Net Fee Schedule LabCorp Net Fee Schedule VADMHMRSAS ...

[Pages:144]LabCorp Net Fee Schedule VADMHMRSAS Contract RFP720C-04093-07D Period: September 1, 2015 through August 31, 2017

Net Fee Schedule 0493 - 15/17 Price List

**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 general guidelines and should not be used without confirming with the applicable payor that their use is appropriate in each case.

LabCorp

Test

Number

LabCorp Test Name

Stat Fees:

099895 Stat Fee (normal hours)

270466 Stat Service (normal hours)

900414 STAT Fee (after hours)

990895 STAT Fee (normal hours)

998074 STAT (normal hours)

998492 STAT Fee (normal hours)

998591 STAT Charge (normal hours)

Courier Fees:

998120 Courier Charge

Draw Fees:

099812 Drawing Fee

996660 Drawing Fee

998085 Venipuncture

998205 Vendor Phlebotomy Fee

998542 Drawing Fee

999326 Offsite Venipuncture Multi Pt

995407 Hourly Phlebotomy Coverage Fee (>72 Hours Notice)

Reference Testing Fees: 480848 %fPSA Reflex 071175 071175 7 Drug-Unb 071910 071910 7 Drug-Scr 072306 072306 7+Alc-Scr 074021 074021 9 Drug-Scr 070340 17-OH P/Creat Ratio, Urine 070085 17-OH Progesterone LCMS 504115 25-Hydroxyvitamin D LCMS D2+D3 001701 5' Nucleotidase 316205 5-HIAA Qn,Random Urine 004069 5-HIAA,Quant.,24 Hr Urine 716159 6-Acetylmorphine, Conf 704411 704411 5 Drug-Unbund 725788 725788 7 Drug-Unbund 726778 726778 7+Alc-Unbund 733339 733339 10+Alc-Scr 733690 733690 12+Oxycodone+Crt-Scr 733692 733692 9+Oxycodone+Crt-Scr 733694 733694 9+Alc+Crt-Scr

Comments

Charge for each hour phleb service provided where notice >72

hours and not regularly scheduled. This charge is in addition to the per collection or draw fee referenced above.

2015 CPT Code**

99199 99199 99199 99199 99199 99199 99199

99199

36415 36415 36415 36415 36415 36415

36415

84154 80301 80301 80301 80301 83498, 82570 83498 82306 83915 83497, 82570 83497 80356 80301 80301 80301 80301 80301, 80302 (x3) 80301 80301

Page 1 of 144

Directory

ATB

RFP of Services Discountable

Test Test

Test

2015 Book Price

2015 Book Price Less 65% ATB

Special Price

Net Fee

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$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 $12.00

$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

Y

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$6.00

$6.00

$6.00

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$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 $20.00

N

N

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Y

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$24.00

$24.00

$55.42

$55.42

$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

$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

$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 $11.25

LabCorp Net Fee Schedule VADMHMRSAS Contract RFP720C-04093-07D Period: September 1, 2015 through August 31, 2017

Net Fee Schedule 0493 - 15/17 Price List

**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 general guidelines and should not be used without confirming with the applicable payor that their use is appropriate in each case.

LabCorp Test

Number 733726 733848 734349 734351 734352 734353 737921 763824 764227 764883 764888 764928 765000 765204 765507 768431 770628 772111 772236 788243 788423 788583 788878 788941 789034 789888 790034 791742 794388 799007 799452 883001 T83001 883041 883042 T83041 T83042 P83051 P83052 P83053 P83054 P83055 P83056 P83057 P83058

