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PLA Codes

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2020 (April)
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Webinar: 2020 Regulatory Update: Hospital Outreach Programs Wednesday, June 17, 2020

CPT® Proprietary Laboratory Analyses (PLA) Codes

PLA Code
Description
Test Name
Lab Name
Effective Date
2020 Medicare
Fee Schedule
XXXXX
RXX XXXXX XXXX XXXXXXX XXXXXX, DNA, XXXXX XXXXXXXXXXX XXXXXXX XXXX XXXXXXXX XX 35 XXXXXXXX XXXX 11 XXXXX XXXXXX, XXXXXXXXX XXXXX XXXXX, XXXXXX RBC XXXXXXX XXXXXXXX PreciseType® HEA Test Immucor, Inc
02/01/2017
$720.00
XXXXX
OXXXXXXX (XXXXXXXXXX), XXXXXXXXXXXX XXXXXXXXXX XX XXXXX XXXXX XXXXXXXXXXX (XXXXXXXX XXXX, XXXXXXXX XXXX XXX XXXXXXXXX) XX XXXXXX XXXXXXXXXXXXXX XXXX XXXXXX XXXX XXXXXXXXXXXX (LC-MS/MS) XXXXX XXXXXXXX XXXXXXXX XXXXXXXXXX XXXXXXXXXXX, XXXXXXXXX XXXXXXXX XX XXXXXXXXXX XX XXXXXXXXXXX XXXXXX PolypDX™ Atlantic Diagnostic Laboratories, LLC
02/01/2017
$25.00
XXXXX
OXXXXXXX (XXXXXXX) XXXXXXXXXXX XXXXXX XX XXXX XXXXXXXX (XXXXXXXXXXXXXX A-1, CA 125 II, XXXXXXXX XXXXXXXXXXX XXXXXXX, XXXXX XXXXXXXXXX XXXXXXX 4, XXXXXXXXXXX), XXXXXXXXX XXXXX, XXXXXXXXX XXXXXXXX XX X XXXXXXXXXX XXXXX Overa (OVA1 Next Generation) Aspira Labs, Inc
02/01/2017
$950.00
XXXXX
OXXXXXXX (XXXXXXXX) XXXX XXXXXXXXXX XXXXXXX XX XXXX-XXXX RT-PCR XX 3 XXXXX (ERG, PCA3, XXX SPDEF), XXXXX, XXXXXXXXX XXXXXXXX XX XXXX XXXXX ExosomeDx® Prostate (IntelliScore) Exosome Diagnostics, Inc
05/01/2017
$760.00
XXXXX
DXXXXXXXX XX XXXXXXXXXXX XXXXXXXXXXX, XXXXXXXXXX, XXXXXXXXXXX XXX XXXXX, 120 XX XXXX XXXXXXXX, XXXXXXXXXX XXXXXXXXXXXXXX XXXX XXXX XXXXXXXXXXXX, XXXXX, XXXXXXXXXXX XXX XXXXXXXX XX XXXX XXXXXXXXXXX XXXXXXXXXX, XXX XXXX XX XXXXXXX Drug-drug, Drug-substance Identification and Interaction Aegis Sciences Corporation
07/01/2018
$246.92
XXXXX
DXXX XXXX(X), XXXXXXXXXXX, XXXX XXXXXXXXXX XXXXXXXXXXXX XX XXXXXXXX XXXXXXX, XXX XXXXXX XX XXXX XXXXXXX, XXXXX, XXXXXXXX XXXXXXXX XXXXXXXXXXXX XXXXXXXXX DNA XXXXXXXXXXXXXX XX XXXXXXXXXX XX XXXXXX DNA, XXX XXXX XX XXXXXXX ToxProtect Genotox Laboratories LTD
08/01/2017
$114.43
XXXXX
HXXXXXXXXXXX XXXXXX XXXXXXXXX XXX XXXXXXXXXX XXXXXXXXXX, DNA, 16S XXX 23S XRNA, XXXA, XXX1, XXXA XXX XXXB, XXXX XXXXXXXXXX XXXXXXXXXX, XXXXXXXX-XXXXX XXXXXXXX-XXXXXXXX XX XXXXX XXXXXX XX XXXXX XXXXXX, XXXXXXXXXX, XXXXXXXX XX XXXXXXXX XX XXXXXXXX XXX XXXXXXXXXX XX XXXXXXXXXXXXXX, XXXXXXXXXXXXXXXX, XXXXXXXXXXXXX, XXXXXXXXXXX, XXXXXXXXXXXX, XXX XXXXXXXXX AmHPR H. Antibiotic Resistance Panel American Molecular Laboratories, Inc
01/01/2019
$597.91
XXXXX
OXXXXXXX (XXXXXX XXXXXX), ERBB2 (HER2) XXXX XXXXXX XX FISH, XXXXX XXXXX XXXX XXXXXXXX-XXXXX XXXXXXXX-XXXXXXXX XXXXXX XXXXXXXX XXXXX XXXXX-XXXXX XXXXXXXXXXXXXXXXX (DEP) XXXXXXX, XXXXXXXX XX ERBB2 XXXX XXXXXXXXX XX XXX-XXXXXXXXX DEPArray™ HER2 PacificDx
