2019 Clinical Diagnostic Laboratory Fee Schedule- Gapfill Final Determinations																																																															
"CPT codes, descriptions and other data only are copyright 2013 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association (AMA)."																																																															
"As outlined in Sec 1834A(c)(4); Explanation of payment rates.--In the case of a clinical diagnostic laboratory test for which payment is made under this subsection, the Secretary shall make available to the public an explanation of the payment rate for the test."																																																															
																																																															
HCPCS*	Modifier	"National
Limit**"	"Mid
Point"	CA1	CA2	HI	NV	AK	ID	OR	WA	AZ	MT	ND	SD	UT	WY	CO	NM	OK	TX	IA	KS	KS	MO2	MO1	NE	IL	MN	WI	AR	LA	MS	IN	MI	FL	PR	AL	GA	TN	SC	VA	WV	NC	DE	DC	MD	NJ	PA	CT	NY2	NY1	NY3	ME	MA	NH	RI	VT	KY	OH	Descriptor	MAC Justifications for Final Recommendations (if blank this indicates CMS received no public comments for that code)	
				01112	01182	01212	01312	02102	02202	02302	02402	03102	03202	03302	03402	03502	03602	04112	04212	04312	04412	05102	05202	05202	05302	05302	05402	06102	06202	06302	07102	07202	07302	08102	08202	09102	09202	10102	10202	10302	11202	11302	11402	11502	12102	12202	12302	12402	12502	13102	13202	13282	13292	14112	14212	14312	14412	14512	15102	15202			
				LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 01	LOC 02	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 12	LOC 15	LOC 07	LOC 15	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 20	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00	LOC 00			
0018U		" $3,002.09 "		" $3,002.09 "	" $3,002.09 "	" $3,002.09 "	" $3,002.09 "	" $3,002.09 "	" $3,002.09 "	" $3,002.09 "	" $3,002.09 "	" $3,002.09 "	" $3,002.09 "	" $3,002.09 "	" $3,002.09 "	" $3,002.09 "	" $3,002.09 "	" $1,921.20 "	" $1,921.20 "	" $1,921.20 "	" $1,921.20 "	" $3,002.09 "	" $3,002.09 "	" $3,002.09 "	" $3,002.09 "	" $3,002.09 "	" $3,002.09 "	" $1,921.20 "	" $1,921.20 "	" $1,921.20 "	" $1,921.20 "	" $1,921.20 "	" $1,921.20 "	" $3,002.09 "	" $3,002.09 "	" $1,921.20 "	" $1,921.20 "	" $3,002.09 "	" $3,002.09 "	" $3,002.09 "	" $3,002.09 "	" $3,002.09 "	" $3,002.09 "	" $3,002.09 "	" $1,921.20 "	" $1,921.20 "	" $1,921.20 "	" $1,921.20 "	" $1,921.20 "	" $1,921.20 "	" $1,921.20 "	" $1,921.20 "	" $1,921.20 "	" $1,921.20 "	" $1,921.20 "	" $1,921.20 "	" $1,921.20 "	" $1,921.20 "	" $3,002.09 "	" $3,002.09 "	" Oncology (thyroid), microRNA profiling by RT-PCR of 10 microRNA sequences, utilizing fine needle aspirate, algorithm reported as a positive or negative result for moderate to high risk of malignancy A3 "		
0019U		" $3,675.00 "		" $3,675.00 "	" $3,675.00 "	" $3,675.00 "	" $3,675.00 "	" $3,675.00 "	" $3,675.00 "	" $3,675.00 "	" $3,675.00 "	" $3,675.00 "	" $3,675.00 "	" $3,675.00 "	" $3,675.00 "	" $3,675.00 "	" $3,675.00 "	 $597.91 	 $597.91 	 $597.91 	 $597.91 	" $3,675.00 "	" $3,675.00 "	" $3,675.00 "	" $3,675.00 "	" $3,675.00 "	" $3,675.00 "	 $328.45 	 $328.45 	 $328.45 	 $597.91 	 $597.91 	 $597.91 	" $3,675.00 "	" $3,675.00 "	 $597.91 	 $597.91 	" $3,675.00 "	" $3,675.00 "	" $3,675.00 "	" $3,675.00 "	" $3,675.00 "	" $3,675.00 "	" $3,675.00 "	 $597.91 	 $597.91 	 $597.91 	 $597.91 	 $597.91 	 $328.45 	 $328.45 	 $328.45 	 $328.45 	 $328.45 	 $328.45 	 $328.45 	 $328.45 	 $328.45 	" $3,675.00 "	" $3,675.00 "	" Oncology, RNA, gene expression by whole transcriptome sequencing, formalinfixed paraffin embedded tissue or fresh frozen tissue, predictive algorithm reported as potential targets for therapeutic agents.
