Order Form Back - api-pt.com

Send orders and payments to: Department 9526, P.O. Box 30516, Lansing, MI 48909-8016 800-333-0958 Fax: 855-900-6119 api-pt.com CLIA Number HCO # LAP/C...

16 downloads 963 Views 398KB Size
Innovative Solutions. Technical Excellence.

2018 Order Form

Send orders and payments to: Department 9526, P.O. Box 30516, Lansing, MI 48909-8016

800-333-0958

CLIA Number

State ID #

HCO #

LAP/CAP #

Fax: 855-900-6119

api-pt.com

COLA #

API # (if applicable)

State

Zip

___ ___ D ___ ___ ___ ___ ___ ___ ___ Shipping Information

Billing Information

Shipping Contact

Billing Contact

Institution Name

Institution Name

Department

Department

Street Address (products cannot be shipped to a P.O. Box)

Mailing Address

Address 2

Address 2

City

State

Zip

City

Phone/Fax:

Phone/Fax:

Email:

Email:

Send copies of reports to: (a copy will also be sent to the address above)

Send additional copies of reports to: (attach a list if more than two)

Attention

Attention

Institution Name and Address

Institution Name and Address

City

State

Zip

City

Phone/Fax:

Phone/Fax:

Email:

Email:

State

Zip

If you would like your order shipped by department, please use a separate form for each department. Please use additional forms if more lines are needed. Catalog Number

Description

Purchase Order #: Authorized Signature: Please complete the attached form if paying by credit card.

Quantity

Unit Price

Total

$ $ $ $ $ $ $ $ $ $ $ $

$ $ $ $ $ $ $ $ $ $ $ $

$ $ $ $ $ $

$ $ $ $ $ $

Sub-Total $ Shipping & Processing $

$99

*Additional Shipping Charges $ Order Total $

*Additional shipping charges may apply for AK, PR and all others sent outside of the continental U.S. *Call API for additional shipping costs if you are located in AK, PR or outside of the continental U.S. Visit www.api-pt.com to view our catalog or call us at 800-333-0958 to request a copy. Remit to: Department 9526, P.O. Box 30516, Lansing, MI 48909-8016

Send to API

AMERICAN PROFICIENCY INSTITUTE - 2018 PRICE LIST CHEMISTRY 137 138 166 130 174 111 112 172 173 114 140 920 165 120 121 122 141 125 144 177 170 148 142 131 135 126 127 179 167 134 128 928 133 160 145 945 176 976 236 147 129 169 171 163 132 136 175 150 146 143 139 123 918

Alcohol Ammonia Amniotic Fluid pH Apolipoproteins B-Ketone Blood Gas Blood Gas Plus ► Blood Lead - 5 Blood Lead - waived - 2 Blood Oximetry Cardiac Markers - 5 Cardiac Markers - 2 ► Additional Cardiac Markers Chemistry 1 Chemistry 2 Chemistry 3 Chemistry - Additional Volume Chemistry - Endocrinology Chemistry - waived CSF & Body Fluid Chemistry ► Cystatin C Ethyl Glucuronide Fetal Fibronectin Fetal ROM Fructosamine Glycohemoglobin - 5 Glycohemoglobin - 2 Additional Glycohemoglobin - 5 Additional Glycohemoglobin - 2 Glycohemoglobin - Whole Blood HemoCue - 5 HemoCue - 2 Immunoassay ► Immunoassay 2 i-Stat Chemistry - 5 i-Stat Chemistry - waived - 2 Lipid Plus - 5 Lipid Plus - 2 Microalbumin Neonatal Bilirubin - 5 Neonatal Bilirubin - 2 Procalcitonin SHBG and Testosterone Sweat Analysis ► Therapeutic Drugs ► Therapeutic Drugs - Add-on to Chemistry ► Thyroid - Special Tumor Markers ► Urine Adulteration Test Urine Chemistry Urine Drug Screen Whole Blood Glucose - 5 Whole Blood Glucose - 3

HEMATOLOGY & COAGULATION (continued) $330 $180 $222 $177 $203 $430 $470 $420 $220 $330 $305 $200 $162 $175 $245 $415 $111 $217 $177 $145 $300 $206 $360 $330 $155 $340 $215 $100 $50 $212 $247 $150 $270 $175 $315 $195 $245 $172 $180 $207 $147 $510 $407 $260 $210 $92 $205 $415 $197 $295 $255 $255 $155

