Laboratory Services Agreement between Specialty Laboratories, Inc. and Unilab Corporation (October 15, 1999)

Contract Categories: Business Operations › Services Agreements
Summary

This agreement, effective October 18, 1999, is between Specialty Laboratories, Inc. and Unilab Corporation. Specialty will provide laboratory testing services for Unilab’s locations in Tarzana, San Jose, and Sacramento for three years, with automatic one-year renewals unless terminated with notice. Unilab agrees to send at least 90% of its external lab specimens to Specialty, subject to certain conditions. Specialty will supply necessary materials and logistics, and Unilab will pay within 30 days of invoicing. Both parties must comply with all relevant laws and regulations, and the agreement can be terminated for cause with notice.

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EX-10.32A 12 a2032067zex-10_32a.txt EXHIBIT 10.32A EXHIBIT 10-32A CONFIDENTIAL TREATMENT HAS BEEN REQUESTED FOR CERTAIN REDACTED PROVISIONS OF THIS AGREEMENT. THE REDACTED PROVISIONS ARE IDENTIFIED BY THREE ASTERISKS ENCLOSED BY BRACKETS AND UNDERLINED. THE CONFIDENTIAL PORTION HAS BEEN RILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION. LABORATORY SERVICES AGREEMENT BY AND BETWEEN SPECIALTY LABORATORIES, INC. AND UNILAB CORPORATION October 15, 1999 1. GENERAL When signed, this document dated this 15th day of October 1999 constitutes an Agreement between SPECIALTY Laboratories, Inc. ("SPECIALTY") with its principal office located in Santa Monica, California and Unilab Corporation ("Unilab") with principal offices located in Tarzana, Sacramento, and San Jose, California. All terms and conditions apply to all three (3) sites with individual differences applicable only to the implementation dates of fee schedules in Attachment A. 2. TERM AND TERMINATION 2.1 This Agreement shall commence on October 18, 1999 and continue for a three (3) year period or until terminated in accordance with this Agreement. In consideration for Unilab's Agreement to enter into a three-year term, (a) Effective the date hereof, [***]* for the Unilab Tarzana location; (b) Effective December 1, 1999, [***]* for the Unilab Northern Location which includes laboratories in San Jose and Sacramento. In addition, as of December 1, 1999, SPECIALTY will implement the Tarzana fee schedules in the Unilab Northern Locations. 2.2 TERMINATION WITH CAUSE. Either party may terminate this Agreement with cause upon thirty (30) days' notice to the other party. "Cause" is hereby defined as a material breach by either party to comply with any of the terms of this Agreement after thirty (30) days written notice of such failure or violation by the other party giving notice of such default or non-compliance and written notice of its intention to so terminate unless within such sixty (60) day period the defaulting party has cured the default. 2.3 RENEWAL. Upon expiration, this Agreement shall automatically renew for successive renewal terms of one (1) year each, unless either party shall have provided the other with ninety- (90) day's advance written notice of its intent not to so renew. 3. MINIMUM REQUIREMENTS During the term of this Agreement, Unilab shall send to SPECIALTY for testing (90%) of all specimens referred to non-Unilab clinical laboratories for testing (the "Minimum Requirements," providing that SPECIALTY offers and desires to perform such tests for Unilab. The test mix shall be in the same ratio, except in those circumstances where such tests are no longer sent out [tests are conducted in-house], as in the base period of August, 1999, and a payor and collection mix is substantially the same ratio as set forth on Attachment B. _____________________________ * PORTIONS OF THIS PAGE HAVE BEEN OMITTED PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION. Page 2 Notwithstanding the foregoing, effective upon a change of control of Unilab (as defined in Section 17), or the purchase by Unilab of a Licensed Clinical Laboratory with a test menu materially broader than that of Unilab, the Minimum Requirements shall require Unilab to send to SPECIALTY for testing a volume of specimens which will result in net revenues (i.e. net of discounts, allowances and bad debts) of at least $800,000 per month, provided however that Specialty makes a commercially reasonable effort to collect payments from Third Party Payors and Patients and that SPECIALTY's collection rate is materially similar to Unilab's experience during the period of January through August 1999. The test mix shall be in the same ratio, except in those circumstances where such tests are no longer sent out [tests are conducted in-house], as in the base period of August 1999, and a payor and collection mix is in substantially the same ratio as set forth on Attachment B. 4. LICENSURE AND ACCREDITATION SPECIALTY is a duly licensed independent clinical laboratory and fully accredited by the College of American Pathologists and CLIA, among other certifying agencies. SPECIALTY agrees to maintain such licensure and accreditation during the term of this Agreement. SPECIALTY shall maintain at all times during the term of this Agreement, appropriate professional liability coverage. 5. SUPPLIES SPECIALTY shall provide, at no cost to Unilab, all necessary supplies for the proper preparation and submission of specimens to SPECIALTY. 6. COURIERS AND LOGISTICS SPECIALTY will provide all courier and logistic services required to adequately address the laboratory testing submitted by three Unilab locations; Tarzana, San Jose, and Sacramento. 7. DISCOUNTS In accordance with this Agreement, [***]*, as set forth in Attachment A. [***]*. 8. INVOICE SPECIALTY shall bill Unilab directly, on a monthly basis for its reference testing services except [***]*. All bills to Unilab shall be submitted [***]*. Unilab shall be responsible for any and all taxes (city, state, etc.) arising as a result of this agreement. SPECIALTY shall submit invoices electronically to Unilab. SPECIALTY shall make a commercially reasonable _____________________________ * PORTIONS OF THIS PAGE HAVE BEEN OMITTED PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION. Page 3 effort to: indicate when [***]* through the identification of date of service due to the provisions in sections 10.1, 10.2, 10.3, and itemize [***]*. 9. PAYMENT TERMS Unilab agrees to pay SPECIALTY within thirty (30) days of the date invoice is received by Unilab. 10. THIRD PARTY BILLING POLICIES 10.1 With respect to those Third Party Payors that Unilab is not prohibited from sub-contracting, [***]* who will cooperate in a commercially reasonable manner, and then by [***]*. SPECIALTY will keep all such information confidential except as required in the normal course of business or as may be required by law. 10.2 In cases where [***]* has billed a patient or Third Party Payor [***]* and a denial is received, [***]* may bill the patient for the services rendered, unless prohibited by law. 10.3 [***]* will assume to responsibility for all flailures to collect payments from Third Party Payors and patients except in those circumstances where [***]* fails to materially provide access to information as described in section 10.1. In such circumstances, [***]* shall have the right to invoice [***]*. [***]* shall have the right to contest such invoice. 11. COMPLIANCE POLICIES Both Unilab and SPECIALTY agree to comply with all applicable regulatory agencies including, but not limited to, CLIA and HCFA. In addition, each party shall administer compliance policies throughout their respective organizations to ensure that such compliance is assured. Examples of such policy topics would include, but not be limited to, patient confidentiality, diagnosis coding, anti-kickback statutes, professional courtesy, Advanced Beneficiary Notice, and CPT-4 coding. 12. SELF-REFERRAL In the event Unilab shall have any physician owners, and is required under applicable law to disclose such ownership. Unilab shall notify SPECIALTY of such fact so that the parties can ensure compliance with self-referral restrictions under applicable federal and state law. 13. CHANGE IN RULES AND REGULATIONS In the event that any Medicare or Medicaid law, rules, regulations, policy (or any other federal, state or local law, rule, regulation, policy, or any interpretation thereof) at any _____________________________ * PORTIONS OF THIS PAGE HAVE BEEN OMITTED PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION. Page 4 time during the term of this agreement prohibits, restricts or has a materially adverse effect on the Agreement, then the parties to this agreement shall negotiate in good faith to amend or terminate the Agreement. 14. INDEPENDENT CONTRACTOR At all times relevant hereto, SPECIALTY shall function as an independent contractor rendering services to Unilab. SPECIALTY shall not be an employee or agent of Unilab and shall not be entitled to any employee benefits from Unilab. 15. RECORDS 15.1 Both parties agree to retain, and make available to the other party upon reasonable request, at their own expense for a period of four (4) years following the furnishing of services under this Agreement itself and all books, documents and records that are necessary to verify the nature and extent of the costs thereof, as mandated by the Secretary of Health and Human Services, the Comptroller General of the United States or any of their duly authorized representatives, in a manner that complies with the requirements of Section 1861(v)(1)(I) of the Social Security Act and any regulations promulgated thereto. Unilab agrees to make available to SPECIALTY upon reasonable request, at their own expense during the term of this contract, all books, documents and records that are necessary to verify the accuracy of billing, payor, and test mix accuracy. 15.2 Both parties agree to notify the other party upon receipt of any such request, related to this Agreement, from any representative of the Secretary of Health and Human Services or the Comptroller General. 15.3 Both parties agree that any subcontracts with related parties involving costs of Ten Thousand Dollars ($10,000) or more during any twelve (12) months period for the performance of duties under this Agreement shall be amended immediately to require of said related parties the same duties. As used herein, the term "related party" means any party owned or controlled by either party or with whom either party is to a significant extent associated or affiliated. 16. INDEMNIFICATION Each party agrees to indemnify, and hold harmless, the other party's directors, officers, employees, and agents from and against any and all claims, actions, or liabilities of any nature which may be assessed against them by third parties in connection with the performance of services under this Agreement, except to the extent of any willful misconduct or gross negligence of the party seeking indemnification. 17. BINDING AFFECT & ASSIGNMENT This Agreement shall be binding upon and inure to the benefit of the parties hereto and their respective successors and assigns provided, however that this Agreement may not be transferred or assigned without the expressed written consent of SPECIALTY, except for _____________________________ * PORTIONS OF THIS PAGE HAVE BEEN OMITTED PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION. Page 5 the pending transaction with Kelso, which is specifically deemed to have been consented to by SPECIALTY. The parties hereto agree that, except for the Kelso transaction, a change of control of Unilab shall constitute an assignment of this Agreement. For purposes of this Agreement, change of control means the acquisition of Unilab by any person, group or entity by means of any transaction or series of related transactions (including, without limitation, any reorganization, merger or consolidation, but excluding any merger effected exclusively for the purpose of changing the domicile of Unilab) in which Unilab's shareholders of record as constituted immediately prior to such acquisition will, immediately after such acquisition, hold less than fifty percent (50%) of the voting power of the surviving or acquiring entity; or a sale of all or substantially all of the assets of Unilab in a transaction in which Unilab's shareholders of record as constituted immediately prior to such sale will, immediately after such sale, hold less than 50% of the voting power of the surviving or acquiring entity. 18. FORCE MAJEURE SPECIALTY shall not be liable for any failure to perform its duties under this Agreement due to acts of God; acts, regulations or laws of any government; war or any other condition or cause beyond SPECIALTY's reasonable control. However, if circumstances prevent SPECIALTY from performing its duties, SPECIALTY agrees to use its commercially reasonable efforts to facilitate transfer of testing to an alternative laboratory as mutually agreed. 19. GOVERNING LAWS This Agreement shall be governed and construed in accordance with the laws of the State of California. 20. ATTORNEY'S FEE/COSTS SPECIALTY and Unilab hereby agree that if any action, suit or proceeding is filed by either party to enforce the terms of this Agreement, the prevailing party shall be entitled to its actual attorney's fees and costs in initiating and/or prosecuting said action, suit or proceeding. 21. VENUE 21.1 Unilab agrees and specifically acknowledges that all of the services undertaken and/or performed by SPECIALTY are rendered from California. 21.2 Unilab agrees that if any actions are to be brought by either SPECIALTY and/or Unilab, that said action, suit or proceeding shall be filed in the Los Angeles Superior Court or Los Angeles Municipal Court. Unilab HEREBY AGREES AND SUBMITS TO PERSONAL JURISDICTION IN LOS ANGELES COUNTY. _____________________________ * PORTIONS OF THIS PAGE HAVE BEEN OMITTED PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION. Page 6 22. CONFIDENTIALITY Neither party will disclose this Agreement or any of its terms or conditions to any third party except as and to the extent that such disclosure may be required by law, and except that either party may make disclosure to its lenders or investors or to potential buyers if such lenders, investors and potential buyers execute and deliver to both parties confidentiality agreements reasonably satisfactory to both parties. Each party agrees to hold in strictest confidence, and not disclose, divulge or communicate to, or use for the benefit or, any other person, corporation or entity, or misuse in any way, and confidential or non-public information of the other party, other that the disclosure, divulgence or communication of such confidential or non-public information or trade secret that may be required by applicable law. 23. NOTICES All notices to be given by one party to the other under this Agreement shall be given in writing, mailed or delivered as follows: Unilab: Unilab Corporation 18408 Oxnard Street Tarzana, California 91356 Attention: SPECIALTY: SPECIALTY Laboratories, Inc. 2211 Michigan Avenue Santa Monica, California 90404 Attention: Contract Administration 24. ENTIRE AGREEMENT This Agreement contains the entire understanding between the parties hereto and supersedes any and all prior Agreements and arrangements between the parties relating to the subject matter hereof. No amendment, change, modification or alteration of the terms and conditions hereof shall be binding unless in writing. _____________________________ * PORTIONS OF THIS PAGE HAVE BEEN OMITTED PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION. Page 7 FOR: ACCEPTED: SPECIALTY LABORATORIES, INC. SANTA MONICA, UNILAB CORPORATION CALIFORNIA TARZANA, CALIFORNIA NAME: Paul F. Beyer NAME: ------------------------- ------------------- SIGNATURE: /s/ Paul F. Beyer SIGNATURE: /s/ ------------------- ------------------- TITLE: President TITLE: Vice President ---------------------- ------------------- DATE: 10/15/99 DATE: 10/15/99 ---------------------- ------------------- Please mail the signed Agreements to: Specialty Laboratories, Inc. 2211 Michigan Avenue Santa Monica, California 90404-3900 Attention: Contract Administration _____________________________ * PORTIONS OF THIS PAGE HAVE BEEN OMITTED PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION. Page 8 ATTACHMENT A UNILAB FFS AND CAP FEE SCHEDULE
- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- 3124 11-DEOXYCORTISOL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3190 17-HYDROXYPROGESTERONE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3492 2-METHYLCITRIC ACID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4558 5,10-METHYLENETETRAHYDROFOLATE REDUCTASE C677T MUTATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4560 5,10-MTHFR C677T MUTATION REFLEX TO A1298C MUTATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4908 5-FLUOROCYTOSINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4908P 5-FLUOROCYTOSINE PEAK & TROUGH [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3310 5-HYDROXYINDOLEACETIC ACID 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3310UR 5-HYDROXYINDOLEACETIC ACID RANDOM URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3286W 5-HYDROXYTRYPTAMINE (SEROTONIN) WHOLE BLOOD [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3286 5-HYDROXYTRYPTAMINE (SEROTONIN) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3286U 5-HYDROXYTRYPTAMINE (SEROTONIN) 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3286UR 5-HYDROXYTRYPTAMINE (SEROTONIN) URINE RANDOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4174 5'NUCLEOTIDASE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4968 ABACAVIR MONITR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2434 ACANTHAMOEBA CULTURE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4100 ACETAMINOPHEN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1410 ACETYLCHOLINE RECEPTOR BINDING AUTOANTIBODIES [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1412 ACETYLCHOLINE RECEPTOR BLOCKING AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1413 ACETYLCHOLINE RECEPTOR MODULATING AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5900 ACTIVATED PROTEIN C RESISTANCE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1678C2 ADDITIONAL SURFACE MARKER - 2 [ONCOLOGY] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1678C ADDITIONAL SURFACE MARKER [ONCOLOGY] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1678 ADDITIONAL SURFACE MARKERS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3131 ADENOSINE DEAMINASE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2501 ADENOVIRUS ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2501C ADENOVIRUS ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2509 ADENOVIRUS AG DETECTION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7589 ADENOVIRUS DNA DETECTR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2444 ADENOVIRUS ENTERIC TYPES 40/41 AG DETECTION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8056 ADENOVIRUS IGG ABS [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8056C ADENOVIRUS IGG ABS CSF [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7700 ADENOVIRUS IGG ANTIBODY INDEX [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1130 ADRENAL TOTAL AUTOANTIBODIES [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3102 ADRENOCORTICOTROPIC HORMONE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5802 AEROBIC BACTERIAL CULTURE: ENVIRONMENTAL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5801 AEROBIC BACTERIAL CULTURE: EYE/EAR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5776 AEROBIC BACTERIAL CULTURE: GENITAL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5775 AEROBIC BACTERIAL CULTURE: RESPIRATORY [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5771 AEROBIC BACTERIAL CULTURE: ROUTINE MISCELLANEOUS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5700 AEROBIC BACTERIAL CULTURE: STOOL COMPREHENSIVE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5772 AEROBIC BACTERIAL CULTURE: THROAT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5773 AEROBIC BACTERIAL CULTURE: URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5714 AEROBIC SUSCEPT: AMINOGLYCOSIDE MIC, HIGH LEVEL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5668AMD AEROBIC SUSCEPT: CUSTOM DRUG-AMDINOCILLIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5668AMI AEROBIC SUSCEPT: CUSTOM DRUG-AMIKACIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5668AMP1 AEROBIC SUSCEPT: CUSTOM DRUG-AMPICILLIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5668AUG AEROBIC SUSCEPT: CUSTOM DRUG-AUGMENTIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5668AZI AEROBIC SUSCEPT: CUSTOM DRUG-AZITHROMYCIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5668AZT AEROBIC SUSCEPT: CUSTOM DRUG-AZTREONAM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5668CAR AEROBIC SUSCEPT: CUSTOM DRUG-CARBENICILLIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5668CEF1 AEROBIC SUSCEPT: CUSTOM DRUG-CEFACLOR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5668CEF3 AEROBIC SUSCEPT: CUSTOM DRUG-CEFAZOLIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5668CEF4 AEROBIC SUSCEPT: CUSTOM DRUG-CEFIXIME [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5668CEF5 AEROBIC SUSCEPT: CUSTOM DRUG-CEFONICID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
Page 1 of 59 * Portions of this page have been omitted pursuant to a request for confidential treatment and filed separately with the Securities and Exchange Commission. ATTACHMENT A UNILAB FFS AND CAP FEE SCHEDULE - ------------- ----------------------------------------------------------------------- ---------- ----------- 5668CEF6 AEROBIC SUSCEPT: CUSTOM DRUG-CEFOPERAZONE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5668CEF8 AEROBIC SUSCEPT: CUSTOM DRUG-CEFOTETAN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5668CEF9 AEROBIC SUSCEPT: CUSTOM DRUG-CEFOXITIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5668CF15 AEROBIC SUSCEPT: CUSTOM DRUG-CEFPODOXIME [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5668CF10 AEROBIC SUSCEPT: CUSTOM DRUG-CEFTAZIDIME [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5668CF14 AEROBIC SUSCEPT: CUSTOM DRUG-CEFTIBUTEN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5668CF11 AEROBIC SUSCEPT: CUSTOM DRUG-CEFTIZOXIME [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5668CF12 AEROBIC SUSCEPT: CUSTOM DRUG-CEFTRIAXONE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5668CF13 AEROBIC SUSCEPT: CUSTOM DRUG-CEFUROXIME [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5668CHL AEROBIC SUSCEPT: CUSTOM DRUG-CHLORAMPHENICOL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5668CIP AEROBIC SUSCEPT: CUSTOM DRUG-CIPROFLOXACIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5668CLA AEROBIC SUSCEPT: CUSTOM DRUG-CLARITHROMYCIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5668CLI AEROBIC SUSCEPT: CUSTOM DRUG-CLINDAMYCIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5668ERY AEROBIC SUSCEPT: CUSTOM DRUG-ERYTHROMYCIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5668GEN AEROBIC SUSCEPT: CUSTOM DRUG-GENTAMICIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5668IMI AEROBIC SUSCEPT: CUSTOM DRUG-IMIPENEM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5668LEV AEROBIC SUSCEPT: CUSTOM DRUG-LEVOFLOXACIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5668NET AEROBIC SUSCEPT: CUSTOM DRUG-NETILMICIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5668NIT AEROBIC SUSCEPT: CUSTOM DRUG-NITROFURANTOIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5668NOR AEROBIC SUSCEPT: CUSTOM DRUG-NORFLOXACIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5668OXA AEROBIC SUSCEPT: CUSTOM DRUG-OXACILLIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5668PEN AEROBIC SUSCEPT: CUSTOM DRUG-PENICILLIN G [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5668PIP1 AEROBIC SUSCEPT: CUSTOM DRUG-PIPERACILLIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5668RIF AEROBIC SUSCEPT: CUSTOM DRUG-RIFAMPIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5668STR AEROBIC SUSCEPT: CUSTOM DRUG-STREPTOMYCIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5668TET AEROBIC SUSCEPT: CUSTOM DRUG-TETRACYCLINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5668TIC AEROBIC SUSCEPT: CUSTOM DRUG-TICARCILLIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5668TOB AEROBIC SUSCEPT: CUSTOM DRUG-TOBRAMYCIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5668TRI AEROBIC SUSCEPT: CUSTOM DRUG-TRIMETHOPRIM/SULFAMETHOXAZOLE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5668VAN AEROBIC SUSCEPT: CUSTOM DRUG-VANCOMYCIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675AMI AEROBIC SUSCEPT: CUSTOM MIC-AMIKACIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675AMP2 AEROBIC SUSCEPT: CUSTOM MIC-AMPICILLIN/SULBACTAM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675AMP1 AEROBIC SUSCEPT: CUSTOM MIC-AMPICILLIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675AUG AEROBIC SUSCEPT: CUSTOM MIC-AUGMENTIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675AZI AEROBIC SUSCEPT: CUSTOM MIC-AZITHROMYCIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675AZT AEROBIC SUSCEPT: CUSTOM MIC-AZTREONAM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675BEN AEROBIC SUSCEPT: CUSTOM MIC-BENZYLPENICILLIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675CAR AEROBIC SUSCEPT: CUSTOM MIC-CARBENICILLIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675CEF1 AEROBIC SUSCEPT: CUSTOM MIC-CEFACLOR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675CEF3 AEROBIC SUSCEPT: CUSTOM MIC-CEFAZOLIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675CF14 AEROBIC SUSCEPT: CUSTOM MIC-CEFEPIME [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675CEF4 AEROBIC SUSCEPT: CUSTOM MIC-CEFIXIME [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675CEF6 AEROBIC SUSCEPT: CUSTOM MIC-CEFOPERAZONE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675CEF7 AEROBIC SUSCEPT: CUSTOM MIC-CEFOTAXIME [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675CEF8 AEROBIC SUSCEPT: CUSTOM MIC-CEFOTETAN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675CEF9 AEROBIC SUSCEPT: CUSTOM MIC-CEFOXITIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675CF15 AEROBIC SUSCEPT: CUSTOM MIC-CEFPODOXIME [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675CF10 AEROBIC SUSCEPT: CUSTOM MIC-CEFTAZIDIME [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675CF11 AEROBIC SUSCEPT: CUSTOM MIC-CEFTIZOXIME [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675CF12 AEROBIC SUSCEPT: CUSTOM MIC-CEFTRIAXONE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675CF13 AEROBIC SUSCEPT: CUSTOM MIC-CEFUROXIME [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675CEP AEROBIC SUSCEPT: CUSTOM MIC-CEPHALOTHIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675CHL AEROBIC SUSCEPT: CUSTOM MIC-CHLORAMPHENICOL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675CIP AEROBIC SUSCEPT: CUSTOM MIC-CIPROFLOXACIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675CLA AEROBIC SUSCEPT: CUSTOM MIC-CLARITHROMYCIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
Page 2 of 59 * Portions of this page have been omitted pursuant to a request for confidential treatment and filed separately with the Securities and Exchange Commission. ATTACHMENT A UNILAB FFS AND CAP FEE SCHEDULE - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675CLI AEROBIC SUSCEPT: CUSTOM MIC-CLINDAMYCIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675ERY AEROBIC SUSCEPT: CUSTOM MIC-ERYTHROMYCIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675GEN AEROBIC SUSCEPT: CUSTOM MIC-GENTAMICIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675IMI AEROBIC SUSCEPT: CUSTOM MIC-IMIPENEM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675LEV AEROBIC SUSCEPT: CUSTOM MIC-LEVOFLOXACIN (LEVAQUIN) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675LOM AEROBIC SUSCEPT: CUSTOM MIC-LOMEFLOXACIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675MEZ AEROBIC SUSCEPT: CUSTOM MIC-MEZLOCILLIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675MIN AEROBIC SUSCEPT: CUSTOM MIC-MINOCYCLINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675NIT AEROBIC SUSCEPT: CUSTOM MIC-NITROFURANTOIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675NOR AEROBIC SUSCEPT: CUSTOM MIC-NORFLOXACIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675OFL AEROBIC SUSCEPT: CUSTOM MIC-OFLOXACIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675OXA AEROBIC SUSCEPT: CUSTOM MIC-OXACILLIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675PEN AEROBIC SUSCEPT: CUSTOM MIC-PENICILLIN G [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675PIP1 AEROBIC SUSCEPT: CUSTOM MIC-PIPERACILLIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675PIP2 AEROBIC SUSCEPT: CUSTOM MIC-PIPERACILLIN/TAZOBACTAM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675QUI AEROBIC SUSCEPT: CUSTOM MIC-QUINUPRISTIN/DALFOPRISTIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675RIF AEROBIC SUSCEPT: CUSTOM MIC-RIFAMPIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675STR AEROBIC SUSCEPT: CUSTOM MIC-STREPTOMYCIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675SUL1 AEROBIC SUSCEPT: CUSTOM MIC-SULFADIAZINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675TET AEROBIC SUSCEPT: CUSTOM MIC-TETRACYCLINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675TIM AEROBIC SUSCEPT: CUSTOM MIC-TIMENTIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675TOB AEROBIC SUSCEPT: CUSTOM MIC-TOBRAMYCIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675TRI AEROBIC SUSCEPT: CUSTOM MIC-TRIMETHOPRIM/SULFAMETHOXAZOLE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675TRO AEROBIC SUSCEPT: CUSTOM MIC-TROVAFLOXACIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5675VAN AEROBIC SUSCEPT: CUSTOM MIC-VANOMYCIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676AMI AEROBIC SUSCEPT: CUSTOM MIC & MBC-AMIKACIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676AMP2 AEROBIC SUSCEPT: CUSTOM MIC & MBC-AMPICILLIN/SULBACTAM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676AMP1 AEROBIC SUSCEPT: CUSTOM MIC & MBC-AMPICILLIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676AZT AEROBIC SUSCEPT: CUSTOM MIC & MBC-AZTREONAM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676CAR AEROBIC SUSCEPT: CUSTOM MIC & MBC-CARBENICILLIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676CEF1 AEROBIC SUSCEPT: CUSTOM MIC & MBC-CEFACLOR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676CEF3 AEROBIC SUSCEPT: CUSTOM MIC & MBC-CEFAZOLIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676CF14 AEROBIC SUSCEPT: CUSTOM MIC & MBC -CEFEPIME [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676CEF4 AEROBIC SUSCEPT: CUSTOM MIC & MBC-CEFIXIME [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676CEF6 AEROBIC SUSCEPT: CUSTOM MIC & MBC-CEFOPERAZONE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676CEF7 AEROBIC SUSCEPT: CUSTOM MIC & MBC-CEFOTAXIME [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676CEF8 AEROBIC SUSCEPT: CUSTOM MIC & MBC-CEFOTETAN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676CEF9 AEROBIC SUSCEPT: CUSTOM MIC & MBC-CEFOXITIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676CF15 AEROBIC SUSCEPT: CUSTOM MIC & MBC-CEFPODOXIME [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676CF10 AEROBIC SUSCEPT: CUSTOM MIC & MBC-CEFTAZIDIME [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676CF11 AEROBIC SUSCEPT: CUSTOM MIC & MBC-CEFTIZOXIME [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676CF12 AEROBIC SUSCEPT: CUSTOM MIC & MBC-CEFTRIAXONE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676CF13 AEROBIC SUSCEPT: CUSTOM MIC & MBC-CEFUROXIME [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676CEP AEROBIC SUSCEPT: CUSTOM MIC & MBC-CEPHALOTHIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676CHL AEROBIC SUSCEPT: CUSTOM MIC & MBC-CHLORAMPHENICOL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676CIP AEROBIC SUSCEPT: CUSTOM MIC & MBC-CIPROFLOXACIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676CLA AEROBIC SUSCEPT: CUSTOM MIC & MBC-CLARITHROMYCIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676CLI AEROBIC SUSCEPT: CUSTOM MIC & MBC-CLINDAMYCIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676ERY AEROBIC SUSCEPT: CUSTOM MIC & MBC-ERYTHROMYCIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676GEN AEROBIC SUSCEPT: CUSTOM MIC & MBC-GENTAMICIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676IMI AEROBIC SUSCEPT: CUSTOM MIC & MBC-IMIPENEM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676NIT AEROBIC SUSCEPT: CUSTOM MIC & MBC-NITROFURANTOIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676NOR AEROBIC SUSCEPT: CUSTOM MIC & MBC-NORFLOXACIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676OFL AEROBIC SUSCEPT: CUSTOM MIC & MBC-OFLOXACIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676OXA AEROBIC SUSCEPT: CUSTOM MIC & MBC-OXACILLIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
Page 3 of 59 * Portions of this page have been omitted pursuant to a request for confidential treatment and filed separately with the Securities and Exchange Commission. ATTACHMENT A UNILAB FFS AND CAP FEE SCHEDULE - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676PEN AEROBIC SUSCEPT: CUSTOM MIC & MBC-PENICILLIN G [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676PIP1 AEROBIC SUSCEPT: CUSTOM MIC & MBC-PIPERACILLIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676PIP2 AEROBIC SUSCEPT: CUSTOM MIC & MBC-PIPERACILLIN/TAZOBACTAM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676QUI AEROBIC SUSCEPT: CUSTOM MIC & MBC-QUINU/DALPRI [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676RIF AEROBIC SUSCEPT: CUSTOM MIC & MBC-RIFAMPIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676STR AEROBIC SUSCEPT: CUSTOM MIC & MBC-STREPTOMYCIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676TET AEROBIC SUSCEPT: CUSTOM MIC & MBC-TETRACYCLINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676TOB AEROBIC SUSCEPT: CUSTOM MIC & MBC-TOBRAMYCIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676TRI AEROBIC SUSCEPT: CUSTOM MIC & MBC-TRIMETHOPRIM/SULFA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676TRO AEROBIC SUSCEPT: CUSTOM MIC & MBC-TROVAFLOXACIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676VAN AEROBIC SUSCEPT: CUSTOM MIC & MBC-VANCOMYCIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5676LEV AEROBIC SUSCEPT: CUSTOM MIC & MBC-LEVOFLOXACIN (LEVAQUIN) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5687 AEROBIC SUSCEPT:GRAM NEG RESISTANT MIC PANEL URINE/NON-URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5685 AEROBIC SUSCEPT: GRAM NEGATIVE MIC PANEL URINE/NON-URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5686 AEROBIC SUSCEPT: GRAM POSITIVE MIC PANEL URINE/NON-URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5713 AEROBIC SUSCEPT: FASTIDIOUS ORGANISM MIC PANEL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9015 AEROBIC SUSCEPT: NOCARDIA/STREPTOMYCES MIC & MBC PANEL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9014 AEROBIC SUSCEPT: NOCARDIA/STREPTOMYCES MIC PANEL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5712 AEROBIC SUSCEPT: STREPTOCOCCUS PNEUMONIAE MIC PANEL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5774 AEROBIC/ANAEROBIC BACTERIAL CULTURE: BLOOD [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2417 AFB CULTURE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2419 AFB CULTURE & STAIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5648 AFB IDENTIFICATION MYCOBACTERIUM SPP [HPLC] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2935 AFB IDENTIFICATION MYCOBACTERIUM SPP RRNA [GEN PROBE] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5320 AFB STAIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5652CLA AFB SUSCEPT: CUSTOM DISK DIFFUSION - CLARITHROMYCIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5652ETH AFB SUSCEPT: CUSTOM DISK DIFFUSION - ETHAMBUTOL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5652MIN AFB SUSCEPT: CUSTOM DISK DIFFUSION - MINOCYCLINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5652RIF AFB SUSCEPT: CUSTOM DISK DIFFUSION - RIFAMPIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5652TRI AFB SUSCEPT: CUSTOM DISK DIFFUSION - TRIMETHOPRIM/SULFA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5655AMI AFB SUSCEPT: CUSTOM DRUG FOR RAPID GROWERS-AMIKACIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5655CEF AFB SUSCEPT: CUSTOM DRUG FOR RAPID GROWERS-CEFOXITIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5655CIP AFB SUSCEPT: CUSTOM DRUG FOR RAPID GROWERS-CIPROFLOXACIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5655CLA AFB SUSCEPT: CUSTOM DRUG FOR RAPID GROWERS-CLARITHROMYCIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5655DOX AFB SUSCEPT: CUSTOM DRUG FOR RAPID GROWERS-DOXYCYCLINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5655ERY AFB SUSCEPT: CUSTOM DRUG FOR RAPID GROWERS-ERYTHROMYCIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5655GEN AFB SUSCEPT: CUSTOM DRUG FOR RAPID GROWERS-GENTAMICIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5655IMI AFB SUSCEPT: CUSTOM DRUG FOR RAPID GROWERS-IMIPENEM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5655KAN AFB SUSCEPT: CUSTOM DRUG FOR RAPID GROWERS-KANAMYCIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5655MIN AFB SUSCEPT: CUSTOM DRUG FOR RAPID GROWERS-MINOCYCLINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5655OFL AFB SUSCEPT: CUSTOM DRUG FOR RAPID GROWERS-OFLOXACIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5655TOB AFB SUSCEPT: CUSTOM DRUG FOR RAPID GROWERS-TOBRAMYCIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5768AMI AFB SUSCEPT: CUSTOM DRUG MYCOBACTERIUM SPP.-AMIKACIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5768ANS AFB SUSCEPT: CUSTOM DRUG MYCOBACTERIUM SPP.-ANSAMYCIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5768AZI AFB SUSCEPT: CUSTOM DRUG MYCOBACTERIUM SPP.-AZITHROMYCIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5768CAP AFB SUSCEPT: CUSTOM DRUG MYCOBACTERIUM SPP.-CAPREOMYCIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5768CIP AFB SUSCEPT: CUSTOM DRUG MYCOBACTERIUM SPP.-CIPROFLOXACIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5768CLA AFB SUSCEPT: CUSTOM DRUG MYCOBACTERIUM SPP.-CLARITHROMYCIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5768CLO AFB SUSCEPT: CUSTOM DRUG MYCOBACTERIUM SPP.-CLOFAZIMINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5768CYC AFB SUSCEPT: CUSTOM DRUG MYCOBACTERIUM SPP.-CYCLOSERINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5768ET1 AFB SUSCEPT: CUSTOM DRUG MYCOBACTERIUM SPP.-ETHAMBUTOL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5768ET2 AFB SUSCEPT: CUSTOM DRUG MYCOBACTERIUM SPP.-ETHIONAMIDE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5768ISO AFB SUSCEPT: CUSTOM DRUG MYCOBACTERIUM SPP.-ISONIAZID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5768PAS AFB SUSCEPT: CUSTOM DRUG MYCOBACTERIUM SPP.-P-AMINOSALICYLIC [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5768PYR AFB SUSCEPT: CUSTOM DRUG MYCOBACTERIUM SPP.-PYRAZINAMIDE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
