Outpatient Lab Charges

Our Commitment to Quality

Helping ensure our patients receive the highest level of care, delivered with dignity and compassion, is our goal with every patient and family member, every time. Our Board challenges us to remain in the Top 10 percent of hospitals in the country in quality scores, and they meet monthly with physicians and clinical staff to analyze the data and develop a plan to better serve our patients. It is this goal-driven mindset that has earned us recognition in key areas for our quality strides. Learn more about our quality awards and recognition.

NOTE: When reviewing the pricing for Lab or Pathology tests, if the section below a test is blank, the test is repeated again and these are additional charges (for example - Glucose four-hour tolerance test will have the test repeated one hour, two hours and then three hours after the initial blood work is collected for a total of four hours. Each test is charged separately). If your lab work is a panel, then several tests may be performed from one blood sample. You may be charged for each test separately

Order Code Description Billing Code Charge CPT Code
FMDS FISH FOR MDS 40200383 $409.50 88271
    40200383 $409.50 88271
    40200383 $409.50 88271
    40200383 $409.50 88271
    40200384 $409.50 88275
    40200384 $409.50 88275
    40200384 $409.50 88275
FMIC Fluconazole MIC 40300036 $471.00 87186
FMON ALLERGEN FUSARIUM MONILIFORME 40200062 $39.43 86003
FNTA FENTANYL & METABOLITE, URINE 30100477 $156.00 80354
FRDI FREE PHENYTOIN 40200247 $76.80 80185
    40200266 $76.80 80186
FREE TESTOSTERONE FREE, ADULT MALE 40200261 $118.29 84402
FRT4 FREE T4 40500127 $70.70 84439
FRUC FRUCTOSAMINE 40200214 $93.39 82985
FRXD FRAGILE X BY DNA 30100321 $1,331.14 81244
FSH FOLLICLE STIM. HORMONE FSH 40500094 $112.06 83001
FSP FIBRIN SPLIT PRODUCT 40500149 $129.28 85362
FTA FTA-ABS 40200219 $50.40 86780
FTDT TDT (TERMINAL DEOXYNUCLEOTIDYL TRANS 40900004 $97.97 88184
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
FTI FTI (INCL. THBR(T-UPTAKE)+T4) 40500133 $43.58 84479
    40500126 $37.37 84436
FTSC FIRST TRIMESTER SCREEN 30200130 $192.00 81508
FUAB FUNGAL ANTIBODIES 40200190 $44.63 86612
    40200187 $44.63 86635
    40200188 $44.63 86606
    40200189 $44.63 86698
FWBX TESTOSTERONE, FREE LC-MS/MS 40200261 $222.60 84402
FXP IMMUNOFIX - SERUM + INTERPRET 40500030 $192.91 86334
G1H GLUCOSE 1 HR PROFILE 40500093 $31.13 82950
G2PP GLUCOSE 2 HOUR POSTPRANDIAL 30100336 $23.23 82947
G6PQ G-6-PDH ENZYME QUANT. 40200282 $72.45 82955
GABP NEUROTIN (GABAPENTIN) 30100345 $89.00 80171
GADA GLUTAMIC ACID DECARBOXYLASE AB 40200135 $193.20 83516
GARL ALLERGEN - GARLIC 40200062 $39.43 86003
