 2021 Clinical Diagnostic Laboratory Fee Schedule- Gapfill Preliminary Determinations 																																																												
" CPT codes, descriptions and other data only are copyright 2020 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 	 Descriptor 	" 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 
				1112	1182	1212	1312	2102	2202	2302	2402	3102	3202	3302	3402	3502	3602	4112	4212	4312	4412	5102	5202	5202	5302	5302	5402	6102	6202	6302	7102	7202	7302	8102	8202	9102	9202	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 
86328	 Rapid Antibody test for detection of severe acute respiratory syndrome coronavirus 2  	$45.28 		$45.28 	$45.28 	$45.28 	$45.28 	$45.28 	$45.28 	$45.28 	$45.28 	$45.28 	$45.28 	$45.28 	$45.28 	$45.28 	$45.28 	$45.23 	$45.23 	$45.23 	$45.23 	$45.28 	$45.28 	$45.28 	$45.28 	$45.28 	$45.28 	$45.28 	$45.28 	$45.28 	$45.23 	$45.23 	$45.23 	$45.28 	$45.28 	$45.23 	$45.23 	$45.28 	$45.28 	$45.28 	$45.28 	$45.28 	$45.28 	$45.28 	$45.23 	$45.23 	$45.23 	$45.23 	$45.23 	$45.28 	$45.28 	$45.28 	$45.28 	$45.28 	$45.28 	$45.28 	$45.28 	$45.28 	$45.28 	$45.28 
86769	 Measure of severe acute respiratory syndrome coronavirus 2 (Covid-19) antibody 	$42.13 		$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 	$42.13 
87635	 Amplifed DNA or RNA probe detection of severe acute respiratory syndrome CoV-2 	$51.31 		$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 
U0001	 Cdc 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel 	$35.92 		$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 	$35.92 
U0002	" 2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple "	$51.31 		$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 	$51.31 
U0003	" Infectious agent detection by nucleic acid (dna or rna); severe acute, high throughput "	$75.00 		$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 
U0004	" 2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple, high throughput "	$75.00 		$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 	$75.00 
0015M	" Adrenal cortical tumor, biochemical assay of 25 steroid markers "	"$1,305.37 "		"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	$503.40 	$503.40 	$503.40 	$503.40 	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	$503.40 	$503.40 	$503.40 	"$1,305.37 "	"$1,305.37 "	$503.40 	$503.40 	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	$503.40 	$503.40 	$503.40 	$503.40 	$503.40 	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "
0016M	" Oncology (bladder), mrna, microarray gene expression profiling of 209 genes "	"$3,489.63 "		"$3,489.63 "	"$3,489.63 "	"$3,489.63 "	"$3,489.63 "	"$3,489.63 "	"$3,489.63 "	"$3,489.63 "	"$3,489.63 "	"$3,489.63 "	"$3,489.63 "	"$3,489.63 "	"$3,489.63 "	"$3,489.63 "	"$3,489.63 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$3,489.63 "	"$3,489.63 "	"$3,489.63 "	"$3,489.63 "	"$3,489.63 "	"$3,489.63 "	"$4,203.21 "	"$4,203.21 "	"$4,203.21 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$3,489.63 "	"$3,489.63 "	"$2,919.60 "	"$2,919.60 "	"$3,489.63 "	"$3,489.63 "	"$3,489.63 "	"$3,489.63 "	"$3,489.63 "	"$3,489.63 "	"$3,489.63 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$4,203.21 "	"$4,203.21 "	"$4,203.21 "	"$4,203.21 "	"$4,203.21 "	"$4,203.21 "	"$4,203.21 "	"$4,203.21 "	"$4,203.21 "	"$3,489.63 "	"$3,489.63 "
