the Directory of Services

Transcription

3520 Progress Drive, Suite C
Bensalem, PA 19020
Phone: 267-525-2470
Toll Free: 866-465-6763
Fax: 267-525-2488
www.adllab.net
TABLE OF CONTENTS
Section
Page
Licenses/Certifications .......................................................... 1
Technical Staff ...................................................................... 2
Contacts/Telephone Extensions............................................ 3
Policies/Procedures .............................................................. 4
Requisition Instructions ........................................................ 5
Test/Diagnosis Code Add on Form ....................................... 6
GC/Chlamydia Procedures ................................................... 7
Blood Culture Procedures ..................................................... 9
ADL Reference and Critical Range ..................................... 10
Panel Test Listing .............................................................. 11
Individual Test Listing.......................................................... 29
Licenses/Certifications
Certifications:
- College of American Pathologist- CAP
Licenses:
- Center for Medicare and Medicaid Services (CMS)
- CLIA
- DEA
- Pennsylvania State License
- New Jersey State License
- Maryland State License
Our main laboratory facility is located in a 21,000+ square foot building in Bensalem, Pennsylvania. We
have state of the art equipment and a qualified and licensed staff.
Atlantic Diagnostic Laboratories provides an extensive line of Clinical Testing Services.
Our testing programs include:
Chemistry
Hematology
Microbiology
Virology
Endocrinology
Immunology
Oncology
Forensic Toxicology
Infectious Diseases
Toxicology
ADL provides services to Physicians Offices, Nursing Homes, Mental and Behavioral Health Clinics &
Hospitals, Drug Rehab Programs, Pain Management and other Health Care Facilities. We also serve as a
reference laboratory for hospitals and national laboratories in the region.
ADL Directory of Services • Page 1
Technical Staff
Harvey J. Bellin, MD, F.A.C.P.
Director of Laboratory
Dr. Bellin is a graduate of Thomas Jefferson Medical College. He is board certified pathologist with over forty four
years of experience in the laboratory field. He has been with ADL for over 15 years.
Aaron Domenico
Operations Manager
Mr. Domenico is a medical technologist with over forty five years of experience in the laboratory field. He has worked
in all aspects of the profession and is the daily manager of ADL.
Carl Selavka, Ph.D, D-ABC
Toxicology Director
Dr. Selavka joined ADL in April of 2014. Dr. Selavka is a board certified criminalists with over twenty-six years of
experience.
Rose Adams, BA, MT (ASCP)
Clinical Laboratory Manager
Ms. Adams is a medical technologist with twenty-eight years of years of experience in the hospital laboratory and
private laboratory field.
Adela Enache, MS, Chemist
Toxicology Manager
Mrs. Enache is a chemist with ten years of experience in clinical chemistry and toxicology.
Doris Zukowski, BS MT (ASCP), Microbiologist
Microbiology Manager
Ms. Zukowski has over 30 years of microbiology experience as well as a lab generalist.
Stephanie Colfer, AS, MLT AMT
Customer Service Manager
Mrs. Colfer is a medical lab technician with 18 years’ experience in the clinical laboratory as a generalist. She joined
ADL in January 2011 and is now using her skills in our Client Service Department.
Karen Domenico
Director Accounts Receivable
Ms. Domenico has over twenty-five years of laboratory billing experience. She manages the daily operations
of all clerical, billing and data entry.
Contacts
Phone:
267-525-2470
Toll Free: 866-465-6763
Fax:
267-525-2488
_______________________________________________________________
Ext. 0:
Client Services
Ext. 202:
Director Accounts Receivable- Karen Domenico
Ext. 204:
Chief Operating Officer- Aaron Domenico
Ext. 205:
Supplies & Logistics- Joel’ Williams
Ext. 206:
Chief Financial Officer: Jim McDevitt
Ext. 207:
Director Client Services- Darin Domenico
Ext. 211:
Microbiology- Doris Zuckowski
Ext. 218:
Clinical Lab Manager- Rose Adams
Ext. 221:
Director- Harvey Bellin, MD, FACP
Ext. 228:
Client Services Manager-Stephanie Colfer
Ext. 254:
Toxicology Manager- Adela Enache
Policies/Procedures
Supplies
All Supplies for the collection of laboratory specimens are provided to clients. Postage mailers are available when
needed. These supplies may be obtained from the main laboratory by using the Supply Request Form and should be
faxed to Client Services at 267-525-2488.
Requisitions
An ADL requisition form must accompany the specimen(s) for each patient. On each requisition form, the patient;
name and all pertinent data must be legibly printed or typed. All tests requests must be checked off, if the test is not
listed on the requisition form please clearly write exactly what testing you need in the additional test area. If you are
ordering a Panel and it is not referenced on your requisition form you must list all the tests in the requested panel.
Regulations require that the referring physician or his/her authorized designee sign the requisition, as well as the
patient. We must receive at least 2 patient identifiers on the form and on the specimen as required by CAP.
Two Identifiers on sample and on request form: (examples)
a.) Patient full first and last name, Date of Birth.
b.) Patient full first and last name, Social Security Number.
c.) Patient Id number (if this is anonymous – this number must match number on request),
Date of Birth.
d.) Patient Id number (if this is anonymous – this number must match number on request),
Social Security Number.
A patient name or ID number if anonymous MUST BE ONE of the identifiers on both the sample, and the request.
REJECTION OF SAMPLE WILL OCCUR IF THE IDENTIFIERS ON
THE SAMPLE DO NOT MATCH THE IDENTIFIERS ON THE REQUISITION FORM.
Specimen Pick up
Atlantic Diagnostic Laboratories' couriers make scheduled specimen pick-ups throughout,
Delaware, Pennsylvania and New Jersey. Call our Courier/ Supplies Department at 267-525-2470 extension 205, to
arrange for pickup of specimens.
Professional Consultation
Our professional staff is available by telephone consultations to answer any questions about test
interpretation, specimen collections and transportation of specimen.
IMPORTANT
Please note that to comply with the federal requirements (CLIA 88) the time and date of the specimen collection
should be clearly added to the request form.
Requisition Instructions
a)
Specimen Date/Date of Collection
b)
Time of Collection
c)
Draw Site (not required)
d)
Patients Full Name
e)
Patients Address
f)
Patient’s Social Security Number
g)
Sex
h)
Date of Birth
i)
Physician: If the Dr’s name is listed check the appropriate box if not write the Dr.’s full
name in the comment section.
j)
ICD-9 Diagnosis code – we will accept either the code or the actual diagnosis spelled out.
Please make sure you are providing the correct diagnosis for the services requested.
k)
Primary Insurance Information:
Client: If your account should be billed check off the Client box.
Medicare: This is usually a 9 digit number with a letter.
Medicaid: We need the patient’s Recipient number.
Blue Shield/Commercial Insurance: It is preferable to send a copy of the front
and back of the patient’s insurance card.
l)
Check off or write in Test Ordered
m) Have Patient or authorized representative of the patient sign the bottom of the form.
n)
Have the Physician or his/her representative sign the form in the Account Information box
in the top left hand corner.
Additional Tests
The laboratory retains serum, urine and whole blood specimens for seven days. Additional testing may be
performed depending on the amount of specimen remaining and specimen stability. Additional tests can be
ordered by completing our ADD TEST form on the next page.
(Please make copies)
ATLANTIC DIAGNOSTIC LABORATORIES, LLC
3520 Progress Drive, Suite C, Bensalem, PA 19020
PHONE: 267-525-2470 FAX: 267-525-2488
TEST & DIAGNOSIS CODE ADD ON REQUEST FORM
Date:
/
/
Client Name:
Dear Client:
The following tests/ICD-9 were verbally added on patient
Accession #:
Date:
/
/
Federal regulations require written authorization on all tests ordered by clients .
Please review, sign and fax this document to ADL at your earliest convenience .
TEST NAME
DIAGNOSIS CODE (5 DIGITS)
1.
1.
2.
2.
3.
3.
4.
4.
Signature of Client’s Authorized Representative:
Printed Name of Client’s Authorized Representative:
FAX THIS FORM TO (267) 525-2488, NO COVER SHEET IS REQUIRED
ATLANTIC DIAGNOSTIC LABORATORIES
GC/Chlamydia Amplified DNA analysis
At present the samples taken for Chlamydia trachomatis and Gonorrhea analysis include urethral and
endocervical swabs, urine samples and vulva swabs. Taking only endocervical swabs from women will
under estimate infection, because urethral infection can occur in the absence of cervical infection. Thus ideally both
urethral and cervical sites need to be investigated. The urethral swab is painful to obtain from both males and
females; the urine sample could alleviate these problems. It is a non-invasive specimen, easily obtained, and
provides sufficient sample for retesting. First-void urine samples have proved an acceptable means of both male and
female chlamydial and Gonorrheal analysis using Probe Tec DNA amplification assays.
ADL uses BD Probe ET real time DNA amplification assay for the detection of GC and CT.
Specimen Collection, Storage and Transport
GC/Chlamydia Amplified DNA analysis
Specimen collection procedure
The Probe Tec ET system is designed to detect the presence of Chlamydia trachomatis and
Neisseria gonorrhea in endocervical swabs, male urethral swabs and male and female
urine specimens
The devices which have been validated for collection swab specimen are:
• BD probe Tec CT/GC Collection kit for endocervical specimens
• BD Probe Tec CT/GC collection kit for male urethral specimens.
• Urine can be collected in a sterile, plastic urine, preservative free container or
can be collected in BD Probe Tec urine processing kit (UPT)
Specimen collection swabs in the form of endocervical and male urethral specimen swab collection kit are supplied
by the laboratory.
Endocervical swab collection procedure
1. Remove excess mucus from the cervical OS with large tipped cleaning swab provided in
the kit and discard.
2. Insert the endocervical collection and dry transport swab into the cervix canal and rotate
for 15-30 seconds.
3. Withdraw the swab carefully and place the swab into transport tube and label the tube
Male urethral swab collection procedure
1. Insert the male urethral collection swab 2-4 cm into the urethra and rotate 3-5 seconds
2. Withdraw the swab and place it into the transport tube.
Urine samples for Amplified DNA analysis
1. Patient should not have urinated at least one hour prior to collection.
2. Collect specimen in a sterile, plastic, preservative free specimen collection cup.
3. The patient should collect the first 15- 29 ml of voided urine.
4. Label the specimen with patients name and I.D
Transport and storage
After the collection the specimens can stored and transported to the laboratory at 2-27o c within 4-6 days.
Do not freeze the urine specimen
Blood Culture
Submit in Blood Culture Bottles Inject at least 5-10 ml of blood into each bottle (Versa Trek Redox) (adult or
pediatric). A maximum of 10 ml per Bottle is recommended. Bottles are FDA cleared to accept as little as 0.1 ml and
still recover the organism if present in sample.
Low Volume Distribution scheme (Adults or Pediatrics)
If you cannot obtain 20 ml of blood, divide the blood as follows:
* >1 ml: divide equally between both the REDOX 1 and REDOX 2 bottles
*< 1 ml but >0.5ml: place 0.5 ml in REDOX 1 bottle and the remainder in REDOX 2 bottle.
* <0.5 ml: put entire specimen in the REDOX 1 bottle.
* Helpful hint: When inoculating bottles, start with REDOX 1 bottle first.
Wipe the venipuncture site with 70 percent alcohol, and then apply two percent Iodine to the site. Allow the
site to dry 1-2 minutes. Before introducing the blood into the bottles, wipe the stopper with two percent iodine.
Allow to dry. Do not vent bottles before transporting to the lab. Send to lab at ambient temperature within 24
hours of collection.
ADL REFERENCE AND CRITICAL RANGES
Dated : 09/02/2009
Test Name
ALBUMIN
ALK PHOSP.
