|
Service/Item
|
Current Fee FY 25-26
|
|
Initial Prenatal Care Visit-Reporting Only
|
$0.00
|
|
Postpartum Care Visit - Reporting Only
|
$0.00
|
|
Incision and Drainage of skin ab
|
$136.00
|
|
Foreign Body Removal
|
$155.00
|
|
Foreign Body Removal
|
$389.00
|
|
Removal Skin Tags
|
$198.00
|
|
Nexplanon Device Insertion
|
$180.00
|
|
Nexplanon Device Removal
|
$210.00
|
|
Nexplanon Device Removal with Insertion
|
$517.04
|
|
Wart/Other Non-skin Tag Lesion Destruction
|
$128.00
|
|
Venipuncture Collection
|
$20.45
|
|
IUD Insertion
|
$174.00
|
|
Fetal Non Stress Test
|
$119.00
|
|
Fetal Non Stress Test
|
$31.00
|
|
Antepartum Care 4-6 Visits (MH Global billing)
|
$708.00
|
|
Antepartum Care 7 or More Visits (MH Global billing)
|
$1266.00
|
|
Postpartum Care Only
|
$228.00
|
|
Foreign Body Removal External Ear
|
$173.00
|
|
Foreign Body removal using irrigation/lavage
|
$31.00
|
|
Removal Impacted Cerumen
|
$72.00
|
|
322758 Basic Metabolic panel- LAB CORP
|
$20.00
|
|
Complete Metabolic Panel (14) - LAB CORP
|
$17.00
|
|
Lipid Panel - LAB CORP
|
$20.00
|
|
Lipid Panel(in house)
|
$20.00
|
|
Renal function panel- LAB CORP
|
$21.00
|
|
Acute Hepatitis Panel - LAB CORP
|
$400.00
|
|
Valproic Acid - LAB CORP
|
$80.60
|
|
Drug Test- LAB CORP
|
$95.00
|
|
Urinalysis w/o Microscopy
|
$22.00
|
|
Urine Pregnancy Test
|
$20.00
|
|
Amine Vaginal Fluid
|
$12.00
|
|
Factor II, DNA Analysis - LAB CORP
|
$394.00
|
|
Spinal Muscular Atrophy - LAB CORP
|
$373.75
|
|
MaterniT21 Plus Core - LAB CORP
|
$373.75
|
|
AFP Tetra - LAB CORP
|
$57.80
|
|
Ammonia - LAB CORP
|
$80.60
|
|
Amylase - LAB CORP
|
$30.55
|
|
Bile Acids - LAB CORP
|
$56.25
|
|
Vitamin D - LAB CORP
|
$68.75
|
|
Creatine Kinase, Total - LAB CORP
|
$18.00
|
|
Cortisol, ACTH Stimulation - LAB CORP
|
$210.00
|
|
Creatinine - LAB CORP
|
$13.00
|
|
Vitamin B-12-LAB CORP
|
$25.00
|
|
DHEA, Serum -LAB CORP
|
$238.55
|
|
Estradiol - LAB CORP
|
$118.75
|
|
Estriol, Serum - LAB CORP
|
$140.00
|
|
Ferritin - LAB CORP
|
$8.00
|
|
Folate (Folic Acid), Serum - LAB CORP
|
$23.00
|
|
Glucose Random/Fasting
|
$26.00
|
|
Glucose 1 Hr. Screen
|
$30.00
|
|
Glucose Tolerance Test (GTT) 3 Hr.
