| Code | Description | States | Median rate |
|---|---|---|---|
| 81000 | Urinalysis with microscopy, non-automated | 47 | $3.65 |
| 81001 | Urinalysis with microscopy, automated | 47 | $3.09 |
| 81002 | Urinalysis without microscopy, non-automated | 47 | $3.10 |
| 81003 | Urinalysis without microscopy, automated | 47 | $2.14 |
| 81005 | Urinalysis, qualitative or semi-quantitative, non-automated | 46 | $2.15 |
| 81007 | Urine bacteria screen, not culture or dipstick | 45 | $23.98 |
| 81015 | Urinalysis, microscopic only | 47 | $2.75 |
| 81020 | Urinalysis, 2 or 3 glass test | 42 | $4.23 |
| 81025 | Urine pregnancy test | 47 | $7.75 |
| 81050 | Timed urine volume measurement | 43 | $3.28 |
| 81105 | Platelet antigen HPA-1 genotyping | 36 | $117.00 |
| 81106 | Platelet antigen HPA-2 genotyping | 35 | $116.72 |
| 81107 | Platelet antigen HPA-3 genotyping | 34 | $113.97 |
| 81108 | Platelet antigen HPA-4 genotyping | 34 | $113.97 |
| 81109 | Platelet antigen HPA-5 genotyping | 34 | $113.97 |
| 81110 | Platelet antigen HPA-6 genotyping | 34 | $113.97 |
| 81111 | Platelet antigen HPA-9 genotyping | 34 | $113.97 |
| 81112 | Platelet antigen HPA-15 genotyping | 34 | $113.97 |
| 81120 | IDH1 gene test, common variants (brain tumors, leukemia) | 33 | $170.42 |
| 81121 | IDH2 gene test, common variants (brain tumors, leukemia) | 33 | $260.85 |
| 81161 | DMD gene deletion and duplication test (muscular dystrophy) | 35 | $245.78 |
| 81162 | BRCA1 and BRCA2 gene test, full sequence and deletions | 45 | $1,642.39 |
| 81163 | BRCA1 and BRCA2 gene test, full sequence | 45 | $404.82 |
| 81164 | BRCA1 and BRCA2 gene test, duplications and deletions | 45 | $505.36 |
| 81165 | BRCA1 gene test, full sequence | 45 | $244.69 |
| 81166 | BRCA1 gene test, duplications and deletions | 45 | $260.67 |
| 81167 | BRCA2 gene test, duplications and deletions | 45 | $244.69 |
| 81168 | CCND1/IGH fusion test (mantle cell lymphoma) | 34 | $180.88 |
| 81170 | ABL1 gene test for drug-resistance variants (CML) | 37 | $263.61 |
| 81171 | AFF2 gene repeat test (fragile XE syndrome) | 30 | $120.69 |
| 81172 | AFF2 gene repeat sizing, abnormal alleles | 30 | $242.11 |
| 81173 | AR gene full sequence (androgen insensitivity) | 30 | $260.52 |
| 81174 | AR gene known family variant test | 30 | $160.11 |
| 81175 | ASXL1 gene full sequence (blood cancers) | 31 | $600.97 |
| 81176 | ASXL1 gene targeted sequence, exon 12 (blood cancers) | 31 | $217.71 |
| 81177 | ATN1 gene repeat test (DRPLA) | 31 | $118.44 |
| 81178 | ATXN1 gene repeat test (spinocerebellar ataxia 1) | 32 | $118.51 |
| 81179 | ATXN2 gene repeat test (spinocerebellar ataxia 2) | 32 | $118.51 |
| 81180 | ATXN3 gene repeat test (spinocerebellar ataxia 3) | 32 | $118.51 |
| 81181 | ATXN7 gene repeat test (spinocerebellar ataxia 7) | 32 | $118.51 |
| 81182 | ATXN8OS gene repeat test (spinocerebellar ataxia 8) | 31 | $118.51 |
| 81183 | ATXN10 gene repeat test (spinocerebellar ataxia 10) | 31 | $118.51 |
| 81184 | CACNA1A gene repeat test (spinocerebellar ataxia 6) | 32 | $118.51 |
| 81185 | CACNA1A gene full sequence (ataxia, migraine) | 32 | $731.17 |
| 81186 | CACNA1A gene known family variant test | 31 | $160.11 |