ALT
AST
AMYLASE
AMMONIA
BUN
CALCIUM
CARBAZEPINE
CHLORIDE
CHOLESTEROL
CO2
CREATININE
DIGOXIN
GGT
GLUCOSE
HEMATOCRIT
HEMOGLOBIN
LDH
LITHIUM
MAGNESIUM
PHENOBARBITAL
PHENYTOIN
PHOSPHOROUS
POTASSIUM
PSA
INR
PTT
RBC
ESR
SODIUM
TOT. BILIRUBIN
T3 UPTAKE
T4
THEOPHYLLINE
TOT. PROTEIN
TRIGLYCERIDES
URIC ACID
TSH
VALPROIC ACID
D.BILIRUBIN
WBC
LIPASE
T4 FREE
PROLACTIN
FOLATE
VIT B 12
FERRITIN
PSA
T3 TOTAL
CA 125
AFP
CA 19-9
CEA
Normal Ranges
3.3--5.0
35--150
0--40
0--37
28--100
11--51
5--10
8.5--10.4
4.0--12.0
96--108
<200
24.0--31.0
0.5--1.5
0.5--2.0
7--51
70--110
33-51
11.0--17.4
91--232
0.6--1.2
1.3--2.5
15.0--40.0
10.0--20.0
2.5--4.8
3.5--5.3
0.00--3.0
23.5--35.9
3.8--5.8
0-20
133--145
0.1--1.3
24.3--39.0
4.5--11.4
10.0--20.0
5.9--8.4
50--200
2.7--8.5
0.5-5.0
50.0--100.0
0-0.5
4.5--12.0
8-78
0.87-1.51
1.39--24.2
7.0-15.4
160-970
15-300
0-3.0
0.79--1.49
<35.0
0.0-8.7
<45.1
<2.5
Confirmed in Duplicate Ranges
Low
High
2.0
6.4
4.9
84.0
11.9
0.5
49.0
23.7
7.9
40.0
0.4
0.9
10.0
5.0
2.0
2.9
3.0
115.0
500.0
150.0
150.0
140.0
100.0
80.0
13.4
15.1
116.0
40.1
4.1
2.1
200.0
400.0
57.3
19.9
350.0
1.5
3.0
49.0
30.0
8.5
6.0
51.0
3.0
51.0
6.8
CALL RANGES
Critical Limits
LOW
HIGH
2.0
500
300
300
140
100
100
6.0
13.0
1.0
20.0
80
120
10
0.4
49
7.9
50
6.0
2.1
400
400
0.1
0.9
1.0
1.0
2.0
2.9
19.9
400
1.5
3
50
40
9
6.0
2.99
3
60
6.8
19.0
3.5
5.0
4.5
161.0
4.0
45.0
13.0
30.0
10.0
115
161
4
4.0
3.0
40.0
3.0
10.0
8
10.0
3.0
25
150
2.9
18.1
2.9
18.1
UNITS
G/DL
U/L
U/L
U/L
U/L
UMOL/L
MG/DL
MG/DL
UG/ML
MMOL/L
MG/DL
MMOL/L
MG/DL
NG/ML
U/L
MG/DL
%
G/DL
U/L
MMOL/L
MG/DL
UG/ML
UG/ML
MG/DL
MMOL/L
NG/ML
SECONDS
M/UL
MM/HR
MMOL/L
MG/DL
%
UG/DL
UG/ML
G/DL
MG/DL
MG/DL
Uiu/ml
UG/ML
MG/DL
K/UL
U/L
NG/ML
NG/ML
NG/ML
PG/ML
NG/ML
NG/ML
NG/ML
U/ML
NG/ML
U/ML
NG/ML
PANEL TEST LISTING
PANEL TEST LISTING
TEST #
TEST NAME
SPECIMEN REQUIREMENTS
*CPT
CODE
PRICE
(STATS ARE
2X LIST
PRICE)
* (The CPT codes provided are based on AMA
guidelines and are for informational purposes only.
CPT coding is the sole responsibility of the billing
party. Please direct any questions regarding coding to
the payer being billed.)
8185 ALLERGEN FOOD PANEL- 1
(Clam IgE, Corn (Maize) IgE , Milk IgE, Peant IgE,
Scallop IgE, Sesami Seed IgE, Shrimp IgE, Soyabeen IgE,
Walnut IgE, Wheat IgE)
Testing Performed Weekly
See Lab Report for Reference ranges
2 ml serum (collect specimen in
8603 x 10
tube with gel barrier - wait until
blood is clotted before
centrifuging - centrifuge for 15
minutes and insure that serum is
separated from the blood cells by
the gel barrier)
8185 ALLERGEN FOOD PANEL- 1
(WHOLE EGG, CHICKEN, BEEF, COW MILK, WHITE
POTATO, BEAN, WHEAT, CASIEN)
86001 X
Testing Performed by Reference Lab
10
the gel barrier)
8650 ALLERGEN MOLD PROFILE
8603X5
(Aspergillus Alternata, Apergillus Fumigatus,
Cladosporium Herbarum, Candida Albicans, Mucor
Racemosus)
See Lab Report for Reference Ranges
the gel barrier)
8750 ALLERGEN RESPIRATIRY PROFILE REGION 1 (NORTH
8603 X 20
tube with gel barrier -- wait until
EAST)
(ALTERNARIA ALTERNATA IGE - ASPERGILLUS
FUMIGATUS IGE BIRCH (T3) IGE
CAT
EPITHELIUM-DANDERIGE CLADOSPORIUM HERBARUM minutes and insure that serum is
IGE COCKROACH IGE
COMMON RAGWEED IGE
the gel barrier)
D.FARINAE IGE D.PTERONYSSINUS IGE
DOG DANDER IGE
ELM (T8) IGE, LAMB'S QUARTERS IGE, MAPLE (BOX
ELDER) IGE, WHITE ASH (T15) IGE
WHITE OAK IGE, Timothy Graass IgE,
Walnut Tree Ig E, Sycomore IgE
Mughort(Sagebrush) IgE, Sheep Sorrel IgE
Bermuda grass IgE)
$500.00
Revised 4/4/2012
PANEL TEST LISTING
TEST #
TEST NAME
8628 ALLERGEN SEAFOOD PROFILE
(CodFish IgE, Shrimp IgE, Tuna IgE, Lobster IgE, Crab IgE
)
Testing
performed Weekly
See Lab report for reference Ranges
51017 AMIODARONE PANEL SERUM/BLOOD LC/MS/MS
(AMIODARONE, DESETHYLAMIODARONE)
Testing Performed STAT and Daily
Reference Ranges:
Amiodarone: 0.3 - 3.0 mg/L
Desethylamiodarone: 0.5 - 2.0 mg/L
51021 AMITRIPTYLINE PANEL SERUM/BLOOD
LC/MS/MS
(AMITRIPTYLINE, NORTRIPTYLINE)
Reference Ranges:
Amitriptyline: 80 - 200 ng/ml
Nortriptyline: 50 - 200 ng/ml
352 AMPHETAMINE ID/CONFIRMATION S/B
LC/MS/MS
(AMPHETAMINE, METHAMPHETAMINE, MDMA, MDA)
Testing Performed Daily Mon-Sun
302 AMPHETAMINE ID/CONFIRMATION URINE LC/MS/MS
(AMPHETAMINE, METHAMPHETAMINE, MDMA, MDA)
Testing Performed Daily
69
ANEMIA PANEL
(FERRITIN, IRON, TIBC, % SATURATION, VITAMIN B12,
FOLATE, RETICULOCYTE)
Reference Ranges: See alphabetical test listing for
each test.
the gel barrier)
1 full red top tube with no additive
or 1 full grey top tube
8603X5
PRICE
(STATS ARE
2X LIST
PRICE)
$50.00
82492
$60.00
*CPT
CODE
1 full red top tube with no additive 80152 X2
$48.00
82145
$200.00
30 ml urine (plastic urine
container)
82145
$200.00
1 full lavender top tube, 1 ml
serum (collect specimen in tube
with gel barrier -- wait until blood
is clotted before centrifuging -
centrifuge for 15 minutes and
insure that serum is separated
from the blood cells by the gel
barrier)
82746,
83540,
82728,
85044,
83550,
82607
$100.00
Revised 4/4/2012
PANEL TEST LISTING
TEST #
TEST NAME
74
353
313
510
354
*CPT
CODE
PRICE
(STATS ARE
2X LIST
PRICE)
85651,
86038,
86431
$44.00
-
$200.00
container)
-
$200.00
80048
$25.00
-
$350.00
ARTHRITIS PANEL
(ERYTHROCYTE SEDIMENTAION RATE, ANA,
RHEUMATOID FACTOR)
SEE
ALPHABETICAL TEST LISTING FOR NORMAL VALUES.
Testing Performed: Erythrocyte Sedimentation Rate
1 full lavender top tube, 1 full red
Daily
top tube with no additive
ANA and Rheumatoid Factor Performed by Reference
Lab Mon--Fri
Reference
Ranges: See alphabetical test listing for each test.
BARBITURATE ID/CONFIRMATION PANEL
SERUM/BLOOD
LC/MS/MS
(BUTALBITAL, PENTOBARBITAL, PHENOBARBITAL,
SECOBARBITAL)
BARBITURATEITURATE ID/CONFIRMATION PANEL
URINE LC/MS/MS
(BUTALBITAL, PENTOBARBITAL, PHENOBARBITAL,
SECOBARBITAL)
BASIC METABOLIC PANEL
(BUN, CREATININE, GLUCOSE, SODIUM, POTASSIUM,
CHLORIDE, CO2 & CALCIUM)
each test.
the gel barrier)
BENZODIAZEPINE ID/CONFIRMATION SERUM/BLOOD
LC/MS/MS
(ALOPRAZOLAM, OH-ALPRAZOLAM, OXAZEPAM,
DIAZEPAM, NORDIAZEPAM, CHLORADIAZEPOXIDE,
CLONAZEPAM, 7-AMINOCLONAZEPAM, LORAZEPAM, 1 full red top tube with no additive
FLURAZEPAM, FLUNITRAZEPAM, MIDAZOLAM, 7-
AMINOFLUNITRAZEPAM, TEMAZEPAM, PRAZEPAM)
Revised 4/4/2012
PANEL TEST LISTING
TEST #
TEST NAME
BENZODIAZEPINE ID/CONFIRMATION URINE
LC/MS/MS
(ALOPRAZOLAM, OH-ALPRAZOLAM, OXAZEPAM,
DIAZEPAM, NORDIAZEPAM, CHLORADIAZEPOXIDE,
CLONAZEPAM, 7-AMINOCLONAZEPAM, LORAZEPAM,
FLURAZEPAM, FLUNITRAZEPAM, MIDAZOLAM, 7-
AMINOFLUNITRAZEPAM, TEMAZEPAM, PRAZEPAM)
355 BUPRENORPHINE ID/CONFIRMATION
SERUM/BLOOD
LC/MS/MS
(BUPRENORPHINE, NORBUPRENORPHINE)
310 BUPRENORPHINE ID/CONFIRMATION URINE
LC/MS/MS
(BUPRENORPHINE, NORBUPRENORPHINE)
51098 CARISOPRODOL PANEL (SOMA) QUANTITATIVE
SERUM/BLOOD
LC/MS/MS
(CARISOPRODOL, MEPROBAMATE)
Reference Range:
Carisoprodol: 3.0 - 26.0 mg/L
Meprobamate: 3.0 - 26.0 mg/L
7040 CBC W/DIFF/PLAT
(WBC,RBC,HGB,HCT,MCV,MCH,MCHC, PLATELET,
ABSOLUTE NEUTROPHILS, ABSOLUTE LYMPHOCYTES,
ABSOLUTE MONOCYTES, ABSOLUTE EOSINOPHILS,
ABSOLUTE BASOPHILS,
% NEUTROPHILS,%
LYMPHOCYTES, % EOSINOPHIL,
% BASOPHIL, %
MONOCYTES, RBC MORPHOLOGY)
Reference Ranges: See Lab Report for all reference
ranges.
865 CELIAC PANEL
(TISSUE TRANSGLUTAMINASE IGA, TOTAL IGA, GLIADIN
ANTIBODY IGA)
Performed by Reference Lab
*CPT
CODE
PRICE
(STATS ARE
2X LIST
PRICE)
container)
-
$350.00
-
$125.00
container)
-
$125.00
83805
$80.00
1 Full lavender top tube (EDTA
Plasma)
85025
$37.00
82784,
83516 X
2
$260.00
300
the gel barrier)
Revised 4/4/2012
PANEL TEST LISTING
TEST #
TEST NAME
51130 CLOMIPRAMINE PANEL SERUM/BLOOD
LC/MS/MS
(CLOMIPRAMINE , NORCLOMIPRAMINE)
Reference Ranges:
Clomipramine: 0.04 - 0.40 mg/L
Norclomipramine : 0.04 - 0.40 mg/L
51130U CLOMIPRAMINE URINE PANEL
LC/MS/MS
(CLOMIPRAMINE , NORCLOMIPRAMINE)
1861 CLOZAPINE QUANTITATIVE SERUM/BLOOD
LC/MS/MS
(CLOZAPINE, NORCLOZAPINE)
Reference Ranges:
Clozapine 0.10--1.50 mg/L
Norclozapine 0.05-0.50 mg/L
15750 CLUB DRUG PANEL (DATE RAPE PANEL)
SERUM/BLOOD & URINE
LC/MS/MS & HEADSPACE
(AMPHETAMINE S/B/U, BARBITURATE S/B/U,
BENZODIAZEPINE S/B/U, COCAINE S/B/U, FENTANYL
S/B/U, MARIJUANA S/B/U, OPIATE S/B/U, OXYCODONE
S/B/U, METHADONE S/B, METHADONE/EDDP U,
PHENCYCLIDINE S/B/U, PROPOXYPHENE S/B/U,
TRICYCLIC S/B/U, NICOTINE U, BUPRENORPHINE U,
ALCOHOL U, ANALGESIC, ANTICOAGULANT, ANTACID,
ANTICONVULSION, ANTIDEPRESSANT,
ANTHIHISTAMINES, ANTIPSYCHOTIC,
ANTIHYPERTENSIVE, CARDIAC, MUSCLE RELAXER,
NSAIDS, SEDATIVE, STIMULANT, SYNTHETIC
NARCOTICS, TRICYLICS, VOLATILES, FLUNITRAZEPAM &
GHB)
356
312
COCAINE ID/CONFIRMATION SERUM/BLOOD
LC/MS/MS
(COCAINE, BENZOYLECGONINE)
Testing Performed Daily Mon-Sun
COCAINE ID/CONFIRMATION URINE LC/MS/MS
(COCAINE, BENZOYLECGONINE)
*CPT
CODE
PRICE
(STATS ARE
2X LIST
PRICE)
80299
$68.00
container)
80299
$68.00
80154
$88.00
plus 30 ml urine (plastic urine
container)
80100
$180.00
-
$140.00
container)
-
$140.00
Revised 4/4/2012
PANEL TEST LISTING
TEST #
TEST NAME
45650C COLOSTRUM DRUG SCREEN
(AMPHETAMINE, BARBITURATE, BENZODIAZEPINE,
COCAINE, MARIJUANA, METHADONE/EDDP, OPIATE,
OXYCODONE, PHENCYCLIDINE, PROPOXYPHENE,
TRICYCLIC, ETHANOL)
540 COMPREHENSIVE PANEL W/ESTIMATED
GLOMECULAR FILTRATION RATE (GFR)
MUST HAVE PATIENTS DATE OF BIRTH FOR ACCURATE
CALCULATION OF THE GFR
(ALBUMIN, ALUBUMIN/GLOBULIN RATIO (calculated),
ALANINE AMINOTRANSFERASE (ALT), ASPARTATE
AMINOTRANSFERASE (AST), BUN, CREATININE, RATIO
(calculated), CALCIUM, CO2, B60CHLORIDE, GFR
(estimated), GLOBULIN (calculated), GLUCOSE,
SODIUM, POTASSIUM,TOTAL BILIRUBIN, TOTAL
PROTEIN)
each test.