|
$77.00
|
|
GGT
|
$17.75
|
|
FSH - LAB CORP
|
$72.50
|
|
A1C Hemoglobin Glycosylated - LAB CORP
|
$12.00
|
|
A1C Hemoglobin Glycosylated (In-house)
|
$57.00
|
|
17-OH Progesterone LCMS - LAB CORP
|
$43.75
|
|
Thyrotropin Receptor Antibody - LAB CORP
|
$216.60
|
|
Insulin - LAB CORP
|
$48.50
|
|
Iron - LAB CORP
|
$18.00
|
|
LDH - LAB CORP
|
$19.00
|
|
Lead, Blood (Adult) - LAB CORP
|
$11.00
|
|
Lipase - LAB CORP
|
$30.55
|
|
Parathyroid Hormone – LAB CORP
|
$89.60
|
|
Bone Specific Alkaline Phosphatase – LAB CORP
|
$132.90
|
|
Potassium - LAB CORP
|
$19.00
|
|
Progesterone - LAB CORP
|
$93.75
|
|
Prolactin - LAB CORP
|
$93.75
|
|
Prostate-Specific Ag - LAB CORP
|
$25.00
|
|
IGF-1 - LAB CORP
|
$260.00
|
|
Testosterone - LAB CORP
|
$84.35
|
|
ALT/SGPT - LAB CORP
|
$17.75
|
|
TSH - LAB CORP
|
$8.00
|
|
Assay of tsi - LAB CORP
|
$354.40
|
|
Transferrin
|
$55.00
|
|
Triiodothyronine T3 - LAB CORP
|
$76.50
|
|
Troponin T - LAB CORP
|
$181.80
|
|
BUN - LAB CORP
|
$17.75
|
|
Uric Acid - LAB CORP
|
$13.00
|
|
Uric Acid, 24 hr. Urine - LAB CORP
|
$25.00
|
|
HCG Serum Quantitative - LAB CORP
|
$15.10
|
|
Hemoglobin
|
$22.00
|
|
CBC with Diff/platelet - LAB CORP
|
$4.00
|
|
Reticulocyte Count - LAB CORP
|
$10.00
|
|
Platelet count - LAB CORP
|
$21.00
|
|
Factor VIII Activity - LAB CORP
|
$230.00
|
|
D-Dimer – LAB CORP
|
$216.60
|
|
PT - LAB CORP
|
$20.00
|
|
Sedimentation Rate-Westergren (EST) - LAB CORP
|
$16.25
|
|
Hgb Solubility - LAB CORP
|
$89.00
|
|
Allergen Profile Food – LAB CORP
|
$191.00
|
|
Antinuclear Antibodies Direct - LAB CORP
|
$56.85
|
|
Sjögren's Ab, Anti - 55-A/55-B - LAB CORP
|
$271.05
|
|
Mononucleosis Test Qual - LAB CORP
|
$42.50
|
|
Diphtheria Antitoxoid Ab - LAB CORP
|
$77.50
|
|
Inhibin A, Ultrasensitive - LAB CORP
|
$81.25
|
|
Helper T-lymphocytes Marker CD4 – LAB CORP
|
$148.35
|
|
Thyroid Peroxidase - LAB CORP
|
$55.00
|
|
Rabies Antibody Testing Lab Corp
|
$118.95
|
|
C-Reactive Protein, Quant - LAB CORP
|
$34.30
|
|
Rheumatoid Arthritis Factors - LAB CORP
|
$27.50
|
|
QuantiFERON-TB Gold Plus - LAB CORP
|
$50.00
|
|
Tuberculin Intradermal Test
|
$23.00
|
|
Tuberculin Intradermal Test – School only
