Forms: Muscle Disease Test Price List

MUSCLE DISEASE TEST PRICE LIST

	Price	CPT Code
MITOCHONDRIAL MYOPATHY PROFILE NADH dehydrogenase NADH cytochrome c reductase Succinate dehydrogenase Succinate cytochrome c reductase Cytochrome c oxidase Citrate synthase*	$560.00 101.00 101.00 101.00 101.00 101.00 101.00	(82657, 84311) x 6 (83912)

FATTY ACID TRANSPORT, MITOCHONDRIAL Carnitine, free and esterified Carnitine palmitoyltransferase (CPT)	140.00 140.00	82379, 82658 83912 82658, 83912

MODIFIED MITOCHONDRIAL MYOPATHY PROFILE Succinate dehydrogenase Cytochrome c oxidase Citrate synthase*	270.00 101.00 101.00 101.00	(82657, 84311) x 3 (83912)

ADDITIONAL MITOCHONDRIAL TESTS Fumarase	101.00	82657, 83912 84311

GLYCOGEN STORAGE DISEASE PROFILE Acid & neutral maltase Phosphorylase Phosphorylase b kinase Phosphofructokinase	504.00 151.00 140.00 140.00 140.00	(82657, 884311) x 4 (83912)

MYOGLOBINURIA PROFILE Phosphorylase Phosphorylase b kinase Phosphofructokinase 3-Phosphoglycerate kinase Phosphoglycerate mutase Carnitine palmitoyltransferase (CPT)	588.00 140.00 140.00 140.00 106.00 106.00 140.00	(82657, 84311) x 6 (83912)

PURINE METABOLISM DEFECTS Myoadenylate deaminase & adenylate kinase CARNITINE PALMITOYLTRANSFERASE II MUTATION PROFILE MYOPHOSPHORYLASE (McARDLE DISEASE) MUTATION PROFILE MYOADENYLATE DEAMINASE MUTATION PROFILE EXERCISE INTOLERANCE MUTATION PROFILE INDIVIDUAL MUTATION ANALYSIS **	213.00 795.00 300.00 300.00 895.00 200.00	82657, 84311 83912 (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)
Citrate synthase will be quantified as a marker for mitochondrial content with any mitochondrial enzyme test requested including CPT. * Any single mutation analysis may be requested from the above Profiles.