Ministry of Health Price List for Ambulatory and...

Servicecode Service name

Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

01996 Day care management of epidural/subarachnoid continuous drugadministration

509.00 498.00 509.00 747.00

01999 General anesthesia for ambulatory treatment, underanesthesiologist supervision

1,307.00 1,279.00 1,307.00 1,919.00

10060 Incision and drainage of abscess/cyst 414.00 405.00 414.00 608.0011100 Biopsy, excluding procedures with specific code 199.00 195.00 199.00 293.0011750 Excision of ingrown nail 319.00 312.00 319.00 468.0011770 Excision of cyst, eg, pilonidal 636.00 622.00 636.00 933.0011975 Insertion, implantable contraceptive capsules (eg, Norplant),

including the cost of contraceptive1,909.00 1,868.00 1,909.00 2,802.00

11976 Removal, implantable contraceptive capsules 179.00 175.00 179.00 263.0012001 Simple repair of superficial wounds 151.00 148.00 151.00 222.0016030 Dressings and/or debridement, without anesthesia, large lesion 386.00 378.00 386.00 567.0017000 Removal of skin lesions, any method 199.00 195.00 199.00 293.0017311 Mohs micrographic technique 9,088.00 8,892.00 9,088.00 13,338.0017999 Soft laser treatment, 1/2 level, per treatment 199.00 195.00 199.00 293.0019085 Biopsy of breast, MRI guidance, per one breast 6,516.00 6,376.00 6,516.00 9,564.0019100 Biopsy of breast; needle core, not using imaging guidance 199.00 195.00 199.00 293.0019101 Biopsy of breast; open, incisional 477.00 467.00 477.00 701.0019102 Biopsy of breast, imaging guidance, excluding CT/MRI 2,282.00 2,233.00 2,282.00 3,350.0019499 Breast examination 0.00 0.00 0.00 0.0020205 Biopsy, muscle, including histological examinations 1,132.00 1,108.00 1,132.00 1,662.0020206 Biopsy, muscle, including all tests, stains, EM 3,184.00 3,115.00 3,184.00 4,673.0020220 Biopsy, bone, trocar/needle, superficial 260.00 254.00 260.00 381.0020520 Foreign body removal, muscle/tendon, local anaesthesia 139.00 136.00 139.00 204.0020600 Arthrocentesis, aspiration and/or injection; small joint or bursa

(eg, fingers, toes)260.00 254.00 260.00 381.00

20605 Arthrocentesis, aspiration and/or injection; intermediate joint orbursa (eg, temporomandibular, acromioclavicular, wrist, elbow orankle, olecranon bursa)

260.00 254.00 260.00 381.00

Ministry of Health Price List for Ambulatory and Hospitalization ServicesOnset date: 21/01/16Sorted by service code


Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

20610 Arthrocentesis, aspiration and/or injection; major joint or bursa(eg, shoulder, hip, knee joint, subacromial bursa)

260.00 254.00 260.00 381.00

20902 Harvesting of cortical bone, cartilage 4,196.00 4,106.00 4,196.00 6,159.0021310 Closed treatment of nasal bone fracture 260.00 254.00 260.00 381.0028899 Intra compartment pressure 584.00 571.00 584.00 857.0029035 Application, body cast, shoulder to hips 331.00 324.00 331.00 486.0029065 Application, cast; shoulder to hand (long arm) 199.00 195.00 199.00 293.0029075 Application, cast, elbow to finger (short arm) 139.00 136.00 139.00 204.0029085 Application, cast, hand and lower forearm (gauntlet) 139.00 136.00 139.00 204.0029345 Application, cast, long leg (thigh to toes) 199.00 195.00 199.00 293.0029405 Application, cast, short leg (below knee to toes) 139.00 136.00 139.00 204.0029700 Cast removal 118.00 115.00 118.00 173.0029720 Repair of spica, body cast or jacket 0.00 0.00 0.00 0.0030110 Excision, nasal polyp(s), simple 260.00 254.00 260.00 381.0030200 Injection into turbinate(s) 144.00 141.00 144.00 212.0030300 Foreign body removal, intranasal, superficial 0.00 0.00 0.00 0.0030801 Cautery and/or ablation, mucosa of turbinates, unilateral/bilateral,

any method260.00 254.00 260.00 381.00

31002 Sinuses lavage 144.00 141.00 144.00 212.0031575 Laryngoscopy, flexible fiberoptic, diagnostic 96.00 94.00 96.00 141.0031579 Laryngoscopy, fiberoptic, with stroboscopy 162.00 159.00 162.00 239.0031622 Bronchoscopy, diagnostic, with/without brushing/washing 1,484.00 1,452.00 1,484.00 2,178.0031636 Bronchoscopy with bronchial stent(s) placement, ambulatory

care13,419.00 13,130.00 13,419.00 19,695.00

32000 Thoracentesis, puncture of pleural cavity for aspiration 260.00 254.00 260.00 381.0036005 Injection of contrast material, including radiology/fluoroscopy 546.00 534.00 546.00 801.0036468 Injections of sclerosing solutions, spider veins (telangiectasia) 118.00 115.00 118.00 173.0036511 Therapeutic apheresis, for white blood cells 3,738.00 3,658.00 3,738.00 5,487.0036513 Therapeutic apheresis, for platelets 3,015.00 2,950.00 3,015.00 4,425.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

36515 Therapeutic apheresis; with extracorporeal immunoadsorptionand plasma reinfusion

9,852.00 9,640.00 9,852.00 14,460.00

36522 Photopheresis, extracorporeal 7,921.00 7,750.00 7,921.00 11,625.0036590 Removal of tunneled central venous access device, with

subcutaneous port or pump, central or peripheral insertion369.00 361.00 369.00 542.00

36600 Arterial blood sampling and diagnosis 199.00 195.00 199.00 293.0038220 Bone marrow aspiration and smear 413.00 404.00 413.00 606.0038221 Bone marrow biopsy and smear 413.00 404.00 413.00 606.0038505 Biopsy or excision of lymph node(s); by needle, superficial 199.00 195.00 199.00 293.0040808 Biopsy, vestibule of mouth 184.00 180.00 184.00 270.0040840 Vestibuloplasty, anterior 843.00 825.00 843.00 1,238.0041010 Incision of lingual frenum (frenotomy) 618.00 605.00 618.00 908.0042699 Salivary glands endoscopy 8,020.00 7,847.00 8,020.00 11,771.0042700 Incision and drainage of peritonsillar abscess 260.00 254.00 260.00 381.0042809 Foreign body removal, pharynx, superficial 0.00 0.00 0.00 0.0043200 Esophagoscopy, diagnostic 301.00 295.00 301.00 443.0043204 Esophagoscopy, with injection sclerosis of esophageal varices 3,707.00 3,627.00 3,707.00 5,441.0043219 Esophageal dilation and stent placement, ambulatory care 17,944.00 17,558.00 17,944.00 26,337.0043235 UGI endoscopy, with/without sampling 1,247.00 1,220.00 1,247.00 1,830.0043240 Endoscopic drainage of pseudocyst of pancreas, EUS guidance 10,240.00 10,020.00 10,240.00 15,030.0043259 Upper gastrointestinal endoscopy; with endoscopic ultrasound

examination1,507.00 1,475.00 1,507.00 2,213.00

43260 ERCP (Endoscopic retrograde cholangiopancreatography),diagnostic

4,020.00 3,933.00 4,020.00 5,900.00

43264 ERCP (Endoscopic retrograde cholangiopancreatography),therapeutic

6,827.00 6,680.00 6,827.00 10,020.00

43450 Esophageal dilation, without using imaging guidance 301.00 295.00 301.00 443.0043750 PEG (Percutaneous Endoscopic Gastrostomy) 2,457.00 2,404.00 2,457.00 3,606.0043760 Replacement of PEG (Percutaneous Endoscopic Gastrostomy) 1,351.00 1,322.00 1,351.00 1,983.00



Price A(ILS)

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Price forPatient

fromAbroad(ILS)

44360 Small intestinal endoscopy, enteroscopy, diagnostic, with/withoutcollection of specimen(s)

2,788.00 2,728.00 2,788.00 4,092.00

45300 Proctosigmoidoscopy, diagnostic 219.00 214.00 219.00 321.0045331 Sigmoidoscopy, flexible, with/without biopsy 719.00 704.00 719.00 1,056.0045378 Colonoscopy, flexible; diagnostic, with/without collection of

specimen(s), population at risk1,124.00 1,100.00 1,124.00 1,650.00

45383 Colonoscopy, with excision of lesion 2,304.00 2,254.00 2,304.00 3,381.0045387 Colonoscopy with dilation and stent placement, ambulatory care 17,944.00 17,558.00 17,944.00 26,337.0045905 Dilation of anal sphincter 342.00 335.00 342.00 503.0046080 Sphincterotomy, anal, division of sphincter under

general/regional anesthesia2,169.00 2,122.00 2,169.00 3,183.00

46500 Injection of sclerosing solution, hemorrhoids 118.00 115.00 118.00 173.0046600 Anoscopy, diagnostic 89.00 87.00 89.00 131.0047999 Extracorporeal shockwave lithotripsy, biliary tract, simple 6,628.00 6,485.00 6,628.00 9,728.0049321 Laparoscopy, surgical, with biopsy (single or multiple) 6,087.00 5,956.00 6,087.00 8,934.0050040 Nephrostomy, nephrotomy with drainage 2,869.00 2,807.00 2,869.00 4,211.0050398 Repositioning/change of nephrostomy or pyelostomy tube 1,711.00 1,674.00 1,711.00 2,511.0050590 Extracorporeal shockwave lithotripsy, kidney, simple, ambulatory

care6,876.00 6,728.00 6,876.00 10,092.00

51045 Insertion of urethral or ureteral stent 2,869.00 2,807.00 2,869.00 4,211.0051700 Bladder irrigation, simple, lavage and/or instillation 139.00 136.00 139.00 204.0051703 Insertion of urethral catheter 144.00 141.00 144.00 212.0051720 Bladder instillation of anticarcinogenic agent 368.00 360.00 368.00 540.0051726 Cystometrogram 546.00 534.00 546.00 801.0051736 Simple uroflowmetry (UFR) 260.00 254.00 260.00 381.0051741 Complex uroflowmetry 1,792.00 1,753.00 1,792.00 2,630.0051772 Urethral pressure profile studies (UPP) (urethral closure pressure

profile)546.00 534.00 546.00 801.00

51784 EMG of anal/urethral sphincter, any technique 546.00 534.00 546.00 801.0052000 Cystourethroscopy 533.00 522.00 533.00 783.00



Price A(ILS)

Price B(ILS)

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Price forPatient

fromAbroad(ILS)

52204 Cystourethroscopy, with biopsy/other surgical procedure 1,391.00 1,361.00 1,391.00 2,042.0053000 Urethrotomy or urethrostomy 533.00 522.00 533.00 783.0053850 Destruction of prostate tissue by thermotherapy 4,847.00 4,743.00 4,847.00 7,115.0053899 Cystoscopic injection of botulinum toxin, including cost of

material3,346.00 3,274.00 3,346.00 4,911.00

54235 Injection of corpora cavernosa 98.00 96.00 98.00 144.0054250 Nocturnal penile tumescence and/or rigidity test 704.00 689.00 704.00 1,034.0055000 Puncture aspiration of hydrocele, with/without injection of

medication301.00 295.00 301.00 443.00

55700 Biopsy, prostate; needle or punch, single or multiple, anyapproach

1,914.00 1,873.00 1,914.00 2,810.00

55870 Electroejaculation 6,723.00 6,578.00 6,723.00 9,867.0057452 Colposcopy, vaginoscopy 137.00 134.00 137.00 201.0057510 Cautery of cervix, any method 139.00 136.00 139.00 204.0058120 Dilation and curettage, diagnostic and/or therapeutic, excluding

induced abortion2,858.00 2,796.00 2,858.00 4,194.00

58300 Insertion of intrauterine device (IUD) 301.00 295.00 301.00 443.0058301 Removal of intrauterine device (IUD) 139.00 136.00 139.00 204.0058321 Artificial insemination, intra-cervical 139.00 136.00 139.00 204.0058322 Artificial insemination, intra-uterine 193.00 189.00 193.00 284.0058323 Sperm washing for artificial insemination 585.00 572.00 585.00 858.0058345 Fallopian tube dilation, catheterization, diagnostic/therapeutic,

ambulatory care4,233.00 4,142.00 4,233.00 6,213.00

58555 Hysteroscopy 533.00 522.00 533.00 783.0058558 Hysteroscopy, surgical, with biopsy/other surgical procedure 974.00 953.00 974.00 1,430.0058563 Uterine thermal therapy 6,252.00 6,117.00 6,252.00 9,176.0058974 Cryopreserved embryos transfer, intrauterine 4,272.00 4,180.00 4,272.00 6,270.0059000 Amniocentesis 265.00 259.00 265.00 389.0059012 Cordocentesis (intrauterine), any method 3,006.00 2,941.00 3,006.00 4,412.0059020 Fetal contraction stress test 770.00 753.00 770.00 1,130.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

59025 Fetal NST (non stress test) 362.00 354.00 362.00 531.0059866 Multifetal pregnancy reduction(s) (MPR), including US guidance 2,858.00 2,796.00 2,858.00 4,194.0059871 Removal of cerclage suture 199.00 195.00 199.00 293.0062270 Spinal puncture, lumbar, diagnostic 728.00 712.00 728.00 1,068.0062272 Spinal puncture, therapeutic 728.00 712.00 728.00 1,068.0062310 Injection, epidural/subarachnoid; cervical/thoracic 509.00 498.00 509.00 747.0062311 Injection, epidural/subarachnoid; lumbar/sacral (caudal) 509.00 498.00 509.00 747.0064400 Injection, anesthetic agent (eg, Lignocaine) 249.00 244.00 249.00 366.0064470 Paravertebral injection 144.00 141.00 144.00 212.0064550 Application of surface (transcutaneous) neurostimulator 260.00 254.00 260.00 381.0064612 Injection of Botulinum toxin, 10 units Botox 276.00 270.00 276.00 405.0065205 Foreign body removal, external eye, superficial 0.00 0.00 0.00 0.0066984 Cataract surgery with insertion of intraocular lens, including cost

of lens, ambulatory care5,722.00 5,599.00 5,722.00 8,399.00

66999 Intracorneal rings for keratoconus treatment, Intacs 7,494.00 7,333.00 7,494.00 11,000.0067210 Retinal photocoagulation, PDT, without material 1,938.00 1,896.00 1,938.00 2,844.0067912 Implantation of upper eyelid gold weight 4,951.00 4,844.00 4,951.00 7,266.0068810 Probing of nasolacrimal duct, with/without irrigation 1,360.00 1,331.00 1,360.00 1,997.0068811 Probing of nasolacrimal duct, with/without irrigation; requiring

general anesthesia3,666.00 3,587.00 3,666.00 5,381.00

69000 Puncture/drainage external ear abscess/hematoma 260.00 254.00 260.00 381.0069200 Foreign body removal, ear, superficial 0.00 0.00 0.00 0.0069210 Removal impacted cerumen 144.00 141.00 144.00 212.0069420 Myringotomy including puncture/aspiration 260.00 254.00 260.00 381.0069436 Tympanostomy (requiring insertion of ventilating tube), general

anesthesia1,567.00 1,533.00 1,567.00 2,300.00

70030 Eye radiology, foreign body detection 313.00 306.00 313.00 459.0070100 Mandible radiology, up to two views 263.00 257.00 263.00 386.0070120 Mastoids radiology, up to two views 139.00 136.00 139.00 204.00



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fromAbroad(ILS)

70170 Dacryocystography, radiological supervision and interpretation 193.00 189.00 193.00 284.0070200 Orbits radiology, up to two views 187.00 183.00 187.00 275.0070210 Paranasal sinuses radiology, up to two views 185.00 181.00 185.00 272.0070240 Sella turcica radiology 260.00 254.00 260.00 381.0070250 Skull radiology, up to two views 130.00 127.00 130.00 191.0070332 TMJ arthrography, including injection and interpretation 331.00 324.00 331.00 486.0070336 TMJ (temporomandibular joint(s)) MRI 1,883.00 1,842.00 1,883.00 2,763.0070360 Neck, soft tissue radiology, trachea 414.00 405.00 414.00 608.0070390 Salivary glands radiology, sialography 393.00 385.00 393.00 578.0070540 Orbit, face and neck MRI 1,883.00 1,842.00 1,883.00 2,763.0070544 Brain MRA 2,056.00 2,012.00 2,056.00 3,018.0070547 Head and/or neck MRA 2,056.00 2,012.00 2,056.00 3,018.0070551 Brain/brain stem MRI, without contrast material 1,883.00 1,842.00 1,883.00 2,763.0071020 Chest radiology, up to two views 120.00 117.00 120.00 176.0071023 Chest radiology, up to two views, with fluoroscopy 368.00 360.00 368.00 540.0071100 Ribs radiology, up to two views 181.00 177.00 181.00 266.0071120 Sternum radiology, up to two views 193.00 189.00 193.00 284.0071550 Thoracic MRI, without contrast material 1,883.00 1,842.00 1,883.00 2,763.0071555 Thoracic MRA, excluding myocardium 2,056.00 2,012.00 2,056.00 3,018.0072010 Spine radiology, entire, up to two views 187.00 183.00 187.00 275.0072040 Cervical spine radiology, up to two views 130.00 127.00 130.00 191.0072070 Thoracic spine radiology, up to two views 130.00 127.00 130.00 191.0072080 Thoracolumbar spine radiology, up to two views 130.00 127.00 130.00 191.0072100 Lumbosacral spine radiology, up to two views 130.00 127.00 130.00 191.0072141 Cervical spine MRI, per patient 1,883.00 1,842.00 1,883.00 2,763.0072146 Thoracic spine MRI, per patient 1,883.00 1,842.00 1,883.00 2,763.0072148 Lumbar spine MRI, per patient 1,883.00 1,842.00 1,883.00 2,763.0072159 Spinal canal and contents MRA 2,056.00 2,012.00 2,056.00 3,018.0072170 Pelvis radiology, up to two views 143.00 140.00 143.00 210.00



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72198 Pelvic MRA 2,056.00 2,012.00 2,056.00 3,018.0072200 SIJ radiology, up to two views 193.00 189.00 193.00 284.0072270 Myelography 1,486.00 1,454.00 1,486.00 2,181.0073000 Clavicle radiology 154.00 151.00 154.00 227.0073010 Scapula radiology 154.00 151.00 154.00 227.0073030 Shoulder radiology, complete, one side, up to two views 139.00 136.00 139.00 204.0073040 Shoulder arthrography, including injection and interpretation 331.00 324.00 331.00 486.0073060 Humerus radiology, up to two views 130.00 127.00 130.00 191.0073070 Elbow radiology, up to two views 130.00 127.00 130.00 191.0073085 Elbow arthrography, including injection and interpretation 331.00 324.00 331.00 486.0073090 Forearm radiology, up to two views 130.00 127.00 130.00 191.0073092 Upper extremity radiology, infant, up to two views 130.00 127.00 130.00 191.0073100 Wrist radiology, up to two views 130.00 127.00 130.00 191.0073115 Wrist, arthrography, including injection and interpretation 331.00 324.00 331.00 486.0073120 Hand radiology, up to two views 130.00 127.00 130.00 191.0073140 Finger(s) radiology, up to two views 130.00 127.00 130.00 191.0073221 Upper extremity joints MRI, without contrast material, per patient 1,883.00 1,842.00 1,883.00 2,763.0073225 Upper extremity MRA 2,056.00 2,012.00 2,056.00 3,018.0073500 Hip radiology, unilateral, one view 130.00 127.00 130.00 191.0073520 Hip radiology, bilateral, including pelvis 130.00 127.00 130.00 191.0073525 Hip arthrography, including injection and interpretation 331.00 324.00 331.00 486.0073542 SIJ arthrography, including injection and interpretation 331.00 324.00 331.00 486.0073550 Femur radiology, up to two views 130.00 127.00 130.00 191.0073560 Knee radiology, up to two views, per side 130.00 127.00 130.00 191.0073562 Knee radiology, third or more additional views 139.00 136.00 139.00 204.0073580 Knee arthrography, including injection and interpretation 331.00 324.00 331.00 486.0073590 Tibia and fibula radiology, up to two views 130.00 127.00 130.00 191.0073592 Lower extremity radiology, infant, up to two views 130.00 127.00 130.00 191.0073610 Ankle radiology, complete, one side 130.00 127.00 130.00 191.00



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73615 Ankle arthrography, including injection and interpretation 331.00 324.00 331.00 486.0073620 Foot radiology, up to two views 130.00 127.00 130.00 191.0073721 Lower extremity joints MRI, without contrast material, per patient 1,883.00 1,842.00 1,883.00 2,763.0073725 Lower extremity MRA 2,056.00 2,012.00 2,056.00 3,018.0074000 Abdomen radiology, without contrast material 185.00 181.00 185.00 272.0074181 Abdominal MRI, per patient 1,883.00 1,842.00 1,883.00 2,763.0074185 Abdominal MRA 2,056.00 2,012.00 2,056.00 3,018.0074220 Esophagus radiology 460.00 450.00 460.00 675.0074230 Swallowing function, with cineradiography/videoradiography 732.00 716.00 732.00 1,074.0074241 UGI fluoroscopy and/or radiology, with/without delayed films 770.00 753.00 770.00 1,130.0074245 UGI fluoroscopy, including serial films 949.00 929.00 949.00 1,394.0074249 Abdomen radiology, small intestine follow-through 460.00 450.00 460.00 675.0074270 Barium enema 546.00 534.00 546.00 801.0074280 Air barium enema, with/without glucagon 879.00 860.00 879.00 1,290.0074290 Cholecystography, oral contrast 458.00 448.00 458.00 672.0074360 Esophageal dilation, imaging guidance 6,107.00 5,976.00 6,107.00 8,964.0074400 IVP, with or without tomography 677.00 662.00 677.00 993.0074420 Urography, retrograde 557.00 545.00 557.00 818.0074450 Urethrocystography, retrograde, radiological supervision and

interpretation430.00 421.00 430.00 632.00

74455 Urethrocystography, radiological supervision and interpretation 538.00 526.00 538.00 789.0074740 Hysterosalpingography, radiology 561.00 549.00 561.00 824.0075552 Cardiac MRI for morphology, per patient 4,228.00 4,137.00 4,228.00 6,206.0075554 Cardiac FMRI, with/without morphology, complete study, per

patient4,228.00 4,137.00 4,228.00 6,206.00

75803 Lymphangiography, extremities 2,162.00 2,115.00 2,162.00 3,173.0075822 Phlebography, venography, including injection and imaging 728.00 712.00 728.00 1,068.0076000 Fluoroscopy 118.00 115.00 118.00 173.0076120 Cineradiography/videoradiography, video capsule 5,495.00 5,377.00 5,495.00 8,066.00



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76140 Interpretation/consultation on imaging made elsewhere 139.00 136.00 139.00 204.0076390 MRS (Magnetic resonance spectroscopy), per patient 2,728.00 2,669.00 2,728.00 4,004.0076512 Ophthalmic US (ultrasound) 181.00 177.00 181.00 266.0076514 Ophthalmic US, corneal pachymetry, determination of corneal

thickness, per patient100.00 98.00 100.00 147.00

76536 Head and neck soft tissues US, with image documentation 362.00 354.00 362.00 531.0076604 Chest US, including mediastinum, with image documentation 622.00 609.00 622.00 914.0076645 Breasts and chest wall US, with image documentation 251.00 246.00 251.00 369.0076700 Abdominal US, excluding screening for aortic aneurysm

diagnosis, with image documentation362.00 354.00 362.00 531.00

76805 Fetal anatomic US, with image documentation 931.00 911.00 931.00 1,367.0076813 Fetal nuchal translucency US, per one fetus, with image

documentation381.00 373.00 381.00 560.00

76814 Fetal nuchal translucency US, per each additional fetus, withimage documentation

251.00 246.00 251.00 369.00

76815 Obstetric US, with image documentation 509.00 498.00 509.00 747.0076825 Echocardiography, fetal, with image documentation 1,066.00 1,043.00 1,066.00 1,565.0076827 Doppler echocardiography, fetal 1,316.00 1,288.00 1,316.00 1,932.0076830 TVUS (Transvaginal Ultrasound) 297.00 291.00 297.00 437.0076831 Uterus and fallopian tube sonography, with contrast material 1,033.00 1,011.00 1,033.00 1,517.0076857 Gynecological US, follicles 190.00 186.00 190.00 279.0076870 Scrotum US, with image documentation 622.00 609.00 622.00 914.0076872 TRUS (transrectal ultrasound), with image documentation 904.00 885.00 904.00 1,328.0076942 Biopsy/surgical procedure, US guidance 2,868.00 2,806.00 2,868.00 4,209.0077002 Biopsy/surgical procedure, fluoroscopic guidance 2,868.00 2,806.00 2,868.00 4,209.0077012 Biopsy/surgical procedure, CT guidance, ambulatory care 5,193.00 5,081.00 5,193.00 7,622.0077021 Biopsy/surgical procedure, MRI guidance, excluding breast,

ambulatory care7,790.00 7,622.00 7,790.00 11,433.00



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77031 Stereotactic localization guidance for breast biopsy/needleplacement, including biopsy, using imaging guidance (eg,mammography)

5,191.00 5,079.00 5,191.00 7,619.00

77032 Mammographic guidance for needle placement, breast (eg, forwire localization or for injection), each lesion, radiologicalsupervision and interpretation