|
$20.00
|
|
RPR - LAB CORP
|
$23.00
|
|
Cytomegalovirus Ab, IgG - LAB CORP
|
$120.75
|
|
Hep B Surface Ab - LAB CORP
|
$58.00
|
|
Hep Be Antibody - LAB CORP
|
$82.40
|
|
Hep A lgG - LAB CORP
|
$60.30
|
|
Hepatitis A Antibody, IgM - LAB CORP
|
$50.70
|
|
Rubella Antibodies, IgG - LAB CORP
|
$45.00
|
|
SARS-CoV-2 Antibody, IgG - LAB CORP
|
$52.70
|
|
Varicella-Zoster V Ab, IgG - LAB CORP
|
$18.10
|
|
Hepatitis C antibody - STATE LAB
|
$57.75
|
|
Antibody Screen - LAB CORP
|
$35.10
|
|
ABO Grouping and Rho(D) Typing - LAB CORP
|
$15.10
|
|
Gonorrhea Culture
|
$52.00
|
|
Strep Gp B Culture - LAB CORP
|
$31.50
|
|
Urine Culture, Routine - LAB CORP
|
$12.35
|
|
Fungus Mycology - LAB CORP
|
$109.85
|
|
Gram Stain Smear
|
$28.00
|
|
Wet Mount
|
$25.00
|
|
Viral Culture, General - LAB CORP
|
$315.00
|
|
HBsAg Screen - LAB CORP
|
$50.00
|
|
Hep Be Antigen - LAB CORP
|
$82.40
|
|
HIV Ab/p24 Ag with Reflex - LAB CORP
|
$115.00
|
|
Rapid RSV
|
$100.00
|
|
COVID19 Ag Test
|
$109.00
|
|
Hep B DNA Quantitative PCR - LAB CORP
|
$686.50
|
|
HCV RealTime Abbott - LAB CORP
|
$850.20
|
|
HSV 1/2 PCR - LAB CORP (order for non-pregnant
patients)
|
$203.45
|
|
Real Time Abbott - HIV Test
|
$125.00
|
|
IADNA Mycoplasma Genitalium Amplified Probe Tech - LAB CORP
|
$118.15
|
|
Monkeypox (orthopoxvirus) PCR- LAB CORP
|
$101.10
|
|
HPV Aptima - LAB CORP
|
$45.50
|
|
SARS-CoV-2, NAA - LAB CORP
|
$67.00
|
|
Agent Antigen Detection
|
$677.25
|
|
Flu Test A&B - bill 2 units
|
$25.00
|
|
Rapid Strep
|
$100.00
|
|
Cytopathy, c/v, interpretation by MD-LAB CORP
|
$246.45
|
|
Pap Smear Cervial Cytopathy - LAB CORP
|
$24.70
|
|
Pap Smear Cervial Cytopathy - LAB CORP
|
$0.00
|
|
Beyfortus 50mg (SP)
|
$767.00
|
|
Beyfortus 100mg (SP)
|
$767.00
|
|
Vaccine Administration (1 dose)
|
$25.00
|
|
Vaccine Administration (2 dose)
|
$25.00
|
|
Vaccine Adm. -intranasal or oral
|
$25.00
|
|
Vaccine Adm.-intranasal or oral, each additional
|
$25.00
|
|
Admin-Moderna COVID-19 Vaccine
|
$96.00
|
|
JYNNEOS (Monkeypox) Vaccine
|
$385.00
|
|
MenQuadfi
|
$253.00
|
|
Bexsero
|
$338.00
|
|
Hepatitis A Adult
|
$122.00
|
|
Hepatitis A (12mos - 18 yrs.)