| 81187 | CNBP gene repeat test (myotonic dystrophy type 2) | 30 | $118.44 |
| 81188 | CSTB gene repeat test (Unverricht-Lundborg epilepsy) | 30 | $118.44 |
| 81189 | CSTB gene full sequence | 31 | $237.46 |
| 81190 | CSTB gene known family variant test | 30 | $160.11 |
| 81191 | NTRK1 gene fusion test (solid tumors) | 34 | $182.63 |
| 81192 | NTRK2 gene fusion test (solid tumors) | 33 | $182.82 |
| 81193 | NTRK3 gene fusion test (solid tumors) | 34 | $182.63 |
| 81194 | NTRK gene family fusion test (solid tumors) | 35 | $456.08 |
| 81195 | CTNNB1 gene targeted sequence, exon 3 (solid tumors) | 21 | $1,263.53 |
| 81200 | ASPA gene common variants (Canavan disease) | 34 | $43.00 |
| 81201 | APC gene test (familial polyposis), full sequence | 40 | $690.83 |
| 81202 | APC gene test (familial polyposis), known family variant | 40 | $239.96 |
| 81203 | APC gene test (polyposis), duplications and deletions | 40 | $178.95 |
| 81204 | AR gene repeat sizing (Kennedy disease) | 32 | $117.41 |
| 81205 | BCKDHB gene common variants (maple syrup urine disease) | 30 | $85.49 |
| 81206 | BCR-ABL gene test (CML), major breakpoint | 41 | $147.56 |
| 81207 | BCR-ABL gene test (CML), minor breakpoint | 41 | $130.36 |
| 81208 | BCR/ABL1 fusion test, other breakpoint (leukemia) | 37 | $185.43 |
| 81209 | BLM gene common variant (Bloom syndrome) | 31 | $36.95 |
| 81210 | BRAF gene test, V600 variants | 40 | $147.61 |
| 81212 | BRCA1 and BRCA2 gene test, 3 common variants | 43 | $380.16 |
| 81215 | BRCA1 gene test, known family variant | 43 | $324.22 |
| 81216 | BRCA2 gene full sequence | 37 | $166.61 |
| 81217 | BRCA2 gene test, known family variant | 44 | $324.41 |
| 81218 | CEBPA gene full sequence (acute myeloid leukemia) | 35 | $217.71 |
| 81219 | CALR gene targeted sequence, exon 9 (blood cancers) | 33 | $109.47 |
| 81220 | Cystic fibrosis gene test, common variants | 42 | $498.02 |
| 81221 | CFTR gene known family variant test (cystic fibrosis) | 35 | $86.48 |
| 81222 | CFTR gene deletion and duplication test (cystic fibrosis) | 38 | $379.79 |
| 81223 | Cystic fibrosis gene test, full sequence | 40 | $449.10 |
| 81224 | CFTR gene intron 8 poly-T test (cystic fibrosis) | 32 | $147.31 |
| 81225 | CYP2C19 gene test (drug metabolism) | 32 | $255.30 |
| 81226 | CYP2D6 gene test (drug metabolism) | 34 | $401.08 |
| 81227 | CYP2C9 gene test (drug metabolism) | 28 | $151.04 |
| 81228 | Chromosome microarray, copy number changes (oligo or SNP) | 36 | $777.60 |
| 81229 | Chromosome microarray with SNP analysis | 40 | $1,027.39 |
| 81230 | CYP3A4 gene test (drug metabolism) | 25 | $157.33 |
| 81231 | CYP3A5 gene test (drug metabolism) | 25 | $157.33 |
| 81232 | DPYD gene test (5-FU and capecitabine toxicity risk) | 27 | $151.04 |
| 81233 | BTK gene test for drug-resistance variants (CLL) | 33 | $151.64 |
| 81234 | DMPK gene repeat test (myotonic dystrophy type 1) | 33 | $118.37 |
| 81235 | EGFR gene test (lung cancer), common variants | 44 | $280.48 |
| 81236 | EZH2 gene full sequence (lymphoma, leukemia) | 31 | $244.69 |
| 81237 | EZH2 gene common variants (lymphoma) | 31 | $151.64 |
| 81238 | F9 gene full sequence (hemophilia B) | 32 | $523.77 |
| 81239 | DMPK gene repeat sizing, abnormal alleles | 32 | $237.60 |