675
*CPT
CODE
PRICE
(STATS ARE
2X LIST
PRICE)
Colostrum specimen
80100
$62.00
the gel barrier)
80053
$55.00
COMPREHENSIVE TOXICOLOGY
SERUM/BLOOD/URINE
COCAINE METABOLITE, FENTANYL, MARIJUANA,
METHADONE/EDDP, OPIATE, OXYCODONE,
PHENCYCLIDINE, PROPOXYPHENE, TRICYCLIC, ETHANOL
- BUPRENORPHINE ON URINE ONLY, ANALGESIC,
1 full red top tube with no additive 80100 X2
ANTICOAGULANT, ANTACID, ANTICONVULSION,
plus 30 ml urine (plastic urine
80101
ANTIDEPRESSANT, ANTHIHISTAMINES,
container)
X14
ANTIPSYCHOTIC, ANTIHYPERTENSIVE, CARDIAC,
MUSCLE RELAXER, NSAIDS, SEDATIVE, STIMULANT,
SYNTHETIC NARCOTICS, TRICYLICS, VOLATILES,
BUPRENORPINE & NORBUPRENORPHINE)
This Panel auto reflexes for confirmations (additional
charge for each confirmation)
$96.00
Revised 4/4/2012
PANEL TEST LISTING
TEST #
TEST NAME
1053 CREATININE ESTIMATED GLOMECULAR FILTRATION
RATE (GFR)
MUST HAVE PATIENTS DATE OF BIRTH FOR ACCURATE
CALCULATION OF THE GFR
Reference Ranges:
Creatinine: 0.5 - 1.3 mg/dl
eGFR NON-AFR. AMERICAN: >60
eGFR AFRICAN AMERICAN: >60
5
DAU PROFILE 5/WORKPLACE (NIDA 5)
(AMPHETAMINE, COCAINE, MARIJUANA, OPIATE,
PHENCYCLIDINE)
All positives must be confirmed by Reflex
confirmation by LC/MS/MS.
50169 DESIPRAMINE QUANTITATIVE PANEL SERUM/BLOOD
LC/MS/MS
(DESPIRAMINE, IMIPRAMINE)
Reference Ranges:
Desipramine: 0.05 -- 0.60 mg/L
Imipramine: 0.05 - 0.20 mg/L
50169U DESIPRAMINE QUANTITATIVE PANEL URINE
LC/MS/MS
(DESPIRAMINE, IMIPRAMINE)
41172 DIAZEPAM QUANTITATIVE PANEL SERUM/BLOOD
LC/MS/MS
(DIAZEPAM, NORDIAZEPAM)
Reference Ranges:
Diazepam: 200 - 2000 ng/ml
Nordiazepam: 200 - 1800 ng/ml
51207 DOXEPIN QUANTITATIVE PANEL SERUM/BLOOD
LC/MS/MS
(DOXEPIN, NORDOXEPIN, TOTAL TRICYCLICS)
Reference Ranges:
Doxepin : 100 - 250 ng/ml
Total Tricyclics: 50 - 300 ng/ml
51207U DOXEPIN URINE PANEL
LC/MS/MS
(DOXEPIN, NORDOXEPIN, TOTAL TRICYCLICS)
*CPT
CODE
the gel barrier)
PRICE
(STATS ARE
2X LIST
PRICE)
$25.00
container)
80101 x5
$50.00
1 full red top tube no gel
80160
$60.00
container)
$90.00
82491
$50.00
80166
$44.00
container)
80166
$44.00
Revised 4/4/2012
PANEL TEST LISTING
TEST #
*CPT
CODE
PRICE
(STATS ARE
2X LIST
PRICE)
80101 x
10
$250.00
1 full red top tube no gel and 30
ml urine (plastic urine container)
80100
$56.00
DRUG OF ABUSE SCREEN SERUM/BLOOD/URINE
COCAINE METABOLITE, FENTANYL, MARIJUANA,
METHADONE/EDDP, OPIATE, OXYCODONE,
PHENCYCLIDINE, PROPOXYPHENE, TRICYCLIC, ETHANOL ml urine (plastic urine container)
-- BUPRENORPHINE ON URINE ONLY)
80100
$56.00
TEST NAME
DRUG OF ABUSE COMPLETE URINE PANEL
(ALCOHOL, AMPHETAMINE & ECSTASY, BARBITURATE,
BENZODIAZEPINE, BUPRENORPHINE, COCAINE
METABOLITE, MARIJUANA, METHADONE/EDDP,
OPIATE, OXYCODONE, PHENCYCLIDINE,
PROPOXYPHENE, -- ALDULTARANTS - SPECIFIC GRAVITY,
CREATININE, PH)
Contact Laboratory to have auto reflex testing
performed on all positive analytes. Practioners
signature required.
5850 DRUG OF ABUSE SCREEN BLOOD/SERUM/URINE
(ALL PERFORMED ON BOTH URINE & BLOOD IF
SENT - AMPHETAMINE, BARBITURATE,
BENZODIAZEPINE, COCAINE METABOLITE,
FENTANYL, MARIJUANA, METHADONE/EDDP,
OPIATE, OXYCODONE, PHENCYCLIDINE,
PROPOXYPHEHE, TRICYCLIC, ETHANOL -
BUPRENORPHINE ON URINE ONLY, ANALGESIC U,
CAFFEINE S/B & U, ANTIHYSTAMINE, ETHANOL S/B &
U, FLUOXETINE U, TRAMADOL U,
BUPRENORPHINE S/B, NORBUPRENORPHINE S/B)
38
625
container)
Revised 4/4/2012
PANEL TEST LISTING
TEST #
TEST NAME
6500 DRUG SCREEN SERUM/BLOOD/URINE
(AMPHETAMINE S/B/U, BARBITURATE S/B/U,
BENZODIAZEPINE S/B/U, COCAINE S/B/U, FENTANYL
S/B/U, MARIJUANA S/B/U, OPIATE S/B/U, OXYCODONE
S/B/U, METHADONE S/B, METHADONE/EDDP U,
PHENCYCLIDINE S/B/U, PROPOXYPHENE S/B/U,
TRICYCLIC S/B/U, NICOTINE U, BUPRENORPHINE U,
ALCOHOL U)
48 ELECTROLYES URINE
(Sodium, Potassium, Chloride)
50 ELECTROLYTES SERUM
(Sodium, Potassium, Chloride & CO2)
Reference Ranges:
Sodium: 135--145 mmol/L
Potassium: 3.5-5.5 mmol/L
Chloride: 98-109 mmol/L
CO2: 24.0-31.0 mmol/L
42233 ETHYLENE GLYCOL/METHANOL SERUM/BLOOD
(ETHYLENE GLYCOL, METHANOL)
51241 FLUOXETINE (PROZAC) QUANTITATIVE
SERUM/BLOOD
LC/MS/MS
(FLUOXETINE, NORFLUOXETINE)
Reference Range:
Fluoxetine: 80.0 -- 400.0 ng/ml
Norfluoxetine: 60.0 - 300.0 ng/ml
51241U FLUOXETINE (PROZAC) QUANTITATIVE URINE
LC/MS/MS
(FLUOXETINE, NORFLUOXETINE)
922 HEMOGLOBIN ELECTROPORESIS
(HEMOGLOGIN A1, FETAL HEMOGLOBIN,
HEMOGLOBIN A2 AND ANY HEMOGLOBIN
VARIANTS - RED BLOOD CELL COUNT,
HEMOGLOBIN, HEMATOCRIT, MCV, MCH, RDW)
*CPT
CODE
PRICE
(STATS ARE
2X LIST
PRICE)
ml urine (plastic urine container)
80101
$56.00
container)
84300,
84133
82436
$30.00
the gel barrier) hemolysis will
affect this test
80051
$30.00
$124.00
82491
$50.00
82491
$50.00
1 full lavender top tube (EDTA
Plasma)
83021,
85014,
85018,
85041
$100.00
Revised 4/4/2012
PANEL TEST LISTING
TEST #
TEST NAME
71
690
HEPATIC FUNCTION PANEL
(TOTAL PROTEIN, ALBUMIN, GLOBULIN, TOTAL
BILIRUBIN, DIRECT BILIRUBIN, INDIRECT BILIRUBIN
calculated, ALKALINE PHOS,AMINOTRANSFERASE (ALT),
ASPARTATE AMINOTRANSFERASE (AST))
each test.
HEPATITIS ACUTE PANEL
(HEP A IGM, HEP B SURFACE AG, HEP B CORE IGM, HEP
C AB)
Performed Daily Mon-Fri
each test.
*CPT
CODE
PRICE
(STATS ARE
2X LIST
PRICE)
the gel barrier)
80076
$30.00
86709,
86705
87340,
86803
the gel barrier)
579 HIV-1 WESTERN BLOT
(GP 41 ANTIGEN, P 24 ANTIGEN, GP 120/160 ANTIGEN, tube with gel barrier - wait until
OTHER BANDS, HIV WB INTERPRETATION)
86689
ranges.
the gel barrier)
57 IRON PANEL
(TOTAL IRON, TIBC, % SATURATION)
Performed Daily
83540,
83550
each test.
the gel barrier)
41281 ISOPROPANOL SERUM/BLOOD PANEL
(ISOPROPANOL, ACETONE)
HEADSPACE
82491
Reference Ranges:
Isopropanol: 0 - 0.020 gm/dl
Acetone: 0 - 300 mg/L
41281U ISOPROPANOL URINE PANEL
(ISOPROPANOL, ACETONE)
HEADSPACE
82491
container)
Reference Ranges:
Isopropanol: Non Detected
Acetone: Non Detected
$150.00
$75.00
$53.00
$32.00
$32.00
Revised 4/4/2012
PANEL TEST LISTING
TEST #
TEST NAME
6970 IV SOLUTION INTEGRITY PANEL
LC/MS/MS
(SUBSTANCE)
40282 KETAMINE PANEL SERUM/BLOOD
LC/MS/MS
(KETAMINE, NORKETAMINE)
Reference Ranges:
Ketamine: 0.20 - 1.00 mg/L
Norketamine: 0.20 - 1.00 mg/L
40282U KETAMINE PANEL URINE
LC/MS/MS
(KETAMINE, NORKETAMINE)
Reference Ranges:
Ketamine: 200 - 1000 ng/ml
Norketamine: 200 - 1000 ng/ml
6800 L/S RATIO - TLC
(LECITHIN/SPHINGOMYELIN, PHOSPHATIDYL
GLYCEROL)
References Ranges:
L/S: >/= 3:1
560 LIPID PANEL
(CHOLESTEROL, TRIGLYCERIDES, HDL, calculated LDL,
CHOLESTEROL/HDL RATIO)
each test.
530
LIVER PANEL W/GGT
(TOTAL PROTEIN, ALBUMIN, GLOBULIN, TOTAL
BILIRUBIN, DIRECT BILIRUBIN, INDIRECT BILIRUBIN,
ALKALINE PHOSPHATASE, ALANINE
AMINOTRANSFERASE (ALT), ASPARTATE
AMINOTRANSFERASE (AST), GAMMA GLUTAMYL
TRANSFERASE (GGT))
each test.