LabCorp Test Name 733726 13+Oxycodone+Crt-Scr 733848 9+Alc+Crt-Scr 734349 3 Drug-Scr 734351 5 Drug-Scr 734352 6 Drug-Scr 734353 7 Drug-Scr 737921 12+Oxycodone+Crt-Unbund 763824 12+Oxycodone+Crt-Unbund 764227 9+Oxyco+Crt-Unbund 764883 11+Oxyco+Alc+Crt-Bund 764888 10+Oxyco+Alc+Crt-Bund 764928 11+Oxycodone+Crt-Bund 765000 11+Oxyco+Alc+Crt-Bund 765204 15+Oxyco-Bund+Bup-Scr 765507 9+MDMA+Oxyco+Crt-Bund 768431 10+Oxycodone+Crt-Bund 770628 7 Drug-Scr 772111 9+Alc+Crt-Scr 772236 8+Alc-Scr 788243 10+Alc-Bund 788423 7 Drug-Bund 788583 10+Crt-Bund 788878 9+MDMA-Bund 788941 7+MDMA-Bund 789034 7+Crt-Bund 789888 6+MDMA+Crt-Bund 790034 9+MDMA+Crt-Bund 791742 10+Oxycodone+Alc-Bund 794388 7 Drug-Bund 799007 7 Drug-Bund 799452 5 Drug-Bund 88300 Surgical Pathology 88300 Tech Comp-1st Site 88304 Surgical Path-1st Site 88304 Surgical Path-2nd Site 88304 Tech Comp-1st Site 88304 Tech Comp-2nd Site 88305 Prof Comp-1st Site 88305 Prof Comp-2nd Site 88305 Prof Comp-3rd Site 88305 Prof Comp-4th Site 88305 Prof Comp-5th Site 88305 Prof Comp-6th Site 88305 Prof Comp-7th Site 88305 Prof Comp-8th Site

Comments

2015 CPT Code** 80301, 80302 (x3)

80301 Test Not Coded

80301 Test Not Coded Test Not Coded 80301, 80302 (x3), 80346 80301, 80302 (x3) 80301, 80346 80301, 80302 (x2) 80301, 80302 80301, 80302 (x3), 80346 80301, 80302 (x2) 80301, 80302 (x4), 80304

80301 80301, 80302

80301 80301 80301 80301 80301 80301 80301 80301 80301 Test Not Coded 80301 80301, 80302 80301 80301 80301 88300 88300 TC 88304 88304 88304 TC 88304 TC 88305 26 88305 26 88305 26 88305 26 88305 26 88305 26 88305 26 88305 26

Page 2 of 144

Directory

ATB

RFP of Services Discountable

Test Test

Test

Y

Y

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2015 Book Price $205.00 $90.50 $37.00 $50.00 $56.50 $63.00 $301.75 $198.00 $255.00 $196.00 $190.00 $313.50 $196.50 $308.00 $158.50 $185.50 $63.00 $88.00 $81.50 $106.75 $66.00 $109.00 $92.50 $71.50 $71.50 $79.00 $98.50 $171.50 $73.00 $73.00 $60.00 $40.00 $31.25 $102.75 $102.75 $80.75 $80.75 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00

2015 Book Price Less 65% ATB

$205.00 $90.50 $37.00 $50.00 $56.50 $63.00 $301.75 $198.00 $255.00 $196.00 $190.00 $313.50 $196.50 $308.00 $158.50 $185.50 $63.00 $88.00 $81.50 $106.75 $66.00 $109.00 $92.50 $71.50 $71.50 $79.00 $98.50 $171.50 $73.00 $73.00 $60.00 $40.00 $31.25 $102.75 $102.75 $80.75 $80.75 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00

Special Price

$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 $20.58

Net 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

LabCorp Net Fee Schedule VADMHMRSAS Contract RFP720C-04093-07D Period: September 1, 2015 through August 31, 2017

Net Fee Schedule 0493 - 15/17 Price List

**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 general guidelines and should not be used without confirming with the applicable payor that their use is appropriate in each case.

