Lenoir County Health Department

LENOIR COUNTY HEALTH DEPARTMENT

CPT/MEDICAID CODES DESCRIPTIONS

/

LCHD FEES EFFECTIVE 07/1/16

NEW PATIENTS

99201 / Office Visit-Level 1 – Minimal / $ 125.00 * CHANGED 11-1-11
99202 / Office Visit-Level 2 – Problem Focused / $150.00 * CHANGED 11-1-11
99203 / Office Visit-Level 3 – Expanded / $175.00 * CHANGED 11-1-11
99204 / Office Visit – Level 4 – Detailed / $250.00 * CHANGED 11-1-11
99205 / Office Visit – Level 5 – Comprehensive / $300.00 * CHANGED 11-1-11
99381 / Preventive Exam – Under 1 Year / (EP $ 90.00) / $175.00 * CHANGED 11-1-11
99382 / Preventive Exam – 1 – 4 years / (EP $ 90.00) / $225.00 * CHANGED 11-1-11
99383 / Preventive Exam – 5 – 11 years (EP $ 90) / $225.00 * CHANGED 11-1-11
99384 / Preventive Exam – 12 – 17 years(EP $ 90) / $225.00 * CHANGED 11-1-11
99385 / Preventive Exam – 18 – 39 years(EP $ 90) / $225.00 * CHANGED 11-1-11
99386 / Preventive Exam – 40 –64 years / $275.00 * CHANGED 11-1-11
99387 /

Preventive Exam – 65 & Older

/ $275.00 * CHANGED 11-1-11
ESTABLISHED PATIENTS
99211 / Office Visit – Level 1 – Minimal / $ 75.00 * CHANGED 11-1-11
99212 / Office Visit – Level 2 – Problem Focused / $ 125.00 * CHANGED 11-1-11
99213 / Office Visit – Level 3 Expanded / $ 150.00 * CHANGED 11-1-11
99214 / Office Visit – Level 4 – Detailed / $ 175.00 * CHANGED 11-1-11
99215 / Office Visit – Level 5 – Comprehensive / $ 225.00 * CHANGED 11-1-11
99391 / Preventive Exam – Under 1 year / (EP $ 90.00) / $150.00 * CHANGED 11-1-11
99392 / Preventive Exam – 1 – 4 years / (EP $ 90.00) / $175.00 * CHANGED 11-1-11
99393 / Preventive Exam – 5 – 11 years (EP $ 90) / $200.00 * CHANGED 11-1-11
99394 / Preventive Exam – 12 – 17 years (EP $ 90) / $200.00 * CHANGED 11-1-11
99395 / Preventive Exam – 18 – 39 years (EP $ 90) / $200.00 * CHANGED 11-1-11
99396 / Preventive Exam – 40 – 64 years / $225.00 * CHANGED 11-1-11
99397 / Preventive Exam – 65 & Older / $225.00 * CHANGED 11-1-11
59430 /

Postpartum Checkup Only

/ $175.00 * ADDED 7-1-16

MATERNITY SERVICES

59025

/ Fetal Non-Stress Test (w/ “25” modifier) / $ 150.00 * CHANGED 11-1-11
J2790 / Rho (D) Immune Globulin / $120.00
76801 / Ultrasound ***(Based on sliding fee scale) / $108.00 ***(Based on sliding fee scale)

51701

/ Insert Urinary Catheter & Remove / $ 65.00

51702

/ Insert Urinary Catheter (Indwelling Cath) / $ 75.00

LU201

/ Pap Repeated due to insufficient cells / -0-

87149

/ Group B Strep (GBS) / $ 11.50 ***(Based on sliding fee scale)

J3490

/ 17-P Injection / $ 50.00

96372

/ Injection Fee (if 17-P injection only) / $ 50.00 (if 17-P only) *CHANGED 11-1-11

59425

/ Antepartum Care Package 4-6 visits / $ 875.00 *CHANGED 10-1-11

59426

/ Antepartum Care Package 7 or more visits / $ 1,550.00 *CHANGED 10-1-11

LU237

/ Soc. Worker Non-Billable Contact(Preg Test Triage) / N/A(began 3-1-14) / -0- Report Only to count All preg test counsel.

LU247

/ RN Non-Billable Contact (Preg Test Triage) / N/A(began 3-1-14) / -0- Report Only to count All preg test counsel.

