What blood work costs: the lab fee schedule against a hospital lab bill

Three things to know before reading any lab price

1. A lab bill is a list of codes. Each test, and the blood draw, has its own five-character code and its own price. A quoted "blood work price" is a sum of codes someone has chosen, and it is only as good as the list behind it.
2. The Medicare rate is not set by a government cost study. CMS says the payment amount for most tests equals the weighted median of private payor rates for the test, collected from labs and updated on a three-year cycle. That ties it to what labs report private payers paying, which is not the same as what any one lab charges a patient.
3. Medicare pays a hospital lab and a stand-alone lab from the same fee schedule. For a cash or commercial patient that says nothing about price: each lab sets its own charge or negotiates its own rate, and a hospital bill can carry other charges as well.

This page gives the Medicare anchors for 29 common codes, shows how hospital outpatient billing treats them, and ends with a script for asking a lab or hospital for its cash price. It does not say which tests anyone should have. Every number is from CMS files read on October 23, 2026.

How the fee schedule is built, and why it matters for a quote

The CMS fact sheet on the clinical laboratory fee schedule (MLN006818, March 2026) sets out the mechanics in six points that matter to a patient reading a quote.

• Medicare pays for clinical diagnostic laboratory tests under the Clinical Laboratory Fee Schedule, and for most of them the amount equals the weighted median of private payor rates for the test.
• Labs report that private payor data to CMS every three years, so a rate stays in effect for three calendar years until the next data collection period.
• CMS does not make geographic adjustments to the rates. A code pays the same in every state, unlike a physician fee, which this site prices for one locality.
• For 2026 there is no phase-in payment reduction. For 2027 through 2029, CMS says it will not reduce a payment by more than 15 percent per year compared with the amount for the preceding year. The next data reporting period ran from May 1 to July 31, 2026.
• Hospital labs, physician office labs and independent labs are all covered settings for diagnostic clinical lab services.

The practical effect is that a quote far above the table below is a quote you can ask about, but also that a quote at or below it is not evidence of a bargain: private payers negotiate around these figures, and a lab that sells to the public may price on its own basis. The Medicare anchor tells you the order of magnitude and which code is doing the work. It does not tell you what you will be billed.

Medicare lab rates by test, 2026

The rates below are from the CMS clinical laboratory fee schedule public use file for the fourth quarter of 2026 (26CLABQ4, 2,243 records). The right-hand column shows each code's status in the hospital outpatient addendum of October 14, 2026: A means the code is paid under a fee schedule outside the outpatient hospital rates, and Q4 means conditionally packaged, as explained in the next section.

Code	CMS descriptor	2026 Medicare rate	Hospital outpatient status
36415	Collection of venous blood by venipuncture	$9.34	Q4
80048	Basic metabolic panel (calcium, total)	$8.46	Q4
80051	Electrolyte panel	$7.01	Q4
80053	Comprehensive metabolic panel	$10.56	Q4
80061	Lipid panel	$13.39	A
80069	Renal function panel	$8.68	Q4
80076	Hepatic function panel	$8.17	Q4
81001	Urinalysis, automated, with microscopy	$3.17	Q4
81003	Urinalysis, automated, without microscopy	$2.25	Q4
82043	Urine albumin, quantitative	$5.78	Q4
82306	Vitamin D, 25 hydroxy	$29.60	Q4
82565	Creatinine, blood	$5.12	Q4
82947	Glucose, quantitative, blood	$3.93	A
83036	Hemoglobin A1c	$9.71	Q4
83735	Magnesium	$6.70	Q4
84153	Prostate specific antigen, total	$18.39	Q4
84439	Thyroxine, free	$9.02	Q4
84443	Thyroid stimulating hormone	$16.80	Q4
85025	Complete blood count with automated differential	$7.77	Q4
85027	Complete blood count, automated	$6.47	Q4
85610	Prothrombin time	$4.29	Q4
86803	Hepatitis C antibody	$14.27	Q4
87086	Urine culture, colony count	$8.07	Q4
87389	HIV-1 antigen with HIV-1 and HIV-2 antibodies	$24.08	Q4
87635	COVID-19 amplified probe test	$51.31	A
87804	Influenza assay, optical	$16.55	Q4
87880	Strep A assay, optical	$16.53	Q4
80307	Drug test, presumptive, chemistry analyzer	$62.14	Q4
G0103	PSA screening	$19.31	A

