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Payment

Payment Options for Clients Within the United States

Direct Billing: Referring institutions and physicians may establish institutional accounts with monthly invoicing. In order to retain your institutional billing status, payment in full is expected upon receipt of each monthly statement. To establish an institutional account, complete the Institutional Account Application or contact Julie at 832-824-4152.

Institutional Account Application (PDF)

Prepayment: We accept checks (payable to John Welsh Cardiovascular Diagnostic Laboratory), money orders, and credit card payment (AMEX, MasterCard, Visa, or Discover). If paying by credit card, please complete the Credit Card Authorization form. Testing will not begin until payment-in-full is received.

Credit Card Authorization Form (PDF)

Payment Options for International Clients

Money Orders: Please make money orders payable to the John Welsh Cardiovascular Diagnostic Laboratory. Testing will not begin until payment-in-full is received.
Credit Card: Payment will be accepted on an approved credit card account (AMEX, MasterCard, Visa, or Discover). If paying by credit card, please complete the Credit Card Authorization form.

Credit Card Authorization Form (PDF)

W-9 Form (PDF)

Service Fees

ACTA2 Mutation Analysis

	Direct and Institutional Billing	CPT Codes
Index Case	$750 per sample	83891, 83898x8, 83904x16, 83912
Additional Family Members	$200 per sample; known familial mutation only	83891, 83898x2, 83904x4, 83912
Prenatal	$600 per fetus	83891x3, 83898x7, 83904x4, 83912

CASQ2 Mutation Analysis

	Direct and Institutional Billing	CPT Codes
Index Case	$750 per sample	83891, 83898x11, 83904x22, 83912
Additional Family Members	$250 per sample; known familial mutation only	83891, 83898x2, 83904x4, 83912
Prenatal	$600 per fetus	83891x3, 83898x7, 83904x4, 83912

CAV3 Mutation Analysis

	Direct and Institutional Billing	CPT Codes
Index Case	$450 per sample	83891, 83898x2, 83904x4, 83912
Additional Family Members	$200 per sample; known familial mutation only	83891, 83898, 83904x2, 83912
Prenatal	$600 per fetus	83891x3, 83898x7, 83904x4, 83912

DES Mutation Analysis

	Direct and Institutional Billing	CPT Codes
Index Case	$750 per sample	83891, 83898x7, 83904x14, 83912
Additional Family Members	$250 per sample; known familial mutation only	83891, 83898x2, 83904x4, 83912
Prenatal	$600 per fetus	83891x3, 83898x7, 83904x4, 83912

EMD Mutation Analysis

	Direct and Institutional Billing	CPT Codes
Index Case	$750 per sample	83891, 83898x3, 83904x6, 83912
Additional Family Members	$250 per sample; known familial mutation only	83891, 83898, 83904x2, 83912
Prenatal	$600 per fetus	83891x3, 83898x5, 83904x2, 83912

FBN1 Mutation Analysis

	Direct and Institutional Billing	CPT Codes
Index Case (Full Gene)	$1,650 per sample	83891, 83898x58, 83904x116, 83912
Index Case - Neonatal MFS (Exons 24-33)	$750 per sample	83891, 83898x7, 83904x14, 83912
Additional Family Members	$200 per sample;known familialmutation only	Please Call 832-824-4155
Prenatal	$600 per fetus	83891x3, 83898x5, 83904x2, 83912

KCNJ2 Mutation Analysis

	Direct and Institutional Billing	CPT Codes
Index Case	$450 per sample	83891, 83898x3, 83904x6, 83912
Additional Family Members	$200 per sample; known familial mutation only	83891, 83898, 83904x2, 83912
Prenatal	$600 per fetus	83891x3, 83898x5, 83904x2, 83912

LAMP2 Mutation Analysis

	Direct and Institutional Billing	CPT Codes
Index Case	$750 per sample	83891, 83898x10, 83904x20, 83912
Additional Family Members	$200 per sample; known familial mutation only	83891, 83898, 83904x2, 83912
Prenatal	$600 per fetus	83891x3, 83898x5, 83904x2, 83912

LMNA Mutation Analysis

	Direct and Institutional Billing	CPT Codes
Index Case	$750 per sample	83891, 83898x11, 83904x22, 83912
Additional Family Members	$250 per sample; known familial mutation only	83891, 83898, 83904x2, 83912
Prenatal	$600 per fetus	83891x3, 83898x5, 83904x2, 83912

MYH11 Mutation Analysis

	Direct and Institutional Billing	CPT Codes
Index Case	$1,500 per sample	83891, 83898x41, 83904x82, 83912
Additional Family Members	$200 per sample; known familial mutation only	83891, 83898x2, 83904x4, 83912
Prenatal	$600 per fetus	83891x3, 83898x7, 83904x4, 83912

