Contract : 5753 Vendor : Quest Diagnostics Description ...

1 Contract : 5753 Vendor : Quest DiagnosticsDescriptionCodeUnite PriceTimeCholesterol6165$ Metabolic Panel w/eGFR944$ DNA Amplified17618$ Screen 7 Panel800$ daysDrug Screen 9 Panel822$ daysDrug Screen 10 Panel821$ daysHepatitis B Surface Antibody Quantitative7292$ C Antibody1590$ Function Panel104$ 1/2 EIA Antibody with Reflexes3200$ DNA (High Risk)110814$ Simplex Type 2 lgG, HerpeSelect100051$ Panel1383$ , ThinPrep, No RESCRN10090$ daysPap, ThinPrep, RESCRN1090$ daysTriglycerides6440$ , 3rd Generation7580$ Culture2400$ lgG123112$ daysSurgical pathology, gross and microscpic exam Level IVAC03$ hrprofile 4747$ Urine 62246224$ daysHepatitis CaB 15901590$ $ days8 Panel Drug Screen819$ daysPregnancy, Urine4723$ $ , Wound2275$ Acid7590$ D, 25 Hydroxy17306$ daysGram Stain2025$ , Aerobic2300$ + INR4021$ Time111126$ daysEBV-VCA IGG AB140465$ daysT3 Free1430$ AB IGM151599$ daysPricing for frequently ordered tests is provided below.

2 For all other tests not listed below, Contractor will provide a 65% discount off of their fee schedule. Contractors Fee Schedule is provided in Exhibit C. For any tests that appear in both the Frequently Ordered Tests List and the Fee Schedule, the pricing provided in the Frequently Ordered Tests List will Ordered TestsContract : 5753 Vendor : Quest DiagnosticsDescriptionCodeUnite PriceTimePricing for frequently ordered tests is provided below. For all other tests not listed below, Contractor will provide a 65% discount off of their fee schedule. Contractors Fee Schedule is provided in Exhibit C. For any tests that appear in both the Frequently Ordered Tests List and the Fee Schedule, the pricing provided in the Frequently Ordered Tests List will Ordered TestsTissue Transglutam IGA1549$ daysRA Diagnostic Panel17669$ daysGroup A Strep Rapid Scn2031$ Scn Group A2032$ A Strep No Rfx2034$ AB Profile3100$ IGG AB3105$ 1 WB W/RFX HIV-23214$ , Mono Scn4317$ Rate Westergren4542$ AB West Blot5233$ $ , Total, Quant7275$ B127610$ AB IGM3110$ AB IGM12486$ daysWestern Blot HIV-13215$ $ $ Discount Allowed off fee schedule for tests not listed Stat Testing Charge per specimenStat Courier ChargeContract : 5753 Vendor .

3 Quest DiagnosticsDESCRIPTIONCODEPRICEDESCRIPTI ONCODEPRICEELECTROLYTES PANEL42$ HIV1 RNA QNT RLTM PCR CSF16186$ PROFILE 68 (SPRUE PANEL)68$ INTERFERON BETA 1A16201$ PROFILE 8888$ INTERFERON BETA 1B AB16202$ PROFILE 101 ANEMIA101$ BUPRENORPHINE W/O CONF,UR16207$ PROFILE 103 ELECTROLYTES103$ ANTIMICROBIAL,RIFABUTIN16208$ AMA HEPATIC FUNCTION PNL104$ MAGNESIUM, 24 HOUR URINE16213$ OBSTETRIC PANEL125$ OPIATES CONF, UR16215$ HEPATITIS B SURVEILLANCE133$ MDMA/MDA, QUANT, UR16216$ NEEDLESTICK/EXPO PROF 145145$ HEPATOCELLULAR CARCINOMA16222$ ALLERGEN PROFILE 184184$ C-KIT MUTATIONS W/REFLEX16237$ RAST FOODS COMPREHENSIVE187$ ARBOVIRUS AB PNL, CSF16240$ RAST HOUSEHOLD INHALANTS188$ INFLUENZA A H1/H3 RT PCR16251$ REGIONAL PLANTS PROFILE189$ RESPIRATORY PNL W/H1N116255$ PROFILE 193 RAST193$ BASE PROF W/CONF, UR16259$ MYELOMA PROFILE 222222$ BASE PROF W/O CONF.

