V3.23 Pathology and Laboratory Services Relative Value Units (Rvus)

TABLE J. — PATHOLOGY AND LABORATORY SERVICES RELATIVE VALUE UNITS (RVUs) v3.23 (January - December 2018) PAGE 1 of 30

CPT/ Conversion Total Charge HCPCS Modifier CPT/HCPCS Code Description Factor/GAAF RVUs Methodology 1 Code Category 36415 Blank COLLECTION VENOUS BLOOD VENIPUNCTURE Pathology 0.08 CLAB 78267 Blank UREA BREATH TEST C-14 ISOTOPIC ACQUISJ ANALYSIS Pathology 0.30 CLAB 78268 Blank UREA BREATH TEST C-14 ISOTOPIC ANALYSIS Pathology 2.57 CLAB 80047 Blank BASIC METABOLIC PANEL CALCIUM IONIZED Pathology 0.32 CLAB 80048 Blank BASIC METABOLIC PANEL CALCIUM TOTAL Pathology 0.32 CLAB 80050 Blank GENERAL HEALTH PANEL Pathology 0.94 FAIR Health 80051 Blank ELECTROLYTE PANEL Pathology 0.27 CLAB 80053 Blank COMPREHENSIVE METABOLIC PANEL Pathology 0.40 CLAB 80055 Blank OBSTETRIC PANEL Pathology 1.83 CLAB 80061 Blank LIPID PANEL Pathology 0.51 CLAB 80069 Blank RENAL FUNCTION PANEL Pathology 0.33 CLAB 80074 Blank ACUTE HEPATITIS PANEL Pathology 1.82 CLAB 80076 Blank HEPATIC FUNCTION PANEL Pathology 0.31 CLAB 80081 Blank OBSTETRIC PANEL Pathology 2.86 CLAB 80150 Blank DRUG SCREEN QUANTITATIVE AMIKACIN Pathology 0.58 CLAB 80155 Blank DRUG ASSAY CAFFEINE Pathology 0.54 CLAB 80156 Blank DRUG ASSAY CARBAMAZEPINE TOTAL Pathology 0.56 CLAB 80157 Blank DRUG ASSAY CARBAMAZEPINE FREE Pathology 0.51 CLAB 80158 Blank DRUG ASSAY CYCLOSPORINE Pathology 0.69 CLAB 80159 Blank DRUG ASSAY CLOZAPINE Pathology 0.71 CLAB 80162 Blank DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL Pathology 0.51 CLAB 80163 Blank DRUG SCREEN QUANTITATIVE DIGOXIN FREE Pathology 0.51 CLAB 80164 Blank DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL Pathology 0.52 CLAB 80165 Blank DRUG SCREEN QUANT DIPROPYLACETIC ACID FREE Pathology 0.52 CLAB 80168 Blank DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE Pathology 0.62 CLAB 80169 Blank DRUG ASSAY EVEROLIMUS Pathology 0.52 CLAB 80170 Blank DRUG SCREEN QUANTITATIVE GENTAMICIN Pathology 0.63 CLAB 80171 Blank DRUG SCREEN QUANTITATIVE GABAPENTIN Pathology 0.51 CLAB 80173 Blank DRUG SCREEN QUANTITATIVE HALOPRIDOL Pathology 0.56 CLAB 80175 Blank DRUG SCREEN QUANTITATIVE LAMOTRIGINE Pathology 0.51 CLAB 80176 Blank DRUG SCREEN QUANTITATIVE LIDOCAINE Pathology 0.56 CLAB 80177 Blank DRUG SCREEN QUANTITATIVE LEVETIRACETAM Pathology 0.51 CLAB 80178 Blank DRUG SCREEN QUANTITATIVE LITHIUM Pathology 0.25 CLAB 80180 Blank DRUG SCREEN QUANTITATIVE MYCOPHENOLATE Pathology 0.69 CLAB 80183 Blank DRUG SCREEN QUANTITATIVE OXCARBAZEPINE Pathology 0.51 CLAB 80184 Blank DRUG SCREEN QUANTITATIVE PHENOBARBITAL Pathology 0.44 CLAB 80185 Blank DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL Pathology 0.51 CLAB 80186 Blank DRUG SCREEN QUANTITATIVE PHENYTOIN FREE Pathology 0.53 CLAB 80188 Blank DRUG SCREEN QUANTITATIVE PRIMIDONE Pathology 0.63 CLAB 80190 Blank DRUG SCREEN QUANTITATIVE PROCAINAMIDE Pathology 0.64 CLAB 80192 Blank DRUG SCREEN QUANTITATIVE PROCAINAMIDE METABOLITE Pathology 0.64 CLAB 80194 Blank DRUG SCREEN QUANTITATIVE QUINIDINE Pathology 0.56 CLAB 80195 Blank DRUG SCREEN QUANTITATIVE SIROLIMUS Pathology 0.52 CLAB 80197 Blank DRUG SCREEN QUANTITATIVE TACROLIMUS Pathology 0.52 CLAB 80198 Blank DRUG SCREEN QUANTITATIVE THEOPHYLLINE Pathology 0.54 CLAB 80199 Blank DRUG SCREEN QUANTITATIVE TIAGABINE Pathology 0.69 CLAB 80200 Blank DRUG SCREEN QUANTITATIVE TOBRAMYCIN Pathology 0.62 CLAB 80201 Blank DRUG SCREEN QUANTITATIVE TOPIRAMATE Pathology 0.46 CLAB 80202 Blank DRUG SCREEN QUANTITATIVE VANCOMYCIN Pathology 0.52 CLAB 80203 Blank DRUG SCREEN QUANTITATIVE ZONISAMIDE Pathology 0.51 CLAB

NOTES: CPT codes and descriptions only are copyright American Medical Association. All rights reserved. Applicable FARS/DFARS apply. 1 - See end of table for note regarding Charge Methodology. TABLE J. — PATHOLOGY AND LABORATORY SERVICES RELATIVE VALUE UNITS (RVUs) v3.23 (January - December 2018) PAGE 2 of 30

CPT/ Conversion Total Charge HCPCS Modifier CPT/HCPCS Code Description Factor/GAAF RVUs Methodology 1 Code Category 80299 Blank QUANTITATION DRUG NOT ELSEWHERE SPECIFIED Pathology 0.52 CLAB 80305 Blank DRUG TEST PRSMV DIR OPT OBS Pathology 0.42 CLAB 80306 Blank DRUG TEST PRSMV INSTRMNT Pathology 0.56 CLAB 80307 Blank DRUG TEST PRSMV CHEM ANLYZR Pathology 2.22 CLAB 80320 Blank DRUG SCREEN QUANTITATIVE ALCOHOLS Pathology 0.51 FAIR Health 80321 Blank DRUG SCREEN QUANT ALCOHOLS BIOMARKERS 1 OR 2 Pathology 0.65 FAIR Health 80322 Blank DRUG SCREEN QUANT ALCOHOLS BIOMARKERS 3 OR MORE Pathology 0.90 FAIR Health 80323 Blank ALKALOIDS NOT OTHERWISE SPECIFIED Pathology 0.63 Unlisted 80324 Blank DRUG SCREEN QUANT AMPHETAMINES 1 OR 2 Pathology 0.61 FAIR Health 80325 Blank DRUG SCREEN QUANT AMPHETAMINES 3 OR 4 Pathology 0.97 FAIR Health 80326 Blank DRUG SCREEN QUANT AMPHETAMINES 5 OR MORE Pathology 1.12 FAIR Health 80327 Blank DRUG SCREEN QUANT ANABOLIC STEROID 1 OR 2 Pathology 0.93 FAIR Health 80329 Blank DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2 Pathology 0.72 FAIR Health 80330 Blank DRUG SCREEN ANALGESICS NON-OPIOID 3-5 Pathology 1.31 FAIR Health 80331 Blank DRUG SCREEN ANALGESICS NON-OPIOID 6 OR MORE Pathology 0.34 FAIR Health 80332 Blank ANTIDEPRESSANTS SEROTONERGIC CLASS 1 OR 2 Pathology 0.60 FAIR Health 80333 Blank ANTIDEPRESSANTS SEROTONERGIC CLASS 3-5 Pathology 0.77 FAIR Health 80334 Blank ANTIDEPRESSANTS SEROTONERGIC CLASS 6 OR MORE Pathology 0.84 FAIR Health 80335 Blank ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 1 OR 2 Pathology 0.49 FAIR Health 80336 Blank ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 3-5 Pathology 1.46 FAIR Health 80337 Blank ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 6/MORE Pathology 1.83 FAIR Health 80338 Blank ANTIDEPRESSANTS NOT OTHERWISE SPECIFIED Pathology 0.49 Unlisted 80339 Blank ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 1-3 Pathology 0.63 Unlisted 80340 Blank ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 4-6 Pathology 0.63 Unlisted 80341 Blank ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 7/MORE Pathology 0.63 Unlisted 80342 Blank ANTIPSYCHOTICS NOT OTHERWISE SPECIFIED 1-3 Pathology 0.63 Unlisted 80343 Blank ANTIPSYCHOTICS NOT OTHERWISE SPECIFIED 4-6 Pathology 0.63 Unlisted 80344 Blank ANTIPSYCHOTICS NOT OTHERWISE SPECIFIED 7/MORE Pathology 0.63 Unlisted 80345 Blank DRUG SCREENING BARBITURATES Pathology 0.71 FAIR Health 80346 Blank DRUG SCREENING BENZODIAZEPINES 1-12 Pathology 1.15 FAIR Health 80347 Blank DRUG SCREENING BENZODIAZEPINES 13 OR MORE Pathology 2.40 FAIR Health 80348 Blank DRUG SCREENING BUPRENORPHINE Pathology 0.71 FAIR Health 80349 Blank DRUG SCREENING CANNABINOIDS NATURAL Pathology 0.59 FAIR Health 80350 Blank DRUG SCREENING CANNABINOIDS SYNTHETIC 1-3 Pathology 0.47 FAIR Health 80351 Blank DRUG SCREENING CANNABINOIDS SYNTHETIC 4-6 Pathology 1.04 FAIR Health 80352 Blank DRUG SCREENING CANNABINOIDS SYNTHETIC 7/MORE Pathology 1.62 FAIR Health 80353 Blank DRUG SCREENING COCAINE Pathology 0.51 FAIR Health 80354 Blank DRUG SCREENING FENTANYL Pathology 0.72 FAIR Health 80355 Blank DRUG SCREENING GABAPENTIN NON-BLOOD Pathology 0.58 FAIR Health 80356 Blank DRUG SCREENING HEROIN METABOLITE Pathology 0.65 FAIR Health 80357 Blank DRUG SCREENING KETAMINE AND NORKETAMINE Pathology 0.71 FAIR Health 80358 Blank DRUG SCREENING METHADONE Pathology 0.59 FAIR Health 80359 Blank DRUG SCREENING METHYLENEDIOXYAMPHETAMINES Pathology 0.67 FAIR Health 80360 Blank DRUG SCREENING METHYLPHENIDATE Pathology 0.57 FAIR Health 80361 Blank DRUG SCREENING OPIATES 1 OR MORE Pathology 1.08 FAIR Health 80362 Blank DRUG SCREENING OPIOIDS AND OPIATE ANALOGS 1 OR 2 Pathology 0.93 FAIR Health 80363 Blank DRUG SCREENING OPIOIDS AND OPIATE ANALOGS 3 OR 4 Pathology 1.34 FAIR Health 80364 Blank DRUG SCREENING OPIOIDS & OPIATE ANALOGS 5/MORE Pathology 2.12 FAIR Health 80365 Blank DRUG SCREENING OXYCODONE Pathology 0.63 FAIR Health 80366 Blank DRUG SCREENING PREGABALIN Pathology 0.61 FAIR Health

CPT/ Conversion Total Charge HCPCS Modifier CPT/HCPCS Code Description Factor/GAAF RVUs Methodology 1 Code Category 80367 Blank DRUG SCREENING PROPOXYPHENE Pathology 0.59 FAIR Health 80368 Blank DRUG SCREENING SEDATIVE HYPNOTICS Pathology 0.66 FAIR Health 80369 Blank DRUG SCREENING SKELETAL MUSCLE RELAXANTS 1 OR 2 Pathology 0.73 FAIR Health 80370 Blank DRUG SCREENING SKEL MUSCLE RELAXANTS 3 OR MORE Pathology 0.91 FAIR Health 80371 Blank DRUG SCREENING STIMULANTS SYNTHETIC Pathology 0.77 FAIR Health 80372 Blank DRUG SCREENING TAPENTADOL Pathology 0.60 FAIR Health 80373 Blank DRUG SCREENING TRAMADOL Pathology 0.61 FAIR Health 80374 Blank DRUG SCREEN STEREOISOMER ANALYSIS 1 DRUG CLASS Pathology 0.42 FAIR Health 80375 Blank DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 1-3 Pathology 0.65 FAIR Health 80376 Blank DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 4-6 Pathology 1.66 FAIR Health 80377 Blank DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 7/MORE Pathology 0.72 FAIR Health 80400 Blank ACTH STIMULATION PANEL ADRENAL INSUFFICIENCY Pathology 1.25 CLAB 80402 Blank ACTH STIMULATION PANEL 21 HYDROXYLASE DEFICIENCY Pathology 3.32 CLAB 80406 Blank ACTH STIMJ PANEL 3 BETA-HYDROXYDEHYD DEFNCY Pathology 2.99 CLAB 80408 Blank ALDOSTERONE SUPPRESSION EVALUATION PANEL Pathology 4.80 CLAB 80410 Blank CALCITONIN STIMULATION PANEL Pathology 3.07 CLAB 80412 Blank CORTICOTROPIC RELEASING HORM STIMJ PANEL Pathology 12.60 CLAB 80414 Blank CHORNC GONAD STIMJ PANEL TSTOSTERONE RESPONSE Pathology 1.97 CLAB 80415 Blank CHORNC GONAD STIMJ PANEL ESTRADIOL RESPONSE Pathology 2.14 CLAB 80416 Blank RENAL VEIN RENIN STIMULATION PANEL Pathology 5.04 CLAB 80417 Blank PERIPHERAL VEIN RENIN STIMULATION PANEL Pathology 1.68 CLAB 80418 Blank COMBINED RAPID ANT PITUITARY EVALUATION PANEL Pathology 22.15 CLAB 80420 Blank DEXMETHASONE SUPPRESSION PANEL 48 HR Pathology 2.75 CLAB 80422 Blank GLUCOSE TOLERANCE PANEL INSULINOMA Pathology 1.76 CLAB 80424 Blank GLUCOSE TOLERANCE PANEL PHEOCHROMOCYTOMA Pathology 1.93 CLAB 80426 Blank GONADOTROPIN RELEASING HORMONE STIMJ PANEL Pathology 5.67 CLAB 80428 Blank GROWTH HORMONE STIMULATION PANEL Pathology 2.55 CLAB 80430 Blank GROWTH HORMONE SUPRJ PANEL GLUCOSE ADMN Pathology 3.00 CLAB 80432 Blank INSULIN-INDUCED C-PEPTIDE SUPRESSION PANEL Pathology 5.16 CLAB 80434 Blank INSULIN TOLERANCE PANEL ACTH INSUFFICIENCY Pathology 3.87 CLAB 80435 Blank INSULIN TOLERANCE PANEL GROWTH HORM DEFNCY Pathology 3.94 CLAB 80436 Blank METYRAPONE PANEL Pathology 3.48 CLAB 80438 Blank THYROTROPIN RELEASING HORMONE STMLJ PANEL 1 HR Pathology 1.93 CLAB 80439 Blank THYROTROPIN RELEASING HORMONE STMLJ PANEL 2 HR Pathology 2.57 CLAB 81000 Blank URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY Pathology 0.12 CLAB 81001 Blank URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY Pathology 0.12 CLAB 81002 Blank URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP Pathology 0.10 CLAB 81003 Blank URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY Pathology 0.09 CLAB 81005 Blank URINALYSIS QUAL/SEMIQUANT EXCEPT IMMUNOASSAYS Pathology 0.08 CLAB 81007 Blank URINALYSIS BACTERIURIA SCR XCPT CULTURE/DIPSTICK Pathology 0.10 CLAB 81015 Blank URINALYSIS MICROSCOPIC ONLY Pathology 0.12 CLAB 81020 Blank URINALYSIS 2/3 GLASS TEST Pathology 0.14 CLAB 81025 Blank URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS Pathology 0.24 CLAB 81050 Blank VOLUME MEASUREMENT TIMED COLLECTION EACH Pathology 0.11 CLAB 81099 Blank UNLISTED URINALYSIS PROCEDURE Pathology 0.10 Unlisted 81105 Blank HPA-1 GENOTYPING Pathology 4.67 Other 81106 Blank HPA-2 GENOTYPING Pathology 4.67 Other 81107 Blank HPA-3 GENOTYPING Pathology 4.67 Other 81108 Blank HPA-4 GENOTYPING Pathology 4.67 Other 81109 Blank HPA-5 GENOTYPING Pathology 4.67 Other

