Outpatient Lab Charges
Our Commitment to Quality
Helping ensure our patients receive the highest level of care, delivered with dignity and compassion, is our goal with every patient and family member, every time. Our Board challenges us to remain in the Top 10 percent of hospitals in the country in quality scores, and they meet monthly with physicians and clinical staff to analyze the data and develop a plan to better serve our patients. It is this goal-driven mindset that has earned us recognition in key areas for our quality strides. Learn more about our quality awards and recognition.
NOTE: When reviewing the pricing for Lab or Pathology tests, if the section below a test is blank, the test is repeated again and these are additional charges (for example - Glucose four-hour tolerance test will have the test repeated one hour, two hours and then three hours after the initial blood work is collected for a total of four hours. Each test is charged separately). If your lab work is a panel, then several tests may be performed from one blood sample. You may be charged for each test separately
| Order Code | Description | Billing Code | Charge | CPT Code |
|---|---|---|---|---|
| UCG | URINE CULTURE GS | 40300030 | $41.51 | 87086 |
| 40300038 | $24.91 | 87205 | ||
| UCL | CHLORIDE RANDOM URINE | 40500082 | $58.10 | 82436 |
| UCOP | COPPER, URINE | 40200278 | $93.39 | 82525 |
| UCRE | CREATININE - RANDOM URINE | 40500029 | $37.35 | 82570 |
| UCYS | CYSTINE RANDOM URINE | 40200176 | $286.65 | 82131 |
| UGDS | DRUG SCREEN - GENERAL URINE | 30100413 | $169.68 | 80307 |
| UGLU | GLUCOSE URINE (SUGAR) | 40500067 | $18.68 | |
| UKET | KETONE URINE (ACETONE) | 40500067 | $18.68 | 81003 |
| UKLF | FREE KAPPA/LAMBDA 24HR URINE | 30000006 | $79.25 | 84156 |
| 30200031 | $79.25 | 86335 | ||
| 30100079 | $79.25 | 83883 | ||
| 30100079 | $79.25 | 83883 | ||
| UMCR | MICROALBUMIN RANDOM URINE | 40500073 | $41.51 | 82043 |
| 40500029 | $41.51 | 82570 | ||
| UMED | METHADONE 300 | 30100411 | $35.00 | 80307 |
| UMET | METANEPHRINES URINE | 40200053 | $101.85 | 83835 |
| UMG | MAGNESIUM/MG RANDOM URINE | 40500109 | $67.67 | 83735 |
| UMIC | URINALYSIS MICROSCOPIC | 40500069 | $37.37 | 81015 |
| UMICRC | URINE MICROSCOPY | 40500069 | $37.37 | 81015 |
| UMTQ | METHAQUALONE QUANTITATIVE, URINE | 30100478 | $577.00 | 80368 |
| UMYO | MYOGLOBIN URINE | 40200211 | $61.95 | 83874 |
| UNA | SODIUM URINE RANDOM | 40500123 | $29.05 | 84300 |
| UOPQ | OPIATES, URINE, QUANT | 30100407 | $65.00 | 80361 |
| 30100476 | $65.00 | 80365 | ||
| UOSM | OSMOLALITY - RANDOM URINE | 40500111 | $20.32 | 83935 |
| UPH | PH URINE | 40500067 | $18.68 | 81003 |
