ministry of health price list for ambulatory and ... fileministry of health price list for...
TRANSCRIPT
Ministry of Health Price List for Ambulatory and Hospitalization Services
Onset date: 01/03/13
Sorted by service code
Servicecode Service name
Price for Patient from
Abroad(ILS)
01996 Day care management of epidural/subarachnoid continuous drug administration
666.00
01999 General anesthesia for ambulatory treatment, under anesthesiologist supervision
1,712.00
10060 Incision and drainage of abscess/cyst 545.00
11100 Biopsy, excluding breast 263.00
11750 Excision of ingrown nail 417.00
11770 Excision of cyst, eg, pilonidal 833.00
11975 Insertion, implantable contraceptive capsules (eg, Norplant), including the cost of contraceptive
2,501.00
11976 Removal, implantable contraceptive capsules 233.00
12001 Simple repair of superficial wounds 197.00
16030 Dressings and/or debridement, without anesthesia, large lesion 506.00
17000 Removal of skin lesions, any method 263.00
17311 Mohs micrographic technique 11,898.00
17999 Soft laser treatment, 1/2 level, per treatment 263.00
19100 Biopsy of breast; needle core, not using imaging guidance 263.00
19101 Biopsy of breast; open, incisional 624.00
19102 Biopsy of breast, using imaging guidance, excluding CT/MRI 2,987.00
19499 Breast examination 0.00
20205 Biopsy, muscle, including histological examinations 1,484.00
20206 Biopsy, muscle, including all tests, stains, EM 4,169.00
20220 Biopsy, bone, trocar/needle, superficial 338.00
20520 Foreign body removal, muscle/tendon, local anaesthesia 185.00
20600 Arthrocentesis, aspiration and/or injection; small joint or bursa (eg, fingers, toes)
338.00
20605 Arthrocentesis, aspiration and/or injection; intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa)
338.00
20610 Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa)
338.00
20902 Harvesting of cortical bone, cartilage 5,493.00
21310 Closed treatment of nasal bone fracture 338.00
28899 Intra compartment pressure 764.00
29035 Application, body cast, shoulder to hips 435.00
29065 Application, cast; shoulder to hand (long arm) 263.00
29075 Application, cast, elbow to finger (short arm) 185.00
29085 Application, cast, hand and lower forearm (gauntlet) 185.00
29345 Application, cast, long leg (thigh to toes) 263.00
29405 Application, cast, short leg (below knee to toes) 185.00
29700 Cast removal 156.00
29720 Repair of spica, body cast or jacket 0.00
29999 Arthroscopy, diagnostic and/or surgical procedures, without using implants
10,199.00
30110 Excision, nasal polyp(s), simple 338.00
30200 Injection into turbinate(s) 191.00
Servicecode Service name
Price for Patient from
Abroad(ILS)
30300 Foreign body removal, intranasal, superficial 0.00
30801 Cautery and/or ablation, mucosa of turbinates, unilateral/bilateral, any method
338.00
31002 Sinuses lavage 191.00
31575 Laryngoscopy, flexible fiberoptic, diagnostic 126.00
31579 Laryngoscopy, fiberoptic, with stroboscopy 212.00
31622 Bronchoscopy, diagnostic, with/without brushing/washing 1,943.00
31636 Bronchoscopy, rigid or flexible, with placement of bronchial stent(s) 17,568.00
32000 Thoracentesis, puncture of pleural cavity for aspiration 338.00
36005 Injection of contrast material, including radiology/fluoroscopy 716.00
36468 Injections of sclerosing solutions, spider veins (telangiectasia) 156.00
36511 Therapeutic apheresis, for white blood cells 4,896.00
36513 Therapeutic apheresis, for platelets 3,948.00
36515 Therapeutic apheresis; with extracorporeal immunoadsorption and plasma reinfusion
12,899.00
36522 Photopheresis, extracorporeal 10,370.00
36590 Removal of tunneled central venous access device, with subcutaneous port or pump, central or peripheral insertion
482.00
36600 Arterial blood sampling and diagnosis 263.00
38220 Bone marrow aspiration and smear 542.00
38221 Bone marrow biopsy and smear 542.00
38505 Biopsy or excision of lymph node(s); by needle, superficial 263.00
40808 Biopsy, vestibule of mouth 240.00
40840 Vestibuloplasty, anterior 1,104.00
41010 Incision of lingual frenum (frenotomy) 809.00
42699 Salivary glands endoscopy 10,500.00
42700 Incision and drainage of peritonsillar abscess 338.00
42809 Foreign body removal, pharynx, superficial 0.00
43200 Esophagoscopy, diagnostic 396.00
43204 Esophagoscopy, with injection sclerosis of esophageal varices 4,853.00
43219 Esophageal dilation and insertion of stent 23,493.00
43235 UGI endoscopy, with/without sampling 1,634.00
43240 Endoscopic drainage of pseudocyst of pancreas, using EUS guidance 13,407.00
43259 Upper gastrointestinal endoscopy; with endoscopic ultrasound examination
1,973.00
43260 ERCP (Endoscopic retrograde cholangiopancreatography), diagnostic 5,264.00
43264 ERCP (Endoscopic retrograde cholangiopancreatography), therapeutic 8,939.00
43450 Esophageal dilation, without using imaging guidance 396.00
43750 PEG (Percutaneous Endoscopic Gastrostomy) 3,216.00
43760 Replacement of PEG (Percutaneous Endoscopic Gastrostomy) 1,770.00
44360 Small intestinal endoscopy, enteroscopy, diagnostic, with/without collection of specimen(s)
3,650.00
45300 Proctosigmoidoscopy, diagnostic 288.00
45331 Sigmoidoscopy, flexible, with/without biopsy 941.00
45378 Colonoscopy, flexible; diagnostic, with/without collection of specimen(s), population at risk
1,472.00
45383 Colonoscopy, with excision of lesion 3,015.00
45387 Colonoscopy, with dilation and stent placement 23,493.00
45905 Dilation of anal sphincter 447.00
Servicecode Service name
Price for Patient from
Abroad(ILS)
46080 Sphincterotomy, anal, division of sphincter under general/regional anesthesia
2,838.00
46500 Injection of sclerosing solution, hemorrhoids 156.00
46600 Anoscopy, diagnostic 119.00
47999 Extracorporeal shockwave lithotripsy, biliary tract, simple 8,678.00
49321 Laparoscopy, surgical, with biopsy (single or multiple) 7,971.00
50040 Nephrostomy, nephrotomy with drainage 3,755.00
50398 Repositioning/change of nephrostomy or pyelostomy tube 2,240.00
50590 Extracorporeal shockwave lithotripsy, kidney; simple 9,000.00
51045 Insertion of urethral or ureteral stent 3,755.00
51700 Bladder irrigation, simple, lavage and/or instillation 185.00
51703 Insertion of urethral catheter 191.00
51720 Bladder instillation of anticarcinogenic agent 480.00
51726 Cystometrogram 716.00
51736 Simple uroflowmetry (UFR) 338.00
51741 Complex uroflowmetry 2,345.00
51772 Urethral pressure profile studies (UPP) (urethral closure pressure profile) 716.00
51784 EMG of anal/urethral sphincter, any technique 716.00
52000 Cystourethroscopy 699.00
52204 Cystourethroscopy, with biopsy/other surgical procedure 1,820.00
53000 Urethrotomy or urethrostomy 699.00
53850 Destruction of prostate tissue by thermotherapy 6,348.00
53899 Cystoscopic injection of botulinum toxin, including cost of material 4,382.00
54235 Injection of corpora cavernosa 128.00
54250 Nocturnal penile tumescence and/or rigidity test 923.00
55000 Puncture aspiration of hydrocele, with/without injection of medication 396.00
55700 Biopsy, prostate; needle or punch, single or multiple, any approach 2,508.00
55870 Electroejaculation 8,802.00
57452 Colposcopy, vaginoscopy 179.00
57510 Cautery of cervix, any method 185.00
58120 Dilation and curettage, diagnostic and/or therapeutic, excluding induced abortion
3,741.00
58300 Insertion of intrauterine device (IUD) 396.00
58301 Removal of intrauterine device (IUD) 185.00
58321 Artificial insemination, intra=cervical 185.00
58322 Artificial insemination, intra=uterine 254.00
58323 Sperm washing for artificial insemination 765.00
58345 Fallopian tube dilation, catheterization, diagnostic/therapeutic 5,543.00
58555 Hysteroscopy 699.00
58558 Hysteroscopy, surgica, with biopsy/other surgical procedure 1,277.00
58563 Uterine thermal therapy 8,186.00
58974 Cryopreserved embryos transfer, intrauterine 5,592.00
59000 Amniocentesis 345.00
59012 Cordocentesis (intrauterine), any method 3,935.00
59020 Fetal contraction stress test 1,007.00
59025 Fetal NST (non stress test) 474.00
59866 Multifetal pregnancy reduction(s) (MPR), including US guidance 3,741.00
59871 Removal of cerclage suture 263.00
62270 Spinal puncture, lumbar, diagnostic 953.00
Servicecode Service name
Price for Patient from
Abroad(ILS)
62272 Spinal puncture, therapeutic 953.00
62310 Injection, epidural/subarachnoid; cervical/thoracic 666.00
62311 Injection, epidural/subarachnoid; lumbar/sacral (caudal) 666.00
64400 Injection, anesthetic agent (eg, Lignocaine) 329.00
64470 Paravertebral injection 191.00
64550 Application of surface (transcutaneous) neurostimulator 338.00
64612 Botolinum Toxin, 10 units Botox administration 362.00
65205 Foreign body removal, external eye, superficial 0.00
66984 Extracapsular cataract removal with insertion of intraocular lens prosthesis, any methods, lens included
7,491.00
66999 Intracorneal rings for keratoconus treatment, Intacs 9,813.00
67210 Retinal photocoagulation, PDT, without material 2,538.00
67912 Implantation of upper eyelid gold weight 6,483.00
68810 Probing of nasolacrimal duct, with/without irrigation 1,779.00
68811 Probing of nasolacrimal duct, with/without irrigation; requiring general anesthesia
4,799.00
69000 Puncture/drainage external ear abscess/hematoma 338.00
69200 Foreign body removal, ear, superficial 0.00
69210 Removal impacted cerumen 191.00
69420 Myringotomy including puncture/aspiration 338.00
69436 Tympanostomy (requiring insertion of ventilating tube), general anesthesia
2,050.00
70030 Eye radiology, foreign body detection 410.00
70100 Mandible radiology, up to two views 342.00
70120 Mastoids radiology, up to two views 185.00
70170 Dacryocystography, radiological supervision and interpretation 254.00
70200 Orbits radiology, up to two views 245.00
70210 Paranasal sinuses radiology, up to two views 242.00
70240 Sella turcica radiology 338.00
70250 Skull radiology, up to two views 170.00
70332 TMJ arthrography, including injection and interpretation 435.00
70336 TMJ (temporomandibular joint(s)) MRI 3,039.00
70360 Neck, soft tissue radiology, trachea 545.00
