LAB TESTS
Container
Tube/# of
tubes
Instructions-refrigerate unless otherwise noted
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/0.2
YEL ACD/2.0
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/0.5
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/0.2
3ml serum ***FROZEN***
0.5ml serum
1ml serum
1ml serum
1ml serum
1ml serum
10ml wbld 2 tubes - rm temp
1ml serum
2ml serum
1ml serum
1mL serum
2ml serum
0.5ml serum
1ml serum - rm temp
1ml serum
1ml serum
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/0.2
CSF TUB/0.2
GOLD SST/0.2
CSF TUB/0.5
GOLD SST/0.2
CSF TUB/0.3
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.2
1ml serum
1ml serum
2ml serum
1ml serum
1ml CSF
1ml serum
1-2 mL sterile CSF container
2ml serum
1-2 mL sterile CSF container
3ml serum
2ml serum or CSF
0.2mL serum
1m serum
1ml serum ***FROZEN***
0.5ml serum
1ml serum
Name
CPT
11 DEOXYCORTICOSTERONE
17 HYDROXYPROGESTERONE
AB ACETYLCHOLINE RECEPTOR/ACHR
AB ADENOVIRUS
AB AMOEBA
AB ANTI DEOXYRIBONUCLEASE B
AB ANTI PLATELET
AB ASPERGILLUS QUANT
AB BARTONELLA HENSELAE IGG/M
AB BETA-2 GLYCOPROTEIN IGG/M/A
AB BLASTOMYCES
AB BORDETELLA PERTUSSIS IGG/M/A
AB BORDETELLA PERTUSSIS IGM
AB BRUCELLA ABORTUS IGG
AB CAMPYLOBACTER JEJUNI
AB CARDIOLIPIN PROFILE
AB CHLAMYDIA DIFFERENTIATION
AB CHLAMYDIA TRACHOMATIS IGG
AB CHLAMYDIA TRACHOMATIS IGM
AB COCCIDIOIDES
AB COCCIDIOIDES CSF
AB CORE HEPATITIS B
AB COXSACKIE A VIRUS CSF PRF
AB COXSACKIE A VIRUS PROFILE
AB COXSACKIE B CSF PROFILE
AB COXSACKIE B VIRUS PROFILE
AB CRYPTOCOCCAL
AB DIPHTHERIA TOXIN IGG
AB DNA SINGLE STRAND
AB ECHINOCOCCUS
AB EHRLICHIA HME IGG/IGM
AB ENDOMYSIAL IGG/IGA TITER
82633
83498
83519
86603
86753
86215
86022
86606 x3
86611
86146 x3
86612
86615 x3
86615
86622
86625
86147 x3
86631 x3
86632 x3
86631
86632
86635
86635
86705
86658 x6
86658 x4
86658
86658
86641
86317
86226
86682
86666 x4
86255 x2
AB EPSTEIN BARR VIRUS PROFILE
AB EXTRACTABLE NUCLEAR AG
AB FORMALDEHYDE IGE
86665 x2,
86664, 86663 GOLD SST/0.5
86235 x2
GOLD SST/0.2
86003 GOLD SST/1.0
86606 x3,
86612, 86635,
86698
GOLD SST/0.2
AB FUNGUS GROUP
AB GD1A IGG/IGM PROF
83520 x2
AB GLIADIN IGA/IGG
83516 x2
AB GLOMERULAR BASMENT MEMBRANE
83520
AB GLUTAMIC ACID DECARBOXYLASE
83519
AB GQ1B (GANGLIOSIDE)
83520
AB H INFLUENZA
86684
AB HEPATITIS A IGM
86709
AB HEPATITIS B SURFACE
86706
AB HEPATITIS BE TOTAL
86707
AB HEPATITIS C RIBA
86804
AB HEPATITIS C TOTAL
86803
AB HEPATITIS D
86692
AB HEPATITIS D IGM
86692
AB HERPES SIMPLEX 1 & 2 IGG
86694
AB HERPES SIMPLEX 1&2 IGM
86694
AB HERPES SIMPLEX 2 IGG
86696
AB HISTONE
86235
AB HISTOPLASMA
86698
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/0.1
GOLD SST./0.5
GOLD SST/0.1
GOLD SST/0.2
GOLD SST/0.2
GOLD SST./0.2
GOLD SST./0.2
GOLD SST/0.5
GOLD SST/1.0
GOLD SST/1.0
GOLD SST/1.0
GOLD SST./1.0
GOLD SST/0.3
GOLD SST/0.2
GOLD SST/0.2
2.5ml serum
2ml serum
1ml serum
2ml serum - rm temp
1ml serum
1ml serum
1ml serum
0.5ml serum
1ml serum
1ml serum
1ml serum
0.5ml serum
1ml serum
1ml serum
1ml serum
1ml serum ***FROZEN***
1ml serum ***FROZEN***
1ml serum
2ml serum
1ml serum
2ml serum
1ml serum
Tests in bold type have established NCD/LCD disgnosis for Medical Nescessity.
LAB TESTS
AB HIV 1 & 2
AB HTLV 1&2 CSF
AB HTLV 1&2 DNA BY PCR
AB HTLV 1&2 W/WESTER BLOT CON
AB INTRINSIC FACTOR
AB LEGIONELLA PNEUMO 1 IGM
AB LEGIONELLA PNEUMO 1-6 IGG
AB LEPTOSPIRA IGM
AB LIVER-KIDNEY MICROSOMAL
AB LYME DISEASE IGM
AB MITOCHONDRIAL
AB MUMPS IGG
AB MUMPS IGM
AB MYCOPLASMA IGM
AB MYELIN ASSOC. GLYCOPROT IGM
AB MYELOPEROXIDASE
AB NEURONAL NUCLEAR PROFILE
AB NEUTROPHILIC CYTOPLASMIC
AB PANCREATIC ISLET CELL
AB PARIETAL CELL
AB PARVOVIRUS IGG
AB PARVOVIRUS IGM
AB PLATELET SERUM7
AB PROTEINASE-3
AB PURKINJE CELL (YO
AB RABIES
AB ROCKY MT FEVER IGG
AB ROCKY MT FEVER IGM
AB RUBELLA IGG
AB RUBELLA IGM
AB RUBEOLA IGG
AB SJOGRENS PROFILE
AB SMOOTH MUSCLE
AB SOLUBLE LIVER ANTIGEN IGG
AB STRIATED MUSCLE
AB STRONGYLOIDES
AB TETANUS
AB THYROID
AB TOXOCARA
AB TRANSGLUTAMINASE
AB TRANSGLUTAMINASE
AB VARICELLA ZOSTER
AB VOLTAGE-GATED CA
ABG BLOOD GAS PH
ACETAMINOPHEN
ACETONE (BLOOD)
ACID PHOSPHATASE PROSTATIC
ACTIVATED PROTEIN C RESISTANCE
ACUTE HEPATITIS PATHWAY
ACYLCARNITINE PROFILE
ADAMTS13 (VWF CLEAVING PROT.)
ADENOVIRUS DETECTION BY PCR
ADRENOCORTICOTROPIC HORMONE
AFP MATERNAL PROFILE
86703
86688
87798
86790
86340
86713
86713
86720
86376
86618
86256
86735
86735
86738
86255
88342
86256
86256 x3
86341
86255
86765
86747
86022
86021
86256
86382
86757
86757
86762
86762
86765
86235 x2
86256
83516
86255
86682
86317
86800, 86376
86682
83516
83516
86787
83519
82800
82003
82010
84066
85307
80074
82017
85246
87798
82024
82105
GOLD HIV/1.0
CSF TUB/0.5
YEL ACD/1.0
GOLD SST/0.1
GOLD SST/0.2
GOLD SST./0.1
GOLD SST./0.1
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/0.1
GOLD SST/0.3
GOLD SST/1.0
GOLD SST/0.2
GOLD SST/0.5
GOLD SST/0.3
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/0.2
GOLD SST./0.2
GOLD SST./0.2
RED/1.0
GOLD SST/0.2
GOLD SST/0.2
RED/1.0
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/1.0
GOLD SST/0.2
GOLD SST/1.0
GOLD SST/0.3
GOLD SST/0.3
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/0.5
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/0.3
HEP SYR/0.1
RED/0.2
GOLD SST/0.2
GOLD SST/0.1
BLUE/1.0
GOLD SST/1.0
GREEN NA./1.0
BLUE/1.0
CSF TUB/1
LAVP/0.2
GOLD SST/1.0
UNOPENED, SPUN SST TUBE.
1ml CSF
5ml YEL ACD WHOLE BLD-RM TEMP
3ml fresh serum (no hemolysis or lipemia)
2ml serum
1ml serum
1ml serum
1ml serum
1ml serum
1ml serum - rm temp
2ml serum
1ml serum
2ml serum
0.5ml serum
1ml serum - rm temp
1ml serum
1mL serum
0.5ml serum
2ml serum
2ml serum
2ml serum
2ml serum
1ml serum
1 mL serum
1ml serum
2ml serum
2ml serum
2ml serum
1ml serum
1ml serum
1ml serum
1ml serum
0.5ml serum
1ml serum
1ml serum
1ml serum
2ml serum
1ml serum
1ml serum
0.5ml serum
0.5ml serum
2ml serum
2ml serum
ABG:FIO2____TEMP____ALLEN'S_____
0.5ml serum
0.5ml serum
2ml serum
2ml plasma ***FROZEN***
2ml serum
1ml plasma ***FROZEN***
1ml NA citrate plasma ***FROZEN***
1ml CSF
1ml plsm*FROZEN*draw in iced LAV tube
UNOPENED GOLD SST
AFP QUAD TEST, MATERNAL
82105,
86336,
84702, 82677 GOLD SST/1.0
UNOPENED GOLD SST
AFP TRIPLE TEST, MATERNAL
AG ASPERGILLUS GALACTOMANNAN
82105,
84702, 82677 GOLD SST/1.0
87305 GOLD SST/1.0
UNOPENED GOLD SST
2ml serum ***FROZEN***
Tests in bold type have established NCD/LCD disgnosis for Medical Nescessity.
