Limited Coverage Test |
CPT Code |
Patient Fee |
AFP Tumor Marker |
82105 |
$117 |
Blood Counts |
Spun Hematocrit
Other than spun Hematocrit
Hemoglobin
CBC
CBC w/Diff |
85013
85014
85018
85027
85025
|
$34
$34
$36
$55
$96 |
CA 27.29 |
86300 |
$92 |
CA 19-9 |
86301 |
$75 |
CA125 |
86304 |
$212 |
Carcinoembryonic Antigen (CEA) |
82378 |
$156 |
Collagen Crosslinked N-Telopeptide, urine |
82523 |
$118 |
C-Reactive Protein, High |
86140 |
$108 |
Culture, Bacterial, Urine Culture / Susceptibility |
87088
87186 |
$68
$76 |
Digoxin |
80162 |
$88 |
Fecal Occult Blood |
82270 |
$36 |
Folate, serum |
82746 |
$117 |
Gammaglutamyl transferase (GGT) |
82977 |
$60 |
Glucose Testing |
82947 |
$44 |
Glycated Protein (Fructosamine) |
82985 |
$108 |
HCG (Human Chorionic Gonadotropin) |
84702 |
$148 |
Hgb A 1 C |
83036 |
$94 |
Hepatic Function Panel |
80076 |
$88 |
HIV-1 RNA Viral Load by Quant PCR |
87536 |
$400 |
HIV Diagnosis Qualitative |
HIV 1&2 Antibody
HIV Antigen p24
HIV Western Blot
HIV Qualitative PCR |
86703
87390
86689
87535 |
$99
$62
$135
$436 |
Ionized Calcium |
82330 |
$44 |
Iron Studies Iron Studies
|
Ferritin
Iron
Transferrin |
82728
83540
84466 |
$107
$72
$92 |
Lipid Testing |
Lipid Panel
Cholesterol
Lipoprotein Electrophoresis
Triglycerides
HDL Cholesterol
LDL Cholesterol, Direct |
80061
82465
83715
84478
83718
83721 |
$84
$33
Call 792-0707
$57
$51
$81 |
Magnesium |
Serum
Fluid
Urine
24HR Urine |
83735
83735
83735
83735 |
$69
$69
$69
$69 |
Pap Smear - Conventional |
Lab Processing
Pathologist Interpretation |
88164
88141 |
$62
$60 |
Pap Smear - Hormonal Eval. |
Lab Processing
Pathologist Interpretation |
88155
88141 |
$54
$60 |
Pap Test - ThinPrep |
Lab Processing
Pathologist Interpretation |
88142
88141 |
$159
$60 |
Phosphorus |
84100 |
$40 |
Potassium Potassium |
Serum
Fluid |
84132
84132 |
$44
$44 |
Protein, Total |
Serum
Protein Electrophoresis
- (serum) (EPR)
(Total Protein required with EPR ) |
84155
84165 |
$48
$199
(EPR $151 +
TP $48) |
PSA (Prostate Specific Antigen) |
84153 |
$153 |
PT (Prothrombin Time) |
85610 |
$35 |
PTT (Partial Thromboplastin Time) |
85730 |
$48 |
Rheumatoid Factor |
86431 |
$88 |
Sedimentation Rate |
85652 |
$49 |
Syphilis Test Syphilis Testing |
RPR Qualitative
RPR Quantitative
VDRL Qualitative |
86592
86593
86592 |
$44
$64
$53 |
Thyroid Testing |
Thyroxine; total
Thyroxine; free
Thyroid Stimulating Hormone |
84436
84439
84443 |
$65
$101
$143 |
Troponin I |
84484 |
$148 |
Urinalysis |
Routine Urinalysis
Urine Hgb only
Urine Bilirubin
Urine pH
Urine Specific Gravity |
81001
81000
81002
81003
81003 |
$53
$55
$40
$36
$36 |
Vitamin B12 |
82607 |
$138 |
