Account Number: Account Name: Special Priced Procedures
Account Number:
Account Name:
Special Priced Procedures
Test
000455
000620
000810
001016
001024
001032
001040
001057
001065
001081
001107
001123
001149
001156
001172
001180
001198
001321
001339
001362
001370
001396
001404
001453
001503
001537
001545
001560
001578
001586
001776
001834
001941
001974
001977
002014
10/16/2018
Description
Thyroid Panel
Thyroid Panel With TSH
Vitamin B12 and Folate
Calcium
Phosphorus
Glucose
BUN
Uric Acid
Cholesterol, Total
Albumin
Alkaline Phosphatase
AST (SGOT)
Thyroxine (T4)
T3 Uptake
Triglycerides
Potassium
Sodium
Iron and TIBC
Iron
Creatine Kinase,Total
Creatinine
Amylase
Lipase
Hemoglobin A1c
Vitamin B12
Magnesium
ALT (SGPT)
Ceruloplasmin
Carbon Dioxide, Total
Copper, Serum
Immunoglobulin G, Qn, Serum
Complement C4, Serum
Complement, Total (CH50)
Thyroxine (T4) Free, Direct, S
Thyroxine (T4) Free, Direct, S
Folate (Folic Acid), Serum
Page 1 of 10
Amount
8.00
14.00
12.00
2.10
2.10
2.10
2.10
2.10
2.10
2.10
2.10
2.10
4.00
4.00
2.10
2.10
2.10
6.00
2.10
2.10
2.10
3.50
3.50
4.00
6.00
4.00
2.10
6.50
2.10
18.00
5.75
4.00
14.80
5.00
5.00
6.00
Account Number:
Account Name:
Special Priced Procedures
Test
002030
002139
002188
002253
002303
003004
003038
003129
003269
003277
003772
004020
004051
004100
004226
004259
004280
004283
004309
004317
004333
004465
004515
004549
004556
004564
004598
004614
004655
004705
004747
004937
005009
005041
005058
005199
10/16/2018
Description
Aldolase
CEA
Triiodothyronine (T3)
AFP, Serum, Tumor Marker
Cancer Antigen (CA) 125
Creatinine Clearance
Urinalysis, Routine
Prot+CreatU (Random)
Calcium, 24Hr Urine
Protein Total, Qn, 24-Hr Urine
Urinalysis, Complete
DHEA-Sulfate
Cortisol
DHEA, Serum
Testosterone, Serum
TSH
Tryptase
Luteinizing Hormone(LH), S
FSH, Serum
Progesterone
Insulin
Prolactin
Estradiol
Estrogens, Total
hCG,Beta Subunit,Qual,Serum
Estrone, Serum
Ferritin, Serum
Estriol, Serum
Vitamin B6, Plasma
Androstenedione LCMS
Prostatic Acid Phos, Serum
Transferrin
CBC With Differential/Platelet
Hemoglobin
Hematocrit
Prothrombin Time (PT)
Page 2 of 10
Amount
5.30
8.00
8.74
9.00
16.50
5.00
2.75
8.00
4.00
3.00
3.00
12.00
8.00
15.00
10.00
3.00
54.00
10.00
10.00
8.00
6.50
8.00
10.00
16.00
10.50
16.00
3.50
10.00
25.00
24.00
9.50
6.00
3.00
3.20
2.75
2.50
Account Number:
Account Name:
Special Priced Procedures
Test
005207
005215
005223
005249
006015
006031
006049
006056
006064
006072
006189
006197
006213
006338
006395
006452
006460
006478
006494
006502
006510
006530
006619
006627
006635
006643
006650
006676
006718
006734
007260
007385
007401
007566
008003
008169
10/16/2018
Description
PTT, Activated
Sedimentation Rate-Westergren
Hgb Solubility
Platelet Count
Antibody Screen
Antistreptolysin O Ab
ABO Grouping and Rho(D) Typing
ABO Grouping
Rh Factor
RPR
Mononucleosis Test, Qual
Rubella Antibodies, IgG
Antibody Identification
Antiextractable Nuclear Ag
Hep B Surface Ab
Complement C3, Serum
Rapid Plasma Reagin, Quant
Toxoplasma gondii Ab, IgG, Qn
Cytomegalovirus (CMV) Ab, IgG
Rheumatoid Arthritis Factor
HBsAg Screen
Hepatitis B Surf Ab Quant
Hep Be Ag
C-Reactive Protein, Quant
Hep Be Ab
Actin (Smooth Muscle) Antibody
Mitochondrial (M2) Antibody