*CPT
CODE
PRICE
(STATS ARE
2X LIST
PRICE)
--
$76.00
82491
$60.00
container)
82491
$60.00
3-4 ml or amniotic fluid (spin
specimen down immediately and
freeze)
83661
$120.00
the gel barrier)
80061
$55.00
the gel barrier)
80076
$60.00
Submit appropriate fluid
Revised 4/4/2012
PANEL TEST LISTING
TEST #
TEST NAME
MARIJUANA CONFIRMATION SERUM/BLOOD
LC/MS/MS
(MARIJUANA, MARIJUANA DELTA 9)
305 MARIJUANA CONFIRMATION URINE
LC/MS/MS
(MARIJUANA, MARIJUANA DELTA 9)
45650 MECONIUM DRUG SCREEN
(ALCOHOL, AMPHETAMINE, BARBITURATE,
METABOLITE, MARIJUANA, METHADONE, OPIATE,
OXYCODONE, PHENCYCLIDINE, PROPOXYPHENE)
51321 MEPHENYTOIN PANEL (MESANTOIN)
QUANTITATIVE
(MEPHENYTOIN, NORMEPHENYTOIN)
SERUM/BLOOD
LC/MS/MS
Reference Range:
Mephentytoin: 25 -- 40 mg/L
358 METHADONE CONFIRMATION SERUM/BLOOD
LC/MS/MS
(METHADONE, EDDP)
306 METHADONE CONFIRMATION URINE
LC/MS/MS
(METHADONE, EDDP)
839 METHADONE FLUID INTEGRITY
LC/MS/MS
(VOLUME, CONCENTRATION, TOTAL METHADONE)
490 METHADONE-- NORMALIZED EDDP URINE
LC/MS/MS
(EDDP, CREATININE)
4350 MMR PANEL
(MEASLES (RUBEOLA), MUMPS, RUBELLA)
Performed Daily Mon-Fri
each test.
*CPT
CODE
PRICE
(STATS ARE
2X LIST
PRICE)
-
$130.00
container)
-
$130.00
Mecomium sample at least 3ml.
80100
x10
$42.00
82492
$54.00
83840
$275.00
container)
83840
$275.00
Submit appropriate fluid
80299
$65.00
-
$40.00
86765,
86735
86762
$131.00
357
container)
Methadone Dosage
the gel barrier)
Revised 4/4/2012
PANEL TEST LISTING
TEST #
TEST NAME
NICOTINE CONFIRM SERUM/BLOOD
LC/MS/MS
(NICOTINE, COTININE)
309 NICOTINE CONFIRM URINE
LC/MS/MS
(NICOTINE, COTININE)
360 OPIATE CONFIRMATION SERUM/BLOOD
LC/MS/MS
(MORPHINE, OXYMORPHONE, HYDROMORPHONE,
CODEINE, HYDROCODONE, OXYCODONE,
6--MONACETYLMORPHINE, DIHYDROCODEINE)
301 OPIATE CONFIRMATION URINE
LC/MS/MS
(MORPHINE, OXYMORPHONE, HYDROMORPHONE,
CODEINE, HYDROCODONE, OXYCODONE,
6-MONACETYLMORPHINE, DIHYDROCODEINE)
45845 OPIATES & SYNTHETIC NARCOTICS URINE
LC/MS/MS
(CODEINE, DIHYDROCODEINE, HYDROCODONE,
HYDROMORPHONE, LEVORPHANOL, MEPERIDINE,
METHADONE/EEDP, MORPHINE,
6MONACETYLMORPHINE, NALOXONE, OXYCODONE,
OXYMORPHONE, PENTAZOCINE, PROPOXYPHENE,
QUININE)
83 ORAL DRUG SCREEN
(COCAINE, MARIJUANA, METHADONE, OPIATE,
PHENCYCLIDINE)
Testing Performed Daily Mon--Sat
82 ORAL DRUG SCREEN
(BARBITURATE, BENZODIAZIPINE, COCAINE,
MARIJUANA, METHADONE, METHAMPHETAMINE,
OPIATE)
Testing Performed Daily Mon-Sat
*CPT
CODE
PRICE
(STATS ARE
2X LIST
PRICE)
359
1 full red top tube with no additive 80101 x2
$250.00
container)
80101 x2
$250.00
-
$300.00
container)
-
$300.00
container)
80100
$450.00
Oral swab (ora sure swab)
80100
$25.00
Oral swab (ora sure swab)
80101
$25.00
Revised 4/4/2012
PANEL TEST LISTING
TEST #
TEST NAME
50407 OXYCARBAZEPINE QUANTITATIVE PANEL
SERUM/BLOOD
LC/MS/MS
(OXYCARBAZEPINE, 10-HYDROXYCARBAZEPINE)
Reference Ranges:
Oxycarbazepine: 6.0 - 10.0 mg/L
10-Hydroxycarbazepine: 6.0 - 10.0 mg/L
361 OXYCODONE ID/CONFIRMATION SERUM/BLOOD
LC/MS/MS
(OXYCODONE, OXYMORPHONE, HYDROMORPHONE,
HYDROCODONE)
311 OXYCODONE ID/CONFIRMATION URINE
LC/MS/MS
(OXYCODONE, OXYMORPHONE, HYDROMORPHONE,
HYDROCODONE)
2507 PAIN MANAGEMENT ORAL PANEL
(AMPHETAMINE/METHAMPHETAMINE,
BENZODIAZEPINE, BUPRENORPHINE, COCAINE,
MARIJUANA, METHADONE, OPIATE, PHENCYCLIDINE,
PROPOXYPHENE, FENTANYL, CARISOPRODOL,
NALOXONE, NALTREXONE, TRAMADOL)
Reflex confirmation of all positives by LC/MS/MS are
performed.
2502 PAIN MANAGEMENT URINE PANEL
(AMPHETAMINE/ECSTASY, BARBITURATE,
METABOLITE, MARIJUANA, METHADONE/EDDP,
METHAMPHETAMINE, OPIATE, OXYCODONE,
PHENCYCLIDINE, PROPOXYPHENE, FENTANYL -
ADULTERANTS - PH, CREATININE, SPECIFIC GRAVITY)
Reflex confirmation of all positives by LC/MS/MS are
performed.
362
308
PHENCYCLIDINE CONFIRMATION SERUM/BLOOD
LC/MS/MS
PHENCYCLIDINE CONFIRMATION URINE
LC/MS/MS
*CPT
CODE
PRICE
(STATS ARE
2X LIST
PRICE)
82491
$42.00
-
$200.00
container)
-
$200.00
Oral swab (OraSure or Quantisals
swab)
80101 x
14
$100.00
container)
80101 x
10
$100.00
-
$100.00
container)
-
$100.00
Revised 4/4/2012
PANEL TEST LISTING
TEST #
TEST NAME
51454 PRIMIDONE QUANTITATIVE PANEL SERUM/BLOOD
LC/MS/MS
(PRIMIDONE (MYSOLINE), PHENOBARBITAL)
Reference Ranges:
Primidone: 5.0 - 12.0 ug/ml
Phenobarbital: 15.0 - 40.0 ug/ml
51456 PROCANAMIDE PANEL LC/MS/MS
(PROCANAMIDE, N-ACETYLPROCANAMIDE NAPA)
Reference Ranges:
Procanamide: 3.0 - 10.0 mg/L
N-Acetylprocanamide: 5 - 20 mg/L
363 PROPOXYPHENE ID/ CONFIRMATION
SERUM/BLOOD
LC/MS/MS
(PROPOXYPHENE, NORPROPOXYPHENE)
307 PROPOXYPHENE ID/ CONFIRMATION URINE
LC/MS/MS
(PROPOXYPHENE, NORPROPOXYPHENE)
880 PROTEIN ELECTROPHORESIS
(TOTAL PROTEIN, PROTEIN ELECTROPHORESIS)
1200 PROTIME/INR
(PROTHROMBIN TIME, INR)
Reference Ranges: These may vary with a new lot of
controls.
Protime: 11.4--14.2 Seconds
INR: 0.90 - 1.10
550 RENAL PANEL
(ALBUUMIN, BUN, BUN/CREATININE RATIO
(calculated), CALCIUM, CO2, CREATININE Estimated
GLOMECULAR FILTRATION RATE (calculated),
GLUCOSE, PHOSPHORUS, POTASSIUM, SODIUM)
each test.
*CPT
CODE
PRICE
(STATS ARE
2X LIST
PRICE)
80184,
80188
$48.00
80192
$50.00
-
$150.00
container)
-
$150.00
the gel barrier)
84155,
84165
$25.00
1 Full unopened sodium citrate
(light blue tube)
85610
$13.00
the gel barrier)
80069
$40.00
Revised 4/4/2012
PANEL TEST LISTING
TEST #
TEST NAME
51483 RISPERIDONE PANEL QUANTITATIVE
SERUM/BLOOD
LC/MS/MS
(RISPERIDONE, 9--HYDROXYRISPERIDONE, TOTAL
ACTIVE DRUG)
Reference Ranges:
Risperidone: 0.020 - 0.160 mg/L
9-Hydroxyrisperidone: 0.03 - 0.20 mg/L
51496 SERTRALINE (ZOLOFT) QUANTITATIVE
SERUM/BLOOD
HPLC
(SERTRRALINE, DESMETHYLSERTRALINE)
Reference Ranges:
Sertraline: 0.03 - 0.20 mg/L
Desmethylsertraline: 0.03 - 0.20 mg/L
520 THYROID PROFILE
(T3 UPTAKE, T4, FREE THYROXINE INDEX T7)
Reference Ranges:
T3 Uptake: 24.3 - 39.0%
T4: 4.5 - 11.4 ug/dl
T7: 1.4 - 3.8
2415 THYROID PROFILE W/TSH
(T3 UPTAKE, T4, TSH)
Reference Ranges:
T3 Uptake: 24.3 - 39.0%
T4: 4.5 - 11.4 ug/dl
TSH: 0.50 - 5.00 mciu/ml
45551 TRICYCLIC ANTIDEPRESSANTS (TCA SREEN)
QUANTITATIVE
SERUM/BLOOD
LC/MS/MS
(AMITRIPTYLINE, NORTRIPTYLINE, CYCLOBENZAPRINE,
DOXEPIN, NORDOXEPIN, DESIPRAMINE, IMIPRAMINE,
TRIMIPRAMINE, NORCLOMIPRAMINE, CLOMIPRAMINE,
PROTRIPTYLINE)
Testing
Performed Daily
*CPT
CODE
PRICE
(STATS ARE
2X LIST
PRICE)
82492
$80.00
80299
$50.00
84479,
84436
$43.00
84479,
84436,
84443
$67.00
80100
$50.00
the gel barrier)
the gel barrier)
Revised 4/4/2012
PANEL TEST LISTING
TEST #
TEST NAME
7170 URINALYSIS
(COLOR, APPEARANCE, SPECIFIC GRAVITY, PH,
GLUCOSE, BILIRUBIN, UROBOLINOGEN, KETONES,
BLOOD, PROTEIN, NITRITE, LEUKOCYTE, WHITE BLOOD
CELLS, RED BLOOD CELLS, AMORPH, EPITHELIAL,
BACTERIA, MUCUS, CRYSTALS, CASTS, YEAST,
TRICHOMONAS)
ranges.
882 URINE PROTEIN ELECTROPORESIS
(TOTAL PROTEIN, PROTEIN ELECTROPHORESIS &
CREATININE)
1820 VITAMIN B12/FOLATE
Performed Daily
Reference Ranges:
Vitamin B12: 160 - 970 pg/ml
Folate: 7.2 - 15.4 ng/ml
886
894
70
VITAMIN D 1, 25-HYDRODY PANEL LC/MS/MS
(VITAMIN D1- 25-D-OH TOTAL, VITAMIN D 1- 25 D-OH
D3, VITAMIN D1-25 D-OH D2)
VITAMIN D 25 HYDROXY PANEL
LC/MS/MS
(VITAMIN D, 25 HYDROXY TOTAL, VITAMIN D, 25-OH
D3, VITAMIN D, 25-OH D2)
Performed Daily
Reference Ranges:
VIT D, 25 HYDROXY TOTAL: 20.0 - 100.0 ng/ml
VITREOUS CHEM PANEL
(SODIUM, POTASSIUM, CHLORIDE, CO2, CREATININE,
BUN, GLUCOSE)
ranges.
