J1263
Williams syndrome, FISH, cytogenetic diagnostics
1 934,00
J1271
FMF, molecular diagnostics, special case
816,00
J1311
BRCA1/BRCA2 founder mutation analysis, breast/ovarian cancer, per patient
764,00
J3001
Familial known mutation, molecular diagnostics
633,00
J8003
Karyotype, cytogenetic diagnostics - chorionic villus
2 889,00
J8891
Prenatal molecular diagnostics, basic
2 085,00
J9001
Prenatal molecular diagnostics, complex
3 050,00
J9900
Fragile X, molecular diagnostics
752,00
J9903
Mental retardation, cytogenetic diagnostics
1 146,00
J9913
Male infertility, cytogenetic diagnostics
J9941
Y chromosome deletion, molecular diagnostics, special case
1 238,00
J9991
Monogenic disease in family, gene location known, molecular diagnostics, special case
4 622,00
L0005
Long cast, local anesthesia
389,00
L0019
Elastic bandage, elstoplast
17,00
L0020
Needle aspiration, US guidance, including cytology
713,00
L0021
Breast needle aspiration, US guidance, including cytology
L0022
Thyroid needle aspiration, US guidance, including cytology, per patient
2 100,00
L0023
Bandage placement or replacement
113,00
L0025
Stitches
0,00
L0026
Stitches removal
60,00
L0030
Parotid needle aspiration, US guidance, including cytology, per patient
1 913,00
L0042
Nephrostomy tube removal
440,00
L0062
Vaginal smear, sampling, processing and interpretation
266,00
L0080
Rehabilitation day care
1 073,00
L0100
TMJ radiology, up to two views
347,00
L0106
Radiology additional view, not elsewhere specified
86,00
L0107
Jaw radiology, third or more additional views
L0108
Mastoids radiology, third or more additional views
L0109
Nasal bones radiology, third or more additional views
L0110
Paranasal sinuses radiology, third or more additional views
L0111
Skull radiology, third or more additional views
L0112
Pelvis radiology, third or more additional views
L0113
Shoulder radiology, complete, one side, third or more additional views
L0114
Elbow radiology, third or more additional views
L0115
Wrist radiology, third or more additional views
L0116
Hand radiology, third or more additional views
L0117
Hip radiology, unilateral, second or more additional views
L0118
Ankle radiology, third or more additional views
L0119
Abdomen radiology, second or more additional views
L0120
TMJ radiology, third or more additional views
L0121
Calcaneus radiology, third or more additional views
L0122
Toe(s) radiology, third or more additional views
L0123
Cervicothoracic spine radiology, Pawlow/Twining, up to two views
L0124
Cervicothoracic spine radiology, Pawlow/Twining, third or more additional views
L0125
Pelvis radiology, outlet
L0126
Pelvis radiology, inlet
L0138
Spine radiology, two parts, up to three views
L0151
Arthrography, including injection and interpretation
441,00
L0160
Chest radiology, third or more additional views
158,00
L0167
Additional charge for device for insertion of left atrial appendage device
36 267,00
L0168
Additional charge for device for implantation of diaphragmatic pacemaker for spinal cord injured patients
163 350,00
L0169
Additional charge for device for implantation of diaphragmatic pacemaker for ALS patients
139 200,00
L0194
Large bandage, bandages & cotton
342,00
L0209
Pregnancy termination approval committee
540,00
L0210
Nasal bones radiology, up to two views
245,00
L0248
Storage of corpse, 2 to 24 hours
473,00
L0268
Spotting and copying patient records, first 10 pages
129,00
L0269
Copying patient records, each 2 additional pages
2,00
L0372
HBIg (Hepatitis B immune globulin), IV
8 766,00
L0396
Varicella Zoster passive immunization, under 12 years of age, eg, varitect
3 806,00
L0397
Varicella Zoster passive immunization, age 12 years or older, eg, varitect
13 335,00
L0409
Small splints, occupational therapy, including cost of material and number of sessions
279,00
L0410
Medium splints, static mouth splint, occupational therapy, including cost of material and number of sessions
539,00
L0411
Medium splints, occupational therapy, including cost of material and number of sessions
L0412
Complex medium splints, occupational therapy, including cost of material and number of sessions
786,00
L0413
Big splints, occupational therapy, including cost of material and number of sessions
1 058,00
L0415
JOBST suit measurement
L0416
Complex medium splints, dynamic mouth splint, occupational therapy, including cost of material and number of sessions
L0438
TRH (Thyrotropin releasing hormone) stimulation panel
965,00
L0444
MRI (Magnetic resonance imaging), excluding tests with specific code
3 134,00
L0446
MRI under general anesthesia, per test
11 192,00
L0486
Geriatric hospital day care
830,00
L0487
Cognitive geriatric hospital day care
432,00
L0491
Cytotoxic capacity testing
1 256,00
L0534
Orthoptic treatment, per treatment
120,00
L0546
Auditory test for cochlear implant surgery candidate
945,00
L0554
FMRI (functional magnetic resonance imaging)
8 483,00
L0560
Internal hospital day care
1 716,00
L0561
Rehabilitative hospital day care
L0564
Histochemical staining including immunohistochemistry
2 499,00
