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OFFICE OF THE SECRETARY OF STATE ARCHIVES DIVISION BEV CLARNO STEPHANIE CLARK SECRETARY OF STATE DIRECTOR

800 SUMMER STREET NE SALEM, OR 97310 503-373-0701

NOTICE OF PROPOSED RULEMAKING INCLUDING STATEMENT OF NEED & FISCAL IMPACT FILED 01/29/2020 5:02 PM CHAPTER 333 ARCHIVES DIVISION OREGON HEALTH AUTHORITY SECRETARY OF STATE PUBLIC HEALTH DIVISION

FILING CAPTION: Update and clarification of Oregon State Public Health Laboratory communicable disease testing fees language

LAST DAY AND TIME TO OFFER COMMENT TO AGENCY: 03/09/2020 5:00 PM The Agency requests public comment on whether other options should be considered for achieving the rule's substantive goals while reducing negative economic impact of the rule on business.

CONTACT: Brittany Hall 800 NE Oregon St. Suite 930 Filed By: 503-449-9808 Portland,OR 97232 Brittany Hall [email protected] Rules Coordinator

HEARING(S) Auxilary aids for persons with disabilities are available upon advance request. Notify the contact listed above. DATE: 03/09/2020 TIME: 9:30 AM OFFICER: Staff ADDRESS: Portland State Office Building 800 NE Oregon St. Room 1B Portland, OR 97232

NEED FOR THE RULE(S):

The Oregon Health Authority, Public Health Division, Oregon State Public Health Laboratory (OSPHL) is proposing to update the rule regarding fees for laboratory services performed. The rule revision seeks to permit the OSPHL to accept payment from public insurance plans. The revision will also clarify the ultimate payer for outstanding charges and update language for clarity. The language also removes fees for specimens submitted in unsatisfactory condition as it does not align with current OSPHL procedures. Finally, the OAR has been re-numbered from OAR 333-024-0240 to distinguish it from rules used by another section for clarity of use.

DOCUMENTS RELIED UPON, AND WHERE THEY ARE AVAILABLE:

ORS chapter 431A: https://www.oregonlegislature.gov/bills_laws/ors/ors431A.html

FISCAL AND ECONOMIC IMPACT:

The rule language does not obligate any entity to submit specimens to, contract with, or remit payment to the OSPHL. However, if specimens are submitted to OSPHL, OSPHL intends to bill public and private insurance plans, Local Public

Page 1 of 26 Health Authorities (LPHAs) or other entities that submit specimens to the OSPHL for testing. Insurance plans may include but may not be limited to Medicaid, including Coordinated Care Organizations (CCOs), Medicare, or private insurance plans. Beginning in 2020, CCOs will be required to consider the OSPHL as an in-network laboratory on their plans as part of their contact with the Oregon Health Authority.

Insurance plans may pay the OSPHL for services rendered for their enrolled members. For plans that currently contract with or remit payment to the OSPHL, there is not expected to be a fiscal impact due to these changes. If new plans contract with or remit payment to the OSPHL, the plan may not incur additional cost if payments are only being directed to an alternate laboratory. A plan may incur additional cost for laboratory services if payment was not previously remitted to another laboratory or if in the past OSPHL did not bill the plan for laboratory testing.

Some LPHAs or entities submitting specimens to the OSPHL may incur a lower fiscal impact because services will be paid by the insurance plan rather than by their organizations.

The rule clarifies the ultimate payer for outstanding charges. The OSPHL does not anticipate this language will result in a fiscal impact because the language puts into rule current operational practice.

The OSPHL anticipates a positive impact to the laboratory revenue streams. The OSPHL will be able to proceed with contracting with public and private insurance plans to obtain payment for laboratory services rendered.

COST OF COMPLIANCE: (1) Identify any state agencies, units of local government, and members of the public likely to be economically affected by the rule(s). (2) Effect on Small Businesses: (a) Estimate the number and type of small businesses subject to the rule(s); (b) Describe the expected reporting, recordkeeping and administrative activities and cost required to comply with the rule(s); (c) Estimate the cost of professional services, equipment supplies, labor and increased administration required to comply with the rule(s).

(1) There may be a cost to the state associated with administrative activities for executing contracts. There is no anticipated cost of compliance impact on units of local government or the public as a result of the proposed changes.

(2)(a) CCOs and entities submitting specimens to the OSPHL that meet the definition of a small business may be subject to this rule. Currently 265 total entities submit specimens to the OSPHL.

It is currently unknown how many entities submitting specimens and CCOs meet the definition of a small business. The OSPHL does not collect data on the number of employees at entities submitting specimens for testing. OSPHL staff attempted to discern the number of staff employed by CCOs and was unable to glean that information.

(b) If contracts are implemented, there may be a marginal increase for public or private insurance plans that meet the definition of a small business to review, track, and sign contracts.

The OSPHL does not anticipate additional costs in this area for entities that submit specimens to the OSPHL.

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Any CCO may remit payment to the OSPHL.

(c) There is no increased need for equipment or supplies for compliance. Public or private insurance plans that meet the definition of a small business may experience an increase in labor and administration needed to implement contracts, if they are pursued.

DESCRIBE HOW SMALL BUSINESSES WERE INVOLVED IN THE DEVELOPMENT OF THESE RULE(S):

A Rules Advisory Committee (RAC) was held. It is unknown whether representatives’ organizations are considered small businesses. The OSPHL expects small businesses will likely be notified during the Notice to Interested Parties process.

WAS AN ADMINISTRATIVE RULE ADVISORY COMMITTEE CONSULTED? YES

AMEND: 333-024-2000

RULE SUMMARY: Amend OAR 333-024-2000 (renumbered from OAR 333-024-0240): • Add language stating that the OSPHL shall accept payment for testing services from Medicare and Medicaid health plans, including Coordinated Care Organizations, at the payment rates required by those programs, thereby permitting the OSPHL to accept payment from public insurance plans. • Clarify the payer responsible for remitting payment to the OSPHL for outstanding charges as the person submitting the specimen to the OSPHL. This aligns OAR with current operations. • Remove language regarding charging submitters for specimens that are unsatisfactory for testing to align with OSPHL authority and current practices. • Remove unnecessary language, update and clarify language.

CHANGES TO RULE:

333-024-2000 Fees for Communicable Disease Tests Performed in the State Laboratory ¶

(1)(a) The person responsible for submitting communicable disease specimens for those tests performed on specimens received in the state public health laboratory on or after March 1, 2014, shall pay a test fee upon billing by the Authority, in accordance withState public health laboratory maximum fees for testing performed are based on the August 2013 Division of Medical Assistance Programs Fee for Service Fee Schedule.¶ (b) Public and private non-profit agencies may apply for a reduction or waiver of the test fees stated in subsection (1)(a) of this rule. Reduction or waiver requests must be sent to the director of the state public health laboratory and be accompanied by proof of non-profit status. Requests should include the estimated number and type of tests anticipated per year. The decision to reduce or waive fees is discretionary withThe person submitting the specimen shall bear ultimate responsibility for remitting payment of state public health laboratory fees.¶ (2) Notwithstanding the fees charged by the state public health laboratory.¶ (2) Specimens which are submitted in an inadequate quantity or any unsatisfactory condition shall be subject to the fee of $5 per repeat specimen except for newborn screening specimens, which may be subject to a ch for testing, the state public health laboratory shall accept payment for testing services from Medicarge of $59 per specimen. Additional specimens from the same infant or patient specifically required or requested by the state public health laboratory, but not because the original specimen was inadequate or unsatisfactory, shall be exempt from additional fees.¶

Page 3 of 26 (3) For tests performed fand Medicaid health plans at the rates established by these programs or plans, including Coordinated Care Organizations (CCOs).¶ (3) A non-profit cor por on behalf of Oregonation or state or local government agencies, as determined by the administraal organization may apply tor to have a significant public health impact, a lesser fee, calculated to recover cohe state public health laboratory for a reduction or waiver of test fees stated in subsection (1)(a) of this rule. Reduction or waiver requests, mayust be charged.¶ (4) All specimens submitted tosent to the director of the state public health laboratory shall be collected according to procedures, protocols, and shipping instructions specified on the Oregon Sand be accompanied by proof of non- profit status. Requests should include the estimated number and type of tests anticipated per year. The state Pp ublic Hhealth Llaboratory's website may, in its discretion, reduce or waive test fees. Statutory/Other Authority: ORS 433.285, ORS 431A.750 Statutes/Other Implemented: 433.285, ORS 431A.750

RULE ATTACHMENTS DO NOT SHOW CHANGES. PLEASE CONTACT AGENCY REGARDING CHANGES.

Page 4 of 26 DMAP Fee for Service Fee Schedule August 2013

Procedure Code Description Mod 1 Mod 2 Rate Type Price Effective Date 80047 METABOLIC PANEL IONIZED CA $8.14 20130101 80048 METABOLIC PANEL TOTAL CA $8.14 20130101 80050 GENERAL HEALTH PANEL $36.75 20011001 80051 ELECTROLYTE PANEL $6.75 20130101 80053 COMPREHEN METABOLIC PANEL $10.17 20130101 80055 OBSTETRIC PANEL $40.00 20011001 80061 LIPID PANEL $12.89 20130101 80069 RENAL FUNCTION PANEL $8.36 20130101 80074 ACUTE PANEL $45.83 20130101 80076 HEPATIC FUNCTION PANEL $7.86 20130101 80102 DRUG CONFIRMATION $12.74 20130101 80104 DRUG SCRN 1 CLASS NONCHROMO $17.85 20130101 80150 ASSAY OF AMIKACIN $14.50 20130101 80152 ASSAY OF AMITRIPTYLINE $17.23 20130101 80154 ASSAY OF BENZODIAZEPINES $17.79 20130101 80156 ASSAY CARBAMAZEPINE TOTAL $14.01 20130101 80157 ASSAY CARBAMAZEPINE FREE $12.75 20130101 80158 ASSAY OF CYCLOSPORINE $17.37 20130101 80160 ASSAY OF DESIPRAMINE $16.56 20130101 80162 ASSAY OF DIGOXIN $12.78 20130101 80164 ASSAY DIPROPYLACETIC ACID $13.04 20130101 80166 ASSAY OF DOXEPIN $14.91 20130101 80168 ASSAY OF ETHOSUXIMIDE $15.73 20130101 80170 ASSAY OF GENTAMICIN $15.77 20130101 80172 ASSAY OF GOLD $15.67 20130101 80173 ASSAY OF HALOPERIDOL $14.01 20130101 80174 ASSAY OF IMIPRAMINE $16.56 20130101 80176 ASSAY OF LIDOCAINE $14.13 20130101 80178 ASSAY OF LITHIUM $6.36 20130101 80182 ASSAY OF NORTRIPTYLINE $13.04 20130101 80184 ASSAY OF PHENOBARBITAL $11.02 20130101 80185 ASSAY OF PHENYTOIN TOTAL $12.75 20130101 80186 ASSAY OF PHENYTOIN FREE $13.24 20130101 80188 ASSAY OF PRIMIDONE $15.97 20130101 80190 ASSAY OF PROCAINAMIDE $16.12 20130101 80192 ASSAY OF PROCAINAMIDE $16.12 20130101 80194 ASSAY OF QUINIDINE $14.05 20130101 80195 ASSAY OF SIROLIMUS $13.21 20130101 80196 ASSAY OF SALICYLATE $6.83 20130101 80197 ASSAY OF TACROLIMUS $13.21 20130101 80198 ASSAY OF THEOPHYLLINE $13.62 20130101 80200 ASSAY OF TOBRAMYCIN $15.51 20130101 80201 ASSAY OF TOPIRAMATE $11.47 20130101 80202 ASSAY OF VANCOMYCIN $13.04 20130101 80299 QUANTITATIVE ASSAY DRUG $13.18 20130101 80400 ACTH STIMULATION PANEL $31.37 20130101 80402 ACTH STIMULATION PANEL $83.66 20130101 80406 ACTH STIMULATION PANEL $75.29 20130101 80408 ALDOSTERONE SUPPRESSION EVAL $120.76 20130101 80410 CALCITONIN STIMUL PANEL $77.32 20130101 80412 CRH STIMULATION PANEL $317.14 20130101 80416 RENIN STIMULATION PANEL $127.01 20130101 80417 RENIN STIMULATION PANEL $42.34 20130101 80418 PITUITARY EVALUATION PANEL $557.70 20130101 80420 DEXAMETHASONE PANEL $69.30 20130101 80422 GLUCAGON TOLERANCE PANEL $44.31 20130101 80424 GLUCAGON TOLERANCE PANEL $48.59 20130101 80426 GONADOTROPIN HORMONE PANEL $142.80 20130101

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Page 5 of 26 DMAP Fee for Service Fee Schedule August 2013

