CN-640000-12007-PRSHT01.pdf

CPT CODE(S) Quest Test Description

ESTIMATED

ANNUAL

QUANTITY

PRICE

PER TEST

EXTENDED

PRICE

ADJUSTED FEES

PER 10/27/2016

AMENDMENT

Quest Test

Code

85029 CBC WITH DIFFERENTIAL/PLATELET 78600 $ 1.10 86,460.00$ 0006399

80053 COMP. METABOLIC PANEL (14) 70600 $ 1.51 106,487.39$ 0010231

80061 *LIPID PANEL WITH LDL/HDL RATIO 55650 $ 1.75 97,387.50$ 0007600

87086 URINE CULTURE, ROUTINE 34245 $ 3.00 102,735.00$ 0000395

83036 HEMOGLOBIN A1C 24825 $ 2.00 49,650.00$ 0000496

84443 TSH 29400 $ 2.00 58,800.00$ 0000899

80076 HEPATIC FUNCTION PANEL (7) 24770 $ 1.16 28,642.05$ 0010256

88142 PAP LB, RFX HPV ASCU 25325 $ 12.60 319,095.00$ 0031530

87491, 87591 CHLAMYDIA/GC AMPLIFICATION 32735 $ 12.00 392,820.00$ 0017305

87491, 87591 CHLAMYDIA/GC RNA,TMA $ 12.00 0011363

87491 CHLAMYDIA RNA, TMA $ 6.00 0011361

87591 GC RNA, TMA $ 6.00 0011362

88164 PAP SMEAR, 1 SLIDE 20905 $ 12.60 263,403.00$ 0003526

87177, 87209 OVA + PARASITE EXAM 18960 $ 5.00 94,800.00$ 0000681

87045, 87046, 87427 STOOL CULTURE 18170 $ 5.50 99,935.00$ 0010108

88141 PHYSICIAN READ PAP 20550 $ 5.00 102,750.00$ 0008779

88142 PAP LB (LIQUID‐BASED) 19060 $ 12.60 240,156.00$ 0035455

85025 87340

86592 86762

86850 86900

86901 PRENATAL PROFILE I 16415 $ 7.00 114,905.00$ 0020210

36415 VENIPUNCTURE 14590 $ 4.00 58,360.00$ 0003259

86703

HIV ANTIBODIES, PRELIMINARY TEST WITH

CONFIRMATION 14780 $ 4.70 69,466.00$ 0019728

83655 LEAD, BLOOD (PEDIATRIC) 13550 $ 4.00 54,200.00$ 0000599

83655 LEAD W/OSHA (B) $ 15.00 * 0003058

82950 GEST. DIABETES 1‐HR SCREEN 13795 $ 1.50 20,692.50$ 0008477

86592 RPR, RFX QN RPR/CONFIRM TP 11200 $ 2.00 22,400.00$ 0000799

86592 RPR(MONITOR)(REFL) $ 2.00 0092156

87081, 87149 STREP GP B CULT/DNA PROBE 10190 $ 7.85 79,991.50$ 0014547

87081, 87150 GBS DNA PCR $ 7.85 0091768

87081, 87150 GBS DNA PCR W/REFL $ 7.85 0091770

81003 URINALYSIS, ROUTINE 10500 $ 0.69 7,245.00$ 0006448

87340 HBSAG SCREEN 8870 $ 4.50 39,915.00$ 0000498

87340 HBSAG (REFL) W/CONF $ 4.50 0023028

84436, 84443, 84479 THYROID PANEL WITH TSH 8170 $ 3.10 25,327.00$ 0007444

82105, 82677, 84702, 86336 AFP TETRA 7130 $ 22.00 156,860.00$ 0030294

87536 RNA, REAL TIME PCR (GRAPH) 7800 $ 45.00 351,000.00$ 0040085

84153 PROSTATE‐SPECIFIC AG, SERUM 7200 $ 3.50 25,200.00$ 0005363

86359, 86360 HELPER SUPPRESSOR SHORT PROF. 2400 $ 6.00 14,400.00$ 0007195

83021, 85660 HGB FRAC. PROFILE 5710 $ 6.00 34,260.00$ 0035489

87621 HPV, HIGH‐RISK 7075 $ 18.00 127,350.00$ 0015949

82043, 82570 MICROALB/CREAT RATIO, RANDM UR 4480 $ 5.00 22,400.00$ 0006517

84439, 84443 TSH+FREE T4 2630 $ 2.00 5,260.00$ 0036127

85660 HGB SOLUBILITY 5180 $ 3.00 15,540.00$ 0000825

86360 CD4/CD8 RATIO PROFILE 3810 $ 13.00 49,530.00$ 0007924

88175 PAP IG, RFX HPV ALL PTH 4160 $ 12.60 52,416.00$ 0058316

81001 UA/M W/RFLX CULTURE, ROUTINE 3040 $ 1.50 4,560.00$ 0003020

84702 HCG,BETA SUBUNIT, QNT, SERUM 4020 $ 4.50 18,090.00$ 0008396

FLORIDA DEPARTMENT OF HEALTH

ATTACHMENT 1

CORE TEST LIST

Revision #3 10/27/2016

Confidential ‐ For Client Internal Use Only 1 of 5

ANNUAL

QUANTITY

PRICE

PER TEST

EXTENDED

PRICE

ADJUSTED FEES

PER 10/27/2016

AMENDMENT

Quest Test

Code

FLORIDA DEPARTMENT OF HEALTH

ATTACHMENT 1

CORE TEST LIST

Revision #3 10/27/2016

80048 BASIC METABOLIC PANEL (8) 3980 $ 1.21 4,804.24$ 0010165

80101 (7) 788612 7 DRUG‐BUND 4240 $ 8.00 33,920.00$ 0014668

82105, 82677, 84702 AFP X‐TRA PROFILE 5100 $ 17.00 86,700.00$ 0007292

85652 SEDIMENTATION RATE‐WESTERGREN 3380 $ 2.00 6,760.00$ 0000809

85610 PROTHROMBIN TIME (PT) 2980 $ 2.50 7,450.00$ 0000761

84550 URIC ACID, SERUM 3190 $ 0.88 2,807.20$ 0000905

88305 88305 SURG PATH‐1ST SITE 3020 $ 18.00 54,360.00$

0003305 /

LFO1

85018 HEMOGLOBIN 2681 $ 0.83 2,225.23$ 0000510

88175 PAP IG (IMAGE GUIDED) 5067 $ 15.75 79,805.25$ 0058315

86787 VARICELLA‐ZOSTER V AB, IGG 2330 $ 6.00 13,980.00$ 0004439

86361 HELPER T‐LYMPH‐CD4 2695 $ 14.00 37,730.00$ 0008360

88175, 87491, 87591 PAP IG, CT‐NG, RFX HPV ASCU 2750 $ 24.60 67,650.00$

0058316, 0017618

86706 HEP B SURFACE AB 1820 $ 2.80 5,096.00$ 0000499

80101 (9) 074021 9 DRUG‐SCR 1600 $ 11.00 17,600.00$ 0023492

86708, 86803, 86704, 86706, 87340 HEPATITIS PANEL (5) 2400 $ 14.00 33,600.00$ 0006462

82951, 82952 GESTATIONAL GLUCOSE TOLERANCE 2090 $ 6.00 12,540.00$ 0006745

86480 QUANTIFERON IN TUBE 1520 $ 25.00 38,000.00$ 0016603

86431 RHEUMATOID ARTHRITIS FACTOR 1710 $ 2.50 4,275.00$ 0004418

80074 HEPATITIS PANEL (4) 2330 $ 18.00 41,940.00$ 0010306

86850 ANTIBODY SCREEN 1770 $ 0.90 1,593.00$ 0000795

82947 GLUCOSE, PLASMA 2210 $ 0.88 1,944.80$ 0000483

82947 GLUCOSE (REFL) $ 0.88 0003091

82945 GLUCOSE, CSF $ 0.88 0000468

87070 AEROBIC BACTERIAL CULTURE 2685 $ 6.00 16,110.00$ 0004550

86038 ANTINUCLEAR ANTIBODIES DIRECT 1430 $ 4.00 5,720.00$ 0000249

87255 HSV CULTURE AND TYPING 1440 $ 8.00 11,520.00$ 0002649

88142, 87621 PAP LB, HPV‐HR 1242 $ 30.60 38,005.20$ 0015003

82040 82247

82310 82435

82465 82565

82947 82977

83540 83615

84075 84100

84132 84155

84295 84450

84460 84478

84520 84550 CMP12+8AC 1365 $ 2.62 3,576.30$

0034389, 0034708

82306 QUESTASSURED VIT D 975 $ 8.00 7,800.00$ 0017306

82306 QUESTASSURED VIT D $ 8.00 * 0092888

82043 MICROALBUMIN, RANDOM URINE 1420 $ 5.00 7,100.00$ 0004555

82607, 82746 VITAMIN B12 AND FOLATE 1365 $ 6.00 8,190.00$ 0007065

82607 VITAMIN B12 $ 3.00 0000927

82746 FOLATE,SERUM $ 3.00 0000466

82746 FOLATE,S(RFL) $ 3.00 0030664

84439 THYROXINE (T4) FREE, DIRECT, S 1800 $ 5.00 9,000.00$ 0000866

84439 T‐4, FREE DIALYSIS $ 5.00 0035167

86695, 86696 HSV 1 AND 2‐SPECIFIC AB, IGG 1325 $ 5.00 6,625.00$ 0006447

Confidential ‐ For Client Internal Use Only 2 of 5

ANNUAL

QUANTITY

PRICE

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PRICE

ADJUSTED FEES

PER 10/27/2016

AMENDMENT

Quest Test

Code

FLORIDA DEPARTMENT OF HEALTH

ATTACHMENT 1

CORE TEST LIST

Revision #3 10/27/2016

82728 FERRITIN, SERUM 1390 $ 4.00 5,560.00$ 0000457

85610, 85730

PROTHROMBIN TIME (PT) AND PARTIAL

THROMBOPLASTIN TIME (PTT) 960 $ 3.50 3,360.00$ 0004914

83550, 83540 IRON AND TIBC 1330 $ 4.50 5,985.00$ 0007573

83550, 83540 IRON,IBC,%SAT (REFL) 4.50$ 0028882

88175, 87621 PAP IG, HPV AND RFX HPV 16/18 280 $ 15.75 4,410.00$ 0058317

86677 H. PYLORI IGG, ABS 860 $ 9.00 7,740.00$ 0029407

84403 TESTOSTERONE, SERUM 790 $ 6.00 4,740.00$ 0000873

86708 HEP A AB, TOTAL 900 $ 2.80 2,520.00$ 0000508

86359, 86360, 86355 T + B‐LYMPHOCYTE DIFFERENTIAL 1300 $ 22.00 28,600.00$ 0036420

83001, 83002

FOLLICLE STIMULATING HORMONE (FSH)