CPT/ Conversion Total Charge HCPCS Modifier CPT/HCPCS Code Description Factor/GAAF RVUs Methodology 1 Code Category 81110 Blank HPA-6 GENOTYPING Pathology 4.67 Other 81111 Blank HPA-9 GENOTYPING Pathology 4.67 Other 81112 Blank HPA-15 GENOTYPING Pathology 4.67 Other 81120 Blank IDH1 COMMON VARIANTS Pathology 5.53 Other 81121 Blank IDH2 COMMON VARIANTS Pathology 8.30 Other 81161 Blank DMD DUPLICATION/DELETION ANALYSIS Pathology 3.93 CLAB 81162 Blank BRCA1&BRCA2 FULL SEQ ANALYS/FULL DUP/DEL ANALYS Pathology 69.75 CLAB 81170 Blank ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS Pathology 9.25 CLAB 81175 Blank ASXL1 FULL GENE SEQUENCE Pathology 21.89 Other 81176 Blank ASXL1 GENE TARGET SEQ ALYS Pathology 9.25 Other 81200 Blank ASPA GENE ANALYSIS COMMON VARIANTS Pathology 1.21 FAIR Health 81201 Blank APC GENE ANALYSIS FULL GENE SEQUENCE Pathology 4.95 FAIR Health 81202 Blank APC GENE ANALYSIS KNOWN FAMILIAL VARIANTS Pathology 1.70 FAIR Health 81203 Blank APC GENE ANALYSIS DUPLICATION/DELETION VARIANTS Pathology 2.46 FAIR Health 81205 Blank BCKDHB GENE ANALYSIS COMMON VARIANTS Pathology 1.39 FAIR Health 81206 Blank BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE Pathology 6.27 CLAB 81207 Blank BCR/ABL1 MINOR BREAKPNT QUALITATIVE/QUANTITATIVE Pathology 5.54 CLAB 81208 Blank BCR/ABL1 OTHER BREAKPNT QUALITATIVE/QUANTITATIVE Pathology 6.15 CLAB 81209 Blank BLM GENE ANALYSIS 2281DEL6INS7 VARIANT Pathology 0.91 FAIR Health 81210 Blank BRAF GENE ANALYSIS V600 VARIANT(S) Pathology 5.02 CLAB 81211 Blank BRCA1&BRCA2 FULL SEQ ANALYS/COMM DUP/DEL BRCA Pathology 61.17 CLAB 81212 Blank BRCA1&BRCA2 ANAL 185DELAG5385INSC/6174DELT Pathology 4.95 CLAB 81213 Blank BRCA1&BRCA2 ANAL UNCOMMON DUP/DEL VARIANTS Pathology 16.33 CLAB 81214 Blank BRCA1 FULL SEQ ANAL&COMMON DUP/DEL VARIANTS Pathology 40.29 CLAB 81215 Blank BRCA1 GENE ANALYSIS KNOWN FAMILIAL VARIANT Pathology 2.61 CLAB 81216 Blank BRCA2 GENE ANALYSIS FULL SEQUENCE ANALYSIS Pathology 7.15 FAIR Health 81217 Blank BRCA2 GENE ANALYSIS KNOWN FAMILIAL VARIANT Pathology 2.61 CLAB 81218 Blank CEBPA GENE ANALYSIS FULL GENE SEQUENCE Pathology 9.25 CLAB 81219 Blank CALR GENE ANALYSIS COMMON VARIANTS IN EXON 9 Pathology 4.65 CLAB 81220 Blank CFTR GENE ANALYSIS COMMON VARIANTS Pathology 7.48 FAIR Health 81221 Blank CFTR GENE ANALYSIS KNOWN FAMILIAL VARIANTS Pathology 4.18 FAIR Health 81222 Blank CFTR GENE ANALYSIS DUPLICATION/DELETION VARIANTS Pathology 3.51 FAIR Health 81223 Blank CFTR GENE ANALYSIS FULL GENE SEQUENCE Pathology 8.96 FAIR Health 81224 Blank CFTR GENE ANALYSIS INTRON 8 POLY-T ANALYSIS Pathology 2.90 FAIR Health 81225 Blank CYP2C19 GENE ANALYSIS COMMON VARIANTS Pathology 8.18 CLAB 81226 Blank CYP2D6 GENE ANALYSIS COMMON VARIANTS Pathology 12.65 CLAB 81227 Blank CYP2C9 GENE ANALYSIS COMMON VARIANTS Pathology 4.90 CLAB 81228 Blank CYTOGENOM CONST MICROARRAY COPY NUMBER VARIANTS Pathology 12.94 FAIR Health 81229 Blank CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR Pathology 23.45 FAIR Health 81230 Blank CYP3A4 GENE COMMON VARIANTS Pathology 4.90 Other 81231 Blank CYP3A5 GENE COMMON VARIANTS Pathology 4.90 Other 81232 Blank DPYD GENE COMMON VARIANTS Pathology 4.90 Other 81235 Blank EGFR GENE ANALYSIS COMMON VARIANTS Pathology 9.25 CLAB 81238 Blank F9 FULL GENE SEQUENCE Pathology 16.83 Other 81240 Blank F2 GENE ANALYSIS 20210G >A VARIANT Pathology 1.88 CLAB 81241 Blank F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT Pathology 2.34 CLAB 81242 Blank FANCC GENE ANALYSIS COMMON VARIANT Pathology 0.98 FAIR Health 81243 Blank FMR1 ANALYSIS EVAL TO DETECT ABNORMAL ALLELES Pathology 2.86 FAIR Health 81244 Blank FMR1 GENE ANALYSIS CHARACTERIZATION OF ALLELES Pathology 2.05 FAIR Health 81245 Blank FLT3 GENE ANALYSIS INTERNAL TANDEM DUP VARIANTS Pathology 4.65 CLAB

CPT/ Conversion Total Charge HCPCS Modifier CPT/HCPCS Code Description Factor/GAAF RVUs Methodology 1 Code Category 81246 Blank FLT3 GENE ANLYS TYROSINE KINASE DOMAIN VARIANTS Pathology 2.33 CLAB 81247 Blank G6PD GENE ALYS CMN VARIANT Pathology 4.90 Other 81248 Blank G6PD KNOWN FAMILIAL VARIANT Pathology 2.61 Other 81249 Blank G6PD FULL GENE SEQUENCE Pathology 16.83 Other 81250 Blank G6PC GENE ANALYSIS COMMON VARIANTS Pathology 1.58 FAIR Health 81251 Blank GBA GLUCOSIDASE/BETA/ACID ANAL COMM VARIANTS Pathology 1.45 FAIR Health 81252 Blank GJB2 GENE ANALYSIS FULL GENE SEQUENCE Pathology 1.44 FAIR Health 81253 Blank GJB2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS Pathology 1.01 FAIR Health 81254 Blank GJB6 GENE ANALYSIS COMMON VARIANTS Pathology 1.37 FAIR Health 81255 Blank HEXA GENE ANALYSIS COMMON VARIANTS Pathology 2.61 FAIR Health 81256 Blank HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS Pathology 2.50 CLAB 81257 Blank HBA1/HBA2 ANALYSIS FOR COMMON DELETIONS/VARIANT Pathology 3.06 FAIR Health 81258 Blank HBA1/HBA2 GENE FAM VRNT Pathology 2.61 Other 81259 Blank HBA1/HBA2 FULL GENE SEQUENCE Pathology 16.83 Other 81260 Blank IKBKAP GENE ANALYSIS COMMON VARIANTS Pathology 0.97 FAIR Health 81261 Blank IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED Pathology 7.57 CLAB 81262 Blank IGH@ REARRANGE ABNORMAL CLONAL POP DIRECT PROBE Pathology 1.67 CLAB 81263 Blank IGH@ VARIABLE REGION SOMATIC MUTATION ANALYSIS Pathology 11.26 CLAB 81264 Blank IGK@ GENE REARRANGE DETECT ABNORMAL CLONAL POP Pathology 5.71 CLAB 81265 Blank COMPARATIVE ANAL STR MARKERS PATIENT&COMP SPEC Pathology 8.22 CLAB 81266 Blank COMPARATIVE ANAL STR MARKERS EA ADDL SPECIMEN Pathology 9.05 FAIR Health 81267 Blank CHIMERISM W/COMP TO BASELINE W/O CELL SELECTION Pathology 7.93 CLAB 81268 Blank CHIMERISM W/COMP TO BASELINE W/CELL SELECTION EA Pathology 9.97 CLAB 81269 Blank HBA1/HBA2 GENE DUP/DEL VRNTS Pathology 5.34 Other 81270 Blank JAK2 GENE ANALYSIS P.VAL617PHE VARIANT Pathology 3.50 CLAB 81272 Blank KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS Pathology 9.25 CLAB 81273 Blank KIT GENE ANALYSIS D816 VARIANT(S) Pathology 3.50 CLAB 81275 Blank KRAS GENE ANALYSIS VARIANTS IN EXON 2 Pathology 5.53 CLAB 81276 Blank KRAS GENE ANALYSIS ADDITIONAL VARIANT(S) Pathology 5.53 CLAB 81283 Blank IFNL3 GENE Pathology 2.34 Other 81287 Blank MGMT METHYLATION ANALYSIS Pathology 2.33 CLAB 81288 Blank MLH1 GENE ANALYSIS PROMOTER METHYLATION ANALYSIS Pathology 4.48 CLAB 81290 Blank MCOLN1 MUCOLIPIN1 GENE ANALYSIS COMMON VARIANTS Pathology 1.04 FAIR Health 81291 Blank MTHFR GENE ANALYSIS COMMON VARIANTS Pathology 1.67 CLAB 81292 Blank MLH1 GENE ANALYSIS FULL SEQUENCE ANALYSIS Pathology 18.11 CLAB 81293 Blank MLH1 GENE ANALYSIS KNOWN FAMILIAL VARIANTS Pathology 7.26 CLAB 81294 Blank MLH1 GENE ANALYSIS DUPLICATION/DELETION VARIANTS Pathology 5.34 CLAB 81295 Blank MSH2 GENE ANALYSIS FULL SEQUENCE ANALYSIS Pathology 4.25 CLAB 81296 Blank MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS Pathology 3.63 CLAB 81297 Blank MSH2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS Pathology 4.25 CLAB 81298 Blank MSH6 GENE ANALYSIS FULL SEQUENCE ANALYSIS Pathology 8.06 CLAB 81299 Blank MSH6 GENE ANALYSIS KNOWN FAMILIAL VARIANTS Pathology 4.52 CLAB 81300 Blank MSH6 GENE ANALYSIS DUPLICATION/DELETION VARIA Pathology 4.53 CLAB 81301 Blank MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF Pathology 11.07 CLAB 81302 Blank MECP2 GENE ANALYSIS FULL SEQUENCE Pathology 7.81 FAIR Health 81304 Blank MECP2 GENE ANALYSIS DUPLICATION/DELETION VARIANT Pathology 5.66 FAIR Health 81310 Blank NPM1 NUCLEOPHOSMIN GENE ANAL EXON 12 VARIANTS Pathology 6.92 CLAB 81311 Blank NRAS GENE ANALYSIS VARIANTS IN EXON 2&3 Pathology 8.30 CLAB 81313 Blank PCA3/KLK3 PROSTATE SPECIFIC ANTIGEN RATIO Pathology 7.30 CLAB 81314 Blank PDGFRA GENE ANALYS TARGETED SEQUENCE ANALYS Pathology 9.25 CLAB

CPT/ Conversion Total Charge HCPCS Modifier CPT/HCPCS Code Description Factor/GAAF RVUs Methodology 1 Code Category 81315 Blank PML/RARALPHA COMMON BREAKPOINTS QUAL/QUANT Pathology 7.92 CLAB 81316 Blank PML/RARALPHA SINGLE BREAKPOINT QUAL/QUAN Pathology 12.09 CLAB 81317 Blank PMS2 GENE ANALYSIS FULL SEQUENCE Pathology 21.89 CLAB 81318 Blank PMS2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS Pathology 5.17 CLAB 81319 Blank PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS Pathology 6.21 CLAB 81321 Blank PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS Pathology 16.83 CLAB 81322 Blank PTEN GENE ANALYSIS KNOWN FAMILIAL VARIANT Pathology 1.64 CLAB 81323 Blank PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT Pathology 2.45 CLAB 81324 Blank PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS Pathology 7.36 FAIR Health 81325 Blank PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS Pathology 11.23 FAIR Health 81327 Blank SEPT9 METHYLATION ANALYSIS Pathology 2.33 CLAB 81328 Blank SLCO1B1 GENE COM VARIANTS Pathology 4.90 Other 81330 Blank SMPD1 GENE ANALYSIS COMMON VARIANTS Pathology 1.14 FAIR Health 81331 Blank SNRPN/UBE3A METHYLATION ANALYSIS Pathology 3.27 FAIR Health 81332 Blank SERPINA1 GENE ANALYSIS COMMON VARIANTS Pathology 1.67 CLAB 81334 Blank RUNX1 GENE TARGETED SEQ ALYS Pathology 9.25 Other 81335 Blank TPMT GENE COM VARIANTS Pathology 4.90 Other 81340 Blank TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD Pathology 7.99 CLAB 81341 Blank TRB@ REARRANGEMENT ANAL DIRECT PROBE METHODOLOGY Pathology 1.90 CLAB 81342 Blank TRG@ GENE REARRANGEMENT ANALYSIS Pathology 7.70 CLAB 81346 Blank TYMS GENE COM VARIANTS Pathology 4.90 Other 81350 Blank UGT1A1 GENE ANALYSIS COMMON VARIANTS Pathology 2.05 FAIR Health 81355 Blank VKORC1 GENE ANALYSIS COMMON VARIANT(S) Pathology 1.74 FAIR Health 81361 Blank HBB GENE COM VARIANTS Pathology 4.90 Other 81362 Blank HBB GENE KNOWN FAM VARIANT Pathology 2.61 Other 81363 Blank HBB GENE DUP/DEL VARIANTS Pathology 5.34 Other 81364 Blank HBB FULL GENE SEQUENCE Pathology 9.25 Other 81370 Blank HLA CLASS I&II LOW HLA-A -B -C -DRB1/3/4/5&DQB Pathology 15.37 CLAB 81371 Blank HLA I&LI LOW RESOLUTION HLA-A -B&-DRB1 Pathology 9.20 CLAB 81372 Blank HLA CLASS I TYPING LOW RESOLUTION COMPLETE Pathology 8.44 CLAB 81373 Blank HLA CLASS I TYPING LOW RESOLUTION ONE LOCUS EACH Pathology 4.26 CLAB 81374 Blank HLA I LOW RESOLUTION ONE ANTIGEN EQUIVALENT EACH Pathology 2.78 CLAB 81375 Blank HLA II LOW RESOLUTION HLA-DRB1/3/4/5 AND -DQB1 Pathology 8.44 CLAB 81376 Blank HLA CLASS II TYPING LOW RESOLUTION ONE LOCUS EA Pathology 4.67 CLAB 81377 Blank HLA II LOW RESOLUTION ONE ANTIGEN EQUIVALENT EA Pathology 3.51 CLAB 81378 Blank HLA I&II HIGH RESOLUTION HLA-A -B -C AND -DRB1 Pathology 13.21 CLAB 81379 Blank HLA CLASS I TYPING HIGH RESOLUTION COMPLETE Pathology 12.82 CLAB 81380 Blank HLA CLASS I TYPING HIGH RESOLUTION ONE LOCUS EA Pathology 6.77 CLAB 81381 Blank HLA I TYPING HIGH RESOLUTION 1 ALLELE/ALLELE GRP Pathology 3.62 CLAB 81382 Blank HLA CLASS II TYPING HIGH RESOLUTION ONE LOCUS EA Pathology 4.73 CLAB 81383 Blank HLA II HIGH RESOLUTION 1 ALLELE/ALLELE GROUP Pathology 4.17 CLAB 81400 Blank MOLECULAR PATHOLOGY PROCEDURE LEVEL 1 Pathology 1.99 FAIR Health 81401 Blank MOLECULAR PATHOLOGY PROCEDURE LEVEL 2 Pathology 2.76 FAIR Health 81402 Blank MOLECULAR PATHOLOGY PROCEDURE LEVEL 3 Pathology 3.20 FAIR Health 81403 Blank MOLECULAR PATHOLOGY PROCEDURE LEVEL 4 Pathology 4.01 FAIR Health 81404 Blank MOLECULAR PATHOLOGY PROCEDURE LEVEL 5 Pathology 4.95 FAIR Health 81405 Blank MOLECULAR PATHOLOGY PROCEDURE LEVEL 6 Pathology 6.13 FAIR Health 81406 Blank MOLECULAR PATHOLOGY PROCEDURE LEVEL 7 Pathology 7.58 FAIR Health 81407 Blank MOLECULAR PATHOLOGY PROCEDURE LEVEL 8 Pathology 11.34 FAIR Health 81408 Blank MOLECULAR PATHOLOGY PROCEDURE LEVEL 9 Pathology 14.99 FAIR Health

CPT/ Conversion Total Charge HCPCS Modifier CPT/HCPCS Code Description Factor/GAAF RVUs Methodology 1 Code Category 81411 Blank AORTIC DYSFUNCTION/DILATION DUP/DEL ANALYSIS Pathology 18.15 FAIR Health 81412 Blank ASHKENAZI JEWISH ASSOC DSRDRS GEN SEQ ANAL 9 GEN Pathology 16.78 CLAB 81413 Blank CAR ION CHNNLPATH INC 10 GNS Pathology 22.36 CLAB 81414 Blank CAR ION CHNNLPATH INC 2 GNS Pathology 22.36 CLAB 81415 Blank EXOME SEQUENCE ANALYSIS Pathology 34.43 FAIR Health 81416 Blank EXOME SEQUENCE ANALYSIS EACH COMPARATOR EXOME Pathology 27.47 FAIR Health 81420 Blank FETAL CHROMOSOMAL ANEUPLOIDY GENOMIC SEQ ANALYS Pathology 22.36 CLAB 81422 Blank FETAL CHRMOML MICRODELTJ Pathology 22.36 CLAB 81432 Blank HEREDITARY BRST CA-RELATED GEN SEQ ANALYS 14 GEN Pathology 25.95 CLAB 81433 Blank HEREDITARY BRST CA-RELATED DUP/DEL ANALYSIS Pathology 16.78 CLAB 81434 Blank HEREDITARY RETINAL DSRDRS GEN SEQ ANALYS 15 GEN Pathology 16.78 CLAB 81435 Blank HEREDITARY COLON CA DSRDRS GEN SEQ ANALYS 10 GEN Pathology 22.36 CLAB 81436 Blank HEREDITARY COLON CA DSRDRS DUP/DEL ANALYS 5 GEN Pathology 22.36 CLAB 81437 Blank HEREDTRY NURONDCRN TUM DSRDRS GEN SEQ ANAL 6 GEN Pathology 16.78 CLAB 81438 Blank HEREDTRY NURONDCRN TUM DSRDRS DUP/DEL ANALYSIS Pathology 16.78 CLAB 81439 Blank INHERITED CARDMYPTHY 5 GNS Pathology 22.36 CLAB 81442 Blank NOONAN SPECTRUM DISORDERS GEN SEQ ANALYS 12 GEN Pathology 16.78 CLAB 81445 Blank GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE Pathology 16.78 CLAB 81448 Blank HRDTRY PERPH NEURPHY PANEL Pathology 22.36 Other 81450 Blank GEN SEQ ANALYS HEMATOLYMPHOID NEO 5-50 GENE Pathology 18.19 CLAB 81455 Blank GEN SEQ ANALYS SOL ORG/HEMTOLMPHOID NEO 51/> GEN Pathology 48.81 FAIR Health 81460 Blank WHOLE MITOCHONDRIAL GENOME Pathology 14.19 FAIR Health 81465 Blank WHOLE MITOCHONDRIAL GENOME ANALYSIS PANEL Pathology 16.67 FAIR Health 81479 Blank UNLISTED MOLELCULAR PATHOLOGY PROCEDURE Pathology 4.65 Unlisted 81490 Blank AUTOIMMUNE RHEUMATOID ARTHRTS ANALYS 12 BIOMRKRS Pathology 16.46 CLAB 81493 Blank COR ART DISEASE MRNA GENE EXPRESSION 23 GENES Pathology 29.04 CLAB 81500 Blank ONCO (OVARIAN) BIOCHEMICAL ASSAY TWO PROTEINS Pathology 5.03 FAIR Health 81503 Blank ONCO (OVARIAN) BIOCHEMICAL ASSAY FIVE PROTEINS Pathology 7.43 FAIR Health 81507 Blank FETAL ANEUPLOIDY 21 18 13 SEQ ANALY TRISOM RISK Pathology 15.57 FAIR Health 81508 Blank FETAL CONGENITAL ABNOR ASSAY TWO PROTEINS Pathology 1.57 FAIR Health 81509 Blank FETAL CONGENITAL ABNOR ASSAY 3 PROTEINS Pathology 10.24 FAIR Health 81510 Blank FETAL CONGENITAL ABNOR ASSAY THREE ANAL Pathology 0.99 FAIR Health 81511 Blank FETAL CONGENITAL ABNOR ASSAY FOUR ANAL Pathology 1.62 FAIR Health 81512 Blank FETAL CONGENITAL ABNOR ASSAY FIVE ANAL Pathology 2.89 FAIR Health 81519 Blank ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES Pathology 95.95 CLAB 81520 Blank ONC BREAST MRNA 58 GENES Pathology 95.95 Other 81521 Blank ONC BREAST MRNA 70 GENES Pathology 95.95 Other 81525 Blank ONCOLOGY COLON MRNA GENE EXPRESSION 12 GENES Pathology 87.10 CLAB 81528 Blank ONCOLOGY COLORECTAL SCREENING QUAN 10 DNA MARKRS Pathology 14.28 CLAB 81535 Blank ONCOLOGY GYNE LIVE TUM CELL CLTR&CHEMO RESP 1ST Pathology 16.26 CLAB 81536 Blank ONCOLOGY GYNE LIVE TUM CELL CLTR&CHEMO RESP ADD Pathology 4.98 CLAB 81538 Blank ONCOLOGY LUNG MS 8-PROTEIN SIGNATURE Pathology 59.26 CLAB 81539 Blank ONCOLOGY PROSTATE PROB SCORE Pathology 16.78 CLAB 81540 Blank ONCOLOGY TUM UNKNOWN ORIGIN MRNA 92 GENES Pathology 81.37 CLAB 81541 Blank ONC PROSTATE MRNA 46 GENES Pathology 95.95 Other 81545 Blank ONCOLOGY THYROID GENE EXPRESSION 142 GENES Pathology 89.79 CLAB 81595 Blank CARDIOLOGY HRT TRNSPL MRNA GENE EXPRESS 20 GENES Pathology 79.15 CLAB 81599 Blank UNLISTED MULTIANALYTE ASSAY ALGORITHMIC ANALYSIS Pathology 0.99 Unlisted 82009 Blank KETONE BODIES SERUM QUALITATIVE Pathology 0.17 CLAB 82010 Blank KETONE BODIES SERUM QUANTITATIVE Pathology 0.31 CLAB

