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)
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
87040
Blood culture and susceptibility
119,00
87045
Feces culture
87070
Culture, other source, excluding blood/urine/feces
87081
Urine culture, non quantitative
87086
Urine culture, quantitative
320,00
87088
Urine culture and susceptibility
179,00
87106
Fungi culture
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
87177
Ova and parasites, direct smear, identification - feces
120,00
87181
Susceptibility studies, antimicrobial agent, per agent
87190
Susceptibility studies, antimycobacterial agent, mycobacteria
354,00
87205
Smear interpretation, stain for bacteria, fungi, parasites or cell types
87207
Smear, special stain for parasites
87250
Virus isolation, including nucleic acid identification, polymerase chain reaction, PCR
609,00
87252
Virus isolation, tissue culture
87253
Virus isolation and identification, tissue culture, any method
965,00
87278
Legionella Ag - urine
236,00
87299
Immunofluorescent study; not otherwise specified
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
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
88130
Sex chromatin identification, Barr bodies
88141
Pap smear, cervical/vaginal, cytopathology, including sampling
162,00
88160
Cytopathology examination and interpretation
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
88313
Bone marrow sampling and iron stain
606,00
88319
Histochemistry/cytochemistry stain for enzyme identification
88346
Immunofluorescent study, each antibody; direct method
1 410,00
88347
Immunofluorescent study, each antibody; indirect method
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
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
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
90585
BCG (Bacillus Calmette-Guerin) vaccine for tuberculosis
90586
BCG vaccine for bladder, live, for intravesical use, per treatment, including material
1 344,00
90749
Immune globulin (Ig), not otherwise specified
90772
Subcutaneous/IM injection, therapeutic/prophylactic/diagnostic
54,00
90862
Pharmacological management/review, mental health
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
