRI PELVIS W/ CONTRAST 72196 CPT 72196 LOCAL TC BOTH 2439.27 1585.53 225.32 fee schedule 1951.42 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1951.42 MRI UP EXT JOINT W/CONT RT 73222 CPT 73222 LOCAL TC BOTH 3234.44 2102.39 225.32 fee schedule 2587.55 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2587.55 MRI UPPER EXTREMITY JOINT BILA 73221 CPT 73221 LOCAL TC BOTH 2787.95 1812.17 225.32 fee schedule 2230.36 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2230.36 MRI UPPER JT W/WO CONT R OR L 73223 CPT 73223 LOCAL TC BOTH 2787.95 1812.17 225.32 fee schedule 2230.36 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2230.36 MRA UPPER EXT W/WO BILAT 73225 CPT 73225 LOCAL TC BOTH 2787.95 1812.17 225.32 fee schedule 2230.36 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2230.36 MRI LOW EXT NON-JT W/WO RT 73720 CPT 73720 LOCAL TC BOTH 2787.95 1812.17 225.32 fee schedule 2230.36 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2230.36 MRI LOWER EXT JT BILAT 73721 CPT 73721 LOCAL TC BOTH 2787.95 1812.17 225.32 fee schedule 2230.36 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2230.36 MRI LOW EXT JNT + CONT R/L 73722 CPT 73722 LOCAL TC BOTH 2439.27 1585.53 225.32 fee schedule 1951.42 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1951.42 MRI ABDOMEN 74181 CPT 74181 LOCAL TC BOTH 4332.87 2816.37 225.32 fee schedule 3466.3 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 3466.3 MRI ABDOMEN W/CONTRAST 74182 CPT 74182 LOCAL TC BOTH 4332.87 2816.37 225.32 fee schedule 3466.3 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 3466.3 MRI ABDOMEN W/WO CONTRAST 74183 CPT 74183 LOCAL TC BOTH 4332.87 2816.37 225.32 fee schedule 3466.3 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 3466.3 MRA ABDOMEN W/WO CONTRAST 74185 CPT 74185 LOCAL TC BOTH 4332.87 2816.37 225.32 fee schedule 3466.3 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 3466.3 "MRI ORBIT,FACE,NECK" 70540 CPT 70540 LOCAL TC BOTH 2439.27 1585.53 225.32 fee schedule 1951.42 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1951.42 "MRI ORBIT,FACE,NECK W CONTRAST" 70542 CPT 70542 LOCAL TC BOTH 2439.27 1585.53 225.32 fee schedule 1951.42 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1951.42 "MRI ORBIT,FACE,NECK W/WO" 70543 CPT 70543 LOCAL TC BOTH 2787.95 1812.17 225.32 fee schedule 2230.36 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2230.36 MRI UPPER EXT NON-JOINT BILAT 73218 CPT 73218 LOCAL TC BOTH 2787.95 1812.17 225.32 fee schedule 2230.36 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2230.36 MRI UP EXT NON-JT W/WO BILAT 73220 CPT 73220 LOCAL TC BOTH 3485.3 2265.45 225.32 fee schedule 2788.24 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2788.24 MRI LOWER EXT NON-JOINT BILAT 73718 CPT 73718 LOCAL TC BOTH 2787.95 1812.17 225.32 fee schedule 2230.36 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2230.36 MRI LOWER EXT NON-JT W BILAT 73719 CPT 73719 LOCAL TC BOTH 2787.95 1812.17 225.32 fee schedule 2230.36 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2230.36 MRI TMJ 70336 CPT 70336 LOCAL TC BOTH 2439.27 1585.53 225.32 fee schedule 1951.42 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1951.42 MRI CHEST 71550 CPT 71550 LOCAL TC BOTH 2787.95 1812.17 225.32 fee schedule 2230.36 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2230.36 MRI CHEST W CONTRAST 71551 CPT 71551 LOCAL TC BOTH 2787.95 1812.17 225.32 fee schedule 2230.36 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2230.36 MRI CHEST W/WO 71552 CPT 71552 LOCAL TC BOTH 2787.95 1812.17 225.32 fee schedule 2230.36 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2230.36 MRA CHEST W/WO 71555 CPT 71555 LOCAL TC BOTH 2787.95 1812.17 225.32 fee schedule 2230.36 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2230.36 MRI BREAST W OR W/O CONTRAST 77058 CPT 77058 LOCAL TC BOTH 2439.27 1585.53 225.32 fee schedule 1951.42 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1951.42 MRI BREAST W OR W/O BILAT 77059 CPT 77059 LOCAL TC BOTH 2439.27 1585.53 225.32 fee schedule 1951.42 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1951.42 MRI BREAST BIL W/WO CONT 77049 CPT 77049 LOCAL TC BOTH 2787.95 1812.17 225.32 fee schedule 2230.36 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2230.36 3-D RENDERING W/INTERPRETATION 76377 CPT 76377 LOCAL TC BOTH 432.27 280.98 225.32 fee schedule 345.82 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 345.82 MRI GUIDANCE FOR NEEDLE PLCMT 77021 CPT 77021 LOCAL TC BOTH 1684.05 1094.63 225.32 fee schedule 1347.24 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1347.24 MRI VACUMM-ASSIT BX OF BREAST 19103 CPT 19103 LOCAL TC BOTH 2013.75 1308.94 225.32 fee schedule 1611 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1611 MRI GUIDED METALLIC CLIP PLCMT 19295 CPT 19295 LOCAL TC BOTH 318.23 206.85 225.32 fee schedule 254.58 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 338.82 MRI REFORMAT SAG/COR/3D/HOLOGR 76376 CPT 76376 LOCAL TC BOTH 658.74 428.18 225.32 fee schedule 526.99 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 526.99 MRI SPECTROSCOPY 76390 CPT 76390 LOCAL TC BOTH 2468.41 1604.47 225.32 fee schedule 1974.73 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1974.73 MRI BONE MARROW BLOOD SUPPLY 77084 CPT 77084 LOCAL TC BOTH 2468.41 1604.47 225.32 fee schedule 1974.73 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1974.73 MRA PELVIS W/CONTRAST 72198 CPT 72198 LOCAL TC BOTH 2439.27 1585.53 225.32 fee schedule 1951.42 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1951.42 MRI LOW EXT JT W/WO 73723 CPT 73723 LOCAL TC BOTH 2787.95 1812.17 225.32 fee schedule 2230.36 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2230.36 MRI EXT NON-JNT W RT OR LT 73219 CPT 73219 LOCAL TC BOTH 3234.44 2102.39 225.32 fee schedule 2587.55 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2587.55 CT HEAD/BRAIN 70450 CPT 70450 LOCAL TC BOTH 1755.87 1141.32 225.32 fee schedule 1404.7 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1404.7 CT HEAD/BRAIN W CONTRAST 70460 CPT 70460 LOCAL TC BOTH 2809.63 1826.26 225.32 fee schedule 2247.7 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2247.7 CT HEAD/BRAIN W/WO CONTRAST 70470 CPT 70470 LOCAL TC BOTH 2809.63 1826.26 225.32 fee schedule 2247.7 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2247.7 CT ORBITS/SELLA/FOSSA/IAC 70480 CPT 70480 LOCAL TC BOTH 2090.59 1358.88 225.32 fee schedule 1672.47 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1672.47 CT ORBITS/SELLA/FOSSA/IAC W 70481 CPT 70481 LOCAL TC BOTH 1861.81 1210.18 225.32 fee schedule 1489.45 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1489.45 CT ORBITS/SELLA/FOSSA/IAC W/WO 70482 CPT 70482 LOCAL TC BOTH 1861.81 1210.18 225.32 fee schedule 1489.45 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1489.45 CT MAXILLIOFACIAL W/CONTRAST 70487 CPT 70487 LOCAL TC BOTH 2090.59 1358.88 225.32 fee schedule 1672.47 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1672.47 CT MAXILLIOFACIAL 70486 CPT 70486 LOCAL TC BOTH 1861.81 1210.18 225.32 fee schedule 1489.45 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1489.45 CT MASILLIOFACIAL W/WOCONTRAST 70488 CPT 70488 LOCAL TC BOTH 1861.81 1210.18 225.32 fee schedule 1489.45 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1489.45 CT NECK SOFT TISSUE 70490 CPT 70490 LOCAL TC BOTH 2090.59 1358.88 225.32 fee schedule 1672.47 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1672.47 CT NECK SOFT TISSUE W/CONT 70491 CPT 70491 LOCAL TC BOTH 1861.81 1210.18 225.32 fee schedule 1489.45 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1489.45 CT NECK SOFT TISSUE W/WO CONT 70492 CPT 70492 LOCAL TC BOTH 1861.81 1210.18 225.32 fee schedule 1489.45 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1489.45 CT CHEST W/O 71250 CPT 71250 LOCAL TC BOTH 2090.59 1358.88 225.32 fee schedule 1672.47 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1672.47 CT CHEST W/CONTRAST 71260 CPT 71260 LOCAL TC BOTH 1861.81 1210.18 225.32 fee schedule 1489.45 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1489.45 CT CHEST W/WO CONTRAST 71270 CPT 71270 LOCAL TC BOTH 1861.81 1210.18 225.32 fee schedule 1489.45 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1489.45 CT ABDOMEN W/O 74150 CPT 74150 LOCAL TC BOTH 2090.59 1358.88 225.32 fee schedule 1672.47 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1672.47 CT ABDOMEN W/CONTRAST 74160 CPT 74160 LOCAL TC BOTH 3635.57 2363.12 225.32 fee schedule 2908.46 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2908.46 CT ABD/PEL WITH CONT 74177 CPT 74177 LOCAL TC BOTH 3635.57 2363.12 225.32 fee schedule 2908.46 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2908.46 CT ABD/PEL WO CONTRAST 74176 CPT 74176 LOCAL TC BOTH 3635.57 2363.12 225.32 fee schedule 2908.46 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2908.46 CT ABD/PEL W/WO CONT 74178 CPT 74178 LOCAL TC BOTH 3635.57 2363.12 225.32 fee schedule 2908.46 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2908.46 CT ABDOMEN W/WO CONTRAST 74170 CPT 74170 LOCAL TC BOTH 3635.57 2363.12 225.32 fee schedule 2908.46 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2908.46 CT PELVIS WO CONTRAST 72192 CPT 72192 LOCAL TC BOTH 3635.57 2363.12 225.32 fee schedule 2908.46 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2908.46 CT PELVIS W/CONTRAST 72193 CPT 72193 LOCAL TC BOTH 3635.57 2363.12 225.32 fee schedule 2908.46 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2908.46 CT PELVIS W/WO CONTRAST 72194 CPT 72194 LOCAL TC BOTH 1393.3 905.65 225.32 fee schedule 1114.64 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1114.64 CT EXTREM UPPER WO CONT LT 73200 CPT 73200 LOCAL TC BOTH 3635.57 2363.12 225.32 fee schedule 2908.46 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2908.46 CT EXTREM (UPPER) W/CONT LT 73201 CPT 73201 LOCAL TC BOTH 1861.81 1210.18 225.32 fee schedule 1489.45 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1489.45 CT EXTREM (LOWER) LT 73700 CPT 73700 LOCAL TC BOTH 1861.81 1210.18 225.32 fee schedule 1489.45 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1489.45 CT LUNG CA SCREENING 71271 CPT 71271 LOCAL TC BOTH 1861.81 1210.18 225.32 fee schedule 1489.45 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1489.45 CT CERVICAL SPINE 72125 CPT 72125 LOCAL TC BOTH 1861.81 1210.18 225.32 fee schedule 1489.45 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1489.45 CT THORACIC SPINE 72128 CPT 72128 LOCAL TC BOTH 1997.21 1298.19 225.32 fee schedule 1597.77 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1597.77 CT LUMBAR 72131 CPT 72131 LOCAL TC BOTH 1997.21 1298.19 225.32 fee schedule 1597.77 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1597.77 CT LUMBAR SPINE WITH CONTRAST 72132 CPT 72132 LOCAL TC BOTH 1997.21 1298.19 225.32 fee schedule 1597.77 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1597.77 CT GUIDANCE NEEDLE BIOPSY 77012 CPT 77012 LOCAL TC BOTH 2195.88 1427.32 225.32 fee schedule 1756.7 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1756.7 CT EXTREM(LOWR) W/WO CONTRAST 73702 CPT 73702 LOCAL TC BOTH 2195.88 1427.32 225.32 fee schedule 1756.7 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1756.7 CT CERVICAL SPINE W CONT 72126 CPT 72126 LOCAL TC BOTH 2090.59 1358.88 225.32 fee schedule 1672.47 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1672.47 CT THORACIC SPINE W/CONT 72129 CPT 72129 LOCAL TC BOTH 1997.21 1298.19 225.32 fee schedule 1597.77 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1597.77 CT THORACIC SPINE W/WO CONT 72130 CPT 72130 LOCAL TC BOTH 1997.21 1298.19 225.32 fee schedule 1597.77 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1597.77 CT LUMBAR W/WO CONTRAST 72133 CPT 72133 LOCAL TC BOTH 2090.59 1358.88 225.32 fee schedule 1672.47 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1672.47 CT STEROTATIC LOCALIZATION 77011 CPT 77011 LOCAL TC BOTH 2090.59 1358.88 225.32 fee schedule 1672.47 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1672.47 CT EXTREM (UPPER)W/WO CONT LT 73202 CPT 73202 LOCAL TC BOTH 2195.88 1427.32 225.32 fee schedule 1756.7 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1756.7 CT ANGIO HEAD 70496 CPT 70496 LOCAL TC BOTH 2090.59 1358.88 225.32 fee schedule 1672.47 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1672.47 CT CERVICAL SPINE W/WO CONTRAS 72127 CPT 72127 LOCAL TC BOTH 2787.95 1812.17 225.32 fee schedule 2230.36 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2230.36 CT ANGIO NECK 70498 CPT 70498 LOCAL TC BOTH 1965.03 1277.27 225.32 fee schedule 1572.02 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 1572.02 CT ANGIO CHEST 71275 CPT 71275 LOCAL TC BOTH 2787.95 1812.17 225.32 fee schedule 2230.36 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2230.36 CT ANGIO PELVIS 72191 CPT 72191 LOCAL TC BOTH 2787.95 1812.17 225.32 fee schedule 2230.36 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2230.36 CT ANGIO UPPER EXT RT/LFT 73206 CPT 73206 LOCAL TC BOTH 2951.74 1918.63 225.32 fee schedule 2361.39 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2361.39 CT ANGIO LOWER EXT RT/LFT 73706 CPT 73706 LOCAL TC BOTH 2951.74 1918.63 225.32 fee schedule 2361.39 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2361.39 CT ANGIO AORTO-ILIOFEMORAL RO 75635 CPT 75635 LOCAL TC BOTH 2951.74 1918.63 225.32 fee schedule 2361.39 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2361.39 CT ANGIO ABD/PELVIS 74174 CPT 74174 LOCAL TC BOTH 2951.74 1918.63 225.32 fee schedule 2361.39 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 2361.39 STOOL CULTURE VIBRIO ONLY 87046 CPT 87046 LOCAL BOTH 6448.18 4191.32 225.32 fee schedule 5158.54 percent of total billed charge 306.82 fee schedule 338.82 fee schedule 225.32 5158.54 NATURAL KILLER CELL (SO) 88184 CPT 88184 LOCAL TC BOTH 71.48 46.46 181.34 fee schedule 57.18 percent of total billed charge 683.46 fee schedule 366.8 fee schedule 57.18 683.46 CARNITINE LEVEL (SO) 82379 CPT 82379 LOCAL BOTH 696.33 452.61 258.44 fee schedule 557.06 percent of total billed charge 61.47 fee schedule 354.53 fee schedule 61.47 557.06 POLIOVIRUS Ab (SO) 86658 CPT 86658 LOCAL BOTH 231.6 150.54 26.34 fee schedule 185.28 percent of total billed charge 92.97 fee schedule 36.29 fee schedule 26.34 185.28 "HCV RT-PCR, QUANT" 87522 CPT 87522 LOCAL BOTH 93.17 60.56 143.28 fee schedule 74.54 percent of total billed charge 722.81 fee schedule 245.93 fee schedule 74.54 722.81 "PROTOPORPHYRIN, FEP/ZPP" 84202 CPT 84202 LOCAL BOTH 315.53 205.09 221.94 fee schedule 252.42 percent of total billed charge 1192.36 fee schedule 528.75 fee schedule 221.94 1192.36 "POST VASECTOMY SPERM EVAL,QUAL" 89321 CPT 89321 LOCAL BOTH 30.93 20.1 82.31 fee schedule 24.74 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 24.74 185.87 C-ANCA 83520 CPT 83520 LOCAL BOTH 153.72 99.92 334.68 fee schedule 122.98 percent of total billed charge 267.5 fee schedule 778.16 fee schedule 122.98 778.16 5-HIAA RANDOM URINE (S0) 83497 CPT 83497 LOCAL BOTH 106.69 69.35 45.38 fee schedule 85.35 percent of total billed charge 99.61 fee schedule 62.52 fee schedule 45.38 99.61 5 HIAA RANDOM URINE-ASSAY (SO) 82570 CPT 82570 LOCAL BOTH 33.9 22.04 43.27 fee schedule 27.12 percent of total billed charge 30.39 fee schedule 54.41 fee schedule 27.12 54.41 CHLAMYDIA IgG 86631 CPT 86631 LOCAL BOTH 77.39 50.3 30.37 fee schedule 61.91 percent of total billed charge 32.32 fee schedule 43.83 fee schedule 30.37 61.91 CHLAMYDIA IgM 86632 CPT 86632 LOCAL BOTH 201.38 130.9 141.48 fee schedule 161.1 percent of total billed charge 155.94 fee schedule 285.18 fee schedule 141.48 285.18 HEP INDUCED PLATELET 86022 CPT 86022 LOCAL BOTH 192.99 125.44 141.48 fee schedule 154.39 percent of total billed charge 155.94 fee schedule 540.58 fee schedule 141.48 540.58 LACOSAMIDE 82542 CPT 82542 LOCAL BOTH 386.04 250.93 99.59 fee schedule 308.83 percent of total billed charge 253.48 fee schedule 250.18 fee schedule 99.59 308.83 ANTIPANCREATIC ISELT CELLS 86341 CPT 86341 LOCAL BOTH 476.62 309.8 29.01 fee schedule 381.3 percent of total billed charge 99.61 fee schedule 39.96 fee schedule 29.01 381.3 "PREGNENOLONE, MS" 84140 CPT 84140 LOCAL BOTH 226.41 147.17 115.71 fee schedule 181.13 percent of total billed charge 9.73 fee schedule 166.98 fee schedule 9.73 181.13 "HBV REAL TIME PCR, QUANT" 87517 CPT 87517 LOCAL BOTH 184.23 119.75 78.85 fee schedule 147.38 percent of total billed charge 82.32 fee schedule 109.86 fee schedule 78.85 147.38 BISMUTH 83018 CPT 83018 LOCAL BOTH 540.27 351.18 221.94 fee schedule 432.22 percent of total billed charge 1192.36 fee schedule 528.75 fee schedule 221.94 1192.36 HAEMOPHILUS INFLUENZAE B Ag 87899 CPT 87899 LOCAL BOTH 230.91 150.09 41.98 fee schedule 184.73 percent of total billed charge 92.97 fee schedule 57.83 fee schedule 41.98 184.73 HYDROXYPROLINE TOTAL 24HR URIN 83505 CPT 83505 LOCAL BOTH 67.33 43.76 223.85 fee schedule 53.86 percent of total billed charge 62.65 fee schedule 51.86 fee schedule 51.86 223.85 "RSV Ab, QUANT" 86756 CPT 86756 LOCAL BOTH 138.65 90.12 44.08 fee schedule 110.92 percent of total billed charge 65.65 fee schedule 51.86 fee schedule 44.08 110.92 "RBC PRETREATMENT, SERUM" 86978 CPT 86978 LOCAL BOTH 65.87 42.82 166.42 fee schedule 52.7 percent of total billed charge 267.95 fee schedule 419.59 fee schedule 52.7 419.59 C5 86160 CPT 86160 LOCAL BOTH 322.51 209.63 171.89 fee schedule 258.01 percent of total billed charge 540.9 fee schedule 236.79 fee schedule 171.89 540.9 CHROMOGRANIN A 86316 CPT 86316 LOCAL BOTH 473.42 307.72 99.59 fee schedule 378.74 percent of total billed charge 421.41 fee schedule 222.38 fee schedule 99.59 421.41 ENDOMYSIAL Ab IgA 86255 CPT 86255 LOCAL BOTH 232.95 151.42 115.71 fee schedule 186.36 percent of total billed