70390 Salivary glands radiology, sialography 513.00
70540 Orbit, face and neck, without contrast material 3,039.00
70551 Brain/brain stem MRI, without contrast material 3,039.00
71020 Chest radiology, up to two views 158.00
71023 Chest radiology, up to two views, with fluoroscopy 480.00
71100 Ribs radiology, up to two views 236.00
71120 Sternum radiology, up to two views 254.00
71550 Thorax MRI, without contrast material 2,937.00
72010 Spine radiology, entire, up to two views 245.00
72040 Cervical spine radiology, up to two views 170.00
72070 Thoracic spine radiology, up to two views 170.00
72080 Thoracolumbar spine radiology, up to two views 170.00
72100 Lumbosacral spine radiology, up to two views 170.00
72141 Cervical spine, MRI, per patient 3,039.00
72146 Thoracic spine, MRI, per patient 3,039.00
72148 Lumbar spine, MRI, per patient 3,039.00
72170 Pelvis radiology, up to two views 189.00
72200 SIJ radiology, up to two views 254.00
Servicecode Service name
Price for Patient from
Abroad(ILS)
72270 Myelography 1,946.00
73000 Clavicle radiology 201.00
73010 Scapula radiology 201.00
73030 Shoulder radiology, complete, one side, up to two views 185.00
73040 Shoulder arthrography, including injection and interpretation 435.00
73060 Humerus radiology, up to two views 170.00
73070 Elbow radiology, up to two views 170.00
73085 Elbow arthrography, including injection and interpretation 435.00
73090 Forearm radiology, up to two views 170.00
73092 Upper extremity radiology, infant, up to two views 170.00
73100 Wrist radiology, up to two views 170.00
73115 Wrist, arthrography, including injection and interpretation 435.00
73120 Hand radiology, up to two views 170.00
73140 Finger(s) radiology, up to two views 170.00
73221 Upper extremity joints MRI, without contrast material, per patient 2,937.00
73500 Hip radiology, unilateral, one view 170.00
73520 Hip radiology, bilateral, including pelvis 170.00
73525 Hip arthrography, including injection and interpretation 435.00
73542 SIJ arthrography, including injection and interpretation 435.00
73550 Femur radiology, up to two views 170.00
73560 Knee radiology, up to two views, per side 170.00
73562 Knee radiology, third or more additional views 185.00
73580 Knee arthrography, including injection and interpretation 435.00
73590 Tibia and fibula radiology, up to two views 170.00
73592 Lower extremity radiology, infant, up to two views 170.00
73610 Ankle radiology, complete, one side 170.00
73615 Ankle arthrography, including injection and interpretation 435.00
73620 Foot radiology, up to two views 170.00
73721 Lower extremity joints MRI, without contrast material, per patient 2,937.00
74000 Abdomen radiology, without contrast material 242.00
74181 Abdomen, MRI, per patient 3,039.00
74220 Esophagus radiology 602.00
74230 Swallowing function, with cineradiography/videoradiography 959.00
74241 UGI fluoroscopy and/or radiology, with/without delayed films 1,007.00
74245 UGI fluoroscopy, including serial films 1,244.00
74249 Abdomen radiology, small intestine follow=through 602.00
74270 Barium enema 716.00
74280 Air barium enema, with/without glucagon 1,149.00
74290 Cholecystography, oral contrast 599.00
74360 Esophageal dilation, using imaging guidance 7,997.00
74400 IVP, with or without tomography 887.00
74420 Urography, retrograde 728.00
74450 Urethrocystography, retrograde, radiological supervision and interpretation
564.00
74455 Urethrocystography, radiological supervision and interpretation 705.00
74740 Hysterosalpingography, radiology 734.00
75552 MRI cardiac morphology, per patient 8,097.00
75554 Cardiac FMRI; with/without morphology, complete study, per patient 8,097.00
75803 Lymphangiography, extremities 2,829.00
Servicecode Service name
Price for Patient from
Abroad(ILS)
75822 Phlebography, venography, including injection and imaging 953.00
76000 Fluoroscopy 156.00
76120 Cineradiography/videoradiography, video capsule 7,193.00
76140 Interpretation/consultation on imaging made elsewhere 185.00
76390 MRS,Magnetic resonance spectroscopy, per patient 8,097.00
76512 Ophthalmic US (ultrasound) 236.00
76514 Ophthalmic US, corneal pachymetry, determination of corneal thickness, per patient
131.00
76536 Head and neck soft tissues US, with image documentation 474.00
76604 Chest US, including mediastinum, with image documentation 815.00
76645 Breasts and chest wall US, with image documentation 330.00
76700 Abdomen US, with image documentation 474.00
76805 Fetal anatomic US, with image documentation 1,218.00
76813 Fetal nuchal translucency US, per one fetus, with image documentation 500.00
76814 Fetal nuchal translucency US, per each additional fetus, with image documentation
330.00
76815 Obstetric US, with image documentation 666.00
76825 Echocardiography, fetal, with image documentation 1,394.00
76827 Doppler echocardiography, fetal 1,725.00
76830 TVUS (Transvaginal Ultrasound) 390.00
76831 Uterus and fallopian tube sonography, with contrast material 1,355.00
76857 Gynecological US, follicles 248.00
76870 Scrotum US, with image documentation 815.00
76872 TRUS (transrectal ultrasound), with image documentation 1,182.00
76942 Biopsy/surgical procedure, US guidance 3,753.00
77002 Biopsy/surgical procedure, using fluoroscopic guidance 3,753.00
77012 Biopsy/surgical procedure, using CT guidance 6,798.00
77021 Biopsy/surgical procedure, using MRI guidance 10,199.00
77031 Stereotactic localization guidance for breast biopsy/needle placement, including biopsy, using imaging guidance (eg, mammography)
6,795.00
77032 Mammographic guidance for needle placement, breast (eg, for wire localization or for injection), each lesion, radiological supervision and interpretation
1,032.00
77054 Mammary ductogram/galactogram, including interpretation 1,335.00
77056 Mammography; bilateral 333.00
77059 MRI, breast, without and/or with contrast material(s); bilateral 3,039.00
77073 Bone length studies (orthoroentgenogram, scanogram) 477.00
77080 DXA, bone density study 296.00
77261 Therapeutic radiology treatment planning, radiotherapy 777.00
77280 Radiotherapy simulation 3,093.00
77295 Radiology simulation=aided field setting, three=dimensional 3,870.00
77401 Radiation treatment delivery, per field 679.00
78000 Thyroid uptake, single determination 390.00
78001 Thyroid uptake, multiple determinations 663.00
78007 Thyroid imaging, with uptake, multiple determinations 1,326.00
78010 Thyroid imaging 863.00
78018 Thyroid imaging; I=131, whole body 4,002.00
78070 Parathyroid imaging 1,995.00
78104 Bone marrow imaging, whole body 3,732.00
Servicecode Service name
Price for Patient from
Abroad(ILS)
78122 Whole blood volume determination, radiopharmaceutical technique 2,477.00
78130 Red cell survival study 4,226.00
78191 Platelet survival study 1,341.00
78195 Lymphatics and lymph nodes imaging 3,696.00
78205 Liver and spleen imaging, SPECT 1,167.00
78215 Liver and spleen imaging, static 1,032.00
78216 Liver and spleen imaging, dynamic and static 1,097.00
78223 Hepatobiliary imaging, with/without pharmacologic intervention, with/without quantitative measurement of gallbladder function
3,042.00
78231 Salivary gland imaging, with serial images 1,269.00
78258 Esophageal motility, dynamic 1,314.00
78262 Gastroesophageal reflux study 990.00
78264 Gastric emptying study 3,939.00
78270 Vitamin B=12 absorption, without intrinsic factor 948.00
78271 Vitamin B=12 absorption, with intrinsic factor 1,299.00
78278 Acute GI bleeding imaging, dynamic and static 3,840.00
78290 Intestine imaging (eg, Meckel's, ectopic gastric mucosa) 1,902.00
78291 Peritoneal=venous shunt patency test (eg, for LeVeen, Denver shunt) 2,690.00
78300 Bone and/or joint imaging, limited area 1,604.00
78306 Bone and/or joint imaging, whole body 1,004.00
78315 Bone and/or joint imaging, three phase 3,234.00
78320 Bone and/or joint imaging, SPECT 1,131.00
78399 Bone and/or joint imaging, whole body, 24 hours later 461.00
78428 Cardiac shunt detection, dynamic 1,056.00
78445 Vascular flow imaging, perfusion 1,380.00
78458 Venous thrombosis imaging, bilateral 1,821.00
78461 Myocardial perfusion imaging, at rest and/or stress, planar 4,425.00
78465 Myocardial perfusion imaging, rest and/or stress, SPECT 5,017.00
78466 Myocardial imaging, infarct, planar 3,294.00
78468 Myocardial imaging, infarct, planar first pass, EF 3,908.00
78469 Myocardial imaging, infarct, SPECT 4,533.00
78472 Cardiac BP imaging, gated planar, rest/stress, EF 2,076.00
78473 Cardiac BP imaging, gated, rest and stress, EF 4,917.00
78478 Myocardial perfusion imaging, with wall motion 6,134.00
78480 Myocardial perfusion study with EF 6,411.00
78481 Cardiac BP imaging, gated planar, rest/stress, first pass, EF 2,048.00
78499 Cardiac BP (pool imaging)imaging, static 993.00
78580 Pulmonary imaging, perfusion 1,185.00
78585 Pulmonary imaging, ventilation and perfusion, Xenon 2,771.00
78587 Pulmonary imaging, ventilation, aerosol 2,282.00
78594 Pulmonary imaging, ventilation, xenon 2,376.00
78596 Pulmonary imaging, ventilation and perfusion, quantitative differential function
3,503.00
78605 Brain imaging, static 1,652.00
78606 Brain imaging, dynamic and static 2,223.00
78607 Brain imaging, SPECT 4,251.00
78610 Brain imaging, dynamic 1,538.00
78630 CSF (Cerebrospinal fluid) imaging, cisternography 6,378.00
78645 CSF flow imaging, shunt evaluation 1,311.00
78650 CSF leakage detection and localization 3,785.00
Servicecode Service name
Price for Patient from
Abroad(ILS)
78660 Radiopharmaceutical dacryocystography 1,595.00
78699 Brain tumor imaging, SPECT 3,836.00
78700 Kidney imaging, static 1,959.00
78701 Kidney imaging, dynamic, GFR 2,223.00
78707 Kidney imaging, dynamic, without pharmacological intervention 1,511.00
78708 Kidney imaging, dynamic, with pharmacological intervention 1,802.00
78710 Kidney imaging, SPECT 1,937.00
78740 Ureteral reflux imaging (cystogram) 1,694.00
78761 Testicular imaging, dynamic and static 983.00
78802 Tumor imaging, planar 6,009.00
78803 Tumor imaging, SPECT 5,237.00
