Transparent Pricing
I have a “client-billing” arrangement with LabCorp that allows me to offer my patients discounted prices that are significantly below market rates. If you are curious about the cost of a test not on this list, please let me know.
Enrollment Panel
The following labs constitute my standard screening panel that I suggest for nearly all new patients. This test panel can tell me a great deal about your general health; it includes tests for diabetes and prediabetes, heart disease, thyroid function, lipids (including not just a standard lipid panel, but also Lipoprotein(a) and Apolipoprotein B / A-1 ratio), autoimmune diseases, inflammation, anemia, gout, kidney problems, liver problems, vitamin deficiencies, and electrolyte imbalances … among other things.
If you do not have known issues with diabetes or hypoglycemia then I recommend a 12-hour fast (i.e. nothing to eat or drink except water) before getting this battery of tests. If you do have diabetes – particularly if you use insulin or other medications that can cause hypoglycemia – then you do not need to fast beforehand.
I’ll also mention that most medications and supplements are okay to take up until the day of the test, but there are 3 that you should be careful about: biotin, Vitamin D, and T3-containing thyroid medications. Biotin – please avoid taking supplemental biotin for at least 2-3 days beforehand as several lab-tests are biotin-dependent and the results might be skewed. (While multivitamins and B vitamins commonly have some biotin in them, the amounts involved are less likely to be a problem than a dedicated biotin supplement, so a 24 hour interval should be sufficient for those.) Vitamin D – avoid taking supplemental Vitamin D the evening before or the morning of the test. Thyroid – levothyroxine (aka Synthroid) is fine to take on the morning of your labs, but if you are taking a T3-containing thyroid medication (e.g. Armour, NP-Thyroid, Cytomel) it might be best if you could time things so that you take your last dose of medicine the evening before your lab draw, ideally about 12 hours before your lab appointment.
| Lab | Cost |
|---|---|
| Amylase & Lipase | $8 |
| Antinuclear Antibodies (by IFA) | $4.50 |
| Apolipoprotein A1 & B ratio | $13.25 |
| Complete Blood Count (CBC) w/diff | $3 |
| Comprehensive Metabolic Panel (CMP) | $4.25 |
| Creatine Kinase | $2.50 |
| CRP, high-sensitivity | $7 |
| Ferritin | $3 |
| GGT | $2.50 |
| Hemoglobin A1c | $3.50 |
| Homocysteine | $15 |
| Insulin | $5.25 |
| Iron and TIBC | $3.75 |
| Lactate Dehydrogenase (LDH) | $2.50 |
| Lactic Acid, Plasma | $10 |
| Lipid Panel | $3.75 |
| Lipoprotein(a) | $9.50 |
| Magnesium, RBC | $20 |
| Phosphorous | $2.50 |
| Prolactin | $5.25 |
| TSH, Free T4, and Free T3 | $10 |
| Uric Acid | $2.50 |
| Urinalysis | $2.50 |
| Vitamin B-12 & Folate | $10 |
| Vitamin D, 25-hydroxy | $13.75 |
| Total Cost: | $167.75 |
Thyroid Lab Panel
The following is my standard thyroid panel. It’s pretty good at allowing me to detect and manage a wide range of thyroid-related issues.
| Lab | Cost |
|---|---|
| TSH (Thyroid Stimulating Hormone) | $3.75 |
| Free T4 | $4.13 |
| Free T3 | $4.13 |
| Reverse T3 | $19.88 |
| Anti-thyroglobulin | $5.25 |
| Anti-TPO (thyroid peroxidase) | $8 |
| Total Cost | $45.14 |
Adrenal & Sex Hormone Tests
- 17-Hydroxy-progesterone: $7.50 – a metabolite of progesterone, important in the production of cortisol.
- ACTH: $12.50 – a pituitary hormone that stimulates production of many other hormones including cortisol.
- Aldosterone:$13.25 – adrenal hormone that’s critically important for regulating blood pressure and telling the kidney to eliminate potassium and retain sodium.
- Androstenedione: $10 – a mild androgen, derived from DHEA, and an important precursor to testosterone.
- Corticosteroid Binding Globulin – $34 – the main transporter protein that carries cortisol; aids in helping to determine how much of the measured total cortisol is in the bound form and how much is in the free (active) form.
- Cortisol: $6.30 – the primary hormone of energy mobilization, made in the adrenal glands. High levels may be associated with anxiety and weight gain.
- DHEA: $24 – a precursor to the sex hormones (particularly in women), made in the adrenal glands.
- DHEA Sulfate: $6 – a DHEA metabolite that’s easier (and cheaper) to measure, made in the adrenal glands.
- Estradiol: $7 – the primary female sex hormone; drives breast development when unopposed by progesterone; important for health in both sexes (particularly bone health).
- Follicle Stimulating Hormone (FSH): $4.50 – a pituitary gonadotropin hormone that drives the production of eggs and estrogen (in women) and maintains testicular health (in men). Helps to stimulate production of all adrenal and sex hormones.
