United Healthcare Lab & Pathology
Compare United Healthcare's contracted rates for lab & pathology services against national averages and other major payers. Use these benchmarks to identify underpaid codes, prepare for contract renegotiations, and validate your reimbursement strategy.
UnitedHealthcare operates the largest commercial network in the U.S., with significant rate variation by metro market, product line, and provider tier.
Introduction
Laboratory reimbursement is governed by the Clinical Laboratory Fee Schedule (CLFS) for Medicare and individually negotiated rates for commercial payers. The Protecting Access to Medicare Act (PAMA) tied Medicare lab rates to weighted median commercial rates, making payer contract benchmarking more critical than ever for hospital labs and reference laboratories.
Lab services are billed using CPT codes organized by discipline — chemistry, hematology, microbiology, anatomic pathology, and molecular diagnostics — with reimbursement varying widely between reference laboratories, hospital outpatient labs, and physician office labs. High-volume tests like CBC and metabolic panels drive aggregate revenue even at low per-test rates, while molecular and specialty testing carries the widest payer-to-payer variation.
Chemistry & Metabolic Panels
Organ & Disease Panels
Bundled chemistry panels that measure multiple analytes in a single test. Panels are among the highest-volume lab tests ordered across inpatient and outpatient settings. Payer reimbursement for panels varies significantly and is a key contract term for reference laboratories.
| Billing Code | Description | Revenue Code | Description | Avg. National UHC Rate |
|---|---|---|---|---|
| 80053 | Comprehen Metabolic Panel, Comprehensive Metabolic Panel This Panel Must Include The Following Albumin 82040 Bilirubin Total 82247 Calcium Total 82310 Carbon Dioxide Bicarbonate 82374 Chloride 82435 Creatinine 82565 Glucose 82947 Phosphatase Alkaline 84075 Potassium 84132 Protein Total 84155 Sodium 84295 Transferase Alanine Amino Alt Sgpt 84460 Transferase Aspartate Amino Ast Sgot 84450 Urea Nitrogen Bun 84520 | 0301 | Laboratory - chemistry | $7.45 |
| 80048 | Basic Metabolic Pnl Total Ca, Basic Metabolic Panel (Calcium Total) This Panel Must Include The Following: Calcium Total (82310) Carbon Dioxide (Bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Potassium (84132) Sodium (84295) Urea Nitrogen (Bun) (84520) | 0301 | Laboratory - chemistry | $5.95 |
| 80061 | Cholesterol Testing, The Lipid Panel Is A Blood Test That Contains Three Measures: Total Cholesterol Hdl (Good Cholesterol) And Triglycerides. Often Ldl (Bad Cholesterol) Is Calculated From These Results. A Lipid Profile Can Help Evaluate The Risk Of Heart Disease. | 0301 | Laboratory - chemistry | $9.53 |
| 80076 | Hepatic Function Panel, Hepatic Function Panel This Panel Must Include The Following Albumin 82040 Bilirubin Total 82247 Bilirubin Direct 82248 Phosphatase Alkaline 84075 Protein Total 84155 Transferase Alanine Amino Alt Sgpt 84460 Transferase Aspartate Amino Ast Sgot 84450 | 0301 | Laboratory - chemistry | $5.73 |
Endocrine & Metabolic Tests
Individual chemistry tests for thyroid function, diabetes management, nutritional status, and metabolic evaluation. These are high-frequency tests with wide variation in commercial payer reimbursement.