|
$59.00
|
|
Twinrix (GSK)
|
$189.00
|
|
HIB PedvaxHIB (3dose)
|
$45.00
|
|
Gardasil 9
|
$469.00
|
|
Trivalent – flu (6 months and older PF prefilled syringe)
|
$32.00
|
|
Rabies Vaccine (RABAVERT)
|
$621.00
|
|
Rabies Vaccine (IMOVAX)
|
$620.00
|
|
Prevnar 20
|
$412.00
|
|
Abrysvo (SP)
|
$438.00
|
|
Roteq - 3 dose
|
$149.00
|
|
Trivalent - flu (6months and older PF prefilled syringe)
|
$25.00
|
|
Kinrix vaccine
|
$94.00
|
|
Pentacel vaccine
|
$180.00
|
|
Daptacel (SP)
|
$36.00
|
|
Measles Mumps Rubella
|
$143.00
|
|
Measles Mumps Rubella Varicella (ProQuad)
|
$417.00
|
|
IPV
|
$68.00
|
|
Tenivac (Td)
|
$66.00
|
|
Tdap
|
$73.00
|
|
Varicella
|
$275.00
|
|
Pediarix
|
$155.00
|
|
Pneumococcal 23
|
$176.00
|
|
HepB-Pediatric (Engerix)
|
$42.00
|
|
Hepatitis B (Adult)
|
$104.00
|
|
Shingrix
|
$324.00
|
|
Moderna COVID-19 Vaccine 6 mo-11yrs
|
$194.00
|
|
Moderna COVID-19 Vaccine 12yrs & up
|
$213.00
|
|
Hearing Evaluation Limited Otoacoustic
|
$103.00
|
|
Ambulatory Blood Pressure Reading
|
$48.00
|
|
Nebulizer Treatment
|
$37.00
|
|
Nebulizer Education
|
$37.00
|
|
Allergy Injection - 1
|
$22.00
|
|
Allergy Injection - 2
|
$30.00
|
|
Developmental Screening
|
$154.80
|
|
Social/Emotional Screening for mother of Child with EPDS; PHQ-2; PHQ-9, PSC; CRAFFT for childe/adolescent.
|
$13.00
|
|
HEADSSS
|
$19.00
|
|
Maternal Depression Screen-EPDS or PHQ-2/PHQ-9Tool
|
$18.00
|
|
Injection IM SQ
|
$46.00
|
|
Initial MNT, Individual, 15 min/Unit
|
$45.00
|
|
Additional MNT, Individual, 15 min/Unit
|
$40.00
|
|
MNT Group, 30 min/Unit
|
$50.00
|
|
Handling/Conveyance Fee
|
$27.00
|
|
Suture/Staple Removal Supplies
|
$33.00
|
|
Form Completion
|
$137.50
|
|
Visual Acuity Screen
|
$20.00
|
|
Office Visit I - New
|
$78.00
|
|
Office Visit II - New
|
$117.00
|
|
Office Visit III - New
|
$166.00
|
|
Office Visit IV - New
|
$244.00
|
|
Office Visit V - New
|
$306.00
|
|
Office Visit I - Established
|
$43.00
|
|
Office Visit II - Established
|
$72.00
|
|
Office Visit III - Established
|
$100.00
|
|
Office Visit IV - Established
|
$153.00
|
|
Office Visit V - Established
|
$228.00
|
|
Preventive Visit under 1 year - New
|
$170.00
|
|
Preventive Visit 1-4 years - New
|
$180.00
|
|
Preventive Visit 5-11 years - New
|
$193.00
|
|
Preventive Visit 12-17 years - New
|
$212.00
|
|
Preventive Visit 18-39 years - New
|
$209.00
|
|
Preventive Visit 40-64 years - New
|
$249.00
|
|
Preventive Visit 65 years and over - New
|
$269.00
|
|
Preventive Visit under 1 year - Established
|
$120.00
|
|
Preventive Visit 1-4 years - Established
|
$131.00
|
|
Preventive Visit 5-11 years - Established
|
$183.00
|
|
Preventive Visit 12-17 years - Established
|
$183.00
|
|
Preventive Visit 18-39 years - Established
|
$180.00
|
|
Preventive Visit 40-64 years - Established
|
$200.00
|
|
Preventive Visit 65 years and over - Established
|
$228.00
|
|
Smoking & Tobacco Use Cessation Counseling, Interm3-10min
|
$31.00
|
|
Smoking & Tobacco Use Cessation Counseling, greater10min
|
$61.00
|
|
TB Screening
|
$23.00
|
|
Postpartum Home Visit
|
$185.00
|
|
Newborn Home Visit
|
$239.00
|
|
Dressing Small < or = 16 Sq Inches
|
$5.00
|
|
Dressing Medium 16-48 Sq Inches
|
$5.00
|
|
Dressing Large > 48 sq inches
|
$10.00
|
|
Oral Evaluation < 3YO
|
$64.00
|
|
Topical application fluoride varnish <3YO
|
$54.00
|
|
Administration Flu Vaccine
|
$30.00
|
|
Administration Pneumococcal Vaccine
|
$30.00
|
|
Admin hepatitis b vaccine
|
$25.00
|
|
Diabetes Mgt Individual 30min/Unit
|
