Merogenomics is a wholesaler of DNA sequencing tests and supporting services for clinical purposes. For this reason, all tests accessed through Merogenomics require a medical doctor to sign the test requisition form. We provide access to the best quality tests for medical purposes to be used by the ordering physician for the medical management of the client/patient. Merogenomics provides educational support for each individual towards informed consent prior to the purchase of the test. Merogenomics provides support to the ordering physician in terms of background information and access to resources. The description of offered tests is subject to change and the website descriptions for Merogenomics may not reflect the exact offer, depending upon test offer changes and website updates.

Test options

Pharmacogenomic Panel

Pharmacogenomics is the study of the variability in drug responses due to heredity. Pharmacogenomic panel sequencing is the process of decoding the order of nucleotide bases in specific DNA sites of selected genes which are currently known to be associated with drug metabolism, transport, mode of action or risk of adverse effects. Variants (changes) observed in the DNA between different individuals afford insights into the variations in medication dosing or toxicity. Please expend the following sections for further details.

$699 CAD

Canadian clients will be charged in Canadian dollars according to conversion rate of the current day. Volume discounts are available. Payment does not occur until after the consultation and the signing of the requisition form by a medical doctor has been completed.

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Test Description

The pharmacogenomic panel analyzes specific DNA alterations (genotyping) that are associated with validated effects on personal responses to various medications
This test is used for clinical purposes and should not be regarded as investigational or for research
The test must be ordered by a medical doctor or a pharmacist who will oversee the clinical report based on the DNA sequence interpretation
The test is for persons interested in genetic diagnosis only in relation to how it impacts their response to medication
The test provides information for over 300 medications used in the treatment of the following conditions: acute migraine, ADHD, allergies, Alzheimer’s disease, anticoagulation, antiplatelet therapy, anxiety, arrhythmias, bacterial infections, benign prostatic hyperplasia, cancer, chronic hepatitis C, depression, diabetes, dyslipidemia, fungal infection, gastroesophageal reflux disease, gout, HIV infection, hypertension, immunosuppression, migraine prophylaxis, overreactive bladder, pain, Parkinson’s disease, psychosis, rheumatoid arthritis, seizures, sleep disorders, and smoking cessation
The test report provides information on gene-drug interaction, and is categorized based on the expected impact, ranging from limited to major gene-drug interaction
The test is for individuals who:
- Require medications for covered conditions
- Used medications without beneficial results
- Use multiple medications
- Experienced unwelcome side affects from medication
- Are taking antithrombotic medications
- Are taking cardiovascular medications
- Are taking psychiatric or neurological drugs
This test is not to diagnose inherited suspected genetic predispositions to cancer or genetic diseases. Please refer to the “Full Genome Sequencing” option below or the Undiagnosed Diseases DNA Tests section for a screening or diagnostic test, respectively, which offers the most comprehensive view of alterations in an individual’s DNA code including pharmacogenetics information and secondary findings
Anonymized patient/client clinically-relevant information will be included in public databases to help with the future medical analysis of human genomes. Databases contain cumulative results from around the world and do not include information that can personally identify the patient/client
The test can be paid for directly by the patient/client. Interest-free payment plans are available. Insurance billing is available and can be investigated up-front to determine out-of-pocket expenses. Institutional billing is also available for organizations that prefer to bill patients/clients directly

Test Deliverables

Merogenomics provides background education towards patient/client informed consent
The collection kit can be for a saliva or blood sample, with prepaid shipping included
Services are fully insured, and are HIPAA, CLIA and CAP compliant
The results are available within 10 days
A concise clinical report is delivered to the ordering doctor only, and then subsequently discussed and shared with the patient/client. The report lists variants associated with the increased risk of affecting an individual’s response to specific medications
The ordering doctor will obtain their own personal login to the web console in order to have direct access to all of the data
The databases used for DNA sequence interpretation are regularly updated, and novel pharmacogenetic findings pertaining to analyzed variants identified in a patient/client will be delivered to the ordering physician for the duration of DNA data storage by the company
Complimentary post-test genetic counselling is offered

