048-1 Wyo. Code R. § 1-6
Current through April 27, 2019
The following fees shall apply for each test request submitted:
| Chemistry | |
| Fee | Test Description |
| $14.00 | Oral fluid collection kit and 4 drug screen w/confirmation |
| $9.00 | Urine analysis kit and 8 drug screen w/confirmation |
| $9.50 | Blood alcohol collection kit w/confirmation and 10 drug screen |
| $90.00 | 20 drug blood screening panel w/alcohol screen and confirmation |
| $9.00 | Ethyl Glucuronide (ETG) |
| $9.00 | Methadone |
| $9.00 | Propoxyphene |
| $8.00 | Cotinine |
| $23.00 | Synthetic marijuana |
| $23.00 | Inhalants |
| $23.00 | Emerging drugs |
| $9.00 | Toxicology screen |
| $9.00 | Toxicology confirmation |
| Microbiology | ||
| Fee | Test Description | CPT code |
| $8.00 | Drinking water total coliform | N/A |
| $8.00 | Drinking water E. coli screen | N/A |
| $4.00 | Occult blood feces | 82270 |
| $20.00 | Immunoassay for blood fecal | 82274 |
| $15.00 | Chemiluminescent assay | 82397 |
| $45.00 | Electrophoretic test | 82664 |
| $10.00 | Assay IgA/IgD/IgG/IgM each | 82784 |
| $6.00 | IgG 1 2 3 or 4 each | 82787 |
| $15.00 | Immunoassay nonAntibody | 83516 |
| $10.00 | Immunoassay dipstick | 83518 |
| $15.00 | Immunoassay quant nos nonab | 83520 |
| $20.00 | Western blot test | 84181 |
| $20.00 | Protein western blot test | 84182 |
| $4.00 | Bl smear w/o diff wbc count | 85008 |
| $5.00 | Chromogenic substrate assay | 85130 |
| $15.00 | Immunoglobulin assay | 86023 |
| $5.00 | Complement fixation each | 86171 |
| $15.00 | Fluorescent Antibody screen | 86255 |
| $15.00 | Fluorescent Antibody titer | 86256 |
| $5.00 | Heterophile Antibody screen | 86308 |
| $5.00 | Heterophile Antibody titer | 86309 |
| $10.00 | Heterophile Antibody absrbj | 86310 |
| $15.00 | Immunoassay infectious agent | 86318 |
| $10.00 | Particle agglut antbdy scrn | 86403 |
| $10.00 | Particle agglut antbdy titr | 86406 |
| $40.00 | Quantiferon Gold (Tb immun measure) | 86480 |
| $3.00 | Syphilis test non-trep qual | 86592 |
| $5.00 | Syphilis test non-trep quant | 86593 |
| $6.00 | Bacterium Antibody | 86609 |
| $15.00 | Borrelia Antibody | 86619 |
| $15.00 | CMV Antibody | 86644 |
| $15.00 | CMV Antibody IgM | 86645 |
| $20.00 | Diphtheria Antibody | 86648 |
| $15.00 | Encephalitis californ antbdy | 86651 |
| $15.00 | Encephaltis east eqne anbdy | 86652 |
| $15.00 | Encephaltis st louis antbody | 86653 |
| $15.00 | Encephaltis west eqne antbdy | 86654 |
| $15.00 | Epstein-barr Antibody | 86663 |
| $15.00 | Epstein-barr nuclear antigen | 86664 |
| $15.00 | Epstein-barr capsid vca | 86665 |
| $10.00 | Francisella tularensis | 86668 |
| $6.00 | Fungus nes Antibody | 86671 |
| $15.00 | Helicobacter pylori Antibody | 86677 |
| $15.00 | Helminth Antibody | 86682 |
| $15.00 | Herpes simplex nes antbdy | 86694 |
| $15.00 | HIV-1/hIV-2 1 result screen | 86703 |
| $15.00 | Hepatitis B Core Antibody total | 86704 |
| $15.00 | Hepatitis B Core Antibody IgM | 86705 |
| $15.00 | Hepatitis B Surface Antibody | 86706 |
| $15.00 | Hepatitis A Antibody total | 86708 |
| $15.00 | Hepatitis A Antibody IgM | 86709 |
| $15.00 | Legionella Antibody | 86713 |
| $15.00 | Leishmania Antibody | 86717 |
