Sonora Quest Laboratories Pay at Time of Service Published Fee Schedule

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Priscilla Bates
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1 Pay at Published Fee Schedule 2046 Alanine Aminotransferase (ALT) $ Albumin $ Alkaline Phosphatase $ Allergen, Arizona Desert Panel $ Allergen, Arizona Mountain Panel $ Allergen, Childhood Panel (Food & Environmental) $ Allergen, Food, Comprehensive Panel $ Allergen, Peanut (f13) IgE w/reflex to Components $ Alpha-Fetoprotein, Tumor Marker (AFP) $ Amino Acid Analysis, LC/MS, Plasma $ Amylase $ ANA Cascading Reflex $ ANA Cascading Reflex plus CCP, Rheumatoid Factor $ ANA Screen w/reflex to Titer $ Antibody Screen w/reflex $ Anti-Thrombin III Activity $ Aspartate Aminotransferase (AST) $ Bacterial Vaginosis/Vaginitis $ Basic Metabolic Panel $ Basic Metabolic Panel W/eGFR $ Beta2-Glycoprotein I Antibodies (IgG, IgA, IgM) $ Beta-2-Microglobulin, Urine $ Bilirubin, Neonatal, Total & Direct $ Bilirubin, Total $ Blood Group and Rh Type $ BRCAvantage Ashkenazi Jewish Screen $ BRCAvantage Comprehensive $2, BRCAvantage Rearrangements $ B-Type Natruiretic Peptide $ CA 125 $ CA 15-3 $ CA 19-9 $ CA $ Calcium $ Carbon Dioxide (C02) $ Cardio IQ (TM) Lipoprotein Fractionation, Ion Mobility $ Cardio IQ Lipoprotein Fractionation, Ion Mobility & Graph $ Cardiolipin Ab, IgG and IgM $ Carisoprodol Screen with Reflex Confirmation $ CEA $ Celiac Disease Cascading Reflex $ CellSearch Circulating Tumor Cells, Breast $ CellSearch Circulating Tumor Cells, Colon $ CFvantage Cystic Fibrosis Expanded Screen $ ChemPanel Basic (Chem 20) $ Chlamydia trachomatis, RNA, TMA, Rectal $ Chlamydia trachomatis, RNA, TMA, Throat $ Chlamydia trachomatis, ThinPrep Vial $ Chlamydia trachomatis, APTIMA Device $70 Effective February 1, 2018 Page 1 of 8 Prices are subject to change.

2 Pay at Published Fee Schedule Chlamydia trachomatis/n. gonorrhoeae, ThinPrep Vial $ Chlamydia trachomatis/n.gonorrhoeae, APTIMA Device $ Chlamydia trachomatis/n.gonorrhoeae, RNA, TMA, Rectal $ Chlamydia trachomatis/n.gonorrhoeae, RNA, TMA, Throat $ Chloride $ Cholesterol $ Chromium, Serum $ Chromosome Microarray,Congenital,Blood $1, Cocci Complement Fixation $ Cocci Screen w/reflex to IMDF and CF Titer $ Coccidioides Screen W/Reflex IMDF Confirmation $ Coenzyme Q10 $ Complete Blood Count w/differential and Platelet Count (CBC) $ Comprehensive Metabolic Panel $ Comprehensive Metabolic Panel (CMP), Lipid Panel, CRP High Sensitivity (hscrp), PSA $ Comprehensive Metabolic Panel (CMP), Lipid Panel, CRP High Sensitivity (hscrp), TSH High $99 Sensitivity Comprehensive Metabolic Panel (CMP), Lipid Panel $ Comprehensive Metabolic Panel w/egfr $ Cortisol, Serum $ Cortisol, Serum AM $ C-Reactive Protein (CRP) $ Creatine Kinase (CK) $ Creatinine $ CRP, High Sensitivity (hscrp) $ Culture, Group B Strep-Prenatal Screen $ Culture, Urine (Includes ID/Sensitivities) $ Cyclic Citrullinated Peptide (CCP) $ Cystic Fibrosis Screen $ D-Dimer, Quantitative $ DHEA, LC/MS/MS $ DHEA-Sulfate $ Dihydrotestosterone, LC/MS/MS $ dsdna Ab $ Electrolyte Panel $ Estradiol (E2) $ Estriol (E3) $ Estrogen Total, Serum $ Estrogens Fractionated $ Estrone (E1) $ Factor V Leiden Mutation $ Fentanyl Screen, Urine w/ Reflex Confirmation $ Ferritin $ Fetal Fibronectin $ Folate $ FSH $ FSH and LH $ General Health Panel $ GGT $15 Effective February 1, 2018 Page 2 of 8 Prices are subject to change.