LU284

/ Enhanced Role RN Contact (Report Only) / N/A / N/A

FAMILY PLANNING

J1050

/ Depo-Provera began using 1-1-13; must bill per unit; each shot is 150 units) / $ 60.00 ( .40 per unit x 150 units per shot = $60 total fee)

J1055

/ Depo-Provera end-dated 12-31-12 / $ 60.00 *END DATED 12-31-12

96372

/ Injection Fee (if Depo only) / $ 50.00 (if Depo only) *CHANGED 11-1-11
S4993 / ***(FP)Birth Control Pills per pack/cycle / $ 8.45***( Based on sliding fee scale)
LU236 / OCP Pickup (Report Only) (Supply only visit) / $ 8.45***(Based on sliding fee scale)
LU235 / Replace OCP’s per pack / $ 8.45***(Based on sliding fee scale)
J7300 / Para Gard T380A (IUD) / $400.00
J7302 / Mirena (IUD) / $800.00 *CHANGED AS OF 8-1-15
58300 / Insertion (IUD) / $ 225.00 * CHANGED 11-1-11

58301

/ Removal (IUD) / $250.00 * CHANGED 11-1-11
57170 / Diaphragm Fitting / $ 150.00 *CHANGED 11-1-11
LU201 / FP Pap Repeated due to insufficient cells / -0-
LU285 / Enhanced Role RN Contact (Report Only) / -0-

FAMILY PLANNING (continued)

J7307 / Nexplanon / $ 800.00 *added 8-21-15
11981 / Nexplanon Insertion / $ 175.00 *added 8-21-15
11982 / Nexplanon Removal / $ 175.00 *added 8-21-15
11983 / Nexplanon Removal with reinsertion / $ 250.00 *added 8-21-15

IMMUNIZATIONS & INJECTIONS

90471EP

/ Admin. Fee (1) (*EP=for children) /

$20 as of 3-1-10

/ $ 30.00 (EP only) *CHANGED 10-1-15
90471 / Admin. Fee (1) / $ 30.00

G0008

/

Admin. Fee (1) for Medicare for flu

/ $ 30.00
G0009 / Admin. Fee (1) for Medicare for pneumonia / $ 30.00

90472EP

/

Admin. Fee (2 or more) *EP

/ $20 as of 11-1-11 / $ 30.00 *CHANGED 10-1-15
90472 / Admin. Fee (2 or more) / $20 as of 11-1-11 / $ 30.00 *CHANGED 10-1-15

90473EP

/ Admin. Fee for Intranasal *EP / $20 as of 11-1-11 / $ 30.00 *CHANGED 10-1-15
90473 / Admin. Fee for Intranasal / $20 as of 11-1-11 / $ 30.00 *CHANGED 10-1-15

90474EP

/ Admin. Fee Injectable w/Intranasal *EP / $20 as of 11-1-11 / $ 30.00 *CHANGED 10-1-15
90474 / Admin. Fee Injectable w/Intranasal / $20 as of 11-1-11 / $ 30.00 *CHANGED 10-1-15
90700 / DtaP / -0-
90702 / DT – Pediatric / -0-
90649 / Guardasil (only XIX & no ins. Pts.) / $ 175 + $30 admin fee = $205 as of 3-1-17
90633 / Hepatitis A / -0-
90744 / Hepatitis B Pediatric / -0-
90746 / Hepatitis B Adult 19 & over ** / $40+$20 as of 8-1-15 / $40.00 * plus admin.fee ($30)=$70 chgd 10-1-15
90281 /

Hepatitis A Immune Globulin

/ -0-
90371 / Hepatitis B Immune Globulin / -0-
90645 / Hib – HBOC – Hib Titer / -0-
90648 / Hib – PRP-T – ACT Hib / -0-
90647 / Hib – Ped Vax / -0-
90655 / Influenza – High Risk 6 – 35 months / As of 10-1-15 / To be based on cost+admin.fee($5+30)
90657 / Influenza – 6 – 36 months Split ** / As of 10-1-15 / To be based on cost+admin.fee($5+30)
90658 / Influenza 3 years & older Split ** / As of 10-1-15 / To be based on cost+admin.fee($5+30)
90660 / Intranasal Flu / As of 10-1-15 / To be based on cost+admin. Fee($5+30)
90662 / Flu – High Dose – 65 & older-Medicare / As of 10-1-15 / To be based on cost+admin fee($35+30)
90663 / H1N1 / - 0 -
90663 / H1N1 Intranasal / - 0 -
90685 / Influenza 6-35 months Preservative Free / As of 10-1-15 / Based on cost+admin. ($5+$30)10-1-15
90686 / Influenza 3-18 yrs old Preservative Free / As of 10-1-15 / Based on cost+admin. ($5+$30)10-1-15
90713 / IPV / -0-
90734 / Menactra MCV4 (meningitis) / $115+$20 on 8-1-15 / $ 115.00 ** plus admin ($30)=$145 as of 10-1-15
90707 / MMR ** x = free vaccine / $60+$20 on 8-1-15 / $60.00 * plus admin.fee ($30)=$90 as of 10-1-15
90723 / Pediarix / -0-
90698 / Pentacil / -0-
90732 / Pneumococcal Vaccine ** / $75+$20 on 8-1-15 / $ 75.00*plus admin. fee($30)=$105*chgd10-1-15
90670 / Prevnar 13 / -0-
90675 /