4 UR16260$ AUTOIMMUNE PROFILE 224224$ PROCALCITONIN16265$ PROFILE 271 PRENATAL271$ FUNGITELL(1-3)-B-D-GLUCAN16283$ ALLERGEN PROFILE 279279$ SRA ASSAY LMWH16284$ PROFILE 283 IMMUNE COMPET283$ SRA ASSAY FONDAPARINUX16285$ C3, C4, COMPLEMENT CH50284$ PLATELET AB SCR INDIRECT16288$ ALLERGEN GRASSES PROFILE300$ QUANT HIV-1 RT PCR (NIH)16290$ ALLERGEN WEEDS PROFILE301$ GTT GESTATIONAL 4 SPEC16292$ ALLERGEN INDOOR INHALANTS302$ IGF-1 ELECTROCHEM16293$ ALLERGEN TREES PROFILE303$ OPIATES EXPANDED,QUANT,UR16298$ ALLERGEN MOLDS PROFILE304$ FRAGILE X DNA ANLYS FETUS16300$ ALLERGEN PEDIATRIC FOOD305$ CAMPYLOBACTER SPECIES AG16302$ ALLERGEN MEATS PROFILE306$ BUPRENORPHINE SCR W/CONF16310$ ALLERGEN GRAINS PROFILE307$ XSENSE FRAGILE X W/RFLX16313$ ALLERGEN PROFILE 311311$ BUPRENORPHINE QUANT URINE16314$ T-HELPER PANEL346$ HEMOGLOBIN A1C WITH EAG16320$ IRON,TIBC AND FERRITIN359$ OSTEOCALCIN, N-MID16322$ HEPATITIS PANEL, ACUTE365$ XSENSE(R)FRAGILE X W/RFLX16326$ ALLERGEN PROF 392 (RAST)392$ LINEZOLID, HPLC16328$ GLUCOSE TOLERANCE 2HR406$ THROMBOPOIETIN (TPO)

5 16336$ GLUCOSE TOLERANCE 1HR410$ GENOMIC ALTER PRENATAL16340$ GLUCOSE TOLERANCE 2 HOUR412$ EML4-ALK GENE FUSION PCR16344$ GLUCOSE TOLERANCE 3HR418$ HISTAMINE, PLASMA16354$ GLUCOSE FAST AND GEST425$ S PNEUMONIAE IGG AB,MAID16374$ ALLERGEN PROF 427 (RAST)427$ C DIFFICILE TOXON B16377$ GTT,GESTATIONAL,4 SPEC428$ CATECHOLAMINES SUPINE16381$ GLUCOSE TOLERANCE 5 HOUR441$ CATECHOLAMINES FRAC 16382$ CSF PROFILE480$ CMV IGG/IGM CSF16385$ MYELOMA PROFILE 635635$ ENCEPHALITIS AB PANEL16405$ PROFILE 688688$ FENTANYL SCREEN UR W/RFLX16407$ ZINC ALUMINUM SERUM784$ EBV PANEL, CSF16420$ DIARRHEA PROFILE 786786$ HIV-1 GENOTYPE TROPISM16430$1, PROFILE 800 7 PANEL TOX800$ HIV-1 VIRTUAL PHENOTYPE16431$ PROFILE 819 8 PANEL TOX819$ PNH W/FLAER16433$ PROFILE 821 10 PANEL TOX821$ CORTISOL FREE RESPONSE X316434$ PROFILE 822 9 PANEL TOX822$ CHRONIC URTICARIA PANEL16440$ PROFILE 866 7 PANEL TOX866$ JC POLYOMA VIRUS DNA, CSF16441$ THYROGLOBULIN PANEL900$ JC POLYOMA DNA, CSF16442$ RENAL FUNCTION PANEL916$ JC POLYOMA VIRUS DNA.