0101U	 Gene sequence analysis panel of 15 genes associated with hereditary colon 	"$1,743.95 "		"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,286.78 "	"$1,286.78 "	"$1,286.78 "	"$1,286.78 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,286.78 "	"$1,286.78 "	"$1,286.78 "	"$1,743.95 "	"$1,743.95 "	"$1,286.78 "	"$1,286.78 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,286.78 "	"$1,286.78 "	"$1,286.78 "	"$1,286.78 "	"$1,286.78 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "
0102U	 Gene sequence analysis panel of 17 genes associated with hereditary breast 	"$1,303.95 "		"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,229.78 "	"$1,229.78 "	"$1,229.78 "	"$1,229.78 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,229.78 "	"$1,229.78 "	"$1,229.78 "	"$1,303.95 "	"$1,303.95 "	"$1,229.78 "	"$1,229.78 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,229.78 "	"$1,229.78 "	"$1,229.78 "	"$1,229.78 "	"$1,229.78 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "
0103U	 Gene sequence analysis panel of 24 genes associated with hereditary ovarian 	"$1,743.95 "		"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,229.78 "	"$1,229.78 "	"$1,229.78 "	"$1,229.78 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,229.78 "	"$1,229.78 "	"$1,229.78 "	"$1,743.95 "	"$1,743.95 "	"$1,229.78 "	"$1,229.78 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,229.78 "	"$1,229.78 "	"$1,229.78 "	"$1,229.78 "	"$1,229.78 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "	"$1,743.95 "
0129U	 Gene analysis of genes associated with hereditary breast cancer and related 	"$1,303.95 "		"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,229.78 "	"$1,229.78 "	"$1,229.78 "	"$1,229.78 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,229.78 "	"$1,229.78 "	"$1,229.78 "	"$1,303.95 "	"$1,303.95 "	"$1,229.78 "	"$1,229.78 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,229.78 "	"$1,229.78 "	"$1,229.78 "	"$1,229.78 "	"$1,229.78 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "	"$1,303.95 "
0139U	 Measurement of 6 central carbon metabolite biomarkers for autism spectrum 	$750.00 		$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 	$750.00 
0140U	 Amplifed DNA probe detection of 15 fungus targets in blood culture specimen 	$156.75 		$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$416.78 	$416.78 	$416.78 	$416.78 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$416.78 	$416.78 	$416.78 	$156.75 	$156.75 	$416.78 	$416.78 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$416.78 	$416.78 	$416.78 	$416.78 	$416.78 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 
0141U	" Amplifed DNA probe detection of 20 gram-positive bacterial targets, 4 gram neg "	$156.75 		$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$451.87 	$451.87 	$451.87 	$451.87 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$451.87 	$451.87 	$451.87 	$156.75 	$156.75 	$451.87 	$451.87 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$451.87 	$451.87 	$451.87 	$451.87 	$451.87 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 
0142U	" Amplifed DNA probe detection of 20 gram-positive bacterial targets, 6 "	$156.75 		$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$559.41 	$559.41 	$559.41 	$559.41 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$559.41 	$559.41 	$559.41 	$156.75 	$156.75 	$559.41 	$559.41 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$559.41 	$559.41 	$559.41 	$559.41 	$559.41 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 	$156.75 
0143U	 Measurement of 120 or more drugs or metabolites in urine specimen 	$114.43 		$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 