$95.00
|
|
Diabetes Mgt Individual 30min/Unit
|
$95.00
|
|
Diabetes Class Group -30 min/Unit
|
$49.00
|
|
Ethanol Testing - LabCorp
|
$15.00
|
|
Ethanol Testing reflex - LabCorp
|
$45.50
|
|
Rapid Flu A & B Test
|
$50.00
|
|
Infectious agent antigen detection test
|
$19.00
|
|
Infectious agent antigen detection
|
$46.00
|
|
Rapid Influenza tests (Type A and/or B)
|
$19.00
|
|
Epinephrine 0.1ml up to 1 ml
|
$3.00
|
|
Injection Depo medroxyprogesterone acetate 1mg/Unit
|
$49.00
|
|
Hydroxyprogesterone caproate, 1 mg, injection (Makena)
|
$49.00
|
|
Rhogam
|
$148.00
|
|
Naloxone Intranasal Spray
|
$94.00
|
|
Hydroxyprogesterone caproate, 1 mg, injection (Makena)
|
$49.00
|
|
Kyleena/Other Levonorgestrel IUD 19.5 mg 5 yr duration
|
$1,686.00
|
|
Liletta/Other Levonorgestrel IUD 52mg 3 yr duration
|
$1,297.00
|
|
Mirena/Other Levonorgestrel IUD 52mg 5 yr duration
|
$1,686.00
|
|
Paraguard/Other Intruterine copper contraceptive
|
$1,573.00
|
|
Nexplanon Etonogestrel (contraceptive) implant system
|
$1,690.00
|
|
Albuterol
|
$0.75
|
|
Albuterol/Ipratopium Bromide
|
$0.75
|
|
College/Work Physical
|
$40.00
|
|
Sports Physical
|
$20.00
|
|
TBST – State test administered
|
$0.00
|
|
TB Subsequent Visit
|
$0.00
|
|
PPD + (high risk)
|
$0.00
|
|
PPD + (low risk)
|
$0.00
|
|
PPD – (high risk)
|
$0.00
|
|
PPD – (low risk)
|
$0.00
|
|
TB Assessment (referred ofr + PDD)
|
$0.00
|
|
LTBI Tx Initiated (high risk)
|
$0.00
|
|
LTBI Tx Initiated (low risk)
|
$0.00
|
|
LTBI Tx Completed (high risk)
|
$0.00
|
|
LTBI Tx Completed (low risk)
|
$0.00
|
|
TB Initial Visit
|
$0.00
|
|
TB Subsequent Visit
|
$0.00
|
|
Positive PPD
|
$0.00
|
|
Anemia B Profile - LAB CORP
|
$90.00
|
|
Lupus Anticoagulant Reflex - LAB CORP
|
$240.00
|
|
Anticardiolipin Ab, IgG/M, Qn - LAB CORP
|
$179.00
|
|
HSV 1 and 2 - Spec Ab,IgG w/Rflx - LAB CORP (order for prenatal patients only)
|
$237.60
|
|
Thyroxine (T4) - LAB CORP
|
$6.50
|
|
Thyroid Panel with TSH - LAB CORP
|
$20.50
|
|
Thyroid cascade profile - LAB CORP
|
$7.70
|
|
Hepatic Function Panel (7)- LAB CORP
|
$14.60
|
|
Pap Lb -LAB CORP
|
$23.00
|
|
Iron + TIBC-LAB CORP
|
$19.50
|
|
Antiphospholipid Syndrome - LAB CORP
|
$945.00
|
|
Measles, Mumps, Rubella Immunity - LAB CORP
|
$265.45
|
|
Antithrombin III, Func/Immunol - LAB CORP
|
$435.00
|
|
IGP, Aptima HPV- LAB CORP
|
$70.20
|
|
PT and PTT- LAB CORP
|
$56.25
|
|
aPTT Mixing Studies - LAB CORP
|
$290.10
|
|
Prot+CreatU (Random) - LAB CORP
|
$56.25
|
|
GC/CT/Trich Urine NAAT - LAB CORP
|
$73.75
|
|
CMP Super Panel – LAB CORP
|
$263.82
|
|
CMP 12 – LAB CORP
|
$21.35
|
|
Anaerobic and Aerobic Culture – LAB CORP
|
$162.85
|
|
Comprehensive Drug Analysis, Ur - LAB CORP
|
$20.55
|
|
Albumin/Creatinine Ratio, Urine - LAB CORP
|
$84.10
|
|
CK Total + Isoenzymes, Serum – LAB CORP
|
$96.50
|
|
Lupus Anticoag/Cardiolipin Ab - LAB CORP
|
$1,353.20
|
|
Cystic Fibrosis/Spinal Muscular Atrophy Panel 81220, 81329 – LAB CORP
|
$373.75
|
|
Cystic Fibrosis/Spinal Mucular Atrophy Panel – LAB CORP
|
$373.75
|
|
Hepatitis B Surface Antibody, Quantitative (use for babies born to Hep B+ mothers) – LAB CORP
|
$46.10
|
|
Epstein-Barr Antibody Profile – LAB CORP
|
$343.55
|
|
Strep Culture, Group A - LAB CORP
|
$48.88
|
|
Vaginitis Plus with Candida - LAB CORP
|
$1,591.75
|
|
Bowel Disorders - LAB CORP
|
$273.66
|
|
Vaginitis Plus Nuswab - LAB CORP
|
$1,060.20
|
|
HB Solu + Rflx Frac - LAB CORP
|
$88.95
|
|
Vit B12 with Folate – LAB CORP
|
$48.10
|
|
Inhibin B - LAB CORP
|
