4) i7 fig · cytochemical profile stain ("dmz) buffy coat preparation 7.1 .i 12 hemosiderin...
TRANSCRIPT
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I / 6.3 1 PRC 1
'MU18 b'M4
! I I
Whole Blood
23102
I 23203 6.3.3 1 Packed Red Cell (NAT) I 780 I
I
23201
23202
6.2.2
I 23301 64.1 I Platelet Concentrate I
23204
Whole Blood (NAT)
480 , 6.3.1 Packed Red Cell
/ 23303 1 64.3 1 Single Donor Platelet (closed system) 1 7.500 1 uadhfim rrox
1,200
6.3.2
6.3.4
6.4
23302
Leucocyte Poored PRC
Leucocyte Poored PRC (NAT)
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6.4.2
23401
I 1 23403 / 65.3 / Aged Plasma 1 400 (
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6.5
6.5.1
23402
I 1 23502 1 66.2 / Leukapheresis 1 7.000 I
23404
1 23503 1 6.6.3 1 Blood ~ x c h a n ~ e ~%LF;O.I Apheriesis I I I I
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Fresh Frozen Plasma
6.5.2
I 23504 1 6.6.4 1 Plasma Exchange HLR%.J Apherresis 1 7,000 1
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6.5.4
6.6
*NAT- Nucleic acid Amplification Technology
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Fresh Frozen Plasma (NAT)
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Cryoprecipitate
l u ~ f i a a ~ u u ~ n 1 ~ 1 6 i n - i
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concentrate
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1 301 01 1 7.1.1.1 1 CBC (+ diff. + RBC morphology + plt count) by automation
7.1 Hematology
7.1.1
1 301 04 1 7.1 1 4 / Hct (Hematocrit)
Blood Cells
30102
301 03
1 301 07 ( 7.1 1 7 1 Bone marrow stain (wright stain)
7.1 .I .2
7.1 .I .3
301 05
30106
CBC (+ diff. + RBC morphology, platelet smear) - Manual
Reticulocyte count
7.1 .I .5
7.1 .I .6
1 301 08 30109
1 301 10
60
30 I
30111 7.1.1.11 Heinzbody
1 301 15 1 7.1 .I .I 5 1 Antibody Identification 1 200 1
ESR (Erythrocyte Sedimentation Rate)
Acid phosphatase with tartrate (hairy cell leukemia)
7,118 / 7.1 .I .9
7.1 .I .I0
301 2
301 13
30114
1 30116 7.1116 / Antibodyscreening
40
200
1 301 17 7.1 .I .I 7 I I I
Blood group (ABO) - Slide method
Bone marrow, iron stain
Cytochemical profile stain ( "dmz )
Buffy coat preparation
7.1 .I 1 2 Hemosiderin test
7.1 .I .I 3
7.1.1.14
50
100
6o I
80
Inclusion body
LAPscore
301 18
30
550
7.1 .I .I8 Blood group (ABO) -Tube method 100
I 30120 ( 7.1 1.20 1 ABO Serum grouplng
30121 7.1.1.21 Rh. Typing I I
1 301 22 1 7.1 1 22 1 Coomb's test - Direct
1 30123 1 7.1 1 2 3 1 Coomb's test - Indirect
30124 7.1.1.24 LEcell
30125 , 7.1.1.25 Osmotic fragility test
1 301 26 1 71 126 I Malarial film
7.1.2 Coagulation
30201 7.1 2.1 PT (Prothombin Time)
1 30202 1 71 2.2 1 PTT (Partial Thomboplastin Time)
1 30203 1 7,123 1 TT (Thrombin Time)
30204 7.1.2.4 VCT (Venous Cloting Time)
30205 7.1.2.5 Clot retraction timeIClot lysis time
30206 7.1.2.6 ELT (Euglobulin Lysis Time)
30207 7.1.2.7 FDP (Fibrin Degradation Product)
I 30209 7.1.2.9 Von Wilebrand factor
3021 0 7.1.2.10 Bleeding time
30211 1 772.1 1 1 Ristocetin cofactor activity
3021 2 7.1.2.1 2 Ristocetin induced agglutination
3021 3 7.1.2.1 3 Dichlorophenol indophenol precipitation test (DCIP)
1 7 , ' ,274 1 Fibrinogen level
3021 5 7.1.2.1 5 Factor assay - Factor ll
3021 6 7.1.2.1 6 Factor assay - Factor V
1 30217 1 7.1.2.1 7 1 Factor assay - Factor V Leiden
30218 7.1.2.18 Factor assay - Factor VII
30219 7.1.2.19 1 Factorassay -FactorVlll
1 30220 1 7.1 2.20 1 Factor assay - Factor Vlll Inhibitor
7.1.2.21 Factor assay - Factor IX 600 ~ 7.1.2.22 Factor assay - Factor IX Inhibitor 1,000
7 1 2 .23 1 Factor assay - Factor X
7.1.2.24 Factor assay - Factor XI 1,000
7.1.2.25 Factor assay - Factor XII 1,000 , 71.2.26 / Platelet aggregration with ADP. Collagen. Adrenaline. Ristocetin I 7.1.2.27 Protein C 250
7.1.2.28 Protein S 250
K 2 q ~ n t i t h r o r n b i ~ Ill activity
7.1 2 .30 1 Heparin anti Xa I 400 ! 7 1 2 .31 / Alpha 2 antiplasmin 1 300 ~ 7.1 2 .33 1 Lupus anticoagulant (screening) I I
8o 1 7.1 2 .34 1 Lupus anticoagulant (confirm). conc RW
I I
7.1.3 Other SubstanceslMoleculeslTests
7.1.3.2 Folate 200
7.1.3.3 Red cell folate (chemiluminescent) 250 ( 7.1 3 . 4 I Serum iron
7.1.3.5 TlBC 80 ~ 7.1.3.6 Ferritin 250
7 1 . 3 7 1 Transferrin
7.1.3.8 EPO (erythropoietin) 250
7.1.3.9 Fetal hemoglobin 8 0
7.1.3.1 1 ( Homocystein
7 . 1 3 .1 2 1 Ham's test
7 1 3 . 1 3 I Hb typing (Hemoglobin typing) - - - -
7.1 3 1 4 IEP ( ~ I H ? U antibody 3 h) 800
IEP (~IM$U antibody 5 62)
Serum viscosity
