MNG Test and Price List 12/3/2014 (by Testing Category/Disease Category) CLIA ID: 11D0703390 GA License: 044-146 MD License: 1241 FL License 800025664 NY PFI: 8159 California License: COS 00800363 When ordering tests, please use our test requisition forms available from our website at www.mnglab.com. Selected testing may be discounted when contracting with us. Please email [email protected] for contracts. USE mngQuickResponse AT OUR WEBSITE TO SUBMIT QUESTIONS BY SECURE HIPAA-COMPLIANT EMAIL FOR RAPID RESPONSE TO QUESTIONS. USE mngSmartDx AT OUR WEBSITE FOR DESCRIPTION OF EACH GENE AND EACH TEST AS WELL MOLECULAR DIFFERENTIAL DIAGNOSIS SEARCH. ORDER mngSmartKits AT OUR WEBSITE FOR SIMPLE SAMPLE PROCESSING AND FREE SHIPPING. NO SUNDAY OR HOLIDAY DELIVERIES ACCEPTED. Test Code *NEW* Test Description RAPID EVALUATION SMART KITS TAT Price CPT Codes *NEW* [ORDER THESE FREE KITS WITH FREE SHIPPING AT WWW.MNGLAB.COM] REK01 Comprehensive Kit: Anticonvulsant-Resistant Epilepsy Rapid Evaluation SmartKit [Metabolic & Molecular Genetic tests] 7 days $3,800.00 see kit REK02 Genetic Testing Kit: Anticonvulsant-Resistant Epilepsy Rapid Evaluation SmartKit [Molecular Genetic tests ONLY] 7 days $2,800.00 81479 8 weeks $1,200.00 81479 NEXT GENERATION SEQUENCING (NGS) PANELS Amyloid Related Disease NGS380 Amyloid Related Disorders NextGen DNA Sequencing Panel (14 Genes) Cardiac Disease Arrhythmia Panels NGS365 Arrhythmia, Comprehensive NextGen DNA Sequencing Panel (50 Genes) 8 weeks $1,850.00 81479 NGS367 Arrhythmogenic Right Ventricular Dysplasia NextGen DNA Sequencing Panel (12 Genes) 8 weeks $1,050.00 81479 NGS369 Brugada Syndrome NextGen DNA Sequencing Panel (11 Genes) 8 weeks $1,050.00 81479 NGS368 Long and Short QT Syndrome NextGen DNA Sequencing Panel (16 Genes) 8 weeks $1,200.00 81280 Ventricular Tachycardia NextGen DNA Sequencing Panel (25 Genes) 8 weeks $1,400.00 81479 NGS366 Cardiomyopathy Panels NGS367 Arrhythmogenic Right Ventricular Dysplasia NextGen DNA Sequencing Panel (12 Genes) 8 weeks $1,050.00 81479 NGS363 Cardiomyopathy, Comprehensive NextGen DNA Sequencing Panel (127 Genes) 8 weeks $1,850.00 81479 NGS364 Left Ventricular Noncompaction NextGen DNA Sequencing Panel (8 Genes) 8 weeks $1,050.00 81479 8 weeks $1,400.00 81479 Congenital Heart Defects Panel NGS370 Congenital Heart Defects NextGen DNA Sequencing Panel (65 Genes) Page 1 of 16 Test Code Test Description TAT Price CPT Codes NEXT GENERATION SEQUENCING (NGS) PANELS Connective Tissue Disease NGS377 Ehlers Danlos, Ehlers Danlos-like Syndromes, and Aneurysm syndromes NextGen DNA Sequencing Panel (36 Genes) 8 weeks $1,850.00 81479 NGS378 Marfan and Marfan-like syndromes NextGen DNA Sequencing Panel (15 Genes) 8 weeks $1,200.00 81479 NGS319 Fever Syndromes NextGen DNA Sequencing Panel (14 Genes) 8 weeks $1,200.00 81479 Fever Syndromes Kidney Disease NGS392 Bartter/Gitelman Syndromes NextGen DNA Sequencing Panel (6 Genes) 8 weeks $1,050.00 81479 NGS379 Polycystic kidney disease NextGen DNA Sequencing Panel (3 Genes) 8 weeks $1,050.00 81479 Metabolic Disorders Cellular Energetics Panels NGS301 Cellular Energetics, Comprehensive NextGen DNA Sequencing Panel (665 genes) 8 weeks $2,300.00 81479 NGS306 Oxidative Phosphorylation (OXPHOS) Defects NextGen DNA Sequencing Panel (411 genes) 8 weeks $2,100.00 81479 NGS351 Leigh disease and Leigh-like syndromes NextGen DNA Sequencing Panel (75 Genes) 8 weeks $1,850.00 81479 NGS198 mtDNA Depletion/mtDNA Deletion Syndromes NextGen DNA Sequencing Panel (14 genes) 8 weeks $1,200.00 81479 NGS197 Coenzyme Q10 Deficiency NextGen DNA Sequencing Panel (12 genes) 8 weeks $1,050.00 81479 NGS355 Cytochrome c oxidase deficiency NextGen DNA Sequencing Panel (40 Genes) 8 weeks $1,400.00 81479 NGS305 Pyruvate and Tricarboxylic Acid Metabolism NextGen DNA Sequencing Panel (33 genes) 8 weeks $1,400.00 81479 NGS304 Pyruvate Metabolism NextGen DNA Sequencing Panel (18 Genes) 8 weeks $1,200.00 81479 NGS302 Carbohydrate Metabolism Disorders NextGen DNA Sequencing Panel (72 genes) 8 weeks $1,850.00 81479 NGS308 Creatine Metabolism Disorders NextGen DNA Sequencing Panel (6 Genes) 8 weeks $1,050.00 81479 NGS311 Glutaric Acidemia Disorders NextGen DNA Sequencing Panel (8 genes) 8 weeks $1,050.00 81479 NGS312 Ketone Body Metabolism Disorders NextGen DNA Sequencing Panel (8 genes) 8 weeks $1,050.00 81479 Lipid Metabolism Disorders NextGen DNA Sequencing Panel (121 genes) 8 weeks $1,850.00 81479 Metabolic Disease Hepatomegaly NextGen DNA Sequencing Panel (73 Genes) 8 weeks $1,850.00 81479 Carbohydrate Metabolism, Hepatomegaly NextGen DNA Sequencing Panel (11 genes) 8 weeks $1,050.00 81479 NGS303 Hepatomegaly and Metabolic Disease Panels NGS383 NGS384 Metabolic Pathway-Specific Panels NGS309 Cobalamin/Homocysteine/Methionine Metabolism Disorders NextGen DNA Sequencing Panel (20 Genes) 8 weeks $1,200.00 81479 NGS327 Congenital Glycosylation Disorders NextGen DNA Sequencing Panel (34 Genes) 8 weeks $1,400.00 81479 NGS314 Methylmalonic Acid Metabolism Disorders NextGen DNA Sequencing Panel (13 Genes) 8 weeks $1,050.00 81479 NGS321 Urea Cycle Disorders NextGen DNA Sequencing Panel (15 Genes) 8 weeks $1,200.00 81479 Page 2 of 16 Test Code Test Description TAT Price CPT Codes NEXT GENERATION SEQUENCING (NGS) PANELS Metabolic Disorders Peroxisome and Lysosome Disease Panels NGS307 Ceroid Lipofuscinosis Disorders NextGen DNA Sequencing Panel (11 genes) 8 weeks $1,050.00 81479 NGS382 Dysostosis multiplex NextGen DNA Sequencing Panel (12 Genes) 8 weeks $1,050.00 81479 NGS313 Lysosomal Disease NextGen DNA Sequencing Panel (24 Genes) 8 weeks $1,200.00 81479 NGS381 Mucopolysaccharidosis and Mucolipid Disorders NextGen DNA Sequencing Panel (13 Genes) 8 weeks $1,050.00 81479 NGS343 Peroxisomal Disease NextGen DNA Sequencing Panel (23 Genes) 8 weeks $1,200.00 81479 Neurologic Disorders COGNITIVE/NEUROBEHAVIORAL DISORDERS Dementia Panels NGS356 Alzheimer Disease/Frontotemporal Demetia NextGen DNA Sequencing Panel (48 Genes) 8 weeks $1,850.00 81479 NGS380 Amyloid Related Disorders NextGen DNA Sequencing Panel (14 Genes) 8 weeks $1,200.00 81479 NGS376 Dementia, Comprehensive NextGen DNA Sequencing Panel (89 Genes) 8 weeks $1,850.00 81479 Intellectual Disability/Autism Panels NGS325 Intellectual Disability, Comprehensive NextGen DNA Sequencing Panel (191 Genes + mtDNA) 8 weeks $1,850.00 81479 NGS349 Intellectual Disability, Nonsyndromic NextGen DNA Sequencing Panel (53 Genes) 8 weeks $1,850.00 81479 NGS350 Intellectual Disability, Syndromic NextGen DNA Sequencing Panel (93 Genes) 8 weeks $1,850.00 81479 8 weeks $1,050.00 81479 CENTRAL HYPOVENTILATION NGS371 Central Hypoventilation NextGen DNA Sequencing Panel (7 Genes) EPILEPSY NGS385 Epilepsy NextGen DNA Sequencing Panel (126 Genes + mtDNA) 8 weeks $1,850.00 81479 NGS386 Epileptic Encephalopathy NextGen DNA Sequencing Panel (41 Genes) 8 weeks $1,850.00 81479 LEUKODYSTROPHY/LEUKOENCEPHALOPATHY/HYPOMYELINATION NGS372 Leukodystrophy/Leukoencephalopathy: Comprehensive Panel NextGen DNA Sequencing Panel (84 Genes) 8 weeks $1,850.00 81280 NGS374 Leukodystrophy/Leukoencephalopathy: Mitochondrial NextGen DNA Sequencing Panel (39 Genes) 8 weeks $1,850.00 81479 NGS373 Leukodystrophy/Leukoencephalopathy: Non-Mitochondrial NextGen DNA Sequencing Panel (40 Genes) 8 weeks $1,200.00 81479 NGS375 Leukodystrophy/Leukoencephalopathy: Vanishing White Matter, Dysmyelinating, and Hypomyelinating Leukodystrophy NextGen DNA Sequencing Panel (52 Genes) 8 weeks $1,850.00 81479 8 weeks $1,400.00 81479 MOVEMENT DISORDERS/DYSTONIA/ATAXIA Ataxia/Episodic Ataxia Panel NGS324 Ataxia/Episodic Ataxia Disorders NextGen DNA Sequencing Panel (33 Genes + mtDNA) Page 3 of 16 Test Code Test Description TAT Price CPT Codes 8 weeks $1,050.00 81479 8 weeks $1,050.00 81479 NEXT GENERATION SEQUENCING (NGS) PANELS Neurologic Disorders MOVEMENT DISORDERS/DYSTONIA/ATAXIA Brain Calcification Panel NGS360 Basal Ganglia Calcification NextGen DNA Sequencing Panel (13 Genes) Brain Iron Accumulation Panel NGS362 Neurodegeneration with Brain Iron Accumulation NextGen DNA Sequencing Panel (9 Genes) Dystonia Panels NGS358 Dystonia: Comprehensive NextGen DNA Sequencing Panel (83 Genes) 8 weeks $1,850.00 81479 NGS359 Dystonia: Primary Dystonia Syndrome NextGen DNA Sequencing Panel (14 Genes) 8 weeks $1,200.00 81479 NGS361 Dystonia: OXPHOS Defects NextGen DNA Sequencing Panel (13 Genes) 8 weeks $1,050.00 81479 8 weeks $1,850.00 81479 Parkinson Disease/Parkinsonism Panels NGS357 Parkinson Disease NextGen DNA Sequencing Panel (73 Genes) NEUROCHEMISTRY-RELATED DISORDERS NGS344 Aicardi-Goutieres Syndrome NextGen DNA Sequencing Panel (6 genes) 8 weeks $1,050.00 81479 NGS316 Dopamine Metabolism Disorders NextGen DNA Sequencing Panel (14 Genes) 8 weeks $1,200.00 81479 NGS310 GABA Metabolism Disorders NextGen DNA Sequencing Panel (22 Genes) 8 weeks $1,200.00 81479 NGS315 Neurotransmitter Metabolism Disorders NextGen DNA Sequencing Panel (93 Genes) 8 weeks $1,850.00 81479 NGS317 Serotonin Metabolism Disorders NextGen DNA Sequencing Panel (27 Genes) 8 weeks $1,400.00 81479 NGS318 Tetrahydrofolate Metabolism Disorders NextGen DNA Sequencing Panel (15 Genes) 8 weeks $1,200.00 81479 NGS320 Tyrosinemia NextGen DNA Sequencing Panel (4 Genes) 8 weeks $1,050.00 81479 8 weeks $1,050.00 81479 8 weeks $1,850.00 81479 NEUROFIBROMATOSIS-RELATED DISORDERS/CAFÉ-AU-LAIT SPOTS NGS335 Neurofibromatosis (NF), NF-Like Disorders NextGen DNA Sequencing Panel (11 Genes) NEUROMUSCULAR DISORDERS Fetal Akinesia/Arthrogryposis Panel NGS348 Fetal Akinesia, Arthrogryposis, or Contractures NextGen DNA Sequencing Panel (143 Genes) Motor Neuron Disease Panels NGS323 Amyotrophic Lateral Sclerosis NextGen DNA Sequencing Panel (23 Genes) 8 weeks $1,200.00 81479 NGS347 Spinal Muscular Atrophy NextGen DNA Sequencing Panel (16 Genes) 8 weeks $1,200.00 81479 Myopathy/Muscular Dystrophy Panels NGS332 Hypokalemic and Hyperkalemic Periodic Paralysis Disorders NextGen DNA Sequencing Panel (6 Genes) 8 weeks $1,050.00 81479 NGS333 Malignant Hyperthermia NextGen DNA Sequencing Panel (2 Genes) 8 weeks $1,050.00 81479 NGS330 Muscular Dystrophy/Myopathy, Comprehensive NextGen DNA Sequencing Panel (163 Genes + mtDNA) 8 weeks $1,850.00 81479 Page 4 of 16 Test Code Test Description TAT Price CPT Codes 8 weeks $1,050.00 81479 NEXT GENERATION SEQUENCING (NGS) PANELS Neurologic Disorders Myopathy/Muscular Dystrophy Panels NGS331 Myasthenic Syndromes, Congenital NextGen DNA Sequencing Panel (12 Genes) NGS345 Charcot Marie Tooth Disease NextGen DNA Sequencing Panel (42 Genes + mtDNA) 8 weeks $1,850.00 81479 NGS346 Hereditary Sensory/Autonomic Neuropathy, Autosomal Recessive and Pain Syndromes NextGen DNA Sequencing Panel (16 Genes) 8 weeks $1,200.00 81479 NGS352 Ophthalmoplegia: Comprehensive NextGen DNA Sequencing Panel (46 Genes) 8 weeks $1,850.00 81479 NGS353 Ophthalmoplegia: Cellular energetics NextGen DNA Sequencing Panel (22 Genes) 8 weeks $1,200.00 81479 NGS354 Ophthalmoplegia: Non-mitochondrial NextGen DNA Sequencing Panel (25 Genes) 8 weeks $1,400.00 81479 Neuropathy Panels Ophthalmoplegia Syndrome Panels NEURONAL MIGRATION DISORDERS NGS387 Neuronal Migration Disorders: Comprehensive NextGen DNA Sequencing Panel (63 Genes) 8 weeks $1,850.00 81479 NGS388 Neuronal Migration Disorders: Non-mitochondrial NextGen DNA Sequencing Panel (54 Genes) 8 weeks $1,850.00 81479 NGS389 Neuronal Migration Disorders: Mitochondrial NextGen DNA Sequencing Panel (11 Genes) 8 weeks $1,050.00 81479 8 weeks $1,400.00 81479 SPASTIC PARAPLEGIA DISORDERS NGS337 Spastic Paraplegia NextGen DNA Sequencing Panel (57 Genes) GENE SEQUENCING PANELS (SANGER SEQUENCING) MOL284 Aicardi-Goutieres MLPA Duplication/Deletion Analysis 2 weeks $375.00 81479 MOL181 Aicardi-Goutieres Full Gene Sequencing Analysis Panel (6 genes) 2 weeks $1,250.00 81479 MOL279 Aicardi-Goutieres Sequencing Panel + MLPA Duplication/Deletion Analysis 2 weeks $1,500.00 81479 MOL178 Dopa-Responsive Dystonia Full Gene Sequencing Analysis Panel (3 genes) 2 weeks $1,050.00 81479 MOL180 Hyperekplexia Full Gene Sequencing Analysis Panel (5 genes) 2 weeks $1,250.00 81479 MOL297 Hyperekplexia Full Gene Sequencing Analysis Panel + MLPA Duplication/Deletion Analysis 2 weeks $1,500.00 81479 MOL285 Hyperekplexia MLPA Panel 2 weeks $375.00 81479 MOL179 Sarcoglycan Full Gene Sequencing Analysis Panel (4 genes) 2 weeks $1,120.00 81479 MOL323 Sarcoglycan Panel MLPA Duplication/Deletion Analysis 2 weeks $500.00 81479 MOL177 Vanishing White Matter Disease Full Gene Sequencing Analysis Panel (5 genes) 2 weeks $1,250.00 81479 GENE SEQUENCING (SANGER), DELETION/DUPLICATION (MLPA) , POINT MUTATIONS - INDIVIDUAL GENES MOL026 ABCB7 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL242 ACAD8 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL243 ACAD9 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL027 ACADM Full Gene Sequencing Analysis 2 weeks $500.00 81479 Page 5 of 16 Test Code Test Description TAT Price CPT Codes GENE SEQUENCING (SANGER), DELETION/DUPLICATION (MLPA) , POINT MUTATIONS - INDIVIDUAL GENES MOL023 ACADM Mutation Screen: c.985A>G, K329E 2 weeks $155.00 81400 MOL028 ACADS Full Gene Sequencing Analysis 2 weeks $500.00 81405 MOL029 ACADVL Full Gene Sequencing Analysis 2 weeks $600.00 81406 MOL261 ACADVL Full Gene Sequencing Analysis + MLPA Duplication/Deletion Analysis 2 weeks $800.00 81406, 81479 MOL260 ACADVL MLPA Duplication/Deletion Analysis 2 weeks $375.00 81479 MOL140 ADCK3 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL309 ADAR1 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL209 ADSL Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL183 AIFM1 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL125 ALDH5A1 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL030 ALDH7A1 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL185 AMPD1 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL110 