CPT/ Conversion Total Charge HCPCS Modifier CPT/HCPCS Code Description Factor/GAAF RVUs Methodology 1 Code Category 82013 Blank ASSAY OF ACETYLCHOLINESTERASE Pathology 0.43 CLAB 82016 Blank ACYLCARNITINES QUALITATIVE EACH SPECIMEN Pathology 0.53 CLAB 82017 Blank ACYLCARNITINES QUANTIATIVE EACH SPECIMEN Pathology 0.64 CLAB 82024 Blank ADRENOCORTICOTROPIC HORMONE ACTH Pathology 1.48 CLAB 82030 Blank ADENOSINE 5-MONOPHOSPHATE CYCLIC Pathology 0.99 CLAB 82040 Blank ALBUMIN SERUM PLASMA/WHOLE BLOOD Pathology 0.19 CLAB 82042 Blank ALBUMIN URINE/OTHER SOURCE QUAN EACH SPECIMEN Pathology 0.20 CLAB 82043 Blank ALBUMIN URINE MICROALBUMIN QUANTIATIVE Pathology 0.22 CLAB 82044 Blank ALBUMIN URINE MICROALBUMIN SEMIQUANTITATIVE Pathology 0.17 CLAB 82045 Blank ALBUMIN ISCHEMIA MODIFIED Pathology 1.30 CLAB 82075 Blank ASSAY OF ALCOHOL BREATH Pathology 0.46 CLAB 82085 Blank ASSAY OF ALDOLASE Pathology 0.37 CLAB 82088 Blank ASSAY OF ALDOSTERONE Pathology 1.56 CLAB 82103 Blank ALPHA-1-ANTITRYPSIN TOTAL Pathology 0.51 CLAB 82104 Blank ALPHA-1-ANTITRYPSIN PHENOTYPE Pathology 0.55 CLAB 82105 Blank ALPHA-FETOPROTEIN SERUM Pathology 0.64 CLAB 82106 Blank ALPHA-FETOPROTEIN AMNIOTIC FLUID Pathology 0.64 CLAB 82107 Blank AFP-L3 FRACTION ISOFORM & TOTAL AFP W/RATIO Pathology 2.46 CLAB 82108 Blank ASSAY OF ALUMINUM Pathology 0.97 CLAB 82120 Blank AMINES VAGINAL FLUID QUALITATIVE Pathology 0.14 CLAB 82127 Blank AMINO ACIDS 1 QUALITATIVE EACH SPECIMEN Pathology 0.53 CLAB 82128 Blank AMINO ACIDS MULTIPLE QUALITATIVE EACH SPECIMEN Pathology 0.53 CLAB 82131 Blank AMINO ACIDS 1 QUANTITATIVE EACH SPECIMEN Pathology 0.64 CLAB 82135 Blank AMINOLEVULINIC ACID DELTA Pathology 0.63 CLAB 82136 Blank AMINO ACIDS 2-5 AMINO ACIDS QUANTITATIVE EA SPEC Pathology 0.64 CLAB 82139 Blank AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE Pathology 0.64 CLAB 82140 Blank ASSAY OF AMMONIA Pathology 0.56 CLAB 82143 Blank AMNIOTIC FLU SCAN Pathology 0.26 CLAB 82150 Blank ASSAY OF AMYLASE Pathology 0.25 CLAB 82154 Blank ANDROSTANEDIOL GLUCURONIDE Pathology 1.10 CLAB 82157 Blank ANDROSTENEDIONE Pathology 1.12 CLAB 82160 Blank ANDROSTERONE Pathology 0.96 CLAB 82163 Blank ANGIOTENSIN II Pathology 0.78 CLAB 82164 Blank ANGIOTENSIN I-CONVERTING ENZYME Pathology 0.56 CLAB 82172 Blank APOLIPOPROTEIN EACH Pathology 0.59 CLAB 82175 Blank ASSAY OF ARSENIC Pathology 0.73 CLAB 82180 Blank ASSAY OF ASCORBIC ACID BLOOD Pathology 0.38 CLAB 82190 Blank ATOMIC ABSRPJ SPECTROSCOPY EA ANALYTE Pathology 0.57 CLAB 82232 Blank BETA-2 MICROGLOBULIN Pathology 0.62 CLAB 82239 Blank BILE ACIDS TOTAL Pathology 0.65 CLAB 82240 Blank BILE ACIDS CHOLYLGLYCINE Pathology 1.02 CLAB 82247 Blank BILIRUBIN TOTAL Pathology 0.19 CLAB 82248 Blank BILIRUBIN DIRECT Pathology 0.19 CLAB 82252 Blank BILIRUBIN FECES QUALITATIVE Pathology 0.17 CLAB 82261 Blank BIOTINIDASE EACH SPECIMEN Pathology 0.64 CLAB 82270 Blank BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER Pathology 0.12 CLAB 82271 Blank BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES Pathology 0.12 CLAB 82272 Blank BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1-3 SPEC Pathology 0.12 CLAB 82274 Blank BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3 Pathology 0.61 CLAB 82286 Blank BRADYKININ Pathology 0.26 CLAB

CPT/ Conversion Total Charge HCPCS Modifier CPT/HCPCS Code Description Factor/GAAF RVUs Methodology 1 Code Category 82300 Blank CADMIUM Pathology 0.88 CLAB 82306 Blank 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED Pathology 1.13 CLAB 82308 Blank CALCITONIN Pathology 1.02 CLAB 82310 Blank CALCIUM TOTAL Pathology 0.20 CLAB 82330 Blank CALCIUM IONIZED Pathology 0.52 CLAB 82331 Blank CALCIUM AFTER CALCIUM INFUSION TEST Pathology 0.20 CLAB 82340 Blank CALCIUM URINE QUANTITATIVE TIMED SPECIMEN Pathology 0.23 CLAB 82355 Blank CALCULUS QUALITATIVE ANALYSIS Pathology 0.44 CLAB 82360 Blank CALCULUS QUANTITATIVE CHEMICAL Pathology 0.49 CLAB 82365 Blank CALCULUS INFRARED SPECTROSCOPY Pathology 0.49 CLAB 82370 Blank CALCULUS XRAY DIFFRACTION Pathology 0.48 CLAB 82373 Blank CARBOHYDRATE DEFICIENT TRANSFERRIN Pathology 0.69 CLAB 82374 Blank CARBON DIOXIDE BICARBONATE Pathology 0.19 CLAB 82375 Blank CARBOXYHEMOGLOBIN QUANTITATIVE Pathology 0.47 CLAB 82376 Blank CARBOXYHEMOGLOBIN QUALITATIVE Pathology 0.23 CLAB 82378 Blank CARCINOEMBRYONIC ANTIGEN CEA Pathology 0.72 CLAB 82379 Blank CARNITINE QUANTITATIVE EACH SPECIMEN Pathology 0.64 CLAB 82380 Blank CAROTENE Pathology 0.35 CLAB 82382 Blank CATECHOLAMINES TOTAL URINE Pathology 0.66 CLAB 82383 Blank CATECHOLAMINES BLOOD Pathology 0.96 CLAB 82384 Blank CATECHOLAMINES FRACTIONATED Pathology 0.97 CLAB 82387 Blank CATHEPSIN-D Pathology 0.80 CLAB 82390 Blank CERULOPLASMIN Pathology 0.41 CLAB 82397 Blank CHEMILUMINESCENT ASSAY Pathology 0.54 CLAB 82415 Blank CHLORAMPHENICOL Pathology 0.48 CLAB 82435 Blank CHLORIDE BLD Pathology 0.18 CLAB 82436 Blank CHLORIDE URINE Pathology 0.19 CLAB 82438 Blank CHLORIDE OTHER SOURCE Pathology 0.19 CLAB 82441 Blank CHLORINATED HYDROCARBONS SCREEN Pathology 0.23 CLAB 82465 Blank CHOLESTEROL SERUM/WHOLE BLOOD TOTAL Pathology 0.17 CLAB 82480 Blank CHOLINESTERASE SERUM Pathology 0.30 CLAB 82482 Blank CHOLINESTERASE RBC Pathology 0.29 CLAB 82485 Blank CHONDROITIN B SULFATE QUANTITATIVE Pathology 0.79 CLAB 82495 Blank ASSAY OF CHROMIUM Pathology 0.78 CLAB 82507 Blank ASSAY OF CITRATE Pathology 1.06 CLAB 82523 Blank COLLAGEN CROSS LINKS ANY METHOD Pathology 0.71 CLAB 82525 Blank ASSAY OF COPPER Pathology 0.47 CLAB 82528 Blank CORTICOSTERONE Pathology 0.86 CLAB 82530 Blank CORTISOL FREE Pathology 0.64 CLAB 82533 Blank CORTISOL TOTAL Pathology 0.62 CLAB 82540 Blank ASSAY OF CREATINE Pathology 0.18 CLAB 82542 Blank COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC Pathology 0.69 CLAB 82550 Blank CREATINE KINASE TOTAL Pathology 0.25 CLAB 82552 Blank CREATINE KINASE ISOENZYMES Pathology 0.51 CLAB 82553 Blank CREATINE KINASE MB FRACTION ONLY Pathology 0.44 CLAB 82554 Blank CREATINE KINASE ISOFORMS Pathology 0.45 CLAB 82565 Blank CREATININE BLOOD Pathology 0.20 CLAB 82570 Blank CREATININE OTHER SOURCE Pathology 0.20 CLAB 82575 Blank CREATININE CLEARANCE Pathology 0.36 CLAB 82585 Blank ASSAY OF CRYOFIBRN Pathology 0.33 CLAB

CPT/ Conversion Total Charge HCPCS Modifier CPT/HCPCS Code Description Factor/GAAF RVUs Methodology 1 Code Category 82595 Blank CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE Pathology 0.25 CLAB 82600 Blank ASSAY OF CYANIDE Pathology 0.74 CLAB 82607 Blank CYANOCOBALAMIN VITAMIN B-12 Pathology 0.58 CLAB 82608 Blank CYANOCOBALAMIN VIT B-12 UNSAT BINDING CAPACITY Pathology 0.55 CLAB 82610 Blank CYSTATIN C Pathology 0.52 CLAB 82615 Blank CSTINE&HOMOCSTINE URINE QUALITATIVE Pathology 0.31 CLAB 82626 Blank DEHYDROEPIANDROSTERONE Pathology 0.97 CLAB 82627 Blank DEHYDROEPIANDROSTERONE-SULFATE Pathology 0.85 CLAB 82633 Blank DESOXYCORTICOSTERONE 11- Pathology 1.18 CLAB 82634 Blank DEOXYCORTISOL 11- Pathology 1.12 CLAB 82638 Blank ASSAY OF DIBUCAINE NUMBER Pathology 0.47 CLAB 82652 Blank 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED Pathology 1.47 CLAB 82656 Blank ELASTASE PANCREATIC FECAL QUAL/SEMI-QUAN Pathology 0.44 CLAB 82657 Blank NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA Pathology 0.69 CLAB 82658 Blank NZYM ACTV BLOOD CELLS/TISS RADACT SUBSTRATE EA Pathology 0.69 CLAB 82664 Blank ELCTROPHORETIC TECHNIQUE NOT ELSEWHERE SPECIFIED Pathology 1.31 CLAB 82668 Blank ASSAY OF ERYTHROPOIETIN Pathology 0.72 CLAB 82670 Blank ASSAY OF ESTRADIOL Pathology 1.07 CLAB 82671 Blank ASSAY OF ESTROGENS FRACTIONATED Pathology 1.23 CLAB 82672 Blank ASSAY OF ESTROGENS TOTAL Pathology 0.83 CLAB 82677 Blank ASSAY OF ESTRIOL Pathology 0.92 CLAB 82679 Blank ASSAY OF ESTRONE Pathology 0.95 CLAB 82693 Blank ASSAY OF ETHYLENE GLYCOL Pathology 0.57 CLAB 82696 Blank ASSAY OF ETIOCHOLANOLONE Pathology 0.90 CLAB 82705 Blank FAT/LIPIDS FECES QUALITATIVE Pathology 0.19 CLAB 82710 Blank FAT/LIPIDS FECES QUANTITATIVE Pathology 0.64 CLAB 82715 Blank FAT DIFFIAL FECES QUANTITATIVE Pathology 0.66 CLAB 82725 Blank FATTY ACIDS NONESTERIFIED Pathology 0.51 CLAB 82726 Blank VERY LONG CHAIN FATTY ACIDS Pathology 0.69 CLAB 82728 Blank ASSAY OF FERRITIN Pathology 0.52 CLAB 82731 Blank FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN Pathology 2.46 CLAB 82735 Blank ASSAY OF FLUORIDE Pathology 0.71 CLAB 82746 Blank ASSAY OF FOLIC ACID SERUM Pathology 0.56 CLAB 82747 Blank ASSAY OF FOLIC ACID RBC Pathology 0.66 CLAB 82757 Blank ASSAY OF FRUCTOSE SEMEN Pathology 0.66 CLAB 82759 Blank ASSAY OF GALACTOKINASE RBC Pathology 0.82 CLAB 82760 Blank ASSAY OF GALACTOSE Pathology 0.43 CLAB 82775 Blank GALACTOSE-1-PHOSPHATE URIDYL TRANSFERASE QUAN Pathology 0.81 CLAB 82776 Blank GALACTOSE-1-PHOSPHATE URIDYL TRANSFERASE SCREEN Pathology 0.32 CLAB 82777 Blank GALECTIN-3 Pathology 0.84 CLAB 82784 Blank ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH Pathology 0.36 CLAB 82785 Blank ASSAY OF GAMMAGLOBULIN IGE Pathology 0.63 CLAB 82787 Blank GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES Pathology 0.31 CLAB 82800 Blank GASES BLOOD PH ONLY Pathology 0.32 CLAB 82803 Blank BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3 Pathology 0.74 CLAB 82805 Blank GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY Pathology 1.08 CLAB 82810 Blank GASES BLOOD O2 SATURATION ONLY DIRECT MEAS Pathology 0.33 CLAB 82820 Blank HGB-O2 AFFINITY PO2 50% SATURATION OXYGEN Pathology 0.38 CLAB 82930 Blank GASTRIC ACID ANALYIS W/PH EACH SPECIMEN Pathology 0.21 CLAB 82938 Blank GASTRIN AFTER SECRETIN STIMULATION Pathology 0.68 CLAB

CPT/ Conversion Total Charge HCPCS Modifier CPT/HCPCS Code Description Factor/GAAF RVUs Methodology 1 Code Category 82941 Blank ASSAY OF GASTRIN Pathology 0.67 CLAB 82943 Blank ASSAY OF GLUCAGON Pathology 0.55 CLAB 82945 Blank GLUCOSE BODY FLUID OTHER THAN BLOOD Pathology 0.15 CLAB 82946 Blank GLUCOSE TOLERANCE TEST Pathology 0.58 CLAB 82947 Blank GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP Pathology 0.15 CLAB 82948 Blank GLUCOSE BLOOD REAGENT STRIP Pathology 0.12 CLAB 82950 Blank GLUCOSE POST GLUCOSE DOSE Pathology 0.18 CLAB 82951 Blank GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS Pathology 0.49 CLAB 82952 Blank GLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENS Pathology 0.15 CLAB 82955 Blank GLUC-6-PHOSPHATE DEHYDROGENASE QUANTITATIVE Pathology 0.37 CLAB 82960 Blank GLUC-6-PHOSPHATE DEHYDROGENASE SCREEN Pathology 0.23 CLAB 82962 Blank GLUC BLD GLUC MNTR DEV CLEARED FDA SPEC HOME USE Pathology 0.09 CLAB 82963 Blank ASSAY OF GLUCOSIDASE BETA Pathology 0.82 CLAB 82965 Blank ASSAY OF GLUTAMATE DEHYDROGENASE Pathology 0.30 CLAB 82977 Blank ASSAY OF GLUTAMYLTRASE GAMMA Pathology 0.28 CLAB 82978 Blank ASSAY OF GLUTATHIONE Pathology 0.54 CLAB 82979 Blank ASSAY OF GLUTATHIONE REDUCTASE RBC Pathology 0.26 CLAB 82985 Blank ASSAY OF GLYCATED PROTEIN Pathology 0.58 CLAB 83001 Blank GONADOTROPIN FOLLICLE STIMULATING HORMONE Pathology 0.71 CLAB 83002 Blank GONADOTROPIN LUTEINIZING HORMONE Pathology 0.71 CLAB 83003 Blank ASSAY OF GROWTH HORMONE HUMAN Pathology 0.64 CLAB 83006 Blank GROWTH STIMULATION EXPRESSED GENE 2 Pathology 0.84 CLAB 83009 Blank HPYLORI BLOOD ANAL UREASE ACT NON-RADACT ISOTOPE Pathology 2.57 CLAB 83010 Blank ASSAY OF HAPTOGLOBIN QUANTITATIVE Pathology 0.48 CLAB 83012 Blank ASSAY OF HAPTOGLOBIN PHENOTYPES Pathology 0.66 CLAB 83013 Blank HPYLORI BREATH ANAL UREASE ACT NON-RADACT ISTOPE Pathology 2.57 CLAB 83014 Blank HPYLORI DRUG ADMINISTRATION Pathology 0.30 CLAB 83015 Blank HEAVY METAL SCREEN Pathology 0.72 CLAB 83018 Blank HEAVY METAL QUANTIATIVE EACH Pathology 0.84 CLAB 83020 Blank HEMOGLOBIN FRACTJ/QUANTJ ELECTROPHORESIS Pathology 0.49 CLAB 83021 Blank HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY Pathology 0.69 CLAB 83026 Blank HEMOGLOBIN COPPER SULFATE METHOD NON-AUTOMATED Pathology 0.09 CLAB 83030 Blank HEMOGLOBIN F FETAL CHEMICAL Pathology 0.32 CLAB 83033 Blank HEMOGLOBIN F FETAL QUALITATIVE Pathology 0.23 CLAB 83036 Blank HEMOGLOBIN GLYCOSYLATED A1C Pathology 0.37 CLAB 83037 Blank HGB GLYCOSYLATED DEVICE CLEARED FDA HOME USE Pathology 0.37 CLAB 83045 Blank HEMOGLOBIN METHEMOGLOBIN QUALITATIVE Pathology 0.19 CLAB 83050 Blank HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE Pathology 0.28 CLAB 83051 Blank ASSAY OF HEMOGLOBIN PLASMA Pathology 0.28 CLAB 83060 Blank HEMOGLOBIN SULFHEMOGLOBIN QUANTITATIVE Pathology 0.32 CLAB 83065 Blank HEMOGLOBIN THERMOLABILE Pathology 0.26 CLAB 83068 Blank HEMOGLOBIN UNSTABLE SCREEN Pathology 0.32 CLAB 83069 Blank ASSAY OF HEMOGLOBIN URINE Pathology 0.15 CLAB 83070 Blank ASSAY OF HEMOSIDERIN QUALITATIVE Pathology 0.18 CLAB 83080 Blank ASSAY OF B-HEXOSAMINIDASE EACH ASSAY Pathology 0.64 CLAB 83088 Blank ASSAY OF HISTAMINE Pathology 1.13 CLAB 83090 Blank ASSAY OF HOMOCYSTEINE Pathology 0.64 CLAB 83150 Blank ASSAY OF HOMOVANILLIC ACID Pathology 0.74 CLAB 83491 Blank HYDROXYCORTICOSTEROIDS 17 Pathology 0.67 CLAB 83497 Blank ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA Pathology 0.49 CLAB