Chromosome study from blood/BM
Chromosome study from amniotic fluidlchorionic v~llus
DNA index (ploidy) for ALL
DNA detection for P, a-thalassemia gene
RT-PCR for BCRIABL gene for diagnosis of CML
By Flow cytometry
Flow cytometry for acute leukemia panel, AML, ALL
Flow cytometry for lVon Hodgkin's lymphoma panel
Flow cytometry for detection of DAF (CD55 and CD59) (blood)
lmmunophenotyping for CD34 surface antigen (blood, flow
cytometry) - -
Flow cytometry for minimal residual disease, B-ALL panel
Flow cytometry for minimal residual disease, T-ALL panel
Flow cytometry for minimal residual disease, ANlL panel
-
Disease association: HLA-B27 typing
KidneyIBone marrow transplantation - Autoantibody (T, B)
KidneyJBone marrow transplantation - Lymphocyte
crossmatch T, B cell
Bone marrow transplantation - HLA-AB common Ag typing
Bone marrow transplantation - HLA-ABC complete typing - - -
Bone marrow transplantation - HLA class II DNA High
Resolution
Transfusion reaction - HLA antibody
Transfusion reaction - Leukoagglutinin
30609
1 7.1.7 1 Stem cells 1
3061 0
3061 1
1 30701 / 7.1.7,l 1 Stem cell cuture for BFU-E number
7.1.6.9
1 30702 7.1.72 1 Stem cell cuture for CFU-GM number I 600 (
7.1.6.10
7.1.6.1 1
Kidney transplantation - HLA-A, B DNA typing
1 30704 1 7.1.7.4 1 Stem cell processing for Autologous PBSC collection
5,000
Kidney transplantation - Panel reactive antibody (PRA)
Kidney transplantation - HLA-DRB, DQB DNA typing
1,300
4.500 ,
30703
1 7.2. Clinical Microscopy
Stem cell processing for Autologous Bone marrow
collection
7.1.7.3
30705
30706
1 72.1 1 Urine examination
7,000
1 31 001 1 721 1 1 Urine Analysis
7.1.7.5
7.1.7.6
Stem cell processing for Bone marrow collection
Stem cell processing for Cord blood collection
31002
31003
31 004
31005
3,000
7,000
'
7.2.1.2
7.2.1.3
7.2.1.4
7.2.1.5
3101 0
31 101
31006 , 7.2.1.6 31 007
31 008
31 009
31 102
b 2 1 7.222 1 Routine concentration
Specific gravity
pH
Albumin
Sugar
7.2.1 .I 0
7.2.1 .I 1
31 201
20
2 0
2 0
2 0
Bile
7.2.1.7
7.2,1.8
7.2.1.9
7.2.1 .I 2
40 I
Hemosiderin
Pregnancy test
7.2.2
7.2.2.1
I I I
Ketone body ---
Phenyketonuria
Urobilinogen
40
100 1 Bence-Jones protein
40
3 0
40 1
40
Stool examination
Routine direct smear
30
3 0
Occult blood 31203 7.2.2.3
1 31302 / 7,2.3.2 1 Giemsa stain for Virus or Parasite mdl~n::
31 301
1 31501 ( 7.2.3.5 ( ElE9lal Herpes virus 6 9 ~ DIF
7.2.3
7.2.3.1
31 303
31401
POI 1 73.1 1 ( Electrolyte (Na. K. CI, CO,) ( lkn: : 20 uln)
Other Examination
Body fluid examination
7.2.3.3
7.2.3.4
31 502
31 503
1 32002 1 7.31 2 1 Blood gas analysis
60
Pneumocystis carinii
Semen analysis
7.2.3.6
7.2.3.7
/ 32005 1 7.3.1.5 1 Lipoprotein electrophoresis
140
110 1
7.3. Clinical Chemistry
32003
32004
Dark field for Treponema
Tzank's smear (wright stain)
7.3.1
1 7.3.2 1 Inorganic
5 0
80
Combined
7.3.1.3
7.3.1.4
32006
1 32101 / 7.3.2.1 1 Osmoarity serum
Liver function test
Lipid profile (Cholesterol, HDL-chol, LDL-chol, TG)
7.3.1.6
PI 0 7 1 7.3.2.7 1 Magnesium
350
200
32105
321 06
Protein electrophoresis 300
7.3.2.5
7.3.2.6
32108
32109
32201
CO,
Calcium
7.3.2.8
7.3.2.9
32202
2 0
45 I
7.3.3
7.3.3.1
Zinc
Phosphorus
7.3.3.2
350
50
OrganiclBiochem
BUN (Blood Urea Nitrogen) 4 5
Creatinine 45
7.3.3.3 Glucose 40
7.3.3.4 1 OGTT (Oral Glucose Tolerance Test) 17~6?m?n 1 5 0 1 7.3.3.5 Uric acid 55
7.3.3.6 Fructosamine 100
73.3.7 1 Blirubin. Direct 1 7.3.3.8 Bilirubin, Total 50
7.3.3.9 Bilirubin, Micro 6 0
73.3.1 0 1 Ammonia 1 300 ~ 7.3.4 Proteins - Enzymes
7.3.4.1 Acid phosphatase, Total 140
7.3.4.2 / Prostatic acid phosphatase KW::
7.3.4.3 Amylase (blood) 100
7.3.4.4 CPK 90
7.3.4.5 CK-MB 120
7.3.4.6 LDH 6 0
7.3.4.7 Troponin I 260 1
7.3.4.8 1 Troponin T
7.3.4.9 Alkaline phosphatase 5 0
7.3.4.1 0 SGOT (AST) 5 0
7.34.1 1 1 SGPT (ALT)
7.3.4.1 2 Gamma glutamyl transpeptidase 130
7.3.4.1 3 Lipase 250
7 .35 1 Proteins - nonenzyme
7.3.5.1 Hb A1C 150
7.3.5.2 Protein, Total 5 0
7.3.5.3 Albumin 50 ~ 7.3.5.4 Albumin, Micro 270
7.3.5.5 1 Protein. Micro
7.3.5.6 Ceruloplasmin 300
7.3.6 1 Lipid & Lipoproteins
32407
7.3.6.1 1 Lipid - Cholesterol
7,362 1 Lipid - TG (Triglyceride) I Go 1
7.3.5.7 NT-pro BNP
32503
7.3.6.7 1 Lipoprotein A
- -
1,500
32505
32506
7.3.6.3
7.372 1 ACTH (IRMA)
1 32504 7.3.6.5
7.3.6.6
32601
Lipid - HDL-chol
1 32605 1 7.3.7,5 1 Renin
73.6.4
90
Apo A
Apo B
7.3.7
7.3.7.1
32603
32604
737.8 1 Thyroid hormone - TSH (Thyroid Stimulating Hormone) I
200 1 200
Lipid - LDL-chol (direct) $ d t l U n l f ~ ~ U ?