Rabies Vaccine - Pre-Exposure & Post Exposure

/

$285+$20 on 8-1-15

/

Ck on cost + admin.fee($30)=$315 as of 10-1-15

90680 /

Rotovirus

/ -0-
90714 /

TD – Preservative Free (age 7 and up)(booster)

/ $25+$20 on 8-1-15 / $ 25.00*plus admin($30)=$55*Changed 10-1-15
90715 / Tdap - 6thgraders, PP women, 1st time college students=free (all others must pay) / $35+$20 on 8-1-15 / $ 35.00* plus admin.fee($30)=$65chged 10-1-15
90703 / TT – Tetanus Toxoid (given after injury) / $40+$20 on 8-1-15 / $ 40.00**plus admin($30)=$70 *chged 10-1-15
90636 / Twin Rix / $95+20 on 8-1-15 / $ 95.00 + admin fee ($30)=$125 as of 10-1-15
90716 / Varicella ** / $105+$20 on 8-1-15 / $105.00* plus adminfee($30)=$135*chged 10-1-15
90736 / Zoster Vaccine (Shingles Shot) / As of 7-1-16 / $250 + admin fee ($30) = $280 *added 6-1-16
MISCELLANEOUS (PRIMARY CARE)

86580P

/

PPD*CHANGED 7-1-11 TO $20 & 11-1-11 TO $35

/ $ 35.00** Flat Fee(for school/work) 11-1-11
LU102 / TB Screening Form Completed** / $ 10.00** Flat Fee ** (for school or work)
End-dated / Modified PE (Breast Exam/Pap Only) / End-dated (no longer can use)
LU201 / Pap Repeated due to insufficient cells / -0-
LU237 / Soc. Work Contact(report only) (non-billable) / -0-(To count ALLpregtest counseling 3-1-14)
LU247 / MH RN Contact (report only) (non-billable) / -0-(To count ALL preg test counseling 3-1-14)
LU011 / Limited Physical – County School Employee / (New school employees or been more than a year
Since last worked at schools) $65 began 6-1-14) LU Code changed 8-1-15
99080 / Form Completion** / $ 10.00 * Flat Fee **CHANGED 11-1-11
LU018 / Copy of Patient Medical Records ** / $ 12.00 + .10 per page; Exception: TPO
LU021 / Copy of Lab Result/Proof of PPD ** / $ 3.00 per page/per result*CHANGED11-1-11
LU031 / Returned Check Fee / $ 25.00 *added 7-1-11
Accounting of Disclosures ** / 1st 12 mo. Period free; 2nd or greater in
12 months - $ 12.00 + .10 per page

MISCELLANEOUS SERVICES

99501 / Post Partum Assessment Home Visit / $ 590.00 * CHANGED 11-1-11
99502 / Newborn Assessment Home Visit / $ 590.00 * CHANGED 11-1-11
96152 / Health & Behavior Intervention*Per Unit / $ 50.00 * Per Unit*CHANGED 11-1-11
S0280 / Pregnancy Medical Home Risk Screening / $ 50.00 *CHANGED 4-1-11
S0281 / Pregnancy Medical Home Postpartum Check-up / $ 150.00 *CHANGED 4-1-11

NUTRITION SERVICES

97802 / Medical Nutrition Therapy *Per Unit / $ 60.00 * Per Unit *CHANGED 3-1-10
97803 / Enhanced Nutrition Counseling *Per Unit / $ 50.00 * Per Unit *CHANGED 3-1-10

ADULT HEALTH

19499 / BCCCP (Breast/Pap) No Charge / Must meet program qualifications

COLPO (PRIMARY CARE)

