Most Frequently Ordered Tests
Patient Discounted Fee Schedule
For Patients Without Insurance
Mid America Clinical Laboratories
2560 N Shadeland Avenue
Indianapolis, IN 46219
Last Updated: 5/7/2014
Mid America Clinical Laboratories is now offering discount laboratory fees for self-pay patients at our Patient Care Centers (PCCs). As part of
this offering, we have implemented a policy for payment up to $150.00 at the time of service. Any remaining balance will be billed directly to
the patient.
We will accept personal checks, Money Orders, Visa, MasterCard or American Express. For the safety of everyone, cash will not be accepted.
Lab tests collected at our Patient Care Centers are eligible for the discounted prices. It will be the responsibility of the patient to bring the inoffice collected specimens to our PCCs for processing and payment.
AB SCR RFX ID/TITER
ABO GROUP & RH TYPE
ADULT FOOD ALLERGY PNL
ALBUMIN
ALLERGY REGION 5 PNL
ALT
TEST
CODE
795
7788
10715
223
51315
823
$ 20.00
$ 25.00
$ 180.00
$ 15.00
$ 370.00
$ 15.00
AMYLASE
ANA TITER & PATTERN
ANA W/REFLEX
ANTI DSDNA AB, EIA
AST
BASIC METABOLIC PNL
BRAIN NATRI. PEPTIDE
BV & VAGINOSIS SCR, DNA
C DIFF TOXIN A & B
CA 125
CA 27.29
CALCIUM
243
36209
249
255
822
10165
37386
14577
37212
29256
29493
303
CALCIUM, IONIZED
CARDIO CRP
CBC (DIFF/PLT)
CBC (DIFF/PLT) W/SMEAR REVIEW
CBC (H/H, RBC, WBC, PLT)
CEA
CELIAC DISEASE COMP
CF CARRIER SCREEN
CHOLESTEROL, TOTAL
CK, TOTAL
COMP METABOLIC PNL
CORTISOL, A.M.
CORTISOL, TOTAL
C-PEPTIDE
CREATININE CLEARANCE
CREATININE W/EGFR
TEST NAME
CRP
CT/NG DNA, SDA, OTV
CT/NG SDA
CULTURE, AEROBIC BACTERIA
CULTURE, BLOOD
CULTURE, GENITAL
TEST
CODE
4420
17618
17305
4550
389
4558
$ 33.09
$ 102.55
$ 102.55
$ 40.95
$ 51.03
$ 20.00
$ 22.53
$ 32.00
$ 20.00
$ 39.00
$ 15.00
$ 20.58
$ 85.20
$ 140.00
$ 25.00
$ 55.00
$ 73.08
$ 15.00
CULTURE, GP. A STREP
CULTURE, THROAT
CULTURE, URINE ROUTINE
CULTURE, AEROBIC/ANAEROBIC
CULTURE, STOOL (S/S/C)
CYTO, THINPREP PAP
DHEA-SULFATE
DIRECT LDL
DRAW FEE, PSC SPECIMEN
DRUG SCREEN 10-50
EBV AB SCREEN
ELECTROLYTE PANEL
4485
394
395
4446
10045
35455
402
8293
3259
2126
6421
34392
$ 25.00
$ 35.91
$ 25.00
$ 35.00
$ 57.03
$ 30.00
$ 50.00
$ 23.00
$ 5.00
$331.80
$ 75.00
$ 17.15
306
10124
6399
20253
1759
978
19955
10458
334
374
10231
4212
367
$ 15.00
$ 30.00
$ 19.00
$ 20.16
$ 17.00
$ 30.00
$ 112.14
$ 357.00
$ 6.40
$ 14.00
$ 25.71
$ 21.00
$ 21.00
ESTRADIOL, ORAL HRT
FERRITIN
FOLATE, SERUM
FSH
GAMMA, GLUT TRANSPEP
GLUCOSE, GEST. SCREEN
GLUCOSE, PLASMA
GLUCOSE, SERUM
GRP A STREP PROBE
HANDLING CHARGE
HCG, SERUM, QUAL
HCG, SERUM, QUANT
HEMOGLOBIN A1C
429
457
466
470
482
8477
484
483
14565
3251
8435
8396
496
$
$
$
$
$
$
$
$
$
$
$
$
$
372
7943
11360
$ 85.05
$ 23.00
$ 15.75
HEP B SURFACE AB QL
HEP B SURFACE AB QN
HEP B SURFACE AG
499
8475
498
$ 23.00
$ 25.00
$ 15.00
FEE
TEST NAME
FEE
55.00
25.00
47.85
30.00
15.00
11.00
15.00
15.00
67.53
28.59
13.75
15.00
20.00
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Patient Discounted Fee Schedule Continued….