78805 Inflammatory process imaging, limited area 5,871.00
78806 Inflammatory process imaging, whole body 7,217.00
78807 Inflammatory process imaging, SPECT 5,237.00
78813 PET=FDG imaging 5,982.00
78999 Tumor imaging, monoclonal antibodies, SPECT 11,073.00
79101 Radiopharmaceutical therapy, polycythemia vera 2,796.00
79403 Radiopharmaceutical therapy, intravenous administration, Zevalin, 90Y=Ibritumomab tiuxetan
2,376.00
79440 Radiopharmaceutical therapy, by intra=articular administration 7,674.00
80053 Chemistry panel 81.00
80061 Lipids panel = blood: Cholesterol, TG, HDL, LDL 65.00
80076 Hepatic function panel 90.00
80100 Drug, qualitative = urine 177.00
80101 Drug, qualitative 263.00
80162 Digoxin 126.00
80178 Lithium 191.00
80195 Sirolimus 432.00
80299 Drug, quantitative 263.00
80400 ACTH stimulation, including blood hormones levels 668.00
80420 Dexamethasone suppression test, 48 hour, include: free cortisol, urine cortisol, volume measurement
198.00
81000 Urinalysis, with microscopy 57.00
81002 Urinalysis stick, manual = urine, panel billing code 26.00
82010 Acetone, quantitative 119.00
82013 Acetylcholinesterase = amniotic fluid 734.00
82017 Acylcarnitine, quantitative = blood/urine 888.00
82030 Cyclic AMP = blood and urine 1,050.00
82040 Albumin = serum 23.00
82042 Albumin, quantitative = urine/other source, excluding serum 23.00
82043 Microalbumin = urine / 24 hours 126.00
82085 Aldolase 263.00
82088 Aldosterone 342.00
82103 Alpha 1 antitrypsin, total 396.00
82105 Alpha=fetoprotein = serum 48.00
82128 Amino acids, qualitative 164.00
82131 Amino acids, quantitative 468.00
82135 Aminolevulinic acid (ALA), quantitative = urine 452.00
82140 Ammonia 257.00
82150 Amylase 47.00
Servicecode Service name
Price for Patient from
Abroad(ILS)
82154 Androstenedione/androstenediol glucoronide 282.00
82160 Androsterone 564.00
82172 Apolipoprotein B1/A1 191.00
82180 Vitamin C, ascorbic acid = blood 185.00
82205 Barbiturates, qualitative = urine 263.00
82232 Beta 2 microglobulin 395.00
82239 Bile acids degradation test 398.00
82247 Bilirubin, total 23.00
82248 Bilirubin, direct 23.00
82261 Biotinidase 374.00
82270 Occult blood = feces 119.00
82306 Calcifediol (25=OH Vitamin D=3) 165.00
82307 Calciferol (Vitamin D) 165.00
82308 Calcitonin 342.00
82310 Calcium, total, excluding urine 23.00
82340 Calcium = urine 45.00
82360 Calculus, quantitative and qualitative analysis 1,392.00
82374 Carbon dioxide (bicarbonate) 156.00
82378 CEA (Carcinoembryonic Ag), including dilution 48.00
82380 Carotene 185.00
82382 Catecholamines, total 815.00
82390 Ceruloplasmin 263.00
82435 Chloride = blood 45.00
82436 Chloride = urine 45.00
82438 Chloride = other source, excluding blood/urine 45.00
82465 Cholesterol, total = blood 23.00
82480 Cholinesterase = serum 119.00
82486 Chromatography, qualitative 191.00
82492 Chromatography, quantitative, any method 191.00
82525 Copper 104.00
82533 Cortisol, total 57.00
82540 Creatine 119.00
82550 CK (Creatine Kinase, CPK), total 23.00
82552 CK (Creatine Kinase, CPK) isoenzymes 377.00
82565 Creatinine = blood 27.00
82570 Creatinine = other fluids, excluding blood 57.00
82575 Creatinine clearance test 80.00
82585 Cryofibrinogen 384.00
82595 Cryoglobulin, qualitative or semi=quantitative (eg, cryocrit) 191.00
82607 Vitamin B=12, cyanocobalamin 212.00
82608 Vitamin B=12, cyanocobalamin, binding capacity 75.00
82626 Dehydroepiandrosterone (DHEA) 90.00
82627 Dehydroepiandrosterone=sulfate (DHEA=S) 90.00
82652 Vitamin D (Calciferol) 1,25=Dihydroxy 668.00
82657 Enzyme activity in blood cells, cultured cells, or tissue, each 263.00
82670 Estradiol 90.00
82672 Estrogens, total, all derivatives 564.00
82677 Estriol 396.00
82679 Estrone 384.00
82705 Fat, qualitative = feces 185.00
Servicecode Service name
Price for Patient from
Abroad(ILS)
82710 Fat, quantitative = feces 599.00
82726 Very long chain fatty acids 1,271.00
82728 Ferritin 44.00
82731 Fetal fibronectin 620.00
82746 Folic acid = serum 189.00
82757 Fructose = seminal fluid 396.00
82759 Galactokinase 1,113.00
82760 Galactose 384.00
82775 Galactose 1 phosphate uridyl transferase, quantitative 599.00
82787 Gammaglobulin, immunoglobulin subclasses 942.00
82800 Gases, pH only = blood 191.00
82803 Gases = blood 240.00
82941 Gastrin 342.00
82945 Glucose = other fluids, excluding blood 119.00
82947 Glucose, quantitative = blood 23.00
82951 Glucose tolerance test (GTT) 263.00
82955 Glucose=6=phosphate dehydrogenase (G6PD), quantitative 564.00
82960 Glucose=6=phosphate dehydrogenase (G6PD), screen 384.00
82977 Gamma glutamyltransferase (GGT) 44.00
82985 Fructosamine/glycated protein 564.00
83001 Gonadotropin, FSH (Follicle stimulating hormone) 44.00
83002 Gonadotropin, LH (Luteinizing hormone) 87.00
83003 GH (Growth hormone), somatotropin 90.00
83010 Haptoglobin, quantitative 435.00
83013 Rapid urease test, helicobacter pylori = exhaled air 65.00
83015 Heavy metal (arsenic, barium, beryllium, bismuth, antimony, mercury, thallium), screen
263.00
83020 Hemoglobin, electrophoresis 159.00
83036 Hemoglobin; glycosylated (A1C) 57.00
83045 Hemoglobin, methemoglobin, qualitative 564.00
83069 Hemoglobin = urine 329.00
83070 Hemosiderin, qualitative = urine 338.00
83071 Hemosiderin, quantitative = urine 338.00
83090 Homocysteine 353.00
83491 Hydroxycorticosteroids, 17= (17=OHCS) 434.00
83497 Hydroxyindolacetic acid, 5=(HIAA) 206.00
83525 Insulin, total 90.00
83540 Iron 57.00
83550 Iron binding capacity 263.00
83586 Ketosteroids , total 384.00
83593 Ketosteroids, 17= (17=KS), fractionation 2,124.00
83605 Lactate (lactic acid) 137.00
83615 Lactate dehydrogenase (LD), (LDH) 23.00
83625 Lactate dehydrogenase (LD), (LDH), isoenzymes, total 564.00
83655 Lead 126.00
83661 Fetal lung maturity assessment, Lecithin/Sphingomyelin ratio = amniotic fluid
716.00
83690 Lipase 47.00
83700 Lipoprotein, electrophoresis = blood 38.00
83718 Lipoprotein, HDL cholesterol 45.00
Servicecode Service name
Price for Patient from
Abroad(ILS)
83719 Lipoprotein, VLDL cholesterol 45.00
83735 Magnesium 23.00
83825 Mercury, quantitative 263.00
83866 Mucopolysaccharides, screen = urine, per patient 410.00
83872 Mucin/other material = synovial fluid, including biochemistry, cytology and culture
410.00
83874 Myoglobin 354.00
83896 Molecular diagnosis of hematologic malignancies 1,809.00
83898 RT=PCR, molecular diagnostics 4,398.00
83918 Organic acids, quantitative = urine 831.00
83930 Osmolality = blood 119.00
83935 Osmolality = urine 119.00
83945 Oxalate, qualitative/quantitative = urine 474.00
83970 Parathormone (parathyroid hormone) 324.00
84060 Acid phosphatase, total 119.00
84061 Acid phosphatase stain 263.00
84066 Acid phosphatase, prostatic 185.00
84075 Alkaline phosphatase 23.00
84080 Alkaline phosphatase isoenzymes 564.00
84100 Phosphorus = blood 23.00
84105 Phosphorus = urine 23.00
84110 Porphobilinogen, quantitative, collection = urine 332.00
84119 Porphobilinogen, quantitative = urine 185.00
84127 Porphyrins, qualitative = feces 294.00
84132 Potassium = blood 23.00
84135 Pregnanediol 384.00
84138 Pregnanetriol 564.00
84144 Progesterone 90.00
84146 Prolactin 132.00
84153 PSA (Prostate specific Ag), total 57.00
84154 PSA (Prostate specific Ag), free 119.00
84155 Protein, total = serum 23.00
84156 Protein, total = urine 23.00
84165 Protein electrophoretic 126.00
84207 Vitamin B=6 (pyridoxal phosphate) 402.00
84210 Phenylpyruvic acid = urine 57.00
84233 Receptor assay, estrogene 882.00
84244 Renin 342.00
84260 Serotonin 206.00
84295 Sodium = blood 23.00
84375 Sugars chromatography 191.00
84376 Sugars (mono=, di=, and oligosaccharides), qualitative = body fluids 410.00
84402 Testosterone, free 185.00
84403 Testosterone, total 90.00
84432 Thyroglobulin 488.00
84436 Thyroxine, total 51.00
84443 Thyroid stimulating hormone (TSH) 51.00
84446 Tocopherol alpha (Vitamin E) 263.00
84450 AST (GOT) Aspartate aminotransferase 44.00
84460 ALT (GPT) Alanine amino transferase 44.00
Servicecode Service name
Price for Patient from
Abroad(ILS)
84466 Transferrin 168.00
84478 Triglycerides 23.00
84479 Thyroid hormone (T3/T4) uptake or binding ratio (THBR) 105.00
84480 Triiodothyronine T3, total (TT=3) 105.00
84484 Troponin, quantitative 218.00
84490 Chymotrypsin, quantitative = feces 329.00
84520 Urea, quantitative = blood 23.00
84540 Urea, quantitative = urine/other fluids, excluding blood 57.00
84550 Uric acid = blood 23.00
84560 Uric acid = body fluids, excluding blood 57.00
84585 Vanillylmandelic acid (VMA) = urine 263.00
84588 Vasopressin (antidiuretic hormone, ADH) 668.00
84590 Vitamin A 185.00
84620 Xylose absorption test = blood/urine 191.00
84681 C=peptide 185.00
84702 hCG (Human chorionic gonadotropin), qualitative/quantitative 126.00
85002 Bleeding time 111.00
85007 Manual differential 54.00
85009 Blood count, manual differential, buffy coat 263.00
85025 CBC (complete blood count) with differential 38.00
85032 Blood smear, manual test 156.00
85044 Reticulocytes manual count 90.00
85049 Platelet, thrombocyte 98.00
85170 Clot retraction 156.00
85210 Clotting, factor II, prothrombin 293.00
85220 Clotting, factor V (AcG or proaccelerin) 384.00
85230 Clotting, factor VII, proconvertin 293.00
85244 Clotting, factor VIII related antigen 380.00
85245 Clotting, factor VIII, ristocetin cofactor 887.00
85250 Clotting, factor IX 426.00
85260 Clotting, factor X (Stuart=Prower) 293.00
85270 Clotting, factor XI (PTA) 293.00
85280 Clotting, factor XII (Hageman) 716.00
85290 Clotting, factor XIII (fibrin stabilizing) 384.00
85301 Clotting anticoagulant, antithrombin III antigen 420.00
85302 Protein C, anticoagulant 522.00
85305 Protein S, anticoagulant 435.00
85362 Fibrinogen degradation (split) products (FDP) (FSP 716.00
85384 Fibrinogen activity 126.00
85390 Fibrinolysins or coagulopathy, screen 564.00
85460 HbF (Hemoglobin fetal) stain 263.00
85475 Hemolysin, acid, Ham test 338.00
85540 LAP (Leukocyte Alkaline Phosphatase) with count 384.00
85549 Muramidase 668.00
85557 Osmotic fragility 384.00
85576 Platelet aggregation 599.00