3 Pay at Published Fee Schedule 2021 Glucose, Fasting $ GIvantage Hereditary Colon Cancer Panel $1, Glucose, Gestational Tolerance, 1 Hour $ Glucose, Gestational Tolerance, 3 Hour (4 Specimens) $ Glucose, Random $ Glucose-6-Phosphate Dehydrogenase (G6PD), Quant $ GlycoMark $ H. Pylori Antigen, Stool $ H. pylori Urea Breath Test - Adult $ H. pylori Urea Breath Test - Collection Fee $ H. pylori Urea Breath Test - Pediatric $ hcg Quant, Tumor Marker $ hcg Quantitative $ HDL $ HE4, Ovarian Cancer Monitoring $ Hematocrit $ Hemoglobin $ Hemoglobin & Hematocrit $ Hemoglobin A1c w/eag $ Hemoglobin A1c w/eag, w/reflex GlycoMark $ Hemoglobin A1c w/eag, Glucose Fasting $ Hemogram w/platelets $ Hepatic Function Panel $ Hepatitis A Antibody, IgM $ Hepatitis A Antibody, Total $ Hepatitis Acute Panel $ Hepatitis B Surface Antibody $ Hepatitis B Surface Antigen w/reflex Confirmation $ Hepatitis C Antibody - includes Reflex to Confirmation $ Hepatitis C Viral RNA, Quant, Real-Time PCR $ Herpes Simplex Virus 2 (IgG), HerpeSelect(R) w/rflx $ Herpes Simplex Virus Antibodies 1/2 Type Specific IgG $ Herpes simplex Virus Culture with Typing $ HIV 1/2 Antigen and Antibodies, 4th Generation, w/reflex $ HLA-B27 Antigen $ Homocysteine $ HPV Genotype 16, 18/45 $ HPV mrna $ HPV mrna w/rflx Genotype 16, 18/45 $ IBD Differentiation Panel $ IGF-1, LC/MS/MS $ Insulin, Fasting $ Iron $ Iron and TIBC $ Iron Deficiency Profile (includes Iron, TIBC & Ferritin) $ Lactic Dehydrogenase $ LDL Cholesterol, Direct $ Lead, Blood, Pediatric $ Leptin $79 Effective February 1, 2018 Page 3 of 8 Prices are subject to change.

