Aetna Lab & Pathology
Compare Aetna's contracted rates for lab & pathology services against national averages and other major payers. Use these benchmarks to identify underpaid codes, prepare for contract renegotiations, and validate your reimbursement strategy.
Aetna's commercial fee schedules are typically tiered by site-of-service and product line, with distinct rate structures for HMO, PPO, and Medicare Advantage networks.
Introduction
Laboratory reimbursement is governed by the Clinical Laboratory Fee Schedule (CLFS) for Medicare and individually negotiated rates for commercial payers. The Protecting Access to Medicare Act (PAMA) tied Medicare lab rates to weighted median commercial rates, making payer contract benchmarking more critical than ever for hospital labs and reference laboratories.
Lab services are billed using CPT codes organized by discipline — chemistry, hematology, microbiology, anatomic pathology, and molecular diagnostics — with reimbursement varying widely between reference laboratories, hospital outpatient labs, and physician office labs. High-volume tests like CBC and metabolic panels drive aggregate revenue even at low per-test rates, while molecular and specialty testing carries the widest payer-to-payer variation.
Chemistry & Metabolic Panels
Organ & Disease Panels
Bundled chemistry panels that measure multiple analytes in a single test. Panels are among the highest-volume lab tests ordered across inpatient and outpatient settings. Payer reimbursement for panels varies significantly and is a key contract term for reference laboratories.
| Billing Code | Description | Revenue Code | Description | Avg. National Aetna Rate |
|---|---|---|---|---|
| 80053 | Comprehensive Metabolic Panel This Panel Must Include The Following: Albumin (82040) Bilirubin, Total (82247) Calcium, Total (82310) Carbon Dioxide (Bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Phosphatase, Alkaline (84075) Potassium (84 | 0301 | Laboratory - chemistry | $13.42 |
| 80048 | Basic Metabolic Panel (Calcium, Total) This Panel Must Include The Following: Calcium, Total (82310) Carbon Dioxide (Bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Potassium (84132) Sodium (84295) Urea Nitrogen (Bun) (84520) | 0301 | Laboratory - chemistry | $10.73 |
| 80061 | Lipid Panel This Panel Must Include The Following: Cholesterol, Serum, Total (82465) Lipoprotein, Direct Measurement, High Density Cholesterol (Hdl Cholesterol) (83718) Triglycerides (84478) | 0301 | Laboratory - chemistry | $17.05 |
| 80076 | Hepatic Function Panel This Panel Must Include The Following: Albumin (82040) Bilirubin, Total (82247) Bilirubin, Direct (82248) Phosphatase, Alkaline (84075) Protein, Total (84155) Transferase, Alanine Amino (Alt) (Sgpt) (84460) Transferase, Aspartate Amino (Ast) | 0301 | Laboratory - chemistry | $10.29 |
Endocrine & Metabolic Tests
Individual chemistry tests for thyroid function, diabetes management, nutritional status, and metabolic evaluation. These are high-frequency tests with wide variation in commercial payer reimbursement.
| Billing Code | Description | Revenue Code | Description | Avg. National Aetna Rate |
|---|---|---|---|---|
| 84443 | Thyroid Stimulating Hormone (Tsh) | 0301 | Laboratory - chemistry | $21.08 |
| 83036 | Hemoglobin Glycated | 0301 | Laboratory - chemistry | $12.54 |
| 82306 | Vitamin D; 25 Hydroxy, Includes Fraction(S), If Performed | 0301 | Laboratory - chemistry | $37.08 |
| 82607 | Cyanocobalamin (Vitamin B-12) | 0301 | Laboratory - chemistry | $18.97 |
Cardiac & Inflammatory Markers
Chemistry tests used in emergency and inpatient settings for cardiac evaluation, inflammatory conditions, and risk stratification. Troponin and BNP are critical ED decision-making tests.
Hematology & Coagulation
Hematology
Complete blood count and related hematologic tests. CBC with differential is the single most frequently ordered lab test in U.S. hospitals and outpatient practices, making it a significant line item in lab payer contracts.
| Billing Code | Description | Revenue Code | Description | Avg. National Aetna Rate |
|---|---|---|---|---|
| 85025 | Complete Blood Cell Count (Red Cells, White Blood Cell, Platelets), Automated Test And Automated Differential White Blood Cell Count | 0305 | Laboratory - hematology | $9.94 |
| 85027 | Blood Count; Complete (Cbc) Automated (Hgb Hct Rbc Wbc And Platelet Count) (Desc Rev 1/1/03) | 0305 | Laboratory - hematology | $8.34 |
| 85652 | Red Blood Cell Sedimentation Rate, To Detect Inflammation, Automated | 0305 | Laboratory - hematology | $3.56 |
| 85044 | Blood Count;Reticulocyte Cnt,Manual | 0305 | Laboratory - hematology | $5.01 |
Coagulation Studies
Tests for blood clotting function including PT/INR for warfarin management, PTT for heparin monitoring, and D-dimer for DVT/PE workup. High-volume in both inpatient anticoagulation management and outpatient monitoring.