85597 Platelet neutralization 734.00
85610 PT (Prothrombin time) 53.00
85635 Reptilase test 263.00
85651 Sedimentation rate = blood 26.00
Servicecode Service name
Price for Patient from
Abroad(ILS)
85670 TT (Thrombin time) = plasma 119.00
85730 PTT (Thromboplastin time) = plasma/blood 57.00
85810 Viscosity = blood 384.00
86000 Agglutinins, febrile, per test 156.00
86021 Leucocyte, Ab 329.00
86022 Platelet, Ab 677.00
86038 ANA (Antinuclear antibodies) 345.00
86060 ASL0 (Antistreptolysin 0), titer 191.00
86140 C=reactive protein 68.00
86147 Cardiolipin, Ab 90.00
86155 Chemotaxis assay 1,806.00
86156 Cold agglutinin, screen 156.00
86157 Cold agglutinin, quantitative 156.00
86162 Complement total hemolytic activity 1,040.00
86171 Complement fixation 236.00
86225 DNA, native or double stranded, Ab 1,158.00
86235 Extractable nuclear antigen, antibody to, any method (eg, nRNP, SS=A, SS=B, Sm, RNP, Sc170, J01), each antibody
159.00
86255 Fluorescent noninfectious agent Ab, not otherwise specified 132.00
86300 CA 15.3 tumor antigen 65.00
86301 CA 19.9, tumor antigen 134.00
86304 CA 125 tumor antigen 57.00
86320 Immunoelectrophoresis = serum 407.00
86325 Immunoelectrophoresis = body fluids, excluding serum, eg, urine, CSF 119.00
86336 Inhibin = serum 312.00
86337 Insulin, Ab 374.00
86341 Islet cell, Ab 159.00
86344 Leukocyte phagocytosis 3,063.00
86353 Lymphocyte transformation 2,204.00
86359 T and B cell count 866.00
86360 T cells absolute CD4 and CD8 count, including ratio 2,712.00
86376 Microsomal antibodies, eg, thyroid or liver=kidney 369.00
86382 Virus neutralization test 443.00
86403 Agglutination, screen (latex, Rose Waller) 185.00
86406 Agglutination, particle, titer, each Ab 396.00
86431 Rheumatoid factor, qualitative/quantitative 156.00
86580 Skin test; tuberculosis, intradermal 84.00
86592 Syphilis test, VDRL, RPR, TPHA, FTA, ELISA 156.00
86619 Borrelia (relapsing fever), Ab 521.00
86644 CMV (cytomegalovirus) Ab 318.00
86648 Diphtheria, Ab 263.00
86677 Helicobacter pylori, Ab = B 65.00
86692 Hepatitis delta, Ab 134.00
86703 HIV screening, central blood bank 0.00
86704 Hepatitis B core antibody (HBcAb), IgG and IgM 80.00
86705 Hepatitis B core Ab (HBcAb), IgM 87.00
86706 Hepatitis B surface Ab (HBsAb) 44.00
86707 Hepatitis Be Ab (HBeAb) 110.00
86708 Hepatitis A antibody (HAAb), total, IgG and IgM 114.00
Servicecode Service name
Price for Patient from
Abroad(ILS)
86709 Hepatitis A Ab (HAAb), IgM or IgG 140.00
86720 Leptospira, Ab 236.00
86738 Mycoplasma, Ab 329.00
86762 Rubella virus IgG and IgM 159.00
86778 Toxoplasma IgM 98.00
86789 West Nile virus IgG and IgM 510.00
86790 Virus/bacteria Ab, not otherwise specified 263.00
86800 Thyroglobulin, Ab 396.00
86803 Hepatitis C, Ab 48.00
86805 Lymphocytotoxicity assay, visual crossmatch; with titration 419.00
86813 HLA typing, A, B, C 2,150.00
86817 HLA typing, DR/DQ 2,781.00
86821 HLA typing, MLC (mixed lymphocyte culture) 2,781.00
86880 DAT (Direct Antiglobulin Test) / Coombs 191.00
86900 Blood typing, including RH 125.00
86901 Rh test 156.00
86903 Blood typing and Rh, Ab, screen 545.00
86904 Blood typing and Rh, Ab 1,079.00
86905 Blood typing; RBC antigens, other than ABO or Rh (D) 1,643.00
86940 Hemolysins and agglutinins, screen 564.00
87001 Animal inoculation, eg, tuberculosis 564.00
87040 Blood culture and susceptibility 117.00
87045 Feces culture 156.00
87070 Culture, other source, excluding blood/urine/feces 117.00
87081 Urine culture, non quantitative 156.00
87086 Urine culture, quantitative 315.00
87088 Urine culture and susceptibility 176.00
87106 Fungi culture 156.00
87109 Mycoplasma culture 236.00
87110 Chlamydia culture 480.00
87116 Mycobacteria culture and identification 513.00
87118 Mycobacterial definitive identification, MTb 261.00
87140 Fluorescence or darkfield microscopy 156.00
87177 Ova and parasites, direct smear, identification = feces 119.00
87181 Susceptibility studies, antimicrobial agent, per agent 156.00
87190 Susceptibility studies, antimycobacterial agent, mycobacteria 350.00
87205 Smear interpretation, stain for bacteria, fungi, parasites or cell types 119.00
87207 Smear, special stain for parasites 156.00
87250 Virus isolation, including nucleic acid identification, polymerase chain reaction, PCR
602.00
87252 Virus isolation, tissue culture 191.00
87253 Virus isolation and identification, tissue culture, any method 953.00
87278 Legionella Ag = urine 233.00
87299 Immunofluorescent study; not otherwise specified 329.00
87340 Hepatitis B surface antigen (HBsAg), any method, including immunofluorescent study
132.00
87350 Hepatitis Be antigen (HBeAg), any method, including immunofluorescent study
110.00
87449 Infectious agent antigen detection, not otherwise specified 542.00
87472 Bartonella henselae and Bartonella quintana, quantification 413.00
87517 Hepatitis B virus DNA/RNA, quantitative 734.00
Servicecode Service name
Price for Patient from
Abroad(ILS)
87522 Hepatitis C virus DNA/RNA, quantitative 1,364.00
87536 HIV=1 DNA/RNA, quantitative 1,908.00
87539 HIV=2 DNA/RNA, quantitative 1,908.00
87556 Mycobacteria tuberculosis, AMTD 656.00
87590 Gonorrhoeae smear 0.00
87620 Papillomavirus (HPV) = tissue, including biopsy 2,709.00
87622 HPV (Human Papillomavirus) smear 566.00
88036 Necropsy (autopsy), limited, gross and/or microscopic; regional 953.00
88130 Sex chromatin identification, Barr bodies 191.00
88141 Pap smear, cervical/vaginal, cytopathology, including sampling 161.00
88160 Cytopathology examination and interpretation 263.00
88230 Karyotype, leukocyte culture 1,647.00
88233 Karyotype, tissue culture 2,124.00
88240 Cryopreservation of cells (eg, bone marrow), per year 2,067.00
88299 B &T cell receptor gene rearrangment analysis 1,539.00
88305 Histologic examination, microscopy and interpretation 263.00
88313 Bone marrow sampling and iron stain 599.00
88319 Histochemistry/cytochemistry stain for enzyme identification 263.00
88346 Immunofluorescent study, each antibody; direct method 1,392.00
88347 Immunofluorescent study, each antibody; indirect method 1,392.00
88348 EM (Electron microscopy), diagnostic 4,665.00
89051 Cell count = body fluids, eg, CSF, joint fluid, excluding blood 185.00
89258 Cryopreserved embryos storage for 5 years 953.00
89259 Cryopreservation, sperm, one year, up to 5 test tubes/straws 1,049.00
89280 Assisted oocyte fertilization, microtechnique 6,313.00
89290 Biopsy, oocyte polar body or embryo blastomere, microtechnique (for pre=implantation genetic diagnosis)
13,599.00
89300 Semen analysis; presence and/or motility of sperm including Huhner test (post coital)
359.00
89320 Semen analysis, complete (volume, count, motility, and differential) 219.00
89325 Sperm Ab 350.00
90371 HBIg (Hepatitis B immune globulin), IM 6,015.00
90375 Rlg (Rabies immune globulin), IM and/or subcutaneous 4,112.00
90384 Rho(D) immune globulin (Rhlg), Anti=D 734.00
90585 BCG (Bacillus Calmette=Guerin) vaccine for tuberculosis 0.00
90586 BCG vaccine for bladder, live, for intravesical use, per treatment, including material
1,326.00
90749 Immune globulin (Ig), not otherwise specified 156.00
90772 Subcutaneous/IM injection, therapeutic/prophylactic/diagnostic 54.00
90862 Pharmacological management/review, mental health 161.00
90870 Electroconvulsive therapy 1,635.00
90880 Hypnotherapy 195.00
90882 Psychosocial intervention = follow up 188.00
90889 Psychiatric medical opinion 896.00
90901 Biofeedback training 581.00
90935 Hemodialysis procedure, per treatment 1,794.00
90945 Dialysis procedure other than hemodialysis (eg, peritoneal dialysis) 812.00
91010 Esophageal motility (manometric study) 1,610.00
91034 Esophagus, acid reflux test, with intraluminal pH electrode for dection of gastroesophageal reflux; prolonged recording
1,610.00
91065 Breath hydrogen test (eg, for detection of lactase deficiency) 296.00
Servicecode Service name
Price for Patient from
Abroad(ILS)
91122 Anorectal manometry 1,610.00
92004 Ophthalmological examination, initial 716.00
92065 Orthoptic evaluation and therapy 156.00
92081 Computerised visual field examination 240.00
92083 Visual field examination (eg, Goldmann visual fields) 191.00
92230 Fluorescein angioscopy, unilateral 1,014.00
92235 Fluorescein angioscopy, bilateral 1,398.00
92240 ICGI eye imaging, with interpretation and report 2,565.00
92250 Fundus photography, one eye 306.00
92270 Electro=oculography with interpretation and report 480.00
92275 Electroretinography with interpretation 1,110.00
92283 Color vision examination 191.00
92284 Dark adaptation examination with interpretation 564.00
92285 External eye photography, with interpretation and report 602.00
92286 Anterior segment photography, one eye 480.00
92287 Anterior segment photography, two eyes 722.00
92310 Contact lens fitting, including adjustment 156.00
92355 Fitting of telescopic lens system, age=related macular degeneration 216.00
92506 Evaluation of speech, language, voice 191.00
92507 Speech therapy, individual 186.00
92508 Speech therapy, group, per hour 156.00
92512 Rhinomanometry 296.00
92526 Feeding and swallowing therapy, per treatment 176.00
92541 Spontaneous nystagmus test, ENG (electronystagmography) 716.00
92551 Hearing test, screening 44.00
92557 Hearing test, comprehensive 263.00
92567 Tympanometry (impedance testing) 114.00
92568 Acoustic reflex testing 254.00
92585 Brain auditory evoked potentials, adult 911.00
92588 Brain evoked potentials, child 1,239.00
92590 Hearing aid fitting 345.00
92593 Hearing aid check/counselling, binaural 263.00
92601 Diagnostic analysis and programing of cochlear implant, binaural, under age 7
2,420.00
92602 Diagnostic analysis and subsequent programing of cochlear implant, monaural, under age 7
788.00
92603 Diagnostic analysis and programing of cochlear implant, binaural, age 7 or over
2,420.00
92604 Diagnostic analysis and subsequent programing of cochlear implant, monaural, age 7 or over
788.00
92620 Central auditory function test(s) 515.00
92633 Auditory rehabilitation following cochlear implant 185.00