0144U	 Measurement of 160 or more drugs or metabolites in urine specimen 	$114.43 		$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 	$114.43 
0151U	 Test for detection of 33 respiratory disease-causing organisms in sputum or 	$191.10 		$191.10 	$191.10 	$191.10 	$191.10 	$191.10 	$191.10 	$191.10 	$191.10 	$191.10 	$191.10 	$191.10 	$191.10 	$191.10 	$191.10 	$530.33 	$530.33 	$530.33 	$530.33 	$191.10 	$191.10 	$191.10 	$191.10 	$191.10 	$191.10 	$191.10 	$191.10 	$191.10 	$530.33 	$530.33 	$530.33 	$191.10 	$191.10 	$530.33 	$530.33 	$191.10 	$191.10 	$191.10 	$191.10 	$191.10 	$191.10 	$191.10 	$530.33 	$530.33 	$530.33 	$530.33 	$530.33 	$191.10 	$191.10 	$191.10 	$191.10 	$191.10 	$191.10 	$191.10 	$191.10 	$191.10 	$191.10 	$191.10 
0152U	" Test for detection of disease-causing organisms, >1,000 target microbial "	"$2,126.20 "		"$2,126.20 "	"$2,126.20 "	"$2,126.20 "	"$2,126.20 "	"$2,126.20 "	"$2,126.20 "	"$2,126.20 "	"$2,126.20 "	"$2,126.20 "	"$2,126.20 "	"$2,126.20 "	"$2,126.20 "	"$2,126.20 "	"$2,126.20 "	$988.30 	$988.30 	$988.30 	$988.30 	"$2,126.20 "	"$2,126.20 "	"$2,126.20 "	"$2,126.20 "	"$2,126.20 "	"$2,126.20 "	"$2,126.20 "	"$2,126.20 "	"$2,126.20 "	$988.30 	$988.30 	$988.30 	"$2,126.20 "	"$2,126.20 "	$988.30 	$988.30 	"$2,126.20 "	"$2,126.20 "	"$2,126.20 "	"$2,126.20 "	"$2,126.20 "	"$2,126.20 "	"$2,126.20 "	$988.30 	$988.30 	$988.30 	$988.30 	$988.30 	"$2,126.20 "	"$2,126.20 "	"$2,126.20 "	"$2,126.20 "	"$2,126.20 "	"$2,126.20 "	"$2,126.20 "	"$2,126.20 "	"$2,126.20 "	"$2,126.20 "	"$2,126.20 "
0153U	 mRNA gene expression profiling of 101 genes in breast growth tissue specimen 	"$3,159.42 "		"$3,159.42 "	"$3,159.42 "	"$3,159.42 "	"$3,159.42 "	"$3,159.42 "	"$3,159.42 "	"$3,159.42 "	"$3,159.42 "	"$3,159.42 "	"$3,159.42 "	"$3,159.42 "	"$3,159.42 "	"$3,159.42 "	"$3,159.42 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$3,159.42 "	"$3,159.42 "	"$3,159.42 "	"$3,159.42 "	"$3,159.42 "	"$3,159.42 "	"$3,159.42 "	"$3,159.42 "	"$3,159.42 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$3,159.42 "	"$3,159.42 "	"$2,919.60 "	"$2,919.60 "	"$3,159.42 "	"$3,159.42 "	"$3,159.42 "	"$3,159.42 "	"$3,159.42 "	"$3,159.42 "	"$3,159.42 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$3,159.42 "	"$3,159.42 "	"$3,159.42 "	"$3,159.42 "	"$3,159.42 "	"$3,159.42 "	"$3,159.42 "	"$3,159.42 "	"$3,159.42 "	"$3,159.42 "	"$3,159.42 "
0156U	 Gene analysis copy number sequence analysis 	$597.91 		$597.91 	$597.91 	$597.91 	$597.91 	$597.91 	$597.91 	$597.91 	$597.91 	$597.91 	$597.91 	$597.91 	$597.91 	$597.91 	$597.91 	"$1,364.00 "	"$1,364.00 "	"$1,364.00 "	"$1,364.00 "	$597.91 	$597.91 	$597.91 	$597.91 	$597.91 	$597.91 	$597.91 	$597.91 	$597.91 	"$1,364.00 "	"$1,364.00 "	"$1,364.00 "	$597.91 	$597.91 	"$1,364.00 "	"$1,364.00 "	$597.91 	$597.91 	$597.91 	$597.91 	$597.91 	$597.91 	$597.91 	"$1,364.00 "	"$1,364.00 "	"$1,364.00 "	"$1,364.00 "	"$1,364.00 "	$597.91 	$597.92 	$597.93 	$597.94 	$597.95 	$597.96 	$597.97 	$597.98 	$597.99 	$597.91 	$597.91 
0157U	 mRNA gene analysis of APC regulator of WNT signaling pathway 	$282.88 		$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$257.40 	$257.40 	$257.40 	$257.40 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$257.40 	$257.40 	$257.40 	$282.88 	$282.88 	$257.40 	$257.40 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$257.40 	$257.40 	$257.40 	$257.40 	$257.40 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 