AND LH 1120 $ 7.00 7,840.00$ 0007137

83001 FSH $ 3.50 0000470

83002 LH $ 3.50 0000615

83002 LH $ 3.50 0014947

80061 85025

82040 82247

8231082435

82565 82947

82977 83540

83615 84075

84100 84132

84155 84295

84450 84460

84520 84550 CMP12+LP+6AC+CBC/D/PLT 920 $ 5.37 4,940.40$

0034389, 0007600, 0034706, 0006399

84450 AST (SGOT) 1420 $ 0.88 1,249.60$ 0000822

86762 RUBELLA ANTIBODIES, IGG 560 $ 0.90 504.00$ 0000802

86762 RUBELLA IGG AB $ 0.90 0023030

86762 RUBELLA IGG AB W/RFL $ 0.90 0010268

86704 HEP B CORE AB, TOT 645 $ 4.70 3,031.50$ 0000501

86777 TOXOPLASMA GONDII AB, IGG, QN 940 $ 8.00 7,520.00$ 0003679

84436 THYROXINE (T4) 1200 $ 0.80 960.00$ 0000867

82607 82728

82746 83550

85025 85045

83540 ANEMIA PROFILE B 715 $ 23.60 16,874.00$

927, 457, 466, 7573, 6399, 84146 PROLACTIN 885 $ 7.00 6,195.00$ 0000746

86140 C‐REACTIVE PROTEIN, QUANT 870 $ 5.00 4,350.00$ 0004420

86803 HCV ANTIBODY 650 $ 2.80 1,820.00$ 0008472

86803 HEP C AB (REFL) $ 2.80 0002960

84436, 84479 THYROID PANEL 260 $ 1.10 286.00$ 0007020

87070 GENITAL CULTURE, ROUTINE 220 $ 8.00 1,760.00$ 0004558

87070 UPPER RESPIRATORY CULTURE 467 $ 8.00 3,736.00$ 0014867

87070 LOWER RESPIRATORY CULTURE 35 $ 8.50 297.50$ 0004556

84450, 84460 ALT+AST 715 $ 0.91 650.65$ 823, 822

82247 82565

84450 84460

84520 84550 ALT+AST+BUN+CREAT+TBILI+URI... 200 $ 1.94 388.00$

823, 822, 294, 375, 287, 905

82247, 84450, 84460 ALT+AST+TBILI 115 $ 0.96 110.40$ 287, 823, 822

87900 HIV GENOSURE(TM) MG 210 $ 15.00 3,150.00$ 0010508

87901 HIV GENOSURE(TM) MG 210 $ 125.00 26,250.00$ 0034949

Confidential ‐ For Client Internal Use Only 3 of 5

ANNUAL

QUANTITY

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AMENDMENT

Quest Test

Code

FLORIDA DEPARTMENT OF HEALTH

ATTACHMENT 1

CORE TEST LIST

Revision #3 10/27/2016

84460 ALT (SGPT) 780 $ 0.88 686.40$ 0000823

87901, 87900 HIV GENOSURE 250 $ 140.00 35,000.00$ 0017534

82565 CREATININE, SERUM 310 $ 0.88 272.80$ 0000375

87522 HCV RT‐PCR, QUANT (GRAPH) 175 $ 45.00 7,875.00$ 0010050

87522 HCV RNA BY PCR,QT $ 45.00 0035645

87517 HBV REAL‐TIME PCR, QUANT 120 $ 45.00 5,400.00$ 0008369

83890, 83893x3, 83896x3, HLA‐B5701 (Abacavir Hypersensitivity)

Test 165 45.00$ 7,425.00$ 0019774

87621 HPV ASR 245 $ 18.00 4,410.00$ 0031532

87624 HPV RNA HR E6/E7 TMA $ 18.00 0090887

TBD QNS HPV HIGH RISK $ 18.00 0016452

TBD QNS HPV HIGH RISK $ 18.00 0016737

87621 HPV RNA HR E6/E7 $ 18.00 0090887

87621 x2 HPV HIGH LOW AR $ 36.00 0017185

87621 x2 HPV GENO 16 AND 18 $ 18.00 0019865

87621 x2 HPV HYBRID CAPTURE 2 $ 36.00 0036453

87621 x2 HPV GENO 16,18/45 $ 36.00 0091826

87621 HPV HR $ 18.00 0092079

87621 HPV HIGH RISK AR $ 18.00 0015949

85027 CBC, PLATELET; NO DIFFERENTIAL 370 $ 0.95 351.50$ 0001759

TBD CYTO, NON‐GYN FLUID 1 $ 45.00 NGF1

TBD

CYTOPATH, NON‐GYN FLUID,

CONCENTRATION TECH. $ 45.00 0003471

86765 MEASLES ANTIBODY IGG $ 14.05 0000964

86762, 86765, 86735 *MMR Panel‐Measles, Mumps, Rubella $ 29.00 0005259

86735 MUMPS VIRUS ANTIBODY IGG $ 14.05 0008624

TBD Non GYN Cytology $ 45.00 0003505

TBD

NON‐GYN SMEAR NO PREP (NON‐

ORDERABLE) $ 45.00 NGP1

83735 MAGNESIUM 300 $ 6.00 1,800.00$ 0000622

87207 MALARIA SMEAR 500 $ 38.00 19,000.00$ 0000831

82274 FECAL IMMUNOCHEM $ 11.00 * 0011290

82274 FECAL IMMUNOCHEM MED $ 11.00 * 0011293

87661 TRICHOMONAS VAG $ 45.00 0019550

87661 T.VAGINALIS RNA,MALE $ 45.00 0090801

81401 TPMT GENOTYPE $ 200.00 0037742

83789 TPMT ACTIVITY $ 180.00 0018831

83883, 83520, 82977, 82247

*LIVER FIBROSIS PANEL (HEPASCORE

(TM)) $ 180.00 0019647

83883 A‐2‐MACROGLOBULIN $ 66.00 0000228

83520 HYALURONIC ACID $ 88.52 0019480

82977 GAMMA GLUTAMYLTRANSFERASE (GGT) $ 24.60 0000482

82247 BILIRUBIN, TOTAL $ 0.88 0000287

86800, 84432 **TG PANEL,REBASELINE $ 56.43 * 0092154

81420 QNATAL(TM) ADVANCED ######### * 0092777

87529 SURESWAB(R), HSV 1/2 $ 75.00 * 0090570

87481 (4) SURESWAB CANDIDIASIS $ 75.00 * 0016494

87512, 87799

(3) BV DNA, QNT REAL‐TIME PCR $ 75.00

0016898

87798 (2)

SURESWAB(R), UREAPLASMA SPECIES,

PCR $ 45.00

0091476

Confidential ‐ For Client Internal Use Only 4 of 5

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Quest Test

Code

FLORIDA DEPARTMENT OF HEALTH

ATTACHMENT 1

CORE TEST LIST

Revision #3 10/27/2016

87338 H.PYLORI AG STOOL $ 27.78 * 0034838

87798

SURESWAB(R), MYCOPLASMA

GENITALIUM, PCR $ 45.00

0091475

87798

SURESWAB(R), MYCOPLASMA HOMINIS,

PCR $ 45.00

0091474

87661 TVAG RNA QL TMA $ 45.00 * 0090521

87902 HCV GENO 3 NS5A $ 550.00 * 0093325

87631 INFLU A/B, RSV RNA $ 112.00 * 0091989

86790 ZIKA VIRUS IGM MAC $ 95.00 * 0094264

87798 x2 ZIKA VIRUS RNA,QU RT $ 200.00 * 0094221

87798 ZIKA VIRUS RNA PCR $ 105.00 * 0093870

Confidential ‐ For Client Internal Use Only 5 of 5

Quest

Test Code Quest Test Description

PRICE

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DISC IND

ADJUSTED FEES

PER 10/27/2016

AMENDMENT

0090581 (H‐HCG), SENSITIVE $205.00 N

0090992 (H‐HCG), SENSITIVE URINE $205.00 N

0017912 (MTHFR), DNA MUTATION NY $312.90 N

0017303 **CHLAMYDIA SDA (Discontinued, replaced with 0011361) $6.00 N

0037694 **HIV 1/2 REFL WB (Discontinued, replaced with 0019728) $4.70 N

0005233 **HIV‐1 AB BY WBA (Discontinued, replaced with

0091432)

$25.00 N

0010110 **HIV‐1/HIV‐2 WEST.BLT (Discontinued, replaced with

0091432)

$25.00 N

0037363 **HIV‐2 AB,EIA (Discontinued, replaced with 0019728) $4.70 N

0017304 **NG SDA (Discontinued, replaced with 0011362) $6.00 N

0017617 **NG, DNA, SDA, OTV (Discontinued, replaced with

0011362)

