Transcription
Net Fee Schedule0493 - 15/17 Price ListLabCorp Net Fee Schedule VADMHMRSAS Contract RFP720C-04093-07DPeriod: September 1, 2015 through August 31, 2017**Please Note Disclaimer: CPT codes are provided here for your convenience; however, correct coding often varies from one carrier to another. Consequently, the AMA CPT* manual codes presented here are intended as generalguidelines and should not be used without confirming with the applicable payor that their use is appropriate in each case.LabCorpTestNumberLabCorp Test NameStat Fees:099895Stat Fee (normal hours)270466Stat Service (normal hours)900414STAT Fee (after hours)990895STAT Fee (normal hours)998074STAT (normal hours)998492STAT Fee (normal hours)998591STAT Charge (normal hours)Courier Fees:998120Courier ChargeDraw Fees:099812Drawing Fee996660Drawing Fee998085Venipuncture998205Vendor Phlebotomy Fee998542Drawing Fee999326Offsite Venipuncture Multi Pt995407Hourly Phlebotomy Coverage Fee ( 72 Hours Notice)Reference Testing Fees:480848%fPSA Reflex071175071175 7 Drug-Unb071910071910 7 Drug-Scr072306072306 7 Alc-Scr074021074021 9 Drug-Scr07034017-OH P/Creat Ratio, Urine07008517-OH Progesterone LCMS50411525-Hydroxyvitamin D LCMS D2 D30017015' Nucleotidase3162055-HIAA Qn,Random Urine0040695-HIAA,Quant.,24 Hr Urine7161596-Acetylmorphine, Conf704411704411 5 Drug-Unbund725788725788 7 Drug-Unbund726778726778 7 Alc-Unbund733339733339 10 Alc-Scr733690733690 12 Oxycodone Crt-Scr733692733692 9 Oxycodone Crt-Scr733694733694 9 Alc Crt-ScrCommentsCharge for each hour phlebservice provided where notice 72hours and not regularlyscheduled. This charge is inaddition to the per collection ordraw fee referenced above.2015 CPT Code**DirectoryRFP of ServicesTestTestATBDiscountableTest2015 BookPrice2015 BookPrice Less65% ATBSpecialPriceNet NNNNNNNNN 40.00 34.00 59.50 18.00 34.00 29.75 12.00 40.00 34.00 59.50 18.00 34.00 29.75 12.0099199YNN 6.00 NN 20.00 20.00 20.00 20.00 20.00 20.00 20.00 20.00 20.00 20.00 20.00 20.00 3.32 3.32 3.32 3.32 3.32 3.32 3.32 3.32 20.00 20.0036415NNN 24.00 24.00 55.42 55.42841548030180301803018030183498, 8257083498823068391583497, 8257083497803568030180301803018030180301, 80302 YNNNNNNNNNNNNNNNNNNNN 65.00 63.00 63.00 66.25 76.00 246.50 121.75 294.00 95.75 107.00 71.50 137.50 50.00 63.00 69.50 100.00 188.25 140.00 88.00 65.00 63.00 63.00 66.25 76.00 246.50 121.75 294.00 95.75 107.00 71.50 137.50 50.00 63.00 69.50 100.00 188.25 140.00 88.00 8.87 10.11 8.87 10.11 63.00 11.59 10.48 246.50 23.29 104.69 6.66 16.08 25.66 37.74 10.42 63.00 10.48 13.31 107.83 59.31 11.25Page 1 of 144 30.57 30.57 61.11 30.57 30.57 30.57 30.57 30.57 30.57 61.11 30.57 30.57 30.57 30.57 6.00 11.59 10.48 23.29 104.69 6.66 16.08 25.66 37.74 10.42 10.48 13.31 107.83 59.31 11.25
Net Fee Schedule0493 - 15/17 Price ListLabCorp Net Fee Schedule VADMHMRSAS Contract RFP720C-04093-07DPeriod: September 1, 2015 through August 31, 2017**Please Note Disclaimer: CPT codes are provided here for your convenience; however, correct coding often varies from one carrier to another. Consequently, the AMA CPT* manual codes presented here are intended as generalguidelines and should not be used without confirming with the applicable payor that their use is appropriate in each P83052P83053P83054P83055P83056P83057P83058LabCorp Test Name733726 13 Oxycodone Crt-Scr733848 9 Alc Crt-Scr734349 