| UPLF | UREA PLEURAL FLUID | 40500136 | $11.11 | 84520 |
| UPO4 | PHOSPHORUS RANDOM URINE | 40500114 | $14.14 | 84105 |
| UPRO | PROTEIN URINE QUALITATIVE | 40500067 | $18.68 | 81003 |
| UPRP | PROPOXYPHENE & METABOLITE, URINE | 30100408 | $293.00 | 80367 |
| UPTF | UREA PERITONEAL FLUID | 40500136 | $11.11 | 84520 |
| URAC | URIC ACID - SERUM | 40500138 | $26.96 | 84550 |
| URAP | URIC ACID - PLASMA | 40500138 | $26.96 | 84550 |
| URS | REDUCING SUBSTANCES URINE | 40500068 | $29.29 | 81005 |
| USG | SPECIFIC GRAVITY URINE | 40500067 | $24.24 | 81003 |
| UTP | PROTEIN, TOTAL - RANDOM URINE | 40500008 | $15.15 | 84156 |
| UTRY | TRICYCLICS, URINE | 40500010 | $142.41 | 80101 |
| UTV | URINE - TOTAL VOLUME & HOURS | 40500027 | $28.37 | 81050 |
| UURE | UREA - RANDOM URINE | 40500137 | $58.58 | 84540 |
| UUUR | URIC ACID - RANDOM URINE | 40500139 | $31.13 | 84560 |
| VAAC | VALPROIC ACID (DEPAKENE) | 40500058 | $78.86 | 80164 |
| VANP | VANCOMYCIN PEAK | 40500066 | $78.78 | 80202 |
| VANT | VANCOMYCIN TROUGH | 40500066 | $78.78 | 80202 |
| VB12 | B12 + FOLATES | 40500085 | $112.06 | 82607 |
| 40500090 | $95.47 | 82746 | ||
| VB1P | VITAMIN B1,PLASMA | 40200301 | $113.10 | 84425 |
| VBGA | BLOOD GAS VENOUS | 40500009 | $96.80 | 82805 |
| VBGN | BLOOD GAS VENOUS NEONATAL | 40500009 | $96.80 | 82805 |
| VBGO | BLOOD GAS VENOUS - ON OXYGEN | 40500009 | $96.80 | 82805 |
| VCCN | VIRAL CULTURE, NON-RESPIRATORY | 40300043 | $99.61 | 87252 |
| VCCR | VIRAL CULTURE, RESPIRATORY | 40300043 | $99.61 | 87252 |
| VDOH | Vitamin D 25-Hydroxy | 40500182 | $100.99 | 82306 |
| VEAB | VIRAL ENCEPHALITIS AB PANEL | 40200321 | $88.20 | 86651 |
| 40200321 | $86.10 | 86651 | ||
| 40200322 | $86.10 | 86652 | ||
| 40200322 | $86.10 | 86652 | ||
| 40200323 | $86.10 | 86653 | ||
| 40200323 | $86.10 | 86653 | ||
| 40200324 | $86.10 | 86654 | ||
| 40200324 | $86.10 | 86654 | ||
| 40200339 | $86.10 | 86790 | ||
| 40200339 | $86.10 | 86790 | ||
| 40200335 | $86.10 | 86765 | ||
| 40200335 | $86.10 | 86765 | ||
| 40200332 | $86.10 | 86735 | ||
| 40200332 | $86.10 | 86735 | ||
| 40200338 | $86.10 | 86787 | ||
| 40200338 | $86.10 | 86787 | ||
| 40200331 | $86.10 | 86727 | ||
| 40200329 | $86.10 | 86694 | ||
| 40200329 | $86.10 | 86694 | ||
| VGP | VAGINITIS PANEL | 30600081 | $90.00 | 87801 |
| 30600082 | $43.75 | 87481 | ||
| 30600082 | $43.75 | 87481 | ||
| 30600082 | $43.75 | 87481 | ||
| 30600076 | $43.75 | 84661 | ||
| VIPR | VASOACTIVE INTESTINAL POLYPEPTIDE | 40200253 | $136.50 | 84586 |
| VIS | VISCOSITY | 40200183 | $50.40 | 85810 |
| VITE | VITAMIN E | 40200304 | $80.94 | 84446 |
| VITK | VITAMIN K1,SERUM | 30100480 | $187.20 | 84597 |