08/01/2017
$107.00
XXXXX
IXXXXXXXXX XXXXXXX (XXXXXXXXX), XXXXXX XXXXXX XX XXXXX XXXXXX XXXXXXXXXX, XXXXXXXXXXXX-XXXXX XXXXXX XX XXXXXX XXXXXXXXXXX, XXX XXXXXXXXX XXXXXXX Bacterial Strain Typing by Whole Genome Sequencing Mayo Clinic
08/01/2017
$427.26
XXXXX
PXXXXXXXXXXX XXXX XXXXXXXXXX, XXXXXXXXXX XX XXXXX XXXXXXX XX LC-MS/MS, XXXXX XXXX XXXXX, XXXXXXXX XX X XXXXXXXXXX XX XX XXXXXXXXX XXXXXX-XXXXX XXXXX, XXX XXXX XX XXXXXXX XXXXXXXXX XXX XXXX XXXXXXXXX XXX XXXXXXXXXXX Cordant CORE™ Cordant Health Solutions
08/01/2017
$114.43
XXXXX
GXXXXXXX XXXXXXXXX, XXXX XXXXXXXXXXXXX XXXXXXXXX XX XXXXX XXXXXX XXXX-XXXXXXXXXX XXXXXXXXXX, DNA, XXXXX XXXXX, XXXXXX XX XXXXXXXX XXXX XXXXXXXXXXXXX(X) MatePair Targeted Rearrangements, Congenital Mayo Clinic
08/01/2017
$2515.60
XXXXX
OXXXXXXX (XXXXX XXXXX XXXXXXXXX), XXXX XXXXXXXXXXXXX XXXXXXXXX XX XXXXX XXXXXX XXXX-XXXXXXXXXX XXXXXXXXXX, DNA, XXXXX XX XXXXXX XXXXXX XX XXXXX, XXXXXX XX XXXXXXXX XXXX XXXXXXXXXXXXX(X) MatePair Targeted Rearrangements, Oncology Mayo Clinic
08/01/2017
$2515.60
XXXXX
HXXXXXXXXX (XXXXXXXXXXXXXX XXXXXXXXX), XXXX XXXXXXXXXXXXX XXXXXXXXX XX XXXXX XXXXXX XXXX-XXXXXXXXXX XXXXXXXXXX, DNA, XXXXX XXXXX XX XXXX XXXXXX, XXXXXX XX XXXXXXXX XXXX XXXXXXXXXXXXX(X) MatePair Targeted Rearrangements, Hematologic Mayo Clinic
08/01/2017
$2515.60
XXXXX
OXXXXXXX (XXXXXXXXXXXXXX XXXXXXXXX), RNA, BCR/ABL1 XXXXX XXX XXXXX XXXXXXXXXX XXXXXX XXXXXXXXXXX, XXXXXXXXXXXX PCR XXXXXXXXXXXXX, XXXXX XX XXXX XXXXXX, XXXXXX XX XXXXXX XXX XXXXXXXX XX XXXXXXXX XXXX XXXXXXXXXXXX BCR-ABL1 major and minor breakpoint fusion transcripts University of Iowa, Department of Pathology
08/01/2017
$163.96
XXXXX
OXXXXXXX (XXXXXXXXXXXXXX XXXXXXXXX), JAK2 XXXXXXXX, DNA, PCR XXXXXXXXXXXXX XX XXXXX 12-14 XXX XXXXXXXX XXXXXXXX, XXXXX XX XXXX XXXXXX, XXXXXX XX JAK2 XXXXXXXX XXX XXXXXXXX XX XXXXXXXX JAK2 Mutation University of Iowa, Department of Pathology
08/01/2017
$91.66
XXXXX
OXXXXXXX (XXXXXXX), XXXXXRNA XXXXXXXXX XX RT-PCR XX 10 XXXXXRNA XXXXXXXXX, XXXXXXXXX XXXX XXXXXX XXXXXXXX, XXXXXXXXX XXXXXXXX XX X XXXXXXXX XX XXXXXXXX XXXXXX XXX XXXXXXXX XX XXXX XXXX XX XXXXXXXXXX ThyraMIR Interpace Diagnostics
10/01/2017
$3002.09
XXXXX
OXXXXXXX, RNA, XXXX XXXXXXXXXX XX XXXXX XXXXXXXXXXXXX XXXXXXXXXX, XXXXXXXX-XXXXX XXXXXXXX-XXXXXXXX XXXXXX XX XXXXX XXXXXX XXXXXX, XXXXXXXXXX XXXXXXXXX XXXXXXXX XX XXXXXXXXX XXXXXXX XXX XXXXXXXXXXX XXXXXX OncoTarget/OncoTreat Columbia University Department of Pathology and Cell Biology
10/01/2017
$3675.00
XXXXX
OXXXXXXX (XXXXXXXX), XXXXXXXXX XX 8 XXXXXXXXXXXXXX (ARF 6, NKX3-1, 5&XXXXX;-UTR-BMI1, CEP 164, 3&XXXXX;-UTR-RXXXXXXX, DXXXXXXXXXX, AURKAIP-1, CSNK2A2), XXXXXXXXXXX XXXXXXXXXXX XXX XXXX XXXXXXXXX XXXXX, XXXXXXXXX XXXXXXXX XX XXXX XXXXX Apifiny® Armune BioScience
10/01/2017
$760.00
XXXXX