Hormones
ACTH (Immulite)
7.3.7.3
7.3.7.4
7.3.7.1 1 1 Thyroid hormone - T3 (Tri - iodothyroxine)
200 ,
350
32609
3261 0
Cortisol
Aldosterone
737.14 1 Osteocalcin
270
600
7.3.7.9
7.3.7.1 0
I 3261 2
3261 3
Thyroid hormone - T4 (Thyroxine)
Thyroid hormone - Free T4 (Free Thyroxine)
7.3.71 2
7.3.7.13
7.3.7.1 5 Calcitonin
180
200
500
7.3.7.16 FSH
7.3.7.17 LH
Thyroid hormone - Free T3 (Free Tri - iodothyroxine )
PTH (intact)
I I
230 ~ 230
I I
200 ~ 200
7.3.7.1 8 Estradiol 300
s99"a
n m i s
32620
32627
32622
GI $u
7.3.7.20
7.3.7.21
7.3.7.22
sif lnis
Testosterone
Free androgen index
Prolactin
32623
32624
32625
32626
51 811Test
250
450
280
7.3.7.23 --
7.3.7.24
7.3.7.25
7.3.7.26
32627 7.3.7.27 Insulin - IGF BP3
7.3.8 Drugs
33001
33002
33003
33004
33005
331 01
33102
33103
33104
331 05
C-peptide
Insulin
Insulin - IG F1
350
250
600
7.3.8.1
7.3.8.2
7.3.8.3
7.3.8.4
7.3.8.5
7.3.8.6
7.3.8.7 - -
7.3.8.8
7.3.8.9
7.3.8.1 0
331 06 7.3.8.1 1 Chlorpromazine
Aminoglycoside
lsoniazid (INH) (HPLC)
Pyrazinamide (HPLC)
Rifampicin (HPLC)
Vancomycin
Carbamazepine (Tegretol)
Phenobarbital
Phenytoin (Dilantin)
Valproic acidlsodium valproate (Depakin) --
Benzodiazepine, Phenothiazine, Tricyclic antidepressant
331 07
331 08
331 09
33201
33202
33203
200
220
220
220
220
240
200
250
250
7.3.8.1 2
7.3.8.1 3
7.3.8.1 4
7.3.8.1 5
7.3.8.1 6
7.3.8.1 7
33204 7.3.8.1 8 Sirolimus
Acetaminophen
Salicylate
Chlorpheniramine
Cyclosporin (CSA)
Methotrexate
Tracolimus
-
33301
33302
300
300 1 250
800
220
800
7.3.8.1 9
7.3.8.20
Theophyline
Digoxin
250
200
Hydrocortisone, Dexamethasone, Prednisolone 250
Wafarin
Toxicology
Aluminium
Cadmium
Chromium 300
Copper 350 1 Lead I 200 1 Lithium 350 ( Manganese 200
Xenobiotic heavy metal (Mercury, Arsenic. Cadmium. Nickel) I 350 ~ Other volatile agent 250
Carbonmonoxide 250 1 Acetone
I
Acetonitrite 250 1 Benzene 250
Butanol 150
Carbamate
Chlorinated hydrocarbon
Chloroform
Cocaine
Ethyl alcohol (Ethanol) 140
Cholinesterase (plasma or red cell) 360 ~ --- -
Ethyl alcohol (Ethanol) (confirm)
Xylene 250
lsopropanol 250
Marijuana (Cannabinoid) (immunoassay) 120
Marijuana (HPLC) 700 -- -
Methamphetamine
Methamphetamine (confirm) 900
Methanol
Opiate (eg. Morphine, Heroin, Codeine) ( a x
Opiate (Morphine, Methadone, Pethidine) (confirm Kaaz) 700
Paraquat 1 250 1 Acetylcholinesterase activity in RBC or Plasma
(Organophosphate)
Urine Chemistry1 hormone1 toxicology
Osmolality urine 120
Sodium 35 , Potassium
Calcium
Creatinine
Protein (Random)
Protein (24 Hours) 8 5
Urine VMA
Urine VIVA (HPLC) I
600 I
Urine catecholamine 800
Urine metanephrine 1 1,000 ( Urine HVA 600
Urine HlAA (5-Hydroxyindoleacetic acid) 600
Urine free cortisol 250
Amylase
Porphyrin 100
Copper (Urine 24 hours) 300 1 Lead (Urine)
Urine organic acid 2,000
1 34204 1 7.3.10.22 / Paraquate (Urine)
1 34207 1 73.1 0.25 1 Cocain (Urine)
34205
1 34206 7.3.1 0.23
7.3.10.24
1 34208
1 34401 1 7.3,11.4 / Organophosphate (Gastric lavage)
34302
Amphetamine (Urine)
Cannabis (Urine)
7.31 0.26
7.3.1 1
300
300 1
7.3.1 1.2
34402
34403
Thinner (Urine)
Body Fluid Chemistry
34303 , 7.3.1 1.3
34404
1 351 01 1 74.5 1 Culture - Routine culture
300 1
Sugar
7.3.1 1.5
7.3.1 1.6
7.4 Microbiology Section I
1 351 02 74.6 1 Culture - Anaerobic culture
7 0
Chloride
7.3.1 1.7
1 351 03 1 74.7 1 Culture - Mycobacterium culture
70
Carbamate (Gastric lavage) , Zinc Phosphide (Gastric lavage)
60
6 0
4 0
40 I
1 35104 1 74.8 Culture - Hernoculture. Manual 919018:
100
100
Arsenic (Gastric lavage)
AFB stain (Acid-Fast Bacilli stain)
Gram stain
Indian ink preparation
KOH preparation
35001
35002
35003
100
7.4.1
7.4.2
7.4.3
35004 , 7.4.4
I 35105
351 06
/ 351 09 1 7.41 3 1 M C , MBC, SBC fIdld8:
35107
351 08
I 1 I