GAST GASTRIN SERUM 40200281 $107.93 82941
GBM GLOMERULAR BASEMENT MEMBRANE AB 40200135 $96.60 83516
GCAD N GONORRHOEAE AMPLIFIED DETECT 40200163 $129.15 87591
GCS GC SCREEN 40300029 $33.20 87081
GCXP GONORRHEA/CHLAMYDIA BY PCR 30600062 $43.43 87591
    30600060 $43.43 87491
GEC GENITAL CULTURE 40300026 $51.89 87070
GECG GENITAL CULTURE GS 40300026 $51.89 87070
    40300038 $24.91 87205
GENP GENTAMICIN PEAK 40500059 $49.49 80170
GENT GENTAMICIN TROUGH 40500059 $49.49 80170
GGT GGT 40500105 $35.29 82977
GHCV HCV GENOTYPING 40200349 $878.19 87902
GHIV HIV-1 GENOTYPING 40200348 $1,094.10 87901
GICR GIARDIA/CRYPTOSPORIDIUM DETECT 40300049 $58.10 87328
    40300050 $72.72 87329
GIGA GLIADIN PEPTIDE AB IGA 40200135 $72.45 83516
GIGG GLIADIN PEPTIDE AB IGG 40200135 $72.45 83516
GLC1 GLUCOSE - GESTATIONAL SCREEN 40500093 $31.13 82950
GLCF GLUCOSE - FASTING 40500035 $23.23 82947
GLDR ALLERGEN - GOLDENROD 40200062 $39.43 86003
GLPL GLUCOSE PLEURAL FLUID 40500043 $11.11 82945
GLPP GLUCOSE 2HR POSTPRANDIAL 40500035 $23.23 82947
GLPT GLUCOSE PERITONEAL FLUID 40500043 $11.11 82945
GLSF GLUCOSE - CSF 40500043 $26.96 82945
GLUC GLUCOSE SERUM 40500035 $23.23 82947
GM1 GM1 ANTIBODY PANEL 40200135 $172.99 83516
    40200083 $172.99 8351691
    40200083 $172.99 8351691
GRAB GRANULOCYTE ANTIBODY 40200308 $368.55 86021
GRBN ALLERGEN, FOOD, GREEN BEAN 40200062 $39.43 86003
GS GRAM STAIN 40300038 $24.91 87205
H12R HSV 1/2 AB, G AND M REFLEX 40200329 $85.10 86694
    40200329 $85.10 86694
HA1B GLYCOHEMOGLOBIN (HGB A1C) 40500097 $60.19 83036
HAAB HEPATITIS A IGM ANTIBODY 40500166 $91.31 86709
HAB HISTONE ANTIBODY 40200135 $57.75 83516
HAMP HERPES SIMPLEX VIRUS 1/2 BY PCR 40200037 $239.46 87529
HAPT HAPTOGLOBIN 40500096 $62.27 83010
HAT HEPATITIS A ANTIBODY (TOTAL) 40200007 $120.36 86708
HB27 HLA B-27 ANTIGEN 40200341 $157.73 86812
HBAB HEPATITIS B SURFACE ANTIBODY 40500165 $74.73 86706
HBAG HEPATITIS B ANTIGEN (HBSAG) 40500170 $25.25 87340
HBCA HEPATITIS B CORE AB (TOTAL) 40200019 $83.02 86704
HBCM HEPATITIS B CORE AB IgM 40500164 $66.42 86705
HBEB HEPATITIS B E ANTIBODY 40200192 $78.86 86707
HBEG HEPATITIS B E ANTIGEN 40200193 $78.86 87350
HBVU HEPATITIS B VIRAL DNA 40200259 $414.75 87517
HCPC HCV RNA QUANT BY PCR 40200345 $433.65 87522
HCV HEPATITIS C VIRUS ANTIBODY 40500168 $96.50 86803
HCVFB HCV FIBROSURE 30100427 $152.00 84450
    30100426 $152.00 84460
    30100428 $152.00 84520
    30100079 $152.00 83883
    30100429 $153.00 82977
HCVNC HCV CONFIRMATION BY QUANT. NAAT 40200345 $433.65 87522
HDLH HEALTH DIAGNOSTIC LAB HANDLING 40500184 $15.00  
HDUS ALLERGEN - HOUSE DUST STIER 40200062 $39.43 86003
HDVB HEPATITIS DELTA ANTIBODY 40200256 $93.39 86692