charge 193.12 fee schedule 230.32 fee schedule 115.71 230.32 AMNISURE (SO) 84112 CPT 84112 LOCAL BOTH 100.25 65.16 114.16 fee schedule 80.2 percent of total billed charge 143.59 fee schedule 51.86 fee schedule 51.86 143.59 HLB-B 1502 38393 CPT 38393 LOCAL BOTH 189.64 123.27 76.93 fee schedule 151.71 percent of total billed charge 120.22 fee schedule 86.71 fee schedule 76.93 151.71 HLA-B1502 81381 CPT 81381 LOCAL BOTH 499.05 324.38 4.18 fee schedule 399.24 percent of total billed charge 25.59 fee schedule 5.76 fee schedule 4.18 399.24 LYME TITERS 86618 CPT 86618 LOCAL BOTH 499.05 324.38 20.55 fee schedule 399.24 percent of total billed charge 322 fee schedule 25.45 fee schedule 20.55 399.24 C1 ESTERASE INHIBITOR FUNCTION 86161 CPT 86161 LOCAL BOTH 590.39 383.75 141.48 fee schedule 472.31 percent of total billed charge 335.91 fee schedule 285.18 fee schedule 141.48 472.31 E CHAFFENIS-HME (MONOCYTSE) 86666 CPT 86666 LOCAL BOTH 64.35 41.83 99.59 fee schedule 51.48 percent of total billed charge 253.48 fee schedule 222.38 fee schedule 51.48 253.48 ANTIFUNGAL SUSCAP CAOFUNGIN 87186 CPT 87186 LOCAL BOTH 168.01 109.21 147.32 fee schedule 134.41 percent of total billed charge 304.27 fee schedule 202.95 fee schedule 134.41 304.27 DAT SINGLE (SO) 86880 CPT 86880 LOCAL BOTH 355.49 231.07 181.34 fee schedule 284.39 percent of total billed charge 351.06 fee schedule 366.8 fee schedule 181.34 366.8 PANEL-COLD 86850 CPT 86850 LOCAL BOTH 128.92 83.8 166.42 fee schedule 103.14 percent of total billed charge 348.42 fee schedule 410.47 fee schedule 103.14 410.47 ADDITIONAL PANEL (SO) 86870 CPT 86870 LOCAL BOTH 488.03 317.22 166.42 fee schedule 390.42 percent of total billed charge 762.6 fee schedule 410.47 fee schedule 166.42 762.6 COMPATIBILITY AHG (SO) 86922 CPT 86922 LOCAL BOTH 98.89 64.28 166.42 fee schedule 79.11 percent of total billed charge 693.9 fee schedule 419.59 fee schedule 79.11 693.9 ANTIBODY TITER (S0) 86886 CPT 86886 LOCAL BOTH 386.9 251.49 166.42 fee schedule 309.52 percent of total billed charge 598.32 fee schedule 410.47 fee schedule 166.42 598.32 RBC ANTIBODY ELUTION (SO) 86860 CPT 86860 LOCAL BOTH 51.48 33.46 166.42 fee schedule 41.18 percent of total billed charge 348.42 fee schedule 410.47 fee schedule 41.18 410.47 KARYOTYPE-CHROMOSOME ANALY(SO) 88262 CPT 88262 LOCAL TC BOTH 244.37 158.84 166.42 fee schedule 195.5 percent of total billed charge 693.9 fee schedule 419.59 fee schedule 166.42 693.9 "OPIATES, URINE W CONF" 80307 CPT 80307 LOCAL BOTH 281.35 182.88 268.28 fee schedule 225.08 percent of total billed charge 151.32 fee schedule 533.66 fee schedule 151.32 533.66 REFLEX IF POSITIVE 80361 CPT 80361 LOCAL BOTH 97.56 63.41 18.15 fee schedule 78.05 percent of total billed charge 71.06 fee schedule 25 fee schedule 18.15 78.05 "LYME DISEASE, RT, PCR" 87476 CPT 87476 LOCAL BOTH 485.49 315.57 18.96 fee schedule 388.39 percent of total billed charge 41.34 fee schedule 26.12 fee schedule 18.96 388.39 "RESP PATHOGEN PROFILE, PCR" 87633 CPT 87633 LOCAL BOTH 540.21 351.14 221.24 fee schedule 432.17 percent of total billed charge 683.46 fee schedule 432.14 fee schedule 221.24 683.46 "RESP PQATHOGEN PROFILE,PCR" 87486 CPT 87486 LOCAL BOTH 685.51 445.58 221.94 fee schedule 548.41 percent of total billed charge 1192.36 fee schedule 528.75 fee schedule 221.94 1192.36 "RESP PATHOGEN PROFILE, PCR" 87581 CPT 87581 LOCAL BOTH 685.51 445.58 221.94 fee schedule 548.41 percent of total billed charge 1192.36 fee schedule 528.75 fee schedule 221.94 1192.36 "RESP PATHOGEN PROFILE, PCR" 87798 CPT 87798 LOCAL BOTH 685.51 445.58 221.94 fee schedule 548.41 percent of total billed charge 248 fee schedule 528.75 fee schedule 221.94 548.41 VON WILLEBRAND FACTOR (VWF) PR 85240 CPT 85240 LOCAL BOTH 685.51 445.58 221.94 fee schedule 548.41 percent of total billed charge 253.48 fee schedule 470 fee schedule 221.94 548.41 VON WILLEBRAND FACTOR (VWF) PR 85245 CPT 85245 LOCAL BOTH 370.85 241.05 99.59 fee schedule 296.68 percent of total billed charge 71.99 fee schedule 250.18 fee schedule 71.99 296.68 VON WILLEBRAND FACTOR (VWF) PR 85246 CPT 85246 LOCAL BOTH 370.85 241.05 99.59 fee schedule 296.68 percent of total billed charge 267.95 fee schedule 250.18 fee schedule 99.59 296.68 "VOLATILES, WHOLE BLOOD" 80320 CPT 80320 LOCAL BOTH 370.85 241.05 99.59 fee schedule 296.68 percent of total billed charge 71.99 fee schedule 250.18 fee schedule 71.99 296.68 FISH MICRODELETION 88271 CPT 88271 LOCAL TC BOTH 64.84 42.15 18.21 fee schedule 51.87 percent of total billed charge 71.06 fee schedule 25.08 fee schedule 18.21 71.06 FISH MICRODELETION 88273 CPT 88273 LOCAL TC BOTH 281.62 183.05 268.28 fee schedule 225.3 percent of total billed charge 151.32 fee schedule 533.66 fee schedule 151.32 533.66 CALPROTECTIN 83993 CPT 83993 LOCAL BOTH 281.67 183.09 268.28 fee schedule 225.34 percent of total billed charge 151.32 fee schedule 533.66 fee schedule 151.32 533.66 ACTIVATED PROTEIN C RESISTANCE 85307 CPT 85307 LOCAL BOTH 812.48 528.11 68.8 fee schedule 649.98 percent of total billed charge 92.97 fee schedule 51.86 fee schedule 51.86 649.98 BK QUANT PCR URINE (SO) 87799 CPT 87799 LOCAL BOTH 192.99 125.44 99.59 fee schedule 154.39 percent of total billed charge 71.99 fee schedule 250.18 fee schedule 71.99 250.18 ALKA PHOS PSA COMPLEXED (SO) 84152 CPT 84152 LOCAL BOTH 983.08 639 221.94 fee schedule 786.46 percent of total billed charge 421.41 fee schedule 470 fee schedule 221.94 786.46 ALKALINE PHOSPHATASES (SO) 84080 CPT 84080 LOCAL BOTH 13.63 8.86 80.42 fee schedule 10.9 percent of total billed charge 120.32 fee schedule 111.12 fee schedule 10.9 120.32 PKU (1) 82760 (SO) 82760 CPT 82760 LOCAL BOTH 13.63 8.86 72.59 fee schedule 10.9 percent of total billed charge 65 fee schedule 86.17 fee schedule 10.9 86.17 PKU (2) 83020 (SO) 83020 CPT 83020 LOCAL BOTH 56.24 36.56 35.17 fee schedule 44.99 percent of total billed charge 98 fee schedule 66.58 fee schedule 35.17 98 PKU (3) 84030 (SO) 84030 CPT 84030 LOCAL BOTH 56.24 36.56 41.98 fee schedule 44.99 percent of total billed charge 92.97 fee schedule 57.83 fee schedule 41.98 92.97 PKU (4) 84437 (SO) 84437 CPT 84437 LOCAL BOTH 56.24 36.56 69.94 fee schedule 44.99 percent of total billed charge 129.45 fee schedule 125.95 fee schedule 44.99 129.45 B12 UNSAT BINDING CAP (SO) 82608 CPT 82608 LOCAL BOTH 30.18 19.62 82.31 fee schedule 24.14 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 24.14 185.87 BONE MARROW-TISSUE CULTURE(SO) 88237 CPT 88237 LOCAL TC BOTH 166.6 108.29 31.71 fee schedule 133.28 percent of total billed charge 248 fee schedule 528.75 fee schedule 31.71 528.75 "TUMOR, TISSUE CULTURE (SO)" 88239 CPT 88239 LOCAL TC BOTH 268.81 174.73 263.86 fee schedule 215.05 percent of total billed charge 154.13 fee schedule 534.32 fee schedule 154.13 534.32 CHROMOSOME ANALYSIS-5 (SO) 88261 CPT 88261 LOCAL TC BOTH 858.49 558.02 265 fee schedule 686.79 percent of total billed charge 722.81 fee schedule 465.55 fee schedule 265 722.81 CHROMOSOME ANALYSIS 20-25 (SO) 88264 CPT 88264 LOCAL TC BOTH 1027.75 668.04 268.28 fee schedule 822.2 percent of total billed charge 60.32 fee schedule 533.66 fee schedule 60.32 822.2 IFE AND PROTEIN 84156 CPT 84156 LOCAL BOTH 268.81 174.73 268.28 fee schedule 215.05 percent of total billed charge 60.32 fee schedule 533.66 fee schedule 60.32 533.66 ELECTROPHORESIS 24 HR URINE 84166 CPT 84166 LOCAL BOTH 79.71 51.81 82.31 fee schedule 63.77 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 63.77 185.87 OTHER FLUIDS W/CONCENTRATION 86335 CPT 86335 LOCAL BOTH 79.71 51.81 82.31 fee schedule 63.77 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 63.77 185.87 "CUTANEOUS IMMUNOFLUOR,Ab(1)(SO" 88347 CPT 88347 LOCAL TC BOTH 79.71 51.81 115.71 fee schedule 63.77 percent of total billed charge 60.32 fee schedule 230.32 fee schedule 60.32 230.32 IMMUNE COMPLEX C1q BINDING(SO) 86332 CPT 86332 LOCAL BOTH 382.53 248.64 284.3 fee schedule 306.02 percent of total billed charge 952.76 fee schedule 540.58 fee schedule 284.3 952.76 CELL CT/DIFF (SO) 89051 CPT 89051 LOCAL BOTH 67.43 43.83 115.71 fee schedule 53.94 percent of total billed charge 53.46 fee schedule 230.32 fee schedule 53.46 230.32 BILE ACIDS 82239 CPT 82239 LOCAL BOTH 138.48 90.01 325.58 fee schedule 110.78 percent of total billed charge 9.73 fee schedule 431.3 fee schedule 9.73 431.3 URINE ORGANIC ACIDS (SO) 83919 CPT 83919 LOCAL BOTH 68.79 44.71 24.94 fee schedule 55.03 percent of total billed charge 47.53 fee schedule 34.36 fee schedule 24.94 55.03 BARTONELLA DNA PCR (SO) 87471 CPT 87471 LOCAL BOTH 270.15 175.6 63.81 fee schedule 216.12 percent of total billed charge 332 fee schedule 126.64 fee schedule 63.81 332 IRRADIATION CHARGE-OBI (SO) 86945 CPT 86945 LOCAL BOTH 578.88 376.27 221.24 fee schedule 463.1 percent of total billed charge 181.85 fee schedule 432.14 fee schedule 181.85 463.1 CRYSTAL EXAM (SO) 89060 CPT 89060 LOCAL BOTH 136.49 88.72 168.97 fee schedule 109.19 percent of total billed charge 65 fee schedule 199.43 fee schedule 65 199.43 FACTOR IX ACTIVITY 85250 CPT 85250 LOCAL BOTH 22.79 14.81 325.58 fee schedule 18.23 percent of total billed charge 143.59 fee schedule 520.54 fee schedule 18.23 520.54 COAGULATION FACTOR XII** 85280 CPT 85280 LOCAL BOTH 255.94 166.36 99.59 fee schedule 204.75 percent of total billed charge 71.99 fee schedule 250.18 fee schedule 71.99 250.18 CYTOLOGY (SO) 88104 CPT 88104 LOCAL TC BOTH 232.26 150.97 99.59 fee schedule 185.81 percent of total billed charge 71.99 fee schedule 250.18 fee schedule 71.99 250.18 FUNGAL STAIN (SO) 88312 CPT 88312 LOCAL TC BOTH 460.39 299.25 243.25 fee schedule 368.31 percent of total billed charge 307.72 fee schedule 492.76 fee schedule 243.25 492.76 GENERAL HEALTH PANEL 80050 CPT 80050 LOCAL BOTH 97.88 63.62 284.3 fee schedule 78.3 percent of total billed charge 100.48 fee schedule 540.58 fee schedule 78.3 540.58 DTT (SO) 86971 CPT 86971 LOCAL BOTH 362.63 235.71 16.53 fee schedule 290.1 percent of total billed charge 32.81 fee schedule 22.77 fee schedule 16.53 290.1 DRUG ABUSE PANEL #8 (SO) 80306 CPT 80306 LOCAL BOTH 406.21 264.04 171.31 fee schedule 324.97 percent of total billed charge 540.9 fee schedule 51.86 fee schedule 51.86 540.9 FISH PERIPHERAL BM ADDON-1(S0) 88275 CPT 88275 LOCAL TC BOTH 302.66 196.73 18.03 fee schedule 242.13 percent of total billed charge 28.65 fee schedule 24.84 fee schedule 18.03 242.13 FOLATE RBC SERUM 82747 CPT 82747 LOCAL BOTH 219.77 142.85 268.28 fee schedule 175.82 percent of total billed charge 45.83 fee schedule 533.66 fee schedule 45.83 533.66 FOLATE RBC SERUM 85014 CPT 85014 LOCAL BOTH 21.61 14.05 34.62 fee schedule 17.29 percent of total billed charge 28.65 fee schedule 48.86 fee schedule 17.29 48.86 HIV QUAN RT PCR W/REF GENO PRI 87536 CPT 87536 LOCAL BOTH 21.61 14.05 99.59 fee schedule 17.29 percent of total billed charge 71.99 fee schedule 250.18 fee schedule 17.29 250.18 FREE PSA (SO) 84154 CPT 84154 LOCAL BOTH 1215.9 790.34 221.94 fee schedule 972.72 percent of total billed charge 248 fee schedule 528.75 fee schedule 221.94 972.72 PSA SCREENING G0103 CPT G0103 LOCAL BOTH 59.43 38.63 82.31 fee schedule 47.54 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 47.54 185.87 FINGERSTICK 36416 CPT 36416 LOCAL BOTH 261.02 169.66 1872.48 fee schedule 208.82 percent of total billed charge 250 fee schedule 2844.37 fee schedule 208.82 2844.37 GONADOTROPIN-RELEASING HORMONE 83727 CPT 83727 LOCAL BOTH 31.21 20.29 3.85 fee schedule 24.97 percent of total billed charge 71.06 fee schedule 5.31 fee schedule 3.85 71.06 GROWTH HORMONE 83003 CPT 83003 LOCAL BOTH 932.41 606.07 55.41 fee schedule 745.93 percent of total billed charge 60.32 fee schedule 113.7 fee schedule 55.41 745.93 INSULIN (5 SPECIMEN) 83525 CPT 83525 LOCAL BOTH 68.62 44.6 41.29 fee schedule 54.9 percent of total billed charge 47.53 fee schedule 56.88 fee schedule 41.29 56.88 "PBG QUANT., RANDOM URINE" 84110 CPT 84110 LOCAL BOTH 286.38 186.15 45.82 fee schedule 229.1 percent of total billed charge 154.13 fee schedule 600.1 fee schedule 45.82 600.1 IBD EXPANDED PANEL 86671 CPT 86671 LOCAL BOTH 51.26 33.32 76.17 fee schedule 41.01 percent of total billed charge 18.22 fee schedule 127.12 fee schedule 18.22 127.12 "ZIKA VIRUS, IGM, SERUM" 86794 CPT 86794 LOCAL BOTH 313.41 203.72 148.14 fee schedule 250.73 percent of total billed charge 40.73 fee schedule 201.23 fee schedule 40.73 250.73 "NICOTINE AND METABOLITE, QUANT" 80323 CPT 80323 LOCAL BOTH 483.65 314.37 166.42 fee schedule 386.92 percent of total billed charge 762.6 fee schedule 419.59 fee schedule 166.42 762.6 "TRAMADOL,SCREEN AND CONF. URIN" 80302 CPT 80302 LOCAL BOTH 266.53 173.24 18.31 fee schedule 213.22 percent of total billed charge 47.53 fee schedule 51.86 fee schedule 18.31 213.22 LD BODY FLUID 83615 CPT 83615 LOCAL BOTH 174.12 113.18 18.02 fee schedule 139.3 percent of total billed charge 32.81 fee schedule 24.83 fee schedule 18.02 139.3 FLOW CYTOMETRY PNH 88185 CPT 88185 LOCAL TC BOTH 12.6 8.19 49.08 fee schedule 10.08 percent of total billed charge 28.65 fee schedule 73.59 fee schedule 10.08 73.59 FLOW CYTOMETRY PNH 88187 CPT 88187 LOCAL TC BOTH 252.75 164.29 258.44 fee schedule 202.2 percent of total billed charge 150.62 fee schedule 354.53 fee schedule 150.62 354.53 HANTAVIRUS ANTIBODIES 86790 CPT 86790 LOCAL BOTH 252.75 164.29 259.05 fee schedule 202.2 percent of total billed charge 143.59 fee schedule 462.6 fee schedule 143.59 462.6 APOLIPOPROTEIN A-1 82172 CPT 82172 LOCAL BOTH 624.83 406.14 166.42 fee schedule 499.86 percent of total billed charge 762.6 fee schedule 410.47 fee schedule 166.42 762.6 LIPOPROTEIN-ASSC PHOSPH A2 ACT 83698 CPT 83698 LOCAL BOTH 89.3 58.05 24.64 fee schedule 71.44 percent of total billed charge 61.58 fee schedule 44.35 fee schedule 24.64 71.44 NMR LIPOPROFILE WITH INSULIN 80061 CPT 80061 LOCAL BOTH 143.19 93.07 49.84 fee schedule 114.55 percent of total billed charge 71.06 fee schedule 68.66 fee schedule 49.84 114.55 "AMPHETAMINES CONFIMATION, URIN" 80324 CPT 80324 LOCAL BOTH 92.15 59.9 16.6 fee schedule 73.72 percent of total billed charge 48.66 fee schedule 22.87 fee schedule 16.6 73.72 "ACYLCARNITINE PROFILE, PLASMA" 82017 CPT 82017 LOCAL BOTH 135.41 88.02 18.38 fee schedule 108.33 percent of total billed charge 41.34 fee schedule 25.31 fee schedule 18.38 108.33 TRICYCLIC ANTIDEPRESSANT 80037 CPT 80037 LOCAL BOTH 748.67 486.64 21.3 fee schedule 598.94 percent of total billed charge 32.81 fee schedule 51.86 fee schedule 21.3 598.94 TRICYCLIC ANTIDEPRESSANT CONFI 80369 CPT 80369 LOCAL BOTH 230.2 149.63 16.53 fee schedule 184.16 percent of total billed charge 32.81 fee schedule 22.77 fee schedule 16.53 184.16 ASSAY OF RENIN 84244 CPT 84244 LOCAL BOTH 230.2 149.63 18.96 fee schedule 184.16 percent of total billed charge 28.65 fee schedule 26.12 fee schedule 18.96 184.16 Resistance Markers w/o Graph 83704 CPT 83704 LOCAL BOTH 90.42 58.77 82.31 fee schedule 72.34 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 71.99 185.87 SARS COV 2 Ab IgG 86769 CPT 86769 LOCAL BOTH 79.6 51.74 52.02 fee schedule 63.68 percent of total billed charge 62.32 fee schedule 91.79 fee schedule 52.02 91.79 GOLD** 80375 CPT 80375 LOCAL BOTH 140.82 91.53 166.42 fee schedule 112.66 percent of total billed charge 565 fee schedule 410.47 fee schedule 112.66 565 GRAM STAIN 87205 CPT 87205 LOCAL BOTH 321.1 208.72 18.99 fee schedule 256.88 percent of total billed charge 32.81 fee schedule 26.16 fee schedule 18.99 256.88 "HEP B CORE ANTIBODY, TOTAL(SO)" 86704 CPT 86704 LOCAL BOTH 137.13 89.13 181.34 fee schedule 109.7 percent of total billed charge 65.83 fee schedule 366.8 fee schedule 65.83 366.8 HEP B SURFACE ANTIBODY(SO) 86706 CPT 86706 LOCAL BOTH 33.53 21.79 154.71 fee schedule 26.82 percent of total billed charge 76.86 fee schedule 266.56 fee schedule 26.82 266.56 HEP BE ANTIBODY (SO) 86707 CPT 86707 LOCAL BOTH 33.53 21.79 154.71 fee schedule 26.82 percent of total billed charge 143.59 fee schedule 266.56 fee schedule 26.82 266.56 "HEPATITIS B SURFACE AG, EIA(SO" 87340 CPT 87340 LOCAL BOTH 33.53 21.79 154.71 fee schedule 26.82 percent of total billed charge 143.59 fee schedule 266.56 fee schedule 26.82 266.56 "HEPATITIS BE AG, EIA (SO)" 87350 CPT 87350 LOCAL BOTH 33.53 21.79 213.6 fee schedule 26.82 percent of total billed charge 60.32 fee schedule 421 fee schedule 26.82 421 HCV GENOTYPE (X) 87902 CPT 87902 LOCAL BOTH 33.53 21.79 213.6 fee schedule 26.82 percent of total billed charge 154.13 fee schedule 421 fee schedule 26.82 421 HEMO.HEREDITARY GENE ANALYSI(X 81256 CPT 81256 LOCAL BOTH 1922.42 1249.57 225.34 fee schedule 1537.94 percent of total billed charge 178.95 fee schedule 581.45 fee schedule 178.95 1537.94 LACTOFERRIN STOOL (SO) 83630 CPT 83630 LOCAL BOTH 360.14 234.09 20.05 fee schedule 288.11 percent of total billed charge 25.59 fee schedule 27.62 fee schedule 20.05 288.11 JAK- 2 MUTATION LC 81270 CPT 81270 LOCAL BOTH 325 211.25 49.08 fee schedule 260 percent of total billed charge 143.59 fee schedule 88.81 fee schedule 49.08 260 Acute Viral Hepatitis Panel 80074 CPT 80074 LOCAL BOTH 1218.63 792.11 20.06 fee schedule 974.9 percent of total billed charge 1020 fee schedule 51.86 fee schedule 20.06 1020 "D,L-Methamphetamine, Urine 714" 80374 CPT 80374 LOCAL BOTH 101.52 65.99 16.66 fee schedule 81.22 percent of total billed charge 92.22 fee schedule 51.86 fee schedule 16.66 92.22 FACTOR V LIEDEN BY PCR 81241 CPT 81241 LOCAL BOTH 127.96 83.17 18.96 fee schedule 102.37 percent of total billed charge 47.53 fee schedule 26.12 fee schedule 18.96 102.37 CHLAM/GC DNA PROBE (SO) 87800 CPT 87800 LOCAL BOTH 539.62 350.75 19.95 fee schedule 431.7 percent of total billed charge 98.35 fee schedule 36.94 fee schedule 19.95 431.7 ASSAY OF NICKEL (SO) 83885 CPT 83885 LOCAL BOTH 36.07 23.45 221.94 fee schedule 28.86 percent of total billed charge 421.41 fee