86738 |
Mycoplasma, Ab |
333,00 |
86762 |
Rubella virus IgG and IgM |
161,00 |
86778 |
Toxoplasma IgM |
99,00 |
86789 |
West Nile virus IgG and IgM |
516,00 |
86790 |
Virus/bacteria Ab, not otherwise specified |
266,00 |
86800 |
Thyroglobulin, Ab |
401,00 |
86803 |
Hepatitis C, Ab |
48,00 |
86805 |
Lymphocytotoxicity assay, visual crossmatch; with titration |
425,00 |
86813 |
HLA typing, A, B, C |
2 178,00 |
86817 |
HLA typing, DR/DQ |
2 817,00 |
86821 |
HLA typing, MLC (mixed lymphocyte culture) |
2 817,00 |
86880 |
DAT (Direct Antiglobulin Test) / Coombs |
194,00 |
86900 |
Blood typing, including RH |
126,00 |
86901 |
Rh test |
158,00 |
86903 |
Blood typing and Rh, Ab, screen |
552,00 |
86904 |
Blood typing and Rh, Ab |
1 092,00 |
86905 |
Blood typing; RBC antigens, other than ABO or Rh (D) |
1 664,00 |
86940 |
Hemolysins and agglutinins, screen |
572,00 |
87001 |
Animal inoculation, eg, tuberculosis |
572,00 |
87040 |
Blood culture and susceptibility |
119,00 |
87045 |
Feces culture |
158,00 |
87070 |
Culture, other source, excluding blood/urine/feces |
119,00 |
87081 |
Urine culture, non quantitative |
158,00 |
87086 |
Urine culture, quantitative |
320,00 |
87088 |
Urine culture and susceptibility |
179,00 |
87106 |
Fungi culture |
158,00 |
87109 |
Mycoplasma culture |
239,00 |
87110 |
Chlamydia culture |
486,00 |
87116 |
Mycobacteria culture and identification |
519,00 |
87118 |
Mycobacterial definitive identification, MTb |
264,00 |
87140 |
Fluorescence or darkfield microscopy |
158,00 |
87177 |
Ova and parasites, direct smear, identification - feces |
120,00 |
87181 |
Susceptibility studies, antimicrobial agent, per agent |
158,00 |
87190 |
Susceptibility studies, antimycobacterial agent, mycobacteria |
354,00 |
87205 |
Smear interpretation, stain for bacteria, fungi, parasites or cell types |
120,00 |
87207 |
Smear, special stain for parasites |
158,00 |
87250 |
Virus isolation, including nucleic acid identification, polymerase chain reaction, PCR |
609,00 |
87252 |
Virus isolation, tissue culture |
194,00 |
87253 |
Virus isolation and identification, tissue culture, any method |
965,00 |
87278 |
Legionella Ag - urine |
236,00 |
87299 |
Immunofluorescent study; not otherwise specified |
333,00 |
87340 |
Hepatitis B surface antigen (HBsAg), any method, including immunofluorescent study |
134,00 |
87350 |
Hepatitis Be antigen (HBeAg), any method, including immunofluorescent study |
111,00 |
87449 |
Infectious agent antigen detection, not otherwise specified |
549,00 |
87472 |
Bartonella henselae and Bartonella quintana, quantification |
419,00 |
87517 |
Hepatitis B virus DNA/RNA, quantitative |
743,00 |
87522 |
Hepatitis C virus DNA/RNA, quantitative |
1 382,00 |
87536 |
HIV-1 DNA/RNA, quantitative |
1 934,00 |
87539 |
HIV-2 DNA/RNA, quantitative |
1 934,00 |
87556 |
Mycobacteria tuberculosis, AMTD |
665,00 |
87590 |
Gonorrhoeae smear |
0,00 |
87620 |
Papillomavirus (HPV) - tissue, including biopsy |
2 745,00 |
87622 |
HPV (Human Papillomavirus) smear |
573,00 |
88036 |
Necropsy (autopsy), limited, gross and/or microscopic; regional |
965,00 |
88130 |
Sex chromatin identification, Barr bodies |
194,00 |
88141 |
Pap smear, cervical/vaginal, cytopathology, including sampling |
162,00 |
88160 |
Cytopathology examination and interpretation |
266,00 |
88230 |
Karyotype, leukocyte culture |
1 668,00 |
88233 |
Karyotype, tissue culture |
2 153,00 |
88240 |
Cryopreservation of cells (eg, bone marrow), per year |
2 094,00 |
88299 |
B &T cell receptor gene rearrangment analysis |
1 559,00 |
88305 |
Histologic examination, microscopy and interpretation |
266,00 |
88313 |
Bone marrow sampling and iron stain |
606,00 |
88319 |
Histochemistry/cytochemistry stain for enzyme identification |
266,00 |
88346 |
Immunofluorescent study, each antibody; direct method |
1 410,00 |
88347 |
Immunofluorescent study, each antibody; indirect method |
1 410,00 |
88348 |
EM (Electron microscopy), diagnostic |
4 727,00 |
89051 |
Cell count - body fluids, eg, CSF, joint fluid, excluding blood |
188,00 |
89258 |
Cryopreserved embryos storage for 5 years |
965,00 |
89259 |
Cryopreservation, sperm, one year, up to 5 test tubes/straws |
1 062,00 |
89280 |
Assisted oocyte fertilization, microtechnique |
6 395,00 |
89290 |
Biopsy, oocyte polar body or embryo blastomere, microtechnique (for pre-implantation genetic diagnosis) |
13 776,00 |
89300 |
Semen analysis; presence and/or motility of sperm including Huhner test (post coital) |
363,00 |
89320 |
Semen analysis, complete (volume, count, motility, and differential) |
222,00 |
89325 |
Sperm Ab |
354,00 |
90371 |
HBIg (Hepatitis B immune globulin), IM |
6 093,00 |
90375 |
Rlg (Rabies immune globulin), IM and/or subcutaneous |
4 166,00 |
90384 |
Rho(D) immune globulin (Rhlg), Anti-D |
743,00 |
90585 |
BCG (Bacillus Calmette-Guerin) vaccine for tuberculosis |
0,00 |
90586 |
BCG vaccine for bladder, live, for intravesical use, per treatment, including material |
1 344,00 |
90749 |
Immune globulin (Ig), not otherwise specified |
158,00 |
90772 |
Subcutaneous/IM injection, therapeutic/prophylactic/diagnostic |
54,00 |
90862 |
Pharmacological management/review, mental health |
162,00 |
90870 |
Electroconvulsive therapy |
1 656,00 |
90880 |
Hypnotherapy |
198,00 |
90882 |
Psychosocial intervention - follow up |
191,00 |
90889 |
Psychiatric medical opinion |
908,00 |
90901 |
Biofeedback training |
588,00 |
90935 |
Hemodialysis procedure, per treatment |
1 818,00 |
90945 |
Dialysis procedure other than hemodialysis (eg, peritoneal dialysis) |
822,00 |
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