LAB TESTS
AG HEPATITIS B SURFACE
AG HEPATITIS BE
AG HLA B27
AG PI-LINKED (PNH)
ALBUMIN
ALCOHOL (ETOH),SERUM
ALCOHOL METHYL BLOOD
ALDOLASE
ALDOSTERONE
ALK PHOS ISOENZYMES
ALKALINE PHOSPHATASE
ALPHA 1 ANTITRYPSIN
ALPHA FETOPROTEIN TUMOR MARKER
ALPHA-1 ANTITRYPSIN
ALPRAZOLAM (XANAX)
ALT (SGPT)
ALUMINUM
AMIKACIN PEAK
AMIKACIN RANDOM
AMIKACIN TROUGH
AMINO ACID FRACTIONATION
AMITRIPTYLINE/NORTRIPTYLINE
AMMONIA
87340
87350
86812
88184
82040
82055
84600
82085
82088
84080
84075
82103
82105
82103, 82104
80154
84460
82108
80150
80150
80150
82139
80152
82140
GOLD SST/0.5
GOLD SST./0.2
LAV/2.0
GREEN NA/2.0
GOLD SST/0.2
RED/0.2
GRAY/1.0
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/0.5
GOLD SST/0.2
GOLD SST/0.2
RED/0.2
GOLD SST/0.2
ROYAL EDTA/0.2
RED/0.2
RED/0.1
RED/0.1
GREEN LITH/1.0
RED/0.2
GREEN PST/1
AMNIOTIC FLD LS/PG PROFILE
AMNIOTIC FLUID PH
AMYLASE
ANDROSTENEDIONE
ANGIOTENSIN-I CONVERTING ENZ
ANTI STREPTOLYSIN O QUANT
ANTINUCLEAR ANTIBODI
ANTITHROMBIN III ACTIVITY
ANTITHROMBIN III ANTIGEN
ANTITHROMBIN III PROFILE
APOLIPOPROTEINS A1 AND B
82570,
84081, 83661
83986
82150
82157
82164
86060
86038
85300
85301
85300, 85301
82172 x2
FLD./0.5
FLD/0.5
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/0.2
BLUE/1.0
BLUE/1.0
BLUE/2.0
GOLD SST/0.2
ARBOVIRUS IGM PANEL
ARSENIC
ARTERIAL BLOOD GAS
AST (SGOT)
BASIC METABOLIC PROFILE
86651,
86653,
86652, 86654
82175
82803
84450
80048
BASIC METABOLIC PROFILE W/CAI
BCR-ABL1 RT-PCR FOR CML/ALL QL
BERYLLIUM
BETA HCG TUMOR MARKER
BETA-2 MICROGLOBULIN
BETA-HYDROXYBUTYRIC ACID
BILE ACIDS TOTAL
BILIRUBIN DIRECT
BILIRUBIN DIRECT AND TOTAL
BILIRUBIN NEONATAL
BILIRUBIN TOTAL
BLEEDING TIME IVY
BLOOD UREA NITROGEN
BRAIN NATRIURETIC PEPTIDE
BUN/CREATININE RATIO
C1 ESTERASE INHIBITOR
C1 ESTERASE, FUNCTIONAL
80047
81206
83018
84702
82232
82010
82239
82248
82248, 82247
82248, 82247
82247
85002
84520
83880
84520, 82565
86160
86161
GOLD SST./1.0
ROYAL EDTA/0.2
HEP SYR/1
GOLD SST/0.2
GOLD SST/0.3
GREEN LITHIUM &
GOLD SST/0.2
LAV/1
ROYAL EDTA/0.5
GOLD SST/1
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/0.2
REDMICRO/1.0
GOLD SST/0.2
BT/1.0
GOLD SST/0.2
LAV/1.0
LAV/1.0
RED/0.2
RED10/0.1
0.5ml serum
1ml serum
7ml EDTA whl bld rm temp
7ml Na Heparin whl bld
0.5ml serum
Use betadine to clean site, no alcohol.
Use betadine to clean site, no alcohol.
2ml serum
1ml serum
4ml serum
0.5ml serum
0.5ml serum
1ml serum
2ml serum
1ml serum *NO SST*
0.5ml serum
Unopened ROYAL BLUE rm temp
Draw 30mins after infusion
Draw 30mins prior to next dos
2ml NA Hep plasma ***FROZEN***
2ml serum *NO SST*
To Lab on ice STAT. FREEZE to transport.
0.5ml serum
2ml serum
1ml serum
0.5ml serum
0.5ml serum
0.5 ml plasma ***FROZEN***
3ml NA CITRATE plasma ***FROZEN***
3.5ml NA CITRATE plasma **FROZEN**
4ml serum
1mL serum
2ml whl bld rm temp
ABG:FIO2____TEMP____ALLEN'S_____
0.5ml serum
0.5ml serum
Unopened Green Lithium Tube and 0.5ml serum
Leuk/Lymph Trans Kit-7ml bld/bone m
4ml ROYAL BLUE EDTA rm temp
1ml serum
1ml serum ***FROZEN***
1ml serum ***FROZEN***
1ml serum ***FROZEN***
0.5ml serum, protect from light
0.5ml serum, protect from light
1 full micro tube,protect from light
0.5ml serum, protect from light
0.5ml serum
1ml EDTA plasma ***FROZEN**
1ml serum *FROZEN*-collect on ice
1ml serum ***FROZEN***
Tests in bold type have established NCD/LCD disgnosis for Medical Nescessity.
LAB TESTS
C1Q BINDING IMMUNE COMPLEX
CA 125
CA 15-3
CA 19-9
CA 27-29
CADMIUM
CALCITONIN
CALCIUM
CALCIUM IONIZED
CARBAMAZEPINE (TEGRETOL)
CARBON DIOXIDE
CEA - CARCINOEMBRYONIC AG
CARNITINE
CAROTENE
CATECHOLAMINES FRACTIONATED
CBC
CBC W/AUTO DIFF
86332
86304
86300
86301
86300
82300
82308
82310
82330
80156
82374
82378
82379
82380
82384
85027
85027
CBC W/MANUAL DIFF
CD4 CD8 PANEL
CD4 PROFILE
CERULOPLASMIN
CHEMISTRY RENAL PROFILE
CHLORIDE
CHOLESTEROL
CHROMIUM
CHROMOGRANIN A
CHROMOSOME ANAL AMNIOTIC FLD
CHROMOSOME ANAL BLD HIGH RES
CHROMOSOME ANAL BLOOD GENETIC
CHROMOSOME ANAL LEUK/LYMPH
CHROMOSOME ANALYSIS FRAGILE X
CK ISOS BY ELECTROPHORESIS
CKMB PROFILE
CLONAZEPAM (KLONOPIN)
CML CHROMOSOME FISH
CMV IGG
CMV IGM
COBALT
COMPLEMENT C1Q
COMPLEMENT C2
COMPLEMENT C3
COMPLEMENT C4
COMPLEMENT C5
COMPLEMENT TOTAL/CH50
COMPREHENSIVE METABOLIC PROF
CO-OX CARBOXYHEMOGLOBIN
CO-OX METHEMOGLOBIN
COPPER
CORTISOL
CORTISOL 90 MINUTE
CORTROSYN STIMULATION TEST
C-PEPTIDE
C-REACTIVE PROTEIN,
CREATINE KINASE (CK)
CREATININE
CRYOGLOBULIN QUAL
CRYOGLOBULINS QUANT
85027, 85007
86360
86361
82390
80069
82435
82465
82495
86316
88262
88271
88262
88263
88248
82552
82550, 82553
80154
GOLD SST/0.2
GOLD SST/0.2
RED/0.3
GOLD SST/0.2
GOLD SST/0.2
ROYAL EDTA/0.2
GOLD SST/0.2
GOLD SST/0.2
GREEN LITH/1
RED/0.2
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/1.0
GOLD SST/0.3
GREEN NA/4.0
LAV/0.9
LAV/0.10
LAV/0.9
1ml EDTA whl bld
LAV/2.0
3 ml Lav (EDTA) rm temp
LAV/2.0
3 ml Lav (EDTA) rm temp
GOLD SST/0.1
1ml serum
GOLD SST/0.2
0.5ml serum
GOLD SST/0.2
0.5ml serum
GOLD SST/0.5
0.5ml serum
ROYAL EDTA/1
3mL ROYAL BLUE EDTA plasma. Rm temp
GOLD SST/0.2
0.5ml serum
FLD./0.5
3-5mls strl amniotic fld
GREEN NA/1.0
10ml adult,2ml ped rm temp.Mon-Thurs
GREEN NA/1.0
5ml whl bld.2ml neonate. Mon-Thurs
GREEN NA/2.0
3ml whl bld Mon-Thurs
2 GREEN NA & 2 LAV10ml NaHep + 10ml EDTA rm temp.Mon-Thurs
GOLD SST/1.0
3ml serum refrigerate
GOLD SST/1.0
0.5ml serum
RED/0.2
2ml serum - No SST
88237, 88264,
88271 x2,
88273, 88275,
88280 x2,
88291 x2
GREEN NA/2.0
86644
86645
83018
86160
86160
86160
86160
86160
86162
80053
82375
83050
82525
82533
82533
80400
84681
86141
82550
82565
82595
86329
1ml serum*FROZEN ON DRY ICE* -20
1ml serum
1ml serum
1ml serum
1ml serum
8ml ROYAL BLUE EDTA rm temp
2ml serum ***FROZEN***
0.5ml serum
Full Dark Green;Pt's Temp_____
1ml serum
0.5ml serum
1ml serum
2.5mL serum ***FROZEN***
2ml serum*FROZEN protect from LIGHT*
2 tubes Na Hep plsm w/4ml ea *FROZEN*
1ml EDTA whl bld
1ml EDTA whl bld
GOLD SST/0.2
GOLD SST/0.2
ROYAL EDTA/0.3
GOLD SST/0.2
RED/0.2
GOLD SST/0.1
GOLD SST/0.2
LAV/0.2
GOLD SST/1.0
GOLD SST/0.2
HEP SYR/0.1
HEP SYR/0.1
ROYAL BLUE/0.3
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/1.0
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/0.2
CRYO 37/0.5
CRYO 37/0.5
3ml whl bld, MON-THUS rm temp
0.5 ml serum
0.5 ml serum
2ml plasma,ROYAL BLUE EDTA
2ml serum FROZEN.Draw in tube on ice.
2ml serum FROZEN.Draw in tube on ice.
1ml serum
1ml serum
0.5ml EDTA plasma ***FROZEN***
0.5ml serum clot 15min & separate*FROZEN*
0.5 ml serum
FIO2____TEMP____ALLEN'S_____
FIO2____TEMP____ALLEN'S_____
1mL serum or EDTA plasma rm temp
1ml serum
1ml serum
1ml serum
1ml serum. Fasting.
0.5ml serum
0.5ml serum
0.5ml serum
RED TOP to Lab STAT,clot in 37 degree bath
RED TOP to Lab STAT,clot in 37 degree bath
Tests in bold type have established NCD/LCD disgnosis for Medical Nescessity.