3 Drug-Scr734351 5 Drug-Scr734352 6 Drug-Scr734353 7 Drug-Scr737921 12 Oxycodone Crt-Unbund763824 12 Oxycodone Crt-Unbund764227 9 Oxyco Crt-Unbund764883 11 Oxyco Alc Crt-Bund764888 10 Oxyco Alc Crt-Bund764928 11 Oxycodone Crt-Bund765000 11 Oxyco Alc Crt-Bund765204 15 Oxyco-Bund Bup-Scr765507 9 MDMA Oxyco Crt-Bund768431 10 Oxycodone Crt-Bund770628 7 Drug-Scr772111 9 Alc Crt-Scr772236 8 Alc-Scr788243 10 Alc-Bund788423 7 Drug-Bund788583 10 Crt-Bund788878 9 MDMA-Bund788941 7 MDMA-Bund789034 7 Crt-Bund789888 6 MDMA Crt-Bund790034 9 MDMA Crt-Bund791742 10 Oxycodone Alc-Bund794388 7 Drug-Bund799007 7 Drug-Bund799452 5 Drug-Bund88300 Surgical Pathology88300 Tech Comp-1st Site88304 Surgical Path-1st Site88304 Surgical Path-2nd Site88304 Tech Comp-1st Site88304 Tech Comp-2nd Site88305 Prof Comp-1st Site88305 Prof Comp-2nd Site88305 Prof Comp-3rd Site88305 Prof Comp-4th Site88305 Prof Comp-5th Site88305 Prof Comp-6th Site88305 Prof Comp-7th Site88305 Prof Comp-8th SiteComments2015 CPT Code**80301, 80302 (x3)80301Test Not Coded80301Test Not CodedTest Not Coded80301, 80302 (x3), 8034680301, 80302 (x3)80301, 8034680301, 80302 (x2)80301, 8030280301, 80302 (x3), 8034680301, 80302 (x2)80301, 80302 (x4), 803048030180301, Test Not Coded8030180301, 803028030180301803018830088300 TC883048830488304 TC88304 TC88305 2688305 2688305 2688305 2688305 2688305 2688305 2688305 26Page 2 of 144DirectoryRFP of NNNNNNNNNNNNNNNNNNNN2015 Book2015 BookPrice LessPrice65% ATB 205.00 205.00 90.50 90.50 37.00 37.00 50.00 50.00 56.50 56.50 63.00 63.00 301.75 301.75 198.00 198.00 255.00 255.00 196.00 196.00 190.00 190.00 313.50 313.50 196.50 196.50 308.00 308.00 158.50 158.50 185.50 185.50 63.00 63.00 88.00 88.00 81.50 81.50 106.75 106.75 66.00 66.00 109.00 109.00 92.50 92.50 71.50 71.50 71.50 71.50 79.00 79.00 98.50 98.50 171.50 171.50 73.00 73.00 73.00 73.00 60.00 60.00 40.00 40.00 31.25 31.25 102.75 102.75 102.75 102.75 80.75 80.75 80.75 80.75 62.00 62.00 62.00 62.00 62.00 62.00 62.00 62.00 62.00 62.00 62.00 62.00 62.00 62.00 62.00 62.00SpecialPrice 8.91 9.85 10.27 10.66 240.56 190.04 47.15 40.51 60.98 32.35 70.09 23.39 42.86 10.48 11.25 12.36 13.31 11.77 16.63 73.29 11.77 15.34 11.77 11.77 12.11 21.50 16.66 43.50 43.50 33.93 33.93 20.58 20.58 20.58 20.58 20.58 20.58 20.58 20.58Net Fee 205.00 90.50 8.91 9.85 10.27 10.66 240.56 198.00 190.04 47.15 40.51 60.98 32.35 70.09 23.39 42.86 10.48 11.25 12.36 13.31 11.77 16.63 92.50 73.29 11.77 15.34 98.50 171.50 11.77 11.77 12.11 21.50 16.66 43.50 43.50 33.93 33.93 20.58 20.58 20.58 20.58 20.58 20.58 20.58 20.58
Net Fee Schedule0493 - 15/17 Price ListLabCorp Net Fee Schedule VADMHMRSAS Contract RFP720C-04093-07DPeriod: September 1, 2015 through August 31, 2017**Please Note Disclaimer: CPT codes are provided here for your convenience; however, correct coding often varies from one carrier to another. Consequently, the AMA CPT* manual codes presented here are intended as generalguidelines and should not be used without confirming with the applicable payor that their use is appropriate in each 182261008649180803088161182675182402017319LabCorp Test Name88305 Surg Path-1st Site88305 Surg Path-2nd Site88305 Surg Path-3rd Site88305 Surg Path-4th Site88305 Surg Path-5th Site88305 Surg Path-6th Site88305 Surg Path-7th Site88305 Surg Path-8th Site88305 Tech Comp-1st Site88305 Tech Comp-2nd Site88305 Tech