| Procedure Code | Laboratory Services | Description | Lowest Rate** | Highest Rate | Cash Pay* |
|---|---|---|---|---|---|
| 36415 | COLL VENOUS BLD VENIPUNCTURE | Insertion of needle into vein for collection of blood sample | Not on test menu*** | Not on test menu | N/A |
| 80048 | METABOLIC PANEL TOTAL CA | Blood test, basic group of blood chemicals (Calcium, total) | $0.00 | $16.56 | $10.15 |
| 80050 | GENERAL HEALTH PANEL | Please see component services (80053, 85025, and 84443) | $0.00 | $70.51 | $42.16 |
| 80053 | COMPREHEN METABOLIC PANEL | Blood test, comprehensive group of blood chemicals | $0.00 | $18.18 | $12.67 |
| 80061 | LIPID PANEL | Blood test, lipids (cholesterol and triglycerides) | $0.00 | $28.30 | $16.07 |
| 80307 | DRUG TEST PRSMV CHEM ANLYZR | Testing for presence of drug, by chemistry analyzers | Not on test menu | Not on test menu | N/A |
| 81001 | URINALYSIS AUTO W/SCOPE | Manual urinalysis test with examination using microscope, automated | $0.00 | $5.45 | $3.80 |
| 81528 | ONCOLOGY COLORECTAL SCR | Gene analysis (colorectal cancer) | Not on test menu | Not on test menu | N/A |
| 82043 | UR ALBUMIN QUANTITATIVE | Urine microalbumin (protein) level | $0.00 | $5.71 | $6.94 |
| 82306 | VITAMIN D 25 HYDROXY | Vitamin D-3 level | $0.00 | $56.19 | $35.52 |
| 82570 | ASSAY OF URINE CREATININE | Creatinine level to test for kidney function or muscle injury | $0.00 | $11.08 | $6.14 |
| 82607 | VITAMIN B-12 | Cyanocobalamin (vitamin B-12) level | $0.00 | $28.78 | $18.10 |
| 82728 | ASSAY OF FERRITIN | Ferritin (blood protein) level | $0.00 | $26.22 | $16.36 |
| 82746 | ASSAY OF FOLIC ACID SERUM | Folic acid level, serum | $0.00 | $30.91 | $17.64 |
| 83036 | HEMOGLOBIN GLYCOSYLATED A1C | Hemoglobin A1C level | $0.00 | $18.53 | $11.65 |
| 83540 | ASSAY OF IRON | Iron level | $0.00 | $12.37 | $7.76 |
| 83550 | IRON BINDING TEST | Iron binding capacity | $0.00 | $16.69 | $10.49 |
| 83735 | ASSAY OF MAGNESIUM | Magnesium level | $0.00 | $26.24 | $8.04 |
| 84153 | ASSAY OF PSA TOTAL | PSA (prostate specific antigen) measurement, total | $0.00 | $31.53 | $22.07 |
| 84403 | ASSAY OF TOTAL TESTOSTERONE | Testosterone (hormone) level, total | $0.00 | $23.30 | $30.97 |
| 84439 | ASSAY OF FREE THYROXINE | Thyroxine (thyroid chemical), free | $0.00 | $15.51 | $10.82 |
| 84443 | ASSAY THYROID STIM HORMONE | Blood test, thyroid stimulating hormone (TSH) | $0.00 | $65.68 | $20.16 |
| 84460 | ALANINE AMINO (ALT) (SGPT) | Liver enzyme (SGPT), level | $0.00 | $10.10 | $6.36 |
| 84481 | FREE ASSAY (FT-3) | Thyroid hormone, T3 measurement, free | $0.00 | $24.19 | $20.33 |
| 85025 | COMPLETE CBC W/AUTO DIFF WBC | Complete blood cell count (red cells, white blood cell, platelets), automated | $0.00 | $14.84 | $9.32 |
| 85027 | COMPLETE CBC AUTOMATED | Complete blood cell count (red cells, white blood cell, platelets), automated | $0.00 | $11.48 | $7.76 |
| 85610 | PROTHROMBIN TIME | Blood test, clotting time | $0.00 | $15.28 | $5.15 |
| 85652 | RBC SED RATE AUTOMATED | Red blood cell sedimentation rate, to detect inflammation, automated | Not on test menu | Not on test menu | N/A |
| 86140 | C-REACTIVE PROTEIN | Measurement C-reactive protein for detection of infection or inflammation | $0.00 | $7.41 | $6.22 |
| 86592 | SYPHILIS TEST NON-TREP QUAL | Syphilis detection test | $0.00 | $4.18 | $5.12 |
| 86803 | HEPATITIS C AB TEST | Hepatitis C antibody measurement | $0.00 | $27.23 | $17.12 |
| 87070 | CULTURE OTHR SPECIMN AEROBIC | Bacterial culture, any other source except urine, blood or stool, aerobic | $0.00 | $16.44 | $10.34 |
| 87077 | CULTURE AEROBIC IDENTIFY | Bacterial culture for aerobic isolates | $0.00 | $15.42 | $9.70 |