80428 GROWTH HORMONE PANEL $64.20 20130101 80430 GROWTH HORMONE PANEL $75.52 20130101 80432 INSULIN SUPPRESSION PANEL $130.00 20130101 80434 INSULIN TOLERANCE PANEL $97.30 20130101 80435 INSULIN TOLERANCE PANEL $99.12 20130101 80436 METYRAPONE PANEL $87.71 20130101 80438 TRH STIMULATION PANEL $48.51 20130101 80439 TRH STIMULATION PANEL $64.68 20130101 80440 TRH STIMULATION PANEL $55.94 20130101 80500 LAB PATHOLOGY CONSULTATION $14.84 20130101 80502 LAB PATHOLOGY CONSULTATION $47.84 20130101 81000 URINALYSIS NONAUTO W/SCOPE $3.05 20130101 81001 URINALYSIS AUTO W/SCOPE $3.05 20130101 81002 URINALYSIS NONAUTO W/O SCOPE $2.46 20130101 81003 URINALYSIS AUTO W/O SCOPE $2.16 20130101 81005 URINALYSIS $2.09 20130101 81007 URINE SCREEN FOR BACTERIA $2.47 20130101 81015 MICROSCOPIC EXAM OF URINE $2.93 20130101 81020 URINALYSIS GLASS TEST $3.55 20130101 81025 URINE PREGNANCY TEST $6.09 20130101 81050 URINALYSIS VOLUME MEASURE $2.88 20130101 81201 APC GENE FULL SEQUENCE $1,602.00 20130701 81202 APC GENE KNOWN FAM VARIANTS $428.00 20130701 81203 APC GENE DUP/DELET VARIANTS $243.00 20130701 81211 BRCA12 SEQ COM DUP/DEL $3,006.00 20130701 81212 BRCA12 18553856174 VAR $518.00 20130701 81214 BRCA1 FULL SEQ COM DUP/DEL $1,575.00 20130701 81215 BRCA1 GENE KNOWN FAM VARIANT $428.00 20130701 81216 BRCA2 GENE FULL SEQUENCE $1,881.00 20130701 81217 BRCA2 GENE KNOWN FAM VARIANT $428.00 20130701 81292 MLH1 GENE FULL SEQ $1,017.00 20130701 81293 MLH1 GENE KNOWN VARIANTS $428.00 20130701 81294 MLH1 GENE DUP/DELETE VARIANT $243.00 20130701 81295 MSH2 GENE FULL SEQ $837.00 20130701 81296 MSH2 GENE KNOWN VARIANTS $428.00 20130701 81297 MSH2 GENE DUP/DELETE VARIANT $243.00 20130701 81298 MSH6 GENE FULL SEQ $981.00 20130701 81299 MSH6 GENE KNOWN VARIANTS $428.00 20130701 81300 MSH6 GENE DUP/DELETE VARIANT $234.00 20130701 81317 PMS2 GENE FULL SEQ ANALYSIS $1,017.00 20130701 81318 PMS2 KNOWN FAMILIAL VARIANTS $428.00 20130701 81319 PMS2 GENE DUP/DELET VARIANTS $243.00 20130701 81401 MOPATH PROCEDURE LEVEL 2 $360.00 20130701 81403 MOPATH PROCEDURE LEVEL 4 $428.00 20130701 81406 MOPATH PROCEDURE LEVEL 7 $1,206.00 20130701 82000 ASSAY OF BLOOD ACETALDEHYDE $11.92 20130101 82003 ASSAY OF ACETAMINOPHEN $19.47 20130101 82009 TEST FOR ACETONE/KETONES $4.35 20130101 82010 ACETONE ASSAY $7.86 20130101 82013 ACETYLCHOLINESTERASE ASSAY $10.75 20130101 82016 ACYLCARNITINES QUAL $13.34 20130101 82017 ACYLCARNITINES QUANT $16.23 20130101 82024 ASSAY OF ACTH $37.17 20130101 82030 ASSAY OF ADP AMP $15.41 20130101 82040 ASSAY OF $4.76 20130101 82042 ASSAY OF URINE ALBUMIN $4.98 20130101 82043 MICROALBUMIN QUANTITATIVE $5.57 20130101 82044 MICROALBUMIN SEMIQUANT $4.40 20130101 82045 ALBUMIN ISCHEMIA MODIFIED $32.66 20130101 82055 ASSAY OF ETHANOL $10.40 20130101

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Page 6 of 26 DMAP Fee for Service Fee Schedule August 2013

82075 ASSAY OF BREATH ETHANOL $11.60 20130101 82085 ASSAY OF ALDOLASE $9.34 20130101 82088 ASSAY OF ALDOSTERONE $39.21 20130101 82101 ASSAY OF URINE ALKALOIDS $28.88 20130101 82103 ALPHA-1-ANTITRYPSIN TOTAL $12.93 20130101 82104 ALPHA-1-ANTITRYPSIN PHENO $13.92 20130101 82105 ALPHA-FETOPROTEIN SERUM $15.41 20130101 82106 ALPHA-FETOPROTEIN AMNIOTIC $15.41 20130101 82108 ASSAY OF ALUMINUM $15.39 20130101 82120 AMINES VAGINAL FLUID QUAL $3.04 20130101 82127 AMINO ACID SINGLE QUAL $13.34 20130101 82128 AMINO ACIDS MULT QUAL $13.34 20130101 82131 AMINO ACIDS SINGLE QUANT $16.23 20130101 82135 ASSAY AMINOLEVULINIC ACID $15.83 20130101 82136 AMINO ACIDS QUANT 2-5 $16.23 20130101 82139 AMINO ACIDS QUAN 6 OR MORE $16.23 20130101 82140 ASSAY OF AMMONIA $14.02 20130101 82143 AMNIOTIC FLUID SCAN $6.61 20130101 82145 ASSAY OF AMPHETAMINES $14.95 20130101 82150 ASSAY OF AMYLASE $6.24 20130101 82154 ANDROSTANEDIOL GLUCURONIDE $27.74 20130101 82157 ASSAY OF ANDROSTENEDIONE $28.17 20130101 82160 ASSAY OF ANDROSTERONE $24.06 20130101 82163 ASSAY OF ANGIOTENSIN II $19.75 20130101 82164 ANGIOTENSIN I ENZYME TEST $14.05 20130101 82172 ASSAY OF APOLIPOPROTEIN $14.91 20130101 82175 ASSAY OF ARSENIC $18.26 20130101 82180 ASSAY OF ASCORBIC ACID $9.51 20130101 82190 ATOMIC ABSORPTION $14.34 20130101 82205 ASSAY OF BARBITURATES $11.02 20130101 82232 ASSAY OF BETA-2 $15.57 20130101 82239 ACIDS TOTAL $16.49 20130101 82240 BILE ACIDS CHOLYLGLYCINE $25.57 20130101 82247 BILIRUBIN TOTAL $4.83 20130101 82248 BILIRUBIN DIRECT $4.83 20130101 82252 FECAL BILIRUBIN TEST $4.38 20130101 82261 ASSAY OF BIOTINIDASE $16.23 20130101 82270 OCCULT BLOOD FECES $3.14 20130101 82271 OCCULT BLOOD OTHER SOURCES $3.14 20130101 82272 OCCULT BLD FECES 1-3 TESTS $3.14 20130101 82274 ASSAY TEST FOR BLOOD FECAL $15.30 20130101 82286 ASSAY OF BRADYKININ $6.63 20130101 82300 ASSAY OF CADMIUM $19.71 20130101 82306 VITAMIN D 25 HYDROXY $23.09 20130101 82308 ASSAY OF CALCITONIN $25.77 20130101 82310 ASSAY OF CALCIUM $4.96 20130101 82330 ASSAY OF CALCIUM $13.15 20130101 82331 CALCIUM INFUSION TEST $4.98 20130101 82340 ASSAY OF CALCIUM IN URINE $5.02 20130101 82355 CALCULUS ANALYSIS QUAL $11.14 20130101 82360 CALCULUS ASSAY QUANT $12.38 20130101 82365 CALCULUS SPECTROSCOPY $12.40 20130101 82370 X-RAY ASSAY CALCULUS $12.05 20130101 82373 ASSAY C-D TRANSFER MEASURE $17.37 20130101 82374 ASSAY BLOOD CARBON DIOXIDE $4.70 20130101 82375 ASSAY CARBOXYHB QUANT $11.86 20130101 82376 ASSAY CARBOXYHB QUAL $5.36 20130101 82378 CARCINOEMBRYONIC ANTIGEN $18.26 20130101 82379 ASSAY OF CARNITINE $16.23 20130101 82380 ASSAY OF CAROTENE $8.88 20130101

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Page 7 of 26 DMAP Fee for Service Fee Schedule August 2013

82382 ASSAY URINE CATECHOLAMINES $16.55 20130101 82383 ASSAY BLOOD CATECHOLAMINES $20.15 20130101 82384 ASSAY THREE CATECHOLAMINES $24.30 20130101 82387 ASSAY OF -D $20.03 20130101 82390 ASSAY OF $10.33 20130101 82397 CHEMILUMINESCENT ASSAY $13.59 20130101 82415 ASSAY OF CHLORAMPHENICOL $12.19 20130101 82435 ASSAY OF BLOOD CHLORIDE $4.42 20130101 82436 ASSAY OF URINE CHLORIDE $4.84 20130101 82438 ASSAY OTHER FLUID CHLORIDES $4.70 20130101 82441 TEST FOR CHLOROHYDROCARBONS $5.78 20130101 82465 ASSAY BLD/SERUM CHOLESTEROL $4.19 20130101 82480 ASSAY SERUM CHOLINESTERASE $7.58 20130101 82482 ASSAY RBC CHOLINESTERASE $7.39 20130101 82485 ASSAY $19.87 20130101 82486 GAS/LIQUID CHROMATOGRAPHY $17.37 20130101 82487 PAPER CHROMATOGRAPHY $13.88 20130101 82488 PAPER CHROMATOGRAPHY $20.56 20130101 82489 THIN LAYER CHROMATOGRAPHY $17.80 20130101 82491 CHROMOTOGRAPHY QUANT SING $17.37 20130101 82492 CHROMOTOGRAPHY QUANT MULT $17.37 20130101 82495 ASSAY OF CHROMIUM $19.52 20130101 82507 ASSAY OF CITRATE $26.75 20130101 82520 ASSAY OF COCAINE $14.58 20130101 82523 COLLAGEN CROSSLINKS $17.98 20130101 82525 ASSAY OF $11.94 20130101 82528 ASSAY OF CORTICOSTERONE $21.67 20130101 82530 CORTISOL FREE $16.08 20130101 82533 TOTAL CORTISOL $15.69 20130101 82540 ASSAY OF CREATINE $4.46 20130101 82541 COLUMN CHROMOTOGRAPHY QUAL $17.37 20130101 82542 COLUMN CHROMOTOGRAPHY QUANT $17.37 20130101 82543 COLUMN CHROMOTOGRAPH/ISOTOPE $17.37 20130101 82544 COLUMN CHROMOTOGRAPH/ISOTOPE $17.37 20130101 82550 ASSAY OF CK CPK $6.27 20130101 82552 ASSAY OF CPK IN BLOOD $12.89 20130101 82553 CREATINE MB FRACTION $11.11 20130101 82554 CREATINE ISOFORMS $11.42 20130101 82565 ASSAY OF CREATININE $4.93 20130101 82570 ASSAY OF URINE CREATININE $4.98 20130101 82575 CREATININE CLEARANCE TEST $9.09 20130101 82585 ASSAY OF CRYOFIBRINOGEN $8.26 20130101 82595 ASSAY OF CRYOGLOBULIN $6.22 20130101 82600 ASSAY OF CYANIDE $18.66 20130101 82607 VITAMIN B-12 $14.50 20130101 82608 B-12 BINDING CAPACITY $13.78 20130101 82615 TEST FOR URINE CYSTINES $7.85 20130101 82626 DEHYDROEPIANDROSTERONE $24.32 20130101 82627 DEHYDROEPIANDROSTERONE $21.39 20130101 82633 DESOXYCORTICOSTERONE $29.81 20130101 82634 DEOXYCORTISOL $28.17 20130101 82638 ASSAY OF DIBUCAINE NUMBER $11.79 20130101 82646 ASSAY OF DIHYDROCODEINONE $19.87 20130101 82649 ASSAY OF DIHYDROMORPHINONE $24.74 20130101 82651 ASSAY OF DIHYDROTESTOSTERONE $24.84 20130101 82652 VIT D 1 25-DIHYDROXY $37.04 20130101 82654 ASSAY OF DIMETHADIONE $13.32 20130101 82656 PANCREATIC ELASTASE FECAL $11.10 20130101 82657 ENZYME CELL ACTIVITY $17.37 20130101 82658 ENZYME CELL ACTIVITY RA $17.37 20130101

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Page 8 of 26 DMAP Fee for Service Fee Schedule August 2013