URINALYSIS, MICROSCOPY & OTHER TESTS 261 239 233 260 273 258 232 272 235 234 270 271 251

Fecal Lactoferrin Gastric Occult Blood Provider Performed Microscopy Rapid Urease Urine Crystals Urine Eosinophils Urinalysis, HCG & FOB Urinalysis-I, HCG & FOB Urine HCG - Qualitative Urine Sediment Automated Urine Microscopy - I Automated Urine Microscopy - S Waived & PPM Package

$165 $180 $160 $152 $339 $75 $140 $177 $160 $55 $202 $202 $225

ANDROLOGY 154 162 151 152 161 153

Antisperm Antibody ► Post-Vasectomy Sperm Analysis ► Sperm Count Sperm Morphology Sperm Motility Sperm Viability

$262 $262 $262 $262 $302 $262

HEMATOLOGY & COAGULATION 211 916 212 917 259 224 225 206 207 168 277 214 914 217 245 246 210 229 221 227 231 240 230 220 242 241 238 226

ACT Hemochron / Helena- 5 ACT Hemochron / Helena - 2 ACT Medtronic - 5 ACT Medtronic - 2 Advanced Virtual Blood Cell ID Blood Cell ID (CMS Scored) Blood Cell ID (Not CMS Scored) Body Fluid Cell Count - C Body Fluid Cell Count - I Body Fluid Microscopy Cell Count & Body Fluid Crystals CoaguChek XS, Plus - 5 CoaguChek XS, Plus - 2 Coagulation (PT, APTT, Fibrinogen) D-dimer - Qualitative D-dimer - Quantitative Fetal Hemoglobin - gastric fluid Flow Cytometry ► Hematology - 3 Hematology - 3S Hematology - 5A Hematology - 5B Hematology - 5C Hematology - 5C2 Hematology - 5D Hematology - 5E Hematology - 5S Hematology - 5M

$350 $260 $350 $260 $180 $57 $57 $205 $205 $66 $275 $258 $203 $185 $150 $152 $245 $430 $270 $270 $308 $305 $308 $267 $305 $305 $307 $308

247 248 252 249 250 209 278 215 216 208 254 255 256 222 223 228 201 202 203 237 244

Hemochron Jr. ACT - LR Hemochron Jr. ACT + Hemochron Jr. Citrate APTT ► Hemochron Jr. Citrate PT Hemochron Jr. PT HemoCue White Blood Cell Count Heparin Assay i-Stat ACT i-Stat/CoaguSense PT/INR Lamellar Body Count Platelet Function - IIb/IIIa Test Platelet Function - Aspirin Test Platelet Function - P2Y12 Test QBC Hematology Reticulocyte Count Sed Rate - A Sed Rate - B (Polymedco Sedimat 15) Sed Rate - C (HemaTech ESR STAT) Sed Rate - D (Alcor i-Sed) Sickle Cell Screen Thromboelastogram

MICROBIOLOGY (continued) $245 $245 $365 $360 $360 $265 $265 $278 $263 $225 $240 $240 $240 $272 $237 $175 $167 $167 $228 $201 $200

IMMUNOLOGY 421 429 424 423 425 413 431 419 437 420 430 432 433 407 436 411 410 910 418 428 408 415 409 416 164 417

ANA - EIA & IFA methods ANA - Latex kits ASO Anti-CCP CRP - High Sensitivity CRP - Qualitative CRP - Quantitative Diagnostic Allergy Additional Diagnostic Allergy H. pylori Antibody HSV-2 Antibody Rapid HIV - 5 Rapid HIV - 2 Immunology Package Immunoproteins / C3 & C4 Infectious Mono & Rheumatoid Factor Infectious Mononucleosis - 5 Infectious Mononucleosis - 2 Lyme Disease Mycoplasma Antibody Rheumatoid Factor Rubella Serum HCG Syphilis Serology Thyroid Antibodies Viral Markers ►

$156 $160 $140 $320 $185 $90 $150 $325 $90 $155 $200 $390 $205 $438 $215 $252 $160 $95 $215 $185 $156 $157 $160 $195 $300 $495

IMMUNOHEMATOLOGY 511 516 519 520 521 517 537 512 532 514 534 518 515 513

ABO / Rh Antibody Elution Antibody Titer - A Antibody Titer - D Antibody Titer - AD Automated Blood Bank Auto Blood Bank w/ Electronic Crossmatch Blood Bank Blood Bank w/ Electronic Crossmatch Direct Antiglobulin Testing DAT - Automated ► Educational Blood Bank Fetal RBC ► Rh Slide Test

