99381 INIT PM E/M NEW PAT INFANT No No Yes FLAT RC No 86.72 N/A 2/1/2015 N/A 8 99382 INIT PM E/M NEW PAT 1-4 YRS No No Yes FLAT RC No 93.36 N/A 2/1/2015 N/A 6 99383 PREV VISIT NEW AGE 5-11 No No Yes FLAT RC No 91.46 N/A 2/1/2015 N/A 6 99384 PREV VISIT NEW AGE 12-17 No No Yes FLAT RC No 99.37 N/A 2/1/2015 N/A 2 99385 PREV VISIT NEW AGE 18-39 No No Yes FLAT RC No 99.37 N/A 2/1/2015 N/A 1 99386 PREV VISIT NEW AGE 40-64 No No Yes FLAT RC No 117.1 N/A 2/1/2015 N/A 1 99387 INIT PM E/M NEW PAT 65+ YRS No No Yes FLAT RC No 126.92 N/A 2/1/2015 N/A 1 99391 PER PM REEVAL EST PAT INFANT No No Yes FLAT RC No 65.83 N/A 2/1/2015 N/A 8 99392 PREV VISIT EST AGE 1-4 No No Yes FLAT RC No 73.74 N/A 2/1/2015 N/A 6 99393 PREV VISIT EST AGE 5-11 No No Yes FLAT RC No 72.79 N/A 2/1/2015 N/A 6 99394 PREV VISIT EST AGE 12-17 No No Yes FLAT RC No 80.39 N/A 2/1/2015 N/A 2 99395 PREV VISIT EST AGE 18-39 No No Yes FLAT RC No 81.34 N/A 2/1/2015 N/A 1 99396 PREV VISIT EST AGE 40-64 No No Yes FLAT RC No 89.89 N/A 2/1/2015 N/A 1 99397 PER PM REEVAL EST PAT 65+ YR No No Yes FLAT RC No 99.06 N/A 2/1/2015 N/A 1 93000 ELECTROCARDIOGRAM COMPLETE No No Yes FLAT RC No 16.39 N/A 2/1/2015 N/A 1 93005 ELECTROCARDIOGRAM TRACING No No Yes FLAT RC No 7.24 N/A 2/1/2015 N/A 1 93010 ELECTROCARDIOGRAM REPORT No No Yes FLAT RC No 9.15 N/A 2/1/2015 N/A 1 EKG FOR INITIAL PREVENT EXAM No No No FLAT RC N/A 16.39 N/A N/A N/A 1 EKG TRACING FOR INITIAL PREV No No No FLAT RC N/A 7.24 N/A N/A N/A 1 EKG INTERPRET & REPORT PREVE No No No FLAT RC N/A 9.15 N/A N/A N/A 1 80048 METABOLIC PANEL TOTAL CA No No Yes PC Yes 8.46 N/A N/A 1 80050 GENERAL HEALTH PANEL No No Yes PC No 50.04 N/A 1/1/2014 N/A 1 80051 ELECTROLYTE PANEL No No Yes PC Yes 7.01 N/A N/A 1 80053 COMPREHEN METABOLIC PANEL No No Yes PC Yes 10.56 N/A N/A 1 82040 ASSAY OF SERUM ALBUMIN No No Yes PC Yes 4.95 N/A N/A 1 82247 BILIRUBIN TOTAL No No Yes PC Yes 5.02 N/A N/A 1 82310 ASSAY OF CALCIUM No No Yes PC Yes 5.16 N/A N/A 1 82374 ASSAY BLOOD CARBON DIOXIDE No No Yes PC Yes 4.7 N/A N/A 1 82435 ASSAY OF BLOOD CHLORIDE No No Yes PC Yes 4.6 N/A N/A 1 82550 ASSAY OF CK (CPK) No No Yes PC Yes 6.51 N/A N/A 1 82565 ASSAY OF CREATININE No No Yes PC Yes 5.12 N/A N/A 1 82977 ASSAY OF GGT No No Yes PC Yes 7.2 N/A N/A 1 84478 ASSAY OF TRIGLYCERIDES No No Yes PC Yes 5.74 N/A N/A 1 85004 AUTOMATED DIFF WBC COUNT No No Yes PC Yes 6.47 N/A N/A 1 85013 SPUN MICROHEMATOCRIT No No Yes PC Yes 3.23 N/A 1/1/2014 N/A 1 85014 HEMATOCRIT No No Yes PC Yes 2.37 N/A N/A 1 85018 HEMOGLOBIN No No Yes PC Yes 2.37 N/A N/A 1 85025 COMPLETE CBC W/AUTO DIFF WBC No No Yes PC Yes 7.77 N/A N/A 1 85027 