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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