0158U	 mRNA gene analysis of mutL homolog 1 	$282.88 		$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$222.88 	$222.88 	$222.88 	$222.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$222.88 	$222.88 	$222.88 	$282.88 	$282.88 	$222.88 	$222.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$222.88 	$222.88 	$222.88 	$222.88 	$222.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 
0159U	 mRNA gene analysis of mutS homolog 2 	$282.88 		$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$125.96 	$125.96 	$125.96 	$125.96 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$125.96 	$125.96 	$125.96 	$282.88 	$282.88 	$125.96 	$125.96 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$125.96 	$125.96 	$125.96 	$125.96 	$125.96 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 
0160U	 mRNA gene analysis of mutS homolog 6 	$282.88 		$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$211.81 	$211.81 	$211.81 	$211.81 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$211.81 	$211.81 	$211.81 	$282.88 	$282.88 	$211.81 	$211.81 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$211.81 	$211.81 	$211.81 	$211.81 	$211.81 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 
0161U	" mRNA gene analysis of PMS1 homolog 2, mismatch repair system component "	$282.88 		$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$223.25 	$223.25 	$223.25 	$223.25 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$223.25 	$223.25 	$223.25 	$282.88 	$282.88 	$223.25 	$223.25 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$223.25 	$223.25 	$223.25 	$223.25 	$223.25 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 
0162U	 Targeted mRNA sequence analysis for genes associated with hereditary colon 	$486.54 		$486.54 	$486.54 	$486.54 	$486.54 	$486.54 	$486.54 	$486.54 	$486.54 	$486.54 	$486.54 	$486.54 	$486.54 	$486.54 	$486.54 	$193.02 	$193.02 	$193.02 	$193.02 	$486.54 	$486.54 	$486.54 	$486.54 	$486.54 	$486.54 	$486.54 	$486.54 	$486.54 	$193.02 	$193.02 	$193.02 	$486.54 	$486.54 	$193.02 	$193.02 	$486.54 	$486.54 	$486.54 	$486.54 	$486.54 	$486.54 	$486.54 	$193.02 	$193.02 	$193.02 	$193.02 	$193.02 	$486.54 	$486.54 	$486.54 	$486.54 	$486.54 	$486.54 	$486.54 	$486.54 	$486.54 	$486.54 	$486.54 
0163U	 Screening test for 3 protein biomarkers of colorectal cancer in serum or plasma 	$390.75 		$390.75 	$390.75 	$390.75 	$390.75 	$390.75 	$390.75 	$390.75 	$390.75 	$390.75 	$390.75 	$390.75 	$390.75 	$390.75 	$390.75 	$308.00 	$308.00 	$308.00 	$308.00 	$390.75 	$390.75 	$390.75 	$390.75 	$390.75 	$390.75 	$390.75 	$390.75 	$390.75 	$308.00 	$308.00 	$308.00 	$390.75 	$390.75 	$308.00 	$308.00 	$390.75 	$390.75 	$390.75 	$390.75 	$390.75 	$390.75 	$390.75 	$308.00 	$308.00 	$308.00 	$308.00 	$308.00 	$390.75 	$390.75 	$390.75 	$390.75 	$390.75 	$390.75 	$390.75 	$390.75 	$390.75 	$390.75 	$390.75 
0164U	 Test for detection of antibodies associated with irritable bowel syndrome in 	$112.02 		$112.02 	$112.02 	$112.02 	$112.02 	$112.02 	$112.02 	$112.02 	$112.02 	$112.02 	$112.02 	$112.02 	$112.02 	$112.02 	$112.02 	$156.89 	$156.89 	$156.89 	$156.89 	$112.02 	$112.02 	$112.02 	$112.02 	$112.02 	$112.02 	$112.02 	$112.02 	$112.02 	$156.89 	$156.89 	$156.89 	$112.02 	$112.02 	$156.89 	$156.89 	$112.02 	$112.02 	$112.02 	$112.02 	$112.02 	$112.02 	$112.02 	$156.89 	$156.89 	$156.89 	$156.89 	$156.89 	$112.02 	$112.02 	$112.02 	$112.02 	$112.02 	$112.02 	$112.02 	$112.02 	$112.02 	$112.02 	$112.02 
0165U	 Test for detection of antigens associated with peanut allergy in blood 	$218.30 		$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$89.65 	$89.65 	$89.65 	$89.65 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$89.65 	$89.65 	$89.65 	$218.30 	$218.30 	$89.65 	$89.65 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$89.65 	$89.65 	$89.65 	$89.65 	$89.65 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 