| 81240 | Prothrombin gene variant test (clotting risk) | 36 | $57.06 |
| 81241 | Factor V Leiden variant test (clotting risk) | 37 | $65.40 |
| 81242 | FANCC gene common variant (Fanconi anemia) | 33 | $33.32 |
| 81243 | FMR1 gene repeat test (fragile X syndrome) | 38 | $51.34 |
| 81244 | FMR1 gene methylation and repeat sizing (fragile X) | 36 | $40.40 |
| 81245 | FLT3 gene internal duplication test (leukemia) | 34 | $141.03 |
| 81246 | FLT3 gene kinase domain variants (leukemia) | 29 | $73.52 |
| 81247 | G6PD gene common variants (G6PD deficiency) | 31 | $154.16 |
| 81248 | G6PD gene known family variant test | 30 | $332.35 |
| 81249 | G6PD gene full sequence | 30 | $531.41 |
| 81250 | G6PC gene common variants (glycogen storage disease 1a) | 27 | $55.56 |
| 81251 | GBA gene common variants (Gaucher disease) | 31 | $44.66 |
| 81252 | GJB2 gene full sequence (hereditary hearing loss) | 33 | $91.01 |
| 81253 | GJB2 gene known family variant test (hearing loss) | 31 | $55.05 |
| 81254 | GJB6 gene common variants (hereditary hearing loss) | 33 | $31.32 |
| 81255 | HEXA gene common variants (Tay-Sachs disease) | 33 | $48.62 |
| 81256 | HFE gene common variants (hemochromatosis) | 37 | $62.42 |
| 81257 | Alpha-globin gene common deletions (alpha thalassemia) | 34 | $100.98 |
| 81258 | Alpha-globin gene known family variant test | 34 | $330.57 |
| 81259 | Alpha-globin gene full sequence | 33 | $528.57 |
| 81260 | IKBKAP gene common variants (familial dysautonomia) | 30 | $39.31 |
| 81261 | IGH gene rearrangement, amplified method (B-cell clonality) | 32 | $178.19 |
| 81262 | IGH gene rearrangement, direct probe (B-cell clonality) | 31 | $58.00 |
| 81263 | IGH variable region somatic mutation analysis (CLL) | 30 | $265.07 |
| 81264 | IGK gene rearrangement (B-cell clonality) | 31 | $152.99 |
| 81267 | Post-transplant chimerism test, without cell selection | 32 | $186.71 |
| 81268 | Post-transplant chimerism test, with cell selection | 31 | $234.71 |
| 81269 | Alpha-globin gene duplication and deletion test | 33 | $178.31 |
| 81270 | JAK2 V617F variant test (blood cancers) | 37 | $82.49 |
| 81271 | HTT gene repeat test (Huntington disease) | 32 | $120.69 |
| 81272 | KIT gene targeted sequence (GIST, mastocytosis) | 35 | $285.03 |
| 81273 | KIT D816 variant test (mastocytosis) | 31 | $107.88 |
| 81274 | HTT gene repeat sizing, abnormal alleles | 32 | $242.11 |
| 81275 | KRAS gene test, exon 2 variants | 39 | $170.42 |
| 81276 | KRAS gene test, additional variants | 38 | $168.79 |
| 81277 | Cytogenomic microarray for tumor copy number changes | 27 | $1,020.80 |
| 81278 | IGH/BCL2 fusion test (follicular lymphoma) | 34 | $182.43 |
| 81279 | JAK2 gene targeted sequence, exons 12-13 (blood cancers) | 37 | $160.11 |
| 81283 | IFNL3 gene variant test (hepatitis C treatment response) | 24 | $64.41 |
| 81284 | FXN gene repeat test (Friedreich ataxia) | 31 | $118.51 |
| 81285 | FXN gene repeat sizing, abnormal alleles | 31 | $237.73 |
| 81286 | FXN gene full sequence | 32 | $237.60 |
| 81287 | MGMT promoter methylation test (glioblastoma) | 27 | $107.75 |
| 81288 | MLH1 promoter methylation test (Lynch syndrome workup) | 33 | $173.09 |
| 81289 | FXN gene known family variant test | 31 | $160.20 |
