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482592 POUDRE VALLEY HEALTH SYSTEM - CONTRACT - AGREEMENT MISC - POUDRE VALLEY HEALTH SYSTEM
1 LABORATORY SERVICES VIA COURIER AGREEMENT THIS LABORATORY SERVICES VIA COURIER AGREEMENT, is made and entered into this 4 th day of October 2016, by and between Poudre Valley Health Care, Inc. d/b/a Poudre Valley Health System, a Colorado non-profit corporation (“PVHS”) and City of Fort Collins, a Colorado municipal corporation, for the benefit of its Risk Management Occupational Health department (“Client”). WHEREAS, PVHS operates Poudre Valley Hospital (“PVH”), a hospital located at 1024 South Lemay Avenue, Fort Collins, CO, and Medical Center of the Rockies (“MCR”), a hospital located at 2500 Rocky Mountain Avenue, Loveland, CO. For purposes of this Agreement, references to PVHS shall include both PVH and MCR; WHEREAS, Client desires to obtain laboratory services via courier for its patients; and WHEREAS, PVHS desires to provide laboratory services via courier to Client’s patients; and WHEREAS, Client and PVHS desire to enter into this Agreement for the provision of laboratory services via courier for Client’s patients in a manner that preserves and enhances patient dignity. NOW, THEREFORE, in consideration of the foregoing and of the mutual promises and covenants contained herein, the parties agree as follows: I. Definitions. Agreement means this Laboratory Services via Courier Agreement. Courier Patient means any person who is under the care of Client and receives services under this Agreement. C.A.P means College of American Pathology. CLIA means Clinical Laboratory Improvement Act. II. Term, Termination, and Rights Upon Termination of this Agreement. 2.1. Term. This Agreement has an initial term commencing as of the Effective Date and continuing in full force and effect for one (1) year (the “Initial Term”). Thereafter this Agreement shall automatically renew for additional one-year terms, unless otherwise terminated as provided herein. 2.2. Termination. Either party may terminate this Agreement with or without cause upon thirty (30) days’ prior written notice to the other party. Said notice shall be deemed received by the other party within four (4) days of the postmarked date if the notice is sent by registered mail, return receipt requested to the address set forth below. DocuSign Envelope ID: 93169EF5-1DCD-4008-A5C5-29C0496CD7FA 2 2.3. Obligations after Termination. Following termination of this Agreement for any reason, the parties agree that all obligations of this Agreement shall also terminate, with the exception of medical records management and payment for any service provided to Courier Patients prior to termination. III. Obligations of the Parties. 3.1. Client’s Obligations. Client agrees to package each specimen for delivery to PVHS. Client shall arrange for delivery of the specimen to PVHS or via PVHS’ Laboratory Courier System. Client shall complete the PVHS Laboratory Courier Request Form, and shall include said form with the specimen. Client also agrees to provide appropriate diagnosis code to support medical necessity or to include a signed Advance Beneficiary Notification for non-covered lab services. In the event said form is not complete, or said form contains erroneous information, Client agrees to cooperate fully with PVHS to resolve any missing or erroneous information. 3.2. PVHS Obligations. PVHS agrees to pick up specimens from Client as arranged and agreed upon by the parties. PVHS shall perform testing as directed by Client as requested on the PVHS Laboratory Courier Request Form. In the event said form is not complete, or said form contains erroneous information, PVHS agrees to contact Client in order to resolve any missing or erroneous information. PVHS shall provide Client with blank PVHS Laboratory Courier Request Forms upon request from Client. 3.3. Billing Method. Except as provided below, Client agrees to pay for laboratory services rendered to Courier Patients according to the fee schedule attached hereto as Attachment A and made a part hereof. Direct billing is submitted to Medicare, Medicaid, and any payer contracted with PVHS. PVHS shall bill financially responsible party in accordance with PVHS usual and customary charges for laboratory services via courier if complete and correct billing information is provided. If complete and correct billing information is not provided, or PVHS is denied payment by Medicare, Medicaid, or any other payer, Client shall pay for those laboratory services. Attachment A to this Agreement may be amended by PVHS upon written notice by PVHS to Client and shall be effective as of the date set forth in the amended Attachment A. In no event shall any rate change be retroactive beyond thirty (30) days. 3.4. Payment Method. If Client is the responsible payer, Client shall make payment within thirty (30) days of receipt of PVHS’ bill. If Client’s payment is not in accordance with Attachment A, either party may bring such error to the other’s attention. If payment is less than the amount indicated on Attachment A, Client agrees to pay the balance due within thirty (30) days of notification of error. If payment is greater than that indicated on Attachment A, PVHS agrees to cooperate with Client to correct the error within thirty (30) days. 3.5. Records. PVHS shall retain all lab orders, results, and billing records as defined in CLIA, CAP, and Medicare requirements. DocuSign Envelope ID: 93169EF5-1DCD-4008-A5C5-29C0496CD7FA 3 3.6. Access to Records. PVHS medical records and financial records shall be, and remain, the property of PVHS and shall not be accessed, removed, or transferred from PVHS except in accordance with applicable state and federal law and regulations and PVHS rules and regulations. To the extent permitted by law and PVHS rules and regulations, PVHS shall permit Client to inspect and request copies of said medical records providing that Client obtains prior written consent from the Courier Patient. PVHS shall be reimbursed its usual and customary charges for copies of medical records. PVHS shall not charge for the written report typically sent to the ordering provider for the Courier Patient’s record, as specified in Section 3.7. 3.7. Client Records. PVHS shall provide the ordering provider with a written report of results for the Courier Patient’s medical record. Client agrees to provide a record handling system which maintains patient confidentiality and reduces requests for duplicate copies. 3.8. Errors, Acts, and Omissions. Each party agrees it shall be liable for its own errors, acts and omissions. 3.9 Ethics. Client understands and agrees that all of its obligations under this Agreement shall be conducted in accordance with all applicable laws and regulations. In addition, Client understands and agrees that all of its business operations will be conducted in accordance with the highest business and ethical standards. 3.10 Equipment and Supplies. PVHS may from time to time provide Client with certain equipment and/or supplies to be used by Client to facilitate PVHS’ provision of services for Courier Patients as provided herein. Client agrees that any such equipment and supplies shall be used only for Courier Patients and shall not be used by Client for any other purpose. Client shall take reasonable steps to ensure the safekeeping of any such equipment and supplies so that it is available for use in connection with Courier Patients. Client agrees to reimburse PVHS for (i) the reasonable cost of any equipment provided by PVHS which is damaged or lost while in Client’s possession, and (ii) the reasonable cost of any supplies provided by PVHS that are lost or are used for any purpose other than the provision of services by PVHS for Courier Patients. Within fifteen (15) days of termination of this Agreement for any reason, or upon the request of PVHS, Client shall (at Client’s expense) return to PVHS all such equipment and any unused supplies. IV. General Provisions. 4.0. Section Headings. The headings of sections in this Agreement are for reference only and shall not affect the meaning of this Agreement. 4.1. Provisions Separable. The provisions of this Agreement are independent of and separable from each other, and no provision shall be affected or rendered invalid or unenforceable by virtue of the fact that for any reason any other or others of them may be invalid or unenforceable in whole or in part. DocuSign Envelope ID: 93169EF5-1DCD-4008-A5C5-29C0496CD7FA 4 4.2. Disputes. Any dispute, controversy, or claim arising out of this Agreement may be settled in a Court having exclusive jurisdiction for any breach thereof in the State of Colorado, County of Larimer. Each party shall be responsible for its own attorney’s fees, costs and expenses arising from any judicial proceeding. 