schedule 470 fee schedule 28.86 470 "PH, PLEURAL FLUID (PHPL)" 83986 CPT 83986 LOCAL BOTH 108.37 70.44 55.41 fee schedule 86.7 percent of total billed charge 71.06 fee schedule 230.32 fee schedule 55.41 230.32 FREE DIRECT MEASURMENT 82681 CPT 82681 LOCAL BOTH 54.23 35.25 64.38 fee schedule 43.38 percent of total billed charge 80.2 fee schedule 88.68 fee schedule 43.38 88.68 PHENOBARB (SO) 80184 CPT 80184 LOCAL BOTH 125.35 81.48 34.39 fee schedule 100.28 percent of total billed charge 92.97 fee schedule 47.37 fee schedule 34.39 100.28 PHEUMOCYSTIS CARINII (SO) 87281 CPT 87281 LOCAL BOTH 168.93 109.8 17.54 fee schedule 135.14 percent of total billed charge 41.34 fee schedule 24.17 fee schedule 17.54 135.14 PHOSPHOLIPIDS (SO) 84311 CPT 84311 LOCAL BOTH 92.15 59.9 194.14 fee schedule 73.72 percent of total billed charge 195.96 fee schedule 417.86 fee schedule 73.72 417.86 PROLACTIN (SO) 84146 CPT 84146 LOCAL BOTH 34.61 22.5 82.31 fee schedule 27.69 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 27.69 185.87 ACID FAST SM&CUL W/REFLORGANID 87116 CPT 87116 LOCAL BOTH 40.67 26.44 80.42 fee schedule 32.54 percent of total billed charge 20.73 fee schedule 111.12 fee schedule 20.73 111.12 "INSULIN,FREE&TOTAL" 83527 CPT 83527 LOCAL BOTH 601.53 390.99 181.34 fee schedule 481.22 percent of total billed charge 351.06 fee schedule 366.8 fee schedule 181.34 481.22 OBSTETRIC PANEL 80081 CPT 80081 LOCAL BOTH 83 53.95 46.04 fee schedule 66.4 percent of total billed charge 71.06 fee schedule 63.42 fee schedule 46.04 71.06 THYROTROPIN RELEASING HOR (SO) 80438 CPT 80438 LOCAL BOTH 467.16 303.65 16.69 fee schedule 373.73 percent of total billed charge 47.53 fee schedule 22.99 fee schedule 16.69 373.73 HEXAGONAL PHOSPHOLIPID 85598 CPT 85598 LOCAL BOTH 738.99 480.34 19.17 fee schedule 591.19 percent of total billed charge 25.59 fee schedule 26.41 fee schedule 19.17 591.19 "SUBSTITUTION,PLASMA FRACTIO EA" 85732 CPT 85732 LOCAL BOTH 258.71 168.16 99.59 fee schedule 206.97 percent of total billed charge 253.48 fee schedule 250.18 fee schedule 99.59 253.48 Leptospira 86720 CPT 86720 LOCAL BOTH 517.42 336.32 99.59 fee schedule 413.94 percent of total billed charge 268.56 fee schedule 250.18 fee schedule 99.59 413.94 FACTOR V11 85230 CPT 85230 LOCAL BOTH 236.25 153.56 166.42 fee schedule 189 percent of total billed charge 267.95 fee schedule 419.59 fee schedule 166.42 419.59 Everolimus 80169 CPT 80169 LOCAL BOTH 258.71 168.16 99.59 fee schedule 206.97 percent of total billed charge 71.99 fee schedule 250.18 fee schedule 71.99 250.18 CORTISOL W/REFLEX TO DEXAMETS 83533 CPT 83533 LOCAL BOTH 575.66 374.18 17.28 fee schedule 460.53 percent of total billed charge 32.81 fee schedule 23.8 fee schedule 17.28 460.53 WRIGHTS STAIN 89055 CPT 89055 LOCAL BOTH 294.77 191.6 46.68 fee schedule 235.82 percent of total billed charge 35.54 fee schedule 64.3 fee schedule 35.54 235.82 VAP CHOLESTEROL PROFILE 83701 CPT 83701 LOCAL BOTH 83.6 54.34 325.58 fee schedule 66.88 percent of total billed charge 143.59 fee schedule 520.54 fee schedule 66.88 520.54 SYNTHETIC CANNABINOID MET 82541 CPT 82541 LOCAL BOTH 243.56 158.31 50.42 fee schedule 194.85 percent of total billed charge 304.27 fee schedule 69.46 fee schedule 50.42 304.27 FACTOR INHIBITOR TEST 85335 CPT 85335 LOCAL BOTH 231.6 150.54 28.94 fee schedule 185.28 percent of total billed charge 32.81 fee schedule 39.87 fee schedule 28.94 185.28 "CYTOPATH CONCENTRATION, SMEAR" 88108 CPT 88108 LOCAL TC BOTH 112.85 73.35 99.59 fee schedule 90.28 percent of total billed charge 71.99 fee schedule 250.18 fee schedule 71.99 250.18 "BONE MARROW, SMEAR INTERP" 85097 CPT 85097 LOCAL BOTH 120.05 78.03 243.42 fee schedule 96.04 percent of total billed charge 571.48 fee schedule 555.46 fee schedule 96.04 571.48 PROINSULIN LEVEL 84206 CPT 84206 LOCAL BOTH 120.05 78.03 99.59 fee schedule 96.04 percent of total billed charge 565 fee schedule 250.18 fee schedule 96.04 565 "CYTOGENETIC STUDIES, SKIN OR O" 88233 CPT 88233 LOCAL TC BOTH 253.93 165.05 82.31 fee schedule 203.14 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 71.99 203.14 SO-MISCRODISECTION MANUAL 88381 CPT 88381 LOCAL TC BOTH 559.19 363.47 263.86 fee schedule 447.35 percent of total billed charge 60.32 fee schedule 534.32 fee schedule 60.32 534.32 HNK1-CD57 PROFILE 86356 CPT 86356 LOCAL BOTH 472.62 307.2 306.75 fee schedule 378.1 percent of total billed charge 96.87 fee schedule 651.28 fee schedule 96.87 651.28 HNK1-CD57 PROFILE 86357 CPT 86357 LOCAL BOTH 237.45 154.34 115.71 fee schedule 189.96 percent of total billed charge 155.94 fee schedule 53.98 fee schedule 53.98 189.96 SO FLOW CYTO 16 OR MORE MARKER 88189 CPT 88189 LOCAL TC BOTH 237.45 154.34 115.71 fee schedule 189.96 percent of total billed charge 155.94 fee schedule 51.86 fee schedule 51.86 189.96 CORTISOL URINARY FREE 82530 CPT 82530 LOCAL BOTH 284.43 184.88 263.86 fee schedule 227.54 percent of total billed charge 154.13 fee schedule 534.32 fee schedule 154.13 534.32 C-TELOPEPTIDE 82523 CPT 82523 LOCAL BOTH 65.81 42.78 28.76 fee schedule 52.65 percent of total billed charge 32.81 fee schedule 39.62 fee schedule 28.76 52.65 DIHYDROTESTOSTERONE 80327 CPT 80327 LOCAL BOTH 396.9 257.99 28.25 fee schedule 317.52 percent of total billed charge 32.81 fee schedule 38.92 fee schedule 28.25 317.52 "INHIBIN A, ULTRASENSATIVE" 86336 CPT 86336 LOCAL BOTH 348.24 226.36 18.41 fee schedule 278.59 percent of total billed charge 32.5 fee schedule 25.37 fee schedule 18.41 278.59 "CANNABINOID CONF, URINE" 80349 CPT 80349 LOCAL BOTH 386.9 251.49 115.71 fee schedule 309.52 percent of total billed charge 154.13 fee schedule 230.32 fee schedule 115.71 309.52 "GI PROFILE, STOOL, PCR" 87507 CPT 87507 LOCAL BOTH 135.41 88.02 18.92 fee schedule 108.33 percent of total billed charge 94.55 fee schedule 31.86 fee schedule 18.92 108.33 VITAMIN C 82180 CPT 82180 LOCAL BOTH 2514.65 1634.52 221.94 fee schedule 2011.72 percent of total billed charge 536.8 fee schedule 528.75 fee schedule 221.94 2011.72 HIV GENOSURE GENOTYPE 87900 CPT 87900 LOCAL BOTH 77.44 50.34 24.74 fee schedule 61.95 percent of total billed charge 32.81 fee schedule 34.09 fee schedule 24.74 61.95 HIV -1 GENOSURE 87901 CPT 87901 LOCAL BOTH 1470.57 955.87 223.85 fee schedule 1176.46 percent of total billed charge 207.67 fee schedule 543.54 fee schedule 207.67 1176.46 HIV GENOSURE INTEGRASE FUSION 87906 CPT 87906 LOCAL BOTH 727.58 472.93 223.85 fee schedule 582.06 percent of total billed charge 207.67 fee schedule 543.54 fee schedule 207.67 582.06 "PHERESIS PLT,LEUK-IRR LVDS 7D" P9037 CPT P9037 LOCAL BOTH 567.79 369.06 243.25 fee schedule 454.23 percent of total billed charge 64.74 fee schedule 492.76 fee schedule 64.74 492.76 Cystatin C 121251 82610 CPT 82610 LOCAL BOTH 2859.71 1858.81 18.32 fee schedule 2287.77 percent of total billed charge 1020 fee schedule 2.99 fee schedule 2.99 2287.77 Infliximab&Anti Ab 503870 80230 CPT 80230 LOCAL BOTH 153.3 99.65 31.92 fee schedule 122.64 percent of total billed charge 86 fee schedule 39.5 fee schedule 31.92 122.64 HCV FIBROSURE 81596 CPT 81596 LOCAL BOTH 686.22 446.04 17.78 fee schedule 548.98 percent of total billed charge 47.53 fee schedule 24.49 fee schedule 17.78 548.98 CELIAC HLA REFLEX TO AB COMBO 81377 CPT 81377 LOCAL BOTH 472.5 307.13 21.1 fee schedule 378 percent of total billed charge 86 fee schedule 51.86 fee schedule 21.1 378 Hemoglobpathy+Fer w/A Thal Rfx 85027 CPT 85027 LOCAL BOTH 1545.86 1004.81 20.52 fee schedule 1236.69 percent of total billed charge 48.66 fee schedule 28.27 fee schedule 20.52 1236.69 "Plasminogen ACT INH-1,AG" 85415 CPT 85415 LOCAL BOTH 195.83 127.29 99.59 fee schedule 156.66 percent of total billed charge 71.99 fee schedule 250.18 fee schedule 71.99 250.18 "SULFONYLUREA SCREEN QT, URINE" 80377 CPT 80377 LOCAL BOTH 91.79 59.66 99.59 fee schedule 73.43 percent of total billed charge 71.99 fee schedule 250.18 fee schedule 71.99 250.18 BANORMAL PT/APTT REFLEXIVE PR 80500 CPT 80500 LOCAL BOTH 344.14 223.69 19.01 fee schedule 275.31 percent of total billed charge 32.81 fee schedule 26.19 fee schedule 19.01 275.31 REFLEX ABNORMAL PT 85611 CPT 85611 LOCAL BOTH 155.46 101.05 19.21 fee schedule 124.37 percent of total billed charge 25.59 fee schedule 26.46 fee schedule 19.21 124.37 REFLEX ABNORMAL APTT 85270 CPT 85270 LOCAL BOTH 141.25 91.81 99.59 fee schedule 113 percent of total billed charge 253.48 fee schedule 250.18 fee schedule 99.59 253.48 "PHEYTOIN, FREE SERUM" 80186 CPT 80186 LOCAL BOTH 210.46 136.8 99.59 fee schedule 168.37 percent of total billed charge 71.99 fee schedule 250.18 fee schedule 71.99 250.18 MTHFR 81291 CPT 81291 LOCAL BOTH 243.77 158.45 17.56 fee schedule 195.02 percent of total billed charge 32.81 fee schedule 24.19 fee schedule 17.56 195.02 PARTIAL D WEAK D TESTING 86901 CPT 86901 LOCAL BOTH 578.88 376.27 20.26 fee schedule 463.1 percent of total billed charge 32.81 fee schedule 27.9 fee schedule 20.26 463.1 ANTIPHOSPHOLIPID SYNDROME 85597 CPT 85597 LOCAL BOTH 515.72 335.22 166.42 fee schedule 412.58 percent of total billed charge 342.48 fee schedule 410.47 fee schedule 166.42 412.58 CALR+ JAK2 EXON 12 +M 81402 CPT 81402 LOCAL BOTH 543.99 353.59 99.59 fee schedule 435.19 percent of total billed charge 253.48 fee schedule 250.18 fee schedule 99.59 435.19 ADALIMUMAB AB 503890 80145 CPT 80145 LOCAL BOTH 2010.73 1306.97 20.79 fee schedule 1608.58 percent of total billed charge 32.81 fee schedule 28.63 fee schedule 20.79 1608.58 MORPHOMETRIC ANALYSIS FISH MANUAL:SINGLE PROBE 88369 CPT 88369 LOCAL TC BOTH 686.22 446.04 16.72 fee schedule 548.98 percent of total billed charge 32.81 fee schedule 23.03 fee schedule 16.72 548.98 MOROHOMETRIC ANALYSIS FISH MANUAL: MULTIPLEX 88377 CPT 88377 LOCAL TC BOTH 710.87 462.07 306.75 fee schedule 568.7 percent of total billed charge 32.22 fee schedule 417.86 fee schedule 32.22 568.7 CLOPIDOGREL P450 C219 81255 CPT 81255 LOCAL BOTH 1421.74 924.13 306.75 fee schedule 1137.39 percent of total billed charge 195.96 fee schedule 651.28 fee schedule 195.96 1137.39 NIC NICOTINE 80303 CPT 80303 LOCAL BOTH 1184.84 770.15 20.01 fee schedule 947.87 percent of total billed charge 41.34 fee schedule 27.57 fee schedule 20.01 947.87 CANDIDA 86628 CPT 86628 LOCAL BOTH 94.79 61.61 18.02 fee schedule 75.83 percent of total billed charge 32.81 fee schedule 24.83 fee schedule 18.02 75.83 INFECTIOUS AGENT ANTIBODY 86318 CPT 86318 LOCAL BOTH 589.04 382.88 141.48 fee schedule 471.23 percent of total billed charge 155.94 fee schedule 285.18 fee schedule 141.48 471.23 APS PROFILE 85210 CPT 85210 LOCAL BOTH 100.25 65.16 115.71 fee schedule 80.2 percent of total billed charge 241.5 fee schedule 230.32 fee schedule 80.2 241.5 Meningitis/Encephalitis 87483 CPT 87483 LOCAL BOTH 236.25 153.56 99.59 fee schedule 189 percent of total billed charge 71.99 fee schedule 250.18 fee schedule 71.99 250.18 ELECTROPHORETIC TECH 82664 CPT 82664 LOCAL BOTH 2646 1719.9 221.94 fee schedule 2116.8 percent of total billed charge 248 fee schedule 528.75 fee schedule 221.94 2116.8 Phosphatidylethanol 80321 CPT 80321 LOCAL BOTH 64.58 41.98 34.11 fee schedule 51.66 percent of total billed charge 143.59 fee schedule 60.92 fee schedule 34.11 143.59 CANDIDA SPECIES 87480 CPT 87480 LOCAL BOTH 342.72 222.77 18.27 fee schedule 274.18 percent of total billed charge 42.83 fee schedule 25.16 fee schedule 18.27 274.18 gardnerella 87510 CPT 87510 LOCAL BOTH 270.7 175.96 221.94 fee schedule 216.56 percent of total billed charge 606.02 fee schedule 528.75 fee schedule 216.56 606.02 MACROPROTACTIN X2 87146 CPT 87146 LOCAL BOTH 270.7 175.96 221.94 fee schedule 216.56 percent of total billed charge 536.8 fee schedule 540.5 fee schedule 216.56 540.5 RESPIRATORY SYNCYTIAL VIRUS 87634 CPT 87634 LOCAL BOTH 297.47 193.36 181.34 fee schedule 237.98 percent of total billed charge 103.29 fee schedule 366.8 fee schedule 103.29 366.8 ADAM TS 13 ACTIV REFLEX PROFIL 85397 CPT 85397 LOCAL BOTH 220.5 143.33 221.94 fee schedule 176.4 percent of total billed charge 253.48 fee schedule 470 fee schedule 176.4 470 STOOL CULTURE 87427 CPT 87427 LOCAL BOTH 529.2 343.98 99.59 fee schedule 423.36 percent of total billed charge 565 fee schedule 250.18 fee schedule 99.59 565 "G6PD, QUANT, BLOOD AND RBC" 83955 CPT 83955 LOCAL BOTH 35.18 22.87 221.24 fee schedule 28.14 percent of total billed charge 264.77 fee schedule 432.14 fee schedule 28.14 432.14 "Bacterial Vaginosis, etc 18272" 87102 CPT 87102 LOCAL BOTH 24.12 15.68 64.03 fee schedule 19.3 percent of total billed charge 304.27 fee schedule 88.21 fee schedule 19.3 304.27 "Bacterial Vaginosis, etc 18272" 84791 CPT 84791 LOCAL BOTH 314.56 204.46 181.34 fee schedule 251.65 percent of total billed charge 351.06 fee schedule 366.8 fee schedule 181.34 366.8 "Bacterial Vaginosis, etc 18272" 87905 CPT 87905 LOCAL BOTH 314.56 204.46 94.11 fee schedule 251.65 percent of total billed charge 32 fee schedule 104.03 fee schedule 32 251.65 OB COMPLICATION 85290 CPT 85290 LOCAL BOTH 314.56 204.46 243.25 fee schedule 251.65 percent of total billed charge 307.72 fee schedule 492.76 fee schedule 243.25 492.76 FACTOR IX GENETIC ANALYSIS 81238 CPT 81238 LOCAL BOTH 188.81 122.73 99.59 fee schedule 151.05 percent of total billed charge 71.99 fee schedule 250.18 fee schedule 71.99 250.18 AUTOIMMUNE LIVER PROFILE (RDL) 86036 CPT 86036 LOCAL BOTH 6804 4422.6 19.91 fee schedule 5443.2 percent of total billed charge 32.81 fee schedule 27.43 fee schedule 19.91 5443.2 AUTOIMMUNE LIVER PROFILE (RDL) 86381 CPT 86381 LOCAL BOTH 309.49 201.17 99.59 fee schedule 247.59 percent of total billed charge 253.48 fee schedule 250.18 fee schedule 99.59 253.48 "SEX DETERMINATION (SRY), DNA" 81400 CPT 81400 LOCAL BOTH 309.49 201.17 122.89 fee schedule 247.59 percent of total billed charge 267.5 fee schedule 291.58 fee schedule 122.89 291.58 ANTINEUTROPHIL CYTO ANBY ANCA 86037 CPT 86037 LOCAL BOTH 809.58 526.23 20.65 fee schedule 647.66 percent of total billed charge 32.81 fee schedule 28.44 fee schedule 20.65 647.66 STI PROFILE XX 76706 CPT 76706 LOCAL TC BOTH 217.35 141.28 99.59 fee schedule 173.88 percent of total billed charge 71.99 fee schedule 250.18 fee schedule 71.99 250.18 STI PROFILE XX 87389 CPT 87389 LOCAL BOTH 337.52 219.39 13.63 fee schedule 270.02 percent of total billed charge 28.65 fee schedule 18.78 fee schedule 13.63 270.02 Voltage-Gated Calcium Channel 86596 CPT 86596 LOCAL BOTH 337.52 219.39 213.6 fee schedule 270.02 percent of total billed charge 238.2 fee schedule 421 fee schedule 213.6 421 VALPROIC ACID; FREE DUORIOKACETUC ACID; FREE 80165 CPT 80165 LOCAL BOTH 450 292.5 126.16 fee schedule 360 percent of total billed charge 92.97 fee schedule 51.86 fee schedule 51.86 360 "Factor X, Chromogenic" 85260 CPT 85260 LOCAL BOTH 348.02 226.21 16.92 fee schedule 278.42 percent of total billed charge 28.65 fee schedule 23.31 fee schedule 16.92 278.42 IA NFCT AB SARSCOV2 COVID 19 86328 CPT 86328 LOCAL BOTH 473.75 307.94 99.59 fee schedule 379 percent of total billed charge 71.99 fee schedule 250.18 fee schedule 71.99 379 Coronavirus AG IA 87426 CPT 87426 LOCAL BOTH 151.19 98.27 115.71 fee schedule 120.95 percent of total billed charge 154.13 fee schedule 51.86 fee schedule 51.86 154.13 CRYO PREP CHARGE 86931 CPT 86931 LOCAL BOTH 151.19 98.27 213.6 fee schedule 120.95 percent of total billed charge 909.81 fee schedule 421 fee schedule 120.95 909.81 FRESH FROZEN PREPARATION FEE 86927 CPT 86927 LOCAL BOTH 6.81 4.43 166.5 fee schedule 5.45 percent of total billed charge 304.27 fee schedule 229.37 fee schedule 5.45 304.27 ABO GROUP 86900 CPT 86900 LOCAL BOTH 95.82 62.28 166.42 fee schedule 76.66 percent of total billed charge 762.6 fee schedule 410.47 fee schedule 76.66 762.6 ANTIGEN IDENTIFICATION-OBI(SO) 86904 CPT 86904 LOCAL BOTH 88.41 57.47 166.42 fee schedule 70.73 percent of total billed charge 348.42 fee schedule 410.47 fee schedule 70.73 410.47 BLOOD GASES MEASURED SA02 82805 CPT 82805 LOCAL BOTH 73.06 47.49 166.42 fee schedule 58.45 percent of total billed charge 342.48 fee schedule 410.47 fee schedule 58.45 410.47 BLOOD GASES CALCULATED SA02 82803 CPT 82803 LOCAL BOTH 429.63 279.26 36.98 fee schedule 343.7 percent of total billed charge 71.06 fee schedule 50.94 fee schedule 36.98 343.7 CO-OX(HEMOGLOBIN) 82820 CPT 82820 LOCAL BOTH 341.97 222.28 36.52 fee schedule 273.58 percent of total billed charge 92.97 fee schedule 50.31 fee schedule 36.52 273.58 CO-OX (METHEMOGLOBIN) 83050 CPT 83050 LOCAL BOTH 36.29 23.59 36.98 fee schedule 29.03 percent of total billed charge 71.06 fee schedule 50.94 fee schedule 29.03 71.06 COOX SULFHEMOGLOBIN 83060 CPT 83060 LOCAL BOTH 70.78 46.01 42.71 fee schedule 56.62 percent of total billed charge 62.3 fee schedule 42.06 fee schedule 42.06 62.3 COOX OXYGEN SAT 82810 CPT 82810 LOCAL BOTH 53.15 34.55 43.02 fee schedule 42.52 percent of total billed charge 96.87 fee schedule 81.74 fee schedule 42.52 96.87 BLOOD PH ONLY 82800 CPT 82800 LOCAL BOTH 87.38 56.8 36.98 fee schedule 69.9 percent of total billed charge 71.06 fee schedule 50.94 fee schedule 36.98 71.06 ANTIDIURETIC HORMONE (SO) 84588 CPT 84588 LOCAL BOTH 101.61 66.05 36.33 fee schedule 81.29 percent of total billed charge 100.48 fee schedule 69.14 fee schedule 36.33 100.48 "TYROSINE,PLASMA (SO)" 84510 CPT 84510 LOCAL BOTH 174.67 113.54 91.35 fee schedule 139.74 percent of total billed charge 61.58 fee schedule 163.8 fee schedule 61.58 163.8 AMINO ACIDS SINGLE QN (SO) 82131 CPT 82131 LOCAL BOTH 93.82 60.98 82.31 fee schedule 75.06 percent of total billed charge 113.46 fee schedule 185.87 fee schedule 75.06 185.87 AMINO ACIDS 2-5 QN (SO) 82136 CPT 82136 LOCAL BOTH 115.83 75.29 23.13 fee schedule 92.66 percent of total billed charge 32.81 fee schedule 31.86 fee schedule 23.13 92.66 FETAL LUNG ASSESSMENT L/S (SO) 83661 CPT 83661 LOCAL BOTH 115.83 75.29 23.6 fee schedule 92.66 