APTX Full Gene Sequencing Analysis 2 weeks $400.00 81405 MOL306 ARHGEF9 Gene Sequencing Analysis 2 weeks $400.00 81479 MOL267 ATL1 (SPG3) Full Gene Sequencing Analysis + MLPA Duplication/Deletion Analysis 2 weeks $800.00 81479 MOL266 ATL1 (SPG3) MLPA Duplication/ Deletion Analysis 2 weeks $375.00 81479 MOL032 ATP1A2 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL214 ATP1A2 MLPA Duplication/Deletion Analysis 2 weeks $375.00 81479 MOL295 ATP5E Full Gene Sequencing 2 weeks $500.00 81479 MOL112 ATPAF2 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL045 BCS1L Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL147 BRAF Full Gene Sequencing Analysis 2 weeks $600.00 81406 MOL271 BSND Full Gene Sequencing Analysis 2 weeks $400.00 81479 MOL073 C10ORF2 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL313 C10ORF2 MLPA Duplication/Deletion Analysis 2 weeks $375.00 81479 MOL033 CACNA1A Full Gene Sequencing Analysis 2 weeks $1,110.00 81479 MOL208 CACNA1A MLPA Duplication/Deletion Analysis 2 weeks $500.00 81479 MOL307 CACNA1S Full Gene Sequencing Analysis 2 weeks $1,110.00 81479 MOL227 CACNB4 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL034 CAPN3 Full Gene Sequencing Analysis 2 weeks $600.00 81406 MOL240 CAPN3 Full Gene Sequencing Analysis + MLPA Duplication/Deletion Analysis 2 weeks $800.00 81406, 81479 Page 6 of 16 Test Code Test Description TAT Price CPT Codes GENE SEQUENCING (SANGER), DELETION/DUPLICATION (MLPA) , POINT MUTATIONS - INDIVIDUAL GENES MOL239 CAPN3 MLPA Duplication/Deletion Analysis 2 weeks $375.00 81479 MOL035 CAV3 Full Gene Sequencing Analysis 2 weeks $300.00 81404 MOL254 CHKB Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL268 CLCNKA Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL287 CLCNKB full Gene Sequencing Analysis + MLPA Duplication/Deletion Analysis 2 weeks $800.00 81479 MOL286 CLCNKB MLPA Duplication/Deletion Analysis 2 weeks $375.00 81479 MOL046 COQ2 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL128 COQ3 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL129 COQ4 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL131 COQ6 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL132 COQ7 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL133 COQ9 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL047 COX10 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL048 COX15 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL182 COX6B1 Full Gene Sequencing Analysis 2 weeks $500.00 81479 MOL049 CPT1A Full Gene Sequencing Analysis 2 weeks $500.00 81479 MOL050 CPT2 Full Gene Sequencing Analysis 2 weeks $600.00 81404 MOL339 DARS Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL094 DARS2 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL141 DBH Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL025 DDC Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL051 DGUOK Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL237 DHFR Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL224 DLAT Full Gene Sequencing Analysis 2 weeks $600.00 81406 MOL225 DLD Full Gene Sequencing Analysis 2 weeks $600.00 81406 MOL302 DMD (Dystrophin) MLPA Duplication/Deletion Analysis 2 weeks $500.00 81479 MOL281 DOK7 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL052 DYSF Full Gene Sequencing Analysis 2 weeks $1,110.00 81408 MOL054 EIF2B1 Full Gene Sequencing Analysis 2 weeks $500.00 81479 MOL055 EIF2B2 Full Gene Sequencing Analysis 2 weeks $500.00 81479 MOL056 EIF2B3 Full Gene Sequencing Analysis 2 weeks $500.00 81479 MOL057 EIF2B4 Full Gene Sequencing Analysis 2 weeks $500.00 81479 Page 7 of 16 Test Code Test Description TAT Price CPT Codes GENE SEQUENCING (SANGER), DELETION/DUPLICATION (MLPA) , POINT MUTATIONS - INDIVIDUAL GENES MOL058 EIF2B5 Full Gene Sequencing Analysis 2 weeks $500.00 81479 MOL145 EMD Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL163 ETFA Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL164 ETFB Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL142 ETFDH Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL165 FASTKD2 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL149 FKRP Full Gene Sequencing Analysis 2 weeks $300.00 81404 MOL150 FKTN Full Gene Sequencing Analysis 2 weeks $500.00 81405 MOL314 FKRP MLPA Duplication/Deletion Analysis 2 weeks $375.00 81479 MOL166 FOLR1 Full Gene Sequencing Analysis 2 weeks $500.00 81479 MOL238 FOXP2 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL210 FOXRED1 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL259 Friedreich's Ataxia Genetic Testing (Trinucleotide repeat expansion) 