4.3. Waiver of Breach. The failure of Client or PVHS to object to or to take affirmative action with respect to any conduct of the other which is a breach of this Agreement shall not be construed as a waiver of that breach or of any prior or future breaches of this Agreement. 4.4. Entire Agreement. This Agreement together with its Attachments constitute the entire understanding of the parties to this Agreement, and supersede all prior proposals, representations, communications, negotiations, and agreements between the parties whether oral or written. 4.5. Assignment. This Agreement may not be assigned, delegated, or transferred by either party without the prior written consent of the other party, provided however, PVHS may, without consent, upon notice to Client, assign this Agreement and the rights and obligations hereunder to any affiliate of University of Colorado Health. 4.6. Unforeseen Circumstances. In the event that PVHS does not have proper facilities to treat courier specimens, or in the event of circumstances beyond its reasonable control such as major disaster, epidemic, war, complete or partial destruction of facilities, disability of a significant number of personnel or significant labor disputes, PVHS shall provide testing services on courier specimens to the extent possible according to its best judgment or limitations of such facilities and personnel as are then available, but PVHS shall have no liability or obligation for delay or failure to provide or arrange for such services. 4.7. Independent Contractors. PVHS and Client are independent contractors, and this Agreement shall not constitute the formation of a partnership, joint venture, or employment relationship. The parties shall not exercise control over the performance of the other hereunder. 4.8. Amendment. Except as otherwise provided for in this Agreement, this Agreement may not be amended or changed in any of its provisions except by a subsequent written agreement signed by duly authorized representatives of Client and PVHS. 4.9. State Approval. If the laws of the state in which this Agreement is to be performed require approval of this Agreement by any regulatory agency of such state, then this Agreement shall only become effective upon the giving of such approval by the relevant state agency. 4.10. Notices. Any notices of other communications required or contemplated under the provisions of this Agreement shall be in writing and delivered in person, evidenced by a signed receipt, or mailed by certified mail, return receipt requested, postage prepaid, to the addresses indicated below. DocuSign Envelope ID: 93169EF5-1DCD-4008-A5C5-29C0496CD7FA 5 If to PVHS: Poudre Valley Health System Attn: Legal Department 2315 East Harmony Road, Ste 200 Fort Collins, CO 80528 If to Client: City of Fort Collins Attn: Safety, Security & Risk Management 215 N. Mason PO Box 580 Fort Collins, CO 80522 4.11. Governing Law. This Agreement shall be interpreted in accordance with and governed by the laws of the State of Colorado. 4.12. HIPAA Compliance. It is the intent of both parties to comply fully with HIPAA. This agreement may be amended if necessary to comply with any Federal or State rules or regulations regarding exchange of patient identifiable information. [Signature Page Follows] DocuSign Envelope ID: 93169EF5-1DCD-4008-A5C5-29C0496CD7FA 6 IN WITNESS WHEREOF, the parties hereto have executed this Agreement through its duly authorized officers, as follows: City of Fort Collins, Colorado Poudre Valley Health Care, Inc. a municipal corporation d/b/a Poudre Valley Health System By: By: ______________________________ Name: __Gerry Paul___ _____________ Name: _Kevin L. Unger_____________ Title: ___Purchasing Director_________ Title: President & CEO_ _____ DocuSign Envelope ID: 93169EF5-1DCD-4008-A5C5-29C0496CD7FA 7 ATTACHMENT A FEE SCHEDULE Established Poudre Valley Health Care, Inc. 2016 Lab Fee Schedule prices for City of Fort Collins Risk Management Occupational Health. Effective July 1st, 2016 DocuSign Envelope ID: 93169EF5-1DCD-4008-A5C5-29C0496CD7FA PROC_CHG_CODE DEF_CPT_CODE HB PROCEDURE_NAME 101‐PVHS‐ LABCLIENT‐FSC 770336 84305 HB SOMATOMEDIN C ‐ IGF‐1 $ 220.00 770640 87449 HB 1,3‐BETA‐D‐GLUCAN $ 211.00 770314 82652 HB 1.25 DIHYDROXYVITAMIN D $ 186.00 774517 82634 HB 11‐DEOXYCORTISOL $ 69.00 774552 83498 HB 17 HYDROXYPROGESTERONE $ 194.00 775072 84143 HB 17‐HYDROXYPREGNENOLONE $ 154.00 774575 83586 HB 17‐KETOSTEROIDS URINE $ 50.00 774550 83491 HB 17‐OH CORTICOSTEROIDS URINE $ 186.00 773452 83519 HB 21‐HYDROXYLASE ANTIBODY $ 90.00 770308 82306 HB 25 HYDROXYVITAMIN D $ 168.00 771074 80299 HB 5‐FLUCYTOSINE $ 155.00 774551 83497 HB 5‐HIAA $ 94.00 774608 83915 HB 5‐NUCLEOTIDASE $ 46.00 775060 82103 HB A‐1‐A FECES $ 115.00 770307 82139 HB AA LONG ‐ 6 OR MORE $ 168.00 770213 86850 HB AB SCREEN RBC EACH SERUM $ 85.00 774999 86900 HB ABO $ 48.00 770223 86900 HB ABO TYPE $ 28.00 774456 82164 HB ACE ‐ CSF $ 144.00 770170 G0480 HB ACETAMINOPHEN $ 98.00 770295 82010 HB ACETONE QUANTITATIVE $ 71.00 773450 83519 HB ACETYLCHOLINE BINDING ANTIBODY $ 265.00 582100 81229 HB ACGH MICROARRAY $ 2,668.00 770711 83516 HB ACHR BLOCKING AB $ 113.00 770264 83516 HB ACHR MODULATING AB $ 100.00 774669 85475 HB ACID HEMOLYSIN $ 89.00 774619 84060 HB ACID PHOSPHATASE TOTAL $ 41.00 770300 82024 HB ACTH $ 177.00 774423 80400 HB ACTH STIM ADRENAL INSUFF $ 176.00 774668 85307 HB ACTIVATED PROTEIN C RESISTANCE $ 97.00 772853 80074 HB ACUTE HEPATITIS PANEL $ 186.00 775155 82016 HB ACYLCARNITINES, QUALITATIVE $ 164.00 775131 88185 HB ADDITIONAL MISC FLOW MARKER $ 48.00 774646 84311 HB ADENOSAMINE DEAMINASE FLUID $ 129.00 774733 86603 HB ADENOVIRUS ANTIBODY $ 126.00 773063 87077 HB AEROBIC ISOL DEFINITIVE ID $ 52.00 581792 87116 HB AFB CULTURE $ 170.00 770513 87153 HB AFB ID BY DNA SEQUENCING $ 194.00 576283 87143 HB AFB ORGANISM IDENTIFICATION $ 219.00 773001 87206 HB AFB SMEAR $ 63.00 773189 87430 HB AG STREP A $ 65.00 775106 82657 HB A‐GALACTOSIDASE ENZYME ACTIVITY $ 575.00 770214 86880 HB AHG DIRECT NEGATIVE ANTISERA EACH $ 44.00 770210 86880 HB AHG DIRECT REFLEX IGG C3 EACH ANTISERA $ 42.00 774802 86886 HB AHG INDIRECT TITER EACH $ 140.00 774447 82135 HB ALA DELTA $ 76.00 778006 82040 HB ALBUMIN BLD $ 22.00 774440 82085 HB ALDOLASE $ 111.00 770301 82088 HB ALDOSTERONE $ 176.00 774441 82088 HB ALDOSTERONE URINE $ 60.00 582008 84075 HB ALK PHOS SERUM $ 72.00 774621 84080 HB ALKALINE PHOSPHATASE ISOENZYMES $ 72.00 576373 86001 HB ALLERG SP IGG QUAN OR SEMIQUAN $ 40.00 DocuSign Envelope ID: 93169EF5-1DCD-4008-A5C5-29C0496CD7FA 575518 86003 HB ALLERGEN SPECIFIC IGE, EACH $ 32.00 582478 86003 HB ALLERGEN SPECIFIC IGE, EACH $ 33.00 771053 80299 HB ALLOPURINOL $ 248.00 575812 82103 HB ALPHA 1 ANTITRYPSIN, TOTAL $ 112.00 773448 82397 HB ALPHA SUBUNIT $ 75.00 771101 83520 HB ALPHA SUBUNIT PGH $ 154.00 774541 82985 HB ALPHA‐1‐ACID GLYCOPROTEIN $ 125.00 774443 82104 HB ALPHA‐1‐ANTITRYP PHENO $ 72.00 774442 82103 HB ALPHA‐1‐ANTITRYPSIN $ 72.00 778010 82105 HB ALPHA‐FETOPROTEIN BLD $ 103.00 778013 84460 HB ALT(SGPT) $ 22.00 774444 82108 HB ALUMINUM $ 129.00 582149 80150 HB AMIKACIN LEVEL PEAK $ 46.00 770302 82128 HB AMINO ACID SCREEN SERUM $ 102.00 770303 82128 HB AMINO ACID SCREEN URINE $ 222.00 771054 80299 HB AMIODARONE & METABOLITE $ 53.00 771063 G0480 HB AMITRIPTYLINE AND NORTRIPTYLINE $ 63.00 778014 82140 HB AMMONIA $ 84.00 778033 82143 HB AMNIOTIC FLUID SCAN $ 62.00 771071 G0480 HB AMPHETAMINE CONFIRMATION 5 OR MORE $ 142.00 778015 82150 HB AMYLASE $ 35.00 770479 82150 HB AMYLASE URINE $ 35.00 576238 86038 HB ANA $ 51.00 773207 87076 HB ANA ISOL DEFINITIVE ID $ 52.00 770346 86039 HB ANA TITER $ 59.00 575340 87798 HB ANAPLASMA PHAGOCYTOPHILIUM BY PCR $ 84.00 774453 82154 HB ANDROSTANEDIOL GLUCURONIDE $ 495.00 774454 82157 HB ANDROSTENEDIONE $ 241.00 770600 81331 HB ANGELMAN PRADER WILLI SYNDROME $ 379.00 774455 82164 HB ANGIOTENSIN CONV ENZYME $ 111.00 770358 86235 HB ANTI PM‐1 $ 141.00 773467 84182 HB ANTI‐68KD ANTIBODIES $ 258.00 770608 80299 HB ANTIBIOTIC LEVEL $ 141.00 772832 86860 HB ANTIBODY ELUTION $ 403.00 770220 86870 HB ANTIBODY ID RBC EACH PANEL $ 214.00 773584 86870 HB ANTIBODY IDENTIFICATION PER RBC PANEL $ 139.00 575631 86850 HB ANTIBODY SCREEN,PREWARMED $ 129.00 774786 86317 HB ANTIBODY TETANUS $ 68.00 775051 86256 HB ANTIBODY TITER, REFLEX $ 94.00 770349 86147 HB ANTI‐CARIOLIPIN IGG, IGM OR IGA $ 94.00 774702 86255 HB ANTI‐GBM IGG BY IFA $ 168.00 772831 86902 HB ANTIGEN DONOR BLD RGT SERUM EA AG TEST $ 117.00 774724 86376 HB ANTI‐LIVER KIDNEY MICROSOME $ 50.00 770428 86255 HB ANTI‐MITOCHONDRIAL ANTIBODY $ 46.00 770277 83520 HB ANTI‐MULLERIAN HORMONE $ 150.00 770425 86255 HB ANTI‐NEUTROPHIL CYTOPLASMIC ABS $ 58.00 770433 86038 HB ANTI‐NUCLEAR ANTIBODIES $ 51.00 774983 86148 HB ANTIPHOSPHOLIPIDSERINE IGG IGM OR IGA $ 90.00 774700 86255 HB ANTI‐RETICULIN ANTIBODY $ 89.00 770354 86235 HB ANTI‐SCL 70 $ 210.00 770352 86235 HB ANTI‐SM/ANTI N‐RNP $ 91.00 576104 86255 HB ANTISMOOTH MUSCLE AB $ 129.00 770454 83516 HB ANTI‐SOLUBLE LIVER ANTIGEN $ 47.00 770356 86235 HB ANTI‐SSA/ANTI‐SSB $ 34.00 575809 86060 HB ANTI‐STREPTOLYSIN O $ 65.00 DocuSign Envelope ID: 93169EF5-1DCD-4008-A5C5-29C0496CD7FA 775873 85300 HB ANTITHROMBIN III ACTIVITY $ 140.00 770644 85307 HB APC RESISTANCE $ 76.00 774457 82172 HB APOLIPOPROTEIN A1 $ 218.00 778401 82172 HB APOLIPOPROTEIN B $ 51.00 774521 81401 HB APOLIPOPROTEIN E PHENOTYPE $ 194.00 774658 84588 HB ARGININE VASOPRESSIN HORMONE $ 71.00 774458 82175 HB ARSENIC BLOOD OR URINE $ 90.00 773564 82175 HB ARSENIC URINE FRACTIONATION $ 232.00 774959 82657 HB ARYLSULFATASE A LEUKOCYTES $ 496.00 775181 87305 HB ASPERGILLUS $ 114.00 778022 84450 HB AST(SGOT) $ 22.00 575671 86890 HB AUTO UNIT, UNUSED CHARGE $ 794.00 576375 86355 HB B CELLS TOTAL COUNT $ 43.00 774714 86753 HB BABESIA MICROTI ABS $ 75.00 576096 87798 HB BABESIA PCR100 $ 161.00 576284 87077 HB BACTERIAL IDENTIFICATION‐REF $ 134.00 774734 86611 HB BARTONELLA IGG OR IGM $ 48.00 779157 80048 HB BASIC METABOLIC PANEL $ 42.00 582710 86940 HB BBC DONLAN1 $ 302.00 582711 86941 HB BBC DONLAN2 $ 302.00 582715 81373 HB BBC HLA $ 281.00 771091 88184 HB B‐CELL CD20 EXPRESSION CD19% $ 247.00 771092 88185 HB B‐CELL CD20 EXPRESSION CD20% $ 48.00 771080 81479 HB B‐CELL GENE REARRANGEMENT $ 190.00 771000 G0480 HB BENZODIAZEPINE 13 OR MORE CONF $ 96.00 771007 G0480 HB BENZODIAZEPINE 1‐12 CONF $ 141.00 770347 86146 HB BETA 2 GLYCOPROTEIN $ 28.00 779115 82232 HB BETA‐2‐MICROGLOBULIN ASSAY $ 145.00 774463 82232 HB BETA‐2‐MICROGLOBULIN UR OR CSF $ 44.00 770499 86335 HB BETA‐2‐TRANSFERRIN $ 117.00 770762 84702 HB BHCG TUMOR MARKER $ 44.00 774464 82239 HB BILE ACIDS TOTAL $ 75.00 576024 82247 HB BILIRUBIN BODY FLUID $ 85.00 778025 82248 HB BILIRUBIN DIRECT $ 22.00 778027 82247 HB BILIRUBIN TOTAL $ 22.00 770484 86902 HB BILL LIQUID ANTIGEN SCREEN/BBC $ 82.00 774735 86612 HB BLASTOMYCES ANTIBODY (ID) $ 71.00 779140 82800 HB BLOOD GAS PH ONLY $ 80.00 779137 82805 HB BLOOD GAS WITH MEAS O2 SAT $ 155.00 575685 36430 HB BLOOD PRODUCT TRANSFUSION $ 837.00 775186 86901 HB BLOOD TYPING‐RH $ 24.00 575988 82272 HB BLOOD,OCCULT,FECES,1‐3 $ 26.00 774622 84080 HB BONE SPECIFIC ALKALINE PHOS $ 194.00 582537 86615 HB BORDETELLA PERTUS AB IGG $ 60.00 575464 87798 HB BORDETELLA PERTUSSIS BY PCR $ 242.00 774736 86618 HB BORELLIA BURGDORFERI AB $ 74.00 774830 87476 HB BORELLIA BURGDORFERI BY PCR $ 194.00 774737 86619 HB BORELLIA HERMISII ANTIBODY $ 327.00 576336 86300 HB BREAST CARCINOMA ASSOC AG $ 165.00 775059 86622 HB BRUCELLA ANTIBODY $ 207.00 770639 80299 HB BUSULFAN LEVEL $ 290.00 773127 87205 HB BV GRAM STAIN $ 63.00 773289 87493 HB C DIFF TOXIN GENE‐AMPLIFIED PROBE $ 141.00 773502 86235 HB C‐ MYOSISTIS ANTI‐JO1 $ 74.00 774831 87491 HB C. TRACHOMATIS AMP PROBE $ 106.00 DocuSign Envelope ID: 93169EF5-1DCD-4008-A5C5-29C0496CD7FA 774691 86161 HB C1 ESTERASE INHIB FUNCTIONAL $ 73.00 774717 86332 HB C1Q BINDING ASSAY $ 238.00 575451 86225 HB C‐1ZZ‐DOUBLE‐STRANDED AUTOABS $ 51.00 576043 86160 HB C4A $ 128.00 779179 86304 HB CA 125 $ 161.00 779180 86300 HB CA 15‐3 $ 191.00 582068 86300 HB CA 27‐29 $ 58.00 774465 82300 HB CADMIUM URINE OR BLOOD $ 170.00 575085 87071 HB C‐AEROBIC CULTURE ROUTINE $ 100.00 575091 87116 HB C‐AFB CULTURE $ 124.00 770512 80155 HB CAFFEINE LEVEL $ 93.00 774466 82308 HB CALCITONIN $ 125.00 770174 82310 HB CALCIUM FOR PTH INTACT $ 22.00 778031 82330 HB CALCIUM IONIZED $ 68.00 778030 82310 HB CALCIUM TOTAL $ 22.00 576111 82340 HB CALCIUM URINE $ 136.00 774467 82365 HB CALCULUS ANALYSIS $ 68.00 575128 82088 HB C‐ALDOSTERONE RENIN RATIO $ 36.00 575239 82105 HB C‐ALPHA‐FETOPROTEIN $ 34.00 775243 83993 HB CALPROTECTIN FECAL $ 157.00 771077 81219 HB CALRETICULIN GENE $ 385.00 774710 86301 HB CANCER ANTIGEN 19‐9 $ 136.00 774709 86300 HB CANCER ANTIGEN 27.29 $ 165.00 774739 86628 HB CANDIDA ANTIBODY (ID) $ 46.00 575079 85384 HB C‐ANGLE FIBRINOGEN ACTIVITY $ 35.00 771095 G0480 HB CANNABINOIDS CONFIRMATION $ 126.00 575344 86148 HB C‐ANTIPHOSPHATIDYLSERINE IGM AB $ 47.00 576345 36416 HB CAPILLARY DRAWING CHARGE $ 30.00 776323 80156 HB CARBAMAZEPINE $ 98.00 771067 80299 HB CARBAMAZEPINE 10‐11 EPOXIDE $ 97.00 774412 80157 HB CARBAMAZEPINE FREE $ 69.00 770494 80156 HB CARBAMAZEPINE TOTAL ‐ SENDOUT $ 69.00 775077 82373 HB CARBOHYDRATE DEF TRANSFERRIN $ 464.00 778058 82374 HB CARBON DIOXIDE $ 22.00 575778 82374 HB CARBON DIOXIDE BICARBONATE $ 80.00 779134 82375 HB CARBOXY HGB QUANT $ 88.00 576069 82379 HB CARNITINE $ 68.00 774468 82379 HB CARNITINE FREE & TOTAL $ 68.00 774469 82380 HB CAROTENE $ 122.00 774470 82384 HB CATECHOL URINE FRACT/FR $ 123.00 770309 82384 HB CATECHOLAMINE PLASMA $ 165.00 575221 86611 HB C‐BARTONELLA HENSELAE IGM $ 17.00 774101 85025 HB CBC WITH AUTO DIFF $ 45.00 775244 85027 HB CBC WITHOUT AUTO DIFF $ 36.00 575347 86146 HB C‐BETA‐Z GLYCOPROTEIN IGG AB $ 62.00 575007 86900 HB C‐BLOOD TYPING ABO $ 28.00 575008 86901 HB C‐BLOOD TYPING RH (D) $ 31.00 575073 89051 HB C‐BODY FLD CELL COUNT $ 65.00 575366 86622 HB C‐BRUCELLA AB IGG $ 103.00 575367 86622 HB C‐BRUCELLA AB IGM $ 103.00 773221 87046 HB C‐C STOOL ADD'L PATHOGEN EA PLATE $ 34.00 773212 87045 HB C‐C STOOL W‐ISOL EXAM SALMONELLA/SHIGELLA $ 65.00 575405 86359 HB C‐CD3 $ 57.00 575406 86360 HB C‐CD4 $ 21.00 581384 81382 HB C‐CELIAC GEN PROM /QUANT1 $ 515.00 DocuSign Envelope ID: 93169EF5-1DCD-4008-A5C5-29C0496CD7FA 575498 87491 HB C‐CHLAMYDIA AMPLIF GEN PROBE $ 106.00 575369 88262 HB C‐CHROMOSOME ANALYSIS $ 850.00 575561 88280 HB C‐CHROMOSOME ANALYSIS ADDITIONAL $ 116.00 575558 88262 HB C‐CHROMOSOME ANALYSIS COUNT $ 206.00 575373 86645 HB C‐CMV‐IGM $ 84.00 575281 86635 HB C‐COCCI COMPLEMENT FIXATION $ 57.00 575282 86635 HB C‐COCCI IMMUNODIFFUSION IGG $ 21.00 575283 86635 HB C‐COCCI IMMUNODIFFUSION IGM $ 21.00 575261 83520 HB C‐COLLAGEN BINDING ACTIVITY $ 97.00 575515 85025 HB C‐COMPLETE BLOOD COUNT $ 11.00 575036 82533 HB C‐CORTISOL BASELINE $ 88.00 575064 89051 HB C‐CSF CELL COUNT $ 65.00 575559 88291 HB C‐CYTOGENETICS INTERPRETATION $ 129.00 575563 88291 HB C‐CYTOGENETICS MOLECULAR INTERP $ 116.00 582530 86361 HB CD4 T CELLS ABSOLUT COUNT $ 88.00 575213 86648 HB C‐DIPHTHERIA TOXOID IGG $ 70.00 778964 82378 HB CEA $ 122.00 770276 82378 HB CEA PC FLUID $ 276.00 770948 82378 HB CEA, BF $ 122.00 771076 81218 HB CEBPA MUTATION DETECTION $ 609.00 770989 88346 HB CELIAC ANTI‐ENDOMYSIAL IGA AB $ 94.00 774330 89051 HB CELL COUNT CSF/BF WITH DIFF $ 65.00 576384 88182 HB CELL MARKER STUDY $ 75.00 774845 88185 HB CELL SURFACE MARKER EACH $ 47.00 575837 89051 HB CELLCOUNT PERITONEN LAVAC $ 34.00 575409 86255 HB C‐ENDOMYSIAL SCREEN $ 113.00 575408 86256 HB C‐ENDOMYSIAL TITER $ 113.00 576247 83516 HB CENTROMERE $ 31.00 771098 83516 HB CENTROMERE AB IGG $ 47.00 575172 88361 HB C‐ER BY VIAS $ 203.00 575387 82670 HB C‐ESTRADIOL (E2) $ 143.00 575386 82679 HB C‐ESTRONE (E1) $ 143.00 575161 85250 HB C‐FACTOR IX ANTIGEN $ 168.00 575499 87591 HB C‐GONORRHOEAE GEN PROBE $ 106.00 575116 87081 HB C‐GTCU $ 50.00 575155 86352 HB C‐HACA MEASUREMENT $ 106.00 575512 87340 HB C‐HEP B SURFACE AG $ 51.00 575358 86706 HB C‐HEPATITIS B SURF AB $ 34.00 575174 88361 HB C‐HER/2‐NEU BY VIAS $ 175.00 575139 88291 HB C‐HER‐21 NEU FISH INTERPRETATION $ 169.00 575562 88289 HB C‐HIGH RESOLUTION STUDY $ 116.00 770953 86790 HB CHIKUNGUNYA IGG, IGM $ 69.00 575514 86701 HB C‐HIV‐1 SCREEN $ 56.00 774740 86631 HB CHLAM PNEUMO IGG $ 35.00 774743 86632 HB CHLAM PNEUMO IGM $ 35.00 778047 82435 HB CHLORIDE BLD $ 22.00 774474 82438 HB CHLORIDE FECES $ 82.00 778048 82438 HB CHLORIDE FLUID $ 98.00 778050 82436 HB CHLORIDE URINE $ 116.00 778052 82465 HB CHOLESTEROL TOTAL $ 22.00 774475 82482 HB CHOLINESTERASE RBC $ 168.00 576392 88261 HB CHROM ANALY 5 CELLS $ 389.00 576394 88264 HB CHROM ANALY;20‐25 CELLS $ 222.00 775121 82495 HB CHROMIUM $ 190.00 773567 85260 HB CHROMOGENIC FACTOR XA $ 111.00 DocuSign Envelope ID: 93169EF5-1DCD-4008-A5C5-29C0496CD7FA 774711 86316 HB CHROMOGRANIN A $ 168.00 576399 88285 HB CHROMOSOME COUNT,ADDITIONAL $ 87.00 770559 82397 HB C‐IBD SGI DIAGNOSTIC‐CHEMILUMIN 1ST $ 21.00 770560 82397 HB C‐IBD SGI DIAGNOSTIC‐CHEMILUMIN ADDN $ 21.00 770709 81479 HB C‐IBD SGI DIAGNOSTIC‐GENETIC 1ST $ 73.00 770710 81479 HB C‐IBD SGI DIAGNOSTIC‐GENETIC