Laboratory Fee Schedule - Maine.gov
Laboratory Fee Schedule - Maine.gov
Laboratory Fee Schedule - Maine.gov
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Procedure<br />
Code<br />
<strong>Laboratory</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Effective January 1, 2013<br />
Modifier Code Description Rate<br />
84378 sugars mono di&oligos 1 quantitative each spec $11.94<br />
84379 sugars mono di&oligos mlt quantitative ea spec $11.94<br />
84392 assay of sulfate urine $6.53<br />
84402 assay of testosterone free $35.00<br />
84403 assay of testosterone total $26.10<br />
84425 assay of thiamine-vitamin b-1 $26.10<br />
84430 assay of thiocyanate $8.10<br />
84431 thromboxane metabolite w/wo thromboxane urine $18.09<br />
84432 assay of thyroglobulin $17.00<br />
84436 assay of thyroxine total $8.00<br />
84437 assay of thyroxine requiring elution $4.41<br />
84439 assay of free thyroxine $10.26<br />
84442 assay of thyroxine binding globulin $18.90<br />
84443 assay of thyroid stimulating hormone tsh $20.52<br />
84445 thyroid stimulating immune globulins tsi $66.95<br />
84446 assay of tocopherol alpha vitamin e $16.20<br />
84449 assay of transcortin cortisol binding globulin $23.02<br />
84450 transferase aspartate amino ast sgot $6.93<br />
84460 transferase alanine amino alt sgpt $6.93<br />
84466 assay of l7383transferrin $17.55<br />
84478 assay of triglycerides $7.40<br />
84479 thyroid horm uptk/thyroid hormone binding ratio $6.48<br />
84480 assay of triiodothyronine t3 total tt3 $13.50<br />
84481 assay of triiodothyronine t3 free $13.50<br />
84482 triiodothyronine t3 reverse $19.93<br />
84484 assay of troponin quantitative $13.53<br />
84485 assay of trypsin duodenal fluid $8.91<br />
84488 assay of trypsin feces qualitative $9.01<br />
84490 trypsin feces quantitative 24-hr collection $10.46<br />
84510 assay of tyrosine $14.30<br />
84512 assay of troponin qualitative $10.15<br />
84520 assay of urea nitrogen quantitative $5.40<br />
84525 assay of urea nitrogen semiquantitative $2.34<br />
84540 assay of urea nitrogen urine $5.76<br />
84545 urea nitrogen clearance $9.08<br />
84550 assay of blood/uric acid $5.76<br />
84560 assay of uric acid other source $4.50<br />
84577 assay of urobilinogen feces quantitative $16.20<br />
84578 assay of urobilinogen urine qualitative $4.47<br />
84580 urobilinogen urine quantitative timed specimen $5.40<br />
84583 assay of urobilinogen urine semiquantitative $6.91<br />
84585 assay of vanillylmandelic acid urine $14.85<br />
84586 assay of vasoactive intestinal peptide $26.24<br />
84588 assay of vasopressin anti-diuretic hormone $46.66<br />
84590 assay of vitamin a $15.73<br />
84591 assay of vitamin not otherwise specified $9.60<br />
84597 assay of vitamin k $18.85<br />
Fac/Non-<br />
Facility
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