Comp-3rd Site88305 Tech Comp-4th Site88305 Tech Comp-6th Site88305 Tech Comp-7th Site88305 Tech Comp-8th Site88307 Surgical Pathology88307 Surgical Pathology88307 Surgical Pathology88307 Tech Comp-1st Site88307 Tech Comp-2nd Site88312 Tech Comp-1st StainAb Scr Antibody IDABO GroupingABO Grouping and Rho(D) TypingAcetaminophen (Tylenol), SAcetylcholine Receptor Ab, AllAChR Binding Abs, SerumAcid Fast Smear CultureAcid Fast Smear Culture W/RflxACTH, PlasmaActin (Smooth Muscle) AntibodyActivated Protein C ResistanceAdd On: hCG,uE3,InhibinAdd'l IHC Per Slide X1 GlblAdd'l IHC Per Slide X1 ProfAdd'l IHC Per Slide X1 TechADHAdulteration (Dilution), UrineAerobe ID SusceptAerobic Bacterial CultureAerobic Cult, Extend IncubatAFB Antibiotic SuscepAFB Cult/Smear, Broth, SuscepAFB Culture and Smear,BrothAFP TetraComments2015 CPT 5 TC88305 TC88305 TC88305 TC88305 TC88305 TC88305 TC88307883078830788307 TC88307 TC88312 TC868708690086900, 869018032983519 (x3)8351987206, 8711687206, 8711682024835168530784702, 82677, 86336Test Not CodedTest Not CodedTest Not Coded84588Test Not Coded87077870708707387190 (x4)87081, 8714987116, 87206, 8701582105, 82677, 84702, 86336Page 3 of 144DirectoryRFP of NNNNNNNNNNNNNNNNNNNN2015 Book2015 BookPrice LessPrice65% ATB 148.00 148.00 148.00 148.00 148.00 148.00 148.00 148.00 148.00 148.00 148.00 148.00 148.00 148.00 148.00 148.00 86.00 86.00 86.00 86.00 86.00 86.00 86.00 86.00 86.00 86.00 86.00 86.00 86.00 86.00 260.50 260.50 260.50 260.50 260.50 260.50 132.25 132.25 132.25 132.25 78.50 78.50 87.00 87.00 30.25 10.59 60.25 21.09 98.25 98.25 700.50 700.50 259.75 259.75 132.00 132.00 132.00 132.00 171.75 171.75 98.50 98.50 135.00 135.00 267.00 267.00 100.00 100.00 65.00 65.00 35.00 35.00 233.00 233.00 8.00 8.00 82.75 82.75 65.25 65.25 65.25 65.25 323.50 323.50 163.25 163.25 163.25 163.25 348.75 348.75SpecialPrice 49.00 49.00 49.00 49.00 49.00 49.00 49.00 49.00 28.42 28.42 28.42 28.42 28.42 28.42 28.42 70.80 70.80 35.75 35.75 33.43 30.20 5.52 22.17 33.80 29.43 29.43 35.49 11.09 49.89 100.00 65.00 35.00 30.75 1.94 17.73 11.09 11.09 138.57 38.80 38.80 36.64Net Fee 49.00 49.00 49.00 49.00 49.00 49.00 49.00 49.00 28.42 28.42 28.42 28.42 28.42 28.42 28.42 70.80 70.80 260.50 35.75 35.75 33.43 30.20 10.59 5.52 22.17 700.50 33.80 29.43 29.43 35.49 11.09 49.89 267.00 100.00 65.00 35.00 30.75 1.94 17.73 11.09 11.09 138.57 38.80 38.80 36.64
Net Fee Schedule0493 - 15/17 Price ListLabCorp Net Fee Schedule VADMHMRSAS Contract RFP720C-04093-07DPeriod: September 1, 2015 through August 31, 2017**Please Note Disclaimer: CPT codes are provided here for your convenience; however, correct coding often varies from one carrier to another. Consequently, the AMA CPT* manual codes presented here are intended as generalguidelines and should not be used without confirming with the applicable payor that their use is appropriate in each 00096354007351AFP with AFP-L3%AFP, Serum, Open Spina BifidaAFP, Serum, Tumor MarkerAFP, Tumor Marker (Serial)AFP-L3% (Serial Monitor)ALA Delta, 24-Hour UrineALA Delta, Random 489603203676528676536082553Alb AST Fe Prot PT PltAlb ProtAlbumin, SerumAldolaseAldosterone LCMS, SerumAldosterone, UrineAldosterone/Renin RatioAlk Phos IsoenzymeAlk Phosphatase, Bone SpecificAlk Phosphatase, Bone SpecificAlkaline Phosphatase (Serial)Alkaline Phosphatase, SAllergen Panel, Food-BerryAllergen Profile, Basic