| Billing Code | Description | Revenue Code | Description | Avg. National Aetna Rate |
|---|---|---|---|---|
| 85610 | Prothrombin Time; | 0305 | Laboratory - hematology | $5.32 |
| 85730 | Thromboplast Time,Part.(Ptt);Plasma/Whol | 0305 | Laboratory - hematology | $7.56 |
| 85379 | Fibrin Degradat Prod D-Dimer Quan | 0305 | Laboratory - hematology | $12.93 |
| 85670 | Thrombin Time; Plasma | 0305 | Laboratory - hematology | $6.93 |
Microbiology & Infectious Disease
Cultures
Bacterial and fungal culture tests for identifying infectious organisms. Blood and urine cultures are among the most commonly ordered microbiology tests in hospital settings, with significant reimbursement variation between rapid and standard methods.
| Billing Code | Description | Revenue Code | Description | Avg. National Aetna Rate |
|---|---|---|---|---|
| 87040 | Culture Bacterial; Blood Aerobic With Isolation And Presumptive Identification Of Isolates (Includes Anaerobic Culture If Appropriate) (Rvsd 1/1/04) | 0306 | Laboratory - bacteriology & microbiology | $12.65 |
| 87045 | Culturre, Bacterial, Definitive; Stool, Aerobic, With Isolation And Preliminary Examination, (Eg, Kia, Lia), Salmonella And Shigella Species | 0306 | Laboratory - bacteriology & microbiology | $11.25 |
| 87070 | Culture Bacterial; Any Other Source Except Urine Blood Or Stool Aerobic With Isolation And Presumptive Identification Of Isolates (Rvsd 1/1/04) | 0306 | Laboratory - bacteriology & microbiology | $10.90 |
| 87086 | Culture, Bacterial, Urine; Quantitative, Colony Count,Urine | 0306 | Laboratory - bacteriology & microbiology | $10.21 |
Molecular & NAAT Testing
Nucleic acid amplification tests (NAAT) for infectious disease detection including STIs, respiratory pathogens, and GI panels. Molecular testing reimbursement is among the most variable across payers, with wide gaps between contracted and out-of-network rates.
| Billing Code | Description | Revenue Code | Description | Avg. National Aetna Rate |
|---|---|---|---|---|
| 87491 | Nucleic Acid Detection; Chlamydia Trachomatis, By Amplified Probe | 0306 | Laboratory - bacteriology & microbiology | $41.98 |
| 87591 | Nucleic Acid Detection; Neisseria Gonorrhoeae, By Amplified Probe | 0306 | Laboratory - bacteriology & microbiology | $41.61 |
| 87631 | Infectious Agent Detection By Nucleic Acid (Dna Or Rna); Respiratory Virus (Eg Adenovirus Influenza Virus Coronavirus Metapneumovirus Parainfluenza Virus Respiratory Syncytial Virus Rhinovirus) Includes Multiplex Reverse Transcrip-Tion When Performed And Multiplex Amplified Probe Technique Multiple Types Or Subtypes 3-5 Types (Desc Revised 01/01/15) | 0306 | Laboratory - bacteriology & microbiology | $150.23 |
| 87635 | (Infectious Agent Detection By Nucleic Acid (Dna Or Rna); Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) Coronavirus Disease [Covid-19] Amplified Probe Technique. | 0306 | Laboratory - bacteriology & microbiology | $61.16 |
Rapid & Point-of-Care Testing
Rapid antigen and point-of-care tests for immediate clinical decision-making. These tests are typically reimbursed at lower rates than molecular assays but have high volume in urgent care and emergency settings.