CPT/ Conversion Total Charge HCPCS Modifier CPT/HCPCS Code Description Factor/GAAF RVUs Methodology 1 Code Category 83498 Blank ASSAY OF HYDROXYPROGESTERONE 17-D Pathology 1.04 CLAB 83500 Blank ASSAY OF HYDROXYPROLINE FREE Pathology 0.87 CLAB 83505 Blank ASSAY OF HYDROXYPROLINE TOTAL Pathology 0.93 CLAB 83516 Blank IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP Pathology 0.44 CLAB 83518 Blank IMMUNOASSAY ANALYTE QUAL/SEMIQUAL SINGLE STEP Pathology 0.32 CLAB 83519 Blank IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY Pathology 0.52 CLAB 83520 Blank IMMUNOASSAY ANALYTE QUANTITATIVE NOS Pathology 0.49 CLAB 83525 Blank ASSAY OF INSULIN TOTAL Pathology 0.44 CLAB 83527 Blank ASSAY OF INSULIN FREE Pathology 0.49 CLAB 83528 Blank ASSAY OF INTRINSIC FACTOR Pathology 0.61 CLAB 83540 Blank ASSAY OF IRON Pathology 0.25 CLAB 83550 Blank IRON BINDING CAPACITY Pathology 0.33 CLAB 83570 Blank ISOCITRIC DEHYDROGENASE Pathology 0.34 CLAB 83582 Blank ASSAY OF KETOGENIC STEROIDS FRACTIONATION Pathology 0.54 CLAB 83586 Blank ASSAY OF KETOSTEROIDS 17- TOTAL Pathology 0.49 CLAB 83593 Blank KETOSTEROIDS 17- FRACTIONATION Pathology 1.01 CLAB 83605 Blank ASSAY OF LACTATE Pathology 0.41 CLAB 83615 Blank LACTATE DEHYDROGENASE LDH Pathology 0.23 CLAB 83625 Blank LACTATE DEHYDROGENASE ISOENZYMES SEP&QUAN Pathology 0.49 CLAB 83630 Blank LACTOFERRIN FECAL QUALITATIVE Pathology 0.75 CLAB 83631 Blank LACTOFERRIN FECAL QUANTITATIVE Pathology 0.75 CLAB 83632 Blank LACTOGEN HPL HUMAN CHORIONIC SOMATOMAMMOTROPIN Pathology 0.77 CLAB 83633 Blank LACTOSE URINE QUALITATIVE Pathology 0.21 CLAB 83655 Blank ASSAY OF LEAD Pathology 0.46 CLAB 83661 Blank FETAL LUNG MATURITY LECITHIN SPHINGOMYELIN RATIO Pathology 0.84 CLAB 83662 Blank FETAL LUNG MATURITY FOAM STABILITY TEST Pathology 0.72 CLAB 83663 Blank FETAL LUNG MATURITY FLUORESCENCE POLARIZATION Pathology 0.72 CLAB 83664 Blank FETAL LUNG MATURITY LAMELLAR BODY DENSITY Pathology 0.72 CLAB 83670 Blank LEUCINE AMINOPEPTIDASE LAP Pathology 0.35 CLAB 83690 Blank ASSAY OF LIPASE Pathology 0.26 CLAB 83695 Blank LIPOPROTEIN (A) Pathology 0.49 CLAB 83698 Blank LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2 Pathology 1.30 CLAB 83700 Blank LIPOPROTEIN BLOOD ELECTROPHORECTIC SEP&QUAN Pathology 0.43 CLAB 83701 Blank LIPOPROTEIN BLOOD HIGH RESOLTJ&QUANTJ SUBCLASS Pathology 0.95 CLAB 83704 Blank LIPOPROTEIN BLOOD QUAN NUMBERS&SUBCLASSES Pathology 1.21 CLAB 83718 Blank LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL Pathology 0.31 CLAB 83719 Blank LIPOPROTEIN DIRECT MEASUREMENT VLDL CHOLESTEROL Pathology 0.44 CLAB 83721 Blank LIPOPROTEIN DIRECT MEASUREMENT LDL CHOLESTEROL Pathology 0.36 CLAB 83727 Blank LUTEINIZING RELEASING FACTOR Pathology 0.66 CLAB 83735 Blank ASSAY OF MAGNESIUM Pathology 0.26 CLAB 83775 Blank ASSAY OF MALATE DEHYDROGENASE Pathology 0.28 CLAB 83785 Blank ASSAY OF MANGANESE Pathology 0.94 CLAB 83789 Blank MASS SPECT&TANDEM MASS SPECT NONDRG ANAL NES EA Pathology 0.69 CLAB 83825 Blank ASSAY OF MERCURY QUANTITATIVE Pathology 0.62 CLAB 83835 Blank METANEPHRINES Pathology 0.65 CLAB 83857 Blank METHEMALBUMIN Pathology 0.41 CLAB 83861 Blank MICROFLUIDIC ANALYSIS TEAR OSMOLARITY Pathology 0.63 CLAB 83864 Blank MUCOPOLYSACCHARIDES ACID QUANTITATIVE Pathology 0.76 CLAB 83872 Blank MUCIN SYNOVIAL FLUID ROPES TEST Pathology 0.22 CLAB 83873 Blank MYELIN BASIC PROTEIN CEREBROSPINAL FLUID Pathology 0.66 CLAB

CPT/ Conversion Total Charge HCPCS Modifier CPT/HCPCS Code Description Factor/GAAF RVUs Methodology 1 Code Category 83874 Blank MYOGLOBIN Pathology 0.49 CLAB 83876 Blank MYELOPEROXIDASE MPO Pathology 1.30 CLAB 83880 Blank NATRIURETIC PEPTIDE Pathology 1.30 CLAB 83883 Blank ASSAY OF NEPHELOMETRY EACH ANALYTE NES Pathology 0.52 CLAB 83885 Blank ASSAY OF NICKEL Pathology 0.94 CLAB 83915 Blank ASSAY OF NUCLEOTIDASE 5'- Pathology 0.43 CLAB 83916 Blank OLIGOCLONAL IMMUNE Pathology 0.77 CLAB 83918 Blank ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN Pathology 0.63 CLAB 83919 Blank ORGANIC ACIDS QUALITATIVE EACH SPECIMEN Pathology 0.63 CLAB 83921 Blank ORGANIC ACID 1 QUANTITATIVE Pathology 0.63 CLAB 83930 Blank ASSAY OF OSMOLALITY BLOOD Pathology 0.25 CLAB 83935 Blank ASSAY OF OSMOLALITY URINE Pathology 0.26 CLAB 83937 Blank ASSAY OF OSTEOCALCIN Pathology 1.14 CLAB 83945 Blank ASSAY OF OXALATE Pathology 0.49 CLAB 83950 Blank ONCOPROTEIN HER-2/NEU Pathology 2.46 CLAB 83951 Blank ONCOPROTEIN DES-GAMMA-CARBOXY-PROTHROMBIN DCP Pathology 2.46 CLAB 83970 Blank ASSAY OF PARATHORMONE Pathology 1.58 CLAB 83986 Blank PH BODY FLUID NOT ELSEWHERE SPECIFIED Pathology 0.14 CLAB 83987 Blank PH EXHALED BREATH CONDENSATE Pathology 0.61 CLAB 83992 Blank ASSAY OF PHENCYCLIDINE Pathology 0.56 CLAB 83993 Blank ASSAY OF CALPROTECTIN FECAL Pathology 0.75 CLAB 84030 Blank ASSAY OF PHENYLALANINE BLOOD Pathology 0.21 CLAB 84035 Blank ASSAY OF PHENYLKETONES QUALITATIVE Pathology 0.14 CLAB 84060 Blank ASSAY OF PHOSPHATASE ACID TOTAL Pathology 0.28 CLAB 84066 Blank ASSAY OF PHOSPHATASE ACID PROSTATIC Pathology 0.37 CLAB 84075 Blank ASSAY OF PHOSPHATASE ALKALINE Pathology 0.20 CLAB 84078 Blank ASSAY OF PHOSPHATASE ALKALINE HEAT STABLE Pathology 0.28 CLAB 84080 Blank ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES Pathology 0.57 CLAB 84081 Blank PHOSPHATIDYLGLYCEROL Pathology 0.63 CLAB 84085 Blank PHOSPHOGLUCONATE 6-DEHYD RBC Pathology 0.26 CLAB 84087 Blank ASSAY OF PHOSPHOHEXOSE ISOMERASE Pathology 0.39 CLAB 84100 Blank ASSAY OF PHOSPHORUS INORGANIC Pathology 0.18 CLAB 84105 Blank ASSAY OF PHOSPHORUS INORGANIC URINE Pathology 0.20 CLAB 84106 Blank PORPHOBILINOGEN URINE QUALITATIVE Pathology 0.16 CLAB 84110 Blank ASSAY OF PORPHOBILINOGEN URINE QUANTITATIVE Pathology 0.32 CLAB 84112 Blank EVAL C/V AMNIOTIC FLUID PROTEIN QUAL EA SPECIMEN Pathology 2.46 CLAB 84119 Blank PORPHYRINS URINE QUALITATAIVE Pathology 0.33 CLAB 84120 Blank PORPHYRINS URINE QUANTITATION & FRACTIONATION Pathology 0.56 CLAB 84126 Blank PORPHYRINS FECES QUANTITATIVE Pathology 0.97 CLAB 84132 Blank POTASSIUM SERUM PLASMA/WHOLE BLOOD Pathology 0.18 CLAB 84133 Blank POTASSIUM URINE Pathology 0.16 CLAB 84134 Blank PREALBUMIN Pathology 0.56 CLAB 84135 Blank PREGNANEDIOL Pathology 0.73 CLAB 84138 Blank PREGNANETRIOL Pathology 0.72 CLAB 84140 Blank PREGNENOLONE Pathology 0.79 CLAB 84143 Blank 17-HYDROXYPREGNENOLONE Pathology 0.87 CLAB 84144 Blank ASSAY OF PROGESTERONE Pathology 0.80 CLAB 84145 Blank PROCALCITONIN (PCT) Pathology 1.02 CLAB 84146 Blank ASSAY OF PROLACTIN Pathology 0.74 CLAB 84150 Blank ASSAY OF PROSTAGLNDIN EACH Pathology 0.95 CLAB

CPT/ Conversion Total Charge HCPCS Modifier CPT/HCPCS Code Description Factor/GAAF RVUs Methodology 1 Code Category 84152 Blank ASSAY OF PROSTATE SPECIFIC ANTIGEN COMPLEXED Pathology 0.70 CLAB 84153 Blank ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL Pathology 0.70 CLAB 84154 Blank ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE Pathology 0.70 CLAB 84155 Blank PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD Pathology 0.14 CLAB 84156 Blank PROTEIN TOTAL XCPT REFRACTOMETRY URINE Pathology 0.14 CLAB 84157 Blank PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC Pathology 0.14 CLAB 84160 Blank PROTEIN TOTAL REFRACTOMETRY ANY SRC Pathology 0.20 CLAB 84163 Blank PREGNANCY-ASSOCIATED PLASMA PROTEIN-A Pathology 0.58 CLAB 84165 Blank PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM Pathology 0.41 CLAB 84166 Blank PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI Pathology 0.68 CLAB 84181 Blank PROTEIN WESTRN BLOT I&R BLOOD/OTHER FLUID Pathology 0.65 CLAB 84182 Blank PROTEIN WESTRN BLOT BLOOD/OTH FLU IMMUNOLOGICAL Pathology 0.69 CLAB 84202 Blank PROTOPORPHYRIN RBC QUANTITATIVE Pathology 0.55 CLAB 84203 Blank PROTOPORPHYRIN RBC SCREEN Pathology 0.33 CLAB 84206 Blank ASSAY OF PROINSULIN Pathology 0.68 CLAB 84207 Blank ASSAY OF PYRIDOXAL PHOSPHATE Pathology 1.07 CLAB 84210 Blank ASSAY OF PYRUVATE Pathology 0.41 CLAB 84220 Blank ASSAY OF PYRUVATE KINASE Pathology 0.36 CLAB 84228 Blank ASSAY OF QUININE Pathology 0.44 CLAB 84233 Blank ASSAY OF RECEPTOR ASSAY ESTROGEN Pathology 2.46 CLAB 84234 Blank ASSAY OF RECEPTOR ASSAY PROGESTERONE Pathology 2.48 CLAB 84235 Blank RECEPTOR ASSAY ENDOCRINE OTH/THN ESTRGN/PROGST Pathology 2.00 CLAB 84238 Blank RECEPTOR ASSAY NON-ENDOCRINE SPECIFY RECEPTOR Pathology 1.40 CLAB 84244 Blank ASSAY OF RENIN Pathology 0.84 CLAB 84252 Blank ASSAY OF RIBOFLAVIN-VITAMIN B-2 Pathology 0.77 CLAB 84255 Blank ASSAY OF SELENIUM Pathology 0.98 CLAB 84260 Blank ASSAY OF SEROTONIN Pathology 1.18 CLAB 84270 Blank ASSAY OF SEX HORMONE BINDING GLOBULIN Pathology 0.83 CLAB 84275 Blank ASSAY OF SIALIC ACID Pathology 0.51 CLAB 84285 Blank ASSAY OF SILICA Pathology 0.90 CLAB 84295 Blank SODIUM SERUM PLASMA OR WHOLE BLOOD Pathology 0.18 CLAB 84300 Blank ASSAY OF URINE SODIUM Pathology 0.19 CLAB 84302 Blank ASSAY OF SODIUM OTHER SOURCE Pathology 0.19 CLAB 84305 Blank ASSAY OF SOMATOMEDIN Pathology 0.81 CLAB 84307 Blank ASSAY OF SOMATOSTATIN Pathology 0.70 CLAB 84311 Blank SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED Pathology 0.27 CLAB 84315 Blank SPECIFIC GRAVITY EXCEPT URINE Pathology 0.10 CLAB 84375 Blank SUGARS CHROMATOGRAPHIC TLC/PAPER CHROMATOGRAPHY Pathology 0.75 CLAB 84376 Blank SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC Pathology 0.21 CLAB 84377 Blank SUGARS MONO DI&OLIGOS MLT QUALITATIVE EACH SPE Pathology 0.21 CLAB 84378 Blank SUGARS MONO DI&OLIGOS 1 QUANTITATIVE EACH SPEC Pathology 0.44 CLAB 84379 Blank SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC Pathology 0.44 CLAB 84392 Blank ASSAY OF SULFATE URINE Pathology 0.18 CLAB 84402 Blank ASSAY OF TESTOSTERONE FREE Pathology 0.97 CLAB 84403 Blank ASSAY OF TESTOSTERONE TOTAL Pathology 0.99 CLAB 84410 Blank TESTOSTERONE BIOAVAILABLE Pathology 2.02 CLAB 84425 Blank ASSAY OF THIAMINE-VITAMIN B-1 Pathology 0.81 CLAB 84430 Blank ASSAY OF THIOCYANATE Pathology 0.44 CLAB 84431 Blank THROMBOXANE METABOLITE W/WO THROMBOXANE URINE Pathology 0.64 CLAB 84432 Blank ASSAY OF THYROGLOBULIN Pathology 0.61 CLAB

CPT/ Conversion Total Charge HCPCS Modifier CPT/HCPCS Code Description Factor/GAAF RVUs Methodology 1 Code Category 84436 Blank ASSAY OF THYROXINE TOTAL Pathology 0.26 CLAB 84437 Blank ASSAY OF THYROXINE REQUIRING ELUTION Pathology 0.25 CLAB 84439 Blank ASSAY OF FREE THYROXINE Pathology 0.34 CLAB 84442 Blank ASSAY OF THYROXINE BINDING GLOBULIN Pathology 0.57 CLAB 84443 Blank ASSAY OF THYROID STIMULATING HORMONE TSH Pathology 0.64 CLAB 84445 Blank THYROID STIMULATING IMMUNE GLOBULINS TSI Pathology 1.94 CLAB 84446 Blank ASSAY OF TOCOPHEROL ALPHA VITAMIN E Pathology 0.54 CLAB 84449 Blank ASSAY OF TRANSCORTIN CORTISOL BINDING GLOBULIN Pathology 0.69 CLAB 84450 Blank TRANSFERASE ASPARTATE AMINO AST SGOT Pathology 0.20 CLAB 84460 Blank TRANSFERASE ALANINE AMINO ALT SGPT Pathology 0.20 CLAB 84466 Blank ASSAY OF L7383TRANSFERRIN Pathology 0.49 CLAB 84478 Blank ASSAY OF TRIGLYCERIDES Pathology 0.22 CLAB 84479 Blank THYROID HORM UPTK/THYROID HORMONE BINDING RATIO Pathology 0.25 CLAB 84480 Blank ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3 Pathology 0.54 CLAB 84481 Blank ASSAY OF TRIIODOTHYRONINE T3 FREE Pathology 0.65 CLAB 84482 Blank TRIIODOTHYRONINE T3 REVERSE Pathology 0.60 CLAB 84484 Blank ASSAY OF TROPONIN QUANTITATIVE Pathology 0.38 CLAB 84485 Blank ASSAY OF TRYPSIN DUODENAL FLUID Pathology 0.29 CLAB 84488 Blank ASSAY OF TRYPSIN FECES QUALITATIVE Pathology 0.28 CLAB 84490 Blank TRYPSIN FECES QUANTITATIVE 24-HR COLLECTION Pathology 0.29 CLAB 84510 Blank ASSAY OF TYROSINE Pathology 0.40 CLAB 84512 Blank ASSAY OF TROPONIN QUALITATIVE Pathology 0.29 CLAB 84520 Blank ASSAY OF UREA NITROGEN QUANTITATIVE Pathology 0.15 CLAB 84525 Blank ASSAY OF UREA NITROGEN SEMIQUANTITATIVE Pathology 0.14 CLAB 84540 Blank ASSAY OF UREA NITROGEN URINE Pathology 0.18 CLAB 84545 Blank UREA NITROGEN CLEARANCE Pathology 0.25 CLAB 84550 Blank ASSAY OF BLOOD/URIC ACID Pathology 0.17 CLAB 84560 Blank ASSAY OF URIC ACID OTHER SOURCE Pathology 0.18 CLAB 84577 Blank ASSAY OF UROBILINOGEN FECES QUANTITATIVE Pathology 0.48 CLAB 84578 Blank ASSAY OF UROBILINOGEN URINE QUALITATIVE Pathology 0.12 CLAB 84580 Blank UROBILINOGEN URINE QUANTITATIVE TIMED SPECIMEN Pathology 0.27 CLAB 84583 Blank ASSAY OF UROBILINOGEN URINE SEMIQUANTITATIVE Pathology 0.19 CLAB 84585 Blank ASSAY OF VANILLYLMANDELIC ACID URINE Pathology 0.59 CLAB 84586 Blank ASSAY OF VASOACTIVE INTESTINAL PEPTIDE Pathology 1.35 CLAB 84588 Blank ASSAY OF VASOPRESSIN ANTI-DIURETIC HORMONE Pathology 1.30 CLAB 84590 Blank ASSAY OF VITAMIN A Pathology 0.44 CLAB 84591 Blank ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED Pathology 0.44 CLAB 84597 Blank ASSAY OF VITAMIN K Pathology 0.52 CLAB 84600 Blank ASSAY OF VOLATILES Pathology 0.61 CLAB 84620 Blank XYLOSE ABSORPTION TEST BLOOD &/URINE Pathology 0.45 CLAB 84630 Blank ASSAY OF ZINC Pathology 0.44 CLAB 84681 Blank ASSAY OF C-PEPTIDE Pathology 0.80 CLAB 84702 Blank GONADOTROPIN CHORIONIC QUANTITATIVE Pathology 0.58 CLAB 84703 Blank GONADOTROPIN CHORIONIC QUALITATIVE Pathology 0.29 CLAB 84704 Blank GONADOTROPIN CHORIONIC HCG FREE BETA CHAIN Pathology 0.58 CLAB 84830 Blank OVULATION TEST VISUAL COLOR COMPARISON HLH Pathology 0.38 CLAB 84999 Blank UNLISTED CHEMISTRY PROCEDURE Pathology 0.36 Unlisted 85002 Blank BLEEDING TIME TEST Pathology 0.17 CLAB 85004 Blank BLOOD COUNT AUTOMATED DIFFERENTIAL WBC COUNT Pathology 0.25 CLAB 85007 Blank BLOOD COUNT SMEAR MCRSCP W/MNL DIFRNTL WBC COUNT Pathology 0.13 CLAB