4 Pay at Published Fee Schedule 9275 Leutinizing Hormone (LH) $ Lipase $ Lipid Panel $ Lipid Panel w/reflex Direct LDL $ Lipid Panel w/reflex Direct LDL & Cardio IQ Lipoprotein Fraction $ Lipid Panel w/reflex Direct LDL & Cardio IQ Lipoprotein Fraction & Graph $ Lipoprotein-Associated Phospholipase A2 (Lp-PLA2) $ Lithium $ Liver Profile $ Lupus Anticoagulant with Reflex $ Lupus Panel $ Lynch Syndrome Panel $3, Magnesium $ Maternal Serum Screen - First Trimester (PAPP-A, hcg) $ Maternal Serum Screen - First Trimester h-hcg (PAPP-A, h-hcg) $ Maternal Serum Screen - Penta (AFP, hcg, ue3, DIA, h-hcg) $ Maternal Serum Screen 1 $ Maternal Serum Screen 3 (AFP, hcg, ue3) $ Maternal Serum Screen 4 (AFP, hcg, ue3, Inhibin A) $ Methylenetetrahydrofolate Reductase (MTHFR), DNA Mutations $ Microalbumin, Urine, Random $ Microsomal TPO-Antibody $ MYvantage Hereditary Comprehensive Cancer Panel $1, N. gonorrhoeae (GC), APTIMA Device $ N. gonorrhoeae (GC), RNA, TMA, Rectal $ N. gonorrhoeae (GC), RNA, TMA, Throat $ N. gonorrhoeae, ThinPrep Vial $ Natural Killer Cells $ Obstetric Panel w/reflexes $ Occult Blood Immunochemical, Screening (InSure ) $ Ova & Parasites, Stool $ Pap ThinPrep $ Pap ThinPrep w/ HPV mrna $ Pap ThinPrep w/ HPV mrna w/rflx HPV Geno $ Pap ThinPrep w/ HPV mrna w/rflx HPV Geno if Pap NIL & HPV + $ Pap ThinPrep w/ HPV mrna, Chlamydia trachomatis/n. gonorrhoeae $ Pap ThinPrep w/rflx HPV mrna if Abn w/rflx HPV Geno $ Pap ThinPrep w/rflx HPV mrna if Abnormal $ Pap ThinPrep w/rflx HPV mrna if Abnormal, Chlamydia trachomatis/n. gonorrhoeae $ Pap ThinPrep w/rflx HPV mrna if ASC-US $ Pap ThinPrep w/rflx HPV mrna if ASC-US w/rflx HPV Geno $ Pap ThinPrep w/rflx HPV mrna if ASC-US, Chlamydia trachomatis/n. gonorrhoeae $ Pap ThinPrep w/rflx HPV mrna if ASC-US/ASC-H $ Pap ThinPrep w/rflx HPV mrna if ASC-US/ASC-H/LG $ Pap ThinPrep, Chlamydia trachomatis/n. gonorrhoeae $ Pap, Liquid w/reflex HPV if Abnormal & Reflex Geno if HPV is detected $ Pap, Liquid w/reflex HPV if ASCUS/ASC-H & Rflx Geno if HPV is detected $ Partial Thromboplastin Time (PTT) $ PDM Alcohol Metabolite, w/confirmation and medmatch $95 Effective February 1, 2018 Page 4 of 8 Prices are subject to change.

5 Pay at Published Fee Schedule PDM Alcohol Metabolites w/confirmation $ PDM Alcohol Metabolites, Quantitative w/medmatch, Ur $ PDM Alcohol Metabolites, Quantitative, Ur $ PDM Amphetamines w/confirmation $ PDM Amphetamines, Quantitative $ PDM Amphetamines, Quantitative w/medmatch $ PDM Amphetamines, w D/L Isomers Quantitative w/medmatch, Ur $ PDM Amphetamines, w D/L Isomers Quantitative, Ur $ PDM Amphetamines, w/confirmation and medmatch $ PDM Barbiturates, Quantitative $ PDM Barbiturates, Quantitative w/medmatch $ PDM Barbiturates, w/confirmation $ PDM Barbiturates, w/confirmation and medmatch $ PDM Base Profile (4 Drugs) without Confirmation $ PDM Base Profile with Confirmation, Ur $ PDM Base Profile, with Conf and medmatch, Ur $ PDM Benzodiazapines, Quant w/medmatch, Ur $ PDM Benzodiazapines, with Confirmation, Ur $ PDM Benzodiazepines with Conf and medmatch, Ur $ PDM Benzodiazepines, Quantitative, Ur $ PDM Buprenorphine Screen, w/confirmation, Ur $ PDM Buprenorphine, Quantitative $ PDM Buprenorphine, Quantitative w/medmatch $ PDM Buprenorphine, w/confirmation and medmatch $ PDM Carisoprodol Quantitative w/medmatch $ PDM Carisoprodol, Quantitative, Ur $ PDM Cocaine Metabolite, Quantitative w/medmatch $ PDM Cocaine Metabolite, Quantitative, Ur $ PDM Cocaine Metabolite, w/confirmation $ PDM Cocaine Metabolite, w/confirmation and medmatch $ PDM Fentanyl, Quantitative $ PDM Fentanyl, Quantitative w/medmatch $ PDM Gabapentin, Quantitative w/medmatch $ PDM Gabapentin, Quantitative, Ur $ PDM Heroin Metabolite Quant w/ medmatch, Ur $ PDM Heroin Metabolite, w/confirmation $ PDM Heroin Metabolite, w/confirmation and medmatch $ PDM Heroin Metabolites Quant, Ur $ PDM Marijuana Metabolite, Quantitative w/medmatch $ PDM Marijuana Metabolite, Quantitative, Ur $ PDM Marijuana Metabolite, w/confirmation $ PDM Marijuana Metabolite, w/confirmation and medmatch $ PDM MDMA/MDA Quant w/ medmatch, Ur $ PDM MDMA/MDA Quant, Ur $ PDM MDMA/MDA, w/confirmation $ PDM MDMA/MDA, w/confirmation and medmatch $ PDM Meperidine, Quantitative $ PDM Meperidine, Quantitative w/medmatch $ PDM Methadone, Quantitative $130 Effective February 1, 2018 Page 5 of 8 Prices are subject to change.

