CodeMap®

.
2025 Clinical Laboratory Fee Schedule CLIA Waived Tests (QW)

Fee schedules do not reflect 2% Payment Adjustment (Sequestration). Click here for more information.

Procedure	Short Descriptor	2024 CLFS	2025 CLFS
XXXXX	Nfct ds vir resp rna 3 trgt	$142.63	$XXX.XX
XXXXX	Nfct ds vir resp rna 4 trgt	$142.63	$XXX.XX
XXXXX	Metabolic panel ionized ca	$13.73	$XXX.XX
XXXXX	Metabolic panel total ca	$8.46	$XXX.XX
XXXXX	Electrolyte panel	$7.01	$XXX.XX
XXXXX	Comprehen metabolic panel	$10.56	$XXX.XX
XXXXX	Lipid panel	$13.39	$XXX.XX
XXXXX	Renal function panel	$8.68	$XXX.XX
XXXXX	Assay of lithium	$6.61	$XXX.XX
XXXXX	Drug test prsmv dir opt obs	$12.60	$XXX.XX
XXXXX	Urinalysis auto w/o scope	$2.25	$XXX.XX
XXXXX	Urine screen for bacteria	$29.98	$XXX.XX
XXXXX	Nfct ds bv&vaginitis dna alg	$262.99	$XXX.XX
XXXXX	Nfct ds bv&vaginitis dna alg		$XXX.XX
XXXXX	Ketone bodys quan	$8.17	$XXX.XX
XXXXX	Assay of serum albumin	$4.95	$XXX.XX
XXXXX	Other source albumin quan ea	$7.78	$XXX.XX
XXXXX	Ur albumin quantitative	$5.78	$XXX.XX
XXXXX	Ur albumin semiquantitative	$6.23	$XXX.XX
XXXXX	Amines vaginal fluid qual	$5.99	$XXX.XX
XXXXX	Assay of amylase	$6.48	$XXX.XX
XXXXX	Bilirubin total	$5.02	$XXX.XX
XXXXX	Occult blood other sources	$5.32	$XXX.XX
XXXXX	Assay test for blood fecal	$15.92	$XXX.XX
XXXXX	Assay of calcium	$5.16	$XXX.XX
XXXXX	Assay of calcium	$13.68	$XXX.XX
XXXXX	Assay blood carbon dioxide	$4.88	$XXX.XX
XXXXX	Assay of blood chloride	$4.60	$XXX.XX
XXXXX	Assay bld/serum cholesterol	$4.35	$XXX.XX
XXXXX	Collagen crosslinks	$18.68	$XXX.XX
XXXXX	Assay of ck (cpk)	$6.51	$XXX.XX
XXXXX	Assay of creatinine	$5.12	$XXX.XX
XXXXX	Assay of urine creatinine	$5.18	$XXX.XX
XXXXX	Assay of estrone	$24.95	$XXX.XX
XXXXX	Assay glucose blood quant	$3.93	$XXX.XX
XXXXX	Glucose test	$4.75	$XXX.XX
XXXXX	Glucose tolerance test (gtt)	$12.87	$XXX.XX
XXXXX	Gtt-added samples	$3.92	$XXX.XX
XXXXX	Assay of ggt	$7.20	$XXX.XX
XXXXX	Assay of glycated protein	$16.76	$XXX.XX
XXXXX	Assay of gonadotropin (fsh)	$18.58	$XXX.XX
XXXXX	Assay of gonadotropin (lh)	$18.52	$XXX.XX
XXXXX	Hemoglobin glycosylated a1c	$9.71	$XXX.XX
XXXXX	Hb glycosylated a1c home dev	$9.71	$XXX.XX
XXXXX	Immunoassay nonantibody	$11.53	$XXX.XX
XXXXX	Immunoassay dipstick	$9.64	$XXX.XX
XXXXX	Immunoassay quant nos nonab	$17.27	$XXX.XX
XXXXX	Assay of lactic acid	$11.57	$XXX.XX
XXXXX	Assay of lead	$12.11	$XXX.XX
XXXXX	Assay of lipoprotein	$8.19	$XXX.XX
XXXXX	Assay of blood lipoprotein	$10.50	$XXX.XX
XXXXX	Microfluid analy tears	$22.48	$XXX.XX
XXXXX	Assay of natriuretic peptide	$39.26	$XXX.XX
XXXXX	Assay ph body fluid nos	$3.58	$XXX.XX
XXXXX	Assay alkaline phosphatase	$5.18	$XXX.XX
XXXXX	Assay of serum potassium	$4.76	$XXX.XX
XXXXX	Assay of protein serum	$3.67	$XXX.XX
XXXXX	Assay of protein other	$4.00	$XXX.XX