percent of total billed charge 28.65 fee schedule 32.51 fee schedule 23.6 92.66 MI-1 (SO) 83516 CPT 83516 LOCAL BOTH 310.07 201.55 49.08 fee schedule 248.06 percent of total billed charge 76.86 fee schedule 88.81 fee schedule 49.08 248.06 CORTISOL 30 MIN (SO) 82533 CPT 82533 LOCAL BOTH 257.62 167.45 44.2 fee schedule 206.1 percent of total billed charge 65.32 fee schedule 133.75 fee schedule 44.2 206.1 SEROQUEL (SO) 80299 CPT 80299 LOCAL BOTH 83.33 54.16 28.81 fee schedule 66.66 percent of total billed charge 98.35 fee schedule 51.86 fee schedule 28.81 98.35 CHOLINESTERASE SERUM (S0) 82480 CPT 82480 LOCAL BOTH 435.69 283.2 17.91 fee schedule 348.55 percent of total billed charge 71.06 fee schedule 24.68 fee schedule 17.91 348.55 CHOLINESTERASE SERUM-2 (SO) 82482 CPT 82482 LOCAL BOTH 54.23 35.25 26.97 fee schedule 43.38 percent of total billed charge 76.86 fee schedule 44.15 fee schedule 26.97 76.86 URINE COPPER (SO) 82525 CPT 82525 LOCAL BOTH 54.23 35.25 26.97 fee schedule 43.38 percent of total billed charge 76.86 fee schedule 44.15 fee schedule 26.97 76.86 "IMMUNOGLOGULIN G,SUBCLS1-4(SO)" 82784 CPT 82784 LOCAL BOTH 215.32 139.96 28.69 fee schedule 172.26 percent of total billed charge 32.81 fee schedule 39.53 fee schedule 28.69 172.26 IMMUNOGLOBULIN G- 1 (SO) 82787 CPT 82787 LOCAL BOTH 46.78 30.41 36.33 fee schedule 37.42 percent of total billed charge 9.73 fee schedule 50.13 fee schedule 9.73 50.13 IMMUNOGLOBULINS A/E/G/M-4 (SO) 82785 CPT 82785 LOCAL BOTH 46.78 30.41 36.33 fee schedule 37.42 percent of total billed charge 76.86 fee schedule 60.5 fee schedule 36.33 76.86 "LACTIC ACID,PLASMA (SO)" 83605 CPT 83605 LOCAL BOTH 45.1 29.32 36.33 fee schedule 36.08 percent of total billed charge 76.86 fee schedule 60.5 fee schedule 36.08 76.86 "SEX HORM BIND GLOB,SERUM(SO)" 84270 CPT 84270 LOCAL BOTH 49.48 32.16 49.08 fee schedule 39.58 percent of total billed charge 65 fee schedule 51.86 fee schedule 39.58 65 ANDROSTANE DIOL GLUCURONIDE(SO 82154 CPT 82154 LOCAL BOTH 127.02 82.56 82.31 fee schedule 101.62 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 71.99 185.87 MTHFR-MOLECULE ISOLATE NUC(SO) 81479 CPT 81479 LOCAL BOTH 459.1 298.42 23.81 fee schedule 367.28 percent of total billed charge 71.06 fee schedule 32.81 fee schedule 23.81 367.28 MTHFR-MOLECULE DIAGNOSTICS(SO) 83892 CPT 83892 LOCAL BOTH 77.22 50.19 21.08 fee schedule 61.78 percent of total billed charge 32 fee schedule 56.87 fee schedule 21.08 61.78 MTHFR-MOLECULE GEL ELECT(SO) 83894 CPT 83894 LOCAL BOTH 77.22 50.19 55.71 fee schedule 61.78 percent of total billed charge 32 fee schedule 91.79 fee schedule 32 91.79 MTHFR-MOLECULE NUC AMPLI (SO) 83898 CPT 83898 LOCAL BOTH 77.22 50.19 58.61 fee schedule 61.78 percent of total billed charge 32 fee schedule 73.35 fee schedule 32 73.35 MTHFR-GENETIC EXAM (SO) 83912 CPT 83912 LOCAL BOTH 77.22 50.19 60.27 fee schedule 61.78 percent of total billed charge 32.81 fee schedule 83.03 fee schedule 32.81 83.03 VITAMIN K1 84597 CPT 84597 LOCAL BOTH 77.22 50.19 63.33 fee schedule 61.78 percent of total billed charge 32 fee schedule 112.74 fee schedule 32 112.74 AMINO ACIDS 6 OR MORE QN(SO) 82139 CPT 82139 LOCAL BOTH 207.22 134.69 92.21 fee schedule 165.78 percent of total billed charge 98.35 fee schedule 164.83 fee schedule 92.21 165.78 PYRUVIC ACID (PYRUATE) (SO) 84210 CPT 84210 LOCAL BOTH 892.34 580.02 23.61 fee schedule 713.87 percent of total billed charge 32.81 fee schedule 32.52 fee schedule 23.61 713.87 "ASSAY, BLD/SERUM CHOLESTROL" 82465 CPT 82465 LOCAL BOTH 182.83 118.84 82.31 fee schedule 146.26 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 71.99 185.87 ASSAY BLOOD LIPOPROTEINS(SO) 83700 CPT 83700 LOCAL BOTH 69.11 44.92 26.97 fee schedule 55.29 percent of total billed charge 76.86 fee schedule 44.15 fee schedule 26.97 76.86 ASSAY OF TRIGLYCERIDES 84478 CPT 84478 LOCAL BOTH 252.54 164.15 50.17 fee schedule 202.03 percent of total billed charge 143.59 fee schedule 89.58 fee schedule 50.17 202.03 METHYLMALONIC ACID M61199(SO) 83921 CPT 83921 LOCAL BOTH 95.5 62.08 82.31 fee schedule 76.4 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 71.99 185.87 24 URINE URIC ACID (SO) 84560 CPT 84560 LOCAL BOTH 162.55 105.66 63.81 fee schedule 130.04 percent of total billed charge 35 fee schedule 126.64 fee schedule 35 130.04 24 URINE MAGNESIUM (SO) 83735 CPT 83735 LOCAL BOTH 82.3 53.5 87.19 fee schedule 65.84 percent of total billed charge 35 fee schedule 109.47 fee schedule 35 109.47 24 URINE HEAVY METAL(SO) 83015 CPT 83015 LOCAL BOTH 75.86 49.31 55.41 fee schedule 60.69 percent of total billed charge 154.13 fee schedule 113.7 fee schedule 55.41 154.13 GAD -65 AUTOANTIBODY (SO) 83519 CPT 83519 LOCAL BOTH 1182.73 768.77 41.98 fee schedule 946.18 percent of total billed charge 92.97 fee schedule 57.83 fee schedule 41.98 946.18 5-NUCLEOTIDASE (SO) 83915 CPT 83915 LOCAL BOTH 203.16 132.05 44.37 fee schedule 162.53 percent of total billed charge 32.81 fee schedule 61.13 fee schedule 32.81 162.53 17-HYDROXYCORTICOSTEROIDS (SO) 83491 CPT 83491 LOCAL BOTH 162.88 105.87 63.81 fee schedule 130.3 percent of total billed charge 195.96 fee schedule 126.64 fee schedule 63.81 195.96 "CYCLIC AMP,URINE (SO)" 82030 CPT 82030 LOCAL BOTH 318.23 206.85 43.02 fee schedule 254.58 percent of total billed charge 20 fee schedule 71.52 fee schedule 20 254.58 K ANTIGEN TYPE 86905 CPT 86905 LOCAL BOTH 254.96 165.72 21.52 fee schedule 203.97 percent of total billed charge 48.66 fee schedule 29.65 fee schedule 21.52 203.97 17 - HYDROXYPROGESTERONE (SO) 83498 CPT 83498 LOCAL BOTH 171.8 111.67 166.42 fee schedule 137.44 percent of total billed charge 342.48 fee schedule 410.47 fee schedule 137.44 410.47 17-KETOSTEROIDS (SO) 83586 CPT 83586 LOCAL BOTH 91.93 59.75 43.54 fee schedule 73.54 percent of total billed charge 54 fee schedule 62.14 fee schedule 43.54 73.54 "ACETONE, SERUM QUAL (SO)" 82009 CPT 82009 LOCAL BOTH 169.95 110.47 48.79 fee schedule 135.96 percent of total billed charge 65 fee schedule 53.37 fee schedule 48.79 135.96 ACETYLCHOLINE RECEPTOR AB (SO) 84238 CPT 84238 LOCAL BOTH 56.24 36.56 21.24 fee schedule 44.99 percent of total billed charge 42.83 fee schedule 29.25 fee schedule 21.24 44.99 DRUG SCREEN 80306 CPT 80306 LOCAL BOTH 579.2 376.48 82.31 fee schedule 463.36 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 71.99 463.36 "ARSENIC, URINE-1 (SO)" 82175 CPT 82175 LOCAL BOTH 1200 83.66 18.15 fee schedule 960 percent of total billed charge 32.81 fee schedule 25 fee schedule 18.15 960 ACTH (SO) 82024 CPT 82024 LOCAL BOTH 131.34 85.37 24.7 fee schedule 105.07 percent of total billed charge 32 fee schedule 26.36 fee schedule 24.7 105.07 EBV Ab EARYL Ag IgG (SO) 86663 CPT 86663 LOCAL BOTH 753.53 489.79 21.3 fee schedule 602.82 percent of total billed charge 52 fee schedule 18.75 fee schedule 18.75 602.82 MOLECULE DOT/SLOT/BLOT (SO) 83893 CPT 83893 LOCAL BOTH 165.57 107.62 144.57 fee schedule 132.46 percent of total billed charge 143.59 fee schedule 51.86 fee schedule 51.86 144.57 MOLECULE ISOLATE (SO) 83890 CPT 83890 LOCAL BOTH 165.2 107.38 58.13 fee schedule 132.16 percent of total billed charge 32 fee schedule 67.01 fee schedule 32 132.16 HLA-DR-4 (DR SPECIFIC)3 (SO) 83896 CPT 83896 LOCAL BOTH 165.2 107.38 55.41 fee schedule 132.16 percent of total billed charge 154.13 fee schedule 113.7 fee schedule 55.41 154.13 ALBUMIN SERUM 82040 CPT 82040 LOCAL BOTH 72.14 46.89 59.37 fee schedule 57.71 percent of total billed charge 62 fee schedule 51.86 fee schedule 51.86 62 "ALBUMIN, PERITONEAL FLD (SO)" 82042 CPT 82042 LOCAL BOTH 85.33 55.46 21.55 fee schedule 68.26 percent of total billed charge 32.81 fee schedule 29.69 fee schedule 21.55 68.26 FRUCTOSAMINE (SO) 82985 CPT 82985 LOCAL BOTH 65.37 42.49 21.55 fee schedule 52.3 percent of total billed charge 71.06 fee schedule 29.69 fee schedule 21.55 71.06 ALDOLASE (SO) 82085 CPT 82085 LOCAL BOTH 23.26 15.12 40.45 fee schedule 18.61 percent of total billed charge 71.06 fee schedule 55.73 fee schedule 18.61 71.06 "HCG,URINE" 84703 CPT 84703 LOCAL BOTH 157.09 102.11 21.89 fee schedule 125.67 percent of total billed charge 32.81 fee schedule 30.16 fee schedule 21.89 125.67 "ALDOSTERONE, URINE (SO)" 82088 CPT 82088 LOCAL BOTH 150.71 97.96 93.57 fee schedule 120.57 percent of total billed charge 65 fee schedule 169.98 fee schedule 65 169.98 ALKALINE PHOSPHATASE (SO) 84075 CPT 84075 LOCAL BOTH 482.73 313.77 22.3 fee schedule 386.18 percent of total billed charge 92.97 fee schedule 30.71 fee schedule 22.3 386.18 ALPHA-1-ANTITRYPSIN (SO) 82103 CPT 82103 LOCAL BOTH 63.7 41.41 71.9 fee schedule 50.96 percent of total billed charge 304.27 fee schedule 99.05 fee schedule 50.96 304.27 ALPHA1 ANTITRYPSIN PHENO-2(SO) 82104 CPT 82104 LOCAL BOTH 196.02 127.41 22.4 fee schedule 156.82 percent of total billed charge 62 fee schedule 51.86 fee schedule 22.4 156.82 "ALPHA-FETOPROTEIN, SERUM (SO)" 82105 CPT 82105 LOCAL BOTH 40.02 26.01 22.48 fee schedule 32.02 percent of total billed charge 41.34 fee schedule 30.97 fee schedule 22.48 41.34 "ALUMINUM, PLASMA (SO)" 82108 CPT 82108 LOCAL BOTH 184.88 120.17 22.48 fee schedule 147.9 percent of total billed charge 41.34 fee schedule 30.97 fee schedule 22.48 147.9 AMIKACIN - TROUGH (SO) 80150 CPT 80150 LOCAL BOTH 252.54 164.15 22.52 fee schedule 202.03 percent of total billed charge 32.81 fee schedule 31.02 fee schedule 22.52 202.03 "KETONE BODIES,BLOOD" 82010 CPT 82010 LOCAL BOTH 37.63 24.46 16.75 fee schedule 30.1 percent of total billed charge 68 fee schedule 51.86 fee schedule 16.75 68 KEPPRA LEVEL (SO) 80177 CPT 80177 LOCAL BOTH 86.68 56.34 21.27 fee schedule 69.34 percent of total billed charge 32.81 fee schedule 29.3 fee schedule 21.27 69.34 AMMONIA 82140 CPT 82140 LOCAL BOTH 514.2 334.23 17.54 fee schedule 411.36 percent of total billed charge 71.06 fee schedule 24.17 fee schedule 17.54 411.36 AMYLASE 82150 CPT 82150 LOCAL BOTH 167.25 108.71 23.63 fee schedule 133.8 percent of total billed charge 48.66 fee schedule 32.55 fee schedule 23.63 133.8 KARYOTYPE- LYMPHOCYTE (SO) 88230 CPT 88230 LOCAL TC BOTH 129.35 84.08 23.7 fee schedule 103.48 percent of total billed charge 32.81 fee schedule 32.64 fee schedule 23.7 103.48 FETAL FIBRONECTIN(SO) 82731 CPT 82731 LOCAL BOTH 278.6 181.09 263.86 fee schedule 222.88 percent of total billed charge 60.32 fee schedule 534.32 fee schedule 60.32 534.32 "MYOGLOBIN,BLOOD (SO)" 83874 CPT 83874 LOCAL BOTH 541.61 352.05 34.39 fee schedule 433.29 percent of total billed charge 92.97 fee schedule 47.37 fee schedule 34.39 433.29 "PHOSPHOROUS,24 HR URINE (SO)" 84105 CPT 84105 LOCAL BOTH 297.96 193.67 55.41 fee schedule 238.37 percent of total billed charge 31.35 fee schedule 113.7 fee schedule 31.35 238.37 ANDROSTENEDIONE (SO) 82157 CPT 82157 LOCAL BOTH 51.48 33.46 74.88 fee schedule 41.18 percent of total billed charge 365.98 fee schedule 235.6 fee schedule 41.18 365.98 ALBUMIN/CREATININE RATI URINE 82043 CPT 82043 LOCAL BOTH 402.54 261.65 23.88 fee schedule 322.03 percent of total billed charge 32.81 fee schedule 32.9 fee schedule 23.88 322.03 ANGIOTENSIN CONVERTING EN (SO) 82164 CPT 82164 LOCAL BOTH 31.14 20.24 21.73 fee schedule 24.91 percent of total billed charge 32.81 fee schedule 29.93 fee schedule 21.73 32.81 "CATECHOLAMINES,FRACTIONATIO(SO" 82384 CPT 82384 LOCAL BOTH 201.16 130.75 24.45 fee schedule 160.93 percent of total billed charge 32.81 fee schedule 33.68 fee schedule 24.45 160.93 "PORPHYRINS,24 HR URINE (SO)" 84120 CPT 84120 LOCAL BOTH 323.69 210.4 26.68 fee schedule 258.95 percent of total billed charge 32.81 fee schedule 36.75 fee schedule 26.68 258.95 ASSAY OF PROTEIN (SO) 84155 CPT 84155 LOCAL BOTH 333.15 216.55 77.19 fee schedule 266.52 percent of total billed charge 32.81 fee schedule 106.34 fee schedule 32.81 266.52 ASSAY OF SERUM PROTEINS (so) 84165 CPT 84165 LOCAL BOTH 19.36 12.58 82.31 fee schedule 15.49 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 15.49 185.87 "ALA DELTA,24 HR URINE (SO)" 82135 CPT 82135 LOCAL BOTH 62.35 40.53 82.31 fee schedule 49.88 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 49.88 185.87 PARATHYROID HORMONE (SO) 82397 CPT 82397 LOCAL BOTH 90.09 58.56 23.17 fee schedule 72.07 percent of total billed charge 48.66 fee schedule 31.91 fee schedule 23.17 72.07 ALKPHOS ISOENZYME (SO) 84078 CPT 84078 LOCAL BOTH 211.6 137.54 26.7 fee schedule 169.28 percent of total billed charge 61.58 fee schedule 48.13 fee schedule 26.7 169.28 BASIC METABOLIC PANEL 80048 CPT 80048 LOCAL BOTH 57.97 37.68 72.25 fee schedule 46.38 percent of total billed charge 65 fee schedule 83.88 fee schedule 46.38 83.88 ARYSULFATASE A DIFIC LEUK (SO) 82657 CPT 82657 LOCAL BOTH 226.84 147.45 16.53 fee schedule 181.47 percent of total billed charge 32.81 fee schedule 22.77 fee schedule 16.53 181.47 CONGENITAL HYPOTHYRODISM (SO) 84443 CPT 84443 LOCAL BOTH 675.01 438.76 33.51 fee schedule 540.01 percent of total billed charge 62.32 fee schedule 46.16 fee schedule 33.51 540.01 GALACTOSEMIA (SO) 82776 CPT 82776 LOCAL BOTH 40.02 26.01 82.31 fee schedule 32.02 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 32.02 185.87 GALLACTOSE 1-PHOSPHATE (SO) 82775 CPT 82775 LOCAL BOTH 40.02 26.01 36.33 fee schedule 32.02 percent of total billed charge 9.73 fee schedule 50.13 fee schedule 9.73 50.13 FATTY ACID OXIDATION (SO) 83789 CPT 83789 LOCAL BOTH 1003.68 652.39 35.84 fee schedule 802.94 percent of total billed charge 99.61 fee schedule 49.37 fee schedule 35.84 802.94 BETA-2-MICROGLOBIN (SO) 82232 CPT 82232 LOCAL BOTH 105.01 68.26 55.41 fee schedule 84.01 percent of total billed charge 154.13 fee schedule 113.7 fee schedule 55.41 154.13 "BETA-HCG, QUANT (SO)" 84702 CPT 84702 LOCAL BOTH 229.55 149.21 24.94 fee schedule 183.64 percent of total billed charge 28.65 fee schedule 34.36 fee schedule 24.94 183.64 FIRST TRIMESTER SCREEN W/NT 84163 CPT 84163 LOCAL BOTH 226.14 146.99 92.89 fee schedule 180.91 percent of total billed charge 65 fee schedule 51.86 fee schedule 51.86 180.91 "BILIRUBIN, DIRECT" 82248 CPT 82248 LOCAL BOTH 482.67 313.74 82.31 fee schedule 386.14 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 71.99 386.14 "BILIRUBIN, TOTAL" 82247 CPT 82247 LOCAL BOTH 84.03 54.62 24.97 fee schedule 67.22 percent of total billed charge 32.81 fee schedule 34.4 fee schedule 24.97 67.22 BUN 84520 CPT 84520 LOCAL BOTH 97.88 63.62 24.94 fee schedule 78.3 percent of total billed charge 32.18 fee schedule 34.36 fee schedule 24.94 78.3 B TYPE PEPTIDE 83880 CPT 83880 LOCAL BOTH 95.17 61.86 83.31 fee schedule 76.14 percent of total billed charge 65 fee schedule 98.29 fee schedule 65 98.29 C-PEPTIDE (SO) 84681 CPT 84681 LOCAL BOTH 186.24 121.06 55.41 fee schedule 148.99 percent of total billed charge 101.09 fee schedule 230.32 fee schedule 55.41 230.32 CAFFEINE (SO) 80155 CPT 80155 LOCAL BOTH 216.68 140.84 92.85 fee schedule 173.34 percent of total billed charge 304.27 fee schedule 127.9 fee schedule 92.85 304.27 CALCITONIN (SO) 82308 CPT 82308 LOCAL BOTH 274.22 178.24 16.77 fee schedule 219.38 percent of total billed charge 32.81 fee schedule 23.1 fee schedule 16.77 219.38 CALCIUM (SO) TOTAL 82310 CPT 82310 LOCAL BOTH 349.76 227.34 25.55 fee schedule 279.81 percent of total billed charge 32.81 fee schedule 35.19 fee schedule 25.55 279.81 "CALCIUM, IONIZED (SO)" 82330 CPT 82330 LOCAL BOTH 88.74 57.68 25.55 fee schedule 70.99 percent of total billed charge 25.59 fee schedule 35.19 fee schedule 25.55 70.99 CARBAMAZEPINE (TEGRETOL) (SO) 80156 CPT 80156 LOCAL BOTH 100.96 65.62 26.12 fee schedule 80.77 percent of total billed charge 48.66 fee schedule 35.98 fee schedule 26.12 80.77 CARBON DIOXIDE 82374 CPT 82374 LOCAL BOTH 362.63 235.71 16.78 fee schedule 290.1 percent of total billed charge 32.81 fee schedule 23.11 fee schedule 16.78 290.1 CARBOXYHEMOGLOBIN (SO) 82375 CPT 82375 LOCAL BOTH 64.03 41.62 26.24 fee schedule 51.22 percent of total billed charge 71.06 fee schedule 36.15 fee schedule 26.24 71.06 CYANIDE (so) 82600 CPT 82600 LOCAL BOTH 480.99 312.64 26.24 fee schedule 384.79 percent of total billed charge 71.06 fee schedule 36.15 fee schedule 26.24 384.79 CAROTENE (SO) 82380 CPT 82380 LOCAL BOTH 145.3 94.45 31.52 fee schedule 116.24 percent of total billed charge 62 fee schedule 45.28 fee schedule 31.52 116.24 CEA (SO) 82378 CPT 82378 LOCAL BOTH 162.88 105.87 26.63 fee schedule 130.3 percent of total billed charge 71.06 fee schedule 36.68 fee schedule 26.63 130.3 "FREE KLLT CHAINS,Qn,URINE (SO)" 83883 CPT 83883 LOCAL BOTH 194.34 126.32 26.25 fee schedule 155.47 percent of total billed charge 71.06 fee schedule 36.17 fee schedule 26.25 155.47 CERULOPLASMIN (SO) 82390 CPT 82390 LOCAL BOTH 169.85 110.4 55.41 fee schedule 135.88 percent of total billed charge 155.94 fee schedule 113.7 fee schedule 55.41 155.94 CKMB 82553 CPT 82553 LOCAL BOTH 29.75 19.34 26.7 fee schedule 23.8 percent of total billed charge 61.58 fee schedule 48.13 fee schedule 23.8 61.58 CK ISOENQYMES (SO) 82550 CPT 82550 LOCAL BOTH 200.4 130.26 30.24 fee schedule 160.32 percent of total billed charge 41.34 fee schedule 41.66 fee schedule 30.24 160.32 CK ISOENZYMES (SO) 82552 CPT 82552 LOCAL BOTH 28.17 18.31 29.43 fee schedule 22.54 percent of total billed charge 92.97 fee schedule 40.54 fee schedule 22.54 92.97 SERUM OSMOLALITY LAB CORP(SO) 83930 CPT 83930 LOCAL BOTH 28.17 18.31 29.57 fee schedule 22.54 percent of total billed charge 98.35 fee schedule 53.31 fee schedule 22.54 98.35 FACTOR II DNA ANALYSIS-1 (SO) 81240 CPT 81240 LOCAL BOTH 103.93 67.55 63.81 fee schedule 83.14 percent of total billed charge 96.87 fee schedule 126.64 fee schedule 63.81 126.64 "COLLECT BLOOD, VENOUS ACCESS" 36591 CPT 36591 LOCAL BOTH 138.48 90.01 19.94 fee schedule 110.78 percent of total billed charge 65 fee schedule 51.86 fee schedule 19.94 110.78 COMPREHENSIVE METABOLIC PANEL 80053 CPT 80053 LOCAL BOTH 117.13 76.13 4.15 