| VMAU | VMA, URINE | 40200171 | $95.47 | 84585 |
| VPCR | VENIPUNCTURE CREDIT | 41000002 | 15.00CR | 36415 |
| VRED | VOLUME REDUCTION FEE | 40400020 | $215.00 | 86960 |
| VTA | VITAMIN A (RETINOL) | 40200361 | $64.05 | 84590 |
| VTB1 | VITAMIN B1, WHOLE BLOOD | 40200301 | $120.36 | 84425 |
| VTB6 | VITAMIN B6 | 40200297 | $236.58 | 84207 |
| VWMP | VON WILLEBRAND SCREEN | 40200203 | $138.08 | 85247 |
| 40200031 | $138.08 | 85240 | ||
| 40200070 | $138.08 | 85246 | ||
| 40200307 | $138.08 | 85245 | ||
| VZC | VARICELLA ZOSTER CULTURE | 40300043 | $99.61 | 87252 |
| VZDF | VARICELLA ZOSTER DFA STAIN | 40300047 | $40.94 | 87290 |
| VZG | VARICELLA ZOSTER VIRUS AB IGG | 40200338 | $89.23 | 86787 |
| VZM | VARICELLA ZOSTER VIRUS AB IGM | 40200338 | $89.23 | 86787 |
| WATM | ALLERGEN, FOOD, WATERMELON | 40200062 | $39.43 | 86003 |
| WBK | POTASSIUM - WHOLE BLOOD | 40500115 | $32.32 | 84132 |
| WBO | WHOLE BLOOD - K, NA, & GLUC | 40500115 | $32.32 | 84132 |
| 40500122 | $32.32 | 84295 | ||
| 40500035 | $32.32 | 82947 | ||
| WCRE | CREATININE, WHOLE BLOOD | 40500012 | $32.32 | 82565 |
| WCUL | WATER CULTURE | 40300026 | $51.89 | 87070 |
| WHET | ALLERGEN - WHEAT | 40200062 | $39.43 | 86003 |
| WHTA | ALLERGEN - WHITE ASH TREE | 40200062 | $39.43 | 86003 |
| WHTF | ALLERGEN - WHITEFISH | 40200397 | $39.43 | 86003 |
| WILW | ALLERGEN - WILLOW TREE | 40200062 | $39.43 | 86003 |
| WLNT | ALLERGEN - WALNUT/BLACK WALNUT | 40200062 | $39.43 | 86003 |
| WNGC | WEST NILE VIRUS AB IGG, CSF | 40200353 | $75.50 | 86789 |
| WNMC | WEST NILE VIRUS AB IGM, CSF | 40200352 | $75.50 | 86788 |
| WNVG | WEST NILE VIRUS ANTIBODY IGG | 40200339 | $86.10 | 86790 |
| WNVM | WEST NILE VIRUS ANTIBODY IGM | 40200339 | $86.10 | 86790 |
| XM | TYPE AND CROSSMATCH | 40400017 | $20.00 | 86901 |
| 40400012 | $38.00 | 86850 | ||
| 40400016 | $13.00 | 86900 | ||
| YOAB | YO ANTIBODY | 40200151 | $1,126.65 | 84182 |
| YSTB | ALLERGEN - BAKER'S YEAST | 40200062 | $39.43 | 86003 |
| ZAR | ZARONTIN (ETHOSUXIMIDE) | 40200265 | $60.19 | 80168 |
| ZINC | ZINC | 40200172 | $78.86 | 84630 |
| ZONE | ZONISAMIDE QUANTITATIVE | 40200164 | $184.00 | 80203 |
| ZP | ZPP TO HEME RATIO | 40200182 | $178.50 | 84202 |
| BG | BLOOD GAS COLLECTION | 41000004 | $32.84 | 36600 |
| BGO | BLOOD GAS COLLECTION - OUTREACH | 41000004 | $32.84 | 36600 |
| BGR | BLOOD GAS | 41000004 | $15.00 | 36600 |
| FS | FINGERSTICK | 41000003 | $15.00 | 36416 |
| FSO | FINGERSTICK - OUTREACH | 41000003 | $15.00 | 36416 |
| FSR | FINGERSTICK | 41000003 | $15.00 | 36416 |
| HS | HEEL STICK | 41000003 | $15.00 | 36416 |
| HSO | HEEL STICK - OUTREACH | 41000003 | $15.00 | 36416 |