35201 ( 7.4.14 1 Urease test (~PdlidfIqlnn'2:l~l:) Y Y
7.4.9
7.4.10
7.4.1 1
7.4.12
Culture - Hemoculture, Automate "Umfi: Y Y
Culture - Helicobacter culture (3Pdb~fIqlnn'2:~~1:)
350
400
Culture for fungus
Sensitivity Test
8 0
130
/ 7.5.1 1 Bacteria I
n a n i ~ 1
1 36003 1 7.5.1.3 1 VDRL (RPR) I 50
7.5. Immunological/Serology and Virology Section
36001
36002
1 36006 ( 7.51 6 1 TPHA
7.5.1 .I
7.5.1.2
36004
36005
1 36008 1 7.51 8 1 S. pneumoniae Ag
AS0 test - Latex
AS0 test - Nephelometry
7.5.1.4
7.5.1.5
36007
110
250
1 3601 3 ( 7.5.1 13 1 H. infuenzae type b Ag
FTA-Abs
FTA-ABS Ig M
7.5.1.7
36010
3601 1
3601 2
1 3601 4 7.5.1 14 1 Helicobacter pyroliIAb
200
200
Leptospira-Ab
7.5.1 .I0
7.5.1 .I 1
7.5.1 .I 2
1 3601 9 1 75.1 19 1 Wei-felix test
120
3601 7
3601 8
N. meningitidis ACYW 135 Ag
N. meningitidis BIE coli K 1 Ag
B. pseudomallei-Ab (Melloid titer)
1 7.5.2 1 Fungal
250
250
8 0
7.5.1 .I 7
7.5.1 .I 8
36020
36021
1 36102 1 7.5.22 ( Histopasma
C. defficile toxin A
TB-DNA (PCR for TB)
7.5.1.20
7.5.1.21
361 01 1 7.52.1 1 Cryptococcus neoformans-Ag titer
1 36103 1 75.23 1 Toxoplasma-Ab
500
1,500 ,
270
Widal's test
Bacterial Antigen
I
100
800
36201
7.5.3
7.5.3.1
Parasites
E. histolytica-Ab 130
%%a 'rlanl%
36301
36302
61 &I
- 36310
3631 1
3631 2
3631 3
36314
3631 5
3631 6
3631 7
3631 8
36319
36320
36321
36322
36323
36330
36331
36332
36333
36350
36351
36352
36353
36360
36361
'3lEln75 51 871Test
7.5.4 Virus: Hepatitis, HIV
7.5.4.4
7.5.4.5
7.5.4.6
7.5.4.7
7.5.4.8
7.5.4.9
7.5.4.1 0
7.5.4.1 1
7.5.4.1 2
7.5.4.1 3
7.5.4.1 4
7.5.4.1 5
7.5.4.1 6
7.5.4.17
7.5.4.1 8
7.5.4.19
7.5.4.20
7.5.4.21
7.5.4.22
7.5.4.23
7.5.4.24
7.5.4.25
7.5.4.26
7.5.4.27
- 7.5.4.1
7.5.4.2
HBc-Ab - PHA
HBc-Ab - ELISA, NIEIA, ECLlA
HBc-Ab (IgM)
HBe-Ag - PHA
HBe-Ag - EILISA, NIEIA, ECLlA
HBe-Ab
HBs-Ab (Hepatitis B surface antibody) - PHA
HBs-Ab (Hepatitis B surface antibody) - ELISA, MEIA, ECLlA
HBs-Ag (Hepatitis B surface antigen) - PHA
HBs-Ag (Hepatitis B surface antigen) - ELISA, MEIA, ECLlA
HBs-Ag (Hepatitis B surface antigen) - PCR - Qualitative
HBs-Ag (Hepatitis B surface antigen) - Quantitative
(Amplicor)
HBs-Ag (Hepatitis B surface antigen) - Quantitative (bDIVA)
HBV Genotype, drug resistance (INNO-LIPA)
HCV-Ab (Hepatitis C Antibody) - PHA
HCV-Ab (Hepatitis C Antibody) - ELISA, MEIA, ECLlA
HCV-Ag - Qualitative - PCR
HCV-Ag - Quantitative (Amplicor, bDNA)
HIV-Ab (screening) - RAPID
HIV-Ab (screening) - GPA, ELISA, MEIA, ECLlA
H IV-Ab (confirm) WESTERhl BLOT
Anti- HTLV-1
HIV-Ag
HIV - Qualitative RT-PCR
Hepatitis - Anti HAV total (ELISA)
Hepatitis - Anti HAV IgM (ELISA)
140
230
300
? 50
300
350
100
180
80
130
1,700
2,200
3,000
3,200
190
300
1,700
2,500
250
140
1,000
150
160
1,700
500
500
HIV - Quantitative, viral load standard method
Viruses: Others I
Chikungunya-Ab 250
Dengue virus-Ab
Dengue virus-Ab (PCR) 800 ~ Dengue - Ig G (HAI) 200
Dengue - Ig M (ELISA)
Cytomeglovirus-Ab 250
Cytomegalovirus (CMV) - Qualitative-PCR 1,600
Cytomegalovirus (CMV) - Viral load (Amplicor)
Cytomegalovirus (CMV) - Ig Gllg M (ELISA)
EBV-lgA (Anti-Epstein Barr Virus) 250 1 EBV-IgG (Anti-Epstein Barr Virus)
HSV-2 Ag (Herpes simplex virus type 2 Ag)
SARS corona virus-Qualitative 1,600
SARS corona virus-Viral load (PCR) 1,600
Adenovirus, Ig Gllg M (ELISA) I 250 ~ Panenterovirus 2,200
Influenza virus-A, B (ELISA) 300
Rota virus
Rotavirus (ds-RNA PAGE test) 250 ~ Rabies-Ab 400
Rabies virus-Ag (FTA) 250
Rabies (NASBA) 1,500
J.E.-Ab 250
West Nile virus 1,500
Nipah virus 1,500
Mumps, Ig G/lg I\ (El-ISA) 250
Measles, Ig Gllg M (ELISA) 250
I
7.5.5.28 Rubella IgG
7 5 5 . 2 9 1 Rubella IgM antibody
7.5.6 Immunology
7.5.6.1 Rheumatoid factor test - Latex
7.5.6.2 1 Rheumatoid factor test - NephelomeBy
