Specialty Testing & Procedures

We make use of all conventional testing labs and methodologies and also have additional specialty testing tools to evaluate your health in innovative ways.

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These procedures are billed at a cash price for collection and then billed by your insurance to you at their price for test completion. We can give you the codes for you to seek reimbursement for the test completion, but not the collection.

$600

Autonomic Nervous System Testing includes a battery of four tests: tilt table, valsalva, heart rate deep breathing and the QSART (quantitative sudomotor axonal reflex test). This testing is done in-office over about 2 hours. We are one of three locations in Washington State doing this testing which can diagnose or rule out POTS (postural orthostatic tachycardia syndrome), hyperadrenergic dysautonomias and other types of dysautonomias.

Symptoms of dysautonomias include dizziness, labile heart rate and possibly blood pressure especially when changing positions from sitting to standing or if standing for an extended period of time.

POTS commonly occurs alongside hypermobility syndromes like Ehlers-Danlos Syndrome, mast cell activation disorders and chronic immune dysfunction like long-COVID and other neuroimmune inflammations. There are treatment options so confirmation of a diagnosis has the potential to target treatment. Payment due at time of testing. We are happy to give you a Superbill to seek reimbursement from your insurance company.

$300

Skin biopsy for small fiber neuropathy (SFN), amyloid and alpha-synuclein deposition. This is a 30 minute in-office procedure in which we numb 3 small areas on your leg (above your knee, below your knee & on your foot) to then take a small punch biopsy of skin to send for pathology testing. The areas are covered with band-aids and are not even large enough to require stitches or special treatment.

Although the most common cause of SFN is diabetic peripheral neuropathy, evidence of damage to the small fibers of the legs may reflect damage in other areas of the nervous system and it is the small fibers which talk to our skin and many of our internal organs. Symptoms may include numbness, tingling, burning sensations or ‘wrong’ sensations or parasthesias almost anywhere in the body. SFN can also impact the gut interrupting gut motility & the secretion of enzymes necessary for digestion.

Amyloid and alpha-synuclein are mis-folded proteins which can reflect an elevated total stress burden in the body and may be associated with Alzheimer’s Disease or Parkinson’s, respectively, although finding deposition in the legs is not diagnostic of these diseases nor does it indicate that developing these diseases is inevitable. Cost is $300 for our in-office procedure testing & processing. The pathology lab will determine their cost which is often covered by insurance (as determined by your insurance). We are happy to give a superbill for you to submit for reimbursement for the procedure. We can give you the codes for you to seek reimbursement for the test completion (but not the collection).

$300

NeuroCognitive testing (CNS Vital Signs) is a reimbursable assessment procedure that utilizes scientifically validated, objective, and reliable computerized neuropsychological tests to evaluate the neurocognitive status of patients and covers a range of mental processes from simple motor performance, attention, memory, to executive functions. It is part of Dale Bredesen’s ‘Cognoscopy’ to look at brain and cognitive health on a serial basis and has been validated for all people aged 8-89 with a 4th grade reading competency. CNS Vital Signs neurocognitive tests are available in 60 languages although the testing reports are only available in English. You can complete this approximately 45-minute testing from the quiet comfort of your own home or online sitting at our office.

Cost is $300 and includes a 30-minute review with one of our clinicians. You do not need to be an established patient to order this testing- please send an inquiry and we can call you for a quick screening.

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General types of specialty testing we offer are listed. Please note this list is continually being refined to stay current with modern testing standards.

Cortisol testing including spot & diurnal salivary patterning
Evidence-Based Functional genomics
Functional methylation patterns
Functional mitochondrial complex testing
Genetic-based Illnesses
Heavy metal unprovoked screening and provoked urine testing
Hormone testing including both spot & month-long rhythm testing
Lyme specialty testing
Mast cell activation syndrome
Mycotoxin testing
Nasal microbiome and biofilm evaluation
Neurotransmitter genomics
Nutrient evaluation with organic acids, fatty acids, minerals, oxalaes, and oxidative stress testing
SIBO testing (small intestinal bacterial overgrowth) for methane, hydrogen and hydrogen sulfide
Specialty autoimmune evaluation
Stool testing for digestive markers, inflammation and microbiome communities
Vaginal microbiome testing for yeast, bacterial vaginosis and trichomonas

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Lab companies from whom we order tests include but are not limited to the following. Please note this list also is continually being refined to stay current with modern testing standards.

Genova

Doctor's Data

Invitae

Vibrant America

GI Map

Cyrex

RealTime

Galaxy

Great Plains Labs

CNS Vital Signs

Religen (MitoSwab, FRAT (Folate Receptor Antibody Testing))

Igenex

Microbiology Dx (MARCONS)

Most specialty tests come in a kit that can be drop-shipped to you directly and include the tubes, collection and processing instructions.

Some kits can be self-collected & shipped via FedEx including salivary samples, cheek swabs, stool testing and blood spot testing in which you poke your finger with a given lancet & put a few drops of blood onto a paper card. These kits include return envelops which can be submitted via the FedEx/ Post Office mail for processing. Results generally come in ~2-5 weeks.

Some kits require blood draws. Some Labcorp, Quest or local offices will draw outside kits- it is up to the individual lab if they will do this. Mobile phlebotomy services (meaning they come draw your blood in your home) are available for some communities including most of Western Washington: ElitePhlebotomy.com (greater Portland and Seattle) and GetLabs.com (greater Seattle). We cannot be responsible for finding you a local phlebotomy option.

Please note there are some restrictions in specialty kit testing in New York State.

Conventional testing is typically drawn at your local LabCorp or Quest Diagnostics lab.

These labs are ordered electronically so should be on file at your local lab when you arrive- you don't need to bring anything with you except ID & your insurance information. Upon request, we can fax lab orders to your local lab (typically a local hospital or clinic) if preferred. You are always able to find a copy of our electronically filed lab orders in your patient portal under 'documents' tab, under 'sent'.

Conventional labs are billed by your insurance so we cannot give you any estimation of cost. We submit codes in the hopes that labs are covered. Sometimes they are and sometimes they are not. We do not complete appeals for labs not covered by insurance as we have no control over these insurance billing decisions.