PDF icon2020 MORL Test Catalog/Menu- No Weekend Deliveries
PDF icon2020 MORL Hearing Loss Test Requisition Form
PDF icon2020 MORL Kidney Testing Requisition Form

Hearing Genetic Testing Test Codes CPT Codes Cost TAT
OtoSCOPE® panel OTOSC08 81430, 81431 $1650   6 weeks   
Usher panel:  USH1 genes: MYO7A, USH1C, CDH23, PCDH15USHIG, CIB2;
USH2 genes: USH2A, GPR98, WHRN (DFNB31); USH3 genes: CLRN)
USH01 81404(x2), 81407(x3),
81408 (x2), 81479(x3)
$1650 6 weeks
GJB2/GJB6 (Connexin 26/30) GJB2_6 81252 / 81254 $356 8 weeks
GJB2/GJB6 (Connexin 26/30) familial GJB2_6F 81253 $220 8 weeks
MTRNR1- C1494T and A1555G variants MTRNR1 81401 – MTRNR1 $185 8 weeks
MTTL1-A3243G variant MTTL1 81401 – MTTL1 $185 8 weeks
MTTS1-A7445G variant MTTS1 81401 – MTTS1 $185 8 weeks
OtoSCOPE Familial Variant Testing (cost is per person/per gene) OTOSCFAM 81403 $220 8 weeks
Kidney Genetic Testing Test Codes CPT Codes Cost TAT
Genetic Renal Panel (appropriate for patients with TMA, TTP, aHUS, DDD and
C3GN) - genes included: CFH, CFI, MCP, CFB, CFHR5, C3, THBD, ADAMTS13,
PLG, DGKE, MMACHC, G6PD, and MLPA
GRP07
81479, 81405
$3000 3 weeks
MLPA (screening the CFH-CFHR5 genomic region) MLPA02 81405 $686 3 weeks
Genetic Renal Panel/Sanger Familial Variant Testing (cost is per person/per gene) GRPFAM 81403 $220 2 weeks
Functional/Biomarker Tests - Panels Test Codes CPT Codes Cost TAT
TMA Functional Panel (11 tests - FH autoantibody, Hemolytic Assay, CH50eqAPFA,
Bb, FH, FI, FB, C3, C4, & sC5b-9.  Note: ADAMTS-13 activity is available 'a la carte')
07TMAFP 83516, 83520, 86160 (x6), 86161(x2), 86162 $2389 4 weeks
C3G Functional Panel (includes the three micro-panels below [Complement Antibody Panel,  Complement Biomarker Panel, Complement Pathway Panel]; appropriate for the
initial evaluation of C3G patients, i.e. DDD or C3GN)
07C3GFP 83516(X2), 83520, 86160 (x10), 86161(x5), 86162, 86334 $4500 4 weeks
Complement Antibody Micro-Panel (6 tests - FB autoantibody, FH autoantibody,
Nef Activity Assay (IFE), C3Nef (C3CSA), C4Nef, C5Nef (C3CSAP); appropriate for
following antibody levels)
01AMP 83516 (x2), 86161(x3), 86334 $1812 4 weeks
Complement Biomarker Micro-Panel (11 tests - soluble C5b-9, FB, FH, FI, Ba, Bb,
C3, C3c, C4, C5 and Properdin Levels; appropriate for following biomarker levels)
02CBMP 83520, 86160 (x10) $2605 4 weeks
Complement Pathway Micro-Panel (3 tests - Hemolytic Assay, APFA, CH50eq; appropriate
for following complement activity and complement blockade)
01CPMP 86161 (x2), 86162 $691 4 weeks
Functional Tests - a la carte - Serum (1 ml frozen) Test Codes CPT Codes Cost TAT
CH50eq 06CH50 86161 $119 2 weeks
Alternative Pathway Functional Assay (APFA) 06APFA 86161 $220 2 weeks
Hemolytic Assay 06HA 86162 $352 4 weeks
C3b Deposition Assay 01C3BDA 86162 $300 4 weeks
FB Autoantibody Testing 06FBAA 83516 $356 4 weeks
FH Autoantibody Testing 06FHAA 83516 $356 2 weeks
Nef Activity Assay (IFE) 06NAA 86334 $200 4 weeks
C3Nef (C3CSA) 06C3NEF 86161 $250 4 weeks
C5Nef (C3CSAP) 06C5NEF 86161 $250 4 weeks
C4Nef 06C4NEF 86161 $400 4 weeks
Biomarker Tests - a la carte - EDTA Plasma (1 ml frozen) Test Codes CPT Codes Cost TAT
C3 Level 06C3L 86160 $110 2 weeks
C3c Level 06C3CL 86160 $358 4 weeks
C4 Level 06C4L 86160 $110 2 weeks
Factor B Level (FB) 06FBL 86160 $165 2 weeks
Ba Level 06BAL 86160 $275 2 weeks
Bb Level 06BBL 86160 $275 2 weeks
Properdin Level 06PL 86160 $330 2 weeks
C5 Level 06C5L 86160 $300 2 weeks
Soluble C5b-9 (sMAC) 06SMAC 83520 $352 2 weeks
Factor H Level (FH) 06FHL 86160 $165 2 weeks
Factor I Level (FI) 06FIL 86160 $165 2 weeks
ADAMTS-13 Assays - Citrated Plasma (1 ml frozen) Test Codes CPT Codes Cost TAT
ADAMTS-13 Activity Assay 01ATS13 85397 $400 24 hours 
ADAMTS-13 Activity Assay w/ reflex to ADAMTS13 Inhibitor Assay if activity <25% 01ATS13RFX 85397, 85335 $800 24 hours

 

Prices & tests offered subject to change on an quarterly basis. Effective 1/3/2020