CPT/ Conversion Total Charge HCPCS Modifier CPT/HCPCS Code Description Factor/GAAF RVUs Methodology 1 Code Category 85008 Blank BLD COUNT SMEAR MCRSCP W/O MNL DIFRNTL WBC COUNT Pathology 0.13 CLAB 85009 Blank BLOOD COUNT MANUAL DIFRNTL WBC COUNT BUFFY COAT Pathology 0.14 CLAB 85013 Blank BLOOD COUNT SPUN MICROHEMATOCRIT Pathology 0.09 CLAB 85014 Blank BLOOD COUNT HEMATOCRIT Pathology 0.09 CLAB 85018 Blank BLOOD COUNT HEMOGLOBIN Pathology 0.09 CLAB 85025 Blank BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC Pathology 0.30 CLAB 85027 Blank BLOOD COUNT COMPLETE AUTOMATED Pathology 0.25 CLAB 85032 Blank BLOOD COUNT MANUAL CELL COUNT EACH Pathology 0.16 CLAB 85041 Blank BLOOD COUNT RED BLOOD CELL AUTOMATED Pathology 0.12 CLAB 85044 Blank BLOOD COUNT RETICULOCYTE AUTOMATED Pathology 0.16 CLAB 85045 Blank BLOOD COUNT RETICULOCYTE AUTOMATED Pathology 0.15 CLAB 85046 Blank BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS Pathology 0.21 CLAB 85048 Blank BLOOD COUNT LEUKOCYTE WBC AUTOMATED Pathology 0.10 CLAB 85049 Blank BLOOD COUNT PLATELET AUTOMATED Pathology 0.17 CLAB 85055 Blank RETICULATED PLATELET ASSAY Pathology 1.02 CLAB 85130 Blank CHROMOGENIC SUBSTRATE ASSAY Pathology 0.45 CLAB 85170 Blank BLOOD CLOT RETRACTION Pathology 0.14 CLAB 85175 Blank CLOT LYSIS TIME WHOLE BLOOD DILUTION Pathology 0.17 CLAB 85210 Blank CLOTTING FACTOR II PROTHROMBIN SPECIFIC Pathology 0.50 CLAB 85220 Blank CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR Pathology 0.67 CLAB 85230 Blank CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR Pathology 0.68 CLAB 85240 Blank CLOTTING FACTOR VIII AHG 1 STAGE Pathology 0.68 CLAB 85244 Blank CLOTTING FACTOR VIII RELATED ANTIGEN Pathology 0.78 CLAB 85245 Blank CLOTTING FACTOR VIII VW FACTOR RISTOCETIN COFACT Pathology 0.88 CLAB 85246 Blank CLOTTING FACTOR VIII VW FACTOR ANTIGEN Pathology 0.88 CLAB 85247 Blank CLOTTING FACTOR VIII MULTIMETRIC ANALYSIS Pathology 0.88 CLAB 85250 Blank CLOTTING FACTOR IX PTC/CHRISTMAS Pathology 0.73 CLAB 85260 Blank CLOTTING FACTOR X STUART-PROWER Pathology 0.68 CLAB 85270 Blank CLOTTING FACTOR XI PTA Pathology 0.68 CLAB 85280 Blank CLOTTING FACTOR XII HAGEMAN Pathology 0.74 CLAB 85290 Blank CLOTTING FACTOR XIII FIBRIN STABILIZING Pathology 0.62 CLAB 85291 Blank CLOTTING FACTOR XIII FIBRN STABILIZ SCREEN SOLUB Pathology 0.34 CLAB 85292 Blank CLOTTING PREKALLIKREIN ASSAY FLETCHER FACT ASSAY Pathology 0.72 CLAB 85293 Blank CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY Pathology 0.72 CLAB 85300 Blank CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY Pathology 0.45 CLAB 85301 Blank CLOTTING INHIBITRS ANTITHROMBN III ANTIGEN ASSAY Pathology 0.41 CLAB 85302 Blank CLOTTING INHIBITORS PROTEIN C ANTIGEN Pathology 0.46 CLAB 85303 Blank CLOTTING INHIBITORS PROTEIN C ACTIVITY Pathology 0.53 CLAB 85305 Blank CLOTTING INHIBITORS PROTEIN S TOTAL Pathology 0.44 CLAB 85306 Blank CLOTTING INHIBITORS PROTEIN S FREE Pathology 0.59 CLAB 85307 Blank ACTIVATED PROTEIN C APC RESISTANCE ASSAY Pathology 0.59 CLAB 85335 Blank FACTOR INHIBITOR TEST Pathology 0.49 CLAB 85337 Blank THROMBOMODULIN Pathology 0.40 CLAB 85345 Blank COAGULATION TIME LEE AND WHITE Pathology 0.16 CLAB 85347 Blank COAGULATION TIME ACTIVATED Pathology 0.16 CLAB 85348 Blank COAGULATION TIME OTHER METHODS Pathology 0.14 CLAB 85360 Blank EUGLOBULIN LYSIS Pathology 0.32 CLAB 85362 Blank FIBRIN DGRADJ SPLT PRODUXS AGGLUJ SLIDE SEMIQUAN Pathology 0.26 CLAB 85366 Blank FIBRIN DGRADJ SPLT PRODUXS PARACOAGJ Pathology 0.33 CLAB 85370 Blank FIBRIN DGRADJ SPLT PRODUCTS QUANTITATIVE Pathology 0.43 CLAB

CPT/ Conversion Total Charge HCPCS Modifier CPT/HCPCS Code Description Factor/GAAF RVUs Methodology 1 Code Category 85378 Blank FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN Pathology 0.27 CLAB 85379 Blank FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE Pathology 0.39 CLAB 85380 Blank FIBRIN DGRADJ PRODUCTS D-DIMER ULTRASENSITIVE Pathology 0.39 CLAB 85384 Blank FIBRINOGEN ACTIVITY Pathology 0.32 CLAB 85385 Blank FIBRINOGEN ANTIGEN Pathology 0.32 CLAB 85390 Blank FIBRINOLYSINS/COAGULOPATHY SCREEN INTERP&REPOR Pathology 0.20 CLAB 85397 Blank COAGJ&FIBRINOLYSIS FUNCTIONAL ACTV NOS EA ANAL Pathology 0.88 CLAB 85400 Blank FIBRINOLYTIC FACTORS & INHIBITORS PLASMIN Pathology 0.34 CLAB 85410 Blank FBRNLYC FACTORS&INHIBITORS ALPHA-2 ANTIPLASMIN Pathology 0.29 CLAB 85415 Blank FBRNLYC FACTORS&INHIBITORS PLSMNG ACTIVATOR Pathology 0.66 CLAB 85420 Blank FBRNLYC FACTORS&INHIBITRS PLSMNG XCPT AGIC ASS Pathology 0.25 CLAB 85421 Blank FBRNLYC FACTORS&INHIBITORS PLSMNG AGIC ASSAY Pathology 0.39 CLAB 85441 Blank HEINZ BODIES DIRECT Pathology 0.16 CLAB 85445 Blank HEINZ BODIES INDUCED ACETYL PHENYLHYDRAZINE Pathology 0.26 CLAB 85460 Blank HGB/RBCS FETAL FETOMATERNAL HEMRRG DIFRNTL LYSIS Pathology 0.30 CLAB 85461 Blank HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE Pathology 0.25 CLAB 85475 Blank HEMOLYSIN ACID Pathology 0.34 CLAB 85520 Blank HEPARIN ASSAY Pathology 0.50 CLAB 85525 Blank HEPARIN NEUTRALIZATION Pathology 0.45 CLAB 85530 Blank HEPARIN-PROTAMINE TOLERANCE TST Pathology 0.54 CLAB 85536 Blank IRON STAIN PERIPHERAL BLOOD Pathology 0.25 CLAB 85540 Blank WBC ALKALINE PHOSPHATASE COUNT Pathology 0.33 CLAB 85547 Blank MECHANICAL FRAGILITY RBC Pathology 0.33 CLAB 85549 Blank MURAMIDASE Pathology 0.72 CLAB 85555 Blank OSMOTIC FRAGILITY RBC UNINCUBATED Pathology 0.26 CLAB 85557 Blank OSMOTIC FRAGILITY RBC INCUBATED Pathology 0.51 CLAB 85576 Blank PLATELET AGGREGATION IN VITRO EACH AGENT Pathology 0.82 CLAB 85597 Blank PHOSPHOLIPID NEUTRALIZATION PLATELET Pathology 0.69 CLAB 85598 Blank PHOSPHOLIPID NEUTRALIZATION HEXAGONAL Pathology 0.69 CLAB 85610 Blank PROTHROMBIN TIME Pathology 0.15 CLAB 85611 Blank PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH Pathology 0.15 CLAB 85612 Blank RUSSELL VIPER VENON TIME UNDILUTED Pathology 0.37 CLAB 85613 Blank RUSSELL VIPER VENOM TIME DILUTED Pathology 0.37 CLAB 85635 Blank REPTILASE TEST Pathology 0.38 CLAB 85651 Blank SEDIMENTATION RATE RBC NON-AUTOMATED Pathology 0.14 CLAB 85652 Blank SEDIMENTATION RATE RBC AUTOMATED Pathology 0.10 CLAB 85660 Blank SICKLING RBC REDUCTION Pathology 0.21 CLAB 85670 Blank THROMBIN TIME PLASMA Pathology 0.22 CLAB 85675 Blank THROMBIN TIME TITER Pathology 0.26 CLAB 85705 Blank THROMBOPLASTIN INHIBITION TISSUE Pathology 0.37 CLAB 85730 Blank THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD Pathology 0.23 CLAB 85732 Blank THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA Pathology 0.25 CLAB 85810 Blank VISCOSITY Pathology 0.45 CLAB 85999 Blank UNLISTED HEMATOLOGY & COAGULATION PROCEDURE Pathology 0.15 Unlisted 86000 Blank AGGLUTININS FEBRILE EACH ANTIGEN Pathology 0.27 CLAB 86001 Blank ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN Pathology 0.20 CLAB 86003 Blank ALLERGEN SPECIFIC IGE QUAN/SEMIQUAN EA ALLERGEN Pathology 0.20 CLAB 86005 Blank ALLERGEN SPECIFIC IGE QUAL MULTIALLERGEN SCREEN Pathology 0.30 CLAB 86008 Blank ALLG SPEC IGE RECOMB EA Pathology 0.69 Other 86021 Blank ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES Pathology 0.58 CLAB

CPT/ Conversion Total Charge HCPCS Modifier CPT/HCPCS Code Description Factor/GAAF RVUs Methodology 1 Code Category 86022 Blank ANTIBODY IDENTIFICATION PLATELET ANTIBODIES Pathology 0.70 CLAB 86023 Blank ANTIBODY IDENTIFICATION PLATELET IMMUNOGL ASSAY Pathology 0.48 CLAB 86038 Blank ANTINUCLEAR ANTIBODIES ANA Pathology 0.46 CLAB 86039 Blank ANTINUCLEAR ANTIBODIES ANA TITER Pathology 0.43 CLAB 86060 Blank ANTISTREPTOLYSIN O TITER Pathology 0.28 CLAB 86063 Blank ANTISTREPTOLYSIN O SCREEN Pathology 0.22 CLAB 86140 Blank C-REACTIVE PROTEIN Pathology 0.20 CLAB 86141 Blank C-REACTIVE PROTEIN HIGH SENSITIVITY Pathology 0.49 CLAB 86146 Blank BETA 2 GLYCOPROTEIN I ANTIBODY EACH Pathology 0.97 CLAB 86147 Blank CARDIOLIPIN ANTIBODY EACH IG CLASS Pathology 0.97 CLAB 86148 Blank ANTI-PHOSPHATIDYLSERINE ANTIBODY Pathology 0.61 CLAB 86152 Blank CELL ENUMERATION IMMUNE SELECTJ & ID FLUID SPEC Pathology 9.39 CLAB 86153 Blank CELL ENUMERATION IMMUNE SELECTJ & ID PHYS INTERP Pathology 1.47 FAIR Health 86155 Blank CHEMOTAXIS ASSAY SPECIFY METHOD Pathology 0.61 CLAB 86156 Blank COLD AGGLUTININ SCREEN Pathology 0.26 CLAB 86157 Blank COLD AGGLUTININ TITER Pathology 0.31 CLAB 86160 Blank COMPLEMENT ANTIGEN EACH COMPONENT Pathology 0.46 CLAB 86161 Blank COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT Pathology 0.46 CLAB 86162 Blank COMPLEMENT TOTAL HEMOLYTIC Pathology 0.78 CLAB 86171 Blank COMPLEMENT FIXATION TESTS EACH ANTIGEN Pathology 0.38 CLAB 86200 Blank CYCLIC CITRULLINATED PEPTIDE ANTIBODY Pathology 0.49 CLAB 86215 Blank DEOXYRIBONUCLEASE ANTIBODY Pathology 0.51 CLAB 86225 Blank DNA ANTIBODY NATIVE/DOUBLE STRANDED Pathology 0.53 CLAB 86226 Blank DNA ANTIBODY SINGLE STRANDED Pathology 0.46 CLAB 86235 Blank EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD Pathology 0.69 CLAB 86255 Blank FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY Pathology 0.46 CLAB 86256 Blank FLUORESCENT NONNFCT AGT ANTB TITER EA ANTIBODY Pathology 0.46 CLAB 86277 Blank GROWTH HORMONE HUMAN ANTIBODY Pathology 0.60 CLAB 86280 Blank HEMAGGLUTINATION INHIBITION TEST HAI Pathology 0.31 CLAB 86294 Blank IMMUNOASSAY TUMOR ANTIGEN QUAL/SEMIQUANTITATIVE Pathology 0.75 CLAB 86300 Blank IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3 Pathology 0.80 CLAB 86301 Blank IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9 Pathology 0.80 CLAB 86304 Blank IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125 Pathology 0.80 CLAB 86305 Blank HUMAN EPIDIDYMIS PROTEIN 4 (HE4) Pathology 0.80 CLAB 86308 Blank HETEROPHILE ANTIBODIES SCREEN Pathology 0.20 CLAB 86309 Blank HETEROPHILE ANTIBODIES TITER Pathology 0.25 CLAB 86310 Blank HETEROPHILE ANTIBODIES TITER AFTER ABSORPTION Pathology 0.28 CLAB 86316 Blank IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE Pathology 0.80 CLAB 86317 Blank IMMUNOASSAY INFECTIOUS AGENT ANTIBODY QUAN NOS Pathology 0.57 CLAB 86318 Blank IMMUNOASSAY NFCT AGT ANTB QUAL/SEMIQUAN 1 STEP Pathology 0.49 CLAB 86320 Blank IMMUNOELECTROPHORESIS SERUM Pathology 0.86 CLAB 86325 Blank IMMUNOELECTROPHORESIS OTHER FLUIDS CONCENTRATION Pathology 0.85 CLAB 86327 Blank IMMUNOELECTROPHORESIS CROSSED Pathology 0.87 CLAB 86329 Blank IMMUNODIFFUSION NOT ELSEWHERE SPECIFIED Pathology 0.54 CLAB 86331 Blank IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY Pathology 0.46 CLAB 86332 Blank IMMUNE COMPLEX ASSAY Pathology 0.93 CLAB 86334 Blank IMMUNOFIXJ ELECTROPHORESIS SERUM Pathology 0.85 CLAB 86335 Blank IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS Pathology 1.12 CLAB 86336 Blank INHIBIN A Pathology 0.60 CLAB 86337 Blank INSULIN ANTIBODIES Pathology 0.82 CLAB