| Billing Code | Description | Revenue Code | Description | Avg. National UHC Rate |
|---|---|---|---|---|
| 84443 | Thyroid Hormone Test, This Test Measures Thyroid Stimulating Hormone (Tsh) Which Can Be An Indicator Of An Over- Or Underactive Thyroid Gland. It Can Also Be Used To Monitor The Effectiveness Of Thyroid Gland Treatment. | 0301 | Laboratory - chemistry | $12.03 |
| 83036 | Blood Sugar (Glucose) Test, This Test Measures Glucose Bound To Hemoglobin In Blood Samples. The Results Show An Average Of Blood Glucose (Sugar) Levels Over The Previous Three Months. | 0301 | Laboratory - chemistry | $7.03 |
| 82306 | Test For Vitamin D Deficiency, This Blood Test Measures The Amount Of Vitamin D Present In The Body And The Bodys Ability To Store It. | 0301 | Laboratory - chemistry | $21.52 |
| 82607 | Test Of Vitamin B12 Deficiency, This Blood Test Checks For Deficiencies Of Vitamin B12 Which Plays An Important Role In Digestion Healthy Nerves And Growth Of Red Blood Cells. | 0301 | Laboratory - chemistry | $10.73 |
Cardiac & Inflammatory Markers
Chemistry tests used in emergency and inpatient settings for cardiac evaluation, inflammatory conditions, and risk stratification. Troponin and BNP are critical ED decision-making tests.
| Billing Code | Description | Revenue Code | Description | Avg. National UHC Rate |
|---|---|---|---|---|
| 84484 | Test For Heart Muscle Injury, This Test Of Troponin (Proteins Key To Muscle Contractions) Is Done At Intervals During An Emergency Visit To Help Identify Whether The Heart Muscle Has Been Injured. | 0301 | Laboratory - chemistry | $8.66 |
| 83880 | Peptide Hormone Test, This Test Measures The Quantity Of Peptide Hormones In A Blood Sample And Can Help To Diagnose Various Types Of Heart Failure. | 0301 | Laboratory - chemistry | $25.56 |
| 86140 | Blood Test For Inflammation, This Test Measures A Protein That Is An Indicator Of Inflammation Related To Bacteria And Tissue Damage. | 0301 | Laboratory - chemistry | $3.70 |
| 82553 | Enzyme (Cpk) Blood Test, This Blood Test Measures The Level Of Creatine Phosphokinase (Cpk) An Enzyme In The Brain Heart Lungs And Skeletal Tissue. Testing Can Confirm An Injury And Identify Damaged Tissue. | 0301 | Laboratory - chemistry | $12.00 |
Hematology & Coagulation
Hematology
Complete blood count and related hematologic tests. CBC with differential is the single most frequently ordered lab test in U.S. hospitals and outpatient practices, making it a significant line item in lab payer contracts.
| Billing Code | Description | Revenue Code | Description | Avg. National UHC Rate |
|---|---|---|---|---|
| 85025 | Complete Blood Count (Cbc), A Complete Blood Count Includes Red Blood Cells White Blood Cells Hemoglobin Hematocrit Platelets And Distribution Of The Cells Within The Blood Volume Sampled. | 0305 | Laboratory - hematology | $5.58 |
| 85027 | Complete Blood Count (Cbc), A Complete Blood Count Includes Red Blood Cells White Blood Cells Hemoglobin Hematocrit Platelets And Distribution Of The Cells Within The Blood Volume Sampled. | 0305 | Laboratory - hematology | $4.58 |
| 85652 | Red Blood Cell Test, This Test Measures The Rate At Which Red Blood Cells Sink To The Bottom Of A Test Tube. This Is A Nonspecific Test For Inflammation And Primarily Helps Detect Blood Cell And Vessel Conditions. | 0305 | Laboratory - hematology | $2.22 |
| 85044 | Red Blood Cell Count, Reticulocytes Are Young Red Blood Cells (Rbcs). The Count Can Be Automated Or Manual Using A Microscope. It Is Used To Evaluate Both Anemia And How Well Bone Marrow Is Creating Rbcs. | 0305 | Laboratory - hematology | $3.10 |
Coagulation Studies
Tests for blood clotting function including PT/INR for warfarin management, PTT for heparin monitoring, and D-dimer for DVT/PE workup. High-volume in both inpatient anticoagulation management and outpatient monitoring.