6 Pay at Published Fee Schedule PDM Methadone, Quantitative w/medmatch $ PDM Methadone, w/confirmation $ PDM Methadone, w/confirmation and medmatch $ PDM Methamphetamine, D/L Isomers, Ur $ PDM Methylphenidate Metabolite, Quantitative $ PDM Methylphenidate, Quantitative w/medmatch $ PDM Opiates, Expanded Quant with medmatch, Ur $ PDM Opiates, Expanded Quantitative, Ur $ PDM Opiates, with Conf and medmatch, Ur $ PDM Opiates, with Confirmation, Ur $ PDM Oxycodone, Quantitative w/medmatch, Ur $ PDM Oxycodone, Quantitative, Ur $ PDM Oxycodone, with Conf and medmatch, Ur $ PDM Oxycodone, with Confirmation, Ur $ PDM Phencyclidine, Quantitative w/medmatch $ PDM Phencyclidine, Quantitative, Ur $ PDM Phencyclidine, w/confirmation $ PDM Phencyclidine, w/confirmation and medmatch $ PDM Pregabalin, Quantitative w/medmatch $ PDM Pregabalin, Quantitative, Ur $ PDM Profile 1, w/ Confirmation, Ur $ PDM Profile 1, w/conf and D/L Isomers w/medmatch, Ur $ PDM Profile 1, w/confirmation and D/L Isomers, Ur $ PDM Profile 1, with Confirmation and medmatch, Ur $ PDM Profile 1, without Confirmation, Ur $ PDM Profile 11 Test w/ Confirmation, UR $ PDM Synthetic Cannabinoids Screen with Confirmation, Urine $ PDM Synthetic Stimulant, Quantitative $ PDM Tapentadol, Quantitative $ PDM Tapentadol, Quantitative, w/medmatch $ PDM Tramadol, Quantitative, Ur $ PDM Tramadol, Quantitative, w/medmatch, Ur $ PDM Tricyclic, Quantitative $ PDM Tricyclic, Quantitative w/medmatch $ PDM, Oral Swab, Alcohol Metabolite $ PDM, Oral Swab, Amphetamines $ PDM, Oral Swab, Barbiturates $ PDM, Oral Swab, Benzodiazepines $ PDM, Oral Swab, Cocaine $ PDM, Oral Swab, Marijuana $ PDM, Oral Swab, MDMA $ PDM, Oral Swab, Meprobamate $ PDM, Oral Swab, Methadone $ PDM, Oral Swab, Methylphenidate $ PDM, Oral Swab, Monitoring Panel 1 w/confirmation $ PDM, Oral Swab, Naltrexone $ PDM, Oral Swab, Nicotine $ PDM, Oral Swab, Opioids $ PDM, Oral Swab, Phencyclidine $105 Effective February 1, 2018 Page 6 of 8 Prices are subject to change.