7.5.6.3 ( FANA
-
7.5.6.5 Anti-Sm
7.5.6.6 Anti-Sm (El-ISA)
7 5 6 . 7 1 Anti-nRNP (Immunodiffusion)
7.5.6.8 Anti-nRNP (ELISA)
7.5.6.9 Anti-Ro (SS-A)
7.5.6.1 0 I Anti-La (SS-B)
7.5.6.11 Anti-Scl 70
7.5.6.1 2 Anticentromere
7 3 6 . 1 3 1 Anti-MPO (Myeloperoxidase)
7 5 , 6 1 4 1 Anti-PR3 (Proteinase 3)
7.5.6.15 1 ANCA - -
7.5.6.1 6 1 Antimitrochondrial
7.5.6.1 7 Smooth muscle Ab
7.5.6.1 8 Anti-LKM (Liver-Kidney Microsome)
7.5.6.19 Thyroid antibody test
7.5.6.20 Complement C3 level - Latex
7.5.6.21 Complement C3 level - Nephelometry - -
7.5.6.22 1 CRP (C-Reactive protein) - Latex
7.5.6.23 CRP (C-Reactive protein) - Nephelometry
7.5.6.24 CH50
7.5.6.25 Cold agglutinin
7.5.6.26 immunoglobulin level (IgG, A, M)
1 37203 1 7.5.6.28 ( T-Lymphocyte subpopulation (CD4)
37202
1 7.5.7 1 "Tumor markers''
7.5.6.27
37301
37302
37303
1 37305 1 7 . 5 . 7 5 ( HCG titer
Heterophile-Ab test
37304
200 1 i
7.5.7.1
7.5.7.2
7.5.7.3
1 3 1 3 1 0 1 7.5.7.9 1 PSA
7.5.7.4
37307
37308
Alpha Fetoprotein (AFP) - PHA
Alpha Fetoprotein (AFP) - ELISA, MEIA, ECI-IA
Beta-HCG
80
270
270
Beta-2 microglobulin, serum/urine
7.5.7.7
7.5.7.8
3731 1
3731 2
3 7 5 0 3 1 7 6 . 3 I Urine organic acid analysis
400
CA 19-9
CEA (Carcinoembryonic antigen)
7.5.7.10
7.5.7.1 1
1 7.6 Genetic testings
600
300 1
37504 7.6.4 Urine Thin layer chromatography for MPS
Free PSA
Prostatic Acid Phosphatase
200
37505
37506
1 37508 1 7.6.8 1 PCR for SRY gene
400
400
2,500 1
Metabolic screen 37501
37507
1 0 1 7.6.9 / PCR (methyation sensitive) for fragile X syndrome
Quantitative plasma amino acid analysis
7.6.1
37502
7.6.5
7.6.6
7.6.2
7.6.7
Carnitinelacylcarnitine analysis
Chromosome breakage study
' 3751 0
I 3751 1
1 3751 3 1 7 6 . 1 3 / PCR-RFLP for spinal muscular atrophy 1 1,000 1
2,000 , 2,500 1
Fluorescence in situ hybridization using probe
3751 2
1 1 7 6 . 1 4 1 PCR-RFLP for Hb E allele
2,500 1
7.6.10
7.6.1 1
7.6.1 2
PCR (multiplex) for DuchenneiBecker muscular dystrophy
MLPA test for Duchenne/Becker niuscular dystrophy
2,500
2,500
PCR (methylation sensitive) for methylation analysis 2,500 1
I I I
3751 5
I
37521 1 76 .21 / Real time PCR for ApoE polymorphism
3751 9
37520
37522 / 7.6.22 ( Real time PCR for Charcot - Marie-Tooth type IA
7.6.1 5
37516
37517
3751 8
1 37523 1 7 .623 ( Real time PCR for CYP450 2C9
7.6.1 9
7.6.20
37524 7.6.24 Real time PCR - Others
PCR-ASA for common V371 GJB2 mutation in heariqg loss
7.6.16
7.6.17
7.6.1 8
500
PCR-Gap (multiplex) for deletional alpha thalassemia
PCR-ASA (multiplex) for non-deletional alpha thalassemia
PCR-ASA for factor V Leiden
PCR-ASA for MTHFR C677T
PCR-ASA (multiplex) for thrombophilia variants
500
500
37525
1 37527 1 76 .27 1 Sequencing of triplet repeats - Huntington disease
5001
500
1,000 ~
37526
r 3 7 5 2 8 1 7.6.28 1 Sequencing of triplet repeats - OPMD
7.6.25
I I I
7.6.26
Long PCR for hemophilia A intron 22 inversion
37529
37530
R 7 G 4 1 Whole gene sequencing - Von Hippel Lindau disease
1,000
Long PCR for glucocorticoid remediable aldosteronism
-
37531
37532
37533
1 37535 1 7.6.35 1 Whole gene sequencing - Dopa-responsive dystonia DYTI
1,000
2,500
1,500
76 .29 1 Sequencing of triplet repeats - SCA type 1.2.3
7.6.31
7.6.32
7.6.33
1 37537 1 7.6.37 1 Whole gene sequencing - Idiopathic pancreatitis PRSSI
7.6.30
I I I I
1 37538 1 7 6 3 8 ( Whole gene sequencing - Metachromatic leukodystrophy 1 5,000 (
Sequencing of triplet repeats - Kennedy disease
Sequencing of triplet repeats - Others
Whole gene sequencing - Beta thalassemia
Whole gene sequencing - GJB2 in hearing loss
1 37539 1 76 .39 1 Whole gene sequencing - MECP2 1 5.000 1
2,500
2,500
2,000
5,000 1 Whole gene sequencing - Hemochromatosis HFE 37536