| Billing Code | Description | Revenue Code | Description | Avg. National UHC Rate |
|---|---|---|---|---|
| 85610 | Test Prothrombin Clotting Time, The Prothrombin Time Test Measures How Well Blood Clots. The Test Commonly Assesses The Effectiveness Of Drugs For Thinning Blood Or Preventing Clots. The Test Also Detects Deficiencies In The Proteins Necessary For Clotting. | 0305 | Laboratory - hematology | $3.82 |
| 85730 | Blood Clotting Time, Partial Thromboplastin Time Assesses The Amount Of Time It Takes For Blood To Clot. The Test Screens For Bleeding Conditions And Is Used To Monitor The Dose Of Heparin And Other Blood Thinners. | 0305 | Laboratory - hematology | $4.29 |
| 85379 | Blood Clotting Problem Test, This Test Is Done To Detect A Problem In The System That Regulates Blood Clotting. It Can Also Detect Whether A Hidden Blood Clot (One That Did Not Produce Symptoms) Has Occurred. | 0305 | Laboratory - hematology | $7.85 |
| 85670 | Thrombin Time Clot Test, This Test Measures Thrombin Time (The Time It Takes For A Blood Clot To Form). It Also Verifies Correct Dosage Of Heparin And Detects Fibrinogen Conditions. | 0305 | Laboratory - hematology | $4.12 |
Microbiology & Infectious Disease
Cultures
Bacterial and fungal culture tests for identifying infectious organisms. Blood and urine cultures are among the most commonly ordered microbiology tests in hospital settings, with significant reimbursement variation between rapid and standard methods.
| Billing Code | Description | Revenue Code | Description | Avg. National UHC Rate |
|---|---|---|---|---|
| 87040 | Blood Test Bacteria Infection, This Test Identifies Early Signs Of A Bacterial Growth And Thus Infection In A Blood Sample. Infections In The Blood (Bacteremia Or Sepsis) Can Cause Serious Illness. | 0306 | Laboratory - bacteriology & microbiology | $7.45 |
| 87045 | Stool Test For Bacteria, This Test Is Done To Look For The Presence Of Bacteria Which May Cause A Diarrheal Illness. A Specimen Of Fecal Material Is Submitted And The Types Of Bacteria Which Grow From That Specimen Are Analyzed. | 0306 | Laboratory - bacteriology & microbiology | $6.80 |
| 87070 | Test For Bacteria Infection, A Sample Of Body Fluid Or Tissue Is Tested For Infectious Bacteria. One Or More Additional Tests Confirm The Result Identify The Bacteria And Estimate How Many Are Present. | 0306 | Laboratory - bacteriology & microbiology | $6.20 |
| 87086 | Urine Test For Bacteria, This Test Diagnoses And Helps Guide Treatment Of A Urinary Tract (Bladder) Infection. A Urine Sample Is Placed Into A Substance That Causes Bacteria In It To Multiply. If Bacteria Are Present The Test Identifies Them. | 0306 | Laboratory - bacteriology & microbiology | $5.83 |
Molecular & NAAT Testing
Nucleic acid amplification tests (NAAT) for infectious disease detection including STIs, respiratory pathogens, and GI panels. Molecular testing reimbursement is among the most variable across payers, with wide gaps between contracted and out-of-network rates.
