| Code | Description | States | Median rate |
|---|---|---|---|
| 84030 | Phenylalanine (PKU) blood test | 45 | $5.48 |
| 84035 | Phenylketones test, qualitative | 46 | $3.58 |
| 84060 | Acid phosphatase test, total | 46 | $7.47 |
| 84066 | Prostatic acid phosphatase test | 46 | $9.64 |
| 84075 | Alkaline phosphatase test | 46 | $5.07 |
| 84078 | Alkaline phosphatase, heat stable | 45 | $7.35 |
| 84080 | Alkaline phosphatase isoenzymes | 45 | $14.41 |
| 84081 | Phosphatidylglycerol test (fetal lung) | 46 | $16.15 |
| 84085 | 6-phosphogluconate dehydrogenase test, red cells | 44 | $8.32 |
| 84087 | Phosphohexose isomerase enzyme test | 46 | $10.49 |
| 84100 | Phosphorus level | 46 | $4.69 |
| 84105 | Phosphorus urine test | 46 | $5.47 |
| 84106 | Porphobilinogen urine test, qualitative | 46 | $5.24 |
| 84110 | Porphobilinogen urine test, quantitative | 46 | $7.60 |
| 84112 | Amniotic fluid leak test (PAMG-1), vaginal swab | 38 | $87.27 |
| 84119 | Porphyrins urine test, qualitative | 46 | $11.45 |
| 84120 | Porphyrins urine test, fractionated | 46 | $13.65 |
| 84126 | Porphyrins stool test, quantitative | 45 | $33.24 |
| 84132 | Potassium level | 46 | $4.48 |
| 84133 | Potassium urine test | 46 | $4.34 |
| 84134 | Prealbumin test | 46 | $13.13 |
| 84135 | Pregnanediol hormone test | 45 | $19.05 |
| 84138 | Pregnanetriol hormone test | 46 | $19.16 |
| 84140 | Pregnenolone hormone test | 46 | $20.21 |
| 84143 | 17-hydroxypregnenolone hormone test | 46 | $21.96 |
| 84144 | Progesterone level | 46 | $20.13 |
| 84145 | Procalcitonin test | 43 | $24.50 |
| 84146 | Prolactin level | 46 | $19.14 |
| 84150 | Prostaglandin test, each | 45 | $35.50 |
| 84152 | PSA test, complexed | 46 | $18.39 |
| 84153 | Prostate-specific antigen (PSA), total | 46 | $18.02 |
| 84154 | PSA test, free | 46 | $18.02 |
| 84155 | Total protein, blood | 46 | $3.59 |
| 84156 | Total protein, urine | 46 | $3.64 |
| 84157 | Total protein, other body fluid | 46 | $3.72 |
| 84160 | Total protein by refractometry | 46 | $5.05 |
| 84163 | PAPP-A pregnancy protein test | 46 | $13.55 |
| 84165 | Protein electrophoresis, blood | 47 | $10.74 |
| 84166 | Protein electrophoresis, urine or spinal fluid | 46 | $17.83 |
| 84181 | Protein Western blot, blood, with interpretation | 46 | $16.18 |
| 84182 | Protein Western blot test | 47 | $24.79 |
| 84202 | Red cell protoporphyrin, quantitative | 46 | $14.03 |
| 84203 | Red cell protoporphyrin screen | 45 | $8.80 |
| 84206 | Proinsulin test | 45 | $23.03 |
| 84207 | Vitamin B6 level | 45 | $26.36 |
| 84210 | Pyruvate blood test | 46 | $12.69 |
| 84220 | Pyruvate kinase enzyme test | 46 | $8.50 |
| 84228 | Quinine level test | 45 | $11.34 |
| 84233 | Estrogen receptor test | 46 | $77.70 |
| 84234 | Progesterone receptor test | 46 | $63.42 |
| 84244 | Renin blood test | 46 | $21.50 |
| 84252 | Vitamin B2 (riboflavin) level | 46 | $18.22 |
| 84255 | Selenium level test | 45 | $22.98 |
| 84260 | Serotonin level test | 46 | $29.05 |
| 84270 | Sex hormone binding globulin test | 45 | $21.19 |
| 84275 | Sialic acid test | 45 | $13.10 |
| 84285 | Silica level test | 46 | $22.69 |
| 84295 | Sodium level | 46 | $4.64 |
| 84300 | Sodium urine test | 46 | $4.60 |
| 84302 | Sodium test, other body fluid | 46 | $4.70 |
| 84305 | IGF-1 (somatomedin) blood test | 46 | $19.34 |