| 81290 | MCOLN1 gene common variants (mucolipidosis IV) | 30 | $38.52 |
| 81291 | MTHFR gene common variants (folate metabolism) | 29 | $57.04 |
| 81292 | MLH1 gene test (Lynch syndrome), full sequence | 41 | $583.55 |
| 81293 | MLH1 gene test (Lynch), known family variant | 40 | $283.67 |
| 81294 | MLH1 gene test (Lynch), duplications and deletions | 40 | $180.03 |
| 81295 | MSH2 gene test (Lynch syndrome), full sequence | 40 | $333.20 |
| 81296 | MSH2 gene known family variant test (Lynch syndrome) | 37 | $284.20 |
| 81297 | MSH2 gene test (Lynch), known family variant | 39 | $188.92 |
| 81298 | MSH6 gene test (Lynch syndrome), full sequence | 40 | $560.30 |
| 81299 | MSH6 gene test (Lynch), known family variant | 39 | $261.80 |
| 81300 | MSH6 gene test (Lynch), duplications and deletions | 39 | $207.76 |
| 81301 | Microsatellite instability test (Lynch syndrome) | 39 | $313.70 |
| 81302 | MECP2 gene full sequence (Rett syndrome) | 30 | $467.63 |
| 81303 | MECP2 gene known family variant test | 26 | $105.91 |
| 81304 | MECP2 gene deletion and duplication test (Rett syndrome) | 31 | $130.94 |
| 81305 | MYD88 L265P variant test (lymphoma) | 33 | $150.32 |
| 81306 | NUDT15 gene test (thiopurine drug toxicity risk) | 26 | $249.85 |
| 81307 | PALB2 gene full sequence (breast and pancreatic cancer) | 37 | $567.59 |
| 81308 | PALB2 gene known family variant test | 35 | $260.67 |
| 81309 | PIK3CA gene targeted sequence (breast and other cancers) | 36 | $239.79 |
| 81310 | NPM1 gene exon 12 variant test (leukemia) | 35 | $211.54 |
| 81311 | NRAS gene variant test (colorectal cancer, melanoma) | 36 | $255.56 |
| 81312 | PABPN1 gene repeat test (oculopharyngeal dystrophy) | 29 | $118.51 |
| 81313 | PCA3/KLK3 urine RNA ratio (prostate cancer) | 20 | $229.55 |
| 81314 | PDGFRA gene targeted sequence (GIST) | 34 | $290.59 |
| 81315 | PML/RARalpha fusion test, common breakpoints (APL) | 36 | $186.58 |
| 81316 | PML/RARalpha fusion test, single breakpoint (APL) | 33 | $186.58 |
| 81317 | PMS2 gene test (Lynch syndrome), full sequence | 39 | $608.85 |
| 81318 | PMS2 gene known family variant test (Lynch syndrome) | 38 | $281.35 |
| 81319 | PMS2 gene test (Lynch), duplications and deletions | 39 | $182.08 |
| 81320 | PLCG2 gene test for drug-resistance variants (CLL) | 29 | $254.22 |
| 81321 | PTEN gene full sequence (Cowden syndrome) | 37 | $514.50 |
| 81322 | PTEN gene known family variant test | 34 | $41.10 |
| 81323 | PTEN gene deletion and duplication test | 36 | $249.90 |
| 81324 | PMP22 gene deletion and duplication test (CMT neuropathy) | 32 | $655.98 |
| 81325 | PMP22 gene full sequence (CMT neuropathy) | 29 | $653.00 |
| 81326 | PMP22 gene known family variant test | 33 | $41.94 |
| 81327 | SEPT9 methylation test (colorectal cancer screening) | 21 | $172.80 |
| 81328 | SLCO1B1 gene test (statin muscle toxicity risk) | 24 | $155.75 |
| 81329 | Spinal muscular atrophy (SMN1) carrier test | 42 | $119.54 |
| 81330 | SMPD1 gene common variants (Niemann-Pick disease) | 31 | $47.00 |
| 81331 | SNRPN/UBE3A methylation (Prader-Willi, Angelman) | 35 | $45.96 |
| 81332 | SERPINA1 gene common variants (alpha-1 antitrypsin) | 32 | $40.00 |
| 81333 | TGFBI gene common variants (corneal dystrophy) | 27 | $120.56 |