COMPLETE CBC AUTOMATED No No Yes PC Yes 6.47 N/A N/A 1 CBC/DIFFWBC W/O PLATELET No No Yes PC Yes 7.77 N/A N/A 1 CBC WITHOUT PLATELET No No Yes PC Yes 6.47 N/A N/A 1 81000 URINALYSIS NONAUTO W/SCOPE No No Yes PC Yes 4.02 N/A N/A 1 81001 URINALYSIS AUTO W/SCOPE No No Yes PC Yes 3.17 N/A N/A 1 81002 URINALYSIS NONAUTO W/O SCOPE No No Yes PC Yes 3.48 N/A N/A 1 81003 URINALYSIS AUTO W/O SCOPE No No Yes PC Yes 2.25 N/A N/A 1 80061 LIPID PANEL No No Yes PC Yes 13.39 N/A N/A 1 82465 ASSAY BLD/SERUM CHOLESTEROL No No Yes PC Yes 4.35 N/A N/A 1 83718 ASSAY OF LIPOPROTEIN No No Yes PC Yes 8.19 N/A N/A 1 83719 ASSAY OF BLOOD LIPOPROTEIN No No Yes PC Yes 12.75 N/A N/A 1 83721 ASSAY OF BLOOD LIPOPROTEIN No No Yes PC Yes 10.5 N/A N/A 1 84478 ASSAY OF TRIGLYCERIDES No No Yes PC Yes 5.74 N/A N/A 1 82947 ASSAY GLUCOSE BLOOD QUANT No No Yes PC Yes 3.93 N/A N/A 2 82950 GLUCOSE TEST No No Yes PC Yes 4.75 N/A N/A 2 82951 GLUCOSE TOLERANCE TEST (GTT) No No Yes PC Yes 12.87 N/A N/A 2 83036 GLYCOSYLATED HEMOGLOBIN TEST No No Yes PC Yes 9.71 N/A N/A 2 83037 GLYCOSYLATED HB HOME DEVICE No No Yes PC Yes 9.71 N/A N/A 2 86480 TB TEST CELL IMMUN MEASURE No No Yes PC Yes 61.98 N/A N/A 1 86481 TB AG RESPONSE T-CELL SUSP No No Yes PC Yes 65.48 N/A 4/1/2015 N/A 1 86580 TB INTRADERMAL TEST No No Yes PC No 3.89 N/A 2/1/2015 N/A 1 86631 CHLAMYDIA ANTIBODY No No Yes PC Yes 11.82 N/A N/A 1 age 11-64 86632 CHLAMYDIA IGM ANTIBODY No No Yes PC Yes 12.68 N/A N/A 1 age 11-64 87110 CHLAMYDIA CULTURE No No Yes PC Yes 15.84 N/A N/A 1 age 11-64 87270 CHLAMYDIA TRACHOMATIS AG IF No No Yes PC Yes 11.98 N/A N/A 1 age 11-64 87320 CHYLMD TRACH AG IA No No Yes PC Yes 15 N/A N/A 1 age 11-64 87490 CHYLMD TRACH DNA DIR PROBE No No Yes PC Yes 22.75 N/A N/A 1 age 11-64 87491 CHYLMD TRACH DNA AMP PROBE No No Yes PC Yes 35.09 N/A N/A 1 age 11-64 87492 CHYLMD TRACH DNA QUANT No No Yes PC Yes 47.57 N/A N/A 1 age 11-64 87810 CHYLMD TRACH ASSAY W/OPTIC No No Yes PC Yes 16.32 N/A 4/1/2015 N/A 1 age 11-64 86689 HTLV/HIV CONFIRMJ ANTIBODY No No Yes PC Yes 19.35 N/A N/A 1 age 11-64 86701 HIV-1ANTIBODY No No Yes PC Yes 8.89 N/A N/A 1 age 11-64 86702 HIV-2 ANTIBODY No No Yes PC Yes 13.52 N/A N/A 1 age 11-64 86703 HIV-1/HIV-2 1 RESULT ANTBDY No No Yes PC Yes 13.71 N/A N/A 1 age 11-64 87389 HIV-1 AG W/HIV-1 & HIV-2 AB No No Yes PC Yes 24.08 N/A N/A 1 age 11-64 87390 HIV-1 AG IA No No Yes PC Yes 24.01 N/A N/A 1 age 11-64 87391 HIV-2 AG IA No No Yes PC Yes 21.9 N/A N/A 1 age 11-64 87806 HIV ANTIGEN W/HIV ANTIBODIES No No Yes PC Yes 16.32 N/A 2/29/2016 N/A 1 age 11-64 86592 SYPHILIS TEST NON-TREP QUAL No No Yes PC Yes 4.27 N/A N/A 1 age 