The span of the table is narrow: 25 of the 29 rates are under $20, and the four exceptions are a drug screen at $62.14, a COVID-19 test at $51.31, vitamin D at $29.60 and an HIV screen at $24.08. That has an effect on how a bill reads. A typical order is four or five low-priced lines plus one draw, and what moves the total is rarely any single test. It is the number of lines and whatever sits outside the lab claim.

A worked order shows the scale. A hypothetical order for a comprehensive metabolic panel (80053), a complete blood count with differential (85025), a lipid panel (80061), a hemoglobin A1c (83036) and a TSH (84443), with one venipuncture (36415), has six lines. At the Medicare rates they are $10.56, $7.77, $13.39, $9.71, $16.80 and $9.34, and the sum of the six lines is $67.57. That sum is a Medicare payment for six separate lines on a claim, not a price for blood work, and nothing here suggests that anyone should order that list. It shows only that a quote of several hundred dollars for the same six codes is a quote worth taking apart line by line.

What differs on a hospital outpatient lab bill

Medicare's pricing of the test is the same in both settings. What differs is the structure of the bill. Three features recur, and each is checkable from the itemized statement.

The draw is its own line

Specimen collection is billed with its own code, 36415, priced at $9.34 in 2026. It is billed per draw, not per test. A hospital outpatient lab, a patient service center or a physician office can bill it, depending on where the blood is drawn. A bill that carries the collection code several times on one date of service, or carries it on a visit where no blood was drawn, is a line to question.

The test can be packaged into a visit

The status column in the table matters when a lab test is done in the course of a hospital clinic or emergency visit. Under the hospital outpatient payment system most of these codes carry status indicator Q4, "conditionally packaged." The Medicare Claims Processing Manual (chapter 4) describes it this way: status Q4 designates packaged payment if the test is billed on the same claim as a service with status J1, J2, S, T, V, Q1, Q2 or Q3, and when it is not, the status changes to A and separate payment is made at the clinical lab fee schedule rate. A few codes in the table, such as the lipid panel and the glucose, carry status A and are paid under the fee schedule regardless. The consequence for a Medicare patient is bookkeeping: on a visit claim the lab line may show no separate payment, and on a lab-only claim it shows the fee schedule rate. The consequence for a patient not on Medicare is a question: does the hospital bill a lab test inside a clinic or emergency visit as its own line at its own charge, or fold it into the visit price? Ask.

A facility or visit charge may ride along

If the blood was drawn in the course of a visit to a hospital-owned clinic, the hospital can add a facility charge for the visit. The code is G0463, "hospital outpatient clinic visit," priced for Medicare at $136.02 in the October 2026 addendum with a minimum copayment of $27.21. A walk-in draw at a hospital's outpatient lab with no visit does not carry that charge, but a lab drawn during a clinic appointment can. This is the same facility fee that the facility fees guide explains for other services, and the reason a "lab at the hospital" and a "lab at the doctor's office" can be billed so differently even when the same panel is run.

Where a rate comes from when there is no private payer data

The weighted-median rule needs private payer data, and some tests do not have any. The CMS fact sheet describes three fallbacks. For a new or revised code, or a code for which no applicable information was reported, CMS sets the rate by crosswalking, which means using the payment amount of an existing test or combination of tests with similar methods and resources. Where no similar test exists, it uses gap-filling, in which the Medicare Administrative Contractors develop a payment amount. And for a new advanced diagnostic laboratory test, a category for tests offered by a single lab, CMS pays the actual list charge for the first three calendar quarters before moving to a median of the private rates the lab reports.

The consequence for a reader of a price list is that the Medicare number does not mean the same thing for every row. For an established code like the comprehensive metabolic panel, it is a median of what private payers pay across many labs. For a new proprietary test it can be the lab's own list charge. Proprietary tests carry codes of four digits and a letter, such as 0001U at $720.00 and 0003U at $950.00 in the 2026 file, and they sit in a different price range from routine chemistry at single digits. This page's table is limited to established, high-volume codes for that reason.