| Billing Code | Description | Revenue Code | Description | Avg. National Aetna Rate |
|---|---|---|---|---|
| 87804 | Infectious Agent Antigen Detection By Immunoassay With Direct Optical (Ie Visual) Observation; Influenza (Desc Rvsd 10/6/20) | 0306 | Laboratory - bacteriology & microbiology | $17.39 |
| 87426 | Infectious Agent Antigen Detection By Immunoassay Technique (Eg Enzyme Immunoassay [Eia] Enzyme- Linked Immunosorbent Assay [Elisa] Fluorescence Immunoassay [Fia] Immuno- Chemiluminometric Assay [Imca]) Qualitative Or Semiquantitative; Severe Acute Respiratory Syndrome Coronavirus (Eg Sars-Cov Sars-Cov-2 [Covid-19]) (Desc Rvsd 10/6/20) | 0306 | Laboratory - bacteriology & microbiology | $51.10 |
| 87880 | Infectious Agent Antigen Detection By Immunoassay With Direct Optical (Ie Visual) Observation; Streptococcus Group A (Desc Rvsd 10/6/20) | 0306 | Laboratory - bacteriology & microbiology | $17.41 |
| 87449 | Infectious Agent Antigen Detection By Immunoassa Technique (Eg Enzyme Immunoassay [Eia] Enzyme Linked Immunosorbent Assay [Elisa] Fluorescence Immunoassay [Fia] Immuno- Chemiluminometric Assay [Imca]) Qualitative Or Semiquantitative; Not Otherwise Specified Each Organism (Desc Rvsd 10/6/20) | 0306 | Laboratory - bacteriology & microbiology | $13.86 |
Urinalysis & Drug Testing
Urinalysis
Routine and microscopic urinalysis for evaluation of kidney function, urinary tract infections, and metabolic conditions. Urinalysis is a high-volume, low-cost test that is often bundled in inpatient billing.
| Billing Code | Description | Revenue Code | Description | Avg. National Aetna Rate |
|---|---|---|---|---|
| 81001 | Urinalysis, By Dip Stick Or Tablet Reagent For Bilirubin, Glucose, Hemoglobin, Ketones, Leukocytes, Nitrite, Ph, Protein, Specific Gravity, Urobilinogen, Any Number Of These Constituents; Automated, With Microscopy | 0307 | Laboratory - urinalysis | $4.22 |
| 81003 | Urinalysis, By Dip Stick Or Tablet Reagent For Bilirubin, Glucose, Hemoglobin, Ketones, Leukocytes, Nitrite, Ph, Protein, Specific Gravity, Urobilinogen, Any Number Of These Constituents; Automated, Without Microscopy | 0307 | Laboratory - urinalysis | $3.02 |
| 81015 | Urinalysis Microscopic Onlyur | 0307 | Laboratory - urinalysis | $3.92 |
Drug Screening & Confirmation
Presumptive and definitive drug testing used in pain management, substance use treatment, pre-employment, and compliance monitoring. Drug testing reimbursement has been under increased payer scrutiny with many plans implementing frequency limits and prior authorization requirements.
| Billing Code | Description | Revenue Code | Description | Avg. National Aetna Rate |
|---|---|---|---|---|
| 80305 | Drug Test(S) Presumptive Any Number Of Drug Classes Any Number Of Devices Or Procedures; Capable Of Being Read By Direct Optical Observation Only (Eg Utilizing Immunoassay [Eg Dipsticks Cups Cards Or Cartridges]) Includes Sample Validation When Performed Per Date Of Service (Desc Revised 1/1/2018) | 0301 | Laboratory - chemistry | $13.74 |
| 80306 | Drug Test(S) Presumptive Any Number Of Drug Classes Any Number Of Devices Or Procedures; Read By Instrument Assisted Direct Optical Observation (Eg Utilizing Immunoassay [Eg Dipsticks Cups Cards Or Cartridges]) Includes Sample Validation When Performed Per Date Of Service (Desc Revised 1/1/2018) | 0301 | Laboratory - chemistry | $17.45 |
| 80307 | Drug Test(S) Presumptive Any Number Of Drug Classes Any Number Of Devices Or Procedures; By Instrument Chemistry Analyzers (Eg Utilizing Immunoassay [Eg Eia Elisa Emit Fpia Ia Kims Ria]) Chromatography (Eg Gc Hplc) And Mass Spectrometry Either With Or Without Chromatography(Eg Dart Desi Gc-Ms Gc-Ms/Ms Lc-Ms Lc-Ms/Ms Ldtd Maldi Tof) Includes Sample Validation When Performed Per Date Of Service (Desc Revised 1/1/2018) | 0301 | Laboratory - chemistry | $67.43 |
| G0480 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed | 0301 | Laboratory - chemistry | $100.13 |
Anatomic Pathology
Surgical Pathology
Tissue examination and diagnosis from biopsies and surgical specimens. Surgical pathology reimbursement is tiered by specimen complexity (levels 1-6), with significant payer variation at the higher complexity levels that involve intraoperative consultation and immunohistochemistry.