TXXXXXXX XXXXXXX XXXXXXXX XXXXXXXX XXXXX, XXX-XXXXX XXXX XXXX XXXXXXXXX, DNA XXX RNA XXXXXXXX, 23 XXXXX, XXXXXXXXXXXXX XXX XXXXXXXX XXXXXXXX XXX XXXXXXXXXXXXXX, XXXXXXXX XX XXXXXXXX/XXXXXXX XX XXXXXXXX XXX XXXXXXXXXX XXXXXXX(XXX) XX XXXXXXXX Oncomine™ Dx Target Test Thermo Fisher Scientific
10/01/2017
$1950.00
XXXXX
OXXXXXXX (XXXXX XXXXXXXXXXX XXXXXXXX), DNA, XXXXXXXXXX XX XXXXXXXX XXXXXX XXXXXXXXXXX, X.D835, X.I836, XXXXX XXXXXXXXXXX XXXXX, XXXXXXXX XX XXXXXXXXX XX XXX-XXXXXXXXX XX FLT3 XXXXXXXX XXX XXXXXXXXXX XXX XX XXXXXXX XXX XXX XX XXXXXXXXXXX LeukoStrat® CDx FLT3 Mutation Assay LabPMM LLC, an Invivoscribe Technologies, Inc Company
10/01/2017
$248.51
XXXXX
GXXXXXXXXXXX XXXXX XXXXX XXXXXXXX (GXXXA), XXXXXXX XXXXXXXX XXXXXXXXX XXXXXXXXXXXX, XXXXXXXXXXXX GlycA Laboratory Corporation of America
01/01/2018
$34.19
XXXXX
TXXXXXXXX, XX XXXXXX XXXXXXXXXXXXXX XXXX XXXXXX XXXX XXXXXXXXXXXX (LC-MS/MS), XXXXX, XXXXXXXXXXXX UrSure Tenofovir Quantification Test Synergy Medical Laboratories
01/01/2018
$85.77
XXXXX
OXXXXXXX (XXXXXXX), DNA XXX XRNA XX 112 XXXXX, XXXX-XXXXXXXXXX XXXXXXXXXX, XXXX XXXXXX XXXXXXXX XX XXXXXXX XXXXXX, XXXXXXXXXXX XXXXXXXX XXXXXXXX XX X XXXXXXXXXXX XXXXXX ("PXXXXXXX, XXXX XXXXXXXXXXX XX XXXXXXXXXX" XX "NXXXXXXX, XXX XXXXXXXXXXX XX XXXXXXXXXX") Thyroseq Genomic Classifier CBLPath, Inc
01/01/2018
$3600.00
XXXXX
JAK2 (JXXXX XXXXXX 2) (XX, XXXXXXXXXXXXXXXXXX XXXXXXXX) XXXX XXXXXXXX, XXXXXXXX XXXXXXXX XXXXXXXX XXXXX 12-15 JAK2 Exons 12 to 15 Sequencing Mayo Clinic
01/01/2018
$135.46
XXXXX
DXXX XXXXXXXXXX (XXXXXXX XXXX XXXXXXXXX XXX XXXX XXXXXXXX), XXXXXXXX XXXXXXXX XXXXXXXX (XX, CYP1A2, CYP2C19, CYP2C9, CYP2D6, CYP3A4, CYP3A5, CYP4F2, SLCO1B1, VKORC1 XXX XX12777823) Focused Pharmacogenomics Panel Mayo Clinic
01/01/2018
$742.27
XXXXX
DXXX XXXXXXXXXX (XXXXXXXX XXXX XXXXXXXX), XXXXXXXX XXXXXXXX XXXXXXXX (XX, CYP2C9, CYP4F2, VKORC1, XX12777823) Warfarin Response Genotype Mayo Clinic
01/01/2018
$134.13
XXXXX
CYP1A2 (XXXXXXXXXX P450 XXXXXX 1, XXXXXXXXX A, XXXXXX 2) (XX, XXXX XXXXXXXXXX) XXXX XXXXXXXX, XXXXXX XXXXXXXX (XX, *1F, *1K, *6, *7) Cytochrome P450 1A2 Genotype Mayo Clinic
01/01/2018
$174.81
XXXXX
COMT (XXXXXXXX-O-XXXXXXXXXXXXXXXXX)(XX, XXXX XXXXXXXXXX) XXXX XXXXXXXX, X.472G>A (XX4680) XXXXXXX Catechol-O-Methyltransferase (COMT) Genotype Mayo Clinic
01/01/2018
$174.81
XXXXX
HTR2A (5-XXXXXXXXXXXXXXXXX XXXXXXXX 2A), HTR2C (5-XXXXXXXXXXXXXXXXX XXXXXXXX 2C) (XX, XXXXXXXXXX XXXXXXXXXX) XXXX XXXXXXXX, XXXXXX XXXXXXXX (XX, HTR2A XX7997012 [X.614-2211T>C], HTR2C XX3813929 [X.-759C>T] XXX XX1414334 [X.551-3008C>G]) Serotonin Receptor Genotype (HTR2A and HTR2C) Mayo Clinic
01/01/2018
$349.62
XXXXX
TPMT (XXXXXXXXXX S-XXXXXXXXXXXXXXXXX), NUDT15 (XXXXX XXXXXXXXXXX 15) (XX, XXXXXXXXXX XXXXXXXXXX) XXXX XXXXXXXX, XXXXXX XXXXXXXX (XX, TPMT *2, *3A, *3B, *3C, *4, *5, *6, *8, *12; NUDT15 *3, *4, *5) Thiopurine Methyltransferase (TPMT) and Nudix Hydrolase (NUDT15) Genotyping Mayo Clinic