788.00 771.00 788.00 1,157.00

77054 Mammary ductogram/galactogram, including interpretation 1,020.00 998.00 1,020.00 1,497.0077056 Mammography; bilateral 253.00 248.00 253.00 372.0077059 Breast MRI, bilateral 1,883.00 1,842.00 1,883.00 2,763.0077073 Bone length studies (orthoroentgenogram, scanogram) 366.00 358.00 366.00 537.0077080 DXA, bone density study 225.00 220.00 225.00 330.0077261 Therapeutic radiology treatment planning, radiotherapy 594.00 581.00 594.00 872.0077280 Radiotherapy simulation 2,362.00 2,311.00 2,362.00 3,467.0077295 Radiology simulation-aided field setting, three-dimensional 2,955.00 2,891.00 2,955.00 4,337.0077401 Radiation treatment delivery, per field 518.00 456.00 467.00 762.0078000 Thyroid uptake, single determination 297.00 291.00 297.00 437.0078001 Thyroid uptake, multiple determinations 507.00 496.00 507.00 744.0078007 Thyroid imaging, with uptake, multiple determinations 1,013.00 991.00 1,013.00 1,487.0078010 Thyroid imaging 659.00 645.00 659.00 968.0078018 Thyroid imaging; I-131, whole body 3,057.00 2,991.00 3,057.00 4,487.0078070 Parathyroid imaging 1,524.00 1,491.00 1,524.00 2,237.0078104 Bone marrow imaging, whole body 2,849.00 2,788.00 2,849.00 4,182.0078122 Whole blood volume determination, radiopharmaceutical

technique1,892.00 1,851.00 1,892.00 2,777.00

78130 Red cell survival study 3,227.00 3,158.00 3,227.00 4,737.0078191 Platelet survival study 1,023.00 1,001.00 1,023.00 1,502.0078195 Lymphatics and lymph nodes imaging 2,822.00 2,761.00 2,822.00 4,142.0078205 Liver and spleen imaging, SPECT 891.00 872.00 891.00 1,308.0078215 Liver and spleen imaging, static 788.00 771.00 788.00 1,157.0078216 Liver and spleen imaging, dynamic and static 837.00 819.00 837.00 1,229.00



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78223 Hepatobiliary imaging, with/without pharmacologic intervention,with/without quantitative measurement of gallbladder function

2,324.00 2,274.00 2,324.00 3,411.00

78231 Salivary gland imaging, with serial images 969.00 948.00 969.00 1,422.0078258 Esophageal motility, dynamic 1,004.00 982.00 1,004.00 1,473.0078262 Gastroesophageal reflux study 755.00 739.00 755.00 1,109.0078264 Gastric emptying study 3,010.00 2,945.00 3,010.00 4,418.0078270 Vitamin B-12 absorption, without intrinsic factor 725.00 709.00 725.00 1,064.0078271 Vitamin B-12 absorption, with intrinsic factor 992.00 971.00 992.00 1,457.0078278 Acute GI bleeding imaging, dynamic and static 2,932.00 2,869.00 2,932.00 4,304.0078290 Intestine imaging (eg, Meckel's, ectopic gastric mucosa) 1,452.00 1,421.00 1,452.00 2,132.0078291 Peritoneal-venous shunt patency test (eg, for LeVeen, Denver

shunt)2,054.00 2,010.00 2,054.00 3,015.00

78300 Bone and/or joint imaging, limited area 1,225.00 1,199.00 1,225.00 1,799.0078306 Bone and/or joint imaging, whole body 767.00 750.00 767.00 1,125.0078315 Bone and/or joint imaging, three phase 2,470.00 2,417.00 2,470.00 3,626.0078320 Bone and/or joint imaging, SPECT 863.00 844.00 863.00 1,266.0078399 Bone and/or joint imaging, whole body, 24 hours later 353.00 345.00 353.00 518.0078428 Cardiac shunt detection, dynamic 805.00 788.00 805.00 1,182.0078445 Vascular flow imaging, perfusion 1,055.00 1,032.00 1,055.00 1,548.0078458 Venous thrombosis imaging, bilateral 1,391.00 1,361.00 1,391.00 2,042.0078461 Myocardial perfusion imaging, at rest and/or stress, planar 3,381.00 3,308.00 3,381.00 4,962.0078465 Myocardial perfusion imaging, rest and/or stress, SPECT 3,833.00 1,782.00 1,827.00 5,625.0078466 Myocardial imaging, infarct, planar 2,515.00 2,461.00 2,515.00 3,692.0078468 Myocardial imaging, infarct, planar first pass, EF 2,985.00 2,921.00 2,985.00 4,382.0078469 Myocardial imaging, infarct, SPECT 3,463.00 3,388.00 3,463.00 5,082.0078472 Cardiac BP imaging, gated planar, rest/stress, EF 1,585.00 1,551.00 1,585.00 2,327.0078473 Cardiac BP imaging, gated, rest and stress, EF 3,756.00 3,675.00 3,756.00 5,513.0078478 Myocardial perfusion imaging, with wall motion 4,685.00 4,584.00 4,685.00 6,876.0078480 Myocardial perfusion study with EF 4,896.00 4,791.00 4,896.00 7,187.00



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78481 Cardiac BP imaging, gated planar, rest/stress, first pass, EF 1,565.00 1,531.00 1,565.00 2,297.0078499 Cardiac BP (pool imaging)imaging, static 757.00 741.00 757.00 1,112.0078580 Pulmonary imaging, perfusion 907.00 887.00 907.00 1,331.0078585 Pulmonary imaging, ventilation and perfusion, Xenon 2,117.00 2,071.00 2,117.00 3,107.0078587 Pulmonary imaging, ventilation, aerosol 1,743.00 1,705.00 1,743.00 2,558.0078594 Pulmonary imaging, ventilation, xenon 1,814.00 1,775.00 1,814.00 2,663.0078596 Pulmonary imaging, ventilation and perfusion, quantitative

differential function2,676.00 2,618.00 2,676.00 3,927.00

78605 Brain imaging, static 1,262.00 1,235.00 1,262.00 1,853.0078606 Brain imaging, dynamic and static 1,697.00 1,660.00 1,697.00 2,490.0078607 Brain imaging, SPECT 3,246.00 3,176.00 3,246.00 4,764.0078610 Brain imaging, dynamic 1,176.00 1,151.00 1,176.00 1,727.0078630 CSF (Cerebrospinal fluid) imaging, cisternography 4,872.00 4,767.00 4,872.00 7,151.0078645 CSF flow imaging, shunt evaluation 1,001.00 979.00 1,001.00 1,469.0078650 CSF leakage detection and localization 2,891.00 2,829.00 2,891.00 4,244.0078660 Radiopharmaceutical dacryocystography 1,216.00 1,190.00 1,216.00 1,785.0078699 Brain tumor imaging, SPECT 2,929.00 2,866.00 2,929.00 4,299.0078700 Kidney imaging, static 1,497.00 1,465.00 1,497.00 2,198.0078701 Kidney imaging, dynamic, GFR 1,697.00 1,660.00 1,697.00 2,490.0078707 Kidney imaging, dynamic, without pharmacological intervention 1,155.00 1,130.00 1,155.00 1,695.0078708 Kidney imaging, dynamic, with pharmacological intervention 1,376.00 1,346.00 1,376.00 2,019.0078710 Kidney imaging, SPECT 1,479.00 1,447.00 1,479.00 2,171.0078740 Ureteral reflux imaging (cystogram) 1,294.00 1,266.00 1,294.00 1,899.0078761 Testicular imaging, dynamic and static 750.00 734.00 750.00 1,101.0078802 Tumor imaging, planar 4,591.00 4,492.00 4,591.00 6,738.0078803 Tumor imaging, SPECT 4,000.00 3,914.00 4,000.00 5,871.0078805 Inflammatory process imaging, limited area 4,485.00 4,388.00 4,485.00 6,582.0078806 Inflammatory process imaging, whole body 5,513.00 5,394.00 5,513.00 8,091.0078807 Inflammatory process imaging, SPECT 4,000.00 3,914.00 4,000.00 5,871.00



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78813 FDG PET imaging 4,570.00 4,472.00 4,570.00 6,708.0078999 Tumor imaging, monoclonal Ab, SPECT 8,458.00 8,276.00 8,458.00 12,414.0079101 Radiopharmaceutical therapy, polycythemia vera 2,134.00 2,088.00 2,134.00 3,132.0079403 Radiopharmaceutical therapy, intravenous administration,

Zevalin, 90Y-Ibritumomab tiuxetan1,814.00 1,775.00 1,814.00 2,663.00

79440 Radiopharmaceutical therapy, by intra-articular administration 5,861.00 5,735.00 5,861.00 8,603.0080053 Chemistry panel 61.00 60.00 61.00 90.0080061 Lipids panel - blood: Cholesterol, TG, HDL, LDL 49.00 48.00 49.00 72.0080076 Hepatic function panel 69.00 68.00 69.00 102.0080100 Drug, qualitative - urine 136.00 133.00 136.00 200.0080101 Drug, qualitative 199.00 195.00 199.00 293.0080162 Digoxin 96.00 94.00 96.00 141.0080178 Lithium 144.00 141.00 144.00 212.0080195 Sirolimus 329.00 322.00 329.00 483.0080299 Drug, quantitative 199.00 195.00 199.00 293.0080400 ACTH stimulation, including blood hormones levels 511.00 500.00 511.00 750.0080420 Dexamethasone suppression test, 48 hour, include: free cortisol,

urine cortisol, volume measurement152.00 149.00 152.00 224.00

81000 Urinalysis, with microscopy 44.00 43.00 44.00 65.0081002 Urinalysis stick, manual - urine, panel billing code 20.00 20.00 20.00 30.0081235 EGFR (Epidermal Growth Factor Receptor) mutation - blood, per

patient4,189.00 4,099.00 4,189.00 6,149.00

82010 Acetone, quantitative 89.00 87.00 89.00 131.0082013 Acetylcholinesterase - amniotic fluid 561.00 549.00 561.00 824.0082017 Acylcarnitine, quantitative - blood/urine 678.00 663.00 678.00 995.0082030 Cyclic AMP - blood and urine 802.00 785.00 802.00 1,178.0082040 Albumin - serum 18.00 18.00 18.00 27.0082042 Albumin, quantitative - urine/other source, excluding serum 18.00 18.00 18.00 27.0082043 Microalbumin - urine / 24 hours 96.00 94.00 96.00 141.00



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82085 Aldolase 199.00 195.00 199.00 293.0082088 Aldosterone 263.00 257.00 263.00 386.0082103 Alpha 1 antitrypsin, total 301.00 295.00 301.00 443.0082105 Alpha-fetoprotein - serum 36.00 35.00 36.00 53.0082128 Amino acids, qualitative 126.00 123.00 126.00 185.0082131 Amino acids, quantitative 358.00 350.00 358.00 525.0082135 Aminolevulinic acid (ALA), quantitative - urine 344.00 337.00 344.00 506.0082140 Ammonia 194.00 190.00 194.00 285.0082150 Amylase 35.00 34.00 35.00 51.0082154 Androstenedione/androstenediol glucoronide 216.00 211.00 216.00 317.0082160 Androsterone 430.00 421.00 430.00 632.0082172 Apolipoprotein B1/A1 144.00 141.00 144.00 212.0082180 Vitamin C, ascorbic acid - blood 139.00 136.00 139.00 204.0082205 Barbiturates, qualitative - urine 199.00 195.00 199.00 293.0082232 Beta 2 microglobulin 300.00 294.00 300.00 441.0082239 Bile acids degradation test 304.00 297.00 304.00 446.0082247 Bilirubin, total 18.00 18.00 18.00 27.0082248 Bilirubin, direct 18.00 18.00 18.00 27.0082261 Biotinidase 286.00 280.00 286.00 420.0082270 Occult blood - feces 89.00 87.00 89.00 131.0082306 Calcifediol (25-OH Vitamin D-3) 127.00 124.00 127.00 186.0082307 Calciferol (Vitamin D) 127.00 124.00 127.00 186.0082308 Calcitonin 263.00 257.00 263.00 386.0082310 Calcium, total, excluding urine 18.00 18.00 18.00 27.0082340 Calcium - urine 34.00 33.00 34.00 50.0082360 Calculus, quantitative and qualitative analysis 1,065.00 1,042.00 1,065.00 1,563.0082374 Carbon dioxide (bicarbonate) 118.00 115.00 118.00 173.0082378 CEA (Carcinoembryonic Ag), including dilution 36.00 35.00 36.00 53.0082380 Carotene 139.00 136.00 139.00 204.00



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82382 Catecholamines, total 622.00 609.00 622.00 914.0082390 Ceruloplasmin 199.00 195.00 199.00 293.0082435 Chloride - blood 34.00 33.00 34.00 50.0082436 Chloride - urine 34.00 33.00 34.00 50.0082438 Chloride - other source, excluding blood/urine 34.00 33.00 34.00 50.0082465 Cholesterol, total - blood 18.00 18.00 18.00 27.0082480 Cholinesterase - serum 89.00 87.00 89.00 131.0082486 Chromatography, qualitative 144.00 141.00 144.00 212.0082492 Chromatography, quantitative, any method 144.00 141.00 144.00 212.0082525 Copper 80.00 78.00 80.00 117.0082533 Cortisol, total 44.00 43.00 44.00 65.0082540 Creatine 89.00 87.00 89.00 131.0082550 CK (Creatine Kinase, CPK), total 18.00 18.00 18.00 27.0082552 CK (Creatine Kinase, CPK) isoenzymes 288.00 282.00 288.00 423.0082565 Creatinine - blood 21.00 21.00 21.00 32.0082570 Creatinine - other fluids, excluding blood 44.00 43.00 44.00 65.0082575 Creatinine clearance test 60.00 59.00 60.00 89.0082585 Cryofibrinogen 293.00 287.00 293.00 431.0082595 Cryoglobulin, qualitative or semi-quantitative (eg, cryocrit) 144.00 141.00 144.00 212.0082607 Vitamin B-12, cyanocobalamin 162.00 159.00 162.00 239.0082608 Vitamin B-12, cyanocobalamin, binding capacity 57.00 56.00 57.00 84.0082626 Dehydroepiandrosterone (DHEA) 69.00 68.00 69.00 102.0082627 Dehydroepiandrosterone-sulfate (DHEA-S) 69.00 68.00 69.00 102.0082652 Vitamin D (Calciferol) 1,25-Dihydroxy 511.00 500.00 511.00 750.0082657 Enzyme activity in blood cells, cultured cells, or tissue, each 199.00 195.00 199.00 293.0082670 Estradiol 69.00 68.00 69.00 102.0082672 Estrogens, total, all derivatives 430.00 421.00 430.00 632.0082677 Estriol 301.00 295.00 301.00 443.0082679 Estrone 293.00 287.00 293.00 431.00



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82705 Fat, qualitative - feces 139.00 136.00 139.00 204.0082710 Fat, quantitative - feces 458.00 448.00 458.00 672.0082726 Very long chain fatty acids 970.00 949.00 970.00 1,424.0082728 Ferritin 33.00 32.00 33.00 48.0082731 Fetal fibronectin 473.00 463.00 473.00 695.0082746 Folic acid - serum 143.00 140.00 143.00 210.0082757 Fructose - seminal fluid 301.00 295.00 301.00 443.0082759 Galactokinase 851.00 833.00 851.00 1,250.0082760 Galactose 293.00 287.00 293.00 431.0082775 Galactose 1 phosphate uridyl transferase, quantitative 458.00 448.00 458.00 672.0082787 Gammaglobulin, immunoglobulin subclasses 721.00 705.00 721.00 1,058.0082800 Gases, pH only - blood 144.00 141.00 144.00 212.0082803 Gases - blood 184.00 180.00 184.00 270.0082941 Gastrin 263.00 257.00 263.00 386.0082945 Glucose - other fluids, excluding blood 89.00 87.00 89.00 131.0082947 Glucose, quantitative - blood 18.00 18.00 18.00 27.0082951 Glucose tolerance test (GTT) 199.00 195.00 199.00 293.0082955 Glucose-6-phosphate dehydrogenase (G6PD), quantitative 430.00 421.00 430.00 632.0082960 Glucose-6-phosphate dehydrogenase (G6PD), screen 293.00 287.00 293.00 431.0082977 Gamma glutamyltransferase (GGT) 33.00 32.00 33.00 48.0082985 Fructosamine/glycated protein 430.00 421.00 430.00 632.0083001 Gonadotropin, FSH (Follicle stimulating hormone) 33.00 32.00 33.00 48.0083002 Gonadotropin, LH (Luteinizing hormone) 65.00 64.00 65.00 96.0083003 GH (Growth hormone), somatotropin 69.00 68.00 69.00 102.0083010 Haptoglobin, quantitative 331.00 324.00 331.00 486.0083013 Rapid urease test, helicobacter pylori - exhaled air 49.00 48.00 49.00 72.0083015 Heavy metal (arsenic, barium, beryllium, bismuth, antimony,

mercury, thallium), screen199.00 195.00 199.00 293.00

83020 Hemoglobin, electrophoresis 123.00 120.00 123.00 180.00



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83036 Hemoglobin; glycosylated (A1C) 44.00 43.00 44.00 65.0083045 Hemoglobin, methemoglobin, qualitative 430.00 421.00 430.00 632.0083069 Hemoglobin - urine 249.00 244.00 249.00 366.0083070 Hemosiderin, qualitative - urine 260.00 254.00 260.00 381.0083071 Hemosiderin, quantitative - urine 260.00 254.00 260.00 381.0083090 Homocysteine 270.00 264.00 270.00 396.0083491 Hydroxycorticosteroids, 17- (17-OHCS) 330.00 323.00 330.00 485.0083497 Hydroxyindolacetic acid, 5-(HIAA) 158.00 155.00 158.00 233.0083525 Insulin, total 69.00 68.00 69.00 102.0083540 Iron 44.00 43.00 44.00 65.0083550 Iron binding capacity 199.00 195.00 199.00 293.0083586 Ketosteroids , total 293.00 287.00 293.00 431.0083593 Ketosteroids, 17- (17-KS), fractionation 1,623.00 1,588.00 1,623.00 2,382.0083605 Lactate (lactic acid) 104.00 102.00 104.00 153.0083615 Lactate dehydrogenase (LD), (LDH) 18.00 18.00 18.00 27.0083625 Lactate dehydrogenase (LD), (LDH), isoenzymes, total 430.00 421.00 430.00 632.0083655 Lead 96.00 94.00 96.00 141.0083661 Fetal lung maturity assessment, Lecithin/Sphingomyelin ratio -

amniotic fluid546.00 534.00 546.00 801.00

83690 Lipase 35.00 34.00 35.00 51.0083700 Lipoprotein, electrophoresis - blood 29.00 28.00 29.00 42.0083718 Lipoprotein, HDL cholesterol 34.00 33.00 34.00 50.0083719 Lipoprotein, VLDL cholesterol 34.00 33.00 34.00 50.0083735 Magnesium 18.00 18.00 18.00 27.0083825 Mercury, quantitative 199.00 195.00 199.00 293.0083866 Mucopolysaccharides, screen - urine, per patient 313.00 306.00 313.00 459.0083872 Mucin/other material - synovial fluid, including biochemistry,

cytology and culture313.00 306.00 313.00 459.00

83874 Myoglobin 271.00 265.00 271.00 398.00



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83896 Molecular diagnosis of hematologic malignancies 1,383.00 1,353.00 1,383.00 2,030.0083898 RT-PCR, molecular diagnostics 3,357.00 3,285.00 3,357.00 4,928.0083918 Organic acids, quantitative - urine 635.00 621.00 635.00 932.0083930 Osmolality - blood 89.00 87.00 89.00 131.0083935 Osmolality - urine 89.00 87.00 89.00 131.0083945 Oxalate, qualitative/quantitative - urine 362.00 354.00 362.00 531.0083970 Parathormone (parathyroid hormone) 247.00 242.00 247.00 363.0084060 Acid phosphatase, total 89.00 87.00 89.00 131.0084061 Acid phosphatase stain 199.00 195.00 199.00 293.0084066 Acid phosphatase, prostatic 139.00 136.00 139.00 204.0084075 Alkaline phosphatase 18.00 18.00 18.00 27.0084080 Alkaline phosphatase isoenzymes 430.00 421.00 430.00 632.0084100 Phosphorus - blood 18.00 18.00 18.00 27.0084105 Phosphorus - urine 18.00 18.00 18.00 27.0084110 Porphobilinogen, quantitative, collection - urine 252.00 247.00 252.00 371.0084119 Porphobilinogen, quantitative - urine 139.00 136.00 139.00 204.0084127 Porphyrins, qualitative - feces 224.00 219.00 224.00 329.0084132 Potassium - blood 18.00 18.00 18.00 27.0084135 Pregnanediol 293.00 287.00 293.00 431.0084138 Pregnanetriol 430.00 421.00 430.00 632.0084144 Progesterone 69.00 68.00 69.00 102.0084146 Prolactin 101.00 99.00 101.00 149.0084153 PSA (Prostate specific Ag), total 44.00 43.00 44.00 65.0084154 PSA (Prostate specific Ag), free 89.00 87.00 89.00 131.0084155 Protein, total - serum 18.00 18.00 18.00 27.0084156 Protein, total - urine 18.00 18.00 18.00 27.0084165 Protein electrophoretic 96.00 94.00 96.00 141.0084207 Vitamin B-6 (pyridoxal phosphate) 306.00 299.00 306.00 449.0084210 Phenylpyruvic acid - urine 44.00 43.00 44.00 65.00



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84233 Receptor assay, estrogene 675.00 660.00 675.00 990.0084244 Renin 263.00 257.00 263.00 386.0084260 Serotonin 158.00 155.00 158.00 233.0084295 Sodium - blood 18.00 18.00 18.00 27.0084375 Sugars chromatography 144.00 141.00 144.00 212.0084376 Sugars (mono-, di-, and oligosaccharides), qualitative - body

fluids313.00 306.00 313.00 459.00

84402 Testosterone, free 139.00 136.00 139.00 204.0084403 Testosterone, total 69.00 68.00 69.00 102.0084432 Thyroglobulin 373.00 365.00 373.00 548.0084436 Thyroxine, total 38.00 37.00 38.00 56.0084443 Thyroid stimulating hormone (TSH) 38.00 37.00 38.00 56.0084446 Tocopherol alpha (Vitamin E) 199.00 195.00 199.00 293.0084450 AST (GOT) Aspartate aminotransferase 33.00 32.00 33.00 48.0084460 ALT (GPT) Alanine amino transferase 33.00 32.00 33.00 48.0084466 Transferrin 129.00 126.00 129.00 189.0084478 Triglycerides 18.00 18.00 18.00 27.0084479 Thyroid hormone (T3/T4) uptake or binding ratio (THBR) 81.00 79.00 81.00 119.0084480 Triiodothyronine T3, total (TT-3) 81.00 79.00 81.00 119.0084484 Troponin, quantitative 167.00 163.00 167.00 245.0084490 Chymotrypsin, quantitative - feces 249.00 244.00 249.00 366.0084520 Urea, quantitative - blood 18.00 18.00 18.00 27.0084540 Urea, quantitative - urine/other fluids, excluding blood 44.00 43.00 44.00 65.0084550 Uric acid - blood 18.00 18.00 18.00 27.0084560 Uric acid - body fluids, excluding blood 44.00 43.00 44.00 65.0084585 Vanillylmandelic acid (VMA) - urine 199.00 195.00 199.00 293.0084588 Vasopressin (antidiuretic hormone, ADH) 511.00 500.00 511.00 750.0084590 Vitamin A 139.00 136.00 139.00 204.0084620 Xylose absorption test - blood/urine 144.00 141.00 144.00 212.00



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84681 C-peptide 139.00 136.00 139.00 204.0084702 hCG (Human chorionic gonadotropin), qualitative/quantitative 96.00 94.00 96.00 141.0085002 Bleeding time 84.00 82.00 84.00 123.0085007 Manual differential 42.00 41.00 42.00 62.0085009 Blood count, manual differential, buffy coat 199.00 195.00 199.00 293.0085025 CBC (complete blood count) with differential 29.00 28.00 29.00 42.0085032 Blood smear, manual test 118.00 115.00 118.00 173.0085044 Reticulocytes manual count 69.00 68.00 69.00 102.0085049 Platelet, thrombocyte 76.00 74.00 76.00 111.0085170 Clot retraction 118.00 115.00 118.00 173.0085210 Clotting, factor II, prothrombin 223.00 218.00 223.00 327.0085220 Clotting, factor V (AcG or proaccelerin) 293.00 287.00 293.00 431.0085230 Clotting, factor VII, proconvertin 223.00 218.00 223.00 327.0085244 Clotting, factor VIII related Ag 290.00 284.00 290.00 426.0085245 Clotting, factor VIII, ristocetin cofactor 677.00 662.00 677.00 993.0085250 Clotting, factor IX 324.00 317.00 324.00 476.0085260 Clotting, factor X (Stuart-Prower) 223.00 218.00 223.00 327.0085270 Clotting, factor XI (PTA) 223.00 218.00 223.00 327.0085280 Clotting, factor XII (Hageman) 546.00 534.00 546.00 801.0085290 Clotting, factor XIII (fibrin stabilizing) 293.00 287.00 293.00 431.0085301 Clotting anticoagulant, antithrombin III antigen 320.00 313.00 320.00 470.0085302 Protein C, anticoagulant 399.00 390.00 399.00 585.0085305 Protein S, anticoagulant 331.00 324.00 331.00 486.0085362 Fibrinogen degradation (split) products (FDP) (FSP 546.00 534.00 546.00 801.0085384 Fibrinogen activity 96.00 94.00 96.00 141.0085390 Fibrinolysins or coagulopathy, screen 430.00 421.00 430.00 632.0085460 HbF (Hemoglobin fetal) stain 199.00 195.00 199.00 293.0085475 Hemolysin, acid, Ham test 260.00 254.00 260.00 381.0085540 LAP (Leukocyte Alkaline Phosphatase) with count 293.00 287.00 293.00 431.00