| Billing Code | Description | Revenue Code | Description | Avg. National UHC Rate |
|---|---|---|---|---|
| 87491 | Test To Confirm Chlamydia, This Is A Test For Confirming Infection With Chlamydia Trachomatis Commonly Transmitted Through Sexual Contact. The Sample Tested May Be Taken From The Cervix Urethra Or Urine. | 0306 | Laboratory - bacteriology & microbiology | $25.09 |
| 87591 | Infect Agnt Detect By Nucleic Acid (Dna Or Rna); Neisseria Gon, Infectious Agent Detection By Nucleic Acid (Dna Or Rna); Neisseria Gon | 0306 | Laboratory - bacteriology & microbiology | $25.02 |
| 87631 | Resp Virus 3 5 Targets, Infectious Agent Detection By Nucleic Acid Dna Or Rna Respiratory Virus Eg Adenovirus Influenza Virus Coronavirus Metapneumovirus Parainfluenza Virus Respiratory Syncytial Virus Rhinovirus Includes Multiplex Reverse Transcription When Performed And Multiplex Amplified Probe Technique Multiple Types Or Subtypes 3 5 Targets | 0306 | Laboratory - bacteriology & microbiology | $93.87 |
| 87635 | Sars Cov 2 Covid 19 Amp Prb, Infectious Agent Detection By Nucleic Acid Dna Or Rna Severe Acute Respiratory Syndrome Coronavirus 2 Sars Cov 2 Coronavirus Disease Covid 19 Amplified Probe Technique | 0306 | Laboratory - bacteriology & microbiology | $41.76 |
Rapid & Point-of-Care Testing
Rapid antigen and point-of-care tests for immediate clinical decision-making. These tests are typically reimbursed at lower rates than molecular assays but have high volume in urgent care and emergency settings.
| Billing Code | Description | Revenue Code | Description | Avg. National UHC Rate |
|---|---|---|---|---|
| 87804 | Test For Flu Virus, Influenza (Flu) Is A Viral Infection Of The Lungs That Causes Fever Cough And Muscle Aches. The Test Checks A Sample From The Nose Or Throat For Influenza A B Or Both Types. | 0306 | Laboratory - bacteriology & microbiology | $15.18 |
| 87426 | Infectious Agent Antigen Detection By Immunoassay Technique (Eg Enzyme Immunoassay [Eia] Enzyme- Linked Immunosorbent Assay [Elisa] Fluorescence Immunoassay [Fia] Immuno- Chemiluminometric Assay [Imca]) Qualitative Or Semiquantitative; Severe Acute Respiratory Syndrome Coronavirus (Eg Sars-Cov Sars-Cov-2 [Covid-19]) (Desc Rvsd 10/6/20) | 0306 | Laboratory - bacteriology & microbiology | $27.59 |
| 87880 | Infectious Agent Detection By, Infectious Agent Detection By Immunoassay With Directoptical Observation Streptococcus Group A Infectious Agent Detection By Immunoassay With Direct | 0306 | Laboratory - bacteriology & microbiology | $13.20 |
| 87449 | Infectious Agent Antigen Detection By Immunoassa Technique (Eg Enzyme Immunoassay [Eia] Enzyme Linked Immunosorbent Assay [Elisa] Fluorescence Immunoassay [Fia] Immuno- Chemiluminometric Assay [Imca]) Qualitative Or Semiquantitative; Not Otherwise Specified Each Organism (Desc Rvsd 10/6/20) | 0306 | Laboratory - bacteriology & microbiology | $8.63 |
Urinalysis & Drug Testing
Urinalysis
Routine and microscopic urinalysis for evaluation of kidney function, urinary tract infections, and metabolic conditions. Urinalysis is a high-volume, low-cost test that is often bundled in inpatient billing.
| Billing Code | Description | Revenue Code | Description | Avg. National UHC Rate |
|---|---|---|---|---|
| 81001 | Urine Analysis, Urine Test That Checks Ph And Looks For Substances Such As Blood Crystals Bile And White Blood Cells (Antibodies). These May Be Viewed Under A Microscope Or Detected With Dip Sticks Or Colorizing Tablets. A Computer Analysis May Be Done As Well. | 0307 | Laboratory - urinalysis | $3.00 |
| 81003 | Urine Analysis, Urine Test That Checks Ph And Looks For Substances Such As Blood Crystals Bile And White Blood Cells (Antibodies). These May Be Viewed Under A Microscope Or Detected With Dip Sticks Or Colorizing Tablets. A Computer Analysis May Be Done As Well. | 0307 | Laboratory - urinalysis | $2.91 |
| 81015 | Urine Bacteria Analysis, This Analysis Checks Urine For The Presence Of Bacteria. The Process May Be Manual Or Automated. While Normally There Is No Bacteria In Urine It May Be Present If A Person Is Ill Or If The Sample Is Contaminated. | 0307 | Laboratory - urinalysis | $2.83 |
Drug Screening & Confirmation
Presumptive and definitive drug testing used in pain management, substance use treatment, pre-employment, and compliance monitoring. Drug testing reimbursement has been under increased payer scrutiny with many plans implementing frequency limits and prior authorization requirements.