Specimen collection away from the lab

The fact sheet adds one more billing item that sits outside a patient service center visit: Medicare pays specimen collection fees and a travel allowance when it is medically necessary for a lab technician to draw a specimen from a nursing home or homebound patient, and pays the travel allowance only when the payment requirements in 42 CFR 414.523 are met. Those rates are updated annually, and the claims manual (chapter 16, section 60) sets them out. If a draw is done at home or in a facility, the bill may carry a collection fee and a travel line that a patient who walks into the lab never sees; they are worth asking about by name.

What Medicare patients owe, and what that says about the rest

Medicare.gov states that you usually pay nothing for Medicare-covered diagnostic laboratory tests, and adds that what you could owe depends on where the test is done, the type of facility, whether your provider accepts assignment, the provider's charges, and any other insurance. It also says your doctor may order services Medicare does not cover and that you can ask your provider how much a test will cost before you have it.

The $0 does not extend to other patients, and the structure is different outside Medicare. A commercial plan pays its negotiated rate for an in-network lab and applies your deductible and coinsurance to it. An out-of-network lab bills on its own terms. A patient with no coverage gets whatever the lab's self-pay price is, and the self-pay price is a business decision, not a rule. This page publishes no self-pay range for lab tests, since none could be verified from a public source. If a lab posts its cash prices on its website or sends them on request, those are the numbers that count, and they should be dated and itemized by code.

Where the bill comes from

Blood work generates up to three kinds of billing party, and knowing which is which helps you find the right office when a line looks wrong.

Party	What it bills	Typical sign on the statement
The ordering clinician or clinic	The visit, and sometimes the draw if it is done in the office	An office-visit code or a hospital clinic visit code, and possibly 36415
The drawing site	The collection code if the site is not the ordering office	A patient service center or hospital outpatient lab name, with 36415
The performing lab	The test codes, each priced separately	A separate statement from the lab, often a different name from the place you went

The performing lab is often not the building you visited. A draw site can send the specimen to a lab under a different name, and that lab sends its own bill. When a statement arrives from a lab you never visited, that is usually why, and the ordering clinician's office can tell you which lab received the specimen. Ask for the list of codes the lab billed and compare them with the order.

What a panel is, and why the same tests as separate lines would cost more

A panel code is a billing object with a defined contents list. The CMS descriptor for the comprehensive metabolic panel, 80053, says the panel must include fourteen named components: albumin, total bilirubin, total calcium, carbon dioxide, chloride, creatinine, glucose, alkaline phosphatase, potassium, total protein, sodium, ALT, AST and urea nitrogen. Each of those has its own code and its own Medicare rate, and the panel is priced as a single code. The comparison is large.

Panel	Components listed by CMS	Panel rate	Sum of the component codes at their own 2026 rates
Basic metabolic panel, 80048	8: calcium, carbon dioxide, chloride, creatinine, glucose, potassium, sodium, urea nitrogen	$8.46	$37.21
Comprehensive metabolic panel, 80053	14, the eight above plus albumin, bilirubin, alkaline phosphatase, total protein, ALT and AST	$10.56	$66.51
Lipid panel, 80061	3: total cholesterol (82465), HDL cholesterol (83718), triglycerides (84478)	$13.39	$18.28

The sums are arithmetic on published separate rates, not a claim about any lab's practice, and a single test ordered by itself is billed at its own rate for good reasons. The use for a patient is on the statement. If a bill shows the individual component codes where a panel code was ordered, or shows a panel code and then repeats one of its components, such as a separate glucose line (82947) on the same specimen as a comprehensive metabolic panel that already lists glucose, that is a pattern to ask about, in writing, with the order in hand. The question is simple: which code was ordered, and why was a different set of codes billed?

Three shapes a quote can take

When you ask for a lab price you may get any of these. The prices are invented, and the point is how to put them on the same footing as the table above.