LAB TESTS
CSF ALBUMIN
CSF ANGIOTENSIN-I CONVERT ENZ
CSF BETA HCG TUMOR MARKER QNT
CSF CELL CT/DIFF
CSF FTA
CSF GLUCOSE
CSF IGG
CSF IGG SYNTHESIS & INDEX
CSF LDH
CSF MYELIN BASIC PROTEIN
CSF OLIGOCLONAL BAND
CSF TOTAL PROTEIN
CSF VDRL QUAL
CYC CTI IGG AB
CYCLOSPORINE
CYSTIC FIBROSIS SCREEN
CYTOMEGALOVIRUS DNA BY PCR CSF
CYTOMEGALOVIRUS DNA PCR QT
D-DIMER
DEHYDROEPIANDROSTERONE (DHEA)
DHEA SULFATE
DIAZEPAM PROFILE
DIGOXIN (LANOXIN)
DISOPYRAMIDE (NORPAC
DIURETIC SCREEN
DNA DOUBLE STRAND AB
DUODENAL DRAINAGE CRYSTALS
ELECTROLYTES PROFILE
ENTEROVIRUS RNA BY PCR, CSF
EOSINOPHIL SMEAR NASAL
EPSTEIN BARR VIRUS DNA BY PCR
ERYTHROPOIETIN
EST GLOM FILT RT BY CYSTATIN-C
ESTIMATED GLOMERULAR FILT RATE
ESTRADIOL
ESTROGEN
ESTROGENS FRACTIONATED
ESTRONE
ETHYLENE GLYCOL
FACTOR II
FACTOR II PROTHROMBIN MUTATION
FACTOR IX
FACTOR V
FACTOR V R506Q LEIDEN PROFILE
FACTOR VII
FACTOR VIII ASSAY
FACTOR VIII INHIBITOR/ANTIFACT
FACTOR X
FACTOR XA HEPARIN,LOW MOLECULA
FACTOR XI
FACTOR XII
FERRITIN
FETAL FIBRONECTIN
FIBRIN DEGRADATION PRODUCTS
FIBRINOGEN
FK 506 (TACROLIMUS)
FLUID ALBUMIN
FLUID AMYLASE
FLUID BETA-2 TRANSFERRIN
FLUID BILIRUBIN
82042
82164
84702
89050
86780
82945
82784
CSF TUB/0.01
CSF TUB./0.2
CSF TUB/0.5
CSF TUB/0.3
CSF TUB./0.2
CSF TUB/0.1
CSF TUB/0.01
82784 x2,
82042, 82040 GOLD SST/0.3
83615 CSF TUB/0.1
83873 CSF TUB./1.0
83916 GOLD SST/0.3
84157 CSF TUB/0.1
86592 CSF TUB/0.1
86200 GOLD SST/0.3
80158 LAV/0.2
81220 LAV/2.0
87496 CSF TUB/1
87497 LAV/1.0
85379 BLUE/0.2
82626 GOLD SST/0.1
82627 GOLD SST/0.2
80154 RED/0.2
80162 RED/0.1
80299 RED/0.2
82492 UR/1.0
86225 GOLD SST/0.3
89060 FLD/0.1
80051 GOLD SST/0.01
87498 CSF TUB/0.1
89190 SWAB/1.0
87798 CSF/0.5
82668 GOLD SST/0.2
82610 GOLD SST/0.2
84520, 82565 GOLD SST/0.2
82670 GOLD SST/0.2
82672 GOLD SST/1.0
82671 GOLD SST/2.0
82679 GOLD SST/0.2
82693 GOLD SST/2.0
85210 BLUE/0.2
81240 LAV/1.0
85250 BLUE/1.0
85220 BLUE/1.0
81241 LAV/1.0
85230 BLUE/1.0
85240 BLUE/1.0
85335 BLUE/2.0
85260 BLUE/1.0
85520 BLUE/2.0
85270 BLUE/0.2
85280 BLUE/0.2
82728 GOLD SST/0.2
82731 SPECIAL/1.0
85362 FSP/1.0
85384 BLUE/0.1
80197 LAV/0.2
82042 FLD/0.1
82150 FLD/0.1
86335 GOLD SST/1.0
82247 FLD/1.0
0.5ml CSF
0.5ml CSF
1ml CSF
1.5ml CSF
1ml CSF
0.5ml CSF
0.5ml CSF
1ml serum and 3ml CSF
0.5ml CSF
1ml CSF **FROZEN**
0.5mls CSF & 0.5ml serum **FROZEN**
0.5ml CSF
1ml CSF
2.0 ml serum
5ml WB
7mL EDTA whl bld,original tubes,rm temp
0.5ml CSF **FROZEN**
2mL EDTA plasma ***FROZEN***
Fill tube till vacuum stops.Do not over fill.
0.5ml serum
1ml serum
1ml serum *NO SST*
1ml serum *NO SST*
1ml serum *NO SST*
30ml Urine -WRAP IN FOIL
1ml serum
1ml fluid
0.5ml serum
0.5ml CSF
nasal swab
0.5ml CSF
1mL serum
0.2ml serum
0.5ml serum
0.5ml serum
3ml serum
7ml serum
1ml serum
7ml serum UNOPENED TUBES
0.5ml plasma
7ml whl bld rm temp
0.5ml plasma ***FROZEN***
0.5ml plasma ***FROZEN***
7ml whl bld rm temp
0.5ml plasma ***FROZEN***
0.5ml plasma ***FROZEN***
2ml Na Cirtate plasma ***FROZEN***
0.5ml plasma ***FROZEN***
2ml Na Cirtate plasma ***FROZEN***
0.5ml plasma ***FROZEN***
0.5ml plasma ***FROZEN***
1ml serum
Special coll kit.Contact Immuno 651-6573
Special coll tube,call 651-6573, clot 1 hr rm temp
Fill tube till vacuum stops.Do not over fill.
1ml whl bld
0.5ml fluid
0.5ml fluid
2ml serum and 2ml fluid
0.5ml fluid
Tests in bold type have established NCD/LCD disgnosis for Medical Nescessity.
LAB TESTS
FLUID CHOLESTEROL
FLUID COMPLEMENT C3
FLUID COMPLEMENT C4
FLUID COUNT/DIFF
FLUID CREATININE
FLUID CRYSTALS
FLUID GLUCOSE
FLUID IGM
FLUID LDH
FLUID LIPASE
FLUID PH
FLUID PROTEIN
FLUID RHEUMATOID FACTOR
FLUID SPECIFIC GRAVITY
FLUID TRIGLYCERIDE
FLUID URIC ACID
FLUOXETINE PROFILE
FOLIC ACID
FOLIC ACID RBC
FOLLICLE STIMULATING HORMONE
FTA
GALACTOSE-1-PHOSPH U
GGT - GAMMA GLUTAMYL TRANS
GASTRIN
GENERAL HEALTH PROFI
GENTAMICIN PEAK
GENTAMICIN RANDOM
GENTAMICIN TROUGH
GESTATIONAL GLUCOSE
GLUCAGON
GLUCOSE
GLUCOSE 2HR PP
GLUCOSE 2HR PP W/GLU
GLUCOSE TOLERANCE 2H
GLUCOSE TOLERANCE 3H
GLUCOSE TOLERANCE 4H
GLUCOSE TOLERANCE 5H
GLUCOSE-6-PHOS DEHYDRO PROFILE
GLY HEMOGLOBIN A1C PROFILE
GROWTH HORMONE (HUMAN)
H PYLORI IGG
HAPTOGLOBIN
HCG BLOOD QUANT
HCG SERUM QUAL
HDL CHOLESTEROL
HEAVY METALS BLOOD
HELI PYLORI AG ST
HEMATOCRIT
HEMOCHROMATOSIS DNA BY PCR
HEMOGLOBIN
HEMOGLOBIN ELECTROPHORESIS
HEPARIN ANTI-Xa LEVE
HEPATITIS A TOTAL
HEPATITIS B CORE TOT
HEPATITIS B DNA BY P
HEPATITIS B DNA PCR
HEPATITIS B DNA,SUPE
HEPATITIS C GENOTYPING
HEPATITIS C QT W/O GENO
HERPES SIMPLEX VIR 1&2 DNA PCR
84311
86160
86160
89050
82570
89060
82945
82784
83615
83690
83986
84157
86431
84315
84478
84560
80299
82746
82747
83001
86780
82776
82977
82941
80050
80170
80170
80170
82950
82943
82947
82947
82950
82951
82951
82951
82951
82955
83036
83003
86677
83010
84702
84703
83718
FLD/0.1
0.5ml fluid
FLD/0.2
0.5ml fluid
FLD/0.2
0.5ml fluid
FLD/0.2
0.5ml fluid
FLD/0.2
0.5ml fluid
FLD/0.5
0.5ml fluid
FLD/0.1
0.5ml fluid
FLD/1.0
0.5ml fluid
FLD/0.1
0.5ml fluid
FLD/1
0.5ml fluid
FLD/0.1
0.5ml fluid
FLD/0.1
0.5ml fluid
FLD/0.3
1ml fluid
FLD/0.1
0.5ml fluid
FLD/0.2
0.5ml fluid
FLD/0.2
0.5ml fluid
RED/0.2
1ml serum
GOLD SST/0.2
1ml serum
LAV/2
2 FULL Lav,1 frz & 1 rm temp
GOLD SST/0.2
1ml serum
GOLD SST/0.5
1ml serum
GREEN NA/1.0
5ml whl bld. Send origial tube.
GOLD SST/0.5
0.5ml serum
GOLD SST/0.5
0.6ml serum*FROZEN*pt must be fasting
LAV/0.5 & GOLD SST1ml EDTA whl bld and 2 mls serum
RED/0.2
Draw 30 minutes post infusion complete
RED/0.2
0.5ml serum
RED/0.2
Draw 30 minutes prior to next dose.
GREEN PST/1.0
1hr gluc post 50gms Glucola,fast not required
LAVP/1.0
3 ml plasma pre-chilled tube-frozen
GOLD SST/0.01
0.5ml serum
GOLD SST/0.1
0.5ml serum
GOLD SST/0.1 & UR 0.5ml serum & 1ml urine each hour
GOLD SST/0.1 & UR 0.5ml serum & 1ml urine each hour
GOLD SST/0.1 & UR 0.5ml serum & 1ml urine each hour
GOLD SST/0.1 & UR 0.5ml serum & 1ml urine each hour
GOLD SST/0.1 & UR 0.5ml serum & 1ml urine each hour
LAV/2
2 full EDTA tubes. Unopened
LAV/0.8
Lav top. Whole blood required.
GOLD SST./1.0
1ml serum, Pt fasting & rest 30 mins prior.
GOLD SST/0.2
0.5ml serum
GOLD SST/0.2
1ml serum
GOLD SST/1.0
Unopened gold top tube.
GOLD SST/1.0
Unopened gold top tube.
GOLD SST/0.2
0.5ml serum
82175,
83655, 83825 ROYAL EDTA/1.0
87338 STOOL/1
85014 LAV/0.1
81256 LAV/1.0
85018 LAV/0.1
83020 LAV/1.0
85520 BLUE/2.0
86708 GOLD SST/0.2
86704 GOLD SST/0.3
87516 GOLD SST/1.0
87517 GOLD SST./1.0
87517 GOLD SST/0.1
87902, 87522 GOLD SST./1.0
87522 GOLD SST./1.0
87529 SWAB/1.0
7ml whl bld
1GM.No Stool PreservativeS
1ml whl bld
5ml EDTA whl bld, rm temp
1ml whl bld
3ml whl bld
2ml plasma ***FROZEN***
1.ml serum
0.5ml serum
2.5ml serum.No hemolysis.***FROZEN***
3ml serum.***FROZEN***
2ml serum.***FROZEN***
2ml serum.***FROZEN***
2ml serum.***FROZEN***
0.5ml serum or vesicle swab
Tests in bold type have established NCD/LCD disgnosis for Medical Nescessity.