ADDN $ 42.00 770569 86140 HB C‐IBD SGI DIAGNOSTIC‐HSCRP $ 33.00 770561 83520 HB C‐IBD SGI DIAGNOSTIC‐IMMUNO QNT 1ST $ 21.00 770562 83520 HB C‐IBD SGI DIAGNOSTIC‐IMMUNO QNT ADDN $ 42.00 770996 88350 HB C‐IBD SGI DNASE SENSI INDIRECT IF IGG SPECIFIC $ 87.00 770995 88346 HB C‐IBD SGI P‐ANCA INDIRECT IF IGG SPECIFIC $ 87.00 775031 82657 HB C‐IBD THIOPURINE S‐METHYLTRANS $ 140.00 575225 88184 HB C‐IGE RECEPTOR AB $ 119.00 575227 88185 HB C‐IGE RECEPTOR REMARK $ 83.00 770809 86335 HB C‐IMMUNOFIXATION URINE $ 66.00 575101 87804 HB C‐INFLUENZA A $ 77.00 575102 87804 HB C‐INFLUENZA B $ 77.00 575242 86336 HB C‐INHIBIN‐A $ 34.00 575142 88274 HB C‐INTERPHASE IN‐SITU HYPRIDIZATI $ 133.00 575176 88187 HB C‐INTERPRETATION FOR PNH EVAL $ 123.00 770641 83516 HB CIQ IGG ANTIBODY $ 111.00 774689 86160 HB CIQ LEVEL $ 218.00 774503 82507 HB CITRIC ACID URINE $ 148.00 774975 82552 HB CK ISOENZYMES $ 87.00 778055 82553 HB CK‐MB FRACTION $ 116.00 771056 G0480 HB CLOMIPRAMINE & METABOLITE $ 60.00 575992 87493 HB CLOSTRIDIUM DIFFICILE $ 141.00 772854 85347 HB CLOTTING TIME ACTIVATED OR $ 49.00 774494 80159 HB CLOZAPINE $ 73.00 774936 86353 HB C‐LYMPH TRANSFORMATION ANTIGEN 1‐2 $ 165.00 774937 86353 HB C‐LYMPH TRANSFORMATION MITOGEN 1‐3 $ 146.00 575081 85390 HB C‐LYSIS 30 MIN AFTER MA $ 17.00 575420 83655 HB C‐LZP LEAD $ 106.00 770773 82495 HB C‐METALS JOINT CHROMIUM $ 60.00 770774 83018 HB C‐METALS JOINT COBALT $ 60.00 575140 88271 HB C‐MOLECULER CYTOGENETICS 1 $ 133.00 779164 86644 HB CMV ‐ IGG $ 84.00 775047 86644 HB CMV AB,IGG $ 36.00 770501 86645 HB CMV ANTIBODY IGM ‐ SENDOUT $ 43.00 770642 87496 HB CMV PCR QUALITATIVE $ 164.00 576023 87497 HB CMV QUANT BY PCR $ 224.00 773503 83516 HB C‐MYOSITIS MI2 PL7 PL12 EJ OJ KU SRP SNRNP $ 46.00 770780 83516 HB C‐MYOSITIS PMSCL $ 77.00 773444 85397 HB COAGULATION FUNCTIONAL ACTIVITY $ 294.00 770697 83018 HB COBALT‐SERUM/PLASMA $ 52.00 771069 G0480 HB COCAINE CONFIRMATION $ 96.00 774746 86635 HB COCCICIODES ANTIBODIES $ 99.00 774747 86635 HB COCCIDIOIDES (CF) $ 99.00 771011 G0480 HB CODEINE QUANT $ 133.00 774244 86157 HB COLD AGGLUTININS TITER $ 37.00 773587 86850 HB COLD ANTIBODY SCREEN ‐ BBC $ 107.00 770631 83520 HB COLLAGEN TYPE II ANTIBODY $ 178.00 774790 86790 HB COLORADO TICK FEVER ABS $ 346.00 779159 80053 HB COMP METABOLIC PANEL $ 52.00 770111 86922 HB COMPATIBILITY AHG $ 74.00 DocuSign Envelope ID: 93169EF5-1DCD-4008-A5C5-29C0496CD7FA 770211 86920 HB COMPATIBILITY IM SPIN $ 167.00 774686 86160 HB COMPLEMENT AG, EACH $ 60.00 774976 86160 HB COMPLEMENT ANTIGEN EA COMPONENT $ 88.00 778059 86160 HB COMPLEMENT C3 AND/OR C4 $ 125.00 774694 86162 HB COMPLEMENT CH 50 OR AH50 $ 129.00 774977 86161 HB COMPLEMENT FUNCTION EACH $ 179.00 576403 88325 HB COMPREHENSIVE CONSULT $ 465.00 775050 87015 HB CONCENTRATE $ 41.00 773219 87015 HB CONCENTRATION INFECT AGT $ 50.00 575895 88332 HB CONSULT;SURGERY,W/FROZEN,ADD'L $ 64.00 575894 88331 HB CONSULT;SURGERY,W/FROZEN,ONE $ 117.00 575643 86886 HB COOMBS TEST, AB TITER $ 140.00 774504 82525 HB COPPER LIVER TISSUE $ 238.00 774505 82525 HB COPPER PLASMA OR RBC $ 146.00 774506 82525 HB COPPER URINE $ 172.00 575748 82533 HB CORTISOL ENDPOINT $ 88.00 770311 82530 HB CORTISOL FREE URINE $ 134.00 770609 82533 HB CORTISOL SALIVA $ 88.00 770312 82533 HB CORTISOL SERUM $ 88.00 774754 86658 HB COXSACKIE A9 VIRUS ANTIBODY $ 95.00 774755 86658 HB COXSACKIE B VIRUS ANTIBODY $ 163.00 770797 80304 HB C‐PAIN MGT DRUG SCR, MULTI CLASS, EA $ 46.00 770795 80301 HB C‐PAIN MGT SINGLE DRUG CLASS LIST A $ 46.00 770557 86256 HB C‐PARANEOPL CSF FLUOR ABS, TITER, EA $ 90.00 770556 86256 HB C‐PARANEOPL CSF FLUOR ABS, TITER, EACH $ 90.00 770550 83519 HB C‐PARANEOPL SERUM ABS ‐ RIA $ 32.00 770551 83519 HB C‐PARANEOPL SERUM ABS BY RIA $ 32.00 770554 83520 HB C‐PARANEOPL SERUM ABS BY RIA NEC $ 32.00 770552 86256 HB C‐PARANEOPL SERUM FLUOR ABS, TITER EA $ 32.00 770553 86256 HB C‐PARANEOPL SERUM FLUOR ABS, TITER EACH $ 32.00 575449 87798 HB C‐PARVOVIRUS B19 DNA $ 164.00 770345 84681 HB C‐PEPTIDE $ 121.00 575173 88361 HB C‐PR BY VIAS $ 175.00 575162 85302 HB C‐PROTEIN C ANTIGEN $ 132.00 770806 84165 HB C‐PROTEIN ELECTROPHORESIS $ 66.00 770810 84166 HB C‐PROTEIN ELECTROPHORESIS URINE $ 66.00 575164 85305 HB C‐PROTEIN S ANTIGEN TOTAL $ 143.00 575133 84207 HB C‐PYRIDOXAL S‐PHOSPHATE $ 110.00 575134 83789 HB C‐PYRIDOXIC ACID $ 75.00 575078 85347 HB C‐R CLOT TIME $ 17.00 779213 86141 HB C‐REACTIVE PROT HIGH SENS $ 19.00 575796 86141 HB C‐REACTIVE PROTEIN,HIGH SENS $ 157.00 778054 82550 HB CREATINE KINASE TOTAL $ 34.00 778064 82565 HB CREATININE BLD $ 22.00 778065 82575 HB CREATININE CLEARANCE $ 44.00 778066 82570 HB CREATININE NON‐BLD $ 35.00 575127 84244 HB C‐RENIN $ 68.00 777629 87260 HB C‐RESP IIFA ADULT ‐ ADENOVIRUS $ 57.00 575659 86922 HB CROSSMATCH‐PREWARMED $ 282.00 575608 86762 HB C‐RUBELLA IGG $ 16.00 774513 82585 HB CRYOFIBRINOGEN $ 51.00 770520 82595 HB CRYOGLOBULIN SCREEN $ 51.00 770602 P9012 HB CRYOPRECIPITATE $ 282.00 576136 87327 HB CRYPTOCOCCUS AG SERUM OR CSF $ 63.00 774328 89060 HB CRYSTAL ID POLARIZED $ 32.00 DocuSign Envelope ID: 93169EF5-1DCD-4008-A5C5-29C0496CD7FA 770471 86039 HB C‐SCLERODERMA ‐ ANA TITER $ 91.00 770474 86256 HB C‐SCLERODERMA ‐ ANTI‐CENTROMERE $ 91.00 770475 83516 HB C‐SCLERODERMA ‐ PM/SCL, TH/TO, U3RNP $ 91.00 770472 86235 HB C‐SCLERODERMA ‐ SCL70/U1RNP/RNA/PM/SCL $ 91.00 575328 86403 HB C‐STREPTOCOCCUS GRP B AG $ 73.00 575033 89230 HB C‐SWEAT COLLECTION IONTOPHORESIS $ 98.00 575067 85810 HB C‐SYN FL VISCOSITY $ 49.00 575068 89060 HB C‐SYN FLD CRYSTALS ONLY $ 32.00 575066 89051 HB C‐SYNOVIAL FLUID COUNT $ 65.00 576029 82523 HB C‐TELOPEPTIDE BETA CROSS LINKED $ 76.00 575214 86774 HB C‐TETANUS TOXOID IGG $ 35.00 770288 86800 HB C‐THYROGLOBULIN ANTIBODY SENDOUTS $ 66.00 770287 84432 HB C‐THYROGLOBULIN BY RIA $ 80.00 575370 88230 HB C‐TISSUE CULTURE $ 166.00 770805 84160 HB C‐TOTAL PROTEIN $ 66.00 770808 84156 HB C‐TOTAL PROTEIN URINE $ 41.00 773025 87040 HB CULT BACT BLOOD $ 222.00 773106 87086 HB CULT BACT URINE $ 87.00 773048 87102 HB CULT FUNGAL NON BLD/SKIN $ 112.00 773049 87101 HB CULT FUNGAL SKIN/HAIR/NAILS $ 112.00 773359 87071 HB CULT GROUP A STREP ANA $ 112.00 773125 87147 HB CULT SEROL ID‐EACH SERUM $ 38.00 773016 87070 HB CULTURE BACTERIAL $ 222.00 773026 87040 HB CULTURE BLOOD BANK PRODUCTS $ 222.00 773145 87088 HB CULTURE URINE PRESUMPTIVE ID $ 62.00 575300 82140 HB C‐URINE AMMONIA $ 60.00 575292 82340 HB C‐URINE CALCIUM $ 31.00 575303 82436 HB C‐URINE CHLORIDE $ 24.00 575294 82507 HB C‐URINE CITRATE $ 114.00 575304 82570 HB C‐URINE CREATININE $ 31.00 575295 83735 HB C‐URINE MAGNESIUM $ 38.00 575296 83945 HB C‐URINE OXALATE $ 60.00 575291 81003 HB C‐URINE PH $ 48.00 575298 84105 HB C‐URINE PHOSPHORUS $ 31.00 575302 84133 HB C‐URINE POTASSIUM $ 28.00 575301 82127 HB C‐URINE QUALITATIVE CYSTINE $ 61.00 575293 84300 HB C‐URINE SODIUM $ 28.00 575299 84392 HB C‐URINE SULFATE $ 33.00 575297 84560 HB C‐URINE URIC ACID $ 28.00 575257 85730 HB C‐VWP APII $ 97.00 575258 85240 HB C‐VWP FACTOR 8 ACT $ 97.00 575259 85245 HB C‐VWP FACTOR FUNCTION $ 134.00 575354 86789 HB C‐WEST NILE VIRUS IGG CSF $ 68.00 575355 86788 HB C‐WEST NILE VIRUS IGM CSF $ 34.00 774514 82600 HB CYANIDE $ 225.00 576119 86200 HB CYCLIC CITRULLINATED PEPTIDE $ 177.00 770435 86200 HB CYCLIC CITRULLINATED PEPTIDE AB $ 24.00 776327 80158 HB CYCLOSPORINE $ 203.00 775242 82610 HB CYSTATIN‐C $ 94.00 775062 86682 HB CYSTERCYSCOSIS AB IGG SERUM OR CSF $ 60.00 770610 82131 HB CYSTINE URINE $ 114.00 770942 88233 HB CYTOGENETIC CULTURE TISSUE $ 298.00 576116 87496 HB CYTOMEGALOVIRUS QUALITATIVE BY PCR $ 281.00 575364 86612 HB C‐ZZ‐BLASTOMYCES AB‐IMMUNODIFF $ 34.00 774299 85379 HB D‐DIMER QUANT $ 107.00 DocuSign Envelope ID: 93169EF5-1DCD-4008-A5C5-29C0496CD7FA 575880 88311 HB DECALCIFICATION PROCEDURE $ 76.00 774791 86790 HB DENGUE FEVER ABS $ 140.00 582222 82633 HB DEOXYCORTICOSTERONE $ 83.00 771066 G0480 HB DESIPRAMINE $ 57.00 771008 G0480 HB DESIPRAMINE QUANT $ 66.00 576382 87798 HB DETECT AGENT NOS,DNA,AMP $ 275.00 770296 83789 HB DEXAMETHASONE $ 129.00 774515 82626 HB DHEA $ 49.00 770988 G0480 HB DIAZEPAM AND NORDIAZEPAM $ 79.00 776458 80162 HB DIGOXIN $ 112.00 771057 82542 HB DIHYDROTESTOSTERONE $ 84.00 576166 86648 HB DIPHTHERIA TOXOID IGG $ 73.00 774752 86317 HB DIPTHERIA ANTIBODY IGG $ 73.00 773589 86880 HB DIRECT ANTIGLOBULIN TEST $ 48.00 576103 86022 HB DIRECT PLATELET ANTIBODIES $ 193.00 576346 99001 HB DNA DIAG HANDLING FEE $ 74.00 576094 86225 HB DNA DOUBLE STRANDED $ 41.00 774695 86215 HB DNASE‐B ANTIBODY $ 39.00 771047 G0480 HB DOXEPIN & METABOLITE $ 65.00 576344 36415 HB DRAWING CHARGE $ 30.00 771048 80299 HB DRUG LEVEL (HPLC) $ 51.00 770992 G0479 HB DRUG SCREEN MECONIUM OR URINE $ 303.00 770163 