0171U	 DNA analysis of targeted sequences in 23 genes for detection of abnormalites 	"$1,519.06 "		"$1,519.06 "	"$1,519.06 "	"$1,519.06 "	"$1,519.06 "	"$1,519.06 "	"$1,519.06 "	"$1,519.06 "	"$1,519.06 "	"$1,519.06 "	"$1,519.06 "	"$1,519.06 "	"$1,519.06 "	"$1,519.06 "	"$1,519.06 "	$759.53 	$759.53 	$759.53 	$759.53 	"$1,519.06 "	"$1,519.06 "	"$1,519.06 "	"$1,519.06 "	"$1,519.06 "	"$1,519.06 "	"$1,519.06 "	"$1,519.06 "	"$1,519.06 "	$759.53 	$759.53 	$759.53 	"$1,519.06 "	"$1,519.06 "	$759.53 	$759.53 	"$1,519.06 "	"$1,519.06 "	"$1,519.06 "	"$1,519.06 "	"$1,519.06 "	"$1,519.06 "	"$1,519.06 "	$759.53 	$759.53 	$759.53 	$759.53 	$759.53 	"$1,519.06 "	"$1,519.06 "	"$1,519.06 "	"$1,519.06 "	"$1,519.06 "	"$1,519.06 "	"$1,519.06 "	"$1,519.06 "	"$1,519.06 "	"$1,519.06 "	"$1,519.06 "
0173U	 Psyc Gene analysis panel for detection of variants in 14 genes associated 	$466.17 		$466.17 	$466.17 	$466.17 	$466.17 	$466.17 	$466.17 	$466.17 	$466.17 	$466.17 	$466.17 	$466.17 	$466.17 	$466.17 	$466.17 	$450.91 	$450.91 	$450.91 	$450.91 	$466.17 	$466.17 	$466.17 	$466.17 	$466.17 	$466.17 	$466.17 	$466.17 	$466.17 	$450.91 	$450.91 	$450.91 	$466.17 	$466.17 	$450.91 	$450.91 	$466.17 	$466.17 	$466.17 	$466.17 	$466.17 	$466.17 	$466.17 	$450.91 	$450.91 	$450.91 	$450.91 	$450.91 	$466.17 	$466.17 	$466.17 	$466.17 	$466.17 	$466.17 	$466.17 	$466.17 	$466.17 	$466.17 	$466.17 
0174U	 Oncology Mass spectrometry testing for 30 protein targets in solid tumor tissue specimen 	"$1,305.37 "		"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	$657.70 	$657.70 	$657.70 	$657.70 	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	$657.70 	$657.70 	$657.70 	"$1,305.37 "	"$1,305.37 "	$657.70 	$657.70 	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	$657.70 	$657.70 	$657.70 	$657.70 	$657.70 	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "	"$1,305.37 "
0175U	 Psyc Gene analysis panel for detection of variants in 15 genes associated 	"$1,336.09 "		"$1,336.09 "	"$1,336.09 "	"$1,336.09 "	"$1,336.09 "	"$1,336.09 "	"$1,336.09 "	"$1,336.09 "	"$1,336.09 "	"$1,336.09 "	"$1,336.09 "	"$1,336.09 "	"$1,336.09 "	"$1,336.09 "	"$1,336.09 "	$450.91 	$450.91 	$450.91 	$450.91 	"$1,336.09 "	"$1,336.09 "	"$1,336.09 "	"$1,336.09 "	"$1,336.09 "	"$1,336.09 "	$892.27 	$892.27 	$892.27 	$450.91 	$450.91 	$450.91 	"$1,336.09 "	"$1,336.09 "	$450.91 	$450.91 	"$1,336.09 "	"$1,336.09 "	"$1,336.09 "	"$1,336.09 "	"$1,336.09 "	"$1,336.09 "	"$1,336.09 "	$450.91 	$450.91 	$450.91 	$450.91 	$450.91 	$892.27 	$892.27 	$892.27 	$892.27 	$892.27 	$892.27 	$892.27 	$892.27 	$892.27 	"$1,336.09 "	"$1,336.09 "
0178U	 Test for detection of antigens associated with peanut allergy in blood 	$218.30 		$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$89.65 	$89.65 	$89.65 	$89.65 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$89.65 	$89.65 	$89.65 	$218.30 	$218.30 	$89.65 	$89.65 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$89.65 	$89.65 	$89.65 	$89.65 	$89.65 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 	$218.30 