| 87081 | CULTURE SCREEN ONLY | Screening test for pathogenic organisms | Not on test menu | Not on test menu | N/A |
| 87086 | URINE CULTURE/COLONY COUNT | Bacterial colony count, urine | $0.00 | $11.57 | $9.68 |
| 87088 | URINE BACTERIA CULTURE | Bacterial urine culture | Not on test menu | Not on test menu | N/A |
| 87186 | MICROBE SUSCEPTIBLE MIC | Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), | $0.00 | $13.87 | $10.38 |
| 87340 | HEPATITIS B SURFACE AG IA | Detection test by immunoassay technique for Hepatitis B surface antigen | $0.00 | $20.19 | $12.40 |
| 87389 | HIV-1 AG W/HIV-1 & -2 AB AG IA | Detection test by immunoassay technique for HIV-1 antigen and HIV-1 and HIV-2 | $0.00 | $12.34 | $28.90 |
| 87491 | CHYLMD TRACH DNA AMP PROBE | Detection test by nucleic acid for chlamydia trachomatis, amplified probe | Not on test menu | Not on test menu | N/A |
| 87591 | N.GONORRHOEAE DNA AMP PROB | Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae | Not on test menu | Not on test menu | N/A |
| 87624 | HPV HI-RISK TYP POOLED RSLT | Detection test by nucleic acid for human papillomavirus (HPV), high-risk types | Not on test menu | Not on test menu | N/A |
| 87661 | TRICHOMONAS VAGINALIS AMPLIF | Infectious agent detection by nucleic acid (DNA or RNA); trichomonas vaginalis, | Not on test menu | Not on test menu | N/A |
| 87798 | DETECT AGENT NOS DNA AMP | Detection test by nucleic acid for organism, amplified probe technique | $0.00 | $38.60 | $42.11 |
| 87801 | DETECT AGNT MULT DNA AMPLI | Detection test by nucleic acid for multiple organisms, amplified probe(s) | Not on test menu | Not on test menu | N/A |
| 88175 | CYTOPATH C/V AUTO FLUID REDO | Pap test, automated thin layer preparation; automated system and manual | Not on test menu | Not on test menu | N/A |
| 88305 | TISSUE EXAM BY PATHOLOGIST | Level IV – Surgical pathology, gross and microscopic examination | Not on test menu | Not on test menu | N/A |
| G0480 | DR TST DEFIN DR ID M P D 1-7 DR CL | Drug test(s), definitive, utilizing (1) drug identification methods able to | Not on test menu | Not on test menu | N/A |
| U0003 | IA DET DNA/RNA; COVID-19 AMP P T | Infectious agent detection by nucleic acid (DNA or RNA); severe acute | Not a valid HCPCS code as of 5/12/23 (see 87635) | Not a valid HCPCS code as of 5/12/23 (see 87635) | N/A |
| U0005 | IA DET NA; SARS-COV-2 COVID-19 | Infectious agent detection by nucleic acid (DNA or RNA); severe acute | Not a valid HCPCS code as of 5/12/23 | Not a valid HCPCS code as of 5/12/23 | N/A |
| 87635 | SARS-COV2 RNA, QL RT-PCR | Amplified DNA or RNA probe detection of severe acute respiratory syndrome | $0.00 | $58.92 | $61.57 |
*Our patient cash-pay rates are determined using a multiple of the 2023 CMS Clinical Laboratory Fee Schedule. Also note that the fee for 80050 is the sum of the fees for the three component service (88053, 85025, and 84443).
**For certain services, the lowest negotiated rate may appear as “$0.00.” A displayed rate of $0.00 indicates that, for some payer contracts, the service is not separately reimbursable and is instead bundled or included within payment for another service. A $0.00 rate does not reflect the actual cost of performing the service, but rather the reimbursement structure established under specific payer agreements.
*** This laboratory does not currently provide all fifty (50) shoppable services identified under Indiana Code § 27-1-3-35. For any shoppable service that is not performed by this laboratory, pricing information is not applicable and will not be listed. The absence of pricing for a particular service reflects that the service is not offered, not that pricing information has been withheld.