ABCDEFGHIJKLMNOPQRSTUVWXYZAAABACADAEAFAGAHAIAJAKALAMANAOAPAQARASATAUAVAWAXAYAZBABBBCBDBEBFBGBHBI
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Clinical Diagnostic Laboratory Fee Schedule- 2022 Gapfill Preliminary Determinations to be implemented in CY 2023
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CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).
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As outlined in Sec 1834A(c)(4); Explanation of payment rates.--In the case of a clinical diagnostic laboratory test for which payment is made under this subsection, the Secretary shall make available to the public an explanation of the payment rate for the test.
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Comments may be submitted to clfs_inquiries@cms.hhs.gov by by July 11, 2022
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HCPCS Descriptor National Limit CA1 CA2 HI NV AK ID OR WA AZ MT ND SD UT WY CO NM OK TX IA KS KS MO2 MO1 NE IL MN WI AR LA MS IN MI FL PR AL GA TN SC VA WV NC DE DC MD NJ PA CT NY2 NY1 NY3 ME MA NH RI VT KY OH
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11121182121213122102220223022402310232023302340235023602411242124312441251025202520253025302540261026202630271027202730281028202910292021010210202103021120211302114021150212102122021230212402125021310213202132821329214112142121431214412145121510215202
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LOC 00 LOC 00 LOC 00 LOC 00 LOC 00 LOC 00 LOC 00 LOC 00 LOC 00 LOC 00 LOC 01 LOC 02 LOC 00 LOC 00 LOC 00 LOC 00 LOC 00 LOC 00 LOC 00 LOC 12 LOC 15 LOC 07 LOC 15 LOC 00 LOC 00 LOC 00 LOC 00 LOC 00 LOC 00 LOC 00 LOC 00 LOC 00 LOC 00 LOC 20 LOC 00 LOC 00 LOC 00 LOC 00 LOC 00 LOC 00 LOC 00 LOC 00 LOC 00 LOC 00 LOC 00 LOC 00 LOC 00 LOC 00 LOC 00 LOC 00 LOC 00 LOC 00 LOC 00 LOC 00 LOC 00 LOC 00 LOC 00
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81349Cytog alys chrml abnr lw-ps$1,197.94 $1,197.94 $1,197.94 $1,197.94 $1,197.94 $1,197.94 $1,197.94 $1,197.94 $1,197.94 $1,197.94 $1,197.94 $1,197.94 $1,197.94 $1,197.94 $1,197.94 $1,160.00$1,160.00$1,160.00$1,160.00$1,197.94 $1,197.94 $1,197.94 $1,197.94 $1,197.94 $1,197.94 $1,197.94 $1,197.94 $1,197.94 $1,160.00$1,160.00$1,160.00$1,197.94 $1,197.94 $1,160.00$1,160.00$1,197.94 $1,197.94 $1,197.94 $1,197.94 $1,197.94 $1,197.94 $1,197.94 $1,160.00$1,160.00$1,160.00$1,160.00$1,160.00$1,197.94 $1,197.94 $1,197.94 $1,197.94 $1,197.94 $1,197.94 $1,197.94 $1,197.94 $1,197.94 $1,197.94 $1,197.94
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81560Trnsplj pd lvr&bwl cd154+cll$263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $519.72$519.72$519.72$519.72$263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $519.72$519.72$519.72$263.21 $263.21 $519.72$519.72$263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $519.72$519.72$519.72$519.72$519.72$263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $263.21
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86408Neutrlzg antb sarscov2 scr$42.13 $42.13 $42.13 $42.13 $42.13 $42.13 $42.13 $42.13 $42.13 $42.13 $42.13 $42.13 $42.13 $42.13 $42.13 $42.13$42.13$42.13$42.13$42.13 $42.13 $42.13 $42.13 $42.13 $42.13 $42.13 $42.13 $42.13 $42.13$42.13$42.13$42.13 $42.13 $42.13$42.13$42.13 $42.13 $42.13 $42.13 $42.13 $42.13 $42.13 $42.13$42.13$42.13$42.13$42.13$42.13 $42.13 $42.13 $42.13 $42.13 $42.13 $42.13 $42.13 $42.13 $42.13 $42.13