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85549 Muramidase 511.00 500.00 511.00 750.0085557 Osmotic fragility 293.00 287.00 293.00 431.0085576 Platelet aggregation 458.00 448.00 458.00 672.0085597 Platelet neutralization 561.00 549.00 561.00 824.0085610 PT (Prothrombin time) 41.00 40.00 41.00 60.0085635 Reptilase test 199.00 195.00 199.00 293.0085651 Sedimentation rate - blood 20.00 20.00 20.00 30.0085670 TT (Thrombin time) - plasma 89.00 87.00 89.00 131.0085730 PTT (Thromboplastin time) - plasma/blood 44.00 43.00 44.00 65.0085810 Viscosity - blood 293.00 287.00 293.00 431.0086000 Agglutinins, febrile, per test 118.00 115.00 118.00 173.0086021 Leucocyte Ab 249.00 244.00 249.00 366.0086022 Platelet Ab 516.00 505.00 516.00 758.0086038 ANA (Antinuclear antibodies) 265.00 259.00 265.00 389.0086060 ASL0 (Antistreptolysin 0), titer 144.00 141.00 144.00 212.0086140 C-reactive protein 53.00 52.00 53.00 78.0086147 Cardiolipin Ab 69.00 68.00 69.00 102.0086155 Chemotaxis assay 1,379.00 1,349.00 1,379.00 2,024.0086156 Cold agglutinin, screen 118.00 115.00 118.00 173.0086157 Cold agglutinin, quantitative 118.00 115.00 118.00 173.0086162 Complement total hemolytic activity 794.00 777.00 794.00 1,166.0086171 Complement fixation 181.00 177.00 181.00 266.0086225 DNA, native or double stranded, Ab 884.00 865.00 884.00 1,298.0086235 ENA (Extractable nuclear Ag) Ab, any method (eg, nRNP, SS-A,

SS-B, Sm, RNP, Sc170, J01), each Ab123.00 120.00 123.00 180.00

86255 Fluorescent noninfectious agent Ab, not otherwise specified 101.00 99.00 101.00 149.0086300 CA 15.3 tumor antigen 49.00 48.00 49.00 72.0086301 CA 19.9, tumor antigen 102.00 100.00 102.00 150.0086304 CA 125 tumor antigen 44.00 43.00 44.00 65.00



Price A(ILS)

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fromAbroad(ILS)

86320 Immunoelectrophoresis - serum 311.00 304.00 311.00 456.0086325 Immunoelectrophoresis - body fluids, excluding serum, eg, urine,

CSF89.00 87.00 89.00 131.00

86336 Inhibin - serum 239.00 234.00 239.00 351.0086337 Insulin Ab 286.00 280.00 286.00 420.0086341 Islet cell Ab 123.00 120.00 123.00 180.0086344 Leukocyte phagocytosis 2,338.00 2,288.00 2,338.00 3,432.0086353 Lymphocyte transformation 1,684.00 1,648.00 1,684.00 2,472.0086359 T and B cell count 662.00 648.00 662.00 972.0086360 T cells absolute CD4 and CD8 count, including ratio 2,072.00 2,027.00 2,072.00 3,041.0086376 Microsomal Ab, eg, thyroid or liver-kidney 283.00 277.00 283.00 416.0086382 Virus neutralization test 339.00 332.00 339.00 498.0086403 Agglutination, screen (latex, Rose Waller) 139.00 136.00 139.00 204.0086406 Agglutination, particle, titer, each Ab 301.00 295.00 301.00 443.0086431 Rheumatoid factor, qualitative/quantitative 118.00 115.00 118.00 173.0086580 Skin test; tuberculosis, intradermal 63.00 62.00 63.00 93.0086592 Syphilis test, VDRL, RPR, TPHA, FTA, ELISA 118.00 115.00 118.00 173.0086619 Borrelia (relapsing fever) Ab 398.00 389.00 398.00 584.0086644 CMV (cytomegalovirus) Ab 242.00 237.00 242.00 356.0086648 Diphtheria Ab 199.00 195.00 199.00 293.0086677 Helicobacter pylori Ab - Blood 49.00 48.00 49.00 72.0086692 Hepatitis delta Ab 102.00 100.00 102.00 150.0086703 HIV screening, central blood bank 0.00 0.00 0.00 0.0086704 HBcAb (Hepatitis B core Antibody), total, IgG and IgM 60.00 59.00 60.00 89.0086705 HBcAb (Hepatitis B core Ab) IgM 65.00 64.00 65.00 96.0086706 HBsAb (Hepatitis B surface Ab) 33.00 32.00 33.00 48.0086707 HBeAb (Hepatitis Be Ab) 83.00 81.00 83.00 122.0086708 HAAb (Hepatitis A antibody), total, IgG and IgM 87.00 85.00 87.00 128.0086709 HAAb (Hepatitis A Ab) IgM/IgG 106.00 104.00 106.00 156.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

86720 Leptospira Ab 181.00 177.00 181.00 266.0086738 Mycoplasma Ab 249.00 244.00 249.00 366.0086762 Rubella virus IgG and IgM 123.00 120.00 123.00 180.0086778 Toxoplasma IgM 76.00 74.00 76.00 111.0086789 West Nile virus IgG and IgM 390.00 382.00 390.00 573.0086790 Virus/bacteria Ab, not otherwise specified 199.00 195.00 199.00 293.0086800 Thyroglobulin Ab 301.00 295.00 301.00 443.0086803 Hepatitis C Ab 36.00 35.00 36.00 53.0086805 Lymphocytotoxicity assay, visual crossmatch; with titration 319.00 312.00 319.00 468.0086813 HLA typing, A, B, C 1,641.00 1,606.00 1,641.00 2,409.0086817 HLA typing, DR/DQ 2,124.00 2,078.00 2,124.00 3,117.0086821 HLA typing, MLC (mixed lymphocyte culture) 2,124.00 2,078.00 2,124.00 3,117.0086880 DAT (Direct Antiglobulin Test) / Coombs 144.00 141.00 144.00 212.0086900 Blood typing, including RH 95.00 93.00 95.00 140.0086901 Rh test 118.00 115.00 118.00 173.0086903 Blood typing and Rh, Ab, screen 414.00 405.00 414.00 608.0086904 Blood typing and Rh, Ab 825.00 807.00 825.00 1,211.0086905 Blood typing; RBC antigens, other than ABO or Rh (D) 1,256.00 1,229.00 1,256.00 1,844.0086940 Hemolysins and agglutinins, screen 430.00 421.00 430.00 632.0087001 Animal inoculation, eg, tuberculosis 430.00 421.00 430.00 632.0087040 Blood culture and susceptibility 89.00 87.00 89.00 131.0087045 Feces culture 118.00 115.00 118.00 173.0087070 Culture, other source, excluding blood/urine/feces 89.00 87.00 89.00 131.0087081 Urine culture, non quantitative 118.00 115.00 118.00 173.0087086 Urine culture, quantitative 241.00 236.00 241.00 354.0087088 Urine culture and susceptibility 135.00 132.00 135.00 198.0087106 Fungi culture 118.00 115.00 118.00 173.0087109 Mycoplasma culture 181.00 177.00 181.00 266.0087110 Chlamydia culture 368.00 360.00 368.00 540.00



Price A(ILS)

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fromAbroad(ILS)

87116 Mycobacteria culture and identification 393.00 385.00 393.00 578.0087118 Mycobacterial definitive identification, MTb 197.00 193.00 197.00 290.0087140 Fluorescence or darkfield microscopy 118.00 115.00 118.00 173.0087177 Ova and parasites, direct smear, identification - feces 89.00 87.00 89.00 131.0087181 Susceptibility studies, antimicrobial agent, per agent 118.00 115.00 118.00 173.0087190 Susceptibility studies, antimycobacterial agent, mycobacteria 268.00 262.00 268.00 393.0087205 Smear interpretation, stain for bacteria, fungi, parasites or cell

types89.00 87.00 89.00 131.00

87207 Smear, special stain for parasites 118.00 115.00 118.00 173.0087250 Virus isolation, including nucleic acid identification, polymerase

chain reaction, PCR460.00 450.00 460.00 675.00

87252 Virus isolation, tissue culture 144.00 141.00 144.00 212.0087253 Virus isolation and identification, tissue culture, any method 728.00 712.00 728.00 1,068.0087278 Legionella Ag - urine 179.00 175.00 179.00 263.0087299 Immunofluorescent study; not otherwise specified 249.00 244.00 249.00 366.0087340 HBsAg (Hepatitis B surface Antigen), any method, including

immunofluorescent study101.00 99.00 101.00 149.00

87350 HBeAg (Hepatitis Be Antigen), any method, includingimmunofluorescent study

83.00 81.00 83.00 122.00

87389 HIV Ab and P24 Ag, ELISA/EIA, at MOH recognized HIVlaboratory

26.00 25.00 26.00 38.00

87449 Infectious agent Ag detection, not otherwise specified 413.00 404.00 413.00 606.0087472 Bartonella henselae and Bartonella quintana, quantification 316.00 309.00 316.00 464.0087517 Hepatitis B virus DNA/RNA, quantitative 561.00 549.00 561.00 824.0087522 Hepatitis C virus DNA/RNA, quantitative 1,041.00 1,019.00 1,041.00 1,529.0087536 HIV-1 DNA/RNA, quantitative 1,457.00 1,426.00 1,457.00 2,139.0087539 HIV-2 DNA/RNA, quantitative 1,457.00 1,426.00 1,457.00 2,139.0087556 Mycobacteria tuberculosis, AMTD 502.00 491.00 502.00 737.0087590 Gonorrhoeae smear 0.00 0.00 0.00 0.0087620 Papillomavirus (HPV) - tissue, including biopsy 2,071.00 2,026.00 2,071.00 3,039.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

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fromAbroad(ILS)

87622 HPV (Human Papillomavirus) smear 431.00 422.00 431.00 633.0088036 Necropsy (autopsy), limited, gross and/or microscopic; regional 728.00 712.00 728.00 1,068.0088130 Sex chromatin identification, Barr bodies 144.00 141.00 144.00 212.0088141 Pap smear, cervical/vaginal, cytopathology, including sampling 124.00 121.00 124.00 182.0088160 Cytopathology examination and interpretation 199.00 195.00 199.00 293.0088230 Karyotype, leukocyte culture 1,259.00 1,232.00 1,259.00 1,848.0088233 Karyotype, tissue culture 1,623.00 1,588.00 1,623.00 2,382.0088240 Cryopreservation of cells (eg, bone marrow), per year 1,579.00 1,545.00 1,579.00 2,318.0088299 B &T cell receptor gene rearrangment analysis 1,177.00 1,152.00 1,177.00 1,728.0088305 Histologic examination, microscopy and interpretation 199.00 195.00 199.00 293.0088313 Bone marrow sampling and iron stain 458.00 448.00 458.00 672.0088319 Histochemistry/cytochemistry stain for enzyme identification 199.00 195.00 199.00 293.0088346 Immunofluorescent study, each Ab; direct method 1,065.00 1,042.00 1,065.00 1,563.0088347 Immunofluorescent study, each Ab; indirect method 1,065.00 1,042.00 1,065.00 1,563.0088348 EM (Electron microscopy), diagnostic 3,563.00 3,486.00 3,563.00 5,229.0089051 Cell count - body fluids, eg, CSF, joint fluid, excluding blood 139.00 136.00 139.00 204.0089258 Cryopreserved embryos storage for 5 years 728.00 712.00 728.00 1,068.0089259 Cryopreservation, sperm, one year, up to 5 test tubes/straws 801.00 784.00 801.00 1,176.0089280 Assisted oocyte fertilization, microtechnique 4,820.00 3,524.00 3,616.00 7,077.0089290 Biopsy, oocyte polar body or embryo blastomere, microtechnique

(for pre-implantation genetic diagnosis)10,389.00 10,165.00 10,389.00 15,248.00

89300 Semen analysis; presence and/or motility of sperm includingHuhner test (post coital)

274.00 268.00 274.00 402.00

89320 Semen analysis, complete (volume, count, motility, anddifferential)

168.00 164.00 168.00 246.00

89325 Sperm Ab 268.00 262.00 268.00 393.0090371 HBIg (Hepatitis B immune globulin), IM 4,595.00 4,496.00 4,595.00 6,744.0090375 Rlg (Rabies immune globulin), IM and/or subcutaneous 3,140.00 3,072.00 3,140.00 4,608.0090384 Rho(D) immune globulin (Rhlg), Anti-D 561.00 549.00 561.00 824.0090585 BCG (Bacillus Calmette-Guerin) vaccine for tuberculosis 0.00 0.00 0.00 0.00



Price A(ILS)

Price B(ILS)

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fromAbroad(ILS)

90586 BCG vaccine for bladder, live, for intravesical use, per treatment,including material

1,013.00 991.00 1,013.00 1,487.00

90749 Immunization for contagious diseases, not otherwise specified 118.00 115.00 118.00 173.0090772 Subcutaneous/IM injection, therapeutic/prophylactic/diagnostic 42.00 41.00 42.00 62.0090862 Psychiatric pharmacological management/review 122.00 119.00 122.00 179.0090870 Electroconvulsive therapy 1,239.00 1,212.00 1,239.00 1,818.0090880 Hypnotherapy 147.00 144.00 147.00 216.0090889 Psychiatric medical opinion 679.00 664.00 679.00 996.0090901 Biofeedback training 444.00 434.00 444.00 651.0090935 Hemodialysis procedure, per treatment 1,371.00 1,341.00 1,371.00 2,012.0090945 Dialysis procedure other than hemodialysis (eg, peritoneal

dialysis)620.00 607.00 620.00 911.00

91010 Esophageal motility (manometric study) 1,229.00 1,203.00 1,229.00 1,805.0091034 Esophagus, acid reflux test, with intraluminal pH electrode for

dection of gastroesophageal reflux; prolonged recording1,229.00 1,203.00 1,229.00 1,805.00

91065 Breath hydrogen test (eg, for detection of lactase deficiency) 225.00 220.00 225.00 330.0091122 Anorectal manometry 1,229.00 1,203.00 1,229.00 1,805.0092004 Ophthalmological examination, initial 546.00 534.00 546.00 801.0092065 Orthoptic evaluation and therapy 118.00 115.00 118.00 173.0092081 Computerised visual field examination 184.00 180.00 184.00 270.0092083 Visual field examination (eg, Goldmann visual fields) 144.00 141.00 144.00 212.0092230 Fluorescein angioscopy, unilateral 776.00 759.00 776.00 1,139.0092235 Fluorescein angioscopy, bilateral 1,069.00 1,046.00 1,069.00 1,569.0092240 ICGI eye imaging, with interpretation and report 1,960.00 1,918.00 1,960.00 2,877.0092250 Fundus photography, one eye 234.00 229.00 234.00 344.0092270 Electro-oculography with interpretation and report 368.00 360.00 368.00 540.0092275 Electroretinography with interpretation 849.00 831.00 849.00 1,247.0092283 Color vision examination 144.00 141.00 144.00 212.0092284 Dark adaptation examination with interpretation 430.00 421.00 430.00 632.0092285 External eye photography, with interpretation and report 460.00 450.00 460.00 675.00



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fromAbroad(ILS)

92286 Anterior segment photography, one eye 368.00 360.00 368.00 540.0092287 Anterior segment photography, two eyes 550.00 538.00 550.00 807.0092310 Contact lens fitting, including adjustment 118.00 115.00 118.00 173.0092355 Fitting of telescopic lens system, age-related macular

degeneration166.00 162.00 166.00 243.00

92506 Evaluation of speech, language, voice 144.00 141.00 144.00 212.0092507 Speech therapy, individual 140.00 137.00 140.00 206.0092508 Speech therapy, group, per hour 118.00 115.00 118.00 173.0092512 Rhinomanometry 225.00 220.00 225.00 330.0092526 Feeding and swallowing therapy, per treatment 135.00 132.00 135.00 198.0092541 Spontaneous nystagmus test, ENG (electronystagmography) 546.00 534.00 546.00 801.0092551 Auditory test, screening 33.00 32.00 33.00 48.0092557 Auditory test, comprehensive 199.00 195.00 199.00 293.0092567 Tympanometry (impedance testing) 87.00 85.00 87.00 128.0092568 Acoustic reflex testing 193.00 189.00 193.00 284.0092585 Brain auditory evoked potentials, adult 696.00 681.00 696.00 1,022.0092588 Brain evoked potentials, child 946.00 926.00 946.00 1,389.0092590 Hearing aid fitting 265.00 259.00 265.00 389.0092593 Hearing aid check/counseling, binaural 199.00 195.00 199.00 293.0092601 Diagnostic analysis and programing of cochlear implant, binaural,

under age 71,849.00 1,809.00 1,849.00 2,714.00

92602 Diagnostic analysis and subsequent programing of cochlearimplant, monaural, under age 7

601.00 588.00 601.00 882.00

92603 Diagnostic analysis and programing of cochlear implant, binaural,age 7 or over

1,849.00 1,809.00 1,849.00 2,714.00

92604 Diagnostic analysis and subsequent programing of cochlearimplant, monaural, age 7 or over

601.00 588.00 601.00 882.00

92620 Central auditory function test(s) 394.00 386.00 394.00 579.0092633 Auditory rehabilitation following cochlear implant 139.00 136.00 139.00 204.0093000 ECG (Electrocardiogram), with interpretation and report 41.00 40.00 41.00 60.00



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fromAbroad(ILS)

93012 CardioBeeper device loan 210.00 205.00 210.00 308.0093015 Cardiovascular stress test 311.00 304.00 311.00 456.0093224 ECG monitoring for 24 hours (Holter) 555.00 543.00 555.00 815.0093307 TTE (transthoracic echocardiography), adult 470.00 460.00 470.00 690.0093312 TEE (transesophageal echocardiography) 1,775.00 1,737.00 1,775.00 2,606.0093350 Effort or Dobutamine stress echocardiography (DSE) 1,106.00 1,082.00 1,106.00 1,623.0093720 Pulmonary function tests, infant, plethysmography, with

interpretation3,403.00 3,330.00 3,403.00 4,995.00

93784 Blood pressure monitoring, for 24 hours 491.00 480.00 491.00 720.0093797 Cardiac rehabilitation, per month 914.00 894.00 914.00 1,341.0093880 Cervical arteries duplex, bilateral 433.00 424.00 433.00 636.0093923 Extremities arteries duplex, stress and rest 409.00 400.00 409.00 600.0093925 Extremity arteries/bypass grafts duplex 433.00 424.00 433.00 636.0093965 Peripheral vessels flow study (eg, Doppler) 181.00 177.00 181.00 266.0093975 Abdomen, pelvis and retroperitoneal vessels duplex 409.00 400.00 409.00 600.0093980 Penile vessels duplex, per patient 559.00 547.00 559.00 821.0094010 Spirometry, simple 128.00 125.00 128.00 188.0094060 Spirometry with bronchodilator 154.00 151.00 154.00 227.0094070 Prolonged bronchi evaluation, methacholine or other chemical

agent907.00 887.00 907.00 1,331.00

94200 Maximal voluntary ventilation 61.00 60.00 61.00 90.0094240 Functional residual volume, noble gas 649.00 635.00 649.00 953.0094250 Expired gas collection, quantitative 323.00 316.00 323.00 474.0094360 Resistance to airflow, plethysmographic method 555.00 543.00 555.00 815.0094400 Breathing response to CO2 (CO2 response curve) 1,083.00 1,060.00 1,083.00 1,590.0094620 Pulmonary stress test, simple, including pre- and post-spirometry 179.00 175.00 179.00 263.0094621 Pulmonary stress testing, complex 1,371.00 1,341.00 1,371.00 2,012.0094640 Inhalation treatment 42.00 41.00 42.00 62.0094664 Demonstration of an aerosol/inhaler use 74.00 72.00 74.00 108.00



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fromAbroad(ILS)

94667 Physiotherapy, lung patient, per treatment 140.00 137.00 140.00 206.0094720 Carbon monoxide diffusing capacity 323.00 316.00 323.00 474.0094760 Noninvasive ear or pulse oximetry for oxygen saturation 89.00 87.00 89.00 131.0094762 Oxygen saturation, overnight oximetry 184.00 180.00 184.00 270.0094772 Pulmonary function tests, passive, child 3,398.00 3,325.00 3,398.00 4,988.0095004 Aeroallergens/food, up to 10 allergens, screen 139.00 136.00 139.00 204.0095012 Nitric oxide determination - exhaled air, per patient 342.00 335.00 342.00 503.0095028 Aeroallergens/food, 11 or over allergens, extended test 331.00 324.00 331.00 486.0095044 Patch or application skin alergy test 180.00 176.00 180.00 264.0095120 Allergen immunotherapy, normal allergen 197.00 193.00 197.00 290.0095130 Allergen immunotherapy, pure allergen 403.00 394.00 403.00 591.0095199 Susceptibility studies, antimicrobial agent; lymphocyte and serum 1,065.00 1,042.00 1,065.00 1,563.0095810 Polysomnography, including EEG, adult 1,198.00 1,172.00 1,198.00 1,758.0095812 EEG (Electroencephalogram) 430.00 421.00 430.00 632.0095813 EEG (Electroencephalogram) extended monitoring 931.00 911.00 931.00 1,367.0095822 EEG (Electroencephalogram), sleep 704.00 689.00 704.00 1,034.0095830 EEG (Electroencephalogram), sphenoidal recording 770.00 753.00 770.00 1,130.0095857 Tensilon test for myasthenia gravis 193.00 189.00 193.00 284.0095861 EMG (electromyography) 260.00 254.00 260.00 381.0095872 EMG (Electromyography) 745.00 729.00 745.00 1,094.0095900 NCT (Nerve conduction test) 594.00 581.00 594.00 872.0095922 Testing of autonomic nervous system function; vasomotor

adrenergic innervation (sympathetic adrenergic function),including beat-to-beat blood pressure and R-R interval changesduring Valsalva maneuver and at least five minutes of passive tilt

517.00 506.00 517.00 759.00

95923 Electrolyte concentration determination, sweat imprint 144.00 141.00 144.00 212.0095930 VEP (visual evoked potential), adult 696.00 681.00 696.00 1,022.0095950 EEG (electroencephalogram), 24 hours 2,096.00 2,051.00 2,096.00 3,077.00



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fromAbroad(ILS)

95990 Refilling and maintenance of implantable pump or reservoir fordrug delivery, spinal (intrathecal, epidural) or brain(intraventricular)

948.00 928.00 948.00 1,392.00

96001 Computerized three dimensional motion and walking analysis,per patient

4,002.00 3,916.00 4,002.00 5,874.00

96567 Photodynamic therapy (PDT), dermal lesions, non-melanoma/solar keratosis

963.00 942.00 963.00 1,413.00

96910 Phototherapy by UVB and tar/petrolatum 143.00 140.00 143.00 210.0096912 Photochemotherapy by PUVA, including psoralens 168.00 164.00 168.00 246.0097001 Physiotherapy, evaluation and treatment planning, adult 224.00 219.00 224.00 329.0097003 Occupational therapy, evaluation and treatment planning, adult 224.00 219.00 224.00 329.0097113 Aquatic physiotherapy/rehabilitation, individual, hydrotherapy 218.00 213.00 218.00 320.0097140 Physiotherapy, individual 140.00 137.00 140.00 206.0097150 Physiotherapy/rehabilitation, group, 4 or more individuals,

including child, per individual42.00 41.00 42.00 62.00

97530 Occupational therapy, individual 140.00 137.00 140.00 206.0097750 Physical performance test or measurement (eg, musculoskeletal,

functional capacity), with written report, eg, evaluation ofpressure on sole

662.00 648.00 662.00 972.00

97802 Medical nutrition counseling and therapy 139.00 136.00 139.00 204.0097810 Acupuncture 199.00 195.00 199.00 293.0099001 Histopathology slides preparation for shipment 316.00 309.00 316.00 464.0099002 Histopathology slides preparation in Israel 458.00 448.00 458.00 672.0099075 Forensic medical opinion 1,849.00 1,809.00 1,849.00 2,714.0099080 Medical opinion 677.00 662.00 677.00 993.0099183 Elective hyperbaric oxygen therapy, per treatment, up to 2 hours 949.00 929.00 949.00 1,394.0099195 Phlebotomy 139.00 136.00 139.00 204.0099212 Follow up allergy testing after 95028 118.00 115.00 118.00 173.0099214 Post hospitalization examination 0.00 0.00 0.00 0.0099223 Pre-operation evaluation, serial tests 898.00 879.00 898.00 1,319.00



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fromAbroad(ILS)

99242 Physician examination, excluding tests with specific code 259.00 136.00 139.00 380.0099283 ER visit, global payment 840.00 822.00 840.00 1,233.0099315 Clinic nurse service, up to 30 minutes 81.00 79.00 81.00 119.0099316 Clinic nurse service, over 30 minutes (eg, guidance for patient

with stoma)171.00 167.00 171.00 251.00

99362 Multidisciplinary team examination 546.00 534.00 546.00 801.0099371 Telephonic consultation for poisoning/medication

information/teratology217.00 212.00 217.00 318.00

99600 Home visit, care worker 188.00 184.00 188.00 276.00C0443 Release of carpal tunnel, in surgical day care 2,058.00 2,014.00 2,058.00 3,021.00C0449 Peripheral nerve decompression/lysis of adhesions, excluding

endoneurolysis, in surgical day care4,007.00 3,921.00 4,007.00 5,882.00

C0460 Peripheral nerve transposition, eg, ulnar nerve, in surgical daycare

4,007.00 3,921.00 4,007.00 5,882.00

C0476 Peripheral nerve repair, old traumatic injury, eg, ulnar nerve, insurgical day care

4,007.00 3,921.00 4,007.00 5,882.00

C0492 Implantation of sacral nerve stimulation electrode/lead, excludingfor chronic pain management, in surgical day care, excludingdevice cost

6,564.00 6,423.00 6,564.00 9,635.00

C0494 Implantation of temporary spinal cord/root/peripheral nervestimulation lead(s) for chronic pain management, in surgical daycare, excluding device cost

4,547.00 4,449.00 4,547.00 6,674.00

C0495 Implantation of permanent spinal cord/root/peripheral nervestimulation lead(s) and generator for chronic pain management,in surgical day care, excluding device cost

8,506.00 8,323.00 8,506.00 12,485.00

C0496 Replacement of permanent spinal cord/root/peripheral nervestimulation generator for chronic pain management, in surgicalday care, excluding device cost

4,547.00 4,449.00 4,547.00 6,674.00

C0670 Excision of thyroglossal/branchial cleft cyst/sinus, in surgical daycare

4,007.00 3,921.00 4,007.00 5,882.00



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fromAbroad(ILS)

C0823 Excision of lesion(s) and/or tissue of eyelid, excluding chalazion,in surgical day care