7 days $200.00 81401 MOL059 FXN Full Gene Sequencing Analysis 2 weeks $500.00 81404 MOL167 GARS Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL315 GARS MLPA Duplication/Deletion Analysis 2 weeks $375.00 81479 MOL213 GCDH Full Gene Sequencing 2 weeks $600.00 81406 MOL234 GCH1 Full Gene Sequencing + MLPA Duplication/Deletion Analysis 2 weeks $600.00 81479 MOL060 GCH1 Full Gene Sequencing Analysis 2 weeks $400.00 81479 MOL215 GCH1 MLPA Duplication/Deletion Analysis 2 weeks $375.00 81479 MOL122 GFAP Full Gene Sequencing Analysis 2 weeks $600.00 81405 MOL155 GFER Full Gene Sequencing Analysis 2 weeks $500.00 81479 MOL113 GFM1 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL332 GJB1 (CX32) Full Gene Sequencing Analysis 2 weeks $400.00 81403 MOL333 GJB1 (CX32) Full Gene Sequencing + MLPA Duplication/Deletion Analysis 2 weeks $600.00 81403, 81479 MOL277 GJB1 (CX32) MLPA Duplication/ Deletion Analysis 2 weeks $375.00 81479 MOL236 GLDC Full Gene Sequencing + MLPA Duplication/Deletion Analysis 2 weeks $800.00 81479 MOL212 GLDC Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL219 GLDC MLPA Duplication/Deletion Analysis 2 weeks $375.00 81479 MOL116 GLRA1 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL120 GLRB Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL308 GLUL Full Gene Sequencing Analysis 2 weeks $600.00 81479 Page 8 of 16 Test Code Test Description TAT Price CPT Codes GENE SEQUENCING (SANGER), DELETION/DUPLICATION (MLPA) , POINT MUTATIONS - INDIVIDUAL GENES MOL251 GPHN Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL061 GYS2 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL062 HADHA Full Gene Sequencing Analysis 2 weeks $600.00 81406 MOL022 HADHA Mutation Screen: c.1528G>C, E510Q 2 weeks $155.00 81479 MOL063 HADHB Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL146 HCCS Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL316 HSPB1 MLPA Duplication/Deletion Analysis 2 weeks $375.00 81479 MOL086 HSPD1 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL064 KCNA1 Full Gene Sequencing Analysis 2 weeks $400.00 81479 MOL270 KCNJ1 Full Gene Sequencing Analysis 2 weeks $400.00 81479 MOL229 KCNQ2 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL330 KCNQ2 Full Gene Sequencing + MLPA Duplication/Deletion Analysis 2 weeks $800.00 81479 MOL216 KCNQ2 MLPA Duplication/Deletion Analysis 2 weeks $375.00 81479 MOL249 Known Familial Mutation (KFM) Analysis (each mutation) 2 weeks $155.00 81403 or 81479 MOL065 LAMA2 Full Gene Sequencing Analysis 2 weeks $1,000.00 81479 MOL317 LAMA2 MLPA Duplication/Deletion Analysis 2 weeks $500.00 81479 MOL335 LITAF Full Gene Sequencing Analysis 2 weeks $500.00 81479 MOL066 LMNA Full Gene Sequencing Analysis 2 weeks $500.00 81406 MOL115 LRPPRC Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL067 MECP2 Full Gene Sequencing Analysis 2 weeks $400.00 81302 MOL187 MECP2 MLPA Duplication/Deletion Analysis 2 weeks $375.00 81304 MOL257 MECP2 Full Gene Sequencing Analysis + MLPA Duplication/Deletion Analysis 2 weeks $600.00 81302, 81304 MOL114 MFN2 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL293 MFN2 MLPA Duplication/Deletion Analysis 2 weeks $375.00 81479 MOL002 Mitochondrial DNA Deletion Analysis 2 weeks $265.00 81479 MOL001 Mitochondrial DNA Depletion Analysis (muscle) 2 weeks $395.00 81479 MOL021 Mitochondrial DNA Sequencing Analysis, whole 2 weeks $500.00 81479 MOL189 Mitochondrial DNA Sequencing with Deletion Analysis 2 weeks $600.00 81479 MOL334 Mitochondrial DNA Depletion Analysis (Leukocyte) 2 weeks $395.00 81479 MOL232 Mitochondrial DNA Sequencing with Deletion and Depletion Analysis 2 weeks $800.00 81479 MOL068 MPV17 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL318 MPV17 MLPA Duplication/Deletion Analysis 2 weeks $375.00 81479 Page 9 of 16 Test Code Test Description TAT Price CPT Codes GENE SEQUENCING (SANGER), DELETION/DUPLICATION (MLPA) , POINT MUTATIONS - INDIVIDUAL GENES MOL250 MPZ Full Gene Sequencing Analysis 2 weeks $600.00 81405 MOL278 MPZ MLPA Duplication/Deletion Analysis 2 weeks $375.00 81479 MOL099 MRPS16 Full Gene Sequencing Analysis 2 weeks $500.00 81479 MOL171 MTHFR Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL139 MTM1 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL290 MTM1 Full Gene Sequencing Analysis + MLPA Duplication/Deletion Analysis 2 weeks $800.00 81479 MOL289 MTM1 MLPA Duplication/Deletion Analysis 2 weeks $375.00 81479 MOL144 MYOT Full Gene Sequencing Analysis 2 weeks $600.00 81405 MOL299 Myotonic Dystrophy 1 Genetic Testing (Trinucleotide repeat expansion) 7 days $225.00 81401 MOL303 Myotonic Dystrophy 2 Genetic