$6.00 N

0008464 *AMYLASE (U)W/CR $28.99 N

0016847 *ANACHOICE STAGE 1 $275.00 N

0019947 *ANACHOICE STAGE 1 $275.00 N

0016848 *ANACHOICE STAGE 2 $198.00 N

0019948 *ANACHOICE STAGE 2 $198.00 N

0016849 *ANACHOICE STAGE 3 $110.00 N

0019704 *APC ‐ R W/RFX $106.59 N

0030340 *BETA 2 GLY (G,A,M) $268.82 N

0000672 *CADMIUM (U) W/CR $128.00 N

0005244 *CATECHOLAMINES(U)W/CR $82.40 N

0015386 *CLOSTRIDIUM DIF W/RFX $77.25 N

0015334 *HEP IND PLT AB W/REFL $100.00 N

0001648 *HIAA 5‐ (U) W/CR $42.15 N

0010435 *HIV 1 RNA W/RFLEX PRFLE $45.00 N

0018967 *HIV 1 RNA, QL TMA $349.00 N

0006346 *HVA (U) W/CR $152.70 N

0019543 *LIPID PANEL WITH RA $1.75 N

0014852 *LIPID PNL W/REF DIR LDL $1.75 N

0006179 *MAGNESIUM (U)W/CR $43.85 N

0006016 *METANEPHRINES(U)W/CR $118.40 N

0034286 *PNEUMOCYSTIS CARNII $123.90 N

0015384 *RF SCR/RFL TO TITER $3.00 N

0019790 *VON WILLEBRAND COMP $729.46 N

0090964 11 DEOXYCORTISOL $136.25 N

0030543 11‐DEOXYCORTISOL $136.25 N

0091455 14 3 3 ETA PROTEIN $124.88 N *

0090966 17 HYDROXYPREGNENOL $110.25 N

0090965 17 HYDROXYPROGESTER $68.15 N

FLORIDA DEPARTMENT OF HEALTH

ATTACHMENT 2

BALANCE OF LINE TEST

Revision #3 10/27/2016

Confidential ‐ For Client Internal Use Only 1 of 98

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AMENDMENT

FLORIDA DEPARTMENT OF HEALTH

ATTACHMENT 2

BALANCE OF LINE TEST

Revision #3 10/27/2016

0015201 17 KETO W/ CREATININE $62.00 N

0015203 17HYDROXY/17KETOSTER $130.40 N

0017654 17‐HYDRXPROG NEO/INF $68.15 N

0015202 17OH‐CORTICOS, 24HR (U) $108.15 N

0017180 17‐OHPROGEST.LC/MSMS $68.15 N

0090967 18 HYDROXYCORT+CORT $359.00 N

0011178 18‐HYDRO. FREE 24HR $229.00 N

0016533 1911A>G MUTATION $299.00 N

0016969 1ST TRI SCR H‐HCG(NY) $253.00 N

0016968 1ST TRI SCR,HCG (NY) $156.00 N

0037916 21 HYDROXYLASE AB $107.00 N

0005276 3‐ALPHA DIOL G $225.75 N

0039625 5‐HIAA,24HR (U) $42.15 N

0019474 6 MONOACETYLMORPHINE $91.00 N

0014859 6 MONOACETYLMORPHINE $60.00 N

0000469 A‐1‐A GLYCOPROTEIN $83.53 N

0000853 A‐1‐ANTITRYPSIN $120.75 N

0000235 A‐1‐ANTITRYPSIN QN $30.72 N

0015340 AAT MUTATION ANALY $275.00 N

0037103 AB TO PM‐1 $106.05 N

0016031 ABL KINASE DOMAIN $400.00 N

0016029 ABL MUTATION $400.00 N

0019783 ABL T315I MUT IN CML CELL $500.00 N

0019782 ABL T315I MUT IN CML LEUM $500.00 N

0015688 ABO AND RH (REFL) $1.20 N

0000785 ABO GROUP $0.60 N

0007788 ABO GRP AND RH TYPE $1.20 N

0036577 ABTI‐TSH AUTOAB $118.00 N

0018979 ACCUTYPE METFORMIN $117.23 N

0090251 ACCUTYPE(R) IL28B $325.00 N

0090252 ACCUTYPE(R) IL28B NY $325.00 N

0016160 ACCUTYPE(R) WARFARIN $500.00 N

0000201 ACETAMINOPHEN $100.00 N

0003198 ACETAMINOPHEN SCN;U $69.00 N *

0000205 ACETONE (B) $81.76 N

0004929 ACETYLCHOLINESTERASE $47.75 N

0016061 ACHONDROPLASIA MUT. $273.00 N

0000206 ACHR BINDING AB $132.00 N

0034459 ACHR BLOCKING $132.00 N

0026474 ACHR MODULATING AB $225.00 N

0104273 ACID FAST GROCOTT'S $185.00 N

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ATTACHMENT 2

BALANCE OF LINE TEST

Revision #3 10/27/2016

0104282 ACID FAST PAS FUNGUS $185.00 N

0004503 ACID FAST STAIN $31.70 N

0104278 ACID FAST STAIN,TIS $155.00 N

0000208 ACID PHOS, PROS, IMM $21.36 N

0000211 ACTH $88.00 N

0014571 ACTH STIM, 2 SPEC $144.08 N

0015043 ACTIN ANTIBODY (IGG) $55.20 N

0003900 ACTINOMYCES CULTURE $169.35 N

0017777 ACYCLOVIR $345.00 N

0014531 ACYLCARNITINE PLASMA $172.00 N

0017698 ADENOSINE DEAMINASE, CSF $120.00 N

0017697 ADENOSINE DEAMINASE, PERI $120.00 N

0017696 ADENOSINE DEAMINASE, PLEU $120.00 N

0000686 ADENOVIRUS AB, SERUM $89.25 N

0038945 ADENOVIRUS AG,EIA $71.20 N

0008538 ADENOVIRUS CSF $70.00 N

0019726 ADENOVIRUS DNA QN $349.00 N

0016046 ADENOVIRUS QL, PCR $240.00 N

0015060 ADIPONECTIN $178.50 N

0036155 ADRENAL AB $19.95 N

0004645 ADRENAL AB RFX TITER $110.20 N

0010715 ADULT FOOD ALLERGY PROF $86.25 N *

0039530 ADULTER, CREAT W/REF $1.06 N

0039531 ADULTERATION, PH $24.55 N

0034118 AEROBIC BACT ID $4.00 N

0018881 AEROBIC CULT W/GS $7.33 N

0019585 AFB CUSTOM DRUG PNL $83.00 N

0090870 AFB ID,SEQ,STAIN PB $395.00 N

0019529 AFP AND AFP‐L3 $108.00 N

0000232 AFP, FLUID W/RFX $67.20 N

0017554 AFP, PERICARDIAL FL $67.20 N

0017410 AFP, PERITONEAL FL $67.20 N

0017555 AFP, PLEURAL FLUID $67.20 N

0000237 AFP,TUMOR (CHIRON) $82.36 N

0006301 ALA, RAND (U) $110.35 N

0000223 ALBUMIN $0.88 N

0017412 ALBUMIN PERITON FL $1.06 N

0000224 ALBUMIN, CSF $14.00 N

0017411 ALBUMIN, PERICARD FL $1.06 N

0017413 ALBUMIN, PLEURAL FL $1.06 N

0017646 ALBUMIN, SYNOVIAL FL $1.06 N

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ATTACHMENT 2

BALANCE OF LINE TEST

Revision #3 10/27/2016

0019938 ALCOHOL QUANT, RAND (U) $100.00 N

0002128 ALCOHOL, ETHANOL (U) $75.00 N

0014920 ALCOHOL, ETHANOL (U) $60.00 N

0000443 ALCOHOL, ETHYL (B) $100.00 N

0000578 ALCOHOL, ISOPROPYL $89.30 N

0000643 ALCOHOL, METHYL (B) $81.70 N

0019450 ALCOHOL,ETHYL (U),QN $100.00 N

0015802 ALCOHOL,ETHYL NO CONF $60.00 N

0018909 ALDO/CORT RATIO 1 $175.00 N

0018910 ALDO/CORT RATIO 2 $175.00 N

0018912 ALDO/CORT RATIO 3 $175.00 N

0018913 ALDO/CORT RATIO 4 $175.00 N

0018914 ALDO/CORT RATIO 5 $175.00 N

0018915 ALDO/CORT RATIO 6 $175.00 N

0018916 ALDO/CORT RATIO 7 $175.00 N