Page 4 of 59 * Portions of this page have been omitted pursuant to a request for confidential treatment and filed separately with the Securities and Exchange Commission. ATTACHMENT A UNILAB FFS AND CAP FEE SCHEDULE - ------------- ----------------------------------------------------------------------- ---------- ----------- 5768RIF AFB SUSCEPT: CUSTOM DRUG MYCOBACTERIUM SPP.-RIFAMPIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5768STR AFB SUSCEPT: CUSTOM DRUG MYCOBACTERIUM SPP.-STREPTOMYCIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5654PAS AFB SUSCEPT: CUSTOM DRUG RADIOMETRIC ASSAY-P-AMINOSAL AC [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5654AM AFB SUSCEPT: CUSTOM DRUG RADIOMETRIC ASSAY-AMIKACIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5654CA AFB SUSCEPT: CUSTOM DRUG RADIOMETRIC ASSAY-CAPREOMYCIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5654CI AFB SUSCEPT: CUSTOM DRUG RADIOMETRIC ASSAY-CIPROFLOXACIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5654CL AFB SUSCEPT: CUSTOM DRUG RADIOMETRIC ASSAY-CLOFAZAMINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5654ET1 AFB SUSCEPT: CUSTOM DRUG RADIOMETRIC ASSAY-ETHAMBUTOL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5654ET2 AFB SUSCEPT: CUSTOM DRUG RADIOMETRIC ASSAY-ETHIONAMIDE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5654IS AFB SUSCEPT: CUSTOM DRUG RADIOMETRIC ASSAY-ISONIAZID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5654KA AFB SUSCEPT: CUSTOM DRUG RADIOMETRIC ASSAY-KANAMYCIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5654PY AFB SUSCEPT: CUSTOM DRUG RADIOMETRIC ASSAY-PYRAZINAMIDE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5654RI AFB SUSCEPT: CUSTOM DRUG RADIOMETRIC ASSAY-RIFAMPIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5654ST AFB SUSCEPT: CUSTOM DRUG RADIOMETRIC ASSAY-STREPTOMYCIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5657 AFB SUSCEPT: M. TUBERCULOSIS COMP PANEL [AGAR PROP] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5646 AFB SUSCEPT: M. TUBERCULOSIS PRIMARY PANEL [AGAR PROP] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5649 AFB SUSCEPT: M. TUBERCULOSIS PRIMARY RADIOMETRIC PANEL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5647 AFB SUSCEPT: M. TUBERCULOSIS SECONDARY PANEL [AGAR PROP] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5650 AFB SUSCEPT: M. TUBERCULOSIS SECONDARY RADIOMETRIC PANEL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5659 AFB SUSCEPT: MAI (MAC) COMPREHENSIVE PANEL [AGAR PROP] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5651 AFB SUSCEPT: MAI (MAC) RADIOMETRIC MIC PANEL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5656 AFB SUSCEPT: MAI (MAC) SYNERGY STUDY (DRUG COMBINATION) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5652 AFB SUSCEPT: MYCOBACTERIUM SPP. "RAPID GROWER" PANEL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5653 AFB SUSCEPT: MYCOBACTERIUM SPP. PANEL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1510 ALBUMIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1510C ALBUMIN CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1510F ALBUMIN FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1555 ALBUMIN QUOTIENT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4102 ALCOHOL, ETHYL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4102U ALCOHOL, ETHYL URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4102W ALCOHOL, ETHYL WHOLE BLOOD [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1392 ALDOLASE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3104 ALDOSTERONE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3104U ALDOSTERONE 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3104UR ALDOSTERONE URINE RANDOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3113 ALDOSTERONE/RENIN RATIO [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3996 ALKALINE PHOSPHATASE ISOENZYMES [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3974 ALKALINE PHOSPHATASE, BONE SPECIFIC [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3930 ALKALINE PHOSPHATASE, TOTAL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1525 ALPHA-1-ACID GLYCOPROTEIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1513 ALPHA-1-ANTITRYPSIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1514 ALPHA-1-ANTITRYPSIN PHENOTYPING [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3280 ALPHA-2-ANTIPLASMIN - FUNCTIONAL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1512 ALPHA-2-MACROGLOBULIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1512U ALPHA-2-MACROGLOBULIN URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3090 ALPHA-FETOPROTEIN - MATERNAL, 2.5 MOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3108 ALPHA-FETOPROTEIN - MATERNAL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3111 ALPHA-FETOPROTEIN - PRENATAL AMNIOTIC FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3109 ALPHA-FETOPROTEIN - TUMOR MARKER [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3109SR ALPHA-FETOPROTEIN W/SERIAL GRAPHICS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3028 ALPHA-FETOPROTEIN & HUMAN CHORIONIC GONADOTROPIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3028SR ALPHA-FETOPROTEIN & HUMAN CHORIONIC GONADOTROPIN W/SERIAL GR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3109F ALPHA-FETOPROTEIN FLUID - NOT FOR PRENATAL TESTING [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3109C ALPHA-FETOPROTEIN CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3092 ALPHA-FETOPROTEIN QUAD SCREEN, 2.5 MOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
Page 5 of 59 * Portions of this page have been omitted pursuant to a request for confidential treatment and filed separately with the Securities and Exchange Commission. ATTACHMENT A UNILAB FFS AND CAP FEE SCHEDULE
- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- 3110 ALPHA-FETOPROTEIN TRIPLE SCREEN 2.0 (TRIPLE MARKER SCREEN) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3091 ALPHA-FETOPROTEIN TRIPLE SCREEN 2.5 (TRIPLE MARKER SCREEN) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4912 ALPRAZOLAM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1347 ALT (SGPT) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4862U ALUMINUM 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4862D ALUMINUM DIALYSATE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4862SR ALUMINUM SERIAL GRAPHICS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4862 ALUMINUM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4862UR ALUMINUM URINE RANDOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4862W ALUMINUM WHOLE BLOOD [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4900 AMIKACIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4900P AMIKACIN PEAK & TROUGH [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4991 AMINO ACID PROFILE, QUANTITATIVE, PLASMA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4993 AMINO ACID PROFILE, QUANT, PLASMA W/REFLEX INTERPRETATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4147 AMIODARONE AND METABOLITES [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4914 AMITRIPTYLINE AND NORTRIPTYLINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4106U AMPHETAMINE/METHAMPHETAMINE URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4961 AMPRENAVIR MONITR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3844 AMYLASE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3846 AMYLASE ISOENZYMES [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1127 ANA,DSDNA,SS-A/SS-B,ENA,SCL-70 AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5708 ANAEROBIC BACTERIAL CULTURE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5709 ANAEROBIC BACTERIAL IDENTIFICATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5711 ANAEROBIC SUSCEPTIBILITY PANEL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1000 ANALYZER [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1005 ANALYZER WITHOUT ANA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1006 ANALYZER WITHOUT RHEUMATOID FACTOR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3106 ANDROSTANEDIOL GLUCURONIDE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3112 ANDROSTENEDIONE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1529 ANGIOEDEMA EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3114 ANGIOTENSIN CONVERTING ENZYME [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3114C ANGIOTENSIN CONVERTING ENZYME CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2019 ANOVULATORY EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2351 ANTIDEOXYRIBONUCLEASE-B ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3116 ANTIDIURETIC HORMONE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5677 ANTIMICROBIAL SERUM INHIBITORY-CIDAL LEVEL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4397 ANTIMONY SERUM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4397U ANTIMONY 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4397UR ANTIMONY URINE RANDOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4397W ANTIMONY WHOLE BLOOD [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1862 ANTINEUTROPHIL CYTOPLASMIC AUTOABS (ANCA) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1066 ANTINUCLEAR ABS EVALUATION W/ C3 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1065 ANTINUCLEAR ABS EVALUATION W/ C4 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1003 ANTINUCLEAR ABS PANEL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1125 ANTINUCLEAR ABS PROFILE #1 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1126 ANTINUCLEAR ABS PROFILE #2 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1121 ANA REFLEX TO PROFILE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1120 ANA REFLEX TO PROFILE #1 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1124 ANA REFLEX TO PROFILE #2 + CARDIOLIPINS & TPO [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1100 ANA W/ INTERNATIONAL UNITS & PATTERN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1100F ANA W/ INTERNATIONAL UNITS & PATTERN FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1122 ANA W/ INTERNATIONAL UNITS & TITER [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1118 ANA W/ REFLEX TO ANALYZER [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3562 ANTIOXIDANT ASSESSR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1776 ANTIPHOSPHOLIPID EVAL & PHOSPHOGLYCEROL/PHOSPHOINOSITOL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
Page 6 of 59 * PORTIONS OF THIS PAGE HAVE BEEN OMITTED PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION. ATTACHMENT A UNILAB FFS AND CAP FEE SCHEDULE
- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- 1080 ANTIPHOSPHOLIPID SYNDROME EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1080S ANTIPHOSPHOLIPID SYNDROME EVALUATION W/O LA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1082 ANTIPHOSPHOLIPID SYNDROME EVALUATION, EXPANDED [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2376 ANTISTREPTOLYSIN O (ASO) ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5952 ANTITHROMBIN III EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5951 ANTITHROMBIN III FUNCTIONAL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3253 ANTITHROMBIN III PLASMA AG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1916 APOLIPOPROTEIN E GENOTYPR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1901 APOLIPOPROTEIN A-1 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1903 APOLIPOPROTEIN B [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1900 APOLIPOPROTEIN EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8226 ARBOVIRUS IGM ABS [IFA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8226C ARBOVIRUS IGM ABS CSF [IFA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7800 ARBOVIRUS IGM ANTIBODY INDEX [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9525 ARBOVIRUS RNA DETECTR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9521 ARBOVIRUS TOTAL ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9521C ARBOVIRUS TOTAL ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4867U ARSENIC 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4867 ARSENIC [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4867UI ARSENIC URINE INDUSTRIAL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4867UR ARSENIC URINE RANDOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4867W ARSENIC WHOLE BLOOD [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4867L ARSENIC LIQUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1010 ARTHRITIS EVALUATION B [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1358 ARTHRITIS RX SELECTR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7598 ASEPTIC MENINGITIS/ENCEPHALITIS DETECTR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2326 ASPERGILLUS TOTAL ABS [DD] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9941 ASPERGILLUS ABS PANEL [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9941C ASPERGILLUS ABS PANEL CSF [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2316 ASPERGILLUS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9961 ASPERGILLUS IGG ABS [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9961C ASPERGILLUS IGG ABS CSF [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9932 ASPERGILLUS IGG ANTIBODY INDEX [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9946 ASPERGILLUS IGM ABS [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9946C ASPERGILLUS IGM ABS CSF [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2506 ASPERGILLUS TOTAL ABS [CF] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2506C ASPERGILLUS TOTAL ABS CSF [CF] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2326C ASPERGILLUS TOTAL ABS CSF [DD] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1345 AST (SGOT) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2011 ATYPICAL PNEUMONIA ABS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2928 ATYPICAL PNEUMONIA DNA DETECTR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5918 AUTOIMMUNE HEPATITIS EVALUATR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5916 AUTOIMMUNE HEPATITIS EVALUATR PLUS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2161 BABESIA MICROTI IGG & IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2161C BABESIA MICROTI IGG & IGM ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2136 BABESIA MICROTI IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2141 BABESIA MICROTI IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2146 BABESIA ORGANISM DETECTION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2151 BABESIOSIS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9601 BACTERIAL AG DETECTION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9601C BACTERIAL AG DETECTION CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9601U BACTERIAL AG DETECTION URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2950 BACTERIAL IDENTIFICATION, AEROBIC ORGANISM ID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2933 BACTERIAL MENINGITIS ULTRARAPID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4072 BACTERICIDAL PERMEABILITY-INCREASING (BPI) PROT AUTOABS EVAL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
Page 7 of 59 * PORTIONS OF THIS PAGE HAVE BEEN OMITTED PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION. ATTACHMENT A UNILAB FFS AND CAP FEE SCHEDULE
- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- 4108 BARBITURATES [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4108U BARBITURATES URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8861 BARTONELLA HENSELAE & B. QUINTANA DNA DETECTR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8863 BARTONELLA HENSELAE & B. QUINTANA IGG & IGM ABS SERODX [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8851 BARTONELLA HENSELAE IGG & IGM ABS [IFA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8851C BARTONELLA HENSELAE IGG & IGM ABS CSF [IFA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7511 BARTONELLA QUINTANA DNA DETECTR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8864 BARTONELLA QUINTANA IGG & IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2413 BARTONELLA SPP CULTURE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1888 BCL-2 GENE TRANSLOCATION [SB] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5354 BCR/ABL ACCUQUANT FOR ALL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5352 BCR/ABL ACCUQUANT FOR CML [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1592 BENCE-JONES PROTEIN EVALUATION (QUAL W/ REFLEX TO QUANT) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4110 BENZODIAZEPINE SCREEN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4110U BENZODIAZEPINE SCREEN URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4073 BENZTROPINE [COGENTIN] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1470 BERYLLIUM-INDUCED LYMPHOCYTE PROLIFERATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1083 BETA-2-GLYCOPROTEIN I (BETA-2-GPI) IGG, IGM & IGA AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3143 BETA-2-MICROGLOBULIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3143C BETA-2-MICROGLOBULIN CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3143F BETA-2-MICROGLOBULIN FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3143U BETA-2-MICROGLOBULIN URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3143SR BETA-2-MICROGLOBULIN W/SERIAL GRAPHICS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3886 BETA-CHEMOKINE PANEL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3187 BETA-HCG PREGNANCY [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3575 BETA-HYDROXYBUTYRATE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4970 BETA-THALASSEMIA AND HEMOGLOBINOPATHY SCREEN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5941 BETA-THROMBOGLOBULIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5300 BICARBONATE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5313 BILIRUBIN FRACTIONATED [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3554 BILIRUBIN, TOTAL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9617 BLADDER TUMOR ANTIGEN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8346 BLASTOMYCES IGG ABS [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8346C BLASTOMYCES IGG ABS CSF [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8340 BLASTOMYCES IGG ANTIBODY INDEX [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2511 BLASTOMYCES TOTAL ABS [CF] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2511C BLASTOMYCES TOTAL ABS CSF [CF] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2328 BLASTOMYCES TOTAL ABS [DD] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2328C BLASTOMYCES TOTAL ABS CSF [DD] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2428 BORDETELLA PERTUSSIS/PARAPERTUSSIS AG DETECTION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2416 BORDETELLA PERTUSSIS/PARAPERTUSSIS CULTURE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2430 BORDETELLA PERTUSSIS/PARAPERTUSSIS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9671 BORDETELLA PERTUSSIS/PARAPERTUSSIS IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9671C BORDETELLA PERTUSSIS/PARAPERTUSSIS IGG ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9676 BORDETELLA PERTUSSIS/PARAPERTUSSIS IGG, IGM & IGA ABS [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9676C BORDETELLA PERTUSSIS/PARAPERTUSSIS IGG, IGM & IGA ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9681 BORDETELLA PERTUSSIS/PARAPERTUSSIS IGM & IGA ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9681C BORDETELLA PERTUSSIS/PARAPERTUSSIS IGM & IGA ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9686 BORDETELLA PERTUSSIS/PARAPERTUSSIS IGM ABS [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7570 BORRELIA BURGDORFERI DNA DETECTR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8941 BORRELIA BURGDORFERI IGG & IGM ABS [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8941C BORRELIA BURGDORFERI IGG & IGM ABS CSF [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8941SF BORRELIA BURGDORFERI IGG & IGM ABS SYNOVIAL FLUID [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7711 BORRELIA BURGDORFERI IGG & IGM ABS [IB] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7711B BORRELIA BURGDORFERI IGG & IGM ABS + BANDS [IB] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
Page 8 of 59 * PORTIONS OF THIS PAGE HAVE BEEN OMITTED PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION. ATTACHMENT A UNILAB FFS AND CAP FEE SCHEDULE
- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- 7711C BORRELIA BURGDORFERI IGG & IGM ABS CSF [IB] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7711CB BORRELIA BURGDORFERI IGG & IGM ABS + BANDS CSF [IB] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7711BNY BORRELIA BURGDORFERI IGG & IGM ABS + BANDS NEW YORK [IB] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7711SF BORRELIA BURGDORFERI IGG & IGM ABS SYNOVIAL FLUID [IB] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7711SFB BORRELIA BURGDORFERI IGG & IGM ABS + BANDS SYN FLUID [IB] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7716 BORRELIA BURGDORFERI IGG & IGM ABS WITH IB [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7716B BORRELIA BURGDORFERI IGG & IGM ABS WITH IB + BANDS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7716BNY BORRELIA BURGDORFERI IGG & IGM ABS WITH IB + BANDS NY [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7716C BORRELIA BURGDORFERI IGG & IGM ABS WITH IB CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7716CB BORRELIA BURGDORFERI IGG & IGM ABS WITH IB + BANDS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7716SF BORRELIA BURGDORFERI IGG & IGM ABS WITH IB SYNOVIAL FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8942 BORRELIA BURGDORFERI IGG & IGM WITH REFLEX IB + BANDS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7970 BORRELIA BURGDORFERI IGG & IGM ANTIBODY INDEX [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7970SF BORRELIA BURGDORFERI IGG & IGM ANTIBODY INDEX SYNOVIAL FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8951 BORRELIA BURGDORFERI IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8951C BORRELIA BURGDORFERI IGG ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8951SF BORRELIA BURGDORFERI IGG ABS SYNOVIAL FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8945 BORRELIA BURGDORFERI IGG ANTIBODY INDEX [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8945SF BORRELIA BURGDORFERI IGG ANTIBODY INDEX SYNOVIAL FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8961 BORRELIA BURGDORFERI IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8961C BORRELIA BURGDORFERI IGM ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8961SF BORRELIA BURGDORFERI IGM ABS SYNOVIAL FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7975 BORRELIA BURGDORFERI IGM ANTIBODY INDEX [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1646 BORRELIA BURGDORFERI LYMPHOCYTE PROLIFERATION ANALYSIS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9396 BORRELIA HERMSII IGG & IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9396C BORRELIA HERMSII IGG & IGM ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9326 BORRELIA HERMSII IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9331 BORRELIA HERMSII IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2415 BORRELIA SPP CULTURE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1840 BREAST CANCER PANEL, BASIC [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1804 BREAST CANCER PROFILE 1 - PARAFFIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1813 BREAST CANCER PROFILE 2 - PARAFFIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1819 BREAST CANCER PROFILE 3 - PARAFFIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1818 BREAST CANCER PROFILE 3 WITH HER-2/NEU REFLEX [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1817 BREAST CANCER PROFILE 4 - PARAFFIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1812 BREAST CANCER PROFILE 5 - PARAFFIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1811 BREAST CANCER PROFILE 6 - PARAFFIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1816 BREAST CANCER PROFILE 7 - PARAFFIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8836 BRUCELLA ABORTUS IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8836C BRUCELLA ABORTUS IGG ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7695 BRUCELLA ABORTUS IGG ANTIBODY INDEX [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8831C BRUCELLA ABORTUS IGG, IGM & IGA ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8831 BRUCELLA ABORTUS IGG, IGM & IGA ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1116 BRUSH BORDER TOTAL AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8241 BURKHOLDERIA (PSEUDOMONAS) PSEUDOMALLEI IGG & IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8241C BURKHOLDERIA (PSEUDOMONAS) PSEUDOMALLEI IGG & IGM ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3121 CA 125 [MEIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3121F CA 125 FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3121NY CA 125 NEW YORK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3121SR CA 125 W/ SERIAL GRAPHICS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3119 CA 15-3 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3119SR CA 15-3 W/SERIAL GRAPHICS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3120 CA 19-9 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3120F CA 19-9 FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3120NY CA 19-9 NEW YORK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
Page 9 of 59 * PORTIONS OF THIS PAGE HAVE BEEN OMITTED PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION. ATTACHMENT A UNILAB FFS AND CAP FEE SCHEDULE
- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- 3120SR CA 19-9 W/SERIAL GRAPHICS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3134 CA27.29 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3134NY CA27.29 NEW YORK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3134SR CA27.29 W/SERIAL GRAPHICS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4868U CADMIUM 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4500 CADMIUM EXPOSURE PANEL - OSHA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4500UR CADMIUM EXPOSURE PANEL - OSHA - RANDOM URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4501U CADMIUM EXPOSURE PANEL 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4502U CADMIUM EXPOSURE PANEL 24HR URINE - LIMITED [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4501UR CADMIUM EXPOSURE PANEL URINE RANDOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4502UR CADMIUM EXPOSURE PANEL URINE RANDOM - LIMITED [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4868 CADMIUM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4868UR CADMIUM URINE RANDOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4868W CADMIUM WHOLE BLOOD [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3126 CALCITONIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4831 CALCIUM, IONIZED [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4836 CALCIUM, TOTAL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4836U CALCIUM, TOTAL 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4836UR CALCIUM URINE RANDOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8176 CALIFORNIA-LA CROSSE ENCEPHALITIS IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8176C CALIFORNIA-LA CROSSE ENCEPHALITIS IGM ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7820 CALIFORNIA-LA CROSSE ENCEPHALITIS IGM ANTIBODY INDEX [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8926 CALIFORNIA-LA CROSSE ENCEPHALITIS TOTAL ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8926C CALIFORNIA-LA CROSSE ENCEPHALITIS ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5704 CAMPYLOBACTER CULTURE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8881 CAMPYLOBACTER FETUS TOTAL ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8881C CAMPYLOBACTER FETUS TOTAL ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8886 CAMPYLOBACTER JEJUNI TOTAL ABS [CF] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8886C CAMPYLOBACTER JEJUNI TOTAL ABS CSF [CF] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8866 CAMPYLOBACTER JEJUNI TOTAL ABS [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8866C CAMPYLOBACTER JEJUNI TOTAL ABS CSF [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9190 CANDIDA AG DETECTION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2346 CANDIDA ALBICANS ABS TITER [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2344 CANDIDA ALBICANS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2343 CANDIDA ALBICANS EVALUATION WITHOUT ANTIGEN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2330 CANDIDA ALBICANS TOTAL ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4132 CANNABINOIDS SCREEN SERUM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4132U CANNABINOIDS URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4114 CARBAMAZEPINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4116 CARBAMAZEPINE, FREE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4005 CARBOHYDRATE-DEFICIENT TRANSFERRIN (CDT) ULTRAQUANT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3999 CARBOHYDRATE-DEFICIENT TRANSFERRIN, QUALITATIVE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3258 CARCINOEMBRYONIC AG (CEA) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3258F CARCINOEMBRYONIC AG FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3258NY CARCINOEMBRYONIC AG NEW YORK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3258SR CARCINOEMBRYONIC AG W/SERIAL GRAPHICS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3258C CARCINOEMBRYONIC AG CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3070 CARCINOID EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3374 CARDIOLIPIN IGA AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3372 CARDIOLIPIN IGG AUTOABS [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3371 CARDIOLIPIN IGG, IGM & IGA AUTOABS [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3373 CARDIOLIPIN IGM AUTOABS [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5991 CARDIOVASCULAR THROMBOTIC RISK ASSESSR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4163 CARNITINES EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3998 CAROTENES, ALPHA AND BETA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
Page 10 of 59 * PORTIONS OF THIS PAGE HAVE BEEN OMITTED PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION. ATTACHMENT A UNILAB FFS AND CAP FEE SCHEDULE
- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- 3304U CATECHOLAMINES, FRACTIONATED 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3304 CATECHOLAMINES, FRACTIONATED PLASMA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3304UR CATECHOLAMINES, FRACTIONATED URINE RANDOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5368 CC-CKR5 DELTA 32 MUTATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1692 CD103 SURFACE MARKER [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1686 CD15/30 SURFACE MARKER [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1687 CD16/56 SURFACE MARKER [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1688 CD19 SURFACE MARKER [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1683 CD3 SURFACE MARKER [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1689 CD38 SURFACE MARKER [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1684 CD4 SURFACE MARKER [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1690 CD41 SURFACE MARKER [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1691 CD42 SURFACE MARKER [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1685 CD8 SURFACE MARKER [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4007 CDT ULTRAQUANT WITH REFLEX TO GENETIC D VARIANTS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1076 CELIAC DISEASE AUTOABS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1077 CELIAC DISEASE EVALUATR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1078 CELIAC DISEASE GENOTYPR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1650 CELLULAR IMMUNE DYSFUNCTION EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1109 CENTROMERE AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1516 CERULOPLASMIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9437 CHLAMYDIA PNEUMONIAE ABS ULTRAQUANT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2401 CHLAMYDIA PNEUMONIAE CULTURE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2922 CHLAMYDIA PNEUMONIAE DNA DETECTR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8081 CHLAMYDIA PNEUMONIAE IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8071 CHLAMYDIA PNEUMONIAE TOTAL & IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8071P CHLAMYDIA PNEUMONIAE TOTAL & IGM ABS PAIRED [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8076 CHLAMYDIA PNEUMONIAE TOTAL ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8021 CHLAMYDIA PSITTACI IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8031 CHLAMYDIA PSITTACI TOTAL & IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8026 CHLAMYDIA PSITTACI TOTAL ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2631C CHLAMYDIA SPP. ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8006 CHLAMYDIA SPP. ABS EVALUATION [EIA/MICRO-IF] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8011 CHLAMYDIA SPP. IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8066 CHLAMYDIA SPP. TOTAL & IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2631 CHLAMYDIA SPP. TOTAL ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2521 CHLAMYDIA SPP. TOTAL ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2521C CHLAMYDIA SPP. TOTAL ABS CSF [CF] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8016 CHLAMYDIA SPP. TOTAL ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2927 CHLAMYDIA TRACHOMATIS / NEISSERIA GONORRHOEAE, RRNA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2440 CHLAMYDIA TRACHOMATIS AG DETECTION [DFA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2400 CHLAMYDIA TRACHOMATIS CULTURE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2925 CHLAMYDIA TRACHOMATIS DETECTION RRNA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7437 CHLAMYDIA TRACHOMATIS DNA [LCR] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9391 CHLAMYDIA TRACHOMATIS IGA ABS [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9391C CHLAMYDIA TRACHOMATIS IGA ABS CSF [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9406 CHLAMYDIA TRACHOMATIS IGG ABS [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9406C CHLAMYDIA TRACHOMATIS IGG ABS CSF [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9401 CHLAMYDIA TRACHOMATIS IGG, IGM & IGA ABS [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9401C CHLAMYDIA TRACHOMATIS IGG, IGM & IGA ABS [EIA] CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9411 CHLAMYDIA TRACHOMATIS IGM ABS [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9411C CHLAMYDIA TRACHOMATIS IGM ABS CSF [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8046 CHLAMYDIA TRACHOMATIS IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8036 CHLAMYDIA TRACHOMATIS TOTAL & IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8041 CHLAMYDIA TRACHOMATIS TOTAL ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
