Lab Testing
Lab work that explains how you actually feel
Standard panels rule out disease. Functional labs explain why you do not feel well when nothing is technically wrong. Dr. Mary uses both, ordered with intention and read in context — not in isolation.
Why lab testing matters — and why context matters more
Most lab work in conventional primary care is built around a simple question: is something wrong enough to diagnose right now? That framing is appropriate when the goal is to rule out acute disease, but it leaves a wide territory of legitimate suffering unaddressed. Patients with persistent fatigue, brain fog, irregular cycles, recurrent gut issues, or stubborn weight changes are routinely told their bloodwork "looks normal" — even when the values sit at the unhealthy edge of a reference range that was never designed to define health. Functional lab interpretation closes that gap by asking a different question: what does the data say about how your body is currently functioning, and where could small, specific interventions move you toward better?
At Cove, we order lab work because it answers a clinical question we already have — not to fish for findings. Every panel is chosen during a real conversation about your history, symptoms, family patterns, prior labs, and goals. The number of tubes drawn is rarely the point. A single, well-targeted thyroid panel that includes Free T3, Reverse T3, and antibodies will outperform a stack of generic screening labs when the clinical question is "is my thyroid struggling?" The skill lives in the selection, not the volume.
Reference ranges deserve a word of honesty, too. Lab ranges are statistical artifacts — typically the central 95 percent of values from a population that already includes a large share of unwell people. A ferritin of 18 ng/mL is "normal" by most lab reports and yet is a frequent driver of hair loss, exercise intolerance, and restless legs. A TSH of 4.2 mIU/L is in-range and a common reason patients feel cold, slow, and bloated. We read your results against functional targets — the ranges associated with feeling well — and then triangulate against your symptoms, exam, and history. Numbers without context are noise.
Lab testing at Cove is collaborative and consent-driven. You will always know what we are ordering, why, what it costs, what we expect to learn, and what we will do with the answer. If a test is unlikely to change the plan, we do not run it. If a test will change the plan, we explain the decision tree before the sample is drawn so the result feels useful instead of unsettling.
Panels we commonly order
Not every patient needs all of these. Dr. Mary selects panels based on your specific concerns, history, and clinical picture — this is a reference of what is available, not a required list.
Hormone panels
Cycle irregularities, perimenopausal turbulence, low libido, fatigue, mood shifts, hair loss, acne, and stubborn weight changes all live downstream of hormone signaling. The right panel depends on your cycle status, symptoms, and what we are trying to confirm or rule out.
Day-21 serum sex hormones
Estradiol, progesterone, testosterone, DHEA-S, SHBG — timed to the luteal phase for cycling patients.
DUTCH Complete
Dried urine metabolites for a full picture of estrogen detox pathways, cortisol rhythm, and androgen flow.
Salivary cortisol rhythm (4-point)
Morning, noon, afternoon, and bedtime samples to map the cortisol curve.
LH / FSH
Confirms perimenopausal or menopausal status; distinguishes hypothalamic patterns.
Prolactin
A common, under-tested driver of cycle disruption.
AM serum cortisol + ACTH
Ordered when an HPA axis red flag is in play and a conventional benchmark is needed.
Comprehensive thyroid
TSH alone is one of the most over-relied-upon tests in primary care. A full thyroid workup picks up the autoimmune patterns, conversion problems, and subclinical hypothyroidism that TSH-only screening regularly misses.
TSH
Functional target 0.5–2.5 mIU/L. The conventional "normal" ceiling of 4.5 misses significant subclinical hypothyroidism.
Free T4 + Free T3
The active hormone (T3) is what tissues use. Conversion problems are common and invisible on TSH alone.
Reverse T3
Elevated rT3 suggests stress, illness, or nutrient deficiency are diverting T4 into an inactive metabolite.
TPO + anti-thyroglobulin antibodies
Confirms Hashimoto's thyroiditis — often present years before TSH rises.
TSI / TRAb (when indicated)
For suspected Graves' disease or unexplained hyperthyroid symptoms.
GI and microbiome
Bloating, reflux, IBS-type patterns, autoimmune flares, skin issues, mood symptoms, and food reactivity often trace back to the gut. Comprehensive stool and breath testing let us see what is actually happening rather than guessing from symptoms.
GI-MAP (Diagnostic Solutions)
PCR-based stool analysis: pathogens, opportunistic overgrowths, commensal balance, H. pylori, parasites, intestinal-health markers.
SIBO breath test (3-hour, lactulose)
Measures hydrogen and methane gas — a frequent driver of bloating, constipation, and IBS patterns.
GI Effects (Genova)
Emphasizes digestion, absorption, inflammation, and short-chain fatty acid production.
H. pylori (stool antigen or breath)
Implicated in reflux, ulcers, and iron-deficiency anemia.
Zonulin
Marker of intestinal permeability in the appropriate clinical context.
Nutrient and micronutrient status
Subclinical nutrient deficiencies are common, often missed by standard ranges, and drive a long list of symptoms that get attributed to stress or aging. We test the nutrients most likely to be relevant for your picture.
25-OH vitamin D
Functional target 50–80 ng/mL. Most Pacific Northwest patients sit between 20 and 35 from November through April.
B12 + methylmalonic acid (MMA)
Serum B12 alone misses functional deficiency. MMA confirms the tissue-level picture.
Iron studies
Ferritin, serum iron, TIBC, transferrin saturation. Ferritin under 50 ng/mL frequently drives fatigue, hair loss, and exercise intolerance.
RBC magnesium + zinc + copper
Red blood cell measurements reflect intracellular status better than serum, especially for magnesium.
Organic acids test (OAT)
Urinary metabolites mapping B-vitamin sufficiency, mitochondrial function, and neurotransmitter turnover.