88305 /

Biopsy Reading Fee from LMH

/ $ 92.00 per container
57452 /

Colposcopy WITHOUT biopsy

/ $ 225.00 * CHANGED 11-1-11
57454 /

Colposcopy w/biopsy & curettage

/ $ 350.00 * CHANGED 11-1-11
57455 /

Colposcopy w/biopsy

/ $ 325.00 * CHANGED 11-1-11
57456 /

Colposcopy w/endocervical curettage

/ $ 300.00 * CHANGED 11-1-11
87621 /

HPV Hybrid Capture Testing

/ $ 104.50
58100 / Endometrial Biopsy / $ 225.00 *Added 11-1-11
57505 /

Endocervical Curettage Only

/ $ 215.00 *Added 3-1-17

CHILD HEALTH SERVICES

D0145 / Oral Varnish less than 3 years old / $ 100.00 * CHANGED 11-1-11
D1206 / Topical Application (Fluoride) / $ 100.00 * CHANGED 11-1-11
96110 / PEDS / $ 30.00 * CHANGED 11-1-11
99173 / Vision (Report Only) / -0-
LU245 / Dental Varnish 3–6 years old(Report only) / $ 75.00
94640 / Breathing Treatment / $ 20.00
92587 / OAE (Hearing Test) / $ 160.00 * CHANGED 11-1-11
92552 / Hearing - Audiometer / $ 50.00 *ADDED 7-1-15
69210 / Remove Impacted Ear Wax / $ 60.00
99420 / Health Risk Assessment / $ 40.00* CHANGED 11-1-11(end dated 12-31-16)
87880 / Rapid Strep Test / $ 50.00 *added 8-1-15
LU283 / CH Enhanced Role RN Contact (Report Only) / N/A
87081 / Throat Culture / $ 14.00 *added 8-5-15
96160 /

Adolescent Risk & Strength Screening

/ $ 40.00 **added 1-1-17
96161 /

Maternal Depression Screening (1-6 mos)

/ $ 40.00 **added 1-1-17
96127 /

Social-Emotional Screen

/ $ 30.00 **added 1-1-17
99408 /

CRAFFT (15 – 30 minutes)

/ $ 60.00 **added 8-1-16
99409 /

CRAFFT (more than 30 minutes)

/ $ 125.00 **added 8-1-16

STD/COMMUNICABLE DISEASE/TB

T1002

/

STD Control Treatment * Per Unit

/ $ 175.00 *Per Unit *CHANGED 11-1-11

LU242

/

Non Billable STD Contact (Report Only)

/

-0-

J0561

/

Bicillin

/ -0- began using 1-1-11

J0696

/

Rocephin

/ -0-

LU282

/

STD Enhanced Role RN Contact (Report Only)

/ N/A

96372

/

Injection Fee for RocephinBicillin

/ $ 50.00/-0- charge to the STD pt.*
*CHANGED 11-1-11)

LU100

/ 101 Pre-test Counseling (Report Only) /

-0-

LU101

/ 101 Post-test Counseling (Report Only) /

-0-

54050 / Wart Removal – Male / $595.00 *CHANGED 11-1-11
56501 /

Wart Removal – Female

/ $595.00 *CHANGED 11-1-11
T1002 / TB Control * Per Unit / $ 175.00 *Per Unit *CHANGED 11-1-11
LU102 / TB Screening Form Completed ** / $ 10.00 ** Flat Fee **
LU240 / Non Billable LPN Contact Only / -0-
86580 /

PPD *CHANGED 7-1-11 TO $20

*CHANGED 11-1-11 TO $35 / $ 35.00(for school or work) (Contacts=free)
*CHANGED 11-1-11
LU243 / Non Billable Communicable Disease Contact / -0-

LABORATORY SERVICES (IN-HOUSE)

82120 / Amines Test (Whiff Test) / $ 25.00 * CHANGED 11-1-11
36416 / Capillary Blood Collection / $ 20.00 *CHANGED 11-1-11

82947QW

/ Glucose – Fasting/Random ** / $ 25.00 ** Flat Fee/sliding fee scale
* CHANGED 11-1-11

82950QW

/ 1 Hr. or 2 Hr. GTT Screen / $ 35.00 * CHANGED 11-1-11

82951QW

/ 3 Hr. GTT / $ 85.00 * CHANGED 11-1-11

82952QW

/ GTT – each specimen more than 3 / $ 25.00 * CHANGED 11-1-11
87081 / GC Culture (FP Waiver & all pts.) / $ 14.00 * CHANGED 8-5-15
99001 / Handling Fee / $ 5.00