Testing (Trinucleotide repeat expansion) 7 days $225.00 81401 MOL102 NDUFA1 Full Gene Sequencing Analysis 2 weeks $500.00 81479 MOL161 NDUFA11 Full Gene Sequencing Analysis 2 weeks $500.00 81479 MOL160 NDUFA2 Full Gene Sequencing Analysis 2 weeks $500.00 81479 MOL106 NDUFAF1 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL101 NDUFAF2 Full Gene Sequencing Analysis 2 weeks $500.00 81479 MOL158 NDUFAF3 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL162 NDUFAF4 Full Gene Sequencing Analysis 2 weeks $500.00 81479 MOL151 NDUFAF5 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL036 NDUFS1 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL103 NDUFS2 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL104 NDUFS3 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL037 NDUFS4 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL157 NDUFS6 Full Gene Sequencing Analysis 2 weeks $500.00 81479 MOL038 NDUFS7 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL039 NDUFS8 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL040 NDUFV1 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL105 NDUFV2 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL211 NUBPL Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL319 NEFL MLPA Duplication/Deletion Analysis 2 weeks $375.00 81479 MOL069 OPA1 Full Gene Sequencing Analysis 2 weeks $600.00 81407 MOL292 OPA1 Full Gene Sequencing Analysis + MLPA Duplication/Deletion Analysis 2 weeks $800.00 81407, 81406 MOL291 OPA1 MLPA Duplication/Deletion Analysis 2 weeks $375.00 81406 Page 10 of 16 Test Code Test Description TAT Price CPT Codes GENE SEQUENCING (SANGER), DELETION/DUPLICATION (MLPA) , POINT MUTATIONS - INDIVIDUAL GENES MOL226 PC Full Gene Sequencing Analysis 2 weeks $600.00 81406 MOL235 PDHA1 Full Gene Sequencing + MLPA Duplication/Deletion Analysis 2 weeks $800.00 81406, 81479 MOL070 PDHA1 Full Gene Sequencing Analysis 2 weeks $600.00 81406 MOL217 PDHA1 MLPA Duplication/Deletion Analysis 2 weeks $375.00 81479 MOL222 PDHB Full Gene Sequencing Analysis 2 weeks $600.00 81405 MOL223 PDP1 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL071 PDSS1 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL072 PDSS2 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL274 PDXK Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL272 PFKM Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL253 PGAM2 Full Gene Sequencing Analysis 2 weeks $400.00 81479 MOL184 PHOX2B Full Gene Sequencing Analysis 2 weeks $500.00 81479 MOL276 PMP22 MLPA Duplication/Deletion Analysis 2 weeks $375.00 81479 MOL074 PNPO Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL075 POLG Full Gene Sequencing Analysis 2 weeks $600.00 81406 MOL294 POLG MLPA Duplication/Deletion Analysis 2 weeks $375.00 81479 MOL109 POLG2 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL153 POMT1 Full Gene Sequencing Analysis 2 weeks $600.00 81406 MOL143 POMT2 Full Gene Sequencing Analysis 2 weeks $600.00 81406 MOL320 PRX MLPA Duplication/Deletion Analysis 2 weeks $375.00 81479 MOL096 PTS Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL107 PUS1 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL076 PYGM Full Gene Sequencing Analysis 2 weeks $600.00 81406 MOL024 PYGM Mutation Screen: c.148C>T, R50X; c.613G>A, G205S; c.1628A>C, K543T 2 weeks $250.00 81401 MOL117 QDPR Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL321 RAB7A MLPA Duplication/Deletion Analysis 2 weeks $375.00 81479 MOL152 RARS2 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL124 RNASEH2A Full Gene Sequencing Analysis 2 weeks $500.00 81479 MOL118 RNASEH2B Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL168 RNASEH2C Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL077 RRM2B Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL322 RRM2B MLPA Duplication/Deletion Analysis 2 weeks $375.00 81479 Page 11 of 16 Test Code Test Description TAT Price CPT Codes GENE SEQUENCING (SANGER), DELETION/DUPLICATION (MLPA) , POINT MUTATIONS - INDIVIDUAL GENES MOL154 RYR1 Full Gene Sequencing Analysis 2 weeks $1,110.00 81408 MOL188 RYR1 Mutation and Deletion Screen 2 weeks $500.00 81406 MOL172 SAMHD1 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL230 SCN1A Full Gene Sequencing Analysis 2 weeks $600.00 81407 MOL248 SCN1A Full Gene Sequencing Analysis + MLPA Duplication/Deletion Analysis 2 weeks $800.00 81407, 81479 MOL218 SCN1A MLPA Duplication/Deletion Analysis 2 weeks $375.00 81479 MOL255 SCN1B Full Gene Sequencing Analysis 2 weeks $400.00 81479 MOL258 SCN9A Full Gene Sequencing 2 weeks $600.00 81479 MOL082 SCO1 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL083 