88272 Cytogenetics 3-5 $ 65.65 88273 Cytogenetics 10-30 $ 78.79 88274 Cytogenetics 25-99 $ 85.36 88275 Cytogenetics 100-300 $ 98.46 88280 Chromosome karyotype study $ 61.54 88283 Chromosome banding study $ 168.21 88285 Chromosome count additional $ 46.58 88289 Chromosome study additional $ 84.44 88371 Protein western blot tissue $ 54.45 88372 Protein analysis w/probe $ 48.44 88720 Bilirubin total transcut $ 12.29 88738 Hgb quant transcutaneous $ 12.29 88740 Transcutaneous carboxyhb $ 12.29 88741 Transcutaneous methb $ 12.29 89050 Body cell count $ 10.42 89051 Body fluid cell count $ 13.50 89055 Leukocyte assessment fecal $ 10.48 Exam synovial fluid crystals $ 17.55 89125 Specimen fat stain $ 10.58 89160 Exam feces for meat fibers $ 8.73 89190 Nasal smear for eosinophils $ 8.73 89300 Semen analysis w/huhner $ 21.89 QW analysis w/huhner $ 21.89 89310 analysis w/count $ 15.59 Semen anal vol/count/mot $ 29.54 89321 Semen anal sperm detection $ 29.54 89321 QW anal sperm detection $ 29.54 anal strict criteria $ 38.00 89325 Sperm antibody test $ 19.12 89329 Sperm evaluation test $ 51.41 89330 Evaluation cervical mucus $ 24.26 89331 Retrograde ejaculation anal $ 48.04 0006M Onc hep gene risk classifier $ - 0007M Onc gastro 51 gene nomogram $ - 0008M Onc breast risk score $ 6,154.96 0009M Fetal aneuploidy trisom risk $ - 0010M Onc prostate prob score $ - Auto.Test Pricing Code, 1-2 Tests $ 12.78 Auto.Test Panel Pricing Code, 3 Tests $ 16.29 ATP04 Auto.Test Panel Pricing Code, 4 Tests $ 17.19
88272 $ 65.65 Cytogenetics 3-5 88273 $ 78.79 Cytogenetics 10-30 88274 $ 85.36 Cytogenetics 25-99 88275 $ 98.46 Cytogenetics 100-300 88280 $ 61.54 Chromosome karyotype study 88283 $ 168.21 Chromosome banding study 88285 $ 46.58 Chromosome count additional 88289 $ 84.44 Chromosome study additional 88371 $ 54.45 Protein western blot tissue 88372 $ 48.44 Protein analysis w/probe 88720 $ 12.29 Bilirubin total transcut 88738 $ 12.29 Hgb quant transcutaneous 88740 $ 12.29 Transcutaneous carboxyhb 88741 $ 12.29 Transcutaneous methb 89050 $ 10.42 Body cell count 89051 $ 13.50 Body fluid cell count 89055 $ 10.48 Leukocyte assessment fecal $ 17.55 Exam synovial fluid crystals 89125 $ 10.58 Specimen fat stain 89160 $ 8.73 Exam feces for meat fibers 89190 $ 8.73 Nasal smear for eosinophils 89300 $ 21.89 Semen analysis w/huhner QW $ 21.89 analysis w/huhner 89310 $ 15.59 analysis w/count $ 29.54 Semen anal vol/count/mot 89321 $ 29.54 Semen anal sperm detection 89321 QW $ 29.54 anal sperm detection $ 38.00 anal strict criteria 89325 $ 19.12 Sperm antibody test 89329 $ 51.41 Sperm evaluation test 89330 $ 24.26 Evaluation cervical mucus 89331 $ 48.04 Retrograde ejaculation anal 0006M $ - Onc hep gene risk classifier 0007M $ - Onc gastro 51 gene nomogram 0008M $ 6,154.96 Onc breast risk score 0009M $ - Fetal aneuploidy trisom risk 0010M $ - Onc prostate prob score $ 12.78 Auto.Test Pricing Code, 1-2 Tests $ 16.29 Auto.Test Panel Pricing Code, 3 Tests ATP04 $ 17.19 Auto.Test Panel Pricing Code, 4 Tests
Rule_18_Exhibit_8_2017.docx