85018QW

/ Hemoglobin / $ 17.00 * CHANGED 11-1-11
82270 / Hemocult / $ 10.00
87880 / Rapid Strep Test / $ 50.00 *added 8-1-15
87205 / Stat Male Smear / $ 30.00 * CHANGED 11-1-11
87081 / Throat Culture / $ 14.00 *CHANGED 8-5-15
81003QW / Urinalysis / $ 15.00 * CHANGED 11-1-11

81001

/ Urine with microscopic / $ 20.00 * CHANGED 11-1-11
81002* / Urine Only (*only used as backup*) / $ 15.00 * CHANGED 11-1-11
81000* /

Urine with micro (*only used as backup*)

/ $ 20.00 * CHANGED 11-1-11
81025 / Urine Pregnancy Test*CHANGED 7-1-11 $20
*CHANGED 11-1-11 $25*CHANGED 9/4/14 $10 / $ 10.00 * CHANGED 9-4-14
36415 / Venipuncture Fee / $ 20.00 * CHANGED 11-1-11
36406 / Venipuncture Fee less than 3 years old / $ 25.00
87210 / Wet Mount / $ 30.00 * CHANGED 11-1-11

STATE LABORATORY

87591/87491 / Chlamydia/GC (GenProbe)(females only) / N/A / N/A
87070 / Culture, Bacteria, Other / N/A / N/A (Began in EPI 2/1/13)
87798 / Detect Agent, NOS DNA AMP / N/A / N/A (Began in EPI 2/1/13)
83020 / Hemoglobin Electrophoresis / N/A / N/A
86704 / HbcAb Hep B Core Antibody / N/A / N/A (Mat pts & EPI)
87340 / HbSAg Antigen (Hepatitis B Sur Ag) / N/A / N/A (Mat pts & EPI)
86706 / HbS Antibody Surface / N/A / N/A
86696 / Herpes / N/A / N/A (if goes to Solstas there is a charge)
86703 / HIV / N/A / N/A (if goes to Solstas there is a charge)
83655 / Lead Test / N/A / N/A
86735 / Mumps Igg/Igm to confirm imm/infection / N/A / N/A
84030 / PKU / N/A / N/A
86762 / Rubella / N/A / N/A
86592 / Syphilis / N/A / N/A
86787 / Varicella Titer to confirm immunity / N/A / N/A
Atlantic Health Associates Lab(for Five Oaks / Animal Hospital)
86382 / Rabies RFFIT Serology Screen / N/A / $ 40.00 per test (done March, 2014)
SOLSTAS LAB (PRIMARY CARE UNLESS SFS PROGRAM REFERRAL)
86900 / ABO Group / N/A / $ 2.00 *changed 8-1-15
86900/86901 / ABO Rh (blood group,type,factor) / N/A / $ 4.00 *changed 8-1-15 ($2+$2=$4.00)
82105 / AFP Maternal Screen Only / N/A / $ 25.00 *added 8-1-15
82107 / AFP Non-Maternal Screen / N/A / $ 42.00 *added 8-1-16
82040 / Albumin / N/A / $ 2.00 *added 8-1-15
82150 / Amylase / N/A / $ 4.00 *added 8-1-15
86038 / Anti-Nuclear AB Antibody (ANA Reflex) / N/A / $ 6.50 *changed 8-1-15
86708 / Anti-HAV (Total) Hep A Antibody Total / N/A / $ 15.00
86850 / Antibody Screen Reflex / N/A / $ 5.00 *changed 8-1-15
86704 / Anti-HBC Hep B Core Antibody Total / N/A / $ 4.50 *added 8-1-15
84075 / Alkaline Phosphatase / N/A / $ 2.00 *added 8-1-15
84460 / ALT/SGPT / N/A / $ 2.00 *chged 8-1-15 TB pts. = free
84450 / AST/SGOT /HbsAB / N/A / $ 2.00 *chged 8-1-15 TB pts. = free
86147 / Anticardiolipin IgG & IgM / N/A / $ 148.50 *added 2-1-11
82239/
83789 / Bile Acids Total/Fractionated along w/Mass Spectrometry Quantative / N/A / $ 82239 = $ 107.00 added 8-1-13 $ 83789 = $ 175.00 Total of both $282
80048 / BMP (“Basic” Metabolic Panel Total CA) / N/A / $ 2.50 *changed 8-1-15
80048/ + / BMP with GFR add to 80048
if male 24291; if female 24292 / N/A / $ 2.50 *changed 8-1-15
82248 / Bilirubin-Direct / N/A / $ 2.00 *added 8-1-15
82247 / Bilirubin (Total) / N/A / $ 2.00 *added 8-1-15
82248 / Bilirubin-Direct-Indirect / N/A / $ 2.00 *added 8-1-15
84520 / BUN (Blood Urea Nitrogen) /