Page 11 of 59 * PORTIONS OF THIS PAGE HAVE BEEN OMITTED PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION. ATTACHMENT A UNILAB FFS AND CAP FEE SCHEDULE
- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- 4916 CHLORDIAZEPOXIDE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5303 CHLORIDE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5303C CHLORIDE CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5303U CHLORIDE 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5303UR CHLORIDE URINE RANDOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3454 CHOLESTEROL EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3352 HDL CHOLESTEROL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3350 CHOLESTEROL, TOTAL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3123PLSR CHOLINESTERASE PLASMA W/ SERIAL GRAPHICS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3123PL CHOLINESTERASE, PLASMA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3123 CHOLINESTERASE SERUM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3123SR CHOLINESTERASE W/ SERIAL GRAPHICS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3123R CHOLINESTERASE RBC [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3123RSR CHOLINESTERASE RBC W/ SERIAL GRAPHICS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3952 CHROMOGRANIN-A [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5832 CHROMOSOME & FISH FOR GENETIC DISORDERS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5840 CHROMOSOME ANALYSIS: ACUTE PROMYELOCYTIC LEUKEMIA T(15;17) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5822 CHROMOSOME ANALYSIS: AMNIOTIC FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5834 CHROMOSOME ANALYSIS: BCR/ABL GENE REARRANGEMENT BY FISH [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5814 CHROMOSOME ANALYSIS: CONGENITAL DISORDERS BLOOD [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5830 CHROMOSOME ANALYSIS: FISH FOR GENETIC DISEASES [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5800 CHROMOSOME ANALYSIS: HEMATOLOGICAL DISORDERS I [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5810 CHROMOSOME ANALYSIS: HEMATOLOGICAL DISORDERS II [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5742 CHROMOSOME ANALYSIS: KAL GENE DELETION BY FISH [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5806 CHROMOSOME ANALYSIS: MOSAICISM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5818 CHROMOSOME ANALYSIS: PRODUCTS OF CONCEPTION/SKIN BIOPSIES [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5844 CHROMOSOME ANALYSIS: STS GENE DELETION BY FISH [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5812 CHROMOSOME ANALYSIS: TRISOMY 12 BY FISH [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5808 CHROMOSOME ANALYSIS: TRISOMY 8 BY FISH [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5838 CHROMOSOME ANAL: X&Y PROBE OPPOSITE SEX BONE MARROW TRANSPL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1651 CHRONIC FATIGUE & IMMUNE DYSFUNCTION SYNDROME EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1652 CHRONIC FATIGUE & IMMUNE DYSFUNCTION SYNDROME WITH NK CELL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1040 CIRCULATING IMMUNE COMPLEX DETECTOR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1040F CIRCULATING IMMUNE COMPLEX DETECTOR FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3970UR CITRATE URINE RANDOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3970U CITRATE 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4962 CLOMIPRAMINE & DESMETHYLCLOMIPRAMINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4918 CLONAZEPAM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2411 CLOSTRIDIUM DIFFICILE CULTURE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7672 CLOSTRIDIUM DIFFICILE CULTURE & TOXIN EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7691 CLOSTRIDIUM DIFFICILE TOXIN A DETECTION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2412 CLOSTRIDIUM DIFFICILE TOXIN B DETECTION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7670 CLOSTRIDIUM DIFFICILE TOXIN EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4964 CLOZAPINE PLASMA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4118 COCAINE METABOLITES SCREEN (SERUM) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4118U COCAINE METABOLITES URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8321 COCCIDIOIDES IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8321C COCCIDIOIDES IGG ABS CSF [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8331 COCCIDIOIDES IGG, IGM & IGA ABS [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8331C COCCIDIOIDES IGG, IGM & IGA ABS CSF [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8316 COCCIDIOIDES IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8316C COCCIDIOIDES IGM ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2526 COCCIDIOIDES TOTAL ABS [CF] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2526C COCCIDIOIDES TOTAL ABS CSF [CF] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2332 COCCIDIOIDES TOTAL ABS [DD] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
Page 12 of 59 * PORTIONS OF THIS PAGE HAVE BEEN OMITTED PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION. ATTACHMENT A UNILAB FFS AND CAP FEE SCHEDULE
- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- 2332C COCCIDIOIDES TOTAL ABS CSF [DD] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9166 COCCIDIOIDES TOTAL ABS [LPA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2030 COCCIDIOIDES TOTAL ABS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9026 COLD AGGLUTININS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1476 COLLAGEN TYPE I & IV IGG AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1477 COLLAGEN TYPE I IGG AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1474 COLLAGEN TYPE II IGG AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1478 COLLAGEN TYPE IV IGG AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8636 COLORADO TICK FEVER TOTAL ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3024 COLORECTAL CANCER MONITOR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3024SR COLORECTAL CANCER MONITOR W/ SERIAL GRAPHICS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5902 COMPLEMENT AH50 AND CH50 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1020 COMPLEMENT EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1021 COMPLEMENT EVALUATION PLUS CH50 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1531 COMPLEMENT FUNCTIONAL ACTIVITY: C1 ESTERASE INHIBITOR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1942 COMPLEMENT FUNCTIONAL ACTIVITY: C2 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1944 COMPLEMENT FUNCTIONAL ACTIVITY: C3 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1946 COMPLEMENT FUNCTIONAL ACTIVITY: C4 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1948 COMPLEMENT FUNCTIONAL ACTIVITY: C5 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1950 COMPLEMENT FUNCTIONAL ACTIVITY: C6 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1952 COMPLEMENT FUNCTIONAL ACTIVITY: C7 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1954 COMPLEMENT FUNCTIONAL ACTIVITY: C8 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1956 COMPLEMENT FUNCTIONAL ACTIVITY: C9 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1600F COMPLEMENT FUNCTIONAL ACTIVITY: TOTAL CH50 FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1600SF COMPLEMENT FUNCTIONAL ACTIVITY: TOTAL CH50 SYNOVIAL FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1020F COMPLEMENT EVALUATION FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1530 COMPLEMENT PROTEIN CONCENTRATION: C1 ESTERASE INHIBITOR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1615 COMPLEMENT PROTEIN CONCENTRATION: C1Q [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1615F COMPLEMENT PROTEIN CONCENTRATION: C1Q FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1605 COMPLEMENT PROTEIN CONCENTRATION: C2 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1501 COMPLEMENT PROTEIN CONCENTRATION: C3 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1501F COMPLEMENT PROTEIN CONCENTRATION: C3 FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1504 COMPLEMENT PROTEIN CONCENTRATION: C4 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1504F COMPLEMENT PROTEIN CONCENTRATION: C4 FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1610 COMPLEMENT PROTEIN CONCENTRATION: C5 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1938 COMPLEMENT PROTEIN CONCENTRATION: C5A [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1976 COMPLEMENT PROTEIN CONCENTRATION: C6 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1978 COMPLEMENT PROTEIN CONCENTRATION: C7 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1980 COMPLEMENT PROTEIN CONCENTRATION: C8 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1982 COMPLEMENT PROTEIN CONCENTRATION: C9 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1511 COMPLEMENT PROTEIN CONCENTRATION: FACTOR B [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1511F COMPLEMENT PROTEIN CONCENTRATION FACTOR B FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1984 COMPLEMENT PROTEIN CONCENTRATION: FACTOR H [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1986 COMPLEMENT PROTEIN CONCENTRATION: FACTOR I [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1988 COMPLEMENT PROTEIN CONCENTRATION: PROPERDIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1486 COMPLEMENT SPLIT PRODUCT CONCENTRATION: C3A [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1486C COMPLEMENT SPLIT PRODUCT CONCENTRATION: C3A CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1968 COMPLEMENT SPLIT PRODUCT CONCENTRATION: FACTOR BB FRAGMENT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1998 COMPLEMENT SPLIT PRODUCT CONCENTRATION: IC3B [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1992 COMPLEMENT SPLIT PRODUCT CONCENTRATION: SC5B-9 COMPLEX [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1992C COMPLEMENT SPLIT PRODUCT CONCENTRATION: SC5B-9 COMPLEX CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1960 COMPLEMENT: AH50 TOTAL FUNCTIONAL ACTIVITY, ALTERNATE PATH [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1994 COMPLEMENT: C1R:C1S:C1 INHIBITOR COMPLEX [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1723 COMPLEMENT: C3 & C4 NEPHRITIC FACTORS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1612 COMPLEMENT: C3 NEPHRITIC FACTOR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
Page 13 of 59 * PORTIONS OF THIS PAGE HAVE BEEN OMITTED PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION. ATTACHMENT A UNILAB FFS AND CAP FEE SCHEDULE
- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- 1996 COMPLEMENT: C3B:BB:PROPERDIN COMPLEX [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1365 COMPLEMENT: C4 ALLOTYPING [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1995 COMPLEMENT: C4 BINDING PROTEIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1721 COMPLEMENT: C4 NEPHRITIC FACTOR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1990 COMPLEMENT: C4D/C4 RATIO [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1600 COMPLEMENT: CH50 TOTAL FUNCTIONAL ACTIVITY, CLASSIC PATH [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5111 COMPLETE BLOOD COUNT & DIFFERENTIAL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5110 COMPLETE BLOOD COUNT, PLATELET COUNT & DIFFERENTIAL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3265 CONGENITAL ADRENAL HYPERPLASIA EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1402 CONGLUTININ SOLID PHASE IMMUNE COMPLEX ASSAY [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1402F CONGLUTININ SOLID PHASE IMMUNE COMPLEX ASSAY FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4870U COPPER 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4859 COPPER LIVER TISSUE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4870PL COPPER PLASMA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4870R COPPER RBC [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4870 COPPER [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4870UR COPPER URINE RANDOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3128 CORTISOL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3128UR CORTISOL, FREE URINE RANDOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3136 CORTISOL [HPLC] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3128U CORTISOL, FREE 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2407 CORYNEBACTERIUM DIPHTHERIAE CULTURE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9371 COXIELLA BURNETII IGG ABS, PHASE 1 & 2 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9371C COXIELLA BURNETII IGG ABS, PHASE 1 & 2 CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9381 COXIELLA BURNETII IGG, IGM & IGA, PHASE 1 & 2 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9381C COXIELLA BURNETII IGG, IGM & IGA ABS, PHASE 1 & 2 CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9376 COXIELLA BURNETII IGM ABS, PHASE 1 & 2 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9376C COXIELLA BURNETII IGM ABS, PHASE 1 & 2 CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2546 COXSACKIEVIRUS A & B ABS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2546C COXSACKIEVIRUS A & B ABS EVALUATION CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2536 COXSACKIEVIRUS A ABS, SEROTYPES 7, 9, 10 & 16 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2536C COXSACKIEVIRUS A ABS, SEROTYPES 7, 9, 10 & 16 CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2541 COXSACKIEVIRUS B ABS, SEROTYPES 1-6 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2541C COXSACKIEVIRUS B ABS, SEROTYPES 1-6 CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3140 C-PEPTIDE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3140U C-PEPTIDE URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1535 C-REACTIVE PROTEIN (INFLAMMATORY) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1535C C-REACTIVE PROTEIN CSF (INFLAMMATORY) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1536 C-REACTIVE PROTEIN ULTRAQUANT (CARDIAC RISK) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3851 CREATINE KINASE ISOENZYMES (CK) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3852 CREATINE KINASE-MB (CKMB) MASS AND RELATIVE INDEX [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3976 CREATINE PHOSPHOKINASE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1320 CREATININE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1320U CREATININE 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1322 CREATININE CLEARANCE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1320UR CREATININE URINE RANDOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2490 CREUTZFELDT-JAKOB DISEASE DETECTR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1151 CRYOFIBRINOGEN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1152 CRYOFIBRINOGENEMIA REFLEXIVE EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1150 CRYOFIBRINOGENS WITH REFLEX [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1156 CRYOGLOBULIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1158 CRYOGLOBULIN & CRYOFIBRINOGEN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1157 CRYOGLOBULINEMIA REFLEXIVE EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1155 CRYOGLOBULINS WITH REFLEX [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9099 CRYPTOCOCCUS ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
Page 14 of 59 * PORTIONS OF THIS PAGE HAVE BEEN OMITTED PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION. ATTACHMENT A UNILAB FFS AND CAP FEE SCHEDULE
- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- 9099C CRYPTOCOCCUS ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9189 CRYPTOCOCCUS AG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9189C CRYPTOCOCCUS AG CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9189U CRYPTOCOCCUS AG URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2439 CRYPTOSPORIDIUM AG DETECTION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4311SR CYCLOSPORINE A AND METABOLITES WHOLE BLOOD W/SG [FPIA-MONO] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4313 CYCLOSPORINE A WHOLE BLOOD [HPLC] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4311 CYCLOSPORINE A AND METABOLITES WHOLE BLOOD [FPIA-MONOCLONAL] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3494 CYSTATHIONINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1138 CYSTATIN C [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9816 CYSTICERCUS IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9816C CYSTICERCUS IGG ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9816CS CYSTICERCUS IGG ABS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5374 CYTOCHROME P450 2D6 EVALUATR - POOR-METABOLIZERS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5917 CYTOKERATIN AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2421 CYTOMEGALOVIRUS AG DETECTION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8562 CYTOMEGALOVIRUS CNS INFECTION ACCUDX [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2418 CYTOMEGALOVIRUS CULTURE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7575 CYTOMEGALOVIRUS DNA DETECTR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9430 CYTOMEGALOVIRUS DNA ULTRAQUANT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9430C CYTOMEGALOVIRUS DNA ULTRARAPID CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9430SR CYTOMEGALOVIRUS DNA ULTRAQUANT W/ SERIAL GRAPHICS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7574 CYTOMEGALOVIRUS GENOTYPR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9436 CYTOMEGALOVIRUS IGG & IGM ABS [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9436C CYTOMEGALOVIRUS IGG & IGM ABS CSF [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9431 CYTOMEGALOVIRUS IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9431C CYTOMEGALOVIRUS IGG ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8560 CYTOMEGALOVIRUS IGG ANTIBODY INDEX [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2486 CYTOMEGALOVIRUS IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2486C CYTOMEGALOVIRUS IGM ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2106U CYTOMEGALOVIRUS IMMEDIATE-EARLY AG URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2106 CYTOMEGALOVIRUS IMMEDIATE-EARLY AG WHOLE BLOOD [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7579 CYTOMEGALOVIRUS PP67 DETECTR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2551 CYTOMEGALOVIRUS TOTAL ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2551C CYTOMEGALOVIRUS TOTAL ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4200 D-DIMER [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3146 DEHYDROEPIANDROSTERONE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3150 DEHYDROEPIANDROSTERONE-SULFATE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4956 DELAVIRDINE MONITR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7646 DENGUE VIRUS IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7646C DENGUE VIRUS IGM ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7602 DENGUE VIRUS RNA DETECTR/SPECIATION TYPES 1-4 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7601 DENGUE VIRUS TOTAL ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7601C DENGUE VIRUS TOTAL ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3973 DEOXYPYRIDINOLINE CROSS-LINKS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4920 DESALKYLFLURAZEPAM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4922 DESIPRAMINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1031 DIABETES EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1032 DIABETES MELLITUS TYPE 1 AUTOANTIBODY EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1036 DIABETES, GENETIC EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4926 DIAZEPAM & NORDIAZEPAM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4957 DIDANOSINE (DDI) MONITR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4120 DIGITOXIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4122 DIGOXIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1415P DIPHTHERIA TOXOID IGG ABS, PRE/POST VACCINATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
Page 15 of 59 * PORTIONS OF THIS PAGE HAVE BEEN OMITTED PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION. ATTACHMENT A UNILAB FFS AND CAP FEE SCHEDULE
- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- 1415 DIPHTHERIA TOXOID IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3351 DIRECT LDL CHOLESTEROL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3127 DISACCHARIDASES [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4124 DISOPYRAMIDE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5980 DISSEMINATED INTRAVASCULAR COAGULOPATHY EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5400NI DNA ANALYSIS [FC] (NO INTERPRETATION) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5402NI DNA ANALYSIS [IA] (NO INTERPRETATION) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1201 DNA AUTOANTIBODIES, DOUBLE-STRANDED [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1290 DNA AUTOABS, SINGLE-STRANDED DNA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1203 DNA AUTOANTIBODIES (CRITHIDIA), DOUBLE-STRANDED [IFA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5402 DNA PLOIDY [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5400U DNA PLOIDY & CELL CYCLE ANALYSIS, BLADDER/URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5400BK BREAST DNA PLOIDY & CELL CYCLE ANALYSIS, BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5400FZ BREAST DNA PLOIDY & CELL CYCLE ANALYSIS, FROZEN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4924 DOXEPIN & NORDOXEPIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4125 DRUGS OF ABUSE SCREEN SERUM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4125U DRUGS OF ABUSE SCREEN URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8181 EASTERN EQUINE ENCEPHALITIS IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8181C EASTERN EQUINE ENCEPHALITIS IGM ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7840 EASTERN EQUINE ENCEPHALITIS IGM ANTIBODY INDEX [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8936 EASTERN EQUINE ENCEPHALITIS TOTAL ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8936C EASTERN EQUINE ENCEPHALITIS TOTAL ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8451 ECHINOCOCCUS IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8451C ECHINOCOCCUS IGG ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8456 ECHINOCOCCUS IGG, IGM & IGE ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2566 ECHOVIRUS ABS, SEROTYPES 4, 9, 11 & 30 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2566C ECHOVIRUS ABS, SEROTYPES 4, 9, 11 & 30 CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7848 EHRLICHIA CHAFFEENSIS(HME) & E. EQUI(HGE) IGG & IGM ABS EVAL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7851 EHRLICHIA CHAFFEENSIS (HME) IGG & IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7848NY EHRLICHIA CHAFFEENSIS(HME) & E. EQUI(HGE) IGG & IGM ABS - NY [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7844 EHRLICHIA EQUI (HGE) IGG & IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7844C EHRLICHIA EQUI (HGE) IGG & IGM ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7844NY EHRLICHIA EQUI (HGE) IGG & IGM ABS NEW YORK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7846 EHRLICHIOSIS (GRANULOCYTIC) & LYME DISEASE EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1225 EJ AUTOANTIBODIES [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5316 ELECTROLYTE PANEL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1580 ELECTROPHORESIS, PROTEIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1580C ELECTROPHORESIS, PROTEIN CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1580U ELECTROPHORESIS, PROTEIN URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2726 ENCEPHALITIS VIRAL ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2726C ENCEPHALITIS VIRAL ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1191 ENDOMYSIAL IGA AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3624C ENDOTOXIN CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3624F ENDOTOXIN FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3624 ENDOTOXIN PLASMA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5695 ENTAMOEBA HISTOLYTICA AG DETECTION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1346 ENTAMOEBA HISTOLYTICA IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8441 ENTAMOEBA HISTOLYTICA IGG, IGM & IGA ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8441C ENTAMOEBA HISTOLYTICA IGG, IGM & IGA ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2650 ENTEROVIRUS RNA DETECTR [PCR] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2651 ENTEROVIRUS RNA DETECTR REFLEX TO SPECIATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3904 EOSINOPHIL CATIONIC PROTEIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3270U EPINEPHRINE 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3270 EPINEPHRINE PLASMA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7583 EPSTEIN-BARR VIRUS DNA DETECTR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
Page 16 of 59 * PORTIONS OF THIS PAGE HAVE BEEN OMITTED PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION. ATTACHMENT A UNILAB FFS AND CAP FEE SCHEDULE
- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- 7584 EPSTEIN-BARR VIRUS DNA ULTRAQUANT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7584C EPSTEIN-BARR VIRUS DNA ULTRARAPID CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7584P EPSTEIN-BARR VIRUS DNA ULTRAQUANT PLASMA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2131 EPSTEIN-BARR VIRUS EARLY AG (EA) IGA ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2131F EPSTEIN-BARR VIRUS EARLY AG (EA) IGA ABS FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2126F EPSTEIN-BARR VIRUS EARLY AG (EA) IGG ABS, DIFF/REST FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2126 EPSTEIN-BARR VIRUS EARLY AG (EA) IGG ABS, DIFF/REST PATTERNS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2211E EPSTEIN-BARR EVAL W/ NUCLEAR AG (EBNA) TITERED TO ENDPOINT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2211 EPSTEIN-BARR VIRUS EVALUATR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2211SB EPSTEIN-BARR VIRUS EVALUATR (END-POINT SBCL) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2211F EPSTEIN-BARR VIRUS EVALUATR FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2266 EPSTEIN-BARR VIRUS NUCLEAR AG (EBNA) IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2266F EPSTEIN-BARR VIRUS NUCLEAR AG (EBNA) IGG ABS FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2271 EPSTEIN-BARR VIRUS NUCLEAR AG (EBNA) IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2271F EPSTEIN-BARR VIRUS NUCLEAR AG (EBNA) IGM ABS FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8981 EPSTEIN-BARR VIRUS VIRAL CAPSID AG (VCA) IGA ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8981F EPSTEIN-BARR VIRUS VIRAL CAPSID AG (VCA) IGA ABS FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2122 EPSTEIN-BARR VIRUS VIRAL CAPSID AG (VCA) IGG & IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2116 EPSTEIN-BARR VIRUS VIRAL CAPSID AG (VCA) IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2116F EPSTEIN-BARR VIRUS VIRAL CAPSID AG (VCA) IGG ABS FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2121 EPSTEIN-BARR VIRUS VIRAL CAPSID AG (VCA) IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2121F EPSTEIN-BARR VIRUS VIRAL CAPSID AG (VCA) IGM ABS FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1842 ER/PGR AND HER-2/NEU WITH REFLEX TO FISH [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3272 ERYTHROCYTE PROTOPORPHYRIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5180 ERYTHROCYTE SEDIMENTATION RATE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1160 ERYTHROPOIETIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5640 ESCHERICHIA COLI 0157:H7 CULTURE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5639 ESCHERICHIA COLI ENTEROHEMORRHAGIC (0157:H7) STOOL CULTURE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5642 ESCHERICHIA COLI ENTEROINVASIVE TOXIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5645 ESCHERICHIA COLI ENTEROPATHOGENIC TOXIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5643 ESCHERICHIA COLI ENTEROTOXIGENIC TOXIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2381 ESCHERICHIA COLI K1 AG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5641 ESCHERICHIA COLI PATHOGENICITY EVALUATION FOR DIARRHEA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5644 ESCHERICHIA COLI VEROTOXIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3155 ESTRADIOL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3158 ESTRIOL TOTAL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3158U ESTRIOL, TOTAL 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3156 ESTRIOL, UNCONJUGATED [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1830 ESTROGEN & PROGESTERONE RECEPTOR - PARAFFIN [IHC] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1831 ESTROGEN RECEPTOR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3166 FRACTIONATED ESTROGENS SERUM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3164 ESTROGENS, TOTAL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3154 ESTRONE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4126 ETHOSUXIMIDE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1210 EXTRACTABLE NUCLEAR AG (ENA) IGG AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5920 F-ACTIN IGG AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5983 FACTOR DEFICIENCY DETECTOR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1941 FACTOR II ACTIVITY [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1949 FACTOR IX ACTIVITY [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1964 FACTOR IX AG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1943 FACTOR V ACTIVITY [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4550 FACTOR V GENOTYPR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4552 FACTOR V HR-2 MUTATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1966 FACTOR V MUTATION [LEIDEN] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1945 FACTOR VII ACTIVITY [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1947 FACTOR VIII ACTIVITY [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
Page 17 of 59 * PORTIONS OF THIS PAGE HAVE BEEN OMITTED PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION. ATTACHMENT A UNILAB FFS AND CAP FEE SCHEDULE
- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- 1967 FACTOR VIII INACTIVATOR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1951 FACTOR X ACTIVITY [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1965 FACTOR X AG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1953 FACTOR XI ACTIVITY [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1955 FACTOR XII ACTIVITY [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1959 FACTOR XIIA, (ACTIVATED) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1957 FACTOR XIII ACTIVITY QUAL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8426 FASCIOLA IGG & IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8426C FASCIOLA IGG & IGM ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8421 FASCIOLA IGG ABS [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8421C FASCIOLA IGG ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9101 FEBRILE AGGLUTININS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4426 FECAL FAT (LIPIDS), QUALITATIVE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4427 FECAL FAT, QUANTITATIVE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2960 FECAL LEUKOCYTES [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3170 FERRITIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1440 FETAL FIBRONECTIN BY SEMI-QUANTITATIVE EIA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1440FPNY FETAL FIBRONECTIN BY SEMI-QUANTITATIVE EIA (FPNY) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8476 FEVER OF UNKNOWN ORIGIN ANTIBODY PANEL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4204 FIBRIN MONOMER, SOLUBLE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1426 FIBRINOGEN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5977 FIBRINOLYSIS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4208 FIBRINOLYTIC DEGRADATION PRODUCT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 12990 FIBROBLAST CULTURE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9301 FILARIA IGG & IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9301C FILARIA IGG & IGM ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2360 FILARIA ORGANISM DETECTION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2655 FLAVIVIRUS DETECTR REFLEX TO SPECIATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2654 FLAVIVIRUS RNA DETECTR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4921 FLECAINIDE [HPLC] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4904 FLUCONAZOLE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4950 FLUOXETINE & NORFLUOXETINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3522 FOLATE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3522B FOLATE RBC [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3174 FOLLICLE-STIMULATING HORMONE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2020 FOLLICLE-STIMULATING HORMONE & LUTEINIZING HORMONE EVAL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5362 FRAGILE X DNA PROBE ANALYSIS [SB/PCR] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5364 FRAGILE X DNA PROBE ANALYSIS WITH CHROMOSOME ANALYSIS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8171 FRANCISELLA TULARENSIS IGG, IGM & IGA ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8171C FRANCISELLA TULARENSIS IGG, IGM & IGA ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8166 FRANCISELLA TULARENSIS TOTAL ABS [AGGLUTININS] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3934 FRUCTOSAMINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2731 FUNGAL ABS [CF] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2731C FUNGAL ABS CSF [CF] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2780 FUNGAL ANTIBODY PANEL: INVASIVE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2780C FUNGAL ANTIBODY PANEL: INVASIVE CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2785 FUNGAL ANTIBODY PANEL: OPPORTUNISTIC [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2785C FUNGAL ANTIBODY PANEL: OPPORTUNISTIC CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2790 FUNGAL ANTIBODY PANEL: SYSTEMIC [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2790C FUNGAL ANTIBODY PANEL: SYSTEMIC CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7224 FUNGAL IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7224C FUNGAL IGG ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7221 FUNGAL IGG, IGM & IGA ABS [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7221C FUNGAL IGG, IGM & IGA ABS CSF [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
Page 18 of 59 * PORTIONS OF THIS PAGE HAVE BEEN OMITTED PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION. ATTACHMENT A UNILAB FFS AND CAP FEE SCHEDULE
- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- 5322 FUNGUS CULTURE & STAIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5779 FUNGUS CULTURE: YEAST SCREEN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5324 FUNGUS IDENTIFICATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5690 FUNGUS IDENTIFICATION, EXOANTIGEN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2940 FUNGUS IDENTIFICATION, RRNA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2941 FUNGAL STAIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5662FC FUNGUS SUSCEPTIBILITY CUSTOM MIC & MFC: 5-FLUOROCYTOSINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5662AM FUNGUS SUSCEPTIBILITY CUSTOM MIC & MFC: AMPHOTERICIN B [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5662FL FUNGUS SUSCEPTIBILITY CUSTOM MIC & MFC: FLUCONAZOLE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5662IT FUNGUS SUSCEPTIBILITY CUSTOM MIC & MFC: ITRACONAZOLE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5662KE FUNGUS SUSCEPTIBILITY CUSTOM MIC & MFC: KETOCONAZOLE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5662MI FUNGUS SUSCEPTIBILITY CUSTOM MIC & MFC: MICONAZOLE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5661FC FUNGUS SUSCEPTIBILITY CUSTOM MIC: 5-FLUOROCYTOSINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5661AM FUNGUS SUSCEPTIBILITY CUSTOM MIC: AMPHOTERICIN B [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5661FL FUNGUS SUSCEPTIBILITY CUSTOM MIC: FLUCONAZOLE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5661IT FUNGUS SUSCEPTIBILITY CUSTOM MIC: ITRACONAZOLE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5661KE FUNGUS SUSCEPTIBILITY CUSTOM MIC: KETOCONAZOLE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5661MI FUNGUS SUSCEPTIBILITY CUSTOM MIC: MICONAZOLE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5660 FUNGUS SUSCEPTIBILITY: MIC PANEL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3364 GABAPENTIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4011 GANGLIOSIDE ASIALO-GM1 AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4011C GANGLIOSIDE ASIALO-GM1 ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4056 GANGLIOSIDE AUTOABS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4006 GANGLIOSIDE GD1A AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4041 GANGLIOSIDE GD1B AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4041C GANGLIOSIDE GD1B ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4058 GANGLIOSIDE GM1 TRIPLE EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4043 GANGLIOSIDE GQ1B AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1441 GANGLIOSIDE MONOSIALIC ACID AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1441C GANGLIOSIDE MONOSIALIC ACID ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5778 GARDNERELLA VAGINALIS & GRP B STREPTOCOCCUS CULTURE SCREEN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3176 GASTRIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4901 GENTAMICIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4901P GENTAMICIN PEAK & TROUGH [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5302 GGT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2473 GIARDIA / CRYPTOSPORIDIUM AG DETECTION [DFA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7526 GIARDIA / CRYPTOSPORIDIUM AG DETECTION [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7760 GIARDIA LAMBLIA AG DETECTION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7726 GIARDIA LAMBLIA IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7751 GIARDIA LAMBLIA IGG, IGM & IGA ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7751C GIARDIA LAMBLIA IGG, IGM & IGA ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7762 GIARDIASIS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2948 GIEMSA STAIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1286 GLIADIN IGA ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1266 GLIADIN IGG & IGA ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1261 GLIADIN IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1136 GLOMERULAR BASEMENT MEMBRANE IGG AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3616 GLUCAGON [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5301 GLUCOSE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5297 GLUCOSE 2HR POST PRANDIAL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5295 GLUCOSE 2HR TOLERANCE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5301C GLUCOSE CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5301P GLUCOSE, PLASMA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1398 GLUCOSE-6 PHOSPHATE DEHYDROGENASE (G-6-PDH) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1033 GLUTAMIC ACID DECARBOXYLASE (GAD) AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
Page 19 of 59 * PORTIONS OF THIS PAGE HAVE BEEN OMITTED PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION. ATTACHMENT A UNILAB FFS and CAP FEE SCHEDULE
- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- 1693 GLYCOPHORIN-A [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3181 GLYCOSYLATED ALBUMIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5667 GRAM NEG SUSCEPT RESIST PANEL URINE/NON-URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5665 GRAM NEGATIVE SUSCEPT PANEL: URINE/NON-URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5666 GRAM POSITIVE SUSCEPTIBILITY PANEL: URINE/NON-URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2438 GRAM STAIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1622 GRANULOCYTE AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1621 GRANULOCYTE COLONY STIMULATING FACTOR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3182 GROWTH HORMONE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3182M0 GROWTH HORMONE RESPONSE TEST, TIMED BASELINE SAMPLE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3182M1 GROWTH HORMONE RESPONSE TEST, TIMED SAMPLE #1 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3182M2 GROWTH HORMONE RESPONSE TEST, TIMED SAMPLE #2 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3182M3 GROWTH HORMONE RESPONSE TEST, TIMED SAMPLE #3 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3182M4 GROWTH HORMONE RESPONSE TEST, TIMED SAMPLE #4 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3182M5 GROWTH HORMONE RESPONSE TEST, TIMED SAMPLE #5 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3182M6 GROWTH HORMONE RESPONSE TEST, TIMED SAMPLE #6 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3182M7 GROWTH HORMONE RESPONSE TEST, TIMED SAMPLE #7 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2955 HAEMOPHILUS DUCREYI CULTURE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9606 HAEMOPHILUS INFLUENZAE B AG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9606C HAEMOPHILUS INFLUENZAE B AG CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9606U HAEMOPHILUS INFLUENZAE B AG URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9861P HAEMOPHILUS INFLUENZAE B IGG ABS, PRE/POST VACCINATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9861 HAEMOPHILUS INFLUENZAE B IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5637 HAEMOPHILUS INFLUENZAE SEROTYPING [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7506 HANTAVIRUS HANTAAN & PUUMALA IGG & IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7507 HANTAVIRUS HANTAAN & PUUMALA IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7508 HANTAVIRUS HANTAAN & PUUMALA IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7501 HANTAVIRUS HANTAAN IGG & IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7496 HANTAVIRUS PUUMALA IGG & IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1517 HAPTOGLOBIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4080 HEAVY METAL PANEL SERUM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4080U HEAVY METAL SCREEN 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4080UR HEAVY METAL SCREEN URINE RANDOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4080W HEAVY METAL SCREEN WHOLE BLOOD [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2443 HELICOBACTER PYLORI ANTIGEN, STOOL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2403 HELICOBACTER PYLORI CULTURE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7458 HELICOBACTER PYLORI CYTOTOXIN A IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7744 HELICOBACTER PYLORI EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7742 HELICOBACTER PYLORI EVALUATR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7986 HELICOBACTER PYLORI IGA ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7761 HELICOBACTER PYLORI IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7460 HELICOBACTER PYLORI IGG, IGM & IGA ABS & CYTOTOXIN A IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7741 HELICOBACTER PYLORI IGG, IGM & IGA ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7736 HELICOBACTER PYLORI IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7481 HELICOBACTER PYLORI TOTAL ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5369 HEMOCHROMATOSIS DNA GENOTYPR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5116 HEMOGLOBIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5112 HEMOGLOBIN & HEMATOCRIT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4972 HEMOGLOBIN A1C [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4972SR HEMOGLOBIN A1C W/SERIAL GRAPHICS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4974 HEMOGLOBIN A2, QUANTITATIVE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4987 HEMOGLOBIN ELECTROPHORESIS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4976 HEMOGLOBIN F, QUANTITATIVE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4978 HEMOGLOBIN S, SCREEN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4982 HEMOGLOBIN VARIANT SCREEN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
Page 20 of 59 * PORTIONS OF THIS PAGE HAVE BEEN OMITTED PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION. ATTACHMENT A UNILAB FFS and CAP FEE SCHEDULE
- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- 4984 HEMOGLOBIN VARIANT SCREEN REFLEX TO ELECTROPHORESIS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5964 HEMOPHILIA A CARRIER SCREEN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5969 HEMOPHILIA B CARRIER SCREEN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5943 HEPARIN ANTIFACTOR XA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5998 HEPARIN CO-FACTOR II (HCII) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5945 HEPARIN-INDUCED THROMBOCYTOPENIA (HIT ASSAY) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5318 HEPATIC FUNCTION PANEL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7756 HEPATITIS A & B VIRUS ACUTE EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2463 HEPATITIS A & B VIRUS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2451 HEPATITIS A VIRUS IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2460 HEPATITIS A VIRUS TOTAL & IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2450 HEPATITIS A VIRUS TOTAL ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2450R HEPATITIS A VIRUS TOTAL ABS W/REFLEX IGM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2464 HEPATITIS A, B & C VIRUS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7758 HEPATITIS A, B & C VIRUS POST EXPOSURE PANEL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7757 HEPATITIS ACUTE PROFILE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2457 HEPATITIS B VIRUS CORE IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2452 HEPATITIS B VIRUS CORE TOTAL ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2476 HEPATITIS B VIRUS CORE TOTAL ABS W/ REFLEX IGM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8141 HEPATITIS B VIRUS DNA DETECTR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8143 HEPATITIS B VIRUS DNA QUANTITATION BY BRANCHED DNA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8137 HEPATITIS B VIRUS DNA ULTRAQUANT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2461 HEPATITIS B VIRUS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8132 HEPATITIS B VIRUS GENOTYPR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2448 HEPATITIS B VIRUS SURFACE ANTIBODY QUANTITATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2454 HEPATITIS B VIRUS SURFACE ANTIGEN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2449 HEPATITIS B VIRUS SURFACE AG NEUTRALIZATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2470 HEPATITIS B VIRUS SURFACE AG WITHOUT NEUTRALIZATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2453 HEPATITIS B VIRUS SURFACE TOTAL ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2456 HEPATITIS BE VIRUS AG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2462 HEPATITIS BE VIRUS AG/AB EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2455 HEPATITIS BE VIRUS TOTAL ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2447 HEPATITIS C VIRUS ABS IMMUNOBLOT [RIBA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2447B HEPATITIS C VIRUS ABS IMMUNOBLOT + BANDS [RIBA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7491 HEPATITIS C VIRUS EVALUATION [RIBA] WITH REFLEX PCR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7491B HEPATITIS C VIRUS EVALUATION + BANDS [RIBA] WITH REFLEX PCR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2446 HEPATITIS C VIRUS IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2445 HEPATITIS C VIRUS IGG ABS W/REFLEX RIBA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2445B HEPATITIS C VIRUS IGG ABS W/REFLEX RIBA + BANDS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7486 HEPATITIS C VIRUS ACCUQUANT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7476 HEPATITIS C VIRUS RNA ACCUQUANT REFLEX SUBTYPR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7486SR HEPATITIS C VIRUS RNA ACCUQUANT W/SERIAL GRAPHICS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7476SR HEPATITIS C VIRUS RNA ACCUQUANT W/ RFX SUBTYPR W/SER GRAPH [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7516 HEPATITIS C VIRUS RNA DETECTR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7518 HEPATITIS C VIRUS RNA DETECTR WITH REFLEX QUANT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7474 HEPATITIS C VIRUS RNA QUANT BY BRANCHED DNA W/RFX ULTRAQUANT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7472 HEPATITIS C VIRUS RNA QUANTITATION BY BRANCHED DNA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7576 HEPATITIS C VIRUS RNA ULTRAQUANT [PCR] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7578 HEPATITIS C VIRUS ULTRAQUANT W/REFLEX TO HCV SUBTYPR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7576SR HEPATITIS C VIRUS RNA ULTRAQUANT [PCR] W/SERIAL GRAPHICS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7578SR HEPATITIS C VIRUS RNA W/SERIAL GRAPH RFX TO HCV SUBTYPR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7473 HEPATITIS C VIRUS SUBTYPR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8131 HEPATITIS DELTA VIRUS AG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2459 HEPATITIS DELTA VIRUS IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7514 HEPATITIS DELTA VIRUS RNA DETECTR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
Page 21 of 59 * PORTIONS OF THIS PAGE HAVE BEEN OMITTED PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION. ATTACHMENT A UNILAB FFS and CAP FEE SCHEDULE
- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- 2465 HEPATITIS DELTA VIRUS TOTAL & IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2458 HEPATITIS DELTA VIRUS TOTAL ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2466 HEPATITIS E VIRUS IGG AND IGM ABS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2467 HEPATITIS E VIRUS IGG ANTIBODIES [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2469 HEPATITIS E VIRUS IGM ANTIBODIES [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2468 HEPATITIS G VIRUS RNA DETECTR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5842 HER-2/NEU [IHC] AND GENE AMPLIFICATION [FISH] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5846 HER-2/NEU [IHC] REFLEX TO GENE AMPLIFICATION [FISH] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5836 HER-2/NEU GENE AMPLIFICATION [FISH] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5965 HEREDITARY THROMBOSIS SCREEN A, NO HEPARIN OR COUMADIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5966 HEREDITARY THROMBOSIS SCREEN B, PATIENTS ON COUMADIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7581 HERPES SIMPLEX VIRUS DNA DETECTR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9474 HERPES SIMPLEX VIRUS DNA ULTRAQUANT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9474C HERPES SIMPLEX VIRUS DNA ULTRARAPID CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9517 HERPES SIMPLEX VIRUS ENCEPHALITIS ACCUDX [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9515 HERPES SIMPLEX VIRUS IGG ANTIBODY INDEX [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9491 HERPES SIMPLEX VIRUS SERODX, TYPES 1 & 2-SPECIFIC IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2571 HERPES SIMPLEX VIRUS TOTAL ABS [CF] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2571C HERPES SIMPLEX VIRUS TOTAL ABS CSF [CF] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9476 HERPES SIMPLEX VIRUS TYPE 1 IGG & IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9476C HERPES SIMPLEX VIRUS TYPE 1 IGG & IGM ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9451 HERPES SIMPLEX VIRUS TYPE 1 IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9451C HERPES SIMPLEX VIRUS TYPE 1 IGG ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9456 HERPES SIMPLEX VIRUS TYPE 1 IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9456C HERPES SIMPLEX VIRUS TYPE 1 IGM ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9481 HERPES SIMPLEX VIRUS TYPE 2 IGG & IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9481C HERPES SIMPLEX VIRUS TYPE 2 IGG & IGM ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9461 HERPES SIMPLEX VIRUS TYPE 2 IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9461C HERPES SIMPLEX VIRUS TYPE 2 IGG ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9466 HERPES SIMPLEX VIRUS TYPE 2 IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9466C HERPES SIMPLEX VIRUS TYPE 2 IGM ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9496 HERPES SIMPLEX VIRUS TYPES 1 & 2 ACCUDX [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2426 HERPES SIMPLEX VIRUS TYPES 1 & 2 AG DETECTION [DFA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2402 HERPES SIMPLEX VIRUS TYPES 1 & 2 CULTURE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8051 HERPES SIMPLEX VIRUS TYPES 1 & 2 IGG & IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8051C HERPES SIMPLEX VIRUS TYPES 1 & 2 IGG & IGM ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9446 HERPES SIMPLEX VIRUS TYPES 1 & 2 IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9446C HERPES SIMPLEX VIRUS TYPES 1 & 2 IGG ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9471 HERPES SIMPLEX VIRUS TYPES 1 & 2 IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9471C HERPES SIMPLEX VIRUS TYPES 1 & 2 IGM ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7494 HERPESVIRUS-6 HUMAN DNA DETECTR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7776 HERPESVIRUS-6 HUMAN IGG & IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7776C HERPESVIRUS-6 HUMAN IGG & IGM ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7786 HERPESVIRUS-6 HUMAN IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7786C HERPESVIRUS-6 HUMAN IGG ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7796 HERPESVIRUS-6, HUMAN IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7796C HERPESVIRUS-6 HUMAN IGM ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7777 HERPESVIRUS-7, HUMAN IGG & IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7775 HERPESVIRUS-7, HUMAN IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7778 HERPESVIRUS-7, HUMAN IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7784 HERPESVIRUS-8, HUMAN ANTIBODIES [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7785 HERPESVIRUS-8, HUMAN DNA DETECTR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9095 HETEROPHILE AGGLUTINATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3188 HIRSUTISM EVALUATION, FEMALE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3354 HISTAMINE WHOLE BLOOD [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
Page 22 of 59 * PORTIONS OF THIS PAGE HAVE BEEN OMITTED PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION. ATTACHMENT A UNILAB FFS and CAP FEE SCHEDULE
- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- 1140 HISTONE-DNA COMPLEX IGG AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2581 HISTOPLASMA ABS [CF] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2581C HISTOPLASMA ABS CSF [CF] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2334 HISTOPLASMA ABS [DD] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2334C HISTOPLASMA ABS CSF [DD] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8315UR HISTOPLASMA ANTIGEN DETECTR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7587 HISTOPLASMA DNA DETECTR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8312 HISTOPLASMA IGG ANTIBODIES [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7705 HISTOPLASMA IGG ANTIBODY INDEX [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8311 HISTOPLASMA IGG, IGM & IGA ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8311C HISTOPLASMA IGG, IGM & IGA ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8313 HISTOPLASMA IGM ANTIBODIES [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3015B HIV-1 & 2 ABS IMMUNOBLOT + BANDS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3015 HIV-1 & 2 IGG ABS IMMUNOBLOT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3012 HIV-1 ABS IMMUNOBLOT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3012B HIV-1 ABS IMMUNOBLOT + BANDS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3013B HIV-1 ABS IMMUNOBLOT + BANDS RFX HIV-2 ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3021B HIV-1 ABS IMMUNOBLOT + BANDS W/RFX HIV-2 ABS IB + BANDS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3012NYB HIV-1 ABS IMMUNOBLOT + BANDS NEW YORK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3012C HIV-1 ABS IMMUNOBLOT CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3021 HIV-1 ABS IMMUNOBLOT W/RFX HIV-2 ABS IB [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3012NY HIV-1 ABS IMMUNOBLOT NEW YORK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5721AZT HIV-1 ANTI-VIRAL DRUG STUDY: AZT IC50 VALUE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5721DDC HIV-1 ANTI-VIRAL DRUG STUDY: DDC IC50 VALUE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5721DDI HIV-1 ANTI-VIRAL DRUG STUDY: DDI IC50 VALUE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5723 HIV-1 ANTI-VIRAL DRUG STUDY: PHENOTYPIC RESISTANCE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5725 HIV-1 CULTURE, QUALITATIVE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5727 HIV-1 CULTURE, QUANTITATIVE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5729 HIV-1 CULTURE, QUANTITATIVE PLASMA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9885 HIV-1 DNA DETECTR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9885NYP HIV-1 DNA DETECTR NEW YORK PROGNOSTIC [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9885N HIV-1 DETECTR NON-BLOOD [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9881 HIV-1 FREE AG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9881C HIV-1 FREE AG CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9881NYD HIV-1 FREE NEW YORK DIAGNOSTIC [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9881NYP HIV-1 FREE NEW YORK PROGNOSTIC [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7479 HIV-1 GENOTYPR (PROTEASE INHIBITOR) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7479NY HIV-1 GENOTYPR (PROTEASE INHIBITOR) NEW YORK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7477 HIV-1 GENOTYPR (REVERSE TRANSCRIPTASE INHIBITOR) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7477NY HIV-1 GENOTYPR (REVERSE TRANSCRIPTASE INHIBITOR) NEW YORK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7480 HIV-1 GENOTYPR PLUS (REV TRANS & PROT INHIB) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7480NY HIV-1 GENOTYPR PLUS (REV TRANS & PROT INHIB) NEW YORK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3080 HIV-1 IMMUNE STATUS MONITOR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5732 HIV-1 PROVIRAL DNA ACCUQUANT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9884A HIV-1 RNA QUANT BY ROCHE AMPLICOR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9884ASR HIV-1 RNA QUANT BY ROCHE AMPLICOR W/SERIAL REPORTING [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7478NY HIV-1 RNA QUANT BY ROCHE REFLEX HIV GENOTYPR RTI NEW YORK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7482NY HIV-1 RNA QUANT BY ROCHE REFLEX GENOTYPR PLUS (NY) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7483NY HIV-1 RNA QUANT BY ROCHE RFX HIV GENOTYPR PI NY [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7483A HIV-1 RNA QUANT BY ROCHE W/RFX ULTRASENS + GENOTYPR (PI) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7483ASR HIV-1 RNA QUANT BY ROCHE W/RFX ULTRASENS + GENO(PI) W/SR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9874A HIV-1 RNA QUANT BY ROCHE REFLX ULTRASENSITIVE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7482ASR HIV-1 RNA QUANT BY ROCHE RFX TO ULTRASENS + GENOTYPR W/SR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7478A HIV-1 RNA QUANT BY ROCHE W/REFLEX ULTRASENS+GENOTYPR (RTI) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7482NYSR HIV-1 RNA QUANT BY ROCHE RFX GENOTYPR PLUS W/SERIAL REP (NY) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
Page 23 of 59 * PORTIONS OF THIS PAGE HAVE BEEN OMITTED PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION. ATTACHMENT A UNILAB FFS AND CAP FEE SCHEDULE
- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- 7478NYSR HIV-1 RNA QUANT BY ROCHE REFLEX HIV GENOTYPR RTI NY W/ SER [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7482A HIV-1 RNA QUANT BY ROCHE RFX TO ULTRASENS + GENOTYPR PLUS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7478ASR HIV-1 RNA QUANT BY ROCHE W/REFLEX ULTRASENS+GENOTYPR W/SR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7485A HIV-1 RNA QUANT BY ROCHE ULTRASENSITIVE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7485ASR HIV-1 RNA QUANT BY ROCHE ULTRASENSITIVE W/SERIAL REP [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9874ASR HIV-1 RNA QUANT BY ROCHE W/REFLEX TO ULTRASENSITIVE W/SR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9886 HIV-1 RNA QUANTITATION BY BRANCHED DNA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9886NY HIV-1 RNA QUANTITATION BY BRANCHED DNA (NEW YORK) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9884NYP HIV-1 RNA QUANT BY ROCHE NEW YORK PROGNOSTIC [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9884NYPS HIV-1 RNA QUANT BY ROCHE NEW YORK PROGNOSTIC W/SER GRAPH [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9874 HIV-1 RNA ULTRAQUANT [BDNA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9872 HIV-1 RNA ULTRAQUANT [BDNA] & CD4 CELL COUNT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9872SR HIV-1 RNA ULTRAQUANT [BDNA] & CD4 CELL COUNT W/SERIAL REPORT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9874NY HIV-1 RNA ULTRAQUANT NEW YORK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7483SR HIV-1 RNA ULTRAQUANT [BDNA] W/RFX HIV GENOTYPR(PI) W/SER GR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7478 HIV-1 RNA ULTRAQUANT [BDNA] W/REFLEX HIV GENOTYPR (RTI) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7478SR HIV-1 RNA ULTRAQUANT [BDNA] REFLEX HIV GENOTYPR W/SER GRAPH [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7483 HIV-1 RNA ULTRAQUANT [BDNA] W/RFX HIV GENOTYPR (PI) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7482 HIV-1 RNA ULTRAQUANT [BDNA] W/RFX HIV GENOTYPR PLUS (RTI+PI) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7482SR HIV-1 RNA ULTRAQUANT [BDNA] W/RFX HIV GENOTYPR PLUS W/SER GR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7483NYSR HIV-1 RNA QUANT BY ROCHE RFX HIV GENOTYPR PI NY W/SER GRAPH [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9874SR HIV-1 RNA ULTRAQUANT [BDNA] W/SERIAL REPORTING [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9846 HIV-1 TOTAL AG, IMMUNE COMPLEX DISRUPTION (ICD) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3019B HIV-1/HIV-2 ABS W/REFLEX IMMUNOBLOT + BANDS (PRIORITY) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9915 HIV-1/HIV-2 ABS W/REFLEX IMMUNOBLOT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9915B HIV-1/HIV-2 ABS W/REFLEX IMMUNOBLOT + BANDS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9915NYB HIV-1/HIV-2 ABS W/REFLEX IMMUNOBLOT + BANDS NEW YORK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9915NY HIV-1/HIV-2 ABS W/REFLEX IMMUNOBLOT NEW YORK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9876NY HIV-2 DNA DETECTOR QUAL NEW YORK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9876 HIV-2 DNA DETECTR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9926 HIV-2 IGG ABS IMMUNOBLOT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9926B HIV-2 IGG ABS IMMUNOBLOT + BANDS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9926C HIV-2 IGG ABS CSF IMMUNOBLOT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9921 HIV-2 IGG ABS W/ REFLEX IB [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9921B HIV-2 IGG ABS W/ REFLEX IB + BANDS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9921NY HIV-2 IGG ABS W/ REFLEX IB NEW YORK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1364 HLA-B27 GENOTYPR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1349 HLA: A & B TYPING, COMPLETE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1356 HLA: A OR B SINGLE ANTIGEN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1351 HLA: A, B & C TYPING, COMPLETE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1035 HLA: A, B, C & DR TYPING, COMPLETE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1350 HLA: B27 TYPING [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1362 HLA: B5 TYPING [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1363 HLA: B7 TYPING [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1354 HLA: B8 TYPING, PRIMARY SCLEROSING CHOLANGITIS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1355 HLA: DIABETES-ASSOCIATED [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1357 HLA: DR SINGLE ANTIGEN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1352 HLA: DR TYPING, COMPLETE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1706 HLA: DR2 & DQ1 - NARCOLEPSY EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1353 HLA: DR3 TYPING, CELIAC DISEASE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1366 HLA-A LOCUS BY PCR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1367 HLA-B LOCUS BY PCR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3334 HOMOCYSTEINE ULTRAQUANT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3334U HOMOCYSTEINE ULTRAQUANT URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3946 HOMOVANILLIC ACID 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
Page 24 of 59 * PORTIONS OF THIS PAGE HAVE BEEN OMITTED PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION. ATTACHMENT A UNILAB FFS AND CAP FEE SCHEDULE
- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- 3947 HOMOVANILLIC ACID, PEDIATRIC [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3946UR HOMOVANILLIC ACID RANDOM URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9898 HTLV I/II IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9898C HTLV I / II IGG ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9899 HTLV I/II IGG ABS W/ REFLEX HTLV I/II IB + BANDS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7780 HTLV I/II ABS IMMUNOBLOT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7780B HTLV I/II ABS IMMUNOBLOT + BANDS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7780CB HTLV I/II ABS IMMUNOBLOT + BANDS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7780C HTLV I/II ABS IMMUNOBLOT CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9896 HTLV-I/II DNA DETECTR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5915 HUMAN ANTI-MOUSE ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3184 HUMAN CHORIONIC GONADOTROPIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3184C HUMAN CHORIONIC GONADOTROPIN CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3184F HUMAN CHORIONIC GONADOTROPIN FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3184SR HUMAN CHORIONIC GONADOTROPIN W/SERIAL GRAPHICS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1638 HUMAN MIXED LYMPHOCYTE REACTION, ONE WAY (MLR) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1639 HUMAN MIXED LYMPHOCYTE REACTION, TWO WAY (MLR) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1820 HUMAN PAPILLOMAVIRUS DETECTR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1824 HUMAN PAPILLOMAVIRUS DETECTR REFLEX TO GENOTYPR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1822 HUMAN PAPILLOMAVIRUS GENOTYPR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3186 HUMAN PLACENTAL LACTOGEN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1086 HUMORAL IMMUNE EVAL + H. INFLUENZAE B [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1086P HUMORAL IMMUNE EVAL + H. INFLUENZAE B, PRE/POST VACC [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1086/12 HUMORAL IMMUNE EVAL + PNEUMO 12 & H. INFLUENZAE B [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1043 HUMORAL IMMUNE EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1043/12 HUMORAL IMMUNE EVALUATION (PNEUMO 12) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1043P/12 HUMORAL IMMUNE EVALUATION (PNEUMO 12), PRE/POST VACC [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1043P HUMORAL IMMUNE EVALUATION, PRE/POST VACC [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1048/12 HUMORAL IMMUNE STATUS SURVEY (PNEUMO 12) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1048P/12 HUMORAL IMMUNE STATUS SURVEY (PNEUMO 12) PRE/POST VACC [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1048 HUMORAL IMMUNE STATUS SURVEY (PNEUMO 4) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1048P HUMORAL IMMUNE STATUS SURVEY (PNEUMO 4) PRE/POST VACC [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1481 HYALURONIC ACID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1481F HYALURONIC ACID FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3261 HYPERALDOSTERONISM EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8157 HYPERSENSITIVITY EVALUATION II [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8156 HYPERSENSITIVITY PNEUMONITIS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3264 HYPERTENSION IV: CUSHING SYNDROME EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1506 IGA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1498 IGA AUTOANTIBODIES TO IGG & IGM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1498C IGA (AUTOANTIBODIES) IGG & IGM ABS PANEL CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1896 IGA (LOC) CNS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1506U IGA 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1431 IGA FIBRONECTIN AGGREGATES & SERUM IGA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1506F IGA FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1436 IGA NEPHROPATHY EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1931 IGA SUBCLASS 1 & 2 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1506UR IGA URINE RANDOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1045C IGA, IGG & IGM QUANTITATION CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1045 IGA, IGG & IGM IMMUNOGLOBULIN QUANTITATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1466C IGA CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1145 IGD [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1145F IGD FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1245 IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1245F IGE FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