4,007.00 3,921.00 4,007.00 5,882.00

C0849 Repair of eyelid position, excluding complex repair, in surgicalday care

4,007.00 3,921.00 4,007.00 5,882.00

C0870 Reconstruction of eyelid, in surgical day care 4,007.00 3,921.00 4,007.00 5,882.00C0889 Repair of eyelid position, complex, in surgical day care 4,007.00 3,921.00 4,007.00 5,882.00C0920 Lacrimal system operation, excluding fistulization, in surgical day

care4,007.00 3,921.00 4,007.00 5,882.00

C1000 Conjunctiva operation, excluding removal of superficial foreignbody, in surgical day care

4,007.00 3,921.00 4,007.00 5,882.00

C1139 Excision of pterygium, without graft, in surgical day care 4,007.00 3,921.00 4,007.00 5,882.00C1511 Extraocular muscle(s) operation for strabismus repair, in surgical

day care4,007.00 3,921.00 4,007.00 5,882.00

C2169 Turbinectomy, in surgical day care 4,007.00 3,921.00 4,007.00 5,882.00C2189 Nose operation/rhinoplasty, in surgical day care 4,007.00 3,921.00 4,007.00 5,882.00C2220 Intranasal antrotomy, excluding FESS, in surgical day care 4,007.00 3,921.00 4,007.00 5,882.00C2840 Excision of tonsil tag/lingual tonsil or adenoidectomy without

tonsillectomy, in surgical day care5,439.00 5,322.00 5,439.00 7,983.00

C3143 Laryngoscopy with biopsy, in surgical day care 4,007.00 3,921.00 4,007.00 5,882.00C3321 Bronchoscopy through artificial stoma, in surgical day care 4,007.00 3,921.00 4,007.00 5,882.00C3324 Bronchoscopy with biopsy, in surgical day care 4,007.00 3,921.00 4,007.00 5,882.00C4011 Biopsy of lymphatic structure, in surgical day care 4,007.00 3,921.00 4,007.00 5,882.00C4021 Excision of lymph node(s), excluding internal mammary, in

surgical day care4,007.00 3,921.00 4,007.00 5,882.00

C4911 Anal fistulotomy/fistulectomy under general anesthesia, insurgical day care

4,007.00 3,921.00 4,007.00 5,882.00

C4943 Destruction of hemorrhoids by cauterization/cryotherapy, insurgical day care

4,007.00 3,921.00 4,007.00 5,882.00

C4945 Ligation of hemorrhoids, in surgical day care 7,144.00 6,990.00 7,144.00 10,485.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

C5011 Biopsy of liver, needle; percutaneous, not using CT/MRIguidance, in surgical day care

4,007.00 3,921.00 4,007.00 5,882.00

C5349 Umbilical hernia repair, up to 5 years of age, in surgical day care 4,007.00 3,921.00 4,007.00 5,882.00C5810 Urethral meatotomy, in surgical day care 4,007.00 3,921.00 4,007.00 5,882.00C5860 Dilation of urethra, in surgical day care 4,007.00 3,921.00 4,007.00 5,882.00C6120 Excision of lesion(s) and/or hydrocele and/or varicocele of tunica

vaginalis/spermatic cord, in surgical day care4,007.00 3,921.00 4,007.00 5,882.00

C6250 Orchiopexy, in surgical day care 4,007.00 3,921.00 4,007.00 5,882.00C6420 Excision/destruction of lesion(s) and/or tissue of penis under

general anesthesia, in surgical day care4,007.00 3,921.00 4,007.00 5,882.00

C6720 Biopsy/conization of cervix, excluding bycauterization/cryosurgery, in surgical day care

4,007.00 3,921.00 4,007.00 5,882.00

C6739 Excision of lesion(s) of cervix, including bycauterization/cryosurgery, in surgical day care

4,007.00 3,921.00 4,007.00 5,882.00

C6759 Cerclage/repair of uterine cervix, in surgical day care 4,007.00 3,921.00 4,007.00 5,882.00C7011 Hymenotomy/hymenectomy, in surgical day care 4,007.00 3,921.00 4,007.00 5,882.00C7024 Biopsy/excision/destruction of lesion(s) of vagina, in surgical day

care4,007.00 3,921.00 4,007.00 5,882.00

C7129 Bartholin's gland/cyst operation under general anesthesia, insurgical day care

4,007.00 3,921.00 4,007.00 5,882.00

C7609 SARPE (Surgically Assisted Rapid Palatal Expansion), insurgical day care

8,249.00 8,071.00 8,249.00 12,107.00

C7744 Biopsy of bone/arthrotomy of hand/foot and finger(s)/toe(s), insurgical day care

4,007.00 3,921.00 4,007.00 5,882.00

C7752 Bunion (eg, hallux valgus) surgery, excluding hammer toe, insurgical day care

8,935.00 8,743.00 8,935.00 13,115.00

C7753 Bunion (eg, hallux valgus) surgery with hammer toe surgery, insurgical day care

15,347.00 15,017.00 15,347.00 22,526.00

C7756 Hammer toe surgery, in surgical day care 8,655.00 8,469.00 8,655.00 12,704.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

C7860 Removal of implanted device from bone, excludingface/hand/foot, in surgical day care

4,007.00 3,921.00 4,007.00 5,882.00

C8044 Capsulotomy of hand/foot and finger(s)/toe(s), in surgical daycare

4,007.00 3,921.00 4,007.00 5,882.00

C8149 Ankle ligament reconstruction, in surgical day care 11,057.00 10,819.00 11,057.00 16,229.00C8201 Tendon sheath incision, in surgical day care 4,007.00 3,921.00 4,007.00 5,882.00C8313 Tenotomy, excluding of hand, in surgical day care 4,007.00 3,921.00 4,007.00 5,882.00C8331 Excision of lesion(s) of tendon sheath, in surgical day care 4,007.00 3,921.00 4,007.00 5,882.00C8350 Excision of bursa, in surgical day care 4,007.00 3,921.00 4,007.00 5,882.00C8611 Biopsy of subcutaneous tissue under general anesthesia, in

surgical day care4,007.00 3,921.00 4,007.00 5,882.00

C8630 Excision/destruction of lesions of skin and subcutaneous tissue,4 or more, in surgical day care

4,007.00 3,921.00 4,007.00 5,882.00

C8660 Free skin grafting, including excision of skin for autogenous graft,in surgical day care

4,007.00 3,921.00 4,007.00 5,882.00

C8689 Repair and reconstruction of skin and subcutaneous tissue, insurgical day care

4,007.00 3,921.00 4,007.00 5,882.00

C8694 Implantation of sacral nerve stimulation generator, excluding forchronic pain management, in surgical day care, excluding devicecost

2,488.00 2,434.00 2,488.00 3,651.00

C9802 Esophagoscopy for removal of foreign body, in surgical day care 4,007.00 3,921.00 4,007.00 5,882.00C999C Surgical hospital day care, excluding procedures with specific

code4,007.00 3,921.00 4,007.00 5,882.00

D0210 Intra oral radiograph - complete series 375.00 367.00 375.00 551.00D0220 Intraoral - periapical first radiographic image 42.00 41.00 42.00 62.00D0230 Intraoral - periapical each additional radiographic image 42.00 41.00 42.00 62.00D0240 Intraoral - occlusal radiographic image 89.00 87.00 89.00 131.00D0330 Panoramic radiographic image 331.00 324.00 331.00 486.00D1201 Application of fluoride, complete 104.00 102.00 104.00 153.00D1351 Sealant, per tooth 154.00 151.00 154.00 227.00D1510 Space maintainer, fixed 777.00 760.00 777.00 1,140.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

D2140 Restoration - one surface, local anesthesia 263.00 257.00 263.00 386.00D2150 Restoration -2/more surfaces, any material 331.00 324.00 331.00 486.00D2330 Resin-based composite restoration - one surface, anterior 447.00 437.00 447.00 656.00D2335 Resin-based composite restoration, anterior 553.00 541.00 553.00 812.00D2390 Resin-based composite restoration - crown 481.00 471.00 481.00 707.00D2752 Crown - porcelain fused to noble metal 2,826.00 2,765.00 2,826.00 4,148.00D2950 Core build-up, including any pins 912.00 892.00 912.00 1,338.00D2952 Post and core in addition to crown 1,332.00 1,303.00 1,332.00 1,955.00D2980 Crown repair 260.00 254.00 260.00 381.00D3220 Pulpotomy, primary/permanent tooth 242.00 237.00 242.00 356.00D3230 Pulpal therapy, resorbable filling - primary tooth, excluding final

restoration481.00 471.00 481.00 707.00

D3310 Root canal therapy - anterior, excluding final restoration 986.00 965.00 986.00 1,448.00D3320 Root canal therapy - bicuspid, excluding final restoration 986.00 965.00 986.00 1,448.00D3330 Root canal therapy - molar, excluding final restoration 986.00 965.00 986.00 1,448.00D3351 Apexification 397.00 388.00 397.00 582.00D3410 Apicoectomy, anterior, including placement of retrograde filling

material988.00 967.00 988.00 1,451.00

D3421 Apicoectomy - bicuspid, including placement of retrograde fillingmaterial

1,234.00 1,207.00 1,234.00 1,811.00

D3425 Apicoectomy - molar, including placement of retrograde fillingmaterial

2,096.00 2,051.00 2,096.00 3,077.00

D3450 Root amputation 1,234.00 1,207.00 1,234.00 1,811.00D3920 Hemisection 863.00 844.00 863.00 1,266.00D4240 Gingival flap, with root planing, per quadrant 847.00 829.00 847.00 1,244.00D4249 Clinical crown lengthening 789.00 772.00 789.00 1,158.00D4260 Osseous surgery, including flap entry and closure, per quadrant 1,088.00 1,065.00 1,088.00 1,598.00D4341 Periodontal scaling and root planing, per meeting, 30 minutes 144.00 141.00 144.00 212.00D5110 Complete acrylic denture - pair 8,265.00 8,087.00 8,265.00 12,131.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

D5213 Partial denture 7,617.00 7,453.00 7,617.00 11,180.00D5730 Reline denture (chairside) 882.00 863.00 882.00 1,295.00D5750 Reline denture - laboratory 2,177.00 2,130.00 2,177.00 3,195.00D5951 Feeding aid; feeding prosthesis 683.00 668.00 683.00 1,002.00D5952 Speech aid prosthesis, pediatric 683.00 668.00 683.00 1,002.00D6010 Surgical placement of dental implant body: endosteal implant,

includes placement of healing cap3,801.00 3,719.00 3,801.00 5,579.00

D6056 Prefabricated abutment for dental implant 2,374.00 2,323.00 2,374.00 3,485.00D7111 Extraction, coronal remnants - deciduous tooth 262.00 256.00 262.00 384.00D7140 Extraction, erupted tooth or exposed root, single 262.00 256.00 262.00 384.00D7141 Extraction, erupted tooth or exposed root, second in the same

session193.00 189.00 193.00 284.00

D7142 Extraction, erupted tooth or exposed root, each additional toothin the same session

130.00 127.00 130.00 191.00

D7210 Surgical removal of erupted tooth requiring elevation ofmucoperiosteal flap and removal of bone and/or section of tooth

271.00 265.00 271.00 398.00

D7220 Removal of impacted tooth - soft tissue 618.00 605.00 618.00 908.00D7230 Removal of impacted tooth - partially bony 863.00 844.00 863.00 1,266.00D7240 Removal of impacted tooth - completely bony 863.00 844.00 863.00 1,266.00D7270 Tooth reimplantation and/or stabilization of accidentally evulsed

or displaced tooth and/or alveolus628.00 614.00 628.00 921.00

D7280 Exposure of impacted/unerupted tooth for orthodontic reasons,including orthodontic attachments

863.00 844.00 863.00 1,266.00

D7320 Alveoloplasty not in conjunction with extractions - per quadrant 636.00 622.00 636.00 933.00D7340 Vestibuloplasty - ridge extension (secondary epithelialization) 843.00 825.00 843.00 1,238.00D7450 Removal of odontogenic cyst 636.00 622.00 636.00 933.00D7950 Bone graft to maxilla/mandible, unilateral 10,846.00 10,613.00 10,846.00 15,920.00D7952 Open sinus augmentation, including bone graft, unilateral 5,132.00 5,022.00 5,132.00 7,533.00D7960 Frenulectomy (frenectomy or frenotomy) 618.00 605.00 618.00 908.00D7993 Bone graft to maxilla/mandible, bilateral 16,531.00 16,175.00 16,531.00 24,263.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

D7994 Open sinus augmentation, including bone graft, bilateral 9,820.00 9,609.00 9,820.00 14,414.00D8050 Interceptive orthodontic therapy, including chin cup 1,660.00 1,624.00 1,660.00 2,436.00D8080 Comprehensive orthodontic treatment of the adolescent

dentition, for one year, up to 3 years4,399.00 4,304.00 4,399.00 6,456.00

D8089 Follow up code of D8080, established adolescent patient forcomprehensive orthodontic treatment

0.00 0.00 0.00 0.00

D8210 Removable dental appliance therapy 882.00 863.00 882.00 1,295.00D8998 Orthodontic treatment preparatory to, and accompanying,

orthognathic surgery, per patient21,204.00 20,748.00 21,204.00 31,122.00

D8999 Orthodontic preparation for orthognathic face mask 1,660.00 1,624.00 1,660.00 2,436.00D9110 Emergency treatment of dental pain 184.00 180.00 184.00 270.00D9220 Deep sedation/general anesthesia, for dental procedure - first

hour1,307.00 1,279.00 1,307.00 1,919.00

D9221 Deep sedation/general anesthesia, for complex dental procedure- more than one hour

1,479.00 1,447.00 1,479.00 2,171.00

D9230 Analgesia, including nitrous, excluding dental treatment 241.00 236.00 241.00 354.00J0011 Costeff syndrome, Methylglutaconic aciduria, molecular

diagnostics, special case478.00 468.00 478.00 702.00

J0021 Adrenoleukodystrophy X-linked, molecular diagnostics, specialcase

478.00 468.00 478.00 702.00

J0031 Canavan disease, molecular diagnostics, special case 478.00 468.00 478.00 702.00J0041 Carnitine Palmitoyl Tranferase, molecular diagnostics, special

case478.00 468.00 478.00 702.00

J0051 Cystinuria, molecular diagnostics, special case 478.00 468.00 478.00 702.00J0061 Glycogen storage disease type 1, molecular diagnostics, special

case478.00 468.00 478.00 702.00

J0071 Hyperglycinemia, nonketotic, molecular diagnostics, special case 478.00 468.00 478.00 702.00J0081 Hyperoxaluria, primary, type 1, molecular diagnostics, special

case478.00 468.00 478.00 702.00

J0091 Isovalericacidemia, molecular diagnostics, special case 478.00 468.00 478.00 702.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

J0101 Lipoamide Dehydrogenase Deficiency, molecular diagnostics,special case

478.00 468.00 478.00 702.00

J0111 Maple syrup urine disease, molecular diagnostics, special case 478.00 468.00 478.00 702.00J0121 Methylmalonicaciduria, mutase deficiency, molecular diagnostics,

special case478.00 468.00 478.00 702.00

J0131 Molybdenum cofactor deficiency, molecular diagnostics, specialcase

478.00 468.00 478.00 702.00

J0141 Peroxysomal disorders, molecular diagnostics, special case 478.00 468.00 478.00 702.00J0151 Phenylketonuria, molecular diagnostics, special case 478.00 468.00 478.00 702.00J0161 Thiamine-responsive megaloblastic anemia, molecular


J0171 Tyrosinemia, molecular diagnostics, special case 478.00 468.00 478.00 702.00J0181 VLCAD (Very Long Chain Acyl CoA Dehydrogenase) deficiency,

molecular diagnostics, special case478.00 468.00 478.00 702.00

J0191 Wilson disease, molecular diagnostics, special case 478.00 468.00 478.00 702.00J0201 Xanthinuria, type I, molecular diagnostics, special case 478.00 468.00 478.00 702.00J0211 CTX (Cerebrotendinous xanthomatosis), molecular diagnostics,

special case478.00 468.00 478.00 702.00

J0221 Hypercholesterolemia, familial, molecular diagnostics, specialcase

478.00 468.00 478.00 702.00

J0232 Lysosomal acid phosphatase deficiency, biochemical diagnostics 1,356.00 1,327.00 1,356.00 1,991.00J0241 Aspartylglucosaminuria, molecular diagnostics, special case 478.00 468.00 478.00 702.00J0242 Aspartylglucosaminuria, biochemical diagnostics 1,356.00 1,327.00 1,356.00 1,991.00J0251 Ceroid lipofuscinosis, molecular diagnostics, special case 478.00 468.00 478.00 702.00J0252 Ceroid lipofuscinosis, biochemical diagnostics 1,356.00 1,327.00 1,356.00 1,991.00J0262 Cholesteryl ester storage disease, biochemical diagnostics 1,356.00 1,327.00 1,356.00 1,991.00J0272 Cystinosis, nephropathic, biochemical diagnostics 1,356.00 1,327.00 1,356.00 1,991.00J0281 Fabry disease, molecular diagnostics, special case 478.00 468.00 478.00 702.00J0282 Fabry disease, biochemical diagnostics 1,356.00 1,327.00 1,356.00 1,991.00J0292 Free sialic acid storage disease, biochemical diagnostics 1,356.00 1,327.00 1,356.00 1,991.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

J0302 Fucosidosis, biochemical diagnostics 1,356.00 1,327.00 1,356.00 1,991.00J0312 GM1 gangliosidosis, biochemical diagnostics 1,356.00 1,327.00 1,356.00 1,991.00J0322 Galactosialidosis, biochemical diagnostics 1,356.00 1,327.00 1,356.00 1,991.00J0331 Gaucher disease, molecular diagnostics, special case 616.00 603.00 616.00 905.00J0332 Gaucher disease, biochemical diagnostics 1,356.00 1,327.00 1,356.00 1,991.00J0341 Glycogen storage disease type 2, Pompe, molecular diagnostics,

special case478.00 468.00 478.00 702.00

J0342 Glycogen storage disease type 2, Pompe, biochemicaldiagnostics

1,356.00 1,327.00 1,356.00 1,991.00

J0351 Ichthyosis, X-linked, molecular diagnostics, special case 478.00 468.00 478.00 702.00J0352 Ichthyosis, X-linked, biochemical diagnostics 1,356.00 1,327.00 1,356.00 1,991.00J0361 Krabbe disease, molecular diagnostics, special case 478.00 468.00 478.00 702.00J0362 Krabbe disease, biochemical diagnostics 1,356.00 1,327.00 1,356.00 1,991.00J0372 Mannosidosis, alpha, biochemical diagnostics 1,356.00 1,327.00 1,356.00 1,991.00J0382 Mannosidosis, beta, biochemical diagnostics 1,356.00 1,327.00 1,356.00 1,991.00J0392 Maroteaux-Lamy syndrome, biochemical diagnostics 1,356.00 1,327.00 1,356.00 1,991.00J0400 MLD (Metachromatic Leukodystrophy), pseudo deficiency,

molecular diagnostics616.00 603.00 616.00 905.00

J0401 MLD (Metachromatic Leukodystrophy), molecular diagnostics,special case

478.00 468.00 478.00 702.00

J0402 MLD (Metachromatic Leukodystrophy), biochemical diagnostics 1,356.00 1,327.00 1,356.00 1,991.00J0412 Mucolipidosis II, biochemical diagnostics 3,084.00 3,018.00 3,084.00 4,527.00J0421 Mucolipidosis III, molecular diagnostics, special case 478.00 468.00 478.00 702.00J0422 Mucolipidosis III, biochemical diagnostics 3,084.00 3,018.00 3,084.00 4,527.00J0431 Mucolipidosis IV, molecular diagnostics, special case 478.00 468.00 478.00 702.00J0442 Mucopolysaccharidosis II, biochemical diagnostics 1,356.00 1,327.00 1,356.00 1,991.00J0452 Mucopolysaccharidosis IV, biochemical diagnostics 1,356.00 1,327.00 1,356.00 1,991.00J0462 Mucopolysaccharidosis I, biochemical diagnostics 1,356.00 1,327.00 1,356.00 1,991.00J0472 Mucopolysaccharidosis VII, biochemical diagnostics 1,356.00 1,327.00 1,356.00 1,991.00J0482 Multiple sulfatase deficiency, biochemical diagnostics 3,084.00 3,018.00 3,084.00 4,527.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

J0491 Niemann-Pick disease, molecular diagnostics, special case 478.00 468.00 478.00 702.00J0492 Niemann-Pick disease, biochemical diagnostics 1,356.00 1,327.00 1,356.00 1,991.00J0501 Niemann-Pick disease, type C, molecular diagnostics, special

case478.00 468.00 478.00 702.00

J0502 Niemann-Pick disease, type C, biochemical diagnostics 4,609.00 4,510.00 4,609.00 6,765.00J0511 Pycnodysostosis, molecular diagnostics, special case 478.00 468.00 478.00 702.00J0512 Pycnodysostosis, biochemical diagnostics 1,356.00 1,327.00 1,356.00 1,991.00J0522 Salla disease, biochemical diagnostics 1,356.00 1,327.00 1,356.00 1,991.00J0532 Sanfilippo syndrome, biochemical diagnostics 3,084.00 3,018.00 3,084.00 4,527.00J0542 Schindler disease, biochemical diagnostics 1,356.00 1,327.00 1,356.00 1,991.00J0552 Sialidosis, biochemical diagnostics 1,356.00 1,327.00 1,356.00 1,991.00J0561 Tay Sachs, molecular diagnostics, special case 478.00 468.00 478.00 702.00J0562 Tay Sachs, biochemical diagnostics 1,356.00 1,327.00 1,356.00 1,991.00J0572 Wolman disease, biochemical diagnostics 1,356.00 1,327.00 1,356.00 1,991.00J0581 Mitochondrial disorder, molecular diagnostics, special case 478.00 468.00 478.00 702.00J0582 Mitochondrial disorder, biochemical diagnosticsJ0591 Deafness, mitochondrial, molecular diagnostics, special case 478.00 468.00 478.00 702.00J0600 Kearns Sayre Syndrome, KSS, molecular diagnostics 1,126.00 1,102.00 1,126.00 1,653.00J0610 Leber Optic Atrophy, LHON, molecular diagnostics 616.00 603.00 616.00 905.00J0621 Leigh syndrome, molecular diagnostics, special case 478.00 468.00 478.00 702.00J0622 Leigh syndrome, biochemical diagnosticsJ0631 Mitochondrial myopathy, Encephalopathy, Lactic Acidosis and

Stroke-like episodes, MELAS, molecular diagnostics, specialcase

616.00 603.00 616.00 905.00

J0641 Myoclonic Epilepsy with Ragged Red Fibers, MERFF, moleculardiagnostics, special case

1,126.00 1,102.00 1,126.00 1,653.00

J0651 Mitochondrial depletion syndrome, molecular diagnostics, specialcase

478.00 468.00 478.00 702.00

J0652 Mitochondrial depletion syndrome, biochemical diagnostics



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

J0661 Alzheimer, early onset/familial, molecular diagnostics, specialcase

478.00 468.00 478.00 702.00

J0671 Ataxia Telangiectasia, molecular diagnostics, special case 478.00 468.00 478.00 702.00J0673 Ataxia Telangiectasia, cytogenetic diagnostics 3,478.00 3,403.00 3,478.00 5,105.00J0681 Charcot-Marie-Tooth neuropathy, molecular diagnostics, special

case973.00 952.00 973.00 1,428.00

J0691 Creutzfeldt-Jakob disease, familial, molecular diagnostics,special case

478.00 468.00 478.00 702.00

J0701 Duchenne, Becker muscular dystrophy, molecular diagnostics,special case

6,794.00 6,648.00 6,794.00 9,972.00

J0710 Familial dysautonomia, molecular diagnostics 309.00 302.00 309.00 453.00J0720 Dystonia, torsion, molecular diagnostics 616.00 603.00 616.00 905.00J0730 Facioscapulohumeral muscular dystrophy-1A, molecular

diagnostics973.00 952.00 973.00 1,428.00

J0740 Hereditary Nerve Pressure Palsy, HNPP, molecular diagnostics 1,126.00 1,102.00 1,126.00 1,653.00J0750 Huntington disease, molecular diagnostics 1,126.00 1,102.00 1,126.00 1,653.00J0761 Inclusion body myopathy, autosomal recessive, molecular


J0771 Insensitivity to pain, congenital, with anhidrosis, moleculardiagnostics, special case

478.00 468.00 478.00 702.00

J0781 LGMD (Limb girdle muscular dystrophy), dysferlin deficiency,molecular diagnostics, special case

478.00 468.00 478.00 702.00

J0790 Myotonic dystrophy, molecular diagnostics 1,126.00 1,102.00 1,126.00 1,653.00J0801 Neurofibromatosis, type 1, molecular diagnostics, special case 478.00 468.00 478.00 702.00J0810 Oculopharyngeal muscular dystrophy, molecular diagnostics 1,126.00 1,102.00 1,126.00 1,653.00J0820 SMA (Spinal Muscular Atrophy), molecular diagnostics 1,126.00 1,102.00 1,126.00 1,653.00J0830 Spinocerebellar ataxia due to an expansion including Friedrich

ataxia, molecular diagnostics1,126.00 1,102.00 1,126.00 1,653.00

J0840 Adenomatous polyposis coli, molecular diagnostics 5,465.00 5,347.00 5,465.00 8,021.00J0841 Adenomatous polyposis coli, molecular diagnostics, special case 478.00 468.00 478.00 702.00J0850 Multiple endocrine neoplasia 2A, molecular diagnostics 1,229.00 1,203.00 1,229.00 1,805.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

J0851 Multiple endocrine neoplasia 2A, molecular diagnostics, specialcase

478.00 468.00 478.00 702.00

J0860 Retinoblastoma, molecular diagnostics 5,465.00 5,347.00 5,465.00 8,021.00J0861 Retinoblastoma, molecular diagnostics, special case 478.00 468.00 478.00 702.00J0870 Von Hippel-Lindau, molecular diagnostics 1,003.00 981.00 1,003.00 1,472.00J0871 Von Hippel-Lindau, molecular diagnostics, special case 478.00 468.00 478.00 702.00J0881 Adrenal hyperplasia, congenital, 11-beta-hydroxylase deficiency,

molecular diagnostics, special case478.00 468.00 478.00 702.00

J0891 Adrenal hyperplasia, congenital, 17-alpha-hydroxylasedeficiency, molecular diagnostics, special case