/ 37541 ( 76 .41 1 Whole gene sequencing - X-linked adrenoleukodystrophy 1 5,000 1
7.6.36
r-
37540
1 2 1 v 6 . 4 2 1 Whole gene sequencing - Wiskott Aldrich syndrome
7.6.40
37543
Whole gene sequencing - ARX 2.500 1 1
7.6.43 Whole gene sequencing - Peutz-Jeghers syndrome 5,000
Whole gene sequencing - Cystinosis
Whole gene sequencing - Bruton hypogammaglobulinemia
Whole gene sequencing - Chronic granulomatous disease
Whole gene sequencing - Methemoglobinemia (cyt b5R)
Whole gene sequencing - Others
Whole gene mutation screening - Marfan syndrome
Whole gene mutation screening - BRCAI ,2
Whole gene mutation screening - HNPCC MSH2, NlLHl
Whole gene mutation screening - ADPKD
Whole gene mutation screening - Wilson disease
Whole gene mutation screening - Hemophilia A
Whole gene mutation screening - Dysferlinopathy
Whole gene mutation screening - DMRV
Whole gene mutation screening - FAP
Limited gene sequencing - CADASIL
Limited gene sequencing - FGFR related conditions
Limited gene sequencing - RET related conditions
Limited gene sequencing - Liddle's syndrome
Limited gene sequencing - Hereditary pancreatitis SPlNKl
Mitochondrial DNA analysis - Leber optic atrophy
Mitochondrial DNA analysis - Kearns SayreICPEO
Mitochondrial DNA analysis - Encephalomyopathy
Microsatellite instability testing from t i s s ~ ~ e specimen
Tumor clonality DNA study
Prenatal diagnosis using direct mutation analysis
Prenatal diagnosis using linkage analysis
38101
38102
38103
38104
1 38105
1 381 07 1 7.7.1.7 / Laryngectomy with neck content
7.7.1 I 7.7.1 .I
7.7.1.2
381 06
1 381 08 7.71 8 1 Thyroidectomy (lobectomy or subtotal or total) 1 1.200 1
7.7.1.3
7.7.1.4
7.7.1.5
fi~aunn~ue?"ua-/mr~rnn~~ej~Krn
Curetting, each specimen
Tongue with neck nodes
7.7.1.6
381 10 1 7.71 10 1 Breast mastectomy and axilary content
Tonsil
Parotid glandlsalivary gland with neck nodes
Jawlmandible with neck content
38109
138111 17.7111 1 Lung, lobectomy
500
1,500
400
1,500
1,800
Larygectomy
( 381 12 ( 7.7.1 .I 2 1 Lung, lobectomy with lymphnodes 1 1,500 1 i
1 -
7.7.1.9
1,000
1 381 15 1 77.1 15 1 Liver resection 1 1,000 1
1
Breast, simple mastectomy
38113
381 14
1 381 16 1 77.1 .I 6 1 Spleen resection
1,000
13811 7 r7.71 .I 7 1 Omentectomy
7.7.1.13
7.7.1 .I4
( 381 18 1 7.7.1 .I 8 1 Whippless specimen i
Heartvalve
Gall bladder
1 I 1 with and without omentum
500
500
381 19
38120
38121
7.7.1 .I 9
7.7.1.20
7.7.1.21
381 22
381 23
1 381 24 38: 25
Gastric biopsy and Giemsa stain
Appendix
Colon, small intestine, stomach, resection
7.7.1.22
7.7.1.23
400
500
1,500
7.7.1 24
7.7.1.25
Kidney, nephrectomy
Urinary bladder with lymphnodes
Penis. amputaion
Penis, with groin nodes
1,000
1,500
1,000
1,500
I
381 26
1 38130 1 7.7.1.30 / Foliopian tube. tubal pregnancy
38129
1 38131 1 7.7.1 3 1 1 Placenta. whole
38127 7.7.1.27 Prostate, TUR-P, Prostatectomy 1,000
400 7.7.1.26
I I I I
7.7.1.29
1 38133 1 7.7.1,33 1 Cervical conization. LEEP
Vasectomy (uni or bilateral)
I
38132
1 38134 ( 7.7.1.34 1 Uterus with cervical conization
Vulvectomy with lympnodes 1,500
7.7.1.32
1 381 37 1 7 .71 3 7 1 Uterus with multiple groups of lymphnodes 1 2.500
38135 7.7.1.35 -
Uterus with or without adnexa
38136
1,000
3 8 1 3 8
38139
381 40
7.7.1.36
381 41
1 PI6 protein, osteocalcin, osteonectin. T-IF-? 1
7 7 , 1 3 8
7.7.1.39
7.7.1.40
r a d L ~ u a a u yuenrcriirn~insisnisuian'u 7117i.niuruin
Uterus with ovarian tumor 1,800
Wertheim'soperation
Leg, amputation for gangrene
Femurlleg amputation, bone and soft tissue
tumor
38201
38202
38203
1.500 7.7.1.41
7.7.2
7.7.2.1
7.7.2.2
7.7.2.3
6~unm7uquinqa.a7u~urn Y Y
Biopsy, 3~ub3a ~uinkiub"n 2 2 u . Y Y
%u~ i l a w i n 2 - 5 2u . w Y
2u~Ga " ~ l i n l ~ ~ j n d i 5 mu.