N/A

/ $ 2.00 *changed 8-1-15
87591/87491 / Chlamydia Trach-N Gonorrhea NAAT Test /

N/A

/ $ 18.00 *added 8-1-15 ($9+$9=$18)
82310 /

Calcium

/ N/A / $ 2.00 *changed 8-1-15
82374 /

Carbon Dioxide

/ N/A / $ 2.00 *added 8-1-15
85025 /

CBC w/Diff

/ N/A / $ 2.00 *changed 8-1-15
85027 / CBC w/o Diff / N/A / $ 2.00 *changed 8-1-15
82435 / Chloride / N/A / $ 2.00 *added 8-1-15
82465 / Cholesterol-Total / N/A / $ 2.00 *added 8-1-15
80053 / CMP/Chem 12 / N/A / $ 3.00 *changed 8-1-15
80053/+ / CMP w/GFR add to 80053 if male 24291 & if female add 24292 / N/A / $ 3.00 *added 8-1-15
CMP w/ BUN Creat Ratio / N/A / $ 3.00 *added 8-1-15
82533 / Cortisol /

N/A

/ $ 37.50 *added 10-2-11
82565 / Creatinine /

N/A

/ $ 2.00 *changed 8-1-15
82550 / Creatine Kinase (CK) /

N/A

/ $ 6.50
82540 / Creatine Assay Serum / N/A / $ 3.50 *added 2-1-11
82570 / Creatinine (Urine) / N/A / $ 4.00 *changed 8-1-15
86140 / C-Reactive Protein (CRP) /

N/A

/ $ 4.50 *changed 8-1-15
87081 / Culture-Group B Strep /

N/A

/ $ 14.00 *changed 8-5-15
87081 / Culture – Throat /

N/A

/ $ 14.00 *changed 8-5-15
87086 / Culture – Urine /

N/A

/ $ 7.00 *added 8-1-15
81220 / Cystic Fibrosis Mutations /

N/A

/ $ 131.50 *added 8-1-15
82626 / DHEA (Assay Dehydroepiandrosterone) /

N/A

/ $ 136.00 *added 3-1-12
80185 / Dilantin (Phenytoin) (if goes to Cherry $9.40) /

N/A

/ $ 30.00 *added 7-1-12 for Solstas
80051 / Electrolytes Panel /

N/A

/ $ 2.00 *changed 8-1-15
82670 / Estradiol (Assay Estradiol) /

N/A

/ $ 8.00 *changed 8-1-15
82677 / Estriol (Assay Estriol) /

N/A

/ $ 110.00 *added 3-1-12
82672 / Estrogen (Assay Estrogen) /

N/A

/ $ 124.00 *added 3-1-12
82679 / Estrone (Assay Estrone) /

N/A

/ $ 130.00 *added 3-1-12
LU275 / Executive Panel for County Employees /

N/A

/ $ 15.00 *only available once/year
LU276 / Executive Panel w/PSA for County Employee /

N/A

/ $ 20.00 * only available once/year
84439 / Executive Panel / N/A / $ 44.00
84439/84153 / Executive Panel w/PSA(84439=$44+84153=$5.50) / N/A / $ 49.50 ($44.00 + $5.50=$49.50)*chged 8-1-15
82728 / Ferritin / N/A / $ 5.00 *changed 8-1-15
82731 / Fetal Fibronectin / N/A / $ 187.50
82746 / Folate (Folic Acid) / N/A / $ 5.00 *changed 8-1-15
83001 / FSH (Follicle Stimulating Hormone Test) / N/A / $ 5.50 *changed 8-1-15
82977 / Gamma GT (GGT) / N/A / $ 6.50
82591 / GTT (3 Specimen) / N/A / $ 5.00 *added 8-1-15
82565 / Glomerular Filtration Rate (GFR) / N/A / $ 12.00 *added 11-1-11
82950 / Glucose Screen / N/A / $ 2.50
82591/82592 / Glucose Tolerance-3 HR / N/A / $ 11.50
83036 / Glycosyliated Hemoglobin Test-HgbA1C /