Test Benefits

Determines which medication is correct to take before its administration and therefore reduces trial and error
Personalized tailoring of drug prescriptions and drug dosages allow for maximizing efficacy and minimizing toxicity
Helps to manage the cardiovascular or thrombotic risk of the patient/client
Prevents unintended interactions between drugs
Improved medical compliance due to the reduced chance of adverse reactions
Test results can be used continuously in future treatments over the course of a patient/client’s lifetime
Patient/client data is securely stored on cloud for subsequent re-analysis
The entire process closely follows the Canadian and American guidelines, therefore there is a high level of proper accountability for the clinic

Test Limitations

Biological sample quality can influence the scope and quality of the final decoded DNA sequence data, and therefore its interpretation
If a new gene or a variant is added to a panel, previous information cannot be updated for that particular gene or variant if the patient/client has not been tested for it in the first place. Therefore to capture any novel DNA sequence information, the patient/client would have to retake the test
It is possible that previously unidentified variants with clinical implication might be present in the selected genes that are not investigated by the test due to an incomplete DNA sequence analysis, therefore a negative result cannot rule out the possibility that the patient carries an unexamined mutation
False positive results can occur and all clinically relevant identified alterations are recommended to be validated by separate technology
The test does not differentiate duplications in the presence of a deletion
The test does not detect alterations which are not caused by a change in the DNA sequence, such as gene expression, epigenetic modifications, fusion, or chromosome conformational changes
The interpretation will be limited to the current state of scientific knowledge of how DNA changes lead to drug responses. This scientific knowledge can also contain mistakes
Samples cannot be accepted if the patient/client has undergone an allogenic transplant such as bone marrow or a peripheral stem cell transplant. A history of hematological disease might exclude test availability in certain circumstances
The test has not been cleared or approved by the US Food and Drug Administration. The FDA does not require this test to go through a premarket FDA review

Ordering Physician Information

All tests offered through Merogenomics require a physician to sign a test requisition for regulatory compliance reasons. A pharmacogenomic test can also be requested by a pharmacist. Once the requisition form is signed by the doctor, the ordering doctor does not have to participate in the process until the receipt of the test results
Merogenomics can provide detailed background information to the ordering physician about the test process. Merogenomics also provides background education towards patient/client informed consent
The test results should be interpreted in context with any other available patient/client clinical findings
It is recommended by sequencing guidelines that the patient/client undergoes genetic counseling prior to and after clinical DNA testing
The DNA sequencing and interpretation takes place in a CLIA/CAP certified laboratory
Patient data is HIPAA compliant, which is securely stored on cloud for continuous re-analysis, and is never sold or shared with third-party companies
The ordering physician or pharmacist can select medications that are most relevant to the particular patient/client for added focus, including dosing guidelines and potential medication alternatives
The ordering physician or pharmacist will be the recipient of the genotyping analysis clinical report. The patient/client will not obtain these results independent of the ordering physician. Merogenomics will not have access to the patient/client report, but can review the report after the receipt of the data if requested by the patient/client
The ordering doctor/pharmacist obtains their own personal login to the diagnostic web console with access to all of the data, in order to:
- Interpret the test results
- Obtain detailed information about all of the medications in the database
- Evaluate drug-to-drug interactions as related to the patient
- Identify alternative medications for the patient
- Analyze medications based on specialty, indication, or the patient’s medical history
- Generate custom reports
The report is designed with doctors in mind and will be divided into the following sections:
- The first page will list the symbols that are used in the report
- A summary of personalized medication pre-selected by the ordering physician (optional)
- All medications organized by specialty and classified based on the severity of the predicted gene-drug interaction
- Hyplotype/genotype results along with the predicted drug phenotype impacts
- The patient/client’s entire genotyping results that make up the analyzed hyplotypes
- The final page is devoted to the methods of testing and the limitations of the procedure
Samples cannot be accepted if the patient/client has undergone an allogenic transplant such as bone marrow or a peripheral stem cell transplant or liver transplant. A history of hematological disease might exclude test availability in certain circumstances
Samples cannot be accepted if the patient/client is experiencing kidney or liver failure
For cancer patients undergoing chemotherapy treatment, the DNA quality may be affected if the patient has received treatment in the past 120 days, potentially requiring sample resubmission
The service provider’s clinical pharmacists can provide information regarding test results to the ordering doctor