fee schedule 93.7 percent of total billed charge 17.14 fee schedule 5.71 fee schedule 4.15 93.7 COMPREHENSIVE SHORT STA PANEL 81442 CPT 81442 LOCAL BOTH 349 226.85 16.57 fee schedule 279.2 percent of total billed charge 32.18 fee schedule 22.83 fee schedule 16.57 279.2 CHLORIDE 82435 CPT 82435 LOCAL BOTH 6804 4422.6 20.99 fee schedule 5443.2 percent of total billed charge 143.59 fee schedule 37.49 fee schedule 20.99 5443.2 "CHLORIDE, URINE RANDOM" 82436 CPT 82436 LOCAL BOTH 62.67 40.74 26.7 fee schedule 50.14 percent of total billed charge 65 fee schedule 30.53 fee schedule 26.7 65 DIBUCAINE ASSAY (SO) 82638 CPT 82638 LOCAL BOTH 63.7 41.41 26.84 fee schedule 50.96 percent of total billed charge 32.81 fee schedule 36.98 fee schedule 26.84 50.96 CHLORPROMAZINE-THORAZINE 84022 CPT 84022 LOCAL BOTH 71.16 46.25 33.18 fee schedule 56.93 percent of total billed charge 32.81 fee schedule 45.71 fee schedule 32.81 56.93 CREATININE (SO) 82565 CPT 82565 LOCAL BOTH 225.17 146.36 68.93 fee schedule 180.14 percent of total billed charge 102 fee schedule 79.13 fee schedule 68.93 180.14 CREATININE CLEARANCE 82575 CPT 82575 LOCAL BOTH 88.74 57.68 30.36 fee schedule 70.99 percent of total billed charge 71.06 fee schedule 41.82 fee schedule 30.36 71.06 MOLECULE NUCLEIC AMPLI (1)(SO) CYSTIC FIBROSIS GENE SCREEN 81403 CPT 81403 LOCAL BOTH 354.84 230.65 30.47 fee schedule 283.87 percent of total billed charge 102 fee schedule 36.26 fee schedule 30.47 283.87 MOLECULE MUTATION SCAN (1)(SO) CYSTIC FIBROSIS GENE SCREEN 83903 CPT 83903 LOCAL BOTH 1172.24 761.96 20.81 fee schedule 937.79 percent of total billed charge 32.81 fee schedule 28.66 fee schedule 20.81 937.79 MOLECULE NUCLEIC AMPLI(2)(SO) CYSTIC FIBROSIS GENE SCREEN 83901 CPT 83901 LOCAL BOTH 233.28 151.63 62.68 fee schedule 186.62 percent of total billed charge 304.27 fee schedule 86.35 fee schedule 62.68 304.27 IMMUKNOW 86352 CPT 86352 LOCAL BOTH 232.95 151.42 60.9 fee schedule 186.36 percent of total billed charge 102 fee schedule 83.89 fee schedule 60.9 186.36 CRYOGLOBULINS (SO) 82595 CPT 82595 LOCAL BOTH 761.43 494.93 115.71 fee schedule 609.14 percent of total billed charge 101.09 fee schedule 230.32 fee schedule 101.09 609.14 CRYFIBRENOGEN (SO) 82585 CPT 82585 LOCAL BOTH 58.3 37.9 30.71 fee schedule 46.64 percent of total billed charge 61.58 fee schedule 54.35 fee schedule 30.71 61.58 CYCLOSPORINE(SO) 80158 CPT 80158 LOCAL BOTH 83.33 54.16 30.61 fee schedule 66.66 percent of total billed charge 61.58 fee schedule 55.73 fee schedule 30.61 66.66 DIGOXIN; TOTAL 80162 CPT 80162 LOCAL BOTH 312.18 202.92 16.85 fee schedule 249.74 percent of total billed charge 71.06 fee schedule 23.21 fee schedule 16.85 249.74 PROGRAF (SO) 80197 CPT 80197 LOCAL BOTH 139.14 90.44 16.85 fee schedule 111.31 percent of total billed charge 41.34 fee schedule 23.21 fee schedule 16.85 111.31 DHEA-S (SO) 82627 CPT 82627 LOCAL BOTH 496.95 323.02 17.62 fee schedule 397.56 percent of total billed charge 41.34 fee schedule 24.27 fee schedule 17.62 397.56 DHEA (SO) 82626 CPT 82626 LOCAL BOTH 382.2 248.43 33.1 fee schedule 305.76 percent of total billed charge 61.58 fee schedule 59.74 fee schedule 33.1 305.76 VIP LEVEL (SO) 84586 CPT 84586 LOCAL BOTH 388.96 252.82 32.97 fee schedule 311.17 percent of total billed charge 61.58 fee schedule 59.98 fee schedule 32.97 311.17 ELECTROLYTES 80051 CPT 80051 LOCAL BOTH 503.76 327.44 89.83 fee schedule 403.01 percent of total billed charge 304.27 fee schedule 123.74 fee schedule 89.83 403.01 ERYTHROPOIETIN(SO) 82668 CPT 82668 LOCAL BOTH 206.89 134.48 16.55 fee schedule 165.51 percent of total billed charge 28.65 fee schedule 22.8 fee schedule 16.55 165.51 ESTRONE (SO) 82679 CPT 82679 LOCAL BOTH 32.5 21.13 34.39 fee schedule 26 percent of total billed charge 92.97 fee schedule 47.37 fee schedule 26 92.97 ESTRADIOL(SO) 82670 CPT 82670 LOCAL BOTH 346.68 225.34 34.39 fee schedule 277.34 percent of total billed charge 92.97 fee schedule 47.37 fee schedule 34.39 277.34 ESTRIOL(SO) 82677 CPT 82677 LOCAL BOTH 58.13 37.78 34.39 fee schedule 46.5 percent of total billed charge 92.97 fee schedule 51.86 fee schedule 34.39 92.97 ESTROGEN (SO) 82672 CPT 82672 LOCAL BOTH 229.55 149.21 34.39 fee schedule 183.64 percent of total billed charge 92.97 fee schedule 47.37 fee schedule 34.39 183.64 DIHYDROTESTERONE 85651 CPT 85651 LOCAL BOTH 237.01 154.06 34.39 fee schedule 189.61 percent of total billed charge 92.97 fee schedule 47.37 fee schedule 34.39 189.61 HB SOLU & RFLX FRAC 85660 CPT 85660 LOCAL BOTH 216.14 140.49 99.59 fee schedule 172.91 percent of total billed charge 268.56 fee schedule 250.18 fee schedule 99.59 268.56 FLUVOXAMINE 82491 CPT 82491 LOCAL BOTH 73.87 48.02 99.59 fee schedule 59.1 percent of total billed charge 268.56 fee schedule 250.18 fee schedule 59.1 268.56 MENOPAUSE TRANSITION GROUP 83001 CPT 83001 LOCAL BOTH 218.41 141.97 27.38 fee schedule 174.73 percent of total billed charge 32.81 fee schedule 37.72 fee schedule 27.38 174.73 MENOPAUSE TRANSITION GROUP 83002 CPT 83002 LOCAL BOTH 112.37 73.04 40.85 fee schedule 89.9 percent of total billed charge 92.97 fee schedule 56.27 fee schedule 40.85 92.97 MENOPAUSE TRANSITION GROUP 84144 CPT 84144 LOCAL BOTH 112.37 73.04 40.91 fee schedule 89.9 percent of total billed charge 92.97 fee schedule 43.13 fee schedule 40.91 92.97 ETHOSUXIMIDE (ZARONTIN)(SO) 80168 CPT 80168 LOCAL BOTH 112.37 73.04 79.16 fee schedule 89.9 percent of total billed charge 92.97 fee schedule 95.7 fee schedule 79.16 95.7 "ETHALENE,GLYCOL (SO)" 82693 CPT 82693 LOCAL BOTH 156.44 101.69 16.97 fee schedule 125.15 percent of total billed charge 92.97 fee schedule 19.55 fee schedule 16.97 125.15 GGT (SO) 82977 CPT 82977 LOCAL BOTH 369.01 239.86 34.39 fee schedule 295.21 percent of total billed charge 92.97 fee schedule 47.37 fee schedule 34.39 295.21 ELEC STOOL OTHER SOURCE 82438 CPT 82438 LOCAL BOTH 86.68 56.34 39.94 fee schedule 69.34 percent of total billed charge 32.81 fee schedule 55.01 fee schedule 32.81 69.34 elect stool 84302 CPT 84302 LOCAL BOTH 120.97 78.63 26.91 fee schedule 96.78 percent of total billed charge 92.97 fee schedule 34.25 fee schedule 26.91 96.78 FECAL REDUCING SUSTANCE (SO) 84999 CPT 84999 LOCAL BOTH 120.97 78.63 82.31 fee schedule 96.78 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 71.99 185.87 FECAL ELECTROL NA K (2) (SO) 82190 CPT 82190 LOCAL BOTH 34.18 22.22 96.02 fee schedule 27.34 percent of total billed charge 365.98 fee schedule 297.46 fee schedule 27.34 365.98 "FECAL FATS, QUANT(SO)" 82710 CPT 82710 LOCAL BOTH 143.24 93.11 24.76 fee schedule 114.59 percent of total billed charge 32.81 fee schedule 34.11 fee schedule 24.76 114.59 FERRITIN 82728 CPT 82728 LOCAL BOTH 253.23 164.6 34.39 fee schedule 202.58 percent of total billed charge 92.97 fee schedule 47.37 fee schedule 34.39 202.58 "GABAPENTIN,WHOLE BLOOD,SERUM" 80171 CPT 80171 LOCAL BOTH 201.16 130.75 34.39 fee schedule 160.93 percent of total billed charge 92.97 fee schedule 47.37 fee schedule 34.39 160.93 GLUCOSE 1/2 HR 82950 CPT 82950 LOCAL BOTH 471.96 306.77 17.3 fee schedule 377.57 percent of total billed charge 41.34 fee schedule 23.83 fee schedule 17.3 377.57 GTT 1 HR- N0 URINE 82951 CPT 82951 LOCAL BOTH 51.81 33.68 37.85 fee schedule 41.45 percent of total billed charge 42.83 fee schedule 52.14 fee schedule 37.85 52.14 FETAL LUNG MATURITY (SO) 84081 CPT 84081 LOCAL BOTH 270.15 175.6 38.47 fee schedule 216.12 percent of total billed charge 48.66 fee schedule 53 fee schedule 38.47 216.12 FETAL LUNG MATURITY (SO) 83663 CPT 83663 LOCAL BOTH 96.15 62.5 72.84 fee schedule 76.92 percent of total billed charge 92.82 fee schedule 100.35 fee schedule 72.84 100.35 FOLIC ACID(SO) 82746 CPT 82746 LOCAL BOTH 109.78 71.36 49.08 fee schedule 87.82 percent of total billed charge 76.86 fee schedule 88.81 fee schedule 49.08 88.81 FREE T3(SO) 84481 CPT 84481 LOCAL BOTH 81.27 52.83 34.62 fee schedule 65.02 percent of total billed charge 71.06 fee schedule 47.7 fee schedule 34.62 71.06 FREE T4 84439 CPT 84439 LOCAL BOTH 56.13 36.48 82.31 fee schedule 44.9 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 44.9 185.87 PSA TOTAL 84153 CPT 84153 LOCAL BOTH 138.81 90.23 82.31 fee schedule 111.05 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 71.99 185.87 FSBS 82948 CPT 82948 LOCAL BOTH 59.43 38.63 82.31 fee schedule 47.54 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 47.54 185.87 GASTRIN (SO) 82941 CPT 82941 LOCAL BOTH 22.01 14.31 37.8 fee schedule 17.61 percent of total billed charge 42.83 fee schedule 51.86 fee schedule 17.61 51.86 GASTROCULT 82271 CPT 82271 LOCAL BOTH 362.63 235.71 37.47 fee schedule 290.1 percent of total billed charge 61.58 fee schedule 67.13 fee schedule 37.47 290.1 "GENTAMYCIN, PEAK" 80170 CPT 80170 LOCAL BOTH 39.64 25.77 25.02 fee schedule 31.71 percent of total billed charge 32.81 fee schedule 34.47 fee schedule 25.02 34.47 GLUCAGON(SO) 82943 CPT 82943 LOCAL BOTH 191.97 124.78 17.3 fee schedule 153.58 percent of total billed charge 32.81 fee schedule 23.83 fee schedule 17.3 153.58 GLUCOSE ADD'L HR 82952 CPT 82952 LOCAL BOTH 426.54 277.25 37.73 fee schedule 341.23 percent of total billed charge 32.81 fee schedule 51.98 fee schedule 32.81 341.23 "GLUCOSE,PLEURAL FLUID" 82945 CPT 82945 LOCAL BOTH 60.94 39.61 38.67 fee schedule 48.75 percent of total billed charge 32 fee schedule 46.21 fee schedule 32 48.75 GLUCOSE POST PRANDIOL 1 HR 82947 CPT 82947 LOCAL BOTH 27.14 17.64 37.8 fee schedule 21.71 percent of total billed charge 42.83 fee schedule 51.86 fee schedule 21.71 51.86 GLUCOSE-6-PHOS DEHYDROGEN (SO) 82955 CPT 82955 LOCAL BOTH 60.94 39.61 37.8 fee schedule 48.75 percent of total billed charge 42.83 fee schedule 52.07 fee schedule 37.8 52.07 GLYCOHEMOGLOBIN (A1C) 83036 CPT 83036 LOCAL BOTH 155.74 101.23 38.78 fee schedule 124.59 percent of total billed charge 154.13 fee schedule 311.78 fee schedule 38.78 311.78 HISTAMINE 24 HR URINE (SO) 83088 CPT 83088 LOCAL BOTH 132.1 85.87 41.98 fee schedule 105.68 percent of total billed charge 92.97 fee schedule 57.83 fee schedule 41.98 105.68 HEAVEY METALS- CADMIUM (SO) 82300 CPT 82300 LOCAL BOTH 485.16 315.35 43.02 fee schedule 388.13 percent of total billed charge 65 fee schedule 81.74 fee schedule 43.02 388.13 HEAVY METALS- LEAD (SO) 83655 CPT 83655 LOCAL BOTH 98.2 63.83 25.28 fee schedule 78.56 percent of total billed charge 42.83 fee schedule 34.83 fee schedule 25.28 78.56 HEAVY METALS-MERCURY (SO) 83825 CPT 83825 LOCAL BOTH 98.2 63.83 49.08 fee schedule 78.56 percent of total billed charge 76.86 fee schedule 88.81 fee schedule 49.08 88.81 HAPTOGLOBIN(SO) 83010 CPT 83010 LOCAL BOTH 98.2 63.83 55.41 fee schedule 78.56 percent of total billed charge 28.65 fee schedule 82.43 fee schedule 28.65 82.43 HDL CHOLESTEROL 83718 CPT 83718 LOCAL BOTH 205.86 133.81 41.43 fee schedule 164.69 percent of total billed charge 248 fee schedule 528.75 fee schedule 41.43 528.75 HEMOGLOBINOPATHY PROFILE (S0) 83021 CPT 83021 LOCAL BOTH 134.76 87.59 54.62 fee schedule 107.81 percent of total billed charge 65 fee schedule 66.59 fee schedule 54.62 107.81 "CHROMIUM, PLASMA" 82495 CPT 82495 LOCAL BOTH 47.1 30.62 41.98 fee schedule 37.68 percent of total billed charge 92.97 fee schedule 51.86 fee schedule 37.68 92.97 HOMO CYSTEINE (SO) 83090 CPT 83090 LOCAL BOTH 712.55 463.16 27.38 fee schedule 570.04 percent of total billed charge 32.81 fee schedule 40.51 fee schedule 27.38 570.04 "HPV, HIGH+LOW RISK (SO)" 83051 CPT 83051 LOCAL BOTH 244.09 158.66 43.02 fee schedule 195.27 percent of total billed charge 65 fee schedule 71.52 fee schedule 43.02 195.27 "IFE,PE,CSF ASSAY PROTEIN(SO)" 84157 CPT 84157 LOCAL BOTH 241.77 157.15 43.02 fee schedule 193.42 percent of total billed charge 96.87 fee schedule 81.74 fee schedule 43.02 193.42 INSULIN GROWTH FACTOR(SO) 84305 CPT 84305 LOCAL BOTH 40.67 26.44 82.31 fee schedule 32.54 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 32.54 185.87 "IRON BINDING CAPACITY,TOTAL" 83550 CPT 83550 LOCAL BOTH 383.23 249.1 82.31 fee schedule 306.58 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 71.99 306.58 "IRON, SERUM" 83540 CPT 83540 LOCAL BOTH 128.7 83.66 48.07 fee schedule 102.96 percent of total billed charge 71.99 fee schedule 55.65 fee schedule 48.07 102.96 LAMOTRIGIMINE (SO) 80175 CPT 80175 LOCAL BOTH 99.88 64.92 47.32 fee schedule 79.9 percent of total billed charge 71.99 fee schedule 55.86 fee schedule 47.32 79.9 LDH ISOENZYMES (SO) 83625 CPT 83625 LOCAL BOTH 408.59 265.58 17.46 fee schedule 326.87 percent of total billed charge 61.58 fee schedule 31.82 fee schedule 17.46 326.87 URINE OXALATE (SO) 83945 CPT 83945 LOCAL BOTH 156.44 101.69 49.08 fee schedule 125.15 percent of total billed charge 76.86 fee schedule 88.81 fee schedule 49.08 125.15 MOLECULE NUCLEIC AMPLI2 SEQ(SO 83900 CPT 83900 LOCAL BOTH 192.61 125.2 64.02 fee schedule 154.09 percent of total billed charge 86.65 fee schedule 116.15 fee schedule 64.02 154.09 "NUCLEIC ACID,HIGH RESOLUTE(SO)" 83909 CPT 83909 LOCAL BOTH 135.41 88.02 60.74 fee schedule 108.33 percent of total billed charge 32.18 fee schedule 83.67 fee schedule 32.18 108.33 CLOPIDOGREL 2C19 GENOTYPE 83914 CPT 83914 LOCAL BOTH 135.41 88.02 63.12 fee schedule 108.33 percent of total billed charge 32.81 fee schedule 86.95 fee schedule 32.81 108.33 LIDOCAINE (SO) 80176 CPT 80176 LOCAL BOTH 138.33 89.91 63.81 fee schedule 110.66 percent of total billed charge 32.81 fee schedule 126.64 fee schedule 32.81 126.64 LIPASE 83690 CPT 83690 LOCAL BOTH 198.72 129.17 17.47 fee schedule 158.98 percent of total billed charge 32.81 fee schedule 24.07 fee schedule 17.47 158.98 LITHIUM (SO) 80178 CPT 80178 LOCAL BOTH 144.22 93.74 49.4 fee schedule 115.38 percent of total billed charge 71.06 fee schedule 68.05 fee schedule 49.4 115.38 HEPATIC FUNCTION PANEL 80076 CPT 80076 LOCAL BOTH 17.58 11.43 17.54 fee schedule 14.06 percent of total billed charge 41.34 fee schedule 24.17 fee schedule 14.06 41.34 LDL DIRECT 83721 CPT 83721 LOCAL BOTH 174.02 113.11 16.69 fee schedule 139.22 percent of total billed charge 28.65 fee schedule 22.99 fee schedule 16.69 139.22 MELANOMA MONITOR PROFILE (S0) 84275 CPT 84275 LOCAL BOTH 33.8 21.97 55.12 fee schedule 27.04 percent of total billed charge 98.35 fee schedule 102.24 fee schedule 27.04 102.24 BARBITUATS 80345 CPT 80345 LOCAL BOTH 30.18 19.62 82.31 fee schedule 24.14 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 24.14 185.87 METANEPHRINES (TOTAL)(SO) 83835 CPT 83835 LOCAL BOTH 266.1 172.97 18.58 fee schedule 212.88 percent of total billed charge 32.81 fee schedule 25.6 fee schedule 18.58 212.88 METHYLMALONIC ACID (SO) 83918 CPT 83918 LOCAL BOTH 346.35 225.13 55.41 fee schedule 277.08 percent of total billed charge 9.73 fee schedule 50.13 fee schedule 9.73 277.08 "TOLUENE, BLOOD" 84600 CPT 84600 LOCAL BOTH 571.41 371.42 63.81 fee schedule 457.13 percent of total billed charge 9.73 fee schedule 126.64 fee schedule 9.73 457.13 METHEMOGLOBIN (SO) 83045 CPT 83045 LOCAL BOTH 259.61 168.75 92.21 fee schedule 207.69 percent of total billed charge 98.35 fee schedule 164.83 fee schedule 92.21 207.69 MOLECULE MUTATIN IP (SO) 83904 CPT 83904 LOCAL BOTH 159.14 103.44 42.61 fee schedule 127.31 percent of total billed charge 61.58 fee schedule 78.01 fee schedule 42.61 127.31 MUCIN CLOT (SO) 83872 CPT 83872 LOCAL BOTH 1143.15 743.05 63.04 fee schedule 914.52 percent of total billed charge 61 fee schedule 112.22 fee schedule 61 914.52 MYELIN BASIC PROTEIN (SO) 83873 CPT 83873 LOCAL BOTH 67.11 43.62 55.41 fee schedule 53.69 percent of total billed charge 76.86 fee schedule 60.5 fee schedule 53.69 76.86 OLIGOCLONAL BANDS (SO) 83916 CPT 83916 LOCAL BOTH 305.36 198.48 55.41 fee schedule 244.29 percent of total billed charge 31.35 fee schedule 113.7 fee schedule 31.35 244.29 "OSMOLALITY, URINE" 83935 CPT 83935 LOCAL BOTH 376.14 244.49 63.81 fee schedule 300.91 percent of total billed charge 31.32 fee schedule 126.64 fee schedule 31.32 300.91 OXCARBAZEPINE (SO) 80183 CPT 80183 LOCAL BOTH 60.94 39.61 63.81 fee schedule 48.75 percent of total billed charge 195.96 fee schedule 126.64 fee schedule 48.75 195.96 THIN LAYER CHROMATOGRAPHY (SO) 82489 CPT 82489 LOCAL BOTH 73.82 47.98 17.54 fee schedule 59.06 percent of total billed charge 41.34 fee schedule 24.17 fee schedule 17.54 59.06 PBGD EYTHROCYTE PARPH 82763 CPT 82763 LOCAL BOTH 242.41 157.57 27.24 fee schedule 193.93 percent of total billed charge 32.81 fee schedule 37.53 fee schedule 27.24 193.93 Narcolepsy Evaluation HLA CLA II TYPE HI RES 1 ALLEL 81383 CPT 81383 LOCAL BOTH 298.87 194.27 35.35 fee schedule 239.1 percent of total billed charge 92.97 fee schedule 58.95 fee schedule 35.35 239.1 PHENYTOIN (DILANTIN) 80185 CPT 80185 LOCAL BOTH 1640.04 1066.03 20.59 fee schedule 1312.03 percent of total billed charge 365.98 fee schedule 99.8 fee schedule 20.59 1312.03 PHOSPHOROUS (SO) 84100 CPT 84100 LOCAL BOTH 276.59 179.78 17.54 fee schedule 221.27 percent of total billed charge 41.34 fee schedule 24.17 fee schedule 17.54 221.27 POTASSIUM 24 URINE 84133 CPT 84133 LOCAL BOTH 56.24 36.56 73.36 fee schedule 44.99 percent of total billed charge 35.54 fee schedule 101.06 fee schedule 35.54 101.06 POTASSIUM SERUM 84132 CPT 84132 LOCAL BOTH 58.95 38.32 77.62 fee schedule 47.16 percent of total billed charge 32 fee schedule 105.94 fee schedule 32 105.94 PRIMIDONE (so) 80188 CPT 80188 LOCAL BOTH 81.27 52.83 77.23 fee schedule 65.02 percent of total billed charge 129.45 fee schedule 139.18 fee schedule 65.02 139.18 PROSTATIC ACID PHOSPHATE (SO) 84066 CPT 84066 LOCAL BOTH 53.54 34.8 17.57 fee schedule 42.83 percent of total billed charge 28.65 fee schedule 51.86 fee schedule 17.57 51.86 TOTAL PARATHYROID HORM (SO) 83970 CPT 83970 LOCAL BOTH 49.8 32.37 70.75 fee schedule 39.84 percent of total billed charge 304.27 fee schedule 104.68 fee schedule 39.84 304.27 PREALBUMIN 