0018917 ALDO/CORT RATIO 8 $175.00 N

0000227 ALDOLASE $19.40 N

0018907 ALDOS/CORT ABOVE VC $175.00 N

0018908 ALDOS/CORT BELOW VC $175.00 N

0018904 ALDOS/CORT LEFT $175.00 N

0018906 ALDOS/CORT PERIPH $175.00 N

0018905 ALDOS/CORT RIGHT $175.00 N

0000230 ALDOSTERONE $84.00 N

0000229 ALDOSTERONE (U) $84.00 N

0039596 ALDOSTERONE 120 MIN $84.00 N

0090497 ALDOSTERONE 30 MIN $84.00 N

0039598 ALDOSTERONE 30 MIN. $84.00 N

0039595 ALDOSTERONE 60 MIN $84.00 N

0039599 ALDOSTERONE 60 MIN. $84.00 N

0019520 ALDOSTERONE 60 MIN. $84.00 N *

0039597 ALDOSTERONE BASELINE $84.00 N

0019545 ALDOSTERONE BASELINE $84.00 N *

0095084 ALDOSTERONE W/O CORT $100.80 N

0017181 ALDOSTERONE,LC/MS/MS $84.00 N

0019573 ALDOSTERONE/CORTISOL $154.00 N

0038263 ALFALFA (W45) IGE ** $16.00 N

0000231 ALK PHOS ISOENZYMES $25.48 N

0019127 ALK1,IHC W/INTERP $165.00 N

0000234 ALKALINE PHOSPHATASE $0.88 N

0091268 ALLERGEN PANEL $288.00 N

0007911 ALLERGY 11,PCS,MOLD $28.75 N

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AMENDMENT

FLORIDA DEPARTMENT OF HEALTH

ATTACHMENT 2

BALANCE OF LINE TEST

Revision #3 10/27/2016

0007912 ALLERGY 12,PCS,ANIML $34.50 N *

0007913 ALLERGY 13,PCS,INSCT $28.75 N

0007914 ALLERGY 14,PCS,PEDS $28.75 N

0007915 ALLERGY 15,PCS,CEREAL $28.75 N

0007916 ALLERGY 16,PCS,VEG $28.75 N

0007917 ALLERGY 17,PCS,SALAD $28.75 N

0007918 ALLERGY 18 PC NUTS $40.25 N *

0007919 ALLERGY 19,PCS,SEAFD $34.50 N *

0007904 ALLERGY 4,PCS,GL $57.50 N

0038828 ALLERGY PNL P.RICO $133.50 N *

0010643 ALLERGY PNL REG 1 $156.50 N *

0010651 ALLERGY PNL REG 10 $156.50 N *

0010653 ALLERGY PNL REG 11 $150.75 N *

0010654 ALLERGY PNL REG 12 $139.25 N *

0010655 ALLERGY PNL REG 13 $150.75 N *

0010668 ALLERGY PNL REG 14 $145.00 N *

0010669 ALLERGY PNL REG 15 $139.25 N *

0010657 ALLERGY PNL REG 16 $133.50 N *

0010658 ALLERGY PNL REG 17 $145.00 N *

0010673 ALLERGY PNL REG 18 $99.00 N *

0010644 ALLERGY PNL REG 2 $145.00 N *

0010285 ALLERGY PNL REG 3 $139.25 N *

0010286 ALLERGY PNL REG 4 $139.25 N *

0010646 ALLERGY PNL REG 5 $155.25 N

0010647 ALLERGY PNL REG 6 $139.25 N *

0010648 ALLERGY PNL REG 7 $145.00 N *

0010649 ALLERGY PNL REG 8 $156.50 N *

0010650 ALLERGY PNL REG 9 $139.25 N *

0091267 ALLERGY REG 6 (REFL) $139.25 N

0011270 ALLERGY SHELLFSH PNL $23.00 N

0007953 ALLERGY,PCS,R3,GRASS $84.88 N

0007983 ALLERGY,PCS,R3,WEEDS $84.88 N

0007957 ALLERGY,PCS,R7,GRASS $81.60 N

0007977 ALLERGY,PCS,R7,TREES $81.60 N

0007987 ALLERGY,PCS,R7,WEEDS $81.60 N

0007101 ALLERGY1, NE $57.50 N

0038137 ALMOND IGG $35.20 N

0016116 ALPHA GLOBIN COMPLETE $610.00 N

0008658 ALPHA SUBUNIT $99.92 N

0011175 ALPHA THAL MUT ANAL $460.00 N

0090102 ALPHA THALA GENOTYPR $460.00 N

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DISC IND

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PER 10/27/2016

AMENDMENT

FLORIDA DEPARTMENT OF HEALTH

ATTACHMENT 2

BALANCE OF LINE TEST

Revision #3 10/27/2016

0014628 ALPHA‐1‐ANTITRYPSIN $51.20 N

0030523 ALPHA‐1‐ANTITRYPSIN $51.20 N

0017409 ALPHA‐FETOPROTEIN, CSF $67.20 N

0016124 ALPHA‐GLOBIN GENE $575.00 N

0004741 ALPRAZOLAM $104.00 N

0030958 ALPRAZOLAM METABOLITE;U $169.00 N

0014451 ALUM 24HR W/O CREAT $74.40 N

0006021 ALUMINUM, B $79.00 N

0000236 AMIKACIN $88.00 N

0008584 AMIKACIN, PEAK $88.00 N

0008583 AMIKACIN, TROUGH $88.00 N

0036184 AMINO ACD,LC/MS,U,NY $623.70 N

0019779 AMINO ACID FOR MSUD $132.00 N

0000767 AMINO ACID FRAC, P $555.90 N

0000238 AMINO ACID SCR $69.72 N

0019768 AMINO ACID,LC/MS(NY) $549.15 N

0036721 AMIODARONE $130.66 N

0000423 AMITRIPTYLINE $48.90 N

0014995 AML1/ETO QN RT‐PCR $268.80 N

0005509 AMMONIA (P) $49.00 N

0035159 AMOXICILLIN $136.84 N

0038476 AMOXICILLIN C6 IGE $5.75 N

0014742 AMPH CONF GCMS URINE $100.00 N

0037198 AMPHET CONF $100.00 N

0070036 AMPHET QL 200 GCMS $91.00 N

0034517 AMPHET. GC/MS MECON $100.00 N

0014740 AMPHETAMINE CON GCMS $100.00 N

0014744 AMPHETAMINE CONF BLD $100.00 N

0014743 AMPHETAMINE SCR W/CONF(B) $160.00 N

0014739 AMPHETAMINE SCR W/CONF(S) $160.00 N

0014741 AMPHETAMINE SCR W/CONF(U) $160.00 N

0014697 AMPHETAMINE‐1000 CLN $60.00 N

0014924 AMPHETAMINE‐1000 CLN $60.00 N

0030464 AMPHETAMINE‐1000 $169.73 N

0000241 AMPHETAMINES (U) $100.00 N

0006028 AMPHETAMINES CONF. $100.00 N

0003038 AMPHETAMINES D/L;SP $259.00 N

0007170 AMPHETAMINES SC/CF $160.00 N

0090262 AMPHETAMINES,QN,U $158.40 N

0020711 AMPHOTERICIN B,HPLC $190.00 N

0014564 AMPICILLIN (C5)IGE $5.75 N

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DISC IND

ADJUSTED FEES

PER 10/27/2016

AMENDMENT

FLORIDA DEPARTMENT OF HEALTH

ATTACHMENT 2

BALANCE OF LINE TEST

Revision #3 10/27/2016

0000243 AMYLASE $24.16 N

0000212 AMYLASE (U) $28.99 N

0091195 AMYLASE (U) $40.85 N

0000845 AMYLASE ISOENZYMES $171.50 N

0017414 AMYLASE, PERITON FL $24.16 N

0017415 AMYLASE, PLEURAL FL $24.16 N

0104279 AMYLOID (CONGO RED) $135.00 N

0059678 ANA AB HEP 2 SUB IFA $4.00 N

0038318 ANA IFA W/REFL $4.00 N

0010547 ANA SC W/REFL DS‐DNA $4.00 N

0010321 ANA SCREEN $4.00 N

0036209 ANA TITER&PATTERN $15.96 N

0095041 ANA TITER/PATTERN $15.96 N

0008268 ANA W/REFL (REFL) $4.00 N

0019946 ANACHOICE(R) SPECIFIC AB CASCADING REFLEX

(Bill Code 10321) (Reflexed tests will bill if indicated)