Technical Information

PCR-based genotyping and copy number variant analysis run on an IntelliQube qPCR Platform using Thermo Fisher TaqMan® and/or LGC Biosearch BHQ® probe-based methods
Possesses over 99.9% sensitivity
Proprietary methods identify and analyze the following types of variants (depending on the gene investigated):
- Small sequence changes
  - Single nucleotide variants (SNVs, alterations that affect only one nucleotide at a time, also termed single nucleotide polymorphisms or SNPs)
  - Insertions and deletions (indels under 50 bp)
- Structural variants (DNA alterations that affect large segments of DNA of more than 50 bp, and can include insertions, deletions, or copy number variations or CNVs: the duplication of a particular DNA segment)
A proprietary haplotyping algorithm is used to convert genotypes to haplotypes
For clinical genes with related pseudogenes, sequencing is performed to confirm the mutation presence in the gene of interest and not in the pseudogene
Only drugs which fit the highest level of published clinical validity (level 1 or level 2 of PharmGKB database) are included in the bioinformatic analysis
Genes investigated: COMT, CYP1A2, CYP2B6, CYP2C cluster, CYP2C9, CYP2C19, CYP2D6, CYP3A4, CYP3A5, CYP4F2, DPYD, DRD2, F2, F5, GRIK4, HLA-A, HLA-B, HTR2A, HTR2C, IL28B (IFNL4), NUDT15, OPRM1, SLC6A4, SLCO1B1, TPMT, UGT1A1, VKORC1

Additional Information

MTHFR gene analytical analysis can be added at no additional cost if requested by the ordering physician
Volume discounts are available. Contact Merogenomics for more details

Book your FREE 30-minute consultation. The link will take you to a booking calendar for the next available session. A consultation is highly recommended to provide appropriate client-informed consent prior to deciding upon any DNA testing. Payment does not occur until after the consultation and the signing of the requisition form by a medical doctor has been completed. For email inquiries, please use the Contact page.

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Full Genome Sequencing

Human genome sequencing is the process of decoding the order of nucleotide bases in the entire human DNA to gain information of interest. Variations observed in the DNA between different individuals afford insight into the variation in specific traits of these individuals. As some traits have an impact on human health, genome sequencing can provide valuable information about human disease that would otherwise be hidden until symptoms appeared. Please expand the following sections for further details.

$4,099 CAD

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Test Description

Whole genome sequencing (including nuclear and mitochondrial DNA), provides the most comprehensive view of alterations in an individual’s DNA code
This test is used for clinical purposes and should not be regarded as investigational or for research
The test must be ordered by a medical doctor who will oversee the clinical report based on the interpretation of the DNA sequence
The test is for presumed healthy individuals who are interested in proactively screening themselves for health predispositions and drug responses
This test is not meant to diagnose an already suspected genetic condition. Please refer to the Undiagnosed Diseases DNA Tests section for diagnostic testing options
Anonymized patient/client clinically-relevant information will be included in public databases to help with the future medical analysis of human genomes. Databases contain cumulative results from around the world and do not include information that can personally identify the patient/client
This test does not provide information on traits that are not medically relevant, such as eye color, fitness performance, and tasting. The test does not analyze ancestry. If and when any such information is scientifically validated, the patient/client will always have the option of analyzing their DNA for any additional purposes by an independent third-party. Merogenomics recommends checking the quality of any company prior to submitting the DNA for analysis
The test can be paid for directly by the patient/client. Interest-free payment plans are available. Insurance billing is available and can be investigated up-front to determine out-of-pocket expenses. Institutional billing is also available for organizations that prefer to bill patients/clients directly