0179U	 Cell-free DNA analysis of targeted sequences in 23 genes for detection of 	"$1,943.21 "		"$1,943.21 "	"$1,943.21 "	"$1,943.21 "	"$1,943.21 "	"$1,943.21 "	"$1,943.21 "	"$1,943.21 "	"$1,943.21 "	"$1,943.21 "	"$1,943.21 "	"$1,943.21 "	"$1,943.21 "	"$1,943.21 "	"$1,943.21 "	"$1,950.00 "	"$1,950.00 "	"$1,950.00 "	"$1,950.00 "	"$1,943.21 "	"$1,943.21 "	"$1,943.21 "	"$1,943.21 "	"$1,943.21 "	"$1,943.21 "	"$1,943.21 "	"$1,943.21 "	"$1,943.21 "	"$1,950.00 "	"$1,950.00 "	"$1,950.00 "	"$1,943.21 "	"$1,943.21 "	"$1,950.00 "	"$1,950.00 "	"$1,943.21 "	"$1,943.21 "	"$1,943.21 "	"$1,943.21 "	"$1,943.21 "	"$1,943.21 "	"$1,943.21 "	"$1,950.00 "	"$1,950.00 "	"$1,950.00 "	"$1,950.00 "	"$1,950.00 "	"$1,943.21 "	"$1,943.21 "	"$1,943.21 "	"$1,943.21 "	"$1,943.21 "	"$1,943.21 "	"$1,943.21 "	"$1,943.21 "	"$1,943.21 "	"$1,943.21 "	"$1,943.21 "
0180U	" Red blood cell antigen genotyping, ABO blood group "	$274.83 		$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$282.88 	$282.88 	$282.88 	$282.88 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$282.88 	$282.88 	$282.88 	$274.83 	$274.83 	$282.88 	$282.88 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 
0206U	" Cell aggregation testing of cultured skin cells for Alzheimer disease, reported "	$511.20 		$511.20 	$511.20 	$511.20 	$511.20 	$511.20 	$511.20 	$511.20 	$511.20 	$511.20 	$511.20 	$511.20 	$511.20 	$511.20 	$511.20 	"$2,334.21 "	"$2,334.21 "	"$2,334.21 "	"$2,334.21 "	$511.20 	$511.20 	$511.20 	$511.20 	$511.20 	$511.20 	$511.20 	$511.20 	$511.20 	"$2,334.21 "	"$2,334.21 "	"$2,334.21 "	$511.20 	$511.20 	"$2,334.21 "	"$2,334.21 "	$511.20 	$511.20 	$511.20 	$511.20 	$511.20 	$511.20 	$511.20 	"$2,334.21 "	"$2,334.21 "	"$2,334.21 "	"$2,334.21 "	"$2,334.21 "	$511.20 	$511.20 	$511.20 	$511.20 	$511.20 	$511.20 	$511.20 	$511.20 	$511.20 	$511.20 	$511.20 
0207U	" Immunofluorescence testing of cultured skin cells for Alzheimer disease, "	"$2,215.40 "		"$2,215.40 "	"$2,215.40 "	"$2,215.40 "	"$2,215.40 "	"$2,215.40 "	"$2,215.40 "	"$2,215.40 "	"$2,215.40 "	"$2,215.40 "	"$2,215.40 "	"$2,215.40 "	"$2,215.40 "	"$2,215.40 "	"$2,215.40 "	$573.18 	$573.18 	$573.18 	$573.18 	"$2,215.40 "	"$2,215.40 "	"$2,215.40 "	"$2,215.40 "	"$2,215.40 "	"$2,215.40 "	"$2,215.40 "	"$2,215.40 "	"$2,215.40 "	$573.18 	$573.18 	$573.18 	"$2,215.40 "	"$2,215.40 "	$573.18 	$573.18 	"$2,215.40 "	"$2,215.40 "	"$2,215.40 "	"$2,215.40 "	"$2,215.40 "	"$2,215.40 "	"$2,215.40 "	$573.18 	$573.18 	$573.18 	$573.18 	$573.18 	"$2,215.40 "	"$2,215.40 "	"$2,215.40 "	"$2,215.40 "	"$2,215.40 "	"$2,215.40 "	"$2,215.40 "	"$2,215.40 "	"$2,215.40 "	"$2,215.40 "	"$2,215.40 "
0208U	" mRNA gene analysis of 108 genes in fine needle aspiration thyroid specimen, "	$473.91 		$473.91 	$473.91 	$473.91 	$473.91 	$473.91 	$473.91 	$473.91 	$473.91 	$473.91 	$473.91 	$473.91 	$473.91 	$473.91 	$473.91 	$981.65 	$981.65 	$981.65 	$981.65 	$473.91 	$473.91 	$473.91 	$473.91 	$473.91 	$473.91 	$473.91 	$473.91 	$473.91 	$981.65 	$981.65 	$981.65 	$473.91 	$473.91 	$981.65 	$981.65 	$473.91 	$473.91 	$473.91 	$473.91 	$473.91 	$473.91 	$473.91 	$981.65 	$981.65 	$981.65 	$981.65 	$981.65 	$473.91 	$473.91 	$473.91 	$473.91 	$473.91 	$473.91 	$473.91 	$473.91 	$473.91 	$473.91 	$473.91 
0209U	 Cytogenomic analysis of whole genome for abnormal chromosomes 	$787.15 		$787.15 	$787.15 	$787.15 	$787.15 	$787.15 	$787.15 	$787.15 	$787.15 	$787.15 	$787.15 	$787.15 	$787.15 	$787.15 	$787.15 	"$5,031.20 "	"$5,031.20 "	"$5,031.20 "	"$5,031.20 "	$787.15 	$787.15 	$787.15 	$787.15 	$787.15 	$787.15 	$787.15 	$787.15 	$787.15 	"$5,031.20 "	"$5,031.20 "	"$5,031.20 "	$787.15 	$787.15 	"$5,031.20 "	"$5,031.20 "	$787.15 	$787.15 	$787.15 	$787.15 	$787.15 	$787.15 	$787.15 	"$5,031.20 "	"$5,031.20 "	"$5,031.20 "	"$5,031.20 "	"$5,031.20 "	$787.15 	$787.15 	$787.15 	$787.15 	$787.15 	$787.15 	$787.15 	$787.15 	$787.15 	$787.15 	$787.15 
