Atlas Wholesale Prices (Labs, Meds, Imaging)
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Atlas Concierge Family Prac (N33009782)
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SPECIAL QUOTE PRICING
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9/21/2015
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* The CPT codes provided are based on AMA guidelines and are for informational purposes only.
CPT coding is the sole responsibility of the billing party. Please direct any questions regarding
coding to the payer being billed.
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SERVICE CODE
SERVICE NAME
CPT CodeEFFECTIVEPRICE
7
32476
*ACUTE HEP PNL (REFL)
9/1/15$62.06
8
33176
*ACUTE HEPATITIS(REFL)
9/1/15$34.28
9
92527
*ADV LIPID/INFLAM PNL
80061, 82172, 83695, 83698, 86141
9/1/15$76.17
10
16845
*ALDO/PRAR, LC/MS/MS
82088, 842449/1/15$59.41
11
29839
*ANA AB PNL COMP
86038, 86225, 86235 (5)
9/1/15$146.00
12
37521
*ANA COMP PNL 1
86038, 86039, 86235 (5), 86255, 86256, 86431
9/1/15$133.00
13
90071
*ANA IFA RA PNL W/RFL
86038, 86200, 86431
9/1/15$33.00
14
90077
*ANA SJOGRENPNL W/RFL
86038, 86235 (2), 86431
9/1/15$29.00
15
37541
*ANGIOEDEMA PANEL
83520, 86160 (3)
9/1/15$116.00
16
15963
*ANGIOEDEMA PNL, ACQUIRED
86160 (2), 86161
9/1/15$93.00
17
17706
*ANGIOEDEMA PNL, H COMP
86160 (2), 86161
9/1/15$65.00
18
37082
*ANGIOEDEMA PROFILE 2
86160, 861619/1/15$53.00
19
7311
*ANTICONVULSANT #1
80184, 801857/28/15$60.82
20
7312
*ANTICONVULSANT #2
80184, 80185, 80188
7/28/15$88.58
21
270
*ARSENIC (U)W/CR
82175, 825709/1/15$31.31
22
92052
*ASCVD RSK PNL W/SCOR
800619/1/15$6.00
23
92053
*ASCVD RSK PNL/SCORE
800619/1/15$6.00
24
90133
*AUTOIMMUNE ATAXIA
82784, 83516, 83519, 86255
9/1/15$178.00
25
19873
*AUTOIMMUNE HEP DIAG PNL
83516, 86038, 86255, 86376
9/1/15$52.00
26
38994
*BETA-2 MICROGLOB(U)W/CR
822329/1/15$36.31
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90863*BHL LP PLUS19/1/15$15.00
28
90864*BHL LP PLUS29/1/15$35.75
29
90865*BHL LP PLUS3
80061, 82172, 83695, 83701 (2)
9/1/15$55.75
30
90471
*BPA, RANDOM URINE
82570, 837899/1/15$89.31
31
37859*C3,C4,CH50
86160 (2), 86162
9/1/15$38.00
32
35071
*C4 ACTIVATION PNL
83520, 861609/1/15$52.00
33
1635
*CA 24HR (U) W/CR
82340, 825709/1/15$25.31
34
15269*CAH PANEL 1
82157, 82533, 82634, 83498, 84403
9/1/15$228.79
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15276*CAH PANEL 6
82088, 82533, 82626, 84140
9/1/15$251.04
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15277*CAH PANEL 7
82157, 83498, 84403
9/1/15$170.95
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15279*CAH PANEL 8
82088, 82528, 82533, 83498, 84144, 84403
9/1/15$380.38
38
16978
*CAH PNL 6C FULL SCR
82157, 82533, 82626, 82634, 83498, 84143, 84144, 84403
9/1/15$591.89
39
10299
*CAH PROFILE 6B
9/1/15$841.97
40
1633
*CALCIUM (U) W/CR
82310, 825709/1/15$25.31
41
92145
*CARDIO ADV LIPID PNL
80061, 82172, 83695, 83704
9/1/15$47.25
42
91716
*CARDIO IQ(TM)LIPID PANEL
800619/1/15$6.00
43
5244
*CATECHOLAMINES(U)W/CR
823849/1/15$35.91
44
15981
*CELIAC COMP, INFANT
82784, 83516 (2)
9/1/15$51.50
45
19955
*CELIAC DISEASE COMP
82784, 835169/1/15$38.00
46
15681
*CELIAC DISEASE PANEL
9/1/15$124.40
47
15980
*CELIAC DISEASE PANEL
9/1/15$51.50
48
17262
*CELIAC DISEASE PNL (REFL