82664 ELECTROPHORETIC TEST $33.06 20130101 82666 ASSAY OF EPIANDROSTERONE $20.67 20130101 82668 ASSAY OF ERYTHROPOIETIN $18.09 20130101 82670 ASSAY OF ESTRADIOL $26.89 20130101 82671 ASSAY OF ESTROGENS $31.08 20130101 82672 ASSAY OF ESTROGEN $20.87 20130101 82677 ASSAY OF ESTRIOL $23.28 20130101 82679 ASSAY OF ESTRONE $24.02 20130101 82690 ASSAY OF ETHCHLORVYNOL $16.63 20130101 82693 ASSAY OF ETHYLENE GLYCOL $14.34 20130101 82696 ASSAY OF ETIOCHOLANOLONE $22.69 20130101 82705 FATS/LIPIDS FECES QUAL $4.26 20130101 82710 FATS/LIPIDS FECES QUANT $16.17 20130101 82715 ASSAY OF FECAL FAT $16.56 20130101 82725 ASSAY OF BLOOD FATTY ACIDS $12.81 20130101 82726 LONG CHAIN FATTY ACIDS $17.37 20130101 82728 ASSAY OF $8.41 20130101 82731 ASSAY OF FETAL $61.98 20130101 82735 ASSAY OF FLUORIDE $17.84 20130101 82742 ASSAY OF FLURAZEPAM $19.05 20130101 82746 ASSAY OF FOLIC ACID SERUM $14.15 20130101 82747 ASSAY OF FOLIC ACID RBC $16.67 20130101 82759 ASSAY OF RBC GALACTOKINASE $20.67 20130101 82760 ASSAY OF GALACTOSE $10.77 20130101 82775 ASSAY GALACTOSE TRANSFERASE $20.27 20130101 82776 GALACTOSE TRANSFERASE TEST $8.07 20130101 82784 ASSAY IGA/IGD/IGG/IGM EACH $6.17 20130101 82785 ASSAY OF IGE $15.85 20130101 82787 IGG 1 2 3 OR 4 EACH $7.72 20130101 82800 BLOOD PH $8.14 20130101 82803 BLOOD GASES ANY COMBINATION $18.62 20130101 82805 BLOOD GASES W/O2 SATURATION $27.31 20130101 82810 BLOOD GASES O2 SAT ONLY $8.40 20130101 82820 HEMOGLOBIN-OXYGEN AFFINITY $9.61 20130101 82930 GASTRIC ANALY W/PH EA SPEC $4.66 20130101 82938 GASTRIN TEST $17.02 20130101 82941 ASSAY OF GASTRIN $16.97 20130101 82943 ASSAY OF GLUCAGON $13.75 20130101 82945 GLUCOSE OTHER FLUID $3.77 20130101 82946 GLUCAGON TOLERANCE TEST $14.50 20130101 82947 ASSAY GLUCOSE BLOOD QUANT $3.77 20130101 82948 REAGENT STRIP/BLOOD GLUCOSE $3.05 20130101 82950 GLUCOSE TEST $4.57 20130101 82951 GLUCOSE TOLERANCE TEST GTT $7.25 20130101 82952 GTT-ADDED SAMPLES $3.77 20130101 82953 GLUCOSE-TOLBUTAMIDE TEST $14.57 20130101 82955 ASSAY OF G6PD ENZYME $9.33 20130101 82960 TEST FOR G6PD ENZYME $5.82 20130101 82962 GLUCOSE BLOOD TEST $1.74 20130101 82963 ASSAY OF GLUCOSIDASE $20.67 20130101 82965 ASSAY OF GDH ENZYME $7.44 20130101 82975 ASSAY OF GLUTAMINE $15.25 20130101 82977 ASSAY OF GGT $6.93 20130101 82978 ASSAY OF GLUTATHIONE $13.72 20130101 82979 ASSAY RBC GLUTATHIONE $6.63 20130101 82980 ASSAY OF GLUTETHIMIDE $11.55 20130101 82985 ASSAY OF GLYCATED PROTEIN $14.50 20130101 83001 ASSAY OF GONADOTROPIN FSH $17.88 20130101 83002 ASSAY OF GONADOTROPIN LH $17.82 20130101 83003 ASSAY GROWTH HORMONE HGH $16.05 20130101

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Page 9 of 26 DMAP Fee for Service Fee Schedule August 2013

83008 ASSAY OF GUANOSINE $16.15 20130101 83009 H PYLORI C-13 BLOOD $64.81 20130101 83010 ASSAY OF QUANT $12.10 20130101 83012 ASSAY OF $14.50 20130101 83013 H PYLORI C-13 BREATH $64.81 20130101 83014 H PYLORI DRUG ADMIN $7.57 20130101 83015 HEAVY METAL SCREEN $17.47 20130101 83018 QUANTITATIVE SCREEN METALS $21.13 20130101 83020 HEMOGLOBIN ELECTROPHORESIS 26 $14.60 20130101 83020 HEMOGLOBIN ELECTROPHORESIS $12.38 20130101 83021 HEMOGLOBIN CHROMOTOGRAPHY $17.37 20130101 83026 HEMOGLOBIN COPPER SULFATE $2.28 20130101 83030 FETAL HEMOGLOBIN CHEMICAL $7.96 20130101 83033 FETAL HEMOGLOBIN ASSAY QUAL $5.73 20130101 83036 GLYCOSYLATED HEMOGLOBIN TEST $9.34 20130101 83045 BLOOD METHEMOGLOBIN TEST $4.77 20130101 83050 BLOOD METHEMOGLOBIN ASSAY $7.05 20130101 83051 ASSAY OF PLASMA HEMOGLOBIN $7.04 20130101 83055 BLOOD SULFHEMOGLOBIN TEST $4.73 20130101 83060 BLOOD SULFHEMOGLOBIN ASSAY $7.96 20130101 83065 ASSAY OF HEMOGLOBIN HEAT $6.63 20130101 83068 HEMOGLOBIN STABILITY SCREEN $8.14 20130101 83069 ASSAY OF URINE HEMOGLOBIN $2.77 20130101 83070 ASSAY OF HEMOSIDERIN QUAL $4.57 20130101 83071 ASSAY OF HEMOSIDERIN QUANT $6.61 20130101 83080 ASSAY OF B HEXOSAMINIDASE $16.23 20130101 83088 ASSAY OF $28.42 20130101 83090 ASSAY OF HOMOCYSTINE $16.23 20130101 83150 ASSAY OF HOMOVANILLIC ACID $18.62 20130101 83491 ASSAY OF CORTICOSTEROIDS 17 $16.86 20130101 83497 ASSAY OF 5-HIAA $12.40 20130101 83498 ASSAY OF PROGESTERONE 17-D $26.15 20130101 83499 ASSAY OF PROGESTERONE 20- $24.26 20130101 83500 ASSAY FREE HYDROXYPROLINE $21.79 20130101 83505 ASSAY TOTAL HYDROXYPROLINE $23.39 20130101 83516 IMMUNOASSAY NONANTIBODY $11.10 20130101 83518 IMMUNOASSAY DIPSTICK $8.16 20130101 83519 RIA NONANTIBODY $13.00 20130101 83520 IMMUNOASSAY QUANT NOS NONAB $12.46 20130101 83525 ASSAY OF INSULIN $11.00 20130101 83527 ASSAY OF INSULIN $12.46 20130101 83528 ASSAY OF $15.30 20130101 83540 ASSAY OF $6.23 20130101 83550 IRON BINDING TEST $8.41 20130101 83570 ASSAY OF IDH ENZYME $8.51 20130101 83582 ASSAY OF KETOGENIC STEROIDS $13.64 20130101 83586 ASSAY 17- KETOSTEROIDS $12.32 20130101 83593 FRACTIONATION KETOSTEROIDS $25.31 20130101 83605 ASSAY OF $10.28 20130101 83615 LACTATE LD LDH ENZYME $5.81 20130101 83625 ASSAY OF LDH ENZYMES $12.32 20130101 83630 LACTOFERRIN FECAL QUAL $18.89 20130101 83631 LACTOFERRIN FECAL QUANT $18.89 20130101 83632 PLACENTAL LACTOGEN $19.45 20130101 83633 TEST URINE FOR LACTOSE $5.29 20130101 83634 ASSAY OF URINE FOR LACTOSE $11.09 20130101 83655 ASSAY OF LEAD $11.65 20130101 83661 L/S RATIO FETAL LUNG $21.15 20130101 83662 FOAM STABILITY FETAL LUNG $18.20 20130101 83663 FLUORO POLARIZE FETAL LUNG $18.20 20130101

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Page 10 of 26 DMAP Fee for Service Fee Schedule August 2013

83664 LAMELLAR BDY FETAL LUNG $18.20 20130101 83670 ASSAY OF LAP ENZYME $8.81 20130101 83690 ASSAY OF LIPASE $6.63 20130101 83701 BLD HR FRACTION $23.88 20130101 83718 ASSAY OF LIPOPROTEIN $7.88 20130101 83719 ASSAY OF BLOOD LIPOPROTEIN $11.19 20130101 83721 ASSAY OF BLOOD LIPOPROTEIN $9.18 20130101 83727 ASSAY OF LRH HORMONE $16.55 20130101 83735 ASSAY OF MAGNESIUM $6.45 20130101 83775 ASSAY MALATE DEHYDROGENASE $7.09 20130101 83785 ASSAY OF MANGANESE $23.66 20130101 83788 MASS SPECTROMETRY QUAL $17.37 20130101 83789 MASS SPECTROMETRY QUANT $17.37 20130101 83805 ASSAY OF MEPROBAMATE $16.96 20130101 83825 ASSAY OF MERCURY $15.65 20130101 83835 ASSAY OF METANEPHRINES $16.30 20130101 83840 ASSAY OF METHADONE $15.72 20130101 83857 ASSAY OF $10.33 20130101 83858 ASSAY OF METHSUXIMIDE $14.25 20130101 83864 MUCOPOLYSACCHARIDES $19.16 20130101 83866 MUCOPOLYSACCHARIDES SCREEN $9.48 20130101 83872 ASSAY SYNOVIAL FLUID $5.36 20130101 83873 ASSAY OF CSF PROTEIN $6.94 20130101 83874 ASSAY OF MYOGLOBIN $12.43 20130101 83876 ASSAY $32.66 20130101 83880 ASSAY OF NATRIURETIC $32.66 20130101 83883 ASSAY NEPHELOMETRY NOT SPEC $13.08 20130101 83885 ASSAY OF NICKEL $23.58 20130101 83887 ASSAY OF NICOTINE $22.79 20130101 83915 ASSAY OF NUCLEOTIDASE $10.73 20130101 83916 OLIGOCLONAL BANDS $19.35 20130101 83918 ORGANIC ACIDS TOTAL QUANT $15.83 20130101 83919 ORGANIC ACIDS QUAL EACH $15.83 20130101 83921 ORGANIC ACID SINGLE QUANT $15.83 20130101 83925 ASSAY OF OPIATES $18.72 20130101 83930 ASSAY OF BLOOD OSMOLALITY $6.36 20130101 83935 ASSAY OF URINE OSMOLALITY $6.56 20130101 83937 ASSAY OF $28.72 20130101 83945 ASSAY OF OXALATE $12.38 20130101 83950 ONCOPROTEIN HER-2/NEU $61.98 20130101 83970 ASSAY OF PARATHORMONE $39.72 20130101 83986 ASSAY PH BODY FLUID NOS $3.44 20130101 83992 ASSAY FOR PHENCYCLIDINE $14.14 20130101 84022 ASSAY OF PHENOTHIAZINE $14.99 20130101 84035 ASSAY OF PHENYLKETONES $3.52 20130101 84060 ASSAY ACID PHOSPHATASE $7.11 20130101 84061 PHOSPHATASE FORENSIC EXAM $7.61 20130101 84066 ASSAY PROSTATE PHOSPHATASE $9.30 20130101 84075 ASSAY $4.98 20130101 84078 ASSAY ALKALINE PHOSPHATASE $7.02 20130101 84080 ASSAY ALKALINE PHOSPHATASES $14.23 20130101 84081 ASSAY PHOSPHATIDYLGLYCEROL $15.90 20130101 84085 ASSAY OF RBC PG6D ENZYME $6.48 20130101 84087 ASSAY PHOSPHOHEXOSE ENZYMES $9.93 20130101 84100 ASSAY OF PHOSPHORUS $4.56 20130101 84105 ASSAY OF URINE PHOSPHORUS $4.98 20130101 84106 TEST FOR PORPHOBILINOGEN $4.12 20130101 84110 ASSAY OF PORPHOBILINOGEN $8.12 20130101 84112 PLACENTA ALPHA MICRO IG C/V $61.98 20130101 84119 TEST URINE FOR PORPHYRINS $8.29 20130101