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86409Neutrlzg antb sarscov2 titer$84.26 $84.26 $84.26 $84.26 $84.26 $84.26 $84.26 $84.26 $84.26 $84.26 $84.26 $84.26 $84.26 $84.26 $84.26 $105.33$105.33$105.33$105.33$84.26 $84.26 $84.26 $84.26 $84.26 $84.26 $84.26 $84.26 $84.26 $105.33$105.33$105.33$84.26 $84.26 $105.33$105.33$84.26 $84.26 $84.26 $84.26 $84.26 $84.26 $84.26 $105.33$105.33$105.33$105.33$105.33$84.26 $84.26 $84.26 $84.26 $84.26 $84.26 $84.26 $84.26 $84.26 $84.26 $84.26
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86413
Sars-cov-2 antb quantitative
$51.43 $51.43 $51.43 $51.43 $51.43 $51.43 $51.43 $51.43 $51.43 $51.43 $51.43 $51.43 $51.43 $51.43 $51.43 $42.13$42.13$42.13$42.13$51.43 $51.43 $51.43 $51.43 $51.43 $51.43 $51.43 $51.43 $51.43 $42.13$42.13$42.13$51.43 $51.43 $42.13$42.13$51.43 $51.43 $51.43 $51.43 $51.43 $51.43 $51.43 $42.13$42.13$42.13$42.13$42.13$51.43 $51.43 $51.43 $51.43 $51.43 $51.43 $51.43 $51.43 $51.43 $51.43 $51.43
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87426Sarscov coronavirus ag ia$35.33 $35.33 $35.33 $35.33 $35.33 $35.33 $35.33 $35.33 $35.33 $35.33 $35.33 $35.33 $35.33 $35.33 $35.33 $42.03$42.03$42.03$42.03$35.33 $35.33 $35.33 $35.33 $35.33 $35.33 $35.33 $35.33 $35.33 $42.03$42.03$42.03$35.33 $35.33 $42.03$42.03$35.33 $35.33 $35.33 $35.33 $35.33 $35.33 $35.33 $42.03$42.03$42.03$42.03$42.03$35.33 $35.33 $35.33 $35.33 $35.33 $35.33 $35.33 $35.33 $35.33 $35.33 $35.33
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87811Sars-cov-2 covid19 w/optic$41.38 $41.38 $41.38 $41.38 $41.38 $41.38 $41.38 $41.38 $41.38 $41.38 $41.38 $41.38 $41.38 $41.38 $41.38 $41.38$41.38$41.38$41.38$41.38 $41.38 $41.38 $41.38 $41.38 $41.38 $41.38 $41.38 $41.38 $41.38$41.38$41.38$41.38 $41.38 $41.38$41.38$41.38 $41.38 $41.38 $41.38 $41.38 $41.38 $41.38 $41.38$41.38$41.38$41.38$41.38$41.38 $41.38 $41.38 $41.38 $41.38 $41.38 $41.38 $41.38 $41.38 $41.38 $41.38
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0018MTrnsplj rnl meas cd154+cll$263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $519.72$519.72$519.72$519.72$263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $519.72$519.72$519.72$263.21 $263.21 $519.72$519.72$263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $519.72$519.72$519.72$519.72$519.72$263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $263.21 $263.21
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0224UAntibody sars-cov-2 titer(s)$51.43 $51.43$51.43$51.43$51.43$51.43$51.43$51.43$51.43$51.43$51.43$51.43$51.43$51.43$51.43$42.13$42.13$42.13$42.13$51.43$51.43$51.43$51.43$51.43$51.43$51.43$51.43$51.43$42.13$42.13$42.13$51.43$51.43$42.13$42.13$51.43 $51.43 $51.43 $51.43 $51.43 $51.43 $51.43 $42.13$42.13$42.13$42.13$42.13$51.43$51.43$51.43$51.43$51.43$51.43$51.43$51.43$51.43$51.43$51.43
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0226U
Svnt sarscov2 elisa plsm srm
$42.28 $42.28 $42.28 $42.28 $42.28 $42.28 $42.28 $42.28 $42.28 $42.28 $42.28 $42.28 $42.28 $42.28 $42.28 $42.28$42.28$42.28$42.28$42.28 $42.28 $42.28 $42.28 $42.28 $42.28 $42.28 $42.28 $42.28 $42.28$42.28$42.28$42.28 $42.28 $42.28$42.28$42.28 $42.28 $42.28 $42.28 $42.28 $42.28 $42.28 $42.28$42.28$42.28$42.28$42.28$42.28 $42.28 $42.28 $42.28 $42.28 $42.28 $42.28 $42.28 $42.28 $42.28 $42.28