| $15.00 | Leptospira Antibody | 86720 |
| $6.00 | Mumps Antibody | 86735 |
| $15.00 | Mycoplasma Antibody | 86738 |
| $15.00 | Neisseria meningitidis | 86741 |
| $15.00 | Parvovirus Antibody | 86747 |
| $14.00 | Protozoa Antibody nos | 86753 |
| $20.00 | Rickettsia Antibody | 86757 |
| $6.00 | Rubella Antibody | 86762 |
| $6.00 | Rubeola Antibody | 86765 |
| $15.00 | Toxoplasma Antibody | 86777 |
| $15.00 | Toxoplasma Antibody IgM | 86778 |
| $15.00 | Treponema pallidum | 86780 |
| $5.00 | Trichinella Antibody | 86784 |
| $6.00 | Varicella-zoster Antibody | 86787 |
| $20.00 | West Nile virus ab IgM | 86788 |
| $20.00 | West Nile virus Antibody | 86789 |
| $15.00 | Virus Antibody nos | 86790 |
| $20.00 | Hepatitis C Antibody | 86803 |
| $5.00 | Specimen infect agnt concntj | 87015 |
| $5.00 | Feces culture aerobic bact | 87045 |
| $5.00 | Stool cultr aerobic bact ea | 87046 |
| $5.00 | Culture othr specimn aerobic | 87070 |
| $5.00 | Culture aerobic quant other | 87071 |
| $5.00 | Culture bacteria anaerobic | 87073 |
| $5.00 | Cultr bacteria except blood | 87075 |
| $10.00 | Culture anaerobe ident each | 87076 |
| $10.00 | Culture aerobic identify | 87077 |
| $5.00 | Culture screen only | 87081 |
| $10.00 | Culture of specimen by kit | 87084 |
| $5.00 | Urine culture/colony count | 87086 |
| $5.00 | Skin fungi culture | 87101 |
| $5.00 | Fungus isolation culture | 87102 |
| $5.00 | Fungi identification yeast | 87106 |
| $5.00 | Fungi identification mold | 87107 |
| $5.00 | Mycoplasma | 87109 |
| $10.00 | Mycobacteria culture | 87116 |
| $10.00 | Mycobacteric identification | 87118 |
| $25.00 | DNA/RNA direct probe | 87149 |
| $40.00 | DNA/RNA amplified probe | 87150 |
| $50.00 | Culture type pulse field gel (PFGE) | 87152 |
| $50.00 | DNA/RNA sequencing | 87153 |
| $4.00 | Macroscopic exam arthropod | 87168 |
| $4.00 | Macroscopic exam parasite | 87169 |
| $4.00 | Pinworm exam | 87172 |
| $5.00 | Tissue homogenization cultr | 87176 |
| $8.00 | Ova and parasites smears | 87177 |
| $5.00 | Microbe susceptible diffuse | 87181 |
| $5.00 | Microbe susceptible disk | 87184 |
| $10.00 | Microbe susceptible mic | 87186 |
| $10.00 | Microbe susceptible mlc | 87187 |
| $3.00 | Smear fluorescent/acid stai | 87206 |
| $5.00 | Smear special stain | 87207 |
| $15.00 | Smear complex stain | 87209 |
| $3.00 | Smear wet mount saline/ink | 87210 |
| $25.00 | Assay toxin or antitoxin | 87230 |
| $15.00 | Cryptosporidium ag if | 87272 |
| $15.00 | Legionella micdadei ag if | 87277 |
| $15.00 | Legion pneumophilia ag if | 87278 |
| $15.00 | Pneumocystis carinii ag if | 87281 |
| $16.32 | Antibody detection nos if | 87299 |
| $15.00 | Adenovirus ag eia | 87301 |
| $15.00 | Aspergillus ag eia | 87305 |
| $15.00 | Chylmd trach ag eia | 87320 |
| $15.00 | Cryptococcus neoform ag eia | 87327 |
| $15.00 | Cryptosporidium ag eia | 87328 |
| $15.00 | Giardia ag eia | 87329 |
| $15.00 | Cytomegalovirus ag eia | 87332 |
| $15.00 | E. coli 0157 ag eia | 87335 |
| $15.00 | H. pylori stool eia | 87338 |
| $15.00 | H. pylori ag eia | 87339 |
| $15.00 | Hepatitis B Surface Antigen | 87340 |
| $15.00 | Histoplasma capsul ag eia | 87385 |