| HSR | HEELSTICK | 41000003 | $15.00 | 36416 |
| VP | VENIPUNCTURE | 41000002 | $15.00 | 36415 |
| VPO | VENIPUNCTURE - OUTREACH | 41000002 | $15.00 | 36415 |
| VPON | VENIPUNCTURE/OUTREACH/NURSING HOME | 41000002 | $15.00 | 36415 |
| VPR | VENIPUNCTURE | 41000002 | $15.00 | 36415 |
| KB | KIRBY BAUER | 40300036 | $43.58 | 87186 |
| 40300061 | $14.14 | 87077 | ||
| MIC | MIC-SUSCEPTIBILITY | 40300036 | $43.58 | 87186 |
| 40300061 | $14.14 | 87077 | ||
| PMIC | STREPTOCOCCUS PNEUMONIAE MIC | 40300036 | $43.58 | 87186 |
| 40300061 | $14.14 | 87077 | ||
| %XM | CROSSMATCH RESULT 1 | 40400007 | $157.00 | 86920 |
| %CRP | POOLED CRYO Administrative | 40400029 | $55.13 | 86965 |
| %CRY | CRYO Processing | 40400023 | $109.00 | P9012 |
| %DPC | DEGLYC PC Processing | 40400037 | $1,082.00 | P9039 |
| %FFP | FFP Administrat | 40400028 | $76.00 | 86927 |
| FFP Processing | 40400033 | $218.00 | P9017 | |
| %FP | FFP(THAWED) Administrat | 40400028 | $76.00 | 86927 |
| FFP(THAWED) Processing | 40400033 | $218.00 | P9017 | |
| %PC | PACKED CELLS Processing | 40400004 | $311.23 | P9021 |
| %PCA | PC-ADSOL Processing | 40400004 | $311.23 | P9021 |
| %PL5 | PLTS 5 DAY Processing | 40400026 | $166.62 | P9019 |
| %PLP | POOLED PLTS Administrat | 40400029 | $150.00 | 86965 |
| %RHG | RHIGG Volume 1 | 40400043 | $121.38 | 90384 |
| %RWB | RECONST WB Volume 1 | 40400044 | $70.80 | P9011 |
| RECONST WB Volume 10 | 40400045 | $70.80 | P9011 | |
| RECONST WB Volume 20 | 40400046 | $80.00 | P9011 | |
| RECONST WB Volume 50 | 40400047 | $118.00 | P9011 | |
| RECONST WB Volume 225 | 40400048 | $196.00 | P9011 | |
| RECONST WB Volume 450 | 40400031 | $399.00 | P9010 | |
| RECONST WB Administrat | 40400030 | $150.00 | 86985 | |
| %WPC | WASHED PC Processing | 40400034 | $1,082.00 | P9022 |
| AFFP | APHERESIS FRESH FROZEN +Administrat | 40400028 | $76.00 | 86927 |
| APHERESIS FRESH FROZEN Processing | 40400033 | $218.00 | P9017 | |
| AP | PACKED CELLS AUTOLOGOUS Processing | 40400004 | $311.23 | P9021 |
| APLI | ACRODOSE PLT LEUKOPOR I+Administrat | 40400035 | $642.00 | P9033 |
| APLK | AUTOLOGOUS PC LEUKO RED+Processing | 40400032 | $429.73 | P9016 |
| APLT | ACRODOSE PLT LEUKOPOR Processing | 40400005 | $540.00 | P9031 |
| AW | WHOLE BLOOD AUTOLOGOUS Processing | 40400031 | $524.09 | P9010 |
| CEPL | INTERCEPT APHERESIS PLT+Processing | 39000031 | $2,332.00 | P9073 |
| CEPL1 | INTERCEPT APHERESIS PLT+Processing | 39000031 | $2,332.00 | P9073 |
| CEPL2 | INTERCEPT APHERESIS PLT+Processing | 39000031 | $2,332.00 | P9073 |
| CEPL3 | INTERCEPT APHERESIS PLT+Processing | 39000031 | $2,332.00 | P9073 |
| CRT | CRYO THAWED Processing | 40400023 | $109.00 | P9012 |