0212U	 Rare diseases genetic testing of complete DNA of first affected person in family 	"$5,475.20 "		"$5,475.20 "	"$5,475.20 "	"$5,475.20 "	"$5,475.20 "	"$5,475.20 "	"$5,475.20 "	"$5,475.20 "	"$5,475.20 "	"$5,475.20 "	"$5,475.20 "	"$5,475.20 "	"$5,475.20 "	"$5,475.20 "	"$5,475.20 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$5,475.20 "	"$5,475.20 "	"$5,475.20 "	"$5,475.20 "	"$5,475.20 "	"$5,475.20 "	"$5,475.20 "	"$5,475.20 "	"$5,475.20 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$5,475.20 "	"$5,475.20 "	"$2,919.60 "	"$2,919.60 "	"$5,475.20 "	"$5,475.20 "	"$5,475.20 "	"$5,475.20 "	"$5,475.20 "	"$5,475.20 "	"$5,475.20 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$5,475.20 "	"$5,475.20 "	"$5,475.20 "	"$5,475.20 "	"$5,475.20 "	"$5,475.20 "	"$5,475.20 "	"$5,475.20 "	"$5,475.20 "	"$5,475.20 "	"$5,475.20 "
0213U	 Rare diseases genetic testing of complete DNA of relative of affected person in 	"$2,709.95 "		"$2,709.95 "	"$2,709.95 "	"$2,709.95 "	"$2,709.95 "	"$2,709.95 "	"$2,709.95 "	"$2,709.95 "	"$2,709.95 "	"$2,709.95 "	"$2,709.95 "	"$2,709.95 "	"$2,709.95 "	"$2,709.95 "	"$2,709.95 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$2,709.95 "	"$2,709.95 "	"$2,709.95 "	"$2,709.95 "	"$2,709.95 "	"$2,709.95 "	"$2,709.95 "	"$2,709.95 "	"$2,709.95 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$2,709.95 "	"$2,709.95 "	"$2,919.60 "	"$2,919.60 "	"$2,709.95 "	"$2,709.95 "	"$2,709.95 "	"$2,709.95 "	"$2,709.95 "	"$2,709.95 "	"$2,709.95 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$2,709.95 "	"$2,709.95 "	"$2,709.95 "	"$2,709.95 "	"$2,709.95 "	"$2,709.95 "	"$2,709.95 "	"$2,709.95 "	"$2,709.95 "	"$2,709.95 "	"$2,709.95 "
0214U	 Rare diseases genetic testing of protein coding genes of first affected person 	"$5,224.60 "		"$5,224.60 "	"$5,224.60 "	"$5,224.60 "	"$5,224.60 "	"$5,224.60 "	"$5,224.60 "	"$5,224.60 "	"$5,224.60 "	"$5,224.60 "	"$5,224.60 "	"$5,224.60 "	"$5,224.60 "	"$5,224.60 "	"$5,224.60 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$5,224.60 "	"$5,224.60 "	"$5,224.60 "	"$5,224.60 "	"$5,224.60 "	"$5,224.60 "	"$5,224.60 "	"$5,224.60 "	"$5,224.60 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$5,224.60 "	"$5,224.60 "	"$2,919.60 "	"$2,919.60 "	"$5,224.60 "	"$5,224.60 "	"$5,224.60 "	"$5,224.60 "	"$5,224.60 "	"$5,224.60 "	"$5,224.60 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$5,224.60 "	"$5,224.60 "	"$5,224.60 "	"$5,224.60 "	"$5,224.60 "	"$5,224.60 "	"$5,224.60 "	"$5,224.60 "	"$5,224.60 "	"$5,224.60 "	"$5,224.60 "
0215U	 Rare diseases genetic testing of protein coding genes of relative of affected 	"$2,574.65 "		"$2,574.65 "	"$2,574.65 "	"$2,574.65 "	"$2,574.65 "	"$2,574.65 "	"$2,574.65 "	"$2,574.65 "	"$2,574.65 "	"$2,574.65 "	"$2,574.65 "	"$2,574.65 "	"$2,574.65 "	"$2,574.65 "	"$2,574.65 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$2,574.65 "	"$2,574.65 "	"$2,574.65 "	"$2,574.65 "	"$2,574.65 "	"$2,574.65 "	"$2,574.65 "	"$2,574.65 "	"$2,574.65 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$2,574.65 "	"$2,574.65 "	"$2,919.60 "	"$2,919.60 "	"$2,574.65 "	"$2,574.65 "	"$2,574.65 "	"$2,574.65 "	"$2,574.65 "	"$2,574.65 "	"$2,574.65 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$2,574.65 "	"$2,574.65 "	"$2,574.65 "	"$2,574.65 "	"$2,574.65 "	"$2,574.65 "	"$2,574.65 "	"$2,574.65 "	"$2,574.65 "	"$2,574.65 "	"$2,574.65 "