LabCorp Test

Number 883051 883052 883053 883054 883055 883056 883057 883058 T83051 T83052 T83053 T83054 T83056 T83057 T83058 883071 883072 883073 T83071 T83072 T83121 114041 006056 006049 007740 086007 085902 183753 183764 004440 006643 117762 017422 W20321 P20321 T20321 010447 788890 182261 008649 180803 088161 182675 182402 017319

LabCorp Test Name 88305 Surg Path-1st Site 88305 Surg Path-2nd Site 88305 Surg Path-3rd Site 88305 Surg Path-4th Site 88305 Surg Path-5th Site 88305 Surg Path-6th Site 88305 Surg Path-7th Site 88305 Surg Path-8th Site 88305 Tech Comp-1st Site 88305 Tech Comp-2nd Site 88305 Tech Comp-3rd Site 88305 Tech Comp-4th Site 88305 Tech Comp-6th Site 88305 Tech Comp-7th Site 88305 Tech Comp-8th Site 88307 Surgical Pathology 88307 Surgical Pathology 88307 Surgical Pathology 88307 Tech Comp-1st Site 88307 Tech Comp-2nd Site 88312 Tech Comp-1st Stain Ab Scr+Antibody ID ABO Grouping ABO Grouping and Rho(D) Typing Acetaminophen (Tylenol), S Acetylcholine Receptor Ab, All AChR Binding Abs, Serum Acid Fast Smear+Culture Acid Fast Smear+Culture W/Rflx ACTH, Plasma Actin (Smooth Muscle) Antibody Activated Protein C Resistance Add On: hCG,uE3,Inhibin Add'l IHC Per Slide X1 Glbl Add'l IHC Per Slide X1 Prof Add'l IHC Per Slide X1 Tech ADH Adulteration (Dilution), Urine Aerobe ID + Suscept Aerobic Bacterial Culture Aerobic Cult, Extend Incubat AFB Antibiotic Suscep AFB Cult/Smear, Broth, Suscep AFB Culture and Smear,Broth AFP Tetra

Comments

2015 CPT Code** 88305 88305 88305 88305 88305 88305 88305 88305

88305 TC 88305 TC 88305 TC 88305 TC 88305 TC 88305 TC 88305 TC

88307 88307 88307 88307 TC 88307 TC 88312 TC 86870 86900 86900, 86901 80329 83519 (x3) 83519 87206, 87116 87206, 87116 82024 83516 85307 84702, 82677, 86336 Test Not Coded Test Not Coded Test Not Coded 84588 Test Not Coded 87077 87070 87073 87190 (x4) 87081, 87149 87116, 87206, 87015 82105, 82677, 84702, 86336

Page 3 of 144

Directory

ATB

RFP of Services Discountable

Test Test

Test

Y

N

N

Y

N

N

Y

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Y

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Y

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Y

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2015 Book Price $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 $260.50 $260.50 $260.50 $132.25 $132.25 $78.50 $87.00 $30.25 $60.25 $98.25 $700.50 $259.75 $132.00 $132.00 $171.75 $98.50 $135.00 $267.00 $100.00 $65.00 $35.00 $233.00 $8.00 $82.75 $65.25 $65.25 $323.50 $163.25 $163.25 $348.75

2015 Book Price Less 65% ATB

$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 $260.50 $260.50 $260.50 $132.25 $132.25 $78.50 $87.00 $10.59 $21.09 $98.25 $700.50 $259.75 $132.00 $132.00 $171.75 $98.50 $135.00 $267.00 $100.00 $65.00 $35.00 $233.00

$8.00 $82.75 $65.25 $65.25 $323.50 $163.25 $163.25 $348.75

Special Price

$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 $36.64

Net 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

LabCorp Net Fee Schedule VADMHMRSAS Contract RFP720C-04093-07D Period: September 1, 2015 through August 31, 2017

Net Fee Schedule 0493 - 15/17 Price List

**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 general guidelines and should not be used without confirming with the applicable payor that their use is appropriate in each case.