$295 $550 $270 $270 $370 $550 $855 $410 $720 $205 $245 $196 $300 $167

MICROBIOLOGY 335 359 321 361 336 368 363 360 317 350 347 316 930 311 328 345 332 369 342 932 315 929 320 330 329 319 312 912 913 365 965 375 351 373 339 333 340 366

Acid Fast Smears Bacterial Vaginosis Basic Bacteriology Package Blood Culture - Add-on Blood Parasites Blood Pathogen Panel Bordetella pertussis Campylobacter - Add-on Candida Culture C. difficile Toxin or Antigen - 5 C. difficile Toxin or Antigen - 2 Chlamydia Antigen - 5 Chlamydia Antigen - 2 Chlamydia/GC Nucleic Acid Comprehensive Bacteriology Cryptococcal Antigen Dermatophyte Culture GI Panel Giardia & Crypto Antigen - 5 Giardia & Crypto Antigen - 2 GC/Group B Strep Culture - 5 GC/Group B Strep Culture - 2 Gram Stain (slides) Additional Gram Stain (slides) Gram Stain - Direct Smears (virtual) Gram Stain - Vaginitis Group A Strep Antigen - 5 Group A Strep Antigen - 2 Group A Strep Antigen - 3 Group B Strep (molecular) - 5 Group B Strep (molecular) - 2 HPV (molecular) H. pylori Antigen, Stool HSV 1 & 2 (molecular) India Ink KOH Slides Legionella Antigen MRSA/Staph aureus (molecular)

$202 $175 $280 $190 $398 $485 $350 $145 $322 $210 $145 $315 $110 $388 $305 $165 $260 $452 $262 $155 $240 $110 $175 $110 $180 $292 $195 $105 $125 $242 $111 $350 $278 $450 $177 $180 $150 $106

356 372 371 344 331 374 334 337 370 348 349 341 343 364 964 313 952 953 362 314 924 324 357 367 322 942 933

MRSA Culture M. tuberculosis (molecular) Meningitis Panel Mycobacteriology Culture ► Mycology Culture Mycoplasma pneumoniae (molecular) Parasitology Parasite Panel (Triage) Respiratory Panel Rotavirus - 5 Rotavirus - 3 S. pneumoniae Antigen Shiga Toxin Strep Pharyngeal (molecular) - 5 Strep Pharyngeal (molecular) - 2 Throat Culture - 5 Throat Culture - 2 Throat Culture - 3 Trichomonas Urine Culture - 5 Urine Culture - 2 Vaginitis Screen VRE Culture VRE (molecular) Virology Package - 5 Virology Package - 2 Virology Package - waived methods - 2

$107 $350 $450 $350 $325 $350 $275 $270 $488 $290 $170 $150 $230 $242 $111 $255 $110 $115 $292 $267 $177 $362 $107 $105 $325 $170 $165

VERIFICATION PROGRAMS CMS only allows PT for one instrument/method. The programs below are to test and report another instrument/method after the PT due date. No results will be reported to CMS or other regulatory agencies. The primary catalog number is shown in parentheses next to each verification program. See page 27 of our online catalog for more details. Contact us at 800-333-0958 or [email protected] if you need assistance. J16 J17 A37 A38 E17 E12 A11 A12 A14 A40 J20 C47 A20 A21 A22 A44 B14 J14 B17 E14 B46 B39 A27 J12 B20 B21 B27 B30 B31 B38 B40 B41 B42 J28 B47 B48 A33 A60 B15 A45 J45 B16 A29 B33 D33 D09 A36 B32 A39 B35 C22 J33 B51 X23 X18 X51 A23 J18

ACT - Hemochron - 2 (916) ACT - Medtronic 2 (917) Alcohol (137) Ammonia (138) Auto Blood Bank (517) Blood Bank (512) Blood Gas (111) Blood Gas Plus (112) Blood Oximetry (114) Cardiac Markers (140) Cardiac Markers - 2 (920) C. difficile Toxin or Antigen - 2 (347) Chemistry 1 (120) Chemistry 2 (121) Chemistry 3 (122) Chemistry - waived (144) CoaguChek XS, Plus (214) CoaguChek XS, Plus - 2 (914) Coagulation (217) DAT (514) D-dimer Quantitative (246) Gastric Occult Blood (239) Glycohemoglobin - 2 (127) Group A Strep Antigen – 2 (912) Hematology - 5C2 (220) Hematology - 3 (221) Hematology - 3S (227) Hematology - 5C (230) Hematology - 5A (231) Hematology - 5S (238) Hematology - 5B (240) Hematology - 5E (241) Hematology - 5D (242) HemoCue - 2 (928) Hemochron Jr. ACT-LR (247) Hemochron Jr. ACT+ (248) Immunoassay (133) Immunoassay 2 (160) i-STAT ACT (215) i-STAT Chemistry - 5 (145) i-STAT Chemistry - waived - 2 (945) i-STAT/CoaguSense PT/INR (216) Neonatal Bilirubin - 2 (129) PPM (233) Rapid HIV - 2 (433) Serum HCG (409) TDM - Add-on to Chem (136) Urinalysis, HCG & FOB (232) Urine Drug Screen (139) Urine HCG-5 (235) Virology Package (322) Virology Package - waived - 2 (933) Waived & PPM Package (251) Extra Results WBG (123) Extra Results WBG (918) Extra Results WBG – waived Package (251) Whole Blood Glucose - 5 (123) Whole Blood Glucose - 3 (918)