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Page 11 of 26 DMAP Fee for Service Fee Schedule August 2013

84120 ASSAY OF URINE PORPHYRINS $14.15 20130101 84126 ASSAY OF FECES PORPHYRINS $24.51 20130101 84127 ASSAY OF FECES PORPHYRINS $11.21 20130101 84132 ASSAY OF SERUM POTASSIUM $4.42 20130101 84133 ASSAY OF URINE POTASSIUM $4.14 20130101 84134 ASSAY OF PREALBUMIN $14.04 20130101 84135 ASSAY OF PREGNANEDIOL $18.41 20130101 84138 ASSAY OF PREGNANETRIOL $18.22 20130101 84140 ASSAY OF PREGNENOLONE $19.89 20130101 84143 ASSAY OF 17-HYDROXYPREGNENO $21.96 20130101 84144 ASSAY OF PROGESTERONE $20.08 20130101 84146 ASSAY OF PROLACTIN $18.65 20130101 84150 ASSAY OF PROSTAGLANDIN $24.02 20130101 84152 ASSAY OF PSA COMPLEXED $17.70 20130101 84153 ASSAY OF PSA TOTAL $17.70 20130101 84154 ASSAY OF PSA FREE $17.70 20130101 84155 ASSAY OF PROTEIN SERUM $3.53 20130101 84156 ASSAY OF PROTEIN URINE $3.53 20130101 84157 ASSAY OF PROTEIN OTHER $3.53 20130101 84160 ASSAY OF PROTEIN ANY SOURCE $4.98 20130101 84163 PAPPA SERUM $14.49 20130101 84165 PROTEIN E-PHORESIS SERUM 26 $14.60 20130101 84165 PROTEIN E-PHORESIS SERUM $10.33 20130101 84166 PROTEIN E-PHORESIS/URINE/CSF 26 $14.60 20130101 84166 PROTEIN E-PHORESIS/URINE/CSF $17.16 20130101 84181 WESTERN BLOT TEST 26 $14.60 20130101 84181 WESTERN BLOT TEST $16.39 20130101 84182 PROTEIN WESTERN BLOT TEST 26 $13.36 20130101 84182 PROTEIN WESTERN BLOT TEST $17.32 20130101 84202 ASSAY RBC PROTOPORPHYRIN $13.80 20130101 84203 TEST RBC PROTOPORPHYRIN $8.28 20130101 84206 ASSAY OF PROINSULIN $17.14 20130101 84207 ASSAY OF VITAMIN B-6 $27.03 20130101 84210 ASSAY OF PYRUVATE $10.44 20130101 84220 ASSAY OF PYRUVATE KINASE $9.08 20130101 84228 ASSAY OF QUININE $11.19 20130101 84233 ASSAY OF ESTROGEN $61.98 20130101 84234 ASSAY OF PROGESTERONE $62.43 20130101 84235 ASSAY OF ENDOCRINE HORMONE $50.36 20130101 84238 ASSAY NONENDOCRINE $35.19 20130101 84244 ASSAY OF RENIN $21.17 20130101 84252 ASSAY OF VITAMIN B-2 $19.47 20130101 84255 ASSAY OF SELENIUM $24.57 20130101 84260 ASSAY OF SEROTONIN $29.81 20130101 84270 ASSAY OF SEX HORMONE GLOBUL $20.91 20130101 84275 ASSAY OF SIALIC ACID $12.93 20130101 84285 ASSAY OF SILICA $22.66 20130101 84295 ASSAY OF SERUM SODIUM $4.63 20130101 84300 ASSAY OF URINE SODIUM $4.68 20130101 84302 ASSAY OF SWEAT SODIUM $4.68 20130101 84305 ASSAY OF SOMATOMEDIN $20.45 20130101 84307 ASSAY OF SOMATOSTATIN $17.59 20130101 84311 SPECTROPHOTOMETRY $6.73 20130101 84315 BODY FLUID SPECIFIC GRAVITY $2.42 20130101 84375 CHROMATOGRAM ASSAY SUGARS $8.41 20130101 84376 SUGARS SINGLE QUAL $5.29 20130101 84377 SUGARS MULTIPLE QUAL $5.29 20130101 84378 SUGARS SINGLE QUANT $11.09 20130101 84379 SUGARS MULTIPLE QUANT $11.09 20130101 84392 ASSAY OF URINE SULFATE $4.57 20130101

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Page 12 of 26 DMAP Fee for Service Fee Schedule August 2013

84402 ASSAY OF FREE TESTOSTERONE $24.50 20130101 84403 ASSAY OF TOTAL TESTOSTERONE $24.84 20130101 84425 ASSAY OF VITAMIN B-1 $20.43 20130101 84430 ASSAY OF THIOCYANATE $8.41 20130101 84432 ASSAY OF $15.46 20130101 84436 ASSAY OF TOTAL THYROXINE $6.61 20130101 84437 ASSAY OF NEONATAL THYROXINE $6.22 20130101 84439 ASSAY OF FREE THYROXINE $8.68 20130101 84442 ASSAY OF THYROID ACTIVITY $14.23 20130101 84443 ASSAY THYROID STIM HORMONE $16.17 20130101 84445 ASSAY OF TSI $48.93 20130101 84446 ASSAY OF VITAMIN E $13.64 20130101 84449 ASSAY OF $17.32 20130101 84450 TRANSFERASE AST SGOT $4.98 20130101 84460 ALANINE AMINO ALT SGPT $5.09 20130101 84466 ASSAY OF $12.29 20130101 84478 ASSAY OF TRIGLYCERIDES $5.53 20130101 84479 ASSAY OF THYROID T3 OR T4 $6.22 20130101 84480 ASSAY TRIIODOTHYRONINE T3 $13.64 20130101 84481 FREE ASSAY FT-3 $16.30 20130101 84482 T3 REVERSE $15.17 20130101 84484 ASSAY OF TROPONIN QUANT $9.47 20130101 84485 ASSAY DUODENAL FLUID $7.22 20130101 84488 TEST FECES FOR TRYPSIN $7.02 20130101 84490 ASSAY OF FECES FOR TRYPSIN $7.32 20130101 84510 ASSAY OF $10.01 20130101 84512 ASSAY OF TROPONIN QUAL $7.41 20130101 84520 ASSAY OF UREA NITROGEN $3.80 20130101 84525 UREA NITROGEN SEMI-QUANT $3.04 20130101 84540 ASSAY OF URINE/UREA-N $4.57 20130101 84545 UREA-N CLEARANCE TEST $6.36 20130101 84550 ASSAY OF BLOOD/URIC ACID $4.35 20130101 84560 ASSAY OF URINE/URIC ACID $4.57 20130101 84577 ASSAY OF FECES/UROBILINOGEN $3.66 20130101 84578 TEST URINE UROBILINOGEN $3.13 20130101 84580 ASSAY OF URINE UROBILINOGEN $6.83 20130101 84583 ASSAY OF URINE UROBILINOGEN $4.84 20130101 84585 ASSAY OF URINE VMA $14.91 20130101 84586 ASSAY OF VIP $34.00 20130101 84588 ASSAY OF VASOPRESSIN $32.66 20130101 84590 ASSAY OF VITAMIN A $11.17 20130101 84591 ASSAY OF NOS VITAMIN $11.17 20130101 84597 ASSAY OF VITAMIN K $13.20 20130101 84600 ASSAY OF VOLATILES $15.47 20130101 84620 XYLOSE TOLERANCE TEST $11.40 20130101 84630 ASSAY OF $10.96 20130101 84681 ASSAY OF C-PEPTIDE $20.03 20130101 84702 CHORIONIC GONADOTROPIN TEST $14.49 20130101 84703 CHORIONIC GONADOTROPIN ASSAY $7.23 20130101 84704 HCG FREE BETACHAIN TEST $14.49 20130101 85002 BLEEDING TIME TEST $4.33 20130101 85004 AUTOMATED DIFF WBC COUNT $6.22 20130101 85007 BL SMEAR W/DIFF WBC COUNT $3.31 20130101 85008 BL SMEAR W/O DIFF WBC COUNT $3.31 20130101 85009 MANUAL DIFF WBC COUNT B-COAT $3.58 20130101 85013 SPUN MICROHEMATOCRIT $2.28 20130101 85014 HEMATOCRIT $2.28 20130101 85018 HEMOGLOBIN $2.28 20130101 85025 COMPLETE CBC W/AUTO DIFF WBC $7.48 20130101 85027 COMPLETE CBC AUTOMATED $6.22 20130101

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Page 13 of 26 DMAP Fee for Service Fee Schedule August 2013

85032 MANUAL CELL COUNT EACH $4.14 20130101 85041 AUTOMATED RBC COUNT $2.90 20130101 85044 MANUAL RETICULOCYTE COUNT $4.14 20130101 85045 AUTOMATED RETICULOCYTE COUNT $3.85 20130101 85046 RETICYTE/HGB CONCENTRATE $5.36 20130101 85048 AUTOMATED LEUKOCYTE COUNT $2.44 20130101 85049 AUTOMATED PLATELET COUNT $4.31 20130101 85055 RETICULATED PLATELET ASSAY $17.42 20130101 85060 BLOOD SMEAR INTERPRETATION $17.62 20130101 85097 BONE MARROW INTERPRETATION $62.77 20130101 85130 CHROMOGENIC SUBSTRATE ASSAY $11.45 20130101 85170 BLOOD CLOT RETRACTION $3.48 20130101 85175 BLOOD CLOT TIME $4.38 20130101 85210 CLOT FACTOR II PROTHROM SPEC $12.50 20130101 85220 BLOOC CLOT FACTOR V TEST $15.41 20130101 85230 CLOT FACTOR VII PROCONVERTIN $15.41 20130101 85240 CLOT FACTOR VIII AHG 1 STAGE $15.41 20130101 85244 CLOT FACTOR VIII RELTD ANTGN $19.64 20130101 85245 CLOT FACTOR VIII VW RISTOCTN $22.08 20130101 85246 CLOT FACTOR VIII VW ANTIGEN $22.08 20130101 85247 CLOT FACTOR VIII MULTIMETRIC $22.08 20130101 85250 CLOT FACTOR IX PTC/CHRSTMAS $15.41 20130101 85260 CLOT FACTOR X STUART-POWER $15.41 20130101 85270 CLOT FACTOR XI PTA $15.41 20130101 85280 CLOT FACTOR XII HAGEMAN $18.62 20130101 85290 CLOT FACTOR XIII FIBRIN STAB $15.41 20130101 85291 CLOT FACTOR XIII FIBRIN SCRN $8.55 20130101 85292 CLOT FACTOR FLETCHER FACT $18.22 20130101 85293 CLOT FACTOR WGHT KININOGEN $18.22 20130101 85300 III ACTIVITY $11.40 20130101 85301 ANTITHROMBIN III ANTIGEN $10.40 20130101 85302 CLOT INHIBIT PROT C ANTIGEN $11.56 20130101 85303 CLOT INHIBIT PROT C ACTIVITY $13.31 20130101 85305 CLOT INHIBIT PROT S TOTAL $11.17 20130101 85306 CLOT INHIBIT PROT S FREE $14.74 20130101 85307 ASSAY ACTIVATED $14.74 20130101 85335 FACTOR INHIBITOR TEST $12.38 20130101 85337 THROMBOMODULIN $10.03 20130101 85345 COAGULATION TIME LEE WHITE $4.14 20130101 85347 COAGULATION TIME ACTIVATED $3.04 20130101 85348 COAGULATION TIME OTR METHOD $3.58 20130101 85360 EUGLOBULIN LYSIS $8.09 20130101 85362 FIBRIN DEGRADATION PRODUCTS $6.17 20130101 85366 FIBRINOGEN TEST $8.29 20130101 85370 FIBRINOGEN TEST $10.93 20130101 85378 FIBRIN DEGRADE SEMIQUANT $6.87 20130101 85379 FIBRIN DEGRADATION QUANT $9.79 20130101 85380 FIBRIN DEGRADJ D-DIMER $9.79 20130101 85384 FIBRINOGEN ACTIVITY $8.18 20130101 85385 FIBRINOGEN ANTIGEN $8.18 20130101 85390 FIBRINOLYSINS SCREEN IR 26 $14.60 20130101 85390 FIBRINOLYSINS SCREEN IR $4.97 20130101 85396 CLOTTING ASSAY WHOLE BLOOD $14.60 20130101 85397 CLOTTING FUNCT ACTIVITY $22.08 20130101 85400 FIBRINOLYTIC $8.51 20130101 85410 FIBRINOLYTIC ANTIPLASMIN $7.42 20130101 85415 FIBRINOLYTIC PLASMINOGEN $16.55 20130101 85420 FIBRINOLYTIC PLASMINOGEN $6.29 20130101 85421 FIBRINOLYTIC PLASMINOGEN $9.80 20130101 85441 HEINZ BODIES DIRECT $4.05 20130101