N/A

/ $ 4.50 *changed 8-1-15
87149 / GBS / N/A / $ 7.50 *changed 8-1-15
86677 / H Pylori AB-IGG / N/A / $ 16.50 *added 8-1-15
84702 / HCG (Blood pregnancy test) / N/A / $ 2.50 *changed 8-1-15
83718 / HDL Cholesterol / N/A / $ 2.00 *added 8-1-15
80074 / Hepatitis Panel (Acute Hepatitis Panel) / N/A / $ 40.00
86708 / Hepatitis A Ab (Antibody) / N/A / $ 15.00
86704 / Hepatitis B Core / N/A / $ 4.50 **added 8-1-15
86706 / Hepatitis B Sur Ab (Antibody) / N/A / $ 9.50 *changed 8-1-15
87340 / Hepatitis B Sur Ag (Antigen) / N/A / $ 7.00 *changed 8-1-15
86803 / Hepatitis C Ab (Antibody) / N/A / $ 6.50 *changed 8-1-15
87389 / HIV ½ AG/AB-4 Gen W RFX / N/A / $ 11.50 *added 8-1-15
86703 / HIV Reflex / N/A / $ 6.50 *added 8-1-15
87624 / HPV / N/A / $ 25.00 *added 8-1-15
87624/88175 / HPV High Risk / N/A / $ 25.00 *added 8-1-15
86695 / Herpes Simplex Type 1 / N/A / $ 11.50 *added 8-1-15
86696 / Herpes Simplex Type 2 / N/A / $ 11.50 *added 8-1-15
86695/86696 / HSV I/II Glyco G AB IGG / N/A / $ 23.00 ($11.50+$11.50=$23) *added 8-1-15
86694 / Herpes 1 & 2 (Serum) / N/A / $ 102.00 *added 10-1-11
87255 / Herpes Test (Viral Transport Media) / N/A / $ 25.00 *added 2-8-11
87529 / Herpes Simplex Virus, PCR / N/A / $ 37.50 *added 8-1-15
80375 / Imuran / N/A / $ 105.00 *added 8-1-16
86336 / Inhibin A / N/A / $ 87.50 *added 2-1-11
83525 / Insulin, Fasting or Random Insulin / N/A / $ 15.00
83540 /

Iron Test Only

/ N/A / $ 2.00 *changed 8-1-15
83540/83550 /

Iron Test/T IBC (total iron binding) Test

/ N/A / $4.00 total ($2.00 + $2.00 =$4.00)*chged 8/1/15
83655 /

Lead, Whole Blood

/ N/A / $ 9.50 *changed 8-1-15
83690 /

Lipase

/ N/A / $ 6.50 *added 8-1-15
83002 /

LH (Luteinizing Hormone Test)

/ N/A / $ 9.00
80061/83721 /

Lipid Panel/Direct LDL, HDL Ratio

/ N/A / $ 11.50 total ($6.50 + $5.00=$ 11.50)
80178 /

Lithium (if goes to Cherry $9.40)

/ N/A / $ 6.50 *changed 8-1-15 for Solstas
80076 /

Liver/Hepatic Function Panel

/ N/A / $ 2.50 *changed 8-1-15
85613 /

Lupus Anticoagulant Panel

/ N/A / $ 154.00 *added 2-1-11
86618 /

Lymes Disease Titer IgG IgM

/ N/A / $ 52.00 *added 5-1-11
86361 /

Lymph Enumeration

/ N/A / $ 62.50 *added 8-1-15
83735 /

Magnesium Test

/ N/A / $ 3.00 *changed 8-1-15
86735 /

Mumps Virus Antibody – IGG

/ N/A / $ 11.50 *added 8-1-15
86765/86735/86762 /

MMR Titer 86765=$7, 86735=$11.50 86762=$3.50

/ N/A / $ 22.00 *changed 8-1-15
82043 /

Micro Albumin

/ N/A / $ 5.00 *changed 8-1-15
83880 /

Natriuretic Peptide

/ N/A / $ 95.00 *added 4-1-12
83704 /

NMR Lipo. Profile

/ N/A / $ 75.00 *added 2-1-11
88142 /

Pap-Thin Prep-Ascus R/HPV

/ N/A / $ 21.00 *added 8-1-15
88175 /

Pap- Thin Prep-Imaging

/ N/A / $ 26.00 *changed 8-1-15
85060 /

Pathology Review

/ N/A / $ 17.50 *added 8-1-15
83970 /

Parathormone (PTH)