Test Deliverables

Merogenomics provides background education towards patient/client informed consent
The collection kit can be for a saliva or a blood sample, with prepaid shipping included
Services are fully insured, and are HIPAA, CLIA and CAP compliant
The test will provide the DNA code of nearly the entire genome using the current best sequencing systems, and will be stored on cloud for the patient/client by the company
The results are available within 8 weeks
A concise clinical report signed by a medical geneticist is delivered to the ordering doctor only, and then subsequently discussed and shared with the patient/client. The report spans three sections:
- The variants that put the individual at an increased risk of developing a disease
- The variants for which the individual is a carrier
- The variants that impact drug responses
Identified pathogenic or likely pathogenic variants are reported even when they fall outside the set of ACMG’s 59 genes recommended for incidental findings
Patients can opt out of obtaining the risk information of diseases that are currently untreatable
The decoding and interpretation of the genome is done utilizing industry gold-standard tools and databases, which also include proprietary systems developed in-house – one of the key determining factors of test quality for medical use
Board-certified medical geneticists will work with the ordering physician to provide a collaborative diagnosis, so that doctors can be as involved in the process as desired
The ordering doctor will obtain their own personal login to the diagnostic web console in order to have direct access to all of the data, including any preliminary findings requiring immediate attention
The previous medical information of the patient/client already collected by the ordering physician will be incorporated into the analysis
Follow-up management will be suggested based on the patient’s diagnosis and available medical history
The entire medico-legal paper work and audit trail is initiated and provided to the clinic
The genome sequence can be re-analyzed in the future using in-silico panels of selected genes (based on the list of suspected phenotypes/diseases), to obtain additional diagnoses if new symptoms appear in the patient. This allows for the incorporation of novel patient medical information and the latest scientific interpretation
The databases used for genome DNA sequence interpretation are updated on a quarterly basis, and if novel findings pertaining to currently unknown variants identified in a patient/client are available, the ordering physician will be continuously notified for the duration of the genome’s storage by the company
The genome sequence can be provided to the patient/client upon request using a secure FTP server download
For couples planning to have children together, and who both order testing, an analysis of their shared carrier status and risks is provided, helping individuals have an in-vitro fertilization pre-implantation genetic diagnosis procedure

Test Benefits

Obtain a diagnosis when other standard testing methods fail to provide a clear answer. A diagnosis is made for DNA variants that are considered strong causal candidates for a genetic disorder, variants which are associated with increased disease risks, or variants involved in drug dosing and/or drug toxicity for certain medications. Studies show that the sequencing approach often leads to a diagnosis more quickly and with lower overall costs than other methods. The variants will be categorized as follows:
- Treatable medical conditions – those in which treatment or intervention is currently available
  - ACMG59 conditions – the current gold-standard of 59 genes affecting 27 medical conditions as recommended by the American College of Medical Genetics and Genomics which is the minimum recommended amount of information to be returned to patients undergoing genomic testing
  - All other conditions for which supporting information is available
- Untreatable medical conditions – those in which there is no cure currently available, such as Alzheimer’s and Parkinson's. This is optional and can be selected to not be received in the report. If such a request is not made, the information is automatically included
- Cancer predisposition – variants that increase the risk of cancer development
- Carrier status – variants that do not cause disease, but if they are also found in a partner, together produce the risk of having children with a disease, and thus is important for reproductive planning
The diagnosis can provide the possibility of guiding or influencing medical care management as follows:
- Treatment of the already existing condition
- Intervention to prevent the condition from developing
- Screening to be able to catch the condition development at its earliest stages
- Preparation for the outcomes, whether through education or by seeking clinical trials
The diagnosis might influence the considerations of additional family members regarding testing, or affect reproductive decisions to avoid passing the same DNA alterations to future offspring
Only a single whole genome sequencing test is required for an individual. The complete sequence information captured in the test allows for an unlimited number of future data reanalysis as more scientific evidence is uncovered, or as new health symptoms materialize, so it provides the best ROI for the investment made. Whole genome sequencing captures small sequence changes, structural variants, tandem repeat expansions, and mitochondrial variants, both in the coding and non-coding regions, all in a single test
The patient/client data is securely stored on cloud for subsequent re-analysis. Data is never sold, or shared with any third-parties unless specifically requested by the patient/client. Such data sharing will require a separate consent form to be signed by the patient/client in addition to the one that is signed to obtain the test
The entire process closely follows the Canadian and American guidelines, therefore there is a high level of proper accountability for the clinic