 "		
0021U		 $760.00 		 $760.00 	 $760.00 	 $760.00 	 $760.00 	 $760.00 	 $760.00 	 $760.00 	 $760.00 	 $760.00 	 $760.00 	 $760.00 	 $760.00 	 $760.00 	 $760.00 	 $328.42 	 $328.42 	 $328.42 	 $328.42 	 $760.00 	 $760.00 	 $760.00 	 $760.00 	 $760.00 	 $760.00 	 $328.45 	 $328.45 	 $328.45 	 $328.42 	 $328.42 	 $328.42 	 $760.00 	 $760.00 	 $328.42 	 $328.42 	 $760.00 	 $760.00 	 $760.00 	 $760.00 	 $760.00 	 $760.00 	 $760.00 	 $328.42 	 $328.42 	 $328.42 	 $328.42 	 $328.42 	 $328.45 	 $328.45 	 $328.45 	 $328.45 	 $328.45 	 $328.45 	 $328.45 	 $328.45 	 $328.45 	 $760.00 	 $760.00 	" Oncology (prostate), detection of 8 autoantibodies (ARF 6, NKX3-1, 5-UTRBMI1, CEP 164, 3-UTR-Ropporin, Desmocollin, AURKAIP-1, CSNK2A2), multiplexed immunoassay and flow cytometry serum, algorithm reported as risk score. "		
0022U		" $1,950.00 "		" $1,950.00 "	" $1,950.00 "	" $1,950.00 "	" $1,950.00 "	" $1,950.00 "	" $1,950.00 "	" $1,950.00 "	" $1,950.00 "	" $1,950.00 "	" $1,950.00 "	" $1,950.00 "	" $1,950.00 "	" $1,950.00 "	" $1,950.00 "	" $1,815.00 "	" $1,815.00 "	" $1,815.00 "	" $1,815.00 "	" $1,950.00 "	" $1,950.00 "	" $1,950.00 "	" $1,950.00 "	" $1,950.00 "	" $1,950.00 "	" $1,815.00 "	" $1,815.00 "	" $1,815.00 "	" $1,815.00 "	" $1,815.00 "	" $1,815.00 "	" $1,950.00 "	" $1,950.00 "	" $1,815.00 "	" $1,815.00 "	" $1,950.00 "	" $1,950.00 "	" $1,950.00 "	" $1,950.00 "	" $1,950.00 "	" $1,950.00 "	" $1,950.00 "	" $1,815.00 "	" $1,815.00 "	" $1,815.00 "	" $1,815.00 "	" $1,815.00 "	" $1,815.00 "	" $1,815.00 "	" $1,815.00 "	" $1,815.00 "	" $1,815.00 "	" $1,815.00 "	" $1,815.00 "	" $1,815.00 "	" $1,815.00 "	" $1,950.00 "	" $1,950.00 "	" Targeted genomic sequence analysis panel, non-small cell lung neoplasia, DNA and RNA analysis, 23 genes, interrogation for sequence variants and rearrangements, reported as presence/absence of variants and associated therapy(ies) to consider. "		
0023U		 $248.51 		 $248.51 	 $248.51 	 $248.51 	 $248.51 	 $248.51 	 $248.51 	 $248.51 	 $248.51 	 $248.51 	 $248.51 	 $248.51 	 $248.51 	 $248.51 	 $248.51 	 $165.51 	 $165.51 	 $165.51 	 $165.51 	 $248.51 	 $248.51 	 $248.51 	 $248.51 	 $248.51 	 $248.51 	 $165.51 	 $165.51 	 $165.51 	 $165.51 	 $165.51 	 $165.51 	 $248.51 	 $248.51 	 $165.51 	 $165.51 	 $248.51 	 $248.51 	 $248.51 	 $248.51 	 $248.51 	 $248.51 	 $248.51 	 $165.51 	 $165.51 	 $165.51 	 $165.51 	 $165.51 	 $165.51 	 $165.51 	 $165.51 	 $165.51 	 $165.51 	 $165.51 	 $165.51 	 $165.51 	 $165.51 	 $248.51 	 $248.51 	" Oncology (acute myelogenous leukemia), DNA, genotyping of internal tandem duplication, p.D835, p.I836, using mononuclear cells, reported