FoodAllergen Profile, Food-BasicAllergen Profile, Food-FishAllergen Profile, Food-FruitAllergen Profile, Food-LegumeAllergen Profile, Food-MeatAllergen Profile, Food-MilkAllergen Profile, Mini-PanelAllergen Profile, MoldAllergen Profile, Ragweed PlusAllergen Profile, ShellfishAllergen Profile, Vegetable IAllergen Profile, Vegetable IIAllergens (4) s(7)Allergens(9)Allergens(9)Allergens(92) FoodsAllergens, Zone 2Allergens, Zone 3Allyl Alcohol, BloodLabCorp Test NameComments2015 CPT Code**8210782105821058210582107821358213585049, 85610, 84155, 82040,84450, 8354082040, 841558204082085820888208882088, 8424484080, 840758408084080840758407586003 (x3)86003 (x9), 8600586003 (x6)86003 (x7)86003 (x5)86003 (x3)86003 (x3)86003 (x6)86003 (x12)86003 (x12)86003 (x4)86003 (x6)86003 (x7)86003 (x9)86003 (x4)86003 (x10)86003 (x4)86003 (x5)86003 (x7)86003 (x9)86003 (x9)86003 (x92)86003 (x30)86003 (x26)84600Page 4 of 144DirectoryRFP of NNNNNNNNNNNNNNNNN2015 Book2015 BookPrice LessPrice65% ATB 257.25 257.25 81.75 81.75 76.25 26.69 99.25 34.74 280.25 280.25 198.25 198.25 198.25 198.25 83.00 27.50 27.00 59.25 141.00 193.75 255.75 89.75 101.25 101.25 50.00 27.00 72.75 242.50 145.50 169.75 121.25 72.75 72.75 145.50 291.00 291.00 97.00 145.50 169.75 218.25 97.00 242.50 97.00 121.25 169.75 218.25 218.25 2,231.00 703.25 630.50 575.75 29.05 9.63 9.45 59.25 141.00 193.75 255.75 89.75 101.25 101.25 17.50 9.45 72.75 242.50 145.50 169.75 121.25 72.75 72.75 145.50 291.00 291.00 97.00 145.50 169.75 218.25 97.00 242.50 97.00 121.25 169.75 218.25 218.25 2,231.00 703.25 630.50 575.75SpecialPrice 83.14 12.20 8.87 19.68 71.24 48.50 1.95 1.75 3.60 23.29 69.63 11.09 33.26 33.26 1.75 44.50 26.70 31.15 13.35 26.70 44.50 57.85 22.25 26.70 31.15 40.05 44.50 22.25 31.15 40.05 40.05 129.05 115.70 402.22Net Fee 83.14 12.20 8.87 19.68 280.25 71.24 48.50 29.05 1.95 1.75 3.60 23.29 69.63 255.75 11.09 33.26 33.26 17.50 1.75 72.75 44.50 26.70 31.15 121.25 72.75 13.35 26.70 44.50 57.85 22.25 26.70 31.15 40.05 97.00 44.50 97.00 22.25 31.15 40.05 40.05 2,231.00 129.05 115.70 402.22
Net Fee Schedule0493 - 15/17 Price ListLabCorp Net Fee Schedule VADMHMRSAS Contract RFP720C-04093-07DPeriod: September 1, 2015 through August 31, 2017**Please Note Disclaimer: CPT codes are provided here for your convenience; however, correct coding often varies from one carrier to another. Consequently, the AMA CPT* manual codes presented here are intended as generalguidelines and should not be used without confirming with the applicable payor that their use is appropriate in each case.LabCorpTestNumberLabCorp Test Name347692AlP ALT AST Creat Glu TBili.332158AlP ALT AST Creat TBili Uri.315865001982511172001545AlP ALT AST TBili Uric A CB.Alpha-1-Antitrypsin, SerumAlpha-ThalassemiaALT ALT AST Creat Uric A Hgb PltALT AST TBiliAluminum, Plasma/SerumAluminum, UrineAmenorrhea ProfileAmikacin , Serum, Peak/TroughAmino Acid Profile, Qn, PlasmaAmino Acid Profile, Qn, UrineAmiodarone (Cordarone), SerumAmitriptyline (Elavil), SerumAmmonia, PlasmaAmphetamine Analysis, WBAmphetamine Confirmation, UrAmphetamine Screen, UrineAmphetamine, UrineAmphetamines (GC/MS), UrineAmphetamines Confirm, UrineAmy LipaseAmylase, SerumAmylase, UrineANAANA Comprehensive PanelANA w/ReflexANA w/Reflex if 163873030577ANA ENA C3 C4 DNA/DS Card(I.ANA RA QnAnaerobic and Aerobic CultureAnaerobic Cult, Extend