( 4) i7 FIG 0513.10105 /a. 071

duu uiunnniuwi?nuiKu a8nisui; so.ra8nisui;qniliu QziauaZniru7qniiu nrut dilin ~ n i l j u a

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s lan ls Blood Bank Section

I 23101 62.1 Whole Blood I 700 (

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6.2

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)

Platelet

6.4.2

23401

I 1 23403 / 65.3 / Aged Plasma 1 400 (

780

A 0 P,

1 S I A I ~ ~ I ~ U ~ ~ ~ ~ ~ U

! I I

Single Donor Platelet (open system)

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

7,000

7,000

Plasma

Fresh Frozen Plasma

6.5.2

I 23504 1 6.6.4 1 Plasma Exchange HLR%.J Apherresis 1 7,000 1

nisrm;uudaudstnau

6.5.4

6.6

*NAT- Nucleic acid Amplification Technology

370

Fresh Frozen Plasma (NAT)

1 .2 nismoaq6nnnsad

~TF1~fldflLL69

670

Cryoprecipitate

l u ~ f i a a ~ u u ~ n 1 ~ 1 6 i n - i

370

T a d Whole blood

2 ;cm

I. diu?nis%Pdnime9faG PI

(A7 Cross matching x

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(%IWI Blood component

x 41uau?h.%)

9 8 9 Packed red

cell 3

b~e"b3~ 3 n

(1 +2)

q n d Platelet

concentrate

10 ycm

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'