CPT/ Conversion Total Charge HCPCS Modifier CPT/HCPCS Code Description Factor/GAAF RVUs Methodology 1 Code Category 86340 Blank INTRINSIC FACTOR ANTIBODIES Pathology 0.58 CLAB 86341 Blank ISLET CELL ANTIBODY Pathology 0.76 CLAB 86343 Blank LEUKOCYTE HISTAMINE RELEASE TEST LHR Pathology 0.48 CLAB 86344 Blank LEUKOCYTE PHAGOCYTOSIS Pathology 0.31 CLAB 86352 Blank CELLULAR FUNCTION ASSAY STIMUL&DETECT BIOMARKE Pathology 5.19 CLAB 86353 Blank LYMPHOCYTE TR MITOGEN/AG INDUCED BLASTOGENESIS Pathology 1.87 CLAB 86355 Blank B CELLS TOTAL COUNT Pathology 1.44 CLAB 86356 Blank MONONUCLEAR CELL ANTIGEN QUANTITATIVE NOS EA Pathology 1.02 CLAB 86357 Blank NATURAL KILLER CELLS TOTAL COUNT Pathology 1.44 CLAB 86359 Blank T CELLS TOTAL COUNT Pathology 1.44 CLAB 86360 Blank T CELLS ABSOLUTE CD4&CD8 COUNT RATIO Pathology 1.80 CLAB 86361 Blank T CELLS ABSOLUTE CD4 COUNT Pathology 1.02 CLAB 86367 Blank STEM CELLS TOTAL COUNT Pathology 1.44 CLAB 86376 Blank MICROSOMAL ANTIBODIES EACH Pathology 0.56 CLAB 86382 Blank NEUTRALIZATION TEST VIRAL Pathology 0.65 CLAB 86384 Blank NITROBLUE TETRAZOLIUM DYE TEST NTD Pathology 0.44 CLAB 86386 Blank NUCLEAR MATRIX PROTEIN 22 NMP22 QUALITATIVE Pathology 0.61 CLAB 86403 Blank PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY Pathology 0.39 CLAB 86406 Blank PARTICLE AGGLUTINATION TITER EACH ANTIBODY Pathology 0.41 CLAB 86430 Blank RHEUMATOID FACTOR QUALITATIVE Pathology 0.22 CLAB 86431 Blank RHEUMATOID FACTOR QUANTITATIVE Pathology 0.22 CLAB 86480 Blank TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON Pathology 2.37 CLAB 86481 Blank TB ANTIGEN RESPONSE GAMMA INTERFERON T-CELL SUSP Pathology 2.86 CLAB 86485 Blank SKIN TEST CANDIDA Pathology 0.22 FAIR Health 86590 Blank STREPTOKINASE ANTIBODY Pathology 0.42 CLAB 86592 Blank SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL Pathology 0.16 CLAB 86593 Blank SYPHILIS TEST QUANTITATIVE Pathology 0.17 CLAB 86602 Blank ANTIBODY ACTINOMYCES Pathology 0.39 CLAB 86603 Blank ANTIBODY ADENOVIRUS Pathology 0.49 CLAB 86606 Blank ANTIBODY ASPERGILLUS Pathology 0.58 CLAB 86609 Blank ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED Pathology 0.49 CLAB 86611 Blank ANTIBODY BARTONELLA Pathology 0.39 CLAB 86612 Blank ANTIBODY BLASTOMYCES Pathology 0.49 CLAB 86615 Blank ANTIBODY BORDETELLA Pathology 0.50 CLAB 86617 Blank ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST Pathology 0.59 CLAB 86618 Blank ANTIBODY BORRELIA BURGDORFERI LYME DISEASE Pathology 0.65 CLAB 86619 Blank ANTIBODY BORRELIA RELAPSING FEVER Pathology 0.51 CLAB 86622 Blank ANTIBODY BRUCELLA Pathology 0.34 CLAB 86625 Blank ANTIBODY CAMPYLOBACTER Pathology 0.50 CLAB 86628 Blank ANTIBODY CANDIDA Pathology 0.46 CLAB 86631 Blank ANTIBODY CHLAMYDIA Pathology 0.45 CLAB 86632 Blank ANTIBODY CHLAMYDIA IGM Pathology 0.48 CLAB 86635 Blank ANTIBODY COCCIDIOIDES Pathology 0.44 CLAB 86638 Blank ANTIBODY COXIELLA BURNETII Q FEVER Pathology 0.46 CLAB 86641 Blank ANTIBODY CRYPTOCOCCUS Pathology 0.55 CLAB 86644 Blank ANTIBODY CYTOMEGALOVIRUS CMV Pathology 0.55 CLAB 86645 Blank ANTIBODY CYTOMEGALOVIRUS CMV IGM Pathology 0.64 CLAB 86648 Blank ANTIBODY DIPHTHERIA Pathology 0.58 CLAB 86651 Blank ANTIBODY ENCEPHALITIS CALIFORNIA LA CROSSE Pathology 0.50 CLAB 86652 Blank ANTIBODY ENCEPHALITIS EASTERN EQUINE Pathology 0.50 CLAB

CPT/ Conversion Total Charge HCPCS Modifier CPT/HCPCS Code Description Factor/GAAF RVUs Methodology 1 Code Category 86653 Blank ANTIBODY ENCEPHALITIS ST. LOUIS Pathology 0.50 CLAB 86654 Blank ANTIBODY ENCEPHALITIS WESTRN EQUINE Pathology 0.50 CLAB 86658 Blank ANTIBODY ENTEROVIRUS Pathology 0.50 CLAB 86663 Blank ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA Pathology 0.50 CLAB 86664 Blank ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA Pathology 0.58 CLAB 86665 Blank ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA Pathology 0.69 CLAB 86666 Blank ANTIBODY EHRLICHIA Pathology 0.39 CLAB 86668 Blank ANTIBODY FRANCISELLA TULARENSIS Pathology 0.40 CLAB 86671 Blank ANTIBODY FUNGUS NOT ELSEWHERE SPECIFIED Pathology 0.47 CLAB 86674 Blank ANTIBODY GIARDIA LAMBLIA Pathology 0.56 CLAB 86677 Blank ANTIBODY HELICOBACTER PYLORI Pathology 0.55 CLAB 86682 Blank ANTIBODY HELMINTH NOT ELSEWHERE SPECIFIED Pathology 0.50 CLAB 86684 Blank ANTIBODY HAEMOPHILUS INFLUENZA Pathology 0.61 CLAB 86687 Blank ANTIBODY HTLV-I Pathology 0.32 CLAB 86688 Blank ANTIBODY HTLV-II Pathology 0.54 CLAB 86689 Blank ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST Pathology 0.74 CLAB 86692 Blank ANTIBODY HEP DELTA AGENT Pathology 0.66 CLAB 86694 Blank ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST Pathology 0.55 CLAB 86695 Blank ANTIBODY HERPES SMPLX TYPE 1 Pathology 0.50 CLAB 86696 Blank ANTIBODY HERPES SMPLX TYPE 2 Pathology 0.74 CLAB 86698 Blank ANTIBODY HISTOPLASMA Pathology 0.48 CLAB 86701 Blank ANTIBODY HIV-1 Pathology 0.34 CLAB 86702 Blank ANTIBODY HIV-2 Pathology 0.52 CLAB 86703 Blank ANTIBODY HIV-1&HIV-2 SINGLE RESULT Pathology 0.52 CLAB 86704 Blank HEPATITIS B CORE ANTIBODY HBCAB TOTAL Pathology 0.46 CLAB 86705 Blank HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY Pathology 0.45 CLAB 86706 Blank HEPATITIS B SURF ANTIBODY HBSAB Pathology 0.41 CLAB 86707 Blank HEPATITIS BE ANTIBODY HBEAB Pathology 0.44 CLAB 86708 Blank HEPATITIS A ANTIBODY HAAB Pathology 0.47 CLAB 86709 Blank HEPATITIS ANTIBODY HAAB IGM ANTIBODY Pathology 0.43 CLAB 86710 Blank ANTIBODY INFLUENZA VIRUS Pathology 0.52 CLAB 86711 Blank ANTIBODY JOHN CUNNINGHAM VIRUS Pathology 0.55 CLAB 86713 Blank ANTIBODY LEGIONELLA Pathology 0.58 CLAB 86717 Blank ANTIBODY LEISHMANIA Pathology 0.47 CLAB 86720 Blank ANTIBODY LEPTOSPIRA Pathology 0.50 CLAB 86723 Blank ANTIBODY LISTERIA MONOCYTOGENES Pathology 0.50 CLAB 86727 Blank ANTIBODY LYMPHOCYTIC CHORIOMENINGITIS Pathology 0.49 CLAB 86732 Blank ANTIBODY MUCORMYCOSIS Pathology 0.50 CLAB 86735 Blank ANTIBODY MUMPS Pathology 0.50 CLAB 86738 Blank ANTIBODY MYCOPLSM Pathology 0.51 CLAB 86741 Blank ANTIBODY NEISSERIA MENINGITIDIS Pathology 0.50 CLAB 86744 Blank ANTIBODY NOCARDIA Pathology 0.50 CLAB 86747 Blank ANTIBODY PARVOVIRUS Pathology 0.57 CLAB 86750 Blank ANTIBODY PLASMODIUM MALARIA Pathology 0.50 CLAB 86753 Blank ANTIBODY PROTOZOA NES Pathology 0.47 CLAB 86756 Blank ANTIBODY RESPIRATORY SYNCTIAL VIRUS Pathology 0.49 CLAB 86757 Blank ANTIBODY RICKETTSIA Pathology 0.74 CLAB 86759 Blank ANTIBODY ROTAVIRUS Pathology 0.50 CLAB 86762 Blank ANTIBODY RUBELLA Pathology 0.55 CLAB 86765 Blank ANTIBODY RUBEOLA Pathology 0.49 CLAB

CPT/ Conversion Total Charge HCPCS Modifier CPT/HCPCS Code Description Factor/GAAF RVUs Methodology 1 Code Category 86768 Blank ANTIBODY SALMONELLA Pathology 0.50 CLAB 86771 Blank ANTIBODY SHIGELLA Pathology 0.50 CLAB 86774 Blank ANTIBODY TETANUS Pathology 0.57 CLAB 86777 Blank ANTIBODY TOXOPLASMA Pathology 0.55 CLAB 86778 Blank ANTIBODY TOXOPLASMA IGM Pathology 0.55 CLAB 86780 Blank ANTIBODY TREPONEMA PALLIDUM Pathology 0.51 CLAB 86784 Blank ANTIBODY TRICHINELLA Pathology 0.48 CLAB 86787 Blank ANTIBODY VARICELLA-ZOSTER Pathology 0.49 CLAB 86788 Blank ANTIBODY WEST NILE VIRUS IGM Pathology 0.64 CLAB 86789 Blank ANTIBODY WEST NILE VIRUS Pathology 0.55 CLAB 86790 Blank ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED Pathology 0.49 CLAB 86793 Blank ANTIBODY YERSINIA Pathology 0.50 CLAB 86794 Blank ZIKA VIRUS IGM ANTIBODY Pathology 0.64 Other 86800 Blank THYROGLOBULIN ANTIBODY Pathology 0.61 CLAB 86803 Blank HEPATITIS C ANTIBODY Pathology 0.55 CLAB 86804 Blank HEPATITIS C ANTIBODY CONFIRMATORY TEST Pathology 0.59 CLAB 86805 Blank LYMPHOCYTOTOXICITY ASSAY VIS CROSSMATCH TITRATJ Pathology 2.00 CLAB 86806 Blank LMPHOCYTOTOXICITY ASSAY VIS CROSSMTCH W/O TITRAT Pathology 1.82 CLAB 86807 Blank SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH Pathology 1.51 CLAB 86808 Blank SERUM SCREENING % REACTIVE ANTIBODY QUICK METH Pathology 1.13 CLAB 86812 Blank HLA TYPING A/B/C SINGLE ANTIGEN Pathology 0.99 CLAB 86813 Blank HLA TYPING A/B/C MULTIPLE ANTIGENS Pathology 2.22 CLAB 86816 Blank HLA TYPING DR/DQ SINGLE ANTIGEN Pathology 1.06 CLAB 86817 Blank HLA TYPING DR/DQ MULTIPLE ANTIGENS Pathology 2.46 CLAB 86821 Blank HLA TYPING LYMPHOCYTE CULTURE MIXED Pathology 2.16 CLAB 86825 Blank HLA CROSSMATCH NONCYTOTOXIC 1ST SERUM/DILUTION Pathology 3.07 CLAB 86826 Blank HLA CROSSMATCH NONCYTOTOXIC ADDL SERUM/DILUTION Pathology 1.02 CLAB 86828 Blank ANTIBODY HLA CLASS I & CLASS II ANTIGENS QUAL Pathology 1.51 CLAB 86829 Blank ANTIBODY HLA CLASS I OR CLASS II ANTIGENS QUAL Pathology 1.13 CLAB 86830 Blank ANTIBODY HLA CLASS I PHENOTYPE PANEL QUALITATIVE Pathology 3.09 CLAB 86831 Blank ANTIBODY HLA CLASS II PHENOTYPE PANEL QUAL Pathology 2.65 CLAB 86832 Blank ANTIBODY HLA CLASS I HIGH DEFINITION PANEL QUAL Pathology 4.85 CLAB 86833 Blank ANTIBODY HLA CLASS II HIGH DEFINITION PANEL QUAL Pathology 4.41 CLAB 86834 Blank ANTIBODY HLA CLASS I SEMIQUANTITATIVE PANEL Pathology 13.67 CLAB 86835 Blank ANTIBODY HLA CLASS II SEMIQUANTITATIVE PANEL Pathology 12.34 CLAB 86849 Blank UNLISTED IMMUNOLOGY Pathology 0.49 Unlisted 86850 Blank ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE Pathology 0.15 CLAB 86860 Blank ANTIBODY ELUTION RBC EACH ELUTION Pathology 0.58 FAIR Health 86870 Blank ANTIBODY ID RBC ANTIBODIES EA PANEL EA SERUM TQ Pathology 0.72 FAIR Health 86880 Blank ANTIHUMAN GLOBULIN DIRECT EACH ANTISERUM Pathology 0.21 CLAB 86885 Blank ANTIHUMAN GLOBULIN INDIR QUAL EA REAGENT CELL Pathology 0.22 CLAB 86886 Blank ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER Pathology 0.20 CLAB 86890 Blank AUTOL BLD/COMPONENT COLLJ STORAGE PREDEPOSITED Pathology 1.53 FAIR Health 86891 Blank AUTOL BLD/COMPONENT COLLJ STORAGE SALVAGE Pathology 2.89 FAIR Health 86900 Blank BLOOD TYPING SEROLOGIC ABO Pathology 0.11 CLAB 86901 Blank BLOOD TYPING SEROLOGIC RH (D) Pathology 0.11 CLAB 86902 Blank BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH Pathology 0.15 CLAB 86904 Blank BLOOD TYPING ANTIGEN SCREEN PATIENT SERUM/UNIT Pathology 0.36 CLAB 86905 Blank BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH Pathology 0.15 CLAB 86906 Blank BLOOD TYPING SEROLOGIC RH PHENOTYPING COMPLETE Pathology 0.30 CLAB

CPT/ Conversion Total Charge HCPCS Modifier CPT/HCPCS Code Description Factor/GAAF RVUs Methodology 1 Code Category 86910 Blank BLOOD TYPING PATERNITY PR INDIV ABO RH&MN Pathology 0.71 ERBRVS 86911 Blank BLOOD TYPING PATERNITY INDIV ADDL ANTIGEN SYS Pathology 0.61 ERBRVS 86920 Blank COMPATIBILITY EACH UNIT IMMEDIATE SPIN TECHNIQUE Pathology 0.67 FAIR Health 86921 Blank COMPATIBILITY EACH UNIT INCUBATION Pathology 0.43 FAIR Health 86922 Blank COMPATIBILITY EACH UNIT ANTIGLOBULIN Pathology 0.66 FAIR Health 86923 Blank COMPATIBILITY EACH UNIT ELECTRONIC Pathology 0.51 FAIR Health 86927 Blank FRESH FROZEN PLASMA THAWING EACH UNIT Pathology 0.24 FAIR Health 86930 Blank FROZEN BLOOD EACH UNIT FREEZING Pathology 3.21 ERBRVS 86931 Blank FROZEN BLOOD EACH UNIT THAWING Pathology 2.41 ERBRVS 86932 Blank FROZEN BLOOD EACH UNIT FREEZING & THAWING Pathology 2.73 ERBRVS 86940 Blank HEMOLYSINS&AGGLUTININS AUTO SCREEN EACH Pathology 0.31 CLAB 86941 Blank HEMOLYSINS&AGGLUTININS INCUBATED Pathology 0.46 CLAB 86945 Blank IRRADIATION BLOOD PRODUCT EACH UNIT Pathology 0.55 FAIR Health 86950 Blank LEUKOCYTE TRANSFUSION Pathology 2.09 ERBRVS 86960 Blank VOLUME REDUCTION BLOOD/BLOOD PRODUCT EACH UNIT Pathology 0.69 FAIR Health 86965 Blank POOLING PLATELETS/OTHER BLOOD PRODUCTS Pathology 0.70 FAIR Health 86970 Blank PRETX RBC ANTIBODY INCUBAT W/CHEM AGNTS/DRUGS EA Pathology 0.66 FAIR Health 86971 Blank PRETX RBC ANTIBODY INCUBAT W/ENZYMES EACH Pathology 0.50 FAIR Health 86972 Blank PRETX RBC ANTIBODY INCUBAT W/DENSITY GRAD SEP Pathology 0.74 FAIR Health 86975 Blank PRETX SERUM RBC ANTIBODY INCUBATION DRUGS EACH Pathology 0.87 ERBRVS 86976 Blank PRETX SERUM RBC ANTIBODY IDENTIFICATION DILUTION Pathology 0.96 ERBRVS 86977 Blank PRETX SERUM RBC ANTB ID INCUBATION INHIBITORS EA Pathology 0.96 ERBRVS 86978 Blank PRETX SERUM RBC ANTIBODY ID DIFFIAL EACH ABSRPJ Pathology 0.59 FAIR Health 86985 Blank SPLITTING BLOOD/BLOOD PRODUCTS EACH UNIT Pathology 0.49 FAIR Health 86999 Blank UNLISTED TRANSFUSION MEDICINE PROCEDURE Pathology 0.15 Unlisted 87003 Blank ANIMAL INOCULATION SMALL ANIMAL W/OBS&DSJ Pathology 0.64 CLAB 87015 Blank CONCENTRATION INFECTIOUS AGENTS Pathology 0.26 CLAB 87040 Blank CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES Pathology 0.39 CLAB 87045 Blank CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL Pathology 0.36 CLAB 87046 Blank CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA Pathology 0.36 CLAB 87070 Blank CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL Pathology 0.33 CLAB 87071 Blank CUL BACT QUAN AEROBIC ISOL XCPT UR BLOOD/STOOL Pathology 0.36 CLAB 87073 Blank CUL BACT QUAN ANAERC ISOL XCPT UR BLOOD/STOOL Pathology 0.36 CLAB 87075 Blank CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID Pathology 0.36 CLAB 87076 Blank CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL Pathology 0.31 CLAB 87077 Blank CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL Pathology 0.31 CLAB 87081 Blank CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ Pathology 0.25 CLAB 87084 Blank CUL PRSMPTV PTHGNC ORGANISMS SCR DNS CHART Pathology 0.33 CLAB 87086 Blank CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE Pathology 0.31 CLAB 87088 Blank CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE Pathology 0.31 CLAB 87101 Blank CUL FNGI MOLD/YEAST PRSMPTV ID SKN HAIR/NAIL Pathology 0.29 CLAB 87102 Blank CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD Pathology 0.32 CLAB 87103 Blank CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD Pathology 0.34 CLAB 87106 Blank CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST Pathology 0.39 CLAB 87107 Blank CULTURE FUNGI DEFINITIVE ID EACH ORGANISM MOLD Pathology 0.39 CLAB 87109 Blank CULTURE MYCOPLASMA ANY SOURCE Pathology 0.59 CLAB 87110 Blank CULTURE CHLAMYDIA ANY SOURCE Pathology 0.75 CLAB 87116 Blank CULTURE TUBERCLE/OTH ACID-FAST BACILLI ANY ISOL Pathology 0.41 CLAB 87118 Blank CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL Pathology 0.42 CLAB 87140 Blank CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM Pathology 0.21 CLAB