G0477 HB DRUGS OF ABUSE SCREEN, URINE $ 341.00 570516 86256 HB DS DNA BY IFA $ 66.00 770297 86256 HB DS DNA IGG ANTIBODY BY CRITHDIA $ 56.00 576246 86225 HB DS‐DNA $ 34.00 774828 87427 HB E.COLI SHIGA LIKE TOXIN BY EIA $ 49.00 779500 86664 HB EB VIRUS EBNA ‐ NUCLEAR AG $ 62.00 773664 86665 HB EB VIRUS VCA IGG AND OR IGM $ 62.00 774759 86682 HB ECHINOCOCCUS AB IGG $ 62.00 774894 86658 HB ECHOVIRUS ‐ SEROTYPE 6 $ 231.00 774757 86666 HB EHRLICHIA CHAFFENSIS ABS $ 69.00 575341 87798 HB EHRLICHIA SPECIES BY PCR $ 58.00 779158 80051 HB ELECTROLYTES PANEL $ 33.00 575657 86923 HB ELECTRONIC CROSSMATCH $ 166.00 575686 86235 HB ENA TO AB NRNP,SS‐A, SS‐B, SM, RNP, SC170, JO‐1 $ 59.00 582519 86256 HB ENDOMYSIAL ANTIBODY $ 56.00 774980 86753 HB ENTAMOEBA HISTOLYTIC AB IGG $ 50.00 576098 87498 HB ENTEROVIRUS BY PCR $ 110.00 774520 82657 HB ENZYME ACTIVITY IN BLD CELLS NOS $ 84.00 773214 87185 HB ENZYME DETECTION $ 38.00 774336 89190 HB EOSINOPHIL SMEAR $ 36.00 772824 89050 HB EOSINOPHIL SMEAR‐ URINE $ 36.00 576093 87799 HB EPSTEIN BARR VIRUS BY PCR $ 129.00 774635 84202 HB ERYTHROCYTE PORHYRIN $ 86.00 774522 82668 HB ERYTHROPOIETIN $ 129.00 774525 82679 HB ESTERONE $ 143.00 779105 82670 HB ESTRADIOL $ 64.00 774524 82677 HB ESTRIOL SERUM $ 44.00 774523 82671 HB ESTROGEN SERUM FRACTIONATED $ 69.00 770172 G0480 HB ETHANOL BLD $ 119.00 771010 G0480 HB ETHANOL QUANT $ 92.00 774415 80168 HB ETHOSUXMIDE $ 202.00 575457 86235 HB EXTRACT NUC AB, EA $ 7.00 775061 86668 HB F TULAREMIA ANTIBODY $ 76.00 DocuSign Envelope ID: 93169EF5-1DCD-4008-A5C5-29C0496CD7FA 576099 85250 HB FACTOR 1X ANTIGEN $ 140.00 582583 85240 HB FACTOR VIII FOR DDAVP $ 195.00 582588 85291 HB FACTOR XIII SCREEN $ 117.00 770606 83520 HB FECAL (PANCREATIC) ELASTASE $ 150.00 774526 82710 HB FECAL FAT $ 221.00 581607 83986 HB FECAL PH $ 39.00 771052 G0480 HB FELBAMATE ‐ FELBATOL $ 186.00 770997 G0480 HB FENTANYL AND METABOLITE $ 102.00 778076 82728 HB FERRITIN $ 71.00 779170 82731 HB FETAL FIBRONECTIN $ 539.00 575667 83033 HB FETAL SCREEN $ 173.00 773229 P9059 HB FFP 8‐24 HRS EACH UNIT $ 508.00 770123 P9017 HB FFP PHERESIS REG $ 508.00 774304 85384 HB FIBRINOGEN SEMI‐QUANT $ 60.00 770750 83520 HB FIBROBLAST GROWTH FACTOR 23 $ 332.00 775130 88184 HB FIRST MISC FLOW MARKER $ 247.00 771049 80299 HB FLECAINIDE $ 170.00 575177 88184 HB FLOW 1ST MARKER $ 89.00 575178 88185 HB FLOW ADDIITONAL MARKER $ 89.00 772809 88184 HB FLOW CYTOMETRY 1ST MARKER $ 247.00 576389 88189 HB FLOW CYTOMETRY INT 16 &> MRKRS $ 245.00 576387 88187 HB FLOW CYTOMETRY INT 2‐8 MARKERS $ 190.00 576388 88188 HB FLOW CYTOMETRY INT 9‐15 MARKRS $ 201.00 770587 81245 HB FLT3 GENE MUTATION $ 320.00 771084 81246 HB FLT3 TKD VARIANTS $ 320.00 770429 86255 HB FLUORSCENT ANTIBODY SCREEN EACH $ 129.00 771055 G0480 HB FLUOXETINE/NORFLUOXETINE $ 57.00 770578 81243 HB FMR1 (FRAGILE X) GENE ANALYSIS $ 164.00 774528 82747 HB FOLATE RBC $ 136.00 778077 82746 HB FOLATE SERUM $ 91.00 770730 81244 HB FRAGILE‐X METHYLATION BY MPCR‐REFLEX $ 742.00 774527 82725 HB FREE FATTY ACIDS $ 649.00 770340 84439 HB FREE T4 $ 91.00 774540 82985 HB FRUCTOSAMINE $ 88.00 770315 83001 HB FSH $ 56.00 773121 87106 HB FUNGAL ID YEAST $ 65.00 773435 87107 HB FUNGAL IDENTIFICATION‐MOLD $ 65.00 773215 87107 HB FUNGAL ID‐MOLD $ 65.00 774491 80171 HB GABAPENTIN ‐ NEURONTIN $ 136.00 774531 82775 HB GALACTOSE‐1‐PUT $ 159.00 778082 82977 HB GAMMA GLUTAMLYTRANSFERASE $ 34.00 775083 82784 HB GAMMAGLOBULINS $ 78.00 770299 82784 HB GAMMAGLOBULINS ‐ CRYOGLOBULIN $ 78.00 770994 G0479 HB GAMMA‐HYDROXYBUTYRIC ACID $ 257.00 771078 G0480 HB GAMMA‐HYDROXYBUTYRIC ACID CONFIRMATION $ 39.00 775190 83516 HB GANGLIOSIDE ANTIBODIES $ 242.00 774537 82941 HB GASTRIN $ 114.00 772858 80050 HB GENERAL HEALTH PANEL $ 180.00 776343 80170 HB GENTAMICIN $ 98.00 770160 87507 HB GI FILM ARRAY PANEL $ 936.00 774566 83516 HB GLIADIN AB IGG OR IGA $ 78.00 774538 82943 HB GLUCAGON $ 47.00 778087 82947 HB GLUCOSE $ 22.00 778088 82945 HB GLUCOSE FL $ 22.00 779142 82950 HB GLUCOSE POST GLUCOSE DOSE $ 22.00 DocuSign Envelope ID: 93169EF5-1DCD-4008-A5C5-29C0496CD7FA 778083 82951 HB GLUCOSE TOLERANCE 3 SPECIMENS $ 39.00 778084 82952 HB GLUCOSE TOLERANCE ADDITONAL SPEC $ 15.00 774539 82955 HB GLUCOSE‐6‐PD $ 201.00 774561 83516 HB GLUTAMIC ACID DECARBOXYLASE AB $ 299.00 774544 83036 HB GLYCATED HEMOGLOBIN $ 39.00 776318 82693 HB GLYCOLS $ 136.00 773124 87205 HB GRAM STAIN‐PRIMARY SOURCE $ 42.00 770159 83013 HB H PYLORI BREATH TEST $ 238.00 774761 86317 HB H. INFLUENZAE B ANTIBODY IGG $ 48.00 779185 86677 HB H. PYLORI AB $ 228.00 774970 87338 HB H. PYLORI ANTIGEN STOOL $ 101.00 774542 83013 HB H. PYLORI BREATH TEST $ 238.00 774416 80173 HB HALOPERIDOL $ 72.00 575679 HB HANDLING FEE $ 161.00 775063 86790 HB HANTA VIRUS IGG OR IGM $ 149.00 778101 83010 HB HAPTOGLOBIN $ 98.00 774221 85460 HB HBG OR RBC FETOMATERNAL LYSIS $ 259.00 778102 87340 HB HBS AG $ 109.00 582614 87517 HB HBV QUANT DNA $ 141.00 778103 84703 HB HCG QUAL/PREG TEST $ 55.00 778079 84702 HB HCG QUANT/BETA SUBUNIT $ 45.00 775076 87521 HB HCV AMPLIFIED PROBE $ 381.00 778104 83718 HB HDL CHOLESTEROL MEASURED $ 34.00 576293 HB HEALTH FAIR ABO AND RH $ 22.00 775104 85441 HB HEINZ BODY, DIRECT COMPONENT $ 261.00 775105 85445 HB HEINZ BODY, IND ACETYLPHENLHDRZN $ 261.00 576327 86677 HB HELICOBACTER PYLORI ANTIBODY $ 100.00 775171 86682 HB HELMINTH ANTIBODY/FILARIAL ANTIBODY $ 144.00 774224 85014 HB HEMATOCRIT NON SPUN $ 36.00 774006 85013 HB HEMATOCRIT SPUN $ 36.00 779182 85018 HB HEMOGLOBIN $ 36.00 779102 83036 HB HEMOGLOBIN AIC $ 71.00 770949 83021 HB HEMOGLOBIN ELECTROPHORESIS $ 177.00 774018 83070 HB HEMOSIDERIN QUAL URINE $ 129.00 779112 86709 HB HEP A AB ‐ IGM $ 141.00 779111 86708 HB HEP A AB TOTAL $ 111.00 775081 87341 HB HEP B AG NEUTRALIZATION $ 63.00 779114 86705 HB HEP B CORE AB ‐ IGM $ 121.00 779113 86704 HB HEP B CORE AB TOTAL $ 141.00 770950 86317 HB HEP B SURF AB QUANT $ 264.00 778018 86706 HB HEP B SURFACE AB TITER $ 104.00 778967 86803 HB HEP C AB $ 48.00 774795 86803 HB HEP C VIRUS AB $ 123.00 775879 85520 HB HEPARIN ASSAY $ 82.00 576144 86022 HB HEPARIN‐INDUCED ANTIBODY $ 305.00 779156 80076 HB HEPATIC FUNCTION PANEL A $ 42.00 774774 86707 HB HEPATITIS B AB TO E INCH $ 161.00 774823 87350 HB HEPATITIS B AG TO E INCH $ 161.00 770714 87912 HB HEPATITIS B VIRUS GENOTYPING $ 595.00 770786 87902 HB HEPATITIS C VIRUS GENOTYPE $ 1,124.00 774765 86692 HB HEPATITIS D DELTA AB TOTAL $ 46.00 774766 86692 HB HEPATITIS D DELTA ANTIBODY IG M $ 171.00 774824 87380 HB HEPATITIS D DELTA ANTIGEN $ 231.00 774767 86694 HB HERPES I/II COMBINED IGM $ 51.00 582617 87529 HB HERPES SIMP VIRUS RPD PCR $ 226.00 DocuSign Envelope ID: 93169EF5-1DCD-4008-A5C5-29C0496CD7FA 774789 86790 HB HERPES VIRUS 6 IGG $ 60.00 773193 86308 HB HETEROPHILE AB SCREEN $ 46.00 772886 85598 HB HEXAGONAL PHOSPHOLIPID NEUTRALIZATION $ 82.00 770318 83080 HB HEXOSAMINIDASE (TAYSACHS) $ 549.00 770579 81256 HB HFE (HEMOCHROMATOSIS) GENE ANALYSIS $ 296.00 770218 85461 HB HGB FETAL ROSETTE $ 173.00 776811 87532 HB HHV 6 PCR QUALITATIVE $ 337.00 770319 87533 HB HHV6 A/B BY QUANTITATIVE PCR $ 247.00 576078 87532 HB HHV‐6 BY RAPID PCR $ 167.00 773279 87533 HB HHV‐6 VIRUS PCR QUANTITATIVE $ 337.00 774548 83088 HB HISTAMINE PLASMA $ 68.00 774547 83088 HB HISTAMINE URINE $ 68.00 576250 83516 HB HISTONE ANTIBODIES $ 24.00 774825 87385 HB HISTOPLASMA AG URINE/SERUM $ 165.00 774770 86698 HB HISTOPLASMA ANTIBODIES $ 204.00 576203 87536 HB HIV QUANT BY BDNA $ 290.00 778110 86703 HB HIV‐1/2 $ 19.00 582634 81383 HB HLACLASS2 1ALLELE OR GRP $ 148.00 779176 83090 HB HOMOCYSTEINE CARDIAC RISK $ 141.00 773220 87176 HB HOMOGENIZATION TISSUE $ 63.00 774549 83150 HB HOMOVANILLIC ACID URINE $ 50.00 775048 86694 HB HSV AB TYPE 1 AND/OR 2, IGG $ 43.00 779511 87529 HB HSV PCR QUALITATIVE $ 232.00 773274 86695 HB HSV TYPE 1 ANTIBODY $ 109.00 773275 86696 HB HSV TYPE 2 ANTIBODY $ 109.00 774764 86689 HB HTLV1 OR HIV CONF WESTERN BLOT $ 194.00 774762 86790 HB HTLV‐I/11 ANTIBODIES (EIA) $ 50.00 770597 81401 HB HUNTINGTON DISEASE $ 234.00 775124 86606 HB HYPERSENSITIVITY ASPERGILLUS $ 108.00 774912 86331 HB HYPERSENSITIVITY PRECIPITINS $ 21.00 770617 86255 HB IBD DIFFERENTATION S. CEREVISIAE IGA/IGG $ 60.00 770613 86671 HB IBD DIFFERENTIATION ANCA $ 60.00 582255 83520 HB IBD7 IMMUNOASSAY ANA QUAN $ 43.00 771050 G0480 HB IBUPROFEN $ 71.00 582239 82784 HB IGA TOTAL $ 44.00 576077 83519 HB IGF BINDING PROTEIN‐1 $ 139.00 770731 81263 HB IGVH GENE SEQUENCING $ 702.00 771065 G0480 HB IMIPRAMINE AND DESIPRAMINE $ 63.00 770298 86334 HB IMMUNOFIXATION ‐ CRYOGLOBULIN $ 63.00 772905 86334 HB IMMUNOFIXATION ELECTROPHORESIS, SERUM $ 66.00 778111 86335 HB IMMUNOFIXATION OTHER FLUIDS WITH CONC $ 66.00 778114 82784 HB IMMUNOGLOB