93000 ECG (Electrocardiogram), with interpretation and report 53.00
93012 CardioBeeper device loan 275.00
93015 Cardiovascular stress test 407.00
93224 ECG monitoring for 24 hours (Holter) 726.00
93307 TTE (transthoracic echocardiography) 614.00
93312 TEE (transesophageal echocardiography) 2,325.00
93350 Effort or Dobutamine stress echocardiography (DSE) 1,448.00
93720 Pulmonary function tests, infant, plethysmography, with interpretation 4,457.00
Servicecode Service name
Price for Patient from
Abroad(ILS)
93784 Blood pressure monitoring, for 24 hours 642.00
93797 Cardiac rehabilitation, per month 1,197.00
93880 Cervical arteries duplex, bilateral 569.00
93923 Extremities arteries duplex, stress and rest 536.00
93925 Extremity arteries/bypass grafts duplex 569.00
93965 Peripheral vessels flow study (eg, Doppler) 236.00
93975 Abdomen, pelvis and retroperitoneal vessels duplex 536.00
93980 Penile vessels duplex, per patient 731.00
94010 Spirometry, simple 167.00
94060 Spirometry with bronchodilator 201.00
94070 Prolonged bronchi evaluation, methacholine or other chemical agent 1,185.00
94200 Maximal voluntary ventilation 81.00
94240 Functional residual volume, noble gas 852.00
94250 Expired gas collection, quantitative 425.00
94360 Resistance to airflow, plethysmographic method 726.00
94400 Breathing response to CO2 (CO2 response curve) 1,421.00
94620 Pulmonary stress test, simple, including pre= and post=spirometry 233.00
94621 Pulmonary stress testing, complex 1,794.00
94640 Inhalation treatment 54.00
94664 Demonstration of an aerosol/inhaler use 96.00
94667 Physiotherapy, lung patient, per treatment 186.00
94720 Carbon monoxide diffusing capacity 425.00
94760 Noninvasive ear or pulse oximetry for oxygen saturation 119.00
94762 Oxygen saturation, overnight oximetry 240.00
94772 Pulmonary function tests, passive, child 4,449.00
95004 Aeroallergens/food, up to 10 allergens, screen 185.00
95012 Nitric oxide determination = exhaled air, per patient 447.00
95028 Aeroallergens/food, 11 or over allergens, extended test 435.00
95044 Patch or application skin alergy test 234.00
95120 Allergen immunotherapy, normal allergen 261.00
95130 Allergen immunotherapy, pure allergen 528.00
95199 Susceptibility studies, antimicrobial agent; lymphocyte and serum 1,392.00
95810 Polysomnography, including EEG 1,568.00
95812 EEG (Electroencephalogram) 564.00
95813 EEG (Electroencephalogram) extended monitoring 1,218.00
95822 EEG (Electroencephalogram), sleep 923.00
95830 EEG (Electroencephalogram), sphenoidal recording 1,007.00
95857 Tensilon test for myasthenia gravis 254.00
95861 EMG (electromyography) 338.00
95872 EMG (Electromyography) 975.00
95900 NCT (Nerve conduction test) 777.00
95922 Testing of autonomic nervous system function; vasomotor adrenergic innervation (sympathetic adrenergic function), including beat=to=beat blood pressure and R=R interval changes during Valsalva maneuver and at least five minutes of passive tilt
678.00
95923 Electrolyte concentration determination, sweat imprint 191.00
95930 VEP (visual evoked potential), adult 911.00
95950 EEG (electroencephalogram), 24 hours 2,744.00
95990 Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal (intrathecal, epidural) or brain (intraventricular)
1,242.00
Servicecode Service name
Price for Patient from
Abroad(ILS)
96001 Computerized three dimensional motion and walking analysis, per patient 5,240.00
96567 Photodynamic therapy (PDT), dermal lesions, non=melanoma/solar keratosis
1,259.00
96910 Phototherapy by UVB and tar/petrolatum 189.00
96912 Photochemotherapy by PUVA, including psoralens 219.00
97001 Physiotherapy, evaluation and treatment planning, adult 294.00
97003 Occupational therapy, evaluation and treatment planning, adult 294.00
97113 Aquatic physiotherapy/rehabilitation, individual, hydrotherapy 287.00
97140 Physiotherapy, individual 186.00
97150 Physiotherapy/rehabilitation, group, 4 or more individuals, including child, per individual
54.00
97530 Occupational therapy, individual 186.00
97750 Physical performance test or measurement (eg, musculoskeletal, functional capacity), with written report, eg, evaluation of pressure on sole
866.00
97802 Medical nutrition counselling and therapy 185.00
97810 Acupuncture 263.00
99001 Histopathology slides preparation for shipment 413.00
99002 Histopathology slides preparation in Israel 599.00
99075 Forensic medical opinion 2,420.00
99080 Medical opinion 887.00
99183 Elective hyperbaric oxygen therapy, per treatment, up to 2 hours 1,244.00
99195 Phlebotomy 185.00
99212 Follow up allergy testing after 95028 156.00
99214 Post hospitalization examination 0.00
99223 Pre=operation evaluation, serial tests 1,176.00
99242 Physician examination, excluding tests with specific code 339.00
99283 ER visit, global payment 1,101.00
99315 Clinic nurse service, up to 30 minutes 105.00
99316 Clinic nurse service, over 30 minutes (eg, guidance for patient with stoma) 225.00
99362 Multidisciplinary team examination 716.00
99371 Telephonic consultation for poisoning/medication information/teratology 285.00
99600 Home visit, care worker 246.00
C0443 Release of carpal tunnel, in surgical day care 2,694.00
C0449 Peripheral nerve decompression/lysis of adhesions, excluding endoneurolysis, in surgical day care
5,246.00
C0460 Peripheral nerve transposition, eg, ulnar nerve, in surgical day care 5,246.00
C0476 Peripheral nerve repair, old traumatic injury, eg, ulnar nerve, in surgical day care
5,246.00
C0492 Implantation/replacement of sacral nerve stimulation electrode/lead, in surgical day care, excluding device cost
5,246.00
C0670 Excision of thyroglossal/branchial cleft cyst/sinus, in surgical day care 5,246.00
C0823 Excision of lesion(s) and/or tissue of eyelid, excluding chalazion, in surgical day care
5,246.00
C0849 Repair of eyelid position, excluding complex repair, in surgical day care 5,246.00
C0870 Reconstruction of eyelid, in surgical day care 5,246.00
C0889 Repair of eyelid position, complex, in surgical day care 5,246.00
Servicecode Service name
Price for Patient from
Abroad(ILS)
C0920 Lacrimal system operation, excluding fistulization, in surgical day care 5,246.00
C1000 Conjunctiva operation, excluding removal of superficial foreign body, in surgical day care
5,246.00
C1139 Excision of pterygium, without graft, in surgical day care 5,246.00
C1511 Extraocular muscle(s) operation for strabismus repair, in surgical day care 5,246.00
C2169 Turbinectomy, in surgical day care 5,246.00
C2189 Nose operation/rhinoplasty, in surgical day care 5,246.00
C2220 Intranasal antrotomy, excluding FESS, in surgical day care 5,246.00
C2840 Excision of tonsil tag/lingual tonsil or adenoidectomy without tonsillectomy, in surgical day care
5,246.00
C3143 Laryngoscopy with biopsy, in surgical day care 5,246.00
C3321 Bronchoscopy through artificial stoma, in surgical day care 5,246.00
C3324 Bronchoscopy with biopsy, in surgical day care 5,246.00
C4011 Biopsy of lymphatic structure, in surgical day care 5,246.00
C4021 Excision of lymph node(s), excluding internal mammary, in surgical day care
5,246.00
C4911 Anal fistulotomy/fistulectomy under general anesthesia, in surgical day care
5,246.00
C4943 Destruction of hemorrhoids by cauterization/cryotherapy, in surgical day care
5,246.00
C5011 Biopsy of liver, needle; percutaneous, not using CT/MRI guidance, in surgical day care
5,246.00
C5349 Umbilical hernia repair, up to 5 years of age, in surgical day care 5,246.00
C5810 Urethral meatotomy, in surgical day care 5,246.00
C5860 Dilation of urethra, in surgical day care 5,246.00
C6120 Excision of lesion(s) and/or hydrocele and/or varicocele of tunica vaginalis/spermatic cord, in surgical day care
5,246.00
C6250 Orchiopexy, in surgical day care 5,246.00
C6420 Excision/destruction of lesion(s) and/or tissue of penis under general anesthesia, in surgical day care
5,246.00
C6720 Biopsy/conization of cervix, excluding by cauterization/cryosurgery, in surgical day care
5,246.00
C6739 Excision of lesion(s) of cervix, including by cauterization/cryosurgery, in surgical day care
5,246.00
C6759 Cerclage/repair of uterine cervix, in surgical day care 5,246.00
C7011 Hymenotomy/hymenectomy, in surgical day care 5,246.00
C7024 Biopsy/excision/destruction of lesion(s) of vagina, in surgical day care 5,246.00
C7129 Bartholin's gland/cyst operation under general anesthesia, in surgical day care
5,246.00
C7744 Biopsy of bone/arthrotomy of hand/foot and finger(s)/toe(s), in surgical day care
5,246.00
C7751 Bunion, eg, hallux valgus / hammer toe/claw operation, in surgical day care
5,246.00
C7860 Removal of implanted device from bone, excluding face/hand/foot, in surgical day care
5,246.00
C8044 Capsulotomy of hand/foot and finger(s)/toe(s), in surgical day care 5,246.00
C8201 Tendon sheath incision, in surgical day care 5,246.00
C8313 Tenotomy, excluding of hand, in surgical day care 5,246.00
C8331 Excision of lesion(s) of tendon sheath, in surgical day care 5,246.00
C8350 Excision of bursa, in surgical day care 5,246.00
Servicecode Service name
Price for Patient from
Abroad(ILS)
C8611 Biopsy of subcutaneous tissue under general anesthesia, in surgical day care
5,246.00
C8630 Excision/destruction of lesions of skin and subcutaneous tissue, 4 or more, in surgical day care
5,246.00
C8660 Free skin grafting, includes excision of skin for autogenous graft, in surgical day care
5,246.00
C8689 Repair and reconstruction of skin and subcutaneous tissue, in surgical day care
5,246.00
C8694 Implantation/replacement of sacral nerve stimulation generator, in surgical day care, excluding device cost
5,246.00
C9802 Esophagoscopy for removal of foreign body, in surgical day care 5,246.00
C999C Surgical hospital day care, excluding procedures with specific code 5,246.00
D0210 Intra oral radiograph = complete series 491.00
D0220 Intraoral periapical film 54.00
D0230 Intraoral periapical, each additional film 54.00
D0240 Intraoral occlusal film 119.00
D0330 Panoramic film 435.00
D1201 Application of fluoride, complete 137.00