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Page 14 of 26 DMAP Fee for Service Fee Schedule August 2013

85445 HEINZ BODIES INDUCED $6.56 20130101 85460 HEMOGLOBIN FETAL $7.45 20130101 85461 HEMOGLOBIN FETAL $6.38 20130101 85475 HEMOLYSIN ACID $8.54 20130101 85520 ASSAY $12.60 20130101 85525 HEPARIN NEUTRALIZATION $11.40 20130101 85530 HEPARIN-PROTAMINE TOLERANCE $13.64 20130101 85536 IRON STAIN PERIPHERAL BLOOD $6.22 20130101 85540 WBC ALKALINE PHOSPHATASE $8.28 20130101 85547 RBC MECHANICAL FRAGILITY $8.28 20130101 85549 MURAMIDASE $18.05 20130101 85555 RBC OSMOTIC FRAGILITY $6.43 20130101 85557 RBC OSMOTIC FRAGILITY $6.44 20130101 85576 BLOOD PLATELET AGGREGATION 26 $14.60 20130101 85576 BLOOD PLATELET AGGREGATION $20.67 20130101 85597 PHOSPHOLIPID PLTLT NEUTRALIZ $17.30 20130101 85610 PROTHROMBIN TIME $3.78 20130101 85611 PROTHROMBIN TEST $3.79 20130101 85612 VIPER VENOM PROTHROMBIN TIME $6.17 20130101 85613 RUSSELL VIPER VENOM DILUTED $6.17 20130101 85635 REPTILASE TEST $9.47 20130101 85651 RBC SED RATE NONAUTOMATED $3.42 20130101 85652 RBC SED RATE AUTOMATED $2.60 20130101 85660 RBC SICKLE CELL TEST $5.31 20130101 85670 THROMBIN TIME PLASMA $5.55 20130101 85675 THROMBIN TIME TITER $6.59 20130101 85705 THROMBOPLASTIN INHIBITION $9.26 20130101 85730 THROMBOPLASTIN TIME PARTIAL $5.78 20130101 85732 THROMBOPLASTIN TIME PARTIAL $6.22 20130101 85810 BLOOD VISCOSITY EXAMINATION $11.23 20130101 86000 AGGLUTININS FEBRILE ANTIGEN $6.72 20130101 86001 ALLERGEN SPECIFIC IGG $5.02 20130101 86003 ALLERGEN SPECIFIC IGE $5.02 20130101 86005 ALLERGEN SPECIFIC IGE $7.67 20130101 86021 WBC IDENTIFICATION $14.49 20130101 86022 PLATELET $17.68 20130101 86023 IMMUNOGLOBULIN ASSAY $11.98 20130101 86038 ANTINUCLEAR ANTIBODIES $11.63 20130101 86039 ANTINUCLEAR ANTIBODIES ANA $10.75 20130101 86060 ANTISTREPTOLYSIN O TITER $7.02 20130101 86063 ANTISTREPTOLYSIN O SCREEN $5.55 20130101 86077 PHYS BLOOD BANK SERV XMATCH $39.07 20130101 86078 PHYS BLOOD BANK SERV REACTJ $39.31 20130101 86079 PHYS BLOOD BANK SERV AUTHRJ $39.07 20130101 86140 C-REACTIVE PROTEIN $4.98 20130101 86141 C-REACTIVE PROTEIN HS $12.46 20130101 86146 BETA-2 ANTIBODY $24.48 20130101 86147 CARDIOLIPIN ANTIBODY EA IG $24.48 20130101 86148 ANTI-PHOSPHOLIPID ANTIBODY $15.46 20130101 86155 CHEMOTAXIS ASSAY $15.38 20130101 86156 COLD AGGLUTININ SCREEN $6.45 20130101 86157 COLD AGGLUTININ TITER $7.76 20130101 86160 COMPLEMENT ANTIGEN $11.55 20130101 86161 COMPLEMENT/FUNCTION ACTIVITY $11.55 20130101 86162 COMPLEMENT TOTAL CH50 $19.55 20130101 86171 COMPLEMENT FIXATION EACH $9.63 20130101 86185 COUNTERIMMUNOELECTROPHORESIS $8.60 20130101 86200 CCP ANTIBODY $12.46 20130101 86215 DEOXYRIBONUCLEASE ANTIBODY $12.75 20130101 86225 DNA ANTIBODY NATIVE $13.22 20130101

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Page 15 of 26 DMAP Fee for Service Fee Schedule August 2013

86226 DNA ANTIBODY SINGLE STRAND $11.66 20130101 86235 NUCLEAR ANTIGEN ANTIBODY $15.41 20130101 86243 FC RECEPTOR $19.74 20130101 86255 FLUORESCENT ANTIBODY SCREEN 26 $14.60 20130101 86255 FLUORESCENT ANTIBODY SCREEN $11.60 20130101 86256 FLUORESCENT ANTIBODY TITER 26 $14.03 20130101 86256 FLUORESCENT ANTIBODY TITER $11.60 20130101 86277 GROWTH HORMONE ANTIBODY $15.14 20130101 86280 HEMAGGLUTINATION INHIBITION $7.88 20130101 86294 IMMUNOASSAY TUMOR QUAL $18.88 20130101 86300 IMMUNOASSAY TUMOR CA 15-3 $20.03 20130101 86301 IMMUNOASSAY TUMOR CA 19-9 $20.03 20130101 86304 IMMUNOASSAY TUMOR CA 125 $20.03 20130101 86308 HETEROPHILE ANTIBODY SCREEN $4.98 20130101 86309 HETEROPHILE ANTIBODY TITER $6.22 20130101 86310 HETEROPHILE ANTIBODY ABSRBJ $7.09 20130101 86316 IMMUNOASSAY TUMOR OTHER $20.03 20130101 86317 IMMUNOASSAY INFECTIOUS AGENT $14.43 20130101 86318 IMMUNOASSAY INFECTIOUS AGENT $12.46 20130101 86320 SERUM IMMUNOELECTROPHORESIS 26 $13.54 20130101 86320 SERUM IMMUNOELECTROPHORESIS $21.57 20130101 86325 OTHER IMMUNOELECTROPHORESIS 26 $13.78 20130101 86325 OTHER IMMUNOELECTROPHORESIS $21.52 20130101 86327 IMMUNOELECTROPHORESIS ASSAY 26 $16.61 20130101 86327 IMMUNOELECTROPHORESIS ASSAY $21.83 20130101 86329 IMMUNODIFFUSION NES $13.51 20130101 86331 IMMUNODIFFUSION OUCHTERLONY $11.53 20130101 86332 IMMUNE COMPLEX ASSAY $23.45 20130101 86334 IMMUNOFIX E-PHORESIS SERUM 26 $14.35 20130101 86334 IMMUNOFIX E-PHORESIS SERUM $21.50 20130101 86335 IMMUNFIX E-PHORSIS/URINE/CSF 26 $14.60 20130101 86335 IMMUNFIX E-PHORSIS/URINE/CSF $28.24 20130101 86336 INHIBIN A $12.46 20130101 86337 INSULIN ANTIBODIES $20.60 20130101 86340 INTRINSIC FACTOR ANTIBODY $14.50 20130101 86341 ISLET CELL ANTIBODY $19.04 20130101 86343 LEUKOCYTE HISTAMINE RELEASE $11.99 20130101 86344 LEUKOCYTE $7.69 20130101 86352 CELL FUNCTION ASSAY W/STIM $130.73 20130101 86353 LYMPHOCYTE TRANSFORMATION $47.17 20130101 86355 B CELLS TOTAL COUNT $36.30 20130101 86357 NK CELLS TOTAL COUNT $36.30 20130101 86359 T CELLS TOTAL COUNT $36.30 20130101 86360 T CELL ABSOLUTE COUNT/RATIO $45.21 20130101 86361 T CELL ABSOLUTE COUNT $17.42 20130101 86367 STEM CELLS TOTAL COUNT $36.30 20130101 86376 MICROSOMAL ANTIBODY EACH $13.99 20130101 86378 MIGRATION INHIBITORY FACTOR $18.94 20130101 86382 NEUTRALIZATION TEST VIRAL $16.28 20130101 86384 NITROBLUE TETRAZOLIUM DYE $10.96 20130101 86403 PARTICLE AGGLUT ANTBDY SCRN $9.81 20130101 86406 PARTICLE AGGLUT ANTBDY TITR $10.23 20130101 86430 RHEUMATOID FACTOR TEST QUAL $5.46 20130101 86431 RHEUMATOID FACTOR QUANT $5.46 20130101 86480 TB TEST CELL IMMUN MEASURE $59.64 20130101 86485 SKIN TEST $27.75 20011001 86486 SKIN TEST NOS ANTIGEN $4.11 20130101 86490 COCCIDIOIDOMYCOSIS SKIN TEST $3.62 20130101 86510 HISTOPLASMOSIS SKIN TEST $4.60 20130101 86580 TB INTRADERMAL TEST $5.84 20130101

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Page 16 of 26 DMAP Fee for Service Fee Schedule August 2013

86590 STREPTOKINASE ANTIBODY $10.63 20130101 86592 SYPHILIS TEST NON-TREP QUAL $4.11 20130101 86593 SYPHILIS TEST NON-TREP QUANT $4.24 20130101 86602 ANTINOMYCES ANTIBODY $9.79 20130101 86603 ADENOVIRUS ANTIBODY $12.38 20130101 86606 ASPERGILLUS ANTIBODY $14.49 20130101 86609 BACTERIUM ANTIBODY $12.40 20130101 86611 BARTONELLA ANTIBODY $9.79 20130101 86612 BLASTOMYCES ANTIBODY $12.42 20130101 86615 BORDETELLA ANTIBODY $12.69 20130101 86617 LYME DISEASE ANTIBODY $14.91 20130101 86618 LYME DISEASE ANTIBODY $16.39 20130101 86619 BORRELIA ANTIBODY $12.87 20130101 86622 BRUCELLA ANTIBODY $8.60 20130101 86625 CAMPYLOBACTER ANTIBODY $12.62 20130101 86628 CANDIDA ANTIBODY $11.55 20130101 86631 CHLAMYDIA ANTIBODY $11.38 20130101 86632 CHLAMYDIA IGM ANTIBODY $12.21 20130101 86635 COCCIDIOIDES ANTIBODY $11.04 20130101 86638 Q FEVER ANTIBODY $11.66 20130101 86641 CRYPTOCOCCUS ANTIBODY $13.87 20130101 86644 CMV ANTIBODY $13.85 20130101 86645 CMV ANTIBODY IGM $16.21 20130101 86648 DIPHTHERIA ANTIBODY $14.64 20130101 86651 ENCEPHALITIS CALIFORN ANTBDY $12.69 20130101 86652 ENCEPHALTIS EAST EQNE ANBDY $12.69 20130101 86653 ENCEPHALTIS ST LOUIS ANTBODY $12.69 20130101 86654 ENCEPHALTIS WEST EQNE ANTBDY $12.69 20130101 86658 ENTEROVIRUS ANTIBODY $12.54 20130101 86663 EPSTEIN-BARR ANTIBODY $12.62 20130101 86664 EPSTEIN-BARR NUCLEAR ANTIGEN $14.72 20130101 86665 EPSTEIN-BARR CAPSID VCA $17.46 20130101 86666 EHRLICHIA ANTIBODY $9.79 20130101 86668 FRANCISELLA TULARENSIS $10.01 20130101 86671 NES ANTIBODY $11.80 20130101 86674 GIARDIA LAMBLIA ANTIBODY $14.17 20130101 86677 ANTIBODY $13.97 20130101 86682 HELMINTH ANTIBODY $12.52 20130101 86684 HEMOPHILUS INFLUENZA ANTIBDY $15.25 20130101 86687 HTLV-I ANTIBODY $8.08 20130101 86688 HTLV-II ANTIBODY $13.48 20130101 86689 HTLV/HIV CONFIRMJ ANTIBODY $18.62 20130101 86692 HEPATITIS DELTA AGENT ANTBDY $16.51 20130101 86694 HERPES SIMPLEX NES ANTBDY $13.85 20130101 86695 HERPES SIMPLEX TYPE 1 TEST $12.69 20130101 86696 HERPES SIMPLEX TYPE 2 TEST $18.62 20130101 86698 HISTOPLASMA ANTIBODY $12.03 20130101 86701 HIV-1ANTIBODY $8.55 20130101 86702 HIV-2 ANTIBODY $13.01 20130101 86703 HIV-1/HIV-2 1 RESULT ANTBDY $13.20 20130101 86704 HEP B CORE ANTIBODY TOTAL $11.60 20130101 86705 HEP B CORE ANTIBODY IGM $11.33 20130101 86706 HEP B SURFACE ANTIBODY $10.33 20130101 86707 HEPATITIS BE ANTIBODY $11.13 20130101 86708 HEPATITIS A TOTAL ANTIBODY $11.92 20130101 86709 HEPATITIS A IGM ANTIBODY $10.83 20130101 86710 INFLUENZA VIRUS ANTIBODY $13.04 20130101 86711 JOHN CUNNINGHAM ANTIBODY $13.85 20130101 86713 LEGIONELLA ANTIBODY $14.73 20130101 86717 LEISHMANIA ANTIBODY $11.79 20130101