01/01/2018
$466.17
XXXXX
NXXXXXXXX (XXXXX XXXXXXX), XXXXXXXXXXXXX XXXXX, XXXXXXXXX XX XXXXX XXXXXXX XX XXXXXXX-XXXXXXX XXXXXXXXXXXXXX XXXXXXXXXX, XXXXXXXXXXX Real-time quaking-induced conversion for prion detection (RT-QuIC) National Prion Disease Pathology Surveillance Center
04/01/2018
$540.99
XXXXX
EXXXX (XX, XXXXXXX XXXXXXXXX), XXXXXX XXXXXXXX-XXXXX XXXXXXXX-XXXXXXXX XXXXX XXXXXX XXX XXXXXX XXXXXXXX, XXXXXXXX XXXXXXXX EXaCT-1 Whole Exome Testing Lab of Oncology-Molecular Detection
04/01/2018
$4780.00
XXXXX
TXXXXXXX XXXXXXX XXXXXXXX XXXXXXXX, XXXXX XXXXX XXXXXXXX, DNA XXXXXXXX XX 324 XXXXX, XXXXXXXXXXXXX XXX XXXXXXXX XXXXXXXX, XXXX XXXX XXXXXX XXXXXXXXXXXXXX, XXXX XXXXXXXXXXXXXX, XXXXXXXXXXXXXX XXXXXXXXXXX XXX XXXXX XXXXXXXXXX XXXXXX FoundationOne CDx™ (F1CDx) Foundation Medicine, Inc
04/01/2018
$3500.00
XXXXX
VXXXXXX D, 25 XXXXXXX D2 XXX D3, XX LC-MS/MS, XXXXX XXXXXXXXXXX, XXXXXXXXXXXX Sensieva™ Droplet 25OH Vitamin D2/D3 Microvolume LC/MS Assay InSource Diagnostics
04/01/2018
$29.60
XXXXX
DXXXXXXXXXXXXXXX XXXX (DNA) XXXXXXXX, XXXXXX XXXXXXXX, XXXX XXXXXXX Anti-dsDNA, High Salt/Avidity University of Washington, Department of Laboratory Medicine
04/01/2018
$13.74
XXXXX
BCR/ABL1 (X(9;22)) (XX, XXXXXXX XXXXXXXXXXX XXXXXXXX) XXXXXXXXXXXXX XXXXXXXX, XXXXX XXXXXXXXXX, XXXXXXXXXXXX MRDx BCR-ABL Test MolecularMD
04/01/2018
$409.90
XXXXX
BXXXXXXX XXXXXXXXXXX, XXXXXXXX XXXXXXXXX XX 5 XXXXXXXXXXX XXXXXXX XXXXXX, XX XXXXXXXXXX, IXM Lyme ImmunoBlot IgM IGeneX Inc
04/01/2018
$17.21
XXXXX
BXXXXXXX XXXXXXXXXXX, XXXXXXXX XXXXXXXXX XX 12 XXXXXXXXXXX XXXXXXX XXXXXX, XX XXXXXXXXXX, IXG Lyme ImmunoBlots IgG IGeneX Inc
04/01/2018
$17.21
XXXXX
TXXX-XXXXX XXXXXXXXX XXXXX BXXXXXXX XXXXX, XXXXXXXX XXXXXXXXX XX 4 XXXXXXXXXXX XXXXXXX XXXXXX, XX XXXXXXXXXX, IXM Tick-Borne Relapsing Fever Borrelia (TBRF) ImmunoBlots IgM Test IGeneX Inc
04/01/2018
$14.86
XXXXX
TXXX-XXXXX XXXXXXXXX XXXXX BXXXXXXX XXXXX, XXXXXXXX XXXXXXXXX XX 4 XXXXXXXXXXX XXXXXXX XXXXXX, XX XXXXXXXXXX, IXG Tick-Borne Relapsing Fever Borrelia (TBRF) ImmunoBlots IgG Test IGeneX Inc
04/01/2018
$14.86
XXXXX
OXXXXXXX (XXXXXX XXXXXX XXXXXXXXX XX XXXX), XRNA, XXXX XXXXXXXXXX XXXXXXXXX XX XXXX-XXXX RT-PCR XX 12 XXXXX (7 XXXXXXX XXX 5 XXXXXXXXXXXX), XXXXXXXXX XXXXXXXX-XXXXX XXXXXXXX-XXXXXXXX XXXXXX, XXXXXXXXX XXXXXXXX XX XXXXXXXXXX XXXXX The Oncotype DX® Breast DCIS Score™ Test Genomic Health, Inc
07/01/2018
$3873.00
XXXXX
FLT3 (XXX-XXXXXXX XXXXXXXX XXXXXX 3) (XX, XXXXX XXXXXXX XXXXXXXX) XXXXXXXX XXXXXX XXXXXXXXXXX (ITD) XXXXXXXX, XXXXXXXXXXXX FLT3 ITD MRD by NGS LabPMM LLC, an Invivoscribe Technologies, Inc Company
07/01/2018
$ 0.00
XXXXX