HELI HELICOBACTER PYLORI ANTIBODY 40300020 $134.89 86677
HEMU HEMOSIDERIN URINE 40500098 $72.72 83070
HEPA HEPARIN ASSOC. AB DETECTION 40200235 $289.80 86022
HFP HEPATIC FUNCTION PANEL 40500054 $64.34 80076
HGBE HEMOGLOBIN ELECTROPHORESIS PROFILE 40200283 $79.80 83021
HGH HUMAN GROWTH HORMONE HGH 40200174 $89.23 83003
HISU HISTOPLASMA GALACTONAMMAN AG UR 30100430 $304.20 87385
HIVCO HIV 1/2 ANTIGEN/ANTIBODY COMBO 30200131 $73.73 87389
HIVP HIV DNA PCR 40200258 $999.60 87535
HL57 HLA-B*5701 GENOTYPING 30100310 $656.25 81381
HLAP HLA A,B,C, PHENOTYPE 40200342 $1,353.45 86813
HMIN ALLERGEN HELMINTHOSPORIUM 40200062 $39.43 86003
HMPD HEMOCHROMATOSIS MUT. DETECTION 30100322 $677.25 81256
HMSU HEAVY METALS PANEL 3, URINE 40200002 $58.80 82175
    40200003 $58.80 83655
    40200004 $59.85 83825
HNW HEELSTICK-NEWBORN WORKUP 40400014 $33.00 86880
    40400016 $13.00 86900
    40400017 $20.00 86901
HOMC HOMOCYSTEINE/CYSTEINE SERUM 40500099 $76.76 83090
HP17 HYDROXYPROGESTERONE-17 40200244 $151.47 83498
HPAG HELICOBACTER PYLORI AG, FECAL 40200367 $216.30 87338
HRP1 HSV1 GLYCOPROTEIN G-SPECIFIC 40200050 $108.15 86695
HRPG HERPES SIMPLEX ANTIBODY IGG 40200329 $85.10 86694
HRPM HERPES SIMPLEX ANTIBODY IGM 40200329 $85.10 86694
HS2G HSV 2 GLYCOPROTEIN G AB, IGG 40200001 $108.15 86696
HSC HERPES SIMPLEX VIRUS CULTURE 40300044 $51.51 87254
HSPA HISTOPLASMA ANTIGEN, SERUM 40200382 $420.00 87385
HSPC HERPES SIMPLEX VIRUS BY PCR 40200037 $409.50 87529
HSVD HERPES SIMPLEX (HSV) DFA STAIN 40300046 $40.94 87274
    40300045 $21.21 87273
HTLV HUMAN T-CELL LEUKEMIA ANTIBODY 40200328 $180.60 86687
HUAB HU ANTIBODY 40200085 $1,126.65 83520
HYMN ALLERGEN - HYMENOPTERA PANEL 40200062 $39.43 86003
    40200062 $39.43 86003
    40200062 $39.43 86003
    40200062 $39.43 86003
    40200062 $39.43 86003
HYPS HYPERSENSITIVITY PNEUMONITIS 40200062 $39.43 86003
    40200062 $39.43 86003
    40200062 $39.43 86003
    40200062 $39.43 86003
    40200126 $26.51 86331
    40200126 $26.51 86331
    40200126 $26.51 86331
    40200126 $26.51 86331
    40200126 $26.51 86331
    40200126 $26.51 86331
    40200126 $26.51 86331
    40200188 $26.51 86606
    40200188 $26.51 86606
    40200188 $26.51 86606
    40200188 $26.51 86606
    40200188 $26.51 86606
HZNT ALLERGEN - HAZELNUT (FILBERT) 40200062 $39.43 86003
HZV HERPES ZOSTER IGG TITER 40300022 $89.23 86787
HZVE HERPES ZOSTER ANTIBODY STATUS 40300022 $89.23 86787
IBSG IBD SGi DIAGNOSTIC 30100153 $87.75 83520
    30100153 $87.75 83520
    30100153 $87.75 83520
    30100153 $87.75 83520
    30100153 $87.75 83520
    30100153 $70.20 83520
    30100153 $70.20 83520
    30100153 $70.20 83520
    30100083 $70.20 82397