- Luteinizing Hormone (LH): $4.50 – a pituitary gonadotropin hormone that drives production of the uterine lining (in women) and testosterone production (in men). Helps to stimulate production of all adrenal and sex hormones.
- Pregnenolone: $46.69 – an important endocannabinoid precursor hormone and neurosteroid. Active throughout the body, particularly the brain. Low levels may be associated with fatigue.
- Prolactin: $5.25 – a pituitary hormone that stimulates the breasts to produce milk. At high levels, may decrease estradiol and testosterone production.
- Progesterone: $8 – in women, the hormone of pregnancy, produced in part in the adrenals and in part in the ovaries. High levels may suppress ovulation. Acts as a GABA agonist within the brain to improve sleep quality.
- Testosterone, total (men): $6 – the primary sex hormone in men; contributes to libido, muscle growth, and a feeling of well-being in both sexes.
- Testosterone, free & total (men): $15
- Testosterone, free & total (high-sensitivity, appropriate for women and hypogonadal men): $21.85
Pap Smears & Sexual Health
- Basic Pap Smear: $26 – a pap smear is a test looking for the presence of abnormal cancerous or precancerous cells on the cervix. Under current guidelines, a pap smear is good for 3 years if results are normal with no recent history of an abnormal pap or high-risk HPV infection.
- HPV / Human Papilloma Virus: $45 – adding this test to a basic pap smear increases the sensitivity for detection of disease by looking for the virus that causes cervical cancer. If this test is done and both the pap smear and HPV test come back normal then current guidelines suggest you won’t need another pap smear for 5 more years.
Anemia Tests
- CBC (complete blood count) with differential & platelets: $3 – shows the amounts and sizes of the various types of cells that make up blood.
- Ferritin: $3 – best measure of iron stores but may also be elevated in inflammatory conditions.
- Iron & TIBC: $3.60 – measures of the amount of iron and the amount of available transferrin iron binding sites.
- Folate (RBC): $6.40 – a critically important vitamin that may be deficient in patients with anemia, fatigue, memory problems, or sensory neuropathy.
- Vitamin B-12: $6 – a critically important vitamin that may be deficient in patients with anemia, fatigue, memory problems, or sensory neuropathy.
- Methylmalonic Acid: $22.35 – a more accurate test for Vitamin B-12 deficiency; assesses tissue level B-12 deficiency, not just serum B-12 level.
- Plasma Zinc: $9
- Serum Copper: $18.75
Cardiovascular Disease Tests
- Lipid panel: $3.75 – the standard “no frills” cholesterol test. Reports Total cholesterol, LDL cholesterol, VLDL cholesterol, HDL cholesterol, and triglycerides.
- ADMA/SDMA (asymmetric and symmetric dimethylarginine): $32 – these arginine metabolites may lead to a number of circulatory problems and are particularly problematic in people with poor kidney function.
- Apolipoprotein A-1 & Apolipoprotein B: $13.25 – protein markers that reflect HDL and LDL particle numbers, respectively. Particle numbers are more accurate predictors of future cardiac problems and strokes than HDL and LDL cholesterol levels.
- NMR Advanced Lipid Profile: $39.38 – a more in-depth lipid panel that includes direct measurement of particle numbers and particle sizes.
- Lipoprotein(a): $9.50 – a separate fraction of LDL cholesterol that can significantly increase risk for cardiac events. Highly heritable.
- High-sensitivity C-reactive Protein (hsCRP): $7 – a test for accurately detecting lower levels of C-reactive protein that may be suggestive of coronary artery disease.
- Homocysteine: $15 – implicated in many problems; higher levels are associated with increased risk of heart attacks, strokes, and dementia.
- Oxidized LDL: $32 – measurement of the damaged fraction of LDL cholesterol that is most responsible for driving atherosclerosis.
- Lp-PLA2: $31 – a marker for ongoing atherosclerotic disease.
Diabetes Tests
- Hemoglobin A1c: $3.38 – a test that provides a rough estimate of what average blood glucose levels have been like for the past 90-120 days.
- Urine microalbumin (protein)/creatinine ratio: $8 – a test that shows vascular disease in the kidneys, common in people with diabetes.
- C-peptide: $8 – a test to assess residual insulin production in someone who injects insulin for diabetes.
- Insulin: $5.25 – an even mildly elevated fasting insulin (meaning “over about 5”, in my book) is one of the earliest warning signs of insulin resistance. The higher the fasting insulin, the more profound the insulin resistance and the greater the likelihood of developing obesity, diabetes, fatty liver, heart disease, and cancer.
