Laboratory Fee Schedule - Maine.gov
Laboratory Fee Schedule - Maine.gov
Laboratory Fee Schedule - Maine.gov
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
Procedure<br />
Code<br />
<strong>Laboratory</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Effective January 1, 2013<br />
Modifier Code Description Rate<br />
86665 antibody epstein-barr eb virus viral capsid vca $18.00<br />
86666 antibody ehrlichia $13.42<br />
86668 antibody francisella tularensis $11.95<br />
86671 antibody fungus not elsewhere specified $13.42<br />
86674 antibody giardia lamblia $18.00<br />
86677 antibody helicobacter pylori $19.95<br />
86682 antibody helminth not elsewhere specified $13.42<br />
86684 antibody haemophilus influenza $13.42<br />
86687 antibody htlv-i $8.10<br />
86688 antibody htlv-ii $13.71<br />
86689 antibody htlv/hiv antibody confirmatory test $25.65<br />
86692 antibody hep delta agent $20.00<br />
86694 antibody herpes smplx non-specific type test $18.00<br />
86695 antibody herpes smplx type 1 $18.00<br />
86696 antibody herpes smplx type 2 $8.00<br />
86698 antibody histoplasma $17.18<br />
86701 antibody hiv-1 $12.21<br />
86702 antibody hiv-2 $14.52<br />
86703 antibody hiv-1&hiv-2 single result $14.52<br />
86704 hepatitis b core antibody hbcab total $15.00<br />
86705 hepatitis b core antibody hbcab igm antibody $15.30<br />
86706 hepatitis b surf antibody hbsab $13.00<br />
86707 hepatitis be antibody hbeab $15.90<br />
86708 hepatitis antibody haab total $14.35<br />
86709 hepatitis antibody haab igm antibody $15.47<br />
86710 antibody influenza virus $13.66<br />
86711 antibody john cunningham virus $10.49<br />
86713 antibody legionella $18.00<br />
86717 antibody leishmania $12.18<br />
86720 antibody leptospira $11.37<br />
86723 antibody listeria monocytogenes $12.18<br />
86727 antibody lymphocytic choriomeningitis $13.66<br />
86729 antibody lymphogranuloma venereum $16.43<br />
86732 antibody mucormycosis $12.18<br />
86735 antibody mumps $17.94<br />
86738 antibody mycoplsm $13.66<br />
86741 antibody neisseria meningitidis $12.18<br />
86744 antibody nocardia $12.18<br />
86747 antibody parvovirus $12.18<br />
86750 antibody plasmodium malaria $12.18<br />
86753 antibody protozoa nes $12.18<br />
86756 antibody respiratory synctial virus $17.72<br />
86757 antibody rickettsia $14.34<br />
86759 antibody rotavirus $18.00<br />
86762 antibody rubella $18.00<br />
86765 antibody rubeola $17.71<br />
86768 antibody salmonella $12.18<br />
Fac/Non-<br />
Facility
Change language