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- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- 1505 IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1505U IGG 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1505C IGG CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1505F IGG FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1625 IGG SUBCLASS 1 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1627 IGG SUBCLASS 2 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1628 IGG SUBCLASS 3 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1629 IGG SUBCLASS 4 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1623 IGG SUBCLASS 1, 2, 3, & 4 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3587 IGG SUBCLASS 2 & 4 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1550 IGG SYNTHESIS RATE, CNS WITH INDEX [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1505UR IGG URINE RANDOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1438 IGG-FIBRONECTIN AGGREGATE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1508 IGM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1891 IGM (LOC) CNS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1508U IGM 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1461C IGM CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1508F IGM FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1508UR IGM URINE RANDOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC161BK IHC ACTH BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC71BK IHC AFP BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC184BK IHC AMYLOID A BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC1 IHC ASSAY [PATHOLOGIST INTERPRETATION] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC14BK IHC BCL-2 BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC73BK IHC BETA-HCG BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC171BK IHC CALCITONIN BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1852 IHC CATHEPSIN D BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC30BK IHC CD15 BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC22BK IHC CD20 (PAN-B CELL) BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC23BK IHC CD3 (PAN-T CELL) BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC29BK IHC CD30 (KI-1) BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC25BK IHC CD4 (T-HELPER CELL) BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC24BK IHC CD43 BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC21BK IHC CD45 (LCA) BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC33BK IHC CD45RA BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC35BK IHC CD45RO BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC39BK IHC CD57 BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC26BK IHC CD68 BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC43BK IHC CEA BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC81BK IHC CHROMOGRANIN BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC185BK IHC COLLAGEN TYPE IV BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC45BK IHC CYTOKERATIN (HMW) BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC46BK IHC CYTOKERATIN (LMW) BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC153BK IHC CYTOKERATIN 7 BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC93BK IHC DESMIN BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1834 IHC EGFR BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC49BK IHC EMA BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC01BK IHC ESTROGEN RECEPTOR BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC97BK IHC FACTOR VIII AG BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC162BK IHC FSH BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC89BK IHC GASTRIN BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC84BK IHC GFAP BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC163BK IHC GH BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC88BK IHC GLUCAGON BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC130BK IHC HAM 56 MACROPHAGE BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
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- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC04BK IHC HER-2/NEU BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC62BK IHC HMB-45 (MELANOMA) BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC87BK IHC INSULIN BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC31BK IHC KAPPA LIGHT CHAIN BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC06BK IHC KI-67 BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC32BK IHC LAMBDA LIGHT CHAIN BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC164BK IHC LH BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC131BK IHC LYSOZYME BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC28BK IHC MAC387 BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC00 IHC MARKER [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC00A IHC MARKER [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC00B IHC MARKER [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC00C IHC MARKER [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC95BK IHC MYOGLOBIN BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC85BK IHC NEUROFILAMENT BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC48BK IHC NSE BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC57BK IHC OC125 BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC08BK IHC P53 BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC50BK IHC PANCREATIC AMYLASE BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC55BK IHC PAN-CYTOKERATIN BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC42BK IHC PAP BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC10BK IHC PCNA BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC74BK IHC PLACENTAL ALKALINE PHOSPHATASE BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC02BK IHC PROGESTERONE RECEPTOR BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC165BK IHC PROLACTIN BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC07BK IHC PS2 BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC41BK IHC PSA (PROSTATE-SPECIFIC AG) BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC61BK IHC S-100 BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC82BK IHC SEROTONIN BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC92BK IHC SMOOTH MUSCLE BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC86BK IHC SYNAPTOPHYSIN BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC170BK IHC THYROGLOBULIN BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC166BK IHC TSH BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- IHC47BK IHC VIMENTIN BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4932 IMIPRAMINE & DESIPRAMINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1401 IMMUNE COMPLEX ASSAY, FLUID PHASE, C1Q BINDING [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1401F IMMUNE COMPLEX ASSAY, FLUID PHASE, C1Q BINDING FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1403 IMMUNE COMPLEX ASSAY, POLYETHYLENE GLYCOL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1403F IMMUNE COMPLEX ASSAY, POLYETHYLENE GLYCOL FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1230 IMMUNE COMPLEX ASSAY, RAJI CELL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1230F IMMUNE COMPLEX ASSAY, RAJI CELL FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1340 IMMUNE STATUS PANEL - DPT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1341 IMMUNE STATUS PANEL - MMR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1882 IMMUNOGLOBULIN GENE REARRANGEMENT, HEAVY-CHAIN JH PROBE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1884 IMMUNOGLOBULIN GENE REARRANGEMENT, KAPPA LIGHT-CHAIN [SB] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3462 IMMUNOREACTIVE TRYPSIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3856 IMMUNOSUPPRESSIVE ACIDIC PROTEIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4965 INDINAVIR MONITR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7536 INFECTIOUS GASTROENTERITIS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2016 INFERTILITY: ENDOCRINE EVALUATION (FEMALE) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2017 INFERTILITY: ENDOCRINE EVALUATION (MALE) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2594 INFLUENZA A & B RNA MULTIPLEXR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8521 INFLUENZA EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8516 INFLUENZA VIRUS A & B IGG, IGM & IGA ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8516C INFLUENZA VIRUS A & B IGG, IGM & IGA ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
Page 27 of 59 * PORTIONS OF THIS PAGE HAVE BEEN OMITTED PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION. ATTACHMENT A UNILAB FFS AND CAP FEE SCHEDULE
- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- 2586 INFLUENZA VIRUS ABS, TYPE A [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2586C INFLUENZA VIRUS ABS, TYPE A CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2591 INFLUENZA VIRUS ABS, TYPE B [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2591C INFLUENZA VIRUS ABS, TYPE B CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2741 INFLUENZA VIRUS ABS, TYPES A & B [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2741C INFLUENZA VIRUS ABS, TYPES A & B CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2423 INFLUENZA TYPES A & B DETECTION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3984 INHIBIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3192 INSULIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3876 INSULIN ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3193 INSULIN FREE AND BOUND [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3959 INSULIN-LIKE GROWTH FACTOR BINDING PROTEIN (IGFBP-3) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3220 INSULIN-LIKE GROWTH FACTOR I [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3290 INTERFERON-ALPHA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3290C INTERFERON-ALPHA CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3295 INTERFERON-BETA AUTOABS (ANTI-INTERFERON-B) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3292 INTERFERON GAMMA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3868 INTERLEUKIN-1 BETA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3868C INTERLEUKIN-1 BETA CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3816 INTERLEUKIN-1 RA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3823 INTERLEUKIN-10 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3812 INTERLEUKIN-12 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3870 INTERLEUKIN-2 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3870C INTERLEUKIN-2 CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3832C INTERLEUKIN-2 RECEPTOR, SOLUBLE CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3832 INTERLEUKIN-2 RECEPTOR, SOLUBLE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3832SF INTERLEUKIN-2 RECEPTOR, SOLUBLE SYNOVIAL FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3814 INTERLEUKIN-4 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3827 INTERLEUKIN-5 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3828 INTERLEUKIN-6 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3822 INTERLEUKIN-8 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3822BW INTERLEUKIN-8 BRONCHIAL WASH [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3196 INTRINSIC FACTOR BLOCKING AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3532 IRON [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3534 IRON BINDING CAPACITY & % SATURATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3536 IRON LIVER TISSUE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3535 IRON STATUS MONITR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3069 ISLET CELL AUTOABS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3066 ISLET CELL AUTOANTIBODIES, COMPLEMENT FIXING [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1165 ISLET CELL IGG CYTOPLASMIC AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1166 ISLET CELL IGG CYTOPLASMIC ABS W/ REFLEX INSULIN AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3356 ISOHEMAGGLUTININ TITER [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 12995W ISOLATION OF LYMPHOCYTES (CELLULAR IMMUNOLOGY) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4915 ISONIAZID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4915P ISONIAZID PEAK & TROUGH [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4905 ITRACONAZOLE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7596 JAPANESE ENCEPHALITIS VIRUS TOTAL ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7596C JAPANESE ENCEPHALITIS VIRUS TOTAL ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8145 JC VIRUS DNA DETECTR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8147 JC VIRUS ULTRAQUANT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8147C JC VIRUS DNA ULTRARAPID CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1207 JO-1 AUTOABS [DD] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1281 JO-1 IGG AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1208 JO-1 IGG AUTOABS [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1741UR KAPPA & LAMBDA LIGHT CHAIN URINE RANDOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
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- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- 1741U KAPPA & LAMBDA LIGHT CHAIN, QUANT 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1731UR KAPPA LIGHT CHAIN URINE RANDOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1731U KAPPA LIGHT CHAIN, QUANT 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4906 KETOCONAZOLE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4168 KIDNEY STONE RISK ASSESSR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1222 KU AUTOANTIBODIES [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3452 LACTATE DEHYDROGENASE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3453 LACTATE DEHYDROGENASE (LD) ISOENZYMES [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4128 LACTIC ACID PLASMA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1736UR LAMBDA LIGHT CHAIN URINE RANDOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1736U LAMBDA LIGHT CHAIN, QUANT 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4966 LAMIVUDINE (3TC) MONITR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4196 LAMOTRIGINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4861U LEAD 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4861C LEAD CAPILLARY [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4861I LEAD WHOLE BLOOD, INDUSTRIAL - OSHA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4861 LEAD [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4861UR LEAD URINE RANDOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4861W LEAD WHOLE BLOOD [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4863 LEAD WHOLE BLOOD AND ZINC PROTOPORPHYRIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4861NY LEAD WHOLE BLOOD NEW YORK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4861IX LEAD WHOLE BLOOD, INDUSTRIAL - OSHA PRIORITY [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4861X LEAD WHOLE BLOOD (PRIORITY) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2504 LEGIONELLA CULTURE: ENVIRONMENTAL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2152 LEGIONELLA NON-PNEUMOPHILA IGG & IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2422 LEGIONELLA PNEUMOPHILA AG DETECTION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9501 LEGIONELLA PNEUMOPHILA AG DETECTION URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2920 LEGIONELLA PNEUMOPHILA DNA DETECTR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2432 LEGIONELLA PNEUMOPHILA EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2153 LEGIONELLA PNEUMOPHILA IGG & IGM ABS, SEROTYPES 1-14 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2156 LEGIONELLA PNEUMOPHILA IGG & IGM ABS, SEROTYPES 1-6 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2156F LEGIONELLA PNEUMOPHILA IGG & IGM ABS, SEROTYPES 1-6 FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2154 LEGIONELLA PNEUMOPHILA IGG ABS, SEROTYPES 1-14 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2159 LEGIONELLA PNEUMOPHILA IGM ABS, SEROTYPES 1-14 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8246 LEGIONELLA PNEUMOPHILA TOTAL ABS, POOLED SEROTYPES 1-6 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8246C LEGIONELLA PNEUMOPHILA TOTAL ABS, POOLED SEROTYPES CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2404 LEGIONELLA SPP. CULTURE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3420 LEISHMANIA IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2398 LEPTOSPIRA CULTURE & DARKFIELD MICROSCOPY [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7621 LEPTOSPIRA IGG & IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7621C LEPTOSPIRA IGG & IGM ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7546 LEPTOSPIRA IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7551 LEPTOSPIRA IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7626 LEPTOSPIROSIS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1670 LEUKEMIA/LYMPHOMA BLOOD EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1672 LEUKEMIA/LYMPHOMA EVALUATION W/ REFLEX WHOLE BLOOD [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1667 LEUKEMIA/LYMPHOMA BONE MARROW EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1674 LEUKEMIA/LYMPHOMA EVALUATION BLOOD [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1679 LEUKEMIA/LYMPHOMA EVALUATION, BONE MARROW OR TISSUE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1682 LEUKEMIA/LYMPHOMA PANEL, CHRONIC BONE MARROW OR TISSUE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1666 LEUKEMIA/LYMPHOMA TISSUE OR BODY FLUID EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1676 LEUKEMIA/LYMPHOMA, COMPREHENSIVE WHOLE BLOOD [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1677 LEUKEMIA/LYMPHOMA, COMPREHENSIVE BONE MARROW OR TISSUE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3978 LEUKOCYTE ALKALINE PHOSPHATASE STAIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3320 L-GLUTAMINE CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
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- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- 4130 LIDOCAINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3369 LIPASE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3369U LIPASE URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3858 LIPID-ASSOCIATED SIALIC ACID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3858SR LIPID-ASSOCIATED SIALIC ACID W/SERIAL GRAPHICS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3446 LIPOPROTEIN [A] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3446E LIPOPROTEIN [A] END-POINT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3445 LIPOPROTEIN ELECTROPHORESIS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8841 LISTERIA MONOCYTOGENES ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8841C LISTERIA MONOCYTOGENES ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8251 LISTERIA MONOCYTOGENES IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8251C LISTERIA MONOCYTOGENES IGG ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7685 LISTERIA MONOCYTOGENES IGG ANTIBODY INDEX [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4871U LITHIUM 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4871 LITHIUM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4871UR LITHIUM URINE RANDOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5922 LIVER CYTOSOL AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1115 LIVER-KIDNEY-MICROSOME AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5923 LIVER-SPECIFIC MEMBRANE LIPOPROTEIN AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1094 LUPUS ACTIVITY REPORTER [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1911 LUPUS ANTICOAGULANT: DRVVT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1915 LUPUS ANTICOAGULANT: HEXAGONAL PHASE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5963 LUPUS ANTICOAGULANT: SCREEN 1 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5976 LUPUS ANTICOAGULANT: SCREEN 2 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5962 LUPUS ANTICOAGULANT: SCREEN 3 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5036 LUPUS CNS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1057 LUPUS CNS EVALUATION SERUM & CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5150 LUPUS ERYTHEMATOSUS CELL PREPARATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1096 LUPUS MONITOR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5045 LUPUS PREGNANCY MONITOR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5021 LUPUS RENAL EVALUATION #1 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5022 LUPUS RENAL EVALUATION #2 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5031 LUPUS RENAL EVALUATION A [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5023 LUPUS RENAL EVALUATION B [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3198 LUTEINIZING HORMONE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8968 LYME CO-INFECTION PANEL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2871 LYMPHADENOPATHY, INFECTIOUS IGM ABS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1062 LYMPHOCYTE ANTIGEN & MITOGEN PROLIFERATION ANALYSIS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1648 LYMPHOCYTE ANTIGEN PROLIFERATION ANALYSIS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1643 LYMPHOCYTE ANTIGEN PROLIFERATION ANALYSIS, CANDIDA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1645 LYMPHOCYTE ANTIGEN PROLIFERATION ASSAYS, PPD (TUBERCULIN) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1644 LYMPHOCYTE ANTIGEN PROLIFERATION ASSAYS, TETANUS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1671 LYMPHOCYTE ENUMERATION, BASIC [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1668 LYMPHOCYTE ENUMERATION, BASIC & NK CELLS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1656 LYMPHOCYTE ENUMERATION, HELPER/INDUCER [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1656SR LYMPHOCYTE ENUMERATION, HELPER/INDUCER W/SERIAL REPORT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1656NY LYMPHOCYTE ENUMERATION, HELPER/INDUCER WITHOUT CBC [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1657 LYMPHOCYTE ENUMERATION, HELPER/SUPPRESSOR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1659 LYMPHOCYTE ENUMERATION, HELPER/SUPPRESSOR - LIMITED [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1657NY LYMPHOCYTE ENUMERATION, HELPER/SUPPRESSOR WITHOUT CBC [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1660 LYMPHOCYTE ENUMERATION, NAIVE/MEMORY CELL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1658 LYMPHOCYTE ENUMERATION, T & B CELL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1655 LYMPHOCYTE ENUMERATION, T CELL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1060 LYMPHOCYTE MITOGEN PROLIFERATION ANALYSIS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1642 LYMPHOCYTE MITOGEN PROLIFERATION ANALYSIS, CON A [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
Page 30 of 59 * PORTIONS OF THIS PAGE HAVE BEEN OMITTED PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION. ATTACHMENT A UNILAB FFS AND CAP FEE SCHEDULE
- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- 1640 LYMPHOCYTE MITOGEN PROLIFERATION ANALYSIS, PHA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1641 LYMPHOCYTE MITOGEN PROLIFERATION ANALYSIS, PWM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 14505W LYMPHOCYTES ISOLATION AND STORAGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2601 LYMPHOCYTIC CHORIOMENINGITIS ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2601C LYMPHOCYTIC CHORIOMENINGITIS ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2606 LYMPHOGRANULOMA VENEREUM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2606C LYMPHOGRANULOMA VENEREUM ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8061 LYMPHOGRANULOMA VENEREUM ABS PANEL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1661 LYMPHOMA PANEL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4103 LYSERGIC ACID DIETHYLAMIDE (LSD) SCREEN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4103U LYSERGIC ACID DIETHYLAMIDE (LSD) SCREEN URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4070 LYSOSOMAL-ASSOCIATED MEMBRANE PROTEIN IGG AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3882 MACROPHAGE INFLAMMATORY PROTEIN-1 ALPHA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3883 MACROPHAGE INFLAMMATORY PROTEIN-1 BETA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4866U MAGNESIUM 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4866R MAGNESIUM RBC [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4866 MAGNESIUM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4866UR MAGNESIUM URINE RANDOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8371C MALARIA IGG & IGM ABS CSF [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8370 MALARIA DNA DETECTR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8371 MALARIA IGG & IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2945 MALARIA ORGANISM DETECTION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4872 MANGANESE SERUM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4872U MANGANESE 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4872R MANGANESE RBC [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4872UR MANGANESE URINE RANDOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4872W MANGANESE WHOLE BLOOD [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3830 MANNOSE-BINDING PROTEIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8771 MEASLES IGG & IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8771C MEASLES IGG & IGM ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8776 MEASLES IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8776C MEASLES IGG ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8600 MEASLES IGG ANTIBODY INDEX [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8781 MEASLES IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8781C MEASLES IGM ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4994 MEGALOBLASTIC ANEMIA ASSESSR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4995 MEGALOBLASTIC ANEMIA EVALUATR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3857 MELANOMA MONITOR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3857SR MELANOMA MONITOR W/SERIAL GRAPHICS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2771 MENINGOENCEPHALOMYELITIS VIRAL ABS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2771C MENINGOENCEPHALOMYELITIS VIRAL ABS EVALUATION CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2771CS MENINGOENCEPHALOMYELITIS VIRAL ABS EVALUATION CSF & SERUM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4873U MERCURY 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4873 MERCURY [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4873UI MERCURY URINE INDUSTRIAL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4873UR MERCURY URINE RANDOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4873W MERCURY WHOLE BLOOD [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5315 METABOLIC PANEL, BASIC [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5317 METABOLIC PANEL, COMPREHENSIVE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3315 METANEPHRINES, FRACTIONATED 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3315UR METANEPHRINES, FRACTIONATION URINE RANDOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3316 METANEPHRINES, TOTAL 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3316UR METANEPHRINES TOTAL URINE RANDOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4134U METHADONE URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4135 METHOTREXATE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
Page 31 of 59 * PORTIONS OF THIS PAGE HAVE BEEN OMITTED PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION. ATTACHMENT A UNILAB FFS AND CAP FEE SCHEDULE
- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- 3496 METHYLMALONIC ACID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3496U METHYLMALONIC ACID URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3241 MI-2 AUTOANTIBODIES [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3442 MICROALBUMIN URINE RANDOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3441 MICROALBUMIN 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3051 MICROMETASTASES DETECTR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5720 MICROSPORIDIA SPORE STAIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4165 MINERALS ANALYSIS RBC W/ K+ [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1102 MITOCHONDRIAL TOTAL AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4880W MOLYBDENUM WHOLE BLOOD [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3125C MONOCLONAL GAMMOPATHIES, CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3125 MONOCLONAL GAMMOPATHIES SERUM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3125U MONOCLONAL GAMMOPATHIES URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4021 MOTOR & SENSORY NEUROPATHY EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4021C MOTOR & SENSORY NEUROPATHY EVALUATION CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4020 MOTOR & SENSORY NEUROPATHY EVALUATR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4026 MOTOR NEUROPATHY EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4026C MOTOR NEUROPATHY EVALUATION CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2050 MRZ REACTION EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4559 MTHFR A1298C MUTATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1055 MULTIPLE SCLEROSIS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9711 MUMPS IGG & IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9711C MUMPS IGG & IGM ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9716 MUMPS IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9716C MUMPS IGG ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9721 MUMPS IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9721C MUMPS IGM ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9728 MUMPS RNA DETECTOR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1025 MYASTHENIA GRAVIS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7475 MYCOBACTERIUM TUBERCULOSIS DNA PCR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7470 MYCOBACTERIUM TUBERCULOSIS GENOTYPR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4910 MYCOPHENOLIC ACID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2399 MYCOPLASMA HOMINIS CULTURE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2929 MYCOPLASMA MULTIPLEXR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2406 MYCOPLASMA PNEUMONIAE CULTURE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2924 MYCOPLASMA PNEUMONIAE DNA DETECTR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8731 MYCOPLASMA PNEUMONIAE IGA ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8731C MYCOPLASMA PNEUMONIAE IGA ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8741 MYCOPLASMA PNEUMONIAE IGG & IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8741C MYCOPLASMA PNEUMONIAE IGG & IGM ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8741P MYCOPLASMA PNEUMONIAE IGG & IGM ABS PAIRED [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8746 MYCOPLASMA PNEUMONIAE IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8746C MYCOPLASMA PNEUMONIAE IGG ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8660 MYCOPLASMA PNEUMONIAE IGG ANTIBODY INDEX [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8736 MYCOPLASMA PNEUMONIAE IGG, IGM & IGA ABS SERODX [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8736C MYCOPLASMA PNEUMONIAE IGG, IGM & IGA ABS SERODX CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8751 MYCOPLASMA PNEUMONIAE IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8751C MYCOPLASMA PNEUMONIAE IGM ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1056 MYELIN BASIC PROTEIN (MBP) AUTOANTIBODIES [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1056C MYELIN BASIC PROTEIN (MBP) AUTOANTIBODIES CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3900 MYELIN BASIC PROTEIN CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4051 MYELIN-ASSOC GLYCOPROT & SULFOGLUCURONYL PARAGLOBOSIDE EVAL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4061 MYELIN-ASSOCIATED GLYCOPROTEIN (MAG) AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1926 MYELIN-ASSOCIATED GLYCOPROTEIN (MAG) IGM AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1926C MYELIN-ASSOCIATED GLYCOPROTEIN (MAG) IGM AUTOABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
Page 32 of 59 * PORTIONS OF THIS PAGE HAVE BEEN OMITTED PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION. ATTACHMENT A UNILAB FFS AND CAP FEE SCHEDULE
- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- 1386 MYELOPEROXIDASE AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1103 MYOCARDIAL TOTAL AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4988 MYOGLOBIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4988UR MYOGLOBIN URINE RANDOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8666 MYOPERICARDITIS VIRAL ABS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8666C MYOPERICARDITIS VIRAL ABS EVALUATION CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3240 MYOSITIS ASSESSR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3242 MYOSITIS ASSESSR PLUS JO-1 AUTOANTIBODIES [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1523 N-ACETYL-B-D-GLUCOSAMINIDASE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1705 NARCOLEPSY EVALUATR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5421 NATURAL KILLER CELL & LAK CELL FUNCTION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5422 NATURAL KILLER CELL EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5420 NATURAL KILLER CELL FUNCTION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1872 NATURAL KILLER CELL QUANTITATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2516 NEISSERIA GONORRHOEAE ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2516C NEISSERIA GONORRHOEAE ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2414 NEISSERIA GONORRHOEAE CULTURE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2930 NEISSERIA GONORRHOEAE AG DETECTION RRNA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2932 NEISSERIA GONORRHOEAE DNA [LCR] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4951 NELFINAVIR MONITR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3282 NEOPTERIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3282C NEOPTERIN CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3172 NEUROBLASTOMA MONITOR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3172SR NEUROBLASTOMA MONITOR W/SERIAL GRAPHICS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7960 NEUROBORRELIOSIS ACCUDX [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7960SF NEUROBORRELIOSIS ACCUDX SYNOVIAL FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7965 NEUROBORRELIOSIS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1052 NEUROFILAMENT-HEAVY (NF-H) SUBUNIT AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1198 NEURONAL IGG AUTOABS FOR CNS LUPUS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1198C NEURONAL IGG AUTOABS FOR CNS LUPUS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1198CS NEURONAL IGG AUTOABS FOR CNS LUPUS SERUM & CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1186 NEURONAL NUCLEAR (HU) AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1186C NEURONAL NUCLEAR (HU) AUTOABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1168 NEURONAL NUCLEAR (HU) IGG AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1168C NEURONAL NUCLEAR (HU) IGG AUTOABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1168CS NEURONAL NUCLEAR (HU) IGG AUTOABS SERUM & CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3860 NEURON-SPECIFIC ENOLASE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3860C NEURON-SPECIFIC ENOLASE CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1383 NEUTROPHIL FUNCTION: ADHERENCE (CD11A, CD11B, CD11C & CD18) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1382 NEUTROPHIL FUNCTION: MYELOPEROXIDASE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4954 NEVIRAPINE MONITR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9620 NMP22 BLADDER TUMOR MARKER [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8151 NOCARDIA IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8151C NOCARDIA IGG ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1804T NON-BREAST CANCER PROFILE 1 - PARAFFIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5400TBK NON-BREAST TISSUE DNA PLOIDY & CELL CYCLE ANALYSIS BLOCK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5400TFZ NON-BREAST TISSUE DNA PLOIDY & CELL CYCLE ANALYSIS, FROZEN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4928 NORDIAZEPAM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4930 NORTRIPTYLINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4266U N-TELOPEPTIDES W/ CREATININE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4556 OBSTETRIC COMPLICATIONS ASSESSR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5250 OCCULT BLOOD [HEMOCULT] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1223 OJ AUTOANTIBODIES [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5910 ANTI-OKT3 IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5912 OKT3 AB QUANTITATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