OXXXXXXX (XXXXXXXX), XRNA, XXXX XXXXXXXXXX XXXXXXXXX XX XXXX-XXXX RT-PCR XX 17 XXXXX (12 XXXXXXX XXX 5 XXXXXXXXXXXX), XXXXXXXXX XXXXXXXX-XXXXX XXXXXXXX-XXXXXXXX XXXXXX, XXXXXXXXX XXXXXXXX XX X XXXX XXXXX Oncotype DX Genomic Prostate Score Genomic Health, Inc
07/01/2018
$3873.00
XXXXX
OXXXXXXX (XXXXX XXXXX XXXXXXXXX), DNA, XXXXXXXX XXXXXXXXXX XX XXXXXXX-XXXXXX XXXXX XX 468 XXXXXX-XXXXXXXXXX XXXXX, XXXXXXXXX XXXXXXXXXXXXX XXX XXXXXXX XXXXXXXXX XXX XXXXXXXXXXXXXX XXXXXXXXXXX, XXXXXXX XXXX XXXXXX XXXXXXXXX, XXXXXXXXX XXXXXXXX-XXXXX XXXXXXXX-XXXXXXXX XXXXX XXXXXX, XXXXXX XX XXXXXXXXXX XXXXXXXXXXX XXXXXXXX(X) MSK-IMPACT (Integrated Mutation Profiling of Actionable Cancer Targets) Memorial Sloan Kettering Cancer Center
07/01/2018
$2919.60
XXXXX
NPM1 (XXXXXXXXXXXXX) (XX, XXXXX XXXXXXX XXXXXXXX) XXXX XXXXXXXX, XXXXXXXXXXXX NPM1 MRD by NGS LabPMM LLC, an Invivoscribe Technologies, Inc Company
07/01/2018
$ 0.00
XXXXX
TXXXXXXX XXXXXXX XXXXXXXX XXXXXXXX XXXXX, XXXXX XXXXXXXXXXX XXXXXXXX, DNA XXXXXXXX, 194 XXXXX, XXXXXXXXXXXXX XXX XXXXXXXX XXXXXXXX, XXXX XXXXXX XXXXXXXX XX XXXXXXXXXXXXXX MyAML NGS Panel LabPMM LLC, an Invivoscribe Technologies, Inc Company
07/01/2018
$2916.60
XXXXX
PXXXXXXXXXXX XXXX XXXXXXXXXX, XXXXXXXXXX XX XXXXX XXXXXXX XX LC-MS/MS, XXXXX, 31 XXXX XXXXX, XXXXXXXX XX XXXXXXXXXXXX XXXXXXX, XXXXXXXX XX XXX XXXXXXXX, XXX XXXX XX XXXXXXX UCompliDx Elite Medical Laboratory Solutions, LLC (LDT)
07/01/2018
$193.71
XXXXX
LXXXXXXXXXX, XXXXX, XXXX XXXXXXXXXX XXXXXXXXXXXXX XXX XXXXXXXXXXXX XX XXXXXXXXXXXX, XXXXXXXXX XXX XXXX XXXXX XXXXXXXXXXX XXXXXXX XXX XXXXXXXXXX XX HDL, LDL, XXX VLDL XX XXXXXXXX XXXX XXXXXXX XXXXXXXXXXXXXXXXXXX VAP Cholesterol Test VAP Diagnostics Laboratory, Inc
07/01/2018
$33.86
XXXXX
OXXXXXXX (XXXXXXXX XXXXXX), FISH XXXXXXXX XX 4 XXXXX (ASAP1, HDAC9, CHD1 XXX PTEN), XXXXXX XXXXXX XXXXXXXX, XXXXXXXXX XXXXXXXX XX XXXXXXXXXXX XX XXXXXX XXXXX XXXXX Prostate Cancer Risk Panel Mayo Clinic
07/01/2018
$2030.00
XXXXX
PXXXXXXXXXXX XXXX XXXXXXXXXX, 14 XX XXXX XXXXXXX XX XXXXX XXX XXXXXXXXXX, XXXXXXXXXX XXXXXX XXXX XXXXXXXXXXXX XXXX XXXXXXXXXXXXXX, XXXXXXXXX XXXXX, XXXXXXXXXXXX XXXXXX XXXX XXXXXXXXXXX XXX XXXXX XXXXXX, XXXXXXXXX XXXXXX-XXXXX XXXXX XXX XXX XXXXXXXXXX XXXX XXXX XXXXXXXX, XXX XXXX XX XXXXXXX AssuranceRx Micro Serum Firstox Laboratories, LLC
07/01/2018
$148.96
XXXXX
CXXXXXXXXX (XXXXX XXXXXXXXXX), XXXX-XXXX DNA, PCR XXXXX XX 96 DNA XXXXXX XXXXXXXXX (94 XXXXXX XXXXXXXXXX XXXXXXXXXXXX XXXXXXX XXX XXX XXXXXXX XXXXXXX), XXXXXX myTAIHEART TAI Diagnostics, Inc
07/01/2018
$3240.00
XXXXX
HXXXXXXXXX (XXXXX XXXXXXXXXXX XXXXXXXX), DNA, XXXXX XXXXXX XXXX-XXXXXXXXXX XXXXXXXXXX XX XXXXXX XXXX XXXXXXXXXXXXX(X), XXXXX XX XXXX XXXXXX, XXXXXX XX XXXXXXXX XXXX XXXXXXXXXXXXX(X) MatePair Acute Myeloid Leukemia Panel Mayo Clinic
07/01/2018
$2515.60
XXXXX