0216U	 DNA analysis of gene sequence of 12 genes for identification and 	"$1,537.02 "		"$1,537.02 "	"$1,537.02 "	"$1,537.02 "	"$1,537.02 "	"$1,537.02 "	"$1,537.02 "	"$1,537.02 "	"$1,537.02 "	"$1,537.02 "	"$1,537.02 "	"$1,537.02 "	"$1,537.02 "	"$1,537.02 "	"$1,537.02 "	$597.91 	$597.91 	$597.91 	$597.91 	"$1,537.02 "	"$1,537.02 "	"$1,537.02 "	"$1,537.02 "	"$1,537.02 "	"$1,537.02 "	"$1,537.02 "	"$1,537.02 "	"$1,537.02 "	$597.91 	$597.91 	$597.91 	"$1,537.02 "	"$1,537.02 "	$597.91 	$597.91 	"$1,537.02 "	"$1,537.02 "	"$1,537.02 "	"$1,537.02 "	"$1,537.02 "	"$1,537.02 "	"$1,537.02 "	$597.91 	$597.91 	$597.91 	$597.91 	$597.91 	"$1,537.02 "	"$1,537.02 "	"$1,537.02 "	"$1,537.02 "	"$1,537.02 "	"$1,537.02 "	"$1,537.02 "	"$1,537.02 "	"$1,537.02 "	"$1,537.02 "	"$1,537.02 "
0217U	 DNA analysis of gene sequence of 51 genes for identification and 	"$2,198.35 "		"$2,198.35 "	"$2,198.35 "	"$2,198.35 "	"$2,198.35 "	"$2,198.35 "	"$2,198.35 "	"$2,198.35 "	"$2,198.35 "	"$2,198.35 "	"$2,198.35 "	"$2,198.35 "	"$2,198.35 "	"$2,198.35 "	"$2,198.35 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$2,198.35 "	"$2,198.35 "	"$2,198.35 "	"$2,198.35 "	"$2,198.35 "	"$2,198.35 "	"$2,198.35 "	"$2,198.35 "	"$2,198.35 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$2,198.35 "	"$2,198.35 "	"$2,919.60 "	"$2,919.60 "	"$2,198.35 "	"$2,198.35 "	"$2,198.35 "	"$2,198.35 "	"$2,198.35 "	"$2,198.35 "	"$2,198.35 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$2,919.60 "	"$2,198.35 "	"$2,198.35 "	"$2,198.35 "	"$2,198.35 "	"$2,198.35 "	"$2,198.35 "	"$2,198.35 "	"$2,198.35 "	"$2,198.35 "	"$2,198.35 "	"$2,198.35 "
0219U	 Gene analysis of human immunodeficiency virus targeted sequence analysis for 	$386.18 		$386.18 	$386.18 	$386.18 	$386.18 	$386.18 	$386.18 	$386.18 	$386.18 	$386.18 	$386.18 	$386.18 	$386.18 	$386.18 	$386.18 	$283.20 	$283.20 	$283.20 	$283.20 	$386.18 	$386.18 	$386.18 	$386.18 	$386.18 	$386.18 	$386.18 	$386.18 	$386.18 	$283.20 	$283.20 	$283.20 	$386.18 	$386.18 	$283.20 	$283.20 	$386.18 	$386.18 	$386.18 	$386.18 	$386.18 	$386.18 	$386.18 	$283.20 	$283.20 	$283.20 	$283.20 	$283.20 	$386.18 	$386.18 	$386.18 	$386.18 	$386.18 	$386.18 	$386.18 	$386.18 	$386.18 	$386.18 	$386.18 
0220U	 Image analysis of breast cancer cell specimen with artificial intelligence 	$706.25 		$706.25 	$706.25 	$706.25 	$706.25 	$706.25 	$706.25 	$706.25 	$706.25 	$706.25 	$706.25 	$706.25 	$706.25 	$706.25 	$706.25 	$590.70 	$590.70 	$590.70 	$590.70 	$706.25 	$706.25 	$706.25 	$706.25 	$706.25 	$706.25 	$706.25 	$706.25 	$706.25 	$590.70 	$590.70 	$590.70 	$706.25 	$706.25 	$590.70 	$590.70 	$706.25 	$706.25 	$706.25 	$706.25 	$706.25 	$706.25 	$706.25 	$590.70 	$590.70 	$590.70 	$590.70 	$590.70 	$706.25 	$706.25 	$706.25 	$706.25 	$706.25 	$706.25 	$706.25 	$706.25 	$706.25 	$706.25 	$706.25 
0221U	" Red blood cell antigen genotyping, ABO, alpha, NGS "	$274.83 		$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$283.20 	$283.20 	$283.20 	$283.20 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$283.20 	$283.20 	$283.20 	$274.83 	$274.83 	$283.20 	$283.20 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$283.20 	$283.20 	$283.20 	$283.20 	$283.20 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 	$274.83 
0222U	" Red blood cell antigen genotyping, RH proximal promoter, exons 1-10, portions, NGS "	$282.88 		$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$283.20 	$283.20 	$283.20 	$283.20 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$283.20 	$283.20 	$283.20 	$282.88 	$282.88 	$283.20 	$283.20 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$283.20 	$283.20 	$283.20 	$283.20 	$283.20 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 	$282.88 