*CPT
CODE
PRICE
(STATS ARE
2X LIST
PRICE)
container)
81000
$25.00
24 hr urine container (no
preservative)
82570,
84156,
84166
$76.00
82607,82
746
the gel barrier)
86252
the gel barrier)
82306
the gel barrier)
2 ml Vitreous Fluid
80048
$88.00
$70.00
$70.00
$55.00
Revised 4/4/2012
PANEL TEST LISTING
TEST #
TEST NAME
45725A VOLATILES &ETHYLENE GLYCOL QUANTITATIVE
SERUM/BLOOD
HEADSPACE
(ACETONE, ETHANOL, ISOPROPANOL/ACETONE,
METHANOL, ETHYLENE GLYCOL)
Reference Range:
Acetone:
0 - 300 mg/L
Ethanol:
0.0 - 0.079 gm/dL
Isopropanol:
0.0 - 0.020 gm/dL
Methanol:
Negative
Ethylene Glycol:
Negative
15725 VOLATILES QUANTITATIVE SERUM/BLOOD
HEADSPACE
(ACETONE, ETHANOL, ISOPROPANOL/ACETONE,
METHANOL)
Reference Range:
Acetone:
0 - 300 mg/L
Ethanol:
0.0 - 0.079 gm/dL
Isopropanol:
0.0 - 0.020 gm/dL
Methanol:
Negative
2095 WORKPLACE PANEL 9 URINE (PRE-EMPLOYMENT)
(AMPHETAMINE/ECSTASY, BARBITURATE,
BENZODIAZEPINE, COCAINE METABOLITE, MARIJUANA,
OPIATE 2K, PHENCYCLIDINE, PROPOXYPHENE, -
ADULTERANTS - CREATININE, SPECIFIC GRAVITY & PH)
All positives must be confirmed by reflex confirmation
by LC/MS/MS. Additional charges apply per analyte.
*CPT
CODE
PRICE
(STATS ARE
2X LIST
PRICE)
1 full red top tube with no additive 84600,
82693
$80.00
84600
$34.00
80101 X8
$50.00
container)
Revised 4/4/2012
INDIVIDUAL TEST LISTING
TEST #
TEST NAME
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
83915
$70.00
86900
$55.00
1 full red top tube with no additive or
1 full grey top tube
82003
$36.00
82010
$32.00
83519
$100.00
82024
$120.00
82040
$15.00
30 ml urine (plastic urine container)
82040
$15.00
80299
$20.00
82055
$16.00
* (The CPT codes provided are based on AMA
guidelines and are for informational purposes
only. CPT coding is the sole responsibility of the
billing party. Please direct any questions
regarding coding to the payer being billed.)
1130
8200
5 NUCLEOTIDASE
ABO GROUP & Rh TYPE
Testing Performed Daily Mon - Fri
50003 ACETAMINOPHEN QUANTITATIVE
SERUM/BLOOD
Testing Performed STAT and daily Mon-Sun
Reference Range: 5 - 26 mg/L
30006 ACETONE SERUM/BLOOD
Head Space G/C
1009 ACETYLCHOLINE RECEPTOR BINDING
ANTIBODY
1038
200
1075
2901
400
ACTH LEVEL
ALBUMIN
Reference Range: 3.3 - 5.0 g/dl
ALBUMIN URINE
ALCOHOL CONFIRMATION URINE
ALCOHOL URINE SCREEN
1 ml serum (collect specimen in tube
with gel barrier -- wait until blood is
clotted before centrifuging -
centrifuge for 15 minutes and insure
that serum is separated from the
blood cells by the gel barrier)
1 full lavender top tube (EDTA plasma)
must have phlebotomist initials on
tube!
with gel barrier - wait until blood is
Plasma)
Revised 3/9/2012
TEST #
TEST NAME
904
1013
8770
201
1851
851
8527
ALDOLASE
ALDOSTERONE
ALERGEN COTTONWOOD IGE
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
82085
$70.00
82088
$95.00
86003
$50.00
84075
$15.00
84075
$60.00
84075,
84080
$36.00
86003
$50.00
ALKALINE PHOSPHATASE
Testing Performed STAT and daily Mon-Sun with gel barrier - wait until blood is
ALKALINE PHOSPHATASE BONE SPEC
ALKALINE PHOSPHATASE ISOENZYME
ALLERGEN APPLE IGE
Revised 3/9/2012
TEST #
TEST NAME
8510
8511
8735
8724
8528
8738
ALLERGEN ASPERGILLUS ALTERNATA IGE
ALLERGEN ASPERGILLUS FUMIGATUS IGE
ALLERGEN BACCHARIS IGE
ALLERGEN BALD CYPRESS IGE
ALLERGEN BANANA
ALLERGEN BARLEY IGE
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
86003
$50.00
86003
$50.00
86003
$50.00
86003
$50.00
86003
$50.00
86003
$50.00
Revised 3/9/2012
TEST #
TEST NAME
8731
8703
8764
8736
8754
8701
ALLERGEN BAYBERRY/SWEET GALE IGE
ALLERGEN BEEF
ALLERGEN BIRCH IGE
ALLERGEN CARELESS WEED IGE
Testing Performed Weekly.
ALLERGEN CAT DANDER IGE
ALLERGEN CHICKEN
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
86003
$50.00
86003
$50.00
86003
$50.00
86003
$50.00
86003
$50.00
86003
$50.00
Revised 3/9/2012
TEST #
TEST NAME
8529
8513
8186
8758
8190
8774
ALLERGEN CHOCOLATE
ALLERGEN CLADOSPORIUM HERBARUM
ALLERGEN CLAM IGE
ALLERGEN COACKROACH IGE
ALLERGEN CODFISH IGE
ALLERGEN COMMON RAGWEED IGE
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
86003
$50.00
86003
$50.00
86003
$50.00
86003
$50.00
86003
$50.00
86003
$50.00
Revised 3/9/2012
TEST #
TEST NAME
8187
8189
8627
8753
8752
8525
ALLERGEN CORN IGE
ALLERGEN COWS MILK IGE
ALLERGEN CRAB IGE
ALLERGEN DERMATOPHAGOIDES FARINAE
IGE
ALLERGEN DERMATOPHOGOIDES
PTERONYSSINUS
Plasma) put tube on ice immediately -
Please note if the specimen is being
sent by mail the specimen must be
seperated and plasma frozen.
ALLERGEN DOG DANDER IGE
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
86003
$50.00
86003
$50.00
86003
$50.00
86003
$50.00
86003
$50.00
86003
$50.00
Revised 3/9/2012
TEST #
TEST NAME
8755
8188
8196
8767
8702
8151
ALLERGEN DOG FENNEL IGE
ALLERGEN EGG WHITE IGE
ALLERGEN EGG YOLK
ALLERGEN ELM IGE
ALLERGEN FRUIT IGE
ALLERGEN HADDOCK IGE
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
86003
$50.00
86003
$50.00
86003
$50.00
86003
$50.00
86003
$50.00
86003
$50.00
Revised 3/9/2012
TEST #
TEST NAME
8739
8741
8198
8733
8734
8766
8184
ALLERGEN HAZELNUT IGE
ALLERGEN LAMB QUARTERS IGE
ALLERGEN LOBSTER IGE
ALLERGEN LOCUST TREE IGE
ALLERGEN MUGHORT (SAGEBRUSH) IGE
ALLERGEN OAK IGE
ALLERGEN ONION IGE
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
86003
$50.00
86003
$50.00
86003
$50.00
86003
$50.00
86003
$50.00
86003
$50.00
86003
$50.00
Revised 3/9/2012
TEST #
TEST NAME
8532
8191
8740
8728
8704
8729
8732
ALLERGEN ORANGE IGE
ALLERGEN PEANUT IGE
ALLERGEN PENICILLIUM NOTATUM IGE
ALLERGEN POPLAR IGE
ALLERGEN PORK
ALLERGEN PRIVET IGE
ALLERGEN RED CEDAR IGE
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
86003
$50.00
86003
$50.00
86003
$50.00
86003
$50.00
86003
$50.00
86003
$50.00
86003
$50.00
Revised 3/9/2012
TEST #
TEST NAME
8725
8727
8775
8737
8777
8192
8193
ALLERGEN RED MAPLE IGE
ALLERGEN RED MULBERRY IGE
ALLERGEN RUSSIAN THISTLE
ALLERGEN RYE IGE
ALLERGEN SHEEP SORREL
ALLERGEN SHRIMP IGE
ALLERGEN SOYBEAN IGE
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
86003
$50.00
86003
$50.00
86003
$50.00
86003
$50.00
86003
$50.00
86003
$50.00
86003
$50.00
Revised 3/9/2012
TEST #
TEST NAME
8730
8769
8757
8674
8150
8197
8194
ALLERGEN SWEET GUM IGE
ALLERGEN SYCOMORE
ALLERGEN TIMOTHY GRASS
ALLERGEN TOMATO IGE
ALLERGEN TREE NUT
ALLERGEN TUNA
ALLERGEN WALNUT
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
86003
$50.00
86003
$50.00
86003
$50.00
86003
$50.00
86003
$50.00
86003
$50.00
86003
$50.00
Revised 3/9/2012
TEST #
TEST NAME
8768
8195
8771
8726
8533
8199
8170
ALLERGEN WALNUT TREE
ALLERGEN WHEAT IGE
ALLERGEN WHITE ASH
ALLERGEN WHITE HICKORY IGE
ALLERGEN WHITE POTATO IGE
ALLERGEN WHITEFISH
ALLERGEN WOOL
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
86003
$50.00
86003
$50.00
86003
$50.00
86003
$50.00
86003
$50.00
86003
$50.00
86003
$50.00
Revised 3/9/2012
TEST #
TEST NAME
876
927
1063
8277
ALPHA FETOPROTEIN TUMOR MARKER
Testing Performed Daily Mon-Fri
Reference Range: 0.0 - 8.7 ng/ml
ALPHA-1 ANTITRYPSIN
ALPHA-1 ANTITRYPSIN STOOL
ALPHA-SUBUNIT
(SUBUNIT OF LH, FSH, TSH & HCG)
50012 ALPRAZOLAM SERUM/BLOOD (XANAX)
Reference Range: 10 - 20 ng/ml
202 ALT (ALANINE AMINOTRANSFERASE)
Reference Range: 0 - 40 u/l
923
8001
9162
9161
8416
203
ALUMINUM
ALUMINUM LEVEL URINE
AMIKACIN PEAK -- HPLC
AMIKACIN TROUGH HPLC
AMINO ACID ANALYSIS, PLASMA
AMMONIA
Testing Performed STAT and Daily Mon-Fri
Reference Range: 11 - 51 umol/L
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
82105
$50.00
82103
$50.00
10 g Stool (plastic urine container)
82103
$50.00
83519
$95.00
80154
$48.00
84460
$20.00
82108
$100.00
82108
$100.00
80150
$65.00
80150
$65.00
82139
$115.00
82140
$40.00
2ml serum (royal blue trace element
tube)
2 mL plasma (sodium heparin green
top)
Plasma) put tube on ice immediately -
Please note if the specimen is being
sent by mail the specimen must be
seperated and plasma frozen.
Revised 3/9/2012
TEST #
TEST NAME
1020
125
803
1027
1133
957
1257
954
981
8016
949
1097
AMYLASE ISOENZYMES
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
82150
$125.00
86038
$24.00
86021
$30.00
82164
$100.00
86850
$50.00
86255
$95.00
83520
$95.00
83516 X 2
$95.00
86803
$71.00
82570,
83018
$71.00
86060
$60.00
82491
$68.00
ANA AB SCREEN
Testing Performed Tue & Thur
ANCA
ANGIOTENSIN CONVERTING ENZYME (ACE)
ANTIBODY SCREEN
Testing Performed STAT and Daily Mon--Fri
ANTI-DNA ANTIBODY
ANTI-GBM
ANTIGLIADIN ANTIBODY IGG, IGA
ANTI-HEPATITIS C IGG
ANTIMONY URINE
ANTI-STREPTOLYSIN O AB (ASO)
Reference Ranges:
≤17 Years <150 IU/mL
>17 Years ≤200 IU/mL
ARIPIPRAZOLE (ABILIFY) SERUM/BLOOD
HPLC
3 ml urine (acid wash & trace metal
free
Revised 3/9/2012
TEST #
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
82491
$68.00
Urine - Acid Wash Container
82175
$50.00
84450
$20.00
82492
$200.00
82491
$60.00
82491
$60.00
82491
$60.00
82491
$80.00
20 ml Urine (Plastic Urine Container)
80100
$120.00
50062 BENZTROPINE (COGENTIN) SERUM/BLOOD 1 ml serum (collect specimen in tube
HPLC
82491
$60.00
TEST NAME
50031 ARIPIPRAZOLE(ABILIFY) U
8018 ARSENIC URINE
204 AST (ASPARTATE AMINOTRANSFERASE)
Reference Range: 0 - 37 u/L
51034 ASTEMIZOLE (HISMANAL) SERUM/BLOOD
HPLC
50036 ATENOLOL (TENORMIN) SERUM/BLOOD
HPLC
50038 ATOMOXETINE (STRATERRA)
SERUM/BLOOD HPLC
50039 AZIDE (HYDRAZOIC ACID) SERUM/BLOOD
HPLC
50041 BACLOFEN (LIORESAL) SERUM/BLOOD
HPLC
6525 BATH SALTS URINE BY LC/MS/MS
Testing Performed STAT and Daily Mon--Sat
See Lab Report for Reference Range
Revised 3/9/2012
TEST #
TEST NAME
BHCG QUANTITATIVE
Testing Performed STAT and Daily Mon-Sat with gel barrier - wait until blood is
Reference Range: >5 miU/ml
40063 BILIRUBIN AMNIOTIC FLUID
meconium in amniotic fluid - keep
HPLC
specimen frozen & protected from
Testing Performed by Reference Lab.
light.