    30100083 $70.20 82397
    30100083 $70.20 82397
    30200009 $105.30 86140
    31000050 $526.50 88346
    31000048 $526.50 88350
    30100337 $100.93 81479
    30100337 $100.93 81479
    30100337 $100.93 81479
    30100337 $100.93 81479
ICA CALCIUM IONIZED 40500032 $120.36 82330
ICP IMMUNE COMPLEX ASSAY 40200220 $791.70 86332
IDPX SUBSTANCE ABUSE PANEL 10 30100411 $367.50 80307
IEP CHOLINESTERASE 40200072 $57.23 82480
    40200391 $57.23 82482
IF24 IMMUNOFIX 24HR URINE w/INTERP 40500037 $149.48 86335
IFBA INTRINSIC FACTOR BLOCKING AB 40200314 $79.80 86340
IFRU IMMUNOFIX RANDOM URINE+INTERP 40500037 $147.46 86335
IGA IMMUNOGLOBULIN IGA 40500091 $91.31 82784
IGD IMMUNOGLOBULIN IGD 40200142 $91.31 82784
IGEF URTICATIA-INDUCED BASOPHIL ACT 40200153 $182.00 88185
    40200154 $182.00 88.185
    40200154 $182.00 88184
IGF INSULIN-LIKE GROWTH FACTOR 40200296 $86.10 84305
IGG IMMUNOGLOBULIN IGG 40500091 $91.31 82784
IGG4 IGG SUBCLASS 4 40200141 $54.34 82787
IGGS IGG SUBCLASSES 40200141 $103.76 82787
    40200141 $103.76 82787
    40200141 $103.76 82787
    40200141 $103.76 82787
IGM IMMUNOGLOBULIN IGM 40500091 $91.31 82784
IGS IMMUNOGLOBULINS IGG,IGA,IGM 40500091 $91.31 82784
    40500091 $91.31 82784
    40500091 $91.31 82784
IMGE IGE 40500021 $80.94 82785
INAH INSULIN ANTIBODIES, HUMAN 40200252 $186.90 86337
INSU INSULIN 40200175 $33.60 83525
IOCS CALCIUM, IONIZED SERUM 40200052 $120.36 82330
IRRF IRRADIATION FEE 40400019 $102.00 86945
ISLD LACTATE DEHYDROGENASE ISOENZYMES 40200158 $49.88 83615
    40200159 $49.88 83625
ISLE ISLET CELL AB, IGG 40200156 $103.95 86341
ISOB ISOPROPANOL (INCLUDES ACETONE) 40200230 $120.75 84600
ISOC CREATINE KINASE ISOENZYME 40200160 $43.05 82550
    40200161 $43.05 82552
JCVP JC VIRUS BY PCR 30100417 $1,030.05 87798
JK2Q JAK2 (V617F) QUANTITATION 30100313 $1,842.75 81270
JO1 JO 1 ANTIBODY, IGG 40200312 $115.50 86235
JONG ALLERGEN - JOHNSON GRASS 40200062 $39.43 86003
K POTASSIUM SERUM 40500115 $26.96 84132
KENT ALLERGEN - JUNE GRASS/KENTUCKY 40200062 $39.43 86003
KEPR KEPPRA (LEVETIRACETAM) 40200363 $207.00 80177
KLQR KAPPA/LAMBDA FREE LIGHT CHAINS 30100079 $201.08 83883
    30100079 $201.08 83883
KSRP KIDNEY STONE RISK PANEL II 40200368 $61.53 82340
    40200369 $61.53 82436
    40200365 $61.53 82507
    40200176 $61.53 82131
    40200370 $61.53 83735
    40200179 $61.53 83945
    40200371 $61.53 84105
    40200372 $61.53 84133
    40200373 $61.53 84300
    40200374 $61.53 84560
LAAC LACTIC ACID PLASMA 40500106 $112.11 83605
LAACS LACTIC ACID SEPSIS 40500106 $112.11 83605
LADA LEGIONELLA ANTIGEN DETECTION 40300056 $57.57 87449
LAMB ALLERGEN - WEED, LAMB'S QUARTER 40200062 $39.43 86003
LAMT LAMOTRIGINE 30100347 $102.00 80175