478.00 468.00 478.00 702.00

J0901 Adrenal hyperplasia, congenital, 21-hydroxylase deficiency,molecular diagnostics, special case

478.00 468.00 478.00 702.00

J0911 Adrenal hypoplasia, congenital, molecular diagnostics, specialcase

478.00 468.00 478.00 702.00

J0921 Pendred syndrome, molecular diagnostics, special case 478.00 468.00 478.00 702.00J0931 Persistent hyperinsulinemic hypoglycemia of infancy, molecular


J0941 Combined factor V and VII deficiency, molecular diagnostics,special case

478.00 468.00 478.00 702.00

J0951 Factor V deficiency, molecular diagnostics, special case 478.00 468.00 478.00 702.00J0961 Factor VII deficiency, molecular diagnostics, special case 478.00 468.00 478.00 702.00J0971 Factor XI deficiency, molecular diagnostics, special case 478.00 468.00 478.00 702.00J0981 Factor XIIIA deficiency, molecular diagnostics, special case 478.00 468.00 478.00 702.00J0991 Fanconi anemia, molecular diagnostics, special case 478.00 468.00 478.00 702.00J0993 Fanconi anemia, cytogenetic diagnostics 3,478.00 3,403.00 3,478.00 5,105.00J1001 Hemoglobinopathies alpha, alpha thalassemias, molecular

diagnostics, special case1,446.00 1,415.00 1,446.00 2,123.00

J1011 Hemoglobinopathies beta, beta thalassemias, moleculardiagnostics, special case

1,446.00 1,415.00 1,446.00 2,123.00

J1021 Hemophilia A, factor VIII deficiency, molecular diagnostics,special case

478.00 468.00 478.00 702.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

J1031 Hemophilia B, factor IX deficiency, molecular diagnostics, specialcase

478.00 468.00 478.00 702.00

J1040 Achondroplasia/thanatophoric dwarfism, molecular diagnostics 478.00 468.00 478.00 702.00J1051 Achromatopsia, molecular diagnostics, special case 478.00 468.00 478.00 702.00J1061 Albinism, molecular diagnostics, special case 478.00 468.00 478.00 702.00J1070 Angelman syndrome/Prader Willi, molecular diagnostics 973.00 952.00 973.00 1,428.00J1081 Autoimmune polyglandular disease, type I, molecular


J1091 Bardet-Biedl syndrome, molecular diagnostics, special case 478.00 468.00 478.00 702.00J1100 Beckwith-Wiedemann syndrome, molecular diagnostics 973.00 952.00 973.00 1,428.00J1111 Bloom syndrome, molecular diagnostics, special case 309.00 302.00 309.00 453.00J1113 Bloom syndrome, cytogenetic diagnostics 3,478.00 3,403.00 3,478.00 5,105.00J1121 Cockayne syndrome, molecular diagnostics, special case 478.00 468.00 478.00 702.00J1122 Cockayne syndrome, biochemical diagnostics 4,609.00 4,510.00 4,609.00 6,765.00J1131 Craniosynostosis, molecular diagnostics, special case 478.00 468.00 478.00 702.00J1140 Cystic fibrosis, molecular diagnostics 616.00 603.00 616.00 905.00J1151 Deafness, congenital, molecular diagnostics, special case 478.00 468.00 478.00 702.00J1161 Epidermolysis Bullosa, congenital, molecular diagnostics, special

case478.00 468.00 478.00 702.00

J1171 Osteopetrosis, recessive, molecular diagnostics, special case 478.00 468.00 478.00 702.00J1181 Polycystic kidneys, dominant, molecular diagnostics, special

case478.00 468.00 478.00 702.00

J1191 Polycystic kidneys, recessive, molecular diagnostics, specialcase

478.00 468.00 478.00 702.00

J1203 Roberts syndrome, cytogenetic diagnostics 3,478.00 3,403.00 3,478.00 5,105.00J1211 Tuberous sclerosis, molecular diagnostics, special case 478.00 468.00 478.00 702.00J1222 Xeroderma pigmentosum, biochemical diagnostics 4,609.00 4,510.00 4,609.00 6,765.00J1233 DiGeorge/velocardiofacial syndrome, FISH, cytogenetic

diagnostics1,457.00 1,426.00 1,457.00 2,139.00

J1243 Rubinstein-Taybi syndrome, FISH, cytogenetic diagnostics 1,457.00 1,426.00 1,457.00 2,139.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

J1253 Smith-Magenis syndrome, FISH, cytogenetic diagnostics 1,457.00 1,426.00 1,457.00 2,139.00J1263 Williams syndrome, FISH, cytogenetic diagnostics 1,457.00 1,426.00 1,457.00 2,139.00J1270 Amplicon sequencing, price per each additional amplicon 173.00 169.00 173.00 254.00J1271 FMF, molecular diagnostics, special case 616.00 603.00 616.00 905.00J1280 Amplicon sequencing, price for single/first amplicon 340.00 333.00 340.00 500.00J1311 BRCA1/BRCA2 founder mutation analysis, breast/ovarian

cancer, per patient574.00 562.00 574.00 843.00

J3001 Familial known mutation, molecular diagnostics 478.00 468.00 478.00 702.00J8003 Karyotype, cytogenetic diagnostics - chorionic villus 2,179.00 2,132.00 2,179.00 3,198.00J8830 Rapid aneuploidy detection, quantitative fluorescent PCR -

amniotic fluid/chorionic villus1,070.00 1,047.00 1,070.00 1,571.00

J8831 Newborn screening for immunodeficiency, including SCID(Severe Combined Immunodeficiency)

39.00 38.00 39.00 57.00

J8891 Prenatal molecular diagnostics, basic 1,572.00 1,538.00 1,572.00 2,307.00J9001 Prenatal molecular diagnostics, complex 2,300.00 2,250.00 2,300.00 3,375.00J9900 Fragile X, molecular diagnostics 568.00 556.00 568.00 834.00J9903 Mental retardation, cytogenetic diagnostics 863.00 844.00 863.00 1,266.00J9913 Male infertility, cytogenetic diagnostics 863.00 844.00 863.00 1,266.00J9941 Y chromosome deletion, molecular diagnostics, special case 932.00 912.00 932.00 1,368.00J9991 Monogenic disease in family, molecular diagnostics, special case 3,483.00 3,408.00 3,483.00 5,112.00L0005 Long cast, local anesthesia 293.00 287.00 293.00 431.00L0019 Elastic bandage, elstoplast 12.00 12.00 12.00 18.00L0020 Needle aspiration, US guidance, including cytology 537.00 525.00 537.00 788.00L0021 Breast needle aspiration, US guidance, including cytology 537.00 525.00 537.00 788.00L0022 Thyroid needle aspiration, US guidance, including cytology, per

patient1,583.00 1,549.00 1,583.00 2,324.00

L0023 Bandage placement or replacement 84.00 82.00 84.00 123.00L0025 Stitches 0.00 0.00 0.00 0.00L0026 Stitches removal 45.00 44.00 45.00 66.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

L0030 Parotid needle aspiration, US guidance, including cytology, perpatient

1,442.00 1,411.00 1,442.00 2,117.00

L0040 Focused US ablation of uterine leiomyomata, MRI guidance 16,778.00 16,417.00 16,778.00 24,626.00L0042 Nephrostomy tube removal 330.00 323.00 330.00 485.00L0062 Vaginal smear, sampling, processing and interpretation 199.00 195.00 199.00 293.00L0080 Rehabilitation day care 808.00 791.00 808.00 1,187.00L0100 TMJ radiology, up to two views 263.00 257.00 263.00 386.00L0106 Radiology additional view, not elsewhere specified 63.00 62.00 63.00 93.00L0107 Jaw radiology, third or more additional views 63.00 62.00 63.00 93.00L0108 Mastoids radiology, third or more additional views 63.00 62.00 63.00 93.00L0109 Nasal bones radiology, third or more additional views 63.00 62.00 63.00 93.00L0110 Paranasal sinuses radiology, third or more additional views 63.00 62.00 63.00 93.00L0111 Skull radiology, third or more additional views 63.00 62.00 63.00 93.00L0112 Pelvis radiology, third or more additional views 63.00 62.00 63.00 93.00L0113 Shoulder radiology, complete, one side, third or more additional

views63.00 62.00 63.00 93.00

L0114 Elbow radiology, third or more additional views 63.00 62.00 63.00 93.00L0115 Wrist radiology, third or more additional views 63.00 62.00 63.00 93.00L0116 Hand radiology, third or more additional views 63.00 62.00 63.00 93.00L0117 Hip radiology, unilateral, second or more additional views 63.00 62.00 63.00 93.00L0118 Ankle radiology, third or more additional views 63.00 62.00 63.00 93.00L0119 Abdomen radiology, second or more additional views 63.00 62.00 63.00 93.00L0120 TMJ radiology, third or more additional views 63.00 62.00 63.00 93.00L0121 Calcaneus radiology, third or more additional views 63.00 62.00 63.00 93.00L0122 Toe(s) radiology, third or more additional views 63.00 62.00 63.00 93.00L0123 Cervicothoracic spine radiology, Pawlow/Twining, up to two

views63.00 62.00 63.00 93.00

L0124 Cervicothoracic spine radiology, Pawlow/Twining, third or moreadditional views

63.00 62.00 63.00 93.00

L0125 Pelvis radiology, outlet 63.00 62.00 63.00 93.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

L0126 Pelvis radiology, inlet 63.00 62.00 63.00 93.00L0138 Spine radiology, two parts, up to three views 293.00 287.00 293.00 431.00L0151 Arthrography, including injection and interpretation 331.00 324.00 331.00 486.00L0160 Chest radiology, third or more additional views 118.00 115.00 118.00 173.00L0167 Additional charge for device for insertion of left atrial appendage

device36,267.00 36,267.00 36,267.00 36,267.00

L0168 Additional charge for device for implantation of diaphragmaticpacemaker for spinal cord injured patients

163,350.00 163,350.00 163,350.00 163,350.00

L0169 Additional charge for device for implantation of diaphragmaticpacemaker for ALS patients

142,079.00 142,079.00 142,079.00 142,079.00

L0170 Additional charge for programmable pump for chronic painrelief/spasticity treatment

47,989.00 47,989.00 47,989.00 47,989.00

L0171 Additional charge for mechanical pump for pain relief 32,691.00 32,691.00 32,691.00 32,691.00L0177 Additional charge for vertical expandable prosthetic titanium rib

system87,500.00 87,500.00 87,500.00 87,500.00

L0178 Additional charge for BAHA (Bone Anchored Hearing Aid), adult 31,854.00 31,854.00 31,854.00 31,854.00L0179 Additional charge for BAHA (Bone Anchored Hearing Aid), child 33,806.00 33,806.00 33,806.00 33,806.00L0180 Additional charge for VNS (Vagus Nerve Stimulator) kit for

epilepsy treatment80,040.00 80,040.00 80,040.00 80,040.00

L0182 Additional charge for intracranial single array neurostimulatorpulse generator kit, including leads, for movement disorders

95,651.00 95,651.00 95,651.00 95,651.00

L0183 Additional charge for intracranial dual array neurostimulator pulsegenerators kit, including leads, for movement disorders

110,501.00 110,501.00 110,501.00 110,501.00

L0184 Additional charge for rechargeable intracranial neurostimulatorpulse generator kit for movement disorders

162,912.00 162,912.00 162,912.00 162,912.00

L0185 Additional charge for leads of intracranial neurostimulator pulsegenerator, for movement disorders

29,803.00 29,803.00 29,803.00 29,803.00

L0187 Additional charge for single/dual array neurostimulator pulsegenerator for intracranial stimulation, without leads, formovement disorders

80,801.00 80,801.00 80,801.00 80,801.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

L0188 Additional charge for rechargeable neurostimulator pulsegenerator for intracranial stimulation, without leads, formovement disorders

133,212.00 133,212.00 133,212.00 133,212.00

L0194 Large bandage, bandages & cotton 260.00 254.00 260.00 381.00L0209 Pregnancy termination approval committee 407.00 398.00 407.00 597.00L0210 Nasal bones radiology, up to two views 185.00 181.00 185.00 272.00L0248 Storage of corpse, 2 to 24 hours 357.00 349.00 357.00 524.00L0268 Spotting and copying patient records, first 10 pages 98.00 96.00 98.00 144.00L0269 Copying patient records, each 2 additional pages 1.00 1.00 1.00 2.00L0280 Additional charge for 90Y for SIRT (Selective Internal Radiation

Therapy) for liver tumor, 90Y60,000.00 60,000.00 60,000.00 60,000.00

L0300 Additional charge for device for percutaneous mitral valve repair 138,842.00 138,842.00 138,842.00 138,842.00L0372 HBIg (Hepatitis B immune globulin), IV 6,610.00 6,468.00 6,610.00 9,702.00L0396 Varicella Zoster passive immunization, under 12 years of age,

eg, varitect2,870.00 2,808.00 2,870.00 4,212.00

L0397 Varicella Zoster passive immunization, age 12 years or older, eg,varitect

10,054.00 9,838.00 10,054.00 14,757.00

L0409 Small splints, occupational therapy, including cost of material andnumber of sessions

211.00 206.00 211.00 309.00

L0410 Medium splints, static mouth splint, occupational therapy,including cost of material and number of sessions

405.00 396.00 405.00 594.00

L0411 Medium splints, occupational therapy, including cost of materialand number of sessions

405.00 396.00 405.00 594.00

L0412 Complex medium splints, occupational therapy, including cost ofmaterial and number of sessions

593.00 580.00 593.00 870.00

L0413 Big splints, occupational therapy, including cost of material andnumber of sessions

799.00 782.00 799.00 1,173.00

L0415 JOBST suit measurement 260.00 254.00 260.00 381.00L0416 Complex medium splints, dynamic mouth splint, occupational

therapy, including cost of material and number of sessions593.00 580.00 593.00 870.00

L0438 TRH (Thyrotropin releasing hormone) stimulation panel 728.00 712.00 728.00 1,068.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

L0444 MRI (Magnetic resonance imaging), excluding tests with specificcode

1,883.00 1,842.00 1,883.00 2,763.00

L0446 MRI under general anesthesia, per test 9,525.00 9,320.00 9,525.00 13,980.00L0486 Geriatric hospital day care 620.00 607.00 620.00 911.00L0487 Cognitive geriatric hospital day care 322.00 315.00 322.00 473.00L0491 Cytotoxic capacity testing 946.00 926.00 946.00 1,389.00L0534 Orthoptic treatment, per treatment 89.00 87.00 89.00 131.00L0546 Auditory test for cochlear implant surgery candidate 712.00 697.00 712.00 1,046.00L0550 MR arthrography 4,273.00 4,181.00 4,273.00 6,272.00L0554 FMRI (functional magnetic resonance imaging) 6,358.00 6,221.00 6,358.00 9,332.00L0560 Internal hospital day care 1,294.00 1,266.00 1,294.00 1,899.00L0561 Rehabilitative hospital day care 1,294.00 1,266.00 1,294.00 1,899.00L0564 Histochemical staining including immunohistochemistry 1,885.00 1,844.00 1,885.00 2,766.00L0574 Breathing capability test 89.00 87.00 89.00 131.00L0591 Extracorporeal shockwave lithotripsy, kidney, complex,

ambulatory care21,587.00 21,122.00 21,587.00 31,683.00

L0621 Kit test 1,023.00 1,001.00 1,023.00 1,502.00L0690 Hotel care, per day, including medical supervision 458.00 448.00 458.00 672.00L0692 Home care, per day, including medical supervision 686.00 671.00 686.00 1,007.00L0717 Harvesting of cornea 6,492.00 6,352.00 6,492.00 9,528.00L0745 Additional charge for MRI for patient with cardiac pacemaker 550.00 538.00 550.00 807.00L0748 Additional charge for MRI contrast material(s) 267.00 261.00 267.00 392.00L0770 Evaluation subscription, children and adolescents, mental health 984.00 963.00 984.00 1,445.00L0771 Evaluation subscription, adult, mental health 700.00 685.00 700.00 1,028.00L0772 Psychotherapy short term subscription, children and adolescents,

mental health1,642.00 1,607.00 1,642.00 2,411.00

L0773 Psychotherapy short term subscription, adult, mental health 1,018.00 996.00 1,018.00 1,494.00L0774 Psychotherapy long term subscription, children and adolescents,

mental health3,557.00 3,480.00 3,557.00 5,220.00

L0775 Psychotherapy long term subscription, adult, mental health 3,522.00 3,446.00 3,522.00 5,169.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

L0784 IV (Intravenous) infusion of fluids 260.00 254.00 260.00 381.00L0785 IV (Intravenous) infusion of drugs 260.00 254.00 260.00 381.00L0787 Deflux injection, vesicoureteral reflux therapy, unilateral,

ambulatory care7,557.00 7,394.00 7,557.00 11,091.00

L0788 Deflux injection, vesicoureteral reflux therapy, bilateral,ambulatory care

13,348.00 13,061.00 13,348.00 19,592.00

L0790 Preparation of blood unit/blood product, price per preparation ofone unit

262.00 256.00 262.00 384.00

L0791 Blood unit/blood product, price per one unit 356.00 356.00 356.00 356.00L0797 Additional charge for pump for subcutaneous apomorphine

injection10,000.00 10,000.00 10,000.00 10,000.00

L0799 IV (Intravenous) iloprost 1,217.00 1,191.00 1,217.00 1,787.00L0804 Home visit, psychiatric team 407.00 398.00 407.00 597.00L0805 Comprehensive cognitive and functional evaluation 1,186.00 1,160.00 1,186.00 1,740.00L0806 Multiprofessional evaluation for rehabilitation planning 1,633.00 1,598.00 1,633.00 2,397.00L0807 Psychological assessment for rehabilitation framework 1,070.00 1,047.00 1,070.00 1,571.00L0808 Psychodiagnostic assessment, complete battery 1,070.00 1,047.00 1,070.00 1,571.00L0809 Psychodiagnostic assessment, partial battery 548.00 536.00 548.00 804.00L0820 Psychiatric hospital day care, adult 417.00 408.00 417.00 612.00L0821 Psychiatric hospital day care, children and adolescents 446.00 436.00 446.00 654.00L0822 Psychiatric community day care, adult 444.00 434.00 444.00 651.00L0823 Psychiatric community day care, children and adolescents 478.00 468.00 478.00 702.00L0830 Intake/periodic evaluation and treatment planning, team, mental

healthL0841 Psychotherapy, individual 260.00 254.00 260.00 381.00L0846 Family/conjoint therapy/counseling, mental health 432.00 423.00 432.00 635.00L0849 Psychotherapy, group 122.00 119.00 122.00 179.00L0882 Family consultation, mental health 305.00 298.00 305.00 447.00L0886 Guidance for other agencies, individual, within service site 305.00 298.00 305.00 447.00L0887 Guidance for other agencies, group, within service site 204.00 200.00 204.00 300.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

L0888 Guidance for other agencies, outside service site 432.00 423.00 432.00 635.00L0889 Consultation/coordination with other agencies, within service site,

mental health305.00 298.00 305.00 447.00

L0890 Consultation/coordination with other agencies, outside servicesite, mental health

432.00 423.00 432.00 635.00

L0892 Psychiatric medical opinion for rehabilitation committee 679.00 664.00 679.00 996.00L0898 Documented telephone consultation to welfare, education and

rehabilitation institutions, per three months, mental healthL0911 Auditory test, complete with anamnesis, child 260.00 254.00 260.00 381.00L0914 Biofeedback training, gastroenterology, single session 357.00 349.00 357.00 524.00L0915 Biofeedback training, gastroenterology, 6 sessions 2,141.00 2,095.00 2,141.00 3,143.00L0934 Circulating anticoagulants, eg, LAC 368.00 360.00 368.00 540.00L0959 Sexual counseling and therapy 430.00 421.00 430.00 632.00L0962 ER (Emergency room) medical examination 300.00 294.00 300.00 441.00L0964 ER (Emergency room) fee 202.00 198.00 202.00 297.00L0969 Collar or sling, including materials 139.00 136.00 139.00 204.00L1015 Enzymes activity with cells separation, six or more enzymes 1,379.00 1,349.00 1,379.00 2,024.00L1028 US (ultrasound), with image documentation 362.00 354.00 362.00 531.00L1030 FibroScan for assessment of liver fibrosis 481.00 471.00 481.00 707.00L1031 FibroTest - blood 745.00 729.00 745.00 1,094.00L1039 CT (Computed Tomography), excluding tests with specific code 649.00 635.00 649.00 953.00L1040 CTA / CT arthrography / CT urography, per patient, excluding

coronary arteries CTA1,170.00 1,145.00 1,170.00 1,718.00

L1077 Surgical obturator, assessment and preparation 11,648.00 11,397.00 11,648.00 17,096.00L1079 Interim obturator 6,115.00 5,983.00 6,115.00 8,975.00L1080 Definitive obturator 16,748.00 16,387.00 16,748.00 24,581.00L1133 Establishing paternity, per patient, including medical forensic

opinion1,888.00 1,847.00 1,888.00 2,771.00

L1139 Pilot medical examination 1,549.00 1,516.00 1,549.00 2,274.00L1275 Thoracic CTA, coronary arteries 2,880.00 2,818.00 2,880.00 4,227.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

L1611 Initial insertion/replacement of speech prosthesis postlaryngectomy

2,954.00 2,890.00 2,954.00 4,335.00

L1714 Intravesical instillation of Hyaluronic acid, per treatment,including material

634.00 620.00 634.00 930.00

L1720 Bladder instillation of Mitomycin, per treatment, including material 1,108.00 1,084.00 1,108.00 1,626.00L1721 Bladder hyperthermia and Mitomycin instillation, per treatment 4,683.00 4,582.00 4,683.00 6,873.00L1922 CT under general anesthesia 1,892.00 1,851.00 1,892.00 2,777.00L1996 Chronic pain control, infiltration 313.00 306.00 313.00 459.00L1997 Chronic pain control, nerves block, fluoroscopic guidance, with

contrast material1,569.00 1,535.00 1,569.00 2,303.00

L1998 Chronic pain control, nerves block, fluoroscopic guidance, withneurolytic substance

1,569.00 1,535.00 1,569.00 2,303.00

L2001 Radiofrequency treatment for pain control, per treatment 4,990.00 4,883.00 4,990.00 7,325.00L2002 Loading of pump for spasticity treatment, Baclofen 3,617.00 3,539.00 3,617.00 5,309.00L2003 Ozone treatment for skin ulcers, per day 248.00 243.00 248.00 365.00L2004 Negative pressure treatment for skin ulcers, per session 642.00 628.00 642.00 942.00L2005 Maggot debridement therapy, per session 512.00 501.00 512.00 752.00L2013 Acetylcholinesterase Ab - serum 409.00 400.00 409.00 600.00L2136 OCT3 (Optical Coherence Tomography), per patient 366.00 358.00 366.00 537.00L2190 Obstetric MRI, fetus, per one fetus 4,273.00 4,181.00 4,273.00 6,272.00L2195 MR enterography 2,722.00 2,663.00 2,722.00 3,995.00L2196 Pelvic/genitalia MRI, excluding prostate 1,883.00 1,842.00 1,883.00 2,763.00L2197 Prostate MRI 4,128.00 4,039.00 4,128.00 6,059.00L2250 Fundus photography, two eyes 362.00 354.00 362.00 531.00L2340 Optometry by an optometrist, per patient 144.00 141.00 144.00 212.00L2498 Corneal imaging 191.00 187.00 191.00 281.00L2528 Nasal potential difference measurements for cystic fibrosis

diagnonsis1,612.00 1,577.00 1,612.00 2,366.00

L2529 Rectal biopsy sampling and testing for Cystic Fibrosis diagnosis,per patient

1,612.00 1,577.00 1,612.00 2,366.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

L2585 Auditory screening test, OAE, infant 0.00 0.00 0.00 0.00L2586 Auditory screening test, AABR, infant 0.00 0.00 0.00 0.00L2588 OAE (Otoacoustic Emissions), diagnostic 89.00 87.00 89.00 131.00L2589 Auditory screening test, AABR, subsequent test, baby 182.00 178.00 182.00 267.00L2699 Extracorporeal shock wave lithotripsy, salivary glands,

ambulatory care5,272.00 5,159.00 5,272.00 7,739.00

L2731 Fibronectin 473.00 463.00 473.00 695.00L2985 Shoulder arthroscopy, simple, ambulatory care 10,116.00 9,898.00 10,116.00 14,847.00L2986 Shoulder arthroscopy, complex, ambulatory care 22,253.00 21,774.00 22,253.00 32,661.00L2987 Elbow/wrist/hand and finger arthroscopy, simple, ambulatory

care12,138.00 11,877.00 12,138.00 17,816.00

L2988 Elbow arthroscopy, complex, ambulatory care 17,759.00 17,377.00 17,759.00 26,066.00L2989 Hip arthroscopy, simple, ambulatory care 20,230.00 19,795.00 20,230.00 29,693.00L2990 Hip arthroscopy, complex, ambulatory care 30,346.00 29,693.00 30,346.00 44,540.00L2991 Knee arthroscopy, simple, ambulatory care 7,790.00 7,622.00 7,790.00 11,433.00L2992 Knee arthroscopy, complex, ambulatory care 19,006.00 18,597.00 19,006.00 27,896.00L2993 Ankle/foot and toe arthroscopy, simple, ambulatory care 10,983.00 10,747.00 10,983.00 16,121.00L2994 Ankle arthroscopy, complex, ambulatory care 15,578.00 15,243.00 15,578.00 22,865.00L2995 Arthroscopy, simple/complex, excluding procedures with specific

code, ambulatory care7,790.00 7,622.00 7,790.00 11,433.00

L3003 ECG monitoring, Flecainide infusion, IV 705.00 690.00 705.00 1,035.00L3013 Rapid urease test, helicobacter pylori, child - exhaled air 49.00 48.00 49.00 72.00L3239 Biopsy, additional payment to EUS, excluding EUS (Endoscopic

ultrasound)2,457.00 2,404.00 2,457.00 3,606.00

L3250 Endoscopic polyp marking, in addition to endoscopy, per patient 876.00 857.00 876.00 1,286.00L3253 RFA (Radiofrequency Ablation) of Barrett's esophagus, per

treatment15,292.00 14,963.00 15,292.00 22,445.00

L3255 Balloon enteroscopy 11,423.00 11,177.00 11,423.00 16,766.00L3307 TTE (transthoracic echocardiography), child 470.00 460.00 470.00 690.00L3560 Patella radiology, up to two views, per side 130.00 127.00 130.00 191.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

