Test Name
|
Patient Out of Pocket
|
|
| ABO, RH TYPE |
$25.00 |
| ALBUMIN |
$9.00 |
| ALK. PHOSPHATASE |
$10.00 |
| ALPHA-1-ANTIRYPSIN |
$25.00 |
| ALPHA-FETOPROTEIN TUMOR MARKER |
$30.00 |
| ALT (SGPT) |
$10.00 |
| AMMONIA |
$30.00 |
| AMYLASE |
$15.00 |
| ANA W/INTERNATIONAL UNITS & TITER |
$25.00 |
| ANEMIA PROFILE |
$135.50 |
| ARTHRITIS PROFILE |
$102.50 |
| ASO |
$15.00 |
| AST (SGOT) |
$10.00 |
| BASIC METABOLIC PANEL |
$20.00 |
| BILIRUBIN DIRECT |
$10.00 |
| BILIRUBIN TOTAL |
$10.00 |
| BIOPSY-1 |
$100.00 |
| BIOPSY-2 |
$200.00 |
| BIOPSY-3 |
$300.00 |
| BORRELIA BURGDORFERI IGG/IGM |
$35.00 |
| BUN |
$10.00 |
| C.DIFFICULE TOXIN |
$36.00 |
| CA 125 |
$35.00 |
| CA 15.3 |
$45.00 |
| CA 19.9 |
$45.00 |
| CALCIUM |
$10.00 |
| CBC W/DIFF |
$15.00 |
| CEA |
$35.00 |
| CELIAC DISEASE EVALUATION |
$120.00 |
| CHLAMYDIA TRACHOMATIS / NEISSERIA GONORRHOEAE |
$70.00 |
| CHLAMYDIA TRACHOMATIS BY REAL-TIME PCR |
$35.00 |
| CHLAMYDIA/N.GONORRHOEAE DNA, SDA |
$140.00 |
| CHLORIDE |
$8.00 |
| CHOLESTROL |
$15.00 |
| COMPREHENSIVE METABOLIC PROFILE |
$20.00 |
| COOMBS INDIRECT |
$55.00 |
| CORTISOL |
$25.00 |
| CREATINE KINASE (CPK) |
$15.00 |
| CREATININE |
$10.00 |
| CREATININE URINE 24 HR. |
$20.00 |
| CRP-HS |
$25.00 |
| CRP-NON CARDIAC (QUANT) |
$25.00 |
| CYCLIC CITRULLINATED PEPTIDE (CCP) IGG AB. |
$75.00 |
| CYSTIC FIBROSIS |
$250.00 |
| DIGOXIN |
$25.00 |
| DILANTIN |
$25.00 |
| DNA AUTOANTIBODIES, DOUBLE-STRANDED |
$27.00 |
| DRUGS OF ABUSE SCREEN SERUM W/O CONFIRMATION |
$50.00 |
| DRUGS OF ABUSE SCREEN URINE W/REFLEX CONFIRMATION |
$25.00 |
| EAR CULTURE |
$25.00 |
| EBV PROFILE |
$155.66 |
| ELECTROLYTES |
$15.00 |
| ESTRADIOL |
$51.00 |
| ESTROGEN |
$40.00 |
| FECAL LEUKOCYTES |
$15.00 |
| FERRITIN |
$25.00 |
| FIBRINOGEN |
$28.00 |
| FOLATE |
$25.00 |
| FSH |
$34.00 |
| GARDNERELLA VAGINALIS BY REAL-TIME PCR |
$35.00 |
| GENITAL CULTURE |
$25.00 |
| GENITAL ULCER DISEASE PANEL BY REAL-TIME |
$35.00 |
| GGT |
$15.00 |
| GLUCOSE FASTING |
$30.00 |
| GLUCOSE PP 1HR |
$10.00 |
| GLUCOSE PP 2 HR |
$10.00 |
| H. PYLORI AB. IGG |
$35.00 |
| H. PYLORI UBIT |
$70.00 |
| HCG BETA SUB. QUAL. |
$28.00 |
| HCG BETA SUB. QUANT. |
$28.00 |
| HELICOBACTER PYLORI IGM ABS. |
$25.00 |
| HELICOBACTER PYLORI ANTIGEN STOOL |
$40.00 |
| HEMOGLOBIN A1C |
$20.00 |
| HEPATIC FUNCTION PANEL |
$20.00 |
| HEPATITIS A TOTAL AB. |
$55.00 |
| HEPATITIS A VIRUS AB IGM |
$25.00 |
| HEPATITIS B CORE AB |
$25.00 |
| HEPATITIS B CORE AB IGM |
$25.00 |
| HEPATITIS B VIRUS SURFACE ANTIBODY QUANT. |
$30.00 |
| HEPATITIS BS AB. |
$25.00 |
| HEPATITIS BS AG. |
$25.00 |
| HEPATITIS C AB |
$25.00 |
| HERPES SIMPLEX VIRUS TYPE 2 IGM AB. |
$35.00 |
| HERPES SIMPLEX VIRUS TYPES 1 & 2 IGG |
$70.00 |
| HERPES SIMPLEX VIRUS TYPES 1 & 2 1GM |
$55.00 |