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- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- 1559 OLIGOCLONAL IMMUNOGLOBULINS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1557 OLIGOCLONAL IMMUNOGLOBULINS [IEF/IFIX] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4138 OPIATES SCREEN (SERUM) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4138U OPIATES URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3204 OSMOLALITY SERUM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3204U OSMOLALITY 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3204UR OSMOLALITY URINE RANDOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3550 OSTEOCALCIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7452 OSTEOPOROSIS EVALUATR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7447 OSTEOPOROSIS MONITOR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2367 OVA & PARASITE: ARTHROPOD IDENTIFICATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2363 OVA & PARASITE: COCCIDIA EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2362 OVA & PARASITE: COMPREHENSIVE EXAM W/ COCCIDIA EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2361 OVA & PARASITE: ROUTINE EXAM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2368 OVA & PARASITE: WORM IDENTIFICATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3038FZ OVARIAN CANCER PROGNOSIS FROZEN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3038BK OVARIAN CANCER PROGNOSIS - PARAFFIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1178 OVARY IGG AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4332U OXALATE 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4332UR OXALATE URINE RANDOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4934 OXAZEPAM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1866 PAN-ANCA EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1868 PAN-ANCA PLUS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3872 PANCREATITIS DETECTR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3872UR PANCREATITIS DETECTR, URINE RANDOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2621 PARAINFLUENZA VIRUS TYPES 1-3 ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2621C PARAINFLUENZA VIRUS TYPES 1-3 ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2424 PARAINFLUENZA TYPES 1-3 DETECTION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2746 PARALYTIC VIRAL ABS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2746C PARALYTIC VIRAL ABS EVALUATION CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1171 PARANEOPLASTIC SYNDROME EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1171C PARANEOPLASTIC SYNDROME EVALUATION CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1171CS PARANEOPLASTIC SYNDROME EVALUATION SERUM & CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1104 PARIETAL CELL TOTAL AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3895 PARTIAL THROMBOPLASTIN TIME (PTT) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3896 PARTIAL THROMBOPLASTIN TIME MIXING STUDIES [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8266 PARVOVIRUS B19 DETECTR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8260 PARVOVIRUS B19 DNA ULTRAQUANT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8261 PARVOVIRUS B19 EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8261C PARVOVIRUS B19 EVALUATION CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8221 PARVOVIRUS B19 IGG & IGM ABS [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8221C PARVOVIRUS B19 IGG & IGM ABS CSF [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8236 PARVOVIRUS B19 IGG & IGM ABS [IB] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8236C PARVOVIRUS B19 IGG & IGM ABS CSF [IB] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4992 PERNICIOUS ANEMIA ASSESSR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4140U PHENCYCLIDINE URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4142 PHENOBARBITAL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4144 PHENYTOIN FREE & TOTAL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4143 PHENYTOIN, FREE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4145 PHENYTOIN, TOTAL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3262 PHEOCHROMOCYTOMA EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1771 PHOSPHATIDIC ACID IGG, IGM & IGA AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1771C PHOSPHATIDIC ACID IGG, IGM & IGA ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1751 PHOSPHATIDYLCHOLINE IGG, IGM & IGA AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1751C PHOSPHATIDYLCHOLINE IGG, IGM & IGA ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
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- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- 1791 PHOSPHATIDYLETHANOLAMINE IGG, IGM & IGA AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1791C PHOSPHATIDYLETHANOLAMINE IGG, IGM & IGA ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1775 PHOSPHATIDYLGLYCEROL IGG, IGM AND IGA AUTOANTIBODIES [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1774 PHOSPHATIDYLINOSITOL IGG, IGM AND IGA AUTOANTIBODIES [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1711 PHOSPHATIDYLSERINE IGG, IGM & IGA AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1711C PHOSPHATIDYLSERINE IGG, IGM & IGA ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5308 PHOSPHORUS INORGANIC [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5308U PHOSPHORUS 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5308UR PHOSPHORUS URINE RANDOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8158 PIGEON SERUM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1224 PL-12 AUTOANTIBODIES [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1226 PL-7 AUTOANTIBODIES [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1492 PLASMINOGEN ACTIVITY [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1491 PLASMINOGEN, QUANTITATIVE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1636 PLATELET AUTOABS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5940 PLATELET AUTOABS, DRUG-INDUCED INCLUDING HEPARIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5995 PLATELET AUTOABS, COMPREHENSIVE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5160 PLATELET COUNT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5942 PLATELET FACTOR 4 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5967 PLATELET FUNCTION EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5958 PLATELET GLYCOPROTEIN AUTOANTIBODY ASSESSR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5957 PLATELET GLYCOPROTEIN IA/IIA TOTAL AUTOANTIBODIES [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5955 PLATELET GLYCOPROTEIN IB/IX TOTAL AUTOANTIBODIES [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5956 PLATELET GLYCOPROTEIN IIB/IIIA TOTAL AUTOANTIBODIES [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1631 PLATELET IGG, IGM & IGA AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1630 PLATELET-ASSOCIATED IGG, IGM & IGA AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1257 PM-SCL AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7745 PNEUMOCYSTIS CARINII AG DETECTION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8091 POLIOVIRUS ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8091P POLIOVIRUS ABS PAIRED [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2626 POLIOVIRUS ABS SEROTYPES 1-3 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2626C POLIOVIRUS ABS SEROTYPES 1-3 CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2023 POLYCYSTIC OVARY EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2676 POLYOMAVIRUS ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2676C POLYOMAVIRUS ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5311 POTASSIUM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4874R POTASSIUM RBC [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5311UR POTASSIUM URINE RANDOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5311U POTASSIUM 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5311C POTASSIUM CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1549 PREALBUMIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5996 PREKALLIKREIN (PKK) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7531 PRIMARY SCLEROSING CHOLANGITIS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4146 PRIMIDONE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4148 PROCAINAMIDE + NAPA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3163 PROGESTERONE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1832 PROGESTERONE RECEPTOR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3206 PROLACTIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1251 PROLIFERATING CELL NUCLEAR AG AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4149U PROPOXYPHENE URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3030 PROSTASURE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3032 PROSTATE CANCER MONITOR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3032F PROSTATE CANCER MONITOR FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3032SR PROSTATE CANCER MONITOR W/SERIAL GRAPHICS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3546 PROSTATE-SPECIFIC AG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
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- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- 3546F PROSTATE-SPECIFIC AG FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3546NY PROSTATE-SPECIFIC AG NEW YORK [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3546SR PROSTATE-SPECIFIC AG W/SERIAL GRAPHICS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3547 PROSTATE-SPECIFIC ANTIGEN, FREE & TOTAL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3547SR PROSTATE-SPECIFIC ANTIGEN, FREE & TOTAL W/SERIAL GRAPHICS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3100 PROSTATIC ACID PHOSPHATASE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3100F PROSTATIC ACID PHOSPHATASE FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3100SR PROSTATIC ACID PHOSPHATASE W/SERIAL GRAPHICS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5992 PROTEIN C & S ACTIVITY [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3836 PROTEIN C ACTIVITY [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5932 PROTEIN C AG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5933 PROTEIN C EVALUATION 1 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5988 PROTEIN C EVALUATION 2 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5989 PROTEIN C EVALUATION 3 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3837 PROTEIN S ACTIVITY [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5935 PROTEIN S AG, FREE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5937 PROTEIN S AG, TOTAL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5938 PROTEIN S EVALUATION 1 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5993 PROTEIN S EVALUATION 2 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5968 PROTEIN S EVALUATION 3 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5994 PROTEIN S EVALUATION 4 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1324 PROTEIN, TOTAL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1324U PROTEIN, TOTAL 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1324C PROTEIN, TOTAL CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1324F PROTEIN, TOTAL FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1324SF PROTEIN, TOTAL SYNOVIAL FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1324UR PROTEIN TOTAL URINE RANDOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1396 PROTEINASE-3 AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5939 PROTHROMBIN FRAGMENT 1.2 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5372 PROTHROMBIN G20210A MUTATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3892 PROTHROMBIN TIME [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3893 PROTHROMBIN TIME MIXING STUDIES [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3942 PTH SCATTERGRAPH (PTH INTACT INCL TOTAL CALCIUM) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3213 PTH, C TERMINAL & INTACT, INCLUDING IONIZED & TOTAL CALCIUM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3208 PTH, C TERMINAL, INCLUDING IONIZED & TOTAL CALCIUM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3945 PTH, C TERMINAL, INCLUDING TOTAL CALCIUM ONLY [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3944 PTH, INTACT, INCLUDING IONIZED & TOTAL CALCIUM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3943 PTH, INTACT, INCLUDING TOTAL CALCIUM ONLY [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3943SR PTH, INTACT, INCLUDING TOTAL CALCIUM W/ SERIAL REPORT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3941 PTH, INTACT ONLY [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3211 PTH, MID-MOLECULE & INTACT, INCLUDING IONIZED & TOTAL CALC. [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3209 PTH, MID-MOLECULE ONLY [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3210 PTH, MID-MOLECULE, INCLUDING IONIZED & TOTAL CALCIUM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3990 PTH-RELATED PROTEIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1187 PURKINJE CELL CYTOPLASMIC (YO) AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1187C PURKINJE CELL CYTOPLASMIC (YO) AUTOABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1176CS PURKINJE CELL CYTOPLASMIC (YO) IGG ABS SERUM & CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1176C PURKINJE CELL CYTOPLASMIC (YO) IGG AUTOABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1176 PURKINJE CELL CYTOPLASMIC (YO) IGG AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7441 PYRUVATE DEHYDROGENASE IGG AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4150 QUINIDINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3885 RANTES [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2364 RAPID PLASMA REAGIN (RPR) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1726 RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- PAX1 COMBINATION MIX: PAX1 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
Page 36 of 59 * PORTIONS OF THIS PAGE HAVE BEEN OMITTED PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION. ATTACHMENT A UNILAB FFS AND CAP FEE SCHEDULE
- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- PAX3 COMBINATION MIX: PAX3 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- PAX4 COMBINATION MIX: PAX4 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3700 RAST-PEDIATRIC FOOD PANEL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3701 RAST-PEDIATRIC FOOD PANEL + IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3702 RAST-FOOD PANEL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3703 RAST-FOOD PANEL + IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3716 RAST-MIDWEST PANEL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3717 RAST-MIDWEST PANEL + IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3704 RAST-MOLDS PANEL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3705 RAST-MOLDS PANEL + IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3718 RAST-NORTHEAST PANEL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3719 RAST-NORTHEAST PANEL + IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3712 RAST-NORTHERN CALIFORNIA PANEL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3713 RAST-NORTHERN CALIFORNIA PANEL + IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3720 RAST-SOUTHEAST PANEL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3721 RAST-SOUTHEAST PANEL + IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3710 RAST-SOUTHERN CALIFORNIA PANEL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3711 RAST-SOUTHERN CALIFORNIA PANEL + IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3714 RAST-SOUTHWEST PANEL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3715 RAST-SOUTHWEST PANEL + IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3722 RAST-WEST COAST PANEL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3723 RAST-WEST COAST PANEL + IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RK212 ABACHI WOOD DUST IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T19 ACACIA IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T19G ACACIA IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RC206 ACTH IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- I71 AEDES COMMUNIS MOSQUITO IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RK205 ALKALASE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F20 ALMOND IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F20G ALMOND IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- K87 ALPHA AMYLASE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F76 ALPHA LACTALBUMIN IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F76G ALPHA LACTALBUMIN IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- M6 ALTERNARIA TENUIS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- M6G ALTERNARIA TENUIS IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T5 AMERICAN BEECH IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T5G AMERICAN BEECH IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RC204 AMOXYCILLIN IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RC203 AMPICILLIN IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF313 ANCHOVY IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF313G ANCHOVY IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- EX72 ANIMALS-CAGED BIRDS MIX: EX72 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- EX71 ANIMALS-FEATHERS MIX: EX71 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- EX73 ANIMALS-FEATHERS MIX: EX73 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- EX70 ANIMALS-RODENTS MIX: EX70 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- EX1 ANIMALS MIX: EX1 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- EX2 ANIMALS MIX: EX2 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- P4 ANISAKIS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF271 ANISE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF271G ANISE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F49 APPLE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F49G APPLE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F237 APRICOT IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F237G APRICOT IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RO202 ARTEMISIA SAL. FISH FEED IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
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- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- P1 ASCARIS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF261 ASPARAGUS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF261G ASPARAGUS IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- M3 ASPERGILLUS FUMIGATUS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- M3G ASPERGILLUS FUMIGATUS IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RM207 ASPERGILLUS NIGER IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RM207G ASPERGILLUS NIGER IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF262 AUBERGINE EGGPLANT IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF262G AUBERGINE EGGPLANT IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- M12 AUREOBASIDIUM PULLULANS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- M12G AUREOBASIDIUM PULLULANS IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T73 AUSTRALIAN PINE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T73G AUSTRALIAN PINE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F96 AVOCADO IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F96G AVOCADO IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- G17 BAHIA IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- G17G BAHIA IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F51 BAMBOO SHOOT IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F51G BAMBOO SHOOT IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F92 BANANA IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F92G BANANA IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- G201 BARLEY (GRASS) IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- G201G BARLEY (GRASS) IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F6 BARLEY (FOOD) IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F6G BARLEY (FOOD) IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF269 BASIL IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF269G BASIL IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF278 BAY LEAF IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF278G BAY LEAF IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F27 BEEF IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F27G BEEF IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF319 BEETROOT IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF319G BEETROOT IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF263 BELL PEPPER IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF263G BELL PEPPER IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- H3 HOUSE DUST-BENCARD IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- H3G HOUSE DUST-BENCARD IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- I76 BERLIN BEETLE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- G2 BERMUDA IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- G2G BERMUDA IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F77 BETA LACTOGLOBULIN IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F77G BETA LACTOGLOBULIN IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F280 BLACK PEPPER IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F280G BLACK PEPPER IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF211 BLACKBERRY IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF211G BLACKBERRY IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RD201 BLOMIA TROPICALIS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RD201G BLOMIA TROPICALIS IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F37 BLUE MUSSEL IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F37G BLUE MUSSEL IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF310 BLUE VETCH IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF310G BLUE VETCH IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF288 BLUEBERRY IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF288G BLUEBERRY IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- M7 BOTRYTIS CINEREA IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
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- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- M7G BOTRYTIS CINEREA IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T1 BOX ELDER IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T1G BOX ELDER IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F18 BRAZIL NUT IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F18G BRAZIL NUT IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF260 BROCCOLI IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF260G BROCCOLI IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- G11 BROME IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- G11G BROME IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RK202 BROMELIN IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF217 BRUSSEL SPROUTS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF217G BRUSSEL SPROUTS IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RE204 BSA (BOVINE SERUM ALBUMIN) IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RE204G BSA (BOVINE SERUM ALBUMIN) IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F11 BUCKWHEAT IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F11G BUCKWHEAT IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F216 CABBAGE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F216G CABBAGE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F93 CACAO IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F93G CACAO IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RW206 CAMOMILLE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RW206G CAMOMILLE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E201 CANARY FEATHERS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E201G CANARY FEATHERS IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- G71 CANARY GRASS REED IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- G71G CANARY GRASS REED IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- M5 CANDIDA ALBICANS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- M5G CANDIDA ALBICANS IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF295 CARAMBOLA IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF295G CARAMBOLA IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF265 CARAWAY IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF265G CARAWAY IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF267 CARDAMON IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF267G CARDAMON IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF296 CAROB IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF296G CAROB IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F31 CARROT IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F31G CARROT IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F78 CASEIN IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F78G CASEIN IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF202 CASHEW NUT IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF202G CASHEW NUT IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- K71 CASTOR BEAN IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E1 CAT EPITHELIUM IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E1G CAT EPITHELIUM IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF291 CAULIFLOWER IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF291G CAULIFLOWER IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RT212 CEDAR IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RT212G CEDAR IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F85 CELERY IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F85G CELERY IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RM202 CEPHALOSPORIUM ACREMONIUM IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RM202G CEPHALOSPORIUM ACREMONIUM IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RM208 CHAETOMIUM GLOBOSUM IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RM208G CHAETOMIUM GLOBOSUM IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
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- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- F81 CHEESE CHEDDAR IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F81G CHEESE CHEDDAR IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F82 CHEESE MOLD TYPE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F82G CHEESE MOLD TYPE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F242 CHERRY IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F242G CHERRY IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RT206 CHESTNUT IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RT206G CHESTNUT IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF309 CHICK PEA IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF309G CHICK PEA IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RE218 CHICKEN DROPPINGS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RE218G CHICKEN DROPPINGS IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E85 CHICKEN FEATHERS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E85G CHICKEN FEATHERS IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F83 CHICKEN MEAT IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F83G CHICKEN MEAT IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RE219 CHICKEN SERUM PROTEIN IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RE219G CHICKEN SERUM PROTEIN IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF279 CHILI PEPPER IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF279G CHILI PEPPER IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RE208 CHINCHILLA EPITHELIUM IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RE208G CHINCHILLA EPITHELIUM IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- I73 CHIRONOMUS THUMMI IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- K85 CHLORAMIN T IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F50 CHUB MACKERAL IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F50G CHUB MACKERAL IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF220 CINNAMON IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF220G CINNAMON IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- M2 CLADOSPORIUM HERBARUM IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- M2G CLADOSPORIUM HERBARUM IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- I72 CLADOTANYTARSUS LEWISI IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F207 CLAM IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F207G CLAM IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF268 CLOVE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF268G CLOVE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W13 COCKLEBUR IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W13G COCKLEBUR IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- I6 COCKROACH IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F36 COCONUT IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F36G COCONUT IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F3 CODFISH IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F3G CODFISH IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF221 COFFEE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF221G COFFEE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T3 COMMON BIRCH SILVER IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T3G COMMON BIRCH SILVER IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F55 COMMON MILLET IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F55G COMMON MILLET IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- G7 COMMON REED IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- G7G COMMON REED IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF323 CONALBUMIN IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF323G CONALBUMIN IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF317 CORIANDER IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF317G CORIANDER IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F8 CORN IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
Page 40 of 59 * PORTIONS OF THIS PAGE HAVE BEEN OMITTED PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION. ATTACHMENT A UNILAB FFS AND CAP FEE SCHEDULE
- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- F8G CORN IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- O1 COTTON CRUDE FIBER IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- K83 COTTONSEED IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T14 COTTONWOOD IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T14G COTTONWOOD IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E4 COW DANDER IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E4G COW DANDER IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F2 COW'S MILK IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F2G COW'S MILK IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F23 CRAB IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F23G CRAB IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF320 CRAYFISH IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF320G CRAYFISH IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF244 CUCUMBER IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF244G CUCUMBER IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- G14 CULTIVATED OAT POLLEN IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- G14G CULTIVATED OAT POLLEN IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- G12 CULTIVATED RYE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- G12G CULTIVATED RYE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- G15 CULTIVATED WHEAT POLLEN IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- G15G CULTIVATED WHEAT POLLEN IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF281 CURRY SANTA MARIA IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF281G CURRY SANTA MARIA IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- M16 CURVULARIA LUNATA IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- M16G CURVULARIA LUNATA IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W8 DANDELION IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W8G DANDELION IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RO207 DAPHNIA FISH FEED IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RT214 DATE (TREE) IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RT214G DATE (TREE) IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF289 DATE (FOOD) IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF289G DATE (FOOD) IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RE216 DEER EPITHELIUM IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RE216G DEER EPITHELIUM IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- D2 DERMATOPHAGOIDES FARINAE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- D2G DERMATOPHAGOIDES FARINAE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- D3 DERMATOPHAGOIDES MICROCERAS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- D3G DERMATOPHAGOIDES MICROCERAS IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- D1 DERMATOPHAGOIDES PTERONYSSINUS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- D1G DERMATOPHAGOIDES PTERONYSSINUS IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF277 DILL IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF277G DILL IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E5 DOG DANDER IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E5G DOG DANDER IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E2 DOG EPITHELIUM IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E2G DOG EPITHELIUM IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RT207 DOUGLAS FIR IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RT207G DOUGLAS FIR IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E86 DUCK FEATHERS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E86G DUCK FEATHERS IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- P2 ECHINOCOCCUS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF264 EEL IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF264G EEL IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F245 EGG IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F245G EGG IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
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- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- F1 EGG WHITE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F1G EGG WHITE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F75 EGG YOLK IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F75G EGG YOLK IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RT205 ELDER IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RT205G ELDER IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF285 ELK/MOOSE MEAT IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF285G ELK/MOOSE MEAT IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T8 ELM IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T8G ELM IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W9 ENGLISH PLANTAIN IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W9G ENGLISH PLANTAIN IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- M14 EPICOCCUM PURPURASCENS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- M14G EPICOCCUM PURPURASCENS IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- K78 ETHYLENE OXIDE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T18 EUCALYPTUS (GUM TREE) IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T18G EUCALYPTUS (GUM TREE) IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- D74 EUROGLYPHYS MAYNEI IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- D74G EUROGLYPHYS MAYNEI IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- I75 EUROPEAN HORNET VENOM IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RG204 FALSE OAT GRASS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RG204G FALSE OAT GRASS IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W4 FALSE RAGWEED IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W4G FALSE RAGWEED IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF219 FENNEL SEED IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF219G FENNEL SEED IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF276 FENNEL FRESH IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF276G FENNEL FRESH IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF305 FENUGREEK IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF305G FENUGREEK IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RE217 FERRET EPITHELIUM IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RE217G FERRET EPITHELIUM IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- K81 FICUS SPP. IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RE214 FINCH FEATHERS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RE214G FINCH FEATHERS IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- I70 FIRE ANT IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- FX3 FOODS-CEREAL MIX: FX3 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- FX5 FOODS-CHILDREN'S FOOD MIX: FX5 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- FX74 FOODS-FISH MIX: FX74 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RFX8 FOOD MIX-FRUIT & NUT: RFX8 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RFX9 FOOD MIX-FRUIT & NUT: RFX9 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RFX15 FOOD MIX-FRUIT: RFX15 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RFX16 FOOD MIX-FRUIT: RFX16 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RFX17 FOOD MIX-FRUIT: RFX17 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RFX21 FOOD MIX-FRUIT: RFX21 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RFX20 FOOD MIX-GRAIN: RFX20 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RFX10 FOOD MIX-MEAT & EGG: RFX10 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- FX73 FOODS-MEAT MIX: FX73 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- FX1 FOODS-NUT MIX: FX1 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RFX22 FOOD MIX-NUT: RFX22 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- FX2 FOODS-SEAFOOD MIX: FX2 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- FX70 FOODS-SPICES MIX: FX70 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- FX71 FOODS-SPICES MIX: FX71 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- FX72 FOODS-SPICES MIX: FX72 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RFX12 FOOD MIX-VEGETABLE & GRAIN: RFX12 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