CPT/ Conversion Total Charge HCPCS Modifier CPT/HCPCS Code Description Factor/GAAF RVUs Methodology 1 Code Category 87143 Blank CULTURE TYPING GAS/HIGH PRES LIQ CHROMATOGRAPHY Pathology 0.48 CLAB 87147 Blank CULTURE TYPING IMMUNOLOGIC OTH/THN IMMUNOFLUORES Pathology 0.20 CLAB 87149 Blank CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM Pathology 0.77 CLAB 87150 Blank CULTYP NUC ACID AMP PRB CULT/ISOLATE EA ORGNISM Pathology 1.34 CLAB 87152 Blank CULTURE TYPING IDENTIFJ PULSE FIELD GEL TYPING Pathology 0.20 CLAB 87153 Blank CULTYP NUCLEIC ACID SEQUENCING METH EA ISOLATE Pathology 4.41 CLAB 87158 Blank CULTURE TYPING OTHER METHODS Pathology 0.20 CLAB 87164 Blank DARK FIELD EXAM ANY SOURCE W/SPECIMEN COLLECTION Pathology 0.41 CLAB 87166 Blank DARK FIELD EXAM ANY SOURCE W/O SPECIMEN COLLECT Pathology 0.43 CLAB 87168 Blank MACROSCOPIC EXAMINATION ARTHROPOD Pathology 0.16 CLAB 87169 Blank MACROSCOPIC EXAMINATION PARASITE Pathology 0.16 CLAB 87172 Blank PINWORM EXAMINATION Pathology 0.16 CLAB 87176 Blank HOMOGENIZATION TISSUE CULTURE Pathology 0.22 CLAB 87177 Blank OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID Pathology 0.34 CLAB 87181 Blank SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ Pathology 0.18 CLAB 87184 Blank SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD Pathology 0.26 CLAB 87185 Blank SUSCEPTIBILITY STUDY ANTIMICROBIAL ENZYME DETCJ Pathology 0.18 CLAB 87186 Blank SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ Pathology 0.33 CLAB 87187 Blank SUSCEPTIBLTY STDY ANTMCRB MICRO/AGAR DILUTJ EA Pathology 0.40 CLAB 87188 Blank SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT Pathology 0.25 CLAB 87190 Blank SUSCEPTIBLTY STDY ANTMCRB MYCOBACT PROPORJ MTHD Pathology 0.22 CLAB 87197 Blank SERUM BACTERICIDAL TITER Pathology 0.57 CLAB 87205 Blank SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL Pathology 0.16 CLAB 87206 Blank SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT Pathology 0.21 CLAB 87207 Blank SMR PRIM SRC SPEC STAIN BODIES/PARASITS Pathology 0.23 CLAB 87209 Blank SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS Pathology 0.69 CLAB 87210 Blank SMR PRIM SRC WET MOUNT NFCT AGT Pathology 0.16 CLAB 87220 Blank TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT Pathology 0.16 CLAB 87230 Blank TOXIN/ANTITOXIN ASSAY TISSUE CULTURE Pathology 0.75 CLAB 87250 Blank VIRUS INOCULATION EGGS/SM ANIMAL OBS&DSJ Pathology 0.75 CLAB 87252 Blank VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT Pathology 1.00 CLAB 87253 Blank VIRUS TISSUE CULTURE ADDL STDY/ID EACH ISOLATE Pathology 0.77 CLAB 87254 Blank VIRUS CENTRIFUGE ENHNCD ID IMFLUOR STAIN EA Pathology 0.75 CLAB 87255 Blank VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC Pathology 1.29 CLAB 87260 Blank IAADI ADENOVIRUS Pathology 0.46 CLAB 87265 Blank IAADI BORDETELLA PRTUSSIS/PARAPRTUSSIS Pathology 0.46 CLAB 87267 Blank IAADI ENTEROVIRUS DIRECT FLUORESCENT ANTIBODY Pathology 0.46 CLAB 87269 Blank IAADI GIARDIA Pathology 0.46 CLAB 87270 Blank IAADI CHLAMYDIA TRACHOMATIS Pathology 0.46 CLAB 87271 Blank IAADI CYTOMEGALOVIRUS DIR FLUORESCENT ANTIBODY Pathology 0.46 CLAB 87272 Blank IAADI CRYPTOSPORIDIUM Pathology 0.46 CLAB 87273 Blank IAADI HERPES SMPLX VIRUS TYPE 2 Pathology 0.46 CLAB 87274 Blank IAADI HERPES SMPLX VIRUS TYPE 1 Pathology 0.46 CLAB 87275 Blank IAADI INFLUENZA B VIRUS Pathology 0.46 CLAB 87276 Blank IAADI INFFLUENZA A VIRUS Pathology 0.46 CLAB 87278 Blank IAADI LEGIONELLA PNEUMOPHILA Pathology 0.46 CLAB 87279 Blank IAADI PARAINFLUENZA VIRUS EACH TYPE Pathology 0.46 CLAB 87280 Blank IAADI RESPIRATORY SYNCTIAL VIRUS Pathology 0.46 CLAB 87281 Blank IAADI PNEUMOCUSTIS CARINII Pathology 0.46 CLAB 87283 Blank IAADI RUBEOLA Pathology 0.46 CLAB

CPT/ Conversion Total Charge HCPCS Modifier CPT/HCPCS Code Description Factor/GAAF RVUs Methodology 1 Code Category 87285 Blank IAADI TREPONEMA PALLIDUM Pathology 0.46 CLAB 87290 Blank IAADI VARICELLA ZOSTER VIRUS Pathology 0.46 CLAB 87299 Blank IAADI NOT OTHERWISE SPECIFIED EACH ORGANISM Pathology 0.46 CLAB 87300 Blank IAADI POLYV MLT ORGANISMS EA POLYV ANTISERUM Pathology 0.46 CLAB 87301 Blank IAAD IA ADENOVIRUS ENTERIC TYP 40/41 Pathology 0.46 CLAB 87305 Blank IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS Pathology 0.46 CLAB 87320 Blank IAAD IA CHLAMYDIA TRACHOMATIS Pathology 0.46 CLAB 87324 Blank IAAD IA CLOSTRIDIUM DIFFICILE TOXIN Pathology 0.46 CLAB 87327 Blank IAAD IA CRYPTOCOCCUS NEOFORMANS Pathology 0.46 CLAB 87328 Blank IAAD IA CRYPTOSPORIDIUM Pathology 0.46 CLAB 87329 Blank IAAD IA GIARDIA Pathology 0.46 CLAB 87332 Blank IAAD IA CYTOMEGALOVIRUS Pathology 0.46 CLAB 87335 Blank IAAD IA ESCHERICHIA COLI 0157 Pathology 0.46 CLAB 87336 Blank IAAD IA ENTAMOEBA HISTOLYTICA DISPAR GRP Pathology 0.46 CLAB 87337 Blank IAAD IA ENTAMOEBA HISTOLYTICA GRP Pathology 0.46 CLAB 87338 Blank IAAD IA HPYLORI STOOL Pathology 0.55 CLAB 87339 Blank IAAD IA HPYLORI Pathology 0.46 CLAB 87340 Blank IAAD IA HEPATITIS B SURFACE ANTIGEN Pathology 0.39 CLAB 87341 Blank IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION Pathology 0.39 CLAB 87350 Blank IAAD IA HEPATITIS BE ANTIGEN Pathology 0.44 CLAB 87380 Blank IAAD IA HEPATITIS DELTA ANTIGEN Pathology 0.63 CLAB 87385 Blank IAAD IA HISTOPLASM CAPSULATUM Pathology 0.46 CLAB 87389 Blank IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE Pathology 0.92 CLAB 87390 Blank IAAD IA HIV-1 Pathology 0.67 CLAB 87391 Blank IAAD IA HIV-2 Pathology 0.67 CLAB 87400 Blank IAAD IA INFLUENZA A/B EACH Pathology 0.46 CLAB 87420 Blank IAAD IA RESPIRATORY SYNCTIAL VIRUS Pathology 0.46 CLAB 87425 Blank IAAD IA ROTAVIRUS Pathology 0.46 CLAB 87427 Blank IAAD IA SHIGA-LIKE TOXIN Pathology 0.46 CLAB 87430 Blank IAAD IA STREPTOCOCCUS GROUP A Pathology 0.46 CLAB 87449 Blank IAAD IA MULT STEP METHOD NOS EACH ORGANISM Pathology 0.46 CLAB 87450 Blank IAAD IA SINGLE STEP METHOD NOS EA ORGANISM Pathology 0.37 CLAB 87451 Blank IAAD IA POLYV MLT ORGANISMS EA POLYV ANTISERUM Pathology 0.37 CLAB 87471 Blank IADNA BARTONELLA AMPLIFIED PROBE TECHNIQUE Pathology 1.34 CLAB 87472 Blank IADNA BARTONELLA HENSELAE&QUINTANA QUANTJ Pathology 1.64 CLAB 87475 Blank IADNA BORRELIA BURGDORFERI DIRECT PROBE TQ Pathology 0.77 CLAB 87476 Blank IADNA BORRELIA BURGDORFERI AMPLIFIED PROBE TQ Pathology 1.34 CLAB 87480 Blank IADNA CANDIDA SPECIES DIRECT PROBE TQ Pathology 0.77 CLAB 87481 Blank IADNA CANDIDA SPECIES AMPLIFIED PROBE TQ Pathology 1.34 CLAB 87482 Blank IADNA CANDIDA SPECIES QUANTIFICATION Pathology 1.60 CLAB 87483 Blank CNS DNA AMP PROBE TYPE 12-25 Pathology 15.93 CLAB 87485 Blank IADNA CHLAMYDIA PNEUMONIAE DIRECT PROBE TQ Pathology 0.77 CLAB 87486 Blank IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ Pathology 1.34 CLAB 87487 Blank IADNA CHLAMYDIA PNEUMONIAE QUANTIFICATION Pathology 1.64 CLAB 87490 Blank IADNA CHLAMYDIA TRACHOMATIS DIRECT PROBE TQ Pathology 0.77 CLAB 87491 Blank IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ Pathology 1.34 CLAB 87492 Blank IADNA CHLAMYDIA TRACHOMATIS QUANTIFICATION Pathology 1.34 CLAB 87493 Blank INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE Pathology 1.34 CLAB 87495 Blank IADNA CYTOMEGALOVIRUS DIRECT PROBE TQ Pathology 0.77 CLAB 87496 Blank IADNA CYTOMEGALOVIRUS AMPLIFIED PROBE TQ Pathology 1.34 CLAB

CPT/ Conversion Total Charge HCPCS Modifier CPT/HCPCS Code Description Factor/GAAF RVUs Methodology 1 Code Category 87497 Blank IADNA CYTOMEGALOVIRUS QUANTIFICATION Pathology 1.64 CLAB 87498 Blank IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP Pathology 1.34 CLAB 87500 Blank INFECTIOUS AGENT DNA/RNA VANCOMYCIN RESISTANCE Pathology 1.34 CLAB 87501 Blank INFECTIOUS AGENT DNA/RNA INFLUENZA EA TYPE Pathology 1.96 CLAB 87502 Blank INFECTIOUS AGENT DNA/RNA INFLUENZA 1ST 2 TYPES Pathology 3.25 CLAB 87503 Blank NFCT AGENT DNA/RNA INFLUENZA >2 TYPES EA ADDL Pathology 0.79 CLAB 87505 Blank NFCT AGENT DNA/RNA GASTROINTESTINAL PATHOGEN Pathology 4.90 CLAB 87506 Blank IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6-11 Pathology 8.16 CLAB 87507 Blank IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25 Pathology 15.93 CLAB 87510 Blank IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ Pathology 0.77 CLAB 87511 Blank IADNA GARDNERELLA VAGINALIS AMPLIFIED PROBE TQ Pathology 1.34 CLAB 87512 Blank IADNA GARDNERELLA VAGINALIS QUANTIFICATION Pathology 1.60 CLAB 87516 Blank IADNA HEPATITIS B VIRUS AMPLIFIED PROBE TQ Pathology 1.34 CLAB 87517 Blank IADNA HEPATITIS B VIRUS QUANTIFICATION Pathology 1.64 CLAB 87520 Blank IADNA HEPATITIS C DIRECT PROBE TECHNIQUE Pathology 0.77 CLAB 87521 Blank IADNA HEPATITIS C AMPLIFIED PROBE&REVRSE TRANSCR Pathology 1.34 CLAB 87522 Blank IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION Pathology 1.64 CLAB 87525 Blank IADNA HEPATITIS G DIRECT PROBE TECHNIQUE Pathology 0.77 CLAB 87526 Blank IADNA HEPATITIS G AMPLIFIED PROBE TECHNIQUE Pathology 1.34 CLAB 87527 Blank IADNA HEPATITIS G QUANTIFICATION Pathology 1.60 CLAB 87528 Blank IADNA HERPES SIMPLX VIRUS DIRECT PROBE TQ Pathology 0.77 CLAB 87529 Blank IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ Pathology 1.34 CLAB 87530 Blank IADNA HERPES SOMPLX VIRUS QUANTIFICATION Pathology 1.64 CLAB 87531 Blank IADNA HERPES VIRUS-6 DIRECT PROBE TQ Pathology 0.77 CLAB 87532 Blank IADNA HERPES VIRUS-6 AMPLIFIED PROBE TQ Pathology 1.34 CLAB 87533 Blank IADNA HERPES VIRUS-6 QUANTIFICATION Pathology 1.60 CLAB 87534 Blank IADNA HIV-1 DIRECT PROBE TECHNIQUE Pathology 0.77 CLAB 87535 Blank IADNA HIV-1 AMPLIFIED PROBE & REVERSE TRANSCRPJ Pathology 1.34 CLAB 87536 Blank IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION Pathology 3.25 CLAB 87537 Blank IADNA HIV-2 DIRECT PROBE TECHNIQUE Pathology 0.77 CLAB 87538 Blank IADNA HIV-2 AMPLIFIED PROBE & REVERSE TRANSCRIPJ Pathology 1.34 CLAB 87539 Blank IADNA HIV-2 QUANT & REVERSE TRANSCRIPTION Pathology 1.64 CLAB 87540 Blank IADNA LEGIONELLA PNEUMOPHILA DIRECT PROBE TQ Pathology 0.77 CLAB 87541 Blank IADNA LEGIONELLA PNEUMOPHILA AMPLIFIED PROBE TQ Pathology 1.34 CLAB 87542 Blank IADNA LEGIONELLA PNEUMOPHILA QUANTIFICATION Pathology 1.60 CLAB 87550 Blank IADNA MYCOBACTERIA SPECIES DIRECT PROBE TQ Pathology 0.77 CLAB 87551 Blank IADNA MYCOBACTERIA SPECIES AMPLIFIED PROBE TQ Pathology 1.34 CLAB 87552 Blank IADNA MYCOBACTERIA SPECIES QUANTIFICATION Pathology 1.64 CLAB 87555 Blank IADNA MYCOBACTERIA TUBERCULOSIS DIR PRB Pathology 0.77 CLAB 87556 Blank IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB Pathology 1.34 CLAB 87557 Blank IADNA MYCOBACTERIA TUBERCULOSIS QUANTIFICATION Pathology 1.64 CLAB 87560 Blank IADNA MYCOBACTERIA AVIUM-INTRACLRE DIR PRB Pathology 0.77 CLAB 87561 Blank IADNA MYCOBACTERIA AVIUM-INTRACLRE AMP PRB Pathology 1.34 CLAB 87562 Blank IADNA MYCOBACTERIA AVIUM-INTRACELLULARE QUANT Pathology 1.64 CLAB 87580 Blank IADNA MYCOPLSM PNEUMONIAE DIRECT PROBE TQ Pathology 0.77 CLAB 87581 Blank IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ Pathology 1.34 CLAB 87582 Blank IADNA MYCOPLSM PNEUMONIAE QUANTIFICATION Pathology 1.60 CLAB 87590 Blank IADNA NEISSERIA GONORRHOEAE DIRECT PROBE TQ Pathology 0.77 CLAB 87591 Blank IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ Pathology 1.34 CLAB 87592 Blank IADNA NEISSERIA GONORRHOEAE QUANTIFICATION Pathology 1.64 CLAB

CPT/ Conversion Total Charge HCPCS Modifier CPT/HCPCS Code Description Factor/GAAF RVUs Methodology 1 Code Category 87623 Blank IADNA HUMAN PAPILLOMAVIRUS LOW-RISK TYPES Pathology 1.34 CLAB 87624 Blank IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES Pathology 1.34 CLAB 87625 Blank IADNA HUMAN PAPILLOMAVIRUS TYPES 16 & 18 ONLY Pathology 1.34 CLAB 87631 Blank IADNA RESPIRATRY PROBE & REV TRNSCR 3-5 TARGETS Pathology 4.90 CLAB 87632 Blank IADNA RESPIRATRY PROBE & REV TRNSCR 6-11 TARGETS Pathology 8.16 CLAB 87633 Blank IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET Pathology 15.93 CLAB 87634 Blank RSV DNA/RNA AMP PROBE Pathology 2.68 Other 87640 Blank IADNA S AUREUS AMPLIFIED PROBE TQ Pathology 1.34 CLAB 87641 Blank IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ Pathology 1.34 CLAB 87650 Blank IADNA STREPTOCOCCUS GROUP A DIRECT PROBE TQ Pathology 0.77 CLAB 87651 Blank IADNA STREPTOCOCCUS GROUP A AMPLIFIED PROBE TQ Pathology 1.34 CLAB 87652 Blank IADNA STREPTOCOCCUS GROUP A QUANTIFICATION Pathology 1.60 CLAB 87653 Blank IADNA STREPTOCOCCUS GROUP B AMPLIFIED PROBE TQ Pathology 1.34 CLAB 87660 Blank IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ Pathology 0.77 CLAB 87661 Blank IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH Pathology 1.34 CLAB 87662 Blank ZIKA VIRUS DNA/RNA AMP PROBE Pathology 1.96 Other 87797 Blank IADNA NOS DIRECT PROBE TQ EACH ORGANISM Pathology 0.77 CLAB 87798 Blank IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM Pathology 1.34 CLAB 87799 Blank IADNA NOS QUANTIFICATION EACH ORGANISM Pathology 1.64 CLAB 87800 Blank IADNA MULTIPLE ORGANISMS DIRECT PROBE TQ Pathology 1.53 CLAB 87801 Blank IADNA MULTIPLE ORGANISMS AMPLIFIED PROBE TQ Pathology 2.68 CLAB 87802 Blank IAADIADOO STREPTOCOCCUS GROUP B Pathology 0.46 CLAB 87803 Blank IAADIADOO CLOSTRIDIUM DIFFICILE TOXIN Pathology 0.46 CLAB 87804 Blank IAADIADOO INFLUENZA Pathology 0.46 CLAB 87806 Blank IAADIADOO HIV1 ANTIGEN W/HIV1 & HIV2 ANTIBODIES Pathology 0.92 CLAB 87807 Blank IAADIADOO RESPIRATORY SYNCTIAL VIRUS Pathology 0.46 CLAB 87808 Blank IAADIADOO TRICHOMONAS VAGINALIS Pathology 0.46 CLAB 87809 Blank INFECTIOUS AGENT IMMUNOASSAY OPTICAL ADENOVIRUS Pathology 0.46 CLAB 87810 Blank CHLAMYDIA TRACHOMATIS Pathology 0.46 CLAB 87850 Blank IAADIADOO NEISSERIA GONORRHOEAE Pathology 0.46 CLAB 87880 Blank IAADIADOO STREPTOCOCCUS GROUP A Pathology 0.46 CLAB 87899 Blank IAADIADOO NOT OTHERWISE SPECIFIED Pathology 0.46 CLAB 87900 Blank NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION Pathology 4.98 CLAB 87901 Blank NFCT GEXYP NUCLEIC ACID HIV REV TRNSCR&PROTEAS Pathology 9.84 CLAB 87902 Blank NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS Pathology 9.84 CLAB 87903 Blank NFCT PHEXYP RESIST TISS CUL HIV FIRST 1-10 DRUGS Pathology 18.68 CLAB 87904 Blank NFCT PHEXYP RESIST TISS CUL HIV EA ADDL DRUG Pathology 1.00 CLAB 87905 Blank INFECTIOUS AGENT ENZYMATIC ACTV OTH/THN VIRUS Pathology 0.47 CLAB 87906 Blank NFCT GEXYP DNA/RNA HIV 1 OTHER REGION Pathology 4.92 CLAB 87910 Blank NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS Pathology 9.84 CLAB 87912 Blank NFCT AGENT GENOTYPE HEPATITIS B VIRUS Pathology 9.84 CLAB 87999 Blank UNLISTED MICROBIOLOGY Pathology 0.39 Unlisted 88000 Blank NECROPSY GROSS EXAMINATION ONLY W/O CNS Pathology 6.23 ERBRVS 88005 Blank NECROPSY GROSS EXAMINATION W/BRAIN Pathology 7.27 ERBRVS 88007 Blank NECROPSY GROSS EXAMINATION W/BRAIN&SPINAL CORD Pathology 7.61 ERBRVS 88012 Blank NECROPSY GROSS EXAMINATION INFANT W/BRAIN Pathology 6.23 ERBRVS 88014 Blank NECROPSY GROSS EXAM STILLBORN/NEWBORN W/BRAIN Pathology 5.71 ERBRVS 88016 Blank NECROPSY GROSS EXAM MACERATED STILLBORN Pathology 7.96 ERBRVS 88020 Blank NECROPSY GROSS & MICROSCOPIC W/O CNS Pathology 10.73 ERBRVS 88025 Blank NECROPSY GROSS & MICROSCOPIC W/BRAIN Pathology 10.38 ERBRVS