L3562 Patella radiology, third or more additional views 139.00 136.00 139.00 204.00L3620 Toe(s) radiology, up to two views 130.00 127.00 130.00 191.00L3621 Calcaneus radiology, up to two views 130.00 127.00 130.00 191.00L3711 Apolipoprotein E, genotype 447.00 437.00 447.00 656.00L3727 Implantation of loop recorder system, including retrieval of

recorded and stored ECG data, physician review andinterpretation of retrieved ECG data, per ILR

12,920.00 12,642.00 12,920.00 18,963.00

L3795 External Counter Pulsation Therapy (ECPT) / Enhanced ExternalCounter Pulsation (EECP) therapy

721.00 705.00 721.00 1,058.00

L3799 Rehabilitation workshop, lung diseases patients, per session 105.00 103.00 105.00 155.00L3890 Apolipoprotein E4, genotype 1,065.00 1,042.00 1,065.00 1,563.00L3900 Prenatal diagnosis, age 35-37, including US, amniocentesis and

laboratory tests2,700.00 2,642.00 2,700.00 3,963.00

L3902 Prenatal diagnosis, over age 37, including US, amniocentesisand laboratory tests

1,773.00 1,735.00 1,773.00 2,603.00

L3903 Prenatal diagnosis, younger than age 35, including US,amniocentesis and karyotype

2,477.00 2,306.00 2,357.00 3,636.00

L4110 Porphobilinogen deaminase, quantitative - RBC 467.00 457.00 467.00 686.00L4152 Hospital circumcision, excluding newborn, ambulatory care 2,627.00 2,570.00 2,627.00 3,855.00L4233 Her-2/neu, immunohistochemistry 368.00 360.00 368.00 540.00L4234 Her-2/neu, FISH method 3,205.00 3,136.00 3,205.00 4,704.00L4283 Enema 28.00 27.00 28.00 41.00L4298 Electrolytes, sodium and potassium 27.00 26.00 27.00 39.00L4450 Urethrocystography, retrograde, under sedation 1,211.00 1,185.00 1,211.00 1,778.00L4581 Additional charge for device for implantation of spinal

cord/root/peripheral nerve stimulation electrode/lead13,243.00 13,243.00 13,243.00 13,243.00

L4583 Additional charge for device for implantation of spinalcord/root/peripheral nerve stimulation generator

60,110.00 60,110.00 60,110.00 60,110.00

L4612 Injection of Botulinum toxin, 30 units Dysport 276.00 270.00 276.00 405.00L4705 hCG and PAPP-A, quantitative - serum 191.00 187.00 191.00 281.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

L4793 Ambulatory evaluaiton of TB suspected patient 1,618.00 1,583.00 1,618.00 2,375.00L4794 Basic evaluation of Mantoux positive patient 196.00 192.00 196.00 288.00L4795 Treatment of active TB patient, first 5 months 7,739.00 7,572.00 7,739.00 11,358.00L4796 Treatment of active TB patient, last month 10,088.00 9,871.00 10,088.00 14,807.00L4797 Evaluation of close contact of Tb patient 642.00 628.00 642.00 942.00L4798 Ambulatory treatment of close contact patient, prevention 225.00 220.00 225.00 330.00L4799 Ambulatory pharmacological treatment of close contact patient,

last month301.00 295.00 301.00 443.00

L4990 Genotype characterization by caryotype analysis 3,126.00 3,059.00 3,126.00 4,589.00L4991 Malignancies genotype, FISH (Fluorescent in Situ Hybridization) 1,399.00 1,369.00 1,399.00 2,054.00L4992 Malignancies genotype, DNA index 1,042.00 1,020.00 1,042.00 1,530.00L4999 Orotic acid - urine 88.00 86.00 88.00 129.00L5339 Laser, additional payment to endoscopy, excluding endoscopy 1,115.00 1,091.00 1,115.00 1,637.00L5378 Colonoscopy, flexible; diagnostic, with/without collection of

specimen(s)1,124.00 1,100.00 1,124.00 1,650.00

L5400 Endoscopic Argon laser treatment 386.00 378.00 386.00 567.00L5441 Femur head from bone bank 1,666.00 1,630.00 1,666.00 2,445.00L5461 Kappa or Lambda light chain, Ig, free - blood 366.00 358.00 366.00 537.00L5799 Angiography 3,331.00 3,259.00 3,331.00 4,889.00L5810 Polysomnography, including EEG, child 1,198.00 1,172.00 1,198.00 1,758.00L5858 Tensilon test for myasthenia gravis; with electromyographic

recording546.00 534.00 546.00 801.00

L5872 Single fiber electromyography, per patient 770.00 753.00 770.00 1,130.00L5925 Sensory evoked potentials (SEP) study, per patient 478.00 468.00 478.00 702.00L5990 Minor ambulatory surgery, including foreign body removal, local

anesthesia331.00 324.00 331.00 486.00

L6002 Cytokins 300.00 294.00 300.00 441.00L6015 Gliadin Ab 234.00 229.00 234.00 344.00L6030 Intraocular injection, excluding material cost 319.00 312.00 319.00 468.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

L6031 Intraocular injection of Bevacizumab (Avastin) 700.00 685.00 700.00 1,028.00L6161 KRAS and NRAS mutations, per patient 2,940.00 2,877.00 2,940.00 4,316.00L6171 Additional charge for intraocular shunt, eg, Ex-PRESS, for

trabeculectomy3,748.00 3,748.00 3,748.00 3,748.00

L6312 CA 72.4 tumor antigen 138.00 135.00 138.00 203.00L6313 NSE (Neuron specific enolase), tumor antigen 138.00 135.00 138.00 203.00L6316 Immunoassay for tumor antigen, quantitative; CA 21-1 125.00 122.00 125.00 183.00L6358 Lymphocyte CD antigen determination, over 6 CD 2,912.00 2,849.00 2,912.00 4,274.00L6375 CT (Computed tomographic) virtual colonoscopy 1,179.00 1,154.00 1,179.00 1,731.00L6414 Hickman placement, angiography guidance 3,233.00 3,163.00 3,233.00 4,745.00L6415 Hickman placement under general anasthesia 4,846.00 4,742.00 4,846.00 7,113.00L6416 Portacath placement, angiography guidance 4,688.00 4,587.00 4,688.00 6,881.00L6417 Portacath placement under general anasthesia 6,451.00 6,312.00 6,451.00 9,468.00L6418 Declotting by thrombolytic agent of Hickman/portacath catheter 179.00 175.00 179.00 263.00L6497 Copying video, echo, catheterization, CD 104.00 102.00 104.00 153.00L6498 Copying of films from folder 42.00 41.00 42.00 62.00L6499 Copying of films from folder, each additional film 20.00 20.00 20.00 30.00L6520 Low density lipoprotein (LDL) apheresis 10,389.00 10,165.00 10,389.00 15,248.00L6538 HLA B57 527.00 516.00 527.00 774.00L6539 HLA B5701 344.00 337.00 344.00 506.00L6550 Oncological treatment, adult, with chemotherapeutic/biological

medications, per patient per day1,475.00 1,443.00 1,475.00 2,165.00

L6551 Oncological treatment, child, with chemotherapeutic/biologicalmedications, per patient per day

1,914.00 1,873.00 1,914.00 2,810.00

L6552 Oncological/hematological treatment, adult, withoutchemotherapeutic/ biological medications, per patient per day

885.00 866.00 885.00 1,299.00

L6553 Oncological/hematological treatment, child, withoutchemotherapeutic/ biological medications, per patient per day

1,150.00 1,125.00 1,150.00 1,688.00

L6611 Bartonella henselae (Cat scratch) IgG - blood 264.00 258.00 264.00 387.00L6612 Bartonella henselae (Cat scratch) IgM - blood 264.00 258.00 264.00 387.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

L6689 HIV or HTLV resistance to medication 2,688.00 2,630.00 2,688.00 3,945.00L6705 HBV, HCV and HIV-1 detection, NAT, at blood bank 138.00 135.00 138.00 203.00L6707 Hepatitis E Ab 263.00 257.00 263.00 386.00L6762 Rubella virus IgG or IgM 130.00 127.00 130.00 191.00L6776 Toxoplasma, Sabin Feldman dye test 231.00 226.00 231.00 339.00L6777 Toxoplasmosis confirmation test 598.00 585.00 598.00 878.00L6778 Toxoplasma avidity testing 319.00 312.00 319.00 468.00L6815 Ultrasound, pregnant uterus, without image documentation 330.00 323.00 330.00 485.00L6821 Ophthalmic YAG laser treatment, per patient 433.00 424.00 433.00 636.00L6822 Ophthalmic Argon laser treatment, per patient 337.00 330.00 337.00 495.00L6830 Creation of arteriovenous fistula for renal dialysis, native or using

graft, ambulatory care13,633.00 13,340.00 13,633.00 20,010.00

L6831 Therapeutic catheterization of AV shunt for renal dialysis,native/with graft, ambulatory care

22,922.00 22,429.00 22,922.00 33,644.00

L6849 Interferon Ab 346.00 339.00 346.00 509.00L6855 Abdominal US for aortic aneurysm diagnosis, screening 104.00 102.00 104.00 153.00L6856 Pelvis US, nonobstetric, with image documentation, complete 362.00 354.00 362.00 531.00L6857 Hips US 362.00 354.00 362.00 531.00L6999 Collagen corneal cross linking for keratoconus and keratectasia

treatment3,271.00 3,201.00 3,271.00 4,802.00

L7001 Physiotherapy, evaluation and treatment planning, child 403.00 394.00 403.00 591.00L7002 Isokinetic assessment and treatment planning 268.00 262.00 268.00 393.00L7003 Occupational therapy, evaluation and treatment planning, child 403.00 394.00 403.00 591.00L7004 Isokinetic physiotherapeutic treatment 221.00 216.00 221.00 324.00L7118 NTM (Non Tuberculous Mycobacteria) identification 427.00 418.00 427.00 627.00L7140 Physiotherapy/rehabilitation, group, up to 4 individuals, including

child, per individual87.00 85.00 87.00 128.00

L7154 Toxoplasma, molecular diagnostics - body fluids 1,176.00 1,151.00 1,176.00 1,727.00L7204 Spermatic veins embolization, ambulatory care 7,883.00 7,713.00 7,883.00 11,570.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

L7210 Photocoagulation, PDT, retina, including material 11,504.00 11,256.00 11,504.00 16,884.00L7525 Replacement/repositioning of biliary drain, percutaneous 2,931.00 2,868.00 2,931.00 4,302.00L7619 Malignant hyperthermia diagnosis test (muscle biopsy) 8,986.00 8,793.00 8,986.00 13,190.00L7751 Brachytherapy, female genitalia 11,037.00 10,799.00 11,037.00 16,199.00L7752 Brachytherapy, lung 6,885.00 6,737.00 6,885.00 10,106.00L7753 Brachytherapy, prostate, ambulatory care 44,141.00 43,191.00 44,141.00 64,787.00L7771 Occupational therapy, group 87.00 85.00 87.00 128.00L7900 Radiotherapy, brain, total, adult, 3DL7901 Radiotherapy, brain, total, adult, IMRTL7902 Radiotherapy, brain, total, adult, VMATL7903 Radiotherapy, brain, partial, adult, 3DL7904 Radiotherapy, brain, partial, adult, IMRTL7905 Radiotherapy, brain, partial, adult, VMATL7906 Radiotherapy, brain, partial, adult, stereotacticL7907 Radiotherapy, brain, child, 3DL7908 Radiotherapy, brain, child, IMRTL7909 Radiotherapy, brain, child, VMATL7910 Radiotherapy, brain, child, stereotacticL7911 Radiotherapy, brain and spinal canal and contents, 3DL7912 Radiotherapy, brain and spinal canal and contents, IMRTL7913 Radiotherapy, brain and spinal canal and contents, VMATL7914 Radiotherapy, head and neck, 3DL7915 Radiotherapy, head and neck, IMRTL7916 Radiotherapy, head and neck, VMATL7917 Radiotherapy, head and neck, stereotacticL7918 Radiotherapy, lung and mediastinum, 3DL7919 Radiotherapy, lung and mediastinum, IMRTL7920 Radiotherapy, lung and mediastinum, VMATL7921 Radiotherapy, lung and mediastinum, stereotactic



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

L7922 Radiotherapy, breast, without lymph nodes, 3DL7923 Radiotherapy, breast, without lymph nodes, IMRTL7924 Radiotherapy, breast, without lymph nodes, VMATL7925 Radiotherapy, breast, with lymph nodes, 3DL7926 Radiotherapy, breast, with lymph nodes, IMRTL7927 Radiotherapy, breast, with lymph nodes, VMATL7928 Radiotherapy, liver, pancreas, gallbladder, stomach, esophagus,

3DL7929 Radiotherapy, liver, pancreas, gallbladder, stomach, esophagus,

IMRTL7930 Radiotherapy, liver, pancreas, gallbladder, stomach, esophagus,

VMATL7931 Radiotherapy, liver, pancreas, gallbladder, stomach, esophagus,

stereotacticL7932 Radiotherapy, rectum, 3DL7933 Radiotherapy, rectum, IMRTL7934 Radiotherapy, rectum, VMATL7935 Radiotherapy, anus, 3DL7936 Radiotherapy, anus, IMRTL7937 Radiotherapy, anus, VMATL7938 Radiotherapy, urinary system, excluding prostate, 3DL7939 Radiotherapy, urinary system, excluding prostate, IMRTL7940 Radiotherapy, urinary system, excluding prostate, VMATL7941 Radiotherapy, prostate, without lymph nodes, 3DL7942 Radiotherapy, prostate, without lymph nodes, IMRTL7943 Radiotherapy, prostate, without lymph nodes, VMATL7944 Radiotherapy, prostate, without lymph nodes, stereotacticL7945 Radiotherapy, prostate, with lymph nodes, 3DL7946 Radiotherapy, prostate, with lymph nodes, IMRTL7947 Radiotherapy, prostate, with lymph nodes, VMAT



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

L7948 Radiotherapy, female genitalia, 3DL7949 Radiotherapy, female genitalia, IMRTL7950 Radiotherapy, female genitalia, VMATL7951 Radiotherapy, skin, total, 3DL7952 Radiotherapy, skin, total, IMRTL7953 Radiotherapy, skin, total, VMATL7954 Radiotherapy, skin, partial, 3DL7955 Radiotherapy, skin, partial, IMRTL7956 Radiotherapy, skin, partial, VMATL7957 Radiotherapy, sarcoma, extremities, adult, 3DL7958 Radiotherapy, sarcoma, extremities, adult, IMRTL7959 Radiotherapy, sarcoma, extremities, adult, VMATL7960 Radiotherapy, benign tumor, excluding head/neck/nervous

system, 3DL7961 Radiotherapy, benign tumor, excluding head/neck/nervous

system, IMRTL7962 Radiotherapy, benign tumor, excluding head/neck/nervous

system, VMATL7963 Palliative radiotherapy, soft tissue metastases, 3DL7964 Palliative radiotherapy, soft tissue metastases, IMRTL7965 Palliative radiotherapy, soft tissue metastases, VMATL7966 Palliative radiotherapy, soft tissue metastases, stereotacticL7967 Palliative radiotherapy, bone metastases, 3DL7968 Palliative radiotherapy, bone metastases, IMRTL7969 Palliative radiotherapy, bone metastases, VMATL7970 Palliative radiotherapy, bone metastases, stereotacticL7971 Radiotherapy, whole body for bone marrow transplantation

candidate, 3D0.00 0.00 0.00 0.00

L7972 Radiotherapy, whole body for bone marrow transplantationcandidate, IMRT

0.00 0.00 0.00 0.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

L7973 Radiotherapy, whole body for bone marrow transplantationcandidate, VMAT

0.00 0.00 0.00 0.00

L8074 Adrenal imaging, medulla, I-123 MIBG, up to 7 years of age 10,652.00 10,423.00 10,652.00 15,635.00L8075 Adrenal imaging, medulla, I-123 MIBG, over 7 years of age 18,488.00 18,090.00 18,488.00 27,135.00L8076 Adrenal imaging, cortex 10,861.00 10,627.00 10,861.00 15,941.00L8170 Semen production from testis, surgical 6,402.00 6,264.00 6,402.00 9,396.00L8180 Chemotherapy resistance, Facs 846.00 828.00 846.00 1,242.00L8181 CD membrane antigen, up to 4 antigens 1,216.00 1,190.00 1,216.00 1,785.00L8182 Testes removal, for sperm isolation; cadaver, at the forensic

medicine institute1,227.00 1,201.00 1,227.00 1,802.00

L8183 Pathological specimen, preparation of slides, at the forensicmedicine institute

100.00 98.00 100.00 147.00

L8184 DNA analysis in liquid blood, soft tissue, semen, at the forensicinstitute

2,668.00 2,611.00 2,668.00 3,917.00

L8186 DNA analysis in dry blood, at the forensic institute 2,808.00 2,748.00 2,808.00 4,122.00L8188 DNA analysis in bone tissue, at the forensic institute 9,801.00 9,590.00 9,801.00 14,385.00L8190 Harvesting of cardiac valve (homograft bank) 1,679.00 1,643.00 1,679.00 2,465.00L8213 Aminolevulinic acid dehydratase (ALA-D), quantitative - RBC 699.00 684.00 699.00 1,026.00L8240 Collection and cryopreservation of umbilical cord blood for

families at risk for 4 years8,993.00 8,799.00 8,993.00 13,199.00

L8242 Allogeneic donor lymphocyte infusions, DLI 3,736.00 3,656.00 3,736.00 5,484.00L8244 Allogeneic lymphocyte proliferation 5,625.00 5,504.00 5,625.00 8,256.00L8245 Allogeneic lymphocyte activation 35,582.00 34,816.00 35,582.00 52,224.00L8250 Chromosome 1 and 19 analysis, per patient 1,994.00 1,951.00 1,994.00 2,927.00L8252 FLT3 and NPM1 internal random duplications, PCR 825.00 807.00 825.00 1,211.00L8268 Cholyl-14-C-Glycine breath test for bile salts deconjugationL8269 C-13 urea test, helicobacter pylori - exhaled air 167.00 163.00 167.00 245.00L8299 Spleen imaging, with heated RBC (red blood cells) 1,168.00 1,143.00 1,168.00 1,715.00L8307 Examination of abortus for diagnosis of malformations 6,189.00 6,056.00 6,189.00 9,084.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

L8379 EGFR (Epidermal Growth Factor Receptor) mutation - tissue, perpatient

1,108.00 1,084.00 1,108.00 1,626.00

L8380 ALK mutation, per patient 2,888.00 2,826.00 2,888.00 4,239.00L8381 BRAF mutation, per patient 735.00 719.00 735.00 1,079.00L8400 DNA extraction - whole blood 89.00 87.00 89.00 131.00L8410 Porphyrins, qualitative - plasma 158.00 155.00 158.00 233.00L8411 Porphyrins, chromatography - plasma 594.00 581.00 594.00 872.00L8412 Porphyrins, chromatography - urine 548.00 536.00 548.00 804.00L8413 Porphyrins, chromatography - feces 628.00 614.00 628.00 921.00L8414 Porphyrins, chromatography - RBC 682.00 667.00 682.00 1,001.00L8599 Pulmonary imaging, dynamic, mucociliary clearence 3,799.00 3,717.00 3,799.00 5,576.00L8606 DatScan brain imaging 13,051.00 12,770.00 13,051.00 19,155.00L8738 HIV Ab and P24 Ag, ELISA/EIA, at MOH recognized HIV clinic 47.00 46.00 47.00 69.00L8739 Delivering a non-negative HIV test result by a physician at MOH

recognized HIV clinic126.00 123.00 126.00 185.00

L8802 Somatostatin receptor scintegraphy 21,010.00 20,558.00 21,010.00 30,837.00L8812 PET imaging, eg, F-18 Choline / Ga-68 PSMA 6,148.00 6,016.00 6,148.00 9,024.00L8970 First stage IVF, including hormonal tests 5,497.00 4,021.00 4,125.00 8,065.00L8971 First stage IVF, excluding hormonal tests 4,284.00 3,136.00 3,215.00 6,289.00L8972 Second stage IVF, excluding hospitalization days 6,627.00 4,845.00 4,968.00 9,727.00L8975 Ovarian tissue cryopreservation 5,460.00 5,342.00 5,460.00 8,013.00L8976 Cryopreserved ovarian tissue storage for 5 years 728.00 712.00 728.00 1,068.00L8977 Oocyte retrieval and cryopreservation, eg, vitrification 6,627.00 4,845.00 4,968.00 9,727.00L8978 Cryopreserved oocytes storage for 5 years 728.00 712.00 728.00 1,068.00L8979 Cryopreserved oocytes transfer, intrauterine, including thawing

and fertilization4,272.00 4,180.00 4,272.00 6,270.00

L9000 Radiopharmaceutical therapy, hyper-thyroidism 1,685.00 1,649.00 1,685.00 2,474.00L9015 Chorionic villus sampling, excluding laboratory processing and

interpretation482.00 472.00 482.00 708.00



Price A(ILS)

Price B(ILS)

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Price forPatient

fromAbroad(ILS)

L9030 Radiopharmaceutical ablation of gland for thyroid carcinoma 6,947.00 6,797.00 6,947.00 10,196.00L9035 Radiopharmaceutical therapy for metastases of thyroid

carcinoma11,025.00 10,788.00 11,025.00 16,182.00

L9079 Injection (eg, neurolytic substance) 98.00 96.00 98.00 144.00L9080 Medical opinion for appointment of legal guardian, including

completion of form and reports678.00 663.00 678.00 995.00

L9183 Emergency hyperbaric oxygen therapy, excluding divingaccidents

11,643.00 11,392.00 11,643.00 17,088.00

L9184 Hyperbaric pretreatment assessment 1,642.00 1,607.00 1,642.00 2,411.00L9201 Physician consulation for a patient insured by another sick fund 166.00 162.00 166.00 243.00L9211 Fire arm license physician examination 124.00 121.00 124.00 182.00L9212 Driving license physician examination 124.00 121.00 124.00 182.00L9215 Fire arm license specialist examination 362.00 354.00 362.00 531.00L9232 Routine examinations for candidates for renal transplantation 5,219.00 5,107.00 5,219.00 7,661.00L9241 Perenatal genetic consultation 574.00 562.00 574.00 843.00L9242 Examination by medical specialist for appointment of legal

guardian, for established patient260.00 254.00 260.00 381.00

L9243 Genetic consultation 574.00 562.00 574.00 843.00L9244 Physician examination, oncologist 259.00 136.00 139.00 380.00L9245 Physician examination, hematologist 259.00 136.00 139.00 380.00L9246 Physician examination, hemato-oncologist 259.00 136.00 139.00 380.00L9247 Physician examination, internal physician 259.00 136.00 139.00 380.00L9248 Physician examination, urologist 259.00 136.00 139.00 380.00L9249 Physician examination, orthopedic physician 259.00 136.00 139.00 380.00L9250 Stammering treatment, individual/group, per course 9,030.00 8,836.00 9,030.00 13,254.00L9251 Stammering treatment, individual/group, per patient/session 172.00 168.00 172.00 252.00L9252 Physician examination, alergologist 259.00 136.00 139.00 380.00L9253 Physician examination, endocrinologist 259.00 136.00 139.00 380.00L9254 Physician examination, otorhinolaryngologist 259.00 136.00 139.00 380.00L9255 Physician examination, obstetrician/gynecologist 259.00 136.00 139.00 380.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

L9256 Physician examination, genetician 259.00 136.00 139.00 380.00L9257 Physician examination, gastroenterologist 259.00 136.00 139.00 380.00L9258 Physician examination, pediatrician 259.00 136.00 139.00 380.00L9259 Cryopreservation, sperm, any additional year, up to 5 test

tubes/straws322.00 315.00 322.00 473.00

L9260 Physician examination, surgeon 259.00 136.00 139.00 380.00L9261 Physician examination, thoracic surgeon 259.00 136.00 139.00 380.00L9262 Physician examination, vascular surgeon 259.00 136.00 139.00 380.00L9263 Physician examination, hand surgeon 259.00 136.00 139.00 380.00L9264 Physician examination, maxillofacial surgeon 259.00 136.00 139.00 380.00L9265 Physician examination, proctologist surgeon 259.00 136.00 139.00 380.00L9266 Physician examination, breast surgeon 259.00 136.00 139.00 380.00L9267 Physician examination, plastic surgeon 259.00 136.00 139.00 380.00L9268 Physician examination, anesthesiologist 259.00 136.00 139.00 380.00L9269 Physician examination, neurosurgeon 259.00 136.00 139.00 380.00L9270 Physician examination, neurologist 259.00 136.00 139.00 380.00L9271 Consultation with a specialist 430.00 421.00 430.00 632.00L9273 Physician examination, nephrologist 259.00 136.00 139.00 380.00L9274 Physician examination, dermatologist 259.00 136.00 139.00 380.00L9275 Physician examination, ophthalmologist 259.00 136.00 139.00 380.00L9276 Physician examination, cardiologist 259.00 136.00 139.00 380.00L9277 Physician examination, rheumatologist 259.00 136.00 139.00 380.00L9278 Physician examination, pulmonologist 259.00 136.00 139.00 380.00L9279 Physician examination, rehabilitation physician 259.00 136.00 139.00 380.00L9281 Emergency physician consulation at sick fund clinic 271.00 265.00 271.00 398.00L9301 Clinic nurse evaluation for a patient insured by another sick fund 117.00 114.00 117.00 171.00L9311 Home visit, nurse 144.00 141.00 144.00 212.00L9321 Outpatient social treatment 144.00 141.00 144.00 212.00L9331 Rehabilitative day care center - long term 283.00 277.00 283.00 416.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