OXXXXXXX (MXXXXX XXXX XXXXXXXXX), XXXXXXXXX XX XXXXXXXXXX XX XXX MXXXXX XXXX XXXXXXX XXXXX XXXXXXXXXXX (XXXXX T XXXXXXX), XXXXX, XXXXXXXXXXXX Merkel SmT Oncoprotein Antibody Titer University of Washington, Department of Laboratory Medicine
07/01/2018
$322.96
XXXXX
OXXXXXXX (MXXXXX XXXX XXXXXXXXX), XXXXXXXXX XX XXXXXXXXXX XX XXX MXXXXX XXXX XXXXXXX XXXXX XXXXXX XXXXXXX (VP1), XXXXX, XXXXXXXX XX XXXXXXXX XX XXXXXXXX Merkel Virus VP1 Capsid Antibody University of Washington, Department of Laboratory Medicine
07/01/2018
$322.96
XXXXX
TXXX XXXXXXXX, XXXXXXX XXXXXXXX XXXXXXXX XXXXXXXX XX XXXXXXXXXX 2, XXXXX XXXXXXXXXXX XXXX-XXXX XXXXX DNA XX XXXXXXXX XXXXX Twins Zygosity PLA Natera, Inc
07/01/2018
$759.05
XXXXX
TXXXXXXXXXXXXX XXXXXXXXXXX XX XXXX XXXXXXXXXX (XXXXXX XXXXXXXXXXX [SXO2], XXXXXXXXXXXXX [XXHXO2], XXXXXXXXXXXXXXX [XXHXR], XXXXXXXXX XXX XXXXXXXXX XXXXXX XXXXXXXXXX XXXXXXXXXXXXXX [XXHX1 XXX XXHX2]), XXXXX XXXXXXX XXXXXXXXX XXXXXX XXXXXXX (SFDI) XXX XXXXX-XXXXXXXX XXXXXXXX Transcutaneous multispectral measurement of tissue oxygenation and hemoglobin using spatial frequency domain imaging (SFDI) Modulated Imaging, Inc
07/01/2018
$25.10
XXXXX
AXXXXXXXXX (XXXXXXXX XXXXX XXXXXXXXXXXXX), IXG XXX IXM XXXXXXXX XX 80 XXXXXXXXXX, XXXXXXXXX XXXXX, XXXXXXXXX XXXXXXXX XXXX X XXXX XXXXX SLE-key® Rule Out Veracis Inc
10/01/2018
$ 0.00
XXXXX
NXXXXXXXX (XXXXXX), 32 XXXXXX XX LC-MS/MS, XXXXX XXXXXX, XXXXXXXXX XXXXXXXX XX XXXXXXXXX XXXXXXXXX XXXXXXXXXX XXXX XXXXXX XXXXXXXX XXXXXXXX NPDX ASD ADM Panel I Stemina Biomarker Discovery, Inc
10/01/2018
$ 0.00
XXXXX
AXXXXXXX, TXXXXXXXX XXXXXXXX, XXXXX XXX XXXXX XXXXXX XXXXXX (RPR), XXXXXXXXXXX, XXXXXXXXXXX BioPlex 2200 Syphilis Total & RPR Assay Bio-Rad Laboratories
10/01/2018
$31.33
XXXXX
SXXXXXXX XXXX, XXX-XXXXXXXXXX XXXXXXXX, XXXXXXXXXXX, XXXXXXXXXXX (RPR) BioPlex 2200 RPR Assay Bio-Rad Laboratories
10/01/2018
$18.09
XXXXX
PXXXXXXXX XXXXX-XXXXX XXXXXXXX-1 (PAMG-1), XXXXXXXXXXX XXXX XXXXXX XXXXXXX XXXXXXXXXXX, XXXXXXX-XXXXXXX XXXXX, XXXX XXXXXXXX PartoSure™ Test Parsagen Diagnostics, Inc
10/01/2018
$15.29
XXXXX
OXXXXXXX (XXXXXX), XXXXXXXXXXXXXXXXXXXX, XXXXXXX XXXXXXXXXX XXXXXXXXX XX 4 XXXXXXXXXX (XXXXXX XXXXXXXXXXXXXXXXX-1 [MMP-1], XXXXXXXXXXXXXXXX XXXXXXX-XXXXXXX XXXX XXXXXXXX XXXXXXXX 6 [CEACAM6], XXXXXXXXXXXXXXXXXXXXXXXX [HYAL1], XXXXXX XXXXXXXXX XX XXXXXX XXXXXXX [HEC1]), XXXXXXXX-XXXXX XXXXXXXX-XXXXXXXX XXXXXXXXXXXX XXXXXX XXXXXX, XXXXXXXXX XXXXXXXX XX XXXXXXXXX XXXX XXXXX BBDRisk Dx™ Silbiotech, Inc
10/01/2018
$ 0.00
XXXXX
CXXXXXX XXXXXXX XXXXX (C. XXXXXXXX, C. XXXXXXXX, C. XXXXXXXXXXXX, C. XXXXXXX, C. XXXXXXXXXX, XXX C. XXXXX), XXXXXXXXX XXXXX XXXXXXXXX XXXX XXXXXXXXXXX XXXXXX XX XXX XXXXXXXX XX XXXXXXX XX XXXX XXXXXXX MYCODART Dual Amplification Real Time PCR Panel for 6 Candida species RealTime Laboratories, Inc
10/01/2018
$142.63
XXXXX