| 81334 | RUNX1 gene targeted sequence (leukemia) | 29 | $287.65 |
| 81335 | TPMT gene common variants (thiopurine drug toxicity risk) | 30 | $151.38 |
| 81336 | SMN1 gene full sequence (spinal muscular atrophy) | 37 | $256.15 |
| 81337 | SMN1 gene known family variant test | 36 | $158.72 |
| 81338 | MPL gene common variants (blood cancers) | 34 | $131.17 |
| 81339 | MPL gene full sequence, exon 10 (blood cancers) | 36 | $161.59 |
| 81340 | T-cell receptor beta rearrangement, amplified method | 31 | $188.03 |
| 81341 | T-cell receptor beta rearrangement, direct probe | 32 | $44.63 |
| 81342 | T-cell receptor gamma rearrangement (T-cell clonality) | 32 | $181.35 |
| 81343 | PPP2R2B gene repeat test (spinocerebellar ataxia 12) | 30 | $119.54 |
| 81344 | TBP gene repeat test (spinocerebellar ataxia 17) | 30 | $119.54 |
| 81345 | TERT promoter variant test (brain tumors, thyroid cancer) | 30 | $160.20 |
| 81346 | TYMS gene variant test (5-FU response) | 24 | $155.75 |
| 81347 | SF3B1 gene common variants (MDS, CLL) | 29 | $167.16 |
| 81348 | SRSF2 gene common variants (MDS) | 28 | $151.64 |
| 81349 | Cytogenomic microarray, copy number, low-pass sequencing | 23 | $1,055.60 |
| 81350 | UGT1A1 gene common variants (irinotecan toxicity, Gilbert) | 25 | $187.20 |
| 81351 | TP53 gene full sequence (Li-Fraumeni, tumors) | 35 | $560.01 |
| 81352 | TP53 gene targeted sequence, exons 4-9 | 32 | $289.97 |
| 81353 | TP53 gene known family variant test | 35 | $268.73 |
| 81355 | VKORC1 gene variant test (warfarin dosing) | 25 | $78.41 |
| 81357 | ZRSR2 gene full sequence (MDS) | 30 | $168.61 |
| 81360 | CYP1A2 gene test (drug metabolism) | 29 | $167.16 |
| 81361 | Beta-globin gene common variants (sickle cell, thalassemia) | 35 | $155.49 |
| 81362 | Beta-globin gene known family variant test | 35 | $333.78 |
| 81363 | Beta-globin gene duplication and deletion test | 35 | $180.03 |
| 81364 | Beta-globin gene full sequence | 35 | $288.71 |
| 81370 | HLA typing, low resolution, class I and II full set | 33 | $361.91 |
| 81372 | HLA typing, low resolution, class I full set | 34 | $334.17 |
| 81373 | HLA typing, low resolution, class I, one locus | 36 | $114.69 |
| 81374 | HLA typing, low resolution, class I, one antigen | 36 | $69.48 |
| 81375 | HLA typing, low resolution, class II full set | 35 | $198.67 |
| 81376 | HLA typing, low resolution, class II, one locus | 36 | $110.00 |
| 81377 | HLA typing, low resolution, class II, one antigen | 34 | $85.27 |
| 81378 | HLA typing, high resolution, class I and II full set | 35 | $311.01 |
| 81379 | HLA typing, high resolution, class I full set | 36 | $301.84 |
| 81380 | HLA typing, high resolution, class I, one locus | 38 | $161.77 |
| 81381 | HLA typing, high resolution, class I, one allele | 38 | $138.30 |
| 81382 | HLA typing, high resolution, class II, one locus | 38 | $114.71 |
| 81383 | HLA typing, high resolution, class II, one allele | 35 | $104.22 |
| 81400 | Molecular pathology procedure, level 1 | 35 | $57.56 |
| 81401 | Molecular pathology procedure, level 2 | 37 | $122.58 |
| 81402 | Molecular pathology procedure, level 3 | 35 | $135.30 |
| 81403 | Molecular pathology procedure, level 4 | 37 | $166.68 |