MTHFR + relevant SNPs
Run selectively. A variant changes how we choose B-vitamin forms but is not a diagnosis on its own.
Cardiometabolic and insulin
The metabolic damage that drives heart disease, type 2 diabetes, and dementia builds quietly for a decade or more before standard glucose testing catches it. Advanced cardiometabolic testing catches those patterns while they are still reversible.
Fasting insulin + glucose + HbA1c
A fasting insulin above 7 µIU/mL signals insulin resistance years before HbA1c moves — the highest-yield trio for unexplained weight gain, fatigue, and PCOS.
Advanced lipid panel (NMR or ApoB)
LDL particle number, ApoB, and Lp(a) capture cardiovascular risk that a standard lipid panel misses.
hs-CRP + homocysteine
Inflammation markers with strong cardiovascular relevance and clear nutritional levers.
Liver enzymes + GGT
GGT is a sensitive early marker of fatty liver and oxidative stress.
Uric acid
Linked to insulin resistance, hypertension, and fatty liver beyond its role in gout.
Food sensitivity and reactivity
Food testing is one of the most misused categories in functional medicine. We use it sparingly and with clear expectations — never as a replacement for an elimination-and-reintroduction trial, which remains the gold standard.
IgG food sensitivity panel (96 or 184 foods)
A hypothesis-generating tool when symptoms are diffuse and an elimination trial has stalled. Results guide, not dictate.
Celiac panel (full)
tTG IgA, deamidated gliadin IgA + IgG, total IgA. Run before recommending any prolonged gluten elimination.
IgE allergy panel
Confirms true IgE-mediated allergy — anaphylaxis, hives, classic seasonal patterns.
Lactose and fructose breath tests
Direct, mechanism-level confirmation of carbohydrate malabsorption.
Histamine and DAO
For patients whose symptoms map to histamine intolerance — flushing, headaches, food-triggered congestion.
How a lab order works at Cove
- 1
We decide what to test, together
During your initial visit or a lab-planning consult, we review your history, current symptoms, prior labs, and goals to identify the specific clinical questions worth answering. You leave with a written list of what is being ordered and why — not a mystery requisition.
- 2
Requisitions go out the same day
Standard labs are sent electronically to Quest Diagnostics or LabCorp. No appointment is required at most locations — you walk in, hand them the requisition, and are typically out in 15 minutes. Specialty functional kits (GI-MAP, DUTCH, organic acids) ship to your home with full instructions.
- 3
You collect the sample on your timeline
Some panels require timing — luteal-phase hormones, fasting metabolic markers, AM cortisol. Your requisition notes any timing requirements, and you can message through the patient portal if you need to confirm.
- 4
Dr. Mary reviews results before you do
Results return through the patient portal. Rather than dropping a wall of values on you with no context, Dr. Mary reviews everything first and prepares an interpretation. You receive a message within three to five business days of the final result.
- 5
A dedicated lab review visit
We schedule a 30 to 45-minute follow-up specifically to walk through results together. You will see the panel on screen, understand what each value means for you, and leave with a written plan — supplements, dietary adjustments, prescriptions, referrals if needed, and a re-test timeline.
What lab work actually costs
Lab fees are billed separately from your visit fee — Cove does not mark up lab work. Standard Quest and LabCorp panels go through your insurance when possible, and both labs publish cash-pay rates that are often reasonable. A comprehensive standard workup (CBC, CMP, full thyroid, vitamin D, iron, lipid panel, HbA1c) typically runs $150 to $300 cash-pay, less if insurance covers any portion.
Specialty functional panels are paid directly to the specialty lab at the time the kit is ordered. Typical 2026 ranges: GI-MAP $360–$400, DUTCH Complete $325–$390, organic acids $325, salivary cortisol rhythm $145–$200, IgG food panel $250–$400 depending on breadth. We quote the exact cost before ordering anything.
We provide a superbill on request for any visit, which you can submit to your insurance for potential out-of-network reimbursement. Patients on HSA or FSA accounts can use those funds for visit and lab fees.
Questions patients ask about labs
Do you order labs through my insurance?
For standard Quest and LabCorp panels, yes — the requisition goes out under your insurance and the lab bills your plan directly. Specialty functional panels (GI-MAP, DUTCH, organic acids) are paid directly to the specialty lab and are not insurance-billed.
How much do specialty functional labs cost?
In 2026, the most commonly ordered specialty panels run roughly: GI-MAP $360–$400, DUTCH Complete $325–$390, organic acids test $325, salivary cortisol rhythm $145–$200, IgG food sensitivity $250–$400 depending on the number of foods tested. We always quote the exact cost before ordering.
Can you order labs without seeing me first?
No. Lab work is most valuable when chosen against your actual history and clinical picture. The initial visit is the foundation; the labs follow.
How long until results are ready to review?
Standard panels return within two to five business days. Specialty kits take 10 to 14 business days from when the sample arrives at the lab. Once the final result is in, Dr. Mary prepares an interpretation, and we schedule a review visit within one to two weeks.
Can I use my HSA or FSA for labs and visits?
Yes. Naturopathic medical care, lab fees, and most prescribed supplements are eligible HSA and FSA expenses. Cove provides receipts and superbills with the relevant CPT and diagnosis codes.
Do you re-test, or is one round of labs enough?
It depends on the panel. Nutrient status, thyroid antibodies, and metabolic markers typically warrant a re-test at three to six months once a protocol is in place. Genetic markers only need to be run once. The re-test cadence is part of the plan we build together.
Ready to take charge of your health?
Your first visit is a 75-minute telemedicine consultation. Dr. Mary will review your complete health history and build a personalized plan together.