OXXXXXXX (XXXXXXXXXX), XXXXXRNA, RT-PCR XXXXXXXXXX XXXXXXXXX XX XXR-31-3X, XXXXXXXX-XXXXX XXXXXXXX-XXXXXXXX XXXXXX, XXXXXXXXX XXXXXXXX XX XX XXXXXXXXXX XXXXX miR-31now™ GoPath Laboratories
10/01/2018
$380.00
XXXXX
CYP2D6 (XXXXXXXXXX P450, XXXXXX 2, XXXXXXXXX D, XXXXXXXXXXX 6) (XX, XXXX XXXXXXXXXX) XXXX XXXXXXXX, XXXXXX XXX XXXXXX XXXX XXXXXXXX (XX, *2, *3, *4, *4N, *5, *6, *7, *8, *9, *10, *11, *12, *13, *14A, *14B, *15, *17, *29, *35, *36, *41, *57, *61, *63, *68, *83, *XN) CYP2D6 Common Variants and Copy Number Mayo Clinic
10/01/2018
$676.37
XXXXX
CYP2D6 (XXXXXXXXXX P450, XXXXXX 2, XXXXXXXXX D, XXXXXXXXXXX 6) (XX, XXXX XXXXXXXXXX) XXXX XXXXXXXX, XXXX XXXX XXXXXXXX (LXXX XXXXXXXXXX XX XXXXXXXX XX XXXX XXX XXXXXXX XXXXXXXXX) CYP2D6 Full Gene Sequencing Mayo Clinic
10/01/2018
$301.35
XXXXX
CYP2D6 (XXXXXXXXXX P450, XXXXXX 2, XXXXXXXXX D, XXXXXXXXXXX 6) (XX, XXXX XXXXXXXXXX) XXXX XXXXXXXX, XXXXXXXX XXXXXXXX XXXXXXXX (XX, CYP2D6-2D7 XXXXXX XXXX) (LXXX XXXXXXXXXX XX XXXXXXXX XX XXXX XXX XXXXXXX XXXXXXXXX) CYP2D6-2D7 Hybrid Gene Targeted Sequence Analysis Mayo Clinic
10/01/2018
$450.91
XXXXX
CYP2D6 (XXXXXXXXXX P450, XXXXXX 2, XXXXXXXXX D, XXXXXXXXXXX 6) (XX, XXXX XXXXXXXXXX) XXXX XXXXXXXX, XXXXXXXX XXXXXXXX XXXXXXXX (XX, CYP2D7-2D6 XXXXXX XXXX) (LXXX XXXXXXXXXX XX XXXXXXXX XX XXXX XXX XXXXXXX XXXXXXXXX) CYP2D7-2D6 Hybrid Gene Targeted Sequence Analysis Mayo Clinic
10/01/2018
$450.91
XXXXX
CYP2D6 (XXXXXXXXXX P450, XXXXXX 2, XXXXXXXXX D, XXXXXXXXXXX 6) (XX, XXXX XXXXXXXXXX) XXXX XXXXXXXX, XXXXXXXX XXXXXXXX XXXXXXXX (XX, XXX-XXXXXXXXXX XXXX XXXX XXXXXXXXXXX/XXXXXXXXXXXXXX XX XXXXX) (LXXX XXXXXXXXXX XX XXXXXXXX XX XXXX XXX XXXXXXX XXXXXXXXX) CYP2D6 trans-duplication/multiplication non-duplicated gene targeted sequence analysis Mayo Clinic
10/01/2018
$450.91
XXXXX
CYP2D6 (XXXXXXXXXX P450, XXXXXX 2, XXXXXXXXX D, XXXXXXXXXXX 6) (XX, XXXX XXXXXXXXXX) XXXX XXXXXXXX, XXXXXXXX XXXXXXXX XXXXXXXX (XX, 5&XXXXX; XXXX XXXXXXXXXXX/XXXXXXXXXXXXXX) (LXXX XXXXXXXXXX XX XXXXXXXX XX XXXX XXX XXXXXXX XXXXXXXXX) CYP2D6 5’ gene duplication/multiplication targeted sequence analysis Mayo Clinic
10/01/2018
$450.91
XXXXX
CYP2D6 (XXXXXXXXXX P450, XXXXXX 2, XXXXXXXXX D, XXXXXXXXXXX 6) (XX, XXXX XXXXXXXXXX) XXXX XXXXXXXX, XXXXXXXX XXXXXXXX XXXXXXXX (XX, 3&XXXXX; XXXX XXXXXXXXXXX/ XXXXXXXXXXXXXX) (LXXX XXXXXXXXXX XX XXXXXXXX XX XXXX XXX XXXXXXX XXXXXXXXX) CYP2D6 3’ gene duplication/multiplication targeted sequence analysis Mayo Clinic
10/01/2018
$450.91
XXXXX
IXXXXXXXXXXXXX XXXXXXXXXXX (M-XXXXXXX), XXXXXXXXXXX, XXXXXXXXXXXXXXXXXXX XXX XXXX XXXXXXXXXXXX, XXXXX XX XXXXX, XXXXXXXXX XXXXXXX M-Protein Detection and Isotyping by MALDI-TOF Mass Spectrometry Mayo Clinic
10/01/2018
$ 0.00
XXXXX
