Test Lab Order
Dr. Josh Shields
2019-12-23T13:59:13-05:00
Test lab Order
Name
*
First
Date
MM slash DD slash YYYY
DIAGNOSIS
Allergic Rhinitis J305
Other Asthma J45998
Dermatitis due to ingested food L272
Rash and other nonspecific skin eruption R21
Nutritional Deficiency
IBS/Diarrhea
IBS/No Diarrhea
Abdominal Pain
Constipation
Diarrhea
Gas
GERD
QUESTS TESTING
Quest Testing Fee ($15)
1st panel with candida Fasting ($315)
1st panel NO candida Fasting ($270)
RETEST2* Fasting ($145)
Out of State FEE ($25)
*Bilirubin, Direct, Indirect and Total ($8) 7286
*CBC ($7) 6399
*Comprehensive Metabolic Panel Fasting ($9) 10231
*Hs-CRP ($16) 10124
*Hemoglobin A1c with eAG ($9) 16802
*Insulin Fasting ($10) 561
*Lipid Panel Fasting ($18) 7600
*Vitamin D (25-Hydroxyvitamin D), LC/MS/MS ($27) 17306
*Thyroid Panel with TSH ($22) 7444
___________________________
___________________________
T3, Free (FT3) ($13) 34429
TPO and TGB ($26) 7260
ANA, w/titer ($28) 249
Candida Antibodies IGG, IGM, IGA ($70) 30440
Creatine Kinase ($6) 374
Ferritin ($8) 457
Iron, Total and Total Iron Binding Capacity ($9) 7573
Gamma Glutamyl Transferase (GGT) ($6) 482
Homocysteine ($20) 31789
Lactate Dehydrogenase (LD) ($3) 593
Magnesium ($6) 622
*Phosphate (as Phosphorus) ($6) 718
Uric Acid ($6) 905
Rheumatoid Factor ($6) 4418
Heart and Artery Health
Cardio IQ Lp Fraction Ion Mobility ($72) 91604
Cardio IQ Lipoprotein (a) ($24) 91729
Cardio IQ Apolipoprotein B ($33) 91726
Omega 3 and 6 Fatty Acids ($72) 92701
CO-Q10 ($55) 19826
CK isoenzymes w/total ($28) 4451
LP-PLA2 Heart Disease and Alzheimer’s ($39) 94218
NT-proBNP ($110) 11188
C-Reactive Protein ($10) 4420
OXLDL ($65) 92769
TMAO ($65) 94154 (No Fish, Fish-Oil or Seafood the 36 hours before the test)
Immune Testing
Anti-Mullerian Hormone ($48) 37227
C4a (lyme, mold bacteria or virus) ($193) 19956
Candida Antibodies IgG ($29) (34897)
Candida Antibodies IgA, IgM, IgG ($70) 30440
Celiac Disease ($127) 11073, 8889,539
Complement c3 ($17) 351
Complement c4 ($17) 353
CCP Anti Cyclic citrullinated peptide (IgG) ($64) 11173
Cytomegalovirus antibody (IGG, IGM) ($72) 6732
Diabetes Type 1 GAD65, IA & Insulin Antibodies ($286) 36177,36178, 34878
Epstein-Barr Virus Antibody ($53) 6421
GAD-65 ($130) 34878
Gliadin Antibody (IgG, IgA) ($30) 8889
Herpes 6 IGG (IgG, IgM) ($99) 34282
Insulin Antibodies ($98) 36178
Intrinsic Factor Antibodies ($43) 568
Islet Antigen 2 ($124) 37933
IgA ($12) 539
IgG ($12) 543
IgM ($12) 545
Lyme Disease Ab blot (IgG, IgM) ($55) 8593
Parietal Cell Antibodies ($39) 15114
Thyroid Stimulating Immunoglobulin ($154) 30551
Thyroid Peroxidase Antibodies ($13) 5081
Thyroglobulin Antibodies ($20) 267
Tissue Transglutaminase (IgG, IgA) ($90) 11073
SED Rate ($8) 809
ABO and RH type ($9) 792 & 785
EBV Antigen D 15447 ($143)
HLA-B27 ($52) (528)
Hormone Testing
Cortisol ($17) 4212 ***Complete between 7am and 9am***
Cortisol ($17) 367 Anytime
C-Peptide ($22) 372
DHEA Sulfate ($24) 402
DHT Dihydrotestosterone ($44) 90567
Estradiol - DAY 3 ($22) 4021
Estrogen Total Serum ($43) 439
FSH and LH - DAY 3 ($22) 7137
Pregnenolone ($60) 31493
Progesterone - ($17) 745
Prolactin ($15) 746
PSA Free and Total ($28) 31348
Reverse T3 ($28) 90963
SHBG ($33) 30740
Testosterone ($17) 873
