Lab Testing Price List
Patient Draw Fee In Office - $28.00 Mobile Draw Fee - $35.00 (or $1/mile if outside of Jackson/Wilson/Teton Village/Moose)
No Mobile Draw Fee for Tests of $200 or More.
Panels Price
Chem Panel (CMP, TSH) Must fast 10 hours $35.00
PSA $20.00
Hemoglobin A1c $20.00
Basic Metabolic Panel: BUN, Calcium, Creatinine, Electro, Glucose $15.00
Comprehensive Metabolic Panel: $25.00
Creatinine Clearance $60.00
Electrolyte panel: Chloride, ECO2, Potassium & Sodium $10.00
Gestational Diabetes Screen82952 x 2/83525 x 3 $45.00
Hepatic Panel: Albumin, ALP, ALT, AST, D. Bili & T. Bili $20.00
Hepatitis Panel: Hep A IgM Ab, HBC IgM Ab, HbsAG $85.00
Insulin Resistance Panel $125.00
Lipid Panel: Cholesterol, Coronary Risk Fact $20.00
Prenatal Panel $85.00
Renal function Panel: $22.00
3 Hour Glucose $75.00
Individual Tests CPT CODE Price
ABO/Rh8 6900/86901 $25.00
Albumin 82040 $13.00
ALP 84075 $13.00
ALT 84460 $13.00
Amylase 82150 $27.00
ANA 86038 $18.00
Antibody ID 86870 $100.00
Antibody Screen 86850 $40.00
AST 84450 $13.00
Bilirubin Total 82247 $20.00
BNP 83880 $100.00
BUN 84520 $13.00
Calcium 82310 $13.00
Calcium (Ionized) 82330 $40.00
CBC w/ Auto Diff 85025 $15.00
Chloride 82435 $13.00
Cholesterol Total 82465 $15.00
C-Peptide 84681 $70.00
CPK 82550 $30.00
Creatinine, Serum 82565 $13.00
Creatinine, Urine 82570 $25.00
CRP High Sensitivity 86140 $50.00
Culture, Blood* 87040 $60.00
Culture, Urine 87086 $25.00
Culture, Wound* 87070 $50.00
D Dimer 85379 $125.00
DHEA-SO 482627 $30.00
Digoxin 80162 $50.00
Direct Coombs (DAT) 86880 $35.00
Direct HDL 83718 $20.00
Direct LDL 83721 $20.00
ECO2 (bicarb) 82374 $20.00
ESR- Sed rate 85652 $20.00
Estradiol 82670 $30.00
Estrogen, Total* 82672 $55.00
Ferritin 82728 $25.50
Fetal Screen $80.00
Free T3 84481 $25.00
Free T4 84439 $25.00
FSH 83001 $50.00
Gen Probe* 87800 $50.00
GGT 82977 $40.00
Glucose 82947 $13.00
Gram Stain 87205 $35.00
Group B Strep. 87802 $25.00
H. Pylori 86677 $35.00
HCG Quant 84702 $30.00
Hematocrit 85014 $10.00
Hemoglobin 85018 $10.00
Hemoglobin A1C (HgB A1C) 83036 $20.00
Hemogram 85027 $10.00
Hepatitis B Surf Ag 87340 $30.00
Hepatitis C Antibody* 86302 $55.00
HIV* 86703 $20.00
H. pylori 86677 $18.00
Influenza 87400 $75.00
Insulin 83525 $20.00
Iron - Total 83540 $35.00
Iron Binding Capacity (TIBC) 83550 $70.00
Lipase 83690 $40.00
Lithium 80178 $65.00
Magnesium 83735 $20.00
Malb/Crea Ratio 82043 $50.00
Manual diff (peripheral blood smear) 85007 $15.00
Occult blood 82270 $20.00
Partial Thromboplastin Time (PTT) 85730 $35.00
Phenytoin, Free* 80186 $70.00
Phenytoin, Total* 80185 $45.00
Phosphorus 84100 $15.00
1 dayPotassium 84132 $13.00
Pregnancy Test, Serum or Urine 81025 $25.00
Progesterone 84144 $35.00
Prolactin 80418/80440/84146 $35.00
Protein, Total (Serum) 84155 $13.00
Protein, Total (Urine) 84156 $13.00
Protime (PT)/INR 85610 $30.00
PSA 84153 $20.00
PTH, Intact 83970 $50.00
Pyrilinks 82570/82523 $35.00/$75.00
Reticulocyte Count 85044/85045 $35.00
Rapid HIV- 186701 $18.00
Rapid Strep A 87880 $35.00
Rheumatoid Factor (RF), Qualitative 86430 $25.00
RPR 86592/86593 $32.00
Rubella 86762 $28.00
Rubeola, IgG* 86765 $60.00
Sex Hormone Binding Globulin (SBG) 84270 $45.00
Sodium 84295 $13.00
Tacrolimus 80197 $65.00 Testosterone, Free 84402 $45.00
Testosterone, Total 84403 $45.00
Thyroglobulin 84432 $45.00
Thyroid Peroxidase 86376 $45.00
Triglycerides 84478 $13.00
TSH 84443 $20.00
Uric Acid 84550 $13.00
Urine Dip 81003 $15.00
Urine Microscopic 81001 $15.00
Urine Culture 87086 $25.00
Valproic Acid 80164 $35.00
Vitamin B12 82607 $30.00
Vitamin D, 25-Hydroxy $40.00
Homocystine $50.00
HIV-1 $18.00
HIV-2 $18.00
RPR Panel $28.00
Clamidia/16G/1616M & Gnonoreia $295.00
HSB: Herpes 1 $70.00
HSB: Herpes 2 $70.00