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- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- - ------------- ----------------------------------------------------------------------- ---------- ----------- RFX11 FOOD MIX-VEGETABLE: RFX11 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RFX13 FOOD MIX-VEGETABLE: RFX13 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RFX14 FOOD MIX-VEGETABLE: RFX14 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RFX18 FOOD MIX-VEGETABLE: RFX18 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RFX19 FOOD MIX-VEGETABLE: RFX19 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- K80 FORMALDEHYDE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RE210 FOX EPITHELIUM IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RE210G FOX EPITHELIUM IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F56 FOXTAIL MILLET IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F56G FOXTAIL MILLET IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- M9 FUSARIUM MONILIFORME IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- M9G FUSARIUM MONILIFORME IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F47 GARLIC IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F47G GARLIC IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RI201 GASTEROPHILUS INTESTIN. IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RE209 GERBIL EPITHELIUM IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RE209G GERBIL EPITHELIUM IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W3 GIANT RAGWEED IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W3G GIANT RAGWEED IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF270 GINGER IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF270G GINGER IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F79 GLUTEN IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F79G GLUTEN IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- D73 GLYCYPHAGUS DOMESTICUS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- D73G GLYCYPHAGUS DOMESTICUS IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E80 GOAT EPITHELIUM IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E80G GOAT EPITHELIUM IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF300 GOAT MILK IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF300G GOAT MILK IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W12 GOLDENROD IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W12G GOLDENROD IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E70 GOOSE FEATHERS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E70G GOOSE FEATHERS IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RI202 GRAIN WEEVIL IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F259 GRAPE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F259G GRAPE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F209 GRAPEFRUIT IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F209G GRAPEFRUIT IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- GX1 GRASSES MIX: GX1 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- GX2 GRASSES MIX: GX2 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- GX3 GRASSES MIX: GX3 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- GX4 GRASSES MIX: GX4 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RGX6 GRASSES MIX: RGX6 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RRX1 GRASSES-WEEDS-TREES MIX: RRX1 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RRX3 GRASSES-WEEDS-TREES MIX: RRX3 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RRX4 GRASSES-WEEDS-TREES MIX: RRX4 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF315 GREEN BEAN IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF315G GREEN BEAN IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- K70 GREEN COFFEE BEAN IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T2 GREY ALDER IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T2G GREY ALDER IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF246 GUAR GUAR GUM IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF246G GUAR GUAR GUM IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF292 GUAVA IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF292G GUAVA IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
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- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- - ------------- ----------------------------------------------------------------------- ---------- ----------- E6 GUINEA PIG EPITHELIUM IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E6G GUINEA PIG EPITHELIUM IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF297 GUM ARABIC IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF297G GUM ARABIC IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF307 HAKE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF307G HAKE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF303 HALIBUT IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF303G HALIBUT IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E84 HAMSTER EPITHELIUM IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E84G HAMSTER EPITHELIUM IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T4 HAZEL IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T4G HAZEL IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F17 HAZEL NUT IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F17G HAZEL NUT IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- M8 HELMINTHOSPORIUM HALODES IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- M8G HELMINTHOSPORIUM HALODES IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF205 HERRING IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF205G HERRING IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RK209 HEXAHYDROPHTHALIC ANHYDRID IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF247 HONEY IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF247G HONEY IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- I1 HONEYBEE VENOM IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- I1G HONEYBEE VENOM IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF324 HOP (FRUIT CONE) IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF324G HOP (FRUIT CONE) IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RT209 HORN BEAM IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RT209G HORN BEAM IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RT203 HORSE CHESTNUT IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RT203G HORSE CHESTNUT IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E3 HORSE DANDER IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E3G HORSE DANDER IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RI204 HORSE FLY IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF321 HORSE MEAT IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF321G HORSE MEAT IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RE205 HORSE SERUM PROTEINS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RE205G HORSE SERUM PROTEINS IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- H1 HOUSE DUST-GREER IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- H1G HOUSE DUST-GREER IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- H2 HOUSE DUST-HOLL. STIER IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- H2G HOUSE DUST-HOLL. STIER IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- HX2 HOUSE DUST MIX: HX2 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- C71 INSULIN BOVINE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- C73 INSULIN HUMAN IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- C70 INSULIN PORCINE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- K77 ISOCYANATE HDI IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- K76 ISOCYANATE MDI IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- K75 ISOCYANATE TDI IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- K72 ISPAGHULA IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T23 ITALIAN CYPRESS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T23G ITALIAN CYPRESS IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF318 JACK FRUIT IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF318G JACK FRUIT IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F60 JACK MACKEREL SCAD IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F60G JACK MACKEREL SCAD IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T17 JAPANESE CEDAR IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
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- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- - ------------- ----------------------------------------------------------------------- ---------- ----------- T17G JAPANESE CEDAR IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F57 JAPANESE MILLET IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F57G JAPANESE MILLET IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- G10 JOHNSON IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- G10G JOHNSON IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- G8 JUNE-KENTUCKY BLUE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- G8G JUNE-KENTUCKY BLUE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F84 KIWI FRUIT IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F84G KIWI FRUIT IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W17 KOCHIA (FIREBUSH) IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W17G KOCHIA (FIREBUSH) IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W10 LAMBS QUARTERS (GOOSEFOOT) IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W10G LAMBS QUARTERS (GOOSEFOOT) IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- K82 LATEX (BRAZILIAN RUBBER TREE) IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F208 LEMON IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F208G LEMON IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F235 LENTIL IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F235G LENTIL IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- D71 LEPIDOGLYPHUS DESTRUCTOR IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- D71G LEPIDOGLYPHUS DESTRUCTOR IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F215 LETTUCE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F215G LETTUCE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF306 LIME IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF306G LIME IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T208 LINDEN IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T208G LINDEN IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F80 LOBSTER IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F80G LOBSTER IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF275 LOVAGE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF275G LOVAGE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RW207 LUPIN IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RW207G LUPIN IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RK208 LYSOZYME IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF266 MACE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF266G MACE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF206 MACKEREL IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF206G MACKEREL IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- G202 MAIZE CORN IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- G202G MAIZE CORN IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RK210 MALEIC ANHYDRID IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F90 MALT IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F90G MALT IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF302 MANDARIN (TANGERINE/CLEMENTINE/SATSUMAS) IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF302G MANDARIN(TANGERINE/CLEMENTINE/SATSUMAS) IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F91 MANGO FRUIT IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F91G MANGO FRUIT IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T11 MAPLE LEAF SYCAMORE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T11G MAPLE LEAF SYCAMORE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF286 MARE'S MILK IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF286G MARE'S MILK IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF274 MARJORAM IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF274G MARJORAM IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W16 MARSH ELDER (ROUGH) IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W16G MARSH ELDER (ROUGH) IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RK204 MAXATASE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
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- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- - ------------- ----------------------------------------------------------------------- ---------- ----------- G4 MEADOW FESCUE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- G4G MEADOW FESCUE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- G16 MEADOW FOXTAIL IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- G16G MEADOW FOXTAIL IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RI203 MEDITERRANEAN FLOUR MOTH IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF311 MEGRIM IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF311G MEGRIM IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T21 MELALEUCA IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T21G MELALEUCA IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F87 MELON IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F87G MELON IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T20 MESQUITE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T20G MESQUITE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RK211 METHYLTETRAHYDROPHTALIC ANHYDRID IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F231 MILK BOILED IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F231G MILK BOILED IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF228 MILK POWDER IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF228G MILK POWDER IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RE203 MINK EPITHELIUM IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RE203G MINK EPITHELIUM IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RRX2 MITE, EPIDERMAL AND MOLD MIX: RRX2 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- MX1 MOLDS MIX: MX1 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- MX2 MOLDS MIX: MX2 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- I8 MOTH IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T6 MOUNTAIN JUNIPER IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T6G MOUNTAIN JUNIPER IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E71 MOUSE EPITHELIUM IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E71G MOUSE EPITHELIUM IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E88 MOUSE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E88G MOUSE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E76 MOUSE SERUM PROTEINS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E76G MOUSE SERUM PROTEINS IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- M4 MUCOR RACEMOSUS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- M4G MUCOR RACEMOSUS IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W6 MUGWORT (SAGE) IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W6G MUGWORT (SAGE) IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T70 MULBERRY IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T70G MULBERRY IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF212 MUSHROOM (CHAMPIGNON) IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF212G MUSHROOM (CHAMPIGNON) IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F89 MUSTARD IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F89G MUSTARD IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F88 MUTTON IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F88G MUTTON IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W20 NETTLE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W20G NETTLE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF282 NUTMEG IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF282G NUTMEG IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T7 OAK IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T7G OAK IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F7 OAT IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F7G OAT IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- PAX5 OCCUPATIONAL MIX: PAX5 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- PAX6 OCCUPATIONAL MIX: PAX6 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F59 OCTOPUS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
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- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- - ------------- ----------------------------------------------------------------------- ---------- ----------- F59G OCTOPUS IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T9 OLIVE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T9G OLIVE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F48 ONION IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F48G ONION IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F33 ORANGE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F33G ORANGE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- G3 ORCHARD (COCKSFOOT) IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- G3G ORCHARD (COCKSFOOT) IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF283 OREGANO IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF283G OREGANO IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F232 OVALBUMIN IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F232G OVALBUMIN IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F233 OVOMUCOID IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F233G OVOMUCOID IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W7 OX-EYE DAISY IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W7G OX-EYE DAISY IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF290 OYSTER IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF290G OYSTER IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F58 PACIFIC SQUID IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F58G PACIFIC SQUID IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RK201 PAPAIN IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF293 PAPAYA IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF293G PAPAYA IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- I4 PAPER WASP VENOM IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F218 PAPRIKA SWEET PEPPER IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F218G PAPRIKA SWEET PEPPER IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E77 PARROT (BUDGERIGAR) DROPPINGS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E77G PARROT (BUDGERIGAR) DROPPINGS IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E78 PARROT (BUDGERIGAR) FEATHERS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E78G PARROT (BUDGERIGAR) FEATHERS IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E79 PARROT (BUDGERIGAR) SERUM PROTEINS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E79G PARROT (BUDGERIGAR) SERUM PROTEINS IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F86 PARSLEY IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F86G PARSLEY IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF294 PASSION FRUIT IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF294G PASSION FRUIT IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F12 PEA IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F12G PEA IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F95 PEACH IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F95G PEACH IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F13 PEANUT IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F13G PEANUT IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F94 PEAR IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F94G PEAR IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T22 PECAN (HICKORY) IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T22G PECAN (HICKORY) IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F201 PECAN NUT IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F201G PECAN NUT IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RM209 PENICILLIUM FREQUENTANS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RM209G PENICILLIUM FREQUENTANS IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- M1 PENICILLIUM NOTATUM IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- M1G PENICILLIUM NOTATUM IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- C1 PENICILLOYL G IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- C2 PENICILLOYL V IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
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- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- - ------------- ----------------------------------------------------------------------- ---------- ----------- G5 PERENNIAL RYE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- G5G PERENNIAL RYE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF301 PERSIMMON IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF301G PERSIMMON IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3745 RAST-PHADIATOP [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- M13 PHOMA BETAE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- M13G PHOMA BETAE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RK203 PHOSPHOLIPASE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- K79 PHTHALIC ANHYDRIDE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E7 PIGEON DROPPINGS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E7G PIGEON DROPPINGS IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RE215 PIGEON FEATHERS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RE215G PIGEON FEATHERS IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W14 PIGWEED IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W14G PIGWEED IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RT213 PINE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RT213G PINE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF253 PINE NUT PIGNOLES IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF253G PINE NUT PIGNOLES IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F210 PINEAPPLE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F210G PINEAPPLE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF203 PISTACHIO IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF203G PISTACHIO IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- M70 PITYROSPORUM ORBICULARE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- M70G PITYROSPORUM ORBICULARE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F254 PLAICE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F254G PLAICE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF255 PLUM IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF255G PLUM IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF224 POPPY SEED IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF224G POPPY SEED IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F26 PORK IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F26G PORK IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F35 POTATO IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F35G POTATO IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T210 PRIVET IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T210G PRIVET IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RC207 PROTAMINE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F225 PUMPKIN IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F225G PUMPKIN IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF226 PUMPKIN SEED IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF226G PUMPKIN SEED IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T72 QUEEN PALM IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T72G QUEEN PALM IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E82 RABBIT EPITHELIUM IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E82G RABBIT EPITHELIUM IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF213 RABBIT MEAT IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF213G RABBIT MEAT IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RE206 RABBIT SERUM PROTEINS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RE206G RABBIT SERUM PROTEINS IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RE211 RABBIT URINE PROTEINS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RE211G RABBIT URINE PROTEINS IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RW203 RAPE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RW203G RAPE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF316 RAPE SEED IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
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- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- - ------------- ----------------------------------------------------------------------- ---------- ----------- RF316G RAPE SEED IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E73 RAT EPITHELIUM IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E73G RAT EPITHELIUM IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E87 RAT IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E87G RAT IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E75 RAT SERUM PROTEINS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E75G RAT SERUM PROTEINS IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E74 RAT URINE PROTEINS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E74G RAT URINE PROTEINS IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF322 RED CURRANT IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF322G RED CURRANT IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF287 RED KIDNEY BEAN IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF287G RED KIDNEY BEAN IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- G9 RED TOP IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- G9G RED TOP IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RE202 REINDEER EPITHELIUM IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RE202G REINDEER EPITHELIUM IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- M11 RHIZOPUS NIGRICANS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- M11G RHIZOPUS NIGRICANS IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F9 RICE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F9G RICE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W11 RUSSIAN THISTLE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W11G RUSSIAN THISTLE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F5 RYE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F5G RYE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F41 SALMON IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F41G SALMON IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RG203 SALT GRASS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RG203G SALT GRASS IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F61 SARDINE PILCHARD IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F61G SARDINE PILCHARD IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RK206 SAVINASE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W15 SCALE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W15G SCALE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- P3 SCHISTOSOMA ABS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- O70 SEMINAL FLUID IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F10 SESAME SEED IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F10G SESAME SEED IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E81 SHEEP EPITHELIUM IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E81G SHEEP EPITHELIUM IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W18 SHEEP SORREL IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W18G SHEEP SORREL IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W1 SHORT (COMMON) RAGWEED IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W1G SHORT (COMMON) RAGWEED IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F24 SHRIMP IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F24G SHRIMP IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- K74 SILK IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- K73 SILK WASTE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF314 SNAIL IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF314G SNAIL IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F14 SOYBEAN IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F14G SOYBEAN IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F214 SPINACH IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F214G SPINACH IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF304 SPINY LOBSTER (LANGUST) IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
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- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- - ------------- ----------------------------------------------------------------------- ---------- ----------- RF304G SPINY LOBSTER (LANGUST) IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RT201 SPRUCE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RT201G SPRUCE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF258 SQUID IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF258G SQUID IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- M10 STEMPHYLIUM BOTROSUM IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- M10G STEMPHYLIUM BOTROSUM IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- D70 STORAGE MITE ACARUS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- D70G STORAGE MITE ACARUS IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- PAX2 STORAGE MITES MIX: PAX2 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F44 STRAWBERRY IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F44G STRAWBERRY IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RW210 SUGAR BEET IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RW210G SUGAR BEET IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF227 SUGAR BEET SEED IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF227G SUGAR BEET SEED IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F583 SUGARCANE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F583G SUGARCANE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RW204 SUNFLOWER IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RW204G SUNFLOWER IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- K84 SUNFLOWER SEED IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF299 SWEET CHESTNUT IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF299G SWEET CHESTNUT IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RT211 SWEET GUM IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RT211G SWEET GUM IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F54 SWEET POTATO IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F54G SWEET POTATO IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- G1 SWEET VERNAL IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- G1G SWEET VERNAL IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E83 SWINE EPITHELIUM IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E83G SWINE EPITHELIUM IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RE212 SWINE URINE PROTEINS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RE212G SWINE URINE PROTEINS IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF312 SWORDFISH IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF312G SWORDFISH IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF272 TARRAGON IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF272G TARRAGON IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF222 TEA IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF222G TEA IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RC208 TETANUS TOXOID IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RO203 TETRAMIN FISH FEED IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF273 THYME IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF273G THYME IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- G6 TIMOTHY IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- G6G TIMOTHY IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RO201 TOBACCO IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RO201G TOBACCO IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F25 TOMATO IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F25G TOMATO IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF298 TRAGACANTH IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF298G TRAGACANTH IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RTX10 TREES MIX: RTX10 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- TX1 TREES MIX: TX1 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- TX2 TREES MIX: TX2 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- TX3 TREES MIX: TX3 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
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- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- - ------------- ----------------------------------------------------------------------- ---------- ----------- TX4 TREES MIX: TX4 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- TX5 TREES MIX: TX5 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- TX6 TREES MIX: TX6 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- TX7 TREES MIX: TX7 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- TX8 TREES MIX: TX8 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- TX9 TREES MIX: TX9 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- M15 TRICHODERMA VIRIDE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- M15G TRICHODERMA VIRIDE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RM210 TRICHOPHYTON MENT. VAR GOETZII IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RM210G TRICHOPHYTON MENT. VAR GOETZII IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RM211 TRICHOPHYTON MENT. VAR INTERDIGITALE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RM211G TRICHOPHYTON MENT. VAR INTERDIGITALE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RM205 TRICHOPHYTON RUBRUM IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RM205G TRICHOPHYTON RUBRUM IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RM203 TRICHOSPORON PULLULANS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RM203G TRICHOSPORON PULLULANS IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- K86 TRIMELLITIC ANHYDRIDE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F204 TROUT IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F204G TROUT IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F40 TUNA IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F40G TUNA IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E89 TURKEY FEATHERS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- E89G TURKEY FEATHERS IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F284 TURKEY MEAT IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F284G TURKEY MEAT IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- D72 TYROPHAGUS PUTRESCENTIAE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- D72G TYROPHAGUS PUTRESCENTIAE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RM204 ULOCLADIUM CHARTARUM IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RM204G ULOCLADIUM CHARTARUM IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RM201 USTILAGO NUDA/TRITICI IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RM201G USTILAGO NUDA/TRITICI IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF234 VANILLA IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF234G VANILLA IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- G13 VELVET IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- G13G VELVET IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W21 WALL PELLITORY JUDAICA IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W21G WALL PELLITORY JUDAICA IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W19 WALL PELLITORY OFFICINALIS IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W19G WALL PELLITORY OFFICINALIS IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F256 WALNUT IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T10 WALNUT TREE POLLEN IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F256G WALNUT IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T10G WALNUT TREE POLLEN IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RW209 WEEDS MIX: RW209 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- WX1 WEEDS MIX: WX1 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- WX2 WEEDS MIX: WX2 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- WX3 WEEDS MIX: WX3 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- WX5 WEEDS MIX: WX5 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- WX6 WEEDS MIX: WX6 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- WX7 WEEDS MIX: WX7 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W2 WESTERN RAGWEED IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W2G WESTERN RAGWEED IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F4 WHEAT IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F4G WHEAT IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- RF236 WHEY IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
