| Item Number | Description | Schedule Fee |
|---|---|---|
| 66731 | TSH quantitation described in item 66716 and 4 tests described in item 66695 (This fee applies where 1 laboratory, or more than 1 laboratory belonging to the same APA, performs the only 5 tests specified on the request form or performs 5 tests and refers the rest to the laboratory of a separate APA) (Item is subject to rule 6) |
$77.40 |
| Total: | $77.40 | |