IGA/G/M/D EACH $ 56.00 774533 82784 HB IMMUNOGLOBULIN A SALIVA $ 36.00 774532 82784 HB IMMUNOGLOBULIN D $ 150.00 576215 82785 HB IMMUNOGLOBULIN E $ 77.00 774898 82787 HB IMMUNOGLOBULIN G SUBCLASS $ 44.00 770734 87798 HB INFECTIOUS DISEASES PCR $ 328.00 770761 86352 HB INFLIXIMAB OR ADALIMUMAB ACT AND NEUT AB $ 336.00 773285 87502 HB INFLUENZA A PCR QUAL $ 137.00 775147 86710 HB INFLUENZA ANTIBODY $ 31.00 773286 87503 HB INFUENZA B PCR QUAL $ 68.00 770498 86336 HB INHIBIN A ‐ SENDOUT $ 86.00 770708 83520 HB INHIBIN B LEVEL $ 50.00 770481 85335 HB INHIBITOR LEVEL $ 219.00 575860 85611 HB INHIBITOR SCREEN PT $ 237.00 DocuSign Envelope ID: 93169EF5-1DCD-4008-A5C5-29C0496CD7FA 576406 88367 HB INSITU HYBRIDIZATION AUTO $ 236.00 576425 88367 HB INSITU HYBRIDZATION,AUTO $ 200.00 576426 88368 HB INSITU HYBRIDZATION,MANUAL $ 281.00 770322 83525 HB INSULIN $ 62.00 774719 86337 HB INSULIN ANTIBODIES HUMAN $ 89.00 582256 82397 HB INSULIN LIKE GFB PROTEIN3 $ 64.00 775169 83520 HB INTERLEUKIN 2 BY MAFD $ 148.00 775096 83520 HB INTERLEUKIN LEVEL $ 358.00 770332 83970 HB INTRAOPERATIVE PTH $ 161.00 774720 86340 HB INTRINSIC FACTOR BLOCK ANTIBODY $ 61.00 774461 83018 HB IODINE $ 230.00 576218 82190 HB IODINE,24 HR URINE $ 230.00 576217 82190 HB IODINE,SERUM $ 202.00 778120 83540 HB IRON $ 34.00 774574 83540 HB IRON TISSUE $ 150.00 770212 86945 HB IRRADIATION OF BLD PROD EA UNIT $ 124.00 771083 88367 HB ISH MORPHOMETRIC COMPUTER ASSISTED INITIAL PROBE $ 238.00 771082 88377 HB ISH MORPHOMETRIC MANUAL EA MULTIPLEX PROBE $ 468.00 771081 88374 HB ISH TESTING COMPUTER ASSISTED EA MULTIPLEX PROBE $ 468.00 774721 86341 HB ISLETCELL AB IGA $ 69.00 771085 81403 HB JAK2 EXON 12‐14 $ 385.00 582620 87798 HB JC VIRUS DNA BY PCR $ 390.00 575055 83520 HB KAPPA/LAMBDA FREE LIGHT CHAINS $ 142.00 581904 82010 HB KETONE BETAHYDROXYBUTYRAT $ 140.00 774246 82009 HB KETONES SEMI‐QUANT SERUM $ 38.00 771075 81273 HB KIT (D816V) MUTATION BY PCR $ 437.00 773224 87220 HB KOH SKIN HAIR OR NAILS ‐ LAB $ 51.00 774579 83661 HB L/S RATIO $ 1,241.00 773616 83789 HB LACOSAMIDE $ 117.00 778122 83605 HB LACTATE $ 34.00 778124 83615 HB LACTATE DEHYDROGENASE $ 56.00 775165 83630 HB LACTOFERRIN, FECAL QUAL $ 73.00 582170 80175 HB LAMOTRIGINE/LAMICTAL LEV $ 125.00 581696 83516 HB L‐ANTIGLIADIN IGA AB $ 20.00 581697 83516 HB L‐ANTIGLIADIN IGG AB $ 59.00 774777 86727 HB LCM ANTIBODY $ 90.00 774577 83625 HB LD ISOENZYME $ 56.00 778125 83615 HB LD NON‐BLD $ 34.00 774578 83655 HB LEAD WHOLE BLOOD OR URINE $ 44.00 775154 86905 HB LECTIN RBC ANTIGEN PANEL $ 161.00 775092 83789 HB LEFLUNOMIDE LEVEL $ 117.00 773401 87541 HB LEGION PNEUMO $ 331.00 774820 87449 HB LEGIONELLA ANTIGEN URINE $ 145.00 774854 87278 HB LEGIONELLA DFA STAIN $ 91.00 582566 86713 HB LEGIONELLA PNEUMOPHIL AB $ 141.00 773439 87081 HB LEGIONELLA SPECIES CULTURE $ 190.00 770620 86717 HB LEISHMANIA IGG $ 70.00 773558 82397 HB LEPTIN $ 122.00 576339 83519 HB LEPTIN $ 172.00 774776 86720 HB LEPTOSPIRA AGGLUTININS $ 213.00 772845 P9040 HB LEUK RDUC RBC IRR $ 828.00 774102 85048 HB LEUKOCYTE (HPC) AUTOMATED $ 36.00 774220 85540 HB LEUKOCYTE ALK PHOS WITH COUNT $ 94.00 576020 89055 HB LEUKOCYTE ASSESSMENT FECAL $ 50.00 770101 P9016 HB LEUKOCYTE REDUCED RED CELLS $ 608.00 DocuSign Envelope ID: 93169EF5-1DCD-4008-A5C5-29C0496CD7FA 575874 88300 HB LEVEL I; SURG PATH/GROSS ONLY $ 96.00 575875 88302 HB LEVEL II;SURG PATH/GROSS+MICRO $ 262.00 575876 88304 HB LEVEL III;SURG PATH/GROSS+MICR $ 306.00 575879 88309 HB LEVEL VI;SURG PATH/GROSS+MICRO $ 653.00 582171 80177 HB LEVETIRACETAM (KEPPRA) $ 72.00 770518 80176 HB LIDOCAINE LEVEL $ 63.00 582276 83883 HB LIGHT CHAINS ASSAY NEPH $ 93.00 778200 83690 HB LIPASE $ 73.00 778131 80061 HB LIPID PANEL $ 73.00 778402 83695 HB LIPOPROTEIN (A) $ 175.00 770632 83698 HB LIPOPROTEIN ASSOC PHOSPHOLIPASE A2 $ 168.00 582147 80061 HB LIPOPROTEIN LIPID PANEL $ 107.00 770545 83704 HB LIPOPROTEIN PARTICAL PROFILE $ 107.00 778134 80178 HB LITHIUM BLOOD $ 34.00 770941 81599 HB LIVER FIBROSIS, CHRONIC VIRAL HEPATITIS $ 256.00 576311 83721 HB LOW DENSITY LIPOPROTEIN, MEAS $ 73.00 582294 84154 HB L‐PSA FREE $ 31.00 582293 84153 HB L‐PSA TOTAL $ 50.00 771079 G0480 HB LSD CONFIRMATION URINE $ 236.00 770998 G0479 HB LSD URINE $ 130.00 582636 88230 HB L‐TISSUE CULTR CHROMOSOME $ 150.00 770316 83002 HB LUTEINIZING HORMONE $ 56.00 774887 86617 HB LYME CONF IGG OR IGM WESTERN BLOT $ 58.00 774670 85549 HB LYSOZYME $ 150.00 773218 87169 HB MACROSCOPIC EXAM PARASITE $ 50.00 778138 83735 HB MAGNESIUM $ 34.00 582264 83735 HB MAGNESIUM LVL 24HR URINE $ 46.00 576035 83735 HB MAGNESIUM RBC $ 87.00 774581 83785 HB MANGANESE $ 44.00 773446 83520 HB MANNOSE BINDING LECTIN $ 156.00 775125 82542 HB MARIJUANA CONFIRMATION $ 126.00 770735 82105 HB MATERNAL SERUM AFP ONLY $ 77.00 770719 81511 HB MATERNAL SERUM SCREEN ‐ SENDOUT $ 101.00 576030 83520 HB MATRIX METAL LOPROTEINASE $ 166.00 576408 85576 HB MAX AMP (A, ADP, AA) $ 103.00 575080 85576 HB MAX AMPLITUDE $ 87.00 576397 88275 HB MCG,IP SITU,100‐300 CELLS $ 174.00 575766 82810 HB MEASURED O2 SATURATION $ 88.00 770987 G0479 HB MECONIUM DRUG SCREEN QUAL CHROM $ 177.00 575158 86356 HB MEM B‐CELL ANTIGEN QUANT $ 65.00 575157 86355 HB MEM‐B CELL TOTAL COUNT $ 100.00 774584 83825 HB MERCURY URINE OR BLOOD $ 90.00 774585 83835 HB METANEPHRINES FRACTIONED $ 180.00 576075 84600 HB METHANOL $ 84.00 779135 83050 HB METHEMOGLOBIN QUANT $ 88.00 776336 80299 HB METHOTREXATE $ 98.00 771058 G0480 HB METHSUXIMIDE/NORMETHSUXIMIDE $ 62.00 773455 83789 HB METHYLHISTAMINE URINE $ 265.00 774612 83921 HB METHYLMALONIC ACID $ 166.00 774418 80299 HB MEXILITINE $ 76.00 774580 83735 HB MG FECES $ 41.00 773369 87186 HB MIC GRAM NEG ORG $ 99.00 773378 87186 HB MIC GRAM POS ORGANISM $ 99.00 575811 82043 HB MICROALBUMIN,URINE,RANDOM $ 107.00 774852 87207 HB MICROSPORIA IN STOOL $ 41.00 DocuSign Envelope ID: 93169EF5-1DCD-4008-A5C5-29C0496CD7FA 582139 99001 HB MISC LAB HANDLING FEE $ 74.00 582140 99001 HB MISC MINIMAL LAB HANDLING $ 26.00 770629 83018 HB MOLYBDENUM SERUM/PLASMA $ 118.00 770741 81402 HB MPL CODON 515 MUTATION $ 616.00 771086 81402 HB MPL EXON 10 $ 385.00 773365 87081 HB MRSA SCREEN $ 71.00 770744 87149 HB MTB DNA PROBE $ 155.00 774835 87556 HB MTB‐AMPLIFIED PROBE $ 303.00 770763 86735 HB MUMPS ANTIBODY IGG AND/OR IGM $ 63.00 779191 86735 HB MUMPS IGG $ 51.00 770476 83519 HB MUSK ANTIBODY QUALITATIVE $ 474.00 774779 86738 HB MYCOPLASMA SEROLOGY IGG/IGM $ 59.00 774587 83873 HB MYELIN BASIC PROTEIN $ 66.00 576232 83520 HB MYELOPEROXIDASE AB $ 268.00 773443 83876 HB MYELOPEROXIDASE ANTIBODY $ 268.00 774588 83874 HB MYOGLOBIN $ 51.00 575725 83874 HB MYOGLOBIN $ 68.00 774836 87591 HB N. GONORRHOEAE AMP PROBE $ 106.00 774865 86382 HB NABFERON INF ANTIBODY $ 146.00 582145 81383 HB NARCOLEPSY ASSOCIATED AG $ 453.00 575834 89190 HB NASAL SMEAR FOR EOS $ 36.00 770696 83516 HB NATALIZUMAB ANTIBODIES ‐ TYSABRI $ 447.00 772901 83880 HB NATRIURETIC PEPTIDE $ 219.00 773364 87081 HB NEISSERIA GONO SCREEN $ 50.00 576312 HB NEONATE TPN BASIC MET PROFILE $ 223.00 576313 HB NEONATE TPN COMPREH MET PROF $ 277.00 773454 86255 HB NEUROMYELITIS OPTICA AB (NMO) IGG $ 207.00 770529 83516 HB NEUROMYELITIS OPTICA/APQ4 IGG AB $ 724.00 774979 86316 HB NEURON SPECIFIC ENOLASE/NSE $ 81.00 774564 83520 HB NEURONAL CELL ANTIBODIES $ 117.00 774676 86021 HB NEUTROPHIL AB IND $ 118.00 771016 G0480 HB NICOTINE + METABS SERUM/PLASMA $ 63.00 771059 G0480 HB NICOTINE + METABS URINE $ 92.00 576376 86357 HB NK CELLS TOTAL COUNT $ 43.00 770758 86255 HB NMDA RECEPTOR ANITBODY SCREEN $ 244.00 770759 86256 HB NMDA RECEPTOR ANTIBODY TITER $ 169.00 576041 83520 HB NMO EVALUATION $ 207.00 576396 88274 HB NO1 CYTO/INTERPHASE IN‐SITU $ 97.00 770940 81599 HB NONALCOHOLIC STEATOHEPATITIS (NASH) FIBROSURE $ 375.00 771064 G0480 HB NORTRIPTYLINE $ 63.00 770310 82523 HB N‐TELOPEPTIDE URINE $ 233.00 775071 82523 HB N‐TELOPEPTIDE/C‐TELOPEPTIDE CROSSLINKS SERUM $ 290.00 582003 83880 HB NT‐PROBNP $ 219.00 773134 87177 HB O & P DIRECT CONC ID $ 99.00 575651 80055 HB OBSTETRIC PANEL $ 84.00 773356 82271 HB OCCULT BLOOD OTHER $ 25.00 575989 82270 HB OCCULT BLOOD X3 SPECIMEN CARD $ 25.00 775085 82042 HB OLIGO ALBUMIN CSF $ 31.00 775086 82040 HB OLIGO ALBUMIN SERUM $ 88.00 775084 82784 HB OLIGO IGG SERUM $ 88.00 775082 83916 HB OLIGOCLONAL BANDS $ 57.00 773354 87328 HB OP SCREEN CRYPTOSPORIDIUM AG $ 77.00 773186 87329 HB OP SCREEN GIARDIA AG $ 77.00 771060 G0480 HB OPIATES CONFIRMATIONS 5 OR MORE $ 63.00 575814 86703 HB ORAQUICK HIV 1‐2 SCREEN $ 145.00 DocuSign Envelope ID: 93169EF5-1DCD-4008-A5C5-29C0496CD7FA 770331 83919 HB ORGANIC ACID $ 480.00 576007 87077 HB ORGANISM ID‐OUTSIDE SOURCE $ 63.00 770991 82542 HB OROTIC OR SUCCINYLACETONE URINE $ 234.00 778142 