Test Limitations

The “entire genome sequence” refers to the current feasibility of technology, as an entire genome is actually not decoded because no technology exists to be able to sequence the full human reference genome. It is not known how much of the human genome remains undiscovered, but estimates range between 2-8%. In addition, the current technologies generate data that typically includes over 98.5% of the known human genome
Biological sample quality can influence the scope and quality of the final decoded DNA sequence data, and therefore its interpretation
It is never possible to guarantee that every DNA change in the genome will be found, therefore a negative result cannot rule out the possibility that the patient carries an unexamined mutation
Certain alterations or variants might not be identified due to the presence of highly homologous pseudogenes (the presence of inactive genes that are highly similar in sequence to active genes), or other confounding factors such as bone marrow transplantation, blood transfusion, or mosaicism (the presence of different variants in a subset of cells in an individual)
The limitations of the sequencing technology might not allow for the complete uncovering of large structural changes within the genome, and might require additional technologies in order to be achieved. Genome sequencing typically focuses on the small sequence alterations and might have a limited scope in the analysis of the gross alterations (such as a segment of a chromosome inverting or moving to a new location)
False positive results can occur and all clinically relevant identified alterations are recommended to be validated by separate technology
The average genome read depth is 30X, but such read depth cannot cover the entire genome. Each patient will present their own unique read depth distribution across the genome. About 0.5% of the genome will be sequenced with a read depth of less than 8X, which is the minimum that is considered high enough to make a statistically confident call about the observed DNA sequence
The test does not detect alterations which are not caused by a change in the DNA sequence, such as gene expression, epigenetic modifications, fusion, chromosome conformational changes, or X-linked recessive mutations in females who manifest disease due to skewed X-inactivation
The interpretation will be limited to the current state of scientific knowledge of how DNA changes lead to a disease. This scientific knowledge can also contain mistakes
Samples cannot be accepted if the patient/client has undergone an allogenic transplant such as bone marrow or a peripheral stem cell transplant. A history of hematological disease might exclude test availability in certain circumstances. Contact Merogenomics to discuss potential alternatives
Psychological consequences can be severe with high risk individuals and patients/clients should be screened prior to testing
The test does not consider somatic alterations (non-inherited DNA changes acquired post-birth throughout one’s lifetime)
The test has not been cleared or approved by the US Food and Drug Administration. The FDA does not require this test to go through a premarket FDA review

Ordering Physician Information

All tests offered through Merogenomics require a physician to sign a test requisition for regulatory compliance reasons. Once the requisition form is signed by the doctor, the ordering doctor does not have to participate in the process until the receipt of the test results
Merogenomics can provide detailed background information to the ordering physician on the test process. Merogenomics also provides additional education towards patient/client informed consent
This test is a screening test for presumed healthy individuals and is not meant to be used as a diagnostic test, and should not be used to diagnose a suspected disease in a patient/client. Please refer to the “Persons with Undiagnosed Diseases” section for diagnostic testing options
It is recommended by genome sequencing guidelines that the patient/client undergoes genetic counseling prior to clinical DNA testing
The DNA sequencing takes place in a CLIA/CAP certified laboratory with subsequent DNA data interpretation performed in an additional CLIA certified laboratory. The interpretation of the DNA data is based on public and private databases of clinical past observations. The final results are overseen and signed by a board-certified medical geneticist prior to delivery to the doctor. This provides one of the highest levels of regulatory oversight towards the generation of clinically meaningful genomic results for patient medical management
Patient data is HIPAA compliant, securely stored on cloud for continuous re-analysis, and never sold or shared with third-party companies
The ordering physician will obtain access to the data with an easy-to-use web console during and post genome sequencing with all of the clinically relevant results. Merogenomics can offer an explanation of the web console use. Merogenomics will not have access to the patient/client’s data using the web console
The ordering physician will be the recipient of the genome sequencing analysis clinical report. The patient/client will not obtain these results independent of the ordering physician. The patient will likewise not gain access to the web-based portal or the final report. Therefore the ordering physician will be providing the information contained in the report to the patient/client. Merogenomics will not have access to the patient/client report, but can review the report after the receipt of the data if requested by the patient/client
The report is designed with doctors in mind and will be divided into the following sections:
- The first page will have a condensed summary listing all of the clinically relevant results ordered into sections:
  - Pathogenic or likely pathogenic results – information requiring the utmost attention spanning the entire genome
  - Carrier status – information important for reproductive planning
  - ACMG 59 status – the 59 genes tied to clinical conditions as most strongly recommended by the American College of Medical Genetics and Genomics guidelines to be reported to patients if they are affected
  - Other – mitochondrial or structural variants. Structural variants are the alteration of the genome involving large segments of DNA
  - Follow-up recommendations
- The second page will list details about each of the mutations and the corresponding conditions
- The final pages are devoted to the methods of testing and the limitations of the procedure
- Pharmacogenetic results are provided in an independent report. This information relates to drug responses and/or toxicity based on public databases listing clinically valid results
It is strongly recommended that all pathogenic or likely pathogenic results are followed up by genetic counseling by the patient/client
The service provider’s board-certified medical geneticists can provide a second opinion for medical management