| Billing Code | Description | Revenue Code | Description | Avg. National Aetna Rate |
|---|---|---|---|---|
| 88305 | Level Iv - Surgical Pathology, Gross And Microscopic Examination Abortion - Spontaneous/Missed Artery, Biopsy Bone Marrow, Biopsy Bone Exostosis Brain/Meninges, Other Than For Tumor Resection Breast, Biopsy, Not Requiring Microscopic Evaluation Of Surgical Margins | 0314 | Laboratory - histology | $97.17 |
| 88304 | Level Iii - Surgical Pathology, Gross And Microscopic Examination Abortion, Induced Abscess Aneurysm - Arterial/Ventricular Anus, Tag Appendix, Other Than Incidental Artery, Atheromatous Plaque Bartholin S Gland Cyst Bone Fragment(S), Other Than Pathologic Fracture | 0314 | Laboratory - histology | $57.72 |
| 88307 | Level V - Surgical Pathology, Gross And Microscopic Examination Adrenal, Resection Bone - Biopsy/Curettings Bone Fragment(S), Pathologic Fracture Brain, Biopsy Brain/Meninges, Tumor Resection Breast, Excision Of Lesion, Requiring Microscopic Evaluation Of Surgical | 0314 | Laboratory - histology | $320.82 |
| 88309 | Level Vi - Surgical Pathology, Gross And Microscopic Examination Bone Resection Breast, Mastectomy - With Regional Lymph Nodes Colon, Segmental Resection For Tumor Colon, Total Resection Esophagus, Partial/Total Resection Extremity, Disarticulation Fetus, With Diss | 0314 | Laboratory - histology | $468.49 |
Cytopathology
Cell-level examination including Pap smears and fine needle aspiration cytology. Pap smear reimbursement has been relatively stable but varies by screening vs. diagnostic indication and whether the test is physician-interpreted or auto-screened.
| Billing Code | Description | Revenue Code | Description | Avg. National Aetna Rate |
|---|---|---|---|---|
| 88175 | Cytopathology, Cervical Or Vaginal (Any Reporting System), Collected In Preservative Fluid, Automated Thin Layer Preparation; With Screening By Automated System And Manual Rescreening Or Review, Under Physician Supervision | 0311 | Laboratory - cytology | $31.28 |
| 88112 | Cytopathology, Selective Cellular Enhancement Technique With Interpretation (Eg, Liquid Based Slide Preparation Method), Except Cervical Or Vaginal | 0311 | Laboratory - cytology | $88.55 |
| 88108 | Cytopathology, Fluids, Washings Or Brushings, With Centrifugation Except Cervical Or Vaginal; Concentration Techniq | 0311 | Laboratory - cytology | $78.89 |
Specimen Collection
Phlebotomy & Specimen Handling
Venipuncture and capillary blood collection services. While individually low-reimbursement, specimen collection fees represent significant aggregate revenue for reference labs and hospital outpatient departments processing thousands of draws per day.
| Billing Code | Description | Revenue Code | Description | Avg. National Aetna Rate |
|---|---|---|---|---|
| 36415 | Routine Venipuncture/Finger/Heel/Ear Stick, Collection, Specimen(S) | 0300 | Laboratory | $5.78 |
| 36416 | Collection Of Capillary Blood Specimen (Eg, Finger, Heel, Ear Stick) | 0300 | Laboratory | $4.77 |
| 99000 | Handling And/Or Conveyance Of Specimen For Transfer From The Office To A Laboratory (Revised 01/01/13) | 0300 | Laboratory | $8.29 |
What is a fee schedule?
A fee schedule is a list of negotiated prices that healthcare providers charge for specific services. These prices vary by payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the applicable fee schedule helps providers optimize billing for accurate reimbursement and helps patients anticipate out-of-pocket costs.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts.
Private Insurance Rates
Negotiated rates between providers and insurance companies.
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
View lab & pathology fee schedules for other major payers
What is Price Transparency?
The federal Price Transparency Rule took effect in July 2022, requiring all commercial payers to publicly disclose their prices through machine-readable files (MRFs). This landmark regulation mandates that insurance companies make healthcare costs transparent to the public. Read more here.
PayerPrice gives you access to the actual prices that insurers are legally required to publish under the Price Transparency Rule. We deliver this data exactly as reported in the insurers' machine-readable files, giving you an accurate view of negotiated rates. While insurers occasionally report incomplete or inaccurate data, our platform ensures you see the same information that insurers have made publicly available.
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