Thyroid Peroxidase (TPO) Ab
Hep B Core Ab, Tot
Hep A Ab, IgM
Valproic Acid (Depakote)(R),S
Digoxin, Serum
Phenytoin (Dilantin), Serum
Digoxin, Random, Serum
Anaerobic and Aerobic Culture
Beta Strep Gp A Culture
Page 3 of 10
Amount
2.50
3.00
6.00
2.75
5.00
5.00
8.00
4.00
4.00
3.00
7.00
5.00
36.00
26.00
6.00
7.75
4.00
25.00
20.00
4.60
7.00
6.50
7.00
6.00
6.75
8.00
10.00
7.50
7.70
9.50
15.00
5.00
9.75
5.00
28.00
5.00
Account Number:
Account Name:
Special Priced Procedures
Test
008250
008334
008342
008649
008680
008847
008904
009001
009134
010165
010322
010330
010363
010389
010390
010801
012005
012518
012708
013664
013672
015040
015057
015610
016123
016881
017319
018705
028142
028480
033852
054601
058495
070001
070045
070085
10/16/2018
Description
HSV Culture and Typing
Genital Culture, Routine
Upper Respiratory Culture
Aerobic Bacterial Culture
Susceptibility, Aer + Anaerob
Urine Culture, Routine
Anaerobic Culture
Fine-Needle Aspiration
Breast Discharge Cytology
Protoporphyrin, FEP/ZPP
Prostate-Specific Ag, Serum
Bile Acids
IGF-1
Triiodothyronine (T3), Free
T3Free
AFP, Serum, Open Spina Bifida
RPR, Rfx Qn RPR/Confirm TP
Antihistone Antibodies
Sjogren's Ab, Anti-SS-A/-SS-B
Protein,Total,Urine
Creatinine, Urine
Antithrombin Activity
Antithrombin Antigen
PTH, Intact
ENA+DNA/DS+Sjogren's
Hep B Core Ab, IgM
AFP Tetra
Antiscleroderma-70 Antibodies
CBC, Platelet, No Differential
FSH and LH
C4+C3
Ca+PTH Intact
Measles/Mumps/Rubella Immunity
Testosterone, Total, LC/MS
Nicotine and Metabolite, Ur Qn
17-OH Progesterone LCMS
Page 4 of 10
Amount
30.20
12.00
8.00
12.00
112.00
7.00
16.00
60.00
60.00
18.00
9.25
8.00
20.00
21.00
21.00
16.00
3.00
23.20
22.50
4.25
6.25
16.00
20.00
8.00
60.50
9.00
76.00
18.00
2.90
20.00
17.90
10.10
35.00
22.75
45.00
112.00
Account Number:
Account Name:
Special Priced Procedures
Test
070104
080465
081950
082016
083935
083940
083950
083952
083953
086207
086231
086264
096206
096339
096537
096552
096560
096651
096727
096776
100800
101550
102277
102525
114041
120295
120766
120790
120816
120832
120857
121137
121186
122101
123026
123810
10/16/2018
Description
Reverse T3, Serum
Protein C Antigen
Vitamin D, 25-Hydroxy
Sex Horm Binding Glob, Serum
Panel 083935
HIV 1/2 Ab Differentiation
RNA Qualitative
RNA Qualitative
RNA Qualitative
C difficile Toxins A+B, EIA
Factor II Activity
Factor VIII Activity
Varicella-Zoster V Ab, IgG
Anti-dsDNA Antibodies
Rubella Antibodies, IgM
Mumps Antibodies, IgG
Rubeola Antibodies, IgG
Toxoplasma gondii Ab,IgM,Qn
Cytomegalovirus (CMV) Ab, IgM
Varicella-Zoster Ab, IgM
Fructosamine
Gestational (Glucose)Diab.Scrn
Gest. Diabetes 1-Hr Screen
Hgb A1c with eAG Estimation
Ab Scr+Antibody ID
LDL Cholesterol (Direct)
C-Reactive Protein, Cardiac
Calculi, Urinary
Creatine Kinase (CK), MB
Troponin I
Fetal Fibronectin
Free K+L Lt Chains,Qn,S
Vitamin B1 (Thiamine), Blood
Hgb Frac. w/o Solubility
PE+Interp(Rfx IFE),S
NMR LipoProf+Graph
Page 5 of 10
Amount
30.00
30.00
20.00
8.00
16.00
84.00
310.00
310.00
310.00
12.00
30.00
30.00
8.00
12.00
8.00
14.50
15.50
25.00
20.00
12.00
6.00
3.00
2.00
4.00
38.00
6.00
10.00
24.00
35.00
25.00
236.00
82.00
18.00
12.00
9.75
45.00
................
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