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Page 17 of 26 DMAP Fee for Service Fee Schedule August 2013

86720 LEPTOSPIRA ANTIBODY $12.69 20130101 86723 LISTERIA MONOCYTOGENES $12.69 20130101 86727 LYMPH CHORIOMENINGITIS AB $12.38 20130101 86729 LYMPHO VENEREUM ANTIBODY $11.50 20130101 86732 MUCORMYCOSIS ANTIBODY $12.69 20130101 86735 MUMPS ANTIBODY $12.56 20130101 86738 MYCOPLASMA ANTIBODY $12.74 20130101 86741 $12.69 20130101 86744 NOCARDIA ANTIBODY $12.69 20130101 86747 PARVOVIRUS ANTIBODY $14.47 20130101 86750 MALARIA ANTIBODY $12.69 20130101 86753 PROTOZOA ANTIBODY NOS $11.92 20130101 86756 RESPIRATORY VIRUS ANTIBODY $12.40 20130101 86757 RICKETTSIA ANTIBODY $18.62 20130101 86759 ANTIBODY $12.69 20130101 86762 RUBELLA ANTIBODY $13.85 20130101 86765 RUBEOLA ANTIBODY $12.40 20130101 86768 SALMONELLA ANTIBODY $12.69 20130101 86771 SHIGELLA ANTIBODY $12.69 20130101 86774 TETANUS ANTIBODY $14.24 20130101 86777 TOXOPLASMA ANTIBODY $13.85 20130101 86778 TOXOPLASMA ANTIBODY IGM $13.86 20130101 86780 TREPONEMA PALLIDUM $12.74 20130101 86784 TRICHINELLA ANTIBODY $12.09 20130101 86787 VARICELLA-ZOSTER ANTIBODY $12.40 20130101 86788 WEST NILE VIRUS AB IGM $16.21 20130101 86789 WEST NILE VIRUS ANTIBODY $13.85 20130101 86790 VIRUS ANTIBODY NOS $12.40 20130101 86793 YERSINIA ANTIBODY $12.69 20130101 86800 THYROGLOBULIN ANTIBODY $15.30 20130101 86803 HEPATITIS C AB TEST $13.73 20130101 86804 HEP C AB TEST CONFIRM $14.91 20130101 86805 LYMPHOCYTOTOXICITY ASSAY $50.32 20130101 86806 LYMPHOCYTOTOXICITY ASSAY $45.79 20130101 86807 CYTOTOXIC ANTIBODY SCREENING $38.08 20130101 86808 CYTOTOXIC ANTIBODY SCREENING $28.56 20130101 86812 HLA TYPING A B OR C $24.84 20130101 86813 HLA TYPING A B OR C $55.80 20130101 86816 HLA TYPING DR/DQ $26.81 20130101 86817 HLA TYPING DR/DQ $61.95 20130101 86821 LYMPHOCYTE CULTURE MIXED $54.33 20130101 86822 LYMPHOCYTE CULTURE PRIMED $35.18 20130101 86825 HLA X-MATH NON-CYTOTOXIC $52.24 20130101 86826 HLA X-MATCH NONCYTOTOXC ADDL $17.42 20130101 86828 HLA CLASS III ANTIBODY QUAL $38.08 20130101 86829 HLA CLASS I/II ANTIBODY QUAL $28.56 20130101 86830 HLA CLASS I PHENOTYPE QUAL $77.69 20130101 86831 HLA CLASS II PHENOTYPE QUAL $66.59 20130101 86832 HLA CLASS I HIGH DEFIN QUAL $122.08 20130101 86833 HLA CLASS II HIGH DEFIN QUAL $110.99 20130101 86834 HLA CLASS I SEMIQUANT PANEL $344.04 20130101 86835 HLA CLASS II SEMIQUANT PANEL $310.75 20130101 86850 RBC ANTIBODY SCREEN $7.81 19970701 86860 RBC ANTIBODY ELUTION $32.48 20000215 86870 RBC ANTIBODY IDENTIFICATION $38.52 20011001 86880 COOMBS TEST DIRECT $5.17 20130101 86885 COOMBS TEST INDIRECT QUAL $5.51 20130101 86886 COOMBS TEST INDIRECT TITER $4.98 20130101 86890 AUTOLOGOUS BLOOD PROCESS $46.51 20011001 86900 BLOOD TYPING ABO $2.87 20130101

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Page 18 of 26 DMAP Fee for Service Fee Schedule August 2013

86901 BLOOD TYPING RH D $2.87 20130101 86902 BLOOD TYPE ANTIGEN DONOR EA $3.68 20130101 86904 BLOOD TYPING PATIENT SERUM $9.15 20130101 86905 BLOOD TYPING RBC ANTIGENS $3.68 20130101 86906 BLOOD TYPING RH PHENOTYPE $7.46 20130101 86920 COMPATIBILITY TEST SPIN $58.92 20011001 86921 COMPATIBILITY TEST INCUBATE $58.92 20060619 86922 COMPATIBILITY TEST ANTIGLOB $58.92 20051205 86940 HEMOLYSINS/AGGLUTININS AUTO $7.89 20130101 86941 HEMOLYSINS/AGGLUTININS $11.66 20130101 86965 POOLING BLOOD PLATELETS $27.35 20011001 87001 SMALL ANIMAL INOCULATION $12.71 20130101 87003 SMALL ANIMAL INOCULATION $16.20 20130101 87015 SPECIMEN INFECT AGNT CONCNTJ $6.43 20130101 87040 BLOOD CULTURE FOR BACTERIA $9.93 20130101 87045 FECES CULTURE AEROBIC BACT $9.08 20130101 87046 STOOL CULTR AEROBIC BACT EA $9.08 20130101 87070 CULTURE OTHR SPECIMN AEROBIC $8.29 20130101 87071 CULTURE AEROBIC QUANT OTHER $9.08 20130101 87073 CULTURE BACTERIA ANAEROBIC $9.08 20130101 87075 CULTR BACTERIA EXCEPT BLOOD $9.11 20130101 87076 CULTURE ANAEROBE IDENT EACH $7.78 20130101 87077 CULTURE AEROBIC IDENTIFY $7.78 20130101 87081 CULTURE SCREEN ONLY $6.38 20130101 87084 CULTURE OF SPECIMEN BY KIT $8.29 20130101 87086 URINE CULTURE/COLONY COUNT $7.77 20130101 87088 URINE BACTERIA CULTURE $7.79 20130101 87101 SKIN FUNGI CULTURE $7.42 20130101 87102 FUNGUS ISOLATION CULTURE $8.09 20130101 87103 BLOOD FUNGUS CULTURE $8.68 20130101 87106 FUNGI IDENTIFICATION $8.41 20130101 87107 FUNGI IDENTIFICATION MOLD $8.41 20130101 87109 MYCOPLASMA $14.81 20130101 87110 CHLAMYDIA CULTURE $18.85 20130101 87116 MYCOBACTERIA CULTURE $10.40 20130101 87118 MYCOBACTERIC IDENTIFICATION $10.53 20130101 87140 CULTURE TYPE IMMUNOFLUORESC $5.37 20130101 87143 CULTURE TYPING GLC/HPLC $12.05 20130101 87147 CULTURE TYPE IMMUNOLOGIC $4.98 20130101 87149 DNA/RNA DIRECT PROBE $19.30 20130101 87150 DNA/RNA AMPLIFIED PROBE $33.77 20130101 87152 CULTURE TYPE PULSE FIELD GEL $5.03 20130101 87153 DNA/RNA SEQUENCING $111.00 20130101 87158 CULTURE TYPING ADDED METHOD $5.03 20130101 87164 DARK FIELD EXAMINATION 26 $13.86 20130101 87164 DARK FIELD EXAMINATION $10.33 20130101 87166 DARK FIELD EXAMINATION $10.87 20130101 87168 MACROSCOPIC EXAM ARTHROPOD $4.11 20130101 87169 MACROSCOPIC EXAM PARASITE $4.11 20130101 87172 PINWORM EXAM $4.11 20130101 87176 TISSUE HOMOGENIZATION CULTR $5.66 20130101 87177 OVA AND PARASITES SMEARS $8.56 20130101 87181 MICROBE SUSCEPTIBLE DIFFUSE $0.81 20130101 87184 MICROBE SUSCEPTIBLE DISK $6.64 20130101 87185 MICROBE SUSCEPTIBLE ENZYME $0.81 20130101 87186 MICROBE SUSCEPTIBLE MIC $8.32 20130101 87187 MICROBE SUSCEPTIBLE MLC $9.98 20130101 87188 MICROBE SUSCEPT MACROBROTH $6.38 20130101 87190 MICROBE SUSCEPT MYCOBACTERI $4.66 20130101 87197 BACTERICIDAL LEVEL SERUM $11.54 20130101

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Page 19 of 26 DMAP Fee for Service Fee Schedule August 2013

87205 SMEAR GRAM STAIN $4.11 20130101 87206 SMEAR FLUORESCENT/ACID STAI $5.17 20130101 87207 SMEAR SPECIAL STAIN 26 $14.60 20130101 87207 SMEAR SPECIAL STAIN $5.77 20130101 87209 SMEAR COMPLEX STAIN $17.30 20130101 87210 SMEAR WET MOUNT SALINE/INK $4.11 20130101 87220 TISSUE EXAM FOR FUNGI $4.11 20130101 87230 ASSAY TOXIN OR ANTITOXIN $19.00 20130101 87250 VIRUS INOCULATE EGGS/ANIMAL $18.82 20130101 87252 VIRUS INOCULATION TISSUE $23.09 20130101 87253 VIRUS INOCULATE TISSUE ADDL $19.43 20130101 87254 VIRUS INOCULATION SHELL VIA $18.82 20130101 87255 GENET VIRUS ISOLATE HSV $32.59 20130101 87260 ADENOVIRUS AG IF $11.54 20130101 87265 PERTUSSIS AG IF $11.54 20130101 87267 ENTEROVIRUS ANTIBODY DFA $11.54 20130101 87269 GIARDIA AG IF $11.54 20130101 87270 CHLAMYDIA TRACHOMATIS AG IF $11.54 20130101 87271 DFA $11.54 20130101 87272 CRYPTOSPORIDIUM AG IF $11.54 20130101 87273 HERPES SIMPLEX 2 AG IF $11.54 20130101 87274 HERPES SIMPLEX 1 AG IF $11.54 20130101 87275 INFLUENZA B AG IF $11.54 20130101 87276 INFLUENZA A AG IF $11.54 20130101 87277 LEGIONELLA MICDADEI AG IF $11.54 20130101 87278 LEGION PNEUMOPHILIA AG IF $11.54 20130101 87279 PARAINFLUENZA AG IF $11.54 20130101 87280 RESPIRATORY SYNCYTIAL AG IF $11.54 20130101 87281 PNEUMOCYSTIS CARINII AG IF $11.54 20130101 87283 RUBEOLA AG IF $11.54 20130101 87285 TREPONEMA PALLIDUM AG IF $11.54 20130101 87290 VARICELLA ZOSTER AG IF $11.54 20130101 87299 ANTIBODY DETECTION NOS IF $11.54 20130101 87300 AG DETECTION POLYVAL IF $11.54 20130101 87301 ADENOVIRUS AG EIA $11.54 20130101 87305 ASPERGILLUS AG EIA $11.54 20130101 87320 CHYLMD TRACH AG EIA $11.54 20130101 87324 CLOSTRIDIUM AG EIA $11.54 20130101 87327 CRYPTOCOCCUS NEOFORM AG EIA $11.54 20130101 87328 CRYPTOSPORIDIUM AG EIA $11.54 20130101 87329 GIARDIA AG EIA $11.54 20130101 87332 CYTOMEGALOVIRUS AG EIA $11.54 20130101 87335 E COLI 0157 AG EIA $11.54 20130101 87336 ENTAMOEB HIST DISPR AG EIA $11.54 20130101 87337 ENTAMOEB HIST GROUP AG EIA $11.54 20130101 87338 HPYLORI STOOL EIA $11.54 20130101 87339 H PYLORI AG EIA $11.54 20130101 87340 HEPATITIS B SURFACE AG EIA $9.94 20130101 87341 HEPATITIS B SURFACE AG EIA $9.94 20130101 87350 HEPATITIS BE AG EIA $11.09 20130101 87380 HEPATITIS DELTA AG EIA $15.79 20130101 87385 HISTOPLASMA CAPSUL AG EIA $11.54 20130101 87389 HIV-1 AG W/HIV-1 HIV-2 AB $23.18 20130101 87390 HIV-1 AG EIA $16.98 20130101 87391 HIV-2 AG EIA $16.98 20130101 87400 INFLUENZA A/B AG EIA $11.54 20130101 87420 RESP SYNCYTIAL AG EIA $11.54 20130101 87425 ROTAVIRUS AG EIA $11.54 20130101 87427 SHIGA-LIKE TOXIN AG EIA $11.54 20130101 87430 STREP A AG EIA $11.54 20130101