SCO2 Full Gene Sequencing Analysis 2 weeks $400.00 81479 MOL041 SDHA Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL042 SDHB Full Gene Sequencing Analysis 2 weeks $600.00 81405 MOL043 SDHC Full Gene Sequencing Analysis 2 weeks $600.00 81405 MOL044 SDHD Full Gene Sequencing Analysis 2 weeks $600.00 81404 MOL336 SEPT9 Full Gene Sequencing Analysis 2 weeks $800.00 81479 MOL078 SGCA Full Gene Sequencing Analysis 2 weeks $500.00 81405 MOL324 SGCA MLPA Duplication/Deletion Analysis 2 weeks $375.00 81479 MOL079 SGCB Full Gene Sequencing Analysis 2 weeks $400.00 81405 MOL325 SGCB MLPA Duplication/Deletion Analysis 2 weeks $375.00 81479 MOL080 SGCD Full Gene Sequencing Analysis 2 weeks $400.00 81405 MOL326 SGCD MLPA Duplication/Deletion Analysis 2 weeks $375.00 81479 MOL282 SGCE MLPA Duplication/Deletion Analysis 2 weeks $375.00 81479 MOL247 SGCE Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL283 SGCE Full Gene Sequencing Analysis + MLPA Duplication/Deletion Analysis 2 weeks $800.00 81479 MOL081 SGCG Full Gene Sequencing Analysis 2 weeks $400.00 81405 MOL327 SGCG MLPA Duplication/Deletion Analysis 2 weeks $375.00 81479 MOL233 SLC12A3 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL245 SLC12A3 Full Gene Sequencing Analysis + MLPA Duplication/Deletion Analysis 2 weeks $800.00 81479 MOL244 SLC12A3 MLPA Duplication/Deletion Analysis 2 weeks $375.00 81479 MOL170 SLC17A5 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL095 SLC18A2 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL228 SLC1A3 Full Gene Sequencing Analysis 2 weeks $400.00 81479 Page 12 of 16 Test Code Test Description TAT Price CPT Codes GENE SEQUENCING (SANGER), DELETION/DUPLICATION (MLPA) , POINT MUTATIONS - INDIVIDUAL GENES MOL262 SLC22A5 (OCTN2) MLPA Duplication/Deletion Analysis 2 weeks $375.00 81479 MOL328 SLC25A4 MLPA Duplication/Deletion Analysis 2 weeks $375.00 81479 MOL169 SLC25A19 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL085 SLC25A20 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL031 SLC25A4 Full Gene Sequencing Analysis 2 weeks $600.00 81404 MOL231 SLC2A1 (GLUT1) Full Gene Sequencing + MLPA Duplication/Deletion Analysis 2 weeks $800.00 81479 MOL121 SLC2A1 (GLUT1) Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL186 SLC2A1 (GLUT1) MLPA Duplication/Deletion Analysis 2 weeks $375.00 81479 MOL097 SLC6A3 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL252 SLC6A4 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL127 SLC6A5 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL246 SLC6A8 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL256 SPAST Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL265 SPAST Full Gene Sequencing Analysis + MLPA Duplication/Deletion Analysis 2 weeks $800.00 81479 MOL264 SPAST MLPA Duplication/Deletion Analysis 2 weeks $375.00 81479 MOL301 Spinal Muscular Atrophy Testing (2 genes - SMN1, SMN2) 2 weeks $375.00 81400, 81401, 81479 MOL087 SPG7 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL126 SPR Full Gene Sequencing Analysis 2 weeks $500.00 81479 MOL331 SPTLC1 Full Gene Sequencing Analysis 2 weeks $800.00 81479 MOL088 SUCLA2 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL089 SUCLG1 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL090 SURF1 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL241 TACO1 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL111 TAZ Full Gene Sequencing Analysis 2 weeks $600.00 81406 MOL148 TCAP Full Gene Sequencing Analysis 2 weeks $500.00 81479 MOL091 TH Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL098 TIMM8A Full Gene Sequencing Analysis 2 weeks $500.00 81479 MOL305 TK2 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL329 TK2 MLPA Duplication/Deletion Analysis 2 weeks $375.00 81479 MOL156 TMEM126A Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL173 TMEM70 Full Gene Sequencing Analysis 2 weeks $500.00 81479 Page 13 of 16 Test Code Test Description TAT Price CPT Codes GENE SEQUENCING (SANGER), DELETION/DUPLICATION (MLPA) , POINT MUTATIONS - INDIVIDUAL GENES MOL159 TNNI2 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL092 TPH2 Full Gene Sequencing Analysis 2 weeks $500.00 81479 MOL137 TPM3 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL119 TREX1 Full Gene Sequencing Analysis 2 weeks $400.00 81479 MOL108 TUFM Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL053 TYMP Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL093 UBE3A Full Gene Sequencing Analysis 2 weeks $600.00 81406 MOL100 UQCRB Full Gene Sequencing Analysis 2 weeks $500.00 81479 MOL174 UQCRQ Full Gene Sequencing Analysis 2 