TEST
CODE
FEE
HEP C AB
HEP PNL ACUTE W/REF
HEPATIC FUNCTION PNL
HETEROPHILE, MONO
HGB & HCT
HIV 1/2 AB SCREEN W/REFLEX
HOMOCYSTEINE, CARDIO
HPV HR
8472
10306
10256
654
7998
19728
31789
31532
$ 25.00
$ 159.25
$ 19.71
$ 12.00
$ 12.00
$ 25.00
$ 30.00
$ 51.30
HSV 1/2 HERPESELECT
IMAGE ASSISTED THIN PREP PAP
IMAGE ASSISTED THIN PREP NO HPV
IMAGE ASSISTED THIN PREP W/HPV
IMMUNOFIXATION, SERUM
IMMUNOGLOBULIN GAM
INSULIN
IRON, TOTAL
IRON, TOTAL & IBC
LDH
LEAD (B)
LIPASE
6447
51180
51179
51181
549
7083
561
571
7573
593
599
606
$
$
$
$
$
$
$
$
$
$
$
$
LIPID PANEL
LIPID PNL W/REFLEX DIRECT LDL
LITHIUM
LUTEINIZING HORMONE
MAGNESIUM
MALB, RANDOM URINE W/O CREAT
MATERNAL SERUM 4
METHYLMALONIC
MICROALB/CREATININE RATIO
OBSTETRIC PANEL
OVA AND PARASITE
PATH REVIEW, LIQ PAP
7600
14852
613
615
622
17674
30294
34879
6517
20210
681
15118
PHOSPHATE (AS PHOS.)
POTASSIUM
PREALBUMIN
PROTIME W/INR
PROGESTERONE
PROLACTIN
PROSTATE SPECIFIC AG
PROTEIN ELECTRO
PROTEIN/CREATININE RATIO
PTH, INTACT/IRMA
PTT, ACTIVATED
718
733
4847
8847
745
746
5363
747
51095
35203
763
TEST NAME
TEST
CODE
FEE
QUANTIFERON - TB
RENAL FUNCTION PANEL
RETICULOCYTE COUNT
RHEUMATOID FACTORS
RPR (DX) REFL FTA
RUBELLA AB, EIA
SED RATE BY MOD WEST
SJOGREN'S ANTIBODIES
51265
10314
793
4418
36126
802
809
7832
$ 110.00
$ 22.29
$ 20.49
$ 15.00
$ 9.50
$ 21.05
$ 8.00
$ 78.00
CULTURE, STREP GRP B
T-3, UPTAKE
T-3, FREE
T-3, TOTAL
T-4, (THYROXINE)
T-4, FREE
TACROLIMUS
TESTOSTERONE, FREE & TOTAL
TESTOSTERONE, TOTAL
TESTOSTERONE, FREE, TOT, BIO
THINPREP W/HPV
THINPREP REFLEX HPV
5617
861
34429
859
867
866
34482
36170
873
14966
15003
31530
$ 35.00
$ 15.00
$ 45.00
$ 28.00
$ 15.00
$ 20.00
$ 98.91
$110.00
$ 60.00
$149.19
$ 81.30
$ 30.00
$ 27.45
$ 27.45
$ 30.87
$ 32.00
$ 25.68
$ 39.00
$ 91.90
$ 119.70
$ 18.00
$ 75.00
$ 75.00
$ 33.00
THINPREP NO HPV
THYROID MICROSOME AB
TP RANDOM URINE W/CREAT
TRIGLYCERIDES
TSH
TSH W/REFLEX FT4
UREA BREATH TEST - H. PYLORI
UREA NITROGEN (BUN)
URIC ACID
URINALYSIS, COMP RFX CULTURE
URINALYSIS, COMPLETE
URINALYSIS, MICROSCOPIC
35455
5081
1715
896
899
36127
14839
294
905
3020
5463
8563
$ 30.00
$ 30.00
$ 53.25
$ 9.05
$ 26.75
$ 26.75
$108.00
$ 15.00
$ 10.00
$ 8.00
$ 8.00
$ 7.75
$
$
$
$
$
$
$
$
$
$
$
URINALYSIS, REFLEX
VALPROIC ACID
VARICELLA VIRUS IGG AB, EIA
VITAMIN A
VITAMIN B1, (TPP)
VITAMIN B12
VITAMIN B12, FOLIC ACID
VITAMIN D 25 HYDROXY LC/MS
7909
916
4439
921
5042
927
7065
17306
$
$
$
$
$
$
$
$
72.00
37.50
37.50
88.80
95.76
86.94
18.75
15.00
28.00
18.00
45.00
10.00
15.00
15.00
63.00
8.00
35.00
38.00
28.75
25.00
52.14
65.00
15.00
TEST NAME
8.00
53.40
28.25
69.00
78.00
44.00
99.75
55.00
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