$4.00 N

0090276 ANAEROBIC BAC 1 DRUG $54.67 N

0090278 ANAEROBIC BAC 2 DRUG $109.34 N

0090279 ANAEROBIC BAC 3 DRUG $164.00 N

0004469 ANAEROBIC CULT. W/GS $7.33 N

0070171 ANCA SC W/RFL TITER $25.00 N

0038914 ANCA SCREEN $131.25 N

0008431 ANCA TITER $186.05 N

0036733 ANCA $229.47 N

0000251 ANDROSTENEDIONE $180.65 N

0090968 ANDROSTENEDIONE $180.65 N

0017182 ANDROSTENEDIONE LCMS $180.65 N

0000683 ANGIOTENSIN CONV ENZ $40.15 N

0090088 ANIDULAFUNGIN, HPLC $146.40 N

0058876 ANNA TITER AND WB $287.00 N

0011266 ANNEXIN V ANTIBODIES $120.00 N

0016316 ANNEXIN‐1,IHC W/INTRP $165.00 N

0016317 ANNEXIN‐1,IHC W/O INTRP $125.00 N

0036669 ANTI C3 & ANTI IGG $29.40 N

0014785 ANTIBODY ELUTION $90.00 N

0037419 ANTIBODY PANEL X 1 $68.40 N

0037420 ANTIBODY PANEL X 2 $136.80 N

0037421 ANTIBODY PANEL X 3 $205.20 N

0037422 ANTIBODY PANEL X 4 $273.60 N

0037423 ANTIBODY PANEL X 5 $342.00 N

0037424 ANTIBODY TITER X 1 $20.35 N

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DISC IND

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AMENDMENT

FLORIDA DEPARTMENT OF HEALTH

ATTACHMENT 2

BALANCE OF LINE TEST

Revision #3 10/27/2016

0037425 ANTIBODY TITER X 2 $40.70 N

0037426 ANTIBODY TITER X 3 $61.05 N

0037427 ANTIBODY TITER X 4 $81.40 N

0037428 ANTIBODY TITER X 5 $101.75 N

0000252 ANTIDIURETIC HORMONE $223.65 N

0000256 ANTI‐DNASE B TITER $96.35 N

0000255 ANTI‐DSDNA AB, EIA $10.00 N

0037092 ANTI‐DSDNA,RFX,TITER $11.00 N

0037429 ANTIGEN TYPE X 1 $24.40 N

0037430 ANTIGEN TYPE X 2 $48.80 N

0037431 ANTIGEN TYPE X 3 $73.20 N

0037432 ANTIGEN TYPE X 4 $97.60 N

0037433 ANTIGEN TYPE X 5 $122.00 N

0037056 ANTIHISTONE AB $86.00 N

0038913 ANTIMIC GRM POS RODS $111.00 N

0016528 ANTIMIC SUS,CAMPYL $247.00 N

0016582 ANTIMICROB SUSC. (3) $247.00 N

0016406 ANTIMICROBIAL CFP $675.00 N

0016404 ANTIMICROBIAL, SYN 2 $80.00 N

0016405 ANTIMICROBIAL, SYN 3 $180.00 N

0016408 ANTIMICROBIAL, SYN 3 $60.00 N

0016409 ANTIMICROBIAL, SYN 3 $60.00 N

0016411 ANTIMICROBIAL, SYN 3 $60.00 N

0016842 ANTI‐MULLERIAN $81.60 N

0010062 ANTIPHOSPHATIDYLSER $225.00 N

0036578 ANTI‐PTH AB $173.50 N

0036574 ANTI‐T3 AUTOAB $126.38 N

0000216 ANTITHROMBIN III ACT $196.50 N

0008267 ANTITHROMBIN III ACTIVITY W/O REFL $157.20 N

0005158 ANTITHROMBIN III AG $196.50 N

0016930 APC GENE DELETE OR DUP $1,550.00 N

0016934 APC GENE SEQUENCING $1,800.00 N

0000022 APC RESISTANCE $106.59 N

0005223 APOLIPOPROTEIN A1 $62.00 N

0007018 APOLIPOPROTEIN A1 B $102.00 N *

0005224 APOLIPOPROTEIN B $25.00 N

0038257 APPLE IGG $35.20 N

0090584 APT TEST $21.00 N

0000961 ARBOVIRUS AB PANEL $364.95 N

0034980 ARBOVIRUS AB PNL $679.00 N

0090413 ARGATROBAN $65.00 N

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DISC IND

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PER 10/27/2016

AMENDMENT

FLORIDA DEPARTMENT OF HEALTH

ATTACHMENT 2

BALANCE OF LINE TEST

Revision #3 10/27/2016

0015922 ARIPIPRAZOLE;S/P $154.00 N

0000269 ARSENIC (B) $104.80 N

0000270 ARSENIC (U) $104.80 N

0091163 ARSENIC (U) $104.80 N

0010494 ARSENIC FRAC.,URINE $260.70 N

0036433 ARSENIC, 24HR (U) $104.80 N

0010295 ASCA IGA $90.00 N

0010294 ASCA IGG $90.00 N

0090994 ASHKENAZI 4 $1,430.00 N

0090891 ASHKENAZI JEWISH 11 $3,473.00 N

0090892 ASHKENAZI JEWISH 11 $3,473.00 N

0039462 ASIALO‐GM‐1 GANGL.AB $115.00 N

0000265 ASO $35.88 N

0010239 ASPERGILLUS G,M,A $368.00 N

0034938 ASPERGILLUS NIGER $5.75 N

0018873 ASPERGILLUS QL PCR $298.00 N

0016174 ASPIRIN RESISTANCE $96.00 N

0011118 ATR1 GENE 1166 A>C $186.00 N

0070162 ATYP P‐ANCA TITER $84.86 N

0017610 ATYPICAL PNEU.DNA PL $582.40 N

FPMI1 AUTOMATED PAP & RVW $19.69 N

FPNR1 AUTOMATED PAP ONLY $16.54 N

0017751 AVIAN H5 W/RFL A,B $260.00 N

0017750 AVIAN INFLUENZA H5 GENE $260.00 N

0016090 AVIAN INFLUENZA RNA $260.00 N

0010639 AVOCADO IGG $35.20 N

0030314 AZITHROMYCIN LEVEL $129.00 N

0010154 B.ANTHRACIS SCREEN $31.85 N

0038513 B.HENSELAE IGG SCR $39.15 N

0038514 B.HENSELAE IGG TITER $38.85 N

0038515 B.HENSELAE IGM SCR $39.15 N

0038516 B.HENSELAE IGM TITER $38.85 N

0011365 B.PER/PARA RT‐PCR $272.00 N

0038517 B.QUINTANA IGG SCR $39.15 N

0038518 B.QUINTANA IGG TITER $38.85 N

0038519 B.QUINTANA IGM SCR $39.15 N

0038520 B.QUINTANA IGM TITER $38.85 N

0036552 B2‐GLYCO I(IGA) $101.74 N

0036554 B2‐GLYCO I(IGG) $83.54 N

0036553 B2‐GLYCO I(IGM) $83.54 N

0017221 BACTERIAL 16S RDNA $332.00 N

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AMENDMENT

FLORIDA DEPARTMENT OF HEALTH

ATTACHMENT 2

BALANCE OF LINE TEST

Revision #3 10/27/2016

0006741 BACTERIAL AG, COMP. $285.10 N

0016583 BACTERIAL CULTURE $53.80 N

0016860 BACTERIAL ID,SEQ $192.00 N

0038248 BANANA IGG $35.20 N

0017454 BARB PRESUMPTIVE SCR $60.00 N

0007377 BARBITURATES (S) $100.00 N

0014921 BARBITURATES CLIN $60.00 N

0018973 BARBITURATES CONF $100.00 N

0092655 BARBITURATES QL CONF $108.73 N *

0007171 BARBITURATES SC/CF $160.00 N

0008416 BARBITURATES, GC/MS $100.00 N

0038574 BARBS (NO CONFIRM) $60.00 N

0014558 BARBS, GC/MS, QL, UR $60.00 N

0038139 BARLEY (FOOD) IGG $35.20 N

0011108 BARTONELLA DNA,PCR $323.00 N

0034388 BASIC METAB PNL W/O CA $1.16 N

0090841 BASIC METAB PNL, PLASMA $1.21 N

0014868 B‐CELL GENE REAR.PCR $201.00 N

0016119 B‐CELL REARRANG.QL LEUMET $201.00 N

0019131 BCL 6 IHC W/INTERP $165.00 N

0017679 BCL‐1/JH T(11,14), PLASMA $385.00 N

0014991 BCL‐1/JH T(11;14) QN.RT‐P $385.00 N

0039584 BCL‐2, IHC $120.00 N

0017690 BCL‐2/JH T(14,18), PLASMA $420.00 N

0015007 BCL‐2/JH T(14;18) QN.RT‐P $420.00 N

0015787 B‐CLL PANEL $685.00 N

0016876 BCR ABL 1 35 NT INS $465.00 N

0091065 BCR ABL1 GENE QN PCR $300.00 N

0015101 BCR/ABL GENE REARRANGEMT $345.60 N

0039636 BCR/ABL GENE, PCR $345.60 N

0015052 BCR/ABL GENE,PCR,QT $345.60 N

0017853 BCR/ABL REARR.QN PCR LEUM $345.60 N

0090476 BECK RF $5.90 N

0038125 BEEF IGG $35.20 N

0014967 BENZO CONF GCMS $96.45 N

0014557 BENZO, GC/MS, QL, UR $100.00 N

0090804 BENZO,QN,GC/MS,URINE $100.00 N

0008417 BENZODIAZEPINE GC/MS $117.30 N

0007172 BENZODIAZEPINE SC/CF $160.00 N

0015770 BENZODIAZEPINE, QL/GCMS ( $91.00 N

0070071 BENZODIAZEPINES $104.00 N

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AMENDMENT

FLORIDA DEPARTMENT OF HEALTH

ATTACHMENT 2

BALANCE OF LINE TEST

Revision #3 10/27/2016

0090264 BENZODIAZEPINES, QUANT,UR $104.00 N

0010640 BETA 2 TRANSFERRIN $379.60 N

0016182 BETA FIB 455G>A $299.00 N

0038955 BETA LACTAMASE DET. $42.00 N

0011201 BETA LACTOGLOBULIN IGG $35.20 N

0016176 BETA2 ADRENERGIC MUT $299.00 N

0038994 BETA‐2 MICROGLOB.(U) $117.05 N

0004944 BETA‐2‐MICROGLOB (U) $117.05 N

0000852 BETA‐2‐MICROGLOBULIN $39.92 N

0014974 BETA‐GLOBIN COMPLETE (TM) $698.00 N

0016346 BETA‐GLOBIN GENE DOSAGE $575.00 N

0090552 BHL, HDLGGE $58.50 N

0090640 BHL, LDLGGE $58.50 N

0014801 BILE ACIDS, TOTAL $45.20 N

0004668 BILE ACIDS,FRAC/TOT $165.00 N

0019546 BILE ACIDS,FRAC/TOT,PREG $165.00 N

0006631 BILI, FRAC, PEDIATR. $0.90 N

0020381 BILI, TOTAL PEDIATR. $0.88 N

0000289 BILIRUBIN, AM. FL. $1.06 N

0000285 BILIRUBIN,DIRECT $0.88 N

0007286 BILIRUBIN,FRAC. $0.91 N

0070132 BIOTINIDASE $102.00 N

0016526 BIOTINIDASE MUTATION $749.00 N

0090957 BISPHENOL A RAND UR $176.00 N

0018889 BK VIRUS DNA,QL CSF $298.00 N