$321.60
|
|
Hemoglobinopathy Fractionation Cascade - LAB CORP
|
$128.95
|
|
|
Pediatric Lead - LAB CORP
|
$80.10
|
|
|
Cortisol– LAB CORP
|
$105.00
|
|
|
IgG, IgA, IgM, Immunologic IgE – LAB CORP
|
$146.35
|
|
|
Bordetella Pertussis Antibodies – LAB CORP
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$348.30
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Mycoplasma genitalium NAA Swab – LAB CORP
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$118.15
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Allergen Respiratory Area 2 – LAB CORP
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$870.55
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OB First Visit Risk Screening
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$63.00
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Postpartum Visit
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$184.00
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Contraceptive Pills
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$12.00
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Emergency Contraception - (My Choice)
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$11.00
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Emergency Contraception (Ella)
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$25.00
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Birthing Class
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Maternal Care Skilled Nurse Home Visit
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$110.00
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RN Services, up to 15 minutes/unit
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$25.00
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Head Lice Check
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$6.15
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A-Feto Protein Maternal Open Spina Bifida
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$19.85
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Bordetella Pertussis PCR (State Lab)
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$0.00
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Aspiration and/or injection of a ganglion cyst(s)
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$78.65
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Thyroid Stimulating Immunoglobulin
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$443.00
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CPR AND FIRST AID
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Adult and Infant/Child CPR only
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$75.00
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Adult and Infant/Child CPR Refresher Class
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$50.00
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Medical Record copies
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Minimum Fee 13 or fewer pages
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$10.00
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First 25 pages
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.75/page
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Pages 26-100
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.50/page
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Pages 101 and more
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.25/page
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