Test. Total Fem. and Children ($17) 15983
Testosterone Free and Total ($39) 36170
T3 Uptake ($6) 861
T4 Free ($9) 866
(Female Day 3) FSH/LH Estradiol ($44) 7137 and 4021
Female Day 21 Progesterone ($17) 745
Thyroid Binding Globulin ($50) 870
AMH Female ($49) 37227
ACTH, Plasma ($57) 211
Nutrient Testing
Vitamin A ($44) 921
Vitamin B6 ($77) 926
Vitamin B9 ($18) 466
Vitamin B12 ($18) 927
Vitamin C ($39) 929
Vitamin E ($39) 931
Iodine ($44) 16599
Selenium RBC ($47) 17133
Zinc ($31) 945
Magnesium ($30) 623
Copper RBC ($59) 3481
Vitamin D 1,25-Dihydroxy ($104) 16558
Prevention
PSA Free and Total ($25) 31348
CA- 125 ($24) 29256
Insulin growth factor ($32) 16293
GENETIC TESTING
Genetic Testing - Health, Traits and Ancestry ($200)
Genetic Testing - Ancestry Only ($100)
Genetic Reporting and Analysis ($100)
Digestive/Immune Testing
Alletess 15 IGE ($195)
Alletess 25 IGE ($325)
Alletess 15 IGE and 96 IGG ($290)
Alletess 25 IGE and 96 IGG ($394)
Alletess 25 IgE and 184 ($508)
Alletess 15 IgE and IgG Mold Testing ($395)
Alletess 96 IgG ($168)
Alletess 96 IgG Finger Prick ($168)
Alletess 184 IgG ($309)
Alletess 184 IgG Finger Prick ($309)
Diagnostic Solutions GI- MAP ($400)
Elissa/Act Enhanced Panel 144 ($360)
Genova Small Intestinal Bacterial Overgrowth SIBO ($290)
Vibrant America 96 IGE Foods ($210)
GI H.pylori ($114)
GI zonulin (stand alone) $130
Trio Sibo ($400)
Diagnostic Solutions GI Pathogens ($259)
Diagnostic Solutions GI-Map w/ Zonulin ($470)
Doctors Data GI 360 ($490)
Great Plains Mycotoxin ($340)
Neurotransmitter and Hormones
DUTCH Adrenal Panel ($235)
DUTCH Complete- Adrenal, Hormones and OATS ($390)
DUTCH Cycle Mapping ($520)
DUTCH Sex Hormones Metabolites ($235)
DUTCH Organic Acid Test Only ($210)
DUTCH Adrenal Panel Add On Cycle Map ONLY ($75)
DUTCH Hormones Metabolites Add On Cycle Map ($75)
DUTCH Organic Acid Test Add On- Any ($75)
Doctors Data Neurotransmitter Testing ($225)
Detoxification Testing
Biotek Environmental Pollutants Testing ($180)
GI Toxic Element Clearance Profile ($160)
Genova Toxic Effects Core ($650)
Great Plains Toxic Test ($280)
Digestive, Detoxification and Neurotransmitters
Genova Nutreval Plasma ($460)
Great Plains OATS test ($350)
Hakala Iodine, Bromide and Fluoride ($215)
Additional dx needed for Vibrant America
Allergic Rhinitis J305
Dermatitis due to ingested food L272
Other Asthma J45998
Rash and other nonspecific skin eruption R21
Total
Note
Special Instructions
Wait till testing is all in before scheduling next visit
Do not need testing before next visit
When testing arrives notify me
6 month follow up
3 month follow up
Need testing for next visit
When testing arrives notify me
When testing arrives send to me and patient
4 month follow up
1 month follow up
Genova* Insurances not accepted: Medicare, Medicaid, TRICARE. If insurance does not pay max out of pocket for Nutreval is $380
Diagnostic Solutions (GI MAP): NO Medicare, HMO's OR TRICARE
Vibrant America: No medicaid or Medicare. Sharp ,Mercy, University Family,Advicare, UHC Community, Care 1st of AZ, Kaiser, Amerigroup, Scripps, Wellcare, Horizon New Jersey, Ambetter, Christian Healthcare, Bright Health, Aetna Better Health
ALL Milena insurance Is HMO
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