0016553 BK VIRUS DNA,QL,PCR $308.00 N

0018901 BK VIRUS DNA,QN CSF $349.00 N

0016581 BK VIRUS DNA,QN,PCR $349.00 N

0091334 BLAC DETECTION COMP $520.00 N

0038482 BLACK OLIVE IGE $16.00 N

0039475 BLASTS, ID DNA PROBE $150.00 N

0008504 BLEEDING TIME, TEMP. $35.85 N

0104277 BLOOD SMEAR INTERP $39.50 N

0090872 BLOOM SYN DNA $235.00 N

0090873 BLOOM SYN DNA (NY) $235.00 N

0016762 BM CORE IMPRINT $80.00 N

0104271 BM INTERP ASPIR SM $40.25 N

0104281 BM INTERP CLOT CELL BX $81.50 N

0104276 BM INTERP CORE BIOP $71.75 N

0037386 BNP $132.90 N

0019416 BOB1,IHC/INTERP $165.00 N

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AMENDMENT

FLORIDA DEPARTMENT OF HEALTH

ATTACHMENT 2

BALANCE OF LINE TEST

Revision #3 10/27/2016

0029498 BONE ALK. PHOS. $75.10 N

0015411 BONE MARROW BX, PC $42.66 N

0015410 BONE MARROW BX,STAIN $55.34 N

0014487 BONE MARROW DNA TYP $360.00 N

BMI1 BONE MARROW, INTER. $157.45 N

0003118 BONE MARROW, INTER. $157.45 N

0034966 BORD PARA/PERT DFA $77.25 N

0059805 BORD PERTUS/PARAPERT $95.00 N

0017825 BORD.PERT.IGG/IGA $190.28 N

0005260 BORDETELLA CULTURE $120.45 N

0016034 BP180 $55.00 N

0016767 BRAF MUTATION ANAL $475.00 N

0090477 BRAF PAPILLARY THYROID $650.00 N

0090956 BRAF V600 MUTATION $650.00 N

0059630 BRAIN NATRI PEPTIDE $132.90 N

0038124 BROCCOLI IGG $35.20 N

0091068 BRUCELLA IGG,IGM $88.80 N

0016136 BULLOUS PEMPHIGOID BP230 $70.00 N

0000296 BUN/CREAT RATIO $0.91 N

0090416 BUPREN AND NALOX (U) $200.00 N

0016315 BUPRENORPHINE QL $60.00 N

0070033 BUPRENORPHINE QL NC $60.00 N

0016314 BUPRENORPHINE QN $100.00 N

0016310 BUPRENORPHINE W/QN $60.00 N

0004413 BUTALBITAL $100.00 N

0014577 BV AND VAG SCR, DNA $192.00 N

0016739 C DIFF DNA TOXIN B $298.00 N

0016947 C DIFF TOXIN A B #2 $52.32 N

0016948 C DIFF TOXIN A B #3 $52.32 N

0037212 C DIFF TOXIN A&B $89.60 N

0004408 C DIFF TOXIN B QL $63.25 N

0016237 C KIT MUT W/REF TO PDGFRA $800.00 N

0019960 C KIT MUT, LEUMETA $800.00 N

0019961 C KIT MUTATION,CELL $800.00 N

0036581 C TRACHOMATIS AB PNL $69.92 N

0005157 C TRACHOMATIS IGM AB $107.40 N

0016505 C. TRACHOMATIS RNA, TMA, $6.00 N

0015031 C. TRACHOMATIS, TMA ALTER $6.00 N

0016596 C.BURNETII DNA PCR $298.00 N

0034403 C.DIFF CYTO.AB.NETU $188.70 N

0038997 C.DIFF TOXIN EIA $89.60 N

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ATTACHMENT 2

BALANCE OF LINE TEST

Revision #3 10/27/2016

0092067 C.DIFF TOXINB QL PCR $104.38 N *

0039525 C.DIFFICILE CULTURE $77.25 N

0004407 C.DIFFICILE CULTURE $77.25 N

0008502 C.TRAC DNA,CX M/URET $48.80 N

0036628 C.TRACH DNA,CONJUN $48.48 N

0070048 C.TRACH RNA,TMA,THROAT $6.00 N

0000297 C1 INHIBITOR, FUNCT $67.75 N

0000298 C1 INHIBITOR, PROTEIN $90.60 N

0000433 C2 COMPLEMENT COMP $101.85 N

0017594 C3, PERITONEAL FLUID $17.64 N

0017593 C3, PLEURAL FLUID $17.64 N

0017597 C3, SYNOVIAL FLUID $17.64 N

0017689 C3A DESARG FRAGMENT $123.00 N

0011218 C3D CIRC IMMUNE $131.00 N

0011335 C4 BINDING PROTEIN $72.00 N

0015914 C4 BINDING PROTEIN $72.00 N

0017596 C4, PERITONEAL FLUID $58.84 N

0017595 C4, PLEURAL FLUID $70.61 N

0017598 C4, SYNOVIAL FLUID $57.40 N

0004943 C4D FRAGMENT, EIA $48.00 N

0000354 C5 COMPLEMENT COMP $101.85 N

0017717 CA 125 W/HAMA $102.40 N

0017416 CA 125, CSF $102.40 N

0005819 CA 15‐3 $69.60 N

0017546 CA 15‐3, CSF $69.60 N

0004698 CA 19‐9 (CENTOCOR) $78.40 N

0017417 CA 19‐9, CSF $78.40 N

0017638 CA 19‐9, PERITONEAL FLUID $78.40 N

0017642 CA 19‐9, PLEURAL FLUID $78.40 N

0001635 CA 24HR W/ CREAT $40.05 N

0017419 CA 27.29, CSF $92.72 N

0017787 CA ENCEPH AB PNL CSF $180.00 N

0039567 CA.ENCEPHAL.AB, CSF $180.00 N

0037310 CA.ENCEPHALITIS,IFA $175.25 N

0029256 CA125 $102.40 N

0029493 CA27.29 CHIRON/BAYER $92.80 N

0038118 CABBAGE IGG $35.20 N

0034549 CACAO (CHOCOLATE) IGG $35.20 N

0000299 CADMIUM (B) $104.80 N

0091170 CADMIUM (U) $104.80 N

0036434 CADMIUM, 24HR (U) $104.80 N

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AMENDMENT

FLORIDA DEPARTMENT OF HEALTH

ATTACHMENT 2

BALANCE OF LINE TEST

Revision #3 10/27/2016

0000305 CAFFEINE $74.05 N

0016072 CAH (21‐OH) RARE MUT $475.00 N

0015291 CAH PANEL 6372 RATIOS $460.40 N

0015283 CAH PANEL 812 RATIOS $274.40 N

0015588 CAH PNL 826 RATIOS $165.84 N *

0030742 CALCITONIN $124.00 N

0019139 CALCITONIN IHC W/INT $165.00 N

0000303 CALCIUM $0.88 N

0001633 CALCIUM (U) $40.05 N

0091180 CALCIUM (U) $40.05 N

0091182 CALCIUM 24HR (U) $42.48 N

0000302 CALCIUM BY AA $1.06 N

0011313 CALCIUM W/O CREAT 24 H UR $40.05 N

0000306 CALCIUM, IONIZED $40.00 N

0090163 CALDESMON,IHC W/INTERPRET $165.00 N

0090213 CALDESMON,IHC W/O INTERPR $125.00 N

0016796 CALPROTECTIN,STOOL $175.00 N

0019142 CALRETININ IHC W/INT $165.00 N

0010980 CAMPATH1 CD52 $120.00 N

0016302 CAMPY AG, EIA $97.00 N

0090905 CANAVAN DISEASE $450.00 N

0090906 CANAVAN DISEASE NY $450.00 N

0059080 CANDIDA ALBICANS DNA $225.00 N

0000939 CANDIDA PRECIPITINS $138.45 N

0090487 CANDIDA SPP PCR BLOOD $476.00 N

0090277 CAPREOMYCIN, HPLC $183.00 N

0026513 CARBAMAZEP & METAB $80.58 N

0007933 CARBAMAZEPINE, F & T $96.77 N

0018948 CARBAMAZEPINE, FREE $105.00 N

0018949 CARBAMAZEPINE, TOTAL $65.36 N

0000329 CARBAMAZEPINE, TOTAL $65.36 N

0000310 CARBON DIOXIDE $0.88 N

0000309 CARBOXYHEMOGLOBIN $34.40 N

0010124 CARDIO CRP $50.00 N

0091743 CARDIO IQ(TM) FIBRINOGEN $74.23 N

0091604 CARDIO IQ(TM)LIPO,IO $40.00 N

0004661 CARDIOLIPIN IGA AB $49.60 N

0004662 CARDIOLIPIN IGG AB $49.60 N

0004663 CARDIOLIPIN IGM AB $49.60 N

0007352 CARDIOLP AB G/M/A $167.40 N

0000312 CARISOPRODOL $122.90 N

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ATTACHMENT 2

BALANCE OF LINE TEST

Revision #3 10/27/2016

0090488 CARISOPRODOL SCREEN $60.00 N

0090578 CARISOPRODOL W/REFL $60.00 N

0070107 CARNITINE, LC/MS/MS $167.00 N

0000311 CAROTENE $66.45 N

0038122 CARROT IGG $35.20 N

0010323 CASHEW NUT IGG $35.20 N

0090411 CASPASE‐3 IHC W/INTERPRET $165.00 N

0090409 CASPASE‐3 IHC W/O INTERP $125.00 N

0018832 CASPOFUNGIN $183.00 N

0008061 CAT & VMA $88.00 N

0000314 CATECHOL, F&T, PL $194.25 N

0091190 CATECHOLAMINES (U) $82.40 N

0039627 CATECHOLAMINES 24HR $82.40 N

0000318 CATECHOLAMINES, FRAC $82.40 N

0016381 CATECHOLAMINES,SUPINE PL $194.25 N

0016382 CATECHOLAMINES,UPRIGHT PL $194.25 N

0038267 CATFISH (F369) IGE $16.00 N

0018843 CBC W/EHRLICHIA $1.10 N

0026524 CBC(DIFF/PLT)W/PATH $40.50 N

0020253 CBC(DIFF/PLT)W/SMEAR $19.71 N

0070212 CBC(REFL) $1.10 N

0014992 CBFB/MYH11 QN RT‐PCR $268.80 N

0037371 CBG (TRANSCORTIN) $83.72 N

0011173 CCP AB IGG $90.00 N

0019150 CD10,IHC/INTERP $165.00 N

0011230 CD117 $165.00 N

0019170 CD138 IHC/INTERP $165.00 N

0015465 CD15, IHC $165.00 N

0090151 CD163 IHC W/INTERPRET $165.00 N

0090201 CD163, IHC W/O INTERPRET $125.00 N

0019144 CD1A,IHC/INTERP $165.00 N

0040019 CD2,IHC W/INTERP $165.00 N

0019153 CD23,IHC/INTERP $165.00 N

0010024 CD3, IHC $165.00 N

0039614 CD30 (KI‐1) $72.00 N

0019154 CD31,IHC/INTERP $165.00 N

0019156 CD34,IHC/INTERP $165.00 N

0019304 CD38 ICH W/O INTERP $125.00 N

0019146 CD4,IHC/INTERP $165.00 N

0010868 CD43 $132.00 N

0015798 CD45, IHC $165.00 N

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AMENDMENT

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ATTACHMENT 2