11-64 86593 SYPHILIS TEST NON-TREP QUANT No No Yes PC Yes 4.4 N/A N/A 1 age 11-64 86780 TREPONEMA PALLIDUM No No Yes PC Yes 13.24 N/A N/A 1 age 11-64 87590 N.GONORRHOEAE DNA DIR PROB No No Yes PC Yes 26.88 N/A N/A 1 age 11-64 87591 N.GONORRHOEAE DNA AMP PROB No No Yes PC Yes 35.09 N/A N/A 1 age 11-64 87592 N.GONORRHOEAE DNA QUANT No No Yes PC Yes 42.84 N/A N/A 1 age 11-64 87850 N. GONORRHOEAE ASSAY W/OPTIC No No Yes PC Yes 16.32 N/A 4/1/2015 N/A 1 age 11-64 87340 HEPATITIS B SURFACE AG IA No No Yes PC Yes 8.73 N/A N/A 1 age 11-64 87341 HEPATITIS B SURFACE AG IA No No Yes PC Yes 8.73 N/A N/A 1 age 11-64 HEPB SCREEN HIGH RISK INDIV No No Yes PC Yes 28.27 N/A N/A 1 age 11-64 86803 HEPATITIS C AB TEST No No Yes PC Yes 14.27 N/A N/A 1 age 11-64 86804 HEP C AB TEST CONFIRM No No Yes PC Yes 15.49 N/A N/A 1 age 11-64 87520 HEPATITIS C RNA DIR PROBE No No Yes PC Yes 27.29 N/A 4/1/2015 N/A 1 age 11-64 87521 HEPATITIS C PROBE&RVRS TRNSC No No Yes PC Yes 35.09 N/A N/A 1 age 11-64 87522 HEPATITIS C REVRS TRNSCRPJ No No Yes PC Yes 42.84 N/A N/A 1 age 11-64 HEP C SCREEN HIGH RISK/OTHER No No Yes PC Yes 19.44 N/A 3/16/2016 N/A 1 age 11-64 82726 LONG CHAIN FATTY ACIDS No No Yes PC Yes 19.75 N/A N/A 1 birth to 60 days 84443 ASSAY THYROID STIM HORMONE No No Yes PC Yes 16.8 N/A N/A 1 birth to 30 days 84030 ASSAY OF BLOOD PKU No No Yes PC Yes 5.5 N/A N/A 1 birth to 30 days 83864 MUCOPOLYSACCHARIDES No No Yes PC Yes 27.1 N/A N/A 1 birth to 60 days 83020 HEMOGLOBIN ELECTROPHORESIS No No Yes PC Yes 12.87 N/A N/A 1 birth to 30 days 83021 HEMOGLOBIN CHROMOTOGRAPHY No No Yes PC Yes 18.06 N/A N/A 1 birth to 30 days 85660 RBC SICKLE CELL TEST No No Yes PC Yes 5.51 N/A N/A 1 birth to 30 days 85014 HEMATOCRIT No No Yes PC Yes 2.37 N/A N/A 2 4 months to 21yrs 85018 HEMOGLOBIN No No Yes PC Yes 2.37 N/A N/A 2 4 months to 21yrs 83026 HEMOGLOBIN COPPER SULFATE No No Yes PC Yes 3.22 N/A N/A 2 4 months to 21yrs NEWBORN METABOLIC SCREENING No No No N/A N/A 5.5 N/A N/A N/A 1 birth to 60 days 83655 ASSAY OF LEAD No No Yes PC Yes 12.11 N/A N/A 1 6 months to 6yrs 86580 TB INTRADERMAL TEST No No Yes PC No 3.89 N/A 2/1/2015 N/A 1 1 month to 21 yrs 80061 LIPID PANEL No No Yes PC Yes 13.39 N/A N/A 1 9 yrs to 64yrs 92551 HEARING Loss Screening No No Yes FLAT RC No 5.5 N/A 2/1/2015 N/A 1 birth to 21 yrs 99172 OCULAR FUNCTION SCREEN No No Yes PC No 9.98 N/A 7/1/2014 N/A 1 birth to 5 yrs 99173 VISUAL ACUITY SCREEN No No Yes NONE No 9.98 N/A 2/1/2015 N/A 1 birth to 21 yrs 96110 DEVELOPMENTAL SCREEN W/SCORE No No Yes FLAT RC No 9.98 N/A 2/1/2015 N/A 2 birth to 36 months 84152 ASSAY OF PSA COMPLEXED No No Yes PC Yes 