XXXXX	Assay of serum sodium	$4.81	$XXX.XX
XXXXX	Assay thyroid stim hormone	$16.80	$XXX.XX
XXXXX	Transferase (ast) (sgot)	$5.18	$XXX.XX
XXXXX	Alanine amino (alt) (sgpt)	$5.30	$XXX.XX
XXXXX	Assay of triglycerides	$5.74	$XXX.XX
XXXXX	Assay of urea nitrogen	$3.95	$XXX.XX
XXXXX	Assay of blood/uric acid	$4.52	$XXX.XX
XXXXX	Chorionic gonadotropin assay	$7.52	$XXX.XX
XXXXX	Hematocrit	$2.37	$XXX.XX
XXXXX	Hemoglobin	$2.37	$XXX.XX
XXXXX	Complete cbc w/auto diff wbc	$7.77	$XXX.XX
XXXXX	Blood platelet aggregation	$24.91	$XXX.XX
XXXXX	Prothrombin time	$4.29	$XXX.XX
XXXXX	Immunoassay tumor qual	$25.57	$XXX.XX
XXXXX	Heterophile antibody screen	$5.18	$XXX.XX
XXXXX	Ia infectious agent antibody	$18.09	$XXX.XX
XXXXX	Ia nfct ab sarscov2 covid19	$45.28	$XXX.XX
XXXXX	Nuclear matrix protein 22	$21.78	$XXX.XX
XXXXX	Lyme disease antibody	$17.03	$XXX.XX
XXXXX	Hiv-1antibody	$8.89	$XXX.XX
XXXXX	Sars-cov-2 covid-19 antibody	$42.13	$XXX.XX
XXXXX	Treponema pallidum	$13.24	$XXX.XX
XXXXX	Hepatitis c ab test	$14.27	$XXX.XX
XXXXX	Culture aerobic identify	$8.08	$XXX.XX
XXXXX	Smear wet mount saline/ink	$5.82	$XXX.XX
XXXXX	Hpylori stool ag ia	$14.38	$XXX.XX
XXXXX	Hiv-1 ag w/hiv-1&-2 ab ag ia	$24.08	$XXX.XX
XXXXX	Influenza a/b each ag ia	$14.13	$XXX.XX
XXXXX	Resp syncytial virus ag ia	$13.91	$XXX.XX
XXXXX	Sarscov coronavirus ag ia	$35.33	$XXX.XX
XXXXX	Sarscov & inf vir a&b ag ia	$70.29	$XXX.XX
XXXXX	Strep a ag ia	$16.81	$XXX.XX
XXXXX	Nos each organism ag ia	$11.98	$XXX.XX
XXXXX	Influenza dna amp probe	$95.80	$XXX.XX
XXXXX	Hepatitis c probe&rvrs trnsc	$35.09	$XXX.XX
XXXXX	Resp virus 3-5 targets	$142.63	$XXX.XX
XXXXX	Resp virus 12-25 targets	$416.78	$XXX.XX
XXXXX	Rsv dna/rna amp probe	$70.20	$XXX.XX
XXXXX	Sars-cov-2 covid-19 amp prb	$51.31	$XXX.XX
XXXXX	Sarscov2 & inf a&b amp prb	$142.63	$XXX.XX
XXXXX	Sarscov2&inf a&b&rsv amp prb	$142.63	$XXX.XX
XXXXX	Strep a dna dir probe	$20.05	$XXX.XX
XXXXX	Strep a dna amp probe	$35.09	$XXX.XX
XXXXX	Detect agnt mult dna ampli	$70.20	$XXX.XX
XXXXX	Influenza assay w/optic	$16.55	$XXX.XX
XXXXX	Hiv ag w/hiv1&2 antb w/optic	$32.77	$XXX.XX
XXXXX	Rsv assay w/optic	$13.10	$XXX.XX
XXXXX	Trichomonas assay w/optic	$15.29	$XXX.XX
XXXXX	Adenovirus assay w/optic	$21.76	$XXX.XX
XXXXX	Sars-cov-2 covid19 w/optic	$41.38	$XXX.XX
XXXXX	Strep a assay w/optic	$16.53	$XXX.XX
XXXXX	Agent nos assay w/optic	$16.07	$XXX.XX
XXXXX	Sialidase enzyme assay	$12.22	$XXX.XX
XXXXX	Semen analysis w/huhner	$9.84	$XXX.XX
XXXXX	Semen anal sperm detection	$12.05	$XXX.XX
XXXXX	Fecal blood scrn immunoassay	$18.05	$XXX.XX
XXXXX	Elisa hiv-1/hiv-2 screen	$18.29	$XXX.XX
XXXXX	Hep c screen high risk/other	$46.35	$XXX.XX
XXXXX	Hiv combination assay	$24.08	$XXX.XX
XXXXX	Covid-19 lab test non-cdc	$51.31	$XXX.XX

CodeMap® is a Registered Trademark of Wheaton Partners, LLC.