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- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- - ------------- ----------------------------------------------------------------------- ---------- ----------- RF236G WHEY IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T15 WHITE ASH IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T15G WHITE ASH IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F15 WHITE BEAN IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F15G WHITE BEAN IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T16 WHITE PINE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T16G WHITE PINE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- I2 WHITE-FACE HORNET VENOM IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- G70 WILD RYE IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- G70G WILD RYE IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T12 WILLOW IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- T12G WILLOW IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W5 WORMWOOD IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- W5G WORMWOOD IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F45 YEAST (BAKERS/BREWERS) IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- F45G YEAST (BAKERS/BREWERS) IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- I5 YELLOW HORNET VENOM IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- I3 YELLOW JACKET VENOM IGE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- I3G YELLOW JACKET VENOM IGG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1070 REACTIVE ARTHRITIS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1070S REACTIVE ARTHRITIS EVALUATION (WITHOUT HLA-B27) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2028 RECURRENT SPONTANEOUS ABORTION: AUTOIMMUNE EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2025 RECURRENT SPONTANEOUS ABORTION: ENDOCRINE EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2027 RECURRENT SPONTANEOUS ABORTION: INFECTIOUS DISEASE EVAL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5314 RENAL FUNCTION PANEL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3214 RENIN ACTIVITY PLASMA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2641 REOVIRUS ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2641C REOVIRUS ABS CSF [CF] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2701 RESPIRATORY INFECTION ABS, ADULT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2701C RESPIRATORY INFECTION ABS, ADULT CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2711 RESPIRATORY INFECTION ABS, CHILD/INFANT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2711C RESPIRATORY INFECTION ABS, CHILD/INFANT CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2425 RESPIRATORY INFECTION EVALUATION, VIRAL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8691C RESPIRATORY SYNCYTIAL VIRUS IGG & IGM ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7522 RESPIRATORY SYNCYTIAL VIRUS RNA DETECTR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2704 RESPIRATORY SYNCYTIAL VIRUS AG DETECTION [DFA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5697 RESPIRATORY SYNCYTIAL VIRUS AG DETECTION [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8691 RESPIRATORY SYNCYTIAL VIRUS IGG & IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2646 RESPIRATORY SYNCYTIAL VIRUS TOTAL ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2646C RESPIRATORY SYNCYTIAL VIRUS TOTAL ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1162 RETICULIN IGA AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1105 RETICULIN TOTAL AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3236 REVERSE TRIIDOTHYRONINE (RT3) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1004 RHEUMATIC EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5052 RHEUMATOID ARTHRITIS MONITOR #2 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5053 RHEUMATOID ARTHRITIS MONITOR #3 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5050 RHEUMATOID ARTHRITIS PROGNOSTICATOR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1015F RHEUMATOID FACTOR (IGM) [NEPH] & SCAT TITER [IHA] FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1540 RHEUMATOID FACTOR AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1015 RHEUMATOID FACTOR AUTOABS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1012 RHEUMATOID FACTOR IGG, IGM & IGA AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1540F RHEUMATOID FACTOR (IGM) FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1113 RHEUMATOID FACTOR IGM AUTOABS [IHA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1273 RIBOSOMAL P PROTEIN IGG AUTOANTIBODY INDEX [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1271 RIBOSOMAL P PROTEIN IGG AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
Page 52 of 59 * PORTIONS OF THIS PAGE HAVE BEEN OMITTED PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION. ATTACHMENT A UNILAB FFS AND CAP FEE SCHEDULE
- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- 1271C RIBOSOMAL P PROTEIN IGG AUTOABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1271CS RIBOSOMAL P PROTEIN IGG AUTOABS SERUM & CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7951 RICKETTSIA CONORII IGG & IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7951C RICKETTSIA CONORII IGG & IGM ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7876 RICKETTSIA RICKETTSII & R. TYPHI IGG & IGM ABS EVAL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7876C RICKETTSIA RICKETTSII & R. TYPHI IGG & IGM ABS EVAL CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7871 RICKETTSIA RICKETTSII & R. TYPHI IGG ABS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7881 RICKETTSIA RICKETTSII & R. TYPHI IGM ABS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7896 RICKETTSIA RICKETTSII IGG & IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7896C RICKETTSIA RICKETTSII IGG & IGM ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7886 RICKETTSIA RICKETTSII IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7891 RICKETTSIA RICKETTSII IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8126 RICKETTSIA TSUTSUGAMUSHI IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7911 RICKETTSIA TYPHI IGG & IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7911C RICKETTSIA TYPHI IGG & IGM ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7901 RICKETTSIA TYPHI IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7906 RICKETTSIA TYPHI IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4919 RIFAMPIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4919P RIFAMPIN PEAK & TROUGH [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4141 RISPERIDONE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1871 RISTOCETIN COFACTOR FUNCTION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4952 RITONAVIR MONITR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1494 RNA-POLYMERASES I, II AND III IGG AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7856 ROTAVIRUS ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7856C ROTAVIRUS ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2472 ROTAVIRUS AG DETECTION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9421 RUBELLA IGG & IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9421C RUBELLA IGG & IGM ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9416 RUBELLA IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9416F RUBELLA IGG ABS FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7770 RUBELLA IGG ANTIBODY INDEX [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2475 RUBELLA IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2475C RUBELLA IGM ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1445 SACCHAROMYCES CEREVISIAE IGG & IGA ANTIBODIES [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5926 S-ADENOSYL-METHIONINE [SAM(E)] ASSESSR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4152 SALICYLATE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3214M SALINE SUPPRESSION TEST [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7631 SALMONELLA IGG, IGM & IGA ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5635 SALMONELLA SEROTYPING [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4967 SAQUINAVIR MONITR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1085 SARCOIDOSIS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8386 SCHISTOSOMA ABS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8326 SCHISTOSOMA IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8351 SCHISTOSOMA IGG, IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8351C SCHISTOSOMA IGG & IGM ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8336 SCHISTOSOMA IGG, IGM & IGE ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1235 SCL-70 IGG AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4875 SELENIUM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4875U SELENIUM 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4875UR SELENIUM URINE RANDOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4875R SELENIUM RBC [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4875W SELENIUM WHOLE BLOOD [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4031 SENSORY NEUROPATHY EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4030 SENSORY NEUROPATHY EVALUATR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4195 SERTRALINE [ZOLOFT] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
Page 53 of 59 * PORTIONS OF THIS PAGE HAVE BEEN OMITTED PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION. ATTACHMENT A UNILAB FFS AND CAP FEE SCHEDULE
- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- 3218 SEX HORMONE BINDING GLOBULIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2034 SEXUALLY TRANSMITTED DISEASE AGENTS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8576 SHIGELLA ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8576C SHIGELLA ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8581 SHIGELLA IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5636 SHIGELLA SEROTYPING [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4986 SICKLE CELL SCREEN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1114 SKIN TOTAL AUTOABS, INTER-EPITHELIAL & DERMAL-EPIDERMAL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1234 SM (SMITH) & U1RNP/SNRNP AUTOANTIBODIES QUANT [HA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1232 SM (SMITH) AUTOABS QUANT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1220 SM (SMITH) IGG AUTOANTIBODIES [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3254 SMALL-CELL CARCINOMA MONITOR, LUNG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1106 SMOOTH MUSCLE TOTAL AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5306 SODIUM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5306U SODIUM 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5306UR SODIUM URINE RANDOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3222 SOMATOSTATIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5225 SPERM IGG AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9151 SPOROTHRIX ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8286 SPOROTHRIX IGG, IGM & IGA ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8286C SPOROTHRIX IGG, IGM & IGA ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1227 SRP AUTOANTIBODIES [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1007 SS-A & SS-B IGG AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1204 SS-A IGG AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1205 SS-B IGG AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8186 ST. LOUIS ENCEPHALITIS IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8186C ST. LOUIS ENCEPHALITIS IGM ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7810 ST. LOUIS ENCEPHALITIS IGM ANTIBODY INDEX [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8921 ST. LOUIS ENCEPHALITIS TOTAL ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8921C ST. LOUIS ENCEPHALITIS TOTAL ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2934 STAPH RESISTANCE MULTIPLEXR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4953 STAVUDINE (D4T) MONITR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4155 STONE ANALYSIS, KIDNEY [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4160 STONE-A-LYZER [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9641 STREPTOCOCCUS GROUP B AG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9641C STREPTOCOCCUS GROUP B AG CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9641U STREPTOCOCCUS GROUP B AG URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9636 STREPTOCOCCUS PNEUMONIAE AG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9636C STREPTOCOCCUS PNEUMONIAE AG CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9636U STREPTOCOCCUS PNEUMONIAE AG URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2386 STREPTOCOCCUS PNEUMONIAE IGG ABS, 12 SEROTYPES [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2386P STREPTOCOCCUS PNEUMONIAE IGG ABS, 12 SEROTYPES PRE/POST [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2370 STREPTOCOCCUS PNEUMONIAE IGG ABS, 4 SEROTYPES [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2370P STREPTOCOCCUS PNEUMONIAE IGG ABS, 4 SEROTYPES PRE/POST [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1337 STREPTOCOCCUS PYOGENES, GROUP A ABS [STREPTOZYME] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5777 STREPTOCOCCUS, BETA GROUP A CULTURE SCREEN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2433 STREPTOCOCCUS, BETA GROUP B CULTURE SCREEN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1107 STRIATIONAL TOTAL AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8566 STRONGYLOIDES IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8566C STRONGYLOIDES IGG ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4046 SULFOGLUCURONYL PARAGLOBOSIDE AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3232 T UPTAKE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3225 T3 FREE, TRACER DIALYSIS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5948 TACROLIMUS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4004 TAU-TRANSFERRIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
Page 54 of 59 * PORTIONS OF THIS PAGE HAVE BEEN OMITTED PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION. ATTACHMENT A UNILAB FFS AND CAP FEE SCHEDULE
- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- - ------------- ----------------------------------------------------------------------- ---------- ----------- 1533 T-CELL HELPER TYPES 1 & 2 EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1880 T-CELL RECEPTOR GENE REARRANGEMENT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2321 TEICHOIC ACID ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2321F TEICHOIC ACID ABS FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1634 TERMINAL DEOXYNUCLEOTIDYL TRANSFERASE BONE MARROW OR TISSUE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1694 TERMINAL DEOXYNUCLEOTIDYL TRANSFERASE BONE MARROW OR TISSUE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1694W TERMINAL DEOXYNUCLEOTIDYL TRANSFERASE WHOLE BLOOD [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1635 TERMINAL DEOXYNUCLEOTIDYL TRANSFERASE WITH IMMUNOPHENOTYPING [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1180 TESTES IGG AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3916 TESTOSTERONE BIOAVAILABLE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3247 TESTOSTERONE, FREE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3248 TESTOSTERONE, FREE & TOTAL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3244 TESTOSTERONE, TOTAL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3917 TESTOSTERONE, WEAKLY BINDING [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1331P TETANUS & DIPHTHERIA TOXOID IGG ABS, PRE/POST VACCINATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1331 TETANUS & DIPHTHERIA TOXOID IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1334P TETANUS TOXOID IGG ABS, PRE/POST VACCINATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1334 TETANUS TOXOID IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4156 THEOPHYLLINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4212 THROMBIN ANTI-THROMBIN (TAT) COMPLEX [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4210 THROMBIN TIME [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5978 THROMBOTIC MARKERS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5990 THROMBOTIC RISK ASSESSR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5972 THROMBOTIC RISK EVALUATION 1 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5971 THROMBOTIC RISK EVALUATION 2 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5973 THROMBOTIC RISK EVALUATION 3 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3298 THROMBOTIC RISK EVALUATION 4 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5985 THROMBUS PRECURSOR PROTEIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1110 THYROGLOBULIN AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3251 THYROGLOBULIN EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3255 THYROGLOBULIN SERUM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1016 THYROID AUTOANTIBODIES [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3060 THYROID ABS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3072 THYROID PANEL, HYPERTHYROIDISM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3074 THYROID PANEL, HYPOTHYROIDISM [MEIA/ICMA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3062 THYROID PEROXIDASE AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3076 THYROID SCREEN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3250 THYROID STIMULATING HORMONE, 3RD GENERATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1091 THYROID STIMULATING IMMUNOGLOBULINS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1092 THYROID STIMULATING IMMUNOGLOBULINS W/OUT TSH [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1090 THYROTROPIN RECEPTOR AUTOANTIBODY [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1093 THYROTROPIN RECEPTOR AUTOANTIBODY W/OUT TSH [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3226 THYROXINE (T4) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3954 THYROXINE (T4) FREE, DIRECT DIALYSIS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3238 THYROXINE BINDING GLOBULIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3228 THYROXINE, FREE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1971 TISSUE FACTOR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3288 TISSUE PLASMINOGEN ACTIVATOR AG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3296 PLASMINOGEN ACTIVATOR INHIBITOR-1 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1002 TISSUE TOTAL AUTOABS SCREEN - TABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1008 TISSUE TOTAL AUTOABS SCREEN PLUS THYROID PEROXIDASE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4902 TOBRAMYCIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4902P TOBRAMYCIN PEAK & TROUGH [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4925 TOPIRAMATE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4925P TOPIRAMATE PEAK & TROUGH [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
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- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- - ------------- ----------------------------------------------------------------------- ---------- ----------- 9901 TORCH IGG & IGM ABS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9901C TORCH IGG & IGM ABS EVALUATION CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9911 TORCH IGG ABS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9911C TORCH IGG ABS EVALUATION CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2231 TORCH IGM ABS EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2231C TORCH IGM ABS EVALUATION CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4162 TOXIC ELEMENT ANALYSIS WHOLE BLOOD [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2436 TOXIC SHOCK SYNDROME ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2437 TOXIC SHOCK SYNDROME EVAL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9766 TOXOCARA IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9761F TOXOCARA IGG, IGM & IGA ABS FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9761 TOXOCARA IGG, IGM & IGA ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2261 TOXOPLASMA ANTIBODY EVALUATION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2261C TOXOPLASMA ANTIBODY EVALUATION CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2261F TOXOPLASMA ANTIBODY EVALUATION FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7521 TOXOPLASMA DNA DETECTOR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8972 TOXOPLASMA ENCEPHALITIS ACCUDX [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7666 TOXOPLASMA IGA ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9426 TOXOPLASMA IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9426C TOXOPLASMA IGG ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9426F TOXOPLASMA IGG ABS FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8970 TOXOPLASMA IGG ANTIBODY INDEX [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7675 TOXOPLASMA IGM ABS [MAC EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7675C TOXOPLASMA IGM ABS CSF [MAC EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7675F TOXOPLASMA IGM ABS FLUID [MAC EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7661 TOXOPLASMA IGM ABS PEDIATRIC [ISAGA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7661C TOXOPLASMA IGM ABS CSF PEDIATRIC [ISAGA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7661F TOXOPLASMA IGM ABS FLUID PEDIATRIC [ISAGA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1519 TRANSFERRIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4002 TRANSFERRIN GENETIC D VARIANTS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1520 TRANSFERRIN RECEPTOR (TFR), SOLUBLE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1029 TRANSGLUTAMINASE IGA AUTOABS [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1027 TRANSGLUTAMINASE IGG AUTOABS [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1030 TRANSGLUTAMINASE IGG, IGM & IGA AUTOABS EVAL [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1028 TRANSGLUTAMINASE IGM AUTOABS [EIA] [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4960 TRAZODONE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1537 TREATABLE ISCHEMIA PREDICTR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9022 TREPONEMA PALLIDUM ANTIBODIES (TP-PA) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7565 TREPONEMA PALLIDUM IGG & IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7565F TREPONEMA PALLIDUM IGG & IGM ABS FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7561 TREPONEMA PALLIDUM IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7561C TREPONEMA PALLIDUM IGG ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7560C TREPONEMA PALLIDUM IGG ABS, FTA-ABS QUANT CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7560 TREPONEMA PALLIDUM IGG ABS, FTA-ABS QUANT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7555 TREPONEMA PALLIDUM IGG ANTIBODY INDEX [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7566 TREPONEMA PALLIDUM IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7566C TREPONEMA PALLIDUM IGM ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2102 TREPONEMA PALLIDUM IGM ABS, FTA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2102C TREPONEMA PALLIDUM IGM ABS, FTA CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2104 TREPONEMA PALLIDUM TOTAL ABS, FTA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2104C TREPONEMA PALLIDUM TOTAL ABS, FTA CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9386 TRICHINELLA IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9386C TRICHINELLA IGG ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9745 TRICHINELLA IGG ANTIBODY INDEX [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9741 TRICHINELLA IGG, IGM & IGA ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
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- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- - ------------- ----------------------------------------------------------------------- ---------- ----------- 9741C TRICHINELLA IGG, IGM & IGA ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4158 TRICYCLICS SCREEN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3346 TRIGLYCERIDES [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3224 TRIIODOTHYRONINE (T3) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3234 TRIIODOTHYRONINE, FREE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7573 TROPHERYMA WHIPPELII DNA DETECTR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3390 TROPONIN (I & T) DETECTR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3393 TROPONIN I [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3392 TROPONIN T [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9316 TRYPANOSOMA CRUZI IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3460 TRYPTASE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3294BW TUMOR NECROSIS FACTOR-ALPHA BRONCHIAL WASH [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3294C TUMOR NECROSIS FACTOR-ALPHA CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3294 TUMOR NECROSIS FACTOR-ALPHA PLASMA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3908 TUMOR NECROSIS FACTOR-BINDING PROTEINS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3908C TUMOR NECROSIS FACTOR-BINDING PROTEINS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1233 U1 RNP/SNRNP AUTOABS QUANT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1215 U1 RNP/SNRNP IGG AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1228 U2 SNRNP AUTOANTIBODIES [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1662 UNDIFFERENTIATED TUMOR PANEL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5319 UREA NITROGEN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2408 UREAPLASMA UREALYTICUM/MYCOPLASMA HOMINIS CULTURE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1310 URIC ACID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4333UR URIC ACID RANDOM URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4333U URIC ACID 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5200 URINALYSIS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7439 UR-SURE C. TRACHOMATIS/N. GONORRHOEAE BY LCR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3017 UTERINE CANCER MONITOR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3017SR UTERINE CANCER MONITOR W/SERIAL GRAPHICS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3360 VALPROIC ACID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3361 VALPROIC ACID, FREE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4903 VANCOMYCIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4903P VANCOMYCIN PEAK & TROUGH [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3319 VANILLYLMANDELIC ACID, PEDIATRIC [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3318U VANILLYLMANDELIC ACID 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3318UR VANILLYLMANDELIC ACID URINE RANDOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2199 VARICELLA-ZOSTER VIRUS AG DETECTION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7585 VARICELLA-ZOSTER VIRUS DNA DETECTOR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8760 VARICELLA-ZOSTER VIRUS DNA ULTRAQUANT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8760C VARICELLA-ZOSTER VIRUS DNA ULTRARAPID CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8761 VARICELLA-ZOSTER VIRUS IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8761C VARICELLA-ZOSTER VIRUS IGG ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7980 VARICELLA-ZOSTER VIRUS IGG ANTIBODY INDEX [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8766 VARICELLA-ZOSTER VIRUS IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8766C VARICELLA-ZOSTER VIRUS IGM ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8756 VARICELLA-ZOSTER VIRUS SERODX, IGG & IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8756C VARICELLA-ZOSTER VIRUS SERODX, IGG & IGM ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3252 VASOACTIVE INTESTINAL PEPTIDE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2366 VDRL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2366C VDRL CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5975 VENOUS THROMBOEMBOLISM (VTE) ASSESSR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2410 VIRAL CULTURE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2442 VIRAL DIARRHEA AG DETECTION [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9530 VIRAL ENCEPHALITIS DETECTR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5680 VIRAL SUSCEPTIBILITY: ACYCLOVIR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
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- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- - ------------- ----------------------------------------------------------------------- ---------- ----------- 5681 VIRAL SUSCEPTIBILITY: FOSCARNET [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5682 VIRAL SUSCEPTIBILITY: GANCICLOVIR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5683 VIRAL SUSCEPTIBILITY: PENCICLOVIR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1240P VISCOSITY PLASMA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1240 VISCOSITY SERUM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3502 VITAMIN A (RETINOL) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3524 VITAMIN A (RETINOL) & E [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3525 VITAMIN A (RETINOL) & VITAMIN D, 25-HYDROXY (CALCIFEROL) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3519 VITAMIN B1 & TRANSKETOLASE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3515 VITAMIN B1 (THIAMINE) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3515F VITAMIN B1 (THIAMINE) FLUID [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3515W VITAMIN B1 (THIAMINE) WHOLE BLOOD [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3518 VITAMIN B1 FUNCTIONAL ASSESSMENT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3504 VITAMIN B12 (CYANOCOBALAMIN) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3020 VITAMIN B12 (CYANOCOBALAMIN) & FOLATE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3500 VITAMIN B2 (RIBOFLAVIN) FUNCTIONAL ASSESSMENT [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3505 VITAMIN B6 (PYRIDOXAL PHOSPHATE) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3508 VITAMIN C (ASCORBIC ACID) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3520 VITAMIN D, 1,25-DIHYDROXY (CALCIFIDOL) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3523 VITAMIN D, 1,25-DIHYDROXY & 25-HYDROXY [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3521 VITAMIN D, 25-HYDROXY (CALCIFEROL) [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3530 VITAMIN E [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4834 VOLTAGE-GATED CALCIUM CHANNEL IGG AUTOABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5981 VON WILLEBRAND EVALUATION WITH MULTIMERS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5984 VON WILLEBRAND EVALUATION WITHOUT MULTIMERS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1907 VON WILLEBRAND FACTOR AG [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1905 VON WILLEBRAND FACTOR MULTIMERS PANEL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 1906 VON WILLEBRAND MULTIMERS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5961 VON WILLEBRAND PROFILE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5960 VON WILLEBRAND PROFILE W/REFLEX TO MULTIMERS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9121 WEIL-FELIX TEST [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8191 WESTERN EQUINE ENCEPHALITIS IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8191C WESTERN EQUINE ENCEPHALITIS IGM ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 7830 WESTERN EQUINE ENCEPHALITIS IGM ANTIBODY INDEX [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8931 WESTERN EQUINE ENCEPHALITIS TOTAL ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8931C WESTERN EQUINE ENCEPHALITIS TOTAL ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9076 WIDAL EVALUATION, SALMONELLA SPP. ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 5702 YERSINIA CULTURE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8676 YERSINIA ENTEROCOLITICA ABS SEROTYPE 0:3 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8676C YERSINIA ENTEROCOLITICA ABS SEROTYPE 0:3 CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8681 YERSINIA ENTEROCOLITICA ABS SEROTYPE 0:8 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8681C YERSINIA ENTEROCOLITICA ABS SEROTYPE 0:8 CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8686 YERSINIA ENTEROCOLITICA ABS SEROTYPE 0:9 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8686C YERSINIA ENTEROCOLITICA ABS SEROTYPE 0:9 CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8696 YERSINIA ENTEROCOLITICA ABS SEROTYPES 0:3, 0:8 & 0:9 [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8696C YERSINIA ENTEROCOLITICA ABS SEROTYPES 0:3, 0:8 & 0:9 CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8721 YERSINIA ENTEROCOLITICA IGA ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8721C YERSINIA ENTEROCOLITICA IGA ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2491 YERSINIA ENTEROCOLITICA IGG ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2491C YERSINIA ENTEROCOLITICA IGG ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9751 YERSINIA ENTEROCOLITICA IGG, IGM & IGA ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 9751C YERSINIA ENTEROCOLITICA IGG, IGM & IGA ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2496 YERSINIA ENTEROCOLITICA IGM ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 2496C YERSINIA ENTEROCOLITICA IGM ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 8711 YERSINIA PSEUDOTUBERCULOSIS TOTAL ABS [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
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- ------------- ----------------------------------------------------------------------- ---------- ----------- FEE FOR CAPITATED TEST CODE TEST DESCRIPTION SERVICE FEE - ------------- ----------------------------------------------------------------------- ---------- ----------- - ------------- ----------------------------------------------------------------------- ---------- ----------- 8711C YERSINIA PSEUDOTUBERCULOSIS TOTAL ABS CSF [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4958 ZALCITABINE (DDC) MONITOR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4959 ZIDOVUDINE (AZT) MONITR [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4877U ZINC 24HR URINE [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4877PL ZINC PLASMA [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3275 ZINC PROTOPORPHYRIN [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 3275I ZINC PROTOPORPHYRIN, INDUSTRIAL [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4877R ZINC RBC [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4877 ZINC [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- ----------- 4877UR ZINC URINE RANDOM [***]* [***]* - ------------- ----------------------------------------------------------------------- ---------- -----------
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