9/1/15$51.50
49
17612
*CELIAC W/O GLIADIN
82784, 835169/1/15$38.00
50
1645
*CHLORIDE (U) W/CR
82436, 825709/1/15$24.31
51
368
*CHLORIDE 24HR (U)W/CR
82436, 825709/1/15$26.31
52
7432
*CHOL AND HDL W RATIO
82465, 837189/1/15$4.00
53
16620
*CHRONIC FATIGUE III
9/1/15$1,353.57
54
90123
*CHRONIC URTICARIA 2PNL
83520, 84443, 86343, 86376, 86800
9/1/15$101.00
55
16440
*CHRONIC URTICARIA PNL
84443, 86343, 86376, 86800
9/1/15$81.00
56
4451
*CK ISOENZYME PANEL
7/28/15$28.43
57
14747
*C-PEPTIDE/GLUCAGON
84681, 8468191 (3)
7/28/15$45.12
58
91437
*CT,NG,TV,HSV1/2 PCR
87491, 87529 (2), 87591, 87661
9/1/15$135.00
59
91448
*CT/NG/TRIC RNA, TMA
87491, 87591, 87661
9/1/15$35.00
60
91436
*CTNG TMA/HSV DNA PCR
87491, 87529 (2), 87591
9/1/15$130.00
61
10108
*CULTURE,STOOL W/RFL
87045, 87046, 87427
7/28/15$36.25
62
91410
*DEMENTIA PANEL
80050, 82607, 82746
9/1/15$28.41
63
92062
*DIAB ASCVD RSK SCOR
80061, 82947, 83036
9/1/15$12.13
64
91712
*DIAB NEW/DX MON PNL
80061, 80076, 82043, 82565, 82570, 82947, 83036
9/1/15$31.78
65
92026
*DIAB RSK PNL W/SCORE
80061, 82947, 83036
9/1/15$11.00
66
92063
*DIABETES & ASCVD
80061, 82947, 83036
9/1/15$11.00
67
91920
*DIABETES RK WO SCORE
80061, 82947, 83036
9/1/15$12.13
68
92027
*DIABETES RSK PNL/SCR
80061, 82947, 83036
9/1/15$12.13
69
91713
*DIABETES,CKD MGT PNL
80051, 82043, 82306, 82310, 82565, 82570, 83970, 84100, 85018
9/1/15$69.29
70
19765
*DIABETIC PROFILE
9/1/15$20.00
71
38940
*ELECTROPH/IMMUNOFIX
82784 (3), 83883 (2), 84155, 84165, 86334
9/1/15$104.00
72
7023
*ENCEPHALITIS EVAL.
7/28/15$46.50
73
7437
*ESTRADIOL & ESTRONE
82670, 826799/1/15$193.57
74
36742
*ESTROGENS, FRACT.(S)
826719/1/15$213.57
75
90923
*FIBRINOLYSIS PANEL
85360, 85362 (2), 85379, 85410, 85415 (2), 85420
9/1/15$220.00
76
14573
*HEAVY METALS, RAND (U)
82175, 82300, 82570, 83018 (2), 83655, 83825
9/1/15$311.91
77
20325
*HELICOBACTER PYLORI
86677 (3)7/28/15$105.30
78
35489
*HEMOGLOBINOPATHY
830215/4/15$11.00
79
16763
*HEMOGLOBINOPATHY EVL
9/1/15$15.85
80
36008
*HEP B IMMUN/PNL(REFL)
9/1/15$23.00
81
7105
*HEP B IMMUNITY PANEL
86704, 867069/1/15$22.00
82
91704
*HEP C INFECTED BASE
80076, 82565, 85025, 86703, 86704, 86706, 86708, 87340, 87902
9/1/15$199.29
83
10306
*HEP PNL ACUTE W/REF
800749/1/15$35.28
84
6462
*HEPATITIS PANEL
86704, 86706, 86708, 86803, 87340
9/1/15$61.00
85
35983
*HEPATITIS PANEL(REFL)
9/1/15$92.78
86
35627
*HEPATITIS PNL (REFL)
9/1/15$87.78
87
6519
*HEPATITIS PNL(REFL)
86704, 86706, 86708, 86803, 87340
9/1/15$66.00
88
24775
*HEPATITIS PNL(REFL)
9/1/15$62.00
89
31480
*HEPATITIS PNL(REFL)
9/1/15$88.78
90
33118
*HEPATITIS PNL(REFL)
9/1/15$61.00
91
91707
*HEPC INF BASE 2 PROF
80076, 82565, 85025, 86703, 87902
9/1/15$151.29
92
91705
*HEPC INFECT AUTOIMM
83516, 83520, 86038, 86255, 86376
9/1/15$76.00
93
91706
*HEPC INFECTED TREAT
82565, 84460, 85025, 87522
9/1/15$68.22
94
1648
*HIAA 5- (U) W/CR
834979/1/15$13.31
95
36707
*HIRSUTISM PANEL 2
82157, 82627, 84402, 84403
9/1/15$119.00
96
37669
*IGA,IGG,IGM IMMUNOF
82784 (3), 86334
9/1/15$37.00
97
7083
*IMMUNOGLOBULINS
82784 (3)9/1/15$17.00
98
10009
*IND TOXIC METAL PNL
9/1/15$339.39
99
5616
*IRON,TIBC,FER PNL
82728, 83540, 83550
7/27/15$10.13
100
4411
*LD ISOENZYME PANEL
83615, 836257/28/15$19.48
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