83930 HB OSMOLALITY $ 38.00 774664 84999 HB OSMOLALITY FECES $ 60.00 778144 83935 HB OSMOLALITY URINE $ 38.00 774260 85557 HB OSMOTIC FRAGILITY RBC INCUBATED $ 263.00 774615 83937 HB OSTEOCALCIN $ 89.00 770485 81503 HB OVA‐1 TEST $ 797.00 774617 83945 HB OXALATE $ 209.00 774616 83945 HB OXALATE URINE $ 111.00 774978 80183 HB OXCARBAZEPINE METABOLITES $ 170.00 576235 80299 HB OXCARBAZPINE METABOLITE (MCH) $ 170.00 774535 82820 HB P50/02 DISSOCIATION $ 547.00 770796 80302 HB PAIN MGT DRUG SCR, PRESUMPTV SING CLASS LIST B $ 26.00 774557 83519 HB PANCREATIC POLYPEPTIDE $ 181.00 575870 88165 HB PAP SMEAR;ROUTINE/DIAGNOSTIC $ 51.00 575866 G0145 HB PAP TEST, CONVENTIONAL, MANUAL SCREENING $ 102.00 575871 P3000 HB PAP TEST, LIQUID BASED, AUTOMATED SCREENING $ 51.00 575868 G0123 HB PAP TEST, LIQUID BASED, MANUAL SCREENING $ 102.00 575865 88175 HB PAPSMEAR;THINPREP/AUTODIAGNOST $ 102.00 771068 G0480 HB PARALDEHYDE + ACETALDEHYDE $ 203.00 582174 80299 HB PAROXETINE LEVEL $ 192.00 774780 86747 HB PARVOVIRUS IGG OR IGM $ 49.00 575981 87081 HB PATHOGENIC ORGANISM SCREEN $ 61.00 773351 87147 HB PENICILLIN BINDING PROTEIN $ 80.00 770171 G0480 HB PENTOBARBITAL $ 93.00 774840 87798 HB PERTUSSIS BY PCR $ 242.00 778145 83986 HB PH NON‐BLD FLUID $ 80.00 770778 83992 HB PHENCYCLIDINE CONF URINE $ 96.00 776304 80184 HB PHENOBARBITAL $ 98.00 775110 84030 HB PHENYLALANINE $ 70.00 774618 84030 HB PHENYLKETONURIA ‐ NBS $ 219.00 582160 80186 HB PHENYTOIN LEVEL FREE $ 62.00 582159 80185 HB PHENYTOIN LEVEL TOTAL $ 50.00 776303 80185 HB PHENYTOIN TOTAL $ 98.00 778009 84075 HB PHOSPHATASE ALK $ 22.00 770634 82542 HB PHOSPHATIDYLETHANOL $ 150.00 778150 84100 HB PHOSPHORUS $ 22.00 773377 87172 HB PINWORM EXAM $ 50.00 582592 85420 HB PLASMINOGEN $ 64.00 582591 85415 HB PLASMINOGEN ACT INHIB ACT $ 112.00 775848 85576 HB PLATELET AGGREGATION/SECRETION $ 55.00 774678 86023 HB PLATELET ANTIBODY DIRECT IGG/IGM $ 193.00 774682 86022 HB PLATELET ANTIBODY INDIRECT $ 116.00 770624 81400 HB PLATELET ANTIGEN GENOTYPING $ 149.00 774201 85049 HB PLATELET AUTO $ 36.00 774981 85576 HB PLATELET FUNCTION ANALYSIS‐PFA100 $ 55.00 582737 P9034 HB PLATELETPHERESIS $ 2,114.00 770586 81315 HB PML/RARA T(15;17) $ 890.00 774712 86317 HB PNEUMOCCAL ANTIBODIES IGG $ 39.00 773563 86317 HB PNEUMOCOCCAL ANTIBODIES IGG W/MODIFIER $ 24.00 770954 87798 HB PNEUMOCYSTIS JIROVECII PCR‐ARUP $ 401.00 770637 83519 HB PNP REFLEX ACHR MODULATING AB $ 142.00 770638 84182 HB PNP REFLEX CRMP5 IGG WB $ 367.00 DocuSign Envelope ID: 93169EF5-1DCD-4008-A5C5-29C0496CD7FA 770636 86341 HB PNP REFLEX GAD56 $ 133.00 774753 86658 HB POLIOVIRUS ANTIBODIES 1 2 3 $ 222.00 770219 86965 HB POOLING PER UNIT $ 215.00 774624 84110 HB PORPHOBILINOGEN QUANT $ 64.00 774626 84126 HB PORPHYRINS FECES $ 224.00 774625 84120 HB PORPHYRINS FRACTIONATED URINE $ 91.00 774644 84311 HB PORPHYRINS SERUM TOTAL $ 61.00 770625 80299 HB POSACONAZOLE LEVEL LC‐MS‐MS $ 102.00 778153 84132 HB POTASSIUM $ 22.00 774667 84999 HB POTASSIUM FECES $ 82.00 778154 84133 HB POTASSIUM URINE $ 35.00 778156 84134 HB PREALBUMIN $ 98.00 771072 G0480 HB PREGABALIN $ 166.00 774627 84140 HB PREGNENOLONE $ 151.00 774812 86977 HB PRETREAT FOR AB ID INC $ 214.00 774814 86978 HB PRETREAT FOR AB ID TRANSF PT $ 312.00 774811 86999 HB PRETREAT FOR AB ID‐RBC SEP $ 156.00 774809 86970 HB PRETREAT FOR AB IS‐GLYCINE $ 158.00 582684 86971 HB PRETREAT RBC ENZYME INCUBATION $ 113.00 776305 80188 HB PRIMIDONE $ 56.00 770963 83880 HB PRO BRAIN NATRIUETIC PEPTIDE NT $ 125.00 773583 84145 HB PROCALCITONIN $ 320.00 779208 84144 HB PROGESTERONE $ 56.00 774636 84206 HB PROINSULIN $ 265.00 770334 84146 HB PROLACTIN $ 56.00 770999 G0480 HB PROPOXYPHENE CONFIRMATION $ 96.00 575805 G0103 HB PROSTATE SPECIFIC AG SCREEN $ 137.00 774620 84066 HB PROSTATIC ACID PHOSPHATASE $ 166.00 778159 84155 HB PROTEIN $ 22.00 775854 85303 HB PROTEIN C ACT CHROM $ 173.00 576059 85302 HB PROTEIN C ANTIGEN $ 80.00 775874 85303 HB PROTEIN C CLOT ACT $ 70.00 778162 84165 HB PROTEIN ELECTROPHORESIS $ 66.00 778165 84166 HB PROTEIN ELECTROPHORESIS URINE $ 66.00 778161 84157 HB PROTEIN OTHER SOURCE $ 35.00 576091 85305 HB PROTEIN S AG TOTAL $ 256.00 576058 85306 HB PROTEIN S ANTIGEN, FREE $ 93.00 775887 85306 HB PROTEIN S CLOT ACT $ 243.00 778168 84156 HB PROTEIN URINE $ 35.00 770712 86849 HB PROTHROMBIN IGG OR IGM $ 103.00 774301 85610 HB PROTHROMBIN TIME INR $ 31.00 779173 84153 HB PSA TOTAL DX $ 137.00 779186 G0103 HB PSA TOTAL SCREEN $ 160.00 770333 83970 HB PTH $ 66.00 774558 82542 HB PTH‐RELATED PROTEIN $ 263.00 774303 85730 HB PTT ACTIVATED $ 38.00 774327 85732 HB PTT ACTIVATED CORRECTION 1:1 $ 237.00 774638 84210 HB PYRUVATE $ 61.00 774639 84220 HB PYRUVATE KINASE $ 83.00 775064 86638 HB Q FEVER PHASE I OR II ANTIBODIES $ 73.00 770756 86638 HB QFEVER ANTIBODY TITER $ 197.00 771062 82542 HB QUANT 6‐MMNP AND 6‐TGN HPLC IN PERIPHERAL RBC $ 233.00 776314 80194 HB QUINIDINE $ 172.00 575664 86975 HB RABBIT ERYTHROCYTE STROMA $ 395.00 774726 86790 HB RABIES ANTIBODY $ 119.00 DocuSign Envelope ID: 93169EF5-1DCD-4008-A5C5-29C0496CD7FA 775187 86850 HB RBC ANTIBODY SCREEN EACH $ 88.00 770231 86905 HB RBC ANTIGEN EACH $ 117.00 770222 86905 HB RBC ANTIGEN EACH IN‐HOUSE $ 117.00 770109 81403 HB RBC GENOTYPE $ 429.00 770768 81479 HB RBC MOLECULAR PHENOTYPING $ 271.00 575665 86978 HB RBC PRE,AUTO‐ABS,RECENT TRX $ 895.00 575662 86970 HB RBC PRETREAT/CHEM,DRUGS $ 158.00 770105 P9022 HB RBC WASHED EACH UNIT $ 1,178.00 779171 86140 HB ‐REACTIVE PROTEIN $ 48.00 770120 P9021 HB RED BLOOD CELLS PACKED $ 608.00 775182 84376 HB REDUCING SUBSTANCES FECAL $ 89.00 576401 88321 HB REF CONSULT PREP ELSEWHERE $ 496.00 576402 88323 HB REF CONSULT W SLIDE PREP $ 474.00 779187 80069 HB RENAL FUNCTION PANEL $ 42.00 770335 84244 HB RENIN ACTIVITY PLASMA $ 130.00 775005 83789 HB RESPERIDONE + METABOLITE $ 101.00 772823 85046 HB RETICULOCYTE AUTOMATED $ 75.00 575833 85045 HB RETICULOCYTE COUNT $ 75.00 774591 83883 HB RETINOL BINDING PROTEIN $ 49.00 770224 86901 HB RH TYPE $ 31.00 575798 86431 HB RHEUMATOID FACTOR,QUANT $ 42.00 582301 84252 HB RIBOFLAVIN $ 313.00 576037 83520 HB RIBOSOME P IGG $ 83.00 774784 86757 HB ROCKY MTN SPOTTED FEVER $ 50.00 576010 87425 HB ROTAVIRUS, EIA $ 99.00 773191 86592 HB RPR $ 17.00 775069 86592 HB RPR SERUM OR VDRL CSF QUALITATIVE $ 90.00 582075 86593 HB RPR TITER $ 60.00 775070 86593 HB RPR TITER (REFLEX) $ 64.00 773687 87807 HB RSV RAPID AG EIA $ 100.00 778171 86762 HB RUBELLA ANTIBODY $ 77.00 774948 86762 HB RUBELLA IGG OR IGM $ 43.00 779190 86765 HB RUBEOLA IGG OR IGM $ 73.00 575481 86765 HB RUBEOLA IGG OR IGM $ 73.00 775149 86671 HB SACCHROMYCES CEREVISIAE AB IGG/ IGA $ 63.00 770169 G0480 HB SALICYLATES $ 98.00 774760 86682 HB SCHISTSOMA ANTOBODIES $ 134.00 772822 85652 HB SEDIMENTATION RATE, AUTOMATED $ 34.00 774640 84255 HB SELENIUM BLOOD $ 66.00 575838 89322 HB SEMEN ANALYSIS $ 152.00 575840 89321 HB SEMEN ANALYSIS POST‐VAS $ 76.00 575839 89050 HB SEMEN COUNT $ 76.00 773163 87184 HB SENS DISK 1‐12 $ 75.00 774641 84260 HB SEROTONIN $ 345.00 770280 86022 HB SEROTONIN RELEASE ASSAY‐BCWI $ 5,205.00 774642 84270 HB SEX HORMONE BINDING GLOBULIN $ 70.00 576073 86376 HB SEX HORMONE BINDING GLOBULIN $ 70.00 774215 85660 HB SICKLE CELL TEST $ 164.00 576080 86790 HB SIN NOMBRE VIRUS AB CONF $ 124.00 773146 87206 HB SMEAR FLUORESCENT AND/OR ACID FAST $ 63.00 773129 87207 HB SMEAR O & P BLOOD $ 32.00 576242 86235 HB SMITH ANTIBODIES $ 34.00 576876 83516 HB SMOOTH MUSCLE AB $ 129.00 778174 84295 HB SODIUM $ 22.00 774666 84302 HB SODIUM FECES $ 82.00 DocuSign Envelope ID: 93169EF5-1DCD-4008-A5C5-29C0496CD7FA 778175 84300 HB SODIUM URINE $ 35.00 774571 84238 HB SOLUBLE TRANSFERRIN RECEPTOR $ 236.00 576264 83520 HB SOLUBLE TRANSFERRIN RECEPTOR $ 236.00 774643 84307 HB SOMATOSTATIN $ 342.00 575884 88312 HB SP STAIN/GROUP 1:ALCIAN YELLOW $ 121.00 575882 88312 HB SP STAIN/GRP I;GMS $ 121.00 575883 88312 HB SP STAIN/GRP I;GRAM $ 121.00 575890 88312 HB SP STAIN/GRP I;PAS $ 176.00 575891 88312 HB SP STAIN/GRP I;PAS+DIASTASE $ 176.00 575886 88313 HB SP STAIN/GRP II;CONGO RED $ 176.00 575887 88313 HB SP STAIN/GRP II;ELASTIC $ 176.00 575889 88313 HB SP STAIN/GRP II;MUCICARMINE $ 176.00 575892 88313 HB SP STAIN/GRP II;RETICULIN $ 176.00 575893 88313 HB SP STAIN/GRP II;TRICHROME $ 176.00 575881 88312 HB SPECIAL STAIN, GROUP I, MICRO‐ORGANISMS $ 121.00 773350 87207 HB SPECIAL STAIN, PARASITES $ 25.00 770230 86985 HB SPLITTING OF BLOOD/PRODUCTS EACH UNIT $ 159.00 575110 87427 HB STOOL CULT SHIGATOXIN 1 $ 53.00 575111 87427 HB STOOL CULT SHIGATOXIN 2 $ 53.00 773559 87899 HB STREP PNEUMO ANTIGEN $ 85.00 576012 87081 HB STREP SCREEN CULTURE (GROUP A) $ 51.00 774730 86403 HB STREPTOZYME $ 38.00 775052 86406 HB STREPTOZYME