Outpatient Services

Laboratory Test (Single)

CPT Code

Price

Complete Blood Count (CBC)

85027

$55

Basic Metabolic Panel (BMP)

80048

$45

Comprehensive Metabolic Panel (CMP)

80053

$55

Hepatic Panel (LFT)

80076

$55

Urinalysis - Routine (UA)

81001

$35

Urinalysis Culture (UAC)

87088

$75

D-Dimer

85379

$45

Uric Acid Level

84550

$25

Urine Pregnancy Test - Qualitative (HCG)

81025

$35

Serum Pregnancy (Qualitative)

84703

$30

Lactate Level (CG4)

82803/83605

$35

Lipase

83690

$60

Lithium Level

80178

$50

Phenytoin Total

80185

$50

Valproic Acid Level

80164

$50

Prothrombin Time with INR (PT/INR)

85730

$50

Phlebotomy & Handling

36415

$20

Triglycerides

84478

$25

HA1C

83036

$55

Fe & TIBC

83540/83550

$55

TSH

84443

$55

T3

84480

$50

Free T4

84439

$50

Thyroid Screen (FT4 & TSH)

84439/84443

$90

PT

85610

$30

PTT

85730

$30

RH

86901

$55

Blood Type

86900

$55

ABO/RH

86901/86900

$60

Magnesium

80051

$55

Ammonia

82140

$75

ESR

85652

$35

CRP

86140

$35

Joint Fluid (Crystals & Cells)

89060/89051

$125

Blood Transfusions (1 Unit & Cross)

$950

Other Outpatient Services

Point of Care Laboratory Test (Single)

CPT Code

Price

Fingerstick Glucose

82962

$15

Urine Drug Screen (10 Panel)

80300

$55

Name of Panel

Included

Price

Nutrition Lab Panel

CMP, CBC, Iron, Thiamine, Vitamin B12, Folate, Vitamin D, Vitamin C, Zinc

$175

Pre-Operative Lab Panel

CBC, CMP, RH Factor, PT INR, aPTT

$140

STD Panel 1 (NAAT)

GC, Chlamydia, Trich

$650

STD Panel 2 (NAAT)

GC, Chlamydia, Trich, Herpes

$750

Thyroid Panel

TSH, FT3, FT4, T3 Uptake

$115

Test

Why

Price

Echocardiogram

Echocardiogram-or echo-is an ultrasound of the heart. Your doctor uses it to look at heart size, structure and function or how well it pumps blood. Your doctor may order an echo to see if the symptoms you're having, such as chest pain or shortness of breath might be related to your heart.

$800

Outpatient Radiology Test

Study

Price

X-ray Any Single Extremity or Joint, 2 Views/3Views

$75

Chest X-ray, 1 View

$115

Chest X-ray PA & LAT, 2 Views

$150

CT Any Body Part Without Contrast

$225

CT Any Body Part With Contrast

$375, labs & IV included

CT Angiogram Any Body Part

$425, labs & IV included

Ultrasound Any Body Part

$300

Ultrasound Pregnancy with Labs

$450

MRI Any Body Part Without Contrast

$325

MRI Any Body Part With Contrast

$475, labs & IV included