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0228UOnc prst8 ma molec prfl alg$173.03 $173.03 $173.03 $173.03 $173.03 $173.03 $173.03 $173.03 $173.03 $173.03 $173.03 $173.03 $173.03 $173.03 $173.03 $26.22$26.22$26.22$26.22$173.03 $173.03 $173.03 $173.03 $173.03 $173.03 $173.03 $173.03 $173.03 $26.22$26.22$26.22$173.03 $173.03 $26.22$26.22$173.03 $173.03 $173.03 $173.03 $173.03 $173.03 $173.03 $26.22$26.22$26.22$26.22$26.22$173.03 $173.03 $173.03 $173.03 $173.03 $173.03 $173.03 $173.03 $173.03 $173.03 $173.03
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0245U
Onc thyr mut alys 10 gen&37
$1,195.82 $1,195.82 $1,195.82 $1,195.82 $1,195.82 $1,195.82 $1,195.82 $1,195.82 $1,195.82 $1,195.82 $1,195.82 $1,195.82 $1,195.82 $1,195.82 $1,195.82 $806.59$806.59$806.59$806.59$1,195.82 $1,195.82 $1,195.82 $1,195.82 $1,195.82 $1,195.82 $1,195.82 $1,195.82 $1,195.82 $806.59$806.59$806.59$1,195.82 $1,195.82 $806.59$806.59$1,195.82 $1,195.82 $1,195.82 $1,195.82 $1,195.82 $1,195.82 $1,195.82 $806.59$806.59$806.59$806.59$806.59$1,195.82 $1,195.82 $1,195.82 $1,195.82 $1,195.82 $1,195.82 $1,195.82 $1,195.82 $1,195.82 $1,195.82 $1,195.82
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0248UOnc brn sphrd cll 12 rx pnl$2,698.45 $2,698.45 $2,698.45 $2,698.45 $2,698.45 $2,698.45 $2,698.45 $2,698.45 $2,698.45 $2,698.45 $2,698.45 $2,698.45 $2,698.45 $2,698.45 $2,698.45 $2,532.62$2,532.62$2,532.62$2,532.62$2,698.45 $2,698.45 $2,698.45 $2,698.45 $2,698.45 $2,698.45 $2,698.45 $2,698.45 $2,698.45 $2,532.62$2,532.62$2,532.62$2,698.45 $2,698.45 $2,532.62$2,532.62$2,698.45 $2,698.45 $2,698.45 $2,698.45 $2,698.45 $2,698.45 $2,698.45 $2,532.62$2,532.62$2,532.62$2,532.62$2,532.62$2,698.45 $2,698.45 $2,698.45 $2,698.45 $2,698.45 $2,698.45 $2,698.45 $2,698.45 $2,698.45 $2,698.45 $2,698.45
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0249UOnc brst alys 32 phsprtn alg$2,219.13 $2,219.13 $2,219.13 $2,219.13 $2,219.13 $2,219.13 $2,219.13 $2,219.13 $2,219.13 $2,219.13 $2,219.13 $2,219.13 $2,219.13 $2,219.13 $2,219.13 $2,510.21$2,510.21$2,510.21$2,510.21$2,219.13 $2,219.13 $2,219.13 $2,219.13 $2,219.13 $2,219.13 $2,219.13 $2,219.13 $2,219.13 $2,510.21$2,510.21$2,510.21$2,219.13 $2,219.13 $2,510.21$2,510.21$2,219.13 $2,219.13 $2,219.13 $2,219.13 $2,219.13 $2,219.13 $2,219.13 $2,510.21$2,510.21$2,510.21$2,510.21$2,510.21$2,219.13 $2,219.13 $2,219.13 $2,219.13 $2,219.13 $2,219.13 $2,219.13 $2,219.13 $2,219.13 $2,219.13 $2,219.13
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0252UFtl aneuploidy str alys dna$759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $900.00$900.00$900.00$900.00$759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $900.00$900.00$900.00$759.05 $759.05 $900.00$900.00$759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $900.00$900.00$900.00$900.00$900.00$759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $759.05
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0253U
Rprdtve med rna gen prfl 238
$3,159.42 $3,159.42 $3,159.42 $3,159.42 $3,159.42 $3,159.42 $3,159.42 $3,159.42 $3,159.42 $3,159.42 $3,159.42 $3,159.42 $3,159.42 $3,159.42 $3,159.42 $1,167.84$1,167.84$1,167.84$1,167.84$3,159.42 $3,159.42 $3,159.42 $3,159.42 $3,159.42 $3,159.42 $3,159.42 $3,159.42 $3,159.42 $1,167.84$1,167.84$1,167.84$3,159.42 $3,159.42 $1,167.84$1,167.84$3,159.42 $3,159.42 $3,159.42 $3,159.42 $3,159.42 $3,159.42 $3,159.42 $1,167.84$1,167.84$1,167.84$1,167.84$1,167.84$3,159.42 $3,159.42 $3,159.42 $3,159.42 $3,159.42 $3,159.42 $3,159.42 $3,159.42 $3,159.42 $3,159.42 $3,159.42