84134 CPT 84134 LOCAL BOTH 379.88 246.92 64.05 fee schedule 303.9 percent of total billed charge 304.27 fee schedule 88.24 fee schedule 64.05 304.27 QUINIDINE (SO) 80194 CPT 80194 LOCAL BOTH 131.02 85.16 77.65 fee schedule 104.82 percent of total billed charge 129.45 fee schedule 139.3 fee schedule 77.65 139.3 RENAL FUNCTION PANEL 80069 CPT 80069 LOCAL BOTH 138.16 89.8 17.57 fee schedule 110.53 percent of total billed charge 47.53 fee schedule 24.21 fee schedule 17.57 110.53 REVERSE TRANSCRIPTION (SO) 83902 CPT 83902 LOCAL BOTH 161.14 104.74 16.6 fee schedule 128.91 percent of total billed charge 53.53 fee schedule 22.87 fee schedule 16.6 128.91 QUANTIFERON CLIENT INCUBATED 86480 CPT 86480 LOCAL BOTH 259.99 168.99 62.08 fee schedule 207.99 percent of total billed charge 32 fee schedule 60.6 fee schedule 32 207.99 SEROTONIN (SO) 84260 CPT 84260 LOCAL BOTH 223.49 145.27 122.89 fee schedule 178.79 percent of total billed charge 279.13 fee schedule 291.58 fee schedule 122.89 291.58 SGOT/AST 84450 CPT 84450 LOCAL BOTH 449.2 291.98 82.31 fee schedule 359.36 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 71.99 359.36 SGPT/ALT 84460 CPT 84460 LOCAL BOTH 97.56 63.41 82.31 fee schedule 78.05 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 71.99 185.87 SODIUM 84295 CPT 84295 LOCAL BOTH 86.68 56.34 82.31 fee schedule 69.34 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 69.34 185.87 "SODIUM, URINE RANDOM" 84300 CPT 84300 LOCAL BOTH 97.56 63.41 82.31 fee schedule 78.05 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 71.99 185.87 STOOL FAT QUALITATIVE (SO) 82705 CPT 82705 LOCAL BOTH 97.56 63.41 82.31 fee schedule 78.05 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 71.99 185.87 "AMINO ACID SCREEN,PLASMA (SO)" 82127 CPT 82127 LOCAL BOTH 77.22 50.19 34.39 fee schedule 61.78 percent of total billed charge 92.97 fee schedule 47.37 fee schedule 34.39 92.97 STOOL OCCULT BLOOD 82272 CPT 82272 LOCAL BOTH 1027.75 668.04 22.67 fee schedule 822.2 percent of total billed charge 32.81 fee schedule 31.23 fee schedule 22.67 822.2 SULFONYUREA SCREEN(SO) 82486 CPT 82486 LOCAL BOTH 102.64 66.72 25.1 fee schedule 82.11 percent of total billed charge 32.81 fee schedule 51.86 fee schedule 25.1 82.11 FRACLIONATED ESTROGENS(SO) 82671 CPT 82671 LOCAL BOTH 500.36 325.23 27.21 fee schedule 400.29 percent of total billed charge 61.58 fee schedule 48.01 fee schedule 27.21 400.29 STONE ANALYSIS (SO) 82360 CPT 82360 LOCAL BOTH 174.45 113.39 34.39 fee schedule 139.56 percent of total billed charge 92.97 fee schedule 51.86 fee schedule 34.39 139.56 T3 UPTAKE 84479 CPT 84479 LOCAL BOTH 206.14 133.99 26.16 fee schedule 164.91 percent of total billed charge 32.81 fee schedule 36.03 fee schedule 26.16 164.91 T3 RIA (REVERSE T3) (SO) 84482 CPT 84482 LOCAL BOTH 97.56 63.41 82.31 fee schedule 78.05 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 71.99 185.87 T3 TOTAL (SO) 84480 CPT 84480 LOCAL BOTH 122.86 79.86 82.31 fee schedule 98.29 percent of total billed charge 1192.36 fee schedule 185.87 fee schedule 82.31 1192.36 TOPAMAX LEVEL (SO) 80201 CPT 80201 LOCAL BOTH 113.51 73.78 82.31 fee schedule 90.81 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 71.99 185.87 TESTOSTERONE 84403 CPT 84403 LOCAL BOTH 125.61 81.65 17.69 fee schedule 100.49 percent of total billed charge 42.83 fee schedule 24.37 fee schedule 17.69 100.49 THEOPHYLLINE 80198 CPT 80198 LOCAL BOTH 213.18 138.57 82.31 fee schedule 170.54 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 71.99 185.87 THIOCYANATE (SO) 84430 CPT 84430 LOCAL BOTH 154.76 100.59 17.62 fee schedule 123.81 percent of total billed charge 41.34 fee schedule 24.27 fee schedule 17.62 123.81 THYROID STIMULATOR IMM GLO(SO) 84445 CPT 84445 LOCAL BOTH 268.16 174.3 82.31 fee schedule 214.53 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 71.99 214.53 THYROXINE (T4) 84436 CPT 84436 LOCAL BOTH 543.34 353.17 82.31 fee schedule 434.67 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 71.99 434.67 THYROXINE BINDING GLOBULIN(SO) 84442 CPT 84442 LOCAL BOTH 97.56 63.41 82.31 fee schedule 78.05 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 71.99 185.87 TOBRAMYCIN PEAK 80200 CPT 80200 LOCAL BOTH 222.09 144.36 82.31 fee schedule 177.67 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 71.99 185.87 "AMINO ACID SCREEN,URINE (SO)" 82128 CPT 82128 LOCAL BOTH 192.61 125.2 17.64 fee schedule 154.09 percent of total billed charge 71.06 fee schedule 24.3 fee schedule 17.64 154.09 TRANSFERRIN (SO) 84466 CPT 84466 LOCAL BOTH 1308.99 850.84 23.1 fee schedule 1047.19 percent of total billed charge 47.53 fee schedule 31.82 fee schedule 23.1 1047.19 TRAMADOL (SO) 80373 CPT 80373 LOCAL BOTH 195 126.75 82.31 fee schedule 156 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 71.99 185.87 "TISSUE TRANSGLUTAMINASE,tTG" 86364 CPT 86364 LOCAL BOTH 101.28 65.83 18.96 fee schedule 81.02 percent of total billed charge 28.65 fee schedule 26.12 fee schedule 18.96 81.02 TROPONIN 84484 CPT 84484 LOCAL BOTH 90 58.5 120.09 fee schedule 72 percent of total billed charge 28.65 fee schedule 223.01 fee schedule 28.65 223.01 "UREA NITROGEN, URINE RANDOM(SO" 84540 CPT 84540 LOCAL BOTH 211.97 137.78 82.31 fee schedule 169.58 percent of total billed charge 253.48 fee schedule 185.87 fee schedule 82.31 253.48 UREA NITROGEN CLEARANCE (SO) 84545 CPT 84545 LOCAL BOTH 77.54 50.4 83.4 fee schedule 62.03 percent of total billed charge 92.97 fee schedule 114.89 fee schedule 62.03 114.89 URIC ACID 84550 CPT 84550 LOCAL BOTH 32.55 21.16 83.43 fee schedule 26.04 percent of total billed charge 71.99 fee schedule 149.31 fee schedule 26.04 149.31 Lipoprotein (A) 83695 CPT 83695 LOCAL BOTH 97.56 63.41 83.77 fee schedule 78.05 percent of total billed charge 71.99 fee schedule 221.73 fee schedule 71.99 221.73 CITRATE 24 HR URINE (SO) 82507 CPT 82507 LOCAL BOTH 50.4 32.76 49.67 fee schedule 40.32 percent of total billed charge 483.38 fee schedule 293.44 fee schedule 40.32 483.38 URINE SULFATE(SO) 84392 CPT 84392 LOCAL BOTH 295.2 191.88 27.54 fee schedule 236.16 percent of total billed charge 32.81 fee schedule 37.94 fee schedule 27.54 236.16 URINE MICROALBUMIN 82044 CPT 82044 LOCAL BOTH 48.51 31.53 82.31 fee schedule 38.81 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 38.81 185.87 "VANCOMYCIN,RANDOM" 80202 CPT 80202 LOCAL BOTH 34.61 22.5 21.74 fee schedule 27.69 percent of total billed charge 71.99 fee schedule 51.86 fee schedule 21.74 71.99 VALPROIC ACID; TOTAL DIPROPLACETIC ACID; TOTAL 80164 CPT 80164 LOCAL BOTH 192.61 125.2 17.7 fee schedule 154.09 percent of total billed charge 32.81 fee schedule 24.38 fee schedule 17.7 154.09 VANILLYLMANDELIC ACID (SO) 84585 CPT 84585 LOCAL BOTH 190.29 123.69 16.86 fee schedule 152.23 percent of total billed charge 48.66 fee schedule 23.22 fee schedule 16.86 152.23 "VIT D 1, 25 DIHDROXY (SO)" 82652 CPT 82652 LOCAL BOTH 254.64 165.52 88.29 fee schedule 203.71 percent of total billed charge 71.99 fee schedule 161.45 fee schedule 71.99 203.71 "VIT D, 25-HYDROXY (SO)" 82306 CPT 82306 LOCAL BOTH 117.66 76.48 33.18 fee schedule 94.13 percent of total billed charge 25.59 fee schedule 45.71 fee schedule 25.59 94.13 "VITAMIN B1, BLOOD" 84425 CPT 84425 LOCAL BOTH 56.94 37.01 25.29 fee schedule 45.55 percent of total billed charge 71.06 fee schedule 34.84 fee schedule 25.29 71.06 VITAMIN A (SO) 84590 CPT 84590 LOCAL BOTH 54.23 35.25 82.31 fee schedule 43.38 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 43.38 185.87 VITAMIN B6 (SO) 84207 CPT 84207 LOCAL BOTH 212.3 138 91.35 fee schedule 169.84 percent of total billed charge 61.58 fee schedule 163.8 fee schedule 61.58 169.84 VITAMIN B12 (SO) 82607 CPT 82607 LOCAL BOTH 282.32 183.51 82.31 fee schedule 225.86 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 71.99 225.86 VITAMIN E (SO) 84446 CPT 84446 LOCAL BOTH 81.27 52.83 31.65 fee schedule 65.02 percent of total billed charge 32.81 fee schedule 43.61 fee schedule 31.65 65.02 "ZINC, WHOLE BLOOD" 84630 CPT 84630 LOCAL BOTH 146.6 95.29 82.31 fee schedule 117.28 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 71.99 185.87 ZONISAMIDE (SO) 80203 CPT 80203 LOCAL BOTH 209.86 136.41 92.21 fee schedule 167.89 percent of total billed charge 98.35 fee schedule 164.83 fee schedule 92.21 167.89 VITAMIN B5 84591 CPT 84591 LOCAL BOTH 243.77 158.45 17.73 fee schedule 195.02 percent of total billed charge 32.81 fee schedule 24.42 fee schedule 17.73 195.02 "BCR-ABL 1, CML/ALL, PCR QUANT" 81170 CPT 81170 LOCAL BOTH 840.87 546.57 91.35 fee schedule 672.7 percent of total billed charge 61.58 fee schedule 163.8 fee schedule 61.58 672.7 METHADONE CONFIRMATION 83840 CPT 83840 LOCAL BOTH 1208.47 785.51 19.65 fee schedule 966.78 percent of total billed charge 92.97 fee schedule 27.07 fee schedule 19.65 966.78 IFE AND SPE 24 HOUR URINE 86355 CPT 86355 LOCAL BOTH 67.6 43.94 55.41 fee schedule 54.08 percent of total billed charge 9.73 fee schedule 50.13 fee schedule 9.73 55.41 "PANCREATIC ELASTASE,FECAL" 82656 CPT 82656 LOCAL BOTH 55.81 36.28 115.71 fee schedule 44.65 percent of total billed charge 335.91 fee schedule 230.32 fee schedule 44.65 335.91 SELENIUM 84255 CPT 84255 LOCAL BOTH 995.2 646.88 33.26 fee schedule 796.16 percent of total billed charge 71.06 fee schedule 45.82 fee schedule 33.26 796.16 ANTI DNASE B STREP ANTIBODIES 86215 CPT 86215 LOCAL BOTH 216.14 140.49 82.31 fee schedule 172.91 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 71.99 185.87 T+B LYMPHOCYTES DIFFERENTIAL 86359 CPT 86359 LOCAL BOTH 142.22 92.44 105.85 fee schedule 113.78 percent of total billed charge 71.99 fee schedule 224.71 fee schedule 71.99 224.71 TRANSCORTIN 84449 CPT 84449 LOCAL BOTH 408.1 265.27 115.71 fee schedule 326.48 percent of total billed charge 155.94 fee schedule 230.32 fee schedule 115.71 326.48 BCR ABL1 TRANSCRIPT DETECTION 81206 CPT 81206 LOCAL BOTH 160.49 104.32 82.31 fee schedule 128.39 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 71.99 185.87 BCR ABL1 TRANSCRIPT DETECTION 81207 CPT 81207 LOCAL BOTH 863.19 561.07 19.65 fee schedule 690.55 percent of total billed charge 92.97 fee schedule 27.07 fee schedule 19.65 690.55 STREP PNEUMO ANTIBODIES 86609 CPT 86609 LOCAL BOTH 863.19 561.07 19.75 fee schedule 690.55 percent of total billed charge 41.32 fee schedule 29.61 fee schedule 19.75 690.55 "BUPRENORPHINE, WB" 80348 CPT 80348 LOCAL BOTH 243.61 158.35 131.34 fee schedule 194.89 percent of total billed charge 41.32 fee schedule 160.4 fee schedule 41.32 194.89 APOE ALZHEIMERS RISK 81401 CPT 81401 LOCAL BOTH 503.76 327.44 18.66 fee schedule 403.01 percent of total billed charge 41.34 fee schedule 25.7 fee schedule 18.66 403.01 RESP VIRUS 22 TARGETS 0202U CPT 0202U LOCAL BOTH 1320.19 858.12 20.67 fee schedule 1056.15 percent of total billed charge 32.81 fee schedule 28.47 fee schedule 20.67 1056.15 somatostian 84307 CPT 84307 LOCAL BOTH 1547.57 1005.92 947.01 fee schedule 1238.06 percent of total billed charge 1927.06 fee schedule 1879.22 fee schedule 947.01 1927.06 THIOPURINE METHY GENO TMPT 81335 CPT 81335 LOCAL BOTH 631.65 410.57 82.31 fee schedule 505.32 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 71.99 505.32 Anti 68kD 165750 84181 CPT 84181 LOCAL BOTH 1320.03 858.02 20.39 fee schedule 1056.02 percent of total billed charge 32.81 fee schedule 28.09 fee schedule 20.39 1056.02 CLONAZEPAM UR AS METABOLITE 80346 CPT 80346 LOCAL BOTH 586.45 381.19 82.31 fee schedule 469.16 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 71.99 469.16 "MLH1 GENE ANAL, FULL SEQ" 81292 CPT 81292 LOCAL BOTH 529.2 343.98 18.59 fee schedule 423.36 percent of total billed charge 32.81 fee schedule 25.61 fee schedule 18.59 423.36 MSH2 GENE ANAL FULL SEQ 81295 CPT 81295 LOCAL BOTH 4490.61 2918.9 20.39 fee schedule 3592.49 percent of total billed charge 32.81 fee schedule 28.09 fee schedule 20.39 3592.49 MSH6 GENE ANAL FULL SEQ 81298 CPT 81298 LOCAL BOTH 4490.61 2918.9 20.39 fee schedule 3592.49 percent of total billed charge 32.81 fee schedule 28.09 fee schedule 20.39 3592.49 PMS2 GENE ANAL FULL SEQ 81317 CPT 81317 LOCAL BOTH 4490.61 2918.9 20.39 fee schedule 3592.49 percent of total billed charge 32.81 fee schedule 28.09 fee schedule 20.39 3592.49 LEUK/LYMPHOMA IMMUNOPH PROFILE 88342 CPT 88342 LOCAL TC BOTH 4490.61 2918.9 20.39 fee schedule 3592.49 percent of total billed charge 32.81 fee schedule 28.09 fee schedule 20.39 3592.49 LACTOFERRIN FECAL QUANT 83631 CPT 83631 LOCAL BOTH 87.45 56.84 284.3 fee schedule 69.96 percent of total billed charge 952.76 fee schedule 540.58 fee schedule 69.96 952.76 BRAF V600 Mutation Analysis 81210 CPT 81210 LOCAL BOTH 539.29 350.54 49.08 fee schedule 431.43 percent of total billed charge 76.86 fee schedule 88.81 fee schedule 49.08 431.43 ENTEROVIRUS RT PCR 87498 CPT 87498 LOCAL BOTH 1056.73 686.87 19.8 fee schedule 845.38 percent of total billed charge 25.59 fee schedule 27.27 fee schedule 19.8 845.38 BLADDER CA FISH MD REVIEW 88120 CPT 88120 LOCAL TC BOTH 617.48 401.36 221.94 fee schedule 493.98 percent of total billed charge 536.8 fee schedule 540.5 fee schedule 221.94 540.5 LYSOZYME 85549 CPT 85549 LOCAL BOTH 3249.69 2112.3 243.42 fee schedule 2599.75 percent of total billed charge 689.52 fee schedule 555.46 fee schedule 243.42 2599.75 VIT B2 84253 CPT 84253 LOCAL BOTH 69.11 44.92 99.59 fee schedule 55.29 percent of total billed charge 253.48 fee schedule 250.18 fee schedule 55.29 253.48 ANGIOTENSIN II 82163 CPT 82163 LOCAL BOTH 236.04 153.43 82.31 fee schedule 188.83 percent of total billed charge 71.99 fee schedule 185.87 fee schedule 71.99 188.83 "HISTOPLASMA ANTIGEN, URINE" 87385 CPT 87385 LOCAL BOTH 377.82 245.58 24.02 fee schedule 302.26 percent of total billed charge 48.66 fee schedule 33.09 fee schedule 24.02 302.26 INFORMA SEQ PRENATAL TEST 81420 CPT 81420 LOCAL BOTH 352.41 229.07 213.6 fee schedule 281.93 percent of total billed charge 995.17 fee schedule 421 fee schedule 213.6 995.17 STRATIFIED JVC AB W/REFLEX 86711 CPT 86711 LOCAL BOTH 3229.36 2099.08 20.98 fee schedule 2583.49 percent of total billed charge 32.81 fee schedule 28.9 fee schedule 20.98 2583.49 INFLAMMATORY BOWEL DISEA (IBD) 86526 CPT 86526 LOCAL BOTH 5675.01 3688.76 160.68 fee schedule 4540.01 percent of total billed charge 540.9 fee schedule 221.35 fee schedule 160.68 4540.01 DRUG ABUSE PROFILE (10 DRUGS) SCREEN SERUM AND PLASMA 80301 CPT 80301 LOCAL BOTH 1092.75 710.29 122.89 fee schedule 874.2 percent of total billed charge 133.41 fee schedule 291.58 fee schedule 122.89 874.2 MANGANESE BLOOD 83785 CPT 83785 LOCAL BOTH 1181.92 768.25 18 fee schedule 945.54 percent of total billed charge 28.65 fee schedule 24.8 fee schedule 18 945.54 PROCALCITONIN PROCALCITONIN 84145 CPT 84145 LOCAL BOTH 264.11 171.67 55.41 fee schedule 211.29 percent of total billed charge 60.32 fee schedule 113.7 fee schedule 55.41 211.29 HOMOGENIZATION TISSUE 87176 CPT 87176 LOCAL BOTH 1060.2 689.13 79.17 fee schedule 848.16 percent of total billed charge 365.98 fee schedule 239.46 fee schedule 79.17 848.16 ANTIHISTONE ANTIBODIES(SO) 86235 CPT 86235 LOCAL BOTH 34.66 22.53 181.34 fee schedule 27.73 percent of total billed charge 351.06 fee schedule 366.8 fee schedule 27.73 366.8 "ALLERGENS,MIA TEST (SO)" 86005 CPT 86005 LOCAL BOTH 63.7 41.41 108.61 fee schedule 50.96 percent of total billed charge 571.48 fee schedule 275.27 fee schedule 50.96 571.48 ASPERGILLIS AB (SO) 86606 CPT 86606 LOCAL BOTH 44.72 29.07 99.59 fee schedule 35.78 percent of total billed charge 32 fee schedule 250.18 fee schedule 32 250.18 TULAREMIA (SO) 86668 CPT 86668 LOCAL BOTH 44.39 28.85 129.63 fee schedule 35.51 percent of total billed charge 32 fee schedule 243.3 fee schedule 32 243.3 WEST NILE VIRUS AB PANEL-1(SO) 86789 CPT 86789 LOCAL BOTH 117.88 76.62 147.65 fee schedule 94.3 percent of total billed charge 32 fee schedule 162.18 fee schedule 32 162.18 WEST NILE VERUS AB PANLE-2(SO) 86788 CPT 86788 LOCAL BOTH 292.49 190.12 166.42 fee schedule 233.99 percent of total billed charge 469.68 fee schedule 410.47 fee schedule 166.42 469.68 CRP 86140 CPT 86140 LOCAL BOTH 292.49 190.12 166.42 fee schedule 233.99 percent of total billed charge 469.68 fee schedule 410.47 fee schedule 166.42 469.68 BRUCELLA ABORTUS IgG (SO) 86622 CPT 86622 LOCAL BOTH 171.74 111.63 99.59 fee schedule 137.39 percent of total billed charge 113.46 fee schedule 250.18 fee schedule 99.59 250.18 TETANUS/DIPHTHERIA Ab-1 (SO) 86317 CPT 86317 LOCAL BOTH 45.1 29.32 141.48 fee schedule 36.08 percent of total billed charge 155.94 fee schedule 285.18 fee schedule 36.08 285.18 COW'S MILK PROTEIN IgG (SO) 86003 CPT 86003 LOCAL BOTH 55.53 36.09 115.71 fee schedule 44.42 percent of total billed charge 154.13 fee schedule 230.32 fee schedule 44.42 230.32 ARBOVIRAL ENCEPHALITIS (SO) 86651 CPT 86651 LOCAL BOTH 100.2 65.13 99.59 fee schedule 80.16 percent of total billed charge 253.48 fee schedule 250.18 fee schedule 80.16 253.48 ARBOVIRAL ENCEPHALITIS (2)(SO) 86652 CPT 86652 LOCAL BOTH 42.34 27.52 141.48 fee schedule 33.87 percent of total billed charge 71.06 fee schedule 285.18 fee schedule 33.87 285.18 ARBPVORAL ENCEPHALITIS-3 (SO) 86653 CPT 86653 LOCAL BOTH 42.34 27.52 141.48 fee schedule 33.87 percent of total billed charge 71.06 fee schedule 285.18 fee schedule 33.87 285.18 ARBOVIRAL ENCEPHALITIS-4 (SO) 86654 CPT 86654 LOCAL BOTH 42.34 27.52 141.72 fee schedule 33.87 percent of total billed charge 143.59 fee schedule 51.86 fee schedule 33.87 143.59 F-094-IgE PEAR 86008 CPT 86008 LOCAL BOTH 42.34 27.52 141.94 fee schedule 33.87 percent of total billed charge 540.9 fee schedule 195.53 fee schedule 33.87 540.9 "INSULIN ANTIBODY,SERUM (SO)" 86337 CPT 86337 LOCAL BOTH 19.9 12.94 99.59 fee schedule 15.92 percent of total billed charge 253.48 fee schedule 250.18 fee schedule 15.92 253.48 INTRINSIC FACTOR ANTIBODY (SO) 86340 CPT 86340 LOCAL BOTH 