IncubatAnaerobic CultureAnaerobic/Aerobic/Gram StainAnal(Rectal) Cytology, LBPANCA PanelAnemia Profile AComments2015 CPT Code**85027, 82947, 84550, 82565,82247, 84075, 84450, 8446085027, 84550, 82565, 82247,84075, 84450, 8446085027, 82247, 84075, 84450,84460, 8455082103812578446085018, 85049, 84550, 82565,84450, 8446082247, 84450, 844608210882108, 8257083001, 83002, 8414680150 0324Test Not Coded82150, 8369082150821508603886225, 86235 (x8)860388603886038, 86147 (x3), 86160 (x2),86225, 86235 (x4)86038, 8643187070, 87075870738707587070, 87075, 872058811286256 (x3), 83520 (x2)83550, 85025, 85045, 83540Page 5 of 144DirectoryRFP of ServicesTestTestATBDiscountableTest2015 BookPrice2015 BookPrice Less65% ATBSpecialPriceNet FeeYNY 55.50 19.43 4.70 4.70YNY 46.25 16.19 4.58 4.58YYNYNYYYYYNY 45.75 72.50 450.00 27.00 16.01 25.38 450.00 9.45 4.46 6.66 461.25 1.75 4.46 6.66 461.25 YYYYNNYYNNNNYNNNNNNYYYYNYY 64.00 22.50 120.25 86.25 284.50 194.00 561.00 561.00 141.00 127.25 98.25 82.25 119.50 24.00 24.00 119.50 119.50 74.50 37.25 37.25 69.25 929.25 69.25 69.25 22.40 7.88 120.25 86.25 99.58 67.90 561.00 561.00 141.00 127.25 34.39 82.25 119.50 24.00 24.00 119.50 119.50 26.08 13.04 13.04 24.24 929.25 24.24 24.24 6.52 2.07 22.17 33.26 15.84 33.26 171.82 215.67 25.49 15.52 3.88 27.72 33.26 4.88 2.44 4.43 4.17 174.56 4.17 4.17 6.52 2.07 22.17 33.26 15.84 33.26 171.82 215.67 25.49 15.52 3.88 27.72 33.26 24.00 24.00 119.50 119.50 4.88 2.44 4.43 4.17 174.56 4.17 4.17NYYNYYYYNNNYYYYYYYNYNNNNNNY 841.75 102.75 198.50 133.25 133.25 235.75 133.00 477.25 109.50 841.75 35.96 198.50 133.25 133.25 235.75 133.00 477.25 38.33 128.87 7.39 34.38 23.29 23.29 41.69 55.42 55.42 9.09 128.87 7.39 34.38 23.29 23.29 41.69 55.42 55.42 9.09
Net Fee Schedule0493 - 15/17 Price ListLabCorp Net Fee Schedule VADMHMRSAS Contract RFP720C-04093-07DPeriod: September 1, 2015 through August 31, 2017**Please Note Disclaimer: CPT codes are provided here for your convenience; however, correct coding often varies from one carrier to another. Consequently, the AMA CPT* manual codes presented here are intended as generalguidelines and should not be used without confirming with the applicable payor that their use is appropriate in each 216010167015117199809671112185001123LabCorp Test NameAnemia Profile BAngiotensin-Converting EnzymeAntiadrenal Antibodies, QuantAntibody IdentificationAntibody IdentificationAntibody ScreenAnticardiolip Ab, IgA/G/M, QnAnticardiolipin Ab, IgA, QnAnticardiolipin Ab, IgG, QnAnticardiolipin Ab, IgG/M, QnAnticardiolipin Ab, IgM, QnAnti-Centromere B AntibodiesAntichromatin AntibodiesAntichromatin AntibodiesAntidiuretic Hormone ProfileAnti-DNA(SS)IgG, Ab, QnAnti-DNase B Strep AntibodiesAnti-dsDNA AntibodiesAnti-dsDNA AntibodiesAntiextractable Nuclear AgAntihistone AntibodiesAntimyeloperoxidase (MPO) AbsAntimyocardial Antibodies, QnAntineutrophil Cytoplasmic AbAntinuclear Ab Reflex CascadeAntinuclear Antibodies DirectAntinuclear Antibodies, IFAAntipancreatic Islet CellsAntiparietal Cell AntibodyAntiphospholipid Syndrome ProfAntiproteinase 3 (PR-3) AbsAntiscleroderma-70 AntibodiesAntiscleroderma-70 AntibodiesAntistreptolysin O AbAntithrombin ActivityAntithrombin III, Func/ImmunolAntithyroglobulin AbAnti-Thyroglobulin AntibodiesApo A1 B RatioApolipoprotein BaPTT Mixing StudiesAripiprazoleArterial Blood GasAST (SGOT)Comments2015 CPT Code**82607, 