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Page 20 of 26 DMAP Fee for Service Fee Schedule August 2013

87449 AG DETECT NOS EIA MULT $11.54 20130101 87450 AG DETECT NOS EIA SINGLE $9.23 20130101 87451 AG DETECT POLYVAL EIA MULT $9.23 20130101 87470 BARTONELLA DNA DIR PROBE $19.30 20130101 87471 BARTONELLA DNA AMP PROBE $33.77 20130101 87472 BARTONELLA DNA QUANT $41.22 20130101 87475 LYME DIS DNA DIR PROBE $19.30 20130101 87476 LYME DIS DNA AMP PROBE $33.77 20130101 87477 LYME DIS DNA QUANT $41.22 20130101 87480 CANDIDA DNA DIR PROBE $19.30 20130101 87481 CANDIDA DNA AMP PROBE $33.77 20130101 87482 CANDIDA DNA QUANT $40.17 20130101 87485 CHYLMD PNEUM DNA DIR PROBE $19.30 20130101 87486 CHYLMD PNEUM DNA AMP PROBE $33.77 20130101 87487 CHYLMD PNEUM DNA QUANT $41.22 20130101 87490 CHYLMD TRACH DNA DIR PROBE $19.30 20130101 87491 CHYLMD TRACH DNA AMP PROBE $33.77 20130101 87492 CHYLMD TRACH DNA QUANT $33.64 20130101 87493 C DIFF AMPLIFIED PROBE $33.77 20130101 87495 CYTOMEG DNA DIR PROBE $19.30 20130101 87496 CYTOMEG DNA AMP PROBE $33.77 20130101 87497 CYTOMEG DNA QUANT $41.22 20130101 87498 ENTEROVIRUS PROBEREVRS TRNS $33.77 20130101 87500 VANOMYCIN DNA AMP PROBE $33.77 20130101 87501 INFLUENZA DNA AMP PROB 1 $49.38 20130101 87502 INFLUENZA DNA AMP PROBE $81.87 20130101 87503 INFLUENZA DNA AMP PROB ADDL $19.99 20130101 87510 GARDNER VAG DNA DIR PROBE $19.30 20130101 87511 GARDNER VAG DNA AMP PROBE $33.77 20130101 87512 GARDNER VAG DNA QUANT $40.17 20130101 87515 HEPATITIS B DNA DIR PROBE $19.30 20130101 87516 HEPATITIS B DNA AMP PROBE $33.77 20130101 87517 HEPATITIS B DNA QUANT $41.22 20130101 87520 HEPATITIS C RNA DIR PROBE $19.30 20130101 87521 HEPATITIS C PROBERVRS TRNSC $33.77 20130101 87522 HEPATITIS C REVRS TRNSCRPJ $41.22 20130101 87525 HEPATITIS G DNA DIR PROBE $19.30 20130101 87526 HEPATITIS G DNA AMP PROBE $33.77 20130101 87527 HEPATITIS G DNA QUANT $40.17 20130101 87528 HSV DNA DIR PROBE $19.30 20130101 87529 HSV DNA AMP PROBE $33.77 20130101 87530 HSV DNA QUANT $41.22 20130101 87531 HHV-6 DNA DIR PROBE $19.30 20130101 87532 HHV-6 DNA AMP PROBE $33.77 20130101 87533 HHV-6 DNA QUANT $40.17 20130101 87534 HIV-1 DNA DIR PROBE $19.30 20130101 87535 HIV-1 PROBEREVERSE TRNSCRPJ $33.77 20130101 87536 HIV-1 QUANTREVRSE TRNSCRPJ $81.87 20130101 87537 HIV-2 DNA DIR PROBE $19.30 20130101 87538 HIV-2 PROBEREVRSE TRNSCRIPJ $33.77 20130101 87539 HIV-2 QUANTREVRSE TRNSCRIPJ $41.22 20130101 87540 LEGION PNEUMO DNA DIR PROB $19.30 20130101 87541 LEGION PNEUMO DNA AMP PROB $33.77 20130101 87542 LEGION PNEUMO DNA QUANT $40.17 20130101 87550 MYCOBACTERIA DNA DIR PROBE $19.30 20130101 87551 MYCOBACTERIA DNA AMP PROBE $33.77 20130101 87552 MYCOBACTERIA DNA QUANT $41.22 20130101 87555 M.TUBERCULO DNA DIR PROBE $19.30 20130101 87556 M.TUBERCULO DNA AMP PROBE $33.77 20130101 87557 M.TUBERCULO DNA QUANT $41.22 20130101

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87560 M.AVIUM-INTRA DNA DIR PROB $19.30 20130101 87561 M.AVIUM-INTRA DNA AMP PROB $33.77 20130101 87562 M.AVIUM-INTRA DNA QUANT $41.22 20130101 87580 M.PNEUMON DNA DIR PROBE $19.30 20130101 87581 M.PNEUMON DNA AMP PROBE $33.77 20130101 87582 M.PNEUMON DNA QUANT $40.17 20130101 87582 M.PNEUMON DNA QUANT $41.13 20120101 87590 N.GONORRHOEAE DNA DIR PROB $19.30 20130101 87591 N.GONORRHOEAE DNA AMP PROB $33.77 20130101 87592 N.GONORRHOEAE DNA QUANT $41.22 20130101 87620 HPV DNA DIR PROBE $19.30 20130101 87621 HPV DNA AMP PROBE $33.77 20130101 87622 HPV DNA QUANT $40.17 20130101 87631 RESP VIRUS 3-11 TARGETS $123.44 20130101 87632 RESP VIRUS 6-11 TARGETS $205.36 20130101 87633 RESP VIRUS 12-25 TARGETS $401.04 20130101 87640 STAPH A DNA AMP PROBE $33.77 20130101 87641 MR-STAPH DNA AMP PROBE $33.77 20130101 87650 STREP A DNA DIR PROBE $19.30 20130101 87651 STREP A DNA AMP PROBE $33.77 20130101 87652 STREP A DNA QUANT $40.17 20130101 87653 STREP B DNA AMP PROBE $33.77 20130101 87660 TRICHOMONAS VAGIN DIR PROBE $19.30 20130101 87797 DETECT AGENT NOS DNA DIR $19.30 20130101 87798 DETECT AGENT NOS DNA AMP $33.77 20130101 87799 DETECT AGENT NOS DNA QUANT $41.22 20130101 87800 DETECT AGNT MULT DNA DIREC $38.60 20130101 87801 DETECT AGNT MULT DNA AMPLI $67.54 20130101 87802 STREP B ASSAY W/OPTIC $11.54 20130101 87803 CLOSTRIDIUM TOXIN A W/OPTIC $11.54 20130101 87804 INFLUENZA ASSAY W/OPTIC $11.54 20130101 87807 RSV ASSAY W/OPTIC $11.54 20130101 87808 TRICHOMONAS ASSAY W/OPTIC $11.54 20130101 87809 ADENOVIRUS ASSAY W/OPTIC $11.54 20130101 87810 CHYLMD TRACH ASSAY W/OPTIC $11.54 20130101 87850 N. GONORRHOEAE ASSAY W/OPTIC $11.54 20130101 87880 STREP A ASSAY W/OPTIC $11.54 20130101 87899 AGENT NOS ASSAY W/OPTIC $11.54 20130101 87900 PHENOTYPE INFECT AGENT DRUG $115.42 20130101 87901 GENOTYPE DNA HIV REVERSE T $247.72 20130101 87902 GENOTYPE DNA/RNA HEP C $247.72 20130101 87903 PHENOTYPE DNA HIV W/CULTURE $470.18 20130101 87904 PHENOTYPE DNA HIV W/CLT ADD $23.09 20130101 87906 GENOTYPE DNA/RNA HIV $123.86 20130101 88104 CYTOPATH FL NONGYN SMEARS 26 $21.09 20130101 88104 CYTOPATH FL NONGYN SMEARS $55.57 20130101 88104 CYTOPATH FL NONGYN SMEARS TC $34.48 20130101 88106 CYTOPATH FL NONGYN FILTER 26 $14.03 20130101 88106 CYTOPATH FL NONGYN FILTER $62.09 20130101 88106 CYTOPATH FL NONGYN FILTER TC $48.06 20130101 88108 CYTOPATH CONCENTRATE TECH 26 $16.31 20130101 88108 CYTOPATH CONCENTRATE TECH $57.45 20130101 88108 CYTOPATH CONCENTRATE TECH TC $41.14 20130101 88112 CYTOPATH CELL ENHANCE TECH 26 $42.80 20130101 88112 CYTOPATH CELL ENHANCE TECH $80.00 20130101 88112 CYTOPATH CELL ENHANCE TECH TC $37.19 20130101 88120 CYTP URNE 3-5 PROBES EA SPEC $451.02 20130101 88120 CYTP URNE 3-5 PROBES EA SPEC TC $409.35 20130101 88121 CYTP URINE 3-5 PROBES CMPTR 26 $36.33 20130101 88121 CYTP URINE 3-5 PROBES CMPTR $405.36 20130101

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88121 CYTP URINE 3-5 PROBES CMPTR TC $369.03 20130101 88130 SEX CHROMATIN IDENTIFICATION $14.48 20130101 88130 SEX CHROMATIN IDENTIFICATION TC $15.55 20080701 88140 SEX CHROMATIN IDENTIFICATION $7.69 20130101 88140 SEX CHROMATIN IDENTIFICATION TC $8.18 20011101 88141 CYTOPATH C/V INTERPRET $23.03 20130101 88142 CYTOPATH C/V THIN LAYER $19.50 20130101 88142 CYTOPATH C/V THIN LAYER TC $21.89 20100501 88143 CYTOPATH C/V THIN LAYER REDO $19.50 20130101 88143 CYTOPATH C/V THIN LAYER REDO TC $21.89 20100501 88147 CYTOPATH C/V AUTOMATED $10.96 20130101 88147 CYTOPATH C/V AUTOMATED TC $12.30 20100501 88148 CYTOPATH C/V AUTO RESCREEN $14.62 20130101 88148 CYTOPATH C/V AUTO RESCREEN TC $16.42 20100501 88150 CYTOPATH C/V MANUAL $10.17 20130101 88150 CYTOPATH C/V MANUAL TC $10.92 20080701 88152 CYTOPATH C/V AUTO REDO $10.17 20130101 88152 CYTOPATH C/V AUTO REDO TC $11.41 20100501 88153 CYTOPATH C/V REDO $10.17 20130101 88153 CYTOPATH C/V REDO TC $11.41 20100501 88154 CYTOPATH C/V SELECT $10.17 20130101 88154 CYTOPATH C/V SELECT TC $11.41 20100501 88155 CYTOPATH C/V INDEX ADD-ON $5.77 20130101 88155 CYTOPATH C/V INDEX ADD-ON TC $6.19 20030101 88160 CYTOPATH SMEAR OTHER SOURCE 26 $18.82 20130101 88160 CYTOPATH SMEAR OTHER SOURCE $46.39 20130101 88160 CYTOPATH SMEAR OTHER SOURCE TC $27.57 20130101 88161 CYTOPATH SMEAR OTHER SOURCE 26 $18.08 20130101 88161 CYTOPATH SMEAR OTHER SOURCE $44.17 20130101 88161 CYTOPATH SMEAR OTHER SOURCE TC $26.08 20130101 88162 CYTOPATH SMEAR OTHER SOURCE 26 $28.73 20130101 88162 CYTOPATH SMEAR OTHER SOURCE $70.12 20130101 88162 CYTOPATH SMEAR OTHER SOURCE TC $41.39 20130101 88164 CYTOPATH TBS C/V MANUAL $10.17 20130101 88164 CYTOPATH TBS C/V MANUAL TC $11.41 20100501 88165 CYTOPATH TBS C/V REDO $10.17 20130101 88165 CYTOPATH TBS C/V REDO TC $11.41 20100501 88166 CYTOPATH TBS C/V AUTO REDO $10.17 20130101 88166 CYTOPATH TBS C/V AUTO REDO TC $11.41 20100501 88167 CYTOPATH TBS C/V SELECT $10.17 20130101 88167 CYTOPATH TBS C/V SELECT TC $11.41 20100501 88172 CYTP DX EVAL FNA 1ST EA SITE 26 $26.14 20130101 88172 CYTP DX EVAL FNA 1ST EA SITE $40.12 20130101 88172 CYTP DX EVAL FNA 1ST EA SITE TC $13.99 20130101 88173 CYTOPATH EVAL FNA REPORT 26 $51.61 20130101 88173 CYTOPATH EVAL FNA REPORT $109.54 20130101 88173 CYTOPATH EVAL FNA REPORT TC $57.93 20130101 88174 CYTOPATH C/V AUTO IN FLUID $20.56 20130101 88174 CYTOPATH C/V AUTO IN FLUID TC $23.08 20100501 88175 CYTOPATH C/V AUTO FLUID REDO $25.49 20130101 88175 CYTOPATH C/V AUTO FLUID REDO TC $28.62 20100501 88177 CYTP FNA EVAL EA ADDL 26 $16.05 20130101 88177 CYTP FNA EVAL EA ADDL $21.64 20130101 88177 CYTP FNA EVAL EA ADDL TC $5.59 20130101 88182 CELL MARKER STUDY 26 $25.78 20130101 88182 CELL MARKER STUDY $79.34 20130101 88182 CELL MARKER STUDY TC $53.56 20130101 88184 FLOWCYTOMETRY/ TC 1 MARKER $64.35 20130101 88185 FLOWCYTOMETRY/TC ADD-ON $39.17 20130101 88187 FLOWCYTOMETRY/READ 2-8 $50.25 20130101