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0254U
Reprdtve med alys 24 chrmsm
$759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $759.05$759.05$759.05$759.05$759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $759.05$759.05$759.05$759.05 $759.05 $759.05$759.05$759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $759.05$759.05$759.05$759.05$759.05$759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $759.05 $759.05
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0255UAndrology infertility assmt$31.60 $31.60 $31.60 $31.60 $31.60 $31.60 $31.60 $31.60 $31.60 $31.60 $31.60 $31.60 $31.60 $31.60 $31.60 $5.57$5.57$5.57$5.57$31.60 $31.60 $31.60 $31.60 $31.60 $31.60 $31.60 $31.60 $31.60 $5.57$5.57$5.57$31.60 $31.60 $5.57$5.57$31.60 $31.60 $31.60 $31.60 $31.60 $31.60 $31.60 $5.57$5.57$5.57$5.57$5.57$31.60 $31.60 $31.60 $31.60 $31.60 $31.60 $31.60 $31.60 $31.60 $31.60 $31.60
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0256U
Tma/tmao prfl ms/ms ur alg
$159.95 $159.95 $159.95 $159.95 $159.95 $159.95 $159.95 $159.95 $159.95 $159.95 $159.95 $159.95 $159.95 $159.95 $159.95 $62.14$62.14$62.14$62.14$159.95 $159.95 $159.95 $159.95 $159.95 $159.95 $159.95 $159.95 $159.95 $62.14$62.14$62.14$159.95 $159.95 $62.14$62.14$159.95 $159.95 $159.95 $159.95 $159.95 $159.95 $159.95 $62.14$62.14$62.14$62.14$62.14$159.95 $159.95 $159.95 $159.95 $159.95 $159.95 $159.95 $159.95 $159.95 $159.95 $159.95
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0257UVlcad leuk nzm actv whl bld$712.47 $712.47$712.47$712.47$712.47$712.47$712.47$712.47$712.47$712.47$712.47$712.47$712.47$712.47$712.47$22.17$22.17$22.17$22.17$712.47$712.47$712.47$712.47$712.47$712.47$712.47$712.47$712.47$22.17$22.17$22.17$712.47$712.47$22.17$22.17$712.47 $712.47 $712.47 $712.47 $712.47 $712.47 $712.47 $22.17$22.17$22.17$22.17$22.17$712.47$712.47$712.47$712.47$712.47$712.47$712.47$712.47$712.47$712.47$712.47
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0260U
Rare ds id opt genome mapg
$1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,424.34$1,424.34$1,424.34$1,424.34$1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,424.34$1,424.34$1,424.34$1,263.53 $1,263.53 $1,424.34$1,424.34$1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,424.34$1,424.34$1,424.34$1,424.34$1,424.34$1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53
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0262UOnc sld tum rtpcr 7 gen$3,200.00 $3,200.00 $3,200.00 $3,200.00 $3,200.00 $3,200.00 $3,200.00 $3,200.00 $3,200.00 $3,200.00 $3,200.00 $3,200.00 $3,200.00 $3,200.00 $3,200.00 $1,167.84$1,167.84$1,167.84$1,167.84$3,200.00 $3,200.00 $3,200.00 $3,200.00 $3,200.00 $3,200.00 $3,200.00 $3,200.00 $3,200.00 $1,167.84$1,167.84$1,167.84$3,200.00 $3,200.00 $1,167.84$1,167.84$3,200.00 $3,200.00 $3,200.00 $3,200.00 $3,200.00 $3,200.00 $3,200.00 $1,167.84$1,167.84$1,167.84$1,167.84$1,167.84$3,200.00 $3,200.00 $3,200.00 $3,200.00 $3,200.00 $3,200.00 $3,200.00 $3,200.00 $3,200.00 $3,200.00 $3,200.00
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0264U
