Forms
* Please open the forms in Adobe Acrobat before printing.
** NOTICE: As of July 2021 the GDL is once again able to perform RB1 promoter methylation analysis. Comprehensive tumor analysis will include promoter methylation analysis.
Billing Information and Turnaround Time
*Reflex testing options: Maximum cost is listed, although our lab only bills for the services performed. Final charge may be less than listed price, but cannot be determined until the testing has been completed.
Retinoblastoma Test Billing Information and Turnaround Time
| Name of Test |
Turnaround Time |
Cost |
CPT Codes |
| Retinoblastoma: Sequence analysis with reflex to deletion/duplication [Blood] |
6-8 weeks |
$2330* |
81407, 81479 |
| Frozen tumor comprehensive analysis with reflex to site specific testing on constitutional DNA |
8-10 weeks |
$4270* |
81407, 81479x2, , 81401x2 |
| Retinoblastoma: Paraffin-embedded Tumor comprehensive analysis with reflex to site specific testing on constitutional DNA |
8-12 weeks |
$4,430* |
81407, 81479x2, 81401x2, 88381 |
| Retinoblastoma: Site specific analysis (familial) |
2-3 weeks |
$520 |
81403 Call for code for deletion/ duplication >5 exons of RB1
|
| Retinoblastoma: Site specific analysis (familial) |
7-10 days |
$764 |
81403, 81265, 99199 Call for code for deletion/ duplication >5 exons of RB1
|
*All prenatal tests include MCC studies
Sample Requirements
- 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 and date sample was obtained
- Send frozen tumor on dry ice.
- Our lab needs 5 x 20micron sections (scrolls) if cut paraffin tumor is sent. NOTE: paraffin tumor can yield an inconclusive result for RB due to the quality of DNA. Specifically, paraffin tumors that have been preserved with picric acid or mercury-containing reagents yield very poor quality DNA.
- If tumor is sent separately from blood sample, please include patient’s name with the tumor sample.
- We accept banked or recently extracted DNA; please include the concentration.
Please see our prenatal section for information on prenatal requirements.
Shipping Instructions
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.
Shipping Address
Genetic Diagnostic Laboratory
University of Pennsylvania
Room 560 Clinical Research Building
415 Curie Boulevard
Philadelphia, PA 19104
Additional Information
Retinoblastoma (RB1) on Online Mendelian Inheritance in Man (OMIM®)