LAB TESTS
HERPES SIMPLEX VIR 1&2 PCR CSF
87529 CSF TUB/0.5
HGB & HCT
HIV 1/O/2 DNA BY PCR W/ ABS
HIV RETROVIRAL GENOTYPE VIRCOG
HIV-1 RNA BY PCR QUANTITATIVE
HIV-1 WESTERN BLOT PROFILE
HOMOCYSTEINE SERUM/PLASMA
IMMUNE COMPLEX/RAJI
IMMUNOCOMPETENCY PAN
IMMUNOFIXATION URINE
IMMUNOFIXATION URINE
IMMUNOGLOBULIN A
IMMUNOGLOBULIN A SUBCLASSES
IMMUNOGLOBULIN D
IMMUNOGLOBULIN E
IMMUNOGLOBULIN G
IMMUNOGLOBULIN G SUBCLASSES
IMMUNOGLOBULIN M
INSULIN
INSULIN AUTOANTIBODIES
INSULIN LIKE-GROWTH FACTOR 1
INSULIN-LIKE GROWTH FACTOR BP3
INTERLEUKIN-6 RECEPTOR
IRON
IRON WITH TOTAL IBC
JANUS KINASE 2 V617F MUTATION
JO-1 AB
KAPPA LAMBDA FREE LIGHT CHAINS
KIDNEY STONE ANALYSIS PROFILE
LACTATE DEHYDROGENASE LDH
LACTIC ACID
LAMOTRIGINE
LDH ISOENZYMES
LEAD, PEDIATRIC
LEAD, ADULT
LEGIONELLA AB
LEGIONELLA AG URINE
LEUKEMIA/LYMPHOMA PROF BY FLOW
LEUKOCYTE ALKALINE P
LEVETIRACETAM (KEPPRA)
LIPASE
LIPID PROFILE (CORONARY RISK)
LIPOPROTEIN A
LIPOPROTEIN-ASSOC PHOSPHOLIPA2
LITHIUM
LIVER PROFILE
LORAZEPAM (ATIVAN)
LUPUS ANTICOAGULANT
LUTEINIZING HORMONE
LYME AB
LYME DISEASE DNA BY PCR
LYSOZYME (MURAMIDASE)
MAGNESIUM - MG
MANUAL DIFFERENTIAL
MERCURY
METABOLIC DISEASE SCREEN (PKU)
METANEPHRINE,PLASMA
METHADONE QUANT (DOLOPHINE)
METHOTREXATE
METHYLMALONIC ACID
MIXED VENOUS BLOOD G
0.5ml CSF
85014, 85018 LAV/0.9
1ml whl bld
87535, 87798 YEL ACD/1&GOLD S 1.5ml Yel ACD & 1 Gold SST
87901 LAVP/2.0
5ml EDTA plasma ***FROZEN**
87536 LAVP./1.0
1ml plasma ***FROZEN***
86689 GOLD HIV/1.0
1 full UNOPENED tube
83090 GOLD SST/1.0
1ml serum. Separate within 1 hour.
86332 LAVP/0.2
1 ml EDTA plasma FROZEN w/in 30 min
88184 LAV/2.0
3 ml Lav EDTA rm temp
84166, 86334 UR24/1.0
24 hour urine specimen
84166, 86335 UR/0.1
30ml Random Urine
82784 GOLD SST/0.1
1ml serum
82784, 82787xGOLD SST/0.2
2ml serum
82784 GOLD SST/0.2
1ml serum
82785 GOLD SST/0.2
1ml serum
82784 GOLD SST/0.1
1ml serum
82784, 82787x GOLD SST/0.2
2 ml serum
82784 GOLD SST/0.1
1ml serum
83525 GOLD SST/0.2
1ml serum
86337 GOLD SST/0.2
0.5ml serum***FROZEN***
84305 GOLD SST/0.2
0.5ml serum
83519 GOLD SST/0.2
0.5ml serum
83520 GOLD SST/0.5
2(1) ml serum aliquots ***FROZEN***
83540 GOLD SST/1.0
2ml serum
83540, 83550 GOLD SST/1.0
2ml serum
81270 LAV/2.0
5-7 ml EDTA whole bld
86235 GOLD SST/0.2
1ml serum
83883 x2
GOLD SST/0.2
1ml serum
82360 STC/0.2
Calculus at room temp. NO ADHESIVE
83615 GOLD SST/0.05
0.5ml serum
83605 GRAY/1.0
0.5ml serum ***FROZEN***
80299 RED/0.2
2ml serum, rm temp, No SST
83625 GOLD SST/1.0
1ml serum ** STRICT RM TEMP**
83655 LAV/0.2
0.5ml EDTA microtainer rm temp
83655 ROYAL EDTA/1.0 7ml Royal Blue EDTA whl bld rm temp
86713 GOLD SST/0.2
0.5ml serum
87449 UR/1
1ml Urine
88184 GREEN NA/2.0
2ml WHL BLD, rm temp, Mon-Thurs
85540 SLIDE/1.0
6 slides fingerstick OR heparin whl bld,rm temp
80299 RED./0.5
1.5 ml serum *NO SST* rm temp
83690 GOLD SST/0.05
0.5ml serum
80061 GOLD SST/0.2
0.5ml serum
83695 GOLD SST/0.1
1ml serum
83698 GOLD SST/0.5
0.3ml serum ***FROZEN***
80178 RED/0.5
0.5ml serum
80076 GOLD SST/0.2
0.5ml serum
80154 RED/0.2
4ml serum *NO SST* rm temp
85597 BLUE/3.0
6ml plasma ***FROZEN***
83002 GOLD SST/0.2
1ml serum
86618 GOLD SST/0.3
1ml serum
87476 YEL ACD/1.0
1ml ACD whl bld, rm temp
85549 GOLD SST/0.2
1ml serum ***FROZEN***
83735 GOLD SST/0.05
0.5ml serum
85007 LAV/0.1
1ml EDTA whl bld
83825 ROYAL EDTA/0.2 7ml EDTA whl bld
S3620 PKU/1.0
heel stick, saturate evenly all circles on card
83835 LAV/2.0
2 ml EDTA plasma ***FROZEN***
83840 RED/1.0
3ml serum *NO SST*
80299 RED/0.5
1ml serum *NO SST*
83921 RED/1.0
2.2ml serum
82803 HEP SYR MV/1
MIXBG:FIO2____TEMP____ALLEN'S____
Tests in bold type have established NCD/LCD disgnosis for Medical Nescessity.
LAB TESTS
MONO SCREEN
MTHFR(METHYLENETETRAFOLATERED)
MUSK ANTIBODY
MYCOPHENOLIC ACID
MYCOPLASMA IGG
MYOGLOBIN QUANT
NEURON SPECIFIC ENOLASE
NEURONTIN
NMR LIPOPROFILE
NUCLEOTIDASE 5'
OSMOLALITY SERUM
OXCARBAZEPINE (TRILEPTAL)
PARANEOPLASTIC SYNDROME
PARATHYROID HORMONE
PARTIAL THROMBOPLAST
PERIPHERAL BLOOD SMEAR
PHENOBARBITAL
PHENYTOIN (DILANTIN)
PHENYTOIN (DILANTIN) FREE
PHOSPHORUS
PLASMINOGEN
PLASMINOGEN ACTIVAT INHIBITOR
PLASMINOGEN PROFILE
PLATELET COUNT
PLATELET FUNCTION STUDIES
PLT HEPARIN INDUCED
POTASSIUM
POTASSIUM, WHOLE BLO
PREALBUMIN
PREGNENOLONE
86308
81291
87185
80299
86738
83874
86316
80299
83704
83915
83930
80299
84182
83970
85730
85008
80184
80185
80186
84100
85420
85415
85049
85576
86022
84132
84132
84134
84140
GOLD SST/0.2
LAV/1.0
RED/0.3
RED/0.2
GOLD SST/0.2
GOLD SST/0.5
GOLD SST/0.1
RED/0.2
SPECIAL./1.0
GOLD SST/0.3
GOLD SST/0.1
RED/0.3
GOLD SST/0.5
RED/0.2
BLUE/0.1
LAV/0.1
RED/0.2
RED/0.2
RED/0.2
GOLD SST/0.05
BLUE/0.2
LAV/1
LAV/1.0
LAV/0.1
BLUE/1.0
RED/0.3
GOLD SST/0.1
GREEN LITH/1.0
GOLD SST/0.1
GOLD SST/0.1
PRENATAL PROFILE
PRIMIDONE (MYSOLINE)
PROCAINAMIDE/NAPA
PROCALCITONIN
PROGESTERONE
PROINSULIN
PROLACTIN
PROTEIN C ACTIVITY
PROTEIN C ANTIGEN
80055
80188
80192
84145
84144
84206
84146
85303
85302
RED/3.0,LAV/1.0
RED/0.2
RED/0.2
GOLD SST/0.5
GOLD SST/0.2
RED/0.2
GOLD SST/0.2
BLUE/1.0
BLUE/1.0
1ml serum
7ml EDTA whl bld, rm temp
2ml serum *NO SST*
1ml serum *NO SST*
1ml serum
1ml serum
1ml serum
2ml serum *NO SST*
LIPONMRP:LCI;R,1 black top Liposcie
2ml serum
0.5ml serum
2ml serum *NO SST*
2ml serum
1 mL serum; FROZEN
Fill tube till vacuum stops.Do not over fill.
1ml EDTA whl bld
1ml serum *NO SST*
1ml serum *NO SST*
1ml serum *NO SST*
0.5ml serum
1 ml sodium citrate plasma ***FROZEN***
1ml whl bld ***FROZEN***
1ml EDTA whole bld rm temp
1ml EDTA whl bld
Fill tube till vacuum stops.Do not over fill.
2ml serum *NO SST*
0.5ml serum
0.5ml whl bld
1ml serum
2.5ml serum ***FROZEN***
Profile includes ABO/RH, Antibody Screen, CBC with Auto Diff,
RPR, Hepatitis B Surface Antigen and Ab Rubella IgG
1ml serum *NO SST*
1ml serum *NO SST*
1ml serum ***FROZEN***
1ml serum ***FROZEN***
1ml serum ***FROZEN*** Patient fasting.
1ml serum
2ml sodium citrate plasma ***FROZEN***
2ml sodium citrate plasma ***FROZEN***
82784 x3,
84155,
84165, 86334
85306
85305
85610
84202
84153, 84154
RED/2.0
BLUE/1.0
BLUE/1.0
BLUE/0.1
ROYAL EDTA/1.0
GOLD SST/0.5
3ml serum
2ml sodium citrate plasma ***FROZEN***
2ml sodium citrate plasma ***FROZEN***
Fill tube till vacuum stops.Do not over fill.
2ml whole blood rm temp (includes Zinc Protoporphyrin)
1ml serum ***FROZEN***
GOLD SST/0.5
GOLD SST/0.5
GOLD SST/1.0
RED/0.5
GOLD SST/1.0
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
1ml serum
1ml serum
2ml serum ***FROZEN***
1ml serum *NO SST*
1ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
PROTEIN IMMUNOELECTR
PROTEIN S ACTIVITY
PROTEIN S PROFILE
PROTHROMBIN TIME
PROTOPORPHYRIN RBC PROFILE
PSA FREE
PROSTATIC SPECIFIC AG DIAGNOSTIC
PROSTATIC SPECIFIC AG SCREEN
PTH INTACT
QUINIDINE
RAPID PLASMA REAGIN
RAST BERMUDA GRASS I
RAST CAT DANDER IGE
RAST CEPHALOSPORIUM
RAST CLADOSPORIUM HE
RAST D.FARINAE IGE
RAST D.PTERONYSSINUS
RAST DOG EPITHELIA I
81400
84153
G0103
83970
80194
86592
86003
86003
86003
86003
86003
86003
86003
Tests in bold type have established NCD/LCD disgnosis for Medical Nescessity.