TITER, REFLEX $ 70.00 774756 86682 HB STRONGYLOIDES ANTIBODY $ 62.00 770626 84311 HB SUCCINYLPURINE URINE QUAL $ 60.00 774648 84311 HB SULFISOXAZOLE (SULFAS) $ 58.00 770993 G0480 HB SULFONYLUREA HYPOGLYCEMICS $ 246.00 774654 84481 HB T3 FREE $ 181.00 774655 84482 HB T3 REVERSE $ 99.00 576269 84479 HB T3 UPTAKE $ 132.00 770339 84436 HB T4 $ 65.00 775122 84439 HB T4 FREE BY DIALYSIS $ 67.00 770337 84403 HB TESTOSTERONE BLOOD $ 120.00 774649 84402 HB TESTOSTERONE FREE $ 70.00 576167 86774 HB TETANUS TOXOID IGG $ 68.00 776302 80198 HB THEOPHYLLINE $ 98.00 575627 36513 HB THERAPEUTIC APHERESIS PLATELET $ 3,739.00 770519 84430 HB THIOCYANATE LEVEL $ 65.00 774322 85670 HB THROMBIN TIME $ 41.00 770633 83520 HB THROMBOPOETIN LEVEL $ 168.00 770338 84432 HB THYROGLOBULIN $ 80.00 770643 84432 HB THYROGLOBULIN LC‐MS‐MS REFLEX $ 45.00 575487 84432 HB THYROGLOBULIN TUMOR MARKER $ 80.00 770432 86800 HB THYROID AB ‐ THYROGLOB $ 66.00 576334 86376 HB THYROID PEROXIDASE AUTOABS $ 64.00 774652 84445 HB THYROID STIM IMMUNOGLOBULIN $ 231.00 774509 80199 HB TIAGABINE $ 151.00 576391 88237 HB TISSUE CULTURE,BONE MARROW $ 463.00 576390 88230 HB TISSUE CULTURE;LYMPHOCYTE $ 120.00 575492 83520 HB TISSUE TRANSGLUTAMINASE IGG OR IGA $ 30.00 775002 83516 HB TISSUE TRANSGLUTAMINASE IGG OR IGA $ 59.00 576185 83516 HB TISSUE TRANSGLUTAMINASE IGA $ 59.00 776340 80200 HB TOBRAMYCIN $ 98.00 771051 G0480 HB TOCAINIDE $ 147.00 774417 80201 HB TOPIRAMATE $ 121.00 DocuSign Envelope ID: 93169EF5-1DCD-4008-A5C5-29C0496CD7FA 774951 86778 HB TORCH TOXOPLASMA IGM $ 125.00 770173 84155 HB TOT PROTEIN FOR SPEP $ 22.00 575383 82550 HB TOTAL CK FOR ISOS $ 87.00 770492 84403 HB TOTAL TESTOSTERONE ‐ SENDOUT $ 181.00 775068 86682 HB TOXOCARA AB IGG $ 69.00 779202 86777 HB TOXOPLASMA IGG $ 110.00 775003 87798 HB TOXOPLASMA PCR $ 164.00 770665 81401 HB TPMT COMMON VARIANTS $ 431.00 771061 82542 HB TPMT ENZYMES 6‐METHYL‐MERCAPTO AND 6‐THIOGUANINE $ 466.00 575681 HB TRANSFER FFP $ 114.00 575680 HB TRANSFER FILTERED RED CELL $ 302.00 575682 HB TRANSFER PLATELET PHERESIS $ 746.00 778179 84466 HB TRANSFERRIN $ 98.00 575684 HB TRANSPORTATION FEE $ 66.00 582175 80299 HB TRAZODONE (DESYREL) $ 53.00 772907 86780 HB TREPONEMA PALLIDUM AB $ 78.00 773571 86780 HB TREPONEMA PALLIDUM ANTOBODY IGM $ 43.00 773570 86780 HB TREPONEMA PALLIDUM ANTOBODY TPPA $ 78.00 774788 86784 HB TRICHINELLA ANTIBODY $ 101.00 773222 87209 HB TRICHROME STAIN $ 75.00 778181 84478 HB TRIGLYCERIDES $ 34.00 779168 84484 HB TROPONIN I $ 56.00 774781 86753 HB TRYPANOSOMA CRUZI AB IGG/IGM $ 67.00 774565 83520 HB TRYPTASE LEVEL $ 110.00 770341 84443 HB TSH HORMONE ULTRASENSITIVE $ 88.00 773582 83520 HB TSH RECEPTOR ANTIBODY $ 236.00 770793 86481 HB TSPOT $ 159.00 575930 88360 HB TUMOR IMMUNOSTAIN, MANUAL $ 232.00 774573 83520 HB TUMOR NECROSIS FACTOR $ 148.00 774783 86757 HB TYPHUS FEVER ANTIBODIES $ 50.00 775111 84510 HB TYROSINE $ 35.00 575842 81015 HB UA MICROSCOPIC $ 22.00 778184 84520 HB UREA NITROGEN $ 22.00 778185 84540 HB UREA NITROGEN URINE $ 24.00 778187 84550 HB URIC ACID $ 22.00 774001 81001 HB URINALYSIS AUTO W/MICRO $ 55.00 772821 81003 HB URINALYSIS AUTO W/O MISCROSCOPY $ 20.00 774344 81003 HB URINALYSIS CHEM AUTO $ 22.00 581670 81002 HB URINALYSIS NON AUTO W/O MICROSCOPY $ 13.00 576343 HB URINE DRUG COLLECTION $ 36.00 582117 83864 HB URINE MUCOPOLYSACCHARIDES $ 320.00 575752 81025 HB URINE PREGNANCY, QUAL $ 51.00 778189 81050 HB URINE VOLUME MEASUREMENT $ 42.00 776339 80164 HB VALPROIC ACID $ 98.00 774413 80165 HB VALPROIC ACID FREE $ 76.00 774399 80164 HB VALPROIC ACID TOTAL $ 76.00 776364 80202 HB VANCOMYCIN $ 98.00 770493 86787 HB VARICELLA ZOSTER IGG ‐ SENDOUT $ 129.00 775102 86787 HB VARICELLA ZOSTER IGM $ 129.00 576164 87798 HB VARICELLA ZOSTER VIRUS PCR $ 119.00 773420 82397 HB VASCULAR ENDOTHELIAL GROWTH FACTOR $ 21.00 774657 84586 HB VASOACTIVE INTESTINAL POLYPEPTIDE $ 95.00 773707 87254 HB VIRUS CULTURE $ 186.00 774671 85810 HB VISCOSITY $ 215.00 774672 85810 HB VISCOSITY WHOLE BLOOD $ 47.00 DocuSign Envelope ID: 93169EF5-1DCD-4008-A5C5-29C0496CD7FA 774659 84590 HB VITAMIN A $ 63.00 774650 84425 HB VITAMIN B1 $ 93.00 778190 82607 HB VITAMIN B‐12 $ 91.00 770627 84591 HB VITAMIN B3 AND/OR B5 $ 119.00 774637 84207 HB VITAMIN B6 $ 110.00 774459 82180 HB VITAMIN C $ 71.00 582198 82306 HB VITAMIN D (25 HYDROXY) $ 168.00 774653 84446 HB VITAMIN E $ 29.00 774661 84597 HB VITAMIN K1 $ 147.00 774487 82726 HB VLC FATTY ACIDS $ 164.00 774656 84585 HB VMA $ 111.00 774562 83519 HB VOLTAGE GATED CA CHANNEL IGG $ 235.00 770635 83519 HB VOLTAGE‐GATED POTASSIUM CHANNEL AB $ 226.00 770292 85247 HB VON WILLEBRAND FACTOR MULTIMERS ‐ QUAL $ 119.00 773367 87081 HB VRE SCREEN $ 71.00 775871 85246 HB VW FACTOR AG $ 97.00 576275 85245 HB VWF ACTIVITY $ 462.00 575260 85246 HB VWP FACTOR ANIGEN $ 97.00 575830 85004 HB WBC DIFFERENTIAL $ 36.00 773282 86789 HB WEST NILE VIRUS IGG $ 129.00 773283 86788 HB WEST NILE VIRUS IGM $ 129.00 772949 87798 HB WEST NILE VIRUS PCR‐QUAL $ 285.00 774839 87798 HB WHIPPLES DISEASE PCR $ 406.00 575016 86920 HB XM COMPATIBILITY‐IS $ 167.00 773368 87081 HB YEAST SCREEN $ 50.00 581754 87046 HB YERSINIA CULTURE STOOL $ 34.00 774663 84630 HB ZINC $ 107.00 774634 84202 HB ZINC PROTOPORPHYRINS $ 106.00 775001 80203 HB ZONISAMIDE $ 92.00 576064 86317 HB ZZ AMOEBIC ANTIBODIES $ 176.00 576120 82390 HB ZZ CERULOPLASMIN $ 104.00 576108 88237 HB ZZ CHROMOSOME ANALYSIS $ 1,698.00 576126 86256 HB ZZ COLORADO TICK FEVER $ 346.00 576153 84702 HB ZZ HUMAN CHOR GONADOTROPIN $ 141.00 576225 88189 HB ZZ LEUKEMIA/LYMPHOMA PHENOTYPE $ 5,576.00 576048 84238 HB ZZ‐ACETYLCHOLINE RECEP $ 265.00 576050 86603 HB ZZ‐ADENOVIRUS AB $ 145.00 576052 82085 HB ZZ‐ALDOLASE $ 111.00 576105 83516 HB ZZ‐ANTI MITOCHONDRIAL $ 112.00 576828 87899 HB ZZ‐CRYPTOCOCCUS AG TITER $ 72.00 576331 82627 HB ZZ‐DHEA SULFATE $ 125.00 576179 85210 HB ZZ‐FACTOR II ACTIVITY $ 160.00 576180 85230 HB ZZ‐FACTOR VII ACTIVITY $ 112.00 576181 85240 HB ZZ‐FACTOR VIII ACTIVITY $ 134.00 576184 85270 HB ZZ‐FACTOR XI ACTIVITY $ 161.00 576193 86255 HB ZZ‐GLOMERULAR BASEMENT MEMBRAN $ 168.00 576211 87522 HB ZZ‐HEP C ULTRAQUANT/REFLEX SUB $ 452.00 576197 86706 HB ZZ‐HEPATITIS B SURFACE AB,QUAN $ 254.00 576210 87902 HB ZZ‐HEPATITIS C SUBTYPE $ 1,124.00 576143 83020 HB ZZ‐HGB ELECTROPHORESIS 83020 $ 171.00 576152 87536 HB ZZ‐HIV‐1 RNA QUANTIFICATION $ 161.00 576209 86812 HB ZZ‐HLA B27 $ 140.00 576194 85613 HB ZZ‐LUPUS TYPE ANTI‐COAGULANT $ 61.00 576249 84105 HB ZZ‐PHOSPHORUS URINE $ 90.00 576257 86638 HB ZZ‐Q FEVER $ 197.00 DocuSign Envelope ID: 93169EF5-1DCD-4008-A5C5-29C0496CD7FA 576255 86480 HB ZZ‐QUANTIFERON TB GOLD $ 196.00 576268 84480 HB ZZ‐T3 TOTAL BY RIA $ 110.00 576270 84436 HB ZZ‐T4 TOTAL $ 132.00 576274 84560 HB ZZ‐URIC ACID URINE $ 166.00 DocuSign Envelope ID: 93169EF5-1DCD-4008-A5C5-29C0496CD7FA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME: CONTACT (A/C, No): FAX E-MAIL ADDRESS: PRODUCER (A/C, No, Ext): PHONE INSURED COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. $ $ $ PROPERTY DAMAGE $ BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOS ONLY AUTOS NON-OWNED OWNED SCHEDULED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT ER OTH- STATUTE PER (MM/DD/YYYY) LIMITS POLICY EXP (MM/DD/YYYY) POLICY EFF LTR TYPE OF INSURANCE POLICY NUMBER INSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB EACH OCCURRENCE $ AGGREGATE $ $ OCCUR CLAIMS-MADE DED RETENTION $ PRODUCTS - COMP/OP AGG $ GENERAL AGGREGATE $ PERSONAL & ADV INJURY $ MED EXP (Any one person) $ EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 9/29/2016 Beecher Carlson Insurance Services, LLC 321 North Clark Street, 5th Floor Chicago, IL 60654 (PROV) Jerilynn Leahy Poudre Valley Health Care, Inc. dba Poudre Valley Health System 2315 E. Harmony Rd Suite 200 Fort Collins CO 80528 32122613 Professional liability limits include errors and omissions coverage. City of Fort Collins Risk Management Occupational Health 215 N. Mason Fort Collins CO 80524 The City of Fort Collins is listed as an additional insured with respect to General Liability only. A HCC0013228 10/1/2016 10/1/2017 1,000,000 500,000 ✓ 5,000 ✓ ✓ 1,000,000 3,000,000 ✓ ✓ 1,000,000 B TJCAP 4251B599-16 10/1/2016 10/1/2017 1,000,000 ✓ D TC2KUB 1761B963-16 10/1/2016 10/1/2017 ✓ Aggregate $16,362,932 1,000,000 Y 1,000,000 1,000,000 A Health Care Professional Liability HCC0013228 10/1/2016 10/1/2017 Per Claim: $1,000,000 Aggregate: $3,000,000 COPIC Insurance Company 11860 Travelers Property Casualty Insurance Co 36161 Travelers Indemnity Company 25658 32122613 | 16-17 GL PL, AU UMB WC (Poudre) | (PROV) Denise Simmons | 9/29/2016 2:14:18 PM (EDT) | Page 1 of 1 DocuSign Envelope ID: 93169EF5-1DCD-4008-A5C5-29C0496CD7FA