LabCorp Test

Number 141300 010801 002253 480012 480300 096354 007351

LabCorp Test Name AFP with AFP-L3% AFP, Serum, Open Spina Bifida AFP, Serum, Tumor Marker AFP, Tumor Marker (Serial) AFP-L3% (Serial Monitor) ALA Delta, 24-Hour Urine ALA Delta, Random Urine

375268 001909 001081 002030 004374 004291 004354 001612 513160 513002 480004 001107 600973 660423 648014 601013 601872 600999 602284 601856 649749 062448 672486 062695 601831 601823 602421 607523 602292 670797 671926 672208 672489 603203 676528 676536 082553

Alb+AST+Fe+Prot+PT+Plt Alb+Prot Albumin, Serum Aldolase Aldosterone LCMS, Serum Aldosterone, Urine Aldosterone/Renin Ratio Alk Phos Isoenzyme Alk Phosphatase, Bone Specific Alk Phosphatase, Bone Specific Alkaline Phosphatase (Serial) Alkaline Phosphatase, S Allergen Panel, Food-Berry Allergen Profile, Basic Food Allergen Profile, Food-Basic Allergen Profile, Food-Fish Allergen Profile, Food-Fruit Allergen Profile, Food-Legume Allergen Profile, Food-Meat Allergen Profile, Food-Milk Allergen Profile, Mini-Panel Allergen Profile, Mold Allergen Profile, Ragweed Plus Allergen Profile, Shellfish Allergen Profile, Vegetable I Allergen Profile, Vegetable II Allergens (4) Foods Allergens(10) Allergens(4) Allergens(5) Allergens(7) Allergens(9) Allergens(9) Allergens(92) Foods Allergens, Zone 2 Allergens, Zone 3 Allyl Alcohol, Blood

Comments

2015 CPT Code** 82107 82105 82105 82105 82107 82135 82135

85049, 85610, 84155, 82040, 84450, 83540 82040, 84155 82040 82085 82088 82088 82088, 84244 84080, 84075 84080 84080 84075 84075 86003 (x3)

86003 (x9), 86005 86003 (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) 84600

Page 4 of 144

Directory

ATB

RFP of Services Discountable

Test Test

Test

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2015 Book Price $257.25 $81.75 $76.25 $99.25 $280.25 $198.25 $198.25

2015 Book Price Less 65% ATB

$257.25 $81.75 $26.69 $34.74 $280.25 $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 $575.75

Special Price

$83.14 $12.20 $8.87 $19.68

$71.24 $48.50

Net Fee $83.14 $12.20 $8.87 $19.68

$280.25 $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 $402.22

$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

LabCorp Net Fee Schedule VADMHMRSAS Contract RFP720C-04093-07D Period: September 1, 2015 through August 31, 2017

Net Fee Schedule 0493 - 15/17 Price List

**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 general guidelines and should not be used without confirming with the applicable payor that their use is appropriate in each case.

LabCorp Test

Number

LabCorp Test Name

347692 AlP+ALT+AST+Creat+Glu+TBili...

332158 AlP+ALT+AST+Creat+TBili+Uri...

315865 001982 511172 001545

AlP+ALT+AST+TBili+Uric A+CB... Alpha-1-Antitrypsin, Serum Alpha-Thalassemia ALT (SGPT)

316566 257451 071548 071555 031138 717330 700068 700140 706705 007476 007054 791588 071282 074401 737693 737892 707013 027094 001396 003293 341776 165092 164962 164863

ALT+AST+Creat+Uric A+Hgb+Plt ALT+AST+TBili Aluminum, Plasma/Serum Aluminum, Urine Amenorrhea Profile Amikacin , Serum, Peak/Trough Amino Acid Profile, Qn, Plasma Amino Acid Profile, Qn, Urine Amiodarone (Cordarone), Serum Amitriptyline (Elavil), Serum Ammonia, Plasma Amphetamine Analysis, WB Amphetamine Confirmation, Ur Amphetamine Screen, Urine Amphetamine, Urine Amphetamines (GC/MS), Urine Amphetamines Confirm, Urine Amy+Lipase Amylase, Serum Amylase, Urine ANA ANA Comprehensive Panel ANA w/Reflex ANA w/Reflex if Positive