7 Pay at Published Fee Schedule PDM, Oral Swab, Zolpidem $ Phosphorus (Inorganic) $ Platelet Count $ Potassium $ Pregnancy, Qualitative $ Pregnenolone, LC/MS/MS $ Progesterone $ Prolactin $ Protein C Antigen $ Protein Electrophoresis $ Protein S Antigen, Total and Free $ Protein, Total $ Protein, Urine, Random, Normalize $ Prothrombin (Factor II) 20210G>A Mutation $ Prothrombin Time/INR (PT/INR) $ PSA Total $ PSA, Total and Free $ QNatal Advanced $ Quantiferon TB Test $ RBC $ Renal Function Panel $ Retic Count without RET-He and Immature Retic Fraction $ Rheumatoid Factor $ RPR Screen w/reflex RPR Titer and TP-PA $ Rubella Antibody IgG $ Rubella, Rubeola, Mumps Abs (IgG) $ Sedimentation $ Selenium, Serum $ Semen Analysis Complete $ Semen Exam, Post Vasectomy $ Sex Hormone Binding Globulin $ Sodium $ STD Panel (includes GC/Chlamydia, Herpes, Syphilis & HIV 4th Generation w/reflexes) $ STD Profile (C. trachomatis/n. gonorrhoeae, T. vaginalis) $ STD Profile (HSV, C.trachomatis/N.gonorrhoeae, T.vaginalis) $ Sureswab Bacterial Vaginosis $ Sureswab Candidiasis $ Sureswab HSV 1/2 $ Syphilis Screen w/reflex RPR and Titer, or TP-PA $ T3 (Triiodothyronine) Antibody $ T3 Free, Non-Dialysis $ T3 Reverse, LC/MS/MS $ T3 Total $ T3 Uptake $ T4 (Thyroxine) $ T4 Free, Non-Dialysis $ T4 Free, TSH High Sensitivity $ Testosterone $ Testosterone, Total & Free $100 Effective February 1, 2018 Page 7 of 8 Prices are subject to change.

8 Pay at Published Fee Schedule Testosterone, Total, LC/MS/MS $ Thyroglobulin Antibodies $ TIBC $ Tramadol Screen with Reflex to Confirmation, Urine $ Trichomonas vaginalis, Aptima Device $ Trichomonas vaginalis, ThinPrep Vial $ TSH High Sensitivity $ TSH High Sensitivity w/reflex T4 Free $ TSI, Thyroid Stimulating Immunoglobulin $ Urea Nitrogen (BUN) $ Uric Acid $ Urinalysis Complete $ Urinalysis Complete w/reflex to Urine Culture $ Urinalysis Diabetic w/microalbumin $ Urogram $ Urogram w/reflex to Microscopic & Urine Culture $ Urogram w/reflex to Microscopic Exam $ Urogram w/reflex to Urine Culture $ Urogram, Obstetric w/reflex to Microscopic & Urine Culture $ Urogram, Obstetric w/reflex to Urine Culture $ Vaginosis/Vaginitis Plus (BV,Candidiasis,T.vaginalis,CT/NG) $ Varicella Zoster Antibody, IgG $ Vascular Endothelial Growth Factor (VEGF), Elisa $ Vitamin B12 $ Vitamin B12 & Folate $ Vitamin B6, Plasma $ Vitamin C, LC/MS/MS $ Vitamin D for Infants, 25-Hydroxy, LC/MS/MS $ Vitamin D, 25-Hydroxy - D2, D3, Total (LC/MS/MS) $ Vitamin D, 25-Hydroxy Total $ Vitamin D,1,25-dihydroxy, LC/MS/MS $ WBC $ Zinc, Plasma/Serum $31 Effective February 1, 2018 Page 8 of 8 Prices are subject to change.

$29.00 $30.00 Blood Glucose Testing (190.20) (Also see Medicare Preventative Services Quick Reference) Carcinoembryonic Antigen (CEA) (190.

$29.00 $30.00 Blood Glucose Testing (190.20) (Also see Medicare Preventative Services Quick Reference) Carcinoembryonic Antigen (CEA) (190. TEST DESCRIPTION INCLUDES TESTS NATIONAL COVERAGE DETERMINATIONS (NCD S) Est. cost Alpha Fetoprotein (190.25) 82105 alpha-fetoprotein, serum $35.96 Blood Counts (CBC) (190.15) 85004 -- Blood count; automated