LAP LEUKOCYTE ALK PHOS STAIN 40200204 $245.70 85540
LBAL ALLERGEN,FOOD,LAMB,IGE 40200062 $39.43 86003
LDCP LEAD, BLOOD CAPILLARY 40200003 $64.34 83655
LDH LDH SERUM 40500044 $35.35 83615
LDIN LEAD INDUSTRIAL EXPOSURE 40200003 $64.34 83655
    40200182 $178.50 84202
LDLD DIRECT LDL 40500023 $72.72 83721
LDPL LDH PLEURAL FLUID 40500044 $17.17 83615
LDPT LDH PERITONEAL FLUID 40500044 $17.17 83615
LDSF LDH - CSF 40200158 $36.75 83615
LDWB LEAD WHOLE BLOOD 40200003 $64.34 83655
LEDU LEAD, URINE 40200003 $64.34 83655
LG1H GLUCOSE 1 HR PROFILE 40500035 $23.23 82947
    40500093 $12.12 82950
LG2H GLUCOSE 2 HR PROFILE 40500035 $23.23 82947
    40500093 $12.12 82950
LG6T GLUCOSE 6HR TOLERANCE 40500013 $70.56 82951
    40500014 $11.11 82952
    40500014 $11.11 82952
    40500014 $11.11 82952
    40500014 $11.11 82952
    40500014 $11.11 82952
LGVP CHLAMYDIA (LGV) ANTIBODY PANEL 40200217 $435.75 86631
LGWB B BURGDORFERI IGG WESTERN BLOT 40200167 $72.45 86617
LH LUTEINIZING HORMONE LH 40500095 $105.85 83002
LI LITHIUM 40500060 $47.72 80178
LIDO LIDOCAINE/XYLOCAINE 40200033 $123.90 80176
LIPA LIPASE 40500108 $95.95 83690
LIPD LIPID-CHOLESTEROL PROFILE 40500053 $68.48 80061
LKM LIVER-KIDNEY-MICROSOME ABS 40200315 $72.45 86376
LLP1 BLAST SCREEN - 8 COLOR ASSAY 40900004 $62.62 88184
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
LLP3 MYELOID LEUKEMIA 8 COLOR ASSAY 40900004 $62.62 88184
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
LLP5 LYMPHOMA (45 GATING) 8 COLOR 40900004 $62.62 88184
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
    40900002 $62.62 88185
LMWB B BURGDORFERI IGM WESTERN BLOT 40200167 $72.45 86617
LNMR LipoFit by NMR 40200093 $184.80 83704
    30100474 $68.48 80061
LOBS ALLERGEN - LOBSTER 40200062 $39.43 86003
LPAB LEGIONELLA PNEUMOPHILA AB 40200330 $53.55 86713
LPOA LIPOPROTEIN (a) 40200020 $98.70 83695
LSP4 LYMPHOCYTE SUBSET PANEL 4 30200137 $189.88 86360
    30200136 $189.88 86359
LSP5 LYMPHOCYTE SUBSET PANEL 5 40900003 $189.88 86360
    40900001 $189.89 86359
    30200138 $62.62 86355
    30200139 $125.24 86357
LSPG L/S RATIO 40200177 $153.56 83661
    40200293 $38.85 84081
LTOL LACTOSE TOLERANCE 40500013 $70.56 82951
    40500014 $11.11 82952
    40500014 $11.11 82952
    40500014 $11.11 82952
LTX ALLERGEN - LATEX 40200062 $39.43 86003
LYMB LYME ANTIBODIES 40200198 $166.01 86618
LYPC LYME BY PCR 40200026 $458.85 87476
LYTE ELECTROLYTES 40500051 $41.51 80051
LYZE LYSOZYME, SERUM OR BODY FLUID 40200392 $63.97 85549
MABS MALARIA ANTIBODIES, TOTAL 40200124 $361.20 86750
MANG MANGANESE, SERUM 40200355 $97.56 83785
MAPL ALLERGEN - MAPLE (BOX ELDER) 40200062 $39.43 86003

Continue to Part 3 of this list.