Test Lab Order

Name*

First

Date

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 ($10)
1st panel with candida ($255)
1st panel NO candida ($210)
RETEST2* ($100)
Out of State FEE ($25)
*Bilirubin, Direct ($7) 285
*CBC ($6) 6399
*Comprehensive Metabolic Panel ($8) 10231
*Hs-CRP ($14) 10124
*Hemoglobin A1c with eAG ($8) 16802
*Insulin ($9) 561
*Lipid Panel ($11) 7600
*25-Hydroxyvitamin D, LC/MS/MS ($19) 17306
*Thyroid Panel with TSH ($14) 7444
___________________________
___________________________
T3, Free (FT3) ($11) 34429
TPO and TGB ($23) 7260
ANA, w/titer ($25) 249
Candida Antibodies IGG, IGM, IGA ($45) 30440
Creatine Kinase ($5) 374
Ferritin ($5) 457
Iron, Total and TIBC ($5) 7573
Gamma Glutamyl Transferase (GGT) ($5) 482
Homocysteine ($18) 31789
Lactate Dehydrogenase (LD) ($3) 593
Magnesium ($5) 622
*Phosphate (as Phosphorus) ($5) 718
Uric Acid ($5) 905
Rheumatoid Factor ($5) 4418

Heart and Artery Health

Cardio IQ Lp Frac., Ion Mobility ($50) 91604
Cardio IQ Lipoprotein (a) ($20) 91729
Cardio IQ Apolipoprotein B ($30) 91726
Cardio IQ Omega 3 and 6 Fatty Acids ($69) 91734
CO-Q10 ($50) 19826
CK isoenzymes w/total ($25) 4451
LP-PLA2 (Inf. of arteries and Alzheimer’s) ($30) 91738
NT-proBNP ($110) 11188

Immune Testing

Hormone Testing

Nutrient Testing

Prevention

PSA Free and Total ($30) 31348
CA- 125 ($30) 29256
Insulin growth factor ($40) 16293

GENETIC TESTING

Genetic Testing - Health, Traits and Ancestry ($200)
Genetic Testing - Ancestry Only ($100)
Genetic Reporting and Analysis ($100)

Digestive/Immune Testing

Neurotransmitter and Hormones

DUTCH Adrenal Panel ($200)
DUTCH Complete- Adrenal, Hormones and OATS ($350)
DUTCH Cycle Mapping (480)
DUTCH Sex Hormones Metabolites ($200)
DUTCH Organic Acid Test Only ($200)
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)
Evexia Neurotransmitter Testing ($225)

Detoxification Testing

Biotek Environmental Pollutants Testing ($180)
GI Toxic Element Clearance Profile ($160)
Genova Toxic Effects Core ($650)

Digestive, Detoxification and Neurotransmitters

Genova Nutreval Plasma ($500)
Genova Nutreval Plasma Insurance ($179)
Great Plains OATS test ($325)
Genova Nutrient and Toxic Elements Blood ($240)
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

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

Where Your Wellness Begins!