| DPCI | DESIG PEDI CMV NEG PC IRR +Volume 1 | 40400044 | $70.80 | P9011 |
| DESIG PEDI CMV NEG PC IRR Volume 5 | 40400050 | $70.80 | P9011 | |
| DESIG PEDI CMV NEG PC IRR Volume 10 | 40400045 | $70.80 | P9011 | |
| DESIG PEDI CMV NEG PC IRR Volume 20 | 40400046 | $80.00 | P9011 | |
| DESIG PEDI CMV NEG PC IRR Volume 40 | 40400049 | $114.00 | P9011 | |
| DESIG PEDI CMV NEG PC IRR Volume 75 | 40400051 | $234.00 | P9011 | |
| DESIG PEDI CMV NEG PC IRR Administrat | 40400030 | $150.00 | 86985 | |
| 40400019 | $102.00 | 86945 | ||
| DPCN | DESIG PEDI CMV NEG PC Volume 1 | 40400044 | $10.00 | P9011 |
| DESIG PEDI CMV NEG PC Volume 5 | 40400050 | $22.00 | P9011 | |
| DESIG PEDI CMV NEG PC Volume 10 | 40400045 | $42.00 | P9011 | |
| DESIG PEDI CMV NEG PC Volume 20 | 40400046 | $80.00 | P9011 | |
| DESIG PEDI CMV NEG PC Volume 40 | 40400049 | $114.00 | P9011 | |
| DESIG PEDI CMV NEG PC Volume 75 | 40400051 | $234.00 | P9011 | |
| DESIG PEDI CMV NEG PC Administrat | 40400030 | $150.00 | 86985 | |
| DPIL | DES PEDI CMV NEG PC IRR+Volume 1 | 40400044 | $70.80 | P9011 |
| DES PEDI CMV NEG PC IRR Volume 5 | 40400050 | $70.80 | P9011 | |
| DES PEDI CMV NEG PC IRR Volume 10 | 40400045 | $70.80 | P9011 | |
| DES PEDI CMV NEG PC IRR Volume 20 | 40400046 | $70.70 | P9011 | |
| DES PEDI CMV NEG PC IRR Volume 40 | 40400049 | $100.00 | P9011 | |
| DES PEDI CMV NEG PC IRR Volume 75 | 40400051 | $187.50 | P9011 | |
| DES PEDI CMV NEG PC IRR Administrat | 40400030 | $150.00 | 86985 | |
| 40400019 | $102.00 | 86945 | ||
| FFPA | APHERESIS FRESH FROZEN +Administrat | 40400028 | $76.00 | 86927 |
| FFPA | APHERESIS FRESH FROZEN +Processing | 40400033 | $218.00 | P9017 |
| FFPB | APHERESIS FRESH FROZEN +Administrat | 40400028 | $76.00 | 86927 |
| APHERESIS FRESH FROZEN Processing | 40400033 | $218.00 | P9017 | |
| FFPC | APHERESIS FRESH FROZEN +Administrat | 40400028 | $76.00 | 86927 |
| APHERESIS FRESH FROZEN Processing | 40400033 | $218.00 | P9017 | |
| FP24 | FFP FROZEN WITHIN 24 HO+Administrat | 40400028 | $76.00 | 86927 |
| FFP FROZEN WITHIN 24 HO Processing | 40400003 | $218.00 | P9059 | |
| FPAT | FFPA(THAWED) Administrat | 40400028 | $76.00 | 86927 |
| FFPA(THAWED Processing | 40400033 | $218.00 | P9017 | |
| FPBT | FFPB(THAWED) Administrat | 40400028 | $76.00 | 86927 |
| FFPA(THAWED Processing | 40400033 | $218.00 | P9017 | |
| FPCT | FFPC(THAWED) Administrat | 40400028 | $76.00 | 86927 |
| FFPA(THAWED Processing | 40400033 | $218.00 | P9017 | |
| MRHO | MICRORHOGAM Volume 1 | 40400052 | $102.00 | 90385 |
| P3LA | APHERESIS PC AS-3 A LEU+Processing | 40400032 | $429.73 | P9016 |