6 UR16446$ COMP METAB WITH EGFR944$ JC POLYOMA VIRUS DNA, UR16447$ THYROID PANEL (T3U,T4,T7)975$ TSH RECEPTOR ANTIBODY16453$ BASIC METABOLIC982$ PROF 1 W/CONF, UR16454$ PAP 1 SLIDE (SCRN)1000$ PROF 2 W/CONF, UR16455$ HUMORAL IMMUNITY STATUS1048$ PROF 3 W/CONF, UR16456$ PAP INTERP BY DR1081$ BASE PROF W/CONF, UR16457$ ERA/PRA IMMUNOPEROXIDASE1088$ LUNG CANCER MUTATION PNL16461$ ERA/PRA IMMUNO NON-BREAST1089$ STEPWISE PART 116463$ Quest Fee ScheduleContract : 5753 Vendor : Quest DiagnosticsDESCRIPTIONCODEPRICEDESCRIPTI ONCODEPRICEQ uest Fee SchedulePAP,THIN LYR,RESCRN(DIAG)1090$ STEPWISE PART 216465$ PAP,THIN LYR,RESCRN(SCRN)1091$ GENOMIC ALTERATIONS16478$ FACTOR VII $ PROF 4 W/CONF, UR16483$ AMINOLEVULINIC ACID,RND1147$ PROF 4 W/CONF, UR16484$ POLIOVIRUS POST VACCINE1156$ HISTOPLASMA AB PANEL, CSF16485$ 11-DEOXYCORTISOL1205$ PROF 4 W/O CONF, UR16486$ DRAW AND PROCESS REFERRED1206$ HYPERSENSITIVITY PNEUMO16490$ DRAW AND SHIP SPECIMEN1216$ HE4,OVARIAN CANCER MONITR16500$ ACETYLCHOLINE $ INFLM BWL DIS DIFF PANEL16503$ FLUVOXAMINE (LUVOX)

7 1231$ METHYLMALONIC ACID URINE16508$ ACTH, PLASMA1232$ KRAS MUTATION ANALYSIS16510$ CORTISOL, PRE ACTH1233$ PHOSPHOLIPIDS, SERUM16513$ CORTISOL, POST ACTH1236$ UGT1A1 GENOTYPING16521$ ACTH STIMULATION,PRE/POST1237$ FISH TOP2A GENE AMP16523$ ALUMINUM1241$ BIOTINIDASE DEFICIENCY16526$ ANDROSTENEDIONE,LC/MS/MS1253$ LEPTOSPIRA AB W/RFLX16529$ STINGING INSECT,IGE W/O T1255$ RETICULIN IGG SCRN W/RFLX16530$ ANTI-DNASE1256$ 1911A>G MUT ANALYSIS16533$ GLOMERULAR BASEMENT $ JAK2 EXONS 12-13 MUTATION16536$ G6PD QUANTITATIVE1262$ BIOTINIDASE ACTIVITY16537$ CHROMIUM, RANDOM URINE1263$ JAK2 V617F,QL,LEUMETA W/R16538$ OXALATE1267$ JAK2 V617F MUTATION16539$ ARSENIC, QUANTITATIVE1271$ BK VIRUS DNA,QL,RT,PCR UR16553$ BCR/ABL GENE REARRANGEMEN1272$ CPK W/CKMB IF INDICATED16555$ MESTINON1275$ VITAMIN D 1,25-DIHYDROXY16558$ PORPHYRINS,FRACTION, PL1276$ THYROGLOBULIN FN ASPIRATE16559$ ARSENIC,QUANTITATIVE,UR1277$ PTH, INTACT, FNA16560$ EPIDERMAL AB W/REFLEX1279$ FUNGAL ID,PHENOTYPE & SEQ16578$ VITAMIN B-12 BINDING1286$ FUNGAL SEQUENCING ITS REG16579$ BETA-2-MICROGLOBULIN1289$ BK VIRUS DNA,QNT,RT,PCR U16581$ ANGIOTENSIN II1291$ FISH,LYMPHOID MYB del6q2316593$ BETA 2 MICROGLOBULIN1292$ TREPONEMA PALLIDUM DNA16595$ B.

8 HERMSII IGG/IGM AB1293$ C. BURNETII DNA,QL,RLTM16596$ BRUCELLA ANTIBODY1295$ IODINE, SERUM & PLASMA16599$ STRONGYLOIDES IGG ABS1299$ IODINE 24-HOUR URINE16602$ C1 INHIBITOR, PROTEIN1301$ ETHYL GLUCURONIDE SULFATE16604$ KETAMINE1303$ CYP2C19 GENOTYPING 16605$ COMPLEMENT C21307$ HUMAN METAPNEUMOVIRUS16607$ ADRENAL AB W/RFL TITER1308$ HEXA MUTATION ANALYSIS16612$ COMPLEMENT C51310$ PHOSPHATIDY IgG,IgA,IgM16619$ IGG/ALBUMIN RATIO1311$ NUCLEAR MATRIX PROTEINS16645$ FUNGAL SUSCEPT MIC PANEL1312$ LYME DISEASE AB, TOTAL16646$ CA 1251313$ CELIAC DISEASE PANEL 116652$ ALPHA 2 ANTIPLASMIN1315$ RETT SYN REARRANGE DELDUP16662$ CA 19-91319$ FISH, DUPLICATION $ CA $ PHOSPHATIDYLCHOLINE IGG16677$ CALCITONIN1322$ PHOSPHATICYLCHOLINE IGM16678$ NEOPTERIN1323$ PHOSPHATIDYLCHOLINE IGA16679$ CARNITINE1328$ PHOSPHATIDYLETHANOLA IgG16680$ VON WILLEBRANDS FACTOR AG1332$ PHOSPHATIDYLETHANOLAM IgM16681$ B.