2.500
1,000
1,800
~ ~ " ~ n l i u l i n w w
d i n ~ ? q % u ~ ; ~ ~ Osteogenic sarcoma @~JIN necrosis
300
500
1,200
38204
38301
38302
I
7.7.2.4
7.7.3
7 , 7 3 1
7 7 . 3 . 2
38303
Frozen section
nioGmuGwins
n~m$u~da f i ' i l a~~ f iw (Histochemistry) a i d n ~ ~
RMI$UL$B~~~)-I l m m u n ~ h i ~ t ~ ~ h e m i s t r y l 6 n R ~
1,800
100
300
7.7.3.3 ~~'29~u~~'af i 'a~ lmmunohistochemistry " d m 500
ntaq%urdsfiou lmmunoperoxidase LLUU~SI
Breast panel " z
nsaq?ubuafiau lmmunoperoxidase bbU1~qSI
Acute leukemia panel
" 2i fl~aq?ubua6au lmmunoperoxidase LLUU?SI
Lymphoma panel = 2
W S ~ ~ ? U L U ~ ~ B U Direct lmmunofluoresence
(Renallskin biopsy )
" 4' rn~aq?ubua6au Indirect Immunofluo-resence
(Renallskin biopsy )
Scanning electron microscope (SEM)
Transmission electron microscope (TEM)
Cytology
Cervical and vaginal smear (Pap smear)
~ ~ a i q i n 4 o s d i d q uasiqsniu (Cytospin)
b ~ a i q i n n i t ~ ~ ~ & a ~ ~ b ~ ~ b ~ n (Fine needle
aspiration)
9, 0/ d9 iinsaq?GqGw~~az?nnsiwi~F~"97u~u~s iiu5niswisssfiawuiw"9%unismsaq"aGqGu
bbfi:nls%nwi b b B ~ f l l ~ i ? X-ray, CT scan, Ultrasonography, MRI, Radionuclide scan bba:
h a f n ~ i i i d ~ iilun"u Tnul1Pnnr i iuPsn~ooau i i~dn~Nr i l u ? (OYiij) iin:ifi$uid~mddiiLqu
Tnunsa ~bBu R6u ((n"fld1ridi~d~nsaun'uiiba"1161"m~dfi"bi07~n) i i n z i ? u ~ w i o i n n l s o l d ,
r~unlssafisqu5'nnrn ina~luauanGmnni~umnfi~~ej7in (vuand I I )
k - i i u ~ n i s ~ ~ ~ ? i h ~ w (8.1 - 8.5)
~ i n q l u ~ i u u n n i s ~ $ f i i s ~ u ? s ~ ~ u n i T m ~ a ~ Computerized tomography bi]u Ionic
contrast media 81%$ Nonionic contrast media % f i ~ m T i n i b ~ ~ m ? u d i i l v u n ~ u T i p 1 n ~ T
1 i v E u n l s n s a q G ~ ~ w ~ a i l n " d ~ ~ a i ~ a ~ n Z r l 4 1 o l n i d i ; l v u n ~ i d k T ? u ~d -con t ras t
d?iliflu(n"nsl.a" l f i ~ n s ~ n ~ ~ ~ u m ~ u d i i ~ ~ u ~ l u s ~ ~ n ~ s " Y
i i ns~ ld i ; i uund~sau i i i ~~nnn7s iau ~ i u nltn'n9u~uo n~odsmnl nlsldfi~ufi?udidl
5tYa
%l'Zlfl75
41 001
41002
41101
41 201
41 202
41 301
42001
5781175
Plain X-ray
niw6/ iub~n~~r~w"a 'bd
Mob~le X-Rays
TM joint
Panoramic/Cephalometry
Dental film
Mass chest (small film)
X-ray: Special
Fluoroscopic observation
a"7 I%l
8.1
8.1 .I
8.1.2
8.1.3
8.1.4
8.1.5
8.1.6
8.2
8.2.1
srlpdaa
film
film
film
film
film
film
Y
n 5s
$7 Fl7
130
270
130
300
80
50
550
MU7'Zlb¶4~
J
Ibaisau~ii~rnv~n e- v
~qi:dsmsa~%u~~n
I
Y
8.2.2 Myelography one part cervicalllumbar n 54 2,000 Y
8.2.3 Myelographycomplete/thoracic n5d 2,400
82.4 ( Sialography 1 nk I I.IOO
Dacryography I I
Y
Venography 1 n k 1 1,700 Y
Mammography n5d 1,100
Mammography with US I nid 1 1 ,600 f i l ? ? 9 _ l b b f i 9 b b f i :
P,
ifiqgdn&G y i u 92
m 9 p s " m n n i s G u ~ e
&a ( sau f i daa~ "1
Barium swallowing
Esophagogram Y
BS with esophagogram n5d 1,300
UGI I n h 1 I ,300
UGI with small bowel series ~ ' I U catheter Pi
Bii~iluGuziu
a d y n l u n o ~ d
"b.n"au f i i u i s n
~ Q n ~ G u w n 3 w y iu16 LLa:
6 ~ d G w G n j n i u
Y
Barium enema, single CM n 54 1,600 Y
Barium enema, double CM Fl 54 2,100
Transhepatic cholangiography I 1 1.900
T-Tube cholangiography 1 nid 1 1 ,200
821 8 1 lntraoperative cholangiography I n!d 1 400 I I I
Y
8.2.1 9 Fistulography 1 FlFd 1 1,200 Y
IVP (Ionic contrast) R 54 1,800 W
Retrograde Pyelography Fl Fd 1,400 "
VCUGICystog ram Fl 54 1,700 Y
Urethrogram n Fd 1,400 w
Hysterosalpingography fl Fd 1,700 Y
Arthrography Fl ?d 1,600 Y
Bone density: X-rays 1 part 19 54 900 Y
Bone density: X-Rays whole body Fl 54 2,800
8.3 Llltrasound Y
8.3.1 US Portable Fl 54 1,000
8.3.2 1 3-D ultrasound I I I I
Y
8.3.3 4-D ultrasound, diagnostic of fetal I n ~ q I 2,500
anomalies, breast biopsy Y
8.3.4 US small part n k 600 Y
8.3.5 US guided for biopsy n 5 600
8 3 , 6 / US Doppler artery or vein I I
Y