BALANCE OF LINE TEST

Revision #3 10/27/2016

0012112 CD45RO $165.00 N

0038995 CD5 $165.00 N

0019418 CD52,IHC/INTERP $165.00 N

0019162 CD56,IHC/INTERP $165.00 N

0019860 CD57,CD3,CD8 FC $450.00 N

0019420 CD57,IHC/INTERP $165.00 N

0019163 CD61,IHC/INTERP $165.00 N

0019164 CD68,IHC/INTERP $165.00 N

0019167 CD79A,IHC/INTERP $165.00 N

0019149 CD8,IHC/INTERP $165.00 N

0016985 CDT(CARBO. DEF.TRANS) $100.00 N

0090153 CDX2, IHC W/INTERP $165.00 N

0090203 CDX2, IHC W/O INTERP $125.00 N

0000978 CEA $67.20 N

0015018 CEA W/HAMA $67.20 N

0017420 CEA, CSF $80.64 N

0017605 CEA, PERICARDIAL FL $80.64 N

0017421 CEA, PERITONEAL FL $80.64 N

0017584 CEA, PLEURAL FLUID $80.64 N

0019171 CEA,MONO,IHC INTERP $165.00 N

0019172 CEA,POLYCLONAL,IHC $165.00 N

0090813 CEBPA MUTAT‐EXTRACTED DNA $414.00 N

0090812 CEBPA MUTATION ANALYSIS $434.00 N

0019806 CEFOTAXIME LEVEL $110.00 N

0017809 CEFOXITIN LEVEL $110.00 N

0038101 CELERY IGG $35.20 N

0000398 CELL CT AND DIFF,CSF $36.20 N

0016011 CELLSEARCH BREAST $580.00 N

0016811 CELLSEARCH COLON $580.00 N

0016812 CELLSEARCH PROSTATE $580.00 N

0016088 CENTROMERE AB, EIA $15.00 N

0000326 CERULOPLASMIN $26.50 N

0095148 CF 23 MUTATION $285.00 N

0010458 CF CARRIER SCREEN $285.00 N

0010463 CF DNA W/RFL POLYMOR $285.00 N

0016080 CFTR GENE DELETION $400.00 N

0015053 CFTR INTRON 8 POLY‐T $228.00 N

0014700 CFTR INTRON8POLY(NY) $228.00 N

0092068 CFVANTAGE(TM) CF SCR $1,200.00 N

0038563 CHEESE, CHEDDAR TYPE IGG $35.20 N

0034701 CHEM TEST 01 $0.88 N

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ATTACHMENT 2

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Revision #3 10/27/2016

0034702 CHEM TEST 02 $0.91 N

0034703 CHEM TEST 03 $0.96 N

0034704 CHEM TEST 04 $1.01 N

0034705 CHEM TEST 05 $1.06 N

0034706 CHEM TEST 06 $1.11 N

0034707 CHEM TEST 07 $1.16 N

0034708 CHEM TEST 08 $1.21 N

0034709 CHEM TEST 09 $1.26 N

0034710 CHEM TEST 10 $1.31 N

0034711 CHEM TEST 11 $1.36 N

0034712 CHEM TEST 12 $1.41 N

0034713 CHEM TEST 13 $1.46 N

0034714 CHEM TEST 14 $1.51 N

0034715 CHEM TEST 15 $1.56 N

0035316 CHEM TEST 16 $1.61 N

0090109 CHEMOKINE MIP 3B $395.00 N

0038958 CHICK PEA IGE $5.75 N

0038128 CHICKEN MEAT IGG $35.20 N

0070188 CHIKUNGUNYA AB W/REF TITE $173.00 N

0016524 CHIKUNGUNYA IGG TITER $108.00 N

0016525 CHIKUNGUNYA IGM TITER $113.00 N

0091683 CHILD ALLER W/REFLS $99.00 N *

0091235 CHILD ALLERGY(REFL) $288.00 N

0038829 CHILDHOOD ALLERGY PROF $76.00 N *

0010659 CHILDHOOD ALLERGY PROFILE $99.00 N *

0017896 CHLAM DNA REFL $48.80 N

0037347 CHLAM TRACH $48.80 N

0015894 CHLAM/GC PCR,SP $140.00 N

0070051 CHLAM/GC,RNA,TMA,THROAT $12.00 N

0004966 CHLAMYDIA AG DFA $34.40 N

0017810 CHLAMYDIA DIR AG,DFA $72.00 N

0017898 CHLAMYDIA DNA REFL $6.00 N

0000987 CHLAMYDIA IGG AB $107.40 N

0015892 CHLAMYDIA PCR, SP $6.00 N

0037111 CHLAMYDIA PNEU.PNL $75.16 N

0016003 CHLAMYDIA PNEUM. PCR $144.00 N

0037346 CHLAMYDIA PSITTACI $69.92 N

0016506 CHLAMYDIA/N. GON RNA, TMA $12.00 N

0091123 CHLORDIAZE/NORDIAZEP $100.00 N

0000603 CHLORDIAZEPOXIDE $127.65 N

0000330 CHLORIDE $0.88 N

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AMENDMENT

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ATTACHMENT 2

BALANCE OF LINE TEST

Revision #3 10/27/2016

0001645 CHLORIDE (U) $16.80 N

0091183 CHLORIDE (U) $42.48 N

0091164 CHLORIDE 24HR (U) $1.06 N

0011314 CHLORIDE W/O CREAT 24H UR $1.06 N

0014520 CHLORIDE W/O CREAT RAND $16.80 N

0000368 CHLORIDE, 24 HOUR UR $1.06 N

0017585 CHOLESTEROL, PERT FL $0.71 N

0000334 CHOLESTEROL, TOTAL $0.59 N

0017586 CHOLESTEROL,PLEUR.FL $0.71 N

0007961 CHOLINEST,DIB INHIB $50.00 N

0000335 CHOLINESTERASE (P) $25.00 N

0039481 CHOLINESTERASE PANEL $75.00 N

0037965 CHOLINESTERASE, S $25.00 N

0000338 CHOLINESTERASE,RBC/P $50.00 N

0091126 CHROM ANALY TIS W/RFL $1,134.50 N

0014593 CHROM ANALYSIS, TISS $1,134.50 N

0039667 CHROM ANYLS TIS NO GROWTH $220.50 N

0018980 CHROM BL RFL OLIGO $635.00 N

0017455 CHROM FANCONI ANEMIA $846.00 N

0014595 CHROM HIGHRESOLUTION $999.35 N

0018983 CHROM HR RFL OLIGO $999.35 N

0014590 CHROM STUDY, AF $724.00 N

0014601 CHROM, CLL/LPD $776.00 N

0010708 CHROM, FOLLOW UP $635.00 N

0014600 CHROM, HEMATOLOGIC $994.80 N

0014602 CHROM, LYMPH NODE $826.30 N

0014597 CHROM, MOSAICISM $635.00 N

0010099 CHROM, SLIDE ANAL. $635.00 N

0014603 CHROM, SOLID TUMOR $903.00 N

0034088 CHROMATIN AUTO AB $55.00 N

0010944 CHROMIUM $93.00 N

0011278 CHROMIUM RANDOM UR $93.00 N

0006085 CHROMIUM, BLOOD $37.60 N

0005248 CHROMIUM, SERUM $111.30 N

0095272 CHROMO STUDY AMNIO $724.00 N

0016379 CHROMOGRANIN A, ECL $127.00 N

0019173 CHROMOGRANIN, IHC/IN $165.00 N

0090929 CHROMOSOMAL, POC $1,590.00 N

0090961 CHROMOSOMAL,ONCOLOGY $1,590.00 N

0090927 CHROMOSOMAL,PRENATAL $1,590.00 N

0014592 CHROMOSOME EVAL. CVS $967.55 N

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AMENDMENT

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ATTACHMENT 2

BALANCE OF LINE TEST

Revision #3 10/27/2016

0014598 CHROMOSOME STUDY,BKG $705.00 N

0016843 CHROMOSOME STUDY,NB $635.00 N

0014596 CHROMOSOME, BLOOD $635.00 N

0016620 CHRONIC FATIGUE III $1,555.00 N

0016621 CHRONIC FATIGUE,PNL $1,259.00 N

0037663 CHSV RAPID METHOD $53.60 N

0011004 CITRATE, RANDOM UR $229.25 N

0091189 CITRIC ACID 24HR (U) $229.25 N

0011315 CITRIC ACID W/O CREAT 24H $229.25 N

0004616 CITRIC ACID, 24HR (U) $229.25 N

0000377 CK ISOENZYMES $52.00 N

0000374 CK, TOTAL $27.20 N

0026642 CK, TOTAL (REFL) $27.74 N

0059221 CK‐MB $60.52 N

0003159 CK‐MB $60.52 N

0017581 CK‐MB (CK‐2) $60.52 N

0014837 CK‐MB WITH RATIO $87.72 N

0038956 CKR‐5 GENE DNA ANAL. $210.00 N

0016135 CLARISURE(R) CGH $1,590.00 N

0016395 CLARISURE(R)CGGH (NY) $1,590.00 N

0016800 CLARISURE,CGH,ONCO $1,590.00 N

0019807 CLARITHROMYCIN LEVEL $110.00 N

0000340 CLONAZEPAM $115.90 N

0040064 CLONAZEPAM URINE $167.00 N

0016924 CLOPIDOGREL CYP2C19 $395.00 N

0016925 CLOPIDOGREL CYP2C19 $395.00 N

0090854 CLORAZEPATE $92.80 N

0016377 CLOSTRIDIUM DIF TBR QL $96.00 N

0015338 CLOTEST(TM) $100.00 N

0035555 CMP W/O ALT $1.46 N

0034389 CMP W/O CO2,ALT $1.41 N

0091252 CMV AB PANEL ELISA $102.40 N

0010600 CMV DNA QN, PCR $342.00 N

0016982 CMV DNA ULTRAQUANT(R $344.00 N

0014980 CMV GENOTYPE $396.00 N

0000403 CMV IGG AB $74.24 N

0037678 CMV IGG AB W/REFL $74.24 N

0019583 CMV IGG AVIDITY $104.00 N

0090583 CMV IGG,NON DONOR $53.40 N

0008503 CMV IGM AB $71.36 N

0090557 CMV W/RFL ND IGG,IGM $192.75 N

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ATTACHMENT 2

BALANCE OF LINE TEST

Revision #3 10/27/2016

0016727 COAG CON LV LIMITED $75.00 N

0016728 COAG CONSULT LV COMP $112.00 N

0000331 COAG FACTOR II ACT $184.05 N

0000352 COAG FACTOR IX ACT $184.05 N

0000344 COAG FACTOR V ACT $184.05 N

0000346 COAG FACTOR VII ACT $184.05 N

0000359 COAG FACTOR X ACT $184.05 N

0000360 COAG FACTOR XI ACT $184.05 N

0000362 COAG FACTOR XII ACT $184.05 N

0000364 COAG FACTOR XIII SCR $110.20 N

0037513 COBALT, RANDOM URINE $128.30 N

0014761 COBALT,24‐HOUR URINE $94.40 N

0040299 COC AB ID W/RFL CF $69.00 N

0090861 COC.SEROLOGY PNL,CSF $118.40 N

0037201 COCAINE CONF $100.00 N

0011328 COCAINE CONF, GC/MS $100.00 N