368894 024141 008003 008900 008904 183111 009160 163873 030577

ANA+ENA+C3+C4+DNA/DS+Card(I... ANA+RA Qn Anaerobic and Aerobic Culture Anaerobic Cult, Extend Incubat Anaerobic Culture Anaerobic/Aerobic/Gram Stain Anal(Rectal) Cytology, LBP ANCA Panel Anemia Profile A

Comments

2015 CPT Code** 85027, 82947, 84550, 82565, 82247, 84075, 84450, 84460 85027, 84550, 82565, 82247,

84075, 84450, 84460 85027, 82247, 84075, 84450,

84460, 84550 82103 81257 84460

85018, 85049, 84550, 82565, 84450, 84460

82247, 84450, 84460 82108

82108, 82570 83001, 83002, 84146

80150 (x2) 82139 82139 80299 80335 82140 80301 80324 80301 80301 80324

Test Not Coded 82150, 83690

82150 82150 86038 86225, 86235 (x8) 86038 86038 86038, 86147 (x3), 86160 (x2), 86225, 86235 (x4) 86038, 86431 87070, 87075 87073 87075 87070, 87075, 87205 88112 86256 (x3), 83520 (x2) 83550, 85025, 85045, 83540

Directory RFP of Services Test Test

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ATB Discountable

Test

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Y Y N N Y Y N N N N Y N N N N N N Y Y Y Y N Y Y

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2015 Book Price

2015 Book Price Less 65% ATB

$55.50

$19.43

$46.25

$16.19

$45.75 $72.50 $450.00 $27.00

$16.01 $25.38 $450.00 $9.45

$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

$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

Special Price

Net Fee

$4.70

$4.70

$4.58

$4.58

$4.46 $6.66 $461.25 $1.75

$4.46 $6.66 $461.25 $1.75

$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 $4.17

$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

Page 5 of 144

LabCorp Net Fee Schedule VADMHMRSAS Contract RFP720C-04093-07D Period: September 1, 2015 through August 31, 2017

Net Fee Schedule 0493 - 15/17 Price List

**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 general guidelines and should not be used without confirming with the applicable payor that their use is appropriate in each case.

LabCorp Test

Number

LabCorp Test Name

042077 010116 082024 006023 006213 006015 161950 161836 161810 161802 161828 164814 012580 160154 046557 161422 096289 096339 160151 006338 012518 163840 085910 162388 164880 164855 164947 160721 006486 250555 163857 018705 160158 006031 015040 015594 006692 500555 216010 167015 117199 809671 112185 001123

Anemia Profile B Angiotensin-Converting Enzyme Antiadrenal Antibodies, Quant Antibody Identification Antibody Identification Antibody Screen Anticardiolip Ab, IgA/G/M, Qn Anticardiolipin Ab, IgA, Qn Anticardiolipin Ab, IgG, Qn Anticardiolipin Ab, IgG/M, Qn Anticardiolipin Ab, IgM, Qn Anti-Centromere B Antibodies Antichromatin Antibodies Antichromatin Antibodies Antidiuretic Hormone Profile Anti-DNA(SS)IgG, Ab, Qn Anti-DNase B Strep Antibodies Anti-dsDNA Antibodies Anti-dsDNA Antibodies Antiextractable Nuclear Ag Antihistone Antibodies Antimyeloperoxidase (MPO) Abs Antimyocardial Antibodies, Qn Antineutrophil Cytoplasmic Ab Antinuclear Ab Reflex Cascade Antinuclear Antibodies Direct Antinuclear Antibodies, IFA Antipancreatic Islet Cells Antiparietal Cell Antibody Antiphospholipid Syndrome Prof Antiproteinase 3 (PR-3) Abs Antiscleroderma-70 Antibodies Antiscleroderma-70 Antibodies Antistreptolysin O Ab Antithrombin Activity Antithrombin III, Func/Immunol Antithyroglobulin Ab Anti-Thyroglobulin Antibodies Apo A1 + B + Ratio Apolipoprotein B aPTT Mixing Studies Aripiprazole Arterial Blood Gas AST (SGOT)