Quote (invented)	What it hides	What to ask
"Blood work, $X flat"	Which codes it covers, and whether the draw is inside it	Please list the codes included, and say whether 36415 is in the price.
"CMP, CBC, lipid, A1c, TSH: $Y"	Whether $Y is the sum of five code prices or a package, and whether a draw or handling fee is extra	What is the price per code, and what is the draw charge?
"Each test $Z"	Whether a panel counts as one test or as its components	Is a comprehensive metabolic panel priced as one code, 80053, or by its parts?

Normalize by code. Once each quote is a list of codes and a price per code, you can set it beside the Medicare anchors, compare two labs line for line, and see at a glance whether a difference is in the tests or in the extras. A quote you cannot put in that form is one the lab has not finished giving you.

A script for asking for the cash price

The call is short if it is specific. These steps follow the structure used in the cash price guide, adapted to lab work.

1. Get the list of tests from the order, with the code for each if the ordering office will give it. If it gives only names, ask the lab to match each name to a code in the quote.
2. Ask the lab, or the hospital's outpatient lab, for the self-pay price for each code, and for the price of the draw. Ask whether the quote is per code or for a panel, and what the panel includes.
3. Ask whether any visit, facility or handling charge applies on top, and whether the price changes if the specimen is drawn in a clinic and sent to the lab.
4. Ask whether the price is the same if the lab is billed through insurance and whether it will accept payment for a test you want to keep out of a claim. Do not assume a cash price counts toward a deductible; the guide on paying cash and your deductible explains why it often does not.
5. Ask how long the quote is good for and who is giving it, and ask for it in writing. Confirm your price in writing before service; a verbal number from the front desk is not a price.

An uninsured patient can ask for a written price ahead of time, and the Good Faith Estimate guide covers when a provider must give one. A routine same-day draw is rarely booked far enough ahead for that to help, so the written quote is a request you can make.

Lab tests Medicare names as preventive screenings

The CMS fact sheet lists the screenings it covers as preventive, and the list is useful for one pricing reason: several have their own billing codes, and the code on the bill tells you which category the lab billed. The named categories are cardiovascular disease, cervical cancer, colorectal cancer, diabetes, HIV infection, prostate cancer, and sexually transmitted infections, hepatitis B and hepatitis C. In the table above, the HIV antigen-antibody test (87389) is $24.08, the hepatitis C antibody test (86803) is $14.27, the prostate screening code (G0103) is $19.31, and the lipid panel (80061) is $13.39.

The fact sheet also says Medicare does not cover lab screenings or tests for patients with no personal disease history and no disease signs or symptoms, with some exceptions such as preventive services. For a bill, that means two things. A screening is billed under a code that says screening, and a test ordered outside the covered list can be denied. If a denial arrives, the order, the code and the Advance Beneficiary Notice, if one was signed, are the documents to put side by side; the ABN guide explains the notice.

If a lab line on your statement does not match what was ordered, the itemized bill guide has the checking steps, and the imaging settings guide prices the other half of a visit that included a scan.

Lab pricing FAQ

Sources behind the rates

CMS, Clinical Laboratory Fee Schedule files, CY 2026 Q4 release (26CLABQ4, PUF_CLFS_CY2026_Q4V1), https://www.cms.gov/medicare/payment/fee-schedules/clinical-laboratory-fee-schedule-clfs/files, read October 23, 2026. CMS, Clinical Laboratory Fee Schedule, MLN006818, March 2026, https://www.cms.gov/files/document/mln006818-clinical-laboratory-fee-schedule.pdf, read October 23, 2026. CMS, OPPS October 2026 Addendum B (updated October 14, 2026), read October 23, 2026. Medicare.gov, Diagnostic laboratory tests, https://www.medicare.gov/coverage/diagnostic-laboratory-tests, read October 23, 2026. CMS, Medicare Claims Processing Manual chapter 4 (Rev. 13799, issued 05-28-26), https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c04.pdf, status indicator Q4, read October 23, 2026. CMS, Know your rights when not using insurance, read October 23, 2026. Medicare rates are payment amounts for Medicare patients. They are not cash prices.