| Billing Code | Description | Revenue Code | Description | Avg. National UHC Rate |
|---|---|---|---|---|
| 80305 | Drug Test Prsmv Dir Opt Obs, Drug Test S Presumptive Any Number Of Drug Classes Any Number Of Devices Or Procedures Capable Of Being Read By Direct Optical Observation Only Eg Utilizing Immunoassay Eg Dipsticks Cups Cards Or Cartridges Includes Sample Validation When Performed Per Date Of Service | 0301 | Laboratory - chemistry | $8.11 |
| 80306 | Drug Test(S) Presumptive Any Number Of Drug Classes Any Number Of Devices Or Procedures; Read By Instrument Assisted Direct Optical Observation (Eg Utilizing Immunoassay [Eg Dipsticks Cups Cards Or Cartridges]) Includes Sample Validation When Performed Per Date Of Service (Desc Revised 1/1/2018) | 0301 | Laboratory - chemistry | $10.89 |
| 80307 | Drug Test Prsmv Chem Anlyzr, Drug Test S Presumptive Any Number Of Drug Classes Any Number Of Devices Or Procedures By Instrument Chemistry Analyzers Eg Utilizing Immunoassay Eg Eia Elisa Emit Fpia Ia Kims Ria Chromatography Eg Gc Hplc And Mass Spectrometry Either With Or Without Chromatography Eg Dart Desi Gc Ms Gc Ms Ms Lc Ms Lc Ms Ms Ldtd Maldi Tof Includes Sample Validation When Performed Per Date Of Service | 0301 | Laboratory - chemistry | $41.48 |
| G0480 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed | 0301 | Laboratory - chemistry | $60.53 |
Anatomic Pathology
Surgical Pathology
Tissue examination and diagnosis from biopsies and surgical specimens. Surgical pathology reimbursement is tiered by specimen complexity (levels 1-6), with significant payer variation at the higher complexity levels that involve intraoperative consultation and immunohistochemistry.
| Billing Code | Description | Revenue Code | Description | Avg. National UHC Rate |
|---|---|---|---|---|
| 88305 | Tissue Exam By Pathologist, Level Iv Surgical Pathology Gross And Microscopic Examination Abortion Spontaneous Missed Artery Biopsy Bone Marrow Biopsy Bone Exostosis Brain Meninges Other Than For Tumor Resection Breast Biopsy Not Requiring Microscopic Evaluation Of Surgical Margins Breast Reduction Mammoplasty Bronchus Biopsy Cell Block Any Source Cervix Biopsy Colon Biopsy Duodenum Biopsy Endocervix Curettings Biopsy Endometrium Curettings Biopsy Esophagus Biopsy Extremity Amputation Traumatic Fallopian Tube Biopsy Fallopian Tube Ectopic Pregnancy Femoral Head Fracture Fingers Toes Amputation Non Traumatic Gingiva Oral Mucosa Biopsy Heart Valve Joint Resection Kidney Biopsy Larynx Biopsy Leiomyoma S Uterine Myomectomy Without Uterus Lip Biopsy Wedge Resection Lung Transbronchial Biopsy Lymph Node Biopsy Muscle Biopsy Nasal Mucosa Biopsy Nasopharynx Oropharynx Biopsy Nerve Biopsy Odontogenic Dental Cyst Omentum Biopsy Ovary With Or Without Tube Non Neoplastic Ovary Biopsy Wedge Resection Parathyroid Gland Peritoneum Biopsy Pituitary Tumor Placenta Other Than Third Trimester Pleura Pericardium Biopsy Tissue Polyp Cervical Endometrial Polyp Colorectal Polyp Stomach Small Intestine Prostate Needle Biopsy Prostate Tur Salivary Gland Biopsy Sinus Paranasal Biopsy Skin Other Than Cyst Tag Debridement Plastic Repair Small Intestine Biopsy Soft Tissue Other Than Tumor Mass Lipoma Debridement Spleen Stomach Biopsy Synovium Testis Other Than Tumor Biopsy Castration Thyroglossal Duct Brachial Cleft Cyst Tongue Biopsy Tonsil Biopsy Trachea Biopsy Ureter Biopsy Urethra Biopsy Urinary Bladder Biopsy Uterus With Or Without Tubes And Ovaries For Prolapse Vagina Biopsy Vulva Labia Biopsy | 0314 | Laboratory - histology | $68.41 |