82728, 82746, 83550,85025, 85045, 83540821648625586870868708685086147 (x3)861478614786147 (x2)8614786235862358623583930, 845888622686215862258622586235 (x2)862358352086256 (x2)86256 (x3)860388603886038863418351685613, 85732, 86147 (x2)835208623586235860608530085300, 85301868008680082172 (x2)8217285730, 85732 (x3)803428280384450Page 6 of 144DirectoryRFP of NNNNNNYNNNNYYNNNY2015 BookPrice 328.00 81.25 101.00 87.00 87.00 30.50 273.00 91.00 91.00 182.00 91.00 103.25 103.25 103.25 288.00 110.75 114.25 103.25 103.25 206.50 103.25 138.00 91.75 201.25 69.25 69.25 83.00 141.00 98.50 374.75 138.00 103.25 103.25 41.50 170.00 330.00 84.50 84.50 118.50 59.25 221.00 189.50 122.75 27.002015 BookPrice Less65% ATB 114.80 81.25 101.00 87.00 87.00 10.68 95.55 91.00 91.00 63.70 91.00 103.25 103.25 103.25 288.00 110.75 114.25 103.25 103.25 206.50 103.25 138.00 91.75 201.25 24.24 24.24 29.05 141.00 98.50 374.75 138.00 103.25 103.25 14.53 170.00 330.00 84.50 84.50 41.48 20.74 221.00 189.50 122.75 9.45SpecialPrice 24.18 8.31 19.96 25.78 25.78 7.77 59.30 13.30 45.95 32.65 22.17 22.17 36.29 24.40 19.96 6.66 6.66 24.94 38.97 16.63 22.17 4.17 4.17 4.17 24.40 35.37 101.37 16.63 18.45 4.43 29.93 45.45 10.26 18.29 97.86 16.63 1.75Net Fee 24.18 8.31 19.96 25.78 25.78 7.77 59.30 91.00 13.30 45.95 32.65 103.25 22.17 22.17 36.29 24.40 19.96 6.66 6.66 24.94 38.97 16.63 91.75 22.17 4.17 4.17 4.17 24.40 35.37 101.37 16.63 18.45 103.25 4.43 29.93 45.45 10.26 84.50 18.29 20.74 221.00 97.86 16.63 1.75
Net Fee Schedule0493 - 15/17 Price ListLabCorp Net Fee Schedule VADMHMRSAS Contract RFP720C-04093-07DPeriod: September 1, 2015 through August 31, 2017**Please Note Disclaimer: CPT codes are provided here for your convenience; however, correct coding often varies from one carrier to another. Consequently, the AMA CPT* manual codes presented here are intended as generalguidelines and should not be used without confirming with the applicable payor that their use is appropriate in each 335362322458180802009134164608164624140889LabCorp Test NameAutoimmune ProfileAzathioprine (Imuran)B pertussis IgG/M/A AbBacterial AntigensBacterial AntigensBacterial Vaginosis, NAABarbiturate Confirmation, UrBarbiturate Screen, UrineBartonella Bact. AerobicBartonella Antibody PanelBartonella henselae IgG/MBasic Metabolic Panel (7)Basic Metabolic Panel (8)Benzodiazepine Confirm, QT, WBBenzodiazepine Confirmation,UrBenzodiazepine Screen, UrineBenzodiazepines Confirm, UrineBenzodiazepines Confirm, UrineBenzodiazepines GC/MS RetestBeta Strep Gp A CultureBeta Thalassemia: HBBBeta-2 Glycoprotein I Ab,G,A,MBeta-2 Microglobulin, SerumBeta-2 Microglobulin, UrineBeta-HydroxybutyrateBile AcidsBile, Qualitative, UrineBilirubin Fraction, NeonatalBilirubin, DirectBilirubin, TotalBilirubin, Total/Direct, SerumBlack Bean IgEBld Drugs of Abuse, 7, WBBlood Culture, RoutineBlood DrawingBlood Drugs of Abuse 6, WBBlood Drugs of Abuse 8, WBBlood-SMR,Periph;Int/Phy 1stBMP8 eGFRBMP8 LP 1AC Hb A1cBody Fluid Culture, SterileBreast Discharge CytologyBrucella Antibody IgG, EIABrucella Antibody IgM, EIAB-Type Natriuretic PeptideComments2015 CPT Code**86038, 86160, 862258037586615 (x3)87802, 87899 (x3)87802, 87899 (x3)87798, 87798 59 (x2)80345803018707086611 (x4)86611 (x2)80051, 82565, 82947, 845208004880347, 827428034680301803468034680346870818140486146 (x3)822328223282010822398100582247, 