350.41 227.77 115.71 fee schedule 280.33 percent of total billed charge 60.32 fee schedule 230.32 fee schedule 60.32 280.33 ANTICARDIOLIPIN IgM (SO) 86147 CPT 86147 LOCAL BOTH 196.78 127.91 115.71 fee schedule 157.42 percent of total billed charge 154.13 fee schedule 230.32 fee schedule 115.71 230.32 ANTI CENTROMERI AB (SO) 86038 CPT 86038 LOCAL BOTH 74.9 48.69 99.59 fee schedule 59.92 percent of total billed charge 421.41 fee schedule 222.38 fee schedule 59.92 421.41 "ANTI DNA AB, SINGLE STRAND(SO)" 86226 CPT 86226 LOCAL BOTH 254.75 165.59 99.59 fee schedule 203.8 percent of total billed charge 71.99 fee schedule 250.18 fee schedule 71.99 250.18 ROCKY MOUNTAIN SPOTTED FEV(SO) 86256 CPT 86256 LOCAL BOTH 445.47 289.56 108.61 fee schedule 356.38 percent of total billed charge 133.41 fee schedule 275.27 fee schedule 108.61 356.38 ROCKY MOUNT FEVER IgM (SO) 86757 CPT 86757 LOCAL BOTH 159.46 103.65 115.71 fee schedule 127.57 percent of total billed charge 213.13 fee schedule 230.32 fee schedule 115.71 230.32 ANTI HIV (SO) ANTIBODY TEST 86701 CPT 86701 LOCAL BOTH 244.09 158.66 166.42 fee schedule 195.27 percent of total billed charge 565 fee schedule 410.47 fee schedule 166.42 565 ANA TITER (SO) 86039 CPT 86039 LOCAL BOTH 21.63 14.06 154.71 fee schedule 17.3 percent of total billed charge 151.72 fee schedule 431.3 fee schedule 17.3 431.3 ANTIMICROSOMAL AB (SO) 86376 CPT 86376 LOCAL BOTH 496.95 323.02 99.59 fee schedule 397.56 percent of total billed charge 71.99 fee schedule 250.18 fee schedule 71.99 397.56 ANTI THYROGLOBULIN AB (SO) 86800 CPT 86800 LOCAL BOTH 131.34 85.37 121.76 fee schedule 105.07 percent of total billed charge 129.45 fee schedule 218.33 fee schedule 105.07 218.33 ANTIPHOSPHATIDYLSERINE G/M/A 86148 CPT 86148 LOCAL BOTH 127.02 82.56 166.42 fee schedule 101.62 percent of total billed charge 762.6 fee schedule 410.47 fee schedule 101.62 762.6 ASO SCREEN (SO) 86060 CPT 86060 LOCAL BOTH 810.42 526.77 99.59 fee schedule 648.34 percent of total billed charge 253.48 fee schedule 222.38 fee schedule 99.59 648.34 AMEOBA ANTIBODY(SO) 86753 CPT 86753 LOCAL BOTH 39.74 25.83 99.59 fee schedule 31.79 percent of total billed charge 113.46 fee schedule 250.18 fee schedule 31.79 250.18 DNA ANTIBODY 86225 CPT 86225 LOCAL BOTH 140.22 91.14 166.42 fee schedule 112.18 percent of total billed charge 267.95 fee schedule 419.59 fee schedule 112.18 419.59 BARTONELLA Ab PANEL (SO) 86611 CPT 86611 LOCAL BOTH 64.03 41.62 106.95 fee schedule 51.22 percent of total billed charge 304.27 fee schedule 147.33 fee schedule 51.22 304.27 B PERFUSSIS lgA Ab (SO) 86615 CPT 86615 LOCAL BOTH 119.56 77.71 133.14 fee schedule 95.65 percent of total billed charge 71.06 fee schedule 183.41 fee schedule 71.06 183.41 "B PERTUSSIS IgG/M/A Ab,QNT(SO)" 86710 CPT 86710 LOCAL BOTH 271.56 176.51 137.92 fee schedule 217.25 percent of total billed charge 143.59 fee schedule 51.86 fee schedule 51.86 217.25 BETA-2 GLYCOPROTEIN 1 Ab-1(SO) 86146 CPT 86146 LOCAL BOTH 134.11 87.17 154.71 fee schedule 107.29 percent of total billed charge 143.59 fee schedule 266.56 fee schedule 107.29 266.56 BLASTOMYCES (SO) 86612 CPT 86612 LOCAL BOTH 147.63 95.96 99.59 fee schedule 118.1 percent of total billed charge 253.48 fee schedule 51.86 fee schedule 51.86 253.48 CA 125 (SO) 86304 CPT 86304 LOCAL BOTH 40.02 26.01 134.26 fee schedule 32.02 percent of total billed charge 304.27 fee schedule 184.95 fee schedule 32.02 304.27 CA 27.29 (SO) 86300 CPT 86300 LOCAL BOTH 376.47 244.71 115.71 fee schedule 301.18 percent of total billed charge 91.29 fee schedule 230.32 fee schedule 91.29 301.18 CA 19-9 (SO) 86301 CPT 86301 LOCAL BOTH 286.06 185.94 115.71 fee schedule 228.85 percent of total billed charge 154.13 fee schedule 230.32 fee schedule 115.71 230.32 CD4 ABSOLUTE (SO) 86361 CPT 86361 LOCAL BOTH 234.31 152.3 115.71 fee schedule 187.45 percent of total billed charge 154.13 fee schedule 230.32 fee schedule 115.71 230.32 CCP IgG ANTIBODIES (SO) 86200 CPT 86200 LOCAL BOTH 219.06 142.39 119.66 fee schedule 175.25 percent of total billed charge 154.13 fee schedule 227.43 fee schedule 119.66 227.43 CD4/CD8 RATIO (SO) 86360 CPT 86360 LOCAL BOTH 55.86 36.31 102.04 fee schedule 44.69 percent of total billed charge 129.45 fee schedule 183.43 fee schedule 44.69 183.43 CMV IgG BY EIA (SO) 86644 CPT 86644 LOCAL BOTH 193.48 125.76 115.71 fee schedule 154.78 percent of total billed charge 180.62 fee schedule 230.32 fee schedule 115.71 230.32 "CMV IgG/lgM, CSF-2 (SO)" 86645 CPT 86645 LOCAL BOTH 115.83 75.29 141.48 fee schedule 92.66 percent of total billed charge 82 fee schedule 285.18 fee schedule 82 285.18 COCCIDIOIDES Ab (SO) 86635 CPT 86635 LOCAL BOTH 278.27 180.88 141.48 fee schedule 222.62 percent of total billed charge 32 fee schedule 51.86 fee schedule 32 222.62 COLD AGGLUTININS (SO) 86157 CPT 86157 LOCAL BOTH 48.51 31.53 141.48 fee schedule 38.81 percent of total billed charge 35.81 fee schedule 51.86 fee schedule 35.81 141.48 COMPLEMENT TOTAL (SO) 86162 CPT 86162 LOCAL BOTH 95.17 61.86 99.59 fee schedule 76.14 percent of total billed charge 421.41 fee schedule 222.38 fee schedule 76.14 421.41 ADENOVIRUS ANTIBODY TITER(SO) 86603 CPT 86603 LOCAL BOTH 331.75 215.64 100.61 fee schedule 265.4 percent of total billed charge 129.45 fee schedule 180.85 fee schedule 100.61 265.4 CRYPTOCOCCAL ANTIGEN (SO) 86403 CPT 86403 LOCAL BOTH 162.88 105.87 127.74 fee schedule 130.3 percent of total billed charge 92.97 fee schedule 175.97 fee schedule 92.97 175.97 ECHINOCOCCUS Ab (SO) 86682 CPT 86682 LOCAL BOTH 82.3 53.5 122.89 fee schedule 65.84 percent of total billed charge 279.13 fee schedule 291.58 fee schedule 65.84 291.58 EBV PANEL (SO) 86665 CPT 86665 LOCAL BOTH 683.51 444.28 154.71 fee schedule 546.81 percent of total billed charge 28.65 fee schedule 220.86 fee schedule 28.65 546.81 FTA/ABS(SO) 86780 CPT 86780 LOCAL BOTH 216.03 140.42 144.73 fee schedule 172.82 percent of total billed charge 60.42 fee schedule 243.1 fee schedule 60.42 243.1 GIARDIA Ab (S0) 86674 CPT 86674 LOCAL BOTH 157.09 102.11 166.42 fee schedule 125.67 percent of total billed charge 469.68 fee schedule 410.47 fee schedule 125.67 469.68 FEBRILE AGGLUTININ-1 (SO) 86000 CPT 86000 LOCAL BOTH 603.63 392.36 148.14 fee schedule 482.9 percent of total billed charge 130.32 fee schedule 201.23 fee schedule 130.32 482.9 H PYLORI(SO) 86677 CPT 86677 LOCAL BOTH 58.95 38.32 99.59 fee schedule 47.16 percent of total billed charge 253.48 fee schedule 250.18 fee schedule 47.16 253.48 HETEROPHILE Ab (SO) 86308 CPT 86308 LOCAL BOTH 151.68 98.59 150.05 fee schedule 121.34 percent of total billed charge 138.12 fee schedule 167.1 fee schedule 121.34 167.1 HIV 2 (SO) 86702 CPT 86702 LOCAL BOTH 93.82 60.98 115.71 fee schedule 75.06 percent of total billed charge 154.13 fee schedule 230.32 fee schedule 75.06 230.32 HIV (SO) 86703 CPT 86703 LOCAL BOTH 234.63 152.51 154.71 fee schedule 187.7 percent of total billed charge 76.86 fee schedule 266.56 fee schedule 76.86 266.56 HIV-1 WESTERN-BLOT (SO) 86689 CPT 86689 LOCAL BOTH 172.01 111.81 154.71 fee schedule 137.61 percent of total billed charge 76.86 fee schedule 266.56 fee schedule 76.86 266.56 VARICELLA-ZOSTER Ab IgM(SO) 86787 CPT 86787 LOCAL BOTH 357.49 232.37 154.71 fee schedule 285.99 percent of total billed charge 28.65 fee schedule 220.86 fee schedule 28.65 285.99 HEPATITUS A VIRUS ANTIBODY(SO) 86709 CPT 86709 LOCAL BOTH 216.35 140.63 166.42 fee schedule 173.08 percent of total billed charge 469.68 fee schedule 410.47 fee schedule 166.42 469.68 HERPES SIMPLEX VIRUS ABIqG(SO) 86695 CPT 86695 LOCAL BOTH 120.2 78.13 154.71 fee schedule 96.16 percent of total billed charge 76.86 fee schedule 266.56 fee schedule 76.86 266.56 "HSV,IGM I/II,(HERPES SIMP)(SO)" 86694 CPT 86694 LOCAL BOTH 54.3 35.3 154.71 fee schedule 43.44 percent of total billed charge 32 fee schedule 220.86 fee schedule 32 220.86 HSV II Ab (SO) 86696 CPT 86696 LOCAL BOTH 57.97 37.68 154.71 fee schedule 46.38 percent of total billed charge 9.73 fee schedule 220.86 fee schedule 9.73 220.86 HEPATITUS C VIRUS AB (SO) 86803 CPT 86803 LOCAL BOTH 75.81 49.28 154.71 fee schedule 60.65 percent of total billed charge 9.82 fee schedule 431.3 fee schedule 9.82 431.3 HEPATITIS C AB (RIBA) (SO) 86804 CPT 86804 LOCAL BOTH 161.14 104.74 166.42 fee schedule 128.91 percent of total billed charge 565 fee schedule 410.47 fee schedule 128.91 565 HEPATITIS PROFILE VII-2 (SO) 86705 CPT 86705 LOCAL BOTH 863.9 561.54 166.42 fee schedule 691.12 percent of total billed charge 565 fee schedule 410.47 fee schedule 166.42 691.12 HEPATITIS PROFILE VII-5 (SO) 86708 CPT 86708 LOCAL BOTH 50.4 32.76 154.71 fee schedule 40.32 percent of total billed charge 76.86 fee schedule 266.56 fee schedule 40.32 266.56 HLA-B27 (SO) 81374 CPT 81374 LOCAL BOTH 58.3 37.9 154.71 fee schedule 46.64 percent of total billed charge 143.59 fee schedule 266.56 fee schedule 46.64 266.56 HUMAN PARVOVIRUS ANTIBODY (SO) 86747 CPT 86747 LOCAL BOTH 142.22 92.44 20.44 fee schedule 113.78 percent of total billed charge 32.81 fee schedule 28.16 fee schedule 20.44 113.78 "IMMUNOELECTROPHERESIS,URINE(SO" 86325 CPT 86325 LOCAL BOTH 548.75 356.69 166.42 fee schedule 439 percent of total billed charge 267.95 fee schedule 410.47 fee schedule 166.42 439 "IMMUNOFIXATION,SERUM (SO)" 86334 CPT 86334 LOCAL BOTH 313.79 203.96 115.71 fee schedule 251.03 percent of total billed charge 60.32 fee schedule 51.86 fee schedule 51.86 251.03 LEGIONELLA ANTIBODY (SO) 86713 CPT 86713 LOCAL BOTH 253.23 164.6 115.71 fee schedule 202.58 percent of total billed charge 154.13 fee schedule 230.32 fee schedule 115.71 230.32 "LYME DISEASE, LINE BLOT" 86617 CPT 86617 LOCAL BOTH 236.37 153.64 166.11 fee schedule 189.1 percent of total billed charge 138.12 fee schedule 51.86 fee schedule 51.86 189.1 CF STUDY 81220 CPT 81220 LOCAL BOTH 162.23 105.45 140.88 fee schedule 129.78 percent of total billed charge 143.59 fee schedule 51.86 fee schedule 51.86 143.59 MUMPS VIRUS AB IGM (SO) 86735 CPT 86735 LOCAL BOTH 340.35 221.23 19.87 fee schedule 272.28 percent of total billed charge 48.66 fee schedule 27.38 fee schedule 19.87 272.28 MYCO PLASMA AB TITER IG6IGM(SO 86738 CPT 86738 LOCAL BOTH 34.88 22.67 166.42 fee schedule 27.9 percent of total billed charge 267.95 fee schedule 419.59 fee schedule 27.9 419.59 RPR 86592 CPT 86592 LOCAL BOTH 473.59 307.83 166.42 fee schedule 378.87 percent of total billed charge 267.95 fee schedule 410.47 fee schedule 166.42 410.47 RUBELLA IgG ANTIBODY 86762 CPT 86762 LOCAL BOTH 76.19 49.52 122.98 fee schedule 60.95 percent of total billed charge 143.59 fee schedule 219.61 fee schedule 60.95 219.61 RUBEOLA Ab lgM (SO) 86765 CPT 86765 LOCAL BOTH 179.48 116.66 166.42 fee schedule 143.58 percent of total billed charge 565 fee schedule 410.47 fee schedule 143.58 565 TETANUS TOXIN AB (SO) 86774 CPT 86774 LOCAL BOTH 72.14 46.89 166.42 fee schedule 57.71 percent of total billed charge 565 fee schedule 410.47 fee schedule 57.71 565 TOXOPLASMA IgG ANTIBODY (SO) 86777 CPT 86777 LOCAL BOTH 226.14 146.99 166.42 fee schedule 180.91 percent of total billed charge 565 fee schedule 419.59 fee schedule 166.42 565 TRYPTASE-immunology proc(SO) 86849 CPT 86849 LOCAL BOTH 241.07 156.7 166.42 fee schedule 192.86 percent of total billed charge 565 fee schedule 419.59 fee schedule 166.42 565 HISTOPLASMOSIS AB (SO) 86698 CPT 86698 LOCAL BOTH 124.65 81.02 166.42 fee schedule 99.72 percent of total billed charge 565 fee schedule 410.47 fee schedule 99.72 565 HODGE TEST 87185 CPT 87185 LOCAL BOTH 280 182 154.71 fee schedule 224 percent of total billed charge 32 fee schedule 220.86 fee schedule 32 224 TORCH 86778 CPT 86778 LOCAL BOTH 241.77 157.15 181.34 fee schedule 193.42 percent of total billed charge 162.94 fee schedule 366.8 fee schedule 162.94 366.8 RABIES TITER 86382 CPT 86382 LOCAL BOTH 259.46 168.65 166.42 fee schedule 207.57 percent of total billed charge 762.5 fee schedule 410.47 fee schedule 166.42 762.5 FIBRIN MONOMER (SO) 85362 CPT 85362 LOCAL BOTH 170.66 110.93 122.89 fee schedule 136.53 percent of total billed charge 267.5 fee schedule 291.58 fee schedule 122.89 291.58 D-DIMER 85379 CPT 85379 LOCAL BOTH 555.19 360.87 99.59 fee schedule 444.15 percent of total billed charge 762.6 fee schedule 255.74 fee schedule 99.59 762.6 D-DIMER 85378 CPT 85378 LOCAL BOTH 152.17 98.91 99.59 fee schedule 121.74 percent of total billed charge 71.99 fee schedule 250.18 fee schedule 71.99 250.18 LUPUS ANTICOAGULANT (SO) 85613 CPT 85613 LOCAL BOTH 114.48 74.41 99.59 fee schedule 91.58 percent of total billed charge 71.99 fee schedule 250.18 fee schedule 71.99 250.18 FETAL HGB SCREEN (SO) 85461 CPT 85461 LOCAL BOTH 661.83 430.19 99.59 fee schedule 529.46 percent of total billed charge 253.48 fee schedule 250.18 fee schedule 99.59 529.46 FETAL HEMOGLOBIN STAIN (SO) 85460 CPT 85460 LOCAL BOTH 94.79 61.61 99.59 fee schedule 75.83 percent of total billed charge 71.99 fee schedule 250.18 fee schedule 71.99 250.18 "ANTITHROMBIN III, ANTIGEN (SO)" 85301 CPT 85301 LOCAL BOTH 644.95 419.22 99.59 fee schedule 515.96 percent of total billed charge 71.99 fee schedule 250.18 fee schedule 71.99 515.96 BLEEDING TIME 85002 CPT 85002 LOCAL BOTH 277.95 180.67 99.59 fee schedule 222.36 percent of total billed charge 71.99 fee schedule 250.18 fee schedule 71.99 250.18 SERUM VISCOSITY (SO) 85810 CPT 85810 LOCAL BOTH 100.58 65.38 96.15 fee schedule 80.46 percent of total billed charge 99.61 fee schedule 132.45 fee schedule 80.46 132.45 FACTOR V (COAGULATION) (SO) 85220 CPT 85220 LOCAL BOTH 73.16 47.55 99.59 fee schedule 58.53 percent of total billed charge 268.56 fee schedule 250.18 fee schedule 58.53 268.56 COAGULATION FACTOR VIII (SO) 85244 CPT 85244 LOCAL BOTH 350.41 227.77 99.59 fee schedule 280.33 percent of total billed charge 71.99 fee schedule 250.18 fee schedule 71.99 280.33 COMPLETE BLOOD CT w/AUTO DIFF 85025 CPT 85025 LOCAL BOTH 455.69 296.2 99.59 fee schedule 364.55 percent of total billed charge 565 fee schedule 255.74 fee schedule 99.59 565 "THROMBOPLASTIN TIME, PARTIAL" 85730 CPT 85730 LOCAL BOTH 129.35 84.08 99.59 fee schedule 103.48 percent of total billed charge 71.99 fee schedule 250.18 fee schedule 71.99 250.18 FIBRINOLYTIC PLASMINOGEN (SO) 85420 CPT 85420 LOCAL BOTH 259.99 168.99 99.59 fee schedule 207.99 percent of total billed charge 268.56 fee schedule 250.18 fee schedule 99.59 268.56 FIBRINOLYTIC ANTIPLASMIN (SO) 85410 CPT 85410 LOCAL BOTH 236.37 153.64 99.59 fee schedule 189.1 percent of total billed charge 565 fee schedule 250.18 fee schedule 99.59 565 FIBRINOGEN (SO) 85384 CPT 85384 LOCAL BOTH 236.37 153.64 99.59 fee schedule 189.1 percent of total billed charge 71.99 fee schedule 250.18 fee schedule 71.99 250.18 THROMBX EVAL 85300 CPT 85300 LOCAL BOTH 236.37 153.64 99.59 fee schedule 189.1 percent of total billed charge 71.99 fee schedule 250.18 fee schedule 71.99 250.18 MANUAL DIFFERENTIAL 85007 CPT 85007 LOCAL BOTH 259.99 168.99 99.59 fee schedule 207.99 percent of total billed charge 71.99 fee schedule 250.18 fee schedule 71.99 250.18 FIBRINOGEN ANTIGEN (SO) 85385 CPT 85385 LOCAL BOTH 55.21 35.89 99.59 fee schedule 44.17 percent of total billed charge 71.99 fee schedule 250.18 fee schedule 44.17 250.18 EOSINOPHIL SMEAR 89190 CPT 89190 LOCAL BOTH 348.02 226.21 99.59 fee schedule 278.42 percent of total billed charge 71.99 fee schedule 250.18 fee schedule 71.99 278.42 HEPARIN ANTI-Xa (SO) 85520 CPT 85520 LOCAL BOTH 51.81 33.68 325.58 fee schedule 41.45 percent of total billed charge 143.59 fee schedule 520.54 fee schedule 41.45 520.54 HEMOGLOBIN 85018 CPT 85018 LOCAL BOTH 482.08 313.35 99.59 fee schedule 385.66 percent of total billed charge 693.9 fee schedule 250.18 fee schedule 99.59 693.9 "IRON STAIN,BLOOD CELLS (SO)" 85536 CPT 85536 LOCAL BOTH 49.8 32.37 99.59 fee schedule 39.84 percent of total billed charge 71.99 fee schedule 250.18 fee schedule 39.84 250.18 LE CELL PREP (SO) 85999 CPT 85999 LOCAL BOTH 124.65 81.02 99.59 fee schedule 99.72 percent of total billed charge 253.48 fee schedule 250.18 fee schedule 99.59 253.48 LEUKOCYTE ALK PHOS (SO) 85540 CPT 85540 LOCAL BOTH 43.69 28.4 99.59 fee schedule 34.95 percent of total billed charge 253.48 fee schedule 250.18 fee schedule 34.95 253.48 PLATELET COUNT 85049 CPT 85049 LOCAL BOTH 55.53 36.09 99.59 fee schedule 44.42 percent of total billed charge 253.48 fee schedule 250.18 fee schedule 44.42 253.48 PROTEIN C (SO) 85302 CPT 85302 LOCAL BOTH 39.64 25.77 99.59 fee schedule 31.71 percent of total billed charge 267.95 fee schedule 250.18 fee schedule 31.71 267.95 PROTEIN S AG (SO) 85305 CPT 85305 LOCAL BOTH 472.94 307.41 99.59 fee schedule 378.35 percent of total billed charge 71.99 fee schedule 250.18 fee schedule 71.99 378.35 PROTEIN S AG-2 (SO) 85306 CPT 85306 LOCAL BOTH 326.67 212.34 99.59 fee schedule 261.34 percent of total billed charge 469.68 fee schedule 250.18 fee schedule 99.59 469.68 PROTHROMBIN TIME 85610 CPT 85610 LOCAL BOTH 326.67 212.34 99.59 fee schedule 261.34 percent of total billed charge 469.68 fee schedule 250.18 fee schedule 99.59 469.68 REPTILASE TIME (SO) 85635 CPT 85635 LOCAL BOTH 73.82 47.98 99.59 fee schedule 59.06 percent of total billed charge 253.48 fee schedule 250.18 fee schedule 59.06 253.48 RETICULOCYTE COUNT 85044 CPT 85044 LOCAL BOTH 355.16 230.85 99.59 fee schedule 284.13 percent of total billed charge 268.56 fee schedule 250.18 fee schedule 99.59 284.13 THROMBX EVAL PROFILE-3 (SO) 85303 CPT 85303 LOCAL BOTH 91.44 59.44 99.59 fee schedule 73.15 percent of total billed charge 71.99 fee schedule 250.18 fee schedule 71.99 250.18 THROMBIN TIME (SO) 85670 CPT 85670 LOCAL BOTH 71.16 46.25 99.59 fee schedule 56.93 percent of total billed charge 469.68 fee schedule 250.18 fee schedule 56.93 469.68 WBC 85048 CPT 85048 LOCAL BOTH 172.66 112.23 99.59 fee schedule 138.13 percent of total billed charge 268.56 fee