LAB TESTS
RAST ENGLISH PLANTAI
RAST EPICOCCUM PURPU
RAST HELMINTHOSPORIU
RAST HELMINTHOSPORIU
RAST IGE QUANTITATIV
RAST LACTOGLOBULIN,B
RAST PENICILLIN G
RAST PENICILLIN V
RAST TEST ALDER TREE
RAST TEST ALLSPICE
RAST TEST ALMOND
RAST TEST ALTERNARIA TENIUS
RAST TEST APPLE
RAST TEST APRICOT
RAST TEST ARTICHOKE
RAST TEST ASPARAGUS
RAST TEST ASPERGILLUS FUMIGATU
RAST TEST AUREOBASIDIUM PULLUL
RAST TEST AVOCADO
RAST TEST BAHIA GRASS
RAST TEST BAKER'S YEAST
RAST TEST BANANA
RAST TEST BARLEY
RAST TEST BASIL
RAST TEST BAY LEAF
RAST TEST BEAN, COFFEE (GREEN)
RAST TEST BEAN, GREEN
RAST TEST BEAN, KIDNEY (RED)
RAST TEST BEAN, LIMA
RAST TEST BEAN, PINTO
RAST TEST BEECH TREE
RAST TEST BEEF
RAST TEST BING CHERRY
RAST TEST BIRCH TREE
RAST TEST BLACKEYE PEA
RAST TEST BLUE MUSSEL
RAST TEST BLUEBERRY
RAST TEST BOTRYTIS
RAST TEST BRAZILNUT
RAST TEST BREWER'S YEAST
RAST TEST BROCCOLI
RAST TEST BRUSSEL SPROUT
RAST TEST BUCKWHEAT
RAST TEST CABBAGE
RAST TEST CANDIDA ALBICANS
RAST TEST CANE SUGAR
RAST TEST CANTALOUPE
RAST TEST CARROT
RAST TEST CASEIN
RAST TEST CASHEW
RAST TEST CATFISH
RAST TEST CAULIFLOWER
RAST TEST CELERY
RAST TEST CHAETOMIUM GLOBOSUM
RAST TEST CHEDDAR CHEESE
RAST TEST CHEESE MOLD
RAST TEST CHICKEN
RAST TEST CHOCOLATE
RAST TEST CINNAMON
RAST TEST CLAM
RAST TEST CLOVES
RAST TEST COCKLEBUR
86003
86003
86003
86003
82785
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
GOLD SST/0.1
GOLD SST/1.0
GOLD SST/1.0
GOLD SST/1.0
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/1.0
GOLD SST/0.5
GOLD SST/1.0
GOLD SST/0.1
GOLD SST/1.0
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.5
GOLD SST/0.5
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/1.0
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/1.0
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/1.0
GOLD SST/0.1
GOLD SST/1.0
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
1ml serum
1ml serum
1ml serum
0.2ml serum
0.5ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
1ml serum
1ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
Tests in bold type have established NCD/LCD disgnosis for Medical Nescessity.
LAB TESTS
RAST TEST COCKROACH
RAST TEST COCONUT
RAST TEST CODFISH
RAST TEST COMMON RAGWEED
RAST TEST CORN
RAST TEST COTTONWOOD TREE
RAST TEST COW DANDER
RAST TEST CRAB
RAST TEST CUCUMBER
RAST TEST CUMIN
RAST TEST CURVULARIA LUNATA
RAST TEST CUTTLEFISH (SQUID)
RAST TEST DILL
RAST TEST DOG DANDER
RAST TEST DOG FENNEL
RAST TEST EGG
RAST TEST EGG WHITE
RAST TEST EGG YOLK
RAST TEST EGGPLANT
RAST TEST ELM TREE
RAST TEST FALSE RAGWEED
RAST TEST FENNEL
RAST TEST FESCUE,MEADOW
RAST TEST FISH MIX
RAST TEST FLOUNDER
RAST TEST FUSARIUM MONILIFORME
RAST TEST FUSARIUM OXYSPORUM
RAST TEST GARLIC
RAST TEST GIANT RAGWEED
RAST TEST GINGER
RAST TEST GLUTEN
RAST TEST GOAT
RAST TEST GOLDENROD
RAST TEST GRAPE
RAST TEST GRAPEFRUIT
RAST TEST GREER HOUSE DUST
RAST TEST GUAVA
RAST TEST GUINEA PIG EPITH
RAST TEST HADDOCK
RAST TEST HALIBUT
RAST TEST HAZELNUT
RAST TEST HICKORY TR
RAST TEST HONEY
RAST TEST HONEYBEE
RAST TEST HORMODENDR
RAST TEST HORSE DAND
RAST TEST HORSE RADI
RAST TEST HOUSE DUST
RAST TEST JOHNSON GR
RAST TEST JUNE GRASS
RAST TEST KIWI
RAST TEST KOCHIA (FI
RAST TEST LAMB QUART
RAST TEST LATEX
RAST TEST LEMON
RAST TEST LETTUCE
RAST TEST LIME
RAST TEST LOBSTER
RAST TEST MALT
RAST TEST MANGO
RAST TEST MAPLE TREE
RAST TEST MAPLE/BOX
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
GOLD SST/0.1
GOLD SST/1.0
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/1.0
GOLD SST/0.1
GOLD SST/0.5
GOLD SST/0.1
GOLD SST/0.5
GOLD SST/0.5
GOLD SST/0.5
GOLD SST/0.5
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/1.0
GOLD SST/1.0
GOLD SST/0.2
GOLD SST/1.0
GOLD SST/1.0
GOLD SST/0.1
GOLD SST/1.0
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/1.0
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/1.0
GOLD SST/0.1
GOLD SST/1.0
GOLD SST/1.0
GOLD SST/0.1
GOLD SST/0.5
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/1.0
GOLD SST/0.1
GOLD SST/1.0
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/1.0
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/1.0
0.5ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
1ml serum
0.2ml serum
1ml serum
1ml serum
1ml serum
1ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
1ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
1ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.1ml serum
0.1ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
Tests in bold type have established NCD/LCD disgnosis for Medical Nescessity.
LAB TESTS
RAST TEST MARSH ELDE
RAST TEST MELONS
RAST TEST MILK
RAST TEST MOLD GROUP
RAST TEST MOSQUITO
RAST TEST MOUNTAIN CEDAR TREE
RAST TEST MUCOR RACEMOSUS
RAST TEST MUGWORT
RAST TEST MULBERRY TREE
RAST TEST MUSHROOM
RAST TEST MUSTARD
RAST TEST NETTLE
RAST TEST NUTMEG
RAST TEST OAK TREE
RAST TEST OAT
RAST TEST OLIVE, GREEN
RAST TEST ONION
RAST TEST ORANGE
RAST TEST OREGANO
RAST TEST OYSTER
RAST TEST PAPAYA
RAST TEST PAPER WASP
RAST TEST PAPRIKA
RAST TEST PARMESAN CHEESE
RAST TEST PARSLEY
RAST TEST PEA
RAST TEST PEACH
RAST TEST PEANUT
RAST TEST PEAR
RAST TEST PECAN
RAST TEST PECAN TREE
RAST TEST PENICILLIUM NOTATUM
RAST TEST PEPPER, BLACK
RAST TEST PEPPER, CAYENNE
RAST TEST PEPPER, CHILI
RAST TEST PEPPER, GREEN
RAST TEST PEPPER, RED
RAST TEST PERENNIAL RYE
RAST TEST PHOMA BETAE
RAST TEST PIGEON DROPPINGS
RAST TEST PINEAPPLE
RAST TEST PINON NUT(PINE NUT)
RAST TEST PISTACHIO NUT
RAST TEST PLUM
RAST TEST POMEGRANATE
RAST TEST POPLAR TREE
RAST TEST PORK
RAST TEST POTATO
RAST TEST PRIVET (LIGUSTRUM)
RAST TEST PULLULARIA PULLULANS
RAST TEST RADISH
RAST TEST RASPBERRY
RAST TEST RAT
RAST TEST RAT EPITHELIA
RAST TEST RAT URINE
RAST TEST RED CEDAR TREE
RAST TEST RED SNAPPER
RAST TEST RHIZOPUS NIGRICANS
RAST TEST RICE
RAST TEST ROUGH PIGWEED
RAST TEST RYE
RAST TEST S.INVICTA (FIRE ANT)
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
GOLD SST/1.0
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/2.0
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/1.0
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.2
GOLD SST/0.1
GOLD SST/1.0
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.2
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/1.0
GOLD SST/0.2
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/1.0
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/0.2
GOLD SST/0.5
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.5
GOLD SST/0.1
GOLD SST/1.0
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/1.0
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/1.0
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/1.0
GOLD SST/0.1
GOLD SST/0.1
0.2ml serum
0.2ml serum
0.2ml serum
3.0ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
1ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
1ml serum
0.2ml serum
0.2ml serum
1ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
1ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
Tests in bold type have established NCD/LCD disgnosis for Medical Nescessity.
LAB TESTS
RAST TEST SAGE
RAST TEST SALMON
RAST TEST SCALLOP
RAST TEST SESAME SEED
RAST TEST SHEEP
RAST TEST SHEEP SORREL
RAST TEST SHRIMP
RAST TEST SOLE
RAST TEST SOYBEAN
RAST TEST SPINACH
RAST TEST SQUASH, YELLOW
RAST TEST STEMPHYLIUM SOLANI
RAST TEST STRAWBERRY
RAST TEST SUNFLOWER SEED
RAST TEST SWEET CHESTNUT
RAST TEST SWEET GUM TREE
RAST TEST SWEET POTATO
RAST TEST SYCAMORE TREE
RAST TEST TANGERINE
RAST TEST TEA
RAST TEST THYME
RAST TEST TILAPIA
RAST TEST TOBACCO
RAST TEST TOMATO
RAST TEST TROUT
RAST TEST TUNA
RAST TEST TURKEY
RAST TEST VANILLA
RAST TEST VERNAL GRASS, SWEET
RAST TEST WALNUT NUT
RAST TEST WALNUT TREE
RAST TEST WATERMELON
RAST TEST WHEAT
RAST TEST WHEY
RAST TEST WHITE ASH TREE
RAST TEST WHITE BEAN
RAST TEST WHITE PINE
RAST TEST WHITE-FACED HORNET
RAST TEST WHITEFISH
RAST TEST WILLOW TREE
RAST TEST WINGSCALE
RAST TEST WOOL
RAST TEST WORMWOOD
RAST TEST YELLOW DOCK
RAST TEST YELLOW HORNET
RAST TEST YELLOW JACKET
RAST TEST ZUCCHINI
RAST TIMOTHY GRASS IGE
RAST TST STEMPHYLIUM BOTRYOSUM
RETICULOCYTE COUNT
RHEUMATOID FACTOR IGG IGA IGM
RHEUMATOID FACTOR QUANTITATIVE
SALICYLATE (ASPIRIN)
SCLERODERMA AB
SEDIMENTATION RATE
SELENIUM
SEROTONIN QUANT
SERUM PROTEIN ELECTR
SEX HORMONE BINDING
SIROLIMUS (RAPAMYCIN
SODIUM
SOLUBLE TRANSFERRIN
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
86003
85044
86431 x3
86431
80196
86235
85651
84255
84260
84155, 84165
84270
80195
84295
84238
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/1.0
GOLD SST/0.3
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/1.0
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/1.0
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.2
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/1.0
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/1.0
GOLD SST/0.1
GOLD SST/1.0
GOLD SST/0.1
GOLD SST/1.0
GOLD SST/1.0
GOLD SST/0.1
GOLD SST/1.0
GOLD SST/1.0
GOLD SST/1.0
GOLD SST/1.0
GOLD SST/0.1
GOLD SST/0.1
GOLD SST/0.2
LAV/0.1
GOLD SST/0.3
GOLD SST/0.2
RED/0.2
GOLD SST/0.2
LAV/1.0
ROYAL EDTA/0.1
RED/0.2
GOLD SST./0.5
GOLD SST/0.2
LAV/1.0
GOLD SST/0.1
GOLD SST/0.1
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
1ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
0.2ml serum
1ml whl bld
1ml serum
1ml serum
1ml serum
1ml serum
2ml whl bld
2ml ROYAL BLUE EDTA plasma
2ml serum ***FROZEN***
2ml serum
1mL serum rm temp
3ml EDTA whl bld
1ml serum
1ml serum ***FROZEN***
Tests in bold type have established NCD/LCD disgnosis for Medical Nescessity.