| P3LB | APHERESIS PC AS-3 B LEU+Processing | 40400032 | $429.73 | P9016 |
| PAIL | PACKED CELLS ADSOL IRR +Processing | 40400040 | $571.71 | P9040 |
| PC3 | PC AS-3 Processing | 40400004 | $311.23 | P9021 |
| PC3A | APHERESIS PC AS-3 A Processing | 40400004 | $311.23 | P9021 |
| PC3B | APHERESIS PC AS-3 B Processing | 40400004 | $311.23 | P9021 |
| PC3L | PC AS-3 LEUKOPOR Processing | 40400032 | $429.73 | P9016 |
| PCA5 | PC AS-5 Processing | 40400004 | $311.23 | P9021 |
| PCAI | ADSOL PC IRRADIATED Processing | 40400039 | $570.26 | P9038 |
| PCAL | PACKED CELLS ADSOL LEUK+Processing | 40400032 | $429.73 | P9016 |
| PCC | PACKED CELLS CMV NEG Processing | 40400004 | $311.23 | P9021 |
| PCCI | CMV NEG PC IRRAD Processing | 40400039 | $570.26 | P9038 |
| PCD | PACKED CELLS DESIGNATED Processing | 40400004 | $330.00 | P9021 |
| PCDI | PC DESIGNATED IRRADIATEDProcessing | 40400039 | $570.26 | P9038 |
| PCDL | PACKED CELLS DESIGNATED+Processing | 40400032 | $429.73 | P9016 |
| PCI | PACKED CELLS IRRADIATED Processing | 40400039 | $570.26 | P9038 |
| PCIL | PLT POOL CMV NG IR LP Administrat | 40400029 | $150.00 | 86965 |
| 40400019 | $102.00 | 86945 | ||
| PCL | PACKED CELLS LEUKOPOR Processing | 40400032 | $429.73 | P9016 |
| PCLA | PACKED CELLS ALYX A LEU+Processing | 40400032 | $429.73 | P9016 |
| PCLB | PACKED CELLS ALYX B LEU+Processing | 40400032 | $429.73 | P9016 |
| PCLC | PACKED CELLS CMV NEG LE+Processing | 40400041 | $360.00 | P9051 |
| PCLI | PLATELET CMVN LEUKOPOR +Processing | 40400035 | $291.59 | P9033 |
| PCNC | PACKED CELL NEONATE CMV+Volume 1 | 40400044 | $70.80 | P9011 |
| PACKED CELL NEONATE CMV Volume 5 | 40400050 | $70.80 | P9011 | |
| PACKED CELL NEONATE CMV Volume 10 | 40400045 | $70.80 | P9011 | |
| PACKED CELL NEONATE CMV Volume 20 | 40400046 | $82.00 | P9011 | |
| PACKED CELL NEONATE CMV Volume 40 | 40400049 | $116.00 | P9011 | |
| PACKED CELL NEONATE CMV Volume 75 | 40400051 | $236.00 | P9011 | |
| PACKED CELL NEONATE CMV Administrat | 40400030 | $150.00 | 86985 | |
| PDIL | PACKED CELLS DES IRR LP+Processing | 40400040 | $571.71 | P9040 |
| PIL | PACKED CELLS IRR LEUKOP+Processing | 40400040 | $571.71 | P9040 |
| PIL1 | PC ALYX A IRR LEUKOPOOR+Processing | 40400040 | $571.71 | P9040 |
| PIL2 | PC ALYX B IRR LEUKOPOOR+Processing | 40400040 | $571.71 | P9040 |
| PILC | PC NEONATE IRR LEUKO CM+Volume 1 | 40400044 | $70.80 | P9011 |
| PC NEONATE IRR LEUKO CM Volume 5 | 40400050 | $70.80 | P9011 | |
| PC NEONATE IRR LEUKO CM Volume 10 | 40400045 | $70.80 | P9011 | |
| PC NEONATE IRR LEUKO CM Volume 20 | 40400046 | $70.80 | P9011 | |
| PC NEONATE IRR LEUKO CM Volume 40 | 40400049 | $100.00 | P9011 | |