Comments

2015 CPT Code** 82607, 82728, 82746, 83550,

85025, 85045, 83540 82164 86255 86870 86870 86850

86147 (x3) 86147 86147

86147 (x2) 86147 86235 86235 86235

83930, 84588 86226 86215 86225 86225

86235 (x2) 86235 83520

86256 (x2) 86256 (x3)

86038 86038 86038 86341 83516 85613, 85732, 86147 (x2) 83520 86235 86235 86060 85300 85300, 85301 86800 86800 82172 (x2) 82172 85730, 85732 (x3) 80342 82803 84450

Page 6 of 144

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2015 Book Price

2015 Book Price Less 65% ATB

$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 $27.00

$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 $9.45

Special Price

Net Fee

$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 $1.75

$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

LabCorp Net Fee Schedule VADMHMRSAS Contract RFP720C-04093-07D Period: September 1, 2015 through August 31, 2017

Net Fee Schedule 0493 - 15/17 Price List

**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 general guidelines and should not be used without confirming with the applicable payor that their use is appropriate in each case.

LabCorp Test

Number 006981 811338 164541 006890 180812 180060 071290 074419 814483 163162 164075 303758 322758 791710 071308 074427 763910 764060 798419 008169 252823 163915 010181 010173 503610 010330 003228 205500 001222 001099 001214 826700 791706 008300 005702 791570 791590 850601 335362 322458 180802 009134 164608 164624 140889

LabCorp Test Name Autoimmune Profile Azathioprine (Imuran) B pertussis IgG/M/A Ab Bacterial Antigens Bacterial Antigens Bacterial Vaginosis, NAA Barbiturate Confirmation, Ur Barbiturate Screen, Urine Bartonella + Bact. Aerobic Bartonella Antibody Panel Bartonella henselae IgG/M Basic Metabolic Panel (7) Basic Metabolic Panel (8) Benzodiazepine Confirm, QT, WB Benzodiazepine Confirmation,Ur Benzodiazepine Screen, Urine Benzodiazepines Confirm, Urine Benzodiazepines Confirm, Urine Benzodiazepines GC/MS Retest Beta Strep Gp A Culture Beta Thalassemia: HBB Beta-2 Glycoprotein I Ab,G,A,M Beta-2 Microglobulin, Serum Beta-2 Microglobulin, Urine Beta-Hydroxybutyrate Bile Acids Bile, Qualitative, Urine Bilirubin Fraction, Neonatal Bilirubin, Direct Bilirubin, Total Bilirubin, Total/Direct, Serum Black Bean IgE Bld Drugs of Abuse, 7, WB Blood Culture, Routine Blood Drawing Blood Drugs of Abuse 6, WB Blood Drugs of Abuse 8, WB Blood-SMR,Periph;Int/Phy 1st BMP8+eGFR BMP8+LP+1AC+Hb A1c Body Fluid Culture, Sterile Breast Discharge Cytology Brucella Antibody IgG, EIA Brucella Antibody IgM, EIA B-Type Natriuretic Peptide

Comments

2015 CPT Code** 86038, 86160, 86225

80375 86615 (x3) 87802, 87899 (x3) 87802, 87899 (x3) 87798, 87798 59 (x2)

80345 80301 87070 86611 (x4) 86611 (x2) 80051, 82565, 82947, 84520 80048 80347, 82742 80346 80301 80346 80346 80346 87081 81404 86146 (x3) 82232 82232 82010 82239 81005 82247, 82248 82248 82247 82247, 82248 86003 80301 87040 36415 80301 80301 85060 80048 80048, 80061, 83036, 84450 87070 88161 86622 86622 83880

Page 7 of 144

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2015 Book Price $206.00 $180.00 $398.25 $602.00 $602.00 $270.00 $119.50 $24.00 $153.00 $216.00 $216.00 $30.00 $30.50 $314.50 $119.50 $24.00 $119.50 $119.50 $183.75 $37.25 $735.00 $255.00 $104.50 $125.25 $82.00 $67.75 $37.25 $27.50 $27.00 $27.00 $27.50 $48.50 $302.50 $63.50 $20.00 $227.50 $289.50 $84.50 $30.50 $153.75 $89.75 $113.50 $80.00 $80.00 $183.75

