ALS BLOOD LAB REQUISITION SIMULATION
ABC LAB REQUISITION SIMULATION
PATIENT NAME:
Reason for order:
ICD10:
ORDERING PHYSICIAN/INTERN (print):
ADD
Term:
DOB:
NPI/MATRIC:
TEST NAME
CODE
COST
Antipancreatic Islet Cells
P160721
$59.00
Best Value Panel - New
P365422 $229.00
C-Reactive Protein (CRP) High Sensitivity (Cardiac)
P120766
$19.00
Cholesterol, Total
P1065
$5.00
Complete Blood Count (CBC) With Differential and Platelet Count
P5009
$10.00
Comprehensive Metabolic Panel
P322000
$15.00
Rheumatoid Arthritis (RA) Expanded Profile
P337791
$79.00
Gluconse and Hemoglobin A1c
P25239
$21.00
Hepatic Function Panel
P322755
$15.00
HIV 1/2 Antibody, Differentiation
P83904
$65.00
HLA B 27 Disease Association
P6924
$59.00
Human Immunodeficiency Virus 1/O/2 (HIV-1/O/2) Antigen/Antibody (Fourth
P83935
Generation)$29.00
Preliminary Test W
Lead Standard Profile, Blood
P38170
$69.00
Lead Standard Profile, Pediatric
P717035
$69.00
Lipid Panel (Compliance)
P303756
$20.00
Lipid Panel with LDL/HDL Ratio
P235010
$15.00
Lipid Panel With Total Cholesterol/HDL Ratio
P221010
$15.00
Opti-ThyroPlex Panel II
P237359 $265.00
Pancreatic Amylase, Serum
P123111
$46.00
Pancreatic Cancer Monitor Profile
P485086
$79.00
Sedimentation Rate (ESR), Westergren
P5215
$12.00
Sexually Transmitted Infection (STI) Panel
P240964 $159.00
T & B Lymphocyte / Natural Killer Cell (CD56) Panel with CBC and Differential
P505370
with Platelet
$139.00
Count
Thyroid Comprehensive Panel I
P333757 $119.00
Thyroid Comprehensive Panel II
P333417 $125.00
Vitamin D, 1,25-Hydroxycalciferol (Calcitriol) and Vitamin D, 25-Hydroxy P80325
$67.00
Vitamin D, 25-Hydroxycalciferol
P81950
$29.00
Total cost
$
