for uninsured services - Saskatchewan Medical Association

SECTION V:LABORATORY MEDICINESpecialist in PathologySpecimen Collection and Referral751V Phlebotomy, venipuncture $47.40752V Phlebotomy, pediatric (0 to 6 years) $71.40771V Referral - Blood $24.20770V Referral - urine $24.20772V Referral - other $30.80756V Referral - TDG - blood (transfer of dangerous goods) $75.00757V Referral - TDG - urine (transfer of dangerous goods) $75.00758V Referral - TDG - other (transfer of dangerous goods) $75.00ChemistryBlood Gases111V Blood gases (pH, p02, pC02, 02 saturation) $16.60112V Blood gas (pH only) $11.80113V Blood gas and metabolytes - (pH, p02, pC02, 02 saturation, $24.40sodium, potassium, chloride, glucose, lactate)114V Blood gas and metabolytes - pH, p02, pC02, 02 saturation, $26.20sodium, potassium, chloride, glucose, lactate and ionizedcalcium118V CoOximetry (any single test) $11.80119V CoOximetry (methemoglobin, carboxyhemoglobin) $15.00120V Blood gas, metabolytes and CoOximetry (pH, p02, pC02, $32.4002 saturation, sodium, potassium, chloride, glucose, lactate,ionized calcium, methemoglobin, carboxyhemoglobin,oxyhemoglobin, hemoglobin-arterial)121V Ionized Ca whole blood $11.80122V Ionized calcium - serum $11.80Routine130V Specimen may be serum/plasma/urine/fluids $11.80-- single analyte131V For each additional analyte performed on the same specimen $1.60from the following menu add - albumin, alk phos, ALT,amylase, AST, total bili, direct bili, calcium, creat CK,CKMB, chloride, TC02, glucose, GGT, ethanol, totalprotein, magnesium cholestrol, triglyceride, HDL chol,iron + total iron binding, uric acid, sodium, potassium, LD,lactate, phos, urea, amonia, acetaminaphen, salicylateUrinalysis/Urine Testing132V Routine urinalysis includes: bilirubin, glucose, hemoglobin, $14.00ketones, leukocytes, nitrates, pH, protein, specific gravity& urobilinogen133V Urine microscopy $11.80134V Myoglobin urine $44.20135V Occult bld (Stool/gastric) $11.80136V Osmolality urine/serum $40.20137V Ketones, reducing substances (urine/feces) $4.00138V 24-hour urine, creatinine clearance $33.40139V 24-hour urine, total protein $31.80141V Alb/Creat Ratio $78.60433V Microalbumin - by automated method $32.60140V Pregnancy test HCG (urine or serum) $46.00Chemistry - Immunology/Rheumatology151V A 1 antitrypsin $32.60152V C3 $32.60153V C4 $32.60162V Ceruloplasmin $32.60155V C-reactive protein $32.60240V Electrophoresis (serum) $78.60156V Electrophoresis CK $78.60157V Electrophoresis CSF/urine $98.60158A IgA $24.60159V IgG $32.60SMA FEE GUIDE - V3 - April 1, 2012