as detection or non-detection of FLT3 mutation and indication for or against the use of midostaurin. "	"Since tests for FLT3 mutations exist and have already been priced on the CLFS, we believe that the approach of pricing 0023U given particular deference to Charges, payment amounts, and resources required for other tests that may be comparable or otherwise relevant 42 CFR 414.508(b)(2)(i)(D) is most appropriate. As such, we continue to recommend a price of $248.51, which was our original recommendation.   "	
0029U		 $742.27 		 $742.27 	 $742.27 	 $742.27 	 $742.27 	 $742.27 	 $742.27 	 $742.27 	 $742.27 	 $742.27 	 $742.27 	 $742.27 	 $742.27 	 $742.27 	 $742.27 	 $450.91 	 $450.91 	 $450.91 	 $450.91 	 $742.27 	 $742.27 	 $742.27 	 $742.27 	 $742.27 	 $742.27 	 $450.91 	 $450.91 	 $450.91 	 $450.91 	 $450.91 	 $450.91 	 $742.27 	 $742.27 	 $450.91 	 $450.91 	 $742.27 	 $742.27 	 $742.27 	 $742.27 	 $742.27 	 $742.27 	 $742.27 	 $450.91 	 $450.91 	 $450.91 	 $450.91 	 $450.91 	 $450.91 	 $450.91 	 $450.91 	 $450.91 	 $450.91 	 $450.91 	 $450.91 	 $450.91 	 $450.91 	 $742.27 	 $742.27 	" Drug metabolism (adverse drug reactions and drug response), targeted sequence analysis (ie, CYP1A2, CYP2C19, CYP2C9, CYP2D6, CYP3A4, CYP3A5, CYP4F2, SLCO1B1, VKORC1 and rs12777823). "	"1. Based on Charges, payment amounts, and resources required for other tests that may be comparable or otherwise relevant 42 CFR 414.508(b)(2)(i)(D), we recommend that the prices for codes 81225 and 81226 be summed, and we recommend a price of $742.27. We also believe that this is in the neighborhood of the cost for the resources typically required to perform similar tests at other labs.  2. Contractors that did not change their recommendation did not feel the information provided justified a change in their prior decision. "	
0030U		 $134.13 		 $134.13 	 $134.13 	 $134.13 	 $134.13 	 $134.13 	 $134.13 	 $134.13 	 $134.13 	 $134.13 	 $134.13 	 $134.13 	 $134.13 	 $134.13 	 $134.13 	 $149.03 	 $149.03 	 $149.03 	 $149.03 	 $134.13 	 $134.13 	 $134.13 	 $134.13 	 $134.13 	 $134.13 	 $149.02 	 $149.02 	 $149.02 	 $149.03 	 $149.03 	 $149.03 	 $134.13 	 $134.13 	 $149.03 	 $149.03 	 $134.13 	 $134.13 	 $134.13 	 $134.13 	 $134.13 	 $134.13 	 $134.13 	 $149.03 	 $149.03 	 $149.03 	 $149.03 	 $149.03 	 $149.02 	 $149.02 	 $149.02 	 $149.02 	 $149.02 	 $149.02 	 $149.02 	 $149.02 	 $149.02 	 $134.13 	 $134.13 	" Drug metabolism (warfarin drug response), targeted sequence analysis (ie, CYP2C9, CYP4F2, VKORC1, rs12777823). "	"This test would be billed using the code G9143, so recommended price is G9143 price.  