| 81404 | Molecular pathology procedure, level 5 | 36 | $247.35 |
| 81405 | Molecular pathology procedure, level 6 | 38 | $273.63 |
| 81406 | Molecular pathology procedure, level 7 | 36 | $254.59 |
| 81407 | Molecular pathology procedure, level 8 | 35 | $793.38 |
| 81408 | Molecular pathology procedure, level 9 | 35 | $1,800.00 |
| 81410 | Aortic aneurysm gene panel, 9 or more genes | 26 | $444.47 |
| 81411 | Aortic aneurysm gene panel, deletion and duplication | 23 | $1,195.84 |
| 81412 | Ashkenazi Jewish carrier screening panel, 9+ genes | 27 | $2,190.83 |
| 81413 | Heart rhythm disorder gene panel, 10 or more genes | 26 | $544.02 |
| 81414 | Heart rhythm disorder gene panel, deletion and duplication | 26 | $544.02 |
| 81415 | Whole exome sequencing | 34 | $4,233.55 |
| 81416 | Whole exome sequencing, comparator (parent or sibling) | 31 | $10,582.50 |
| 81417 | Whole exome re-evaluation of stored data | 28 | $282.20 |
| 81418 | Drug metabolism gene panel, 6 or more genes | 21 | $793.27 |
| 81419 | Epilepsy gene panel, 25 or more genes | 26 | $2,098.42 |
| 81420 | Cell-free fetal DNA screen for chromosome disorders | 45 | $655.82 |
| 81422 | Fetal chromosome microdeletion screen from maternal blood | 22 | $676.27 |
| 81425 | Whole genome sequencing | 28 | $4,432.18 |
| 81426 | Whole genome sequencing, comparator (parent or sibling) | 28 | $2,387.30 |
| 81427 | Whole genome re-evaluation of stored data | 24 | $2,103.89 |
| 81430 | Hearing loss gene panel, 60 or more genes | 23 | $1,433.05 |
| 81431 | Hearing loss gene panel, deletion and duplication | 22 | $608.04 |
| 81432 | Hereditary breast cancer gene panel, 10 or more genes | 26 | $1,143.24 |
| 81434 | Hereditary retinal disorder gene panel, 15 or more genes | 25 | $538.12 |
| 81435 | Hereditary colon cancer gene panel, 10 or more genes | 28 | $1,084.89 |
| 81437 | Hereditary endocrine tumor gene panel, 6 or more genes | 23 | $1,143.24 |
| 81439 | Hereditary cardiomyopathy gene panel, 5 or more genes | 25 | $526.41 |
| 81440 | Mitochondrial nuclear gene panel, 100 or more genes | 18 | $2,765.57 |
| 81441 | Inherited bone marrow failure gene panel, 30+ genes | 32 | $2,159.32 |
| 81442 | Noonan spectrum gene panel, 10 or more genes | 21 | $1,906.70 |
| 81443 | Genetic carrier screening panel, 15 or more genes | 31 | $2,181.51 |
| 81445 | Solid tumor gene panel, 5 to 50 genes, DNA | 31 | $531.83 |
| 81448 | Hereditary peripheral neuropathy gene panel, 5+ genes | 28 | $526.41 |
| 81449 | Solid tumor gene panel, 5 to 50 genes, RNA | 30 | $516.90 |
| 81450 | Blood cancer gene panel, 5 to 50 genes, DNA | 30 | $672.70 |
| 81451 | Blood cancer gene panel, 5 to 50 genes, RNA | 32 | $656.99 |
| 81455 | Tumor gene panel, 51 or more genes, DNA | 30 | $2,469.98 |
| 81456 | Tumor gene panel, 51 or more genes, RNA | 32 | $2,522.53 |
| 81457 | Solid tumor panel, DNA, with microsatellite instability | 25 | $774.89 |
| 81458 | Solid tumor panel, DNA, with copy number and MSI | 24 | $885.22 |
| 81459 | Solid tumor panel, DNA or DNA+RNA, copy number, MSI, TMB | 27 | $2,391.88 |
| 81460 | Mitochondrial genome full sequence | 21 | $1,134.97 |
| 81462 | Solid tumor liquid biopsy, copy number and rearrangements | 23 | $1,052.33 |