schedule 250.18 fee schedule 99.59 268.56 Antipsychotic Drug Screen 80344 CPT 80344 LOCAL BOTH 79.93 51.95 99.59 fee schedule 63.94 percent of total billed charge 267.95 fee schedule 255.74 fee schedule 63.94 267.95 URINE CHLAMYDIA/GC LIGASE(SO) 87491 CPT 87491 LOCAL BOTH 615.7 400.21 18.53 fee schedule 492.56 percent of total billed charge 32.81 fee schedule 25.53 fee schedule 18.53 492.56 CHLAMYDIA/GC AMPLIFIED-2 (SO) 87591 CPT 87591 LOCAL BOTH 204.13 132.68 221.94 fee schedule 163.3 percent of total billed charge 1214.79 fee schedule 528.75 fee schedule 163.3 1214.79 AEROBIC CULTURE 87077 CPT 87077 LOCAL BOTH 68.73 44.67 221.94 fee schedule 54.98 percent of total billed charge 268.56 fee schedule 528.75 fee schedule 54.98 528.75 ANTIBIOTIC DISK SENSITIVITY 87184 CPT 87184 LOCAL BOTH 86.68 56.34 181.34 fee schedule 69.34 percent of total billed charge 120.32 fee schedule 366.8 fee schedule 69.34 366.8 KOH 87220 CPT 87220 LOCAL BOTH 76.57 49.77 181.34 fee schedule 61.26 percent of total billed charge 351.06 fee schedule 366.8 fee schedule 61.26 366.8 GIARDIA/CRYPTOSPORIDUM 87328 CPT 87328 LOCAL BOTH 76.57 49.77 181.34 fee schedule 61.26 percent of total billed charge 141.48 fee schedule 366.8 fee schedule 61.26 366.8 GIARDIA/CRYPTOSPORDIDUM 87329 CPT 87329 LOCAL BOTH 210.36 136.73 206.24 fee schedule 168.29 percent of total billed charge 71.99 fee schedule 236.78 fee schedule 71.99 236.78 CHLAMYDIA DETECTION (SO) 87320 CPT 87320 LOCAL BOTH 210.36 136.73 206.61 fee schedule 168.29 percent of total billed charge 138.12 fee schedule 257.21 fee schedule 138.12 257.21 CHLAMYDIA CULTURE (SO) 87110 CPT 87110 LOCAL BOTH 195 126.75 194.14 fee schedule 156 percent of total billed charge 71.99 fee schedule 417.86 fee schedule 71.99 417.86 C-DIFFICILE TOXIN A-EIA (SO) 87324 CPT 87324 LOCAL BOTH 113.78 73.96 181.34 fee schedule 91.02 percent of total billed charge 120.32 fee schedule 366.8 fee schedule 91.02 366.8 C-DIFF CULTURE (SO) 87075 CPT 87075 LOCAL BOTH 221.76 144.14 194.14 fee schedule 177.41 percent of total billed charge 71.99 fee schedule 417.86 fee schedule 71.99 417.86 C-DIFFICILE TOXIN B (SO) 87230 CPT 87230 LOCAL BOTH 42.34 27.52 181.34 fee schedule 33.87 percent of total billed charge 683.46 fee schedule 366.8 fee schedule 33.87 683.46 CHLAMYDIA DNA DIRECT PROBE(SO) 87490 CPT 87490 LOCAL BOTH 190.29 123.69 181.34 fee schedule 152.23 percent of total billed charge 154.13 fee schedule 311.78 fee schedule 152.23 311.78 CMV ANTIGENEMIA (S0) 87271 CPT 87271 LOCAL BOTH 230.91 150.09 221.94 fee schedule 184.73 percent of total billed charge 1214.79 fee schedule 528.75 fee schedule 184.73 1214.79 "CULTURE,OTHER SOURCE" 87070 CPT 87070 LOCAL BOTH 394.42 256.37 193.19 fee schedule 315.54 percent of total billed charge 155.94 fee schedule 383.94 fee schedule 155.94 383.94 CYTOMEGALOVIRUS QUANT PCR (SO) 87497 CPT 87497 LOCAL BOTH 165.2 107.38 181.34 fee schedule 132.16 percent of total billed charge 71.99 fee schedule 366.8 fee schedule 71.99 366.8 RESP ANTIGEN PANEL (1) (SO) 87260 CPT 87260 LOCAL BOTH 1086.96 706.52 221.94 fee schedule 869.57 percent of total billed charge 1246.11 fee schedule 528.75 fee schedule 221.94 1246.11 RESP ANTIGEN PANEL (2A) (SO) 87275 CPT 87275 LOCAL BOTH 94.79 61.61 189.38 fee schedule 75.83 percent of total billed charge 304.27 fee schedule 260.89 fee schedule 75.83 304.27 RESP ANTGEN PANEL (3) (SO) 87276 CPT 87276 LOCAL BOTH 94.79 61.61 193.19 fee schedule 75.83 percent of total billed charge 155.94 fee schedule 383.94 fee schedule 75.83 383.94 RESP ANTIGEN PANEL (4A) (SO) 87279 CPT 87279 LOCAL BOTH 94.79 61.61 193.19 fee schedule 75.83 percent of total billed charge 358.02 fee schedule 383.94 fee schedule 75.83 383.94 RESP ANTIGEN PANEL (5) (SO) 87280 CPT 87280 LOCAL BOTH 94.79 61.61 194.14 fee schedule 75.83 percent of total billed charge 154.13 fee schedule 417.86 fee schedule 75.83 417.86 RESP ANTIGEN PANEL (4B) 87299 CPT 87299 LOCAL BOTH 94.79 61.61 194.14 fee schedule 75.83 percent of total billed charge 195.96 fee schedule 417.86 fee schedule 75.83 417.86 RESP ANTIGNE PANEL (2B) (SO) 87252 CPT 87252 LOCAL BOTH 94.79 61.61 194.14 fee schedule 75.83 percent of total billed charge 71.99 fee schedule 417.86 fee schedule 71.99 417.86 CRYPTOSPORIDIUM (SO) 87206 CPT 87206 LOCAL BOTH 94.79 61.61 181.34 fee schedule 75.83 percent of total billed charge 154.13 fee schedule 311.78 fee schedule 75.83 311.78 "CULTURE & SMEAR, GC" 87081 CPT 87081 LOCAL BOTH 21.36 13.88 181.34 fee schedule 17.09 percent of total billed charge 351.06 fee schedule 366.8 fee schedule 17.09 366.8 "CULTURE, ANAEROBIC" 87076 CPT 87076 LOCAL BOTH 182.18 118.42 181.34 fee schedule 145.74 percent of total billed charge 568.83 fee schedule 366.8 fee schedule 145.74 568.83 "CULTURE, BLOOD" 87040 CPT 87040 LOCAL BOTH 136.49 88.72 181.34 fee schedule 109.19 percent of total billed charge 110.56 fee schedule 366.8 fee schedule 109.19 366.8 "CULTURE, FUNGAL (CO)" 87106 CPT 87106 LOCAL BOTH 128.37 83.44 177.67 fee schedule 102.7 percent of total billed charge 71.99 fee schedule 209.18 fee schedule 71.99 209.18 "FUNGAL CULTURE, BLOOD(SO)" 87103 CPT 87103 LOCAL BOTH 116.48 75.71 181.34 fee schedule 93.18 percent of total billed charge 351.06 fee schedule 366.8 fee schedule 93.18 366.8 FUNGUS CULTURE (SO) 87101 CPT 87101 LOCAL BOTH 58.3 37.9 181.34 fee schedule 46.64 percent of total billed charge 121.84 fee schedule 366.8 fee schedule 46.64 366.8 "CULTURE,STOOL" 87045 CPT 87045 LOCAL BOTH 39.31 25.55 181.34 fee schedule 31.45 percent of total billed charge 103.29 fee schedule 366.8 fee schedule 31.45 366.8 "CULTURE, URINE" 87086 CPT 87086 LOCAL BOTH 201.48 130.96 180.49 fee schedule 161.18 percent of total billed charge 268.6 fee schedule 347.98 fee schedule 161.18 347.98 "ROTAVIRUS, DIRECT DETENTION(SO" 87425 CPT 87425 LOCAL BOTH 242.74 157.78 181.34 fee schedule 194.19 percent of total billed charge 84.01 fee schedule 366.8 fee schedule 84.01 366.8 "VIRAL CULTURE, BLOOD(SO)" 87253 CPT 87253 LOCAL BOTH 37.63 24.46 213.6 fee schedule 30.1 percent of total billed charge 321.15 fee schedule 421 fee schedule 30.1 421 VIR CULTUR RAPID VARICELLA(SO) 87254 CPT 87254 LOCAL BOTH 127.34 82.77 181.5 fee schedule 101.87 percent of total billed charge 304.27 fee schedule 250.02 fee schedule 101.87 304.27 GC DNA PROBE (SO) 87590 CPT 87590 LOCAL BOTH 221.43 143.93 184.6 fee schedule 177.14 percent of total billed charge 71.99 fee schedule 210.48 fee schedule 71.99 210.48 PANEL 162100 (HIV Ab BY RNA-IC 87535 CPT 87535 LOCAL BOTH 230.91 150.09 221.94 fee schedule 184.73 percent of total billed charge 71.99 fee schedule 528.75 fee schedule 71.99 528.75 "H PYLORI STOOL AG, EIA (S0)" 87338 CPT 87338 LOCAL BOTH 405.24 263.41 221.94 fee schedule 324.19 percent of total billed charge 1422.06 fee schedule 528.75 fee schedule 221.94 1422.06 "HSV 1/2 PCR,CSF (SO)" 87529 CPT 87529 LOCAL BOTH 281.67 183.09 208.75 fee schedule 225.34 percent of total billed charge 129.45 fee schedule 372.93 fee schedule 129.45 372.93 "HERPES CULTURE/TYPING,CSF (SO)" 87255 CPT 87255 LOCAL BOTH 709.89 461.43 221.94 fee schedule 567.91 percent of total billed charge 1192.36 fee schedule 528.75 fee schedule 221.94 1192.36 HEPATITIS C VIRUS RNA QUAL(SO) 87521 CPT 87521 LOCAL BOTH 408.59 265.58 186.44 fee schedule 326.87 percent of total billed charge 71.99 fee schedule 392.09 fee schedule 71.99 392.09 URINE CULTURE ID EA ISOLATE 87088 CPT 87088 LOCAL BOTH 1233.56 801.81 221.94 fee schedule 986.85 percent of total billed charge 1192.36 fee schedule 528.75 fee schedule 221.94 1192.36 INFLUENZA (SO) 87400 CPT 87400 LOCAL BOTH 134.76 87.59 181.34 fee schedule 107.81 percent of total billed charge 351.06 fee schedule 366.8 fee schedule 107.81 366.8 INTEC AGENT DETECTION (SO) 87797 CPT 87797 LOCAL BOTH 71.16 46.25 213.6 fee schedule 56.93 percent of total billed charge 131.66 fee schedule 421 fee schedule 56.93 421 INFLUENZE Ab A & B 87804 CPT 87804 LOCAL BOTH 192.61 125.2 221.94 fee schedule 154.09 percent of total billed charge 421.41 fee schedule 470 fee schedule 154.09 470 INDIA INK (SO) 87210 CPT 87210 LOCAL BOTH 144.54 93.95 221.94 fee schedule 115.63 percent of total billed charge 421.41 fee schedule 470 fee schedule 115.63 470 LEGIONELLA PNEUMOPHIA UR AG(SO 87449 CPT 87449 LOCAL BOTH 77.54 50.4 181.34 fee schedule 62.03 percent of total billed charge 108.2 fee schedule 366.8 fee schedule 62.03 366.8 LEGIONELLA DNA (SO) 87278 CPT 87278 LOCAL BOTH 256.97 167.03 221.24 fee schedule 205.58 percent of total billed charge 505.2 fee schedule 432.14 fee schedule 205.58 505.2 "HEP B VIRUS,DNA,QUAL (SO)" 87516 CPT 87516 LOCAL BOTH 77.22 50.19 193.19 fee schedule 61.78 percent of total billed charge 198.22 fee schedule 383.94 fee schedule 61.78 383.94 HEP Be Ag (SO) 87530 CPT 87530 LOCAL BOTH 542.38 352.55 221.94 fee schedule 433.9 percent of total billed charge 1192.36 fee schedule 528.75 fee schedule 221.94 1192.36 MALARIAL THICK/THIN SMEAR (SO) 87207 CPT 87207 LOCAL BOTH 196.02 127.41 221.94 fee schedule 156.82 percent of total billed charge 693.9 fee schedule 528.75 fee schedule 156.82 693.9 OVA AND PARASITE EXAM (SO) 87177 CPT 87177 LOCAL BOTH 56.24 36.56 181.34 fee schedule 44.99 percent of total billed charge 161.32 fee schedule 366.8 fee schedule 44.99 366.8 PARASITE ID (SO) 87169 CPT 87169 LOCAL BOTH 35.85 23.3 181.34 fee schedule 28.68 percent of total billed charge 134.57 fee schedule 366.8 fee schedule 28.68 366.8 PARASITE ID ARTHROPOD 87168 CPT 87168 LOCAL BOTH 151.36 98.38 181.34 fee schedule 121.09 percent of total billed charge 113.47 fee schedule 366.8 fee schedule 113.47 366.8 "RSV ANTIGEN,NASAL WASH (SO)" 87420 CPT 87420 LOCAL BOTH 131.51 85.48 181.34 fee schedule 105.21 percent of total billed charge 120.32 fee schedule 366.8 fee schedule 105.21 366.8 STREP SCREEN THROAT 87880 CPT 87880 LOCAL BOTH 333.15 216.55 213.6 fee schedule 266.52 percent of total billed charge 382.9 fee schedule 421 fee schedule 213.6 421 TB DNA BY PCR (SO) 87556 CPT 87556 LOCAL BOTH 135.08 87.8 223.85 fee schedule 108.06 percent of total billed charge 71.99 fee schedule 51.86 fee schedule 51.86 223.85 ADNEOVIRUS TYPE 40/41/ROTAVIRU 87301 CPT 87301 LOCAL BOTH 1256.55 816.76 221.94 fee schedule 1005.24 percent of total billed charge 248 fee schedule 528.75 fee schedule 221.94 1005.24 C-DIFFICILE TOXIN GENE NAA 87493 CPT 87493 LOCAL BOTH 449.31 292.05 194.14 fee schedule 359.45 percent of total billed charge 71.99 fee schedule 417.86 fee schedule 71.99 417.86 CALCIUM/CREATININE RAMDOM 82340 CPT 82340 LOCAL BOTH 507.82 330.08 221.94 fee schedule 406.26 percent of total billed charge 951.35 fee schedule 540.5 fee schedule 221.94 951.35 URINE TOTAL VOLUME 81050 CPT 81050 LOCAL BOTH 27.14 17.64 26.13 fee schedule 21.71 percent of total billed charge 71.99 fee schedule 33.95 fee schedule 21.71 71.99 URINE DIPSTICK 81003 CPT 81003 LOCAL BOTH 55.86 36.31 19.47 fee schedule 44.69 percent of total billed charge 12.31 fee schedule 540.58 fee schedule 12.31 540.58 KETONE URINE 81002 CPT 81002 LOCAL BOTH 40.67 26.44 19.31 fee schedule 32.54 percent of total billed charge 32.81 fee schedule 26.6 fee schedule 19.31 32.81 SPERM COUNT COMPLETE 89320 CPT 89320 LOCAL BOTH 86.74 56.38 19.24 fee schedule 69.39 percent of total billed charge 32.81 fee schedule 26.5 fee schedule 19.24 69.39 SPECIFIC GRAVITY ON FLUID 81000 CPT 81000 LOCAL BOTH 242.74 157.78 333.54 fee schedule 194.19 percent of total billed charge 304.27 fee schedule 751.41 fee schedule 194.19 751.41 SPERM POST VASECTOMY 89310 CPT 89310 LOCAL BOTH 48.13 31.28 19.22 fee schedule 38.5 percent of total billed charge 32.81 fee schedule 26.47 fee schedule 19.22 38.5 CREATINE 24 HR URINE 82540 CPT 82540 LOCAL BOTH 91.44 59.44 325.58 fee schedule 73.15 percent of total billed charge 76.86 fee schedule 520.54 fee schedule 73.15 520.54 URINALYSIS/COMPLETE 81001 CPT 81001 LOCAL BOTH 40.17 26.11 28.81 fee schedule 32.14 percent of total billed charge 98.35 fee schedule 51.97 fee schedule 28.81 98.35 "REDUCING SUBSTANCES,URINE(SO)" 81005 CPT 81005 LOCAL BOTH 54.23 35.25 19.24 fee schedule 43.38 percent of total billed charge 32.81 fee schedule 26.5 fee schedule 19.24 43.38 "UALC,EMP ALCOHOL TEST EXCEP BREATHING" 82055 CPT 82055 LOCAL BOTH 25.42 16.52 19.35 fee schedule 20.34 percent of total billed charge 25.59 fee schedule 26.65 fee schedule 19.35 26.65 OSTEGENESIS IMPERFECTA PANEL 81406 CPT 81406 LOCAL BOTH 32.45 21.09 21.79 fee schedule 25.96 percent of total billed charge 32.81 fee schedule 30.01 fee schedule 21.79 32.81 MOLECULAR PATH PROC LEVEL 9 81408 CPT 81408 LOCAL BOTH 1804.59 1172.98 20.83 fee schedule 1443.67 percent of total billed charge 71.06 fee schedule 28.7 fee schedule 20.83 1443.67 CYTOSPIN PROCESS 88106 CPT 88106 LOCAL TC BOTH 3609.19 2345.97 20.88 fee schedule 2887.35 percent of total billed charge 98.35 fee schedule 38.11 fee schedule 20.88 2887.35 "SPECSTAIN, GRP III, ENZYME" 88319 CPT 88319 LOCAL TC BOTH 116.55 75.76 243.25 fee schedule 93.24 percent of total billed charge 112.75 fee schedule 492.76 fee schedule 93.24 492.76 BLOOD SMEAR PERIPHERAL 85060 CPT 85060 LOCAL BOTH 732.28 475.98 284.3 fee schedule 585.82 percent of total billed charge 155.94 fee schedule 540.58 fee schedule 155.94 585.82 KRAS MUTATION 81275 CPT 81275 LOCAL BOTH 97.56 63.41 99.59 fee schedule 78.05 percent of total billed charge 267.95 fee schedule 255.74 fee schedule 78.05 267.95 GROSS EXAMINATION ONLY 88300 CPT 88300 LOCAL TC BOTH 2437.27 1584.23 20.11 fee schedule 1949.82 percent of total billed charge 71.06 fee schedule 27.7 fee schedule 20.11 1949.82 GROSS & MICROSCOPIC EXAM-LEV 2 88302 CPT 88302 LOCAL TC BOTH 336.89 218.98 268.28 fee schedule 269.51 percent of total billed charge 60.32 fee schedule 533.66 fee schedule 60.32 533.66 GROSS AND MICROSCOPIC -LEVEL 3 88304 CPT 88304 LOCAL TC BOTH 212.63 138.21 268.28 fee schedule 170.1 percent of total billed charge 154.13 fee schedule 533.66 fee schedule 154.13 533.66 GROSS AND MICROSCOPIC- LEVEL 4 88305 CPT 88305 LOCAL TC BOTH 279.89 181.93 268.28 fee schedule 223.91 percent of total billed charge 120.02 fee schedule 533.66 fee schedule 120.02 533.66 GROSS AND MICROSCOPIC- LEVEL 5 88307 CPT 88307 LOCAL TC BOTH 416.43 270.68 268.28 fee schedule 333.14 percent of total billed charge 154.13 fee schedule 533.66 fee schedule 154.13 533.66 GROSS AND MICROSCOPIC- LEVEL 6 88309 CPT 88309 LOCAL TC BOTH 538.26 349.87 268.28 fee schedule 430.61 percent of total billed charge 60.32 fee schedule 533.66 fee schedule 60.32 533.66 DECALCIFICATION PROCEDURE 88311 CPT 88311 LOCAL TC BOTH 618.51 402.03 268.28 fee schedule 494.81 percent of total billed charge 154.13 fee schedule 533.66 fee schedule 154.13 533.66 GRP 2 RETC STAIN GORDAN/SWEETS GPR 2 RETC STAIN GORDAN/SWEETS 88313 CPT 88313 LOCAL TC BOTH 138.81 90.23 277.22 fee schedule 111.05 percent of total billed charge 304.27 fee schedule 381.89 fee schedule 111.05 381.89 FROZEN SECTION CONSULT 88331 CPT 88331 LOCAL TC BOTH 188.51 122.53 284.3 fee schedule 150.81 percent of total billed charge 144.79 fee schedule 540.58 fee schedule 144.79 540.58 FROZEN SECTION ADD'L BLOCK 88332 CPT 88332 LOCAL TC BOTH 412 267.8 284.3 fee schedule 329.6 percent of total billed charge 155.94 fee schedule 540.58 fee schedule 155.94 540.58 SO IMMUNOPEROXIDASE ADD 88341 CPT 88341 LOCAL TC BOTH 292.49 190.12 284.3 fee schedule 233.99 percent of total billed charge 155.94 fee schedule 540.58 fee schedule 155.94 540.58 EM DIAGNOSTIC(SO) 88348 CPT 88348 LOCAL TC BOTH 980.32 637.21 284.3 fee schedule 784.26 percent of total billed charge 155.94 fee schedule 540.58 fee schedule 155.94 784.26 EM EMBED (SO) 88399 CPT 88399 LOCAL TC BOTH 1780.2 1157.13 284.3 fee schedule 1424.16 percent of total billed charge 952.76 fee schedule 540.58 fee schedule 284.3 1424.16 "FNA EVAL, INTERP & REPORT" 88173 CPT 88173 LOCAL TC BOTH 550.38 357.75 306.75 fee schedule 440.3 percent of total billed charge 154.13 fee schedule 417.86 fee schedule 154.13 440.3 "HER-2/NEW, ER/PR-COMPUTER ASSI" 88360 CPT 88360 LOCAL TC BOTH 173.09 112.51 252.3 fee schedule 138.47 percent of total billed charge 92.97 fee schedule 347.56 fee schedule 92.97 347.56 "HER-2/NEWU, ER/PR COMPUTER ASS" 88361 CPT 88361 LOCAL TC BOTH 166.23 108.05 290.58 fee schedule 132.98 percent of total billed charge 683.46 fee schedule 576.08 fee schedule 132.98 683.46 MORPHOMETRIC ANALY IN SITU HYB MORPHOMETRIC ANALY IN SITU HYB 88368 CPT 88368 LOCAL TC BOTH 232.74 151.28 294 fee schedule 186.19 percent of total billed charge 540.9 fee schedule 405 fee schedule 186.19 540.9 MORPHMETIRIC ANALYSIS; TUMOR 88358 CPT 88358 LOCAL TC BOTH 333.15 216.55 306.75 fee schedule 266.52 percent of total billed charge 51.28 fee schedule 651.28 fee schedule 51.28 651.28 TISSUE-IN SITU-HYBRID SING PRO 88365 CPT 88365 LOCAL TC BOTH 81.97 53.28 290.58 fee schedule 65.58 percent of total billed charge 105.84 fee schedule 576.08 fee schedule 65.58 576.08 IN SITU HYBRID EA ADD PROBE 88364 CPT 88364 LOCAL TC BOTH 317.48 206.36 306.75 fee schedule 253.98 percent of total billed charge 90.06 fee schedule 651.28 fee schedule 90.06 651.28 COLUMN CHROMOTOGRAPH/ISOTOPE 82544 CPT 82544 LOCAL BOTH 317.48 206.36 304.36 fee schedule 253.98 percent of total billed charge 60.42 fee schedule 563.15 fee schedule 60.42 563.15 CELL MARKER (SO) 88182 CPT 88182 LOCAL TC BOTH 255.94 166.36 29.42 fee schedule 204.75 percent of total billed charge 71.99 fee schedule 37.18 fee schedule 29.42 204.75 HISTOCHEMICAL STAIN FROZEN TIS 88314 CPT 88314 LOCAL TC BOTH 940.75 611.49 257.53 fee schedule 752.6 percent of total billed charge 71.99 fee schedule 1233.22 fee schedule 71.99 1233.22 "MORPHOMETRIC ANALYSIS,SKELETAL" 88355 CPT 88355 LOCAL TC BOTH 341.27 221.83 284.3 fee schedule 273.02 percent of total billed charge 155.94 fee schedule 540.58 fee schedule 155.94 540.58