Rare ds id opt genome mapg
$1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,424.34$1,424.34$1,424.34$1,424.34$1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,424.34$1,424.34$1,424.34$1,263.53 $1,263.53 $1,424.34$1,424.34$1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,424.34$1,424.34$1,424.34$1,424.34$1,424.34$1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53 $1,263.53
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0265U
Rar do whl gn&mtcdrl dna als
$5,475.80 $5,475.80 $5,475.80 $5,475.80 $5,475.80 $5,475.80 $5,475.80 $5,475.80 $5,475.80 $5,475.80 $5,475.80 $5,475.80 $5,475.80 $5,475.80 $5,475.80 $5,475.20$5,475.20$5,475.20$5,475.20$5,475.80 $5,475.80 $5,475.80 $5,475.80 $5,475.80 $5,475.80 $5,475.80 $5,475.80 $5,475.80 $5,475.20$5,475.20$5,475.20$5,475.80 $5,475.80 $5,475.20$5,475.20$5,475.80 $5,475.80 $5,475.80 $5,475.80 $5,475.80 $5,475.80 $5,475.80 $5,475.20$5,475.20$5,475.20$5,475.20$5,475.20$5,475.80 $5,475.80 $5,475.80 $5,475.80 $5,475.80 $5,475.80 $5,475.80 $5,475.80 $5,475.80 $5,475.80 $5,475.80
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0266UUnxpl cnst hrtbl do gn xprsn$3,200.00 $3,200.00$3,200.00$3,200.00$3,200.00$3,200.00$3,200.00$3,200.00$3,200.00$3,200.00$3,200.00$3,200.00$3,200.00$3,200.00$3,200.00$2,919.60$2,919.60$2,919.60$2,919.60$3,200.00$3,200.00$3,200.00$3,200.00$3,200.00$3,200.00$3,200.00$3,201.00$3,202.00$2,919.60$2,919.60$2,919.60$3,200.00$3,200.00$2,919.60$2,919.60$3,200.00 $3,200.00 $3,200.00 $3,200.00 $3,200.00 $3,200.00 $3,200.00 $2,919.60$2,919.60$2,919.60$2,919.60$2,919.60$3,200.00$3,201.00$3,202.00$3,203.00$3,204.00$3,205.00$3,206.00$3,207.00$3,208.00$3,200.00$3,200.00
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0267U
Rare do id opt gen mapg&seq
$6,739.33 $6,739.33$6,739.33$6,739.33$6,739.33$6,739.33$6,739.33$6,739.33$6,739.33$6,739.33$6,739.33$6,739.33$6,739.33$6,739.33$6,739.33$6,455.54$6,455.54$6,455.54$6,455.54$6,739.33$6,739.33$6,739.33$6,739.33$6,739.33$6,739.33$6,739.33$6,739.33$6,739.33$6,455.54$6,455.54$6,455.54$6,739.33$6,739.33$6,455.54$6,455.54$6,739.33 $6,739.33 $6,739.33 $6,739.33 $6,739.33 $6,739.33 $6,739.33 $6,455.54$6,455.54$6,455.54$6,455.54$6,455.54$6,739.33$6,739.33$6,739.33$6,739.33$6,739.33$6,739.33$6,739.33$6,739.33$6,739.33$6,739.33$6,739.33
35
0268U
Hem ahus gen seq alys 15 gen
$608.17 $608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$1,020.28$1,020.28$1,020.28$1,020.28$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$1,020.28$1,020.28$1,020.28$608.17$608.17$1,020.28$1,020.28$608.17 $608.17 $608.17 $608.17 $608.17 $608.17 $608.17 $1,020.28$1,020.28$1,020.28$1,020.28$1,020.28$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17
36
0269U
Hem aut dm cgen trmbctpna 14
$608.17 $608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$777.13$777.13$777.13$777.13$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$777.13$777.13$777.13$608.17$608.17$777.13$777.13$608.17 $608.17 $608.17 $608.17 $608.17 $608.17 $608.17 $777.13$777.13$777.13$777.13$777.13$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17
37
0270U
Hem cgen coagj do 20 genes
$608.17 $608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$766.79$766.79$766.79$766.79$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$766.79$766.79$766.79$608.17$608.17$766.79$766.79$608.17 $608.17 $608.17 $608.17 $608.17 $608.17 $608.17 $766.79$766.79$766.79$766.79$766.79$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17
