FWIC Laboratory Prices

Self-Pay Laboratory and X-ray Pricing

***All payments are due at time of service for Self-Pay patients
***These prices are not insurance prices and insurance will not be billed if paying as Self-Pay

Laboratory Test Self Pay Cost Laboratory Test Self Pay Cost
Amylase 25.00 Upper Respiratory Culture 80.00
ANA  without reflex code 164855 35.00 Uric Acid 40.00
ANA with Reflex code 164863 35.00 Urine Culture Comprehensive 60.00
Antinuclear Antibodies Direct 30.00 Urine Dip 10.00
Albumin/Creatinine Ratio 30.00 Variella-Zoster V Ab, IgG 50.00
Blood Type 45.00 Viral Culture General 135.00
CBC 40.00 Vitamin B12 and Folate 40.00
Celiac Panel 150.00 Vitamin D Hydroxy 60.00
Chem Panel (CMP) 40.00    
CMP14+LP+CBC/D/Plt+TSH 90.00 Xray  
CMP14+LP+CBC/DPlt+TSH +PSA 90.00 AC Joint 50.00
Cortisol 25.00 Ankle 50.00
C-Reactive Protein Cardiac 40.00 Chest 1 View 50.00
CRP 20.00 Chest 2 View 65.00
Estradiol 50.00 Chest 3 View 75.00
Ferritin 30.00 Clavicle 50.00
FSH and LSH 50.00 Elbow 3 View 50.00
GGT 40.00 Eyes Foreign Body 50.00
Glucose Finger Stick 10.00 Facial Bones Complete 55.00
Gon/Chlamydia 100.00 Femur 2 Views 60.00
H. Pylori, IgG Abs 40.00 Femur 3 Views 70.00
HCG, Qual 35.00 Fingers 2 Views 50.00
Hemoglobin A1c 35.00 Fingers 3 Views 60.00
Hepatitis Panel 90.00 Foot 3 Views 65.00
Hep A Ab, IgM 105.00 Forearm 2 Views 55.00
Hep B Surface Ab 100.00 Hand 3 Views 55.00
HIV 70.00 Heel 2 Views 50.00
HIV 1/2 Ab 150.00 Humerus 2 Views 60.00
HSV Culture without Typing 150.00 Knee 3 Views 60.00
Iron and TIBC 25.00 Sacrum/Coccyx 2 Views 50.00
Lipase 40.00 Sacrum/Coccyx 2 Views 50.00
Lipid Panel 40.00 SI Joint 3 Views 50.00
Magnesium 25.00 Sinuses 3 Views 50.00
Monospot 80.00 Skull 4 Views 80.00
Pap Smear 200.00 Spine Cervical 4 Views 80.00
Pap Smear w HPV/GC 485.00 Spine Lumbar 4 Views 80.00
Pap Smear w HPV 355.00 Spine Thoracic 3 Views 70.00
Prothrombin Time (PT/INR) 20.00 Spine Scoliosis 3 Views 80.00
PSA (only) 50.00 Tib/Fib 2 Views 50.00
PSA Serial Monitor 45.00 Toes 2 Views 50.00
Rapid Strep Test 30.00 Wrist 3 Views 50.00
Strep Culture Group A 90.00 Radiologist Read*** 15.00
Renal Panel 30.00    
Rheumatoid Arthritis Factor (RAF) 50.00    
RPR 45.00    
Sedimentation Rate Westergren (ESR) 30.00    
Testosterone Free and Total 90.00    
Urine Microalbumin 30.00    
Thyroid Panel 37.00    
Thyroid Panel with TSH 40.00    
T3 Uptake 15.00    
T4 15.00    
Trichomonas 155.00    

***All x-rays require a radiologist to read therefore will incur an additional charge of $15.00
All Prices are subject to change depending on complexity and time required for patient care. All prices are also in addition to the patient visit/consult price