Forms: Comprehensive test price list

CLINICAL LABORATORY--GENETICS THE BUFFALO GENERAL HOSPITAL 100 High Street, Buffalo, NY 14203 (716) 859-7741 FAX (716) 859-7749 Georgirene D. Vladutiu, Ph.D., Director
COMPREHENSIVE TEST PRICE LIST

BIOCHEMISTRY	Price	CPT Code
Acid maltase & neutral maltase Amino acids (full profile, plasma, urine or CSF) PKU follow-up testing Phenylalanine + tyrosine (dried blood assay) Short run--phenylalanine + tyrosine only Short run--branched chain (val, leu, ileu) only Carnitine (tissue, serum) Carnitine palmitoyltransferase + Citrate synthase Citrate synthase Cytochrome c oxidase Fumarase -Galactosidase -Galactosidase -1,4-Glucosidase -Glucosidase -Hexosaminidase A (Quantitative) -Hexosaminidase A & B, Total (Quantitative) -Hexosaminidase A & B (Qualitative, Tay-Sachs carrier screen) Lactate dehydrogenase Mucopolysaccharide spot test (MPS) Myoadenylate deaminase NADH cytochrome c reductase NADH dehydrogenase Phosphofructokinase Phosphoglucoisomerase 3-Phosphoglycerate kinase Phosphoglycerate mutase Phosphorylase Phosphorylase b kinase Succinate cytochrome c reductase Succinate dehydrogenase	$151.00 252.00 87.00 87.00 87.00 140.00 241.00 101.00 101.00 101.00 84.00 84.00 84.00 84.00 84.00 112.00 112.00 106.00 56.00 213.00 101.00 101.00 140.00 106.00 106.00 106.00 140.00 140.00 106.00 106.00	82657,83912,84311 82139 82136,83912 82136,83912 82136,83912 82379,82658,83912 82658,83912,82657 82657,84311,83912 82657,84311,83912 82657,83912,84311 84155,82657,83912 84155,82657,83912 84155,82657,83912 82963,84155,83912 84155,83080,83912 84155,83080,83912 82664,83080,83912 82657,84311, 83912 83864 82657,84311,83912 82657,84311,83912 82657,84311,83912 82657,84311,83912 82657,84311,83912 82657,84311,83912 82657,84311,83912 82657,84311,83912 82657,84311,83912 82657,84311,83912 82657,84311,83912

COMPREHENSIVE TEST PRICE LIST-- Page 2

SCREENS	Price	CPT Code
Glycogen Storage Disease Profile--4 tests (muscle) Mitochondrial Myopathy Profile--6 tests (muscle, liver) Modified Mitochondrial Myopathy Profile--3 tests Myoglobinuria Profile-- (8 tests; incl. Citrate synthase) Metabolic Profile (urine) Carnitine Palmitoyltransferase II Mutation Profile (6 mutations) Myophosphorylase (McArdle disease) Mutation Profile (2 mutations) Myoadenylate Deaminase Mutation Profile (2 mutations) Exercise Intolerance Mutation Profile (7 mutations) Individual Mutation Analysis*	504.00 560.00 270.00 689.00 62.00 375.00 200.00 200.00 450.00 200.00	(82657, 84311) x 4 (83912) (82657, 84311) x 6 (83912) (82657, 84311) x 3 (83912) (82657, 84311) x 6 (83912) 80100 (83891) (83892, 83893, 83896) x 12 (83894, 83898) x 4 (83912) (83891) (83892, 83893, 83896) x 4 (83894, 83898) x 2 (83912) (83891) (83892, 83893, 83896) x 4; (83894, 83898) x 2 (83912) (83891) (83892, 83893, 83896) x 14 (83894, 83898) x 8 (83912) (83891) (83892, 83893, 83896) x 2 (83894) (83898) (83912)