884 BIOPSY
Tissue Sample - (culture transport
media)
40067 BISACODYL (DUCOLAX) SERUM/BLOOD
HPLC
blood cells by the gel barrier) or 30 ml
urine (plastic urine container)
8015 BISMUTH URINE
Urine - Acid Wash Container
917 BLOOD CULTURE
** Please see page 8 of this manual
Additional charges apply for each organism for specimen collection procedures**
and sensitivity performed.
978 B-TYPE NATRIURETIC PEPTIDE (BNP)
Testing Performed STAT and Daily Mon-Sat
Plasma) if drawing a CBC draw 2 tubes
Reference Range: <100 pg/ml
207 BUN (BLOOD UREA NITROGEN)
Testing Performed STAT and Daily Mon-Sun with gel barrier - wait until blood is
Reference Range: 5 - 20 mg/dl
50072 BUPROPION (WELLBUTRIN) SERUM/BLOOD
LC/MS/MS QUALITATIVE
See Lab Result for Reference Range
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
84702
$32.00
82247
$60.00
88233
$205.00
82491
$60.00
83018
$120.00
87040
$35.00
83880
$49.56
84520
$15.00
82491
$60.00
82491
$60.00
808
50074 BUSPIRONE (BUSPAR) SERUM/BLOOD
LC/MS/MS QUALITATIVE
See Lab Result for Reference Range
Revised 3/9/2012
TEST #
TEST NAME
50073 BUTABARBITAL (BUTISOL) SERUM/BLOOD
LC/MS/MS
802 CA 125
Reference Range: <35 U/ml
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
82491
$50.00
86304
$69.00
86301
$90.00
86300
$90.00
82491
$42.00
82491
$42.00
82310
$15.00
1012 CA 19-9
920 CA 27, 29
40076 CAFFEINE QUANTITATIVE SERUM/BLOOD 1 ml serum (collect specimen in tube
LC/MS/MS
Testing Performed STAT and daily Mon-Sun clotted before centrifuging -
Reference Range: 8.0 - 20.0 mg/L
6928 CAFFEINE URINE LC/MS/MS
208 CALCIUM
Reference Range: 8.5 - 10.4 mg/dl
Revised 3/9/2012
TEST #
TEST NAME
952
CALCIUM, IONIZED
8022
CALCIUM, URINE 24 HR
209 CARBAMAZEPINE
Reference Range: 4.0 - 12.0 ug/ml
50087 CARBAMAZEPINE EPOXIDE LC/MS/MS
50086 CARBAMAZEPINE FREE LC/MS/MS
40097 CARBOXYHEMOGLOBIN QUANTITATIVE UV
Reference Range:
NON--SMOKERS: UP TO 4% SAT
SMOKERS: UP TO 8% SAT
1185
1024
6921
892
854
959
1052
CARDIAC CRP
Reference Range: <1.0 mg/L
CARDIOLIPIN AB IGG
CARISOPRODOL UA (SOMA) QUALITATIVE
LC/MS/MS
Reference Range: Negative
CARNITINE
CAROTENE
CATECHOLAMINES 24 HR URINE
CCP-AB IGG
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
82330
$50.00
82340
$50.00
80156
$40.00
80156
$60.00
80156
$46.00
Plasma)
82375
$44.00
86141
$68.00
1 ml citrated plasma (light blue top)
86147
$320.00
83805
$80.00
82379
$183.00
82380
$86.00
82384
$40.00
86200
$40.00
centrifuge immediately and do not
open - if ordering other tests draw
additional tubes
24 hour urine container no
Preservative
Overnight Fasting
24 hour urine container with additive
6NHCL
clotted before centrifuging --
Revised 3/9/2012
TEST #
TEST NAME
872
843
800
928
CD4/CD8
C-DIFF DNA
Performed using Illumigene Loop-Mediated
Isothermal DNA Amplification (LAMP) to
detect the Pathogenicity Locus (PaLoc) of
Toxigenic C. Difficle
CEA
Reference Range: <2.5ng/ml
CERULOPLASMIN
50096 CETIRIZINE (ZYRTEC) QUALITATIVE
SERUM/BLOOD LC/MS/MS
8263 CHLAMYDIA AB
1125 CHLAMYDIA DNA SWAB
1104 CHLAMYDIA DNA URINE
1127 CHLAMYDIA/GC DNA SWAB
1099
6877
CHLAMYDIA/GC DNA URINE
Testing Performed by Weekly
CHLORADIAZEPOXIDE (LIBRIUM)
QUANTITATIVE SERUM/BLOOD
LC/MS/MS
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
Plasma)
86360
$90.00
5 gm stool (plastic urine container)
refrigerate immediately 2-8° C
87493
$50.00
82378
$21.00
82390
$75.00
82491
$60.00
86631
$55.00
87491
$55.00
87490
$55.00
87491
$110.00
87491
$110.00
82491
$60.00
** Please see page 7 of the Directory
of Services Manual for specimen
collection procedures**
Revised 3/9/2012
TEST #
TEST NAME
40099 CHLORALHYDRATE (NOCTEC) QUALITATIVE
SERUM/BLOOD
COLORIMETRIC
210 CHLORIDE
Reference Range: 98 - 109 mmol/L
1048
979
211
CHLORIDE RANDOM URINE
CHLORIDE URINE 24 HR
CHOLESERTROL
Reference Range: <200 mg/dl
8021
CHOLINESTERASE, RBC
50128 CIMETIDINE (TAGAMET) QUALITATIVE
SERUM/BLOOD
LC/MS/MS
50127 CITALOPRAM (CELEXA) QUANTITATIVE
SERUM/BLOOD
LC/MS/MS
875
CKMB (CK/MB ISOENZYMES)
51134 CLORAZEPATE (TRANXENE) QUALITATIVE
SERUM/BLOOD
LC/MS/MS
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
82491
$68.00
82435
$15.00
Urine
82436
$15.00
24 hr urine (no preservative)
82436
$30.00
82465
$20.00
1 full lavender top tube (EDTA plasma)
82480,
82482
$75.00
82491
$60.00
82491
$60.00
82553
$65.00
80154
$50.00
Revised 3/9/2012
TEST #
TEST NAME
212
931
1004
932
960
1133
989
8273
801
822
935
CO2 (CARBON DIOXIDE)
Reference Range: 24.0 -- 31.0 mmol/L
COMPLEMENT COMPONENT C3
COMPLEMENT TOTAL CH 50
COMPLIMENT COMPONENT C4
COOMBS DIRECT
COOMBS INDIRECT- *(SEE TEST 1133
ANTIBODY SCREEN)
COPPER URINE
COPPER URINE 24 HR
CORTISOL AM
Reference Range: 4.0 - 22.0 ug/dL
CORTISOL PM
COXSACKIE B AB
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
82374
$15.00
86161
$55.00
86162
$75.00
86160
$55.00
86880
$46.55
5 mL whole blood(ACD-A yellow-top
tube)
86880
$46.55
7 ml urine (acid wash container) 2nd
void of the day
82525
$75.00
Urine - Acid Wash
82525
$100.00
82530
$24.00
82533
$24.00
86658 X 6
$300.00
5 mL whole blood(ACD-A yellow-top
tube)
Revised 3/9/2012
TEST #
TEST NAME
908
873
883
757
277
213
272
996
RC
UC
C-PEPTIDE
CPK
C-REACTIVE PROTEIN
Reference Range: <10.0 mg/L
CREATININE 24 HR
CREATININE CLEARANCE 24 HR
CREATININE SERUM
Reference Range: 0.5 - 1.3 g/dl
CREATININE URINE RANDOM
Reference Range: 20 - 320 mg/dl
CRYOGLOBULINS
CULTURE (ANY SOURCE EXCEPT URINE)
PLEASE INDICATE ON THE REQUEST FORM
THE SOURCE OF THE CULTURE
Additional charges apply for each organism
and sensitivity performed.
CULTURE, URINE
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
84681
$50.00
82550
$25.00
86140
$21.00
24 hr urine container (no preservative)
82570
$15.00
& 1 ml serum (collect specimen in
tube with gel barrier - wait until blood
is clotted before centrifuging -
82575
$50.00
82565
$11.00
82565
$11.00
82595
$60.00
appropriate swab
87070
$17.00
30 ml urine - clean catch
87086
$11.79
blood cells by the gel barrier) fasting
Revised 3/9/2012
TEST #
TEST NAME
40152 CYANIDE QUANTITATIVE SERUM/BLOOD
ULTRAVIOLET
See Lab Report for reference ranges.
50153 CYCLOBENZAPRINE SERUM/BLOOD
LC/MS/MS
6933 CYCLOBENZAPRINE URINE LC/MS/MS
1019 CYCLOSPORINE
Testing Performed by Reference Lab.
975 D-DIMER QUANTITATIVE
50171 DEXTROMETHORPHAN QUANTITATIVE
SERUM/BLOOD
LC/MS/MS
50171 DEXTROMETHORPHAN URINE
LC/MS/MS
Reference Range: Non Detected
906 DHEA - SULFATE
DIGOXIN
Reference Range: 0.5 - 2.0 ng/mL
50190 DILTIAZEM (CARDIZEM) QUALITATIVE
LC/MS/MS
50195 DIPHENHYDRAMINE QUANTITATIVE
LC/MS/MS
Testing Performed STAT & Daily
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
Whole Blood (grey tube)
82600
$46.00
82491
$48.00
82491
$48.00
1 full lavender top tube (EDTA-Plasma)
80158
$150.00
1 full sodium citrate (light blue tube)
unopened
85379
$250.00
82491
$58.00
82491
$58.00
82627
$156.00
80162
$21.00
82491
$90.00
82491
$42.00
214
Revised 3/9/2012
TEST #
TEST NAME
205
DIRECT BILIRUBIN
Reference Range: 0 - 0.5 mg/dL
50202 DISOPYRAMIDE (NORPACE) QUANTITATIVE
SERUM/BLOOD
LC/MS/MS
1005 DOUBLE STRANDED DNA ANTIBODIES
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
82248
$15.00
82491
$36.00
86225
$85.00
82491
$42.00
82491
$38.00
86255
$90.00
51209 DOXYLAMINE (DRAMAMINE) QUALITATIVE
SERUM/BLOOD
LC/MS/MS
Reference Range:0.04 - 0.40 mg/L
50212 DYPHYLLINE (ASMINYL) QUALITATIVE
SERUM/BLOOD
HPLC
1007 ENDOMYSIAL AB IGA
50216 EPHEDRINE QUANTITATIVE
SERUM/BLOOD
HPLC
1101 EPSTEIN BARR IGG AB VCA
$90.00
86665
$77.00
Revised 3/9/2012
TEST #
TEST NAME
1100
862
EPSTEIN BARR IGM
ERYTHROPOIETIN
50221 ESCITALOPRAM (LEXAPRO) QUANTITATIVE
SERUM/BLOOD
LC/MS/MS
902 ESTRADIOL
Testing Preformed Daily
1189 ESTRIOL SERUM
40009 ETHANOL QUANTITATIVE SERUM/BLOOD
HEADSPACE GC
Reference Range: 0.0 - 0.079 g/dL
50227 ETHOSUXIMIDE (ZARONTIN)
LC/MS/MS
40233 ETHYLENE GLYCOL (ANTIFREEZE)
QUANTITATIVE
SERUM/ BLOOD
GC FID
Reference Range: NEGATIVE
756 FECAL FAT
42237 FENTANYL SERUM/BLOOD QUALITATIVE
LC/MS/MS
Reference Range: 0.5 ng/mL
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
86664
$77.00
82668
$29.00
82491
$60.00
82670
$38.00
82677
$100.00
82055
$32.00
82491
$50.00
82491
$60.00
frozen
82705
$42.00
82491
$72.00
Revised 3/9/2012
TEST #
TEST NAME
FENTANYL SERUM/BLOOD QUANTITATIVE
LC/MS/MS
6550 FENTANYL URINE QUALITATIVE
LC/MS/MS
6716 FENTANYL URINE QUANTITATIVE
LC/MS/MS
40237 FENTANYL INTEGRITY -
(PATCHES, SYRINGES, AND
PHARMACEUTICAL SAMPLES)
LC/MS/MS
804 FERRITIN
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
82491
$72.00
82491
$72.00
82491
$72.00
appropriate specimen
83519
$72.00
82728
$42.00
1 full blue top tube (citrated plasma)
85384
$17.00
82491
$50.00
82491
$70.00
82491
$70.00
6716
1180
FIBRINOGEN
50240 FLECAINIDE (TAMBOCOR) QUALITATIVE
SERUM/BLOOD
LC/MS/MS
50238 FLUNITRAZEPAM (ROHYPNOL)
QUANTITATIVE
SERUM/BLOOD
LC/MS/MS
Reference Range: 5-15 ng/mL
6973 FLUNITRAZEPAM (ROHYPNOL)
QUANTITATIVE URINE
LC/MS/MS
Revised 3/9/2012
TEST #
TEST NAME
41243 FLURAZEPAM (DALMANE) QUANTITATIVE
SERUM/BLOOD
LC/MS/MS
6616 FLURAZEPAM (DALMANE) QUANTITATIVE
URINE
LC/MS/MS
Reference Range: >10.0 mg/L
805 FOLATE
Reference Range: 7.2 - 15.4 ng/ml
818
899
806
916
FREE T4
Reference Range: 0.87 - 1.51 ng/dl
FRUCTOSAMINE
FSH
G6PD
50246 GABAPENTIN (NEURONTIN) QUANTITATIVE
SERUM/BLOOD
6974 GAMMAHYDROXYBUTYRATE (GHB)
QUANTITATIVE
SERUM/BLOOD
GC/FID
Reference Range: Effective > 20 mg/L
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
82491
$50.00
82742
$25.00
82746
$20.54
84439
$42.00
82985
$30.00
83001
$25.00
82955
$100.00
82491
$62.00
82491
$80.00
Plasma)
Revised 3/9/2012
TEST #
TEST NAME
51247 GAMMAHYDROXYBUTYRATE (GHB) URINE
QUANTITATIVE
GC/FID
Reference Range: Above 100 mg/l indicates
recent ingestion of GHB.