"	
0035U		 $540.99 		 $540.99 	 $540.99 	 $540.99 	 $540.99 	 $540.99 	 $540.99 	 $540.99 	 $540.99 	 $540.99 	 $540.99 	 $540.99 	 $540.99 	 $540.99 	 $540.99 	 $427.23 	 $427.23 	 $427.23 	 $427.23 	 $540.99 	 $540.99 	 $540.99 	 $540.99 	 $540.99 	 $540.99 	 $427.33 	 $427.33 	 $427.33 	 $427.23 	 $427.23 	 $427.23 	 $540.99 	 $540.99 	 $427.23 	 $427.23 	 $540.99 	 $540.99 	 $540.99 	 $540.99 	 $540.99 	 $540.99 	 $540.99 	 $427.23 	 $427.23 	 $427.23 	 $427.23 	 $427.23 	 $427.33 	 $427.33 	 $427.33 	 $427.33 	 $427.33 	 $427.33 	 $427.33 	 $427.33 	 $427.33 	 $540.99 	 $540.99 	" Neurology (prion disease), cerebrospinal fluid, detection of prion protein by quaking-induced conformational conversion, qualitative "		
0041U		 $17.21 		 $17.21 	 $17.21 	 $17.21 	 $17.21 	 $17.21 	 $17.21 	 $17.21 	 $17.21 	 $17.21 	 $17.21 	 $17.21 	 $17.21 	 $17.21 	 $17.21 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $17.21 	 $17.21 	 $17.21 	 $17.21 	 $17.21 	 $17.21 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $17.21 	 $17.21 	 $68.06 	 $68.06 	 $17.21 	 $17.21 	 $17.21 	 $17.21 	 $17.21 	 $17.21 	 $17.21 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $17.21 	 $17.21 	" Borrelia burgdorferi, antibody detection of 5 recombinant protein groups, by immunoblot, IgM. "	"We recommend no change to the price of 0041U, 0042U, 0043U, and 0044U. Since there are established existing tests that are similar, we believe that the consideration of Charges, payment amounts, and resources required for other tests that may be comparable or otherwise relevant (42 CFR 414.508(b)(2)(i)(D)) provides the most appropriate approach to price this test."	
0042U		 $17.21 		 $17.21 	 $17.21 	 $17.21 	 $17.21 	 $17.21 	 $17.21 	 $17.21 	 $17.21 	 $17.21 	 $17.21 	 $17.21 	 $17.21 	 $17.21 	 $17.21 	 $72.82 	 $72.82 	 $72.82 	 $72.82 	 $17.21 	 $17.21 	 $17.21 	 $17.21 	 $17.21 	 $17.21 	 $72.82 	 $72.82 	 $72.82 	 $72.82 	 $72.82 	 $72.82 	 $17.21 	 $17.21 	 $72.82 	 $72.82 	 $17.21 	 $17.21 	 $17.21 	 $17.21 	 $17.21 	 $17.21 	 $17.21 	 $72.82 	 $72.82 	 $72.82 	 $72.82 	 $72.82 	 $72.82 	 $72.82 	 $72.82 	 $72.82 	 $72.82 	 $72.82 	 $72.82 	 $72.82 	 $72.82 	 $17.21 	 $17.21 	" Borrelia burgdorferi, antibody detection of 12 recombinant protein groups, by immunoblot, IgG. "	"We recommend no change to the price of 0041U, 0042U, 0043U, and 0044U. Since there are established existing tests that are similar, we believe that the consideration of Charges, payment amounts, and resources required for other tests that may be comparable or otherwise relevant (42 CFR 414.508(b)(2)(i)(D)) provides the most appropriate approach to price this test."	
0043U		 $14.86 		 $14.86 	 $14.86 	 $14.86 	 $14.86 	 $14.86 	 $14.86 	 $14.86 	 $14.86 	 $14.86 	 $14.86 	 $14.86 	 $14.86 	 $14.86 	 $14.86 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $14.86 	 $14.86 	 $14.86 	 $14.86 	 $14.86 	 $14.86 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $14.86 	 $14.86 	 $68.06 	 $68.06 	 $14.86 	 $14.86 	 $14.86 	 $14.86 	 $14.86 	 $14.86 	 $14.86 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $14.86 	 $14.86 	" Tick-borne relapsing fever Borrelia group, antibody detection to 4 recombinant protein groups, by immunoblot, IgM. "	"We recommend no change to the price of 0041U, 0042U, 0043U, and 0044U. Since there are established existing tests that are similar, we believe that the consideration of Charges, payment amounts, and resources required for other tests that may be comparable or otherwise relevant (42 CFR 414.508(b)(2)(i)(D)) provides the most appropriate approach to price this test."	