/

N/A

/ $ 15.00
86747 /

Parvovirus B19, IgG & IgM Antibodies

/

N/A

/ $ 175.00 *added 2-1-12
84100 / Phosphorous / N/A / $ 2.00 *changed 8-1-15
84132 / Potassium ( Serum) / N/A / $ 2.00 *changed 8-1-15
84144 / Progesterone (Assay Progesterone) / N/A / $ 52.00 *added 3-1-12
84146 / Prolactin / N/A / $ 8.50 *changed 8-1-15
85610 / Prothrombin Time / N/A / $ 5.00
84165 / Protein Electrophoresis, Serum / N/A / $ 12.50 *added 2-1-11
84166 / Protein Electrophoresis, Urine, Random / N/A / $ 69.00 *added 2-1-11
84155 / Protein, Total Serum / N/A / $ 2.00 *changed 8-1-15
84156 / Protein, Urine / N/A / $ 4.00
84153 /

PSA Only

/

N/A

/ $ 5.50 *changed 8-1-15
84152 / PSA Complex with Total & Free / N/A / $ 59.00 *added 9-1-13
85610 / PT / N/A / $ 5.00
85730 / PTT / N/A / $ 5.00
86480 / Quantiferon Gold Test / N/A / $ 69.00 *changed 8-1-15 *TB pts = Free
86317 / Rabies Titer / N/A / $ 39.50 *changed 8-1-15
80069 / Renal Function Panel / N/A / $ 3.00 *changed 8-1-15
80069/ + / Renal Profile w/GFR add to 80069 +
if Male 24291/if Female 24292 / N/A / $ 3.00 *added 8-1-15
85045 / Reticulocyte Count / N/A / $ 10.00 *changed 8-1-15
86901 / RH Type / N/A / $ 2.00 *added 8-1-15
86431 / Rheumatoid Factor (RA Factor) / N/A / $ 6.50 *changed 8-1-15
86757 / Rickettsia (Rocky Mt. Spotted Fever)IgG,IgM / N/A / $ 121.00 *added 5-1-11
86762 / Rubella Titer / N/A / $ 3.50 *changed 8-1-15
86765 / Rubeola Measles AB-IGG / N/A / $ 7.00 *changed 8-1-15
85652 / Sed Rate-RBC (Automated) / N/A / $ 2.50 *changed 8-1-15
84295 / Sodium / N/A / $ 2.00 *added 8-1-15
87046 / Stool Culture / N/A / $ 21.00 *added 9-1-15
87880 / Strep Screen / N/A / $ 50.00 *added 8-1-15
80156 / Tegretol / N/A / $ 11.25 *added 2-1-13 for Solstas
84481 / T3 Free / N/A / $ 2.50 *added 8-1-15
84480 / T3-Total / N/A / $ 2.50 *added 8-1-15
84436 / T4 (&T4 Total) / N/A / $ 2.50 *added 8-1-15
84402 / Testosterone / N/A / $ 14.00 *changed 8-1-15
84403 / Testosterone Total / N/A / $ 10.00 *changed 8-1-15
84402/84403 / Testosterone Free & Total / N/A / $ 24.00 *changed 8-1-15
86800 / Thyroglobulin Antibody / N/A / $ 35.00 *added 5-1-13
86376 / Thyroid Peroxidase (TPO) Antibody / N/A / $ 35.00 *added 5-1-13
84479 / Thyroid Panel w/TSH / N/A / $ 12.50 *changed 8-1-15
84478 / Triglyceride / N/A / $ 2.00 *added 8-1-15
84443 / TSH Only / N/A / $ 12.50
84550 /

Uric Acid

/ N/A / $ 2.00 *changed 8-1-15
87086 / Urine Culture & Sensitivity / N/A / $ 7.00 *Based on S/F Scale *changed 8-1-15
84156 / Urine, Total Protein / N/A / $ 4.00 *added 2-1-11
86787 / Varicella Zoster Ab (Antibody) Titer / N/A / $ 7.50 *changed 8-1-15
82607 / Vitamin B-12 / N/A / $ 5.50 *changed 8-1-15
82306 / Vitamin D (25-Hydroxy) / N/A / $ 25.00 *changed 8-1-15

LAB CORP

82340 / 24 Hour Urine (Calcium)***(Based on / N/A / $ 20.00 ***(Based on sliding fee scale)
82575 / 24 Hour Urine (Creatinine)*** sliding fee / N/A / $ 10.00 ( Which includes these 3 tests
84155 / 24 Hour Urine (Protein) *** scale) /

N/A

/ $ 15.00 that equal $ 45 total)

CHAPEL HILL

82105 /

AFP

/ N/A / N/A