| 88304 | Tissue Exam By Pathologist, Level Iii Surgical Pathology Gross And Microscopic Examination Abortion Induced Abscess Aneurysm Arterial Ventricular Anus Tag Appendix Other Than Incidental Artery Atheromatous Plaque Bartholin S Gland Cyst Bone Fragment S Other Than Pathologic Fracture Bursa Synovial Cyst Carpal Tunnel Tissue Cartilage Shavings Cholesteatoma Colon Colostomy Stoma Conjunctiva Biopsy Pterygium Cornea Diverticulum Esophagus Small Intestine Dupuytren S Contracture Tissue Femoral Head Other Than Fracture Fissure Fistula Foreskin Other Than Newborn Gallbladder Ganglion Cyst Hematoma Hemorrhoids Hydatid Of Morgagni Intervertebral Disc Joint Loose Body Meniscus Mucocele Salivary Neuroma Morton S Traumatic Pilonidal Cyst Sinus Polyps Inflammatory Nasal Sinusoidal Skin Cyst Tag Debridement Soft Tissue Debridement Soft Tissue Lipoma Spermatocele Tendon Tendon Sheath Testicular Appendage Thrombus Or Embolus Tonsil And Or Adenoids Varicocele Vas Deferens Other Than Sterilization Vein Varicosity | 0314 | Laboratory - histology | $40.11 |
| 88307 | Tissue Exam By Pathologist, Level V Surgical Pathology Gross And Microscopic Examination Adrenal Resection Bone Biopsy Curettings Bone Fragment S Pathologic Fracture Brain Biopsy Brain Meninges Tumor Resection Breast Excision Of Lesion Requiring Microscopic Evaluation Of Surgical Margins Breast Mastectomy Partial Simple Cervix Conization Colon Segmental Resection Other Than For Tumor Extremity Amputation Non Traumatic Eye Enucleation Kidney Partial Total Nephrectomy Larynx Partial Total Resection Liver Biopsy Needle Wedge Liver Partial Resection Lung Wedge Biopsy Lymph Nodes Regional Resection Mediastinum Mass Myocardium Biopsy Odontogenic Tumor Ovary With Or Without Tube Neoplastic Pancreas Biopsy Placenta Third Trimester Prostate Except Radical Resection Salivary Gland Sentinel Lymph Node Small Intestine Resection Other Than For Tumor Soft Tissue Mass Except Lipoma Biopsy Simple Excision Stomach Subtotal Total Resection Other Than For Tumor Testis Biopsy Thymus Tumor Thyroid Total Lobe Ureter Resection Urinary Bladder Tur Uterus With Or Without Tubes And Ovaries Other Than Neoplastic Prolapse | 0314 | Laboratory - histology | $216.13 |
| 88309 | Tissue Exam By Pathologist, Level Vi Surgical Pathology Gross And Microscopic Examination Bone Resection Breast Mastectomy With Regional Lymph Nodes Colon Segmental Resection For Tumor Colon Total Resection Esophagus Partial Total Resection Extremity Disarticulation Fetus With Dissection Larynx Partial Total Resection With Regional Lymph Nodes Lung Total Lobe Segment Resection Pancreas Total Subtotal Resection Prostate Radical Resection Small Intestine Resection For Tumor Soft Tissue Tumor Extensive Resection Stomach Subtotal Total Resection For Tumor Testis Tumor Tongue Tonsil Resection For Tumor Urinary Bladder Partial Total Resection Uterus With Or Without Tubes And Ovaries Neoplastic Vulva Total Subtotal Resection | 0314 | Laboratory - histology | $325.89 |
Cytopathology
Cell-level examination including Pap smears and fine needle aspiration cytology. Pap smear reimbursement has been relatively stable but varies by screening vs. diagnostic indication and whether the test is physician-interpreted or auto-screened.