0044U		 $14.86 		 $14.86 	 $14.86 	 $14.86 	 $14.86 	 $14.86 	 $14.86 	 $14.86 	 $14.86 	 $14.86 	 $14.86 	 $14.86 	 $14.86 	 $14.86 	 $14.86 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $14.86 	 $14.86 	 $14.86 	 $14.86 	 $14.86 	 $14.86 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $14.86 	 $14.86 	 $68.06 	 $68.06 	 $14.86 	 $14.86 	 $14.86 	 $14.86 	 $14.86 	 $14.86 	 $14.86 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $68.06 	 $14.86 	 $14.86 	" Tick-borne relapsing fever Borrelia group, antibody detection to 4 recombinant protein groups, by immunoblot, IgG. "	"We recommend no change to the price of 0041U, 0042U, 0043U, and 0044U. Since there are established existing tests that are similar, we believe that the consideration of Charges, payment amounts, and resources required for other tests that may be comparable or otherwise relevant (42 CFR 414.508(b)(2)(i)(D)) provides the most appropriate approach to price this test."	
0048U		" $2,919.60 "		" $2,919.60 "	" $2,919.60 "	" $2,919.60 "	" $2,919.60 "	" $2,919.60 "	" $2,919.60 "	" $2,919.60 "	" $2,919.60 "	" $2,919.60 "	" $2,919.60 "	" $2,919.60 "	" $2,919.60 "	" $2,919.60 "	" $2,919.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,919.60 "	" $2,919.60 "	" $2,919.60 "	" $2,919.60 "	" $2,919.60 "	" $2,919.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,919.60 "	" $2,919.60 "	" $2,916.60 "	" $2,916.60 "	" $2,919.60 "	" $2,919.60 "	" $2,919.60 "	" $2,919.60 "	" $2,919.60 "	" $2,919.60 "	" $2,919.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,919.60 "	" $2,919.60 "	"Oncology (solid organ neoplasia), DNA, targeted sequencing of protein-coding exons of 468 cancer-associated genes, including interrogation for somatic mutations and microsatellite instability, matched with normal specimens, utilizing formalin-fixed paraffin-embedded tumor tissue, report of clinically significant mutation(s)"		
0050U		" $2,916.60 "		" $2,919.60 "	" $2,919.60 "	" $2,919.60 "	" $2,919.60 "	" $2,919.60 "	" $2,919.60 "	" $2,919.60 "	" $2,919.60 "	" $2,919.60 "	" $2,919.60 "	" $2,919.60 "	" $2,919.60 "	" $2,919.60 "	" $2,919.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,919.60 "	" $2,919.60 "	" $2,919.60 "	" $2,919.60 "	" $2,919.60 "	" $2,919.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,919.60 "	" $2,919.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" Targeted genomic sequence analysis panel, acute myelogenous leukemia, DNA analysis, 194 genes, interrogation for sequence variants, copy number variants or rearrangements "	"1. After further discussion with the laboratory and getting additional information, we realize that this test provides more information, and we are recommending that it be priced at $2,919.60, which is the price given 81455 and the price that we have assigned to similar tests providing a similar amount of information.   2. Contractors that did not change their recommendation did not feel the information provided justified a change in their prior decision. "	