Technical Information

The DNA sample is prepared using TrueSeq PCR-Free Library and is sequenced using Illumina HiSeq X Ten System at 30X mean mappable coverage with an average of 5% of the genome covered at ≥20X, with 97.3% of the genome covered at ≥8x and 99.4% of HGMD and ClinVar annotated variants covered at ≥8x
The test offers 95% sensitivity, 99.99955% specificity and 99.6% positive predictive value for SNVs. 97.9%, 96.0% and 95.2% sensitivity for indels of 1-5, 6-15 and 16-50 nucleotides respectively. 96% clinical sensitivity for structural variants
Extracted genomic DNA can also be submitted for sequencing, if it has been isolated from a CLIA-certified laboratory or equivalent
State of the art bioinformatics tools are used based on the Broad Institute’s gold-standard and best practices for alignment and variant calling
Extensive data quality control is utilized: mapped read percentage, percentage of properly paired reads versus failed reads and duplicate reads, coverage statistics, gender and pedigree concordance
Proprietary methods identify and analyze four types of variants:
- Small sequence changes
  - Single nucleotide variants (SNVs, alterations that affect only one nucleotide at a time, also termed single nucleotide polymorphisms or SNPs)
  - Insertions and deletions (indels under 50 bp)
- Structural variants (DNA alterations that affect large segments of DNA of more than 50 bp, and can include insertions, deletions, inversions, breakpoints or copy number variations or CNVs: the duplication of a particular DNA segment)
- Trinucleotide repeat expansions (repetition of a small DNA segment)
- Mitochondrial variants
Variants are classified as pathogenic, likely pathogenic, or of unknown significance according to the established guidelines by the American College of Medical Genetics and Genomics /Association for Molecular Pathology from 2015 (Richards S et al. 2015. Genet Med 17(5): 405–424)
Structural variants larger than 3 Mbp in size are reported. Smaller structural variants are reported only when pathogenic or are likely pathogenic and related to the patient/client’s phenotype
Mitochondrial DNA includes sequence variants and indels under 20 bp only. Heteroplasmy (the presence of more than one type of mitochondrial genome), is reported to the level of ≥4%
Clinically relevant short tandem repeat expansions are reported for >20 known pathogenic loci without identifying a specific repeat number
Best-in-class public and commercial databases and tools used for annotations:
- Disease association: HGMD Professional, Genome Trax, ClinVar, OMIM, Orphanet, Gene Tests
- Population frequencies: gnomAD, dbSNP, ensemble, 1000 Genomes Project, ExAC, NHLBI Exome Sequencing Project and service provider proprietary database
- Severity prediction: SIFT, MutationAssessor, MutationTaster, GWAVA, PolyPhen2, FATHMM, LRT
- Conservation prediction: SiPhy, GERP++, PhyloP, PhastCons
- Gene essentiality: according to Georgi B et al. 2013. PLoS Genet 9(5):e1003484
- Gene tolerance: RVIS score according to Petrovski S et al. 2013. PLoS Genet 9(8):e1003709
Customizable medico-legal documentation can be provided and include: electronic patient questionnaire, patient informed consent, physician disclaimer, research and clinical use documentation, and territory specific materials

Additional Information

Expedited results are available within 4 weeks for an additional cost
Access to a genetic counselor is available before and/or after the receipt of the test results for an additional cost. This is highly recommended, especially after the results are received
All pathogenic or likely pathogenic results can be verified by separate independent Sanger sequencing technology for an additional cost
DNA sequence data is available for download by the paying client using a secure web portal at no extra cost. The file format is available either as FASTQ/BAM (the entire sequence data from a patient submitted sample), or as a VCF file (list of variants that differ from the human genome reference that was used for the alignment of the client’s genome data)
Extracted genomic DNA can also be submitted for sequencing, isolated from a CLIA-certified laboratory or equivalent. Contact Merogenomics to discuss additional alternatives
Volume discounts are available starting with a minimum of five samples. Contact Merogenomics for more details

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Related Information:

Types of Genome Sequencing Procedures

Cancer DNA Tests

Prenatal DNA Tests

Undiagnosed Diseases DNA Tests

Genomic Education