43501 8.3.7 US upperl~ower 1 n k 1 600 I I I I
Y
43502 8.3.8 US whole abdomen 1 n?;l I 800
4360 1
43701
44001
44002
44003
8.3.9
8.3.10
44004
44005
8 4 . 7 1 CT Brain with CM
8.4.1
8.4.2
8.4.3
441 01
8 4 . 8 ( CT IACITernporal bone screening
- - - -
US endovaginal or endorectal probe
Bone density: US
8.4.4
8.4.5
8.4.9 1 CT Pituitary gland 2 planes w i t h C ~
CT 1 part + multiphase CM
CT 1 part + 3D Navigator
3D CT scan
8.4.6
84.1 3 1 CT Facial bone
El
Fl Y
n ?4
Additional surface 3D views
Additional multiphase
8 4 . 1 4 / CT PNS screening 1 plane
800
650
Y
~ 7 4 Y
flT4 Y
n%
CT Brain NC
6,000
14.000
8,000 Y
n P,
n ?d
300
1,000 Y
n El
44203
44204
3,000
8.4.1 5
8.4.16
CT PNSlTemporal bone 2 planes NC
CT PNS 2 planes with CM
w
n Y
n El
5,700
5,000
5Gii
418fl15
1 44205
44206 8.4.18 CT Nasopharynx 2 planes with CM 5,000
ii Ku
8.4.17
44207
44208
44301
44302
siw nis
CT Orbits 2 planes with CM
8.4.1 9
8.4.20
8.4.21
1 44402 44403
44401 8.4.23 CTA heart n 54 16,500
8.4.22
- --
8.4.26 CT Upper abdomen CM
miaa
Y
i? Td
CT Neck CM
CT Larynx CM
CT Chestllung CM
8.4.24
8.4.25
1 44503 44701
44702
600 ?9~%: set -I
High resolution CT scan of lung
Us~ng Nonionic CM add
Fine needle aspiration under
$ 1 ~ 1 1
5,000
Y
n ?d v
n Td Y
n Td
CTA Whole aorta
CTA 1 part1abd.aorta
8.4.28
8.4.29
8.4.30
50 ml. Y
fl Td
1 guidance I
M ~ I R ~ 9 ~ q
5,000
Y
PI Td Y
fluoroscope, UIS, or CT guidance
Biopsy under fluoroscope, UIS, or CT
sterile bbWz set
5,000
5,000
4,000
n ?d Y
n Td
CT Whole abdomen CM
Bone density: CT
CT Extremity and joint
-
11,200
6,200
Y
n Td
45002 1 8.5.2 1 MRI 1 part + 3D navigator I nk 1 16.0001
Y
i? rd w
i? Td Y
n ?d
45001
-8,5.3 / Functional MRI
9,000
3,500
5,000
2,300
FOOT ( 8.5.4 ( MR spectroscopy
sterile bbt?zbiu
?9U%q set
8.5
8.5.1
M RI
IMRI 1 small part or small organ
I I 1 45005 I I I
8.5.5
, 45101
Y
i? Td
Y
MR SRT or SRS only 4,500
8.5.6
4,600
needle
MRI Brain v
i? Td 8,500
45104 1 85.9 1 MRI Pituitary gland I i=lk 1 8 . 9 0 0 r Y
sGi4 '218T119
451 02
45103
41Ku
8.5.7
8.5.8
451 05
45106
45107
45109 - 451 10 8.5.1 5 MRI Brachial plexus -- 451 I I 8.5.1 6 MRI Sacral plexus
I I
45202 8.5.18 MRI PNS 8,900
si~1n15
NlRl Brain + MRA
NlRl Brain + CSF flow
8.5.1 0
8.5.1 1
8.5.12
1 45203 1 85.19 1 MRI Nasopharynx/Oropharynx I mid I 8,900 /
451 08
uiaa
Y
fl?d Y
i=l ?d
MRI ACICranial nerve
MR Cisternography
MRI Spine 1 part
8.5.1 3 MRI Whole spine
1 I I 1 I
51 81
11,000
v
i=l ?d Y
i=l ?d Y
fl?d Y
i=l ?d
I I I I I
1 45402 1 8.5.25 1 MRI Heart CgHDiCine 1 ~ i d / 11.400 1 I
wa~er~ssq
8,900
11,400
8,900
45204
45301
11,000 1
17,000
8.5.20 Y
MRI NecklLarynxlThyroid glands I n?d I 8,900
. - --
45302
45303
45401
I
I
8.5.21
MRI Breast (1 side)
MRI Breasts (2 s~des)
MRI Heart + perfus~on
8.5 22
8 5.23
8.5 24
45403
45404
45405
1 45407 ( 85.30 1 MRA ThoraciclAbdominal aorta I
Y
MRI Chest I n h I 8,900
I
45406
1 45408 1 85.31 1 MRA Renal artery I
Y
i9 ?d Y
n?d Y
PI ?d
8.5.26
8.5.27
8.5.28
85.29
- - -
7,500
1 1,000
11,400
MRI Heart screening ASD
Stress cardiac MRI
MRA Carotid
---
MRA Pulmonary
45409
4541 0 I I I I I I
Y
n?d Y
n?d e,
n ?d
MRA Femoral artery1Peripheral run off
MRV Chest/ Portal v./Femoral v.
8.5.32
8.5.33
11,400
20,000
11,000 Y
PI ?d
w
NlRA or MRV only I n k I 8,700 4541 1
11,000
Y
n ?d w
i=l?d
8.5.34
11,000
11,000
MRI + MRA (nonbrain) 1 1,200
MRI + MRA + MRV 14,300
MRI UpperlLower abdomen 8,900
MRI Whole abdomen 1 nk 1 13,300 Y,
MRCP only m ?d 8,700 Y
MRCP + upper abdomen n ?d 11,400 Y
MR Urography n ?d 11,400 v
NlRl Prostate n ?d 8,900
MRI Prostate special coil / 6 4 1 10,500 Y
MRI Bone/Joint/Extremity 1 part n ?d 8,900
Using Gd contrast medium 15 ml. 2,500
Using Ferucarbotran contrast medium Vial 9,050
b 7 ndu~nrvliioqinsiwnisoliu 100 w w Mawo 8.1-8.5 G1s6u rraz Ausiwnis
ndIiariuisar?iaur~asVi'