| HIV-1/HIV-2 AB WITH REFLEX TO WB |
$25.00 |
| HOMOCYSTEINE |
$31.00 |
| HPV TYPE DETECT BY PCR |
$35.00 |
| HSV-1, HSV2 BY REAL TIME PCR |
$35.00 |
| ID & SUSCEPTIBILITY |
$15.00 |
| IGE, TOTAL |
$30.00 |
| INLFUENZA A VIRUS AG |
$35.00 |
| INFLUENZA B VIRUS AG |
$35.00 |
| INFLUENZA VIRUS, TYPES A & B DETECTION (DFA) |
$40.00 |
| INFLUENZA VIRUS A & B IGG/IGM AB. |
$40.00 |
| INSULIN |
$20.00 |
| IRON |
$15.00 |
| LEAD, WHOLE BLOOD |
$25.00 |
| LH |
$40.00 |
| LIPASE |
$15.00 |
| LIPID PROFILE |
$30.00 |
| LIPID PROFILE & LDL |
$40.00 |
| LITHIUM |
$45.00 |
| MAGNESIUM, SERUM |
$15.00 |
| MALARIA, SMEAR |
$15.00 |
| MEASLES IGG AB. |
$20.00 |
| METANEPHRINES FRACTIONATED 24HR URINE |
$45.00 |
| MICROALBUMIN/CREATININE RATIO |
$30.00 |
| MMR |
$50.00 |
| MONOSPOT |
$15.00 |
| MUMPS IGG |
$35.00 |
| MUMPS IGG & IGM |
$60.00 |
| MUMPS IGM |
$35.00 |
| MYCOPLASMA GENITALIUM BY PCR |
$30.00 |
| MYCOPLASMA HOMINS BY PCR |
$35.00 |
| NEISSERIA GONORRHOEAE BY PCR |
$35.00 |
| OVA & PARASITE ROUTINE EXAM X3 |
$50.00 |
| OVA & PARASITE WORM IDENTIFICATION |
$35.00 |
| PAP SMEAR |
$30.00 |
| PAPILLO VIRUS SCREEN |
$60.00 |
| PARVOVIRUS B19 IGG & IGM AB. |
$25.00 |
| PHENOBARBITAL |
$30.00 |
| PHOSPHOROUS, SERUM |
$10.00 |
| PITUITARY PROFILE |
$150.00 |
| POTASIUM, SERUM |
$10.00 |
| PROGESTERONE |
$38.00 |
| PROLACTIN |
$35.00 |
| PROSTATIC ACID PHOS. |
$45.00 |
| PROTEIN TOTAL |
$7.00 |
| PSA FREE |
$60.00 |
| PSA FREE & TOTAL |
$60.00 |
| PSA TOTAL |
$34.00 |
| PT/INR |
$10.00 |
| PTT |
$15.00 |
| RETICULOCYTE CELL COUNT |
$15.00 |
| RHEMATOID FACTOR |
$15.00 |
| ROUTINE CULTURE |
$40.00 |
| RPR |
$15.00 |
| RUBELLA IGG AB. |
$30.00 |
| SED RATE (ESR) |
$10.00 |
| SICKLE CELL SCREEN |
$45.00 |
| SM (SMITH) IGG AUTOANTIBODIES |
$30.00 |
| SODIUM |
$8.00 |
| STOOL COMPREHENSIVE CULTURE REFLEX TO SUSCEPTIBILTY |
$30.00 |
| T3 TOTAL |
$25.00 |
| T3 UPTAKE |
$12.00 |
| T4 (FREE THYROXINE) |
$20.00 |
| T4 TOTAL |
$26.00 |
| TEGRETOL |
$27.00 |
| TESTOSTERONE, FREE & TOTAL |
$80.00 |
| TESTOSTERONE, TOTAL |
$40.00 |
| THEOPHYLLINE |
$35.00 |
| THIN PRE PAP W/RFX HPV |
$90.00 |
| THIN PREP |
$50.00 |
| THROAT CULTURE |
$15.00 |
| THYROID AUTOANTIBODIES |
$50.00 |
| THYROID PEROXIDASE AUTOANTIBODIES |
$15.00 |
| THYROID PROFILE |
$60.00 |
| TIBC |
$16.00 |
| TSH |
$30.00 |
| URIC ACID |
$10.00 |
| URIC ACID 24HR URINE |
$15.00 |
| URINALYSIS |
$7.50 |
| URINE C & S |
$15.00 |
| URINE CYTOLOGY |
$40.00 |
| URINE MICROSCOPY |
$7.50 |
| VAGINAL CULTURE |
$40.00 |
| VALPORIC ACID |
$30.00 |
| VANILLYMANDELIC ACID 24HR URINE |
$30.00 |
| VARICELLA ZOSTER VIRUS IGG, AB. |
$20.00 |
| VITAMIN B-12 & FOLATE |
$50.00 |
| VITAMIN B-12 |
$25.00 |
| VITAMIN D-25 HYDROXY (CALCIFEDIOL) |
$50.00 |
| WOUND CULTURE |
$50.00 |
| ZINC |
$20.00 |