| $15.00 | Influenza A/B ag eia | 87400 |
| $15.00 | Resp syncytial ag eia | 87420 |
| $15.00 | Rotavirus ag eia | 87425 |
| $15.00 | Shiga-like toxin ag eia | 87427 |
| $15.00 | Ag detect nos eia mult | 87449 |
| $13.00 | Ag detect nos eia single | 87450 |
| $13.00 | Ag detect polyval eia mult | 87451 |
| $40.00 | Bartonella DNA amp probe | 87471 |
| $40.00 | Lyme dis DNA amp probe | 87476 |
| $40.00 | Candida DNA amp probe | 87481 |
| $40.00 | Chylmd pneum DNA amp probe | 87486 |
| $12.00 | Chylmd trach DNA amp probe | 87491 |
| $14.00 | Chylmd trach and N. gono DNA amp probe | 87491 |
| $40.00 | C. diff amplified probe | 87493 |
| $40.00 | Cytomeg DNA amp probe | 87496 |
| $40.00 | Enterovirus probe&revrs trns | 87498 |
| $20.00 | Influenza DNA amp prob 1+ | 87501 |
| $20.00 | Influenza DNA amp probe | 87502 |
| $100.00 | Nfct agent detection gi | 87505 |
| $150.00 | IaDNA-DNA/RNA probe tq 6-11 | 87506 |
| $250.00 | IaDNA-DNA/RNA probe tq 12-25 | 87507 |
| $40.00 | Hepatitis B DNA amp probe | 87516 |
| $50.00 | Hepatitis B DNA quant | 87517 |
| $25.00 | Hepatitis C RNA dir probe | 87520 |
| $40.00 | Hepatitis C probe&rvrs trnsc | 87521 |
| $55.00 | Hepatitis C revrs trnscrp | 87522 |
| $45.00 | Hsv DNA amp probe | 87529 |
| $45.00 | HIV-1 probe&reverse trnscrpj | 87535 |
| $115.00 | HIV-1 quant&revrse trnscrpj | 87536 |
| $25.00 | Legion pneumo DNA dir prob | 87540 |
| $40.00 | Legion pneumo DNA amp prob | 87541 |
| $56.82 | Legion pneumo DNA quant | 87542 |
| $20.00 | Mycobacteria DNA dir probe | 87550 |
| $40.00 | Mycobacteria DNA amp probe | 87551 |
| $20.00 | M.tuberculo DNA dir probe | 87555 |
| $40.00 | M.tuberculo DNA amp probe | 87556 |
| $20.00 | M.avium-intra DNA dir prob | 87560 |
| $40.00 | M.avium-intra DNA amp prob | 87561 |
| $40.00 | M.pneumon DNA amp probe | 87581 |
| $12.00 | N.gonorrhoeae DNA amp prob | 87591 |
| $45.00 | HPV low-risk types | 87623 |
| $45.00 | HPV high-risk types | 87624 |
| $45.00 | HPV types 16 & 18 only | 87625 |
| $100.00 | Resp virus 3-11 targets | 87631 |
| $150.00 | Resp virus 6-11 targets | 87632 |
| $200.00 | Resp virus 12-25 targets | 87633 |
| $47.76 | Staph a DNA amp probe | 87640 |
| $47.76 | Mr-Staph DNA amp probe | 87641 |
| $27.29 | Strep A DNA dir probe | 87650 |
| $47.76 | Strep A DNA amp probe | 87651 |
| $47.76 | Strep B DNA amp probe | 87653 |
| $45.00 | Trichomonas vaginalis amplif | 87661 |
| $25.00 | Detect agent nos DNA dir | 87797 |
| $35.00 | Pertussis (PCR) | 87798 |
| $40.00 | Norovirus molecular | 87798 |
| $40.00 | Detect agent nos DNA amp | 87798 |
| $55.00 | Detect agent nos DNA quant | 87799 |
| $50.00 | Detect agnt mult DNA direc | 87800 |
| $95.00 | Detect agnt mult DNA ampli | 87801 |
| $16.32 | Strep B assay w/optic | 87802 |
| $30.00 | HIV antigen w/HIV antibodies | 87806 |
| $15.00 | RSV assay w/optic | 87807 |
| $15.00 | Adenovirus assay w/optic | 87809 |
| $6.00 | Group A Strep assay | 87880 |
| $16.32 | Agent nos assay w/optic | 87899 |
| $300.00 | Genotype DNA/RNA Hep C | 87902 |
| $250.00 | Genotype DNA Hepatitis B | 87912 |
| $26.88 | Protein analysis w/probe | 88372 |
| $15.00 | HIV-1/HIV-2 confirm | 86703-92 |
048-1 Wyo. Code R. § 1-6
Amended, Eff. 1/13/2016.