0070038 COCAINE MET 100 GCMS $113.75 N

0007173 COCAINE METAB SC/CF $160.00 N

0005530 COCAINE METAB. GC/MS $100.00 N

0014698 COCAINE METAB‐CLIN $60.00 N

0014925 COCAINE METAB‐CLIN $60.00 N

0092657 COCAINE QL CONFIRM $108.73 N *

0033963 COCAINE SCR MECONIUM $60.00 N

0090799 COCC AB (TP AG) $48.00 N

0090862 COCC MONITOR PNL,CSF $123.20 N

0090859 COCC. MONITOR PNL,S $123.20 N

0090858 COCC. SEROLOGY PNL,S $118.40 N

0019963 COCCI AB TO TP/F AG $69.00 N

0019962 COCCI TOTAL AB,W/RFX $98.00 N

0000908 COCCIDIO AB, ID $76.30 N

0014760 COCCIDIOIDES DNA PROBE $150.00 N

0017788 COCCIDIOIDES ID,CSF $76.30 N

0070166 COCKERELL DIR IMMUNO $556.00 N

0038110 CODFISH IGG $35.20 N

0019826 COENZYME Q10 $100.00 N

0038560 COFFEE IGG $35.20 N

0000349 COLD HEMAGGLUTININS $22.50 N

0017406 COLLAGEN TYPE I CTX $141.78 N

0016983 COLOVANTAGE(TM) $355.00 N

0016984 COLOVANTAGE(TM)(NY) $355.00 N

0005704 COMP C3C4 $138.33 N

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ATTACHMENT 2

BALANCE OF LINE TEST

Revision #3 10/27/2016

0006635 COMP DRUG SCR (U) $225.00 N

0005229 COMP DRUG SCR S/P $195.00 N

0023020 COMP DRUG SCR S/PUG $390.00 N

0006640 COMP DRUG SCR US/P $330.00 N

0023019 COMP DRUG SCREEN G $150.00 N

0090839 COMP METAB PNL, PLASMA $1.51 N

0090840 COMP METAB W/ADJ CAL PLS $1.51 N

0000351 COMPLEMENT C3C $14.70 N

0000353 COMPLEMENT C4C $58.84 N

0000981 COMPLEMENT COMP C1Q $87.45 N

0000618 COMPLEMENT, (CH50) $45.00 N

0015218 CONSULT & REPORT, REF MAT $106.09 N

0015217 CONSULT & REPORT, REF MAT $45.47 N

CRS1 CONSULT & REPORT, SM $109.00 N

0039469 CONTROL PT, PTT $43.20 N

0000361 COOMBS, DIRECT $14.70 N

0000363 COPPER $29.90 N

0000365 COPPER (U) $80.65 N

0000563 COPPER, LIVER $156.40 N

0015319 COPPER, R/UR/W/CREAT $80.65 N

0035378 COPPER;B $65.00 N

0019081 CORD BLOOD ABO/RH $1.20 N

0090582 CORT FREE,LC/MS/MS $108.80 N

0006547 CORTICOSTERONE $149.94 N

0090970 CORTICOSTERONE $147.00 N

0090971 CORTISOL $70.00 N

0038171 CORTISOL 15 MIN $70.00 N

0038172 CORTISOL 30 MIN $70.00 N

0038173 CORTISOL 60 MIN $70.00 N

0038149 CORTISOL BASELINE $70.00 N

0006738 CORTISOL, 2 SPEC $140.00 N

0007303 CORTISOL, 3 SPEC $210.00 N

0006736 CORTISOL, 4 SPEC $280.00 N

0006735 CORTISOL, 5 SPEC $350.00 N

0006734 CORTISOL, 6 SPEC $420.00 N

0004212 CORTISOL, A.M. $70.00 N

0000370 CORTISOL, FREE (U) $108.80 N

0011280 CORTISOL, FREE 24HR $108.80 N

0014534 CORTISOL, FREE 24HR $108.80 N

0037077 CORTISOL, FREE‐TOTAL $194.82 N

0004213 CORTISOL, P.M. $70.00 N

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ATTACHMENT 2

BALANCE OF LINE TEST

Revision #3 10/27/2016

0090917 CORTISOL, SALIVA 1 $70.00 N

0090918 CORTISOL, SALIVA 2 $70.00 N

0090919 CORTISOL, SALIVA 3 $70.00 N

0090920 CORTISOL, SALIVA 4 $70.00 N

0011281 CORTISOL, SERUM $70.00 N

0000367 CORTISOL, TOTAL $70.00 N

0036423 CORTISOL,FREE $127.05 N

0016471 CORTISOL,FREE,30 MIN $127.05 N

0016472 CORTISOL,FREE,60 MIN $127.05 N

0016470 CORTISOL,FREE,BASE $127.05 N

0019897 CORTISOL,SALIVA $70.00 N

0037098 CORTISONE,SERUM $155.94 N

0058845 COTININE $82.73 N

0090207 COX‐2, IHC W/O INTERPRET $125.00 N

0090157 COX‐2,IHC W/INTERPRET $165.00 N

0019895 COXSACKIE A AB, CSF $143.00 N

0007656 COXSACKIE B (1‐6) AB $135.20 N

0034511 COXSACKIE B 1 6,CSF $143.00 N

0000372 C‐PEPTIDE $50.60 N

0039577 C‐PEPTIDE 10 MINUTES $50.60 N

0039578 C‐PEPTIDE 15 MINUTES $50.60 N

0039581 C‐PEPTIDE 30 MINUTES $50.60 N

0039576 C‐PEPTIDE 5 MINUTE $50.60 N

0039575 C‐PEPTIDE BASELINE $50.60 N

0039580 C‐PEPTIDE BASELINE $50.60 N

0039583 C‐PEPTIDE, 120 MINUTES $50.60 N

0015843 C‐PEPTIDE, 2 SPEC $101.20 N

0015844 C‐PEPTIDE, 3 SPEC $151.80 N

0015845 C‐PEPTIDE, 4 SPEC $202.40 N

0031345 C‐PEPTIDE, 5 SPEC $253.00 N

0015846 C‐PEPTIDE, 6 SPEC $303.60 N

0039582 C‐PEPTIDE, 60 MINUTES $50.60 N

0015847 C‐PEPTIDE, 7 SPEC $354.20 N

0015848 C‐PEPTIDE, 8 SPEC $404.80 N

0015448 C‐PEPTIDE, 9 SPEC $455.40 N

0038143 CRAB IGG $35.20 N

0017422 CREAT, PERITONEAL FL $1.06 N

0000592 CREATINE, 24HR (U) $34.68 N

0037091 CREATINE, SERUM $76.50 N

0000381 CREATININE (U) $1.06 N

0007943 CREATININE CLEARANCE $52.55 N

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AMENDMENT

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ATTACHMENT 2

BALANCE OF LINE TEST

Revision #3 10/27/2016

0008459 CREATININE RAND (U) $1.06 N

0017401 CRP, HIGH SENS, CSF $60.00 N

0000376 CRYOFIBRINOGEN $56.75 N

0037358 CRYOGLOB EVAL $30.20 N

0000383 CRYOGLOBULIN QL $30.20 N

0036562 CRYOGLOBULIN,%CRYO $70.50 N

0011197 CRYP.AG EIA W/TITER $12.00 N

0011196 CRYP.AG L.A. W/TITER $93.05 N

0037213 CRYPTO AG DFA $63.95 N

0090389 CRYPTO AG, EIA $89.18 N *

0030429 CRYPTOCOCCUS AB (S) $72.83 N

0011198 CRYPTOCOCCUS AG,TITR $73.15 N

0000397 CRYSTALS (U) $71.30 N

0003134 CRYSTALS, FLUID $71.30 N

0004563 CRYSTALS, SYN FLD $71.30 N

0017615 CT DNA, SDA, OTV $6.00 N

0017899 CT DNA,SDA,OTV REFL $6.00 N

0020913 CT,DIFF FLUID,OTHER $36.20 N

0006740 CT,DIFF PERICARDIAL $36.20 N

0007709 CT,DIFF PERITONEAL $36.20 N

0000327 CT,DIFF PLEURAL FL $36.20 N

0004562 CT,DIFF SYNOVIAL FL $36.20 N

0091046 CT,TMA(ALTER) RECTAL $72.80 N

0006919 CT/GC DNA,CX M/URET $97.60 N

0017618 CT/NG DNA, SDA, OTV $12.00 N

0090888 CT/NG RNA,TMA (REFL) $140.00 N

0090962 CT/NG RNA,TMA (REFL) $140.00 N

0037869 CULT SETUP AMNIO CVS $85.50 N

0037871 CULT SETUP BLOOD $85.50 N

0037872 CULT SETUP MARROWBLD $85.50 N

0037870 CULT SETUP TISSUE $85.50 N

0016939 CULT, BLOOD NO. 2 $61.80 N

0016940 CULT, BLOOD NO. 3 $61.80 N

0004475 CULT, CAMPYLOBAC. $2.32 N

0000690 CULT, CHLAMYDIA $137.15 N

0003920 CULT, DIPHTHERIA $73.70 N

0004477 CULT, EAR, EXT. $53.15 N

0016953 CULT, EAR, EXT. LEFT $53.15 N

0016952 CULT, EAR, EXT. RGT $53.15 N

0004480 CULT, EYE, EXT. $53.15 N

0016999 CULT, FLU W/RFL H1N1 $128.90 N

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BALANCE OF LINE TEST

Revision #3 10/27/2016

0004606 CULT, FUNGUS (B) $65.34 N

0011246 CULT, GBS PROBE AST $7.85 N

0002692 CULT, HSV, RAPID $8.00 N

0002650 CULT, INFLU/PARA $254.00 N

0000688 CULT, LEGIONELLA $155.10 N

0004507 CULT, M PNEUMO. $127.65 N

0004554 CULT, MYCOBACT $63.82 N

0000480 CULT, NEISSERIA $42.70 N

0016946 CULT, SALM/SHIG #2 $36.55 N

0016960 CULT, SALM/SHIG #3 $36.55 N

0005617 CULT, STREP GRP B $7.85 N

0003960 CULT, T.VAGINALIS $55.70 N

0000394 CULT, THROAT $8.00 N

0004489 CULT, VIBRIO $53.00 N

0002691 CULT, VZV, RAPID $128.90 N

0004487 CULT, YERSINIA $53.15 N

0003021 CULT,(U), SPECIAL $3.00 N

0016942 CULT,CAMPYLOBAC NO.2 $51.15 N

0016943 CULT,CAMPYLOBAC NO.3 $51.15 N

0004553 CULT,FUNGUS,OTHER $61.60 N

0004605 CULT,FUNGUS,SKIN $78.54 N

0004479 CULT,SURVEILLANCE $53.80 N

0039522 CULTURE FUNGUS BLOOD $61.60 N

0039515 CULTURE FUNGUS S/H/N $58.00 N

0016945 CULTURE, AEROBIC #2 $63.25 N

0000389 CULTURE, BLOOD $61.80 N

0019512 CULTURE, CF $53.15 N

0000388 CULTURE, CSF $73.70 N

0008631 CULTURE, E COLI 0157 $51.75 N

0002647 CULTURE, ENTEROVIRUS $254.00 N

0016951 CULTURE, EYE, LEFT $42.70 N

0016950 CULTURE, EYE, RIGHT $53.15 N

0016954 CULTURE, GENITAL #2 $46.84 N

0004485 CULTURE, GP. A STREP $22.04 N

0008513 CULTURE, H DUCREYI $58.55 N

0000689 CULTURE, VIRUS $254.00 N

0020541 CULTURE, YEAST $77.00 N

0004446…