CPT/ Conversion Total Charge HCPCS Modifier CPT/HCPCS Code Description Factor/GAAF RVUs Methodology 1 Code Category 88027 Blank NECROPSY GROSS&MCRSCP BRAIN & SPINAL CORD Pathology 11.07 ERBRVS 88028 Blank NECROPSY GROSS & MICROSCOPIC INFANT W/BRAIN Pathology 6.23 ERBRVS 88029 Blank NECROPSY GROSS&MCRSCP STILLBORN/NEWBORN BRAIN Pathology 6.23 ERBRVS 88036 Blank NECROPSY LIMITED GROSS&/MCRSCP REGIONAL Pathology 3.11 ERBRVS 88037 Blank NECROPSY LIMITD GROSS&/MCRSCP SINGLE ORGAN Pathology 2.77 ERBRVS 88040 Blank NECROPSY FORENSIC EXAMINATION Pathology 17.30 ERBRVS 88045 Blank NECROPSY CORONER CALL Pathology 1.73 ERBRVS 88099 Blank UNLISTED NECROPSY PROCEDURE Pathology 10.38 Unlisted 88130 Blank SEX CHROMATIN IDENTIFICATION BARR BODIES Pathology 0.58 CLAB 88140 Blank SEX CHROMATIN IDENTJ PERIPHERAL BLOOD SMEAR Pathology 0.31 CLAB 88142 Blank CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN Pathology 0.77 CLAB 88143 Blank CYTP C/V FLU AUTO THIN MNL SCR&RESCR PHYS Pathology 0.77 CLAB 88147 Blank CYTP SMRS C/V SCR AUTOMATED SYSTEM PHYS SUPV Pathology 0.40 CLAB 88148 Blank CYTP SMRS C/V SCR AUTO SYS MNL RESCR PHYS Pathology 0.58 CLAB 88150 Blank CYTP SLIDES C/V MNL SCR UNDER PHYS Pathology 0.40 CLAB 88152 Blank CYTP SLIDES C/V MNL SCR&CPTR RESCR PHYS Pathology 0.40 CLAB 88153 Blank CYTP SLIDES C/V MNL SCR&RESCR PHYS Pathology 0.40 CLAB 88155 Blank CYTP SLIDES C/V DEFINITIVE HORMONAL EVAL Pathology 0.23 CLAB 88164 Blank CYTP SLIDES CERV/VAG MNL SCRN PHYSICIAN SUPV Pathology 0.40 CLAB 88165 Blank CYTP SLIDES C/V MNL SCR&RESCR PHYS SUPV Pathology 0.40 CLAB 88166 Blank CYTP SLIDES C/V MNL SCR&CPTR RESCR PHYS SUPV Pathology 0.40 CLAB 88167 Blank CYTP SLIDES C/V MNL SCR&CPTR RESCR CELL S&I Pathology 0.40 CLAB 88174 Blank CYTP C/V AUTO THIN LYR PREPJ SCR SYS PHYS Pathology 0.82 CLAB 88175 Blank CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS Pathology 1.01 CLAB 88199 Blank UNLISTED CYTOPATHOLOGY PROCEDURE Pathology 1.90 Unlisted 88199 26 UNLISTED CYTOPATHOLOGY PROCEDURE Pathology 0.80 Unlisted 88199 TC UNLISTED CYTOPATHOLOGY PROCEDURE Pathology 1.10 Unlisted 88230 Blank TISS CUL NON-NEO DISORDERS LYMPHOCYTE Pathology 4.45 CLAB 88233 Blank TISS CUL NON-NEO DISORDERS SKN/OTH SOLID TISS BX Pathology 5.38 CLAB 88235 Blank TISS CUL NON-NEO DISORDERS AMNIOTIC/CHORNC CELLS Pathology 5.63 CLAB 88237 Blank TISS CUL NEO DISORDERS BONE MARROW BLOOD CELLS Pathology 4.83 CLAB 88239 Blank TISS CUL NEO DISORDERS SOLID TUMOR Pathology 5.64 CLAB 88240 Blank CRYOPRSRV FRZING&STORAGE CELLS EA CELL LINE Pathology 0.39 CLAB 88241 Blank THAWING&EXPANSION FROZEN CELLS EACH ALIQUOT Pathology 0.39 CLAB 88245 Blank CHRMSM BREAKAGE BASELINE SISTER 20-25 CLL Pathology 5.69 CLAB 88248 Blank CHRMSM BREAKAGE BASELINE BREAKAGE 50-100 CLL Pathology 6.62 CLAB 88249 Blank CHRMSM BREAKAGE SYNDS SCORE 100 CLL Pathology 6.62 CLAB 88261 Blank CHRMSM COUNT 5 CELL 1KARYOTYPE BANDING Pathology 6.76 CLAB 88262 Blank CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING Pathology 4.76 CLAB 88263 Blank CHRMSM COUNT 45 CELL MOSAICISM 2KARYOTYPE Pathology 5.74 CLAB 88264 Blank CHRMSM ANALYZE 20-25 CELLS Pathology 4.76 CLAB 88267 Blank CHRMSM ALYS AMNIOTIC/VILLUS 15 CELL 1KARYOTYPE Pathology 6.87 CLAB 88269 Blank CHRMSM SITU AMNIOTIC CLL 6-12 COLONIES 1KARYOTYP Pathology 6.36 CLAB 88271 Blank MOLECULAR CYTOGENETICS DNA PROBE EACH Pathology 0.82 CLAB 88272 Blank MOLECULAR CYTOGENETICS CHRMOML ISH 3-5 CELLS Pathology 1.02 CLAB 88273 Blank MOLECULAR CYTOGENETICS CHRMOML ISH 10-30 CLL Pathology 1.23 CLAB 88274 Blank MOLECULAR CYTOGENETICS INTERPHASE ISH 25-99 CLL Pathology 1.33 CLAB 88275 Blank MOLEC CYTG INTERPHASE ISH ANALYZE 100-300 CLL Pathology 1.54 CLAB 88280 Blank CHRMSM ANALYSIS ADDL KARYOTYP EACH STUDY Pathology 0.96 CLAB 88283 Blank CHRMSM ANALYSIS ADDL SPECIALIZED BANDING Pathology 2.62 CLAB

CPT/ Conversion Total Charge HCPCS Modifier CPT/HCPCS Code Description Factor/GAAF RVUs Methodology 1 Code Category 88285 Blank CHRMSM ANALYSIS ADDL CELLS COUNTED EACH STUDY Pathology 0.73 CLAB 88289 Blank CHRMSM ANALYSIS ADDL HIGH RESOLUTION STUDY Pathology 1.32 CLAB 88299 Blank UNLISTED CYTOGENETIC STUDY Pathology 1.33 Unlisted 88371 Blank PROTEIN ANAL TISSUE WESTERN BLOT W/INTERP&REPO Pathology 0.85 CLAB 88372 Blank PROTEIN ALYS WSTRN BLOT I&R IMMUNOLOGICAL EA Pathology 0.87 CLAB 88375 Blank OPTICAL ENDOMICROSCOPIC IMAGE INTERP & REPORT Pathology 1.26 ERBRVS 88399 Blank UNLISTED SURGICAL PATHOLOGY PROCEDURE Pathology 1.91 Unlisted 88399 26 UNLISTED SURGICAL PATHOLOGY PROCEDURE Pathology 1.09 Unlisted 88399 TC UNLISTED SURGICAL PATHOLOGY PROCEDURE Pathology 0.82 Unlisted 88720 Blank BILIRUBIN TOTAL TRANSCUTANEOUS Pathology 0.19 CLAB 88738 Blank HGB QUANTITATIVE TRANSCUTANEOUS Pathology 0.19 CLAB 88740 Blank HEMOGLOBIN QUAN TC PER DAY CARBOXYHEMOGLOBIN Pathology 0.19 CLAB 88741 Blank HEMOGLOBIN QUANTITATIVE TC PER DAY METHEMOGLOBIN Pathology 0.19 CLAB 88749 Blank UNLISTED IN VIVO LABORTORY SERVICE Pathology 0.19 Unlisted 89050 Blank CELL COUNT MISCELLANEOUS BODY FLUIDS Pathology 0.18 CLAB 89051 Blank CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT Pathology 0.21 CLAB 89055 Blank LEUKOCYTE ASSMT FECAL QUAL/SEMIQUANTITATIVE Pathology 0.16 CLAB 89060 Blank CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID Pathology 0.27 CLAB 89125 Blank FAT STAIN FECES URINE/RESPIR SECRETIONS Pathology 0.17 CLAB 89160 Blank MEAT FIBERS FECES Pathology 0.14 CLAB 89190 Blank NASAL SMEAR EOSINOPHILS Pathology 0.18 CLAB 89240 Blank UNLIS MISC PATH Pathology 0.18 Unlisted 89250 Blank CUL OOCYTE/EMBRYO <4 DAYS Pathology 12.08 FAIR Health 89251 Blank CUL OOCYTE/EMBRYO < 4 D CO-CULT OCYTE/EMBRY Pathology 13.09 FAIR Health 89253 Blank ASSTD EMBRYO HATCHING MICROTQS ANY METH Pathology 5.74 FAIR Health 89254 Blank OOCYTE ID FROM FOLLICULAR FLU Pathology 5.57 FAIR Health 89255 Blank PREPJ EMBRYO TR Pathology 3.62 FAIR Health 89257 Blank SPRM ID FROM ASPIR OTH/THN SEMINAL Pathology 4.32 FAIR Health 89258 Blank CRYOPRSRV EMBRYO Pathology 6.78 FAIR Health 89259 Blank CRYOPRSRV SPRM Pathology 1.50 FAIR Health 89260 Blank SPRM ISOL SMPL PREP INSEMINATION/DX SEMEN ALYS Pathology 1.44 FAIR Health 89261 Blank SPRM ISOL CPLX PREP INSEMINATION/DX SEMEN ALYS Pathology 1.80 FAIR Health 89264 Blank SPRM ID FROM TSTIS TISS FRSH/CRYOPRSRVD Pathology 5.19 FAIR Health 89268 Blank INSEMINATION OOCYTES Pathology 4.61 FAIR Health 89272 Blank EXTND CUL OOCYTE/EMBRYO 4-7 DAYS Pathology 7.98 FAIR Health 89280 Blank ASSTD FERTILIZATION MICROTQ 10 OOCYTES Pathology 15.51 FAIR Health 89290 Blank BX OOCYTE MICROTQ 5 EMBRY Pathology 15.47 FAIR Health 89300 Blank SEMEN ALYS PRESENCE&/MOTILITY SPRM HUHNER Pathology 0.34 CLAB 89310 Blank SEMEN ALYS MOTILITY&CNT X W/HUHNER TST Pathology 0.33 CLAB 89320 Blank SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT Pathology 0.46 CLAB 89321 Blank SEMEN ANALYSIS SPERM PRESENCE&/MOTILITY SPRM Pathology 0.46 CLAB 89322 Blank SEMEN ANALYSIS STRICT MORPHOLOGIC CRITERIA Pathology 0.59 CLAB 89325 Blank SPERM ANTIBODIES Pathology 0.41 CLAB 89329 Blank SPERM EVALUATION HAMSTER PENETRATION TEST Pathology 0.80 CLAB 89330 Blank SPERM EVALUATION CERVICAL MUCOUS PENETRATION Pathology 0.38 CLAB 89331 Blank SPERM EVALUATION RETROGRADE EJACULATION URINE Pathology 0.75 CLAB 89335 Blank CRYOPRSRV REPRODUCTIVE TISSUE TESTICULAR Pathology 2.57 FAIR Health 89337 Blank CRYOPRESERVATION MATURE OOCYTE(S) Pathology 10.72 FAIR Health

CPT/ Conversion Total Charge HCPCS Modifier CPT/HCPCS Code Description Factor/GAAF RVUs Methodology 1 Code Category 89342 Blank STORAGE PER YEAR EMBRYO Pathology 2.82 FAIR Health 89343 Blank STORAGE PER YEAR SPERM/SEMEN Pathology 2.15 FAIR Health 89344 Blank STORAGE PER YR REPRDTVE TISS TSTICULAR/OVARIAN Pathology 2.02 FAIR Health 89346 Blank STORAGE PER YEAR OOCYTE Pathology 3.07 FAIR Health 89352 Blank THAWING CRYOPRESERVED EMBRYO Pathology 5.97 FAIR Health 89353 Blank THAWING CRYOPRESERVED SPERM/SEMEN EACH ALIQUOT Pathology 0.77 FAIR Health 89354 Blank THAWING CRYOPRESERVED TESTICULAR/OVARIAN Pathology 1.59 FAIR Health 89356 Blank THAWING CRYOPRESERVED OOCYTES EACH ALIQUOT Pathology 4.71 FAIR Health 89398 Blank UNLISTED REPRODUCTIVE MEDICINE LAB PROCEDURE Pathology 0.46 Unlisted 0357T Blank CRYOPRESERVATION IMMATURE OOCYTE(S) Pathology 5.78 v3.21 G0027 Blank SEMEN ANALYSIS Pathology 0.25 CLAB G0103 Blank PSA SCREENING Pathology 0.70 CLAB G0123 Blank SCREEN CERV/VAG THIN LAYER Pathology 0.77 CLAB G0143 Blank SCR C/V CYTO,THINLAYER,RESCR Pathology 0.77 CLAB G0144 Blank SCR C/V CYTO,THINLAYER,RESCR Pathology 0.82 CLAB G0145 Blank SCR C/V CYTO,THINLAYER,RESCR Pathology 1.01 CLAB G0147 Blank SCR C/V CYTO, AUTOMATED SYS Pathology 0.40 CLAB G0148 Blank SCR C/V CYTO, AUTOSYS, RESCR Pathology 0.58 CLAB G0306 Blank CBC/DIFFWBC W/O PLATELET Pathology 0.30 CLAB G0307 Blank CBC WITHOUT PLATELET Pathology 0.25 CLAB G0328 Blank FECAL BLOOD SCRN IMMUNOASSAY Pathology 0.61 CLAB G0432 Blank EIA HIV-1/HIV-2 SCREEN Pathology 0.52 CLAB G0433 Blank ELISA HIV-1/HIV-2 SCREEN Pathology 0.52 CLAB G0435 Blank ORAL HIV-1/HIV-2 SCREEN Pathology 0.46 CLAB G0471 Blank VEN BLOOD COLL SNF/HHA Pathology 0.14 CLAB G0472 Blank HEP C SCREEN HIGH RISK/OTHER Pathology 0.55 CLAB G0475 Blank HIV COMBINATION ASSAY Pathology 0.92 CLAB G0476 Blank HPV COMBO ASSAY CA SCREEN Pathology 1.34 CLAB G0480 Blank DRUG TEST DEF 1-7 CLASSES Pathology 3.28 CLAB G0481 Blank DRUG TEST DEF 8-14 CLASSES Pathology 4.49 CLAB G0482 Blank DRUG TEST DEF 15-21 CLASSES Pathology 5.69 CLAB G0483 Blank DRUG TEST DEF 22+ CLASSES Pathology 7.07 CLAB G0659 Blank DRUG TEST DEF SIMPLE ALL CL Pathology 2.22 CLAB G9143 Blank WARFARIN RESPON GENETIC TEST Pathology 4.61 CLAB P2031 Blank HAIR ANALYSIS Pathology 0.53 v3.21 P2038 Blank BLOOD MUCOPROTEIN Pathology 0.19 CLAB P3000 Blank SCREEN PAP BY TECH W MD SUPV Pathology 0.40 CLAB P7001 Blank CULTURE BACTERIAL URINE Pathology 0.67 FAIR Health P9603 Blank ONE-WAY ALLOW PRORATED MILES Pathology 0.01 5% Sample P9604 Blank ONE-WAY ALLOW PRORATED TRIP Pathology 0.14 FAIR Health P9612 Blank CATHETERIZE FOR URINE SPEC Pathology 0.08 CLAB P9615 Blank URINE SPECIMEN COLLECT MULT Pathology 0.08 CLAB Q0111 Blank WET MOUNTS/ W PREPARATIONS Pathology 0.16 CLAB Q0112 Blank POTASSIUM HYDROXIDE PREPS Pathology 0.16 CLAB Q0113 Blank PINWORM EXAMINATIONS Pathology 0.21 CLAB Q0114 Blank FERN TEST Pathology 0.27 CLAB Q0115 Blank POST-COITAL MUCOUS EXAM Pathology 0.38 CLAB S3600 Blank STAT LAB Pathology 0.15 v3.21 S3601 Blank STAT LAB HOME/NF Pathology 0.50 v3.21 S3620 Blank NEWBORN METABOLIC SCREENING Pathology 0.35 v3.21

CPT/ Conversion Total Charge HCPCS Modifier CPT/HCPCS Code Description Factor/GAAF RVUs Methodology 1 Code Category S3630 Blank EOSINOPHIL BLOOD COUNT Pathology 0.21 v3.21 S3645 Blank HIV-1 ANTIBODY TESTING OF OR Pathology 0.15 v3.21 S3650 Blank SALIVA TEST, HORMONE LEVEL; Pathology 3.09 v3.21 S3652 Blank SALIVA TEST, HORMONE LEVEL; Pathology 2.51 v3.21 S3655 Blank ANTISPERM ANTIBODIES TEST Pathology 0.51 v3.21 S3900 Blank SURFACE EMG Pathology 1.27 v3.21 1 Charge Methodology: 5% Sample: RVUs based on the Medicare 5% Sample Part B database. CLAB: RVUs derived from the Clinical Lab fee schedule. ERBRVS: RVUs based on Essential RBRVS RVUs. FAIR Health: Charge developed from FAIR Health database. Unlisted: Developed based on the weighted median of the total RVUs of CPT/HCPCS codes within the series in which the unlisted procedure occurs. v3.21: RVUs from v3.21 were adopted for v3.23. Other: RVUs based on methods not specified above, including crosswalks from similar code charges.