weeks $500.00 81479 ZMPSTE24 Full Gene Sequencing Analysis 2 weeks $600.00 81479 MOL138 METABOLIC ANALYSES MET01 Amino acids (CSF) 2 weeks $200.00 82139 MET02 Amino acids (plasma) 2 weeks $200.00 82139 MET03 Amino acids (Urine) 2 weeks $200.00 82139 MET04 Coenzyme Q10 (Leukocytes) 2 weeks $215.00 82491 MET05 Coenzyme Q10 (Muscle) 2 weeks $215.00 82491 MET07 Lactate (CSF) 2 weeks $100.00 83605 MET08 Lactate (plasma) 2 weeks $100.00 83605 MET09 Phenylalanine Loading Assay (Plasma) 2 weeks $400.00 82136 MET10 Pyruvate (blood) 2 weeks $100.00 84210 MET11 Pyruvate (CSF) 2 weeks $100.00 84210 MET12 Thymidine/Deoxyuridine analytes (Plasma) 2 weeks $190.00 82492 MET13 Carnitine (Plasma) 2 weeks $150.00 82379 MET14 Urine organic acids 2 weeks $180.00 83919 MET15 Acylcarnitines (Plasma) 2 weeks $150.00 82017 MET18 Fatty Acid Oxidation (Fibroblasts) 3 weeks $750.00 83789 MET19 Creatine and Guanidinoacetate (Plasma) 2 weeks $150.00 82017 MET20 Alpha aminoadipic semialdehyde (Urine) 2 weeks $150.00 82017 MET22 Folate receptor antibody assay (Plasma/ Serum) 2 weeks $200.00 83520 MET23 Creatine and Guanidinoacetate (Plasma) 2 weeks $150.00 82017 MET24 Glucose (Plasma) 2 weeks $100.00 82947 MET25 Folate receptor antibody assay (CSF) 2 weeks $200.00 83520 Page 14 of 16 Test Code Test Description TAT Price CPT Codes NEUROCHEMISTRY ANALYSES NC01 CSF 5-Methyltetrahydrofolate 2 weeks $180.00 82491 NC02 CSF Neopterin 2 weeks $100.00 82491 NC03 CSF Neopterin/Tetrahydrobiopterin 2 weeks $190.00 82492 NC04 CSF Neurotransmitter Metabolites (5HIAA, HVA, 3OMD) 2 weeks $190.00 82492 NC05 CSF Pyridoxal 5'-phosphate 2 weeks $180.00 82491 NC06 CSF Succinyladenosione 2 weeks $180.00 82491 NC07 CSF Sialic Acid 2 weeks $180.00 82017 NC08 CSF Alpha aminoadipic semialdehyde 2 weeks $180.00 82017 NC09 CSF 4-Hydroxybutyric acid 2 weeks $150.00 82543 CSF Glucose 2 weeks $100.00 82947 NC10 TISSUE CULTURE TC01 Cryopreservation of cells 7 days $60.00 88240 TC03 Thaw & Expand cells 3 weeks $300.00 88241 TC04 Tissue Culture of Lymphocytes with EBV Transformation 4 weeks $300.00 88230 TC05 Mycoplasma testing of cells 7 days $65.00 87109 TC06 Tissue Culture of skin fibroblasts (includes skin biopsy processing) 3 weeks $300.00 88233 ENZYMOLOGY ENZ01 Aromatic L-amino acid Decarboxylase Enzyme Analysis (Plasma) 3 weeks $650.00 82657 , 82491 ENZ02 GTP-Cyclohydrolase Enzyme Analysis (Fibroblasts) 3 weeks $750.00 82657 , 82491 ENZ03 Mitochondrial Respiratory Chain Enzyme Analysis 7 days $600.00 82657 , 84311 ENZ06 Thymidine Phosphorylase Enzyme Analysis (Leukocytes) 3 weeks $250.00 82657 88371 PROTEIN CHEMISTRY ANALYSES PC01 Blue Native OXPHOS Supercomplex Analysis 2 weeks $800.00 PC02 Clear Native In-Gel OXPHOS Complex Enzymology 2 weeks $1,200.00 88371 , 82657 PC03 Clear Native OXPHOS Assembly Analysis (separation & immunoblot) 2 weeks $1,200.00 88371 PC04 Quantitative OXPHOS subunit Western Blot 2 weeks $800.00 88371 PC05 PDH Western Blot 2 weeks $800.00 88371 PC06 Quantitative OXPHOS subunit Western Blot (Fibroblasts) 4 weeks $925.00 88371 PC07 Clear Native OXPHOS Assembly Analysis (separation & immunoblot) (Fibroblasts) 4 weeks $1,325.00 88371 PC08 Clear Native In-Gel OXPHOS Complex Enzymology (Fibroblasts) 4 weeks $1,325.00 88371 , 82657 PC09 Blue Native OXPHOS Supercomplex Analysis (Fibroblasts) 4weeks $925.00 Page 15 of 16 88371 Test Code Test Description TAT Price 4 weeks $1,230.00 CPT Codes RESPIROMETRY RES01 High Resolution Respirometry (Fibroblasts) 82657 HISTOLOGY Muscle HIS52 Muscle Histology/Histochemistry: Routine Panel (Frozen Tissue) 7 days $530.00 HIS53 Muscle Histology/Histochemistry: Metabolic Myopathy (Frozen Tissue) 7 days $1,000.00 88314, 88319 88313, 88314, 88319 HIS54 Muscle Immunohistochemistry: Muscular Dystrophy/Hereditary Myopathy (Frozen & Formalin-Fixed Tissue) 7 days $1,250.00 88342 HIS55 Muscle Immunohistochemistry: Autoimmune Myopathy/Muscular Dystrophy/Myopathy/Inclusion Body Myositis (Frozen Tissue) 7 days $250.00 88342 HIS56 Muscle Immunohistochemistry: Mitochondrial Diseases (Formalin-Fixed Tissue) 7 days $3,135.00 88346 HIS57 Muscle Immunohistochemistry: Autoimmune Myopathy/Muscular Dystrophy/Myopathy (Formalin-Fixed Tissue) 7 days $750.00 88342 HIS58 Muscle Immunohistochemistry: Inclusion Body Myositis (Formalin-Fixed Tissue) 7 days $1,000.00 88342 HIS59 Immunohistochemical Stain: Desmin [Myopathy/Cardiomyopathy] (Formalin-Fixed Tissue) 7 days $125.00 88342 HIS60 Immunohistochemical Stain: Fibroblast Growth Factor-21 (FGF-21) [Mitochondrial Disease] (Frozen Tissue) 7days $125.00 88342 Page 16 of 16
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