PXXX XXXXXXXXXX (XXXXXX-XXX XXXXXXXX) XXXXXXXXXX XXXXX, 16 XXXXXX XXXXXXXX (XX, ABCB1, COMT, DAT1, DBH, DOR, DRD1, DRD2, DRD4, GABA, GAL, HTR2A, HTTLPR, MTHFR, MUOR, OPRK1, OPRM1), XXXXXX XXXX XX XXXXX XXXXXXXX XXXXXX XXXXXX, XXXXXXXXX XXXXXXXX XX XXXXXXXX XX XXXXXXXX XXXX XX XXXXXX-XXX XXXXXXXX INFINITI® Neural Response Panel PersonalizeDx Labs
10/01/2018
$450.91
XXXXX
CXXXXXXXXXX DNA XXXXXXXX XXXXX XXXXXXXX XXXXXXXX XXXXXX-XXXXXXXXXX XXXXXXXXXXXXX (SNPX), XXXXX XXX XXXXXX DNA, XXX XXXXXXXX XXXXXXXX XXXXXXXXXXXX ToxLok™ InSource Diagnostics
10/01/2018
$ 0.00
XXXXX
OXXXXXXX (XXXX), XXXX XXXXXXXXXXXXX XXXXXXXX XX XXXXXXXX-3-XXXXXXX XXXXXXX XXX XXXXXXXXX XXXXXXXX XXXXXXXX-XXXX XXXX 1 XXXXXXX M130, XXXX XXXX XXXXXXXX XXXX XXXXXXX (XXX, XXXXXXX XXXXXX, XXXXXX XXXXXXXX, XXXXXX-XXXXXXXXXXX XXXXXX XXX XXXXXX XXXXXXXX), XXXXXXXXX XXXXXX, XXXXXXXXX XXXXXXXX XX X XXXXXXXXXXX XXXXXXXXXXX XX XXXXXXXXXX BDX-XL2 Biodesix®, Inc
01/01/2019
$3520.00
XXXXX
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OXXXXXXX (XXXXXX), XRNA, XXXX XXXXXXXXXX XXXXXXXXX XX XXXX-XXXXXXXXXX XXXXXXXXXX XX 101 XXXXX, XXXXXXXXX XXXXXXXX-XXXXX XXXXXXXX-XXXXXXXX XXXXXX, XXXXXXXXX XXXXXXXX XX X XXXXXX XXXXXXXX XXXXXX XXXXXX XXXXXXXX XXXXXXX(X) XXXX XXXXXXXXXXX XX XXXXXX XXXX XXXXXXXXXXX Insight TNBCtype™ Insight Molecular Labs
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PIK3CA (XXXXXXXXXXXXXXXXXXXX-4,5-XXXXXXXXXXXX 3-XXXXXX, XXXXXXXXX XXXXXXX XXXXX) (XX, XXXXXX XXXXXX) XXXX XXXXXXXX (XX, X.C420R, X.E542K, X.E545A, X.E545D [X.1635G>T XXXX], X.E545G, X.E545K, X.Q546E, X.Q546R, X.H1047L, X.H1047R, X.H1047Y) therascreen PIK3CA RGQ PCR Kit QIAGEN GmbH
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CXXX XXXXXX (XX, XXXXXXXXXXXX XXXXXXXXXX, XXXXXXXXXXXXX), XXXXXXXX XXXXXXXX SMASH™ New York Genome Center
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MLH1 (XXXL XXXXXXX 1) (XX, XXXXXXXXXX XXX-XXXXXXXXX XXXXXXXXXX XXXXXX, LXXXX XXXXXXXX) XRNA XXXXXXXX XXXXXXXX (LXXX XXXXXXXXXX XX XXXXXXXX XX XXXX XXX XXXXXXX XXXXXXXXX) CustomNext + RNA: MLH1 Ambry Genetics®
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MSH2 (XXXS XXXXXXX 2) (XX, XXXXXXXXXX XXXXX XXXXXX, LXXXX XXXXXXXX) XRNA XXXXXXXX XXXXXXXX (LXXX XXXXXXXXXX XX XXXXXXXX XX XXXX XXX XXXXXXX XXXXXXXXX) CustomNext + RNA: MSH2 Ambry Genetics®
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MSH6 (XXXS XXXXXXX 6) (XX, XXXXXXXXXX XXXXX XXXXXX, LXXXX XXXXXXXX) XRNA XXXXXXXX XXXXXXXX (LXXX XXXXXXXXXX XX XXXXXXXX XX XXXX XXX XXXXXXX XXXXXXXXX) CustomNext + RNA: MSH6 Ambry Genetics®
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PMS2 (PMS1 XXXXXXX 2, XXXXXXXX XXXXXX XXXXXX XXXXXXXXX) (XX, XXXXXXXXXX XXX-XXXXXXXXX XXXXXXXXXX XXXXXX, LXXXX XXXXXXXX) XRNA XXXXXXXX XXXXXXXX (LXXX XXXXXXXXXX XX XXXXXXXX XX XXXX XXX XXXXXXX XXXXXXXXX) CustomNext + RNA: PMS2 Ambry Genetics®
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