2015 Book Price Less 65% ATB

$206.00 $180.00 $398.25 $602.00 $602.00 $270.00 $119.50 $24.00 $153.00 $216.00 $216.00 $10.50 $10.68 $314.50 $119.50 $24.00 $119.50 $119.50 $183.75 $37.25 $735.00 $255.00 $104.50 $125.25 $82.00 $67.75 $13.04

$9.63 $9.45 $9.45 $9.63 $48.50 $302.50 $63.50 $20.00 $227.50 $289.50 $84.50 $10.68 $53.81 $89.75 $113.50 $80.00 $80.00 $183.75

Special Price

$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 $36.58

Net 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

LabCorp Net Fee Schedule VADMHMRSAS Contract RFP720C-04093-07D Period: September 1, 2015 through August 31, 2017

Net Fee Schedule 0493 - 15/17 Price List

**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 general guidelines and should not be used without confirming with the applicable payor that their use is appropriate in each case.

LabCorp Test

Number 001040 024778 764400 761153 763400 764130 220955

LabCorp Test Name BUN BUN+Creat Buprenorphine Confirm, Urine Buprenorphine, Urine Buprenorphine, Urine Buprenorphine, Urine Burkholderia Pseudom. Ab, IFA

182725 182717 182709 180055 188045 183988 086207 180448 183620 067108 067116 120220 123014 033852 144733 480061 483404 002261 140293 480293 004945 054601 004895 081091 003269 004804 013706 001016 058099 120790 120691 123255 180141 002303 143404 180033 180010

BV+Ct/Ng/Tv NAA+Yeast Culture BV+Trich NAA+Yeast Culture BV+Yeast Culture C albicans + C glabrata, NAA C difficile Toxigenic Culture C difficile Toxin Gene NAA C difficile Toxins A+B, EIA C difficile, Cytotoxin B C. trachomatis NAA, Confirm C001-IgE Penicillin G C002-IgE Penicillin V C1 Esterase Inhibitor, Func C3d Immune Complexes C4+C3 CA 125 in the Presence of HAMA CA 125, Serum (Serial) CA 15-3 (Serial Monitor) CA 19-9 CA 27.29 CA 27.29 (Serial Monitor) Ca+Creat+P+PTH Intact Ca+PTH Intact Calcitonin, Serum Calcitriol(1,25 di-OH Vit D) Calcium, 24Hr Urine Calcium, Ionized, Serum Calcium, Random Urine Calcium, Serum Calcium+Calcium, Ionized Calculi, Urinary Calculi, Urinary, with Photo Calprotectin, Fecal Campylobacter Culture Cancer Antigen (CA) 125 Cancer Antigen (CA) 15-3 Candida 4 Species Profile, NAA Candida 6 Species Profile, NAA

Comments

2015 CPT Code** 84520

82565, 84520 80348 80301 80301 80301

86609 (x2) 87905, 87102, 87491, 87591,

87661 87905, 87102, 87661

87905, 87102 87481, 87481 59

87075 87493 87324 87230 87491 59 86003 86003 86161 86332 86160 (x2) 86304 86304 86300 86301 86300 86300 83970, 82310, 82565, 84100 83970, 82310 82308 82652 82340 82330 82340 82310 82330, 82310 82360 82360 83993 87046 86304 86300 87481 (x4) 87481, 87481 59 (x5)

Page 8 of 144

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2015 Book Price $27.00 $27.50 $119.50 $58.00 $58.00 $60.00 $251.25

2015 Book Price Less 65% ATB

$9.45 $9.63 $119.50 $58.00 $58.00 $60.00 $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 $607.50

Special Price

$1.75 $1.95 $48.52 $17.43 $20.49 $17.73 $215.67

Net 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

$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 $156.00

$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

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