D1351 Sealant = per tooth 201.00
D1510 Space maintainer, fixed 1,016.00
D2140 Restoration = one surface, local anesthesia 342.00
D2150 Restoration =2/more surfaces, any material 435.00
D2330 Resin=based composite restoration = one surface, anterior 585.00
D2335 Resin=based composite restoration, anterior 723.00
D2390 Resin=based composite restoration = crown 630.00
D2752 Crown = porcelain fused to noble metal 3,701.00
D2950 Core build=up, including any pins 1,193.00
D2952 Post and core in addition to crown 1,745.00
D2980 Crown repair 338.00
D3220 Pulpotomy, primary/permanent tooth 317.00
D3230 Pulpal therapy, resorbable filling = primary tooth, excluding final restoration
630.00
D3310 Root canal therapy = anterior, excluding final restoration 1,292.00
D3320 Root canal therapy = bicuspid, excluding final restoration 1,292.00
D3330 Root canal therapy = molar, excluding final restoration 1,292.00
D3351 Apexification 518.00
D3410 Apicoectomy, anterior, including placement of retrograde filling material 1,295.00
D3421 Apicoectomy = bicuspid, including placement of retrograde filling material
1,614.00
D3425 Apicoectomy = molar, including placement of retrograde filling material 2,744.00
D3450 Root amputation 1,614.00
D3920 Hemisection 1,131.00
D4240 Gingival flap, with root planing, per quadrant 1,109.00
D4249 Clinical crown lengthening 1,034.00
D4260 Osseous surgery, including flap entry and closure, per quadrant 1,427.00
D4341 Periodontal scaling and root planing, per meeting, 30 minutes 191.00
D5110 Complete acrylic denture = pair 10,823.00
D5213 Partial denture 9,974.00
D5730 Reline denture (chairside) 1,155.00
D5750 Reline denture = laboratory 2,849.00
Servicecode Service name
Price for Patient from
Abroad(ILS)
D5951 Feeding aid; feeding prosthesis 894.00
D5952 Speech aid prosthesis, pediatric 894.00
D6010 Surgical placement of dental implant body: endosteal implant, includes placement of healing cap
4,976.00
D6056 Prefabricated abutment for dental implant 3,108.00
D7111 Extraction, coronal remnants = deciduous tooth 341.00
D7140 Extraction, erupted tooth or exposed root, single 341.00
D7141 Extraction, erupted tooth or exposed root, second in the same session 254.00
D7142 Extraction, erupted tooth or exposed root, each additional tooth in the same session
170.00
D7210 Surgical removal of erupted tooth requiring elevation of mucoperiosteal flap and removal of bone and/or section of tooth
354.00
D7220 Removal of impacted tooth = soft tissue 809.00
D7230 Removal of impacted tooth = partially bony 1,131.00
D7240 Removal of impacted tooth = completely bony 1,131.00
D7270 Tooth reimplantation and/or stabilization of accidentally evulsed or displaced tooth and/or alveolus
824.00
D7280 Exposure of impacted/unerupted tooth for orthodontic reasons, including orthodontic attachments
1,131.00
D7320 Alveoloplasty not in conjunction with extractions = per quadrant 833.00
D7340 Vestibuloplasty = ridge extension (secondary epithelialization) 1,104.00
D7450 Removal of odontogenic cyst 833.00
D7950 Bone graft to maxilla/mandible, unilateral 14,199.00
D7952 Open sinus augmentation, including bone graft, unilateral 6,719.00
D7960 Frenulectomy (frenectomy or frenotomy) 809.00
D7993 Bone graft to maxilla/mandible, bilateral 21,642.00
D7994 Open sinus augmentation, including bone graft, bilateral 12,858.00
D8050 Interceptive orthodontic therapy, including chin cup 2,172.00
D8080 Comprehensive orthodontic treatment of the adolescent dentition, for one year, up to 3 years
5,760.00
D8089 Follow up code of D8080, established adolescent patient for comprehensive orthodontic treatment
0.00
D8210 Removable dental appliance therapy 1,155.00
D8999 Orthodontic preparation for orthognatic face mask 2,172.00
D9110 Emergency treatment of dental pain 240.00
D9220 Deep sedation/general anesthesia, for dental procedure = first hour 1,712.00
D9221 Deep sedation/general anesthesia, for complex dental procedure = more than one hour
1,937.00
D9230 Analgesia, including nitrous, excluding dental treatment 315.00
J0011 Costeff syndrome, Methylglutaconic aciduria, molecular diagnostics, special case
626.00
J0021 Adrenoleukodystrophy X=linked, molecular diagnostics, special case 626.00
J0031 Canavan disease, molecular diagnostics, special case 626.00
J0041 Carnitine Palmitoyl Tranferase, molecular diagnostics, special case 626.00
J0051 Cystinuria, molecular diagnostics, special case 626.00
J0061 Glycogen storage disease type 1, molecular diagnostics, special case 626.00
J0071 Hyperglycinemia, nonketotic, molecular diagnostics, special case 626.00
J0081 Hyperoxaluria, primary, type 1, molecular diagnostics, special case 626.00
J0091 Isovalericacidemia, molecular diagnostics, special case 626.00
J0101 Lipoamide Dehydrogenase Deficiency, molecular diagnostics, special case
626.00
J0111 Maple syrup urine disease, molecular diagnostics, special case 626.00
Servicecode Service name
Price for Patient from
Abroad(ILS)
J0121 Methylmalonicaciduria, mutase deficiency, molecular diagnostics, special case
626.00
J0131 Molybdenum cofactor deficiency, molecular diagnostics, special case 626.00
J0141 Peroxysomal disorders, molecular diagnostics, special case 626.00
J0151 Phenylketonuria, molecular diagnostics, special case 626.00
J0161 Thiamine=responsive megaloblastic anemia, molecular diagnostics, special case
626.00
J0171 Tyrosinemia, molecular diagnostics, special case 626.00
J0181 VLCAD (Very Long Chain Acyl CoA Dehydrogenase) deficiency, molecular diagnostics, special case
626.00
J0191 Wilson disease, molecular diagnostics, special case 626.00
J0201 Xanthinuria, type I, molecular diagnostics, special case 626.00
J0211 CTX (Cerebrotendinous xanthomatosis), molecular diagnostics, special case
626.00
J0221 Hypercholesterolemia, familial, molecular diagnostics, special case 626.00
J0232 Lysosomal acid phosphatase deficiency, biochemical diagnostics 1,776.00
J0241 Aspartylglucosaminuria, molecular diagnostics, special case 626.00
J0242 Aspartylglucosaminuria, biochemical diagnostics 1,776.00
J0251 Ceroid lipofuscinosis, molecular diagnostics, special case 626.00
J0252 Ceroid lipofuscinosis, biochemical diagnostics 1,776.00
J0262 Cholesteryl ester storage disease, biochemical diagnostics 1,776.00
J0272 Cystinosis, nephropathic, biochemical diagnostics 1,776.00
J0281 Fabry disease, molecular diagnostics, special case 626.00
J0282 Fabry disease, biochemical diagnostics 1,776.00
J0292 Free sialic acid storage disease, biochemical diagnostics 1,776.00
J0302 Fucosidosis, biochemical diagnostics 1,776.00
J0312 GM1 gangliosidosis, biochemical diagnostics 1,776.00
J0322 Galactosialidosis, biochemical diagnostics 1,776.00
J0331 Gaucher disease, molecular diagnostics, special case 806.00
J0332 Gaucher disease, biochemical diagnostics 1,776.00
J0341 Glycogen storage disease type 2, Pompe, molecular diagnostics, special case
626.00
J0342 Glycogen storage disease type 2, Pompe, biochemical diagnostics 1,776.00
J0351 Ichthyosis, X=linked, molecular diagnostics, special case 626.00
J0352 Ichthyosis, X=linked, biochemical diagnostics 1,776.00
J0361 Krabbe disease, molecular diagnostics, special case 626.00
J0362 Krabbe disease, biochemical diagnostics 1,776.00
J0372 Mannosidosis, alpha, biochemical diagnostics 1,776.00
J0382 Mannosidosis, beta, biochemical diagnostics 1,776.00
J0392 Maroteaux=Lamy syndrome, biochemical diagnostics 1,776.00
J0400 MLD (Metachromatic Leukodystrophy), pseudo deficiency, molecular diagnostics
806.00
J0401 MLD (Metachromatic Leukodystrophy), molecular diagnostics, special case
626.00
J0402 MLD (Metachromatic Leukodystrophy), biochemical diagnostics 1,776.00
J0412 Mucolipidosis II, biochemical diagnostics 4,038.00
J0421 Mucolipidosis III, molecular diagnostics, special case 626.00
J0422 Mucolipidosis III, biochemical diagnostics 4,038.00
J0431 Mucolipidosis IV, molecular diagnostics, special case 626.00
J0442 Mucopolysaccharidosis II, biochemical diagnostics 1,776.00
J0452 Mucopolysaccharidosis IV, biochemical diagnostics 1,776.00
Servicecode Service name
Price for Patient from
Abroad(ILS)
J0462 Mucopolysaccharidosis I, biochemical diagnostics 1,776.00
J0472 Mucopolysaccharidosis VII, biochemical diagnostics 1,776.00
J0482 Multiple sulfatase deficiency, biochemical diagnostics 4,038.00
J0491 Niemann=Pick disease, molecular diagnostics, special case 626.00
J0492 Niemann=Pick disease, biochemical diagnostics 1,776.00
J0501 Niemann=Pick disease, type C, molecular diagnostics, special case 626.00
J0502 Niemann=Pick disease, type C, biochemical diagnostics 6,036.00
J0511 Pycnodysostosis, molecular diagnostics, special case 626.00
J0512 Pycnodysostosis, biochemical diagnostics 1,776.00
J0522 Salla disease, biochemical diagnostics 1,776.00
J0532 Sanfilippo syndrome, biochemical diagnostics 4,038.00
J0542 Schindler disease, biochemical diagnostics 1,776.00
J0552 Sialidosis, biochemical diagnostics 1,776.00
J0561 Tay Sachs, molecular diagnostics, special case 626.00
J0562 Tay Sachs, biochemical diagnostics 1,776.00
J0572 Wolman disease, biochemical diagnostics 1,776.00
J0581 Mitochondrial disorder, molecular diagnostics, special case 626.00
J0582 Mitochondrial disorder, biochemical diagnostics
J0591 Deafness, mitochondrial, molecular diagnostics, special case 626.00
J0600 Kearns Sayre Syndrome, KSS, molecular diagnostics 1,475.00
J0610 Leber Optic Atrophy, LHON, molecular diagnostics 806.00
J0621 Leigh syndrome, molecular diagnostics, special case 626.00
J0622 Leigh syndrome, biochemical diagnostics
J0631 Mitochondrial myopathy, Encephalopathy, Lactic Acidosis and Stroke=like episodes, MELAS, molecular diagnostics, special case
806.00
J0641 Myoclonic Epilepsy with Ragged Red Fibers, MERFF, molecular diagnostics, special case
1,475.00
J0651 Mitochondrial depletion syndrome, molecular diagnostics, special case 626.00
J0652 Mitochondrial depletion syndrome, biochemical diagnostics
J0661 Alzheimer, early onset/familial, molecular diagnostics, special case 626.00