NKX2.5 Mutation Analysis

	Direct and Institutional Billing	CPT Codes
Index Case	$450 per sample	83891, 83898x2, 83904x4, 83912
Additional Family Members	$200 per sample; known familial mutation only	83891, 83898, 83904x2, 83912
Prenatal	$600 per fetus	83891x3, 83898x7, 83904x4, 83912

SCO2 Mutation Analysis

	Direct and Institutional Billing	CPT Codes
Index Case	$300 per sample	83891, 83898x2, 83904x4, 83912
Additional Family Members	$250 per sample; known familial mutations only	83891, 83898x2, 83904x4, 83912
Prenatal	$600 per fetus	83891x3, 83898x7, 83904x4, 83912

SURF1 Mutation Analysis

	Direct and Institutional Billing	CPT Codes
Index Case	$750 per sample	83891, 83898x5, 83904x10, 83912
Additional Family Members	$250 per sample; known familial mutations only	83891, 83898x2, 83904x4, 83912
Prenatal	$600 per fetus	83891x3, 83898x7, 83904x4, 83912

TAZ(G4.5) Mutation Analysis

	Direct and Institutional Billing	CPT Codes
Index Case	$600 per sample	83891, 83898x6, 83904x12, 83912
Additional Family Members	$180 per sample; known familial mutation only	83891, 83898, 83904x2, 83912
Prenatal	$600 per fetus	83891x3, 83898x5, 83904x2, 83912

TBX5 Mutation Analysis

	Direct and Institutional Billing	CPT Codes
Index Case	$750 per sample	83891, 83898x9, 83904x18, 83912
Additional Family Members	$200 per sample; known familial mutation only	83891, 83898, 83904x2, 83912
Prenatal	$600 per fetus	83891x3, 83898x5, 83904x2, 83912

TGFBR1 Mutation Analysis

	Direct and Institutional Billing	CPT Codes
Index Case	$600 per sample	83891, 83898x9, 83904x18, 83912
Additional Family Members	$200 per sample; known familial mutation only	83891, 83898, 83904x2, 83912
Prenatal	$600 per fetus	83891x3, 83898x7, 83904x4, 83912

TGFBR2 Mutation Analysis

	Direct and Institutional Billing	CPT Codes
Index Case	$600 per sample	83891, 83898x10, 83904x20, 83912
Additional Family Members	$200 per sample; known familial mutation only	83891, 83898, 83904x2, 83912
Prenatal	$600 per fetus	83891x3, 83898x7, 83904x4, 83912

ZASP (LDB3) Mutation Analysis

	Direct and Institutional Billing	CPT Codes
Index Case	$800 per sample	83891, 83898x17, 83904x34, 83912
Additional Family Members	$200 per sample; known familial mutation only	83891, 83898, 83904x2, 83912
Prenatal	$600 per fetus	83891x3, 83898x7, 83904x4, 83912

Genetic Testing Panels

	Direct and Institutional Billing	CPT Codes
PANEL A	$4,400 per sample	83891x5, 83898x123, 83904x246, 83912x5
PANEL B	$1,000 per sample	83891x2, 83898x11, 83904x22, 83912x2
PANEL C	$2,500 per sample	83891x5, 83898x51, 83904x102, 83912x5
PANEL D	$1,850 per sample	83891x3, 83898x34, 83904x68, 83912x3
PANEL E	$2,500 per sample	83891x5, 83898x40, 83904x80, 83912x5
PANEL F	$2,500 per sample	83891x5, 83898x36, 83904x72, 83912x5
PANEL G	$750 per sample	83891x2, 83898x5, 83904x10, 83912x2
PANEL H	$1,600 per sample	83891x3, 83898x21, 83904x42, 83912x3
PANEL I	$450 per sample	83891, 83898x2, 83904x4, 83912
PANEL J	$2,000 per sample	83891x4, 83898x23, 83904x46, 83912x4

Viral PCR Analysis

	Direct and Institutional Billing	CPT Codes
Adenovirus	$370 per sample	83891, 83898x4, 83912
Cytomegalovirus	$370 per sample	83891, 83898x4, 83912
Epstein-Barr virus	$370 per sample	83891, 83898x4, 83912
Enterovirus	$370 per sample	83891, 83902, 83898x4, 83912
Influenza A virus	$370 per sample	83891, 83902, 83898x4, 83912
Mumps virus	$370 per sample	83891, 83902, 83898x4, 83912
Parvovirus	$370 per sample	83891, 83898x4, 83912
Rubella virus	$370 per sample	83891, 83902, 83898x4, 83912
Respiratory syncytial virus	$370 per sample	83891, 83902, 83898x4, 83912
Viral Panel	$740 per sample	83891, 83902, 83898x14, 83912

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(Modified Sep. 04, 2009)