1124 GC DNA SWAB
1105 GC DNA URINE
1046 GENTAMYCIN PEAK QUANTITATIVE
SERUM/BLOOD
1044 GENTAMYCIN TROUGH QUANTITATIVE
SERUM/BLOOD
218 GGT (GAMMA GLUTAMYL TRANSFERASE)
219
866
GLUCOSE
Reference Range: 70 - 110 mg/dL
GLUTAMIC ACID DECARB (GAD65)
50260 HALDOL (HALOPERIDOL) QUANTITATIVE
SERUM/BLOOD
LC/MS/MS
Reference Range: 5 - 80 ng/mL
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
$80.00
DNA swab - call laboratory for supplies
87591
$55.00
87797
$55.00
80170
$45.00
80170
$45.00
82977
$20.00
82947
$20.00
83519,
86337,
83641
$100.00
80173
$50.00
Revised 3/9/2012
TEST #
TEST NAME
921
220
716
715
809
HAPTOGLOBIN
HDL
HEMATOCRIT
Reference Range:
Female:
0 months - 8 years 33.0 - 42.0 g/dl
9 years - 11 years
34.0 - 43.0 g/dl
12 years - 17 years 34.0 - 44.0 g/dl
17 years or older
35.0 - 47.0 g/dl
Male:
9 years - 11 years
34 .0 -43.0 g/dl
12 years - 14 years 35.0 - 45.0 g/dl
15 years or older
39.0 - 51.0 g/dl
HEMOGLOBIN
Reference Range:
Female:
10 years - 12 years 12.0 - 15.0 g/dl
13 years - 17 years 11.5 - 15.3 g/dl
18 years or older
11.7 - 16.1 g/dl
Male:
10 years - 12 years 12.0 - 15.0 g/dl
13 years - 17 years 12.0 - 16.6 g/dl
18 years or older
12.6 -- 17.4 g/dl
HEMOGLOBIN A1C
Reference Range: 4.4 - 6.4 %
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
83010
$95.00
83718
$20.00
Plasma)
85014
$10.00
Plasma)
85018
$10.00
Plasma)
83036
$25.00
Revised 3/9/2012
TEST #
TEST NAME
823
903
891
1114
991
1120
940
937
HEP A IGG/IGM TOTAL
HEP B VIRAL DNA PCR QUALITATIVE
HEP C RNA BY PCR
HEPATITIS A IGM
HEPATITIS B CORE IGG
HEPATITIS B CORE IGG/IGM
HEPATITIS B CORE IGM
HEPATITIS BE ANTIBODY
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
86708
$30.00
87516
$250.00
2 full lavender top tube (EDTA Plasma)
87522
$89.00
86709
$30.00
86704
$30.00
86705
$70.00
86705
$35.00
86707
$30.00
Revised 3/9/2012
TEST #
TEST NAME
936
825
824
826
1088
905
1906
1054
HEPATITIS BE ANTIGEN
HEPATITIS BSAB
HEPATITIS BSAG
HEPATITIS C
HEPATITIS C BY RIBA
HEPATITIS C VIRAL RNA QUALITATIVE
HEPATITIS C VIRAL RNA QUANTITATIVE
Reference Range: Not Detected
HEPATITS BSAB TITER
Reference Range: >10 miu/mL
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
87350
$30.00
86706
$30.00
87340
$30.00
86803
$30.00
86803
$100.00
87522
$190.00
1 full white top tube (PPT-potassium
EDTA)
87521
$300.00
86706
$75.00
Revised 3/9/2012
TEST #
TEST NAME
1051
1029
1084
1085
1126
1083
972
1191
HEPATITS BSAG CONFIRMATION
HEPTIMAX TM
HERPES 1 AB IGG
HERPES II IGG AB
HERPES II IGM
HERPES SIMPLEX 1 & 2
HETEROPHILE (MONO) SCREEN
HISTOPLASMA (URINE)
3 ml frozen plasma EDTA lavender top
tube
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
87340
$75.00
87522
$190.00
86695
$20.00
86696
$20.00
87273
$20.00
86695
$40.00
86308
$45.00
87385
$109.00
Revised 3/9/2012
TEST #
TEST NAME
869
2401
1210
863
1119
944
852
953
1064
HIV -1 AB
Reference Range: Non-Reactive
HIV 2 SCREEN
HIV AB PHENOTYPE
HIV RNA BY PCR
HLA - B5701 TYPING
HOMOCYSTEINE
H-PYLORI IGG
H-PYLORI IGM
H-PYLORI STOOL
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
86701
$24.00
87391
$67.00
87903,
87904 x5
$450.00
87536
$160.00
83891,
83896
(x30),
83900,
83912
$195.00
83090
$30.00
86677
$26.00
86317
$26.00
87338
$50.00
clotted before centrifuging - centrifuge
for 15 minutes and insure that serum
is separated from the blood cells by
the gel barrier) fasting 8 hours
refrigerate immediately
Revised 3/9/2012
TEST #
TEST NAME
1086
1132
HSV IGM AB
HTLV AB
50267 HYDROXYZINE (VISTARIL) QUALITATIVE
SERUM/BLOOD
LC/MS/MS
50269 IBUPROFEN QUANTITATIVE
SERUM/BLOOD
LC/MS/MS
857 IGA
834
832
IGE
IGG
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
86695
$20.00
86790
$50.00
82491
$54.00
82491
$42.00
82784
$10.00
82785
$10.00
82784
$10.00
Revised 3/9/2012
TEST #
TEST NAME
833
963
962
810
264
IGM
IMMUNOFIXATION SERUM
IMMUNOFIXATION UA (BENCE JONES)
IMMUNOGLOBULINS
INDIRECT BILIRUBIN
Reference Range: 0 - 0.9 mg/L
50275 INDOMETHACIN (INDOCIN) QUALITATIVE
SERUM/BLOOD
LC/MS/MS
850 INFLUENZA A & B RAPID TEST
860
INSULIN
Reference Range: 2.6 - 24.9 uU/L
clotted before centrifuging - centrifuge
for 15 minutes and insure that serum
is separated from the blood cells by
the gel barrier) fasting 8 hours
special swab - call laboratory for
supplies
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
82784
$10.00
86334
$41.00
86334
$41.00
82784
$21.00
82247,
82248
$15.00
82941
$60.00
87404
$35.00
83525
$30.00
Revised 3/9/2012
TEST #
TEST NAME
8271
926
221
8272
320
6982
1106
898
222
1039
1018
INSULIN ANTIBODIES
INTRINSIC FACTOR ANITBODY
IRON
Reference Range: 50 - 170 ug/dL
ISLET CELL AUTOANTIBODIES
K2 (SPICE) LC/MS/MS CONFRIMATION
See Lab Report for reference ranges
K2 (SPICE) LC/MS/MS SCREEN
See Lab Report for reference ranges
KAPP/LAMBDA LIGHT CHAIN
LAMOTRIGINE (LAMICTAL) QUANTITATIVE
SERUM/BLOOD
LC/MS/MS
LDH
Reference Range: 91 - 232 U/L
LDH ISOENZYMES
LDL (DIRECT)
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
86337
$95.00
86340
$106.00
83540
$9.05
86341 x2
$150.00
80100
$90.00
80100
$60.00
83883 x3
$150.00
82491
$40.00
83615
$8.44
83625
$75.00
83721
$45.00
Revised 3/9/2012
TEST #
TEST NAME
840
1023
895
LEAD WHOLE BLOOD
Reference Range: 0 - 10 ug/dL
LEUKOCYTE ALKALINE PHOS
LEUTINIZING HORMONE
See Report for Reference Range
50295 LEVETIRACETAM (KEPRA) QUANTITATIVE
SERUM/BLOOD
LC/MS/MS
50300 LIDOCAINE QUANTITATIVE
SERUM/BLOOD
LC/MS/MS
8266 LIGHT CHAINS FREE (SERUM)
811
821
8260
LIPASE
LITHIUM
Reference Range: 0.6 - 1.2 mmol/L
LKM-I IgG AB
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
83655
$18.00
85540
$80.00
83002
$20.00
82491
$62.00
80176
$40.00
83883
(x2),
84155,
84165
$125.00
83690
$9.62
80178
$9.65
86376
$21.00
5 ml whole blood (sodium heparin -
green tube)
Revised 3/9/2012
TEST #
TEST NAME
50304 LORATIDINE (CLARITIN) QUALITATIVE
SERUM/BLOOD
LC/MS/MS
50306 LORAZEPAM (ATIVAN) QUANTITATIVE
SERUM/BLOOD
LC/MS/MS
51308 LOXAPINE (AMOXAPINE) QUALITATIVE
SERUM/BLOOD
LC/MS/MS
1033 LUPUS ANTICOAGULANT PANEL
868 LYME DISEASE AB
2000
236
LYMES AB WESTERN BLOT
MAGNESIUM
Reference Range: 1.3 - 2.7 mg/dL
50355 MDMA (ECSTASY) QUANTITATIVE
SERUM/BLOOD
LC/MS/MS
Reference Range: Not Detected
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
82491
$80.00
82491
$50.00
82491
$60.00
1 full blue top tube (citrated plasma)
86147
$30.00
86618
$29.00
86617
$51.00
83735
$9.36
82491
$72.00
Revised 3/9/2012
TEST #
TEST NAME
947
MEASLES IGG (RUBEOLA)
51320 MEPERIDINE (DEMEROL) QUANTITATIVE
SERUM/BLOOD
LC/MS/MS
50327 MEPROBAMATE (EQUANIL) QUANTITATIVE
SERUM/BLOOD
LC/MS/MS
41329 MESCALINE ALKALOIDS (PEYOTE)
QUALITATIVE
SERUM/BLOOD
LC/MS/MS
842 METHADONE PEAK QUANTITATIVE
SERUM/BLOOD
LC/MS/MS
845 METHADONE RANDOM QUANTITATIVE
SERUM/BLOOD
LC/MS/MS
841 METHADONE TROUGH QUANTITATIVE
SERUM/BLOOD
LC/MS/MS
6802 METHANOL QUANTITATIVE
SERUM/BLOOD
HEADSPACE GC
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
86765
$45.00
82491
$6.00
83805
$80.00
82542
$90.00
80299
$22.00
80299
$22.00
80299
$22.00
84600
$64.00
Revised 3/9/2012
TEST #
TEST NAME
METHANOL QUANTITATIVE URINE
HEADSPACE GC
50353 METHOTREXATE (FOLEX) QUANTITATIVE
SERUM/BLOOD
IMMUNOASSAY
943
METHYLMALONIC ACID
50356M METHYPHENIDATE (RITALIN)
QUANTITATIVE
URINE
LC/MS/MS
50361 METOPROLO (LOPRESSOR) QUALITATIVE
SERUM/BLOOD
LC/MS/MS
812
MICRO ALBUMIN
Reference Range: 0 - 92.1 mg/L
50365 MIDAZOLAM (VERSED) QUANTITATIVE
SERUM/BLOOD
LC/MS/MS
Reference Range: 0.08- 0.25 mg/L
50366 MIRTAZAPINE (REMERON) QUALITATIVE
SERUM/BLOOD
LC/MS/MS
986
MITOCHODRIAL ANTIBODY
PRICE
(STATS
ARE 2X
LIST PRICE)
* CPT
CODE
84600
$64.00
82491
$52.00
83921
$24.04
82542
$60.00
82491
$60.00
82043
$8.09
80154
$60.00
82491
$50.00
86256
$95.00
6802U
Revised 4/6/2015
TEST #
TEST NAME
933
1022
964
MUMPS ANITBODY IGG
Testing Performed Daily Tues & Thur
Reference Range:
<0.90:
Indicates no detectable IGG AB
0.91-1.09: Equivocal: Should be Retested
>1.10:
Positive, indicated a current or
previous infection with Mumps virus or
prior vaccination against Mumps virus.