9 HENSELAE IgG,IgM REFLX1334$ PHOSPHATIDYLETHANOLAM IgA16682$ CATECHOLAMINES, $ HSV AB IGM W/RFL TITER16684$ ALLERGEN WHITE ASH1341$ PHOSPHATIDYLINOSITOL IgM16685$ CATECHOLAMINES, 24 HR UR1343$ PHOSPHATIDYLINOSITOL IgA16686$ CHLAMYDOPHILA PSITTACI AB1346$ EPSTEIN-BARR VIRUS ISH16688$ ALLERGEN ITALIAN CYPRESS1347$ IGG,IGA INDRCT IMMUNFLOR16690$ BACTERIAL ANTIGEN PANEL1349$ ORGANIC ACID URINE QUANT16693$ CATECHOLAMINES, FRACT1350$ HEP B VIRUS DNA, W/RFLX16694$ METHYLMALONIC/HOMOCYSTEIN1356$ IMMUNOGLOBULIN CSF PROF16705$ COPPER, URINE1364$ INSCAPE ER/PR/HER2 QNT16707$ PLASMINOGEN1366$ HIV-1 CORECEPTOR TROPISM16710$ Contract : 5753 Vendor : Quest DiagnosticsDESCRIPTIONCODEPRICEDESCRIPTI ONCODEPRICEQ uest Fee ScheduleCREATINE, URINE1367$ HGB A1C W/RFLX GLYCOMARK16715$ CYSTINE QUANTITATIVE, UR1376$ HSV TYPE 1 & 2 W/INTERP16720$ CHLAMYDIA DNA PROBE1377$ PYRAZINAMIDE, HPLC16726$ GONORRHEA DNA PROBE (GC)

10 1378$ RUBELLA RNA,QL,RT,PCR16730$ DHEA,LC/MS/MS1379$ TAMOXIFEN P450 GENOTYPE16731$ CHLAMYDIA DNA SCRN W/RFLX1380$ METHYLMALONIC ACID QNT16732$ GROUP B STREP DNA PRB CUL1381$ QNS HPV HIGH RISK16737$ LIPID PANEL1383$ C DIF DNA/TOXIN B GENE QL16739$ MULTIPLE SCLEROSIS PANEL1387$ VIT D,25-HYDROXY,1,25-D16761$ ALPHA SUBUNIT1391$ SLOS & STSD SCREEN16764$ 3HR GTT/INSULIN TOLERANCE1392$ BRAF MUTATION ANALYSIS16767$ PORPHYRINS, 24HR $ YERSINIA ENTEROC IGG,IGA16768$ PTH INTACT/IONIZ CALCIUM1396$ HLA-A29 DNA TYPING16773$ REVERSE T31411$ HLA-B51 DNA TYPING16775$ POLIO VIRUS ANTIBODY1425$ CF MUTATION SCREEN16790$ COXSACKIE A VIRUS PANEL1428$ CALPROTECTIN, STOOL16796$ HIV 1&2 ANTIBODIES1429$ GENOMIC ALTERATIONS CGH16800$ T3, FREE1430$ HEMOGLOBIN A1C W/EAG16802$ MAG AUTOANTIBODY1431$ INFLUENZA A H1N1,RT,PCR16807$ NEURONAL NUCLEAR (RI)1432$ CELLSEARCH TUMOR, COLON16811$ YO (PURKINJE CELL) AB1435$ CELLSEARCH, PROSTATE16812$ NEURONAL NUCLEAR (HU)1437$ ANA SCREEN W/REFLEXES16814$ HU AND YO AUTOANTIBODY1438$ OXALATE, RANDOM URINE16817$ GIARDIA ANTIBODIES (IFA)1439$ NRAS MUTATION ANALYSIS16818$ HEP C SUPPLEMENTAL (RIBA)1450$ FETOMATERNAL BLEED, FLOW16828$ HALOPERIDOL (HALDOL)