| PC NEONATE IRR LEUKO CM Volume 75 | 40400051 | $187.50 | P9011 | |
| PC NEONATE IRR LEUKO CM Administrat | 40400030 | $150.00 | 86985 | |
| 40400019 | $102.00 | 86945 | ||
| PLA7 | PLATELET PHERESIS LEUKO+Processing | 40400036 | $1,171.08 | P9035 |
| PLB7 | PLATELET PHERESIS LEUKO+Processing | 40400036 | $1,171.08 | P9035 |
| PLC | PLATELET CMV NEG Processing | 40400026 | $166.62 | P9019 |
| PLCP | CMV NEG PLT,POOLED Administrat | 40400029 | $150.00 | 86965 |
| PLFP | POOLED FFP Administrat | 40400029 | $150.00 | 86965 |
| PLIL | PLATELETS POOLED IRR LE+Administrat | 40400029 | $150.00 | 86965 |
| 40400019 | $102.00 | 86945 | ||
| PLIP | PLATELETS IRRADIATED, P+Administrat | 40400029 | $150.00 | 86965 |
| 40400019 | $102.00 | 86945 | ||
| PLPL | PLATELETS, POOLED LEUKO+Administrat | 40400029 | $150.00 | 86965 |
| PNCI | PEDI CMV NEG PC IRRADIA+Volume 1 | 40400044 | $70.80 | P9011 |
| PEDI CMV NEG PC IRRADIA Volume 5 | 40400050 | $70.80 | P9011 | |
| PEDI CMV NEG PC IRRADIA Volume 10 | 40400045 | $70.80 | P9011 | |
| PEDI CMV NEG PC IRRADIA Volume 20 | 40400046 | $82.00 | P9011 | |
| PEDI CMV NEG PC IRRADIA Volume 40 | 40400049 | $116.00 | P9011 | |
| PEDI CMV NEG PC IRRADIA Volume 75 | 40400051 | $236.00 | P9011 | |
| PEDI CMV NEG PC IRRADIA Administrat | 40400019 | $102.00 | 86945 | |
| 40400030 | $150.00 | 86985 | ||
| PNCL | PACKED CELLS PEDI CMV N+Volume 1 | 40400044 | $70.80 | P9011 |
| PACKED CELLS PEDI CMV N Volume 5 | 40400050 | $70.80 | P9011 | |
| PACKED CELLS PEDI CMV N Volume 10 | 40400045 | $70.80 | P9011 | |
| PACKED CELLS PEDI CMV N Volume 20 | 40400046 | $70.80 | P9011 | |
| PACKED CELLS PEDI CMV N Volume 40 | 40400049 | $100.00 | P9011 | |
| PACKED CELLS PEDI CMV N Volume 75 | 40400051 | $187.50 | P9011 | |
| PACKED CELLS PEDI CMV N Administrat | 40400030 | $150.00 | 86985 | |
| PNDI | PACKED CELLS CMVN DES I+Processing | 40400039 | $570.26 | P9038 |
| PPAI | PHER PLT LPA IRR Processing | 40400038 | $1,486.55 | P9037 |
| PPBI | PHER PLT LPB IRR Processing | 40400038 | $1,486.55 | P9037 |
| PPCI | PHER PLT LPC IRR Processing | 40400038 | $1,486.55 | P9037 |
| PPCILA | PLT PHER A CMV NEG IRR +Processing | 40400038 | $1,118.00 | P9037 |
| PPCILB | PLT PHER B CMV NEG IRR +Processing | 40400038 | $1,118.00 | P9037 |
| PPCILC | PLT PHER C CMV NEG IRR +Processing | 40400038 | $1,118.00 | P9037 |
| PPCL | PLT PHER CMV NEG LKPO Processing | 40400036 | $1,023.00 | P9035 |
| PPCLA | PHER A PLT CMVN LEUKO Processing | 40400036 | $1,023.00 | P9035 |
| PPCLB | PHER B PLT CMVN LEUKO Processing | 40400036 | $1,023.00 | P9035 |
| PPCLC | PHER C PLT CMVN LEUKO Processing | 40400036 | $1,023.00 | P9035 |