LAB TESTS
STONE ANALYSIS PROFILE
82360 STC/0.2
Calculus at room temp-NO ADHESIVE TAPE
STONE FORMER PROFILE
STOOL ALPHA 1 ANTITRSIN
STOOL FAT 24HR
STOOL OSMOLALITY
STOOL PH
STOOL POTASSIUM
STOOL REDUCING SUBSTANCE
STOOL SODIUM
SULFONYLUREA HYPOGLYCEMIC SCR
82340,83735,
84105,84560,
82131,82507,
83945
82103
82710
84999
89240
82190
84376
84302
80299
24hr UR
STOOL/1.0
STQUANT./1.0
STOOL/0.2
STOOL/1.0
STOOL/0.2
STOOL/0.5
STOOL/0.2
RED/0.5
T&B LYMPHS/NATURAL KILLER CELL
T3 FREE
T3 REVERSE
T3 UPTAKE
T4 (THYROXINE)
T4 FREE
TESTOSTERONE TOTAL
TESTOSTERONE,FREE & WEAK BOUND
THEOPHYLLINE (AMINOPPHYLLINE)
THIORIDAZINE & MESORIDAZINE
THROMBIN TIME
THYROGLOBULIN
THYROGLOBULIN AB
THYROGLOBULIN PROFILE
THYROID PEROXIDASE
THYROID STIM IMMUNOGLOBULIN
THYROID STIMULATING HORMONE
THYROXINE BINDING GLOBULIN
TOBRAMYCIN PEAK
TOBRAMYCIN RANDOM
TOBRAMYCIN TROUGH
TOLUENE
TOPIRAMATE (TOPAMAX)
TOTAL PROTEIN
TOTAL T3
TOXOPLASMA IGG
TOXOPLASMA IGM
TRANSFERRIN
TREPONEMA PALLIDUM AB BY MHA
TRICYCLIC QUANT
TRIGLYCERIDES
TROPONIN-I
TRYPTASE
UA BLOOD DIPSTICK
UA GLUCOSE DIPSTICK
UA KETONE DIPSTICK
UA MICROSCOPIC ONLY
UA PH DIPSTICK
UA SPECIFIC GRAVITY
UA W/MICROSCOPIC IF INDICATED
UR 17 HYDROXYCORTICOSTEROIDS
UR 17 KETOSTEROIDS TIMED
UR ALDOSTERONE TIMED
UR AMINO LEVULONIC ACID TIMED
UR AMYLASE TIMED
86355,86357,
86359, 86360
84481
84482
84479
84436
84439
84403
84270, 84403
80198
84022
85670
84432
86800
84432, 86800
86376
84445
84443
84442
80200
80200
80200
84600
80201
84155
84480
86777
86778
84466
86780
80101
84478
84484
83520
81003
81003
81003
81015
81003
81003
81003
83491
83586
82088
82135
82150
YEL ACD/1.0 & LAV/ 7ml ACD whl bld & 7ml EDTA whl bld rm temp
GOLD SST/0.2
1ml serum
GOLD SST/0.2
2ml serum
GOLD SST/0.1
1ml serum
GOLD SST/0.2
1ml serum
GOLD SST/0.2
1ml serum
GOLD SST/0.5
1ml serum
GOLD SST/1.0
1ml serum
RED/0.2
1ml serum *NO SST*
RED/0.5
2ml serum *NO SST*
BLUE/0.5
2ml sodium citrate plt poor plasma **FROZEN**
RED/0.2
1ml serum
GOLD SST/0.2
1ml serum
GOLD SST/0.2
1ml serum
GOLD SST/0.2
1ml serum
GOLD SST/0.1
3ml serum
GOLD SST/0.2
1ml serum
GOLD SST/0.2
0.5ml serum
RED/0.1
Draw 30 minutes post infusion complete.
RED/0.1
1ml serum
RED/0.1
Draw 30 minutes prior to next dose.
LAV/1.0
7ml EDTA unopened tube,clean site with iodine
RED/0.2
1ml serum *NO SST*
GOLD SST/0.1
0.5ml serum
GOLD SST/0.2
1ml serum
GOLD SST/0.3
0.5ml serum
GOLD SST/0.3
0.5ml serum
GOLD SST/0.1
0.5ml serum
GOLD SST/0.2
1ml serum
RED./0.2
2ml serun
GOLD SST/0.1
0.5 SERUM
GOLD SST/0.1
1ml serum
RED/0.2
1 mL serum
UR/0.3
5ml random urine. NO Boric Acid tubes.
UR/0.3
5ml random urine. NO Boric Acid tubes.
UR/0.3
5ml random urine. NO Boric Acid tubes.
UR/0.3
5ml random urine. NO Boric Acid tubes.
UR/0.3
5ml random urine. NO Boric Acid tubes.
UR/0.3
5ml random urine. NO Boric Acid tubes.
UR/0.3
5ml random urine. NO Boric Acid tubes.
UR24
24hr urine, keep on ice.
UR24
24hr urine, keep on ice.
UR24
24hr urine, keep on ice.
UR24
24hr urine, keep on ice.
UR/1.0
24hr urine, keep on ice.
24hr UR on ice
5gms random or 24 hr ***FROZEN***
24hr spec 1 gal can
3mL liquid stool
1gm fresh stool
20ml liquid only ***FROZEN***
1gm fresh random stool
20ml liquid only ***FROZEN***
2ml serum. No SST.
Tests in bold type have established NCD/LCD disgnosis for Medical Nescessity.
LAB TESTS
UR BETA-2 MICROGLOBULIN
UR CADMIUM
UR CALCIUM
UR CALCIUM TIMED
UR CALCIUM/CREATININE RATIO
UR CATECHOLAMINE FRACT TIMEED
UR CHLORIDE RANDOM
UR CHLORIDE TIMED
UR CITRATE TIMED
UR CORTISOL FREE TIMED
UR CREATININE CLEARANCE
UR CREATININE RANDOM
UR CREATININE TIMED
UR CYSTINE TIMED
UR EOSINOPHIL SMEAR
UR FREE CATECHOLAMINE RANDOM
UR HCG QUAL
UR HEAVY METALS SCREEN
UR HEMOSIDERIN
UR HISTAMINE
UR HOMOVANILLIC ACID RANDOM
UR HYDROXYINDOLEACETIC ACID QT
UR HYDROXYPROLINE TOTAL
UR KAPPA LAMBDA FREE LIGHT
UR LEAD TIMED
UR MAGNESIUM
UR MAGNESIUM TIMED
UR MERCURY TIMED
UR METANEPHRINES FRACTIONATED
UR METANEPHRINES RANDOM
UR METHYLMALONIC ACID
UR MICROALBUMIN RANDOM
UR MICROALBUMIN TIMED
UR MICROALBUMIN/CREAT RATIO
UR MYOGLOBIN QUANT
UR NICOTINE QUAL
UR N-TELOPEPTIDE RANDOM
UR ORGANIC ACID SCREEN
UR OSMOLALITY RANDOM
UR OXALATE TIMED
UR PHOSPHORUS
UR PHOSPHORUS TIMED
UR PORPHOBILINOGEN TIMED
UR PORPHYRINS RANDOM
UR PORPHYRINS TIMED
UR POTASSIUM RANDOM
UR POTASSIUM TIMED
UR PROTEIN ELECTROPHORESIS RDM
UR PROTEIN RANDOM
UR PROTEIN TIMED
UR SODIUM RANDOM
UR SODIUM TIMED
UR UREA NITROGEN CLEARANCE 24
UR UREA NITROGEN RANDOM
UR UREA NITROGEN TIMED
UR URIC ACID RANDOM
UR URIC ACID TIMED
UR VANADIUM
UR VANILLYLMANDELIC ACID RAND
10ml random urine. Patient should empty the bladder, then drink
a lrg glass of water
and collect a urine sample within 1 hour.
UR/0.5
UR/1.0
2.5ml random urine rm temp
UR/0.1
Random urine specimen.
UR24/0.4
24hr urine, keep on ice.
UR/0.1
Random urine specimen.
UR24 HCL/0.2
24hr urine, keep on ice.
UR/0.1
Random urine specimen.
UR24/0.1
24hr urine, keep on ice.
UR24/1.0
24hr urine, keep on ice.
UR24/0.2
24hr urine, keep on ice.
UR24/0.1 & GOLD S 24hr urine, keep on ice & 1ml serum.Hgt & wgt
UR/0.1
Random urine specimen.
UR24/0.1
24hr urine, keep on ice.
UR24 HCL/1.0
24hr urine, keep on ice.
UR/1
Random urine specimen.
UR/0.5
10ml random urine specimen.
UTUBE/0.5
Random urine specimen.
82232
82300
82340
82340
82340, 82570
82384
82436
82436
82507
82530
82575
82570
82570
82131
87205
82382
81025
82175,83655,
83825
UR24/0.2
24hr urine, keep on ice.
83070 UR./1.0
10ml first AM specimen.
83088 UR24/0.5
24hr urine, keep on ice.
83150 UR RDM HCL/0.5 10ml random urine specimen.
83497 UR24/0.2
24hr urine, keep on ice.
83505 UR24 HCL/1.0
24hr urine, keep on ice.
83883 x2UR/0.2
10ml random urine specimen.
83655 UR24/0.2
24hr(or random)urine rm temp
83735 UR24 HCL/0.1
Random sample.
83735 UR24 HCL/0.3
24hr urine, keep on ice.
83825 UR24/0.2
24hr urine, keep on ice.
83835 UR24 HCL/0.2
24hr urine, keep on ice.
83835, 82570 UR RDM HCL/0.2 10ml random urine specimen.
83921 UR/0.2
5 ml random urine REFRIGERATE
82043 UR CUP/0.5
10ml random urine specimen.
82043 UR24/0.1
24hr urine, keep on ice.
82570, 82043 UR/1.0
10ml random urine specimen.
83874 UR/0.2
10ml rndm urine, early morning or post exercise
80101 UR/0.1
5ml random urine specimen.