| 84307 | Somatostatin level test | 46 | $17.22 |
| 84311 | Spectrophotometry test, other analyte | 43 | $7.29 |
| 84315 | Specific gravity, non-urine fluid | 44 | $2.95 |
| 84375 | Sugar chromatography test | 45 | $31.20 |
| 84376 | Sugar test, single, qualitative | 45 | $5.50 |
| 84377 | Sugar test, multiple, qualitative | 45 | $5.39 |
| 84378 | Sugar test, single, quantitative | 45 | $11.30 |
| 84379 | Sugar test, multiple, quantitative | 45 | $11.24 |
| 84392 | Sulfate urine test | 45 | $4.94 |
| 84402 | Testosterone test, free | 46 | $25.15 |
| 84403 | Testosterone, total | 46 | $25.50 |
| 84410 | Testosterone test, bioavailable | 38 | $50.52 |
| 84425 | Vitamin B1 (thiamine) level | 46 | $19.69 |
| 84430 | Thiocyanate level test | 46 | $10.34 |
| 84431 | Thromboxane metabolite urine test | 38 | $29.07 |
| 84432 | Thyroglobulin blood test | 46 | $15.50 |
| 84436 | Thyroxine (T4), total | 46 | $6.72 |
| 84437 | Thyroxine (T4) test, newborn filter paper | 45 | $6.18 |
| 84439 | Thyroxine (T4), free | 46 | $8.71 |
| 84442 | Thyroxine-binding globulin test | 46 | $13.71 |
| 84443 | Thyroid stimulating hormone (TSH) | 46 | $16.22 |
| 84445 | Thyroid stimulating immunoglobulin test | 46 | $45.51 |
| 84446 | Vitamin E level | 46 | $13.15 |
| 84449 | Cortisol binding globulin test | 44 | $17.95 |
| 84450 | AST liver enzyme | 46 | $5.07 |
| 84460 | ALT liver enzyme | 46 | $5.18 |
| 84466 | Transferrin test | 46 | $12.47 |
| 84478 | Triglycerides | 46 | $5.62 |
| 84479 | Thyroid hormone uptake test | 46 | $6.33 |
| 84480 | Triiodothyronine (T3), total | 46 | $13.69 |
| 84481 | T3 test, free | 46 | $15.67 |
| 84482 | Reverse T3 test | 45 | $14.18 |
| 84484 | Troponin, quantitative | 46 | $11.22 |
| 84485 | Trypsin test, duodenal fluid | 45 | $7.18 |
| 84488 | Trypsin test, stool, qualitative | 46 | $7.08 |
| 84490 | Trypsin test, stool, quantitative, 24-hour | 46 | $8.89 |
| 84510 | Tyrosine level test | 46 | $9.57 |
| 84512 | Troponin test, qualitative | 44 | $9.08 |
| 84520 | BUN (blood urea nitrogen) | 46 | $3.86 |
| 84525 | Urea nitrogen dipstick test | 44 | $4.44 |
| 84540 | Urea nitrogen urine test | 45 | $5.00 |
| 84545 | Urea clearance test | 46 | $6.66 |
| 84550 | Uric acid, blood | 46 | $4.42 |
| 84560 | Uric acid test, other body fluid | 46 | $4.80 |
| 84577 | Urobilinogen stool test, quantitative | 46 | $15.03 |
| 84578 | Urobilinogen urine test, qualitative | 46 | $3.87 |
| 84580 | Urobilinogen urine test, quantitative, timed | 46 | $8.46 |
| 84583 | Urobilinogen urine test, semi-quantitative | 46 | $5.45 |
| 84585 | VMA urine test | 46 | $15.15 |
| 84586 | VIP hormone test | 43 | $31.43 |
| 84588 | Antidiuretic hormone (vasopressin) test | 46 | $32.76 |
| 84590 | Vitamin A level | 46 | $11.35 |
| 84591 | Vitamin level test, other | 41 | $14.75 |
| 84597 | Vitamin K level | 44 | $13.42 |
| 84600 | Volatile chemicals test | 45 | $15.99 |
| 84620 | Xylose absorption test | 46 | $11.71 |
| 84630 | Zinc level test | 46 | $11.14 |
| 84681 | C-peptide test | 46 | $19.16 |
| 84702 | Pregnancy hormone (hCG), quantitative | 46 | $13.47 |
| 84703 | Pregnancy hormone (hCG), qualitative | 46 | $7.49 |
| 84704 | hCG free beta test | 45 | $13.76 |
| 84830 | Ovulation test, urine LH color kit | 35 | $11.43 |
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.