| PPIL | PLATELET PHERESIS IRR L+Processing | 40400038 | $1,486.55 | P9037 |
| PPL7 | PLATELET PHERESIS LEUKO+Processing | 40400036 | $1,171.08 | P9035 |
| PPLA | PLT PHERESIS LEUK A Processing | 40400036 | $1,171.08 | P9035 |
| PPLB | PLT PHERESIS LEUK B Processing | 40400036 | $1,171.08 | P9035 |
| PPLC | PLT PHERESIS LEUK C Processing | 40400036 | $1,171.08 | P9035 |
| PPPL | PLATELET PHERESIS LEUKO+Processing | 40400036 | $1,171.08 | P9035 |
| PSCIL | SPLT PLT PHER CMVN IRR +Volume 10 | 40400048 | $70.80 | P9011 |
| SPLT PLT PHER CMVN IRR Volume 20 | 40400046 | $100.00 | P9011 | |
| SPLT PLT PHER CMVN IRR Volume 40 | 40400049 | $250.00 | P9011 | |
| SPLT PLT PHER CMVN IRR Volume 75 | 40400051 | $375.00 | P9011 | |
| SPLT PLT PHER CMVN IRR Administrat | 40400030 | $150.00 | 86985 | |
| 40400019 | $102.00 | 86945 | ||
| PSCILA | SPLT PLT PHER A CMVN IR+Volume 10 | 40400048 | $50.00 | P9011 |
| SPLT PLT PHER A CMVN IR Volume 20 | 40400046 | $100.00 | P9011 | |
| SPLT PLT PHER A CMVN IR Volume 40 | 40400049 | $200.00 | P9011 | |
| SPLT PLT PHER A CMVN IR Volume 75 | 40400051 | $375.00 | P9011 | |
| SPLT PLT PHER A CMVN IR Administrat | 40400030 | $150.00 | 86985 | |
| 40400019 | $102.00 | 86945 | ||
| PSCILB | SPLT PLT PHER B CMVN IR+Volume 10 | 40400048 | $50.00 | P9011 |
| SPLT PLT PHER B CMVN IR Volume 20 | 40400046 | $100.00 | P9011 | |
| SPLT PLT PHER B CMVN IR Volume 40 | 40400049 | $200.00 | P9011 | |
| SPLT PLT PHER B CMVN IR Volume 75 | 40400051 | $375.00 | P9011 | |
| SPLT PLT PHER B CMVN IR Administrat | 40400030 | $150.00 | 86985 | |
| 40400019 | $102.00 | 86945 | ||
| PSCILC | SPLT PLT PHER C CMVN IR+Volume 10 | 40400048 | $50.00 | P9011 |
| SPLT PLT PHER C CMVN IR Volume 20 | 40400046 | $100.00 | P9011 | |
| SPLT PLT PHER C CMVN IR Volume 40 | 40400049 | $200.00 | P9011 | |
| SPLT PLT PHER C CMVN IR Volume 75 | 40400051 | $375.00 | P9011 | |
| SPLT PLT PHER C CMVN IR Administrat | 40400030 | $150.00 | 86985 | |
| 40400019 | $102.00 | 86945 | ||
| PVIL | PACKED CELLS CMVN IRR L+Processing | 40400042 | $685.68 | P9058 |
| RWBI | RECONSTITUTED WB IRRADI+Volume 1 | 40400044 | $70.80 | P9011 |
| RECONSTITUTED WB IRRAD Volume 10 | 40400045 | $70.80 | P9011 | |
| RECONSTITUTED WB IRRAD Volume 20 | 40400046 | $80.00 | P9011 | |
| RECONSTITUTED WB IRRAD Volume 50 | 40400047 | $118.00 | P9011 | |
| RECONSTITUTED WB IRRAD Volume 225 | 40400048 | $196.00 | P9011 | |
| RECONSTITUTED WB IRRAD Volume 450 | 40400031 | $399.00 | P9010 | |
| RECONSTITUTED WB IRRAD Administrat | 40400019 | $102.00 | 86945 | |
| 40400030 | $150.00 | 86985 | ||
| SPIL | PLATELET IRRADIATED LEU+Processing | 40400035 | $291.59 | P9033 |