82248822488224782247, , 80061, 83036, 844508707088161866228662283880Page 7 of 144DirectoryRFP of NYYYYYNNNNNNNYYNNNNN2015 Book2015 BookPrice LessPrice65% ATB 206.00 206.00 180.00 180.00 398.25 398.25 602.00 602.00 602.00 602.00 270.00 270.00 119.50 119.50 24.00 24.00 153.00 153.00 216.00 216.00 216.00 216.00 30.00 10.50 30.50 10.68 314.50 314.50 119.50 119.50 24.00 24.00 119.50 119.50 119.50 119.50 183.75 183.75 37.25 37.25 735.00 735.00 255.00 255.00 104.50 104.50 125.25 125.25 82.00 82.00 67.75 67.75 37.25 13.04 27.50 9.63 27.00 9.45 27.00 9.45 27.50 9.63 48.50 48.50 302.50 302.50 63.50 63.50 20.00 20.00 227.50 227.50 289.50 289.50 84.50 84.50 30.50 10.68 153.75 53.81 89.75 89.75 113.50 113.50 80.00 80.00 80.00 80.00 183.75 183.75SpecialPrice 15.26 216.26 216.26 62.00 33.26 99.77 77.56 77.56 2.55 2.67 83.14 33.26 7.78 33.26 107.83 6.09 16.63 16.63 12.74 7.48 3.88 1.75 1.75 1.95 12.20 3.32 106.70 149.65 60.98 2.67 10.31 17.73 44.34 28.69 28.69 36.58Net Fee 15.26 180.00 398.25 216.26 216.26 62.00 33.26 24.00 99.77 77.56 77.56 2.55 2.67 83.14 33.26 7.78 33.26 119.50 107.83 6.09 735.00 16.63 16.63 125.25 82.00 12.74 7.48 3.88 1.75 1.75 1.95 48.50 302.50 12.20 3.32 106.70 149.65 60.98 2.67 10.31 17.73 44.34 28.69 28.69 36.58
Net Fee Schedule0493 - 15/17 Price ListLabCorp Net Fee Schedule VADMHMRSAS Contract RFP720C-04093-07DPeriod: September 1, 2015 through August 31, 2017**Please Note Disclaimer: CPT codes are provided here for your convenience; however, correct coding often varies from one carrier to another. Consequently, the AMA CPT* manual codes presented here are intended as generalguidelines and should not be used without confirming with the applicable payor that their use is appropriate in each 00764130220955BUNBUN CreatBuprenorphine Confirm, UrineBuprenorphine, UrineBuprenorphine, UrineBuprenorphine, UrineBurkholderia Pseudom. Ab, 1002303143404180033180010BV Ct/Ng/Tv NAA Yeast CultureBV Trich NAA Yeast CultureBV Yeast CultureC albicans C glabrata, NAAC difficile Toxigenic CultureC difficile Toxin Gene NAAC difficile Toxins A B, EIAC difficile, Cytotoxin BC. trachomatis NAA, ConfirmC001-IgE Penicillin GC002-IgE Penicillin VC1 Esterase Inhibitor, FuncC3d Immune ComplexesC4 C3CA 125 in the Presence of HAMACA 125, Serum (Serial)CA 15-3 (Serial Monitor)CA 19-9CA 27.29CA 27.29 (Serial Monitor)Ca Creat P PTH IntactCa PTH IntactCalcitonin, SerumCalcitriol(1,25 di-OH Vit D)Calcium, 24Hr UrineCalcium, Ionized, SerumCalcium, Random UrineCalcium, SerumCalcium Calcium, IonizedCalculi, UrinaryCalculi, Urinary, with PhotoCalprotectin, FecalCampylobacter CultureCancer Antigen (CA) 125Cancer Antigen (CA) 15-3Candida 4 Species Profile, NAACandida 6 Species Profile, NAALabCorp Test NameComments2015 CPT Code**8452082565, 845208034880301803018030186609 (x2)87905, 87102, 87491, 87591,8766187905, 87102, 8766187905, 8710287481, 87481 598707587493873248723087491 598600386003861618633286160 (x2)86304863048630086301863008630083970, 82310, 82565, 8410083970, 8231082308826528234082330823408231082330, 8231082360823608399387046863048630087481 (x4)87481, 87481 59 (x5)Page 8 of 144DirectoryRFP of YYNNYYYYYNNNNYNNN2015 Book2015 BookPrice LessPrice65% ATB 27.00 9.45 27.50 9.63 119.50 119.50 58.00 58.00 58.00 58.00 60.00 60.00 251.25 251.25 484.75 261.25 201.75 202.50 67.75 125.00 107.00 120.00 160.00 19.75 19.75 189.00 153.00 