L9342 Prosthesis extension 263.00 257.00 263.00 386.00L9343 Sheltered housing, per day 35.00 34.00 35.00 51.00L9345 Care hostel, per day 131.00 128.00 131.00 192.00L9346 Care hostel, extended, per day 162.00 159.00 162.00 239.00L9347 Short term treatment center, per day 124.00 121.00 124.00 182.00L9348 Club activity, per month, 8 visits at least, child 352.00 344.00 352.00 516.00L9349 Treatment boarding school services, per month 7,159.00 7,005.00 7,159.00 10,508.00L9350 Club activity, per month, 8 visits at least 283.00 277.00 283.00 416.00L9351 Occupational club activity, per day 44.00 43.00 44.00 65.00L9352 Sheltered factory, per day 65.00 64.00 65.00 96.00L9353 Occupational rehabilitation, extended, per day 81.00 79.00 81.00 119.00L9354 Sheltered housing, extended, per day 88.00 86.00 88.00 129.00L9355 School, per month, child/adolescent 1,102.00 1,078.00 1,102.00 1,617.00L9359 Medical evaluation based on documents 123.00 120.00 123.00 180.00L9360 Risk assessment of sex offenders 3,527.00 3,451.00 3,527.00 5,177.00L9377 Physician services in parent home 263.00 257.00 263.00 386.00L9379 Physician services in hostel 139.00 136.00 139.00 204.00L9394 Physician services in boarding school 87.00 85.00 87.00 128.00L9413 Medical records printout 44.00 43.00 44.00 65.00L9420 Calibration of instruments for measuring radiation 711.00 696.00 711.00 1,044.00L9480 Results reporting, free of charge 0.00 0.00 0.00 0.00L9490 Follow up service, free of charge 0.00 0.00 0.00 0.00L9499 Social services - coordination, connection and mediation 158.00 155.00 158.00 233.00L9500 Medical examination, first visit - child development 663.00 649.00 663.00 974.00L9501 Medical examination, follow up - child development 397.00 388.00 397.00 582.00L9502 Psychological cognitive assessment - child development 817.00 799.00 817.00 1,199.00L9503 Family workup and diagnosis - child development 397.00 388.00 397.00 582.00L9504 Neuropsychological assessment - child development 1,120.00 1,096.00 1,120.00 1,644.00L9505 Cognitive evaluation for rehabilitation - child development 1,017.00 995.00 1,017.00 1,493.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

L9506 Learning disabilities evaluation - child development 1,379.00 1,349.00 1,379.00 2,024.00L9507 Multidisciplinary team for rehabilitation - child development 1,391.00 1,361.00 1,391.00 2,042.00L9509 Patient presentation to rehabilitation/district psychiatric

committeeL9510 Speech therapy, evaluation and treatment planning - child

development403.00 394.00 403.00 591.00

L9511 Aquatic physiotherapy/rehabilitation, group, up to 4 individuals,inculding child, hydrotherapy

157.00 154.00 157.00 231.00

L9512 Speech therapy, individual - child development 206.00 202.00 206.00 303.00L9513 Occupational therapy, individual - child development 206.00 202.00 206.00 303.00L9514 Physiotherapy, individual - child development 224.00 219.00 224.00 329.00L9516 Psycho/behavioral therapy - child development 249.00 244.00 249.00 366.00L9517 Developmental examination - nurse - child development 180.00 176.00 180.00 264.00L9518 Therapy/counseling, family/conjoint - child development 550.00 538.00 550.00 807.00L9519 Biofeedback training - child development 444.00 434.00 444.00 651.00L9520 Evaluation of supportive communication - child development 1,467.00 1,435.00 1,467.00 2,153.00L9521 Staff meeting with parents - child development 494.00 483.00 494.00 725.00L9523 Multiprofessional consulation for parents - child development 154.00 151.00 154.00 227.00L9525 Additional consulation - child development 191.00 187.00 191.00 281.00L9528 Physiotherapy, group - child development 162.00 159.00 162.00 239.00L9529 Speech therapy, group - child development 162.00 159.00 162.00 239.00L9530 Occupational therapy, group - child development 162.00 159.00 162.00 239.00L9600 Home visit, health care professional - child development 290.00 284.00 290.00 426.00L9611 Psychological evaluation due to physical disease 184.00 180.00 184.00 270.00L9612 Therapeutic support, individual, due to physical disease 142.00 139.00 142.00 209.00L9616 Neuropsychological assessment, complete batteryL9617 Neuropsychological assessment, partial battery 1,312.00 1,284.00 1,312.00 1,926.00L9636 Additional charge for Plerixafor (Mozobil), per ampoule 32,985.00 32,985.00 32,985.00 32,985.00L9638 Additional charge for Defibrotide (Defitelio), adult, per treatment

cycle361,890.00 361,890.00 361,890.00 361,890.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

L9639 Additional charge for Defibrotide (Defitelio), child, per treatmentcycle

96,504.00 96,504.00 96,504.00 96,504.00

L9855 Induced abortion, surgical, including curettage 2,858.00 2,796.00 2,858.00 4,194.00L9856 Induced abortion, pharmaceutical 2,060.00 2,016.00 2,060.00 3,024.00L9857 Induced abortion, surgical, following pharmaceutical abortion 0.00 0.00 0.00 0.00L9899 Prenatal course 622.00 609.00 622.00 914.00L9900 Provision of therapeutic radiopharmaceutical(s) 855.00 837.00 855.00 1,256.00L9999 Radiopharmaceutical therapy,

pheochromocytoma/neuroblastoma; I-131-MIBG28,362.00 27,751.00 28,362.00 41,627.00

G0018 Transjugular intrahepatic portosystemic stent/shunt, TIPS 34,344.00 33,605.00 34,344.00 33,605.00G0024 Obstetric and neonatal hospitalization 3,063.00 12,505.00 5,830.00G0026 Preterm infant hospitalization 3,063.00 198,405.00 5,830.00G0028 Cryotherapy of prostatic cancer 36,314.00 35,532.00 36,314.00 35,532.00G0031 Insertion of stent to abdominal aortic aneurysm, stent graft 116,845.00 114,330.00 116,845.00 114,330.00G0032 Bone marrow transplantation, haploid, including stem cells

separation563,127.00 551,005.00 563,127.00 551,005.00

G0033 Isolated limb perfusion in patient with sarcoma 110,849.00 108,463.00 110,849.00 108,463.00G0035 Interventional neuroradiology for intracranial aneurysm

embolization/occlusion by catheterization, including use of stent,eg, SILK, and coils

97,371.00 95,275.00 97,371.00 95,275.00

G0036 Insertion of intraocular lens, including cost of lens, inpatient care 5,722.00 5,599.00 5,722.00 8,399.00G0037 Tension free vaging tape for incontinence (TVT) 8,789.00 8,600.00 8,789.00 8,600.00G0045 Mastectomy, bilateral 26,888.00 26,309.00 26,888.00 26,309.00G0047 Breast reconstruction, bilateral 44,292.00 43,339.00 44,292.00 43,339.00G0048 Breast reconstruction following mastectomy, bilateral 67,108.00 65,663.00 67,108.00 65,663.00G0049 Breast reconstruction following mastectomy, unilateral 40,072.00 39,209.00 40,072.00 39,209.00G0050 Breast reconstruction, unilateral, including nipple reconstruction 26,271.00 25,705.00 26,271.00 25,705.00G0051 Mastectomy, unilateral 17,923.00 17,537.00 17,923.00 17,537.00G0054 Lower extremities veins surgery, including varicose veins 11,294.00 11,051.00 11,294.00 11,051.00G0055 Blood vessels surgery, including nonautogenous graft 63,380.00 62,016.00 63,380.00 62,016.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

G0057 Lung transplantation 386,322.00 378,006.00 386,322.00 378,006.00G0058 Heart-lung transplant 540,855.00 529,212.00 540,855.00 529,212.00G0059 Bone marrow transplantation; allogenic 358,689.00 350,968.00 358,689.00 350,968.00G0060 Bone marrow transplantation; autologous 235,657.00 230,584.00 235,657.00 230,584.00G0061 Renal and/or pancreas transplantation 257,549.00 252,005.00 257,549.00 252,005.00G0062 Heart transplantation 386,322.00 378,006.00 386,322.00 378,006.00G0063 Liver transplantation 1,113,233.0 1,089,269.0 1,113,233. 1,089,269.0G0064 Corneal surgery, including cost of cornea 22,070.00 21,595.00 22,070.00 21,595.00G0066 Inguinal/femoral hernia repair, hospital day care 3,917.00 3,833.00 3,917.00 5,750.00G0067 Craniotomy 71,878.00 70,331.00 71,878.00 70,331.00G0070 Prostatectomy, open 17,076.00 16,708.00 17,076.00 16,708.00G0074 Therapeutic catheterization, excluding cardiac catheterization 38,005.00 37,187.00 38,005.00 37,187.00G0075 Hysterectomy 16,778.00 16,417.00 16,778.00 16,417.00G0077 Transurethral prostatectomy 17,076.00 16,708.00 17,076.00 16,708.00G0078 Hospital circumcision, excluding newborn, inpatient care 2,627.00 2,570.00 2,627.00 3,855.00G0083 Osteotomy of spine, including implants, discectomy 31,275.00 30,602.00 31,275.00 30,602.00G0084 Osteotomy of spine, including implants, excluding discectomy 57,433.00 56,197.00 57,433.00 56,197.00G0089 Treatment of heavy burns 218,987.00 214,273.00 218,987.00 214,273.00G0090 Treatment of medium burns 125,129.00 122,435.00 125,129.00 122,435.00G0096 Gastric banding, laparoscopic, excluding band cost 13,720.00 13,425.00 13,720.00 13,425.00G00A1 Transcatheter placement of an intravascular stent graft, thoracic

aorta188,149.00 184,099.00 188,149.00 184,099.00

G00A2 Hyperbaric chamber treatment of patients injured in divingaccidents, up to 8 hours

37,357.00 36,553.00 37,357.00 36,553.00

G00A3 Hyperbaric chamber treatment of patients injured in divingaccidents, over 8 hours, and/or using a mixture of gases eg,Heliox

50,670.00 49,579.00 50,670.00 49,579.00

G00A4 Spermatic veins embolization, inpatient care 7,883.00 7,713.00 7,883.00 11,570.00G00A5 Chemotherapy administration, inpatients, in addition to inpatient

day charge3,117.00 3,050.00 3,117.00 4,575.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

G00A6 Open/closed reduction with internal fixation of fracture of neck offemur or internal fixation only of fracture of neck of femur

28,837.00 28,216.00 28,837.00 28,216.00

G00A8 Insertion of biventricular cardiac pacemaker 58,152.00 56,900.00 58,152.00 56,900.00G00A9 Insertion of cardiac pacemaker/defibrillator, excluding machine

costG00B1 Repair of cleft lip 20,664.00 20,219.00 20,664.00 20,219.00G00B2 Correction of cleft palate (including Push-Back palatoplasty) 20,664.00 20,219.00 20,664.00 20,219.00G00B3 Revision of cleft palate repair, velopharyngoplasty 20,664.00 20,219.00 20,664.00 20,219.00G00B4 Repair of cleft lip & limited rhinoplasty, for cleft palate 20,664.00 20,219.00 20,664.00 20,219.00G00B5 Closure of fistulae of mouth, for cleft palate 14,004.00 13,703.00 14,004.00 13,703.00G00B6 Bone graft to facial bone, for cleft palate 24,545.00 24,017.00 24,545.00 24,017.00G00B7 Jaw distraction osteogenesis, excluding device cost 20,664.00 20,219.00 20,664.00 20,219.00G00C1 Fallopian tube catheterization, diagnostic or therapeutic, inpatient

care4,233.00 4,142.00 4,233.00 6,213.00

G00C2 Radiofrequency ablation of liver lesion(s) (tumor or metastases) 15,795.00 15,455.00 15,795.00 15,455.00G00C3 Esophageal dilation and stent placement, inpatient care 17,944.00 17,558.00 17,944.00 26,337.00G00C5 Local excision of lesion or tissue of bone (i.e. osteoid osteoma),

CT guidance9,817.00 9,606.00 9,817.00 9,606.00

G00C6 Intra-amniotic injection for late abortion 3,552.00 3,476.00 3,552.00 3,476.00G00C7 Arthroplasty with prosthetic replacement or implant of total or

partial wrist (distal radius, carpocarpal or carpometacarpal joints)13,222.00 12,937.00 13,222.00 12,937.00

G00C8 Arthroplasty with prosthetic replacement or implant of foot or toejoint

22,914.00 22,421.00 22,914.00 22,421.00

G00D1 Implantation or replacement of artificial urinary sphincter 51,932.00 50,814.00 51,932.00 50,814.00G00D2 Insertion of skin tissue expander(s), excluding breast 22,052.00 21,577.00 22,052.00 21,577.00G00D3 Closed (percutaneous) biopsy of brain, stereotactic method

including burr holes16,602.00 16,245.00 16,602.00 16,245.00

G00D4 Orthopedic oncologic surgery, excision of soft tissues 69,212.00 67,722.00 69,212.00 67,722.00G00D5 Orthopedic oncologic surgery, revision of an artificial joint or

implant220,275.00 215,533.00 220,275.00 215,533.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

G00D6 Orthopedic oncologic surgery, complex amputation ordisarticulation

79,681.00 77,966.00 79,681.00 77,966.00

G00D7 Orthopedic oncologic surgery, destructive and reconstructivesurgery

197,207.00 192,962.00 197,207.00 192,962.00

G00D8 Thoracic surgery 42,742.00 41,822.00 42,742.00 41,822.00G00E1 Intra-arterial administration of chemotherapy or

chemoembolization, under angiography13,618.00 13,325.00 13,618.00 13,325.00

G00E5 Insertion (initial or replacement) of single/dual chamber cardiacpacemaker

29,251.00 28,621.00 29,251.00 28,621.00

G00E6 Radical trachelectomy and lymphadenectomy 18,158.00 17,767.00 18,158.00 17,767.00G00E7 Brachytherapy, eye 32,458.00 31,759.00 32,458.00 31,759.00G00E9 Video and EEG monitoring, inpatient care 50,075.00 48,997.00 50,075.00 48,997.00G00F1 Creation of arteriovenous fistula for renal dialysis, native or using

graft, inpatient care13,633.00 13,340.00 13,633.00 20,010.00

G00F2 Gastric bypass, laparoscopic 58,460.00 57,202.00 58,460.00 57,202.00G00F3 Thoracic sympathectomy 9,681.00 9,473.00 9,681.00 9,473.00G00F4 Thyroidectomy, complete/partial 17,528.00 17,151.00 17,528.00 17,151.00G00F5 Gastrectomy, total/partial 59,692.00 58,407.00 59,692.00 58,407.00G00F6 Appendectomy, laparoscopic 19,101.00 18,690.00 19,101.00 18,690.00G00F7 Whipple operation (radical pancreatic duodenectomy or radical

subtotal pancreatectomy)103,862.00 101,626.00 103,862.00 101,626.00

G00F8 Vertebroplasty 10,391.00 10,167.00 10,391.00 10,167.00G00F9 Wada test 11,341.00 11,097.00 11,341.00 11,097.00G00G1 Catheterization, insertion of umbrella like device for repair of

cardial septal defects or patent ductus arteriosus (PDA)78,119.00 76,437.00 78,119.00 76,437.00

G00G2 Kyphoplasty 49,242.00 48,182.00 49,242.00 48,182.00G00G3 Mastectomy, partial (eg, lumpectomy), excludes biopsy of breast 9,088.00 8,892.00 9,088.00 8,892.00G00G4 Brachytherapy, prostate, inpatient care 44,141.00 43,191.00 44,141.00 64,787.00G00G5 Therapeutic catheterization of AV shunt for renal dialysis,

native/with graft, inpatient care22,922.00 22,429.00 22,922.00 33,644.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

G00G6 Extracorporeal shockwave lithotripsy, salivary stones, inpatientcare

5,272.00 5,159.00 5,272.00 7,739.00

G00G7 Deflux injection, vesicoureteral reflux therapy, unilateral, inpatientcare

7,557.00 7,394.00 7,557.00 11,091.00

G00G8 Deflux injection, vesicoureteral reflux therapy, bilateral, inpatientcare

13,348.00 13,061.00 13,348.00 19,592.00

G00G9 Extracorporeal shockwave lithotripsy, kidney, simple, inpatientcare

6,876.00 6,728.00 6,876.00 10,092.00

G00H2 Inpatient, per day, up to 3 days in acute care hospital, excludingdepartments with specific code

3,063.00 2,915.00 2,979.00 5,830.00

G00H4 Inpatient, per day, for fourth day or longer in acute care hospital,excluding departments with specific code

2,664.00 2,535.00 2,591.00 5,070.00

G00H5 Inpatient, per day, Dermatology and Venereology Department inacute care hospital

2,664.00 2,535.00 2,591.00 5,070.00

G00H6 Inpatient, per day, Ophthalmology and Pediatric OphthalmologyDepartments in acute care hospital

2,664.00 2,535.00 2,591.00 5,070.00

G00H7 Inpatient, per day, Rehabilitation Department in acute carehospital

2,664.00 2,535.00 2,591.00 5,070.00

G00J3 Inpatient day, Acute Geriatric, Pulmonary and TuberculosisDepartments, geriatric hospitals and centers

2,048.00 1,949.00 1,992.00 3,898.00

G00J4 Inpatient day, Geriatric Rehabilitation Department, geriatrichospitals and centers

1,280.00 1,218.00 1,245.00 2,436.00

G00J5 Inpatient day, Complex Care Nursing Department, geriatrichospitals and centers

772.00 735.00 751.00 1,470.00

G00J7 Inpatient day, Departments for the Independent, geriatrichospitals and centers

283.00 269.00 275.00 538.00

G00J8 Inpatient day, Departments for the Frail, geriatric hospitals andcenters

451.00 429.00 438.00 858.00

G00M1 Inpatient day, Department of Internal Medicine in acute carehospital

2,169.00 2,064.00 2,109.00 4,128.00

G00M2 Inpatient day, Rheumatology Department in acute care hospital 2,169.00 2,064.00 2,109.00 4,128.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

G00M3 Inpatient day, Department of Pulmonary Medicine in acute carehospital

2,169.00 2,064.00 2,109.00 4,128.00

G00M4 Inpatient day, Department of Geriatric Internal Medicine in acutecare hospital

2,169.00 2,064.00 2,109.00 4,128.00

G00M5 Inpatient day, Gastroenterology Department in acute carehospital

2,169.00 2,064.00 2,109.00 4,128.00

G00M6 Inpatient day, Observation Department in acute care hospital 2,169.00 2,064.00 2,109.00 4,128.00G00N1 Inpatient day, General Intensive Care Department in acute care

hospital2,664.00 2,535.00 2,591.00 5,070.00

G00N3 Inpatient day, Respiratory Intensive Care Department in acutecare hospital

2,664.00 2,535.00 2,591.00 5,070.00

G00N5 Inpatient day, Pediatric Intensive Care Department in acute carehospital

2,664.00 2,535.00 2,591.00 5,070.00

G00N7 Inpatient day, Neurosurgical Intensive Care Department in acutecare hospital

2,664.00 2,535.00 2,591.00 5,070.00

G00N9 Additional inpatient day charge, Intensive Care Departments:General, Respirtory, Pediatric and Neurosurgery, up to 4 duringthe same hospitalization

5,337.00 5,078.00 5,190.00 10,156.00

G00P1 Inpatient day, Acute geriatric Department in acute care hospital 1,614.00 1,536.00 1,570.00 3,072.00G00P2 Inpatient day, Geriatric Rehabilitation Department in acute care

hospital1,614.00 1,536.00 1,570.00 3,072.00

G00P3 Inpatient day, Department of high Dependency Nursing in acutecare hospital

1,614.00 1,536.00 1,570.00 3,072.00

G00Q1 Acute inpatient day, psychiatric department 1,117.00 1,063.00 1,086.00 2,126.00G00Q2 Long term inpatient day, psychiatric department 858.00 816.00 834.00 1,632.00G00Q3 Inpatient day, children and adolescents, psychiatric department 1,342.00 1,277.00 1,305.00 2,554.00G00Q4 Inpatient day, secure acute psychiatric department 1,117.00 1,063.00 1,086.00 2,126.00G00Q5 Hospitalization leave for acclimatization, per day, adult,

psychiatric department429.00 408.00 417.00 816.00

G00Q6 Hospitalization leave for acclimatization, per day, children andadolescents, psychiatric department

458.00 436.00 446.00 872.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

G00Q7 Artificial liver therapy, eg, MARS, additional inpatient day charge 27,429.00 26,839.00 27,429.00 40,259.00G00Q8 Chronic artificial ventilation care, per day, all hospitals 1,721.00 1,638.00 1,674.00 3,276.00G00R1 Extracorporeal shockwave lithotripsy, kidney, complex, inpatient

care21,587.00 21,122.00 21,587.00 31,683.00

G00R2 Biopsy, CT guidance, inpatient care 5,193.00 5,081.00 5,193.00 7,622.00G00R3 Biopsy, MRI guidance, excluding breast, inpatient care 7,790.00 7,622.00 7,790.00 11,433.00G00R4 Continuous intra-arterial administration of chemotherapeutic

substance20,756.00 20,309.00 20,756.00 20,309.00

G00R5 Vertebral excision and fusion 183,726.00 179,771.00 183,726.00 179,771.00G00R6 Vertebral refusion 220,275.00 215,533.00 220,275.00 215,533.00G00R7 Secondary insertion of intraocular lens prosthesis 3,641.00 3,563.00 3,641.00 3,563.00G00R8 Single suture loop pupilloplasty 5,826.00 5,701.00 5,826.00 5,701.00G00R9 Vitrectomy 15,782.00 15,442.00 15,782.00 15,442.00G00S1 Bronchoscopy with bronchial stent(s) placement, inpatient care 13,419.00 13,130.00 13,419.00 19,695.00G00S4 Radical neck lymph nodes dissection, unilateral/bilateral 28,730.00 28,112.00 28,730.00 28,112.00G00S5 Lobectomy of liver 85,057.00 83,226.00 85,057.00 83,226.00G00S6 Partial hepatectomy 47,610.00 46,585.00 47,610.00 46,585.00G00S7 Maxillectomy/mandibulectomy, partial/total, including immediate

insertion of surgical obturator40,913.00 40,032.00 40,913.00 40,032.00

G00S8 Stereotactic radiosurgery, brain 50,969.00 49,872.00 50,969.00 49,872.00G00S9 Implantation of heart assist system 586,252.00 573,632.00 586,252.00 573,632.00G00T3 Isolated limb perfusion in patient with melanoma 110,849.00 108,463.00 110,849.00 108,463.00G00T4 Colonoscopy with dilation and stent placement, inpatient care 17,944.00 17,558.00 17,944.00 26,337.00G00T5 Removal of heart pacemaker lead(s) (electrodes) without

replacement36,233.00 35,453.00 36,233.00 35,453.00

G00T6 Removal of heart pacemaker lead(s) (electrodes) withreplacement of electrodes and pacemaker device

50,862.00 49,767.00 50,862.00 49,767.00

G00T7 Scoliosis/kyphosis repair operation 127,121.00 124,385.00 127,121.00 124,385.00G00T8 Emergency coronary artery catheterization for removal of

obstruction, including insertion of drug eluting stent(s)56,217.00 55,007.00 56,217.00 55,007.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

G00T9 Radical hysterectomy, abdominal/vaginal 25,966.00 25,407.00 25,966.00 25,407.00G00U1 Colorectal surgery 52,032.00 50,912.00 52,032.00 50,912.00G00U2 Surgical fistulization of lacrimal tract to nasal cavity using balloon

dilatation, including dacryocystorhinostomy7,564.00 7,401.00 7,564.00 7,401.00

G00U3 Intravenous injection of rtPA, acute cerebrovascular stroke within4.5 hours of stroke symptoms onset

45,439.00 44,461.00 45,439.00 44,461.00

G00U4 Therapeutic catheterization, acute cerebrovascular stroke within8 hours of stroke symptoms onset

116,845.00 114,330.00 116,845.00 114,330.00

G00U5 Functional endoscopic nasal/sinus surgery (FESS), simple 15,577.00 15,242.00 15,577.00 15,242.00G00U6 Functional endoscopic nasal/sinus surgery (FESS), complex 37,380.00 36,575.00 37,380.00 36,575.00G00U7 Tonsillectomy without/with adenoidectomy 5,439.00 5,322.00 5,439.00 5,322.00G00U9 Enucleation of eyeball 15,620.00 15,284.00 15,620.00 15,284.00G00V2 Lengthening and adjustment of vertical expandable prosthetic

titanium rib system25,287.00 24,743.00 25,287.00 24,743.00

G00V3 Replacement of vertical expandable prosthetic titanium ribsystem implants

56,599.00 55,381.00 56,599.00 55,381.00

G00V4 Percutaneous pulmonary valve replacement, excluding valvecost

42,706.00 41,787.00 42,706.00 41,787.00

G00V5 Percutaneous aortic valve replacement, excluding valve cost 48,610.00 47,564.00 48,610.00 47,564.00G00V6 Repair of inguinal/femoral hernia, unilateral, inpatient care 11,200.00 10,959.00 11,200.00 10,959.00G00V7 Repair of inguinal/femoral hernia, bilateral, inpatient care 14,931.00 14,610.00 14,931.00 14,610.00G00V8 Plastic surgery following significant weight loss 35,583.00 34,817.00 35,583.00 34,817.00G00V9 Bone graft to maxilla/mandible, autogenic graft from pelvis/scalp 32,965.00 32,255.00 32,965.00 32,255.00G00W1 Scleral buckling, with/without implant 11,165.00 10,925.00 11,165.00 10,925.00G00W2 Trabeculectomy 5,403.00 5,287.00 5,403.00 5,287.00G00W3 Intraocular valve implantation, eg, Ahmed, for glaucoma therapy 14,781.00 14,463.00 14,781.00 14,463.00G00W4 Repair of blepharoptosis, under 18 years, unilateral/bilateral 8,622.00 8,436.00 8,622.00 8,436.00G00W5 Repair of blepharoptosis, 18 years and older, unilateral/bilateral 5,340.00 5,225.00 5,340.00 5,225.00G0100 Additional charge for DRG in multiple trauma, admission from ER 12,982.00 12,703.00 12,982.00 12,703.00G0101 ORIF/CRIF of pelvis, closed/open fracture 64,187.00 62,805.00 64,187.00 62,805.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