J0671 Ataxia Telangiectasia, molecular diagnostics, special case 626.00
J0673 Ataxia Telangiectasia, cytogenetic diagnostics 4,553.00
J0681 Charcot=Marie=Tooth neuropathy, molecular diagnostics, special case 1,275.00
J0691 Creutzfeldt=Jakob disease, familial, molecular diagnostics, special case 626.00
J0701 Duchenne, Becker muscular dystrophy, molecular diagnostics, special case
8,895.00
J0710 Familial dysautonomia, molecular diagnostics 405.00
J0720 Dystonia, torsion, molecular diagnostics 806.00
J0730 Facioscapulohumeral muscular dystrophy=1A, molecular diagnostics 1,275.00
J0740 Hereditary Nerve Pressure Palsy, HNPP, molecular diagnostics 1,475.00
J0750 Huntington disease, molecular diagnostics 1,475.00
J0761 Inclusion body myopathy, autosomal recessive, molecular diagnostics, special case
626.00
J0771 Insensitivity to pain, congenital, with anhidrosis, molecular diagnostics, special case
626.00
J0781 LGMD (Limb girdle muscular dystrophy), dysferlin deficiency, molecular diagnostics, special case
626.00
J0790 Myotonic dystrophy, molecular diagnostics 1,475.00
J0801 Neurofibromatosis, type 1, molecular diagnostics, special case 626.00
Servicecode Service name
Price for Patient from
Abroad(ILS)
J0810 Oculopharyngeal muscular dystrophy, molecular diagnostics 1,475.00
J0820 SMA (Spinal Muscular Atrophy), molecular diagnostics 1,475.00
J0830 Spinocerebellar ataxia due to an expansion including Friedrich ataxia, molecular diagnostics
1,475.00
J0840 Adenomatous polyposis coli, molecular diagnostics 7,154.00
J0841 Adenomatous polyposis coli, molecular diagnostics, special case 626.00
J0850 Multiple endocrine neoplasia 2A, molecular diagnostics 1,610.00
J0851 Multiple endocrine neoplasia 2A, molecular diagnostics, special case 626.00
J0860 Retinoblastoma, molecular diagnostics 7,154.00
J0861 Retinoblastoma, molecular diagnostics, special case 626.00
J0870 Von Hippel=Lindau, molecular diagnostics 1,313.00
J0871 Von Hippel=Lindau, molecular diagnostics, special case 626.00
J0881 Adrenal hyperplasia, congenital, 11=beta=hydroxylase deficiency, molecular diagnostics, special case
626.00
J0891 Adrenal hyperplasia, congenital, 17=alpha=hydroxylase deficiency, molecular diagnostics, special case
626.00
J0901 Adrenal hyperplasia, congenital, 21=hydroxylase deficiency, molecular diagnostics, special case
626.00
J0911 Adrenal hypoplasia, congenital, molecular diagnostics, special case 626.00
J0921 Pendred syndrome, molecular diagnostics, special case 626.00
J0931 Persistent hyperinsulinemic hypoglycemia of infancy, molecular diagnostics, special case
626.00
J0941 Combined factor V and VII deficiency, molecular diagnostics, special case
626.00
J0951 Factor V deficiency, molecular diagnostics, special case 626.00
J0961 Factor VII deficiency, molecular diagnostics, special case 626.00
J0971 Factor XI deficiency, molecular diagnostics, special case 626.00
J0981 Factor XIIIA deficiency, molecular diagnostics, special case 626.00
J0991 Fanconi anemia, molecular diagnostics, special case 626.00
J0993 Fanconi anemia, cytogenetic diagnostics 4,553.00
J1001 Hemoglobinopathies alpha, alpha thalassemias, molecular diagnostics, special case
1,895.00
J1011 Hemoglobinopathies beta, beta thalassemias, molecular diagnostics, special case
1,895.00
J1021 Hemophilia A, factor VIII deficiency, molecular diagnostics, special case 626.00
J1031 Hemophilia B, factor IX deficiency, molecular diagnostics, special case 626.00
J1040 Achondroplasia/thanatophoric dwarfism, molecular diagnostics 626.00
J1051 Achromatopsia, molecular diagnostics, special case 626.00
J1061 Albinism, molecular diagnostics, special case 626.00
J1070 Angelman syndrome/Prader Willi, molecular diagnostics 1,275.00
J1081 Autoimmune polyglandular disease, type I, molecular diagnostics, special case
626.00
J1091 Bardet=Biedl syndrome, molecular diagnostics, special case 626.00
J1100 Beckwith=Wiedemann syndrome, molecular diagnostics 1,275.00
J1111 Bloom syndrome, molecular diagnostics, special case 405.00
J1113 Bloom syndrome, cytogenetic diagnostics 4,553.00
J1121 Cockayne syndrome, molecular diagnostics, special case 626.00
J1122 Cockayne syndrome, biochemical diagnostics 6,036.00
J1131 Craniosynostosis, molecular diagnostics, special case 626.00
J1140 Cystic fibrosis, molecular diagnostics 806.00
Servicecode Service name
Price for Patient from
Abroad(ILS)
J1151 Deafness, congenital, molecular diagnostics, special case 626.00
J1161 Epidermolysis Bullosa, congenital, molecular diagnostics, special case 626.00
J1171 Osteopetrosis, recessive, molecular diagnostics, special case 626.00
J1181 Polycystic kidneys, dominant, molecular diagnostics, special case 626.00
J1191 Polycystic kidneys, recessive, molecular diagnostics, special case 626.00
J1203 Roberts syndrome, cytogenetic diagnostics 4,553.00
J1211 Tuberous sclerosis, molecular diagnostics, special case 626.00
J1222 Xeroderma pigmentosum, biochemical diagnostics 6,036.00
J1233 DiGeorge/velocardiofacial syndrome, FISH, cytogenetic diagnostics 1,908.00
J1243 Rubinstein=Taybi syndrome, FISH, cytogenetic diagnostics 1,908.00
J1253 Smith=Magenis syndrome, FISH, cytogenetic diagnostics 1,908.00
J1263 Williams syndrome, FISH, cytogenetic diagnostics 1,908.00
J1271 FMF, molecular diagnostics, special case 806.00
J1311 BRCA1/BRCA2 founder mutation analysis, breast/ovarian cancer, per patient
753.00
J3001 Familial known mutation, molecular diagnostics 626.00
J8003 Karyotype, cytogenetic diagnostics = chorionic villus 2,852.00
J8891 Prenatal molecular diagnostics, basic 2,058.00
J9001 Prenatal molecular diagnostics, complex 3,011.00
J9900 Fragile X, molecular diagnostics 743.00
J9903 Mental retardation, cytogenetic diagnostics 1,131.00
J9913 Male infertility, cytogenetic diagnostics 1,131.00
J9941 Y chromosome deletion, molecular diagnostics, special case 1,221.00
J9991 Monogenic disease in family, molecular diagnostics, special case 4,562.00
L0005 Long cast, local anesthesia 384.00
L0019 Elastic bandage, elstoplast 17.00
L0020 Needle aspiration, US guidance, including cytology 704.00
L0021 Breast needle aspiration, US guidance, including cytology 704.00
L0022 Thyroid needle aspiration, US guidance, including cytology, per patient 2,073.00
L0023 Bandage placement or replacement 111.00
L0025 Stitches 0.00
L0026 Stitches removal 59.00
L0030 Parotid needle aspiration, US guidance, including cytology, per patient 1,889.00
L0042 Nephrostomy tube removal 434.00
L0062 Vaginal smear, sampling, processing and interpretation 263.00
L0080 Rehabilitation day care 1,059.00
L0100 TMJ radiology, up to two views 342.00
L0106 Radiology additional view, not elsewhere specified 84.00
L0107 Jaw radiology, third or more additional views 84.00
L0108 Mastoids radiology, third or more additional views 84.00
L0109 Nasal bones radiology, third or more additional views 84.00
L0110 Paranasal sinuses radiology, third or more additional views 84.00
L0111 Skull radiology, third or more additional views 84.00
L0112 Pelvis radiology, third or more additional views 84.00
L0113 Shoulder radiology, complete, one side, third or more additional views 84.00
L0114 Elbow radiology, third or more additional views 84.00
L0115 Wrist radiology, third or more additional views 84.00
Servicecode Service name
Price for Patient from
Abroad(ILS)
L0116 Hand radiology, third or more additional views 84.00
L0117 Hip radiology, unilateral, second or more additional views 84.00
L0118 Ankle radiology, third or more additional views 84.00
L0119 Abdomen radiology, second or more additional views 84.00
L0120 TMJ radiology, third or more additional views 84.00
L0121 Calcaneus radiology, third or more additional views 84.00
L0122 Toe(s) radiology, third or more additional views 84.00
L0123 Cervicothoracic spine radiology, Pawlow/Twining, up to two views 84.00
L0124 Cervicothoracic spine radiology, Pawlow/Twining, third or more additional views
84.00
L0125 Pelvis radiology, outlet 84.00
L0126 Pelvis radiology, inlet 84.00
L0138 Spine radiology, two parts, up to three views 384.00
L0151 Arthrography, including injection and interpretation 435.00
L0160 Chest radiology, third or more additional views 156.00
L0167 Additional charge for device for insertion of left atrial appendage device 36,267.00
L0168 Additional charge for device for implantation of diaphragmatic pacemaker for spinal cord injured patients
163,350.00
L0169 Additional charge for device for implantation of diaphragmatic pacemaker for ALS patients
142,079.00
L0170 Additional charge for programmable pump for chronic pain relief/spasticity treatment
47,989.00
L0171 Additional charge for mechanical pump for pain relief 32,691.00
L0177 Additional charge for vertical expandable prosthetic titanium rib system 87,500.00
L0178 Additional charge for BAHA (Bone Anchored Hearing Aid), adult 31,854.00
L0179 Additional charge for BAHA (Bone Anchored Hearing Aid), child 33,806.00
L0180 Additional charge for VNS (Vagus Nerve Stimulator) kit for epilepsy treatment
80,040.00
L0182 Additional charge for intracranial single array neurostimulator pulse generator kit, including leads, for movement disorders
95,651.00
L0183 Additional charge for intracranial dual array neurostimulator pulse generators kit, including leads, for movement disorders
110,501.00
L0184 Additional charge for rechargeable intracranial neurostimulator pulse generator kit for movement disorders
162,912.00
L0185 Additional charge for leads of intracranial neurostimulator pulse generator, for movement disorders
29,803.00
L0187 Additional charge for single/dual array neurostimulator pulse generator for intracranial stimulation, without leads, for movement disorders
80,801.00
L0188 Additional charge for rechargeable neurostimulator pulse generator for intracranial stimulation, without leads, for movement disorders
133,212.00
L0194 Large bandage, bandages & cotton 338.00
L0209 Pregnancy termination approval committee 533.00
L0210 Nasal bones radiology, up to two views 242.00
L0248 Storage of corpse, 2 to 24 hours 467.00