133.00 153.25 145.75 133.75 119.50 122.75 145.75 164.50 163.50 175.50 245.25 28.50 75.25 28.50 27.00 87.25 70.25 81.25 200.00 50.75 122.75 110.75 405.00 607.50 484.75 261.25 201.75 202.50 67.75 125.00 107.00 120.00 160.00 19.75 19.75 189.00 153.00 46.55 153.25 51.01 133.75 119.50 122.75 145.75 57.58 57.23 175.50 245.25 9.98 26.34 9.98 9.45 30.54 70.25 81.25 200.00 50.75 42.96 110.75 405.00 607.50SpecialPrice 1.75 1.95 48.52 17.43 20.49 17.73 215.67 135.48 120.18 89.18 52.00 13.86 11.96 12.25 4.45 4.45 67.94 38.80 8.86 15.80 13.30 55.00 15.37 26.60 2.78 4.43 2.44 1.75 16.63 16.63 16.80 13.30 15.80 104.00 156.00Net Fee 1.75 1.95 48.52 17.43 20.49 17.73 215.67 135.48 120.18 89.18 52.00 13.86 125.00 11.96 12.25 160.00 4.45 4.45 67.94 38.80 8.86 15.80 51.01 133.75 119.50 13.30 55.00 15.37 57.23 175.50 26.60 2.78 4.43 2.44 1.75 30.54 16.63 16.63 200.00 16.80 13.30 15.80 104.00 156.00
Net Fee Schedule0493 - 15/17 Price ListLabCorp Net Fee Schedule VADMHMRSAS Contract RFP720C-04093-07DPeriod: September 1, 2015 through August 31, 2017**Please Note Disclaimer: CPT codes are provided here for your convenience; however, correct coding often varies from one carrier to another. Consequently, the AMA CPT* manual codes presented here are intended as generalguidelines and should not be used without confirming with the applicable payor that their use is appropriate in each 5017028142LabCorp Test NameCannabinoid (GC/MS), UrineCannabinoid Analysis, WBCannabinoid Confirmation, UrCannabinoid Confirmation, UrCannabinoid Screen, UrineCannabinoid, Qual, UrineCannabinoid/Creatinine RatioCarbamazepine(Tegretol), SCarbamazepine, Free, SerumCarbamazepine-10,11 EpoxideCarbon Dioxide, TotalCarbon Monoxide, BloodCarisoprodol/Meprobamate, UrCarnitine, TotalCarnitine, Total and FreeCarotene, BetaCatecholamine VMA, 24-Hr UrineCatecholamines, PlasmaCatecholamines,Ur.,Free,24 HrCatecholamines,Ur.,Free,RandomCBC With Differential/PlateletCBC, No Differential/PlateletCBC, Platelet, No Differential282020CBC/D/Plt RPR Rh ABO Rub Ab.371184CBC/D/Plt RPR Rh ABO Rub Ab.233783977709CBC/D/Plt RPR UA Rh ABO Rub.CBC/Diff Ambiguous Default115907CBC/Differential (No 5165118334971341142CBC Hematology ReviewCBC Platelet Hem ReviewCBC TestT DHEA S Prog E2 Te.CCP Antibodies IgG/IgACD4/CD8 Ratio ProfileCEACEA (Serial Monitor)Celiac Disease Ab Screen w/RfxCeliac Disease Antibody ScreenCeliac Disease Complete PanelComments2015 CPT Code**80349803018034980349803018030180301, 82384, 84585823848238482384, 825708502585014, 85018, 85041, 850488502785025, 87340, 86592, 86762,86787, 86850, 86900, 8690182306, 87340, 86592, 86850,86900, 86762, 86901, 83655,8502581003, 85025, 87340, 86592,86703, 86762, 86850, 86900,869018502585014, 85018, 85041, 85048,8500485014, 85018, 85041, 85048,8500785027, 85007Test Not Coded8620086360823788237882784, 83516 (x2)82784, 83516 (x2)82784, 83516 (x4)Page 9 of 144DirectoryRFP of NYYY2015 Book2015 BookPrice LessPrice65% ATB 119.50 119.50 82.25 82.25 119.50 119.50 119.50 119.50 24.00 24.00 24.00 24.00 69.25 69.25 98.
Consequently, the AMA CPT* manual codes presented here are intended as general guidelines and should not be used without confirming with the applicable payor that their use is appropriate in each case. Page 1 of 144. Net Fee Schedule LabCorp Net Fee Schedule VADMHMRSAS Contract RFP720C-04093-07D 0493 - 15/17 Price List