Other Labs
- Lyme antibody (total) with reflex to Western Blot: $16.25 (chronic fatigue, chronic headaches, chronic joint pains – not useful for those previously diagnosed with Lyme disease)
- Lyme Western Blot confirmatory testing: $23 (may not be useful for those previously diagnosed with Lyme)
- Ovarian cancer (*) – see below
- Prostate Screening Antigen (PSA): $5.25 (**); Total PSA with %free PSA: $13.13 (better for those with known history of elevated or borderline elevated PSA)
- Uric Acid: $2.50
- Vitamin D level: $13.75
- Magnesium, RBC: $19.88 (***)
In-office
In-office fingerstick glucose testing and urine dipstick tests are complimentary.
Genetic Testing
Although I am generally a proponent of genetic testing, I recognize that many people have concerns that somebody (whether themselves or others) might learn learn something about them that they would rather not have known. Although I will not attempt to address privacy concerns beyond noting that there are (currently) laws prohibiting health insurance companies and large employers from genetic discrimination, I strongly believe there can be significant benefits to having personal access to one’s own genetic information. In particular it’s important to know that genetic predispositions are not destiny: environmental factors are crucial in determining how likely we are to actually develop many major health problems. Potentially avoidable tragedies include such things as Alzheimer’s Disease, cancer, diabetes, heart disease, and Parkinson’s. (Yes, really!) In other cases genetic sequencing can help us make diagnoses of existing problems or identify which interventions are likely to work and which are likely to be ineffective (personalized medicine).
For most people who are interested in learning something about their genes but don’t have much money to spend I recommend getting their genome sequenced through 23andme.com. The 23andme Ancestry test actually includes the same SNP sequencing data as their more expensive Ancestry and Health test and is normally available for only $99, but is occasionally offered for less when they are running a special. Due to legal restrictions imposed by the FDA, the health reports offered by 23andme aren’t nearly as useful as the raw data files they also give you access to. You can use your raw 23andme data to obtain much more useful reports from third-party analysis services such as Genetic Genie, Livewello, or Promethease (among others).
Ancestry.com is another reasonable option for obtaining SNP data. The last time I checked, I had the sense that it may be slightly inferior to 23andme for health-related information but slightly superior for genealogy.
Whole Genome Sequencing (“WGS”) is the gold standard of genetic sequencing in most cases because it allows one to get effectively ALL of their DNA data. As of this writing (November, 2021) WGS with 30x average sampling (“clinical grade”) is now available for only $299 from Nebula Genomics.
Additional Notes
(*) As of 2018, the marker tests for ovarian cancer screening (e.g. CA-125) are considered worthless by the FDA, the American College of Obstetricians and Gynecologists, and the US Preventive Services Task Force (among others). In the case of CA-125, for example, too many false positives occur, leading to an abundance of testing by ultrasound; an abnormality on ultrasound (which could also come from common things like ovarian cysts) then leads to a great number of exploratory surgeries — of which only about 1 in 20 will find a cancer.
Even ignoring all of the grief, worry, and extra surgeries caused by the huge numbers of false positives, it turns out there is no statistical difference in terms of the number of lives saved by testing for these markers. Unfortunately, by the time the CA-125 test turns positive, the cancer has generally already spread. Other markers (or panels of several markers) have not been shown to be any more effective.
Ovarian cancer is estimated to kill about 1 in 75 US women. Although the future holds some hope for the early detection of ovarian and other cancers (based on screening for oncogenic microRNA expression patterns), that technology has yet to arrive in physician offices. For now genetic screening (as discussed above) remains the most reasonable and effective means of identifying at-risk women.
(**) I do not necessarily recommend PSA testing, but I also do not necessarily recommend against obtaining it. It should be recognized that there are pros and cons associated with checking a PSA. It may be valuable for detecting prostate cancer at an early stage, but there is a great deal of controversy surrounding the wisdom of doing so, particularly for older men. This is because prostate cancer is usually a slow growing disease. Most men with prostate cancer will grow old and die from something else without ever knowing they have it — unless we test for it. Aggressive treatment of prostate cancer commonly results in undesirable side effects with only marginally increased odds of longer-term survival. (Please note the abundance of italicized weasel words, however; although the US Preventive Services Task Force recommends against the PSA for prostate cancer screening, different men have different priorities, so the choice is up to you.) If you have previously been treated for prostate cancer, then a high-sensitivity PSA is still recommended. For an informed perspective from a man treated for early prostate cancer that was detected by an elevated PSA, you might want to see this article from Men’s Health magazine.
(***) Due to inadequate consumption of green leafy vegetables, magnesium deficiency in Americans is now more common than not. It has many consequences, some of them fairly profound. There are two readily available tests to assess magnesium status: The cheap test (serum magnesium) is essentially worthless for most people most of the time as it generally shows a “normal” serum magnesium level even in people with a profound and symptomatic magnesium deficiency. The RBC magnesium test is better because instead of looking to see how much magnesium is floating around in between the blood cells, it measures how much magnesium is actually inside the blood cells — which turns out to be a much better gauge of overall magnesium levels in our tissues.