82523 UR/0.5
20ml urine from second morning void
83919 UR/0.5
10ml random urine specimen.
83935 UR/0.1
10ml random urine specimen.
83945 UR24 HCL/1.0
24hr urine, keep on ice.
84105 UR/1.0
10ml random urine specimen.
84105 UR24/0.3
24hr urine, keep on ice.
84110 UR24 GA/1.0
24hr urine, keep on ice
84120 UR/0.3
10ml random urine*PROTECT FROM LIGHT*
84120 UR24 NACAR/0.2 24hr urine, keep on ice*PROTECT FROM LIGHT*
84133 UR/0.1
10ml random urine specimen.
84133 UR24/0.1
24hr urine, keep on ice
84166 UR./1.0
10ml random urine specimen.
84156 UR/1.0
10ml random urine specimen.
84156 UR24/0.1
24hr urine, keep on ice
84300 UR/0.1
10ml random urine specimen.
84300 UR24/0.1
24hr urine, keep on ice
84540 UR24/1.0 & GOLD S 24hr urine, keep on ice & 1ml serum.Hgt & wgt
84540 STC/1.0
10ml random urine specimen.
84540 UR24/0.1
24hr urine, keep on ice
84560 UR/0.1
10ml random urine specimen.
84560 UR24 NaOH/1.0
24hr urine, keep on ice
83018 UR/0.25
10ml random urine specimen. Rm temp.
84585 UR RDM HCL/0.5 10ml random urine specimen.
Tests in bold type have established NCD/LCD disgnosis for Medical Nescessity.
LAB TESTS
UR VANILLYLMANDELIC ACID TIMED
URIC ACID
URINALYSIS WITH MICROSCOPIC
URINE DRUG SCREEN QUALITATIVE
URINE PROTEIN ELECTROPHORESIS
VALPROIC ACID (DEPAKENE)
VANCOMYCIN PEAK
VANCOMYCIN RANDOM
VANCOMYCIN TROUGH
VAP CHOLESTEROL GROUP
VARICELLA ZOSTER AB
VARICELLA ZOSTER DNA PCR, CSF
VASOACTIVE INTESTINAL PEPTIDE
VASOPRESSIN/ANTIDIURETIC HORM
VISCOSITY
VITAMIN A
VITAMIN B1 (THIAMINE)
VITAMIN B12
VITAMIN B12 & FOLATE
VITAMIN B6/PYRIDOXINE
VITAMIN D 1,25-DIHYDROXY
VITAMIN D 25-HYDROXY
VITAMIN E
VITAMIN K1
VON WILLEBRAND AG
VON WILLEBRAND RISTOCETIN
WARFARIN (COUMADIN)
WEST NILE RNA BY PCR
WHITE BLOOD CELL
ZINC
ZONISAMIDE (ZONEGRAN)
84585
84550
81001
80104
84166
80164
80202
80202
80202
83701, 84478
86787
87798
84586
84588
85810
84590
84425
82607
82607, 82746
84207
82652
82306
84446
84597
85244
85245
80299
87798
85048
84630
82542
UR24 HCL/0.2
GOLD SST/0.05
UR/0.3
UR/1.0
UR24./0.1
RED/0.2
RED/0.1
RED/0.1
RED/0.2
GOLD SST/1.0
GOLD SST/0.3
CSF TUB/1.0
LAV/2.0
LAV/0.2
GOLD SST/0.7
GOLD SST/1.0
LAVP/1.0
GOLD SST/0.2
GOLD SST/0.8
LAVP/1.0
GOLD SST./1.0
GOLD SST/1.0
GOLD SST/1.0
GOLD SST/1.0
BLUE/0.2
BLUE/0.2
RED/0.7
GOLD SST/2.0
LAV/0.1
ROYAL EDTA/0.3
RED/0.2
24hr urine, keep on ice
0.5ml serum
2ml random urine specimen.*NO BORIC ACID*
10ml random urine specimen.
24hr urine, keep on ice
1ml serum *NO SST*
Draw 1 hour post infusion complete.*NO SST*
1ml serum *NO SST*
Draw 30 minutes prior to next dose.*NO SST*
2ml serum
1ml serum
0.5ml CSF ***FROZEN***
Draw in chilled LAV Tube & send on ice.
Draw in chilled LAV,2ml plasma**FROZEN**
1mL serum
5ml serum*PROTECT FROM LIGHT**FROZEN**
2ml plsm *PROTECT FROM LIGHT**FROZEN**
1ml serum
2ml serum
1ml EDTA plsm*PROTECT FROM LIGHT**FROZEN*
3ml serum
1ml serum
2ml serum*PROTECT FROM LIGHT*
1ml serum*PROTECT FROM LIGHT**FROZEN**
2ml plasma ***FROZEN***
0.5ml plasma ***FROZEN***
2ml serum *NO SST*
1ml SERUM or CSF ***FROZEN***
1ml whl bld
2ml EDTA plasma
1ml serum
Tests in bold type have established NCD/LCD disgnosis for Medical Nescessity.
MICROBIOLOGY
Specify specimen source and specimen description on all cultures.
Container/
Count
Collection Instructions
Name
CPT
AFB POLYMERASE CHAIN REACTION
AFB SMEAR
C. DIFFICILE ANTIGEN & TOXIN
87556 STC/1
87206 STC/1
STC./1
87324 x2
CHLAMYDIA BY NUCLEIC ACID AMP
CRYPTOCOCCAL ANTIGEN
87491 UR CUP/0.5
86403 RED/1
Submit in sterile container.
Submit in sterile container.Use of swabs not recommended.
Send to lab within 1 hr of collection.
20ml 1st voided urine, other sources put in viral transport containers.
Serum or CSF.
CULTURE AFB
CULTURE AFB BLOOD
87206, 87116 STC/1
87116 STC/1
Do not submit AFB Cultures on swabs. Sterile Container.
Collect in Isolator tube
CULTURE AMNIOTIC FLUID
CULTURE ANAEROBIC
87205, 87070 STC/1
87075 ANA SWAB
Fld in sterile container.Avoid vaginal contamination.Includes Gram Stain.
Transport asap in Carey Blair transport tube
CULTURE ASPIRATE ENDOTRAC TUBE
87205, 87070 STC/1
Sputum in sterile container, includes Gram Stain.
CULTURE ASPIRATE TRANSTRACHEAL
87205, 87070 STC/1
Sputum in sterile container, includes Gram Stain.
Use aseptic technique. Collect 8-10 mL of blood from adults and 1-3 from
children less than or equal to 12 years. Each set should be from a different
sites at least 5 minutes apart.
CULTURE BLOOD
87040 BC ANA/1
CULTURE BRONCHIAL BRUSHING
87205, 87070
87070
87081
87205,
87071
87205,
87070
STC/1
Sterile container. Gram stain included.
CULTURE BRONCHIAL LAVAGE
87205, 87070 STC/1
Sterile container. Gram stain included.
CULTURE BRONCHIAL WASHING
CULTURE BURN
CULTURE CATHETER TIP
CULTURE CERVIX
CULTURE CHLAMYDIA
CULTURE CHLAMYDIA PNEUMONIAE
CULTURE CMV
87205, 87070
87070
87070
87070
87110
87110
87252
Sterile container. Gram stain included.
Sterile container or swab.
Sterile container.
Sterile container or swab.
Submit In Viral/Chlamydia Transport
Submit In Viral/Chlamydia Transport
Collect in VTM,except bld 7ml in Hep tube
CULTURE CSF
87205, 87070 STC/1
Sterile container. Gram stain included.
CULTURE EAR
CULTURE ENVIRONMENTAL
87205, 87070 STC/1
STC/1
N/A
Sterile container or swab. Gram stain included.
CULTURE EYE
87205, 87070 STC/1
Sterile container or swab. Gram stain included.
CULTURE FUNGUS
CULTURE FUNGUS BLOOD
CULTURE GC
CULTURE GENITAL
CULTURE HERPES
CULTURE LEGIONELLA
CULTURE MYCOPLASMA RESPIRATORY
CULTURE NASOPHARYNGEAL
87205, 87102
87103
87070
87070
87252
87081
87109
87070
Tissues or fluids are preferred. Use of Swab is Discouraged.
Collect in Isolator tube
Culturette
Culturette
Submit in Viral Transport Media.
Sterile container or sterile syringe
Special Mycoplasma Transport Media
Culturette
CULTURE PERITONEAL FLUID
CULTURE PLACENTAL
87205, 87070 STC/1
87070 STC/1
Sterile container or swab. Gram stain included.
Sterile container or swab.
CULTURE PLEURAL FLUID
87205, 87070 STC/1
Sterile container. Gram stain included.
CULTURE SINUS
87205, 87070 SW/1
Culturette. Gram stain included
CULTURE SPUTUM
87205, 87070 STC/1
Sterile container. Gram stain included.
CULTURE BODY FLUID
CULTURE BONE MARROW
CULTURE BORDETELLA PERTUSSIS
CULTURE BRONCH BRUSH PROTECTED
STC/1
STC/1
REGAN
Sterile container or swab. Gram stain included.
Innoculate into Blood Culture medium.
Submit in Regan Lowe transport media.
STC/1
Sterile container. Gram stain included.
STC/1
STC/1
STC/1
STC/1
VTM/1
VTM/0.5
STC/1
STC/1
STC/1
SW/1
SW/1
VTM/1
STC/1
STC/1
SW/1
Tests in bold type have established LMRP disgnosis for Medical Nescessity.
MICROBIOLOGY
Specify specimen source and specimen description on all cultures.
CULTURE STOOL (Stool Cult, Chlamydia Ag 87045, 87499,
& Shigatoxin included)
87427
STC/1
CULTURE STOOL VIBRIO
87081 STC/1
CULTURE STOOL YERSINIA
87081 STC/1
CULTURE THROAT
87070 SW/1
Sterile container.
Sterile container.
Sterile container.
Culturette
CULTURE TISSUE
CULTURE TISSUE QUANTITATIVE
87205, 87070 STC/1
87071 STC/1.0
Sterile container. Gram stain included.
Tissue for quantitation and grinding
CULTURE TRACHEA
CULTURE URINE
CULTURE VIRUS
87205, 87070
87086
87252
87070,
87205
SW/1
BORIC/1.0
STC/1
Culturette
Submit in Boric Acid tube or (Sterile Container regrigerated)
Collect in viral transport media
SW/1
Culturette. Gram stain included
CULTURE WOUND
DNA PROBE FOR CHLAMYDIA
87490 APTIMA-UR/1 Use Aptima Collection Kit.
DNA PROBE FOR GC
87590 APTIMA-UR/1 Use Aptima Collection Kit.
DNA PROBE GC/CHLAMYDIA
FECAL OCCULT BLOOD
FECAL OCCULT BLOOD SCREEN
GASTRIC BX, H.PYLORI SCREEN
GASTRIC OCCULT BLOOD
GC BY NUCLEIC ACID AMP
GIARDIA ANTIGEN EIA
GRAM STAIN
87490, 87590
82272
82270
87077
82271
APTIMA-UR/1
STOOL/1
STOOL/1.0
UREA/1.0
STC/1
87591 UR CUP/0.5
87329 STOOL/0.2
87205 SWAB/0.10
Use Aptima Collection Kit.