38
0271U
Hem cgen neutropenia 23 gen
$608.17 $608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$733.62$733.62$733.62$733.62$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$733.62$733.62$733.62$608.17$608.17$733.62$733.62$608.17 $608.17 $608.17 $608.17 $608.17 $608.17 $608.17 $733.62$733.62$733.62$733.62$733.62$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17
39
0272U
Hem genetic bld do 51 genes
$608.17 $608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$1,511.48$1,511.48$1,511.48$1,511.48$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$1,511.48$1,511.48$1,511.48$608.17$608.17$1,511.48$1,511.48$608.17 $608.17 $608.17 $608.17 $608.17 $608.17 $608.17 $1,511.48$1,511.48$1,511.48$1,511.48$1,511.48$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17
40
0273U
Hem gen hyprfibrnlysis 8 gen
$608.17 $608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$676.28$676.28$676.28$676.28$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$676.28$676.28$676.28$608.17$608.17$676.28$676.28$608.17 $608.17 $608.17 $608.17 $608.17 $608.17 $608.17 $676.28$676.28$676.28$676.28$676.28$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17
41
0274UHem gen pltlt do 43 genes$608.17 $608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$1,363.63$1,363.63$1,363.63$1,363.63$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$1,363.63$1,363.63$1,363.63$608.17$608.17$1,363.63$1,363.63$608.17 $608.17 $608.17 $608.17 $608.17 $608.17 $608.17 $1,363.63$1,363.63$1,363.63$1,363.63$1,363.63$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17
42
0276U
Hem inh thrombocytopenia 23
$608.17 $608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$996.55$996.55$996.55$996.55$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$996.55$996.55$996.55$608.17$608.17$996.55$996.55$608.17 $608.17 $608.17 $608.17 $608.17 $608.17 $608.17 $996.55$996.55$996.55$996.55$996.55$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17
43
0277UHem gen pltlt funcj do 31$608.17 $608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$1,061.69$1,061.69$1,061.69$1,061.69$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$1,061.69$1,061.69$1,061.69$608.17$608.17$1,061.69$1,061.69$608.17 $608.17 $608.17 $608.17 $608.17 $608.17 $608.17 $1,061.69$1,061.69$1,061.69$1,061.69$1,061.69$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17
44
0278U
Hem gen thrombosis 12 genes
$608.17 $608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$658.99$658.99$658.99$658.99$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$658.99$658.99$658.99$608.17$608.17$658.99$658.99$608.17 $608.17 $608.17 $608.17 $608.17 $608.17 $608.17 $658.99$658.99$658.99$658.99$658.99$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17$608.17
45
46
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49
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51
52
53
54
55
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59
60
61
62
63
64
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70
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80
81
82
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91
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100