- IMAGe Info Sheet
- IMAGe Sample Requirements
- IMAGe Sample Requirements – Prenatal
- IMAGe Request Form – Proband
- IMAGe Request Form – Familial
- IMAGe Request Form – Prenatal
*Please open the forms in Adobe Acrobat before printing.
Billing Information and Turnaround Time
|Name of Test||Turnaround Time||Cost||CPT Codes|
|IMAGe syndrome: CDKN1C sequencing||4-6 weeks||$600||81404|
|IMAGe syndrome: known familial mutation||2-3 weeks||$360||81403|
|IMAGe syndrome: prenatal diagnosis||1-3 weeks||$700*
|81404, 81265 (suspected mutation)
81403, 81265 (known mutation)
- We require 2 EDTA tubes (lavender top) of blood - approximately 4 mL per tube
- For a newborn sample, obtain 2 EDTA tube (lavender top) of blood - approximately 1-2 mL per tube
- Label each tube with the patient’s name, date sample was obtained, and patient’s date of birth
- We accept banked or recently extracted DNA; please include the concentration. Please call the laboratory to inquire about the amount needed for testing.
Please see our prenatal section for information on prenatal requirements.
Shipping Sample: Ship at room temperature via Federal Express or other overnight courier that guarantees AM delivery to arrive Monday-Friday. There is no one in the laboratory evenings and weekends to receive samples. If sample is drawn on a Friday, please refrigerate it until shipment on the following business day.
Genetic Diagnostic Laboratory
University of Pennsylvania
415 Anatomy–Chemistry Building
3620 Hamilton Walk
Philadelphia, PA 19104