Diagnostic code, use for patient with symptoms.
Screening code,use for pt without symptoms.
Urea Broth obtained from Micro Lab.
Sterile container
20ml 1st voided urine, other sources put in viral transport containers.
Stool in clean, dry container.
Sterile container
INFLUENZAE A & B ANTIGEN
KOH PREP
LEGIONELLA ANTIGEN URINE
LEGIONELLA DFA
MALARIA SMEAR
MICROSPORIDIUM EXAM
MRSA CULTURE
87400 (X2)
87220
87449
87278
87207
87207
87147
STC/1
SLIDE/1
UR/0.5
STC/0.5
SLIDE/4
STOOL/0.5
SW/2
N/P washing, aspirate or swab.
Skin scrapings or hair in sterile cup
5ml urine in sterile container
Lung bx;sputum;aspirate;bronchial specimens.
2 ml venous blood EDTA
Stool or duodenal aspirate in 10% F
Culturette
OVA AND PARASITE
PINWORM PREP
RAPID STREP A ANTIGEN
ROTAVIRUS ANTIGEN
RSV ANTIGEN
SHIGA TOXINS
SMEAR FECES CRYPTOSPORIDIUM
SMEAR FUNGUS
SMEAR HERPES
SMEAR PERTUSSIS
SMEAR VARICELLA ZOSTER DFA
STOOL FAT QUALITATIVE
STOOL WBC
STREP A CULTURE
STREP B CULTURE
STREP PNEUMONIAE ANTIGEN
UR HISTOPLASMA ANTIGEN
87177, 87206,
87209
87172
87880
87425
87420
87427
87206
87205
87274
87265
87290
82705
89055
87081
87081
87899
87385
STC/1
TAPE/1
SW/1.0
STC/0.10
STC/1
STC/1.0
STOOL/0.5
STC/0.3
SLIDE/1
SLIDE/2
VTM/0.5
STOOL/1
STC/1
SW/1.0
SW/1.0
STC/0.2
UR/0.1
Sterile container.
Use PINWORM PADDLE to collect spec.
Use Strep Kit polyester swabs ONLY.
Stool in sterile container.
N/P washing, aspirate or swab
Stool in sterile container.
Stool in sterile container.
Air-dry slide in sterile container.
Air-dry slide in sterile container.
Air-dry slide with two thin preps.
Air-dry slide in sterile container.
Collect specimen in clean, dry container
Sterile container.
Culturette
Culturette
1ml serum or 5ml urine
5ml random urine ***FROZEN***
VARICELLA ZOSTER CULTURE & DFA
87290, 87252 STC/1
Collect in viral transport media
VIRAL RESPIRATORY PANEL
WET PREP
87280,87260,
87279,87276,
87275, 87299 NVTM SWAB
87210 SW/1.0
N/P NVTM SWAB (OBTAIN SWAB FROM MICRO)
Send swab in 1cc of saline to lab.
Tests in bold type have established LMRP disgnosis for Medical Nescessity.
COLLECTION FEES
NAME
ARTERIAL PUNCTURE
CAPILLARY COLLECTION
UR COLLECTION DRUG SCREEN
UR VOLUME CHARGE
VENIPUNCTURE
CPT
36600
36416
99001
81050
36415
PATHOLOGY PROCEDURES
Procedure Name
ACTIN IMMUNOPEROXIDASE STAIN
AFP IMMUNOPEROXIDASE STAIN
BCL-2 IMMUNOPEROXIDASE STAIN
CALRETININ IMMUNOPEROXIDASE STAIN
CD117 (C-KIT) IMMUNOPEROXIDASE STAIN
CD20 IMMUNOPEROXIDASE STAIN
CD3 IMMUNOPEROXIDASE STAIN
CD30 IMMUNOPEROXIDASE STAIN
CD34 IMMUNOPEROXIDASE STAIN
CEA IMMUNOPEROXIDASE STAIN
CHLAMYDIA T AMP PROBE
CHROMOGRANIN IMMUNOPEROXIDASE STAIN
CYTOKERATIN 20 IMMUNOPEROXIDASE STAIN
CYTOKERATIN 7 IMMUNOPEROXIDASE STAIN
CYTOKERATIN COCKTAIL IMMUNOPEROXIDASE ST
CYTOLOGY SMEAR
CYTOLOGY SPUTUM SACCOMANNO TECHNIQUE
CYTOLOGY WITH SPIN PREP NON-GYN
DESMIN IMMUNOPEROXIDASE STAIN
E-CADHERIN IMMUNOPEROXIDASE STAIN
EMA IMMUNOPEROXIDASE STAIN
ERA IMMUNOPEROXIDASE STAIN
FROZEN SECTION 1 SPECIMEN
FROZEN SECTION EACH ADDITIONAL BLOCK
GC AMP PROBE
GFAP IMMUNOPEROXIDASE STAIN
GROSS EXAM ONLY SURGICAL PATH
HEAVY CHAIN MYOSIN IMMUNOPEROXIDASE STAIN
HELICOBACTER PYLORI IMMUNOPEROXIDASE STA
HERPES I & II IMMUNOPEROXIDASE STAIN
HMB-45 IMMUNOPEROXIDASE STAIN
HMW CYTOKERATIN IMMUNOPEROXIDASE STAIN
HPV HIGH RISK AMP PROBE (THIN PREP PAP)
KAPPA LIGHT CHAIN IMMUNOPEROXIDASE STAIN
KI-67 IMMUNOPEROXIDASE STAIN
LAMDA LIGHT CHAIN IMMUNOPEROXIDASE STAIN
LCA IMMUNOPEROXIDASE STAIN
MELAN-A IMMUNOPEROXIDASE STAIN
MLH-1 IMMUNOPEROXIDASE STAIN
MSH-2 IMMUNOPEROXIDASE STAIN
NSE IMMUNOPEROXIDASE STAIN
PANCYTOKERATIN IMMUNOPEROXIDASE STAIN
PAP SMEAR DIAGNOSITS
PAP SMEAR SCREEN
PATH STAIN GROUP 1
PATH STAIN GROUP 2
PCP IMMUNOPEROXIDASE STAIN
PRA IMMUNOPEROXIDASE STAIN
PSA IMMUNOPEROXIDASE STAIN
S-100 IMMUNOPEROXIDASE STAIN
SURG PATH GROSS & MICRO -LEVEL 1
SURG PATH GROSS & MICRO -LEVEL 2
SURG PATH GROSS & MICRO -LEVEL 3
SURG PATH GROSS & MICRO -LEVEL 4
SURG PATH GROSS & MICRO -LEVEL 5
SURG PATH GROSS & MICRO -LEVEL 6
SYNAPTOPHYSIN IMMUNOPEROXIDASE STAIN
THIN PREP PAP SMEAR
TOUCH PREP EACH ADDITTIONAL SITE
TOUCH PREP WITHOUT FROZEN INITIAL SITE
TTF 1 IMMUNOPEROXIDASE STAIN
VIMENTIN IMMUNOPEROXIDASE STAIN
HCPCS/CPT
88342
88342
88342
88342
88342
88342
88342
88342
88342
88342
87491
88342
88342
88342
88342
88104
88108
88108
88342
88342
88342
88342
88331
88332
87591
88342
88300
88342
88342
88342
88342
88342
87621
88342
88342
88342
88342
88342
88342
88342
88342
88342
88164
P3000
88312
88313
88342
88342
88342
88342
88300
88302
88304
88305
88307
88309
88342
88142
88334
88333
88342
88342
Reflex Tests
*Columns marked with an * represents Medicare reimbursement.
Reflex Testing
Ordered Test
+ ANA
+ Antibody Screen
CPT
86038
86850
Reflex Test
CPT
Added
$16.62 ANA Titer
$14.49 Antibody ID
86039
86870
*
*
$15.35
$25.15
R or O
R
R
Antigen
86905
Testing
AHG XM x 86922x2
DAT
86880
Absorption
86978
Antigen
86902
Testing
86880
IgG DAT
$14.49
$7.39
R
Comp DAT
Elution
KleihauerHBsAg
HIV
Western
Blot
Gram Stain
ID and MIC
86880
86860
85460
86382
86689
$7.39
$25.15
$3.32
$23.25
$26.60
R
R
R
R
87205
87186
$3.22
$11.88
R
+ Culture
ID and MIC
87186
$11.88
R
(see list under
Protocol)
**Anaer
Org ID
***Samonel
la/Shigella
87076
$11.11
87147
$6.13
87147
$6.13
+AB SCR Auto
Controls
+ABSCR PCells
37degreeAHG
+DAT
w/polyspecific
coombs
+ IgG DAT
+Fetal Screen
+ HBsAg
+ HIV1&2
85461
87340
86703
$9.12
$14.20
$12.21
+ Blood Culture
87040
$14.19
$25.15
$7.39
$25.15
$5.25
Type
D-Test
Carbapenem 87184
$9.49
ase
R – required reflex testing, O – optional reflex testing
* Dollar values reflect Medicare fee schedule and/or APC amount
** Reflexed with any positive culture except urine, respiratory, and stool cultures
*** Reflexed with positive stool cultures
Page 26
R
R
Reflex Tests
*Columns marked with an * represents Medicare reimbursement.
+ Crypto Ag
Reactive RPR
Reactive VDRL CSF
Qual
CSF Cell Count with
>4 WBC
Body Fluid Cell
Count
with >4 WBC
Platelet Function
Studies
with Aggregation
Collagen
Epinephrine >184
Abnormal UA
Chemistry
COLU –anything but
yellow
APPU
–cloudy/bloody
PHU-9
LEUU->=25ul
NITU-+
PROU->=15mg/dl
GLUUD->=50mg/dl
86403
86592
86592
$14.01 India Ink
$5.87 RPR Titer
$5.87 VDRL
Quant
$6.50 CSF Count
with Diff
87210
86593
86593
$5.87
$6.05
$6.05
89051
$2.43
R
89050
$6.50 Body Fluid
with Diff
89051
$2.43
R
85576
$29.53 Aggregation
Collagen
ADP
85576
$29.53
R
81003
$3.09 UA with
Micro
81001
$4.35
89050
KETU->=5mg/dl
URO->=4mg/dl
BILU->=1
BLU->=10ul
UAwithMicro Cult if
81001
$4.35 Urine
87086
$11.10
Indicated + Nitrite or
Culture
+ Leukocyte esterase
and
>10 WBC on
microscopic
R – required reflex testing, O – optional reflex testing
* Dollar values reflect Medicare fee schedule and/or APC amount
** Reflexed with any positive culture except urine, respiratory, and stool cultures
*** Reflexed with positive stool cultures
Page 27
R
R
R
R
O
Reflex Tests
*Columns marked with an * represents Medicare reimbursement.
+ C diff Antigen with
87324 x 2
$16.49 C diff
87798
$26.97
– C diff toxin or
each NAAT
-Cdiff Antigen with +
Cdiff toxin
-STREP A SCR
87880
$16.49 STREP A
87081
$9.12
Pt<18 Yrs
CULTURE
R – required reflex testing, O – optional reflex testing
* Dollar values reflect Medicare fee schedule and/or APC amount
** Reflexed with any positive culture except urine, respiratory, and stool cultures
*** Reflexed with positive stool cultures
Page 28
R
R