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88188 FLOWCYTOMETRY/READ 9-15 $64.16 20130101 88189 FLOWCYTOMETRY/READ 16 $77.99 20130101 88230 TISSUE CULTURE LYMPHOCYTE $73.89 20130101 88233 TISSUE CULTURE SKIN/BIOPSY $135.41 20130101 88235 TISSUE CULTURE PLACENTA $77.29 20130101 88237 TISSUE CULTURE BONE MARROW $121.53 20130101 88239 TISSUE CULTURE TUMOR $135.91 20130101 88240 CELL CRYOPRESERVE/STORAGE $9.72 20130101 88241 FROZEN CELL PREPARATION $9.72 20130101 88245 ANALYSIS 20-25 $143.23 20130101 88248 CHROMOSOME ANALYSIS 50-100 $166.63 20130101 88249 CHROMOSOME ANALYSIS 100 $166.63 20130101 88261 CHROMOSOME ANALYSIS 5 $170.05 20130101 88262 CHROMOSOME ANALYSIS 15-20 $119.93 20130101 88263 CHROMOSOME ANALYSIS 45 $144.61 20130101 88264 CHROMOSOME ANALYSIS 20-25 $119.93 20130101 88267 CHROMOSOME ANALYS PLACENTA $172.98 20130101 88269 CHROMOSOME ANALYS AMNIOTIC $160.04 20130101 88271 CYTOGENETICS DNA PROBE $20.61 20130101 88272 CYTOGENETICS 3-5 $25.76 20130101 88273 CYTOGENETICS 10-30 $30.92 20130101 88274 CYTOGENETICS 25-99 $33.50 20130101 88275 CYTOGENETICS 100-300 $38.64 20130101 88280 CHROMOSOME KARYOTYPE STUDY $24.15 20130101 88283 CHROMOSOME BANDING STUDY $66.01 20130101 88285 CHROMOSOME COUNT ADDITIONAL $18.28 20130101 88289 CHROMOSOME STUDY ADDITIONAL $21.25 20130101 88291 CYTO/MOLECULAR REPORT $22.37 20130101 88300 SURGICAL PATH GROSS 26 $3.19 20130101 88300 SURGICAL PATH GROSS $10.50 20130101 88300 SURGICAL PATH GROSS TC $7.32 20130101 88302 TISSUE EXAM BY PATHOLOGIST 26 $4.95 20130101 88302 TISSUE EXAM BY PATHOLOGIST $22.40 20130101 88302 TISSUE EXAM BY PATHOLOGIST TC $17.44 20130101 88304 TISSUE EXAM BY PATHOLOGIST 26 $8.23 20130101 88304 TISSUE EXAM BY PATHOLOGIST $32.34 20130101 88304 TISSUE EXAM BY PATHOLOGIST TC $24.11 20130101 88305 TISSUE EXAM BY PATHOLOGIST 26 $27.17 20130101 88305 TISSUE EXAM BY PATHOLOGIST $51.28 20130101 88305 TISSUE EXAM BY PATHOLOGIST TC $24.11 20130101 88307 TISSUE EXAM BY PATHOLOGIST 26 $60.41 20130101 88307 TISSUE EXAM BY PATHOLOGIST $216.61 20130101 88307 TISSUE EXAM BY PATHOLOGIST TC $156.20 20130101 88309 TISSUE EXAM BY PATHOLOGIST 26 $106.69 20130101 88309 TISSUE EXAM BY PATHOLOGIST $327.40 20130101 88309 TISSUE EXAM BY PATHOLOGIST TC $220.71 20130101 88311 DECALCIFY TISSUE 26 $8.99 20130101 88311 DECALCIFY TISSUE $14.83 20130101 88311 DECALCIFY TISSUE TC $5.84 20130101 88312 SPECIAL STAINS GROUP 1 26 $19.60 20130101 88312 SPECIAL STAINS GROUP 1 $71.11 20130101 88312 SPECIAL STAINS GROUP 1 TC $51.51 20130101 88313 SPECIAL STAINS GROUP 2 26 $8.74 20130101 88313 SPECIAL STAINS GROUP 2 $49.15 20130101 88313 SPECIAL STAINS GROUP 2 TC $40.40 20130101 88314 HISTOCHEMICAL STAINS ADD-ON 26 $16.56 20130101 88314 HISTOCHEMICAL STAINS ADD-ON $58.94 20130101 88314 HISTOCHEMICAL STAINS ADD-ON TC $42.38 20130101 88319 ENZYME HISTOCHEMISTRY 26 $19.91 20130101 88319 ENZYME HISTOCHEMISTRY $63.52 20130101

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Page 24 of 26 DMAP Fee for Service Fee Schedule August 2013

88319 ENZYME HISTOCHEMISTRY TC $43.61 20130101 88321 MICROSLIDE CONSULTATION $68.06 20130101 88323 MICROSLIDE CONSULTATION 26 $61.34 20130101 88323 MICROSLIDE CONSULTATION $103.72 20130101 88323 MICROSLIDE CONSULTATION TC $42.38 20130101 88325 COMPREHENSIVE REVIEW OF DATA $153.51 20130101 88329 PATH CONSULT INTROP $41.90 20130101 88331 PATH CONSULT INTRAOP 1 BLOC 26 $45.29 20130101 88331 PATH CONSULT INTRAOP 1 BLOC $73.11 20130101 88331 PATH CONSULT INTRAOP 1 BLOC TC $27.81 20130101 88332 PATH CONSULT INTRAOP ADDL 26 $22.35 20130101 88332 PATH CONSULT INTRAOP ADDL $31.89 20130101 88332 PATH CONSULT INTRAOP ADDL TC $9.54 20130101 88333 INTRAOP CYTO PATH CONSULT 1 26 $45.78 20130101 88333 INTRAOP CYTO PATH CONSULT 1 $76.80 20130101 88333 INTRAOP CYTO PATH CONSULT 1 TC $31.02 20130101 88334 INTRAOP CYTO PATH CONSULT 2 26 $28.21 20130101 88334 INTRAOP CYTO PATH CONSULT 2 $47.88 20130101 88334 INTRAOP CYTO PATH CONSULT 2 TC $19.66 20130101 88342 IMMUNOHISTOCHEMISTRY 26 $31.02 20130101 88342 IMMUNOHISTOCHEMISTRY $84.02 20130101 88342 IMMUNOHISTOCHEMISTRY TC $53.00 20130101 88346 IMMUNOFLUORESCENT STUDY 26 $30.96 20130101 88346 IMMUNOFLUORESCENT STUDY $79.76 20130101 88346 IMMUNOFLUORESCENT STUDY TC $48.80 20130101 88347 IMMUNOFLUORESCENT STUDY 26 $28.24 20130101 88347 IMMUNOFLUORESCENT STUDY $58.03 20130101 88347 IMMUNOFLUORESCENT STUDY TC $29.79 20130101 88348 ELECTRON MICROSCOPY 26 $54.67 20130101 88348 ELECTRON MICROSCOPY $526.53 20130101 88348 ELECTRON MICROSCOPY TC $471.87 20130101 88349 SCANNING ELECTRON MICROSCOPY 26 $29.47 20130101 88349 SCANNING ELECTRON MICROSCOPY $317.50 20130101 88349 SCANNING ELECTRON MICROSCOPY TC $288.03 20130101 88355 ANALYSIS SKELETAL MUSCLE 26 $61.02 20130101 88355 ANALYSIS SKELETAL MUSCLE $133.52 20130101 88355 ANALYSIS SKELETAL MUSCLE TC $72.50 20130101 88356 ANALYSIS NERVE 26 $93.99 20130101 88356 ANALYSIS NERVE $202.28 20130101 88356 ANALYSIS NERVE TC $108.29 20130101 88358 ANALYSIS TUMOR 26 $32.09 20130101 88358 ANALYSIS TUMOR $59.90 20130101 88358 ANALYSIS TUMOR TC $27.81 20130101 88360 TUMOR IMMUNOHISTOCHEM/MANUAL 26 $38.63 20130101 88360 TUMOR IMMUNOHISTOCHEM/MANUAL $92.86 20130101 88360 TUMOR IMMUNOHISTOCHEM/MANUAL TC $54.23 20130101 88361 TUMOR IMMUNOHISTOCHEM/COMPUT 26 $42.06 20130101 88361 TUMOR IMMUNOHISTOCHEM/COMPUT $114.07 20130101 88361 TUMOR IMMUNOHISTOCHEM/COMPUT TC $72.01 20130101 88362 NERVE TEASING PREPARATIONS 26 $80.09 20130101 88362 NERVE TEASING PREPARATIONS $226.90 20130101 88362 NERVE TEASING PREPARATIONS TC $146.80 20130101 88363 XM ARCHIVE TISSUE MOLEC ANAL $41.26 20130101 88365 INSITU HYBRIDIZATION FISH 26 $42.91 20130101 88365 INSITU HYBRIDIZATION FISH $130.22 20130101 88365 INSITU HYBRIDIZATION FISH TC $87.32 20130101 88367 INSITU HYBRIDIZATION AUTO 26 $44.04 20130101 88367 INSITU HYBRIDIZATION AUTO $187.90 20130101 88367 INSITU HYBRIDIZATION AUTO TC $143.86 20130101 88368 INSITU HYBRIDIZATION MANUAL 26 $45.44 20130101

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Page 25 of 26 DMAP Fee for Service Fee Schedule August 2013

88368 INSITU HYBRIDIZATION MANUAL $169.05 20130101 88368 INSITU HYBRIDIZATION MANUAL TC $123.61 20130101 88371 PROTEIN WESTERN BLOT TISSUE 26 $14.10 20130101 88371 PROTEIN WESTERN BLOT TISSUE $21.39 20130101 88372 PROTEIN ANALYSIS W/PROBE 26 $11.63 20130101 88372 PROTEIN ANALYSIS W/PROBE $21.89 20130101 88381 MICRODISSECTION MANUAL 26 $37.70 20130101 88381 MICRODISSECTION MANUAL $111.69 20130101 88381 MICRODISSECTION MANUAL TC $73.98 20130101 88387 TISS EXAM MOLECULAR STUDY 26 $20.40 20130101 88387 TISS EXAM MOLECULAR STUDY $24.76 20130101 88387 TISS EXAM MOLECULAR STUDY TC $4.36 20130101 88388 TISS EX MOLECUL STUDY ADD-ON 26 $17.30 20130101 88388 TISS EX MOLECUL STUDY ADD-ON $24.13 20130101 88388 TISS EX MOLECUL STUDY ADD-ON TC $6.83 20130101 88720 BILIRUBIN TOTAL TRANSCUT $4.83 20130101 89049 CHCT FOR MAL HYPERTHERMIA $200.71 20130101 89050 BODY FLUID CELL COUNT $4.55 20130101 89051 BODY FLUID CELL COUNT $5.30 20130101 89055 LEUKOCYTE ASSESSMENT FECAL $4.11 20130101 89060 EXAM SYNOVIAL FLUID CRYSTALS 26 $14.35 20130101 89060 EXAM SYNOVIAL FLUID CRYSTALS $6.88 20130101 89125 SPECIMEN FAT STAIN $2.77 20130101 89160 EXAM FECES FOR FIBERS $3.55 20130101 89190 NASAL SMEAR FOR $4.57 20130101 89220 SPUTUM SPECIMEN COLLECTION $12.75 20130101 89230 COLLECT SWEAT FOR TEST $1.64 20130101

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