MYOGLOBIN (URINE)
MYOGLOBIN SERUM
50376 NAPROXEN (NAPROSYN, ALLEVE)
QUALITATIVE
SERUM/BLOOD
LC/MS/MS
751 OCCULT BLOOD
50400 OLANZAPINE (ZYPREXA) QUANTITATIVE
SERUM/BLOOD
LC/MS/MS
50401 OMEPRAZOLE (PRILOSEC) QUALITATIVE
SERUM/BLOOD
LC/MS/MS
930 OSMOLALITY SERUM
Reference Range: 275 - 295 mOsm/Kg
929
744
OSMOLALITY URINE
OVA & PARASITES
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
86735
$35.00
83874
82874
82491
$50.00
hemoccult card or 2 gm stool (plastic
urine container)
82270
$15.00
82491
$76.00
82491
$98.00
83930
$45.00
83935
$15.00
15 gm stool (preserved with 10%
formalin & PVA)
87177
$50.00
Revised 3/9/2012
TEST #
TEST NAME
50409 OXAZEPAM (SERAX) QUANTITATIVE
SERUM/BLOOD
LC/MS/MS
794 PAP SMEAR (ANAL) THIN PREP
Testing Performed by Mercy Health Lab
896 PAP SMEAR SCREENING
793 PAP SMEAR THIN PREP
50420 PAROXETINE (PAXIL) QUALITATIVE
SERUM/BLOOD
LC/MS/MS
Reference Range: 0.05 - 0.30mg/L
123 PARTIAL THROMBOPLASTIN TIME (PTT)
Reference Range: 23.4 - 35.0 seconds
8269 PARVOVIRUS B19-REAL TIME BY PCR
223 PHENOBARBITAL
Reference Range: 15.0 - 40.0 ug/mL
1031 PHENOSENSE HIV COMP
50441 PHENTERMINE QUALITATIVE
SERUM/BLOOD
LC/MS/MS
Reference Range: 50-150 ng/ml
40441 PHENTERMINE QUALITATIVE URINE
LC/MS/MS
224 PHENYTOIN (DILANTIN)
50448 PHENYTOIN FREE (DILANTIN)
LC/MS/MS
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
80154
$50.00
Thin prep slide
88147
$110.00
Slide
P3000
$23.00
Thin prep slide
88147
$110.00
82491
$46.00
1 Full unopened sodium citrate (light
blue tube)
85730
$30.00
1 full white top tube (PPT-potassium
EDTA)
87798
$200.00
80184
$16.72
87903
87904 x10
$520.00
82491
$90.00
80101
$20.00
80185
$19.36
82491
$46.00
Revised 3/9/2012
TEST #
TEST NAME
225
8261
226
PHOSPHOROUS
Reference Range:
0 months - 14 years 4.0 - 7.0 mg/dL
15 years & over
2.6 - 4.5 mg/dL
PHOSPOROUS URINE
POTASSIUM
Reference Range: 3.5 - 5.5 mmol/L
51450 PRAZEPAM (CENTRAX) QUANTITATIVE
SERUM/BLOOD
LC/MS/MS
Reference Range: 10-40 ng/ml
227 PRE-ALBUMIN
807
983
813
PREGNANCY SERUM
PROBNP (B TYPE NATRIUETIC PEPTIDE)
PROGESTERONE
Reference Range:
Progesterone Interpretation:
Females:
Follicular Phase:
0.2 - 1.5 ng/mL
Ovulatory Phase:
0.8 - 3.0 ng/mL
Luteal phase:
1.7-27.0 ng/mL
Postmenopausal: 0.1 - 0.8 ng/mL
Males:
0.2 - 1.4 ng/mL
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
84100
$6.63
84105
$18.00
84132
$6.42
84132
$6.42
84134
$20.38
84703
$25.00
83880
84144
$35.00
Revised 3/9/2012
TEST #
TEST NAME
1860
PROINSULIN
814
PROLACTIN
PROTEIN URINE 24 HR
Reference Range: 0.05-0.15 g/24hr
50463 PROTRIPTYLINE (TRIPTIL, VIVACTIL)
QUALITATIVE
SERUM/BLOOD
LC/MS/MS
50463U PROTRIPTYLINE (TRIPTIL, VIVACTIL) URINE
QUALITATIVE
LC/MS/MS
815 PSA
Reference Range:
0 months - 40 years 0. 0 - 1.30 ng/mL
41 years - 50 years 0. 0 - 2.00 ng/mL
51 years - 60 years 0. 0 - 3.00 ng/mL
61 years - 70 years 0. 0 - 4.00 ng/mL
71 years & over
0. 0 - 4.50 ng/mL
855 PSA FREE
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
84146
$21.00
84155
$69.00
82491
$50.00
84153
$25.70
84154
$27.00
Overnight Fasting is Preferred
749
Revised 3/9/2012
TEST #
TEST NAME
50466 PSILOCIN (HALLUCINOGEN) QUALITATIVE
SERUM/BLOOD
LC/MS/MS
816 PTH INTACT
Testing Performed Tues & Thurs
See Lab report for Reference Range
50470 QUETIAPINE (SEROQUEL) QUANTITATIVE
SERUM/BLOOD
LC/MS/MS
Reference Range: 0.040-0.400 mg/L
6946 QUINIDINE QUALITATIVE
SERUM/BLOOD
LC/MS/MS
50475 QUININE (ANTIMALARIAL) QUALITATIVE
SERUM/BLOOD
LC/MS/MS
50478 RANITIDINE (ZANTAC) QUALITATIVE
SERUM/BLOOD
LC/MS/MS
987 RBC, FOLATE
719 RETIC
885 RHEUMATOID FACTOR
Reference Range: 3.5-14 iu/mL
8417
RIBOSOMAL AB
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
82491
$60.00
83970
$62.00
82491
$52.00
80194
$24.00
84228
$44.00
82491
$80.00
82747
Plasma)
85044
$6.01
86431
$13.00
83520
$45.00
Revised 3/9/2012
TEST #
TEST NAME
1057
ROTAVIRUS AG
828 RPR
SEE TEST Testing Performed Daily
628 Reference Range: Non-Reactive
945
RUBELLA IGG ANTIBODY
50486 SALICYLAMIDE (SALICYLIC AMIDE)
QUALITATIVE SERUM/BLOOD
LC/MS/MS
45489 SALICYLATES QUANTITATIVE
SERUM/BLOOD
LC/MS/MS
45489U SALICYLATES URINE QUALITATIVE
LC/MS/MS
838 SCLERADERMA (SCL70)
50495 SECOBARBITAL (SECONAL) QUANTITATIVE
SERUM/BLOOD
LC/MS/MS
718 SED RATE MODIFIED WESTERGREN (ESR)
Reference Range: 0 - 20 mm/hr
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
87425
$20.00
86592
$35.00
86762
$20.00
84311
$60.00
80196
$64.00
80196
$64.00
86235
$127.00
82205
$80.00
Plasma)
85651
$15.00
refrigerate immediately
Revised 3/9/2012
TEST #
TEST NAME
915
946
741
994
853
228
976
1034
2015
SERODIA TP-PA
SEROTONIN SERUM/BLOOD
SICKLE CELL
SJORGRENS SSA - SSB
SMOOTH MUSCLE AB
SODIUM
Reference Range: 133 - 145 mmol/L
SODIUM URINE 24HR
Reference Range:40-220 mmol/hr
SPUTUM - AFB
STOOL FOR NOROVIRUS
1045 STOOL GIARDIA/CRYPTOSPORIDIUM
See Result Report for Reference Range
877 STOOL WBC (LEUKOCYTES)
40498 STRYCHNINE QUALITATIVE
SERUM/BLOOD
LC/MS/MS
Plasma)
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
86780
$20.00
84260
85660
$15.00
86235
$133.00
86255
$22.00
84295
$6.72
84300
$15.00
Collect first morning deep cough
sputum or induced sputum in a sterile
urine container
87206
$65.00
2 gm stool in a sterile urine container
87449
$120.00
15 gm stool (preserved with 10%
formalin)
87328
$45.00
89055
$15.00
82491
$86.00
Revised 3/9/2012
TEST #
TEST NAME
934
233
817
229
984
T3 FREE
Reference Range: 2.15 - 3.95 pg/mL
T3 UPTAKE
T3, TOTAL
T4 TOTAL
TACROLIMUS
51514 TEMAZEPAM (RESTORIL) QUANTITATIVE
SERUM/BLOOD
LC/MS/MS
900 TESTOSTERONE
Reference Range: 250 - 1100 ng/dL
993 TESTOSTERONE FREE
230 THEOPHYLLINE
50523 THIOCYANATE (NIPRIDE) QUALITATIVE
SERUM/BLOOD
LC/MS/MS
Testing Performed STAT & Daily Mon-Fri
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
84480
$28.00
84479
$25.00
84480
$30.00
84436
$25.00
80197
$176.00
82491
$50.00
84403
$27.00
84402
$40.00
80198
$20.66
82491
$50.00
Revised 3/9/2012
TEST #
TEST NAME
51527 THIORIDAZINE (MELLARIL) QUALITATIVE
SERUM/BLOOD
LC/MS/MS
827 THYROGLOBULIN
829
1145
988
881
206
231
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
82491
$42.00
84432
$40.00
86376
$80.00
84445
$350.00
THYROID PEROXIDASE AB
THYROID STIMULATING
IMMUNOGLOBULIN Testing Performed by with gel barrier - wait until blood is
Reference Lab
TISSUE TRANSGLUTAMINASE IGG
TOPIRAMATE (TOPAMAX)
TOTAL BILIRUBIN
Reference Range: 0.1 - 1.3 mg/dL
TOTAL PROTEIN
Reference Range: 5.9 - 8.4 g/dL
83516
80299
$83.00
82247
$7.02
84155
$5.12
Revised 3/9/2012
TEST #
TEST NAME
50539 TRAMADOL (ULTRAM) QUANTITATIVE
SERUM/BLOOD
LC/MS/MS
50540 TRAZADONE (DESYREL) QUANTITATIVE
SERUM/BLOOD
LC/MS/MS
50546 TRIAZOLAM (HALCION) QUANTITATIVE
SERUM/BLOOD
LC/MS/MS
232 TRIGLYCERIDES
51561 TRIMIPRAMINE (SURMONTIL)
QUANTITATIVE
SERUM/BLOOD
LC/MS/MS
909 TROPONIN
819
1152
TSH
Reference Range: 0.50 - 5.00 mciu/mL
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
82491
$60.00
82491
$42.00
82491
$50.00
84478
$8.04
82491
$80.00
84484
$34.00
84443
$35.00
86481
$100.00
T-SPOT TB TEST
Testing Performed STAT and Daily Mon-Fri ,
2 full- 6ml green top tubes (Sodium
Specimen must be delivered by 12pm on
Heparin)
Friday
Revised 3/9/2012
TEST #
TEST NAME
234
735
235
831
1129
830
1061
913
URIC ACID
Reference Range:
Female: 2.7 - 7.3 mg/dL
Male:
4.0 - 8.5 mg/dL
URINE PREGNANCY
VALPORIC ACID
VANCOMYCIN PEAK
VANCOMYCIN RANDOM
VANCOMYCIN TROUGH
VAP (TRADE MARK) - CHOLESTEROL
VARICELLA-ZOSTER IGG
Testing Performed Daily Tues & Thur
Reference Ranges: See Lab Report for all
reference ranges.
50578 VENLAFAXINE (EFFEXOR) QUANTITATIVE
SERUM/BLOOD
LC/MS/MS
50577 VERAPAMIL (ISOPTIN) QUALITATIVE
SERUM/BLOOD
LC/MS/MS
1002 VITAMIN A
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
84550
$6.31
81025
$12.00
80164
$19.78
80202
$18.93
80202
$15.00
80202
$18.93
82465
$50.00
82607
$20.00
82491
$60.00
82491
$60.00
1 full grey top tube - Overnight fasting
84590
clotted before centrifuging --
Revised 3/9/2012
TEST #
TEST NAME
864
50582
50591
50594
50595
50226
VITAMIN K LEVEL
WARFARIN (COUMADIN) QUALITATIVE
SERUM/BLOOD
LC/MS/MS
ZALEPLON (SONATA) QUANTITATIVE
SERUM/BLOOD
LC/MS/MS
ZOLPIDEM (AMBIEN) QUANTITATIVE
SERUM/BLOOD
LC/MS/MS
Reference Range: 0.08- 0.30 mg/L
ZONISAMIDE (ZONEGRAN) QUANTITATIVE
SERUM/BLOOD
LC/MS/MS
ZOPICLONE (LUNESTA) QUANTITATIVE
SERUM/BLOOD
LC/MS/MS
* CPT
CODE
PRICE (STATS
ARE 2X LIST
PRICE)
4 ml plasma (sodium heparin tube -
green top tube) freeze immediately
84597
$260.00
82491
$48.00
82491
$60.00
82491
$60.00
82491
$64.00
82491
$60.00
Revised 3/9/2012

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