18.39 N/A N/A 1 men over 40 84153 ASSAY OF PSA TOTAL No No Yes PC Yes 18.39 N/A N/A 1 men over 40 84154 ASSAY OF PSA FREE No No Yes PC Yes 18.39 N/A N/A 1 men over 40 PROSTATE CA SCREENING; DRE No No No N/A N/A 19.31 N/A N/A N/A 1 men over 40 PSA SCREENING No No Yes PC Yes 19.31 N/A N/A 1 men over 40 88142 CYTOPATH C/V THIN LAYER No No Yes PC Yes 14.6 N/A 1/1/2013 N/A 1 88143 CYTOPATH C/V THIN LAYER REDO No No Yes PC Yes 23.04 N/A N/A 1 88147 CYTOPATH C/V AUTOMATED No No Yes PC Yes 14.49 N/A N/A 1 88148 CYTOPATH C/V AUTO RESCREEN No No Yes PC Yes 14.49 N/A N/A 1 88150 CYTOPATH C/V MANUAL No No Yes PC Yes 14.49 N/A N/A 1 88152 CYTOPATH C/V AUTO REDO No No Yes PC Yes 14.49 N/A N/A 1 88153 CYTOPATH C/V REDO No No Yes PC Yes 14.49 N/A N/A 1 88155 CYTOPATH C/V INDEX ADD-ON No No Yes PC Yes 8.15 N/A N/A 1 88164 CYTOPATH TBS C/V MANUAL No No Yes PC Yes 14.49 N/A N/A 1 88165 CYTOPATH TBS C/V REDO No No Yes PC Yes 14.49 N/A N/A 1 88166 CYTOPATH TBS C/V AUTO REDO No No Yes PC Yes 14.49 N/A N/A 1 88167 CYTOPATH TBS C/V SELECT No No Yes PC Yes 14.49 N/A N/A 1 88174 CYTOPATH C/V AUTO IN FLUID No No Yes PC Yes 25.37 N/A N/A 1 88175 CYTOPATH C/V AUTO FLUID REDO No No Yes PC Yes 14.76 N/A 1/1/2006 N/A 1 SCREEN CERV/VAG THIN LAYER No No Yes PC Yes 14.6 N/A 9/1/2001 N/A 1 SCREEN C/V THIN LAYER BY MD No No Yes NONE No 14.49 N/A 4/1/2015 N/A 1 SCR C/V CYTO,THINLAYER,RESCR No No Yes PC Yes 14.49 N/A 9/1/2001 N/A 1 SCR C/V CYTO,THINLAYER,RESCR No No No N/A N/A 14.49 N/A N/A N/A 1 SCR C/V CYTO,THINLAYER,RESCR No No No N/A N/A 14.49 N/A N/A N/A 1 SCR C/V CYTO, AUTOMATED SYS No No Yes PC Yes 14.49 N/A N/A 1 SCR C/V CYTO, AUTOSYS, RESCR No No Yes PC Yes 14.49 N/A N/A 1 OBTAINING SCREEN PAP SMEAR No No Yes PC No 20.38 N/A 8/1/2015 N/A 1 77080 DXA BONE DENSITY AXIAL No No Yes PC No 26.92 N/A 4/1/2015 N/A 1 at risk women 77081 DXA BONE DENSITY/PERIPHERAL No No Yes PC No 11.56 N/A 4/1/2015 N/A 1 99202 Office o/p new sf 15-29 min No No Yes FLAT RC No 74.06 N/A 2/1/2015 N/A 99203 Office o/p new low 30-44 min No No Yes FLAT RC No 113.85 N/A 2/1/2015 N/A 99204 Office o/p new mod 45-59 min No No Yes FLAT RC No 169.57 N/A 2/1/2015 N/A 99205 Office o/p new hi 60-74 min No No Yes FLAT RC No 224.25 N/A 4/1/2015 N/A 99211 Off/op est may x req phy/qhp No No Yes FLAT RC No 23.53 N/A 2/1/2015 N/A 99212 Office o/p est sf 10-19 min No No Yes FLAT RC No 57.45 N/A 2/1/2015 N/A 99213 Office o/p est low 20-29 min No No Yes FLAT RC No 92.05 N/A 2/1/2015 N/A 99214 Office o/p est mod 30-39 min No No Yes FLAT RC No 129.77 N/A 2/1/2015 N/A 99215 Office o/p est hi 40-54 min No Yes FLAT RC No 183.07 N/A 4/1/2015 N/A