| Billing Code | Description | Revenue Code | Description | Avg. National UHC Rate |
|---|---|---|---|---|
| 88175 | Cytopath C V Auto Fluid Redo, Cytopathology Cervical Or Vaginal Any Reporting System Collected In Preservative Fluid Automated Thin Layer Preparation With Screening By Automated System And Manual Rescreening Or Review Under Physician Supervision | 0311 | Laboratory - cytology | $25.59 |
| 88112 | Advanced Lab Study Of Cells, Advanced Cytopathology (Cell) Study Of Complicated Cell Samples Using Substances To Enhance The Microscopic View For Better Detection Of Disease Type Or Comparison With Previous Studies. | 0311 | Laboratory - cytology | $69.12 |
| 88108 | Laboratory Study Of Cells, Examination Of A Cell Sample Using Techniques To Identify If A Disease Is Present Or Not (Cytopathology). Results Are Interpreted For A Report. | 0311 | Laboratory - cytology | $55.26 |
Specimen Collection
Phlebotomy & Specimen Handling
Venipuncture and capillary blood collection services. While individually low-reimbursement, specimen collection fees represent significant aggregate revenue for reference labs and hospital outpatient departments processing thousands of draws per day.
| Billing Code | Description | Revenue Code | Description | Avg. National UHC Rate |
|---|---|---|---|---|
| 36415 | Routine Venipuncture Or Finge, Routine Venipuncture Or Fingerheelear Stick Forcollection Of Specimen(S) Routine Venipuncture Or Fingerheelear Stick For | 0300 | Laboratory | $2.91 |
| 36416 | Collect Of Capillary Blood Specimen (Eg Finger Heel Ear Stick), Collection Of Capillary Blood Specimen (Eg Finger Heel Ear Stick) | 0300 | Laboratory | $2.93 |
| 99000 | Handling Andor Conveyance Of, Handling Andor Conveyance Of Specimen For Transfer From Thephysicians Office To A Laboratory Handling Andor Conveyance Of Specimen For Transfer From The | 0300 | Laboratory | $3.80 |
What is a fee schedule?
A fee schedule is a list of negotiated prices that healthcare providers charge for specific services. These prices vary by payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the applicable fee schedule helps providers optimize billing for accurate reimbursement and helps patients anticipate out-of-pocket costs.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts.
Private Insurance Rates
Negotiated rates between providers and insurance companies.
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
View lab & pathology fee schedules for other major payers
What is Price Transparency?
The federal Price Transparency Rule took effect in July 2022, requiring all commercial payers to publicly disclose their prices through machine-readable files (MRFs). This landmark regulation mandates that insurance companies make healthcare costs transparent to the public. Read more here.
PayerPrice gives you access to the actual prices that insurers are legally required to publish under the Price Transparency Rule. We deliver this data exactly as reported in the insurers' machine-readable files, giving you an accurate view of negotiated rates. While insurers occasionally report incomplete or inaccurate data, our platform ensures you see the same information that insurers have made publicly available.
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