0053U		" $2,030.00 "		" $2,030.00 "	" $2,030.00 "	" $2,030.00 "	" $2,030.00 "	" $2,030.00 "	" $2,030.00 "	" $2,030.00 "	" $2,030.00 "	" $2,030.00 "	" $2,030.00 "	" $2,030.00 "	" $2,030.00 "	" $2,030.00 "	" $2,030.00 "	 $760.00 	 $760.00 	 $760.00 	 $760.00 	" $2,030.00 "	" $2,030.00 "	" $2,030.00 "	" $2,030.00 "	" $2,030.00 "	" $2,030.00 "	 $760.00 	 $760.00 	 $760.00 	 $760.00 	 $760.00 	 $760.00 	" $2,030.00 "	" $2,030.00 "	 $760.00 	 $760.00 	" $2,030.00 "	" $2,030.00 "	" $2,030.00 "	" $2,030.00 "	" $2,030.00 "	" $2,030.00 "	" $2,030.00 "	 $760.00 	 $760.00 	 $760.00 	 $760.00 	 $760.00 	 $760.00 	 $760.00 	 $760.00 	 $760.00 	 $760.00 	 $760.00 	 $760.00 	 $760.00 	 $760.00 	" $2,030.00 "	" $2,030.00 "	" Oncology (prostate cancer), FISH analysis of 4 genes (ASAP1, HDAC9, CHD1 and PTEN), needle biopsy specimen, algorithm reported as probability of higher tumor grade "		
0055U		" $3,240.00 "		" $3,240.00 "	" $3,240.00 "	" $3,240.00 "	" $3,240.00 "	" $3,240.00 "	" $3,240.00 "	" $3,240.00 "	" $3,240.00 "	" $3,240.00 "	" $3,240.00 "	" $3,240.00 "	" $3,240.00 "	" $3,240.00 "	" $3,240.00 "	" $3,209.88 "	" $3,209.88 "	" $3,209.88 "	" $3,209.88 "	" $3,240.00 "	" $3,240.00 "	" $3,240.00 "	" $3,240.00 "	" $3,240.00 "	" $3,240.00 "	" $3,209.88 "	" $3,209.88 "	" $3,209.88 "	" $3,209.88 "	" $3,209.88 "	" $3,209.88 "	" $3,240.00 "	" $3,240.00 "	" $3,209.88 "	" $3,209.88 "	" $3,240.00 "	" $3,240.00 "	" $3,240.00 "	" $3,240.00 "	" $3,240.00 "	" $3,240.00 "	" $3,240.00 "	" $3,209.88 "	" $3,209.88 "	" $3,209.88 "	" $3,209.88 "	" $3,209.88 "	" $3,209.88 "	" $3,209.88 "	" $3,209.88 "	" $3,209.88 "	" $3,209.88 "	" $3,209.88 "	" $3,209.88 "	" $3,209.88 "	" $3,209.88 "	" $3,240.00 "	" $3,240.00 "	" Cardiology (heart transplant), cell-free DNA, PCR assay of 96 DNA target sequences (94 single nucleotide polymorphism targets and two control targets), plasma "		
0056U		" $2,515.60 "		" $2,515.60 "	" $2,515.60 "	" $2,515.60 "	" $2,515.60 "	" $2,515.60 "	" $2,515.60 "	" $2,515.60 "	" $2,515.60 "	" $2,515.60 "	" $2,515.60 "	" $2,515.60 "	" $2,515.60 "	" $2,515.60 "	" $2,515.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,515.60 "	" $2,515.60 "	" $2,515.60 "	" $2,515.60 "	" $2,515.60 "	" $2,515.60 "	" $2,515.60 "	" $2,516.60 "	" $2,517.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,515.60 "	" $2,515.60 "	" $2,916.60 "	" $2,916.60 "	" $2,515.60 "	" $2,515.60 "	" $2,515.60 "	" $2,515.60 "	" $2,515.60 "	" $2,515.60 "	" $2,515.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,916.60 "	" $2,517.60 "	" $2,518.60 "	" $2,519.60 "	" $2,520.60 "	" $2,521.60 "	" $2,522.60 "	" $2,523.60 "	" $2,524.60 "	" $2,525.60 "	" $2,515.60 "	" $2,515.60 "	" Hematology (acute myelogenous leukemia), DNA, whole genome next generation sequencing to detect gene rearrangement(s), blood or bone marrow, report of specific gene rearrangement(s). "		
0057U		 deleted 																																																											"Oncology (solid organ neoplasia), mRNA, gene expression profiling by massively parallel sequencing for analysis of 51 genes, utilizing formalin-fixed paraffin embedded tissue, algorithm reported as a normalized percentile rank."		
																																																															
																																																															
																																																															
																																																															