G0102 Arthroplasty with prosthetic replacement/implant of radial head,excluding open fracture

37,556.00 36,748.00 37,556.00 36,748.00

G0103 Arthroplasty with prosthetic replacement/implant of radial head,open fracture

58,698.00 57,434.00 58,698.00 57,434.00

G0104 ORIF of foot, closed fracture, excluding calcaneus 40,151.00 39,287.00 40,151.00 39,287.00G0105 ORIF of foot, open fracture, excluding calcaneus 58,698.00 57,434.00 58,698.00 57,434.00G0106 ORIF of calcaneus/operation on femur, excluding neck of femur,

closed fracture32,237.00 31,543.00 32,237.00 31,543.00

G0107 ORIF of calcaneus/operation on femur, excluding neck of femur,open fracture

49,437.00 48,373.00 49,437.00 48,373.00

G0108 Operation on clavicle/humerus/forearm, closed fracture, includingclosed dislocation of acromioclavicular joint, excluding distalhumerus and shaft of radius/ulna, including bone graft

27,636.00 27,041.00 27,636.00 27,041.00

G0109 Operation on clavicle/humerus/forearm, open fracture, includingopen dislocation of acromioclavicular joint, excluding distalhumerus and shaft of radius/ulna

39,882.00 39,023.00 39,882.00 39,023.00

G0110 ORIF/CRIF/EF of tibia and/or fibula, closed fracture 37,118.00 36,319.00 37,118.00 36,319.00G0111 ORIF/CRIF/EF of tibia and/or fibula, open fracture, including use

of bone marrow aspiration concentrate62,694.00 61,344.00 62,694.00 61,344.00

G0112 ORIF of patella/ankle / CRIF of calcaneus, closed fracture 22,142.00 21,665.00 22,142.00 21,665.00G0113 ORIF of patella/ankle / CRIF of calcaneus, open fracture 35,879.00 35,107.00 35,879.00 35,107.00G0114 CRIF of ankle/foot, closed fracture, excluding calcaneus 14,450.00 14,139.00 14,450.00 14,139.00G0115 CRIF of ankle/foot, open fracture, excluding calcaneus 24,872.00 24,337.00 24,872.00 24,337.00G0116 Exploration of tendon/nerve of upper limb, including ganglion

decompression/lysis of adhesions8,310.00 8,131.00 8,310.00 8,131.00

G0117 Suture of extensor tendons of hand, including delayed suture 13,725.00 13,430.00 13,725.00 13,430.00G0118 Suture of tendons/nerves of upper limb, including delayed suture,

excluding extensor tendons of hand23,661.00 23,152.00 23,661.00 23,152.00

G0120 ORIF/EF of phalange of hand, closed fracture, including bonegraft

16,364.00 16,012.00 16,364.00 16,012.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

G0121 ORIF/EF of phalange of hand, open/complex fracture 22,301.00 21,821.00 22,301.00 21,821.00G0122 ORIF/EF of phalange of hand, with suture of tendons/nerves,

closed/open fracture31,400.00 30,724.00 31,400.00 30,724.00

G0123 ORIF/EF of phalanges of hand, closed fractures, including bonegraft

22,763.00 22,273.00 22,763.00 22,273.00

G0124 ORIF/EF of phalanges of hand, open/complex fractures 29,182.00 28,554.00 29,182.00 28,554.00G0125 ORIF/EF of phalanges of hand, with suture of tendons/nerves,

closed/open fractures38,448.00 37,620.00 38,448.00 37,620.00

G0126 ORIF/EF of metacarpal, closed fracture, including bone graft 17,696.00 17,315.00 17,696.00 17,315.00G0127 ORIF/EF of metacarpal, open/complex fracture 22,890.00 22,397.00 22,890.00 22,397.00G0128 ORIF/EF of metacarpal, with suture of tendons/nerves,

closed/open fracture32,802.00 32,096.00 32,802.00 32,096.00

G0129 ORIF/EF of metacarpals, closed fractures, including bone graft 26,276.00 25,710.00 26,276.00 25,710.00G0130 ORIF/EF of metacarpals, open/complex fractures 32,924.00 32,215.00 32,924.00 32,215.00G0131 ORIF/EF of metacarpals, with suture of tendons/nerves,

closed/open fractures40,318.00 39,450.00 40,318.00 39,450.00

G0132 ORIF of carpal(s), closed fracture, including bone graft 22,447.00 21,964.00 22,447.00 21,964.00G0133 ORIF of carpal(s), open/complex fracture, including bone graft 28,381.00 27,770.00 28,381.00 27,770.00G0134 ORIF of carpal(s), with suture of tendons/nerves, closed/open

fracture, including bone graft37,870.00 37,055.00 37,870.00 37,055.00

G0135 CRIF of hand, with suture of tendons/nerves, closed/openfracture(s)

33,583.00 32,860.00 33,583.00 32,860.00

G0136 Open reduction of closed dislocation of wrist 26,276.00 25,710.00 26,276.00 25,710.00G0137 Open reduction of open/complex dislocation of wrist 32,924.00 32,215.00 32,924.00 32,215.00G0138 Open reduction of dislocation of wrist, with suture of

tendons/nerves40,318.00 39,450.00 40,318.00 39,450.00

G0139 Reattachment of any part of upper extremity 71,252.00 69,718.00 71,252.00 69,718.00G0140 Open/close reduction of fracture(s) of zygoma/maxilla/mandible,

including internal fixation24,034.00 23,517.00 24,034.00 23,517.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

G0141 Open reduction of fractures of orbit/ Le Fort type 2 or 3 / TMJfracture with dislocation, with insertion of synthetic implant/bonegraft to facial bone

37,069.00 36,271.00 37,069.00 36,271.00

G0142 Open reduction of comminuted fractures of facial bones, withinsertion of synthetic implant/bone graft

106,579.00 104,285.00 106,579.00 104,285.00

G0144 ORIF of distal humerus, closed fracture, including bone graft 37,556.00 36,748.00 37,556.00 36,748.00G0145 ORIF of distal humerus, open fracture 58,698.00 57,434.00 58,698.00 57,434.00G0146 ORIF/EF of shaft of radius/ulna, closed fracture, including bone

graft20,479.00 20,038.00 20,479.00 20,038.00

G0147 ORIF/EF of shaft of radius/ulna, open fracture 35,879.00 35,107.00 35,879.00 35,107.00G0148 CRIF of distal humerus/forearm/hand, closed fracture, including

bone graft13,413.00 13,124.00 13,413.00 13,124.00

G0149 CRIF of distal humerus/forearm/hand, open fracture, includingcomplex fracture(s) of hand

24,872.00 24,337.00 24,872.00 24,337.00

G0150 Removal of gastric band 13,720.00 13,425.00 13,720.00 13,425.00G0151 Sleeve gastrectomy 47,384.00 46,364.00 47,384.00 46,364.00G0152 Sleeve gastrectomy with removal of gastric band 48,619.00 47,572.00 48,619.00 47,572.00G0153 Sleeve gastrectomy with repair of diaphragmatic hernia 48,619.00 47,572.00 48,619.00 47,572.00G0154 Sleeve gastrectomy with total cholecystectomy 50,128.00 49,049.00 50,128.00 49,049.00G0155 Gastric bypass surgery with removal of gastric band 59,699.00 58,414.00 59,699.00 58,414.00G0156 Gastric bypass surgery with repair of diaphragmatic hernia 59,699.00 58,414.00 59,699.00 58,414.00G0157 Gastric bypass surgery with total cholecystectomy 61,104.00 59,789.00 61,104.00 59,789.00G0158 Ovarian tissue retrieval, laparoscopic 7,387.00 7,228.00 7,387.00 7,228.00G0160 Implantation/replacement/removal of cochlear prosthetic device,

excluding device cost16,576.00 16,219.00 16,576.00 16,219.00

G0161 Repair of cystocele with graft/prosthesis 12,048.00 11,789.00 12,048.00 11,789.00G0162 Repair of rectocele with graft/prosthesis 12,048.00 11,789.00 12,048.00 11,789.00G0163 Repair of cystocele and rectocele with graft/prosthesis 19,611.00 19,189.00 19,611.00 19,189.00G0164 Repair of cystocele with graft/prosthesis and tension free vaging

tape for incontinence17,863.00 17,478.00 17,863.00 17,478.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

G0165 Repair of rectocele with graft/prosthesis and tension free vagingtape for incontinence

17,863.00 17,478.00 17,863.00 17,478.00

G0166 Repair of cystocele and rectocele with graft/prosthesis andtension free vaging tape for incontinence

25,427.00 24,880.00 25,427.00 24,880.00

G0167 Percutaneous insertion of left atrial appendage device, excludingdevice cost

13,704.00 13,409.00 13,704.00 13,409.00

G0168 Implantation of diaphragmatic pacemaker, excluding device cost 17,703.00 17,322.00 17,703.00 17,322.00G0169 Pump for spasticity treatment preimplantation assessment,

Baclofen14,737.00 14,420.00 14,737.00 14,420.00

G0170 Implantation of pump for chronic pain relief/spasticity treatment,with drug loading, eg, Baclofen/Morphine, excluding pump cost

15,226.00 14,898.00 15,226.00 14,898.00

G0171 Heart surgery, valves 78,119.00 76,437.00 78,119.00 76,437.00G0172 Heart surgery, bypass 78,119.00 76,437.00 78,119.00 76,437.00G0173 Heart surgery, valves and bypass 78,119.00 76,437.00 78,119.00 76,437.00G0174 Heart surgery, excluding valves and bypass surgery 78,119.00 76,437.00 78,119.00 76,437.00G0175 Cholecystectomy, open, partial/complete 17,976.00 17,589.00 17,976.00 17,589.00G0176 Cholecystectomy, laparoscopic, partial/complete 17,976.00 17,589.00 17,976.00 17,589.00G0177 Implantation of vertical expandable prosthetic titanium rib

system, excluding system cost27,302.00 26,714.00 27,302.00 26,714.00

G0178 Implantation of BAHA (Bone Anchored Hearing Aid), excludingdevice cost

10,686.00 10,456.00 10,686.00 10,456.00

G0179 Diagnostic catheterization, excluding cardiac catheterization 15,110.00 14,785.00 15,110.00 14,785.00G0180 Implantation of VNS (Vagus Nerve Stimulator) kit for epilepsy

treatment, excluding device cost17,185.00 16,815.00 17,185.00 16,815.00

G0181 Diagnostic cardiac catheterization 15,110.00 14,785.00 15,110.00 14,785.00G0182 Implantation of intracranial neurostimulator pulse generator kit,

including leads, or replacement of leads, for movementdisorders, excluding devices cost

34,372.00 33,632.00 34,372.00 33,632.00

G0184 Therapeutic cardiac catheterization, excision/destruction oflesion/tissue of heart

42,464.00 41,550.00 42,464.00 41,550.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

G0185 Therapeutic cardiac catheterization, coronary arteries 42,464.00 41,550.00 42,464.00 41,550.00G0186 Percutaneous balloon valvuloplasty 42,464.00 41,550.00 42,464.00 41,550.00G0187 Replacement of neurostimulator pulse generator for intracranial

stimulation, without leads, for movement disorders, excludingdevice cost

17,185.00 16,815.00 17,185.00 16,815.00

G0188 Parathyroidectomy, partial 19,987.00 19,557.00 19,987.00 19,557.00G0189 Parathyroidectomy, complete 19,987.00 19,557.00 19,987.00 19,557.00G0190 Type 2/3 tympanoplasty, including replacement of auditory

ossicles13,196.00 12,912.00 13,196.00 12,912.00

G0191 Simple mastoidectomy 23,656.00 23,147.00 23,656.00 23,147.00G0192 Radical mastoidectomy, including modified radical

mastoidectomy29,698.00 29,059.00 29,698.00 29,059.00

G0193 Myringoplasty, including perforation closure 14,659.00 14,343.00 14,659.00 14,343.00G0194 Excision of salivary glands, excluding parotid, partial/complete 16,116.00 15,769.00 16,116.00 15,769.00G0195 Excision/destruction of vocal cord(s) lesion/tissue 13,060.00 12,779.00 13,060.00 12,779.00G0196 Excision of vocal cord(s) 22,516.00 22,031.00 22,516.00 22,031.00G0197 Maxillectomy/mandibulectomy with microsurgical reconstruction 72,967.00 71,396.00 72,967.00 71,396.00G01H4 Inpatient, per day, for fourth day or longer in acute care hospital,

excluding departments with specific code - out of cap2,664.00 2,535.00 2,591.00 5,070.00

G01H5 Inpatient, per day, Dermatology and Venereology Department inacute care hospital - out of cap

2,664.00 2,535.00 2,591.00 5,070.00

G01H6 Inpatient, per day, Ophthalmology and Pediatric OphthalmologyDepartments in acute care hospital - out of cap

2,664.00 2,535.00 2,591.00 5,070.00

G01H7 Inpatient, per day, Rehabilitation Department in acute carehospital - out of cap

2,664.00 2,535.00 2,591.00 5,070.00

G01M1 Inpatient day, Department of Internal Medicine in acute carehospital - out of cap

2,169.00 2,064.00 2,109.00 4,128.00

G01M2 Inpatient day, Rheumatology Department in acute care hospital -out of cap

2,169.00 2,064.00 2,109.00 4,128.00

G01M3 Inpatient day, Department of Pulmonary Medicine in acute carehospital - out of cap

2,169.00 2,064.00 2,109.00 4,128.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

G01M4 Inpatient day, Department of Geriatric Internal Medicine in acutecare hospital - out of cap

2,169.00 2,064.00 2,109.00 4,128.00

G01M5 Inpatient day, Gastroenterology Department in acute carehospital - out of cap

2,169.00 2,064.00 2,109.00 4,128.00

G01M6 Inpatient day, Observation Department in acute care hospital -out of cap

2,169.00 2,064.00 2,109.00 4,128.00

G01N1 Inpatient day, General Intensive Care Department in acute carehospital - out of cap

2,664.00 2,535.00 2,591.00 5,070.00

G01N3 Inpatient day, Respiratory Intensive Care Department in acutecare hospital - out of cap

2,664.00 2,535.00 2,591.00 5,070.00

G01N5 Inpatient day, Pediatric Intensive Care Department in acute carehospital - out of cap

2,664.00 2,535.00 2,591.00 5,070.00

G01N7 Inpatient day, Neurosurgical Intensive Care Department in acutecare hospital - out of cap

2,664.00 2,535.00 2,591.00 5,070.00

G01P1 Inpatient day, Acute geriatric Department in acute care hospital -out of cap

1,614.00 1,536.00 1,570.00 3,072.00

G01P2 Inpatient day, Geriatric Rehabilitation Department in acute carehospital - out of cap

1,614.00 1,536.00 1,570.00 3,072.00

G01P3 Inpatient day, Department of high Dependency Nursing in acutecare hospital - out of cap

1,614.00 1,536.00 1,570.00 3,072.00

G01Q8 Chronic artificial ventilation care, per day, all hospitals - out ofcap

1,721.00 1,638.00 1,674.00 3,276.00

G0200 POVH (Postoperative Ventral Hernia) repair, open 29,504.00 28,869.00 29,504.00 28,869.00G0201 POVH (Postoperative Ventral Hernia) repair, laparoscopic 29,504.00 28,869.00 29,504.00 28,869.00G0202 Anterior abdominal wall hernia repair, excluding POVH, open 21,007.00 20,555.00 21,007.00 20,555.00G0203 Anterior abdominal wall hernia repair, excluding POVH,

laparoscopic21,007.00 20,555.00 21,007.00 20,555.00

G0204 Diaphragmatic hernia repair, laparoscopic 27,401.00 26,811.00 27,401.00 26,811.00G0206 Umbilical hernia repair, age 5 years or older, open 13,451.00 13,161.00 13,451.00 13,161.00G0207 Umbilical hernia repair, age 5 years or older, laparoscopic 13,451.00 13,161.00 13,451.00 13,161.00G0208 Esophagogastric sphincteric competence creation 30,299.00 29,647.00 30,299.00 29,647.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

G0210 Percutaneous nephrostomy, including fragmentation 38,804.00 37,969.00 38,804.00 37,969.00G0214 Partial nephrectomy, open 36,419.00 35,635.00 36,419.00 35,635.00G0215 Partial nephrectomy, laparoscopic 36,419.00 35,635.00 36,419.00 35,635.00G0216 Complete nephrectomy, including ureterectomy, open 38,560.00 37,730.00 38,560.00 37,730.00G0217 Complete nephrectomy, including ureterectomy, laparoscopic 38,560.00 37,730.00 38,560.00 37,730.00G0220 Ureteroscopy, diagnostic, with/without biopsy 12,352.00 12,086.00 12,352.00 12,086.00G0221 Ureteroscopy, therapeutic, including RIRS 18,967.00 18,559.00 18,967.00 18,559.00G0225 Endoscopic excision of rectal tumor, transanal approach 8,200.00 8,023.00 8,200.00 8,023.00G0229 Excision of hemorrhoids 5,331.00 5,216.00 5,331.00 5,216.00G0230 Salpingectomy, laparoscopic, unilateral/bilateral 14,607.00 14,293.00 14,607.00 14,293.00G0231 Salpingo-oophorectomy, laparoscopic, unilateral/bilateral 14,607.00 14,293.00 14,607.00 14,293.00G0240 Reduction mammoplasty, female, excluding surgery following

significant weight loss17,479.00 17,103.00 17,479.00 17,103.00

G0241 Reduction mammoplasty, male, excluding surgery followingsignificant weight loss

13,675.00 13,381.00 13,675.00 13,381.00

G0250 Corneal surgery with insertion of intraocular lens, including costof cornea and lens

25,218.00 24,675.00 25,218.00 24,675.00

G0251 Insertion of intraocular lens with trabeculectomy, including cost oflens

7,392.00 7,233.00 7,392.00 7,233.00

G0252 Vitrectomy with insertion of intraocular lens, including cost of lens 19,163.00 18,750.00 19,163.00 18,750.00G0253 Vitrectomy with scleral buckling, with/without implant 19,559.00 19,138.00 19,559.00 19,138.00G0254 Single suture loop pupilloplasty with insertion of intraocular lens,

including cost of lens9,575.00 9,369.00 9,575.00 9,369.00

G0255 Single suture loop pupilloplasty with secondary insertion ofintraocular lens, including cost of lens

8,629.00 8,443.00 8,629.00 8,443.00

G0256 Repair of corneal injury 11,436.00 11,190.00 11,436.00 11,190.00G0257 Repair of retinal detachment by injection of gas 8,186.00 8,010.00 8,186.00 8,010.00G0258 Foreign body removal from posterior segment of eye, with/

without use of magnet18,724.00 18,321.00 18,724.00 18,321.00

G0259 Diagnostic aspiration of vitreous 13,845.00 13,547.00 13,845.00 13,547.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

G0260 Excision of lesion of orbit 17,539.00 17,161.00 17,539.00 17,161.00G0270 Radical prostatectomy, open 30,762.00 30,100.00 30,762.00 30,100.00G0277 Radical prostatectomy, laparoscopic 30,762.00 30,100.00 30,762.00 30,100.00G0280 SIRT (Selective Internal Radiation Therapy) for liver tumor, 90Y,

excluding material cost47,690.00 46,663.00 47,690.00 46,663.00

G0287 Orthognathic surgery of jaw, excluding distraction osteogenesis 25,178.00 24,636.00 25,178.00 24,636.00G0288 Orthognathic surgery of jaws for severe congenital functional

disorder, excluding distraction osteogenesis33,668.00 32,943.00 33,668.00 32,943.00

G0289 Orthognathic surgery of jaws for severe developmental functionaldisorder, excluding distraction osteogenesis

33,668.00 32,943.00 33,668.00 32,943.00

G0290 Splenectomy, open, partial/complete 28,782.00 28,162.00 28,782.00 28,162.00G0291 Splenectomy, laparoscopic, partial/complete 28,782.00 28,162.00 28,782.00 28,162.00G0292 Partial pancreatectomy, open 34,989.00 34,236.00 34,989.00 34,236.00G0293 Partial pancreatectomy, laparoscopic 34,989.00 34,236.00 34,989.00 34,236.00G0300 Percutaneous mitral valve repair with implanted device,

excluding device cost21,906.00 21,434.00 21,906.00 21,434.00

G0310 Partial hip replacement for fracture of neck of femur, within 48hours of hospitalization

54,530.00 53,356.00 54,530.00 53,356.00

G0311 Total hip replacement for fracture of neck of femur, within 48hours of hospitalization

60,691.00 59,385.00 60,691.00 59,385.00

G0312 Hip replacement, primary, excluding for fracture 40,069.00 39,206.00 40,069.00 39,206.00G0313 Total knee replacement, primary 40,069.00 39,206.00 40,069.00 39,206.00G0314 Total ankle replacement, primary 40,069.00 39,206.00 40,069.00 39,206.00G0315 Total shoulder replacement, primary 40,069.00 39,206.00 40,069.00 39,206.00G0316 Partial shoulder replacement, primary 36,354.00 35,571.00 36,354.00 35,571.00G0317 Metacarpophalangeal and interphalangeal joint replacement,

including arthroplasty without implant17,477.00 17,101.00 17,477.00 17,101.00

G0318 Hip/knee liner replacement, revision 40,069.00 39,206.00 40,069.00 39,206.00G0319 Joint replacement, revision, excluding liner replacement and first

stage for infection69,116.00 67,628.00 69,116.00 67,628.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

G0320 Joint replacement, revision, first stage for infection, includingspacer implantation

33,827.00 33,099.00 33,827.00 33,099.00

G0321 Joint replacement, revision, two stage for infection, during thesame hospitalization

87,648.00 85,761.00 87,648.00 85,761.00

G0322 Pelvic osteotomy for CDH/DDH (Congenital/DevelopmentalDislocation of Hip) treatment, child

20,796.00 20,348.00 20,796.00 20,348.00

G0323 Femoral osteotomy for CDH/DDH (Congenital/DevelopmentalDislocation of Hip) treatment, child

22,366.00 21,885.00 22,366.00 21,885.00

G0324 Hip arthrotomy for CDH/DDH (Congenital/DevelopmentalDislocation of Hip) treatment, child

25,739.00 25,185.00 25,739.00 25,185.00

G0325 Shoulder arthroscopy, simple, inpatient care 10,116.00 9,898.00 10,116.00 14,847.00G0326 Shoulder arthroscopy, complex, inpatient care 22,253.00 21,774.00 22,253.00 32,661.00G0327 Elbow/wrist/hand and finger arthroscopy, simple, inpatient care 12,138.00 11,877.00 12,138.00 17,816.00G0328 Elbow arthroscopy, complex, inpatient care 17,759.00 17,377.00 17,759.00 26,066.00G0329 Hip arthroscopy, simple, inpatient care 20,230.00 19,795.00 20,230.00 29,693.00G0330 Hip arthroscopy, complex, inpatient care 30,346.00 29,693.00 30,346.00 44,540.00G0331 Knee arthroscopy, simple, inpatient care 7,790.00 7,622.00 7,790.00 11,433.00G0332 Knee arthroscopy, complex, inpatient care 19,006.00 18,597.00 19,006.00 27,896.00G0333 Ankle/foot and toe arthroscopy, simple, inpatient care 10,983.00 10,747.00 10,983.00 16,121.00G0334 Ankle arthroscopy, complex, inpatient care 15,578.00 15,243.00 15,578.00 22,865.00G0335 Arthroscopy, simple/complex, excluding procedures with specific

code, inpatient care7,790.00 7,622.00 7,790.00 11,433.00

G0336 Subtalar arthrodesis 13,311.00 13,024.00 13,311.00 13,024.00G0337 Triple arthrodesis 17,831.00 17,447.00 17,831.00 17,447.00G0338 Ankle arthrodesis, tibiotalar/fibulotalar 19,166.00 18,753.00 19,166.00 18,753.00G0339 Ankle arthrodesis, tibiotalar/talofibular, with subtalar/triple

arthrodesis17,491.00 17,114.00 17,491.00 17,114.00

G0340 Midtarsal/tarsometatarsal arthrodesis 10,869.00 10,635.00 10,869.00 10,635.00G0341 Wrist arthrodesis, radiocarpal 24,532.00 24,004.00 24,532.00 24,004.00G0342 Wrist arthrodesis, carpometacarpal 8,375.00 8,195.00 8,375.00 8,195.00



Price A(ILS)

Price B(ILS)

Price C(ILS)

Price forPatient

fromAbroad(ILS)

G0343 Wrist arthrodesis, total 19,755.00 19,330.00 19,755.00 19,330.00G0344 Tendon/ligament release, child, excluding for clubfoot 14,748.00 14,431.00 14,748.00 14,431.00G0345 Tendons/ligaments release, child, excluding for clubfoot 15,173.00 14,846.00 15,173.00 14,846.00G0346 Tendon/ligament release for clubfoot, child 16,012.00 15,667.00 16,012.00 15,667.00G0347 Tendon of hand transfer/transplantation 11,014.00 10,777.00 11,014.00 10,777.00G0348 Tendon of foot transfer/transplantation 13,545.00 13,253.00 13,545.00 13,253.00G0349 Lower limb epiphyseal stapling, including external/internal

fixation26,009.00 25,449.00 26,009.00 25,449.00

G0350 Lower limb lengthening for deformity correction, includingexternal/internal fixation

90,709.00 88,756.00 90,709.00 88,756.00


Ministry of Health Price List for Ambulatory and...

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