$220 $175 $260 $180 $550 $410 $100 $100 $100 $175 $120 $112 $100 $100 $100 $135 $205 $130 $140 $160 $120 $130 $210 $95 $265 $270 $265 $305 $305 $307 $305 $305 $305 $110 $190 $190 $210 $130 $200 $160 $95 $200 $145 $125 $140 $40 $60 $125 $190 $125 $240 $120 $177 $0 $0 $0 $210 $112

SUPPLEMENTAL ITEMS 957 958 REG

$15 API 3-Ring Binder (U.S. Customers Only) API 3-Ring Binder Tabs Only $0 Shipping & Processing $99 ► Some analytes within this program are not CAP accepted. See our online catalog for the most recent list of CAP accepted programs. Additional shipping charges may apply to Alaska and countries outside of the U.S.

Hematology Instrument List www.api-pt.com

Instrument Name Body Fluid Cell Count

Abbott Cell-Dyn-all models Coulter AC-T, HmX, LH, MAXM, Unicel DxH- all models Iris iQ Siemens Advia 120/2120 Sysmex XE, XN, XS, XT-all models

Hematology

Abbott Cell-Dyn 1400 through 1800 Abbott Cell-Dyn 3000 through 5000 Abbott Cell-Dyn Emerald Abbott Cell-Dyn Emerald 22 Abbott Cell-Dyn Ruby, Sapphire CDS Medonic CA CDS Medonic M-Series Coulter AcT-5 Coulter Ac-T – all 3 part differential models Coulter HmX, GEN-S Coulter JT, T- all models Coulter LH500, MAXM, STKS Coulter LH-750/755/780/785 Coulter Micro Diff- all models Coulter UniCel DxH 300 Coulter UniCel DxH 600, 800 Danam Datacell- all models Diatron Abacus 5 Drew (Danam) Excell 16 Drew D3, Evolution Drew Excell 22, 2280 HemoCue- all models (for WBC only) Horiba ABX 9000, 9100, Micros, Minos - all models Horiba ABX Pentra- all models Humacount Infolab Excell 16, I-1600, I-1800- all models MD Mascot 800 Mindray 5000 Series Mindray BC - all models QBC Autoread, Autoread Plus QBC Reader - Manual Siemens Advia 120, 2120- all models Siemens Advia 56 Siemens Advia 60 Sysmex KX Series, pocH-100i Sysmex XE, XN, XS, XT - all models Sysmex XP-300

800-333-0958

API Catalog Number 206 206 207 206 206 221 242 221 242 242 221 227 231 221 220 221 220 230 221 221 230 221 242 221 221 241 209 221 231 221 221 221 226 221 222 222 240 242 221 227 238 227

Sedimentation Rate Alcor i-Sed BD Seditainer Chase Westergren 830 SO Dispette, Dispette 2 Globe Scientific- all methods Griener SRS, SRT HemaTech ESR STAT PLUS, STAT 180 Life Science Technologies ESRA MiniVes Polymedco Sedimat 15, 15 Plus Polymedco Sedimat/Sediplast Sedifast, Sediplast, Sediten, Seditube StaRRsed Compact Statspin ESRA-10 Streck / Analys ESR, Auto ESR Plus- all methods Ulstar Scientific Sed-Pac Ves Matic- all models Vital Diagnostic Excyte- all models Winpette

203 228 228 228 228 228 202 228 228 201 228 228 228 228 228 228 228 228 228

American Proficiency Institute accepts Discover, MasterCard, and Visa credit card payments. Please complete the form in its entirety to ensure timely processing. All information is kept confidential.

Discover

MasterCard

Visa