| 81463 | Solid tumor liquid biopsy, with copy number and MSI | 24 | $1,095.09 |
| 81464 | Solid tumor liquid biopsy, copy number, MSI, TMB, fusions | 21 | $2,630.81 |
| 81465 | Mitochondrial genome deletion test | 20 | $833.92 |
| 81470 | X-linked intellectual disability gene panel, 60+ genes | 19 | $731.20 |
| 81490 | Rheumatoid arthritis disease-activity blood score | 15 | $741.35 |
| 81493 | Coronary artery disease gene-expression blood score | 16 | $916.59 |
| 81500 | Ovarian cancer risk score, 2 proteins (ROMA) | 20 | $232.09 |
| 81503 | Ovarian cancer risk score, 5 proteins (OVA1) | 21 | $791.04 |
| 81504 | Tissue-of-origin gene expression test, unknown primary | 17 | $458.58 |
| 81506 | Diabetes risk score, 7 blood markers | 15 | $62.03 |
| 81507 | Cell-free DNA screen for trisomy 21, 18 and 13 (Harmony) | 40 | $687.68 |
| 81508 | Fetal aneuploidy screen, 2 maternal proteins | 24 | $46.92 |
| 81509 | Fetal aneuploidy screen, 3 maternal proteins | 20 | $1,298.38 |
| 81510 | Fetal aneuploidy screen, 3 proteins, second trimester | 22 | $49.99 |
| 81511 | Fetal aneuploidy screen, 4 proteins, second trimester | 27 | $135.37 |
| 81512 | Fetal aneuploidy screen, 5 proteins, second trimester | 21 | $62.57 |
| 81513 | Bacterial vaginosis molecular score | 36 | $123.37 |
| 81514 | Vaginitis molecular panel (BV, yeast, trichomonas) | 32 | $227.49 |
| 81519 | Breast cancer 21-gene recurrence score test | 46 | $3,319.16 |
| 81520 | Breast cancer recurrence score, 58 genes (Prosigna) | 34 | $2,259.19 |
| 81521 | Breast cancer recurrence score, 70 genes (MammaPrint) | 31 | $3,444.98 |
| 81522 | Breast cancer recurrence score, 12 genes (EndoPredict) | 36 | $3,415.50 |
| 81525 | Colon cancer recurrence score, 12 genes | 15 | $2,747.92 |
| 81528 | Stool DNA colorectal cancer screening test (Cologuard) | 42 | $432.54 |
| 81529 | Melanoma metastasis risk score, 31 genes | 24 | $6,282.64 |
| 81535 | Chemotherapy response assay, live tumor cells, first drug | 20 | $496.60 |
| 81536 | Chemotherapy response assay, each added drug | 20 | $152.17 |
| 81538 | Lung cancer treatment response blood score, 8 proteins | 18 | $2,531.86 |
| 81539 | Prostate cancer risk score, 4 kallikreins (4Kscore) | 23 | $680.01 |
| 81540 | Tissue-of-origin gene expression test, 92 genes | 15 | $3,240.00 |
| 81541 | Prostate cancer mortality risk score, 46 genes | 29 | $3,415.50 |
| 81542 | Prostate cancer metastasis risk score, 22 genes | 28 | $3,444.98 |
| 81546 | Thyroid nodule gene expression classifier | 33 | $3,060.00 |
| 81551 | Prostate cancer methylation test on negative biopsy | 16 | $1,827.00 |
| 81552 | Uveal melanoma metastasis risk score, 15 genes | 24 | $6,916.65 |
| 81554 | Lung fibrosis gene classifier from bronchoscopy sample | 23 | $4,757.50 |
| 81595 | Heart transplant rejection blood gene score (AlloMap) | 28 | $2,881.94 |
| 81596 | Liver fibrosis blood score, hepatitis C (FibroSure) | 31 | $63.05 |
Published Medicaid fee-for-service schedule amounts, not a coverage or eligibility guarantee. Managed-care plan rates can differ. Where no prior-authorization flag is shown, the state does not publish one. Descriptions are ProviderSignal's own plain-language labels or public-domain CMS text.