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

1 146,00

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

713,00

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

86,00

L0108

Mastoids radiology, third or more additional views

86,00

L0109

Nasal bones radiology, third or more additional views

86,00

L0110

Paranasal sinuses radiology, third or more additional views

86,00

L0111

Skull radiology, third or more additional views

86,00

L0112

Pelvis radiology, third or more additional views

86,00

L0113

Shoulder radiology, complete, one side, third or more additional views

86,00

L0114

Elbow radiology, third or more additional views

86,00

L0115

Wrist radiology, third or more additional views

86,00

L0116

Hand radiology, third or more additional views

86,00

L0117

Hip radiology, unilateral, second or more additional views

86,00

L0118

Ankle radiology, third or more additional views

86,00

L0119

Abdomen radiology, second or more additional views

86,00

L0120

TMJ radiology, third or more additional views

86,00

L0121

Calcaneus radiology, third or more additional views

86,00

L0122

Toe(s) radiology, third or more additional views

86,00

L0123

Cervicothoracic spine radiology, Pawlow/Twining, up to two views

86,00

L0124

Cervicothoracic spine radiology, Pawlow/Twining, third or more additional views

86,00

L0125

Pelvis radiology, outlet

86,00

L0126

Pelvis radiology, inlet

86,00

L0138

Spine radiology, two parts, up to three views

389,00

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

539,00

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

342,00

L0416

Complex medium splints, dynamic mouth splint, occupational therapy, including cost of material and number of sessions

786,00

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

1 716,00

L0564

Histochemical staining including immunohistochemistry

2 499,00