L0268 Spotting and copying patient records, first 10 pages 128.00
L0269 Copying patient records, each 2 additional pages 2.00
L0372 HBIg (Hepatitis B immune globulin), IV 8,654.00
L0396 Varicella Zoster passive immunization, under 12 years of age, eg, varitect 3,756.00
Servicecode Service name
Price for Patient from
Abroad(ILS)
L0397 Varicella Zoster passive immunization, age 12 years or older, eg, varitect 13,163.00
L0409 Small splints, occupational therapy, including cost of material and number of sessions
276.00
L0410 Medium splints, static mouth splint, occupational therapy, including cost of material and number of sessions
531.00
L0411 Medium splints, occupational therapy, including cost of material and number of sessions
531.00
L0412 Complex medium splints, occupational therapy, including cost of material and number of sessions
776.00
L0413 Big splints, occupational therapy, including cost of material and number of sessions
1,044.00
L0415 JOBST suit measurement 338.00
L0416 Complex medium splints, dynamic mouth splint, occupational therapy, including cost of material and number of sessions
776.00
L0438 TRH (Thyrotropin releasing hormone) stimulation panel 953.00
L0444 MRI (Magnetic resonance imaging), excluding tests with specific code 3,093.00
L0446 MRI under general anesthesia, per test 11,048.00
L0486 Geriatric hospital day care 819.00
L0487 Cognitive geriatric hospital day care 426.00
L0491 Cytotoxic capacity testing 1,239.00
L0534 Orthoptic treatment, per treatment 119.00
L0546 Auditory test for cochlear implant surgery candidate 933.00
L0554 FMRI (functional magnetic resonance imaging) 8,373.00
L0560 Internal hospital day care 1,694.00
L0561 Rehabilitative hospital day care 1,694.00
L0564 Histochemical staining including immunohistochemistry 2,468.00
L0574 Breathing capability test 119.00
L0591 Extracorporeal shockwave lithotripsy, kidney; complex 28,263.00
L0621 Kit test 1,341.00
L0690 Hotel care, per day, including medical supervision 599.00
L0692 Home care, per day, including medical supervision 897.00
L0717 Harvesting of cornea 8,499.00
L0749 MRI, additional payment for gadolinum contrast 341.00
L0784 IV (Intravenous) infusion of fluids 338.00
L0785 IV (Intravenous) infusion of drugs 338.00
L0787 Deflux injection, vesicoureteral reflux therapy, unilateral 9,893.00
L0788 Deflux injection, vesicoureteral reflux therapy, bilateral 17,477.00
L0790 Preparation of blood unit, price per preparation of one unit 341.00
L0791 Blood unit, price per one unit 250.00
L0797 Additional charge for pump for subcutaneous apomorphine injection 10,000.00
L0799 IV (Intravenous) ileoprost 1,596.00
L0800 Psychotherapy, individual, combined 474.00
L0801 Psychiatric clinic evaluation 228.00
L0802 Diagnostic interview/intake 228.00
L0803 Home visit, member of psychiatric team 195.00
L0804 Home visit, psychiatric team 537.00
L0805 Comprehensive cognitive testing, 3 visits 1,563.00
L0806 Multiprofessional evaluation for rehabilitation planning 2,156.00
L0807 Psychological assessment for rehabilitation framework 1,412.00
L0808 Psychodiagnostic assessment = full battery 1,412.00
Servicecode Service name
Price for Patient from
Abroad(ILS)
L0809 Psychodiagnostic assessment = partial battery 725.00
L0820 Psychiatric hospital day care, adult, all hospitals 542.00
L0821 Psychiatric hospital day care, children and adolescents, all hospitals 581.00
L0822 Psychiatric community day care, adult 585.00
L0823 Psychiatric community day care, children and adolescents 632.00
L0841 Psychotherapy/counseling, individual 342.00
L0843 Patient's treatment framework assessment 1,412.00
L0846 Family or conjoint therapy/counseling 573.00
L0849 Psychotherapy, group, per session 161.00
L0885 Psychotherapy/counselling, group, institutions/families/schools 725.00
L0886 Guidance for other agencies, individual, within service site 401.00
L0887 Guidance for other agencies, goup, within service site 272.00
L0888 Guidance for other agencies, outside service site 573.00
L0899 Psychosocial diagnosis and evaluation 242.00
L0911 Hearing test, complete, anamnesis, child 338.00
L0914 Biofeedback training, gastroenterology, single session 467.00
L0915 Biofeedback training, gastroenterology, 6 sessions 2,804.00
L0934 Circulating anticoagulants, eg, LAC 480.00
L0959 Sexual counseling and therapy 564.00
L0962 ER (Emergency room) medical examination 395.00
L0964 ER (Emergency room) fee 264.00
L0969 Collar or sling, including materials 185.00
L1015 Enzymes activity with cells separation, six or more enzymes 1,806.00
L1028 US (ultrasound), with image documentation 474.00
L1030 FibroScan for assessment of liver fibrosis 630.00
L1031 FibroTest = blood 975.00
L1039 CT (Computed Tomography), excluding tests with specific code 852.00
L1040 CTA / CTArthro / CT urography, per patient, excluding thorax coronary arteries CTA
1,532.00
L1077 Surgical obturator, assessment and preparation 15,249.00
L1079 Interim obturator 8,007.00
L1080 Definitive obturator 21,926.00
L1133 Establishing paternity, per patient, including medical forensic opinion 2,472.00
L1139 Pilot medical examination 2,030.00
L1275 CTA chest, coronary arteries 3,771.00
L1611 Initial insertion/replacement of speech prosthesis post laryngectomy 3,869.00
L1720 Bladder instillation of Mitomycin, per treatment, including material 1,451.00
L1721 Bladder hyperthermia and Mitomycin instillation, per treatment 6,129.00
L1922 CT under general anesthesia 2,477.00
L1996 Chronic pain control, infiltration 410.00
L1997 Chronic pain control, nerves block, using fluoroscopic guidance, with contrast material
2,052.00
L1998 Chronic pain control, nerves block, using fluoroscopic guidance, with neurolytic substance
2,052.00
L2001 Radiofrequency treatment for pain control, per treatment 6,534.00
L2002 Loading of pump for spasticity treatment, Baclofen 4,736.00
L2003 Ozone treatment for skin ulcers, per day 326.00
L2004 Negative pressure treatment for skin ulcers, per session 842.00
L2005 Maggot debridement therapy, per session 671.00
L2013 Acetylcholinesterase, Ab = serum 536.00
Servicecode Service name
Price for Patient from
Abroad(ILS)
L2136 OCT3 (Optical Coherence Tomography), per patient 477.00
L2196 Pelvis/genitalia MRI, excluding prostate 3,062.00
L2197 Prostate MRI 6,117.00
L2250 Fundus photography, two eyes 474.00
L2340 Optometry by an optometrist, per patient 191.00
L2498 Corneal imaging 251.00
L2528 Nasal potential difference measurements for cystic fibrosis diagnonsis 2,109.00
L2529 Rectal biopsy sampling and testing for Cystic Fibrosis diagnosis, per patient
2,109.00
L2585 Auditory screening test, OAE, infant 0.00
L2586 Auditory screening test, AABR, infant 0.00
L2588 OAE (Otoacoustic Emissions), diagnostic 117.00
L2589 Auditory screening test, AABR, subsequent test, baby 237.00
L2699 Extracorporeal shock wave lithotripsy, salivary glands 6,902.00
L2731 Fibronectin 620.00
L2999 Arthroscopy, complex and/or high skill surgical procedures, using implants
20,396.00
L3003 ECG monitoring, Flecainide infusion, IV 924.00
L3013 Rapid urease test, helicobacter pylori, child = exhaled air 65.00
L3239 Biopsy, additional payment to EUS, excluding EUS (Endoscopic ultrasound)
3,216.00
L3250 Endoscopic polyp marking, in addition to endoscopy, per patient 1,146.00
L3255 Balloon enteroscopy 14,957.00
L3307 TTE (transthoracic echocardiography), child 614.00
L3560 Patella radiology, up to two views, per side 170.00
L3562 Patella radiology, third or more additional views 185.00
L3620 Toe(s) radiology, up to two views 170.00
L3621 Calcaneus radiology, up to two views 170.00
L3711 Apolipoprotein E, genotype 584.00
L3727 Implantation of loop recorder system, including retrieval of recorded and stored ECG data, physician review and interpretation of retrieved ECG data, per ILR
16,916.00
L3795 External Counter Pulsation Therapy (ECPT) / Enhanced External Counter Pulsation (EECP) therapy
942.00
L3799 Rehabilitation workshop, lung diseases patients, per session 98.00
L3890 Apolipoprotein E4, genotype 1,392.00
L3900 Prenatal diagnosis, age 35=37, including US, amniocentesis and laboratory tests
3,536.00
L3902 Prenatal diagnosis, over age 37, including US, amniocentesis and laboratory tests
2,321.00
L3903 Prenatal diagnosis, younger than age 35, including US, amniocentesis and karyotype
3,242.00
L4110 Porphobilinogen deaminase, quantitative = RBC 611.00
L4152 Hospital circumcision, excluding newborn 3,440.00
L4233 Her=2/neu, immunohistochemistry 480.00
L4234 Her=2/neu, FISH method 4,196.00
L4283 Enema 36.00
L4298 Electrolytes, sodium and potassium 35.00
L4450 Urethrocystography, retrograde, under sedation 1,587.00
L4581 Additional charge for device for implantation/replacement of sacral nerve stimulation electrode/lead
12,876.00
Servicecode Service name
Price for Patient from
Abroad(ILS)
L4583 Additional charge for device for implantation/replacement of sacral nerve stimulation generator
57,727.00
L4612 Botolinum Toxin, 30 units Dysport administration 362.00
L4705 hCG and PAPP=A, quantitative = serum 251.00
L4793 Ambulatory evaluaiton of TB suspected patient 2,118.00
L4794 Basic evaluation of Mantoux positive patient 260.00
L4795 Treatment of active TB patient, first 5 months 10,131.00
L4796 Treatment of active TB patient, last month 13,208.00
L4797 Evaluation of close contact of Tb patient 842.00
L4798 Ambulatory treatment of close contact patient, prevention 296.00
L4799 Ambulatory pharmacological treatment of close contact patient, last month
396.00
L4990 Genotype characterization by caryotype analysis 4,095.00
L4991 Malignancies genotype, FISH (Fluorescent in Situ Hybridization) 1,832.00
L4992 Malignancies genotype, DNA index 1,365.00
L4999 Orotic acid = urine 116.00
L5339 Laser, additional payment to endoscopy, excluding endoscopy 1,461.00
L5378 Colonoscopy, flexible; diagnostic, with/without collection of specimen(s) 1,472.00
L5400 Endoscopic Argon laser treatment 506.00
L5441 Femur head from bone bank 2,181.00
L5461 Kappa or Lambda light chain, Ig, free = blood 477.00
L5799 Angiography 4,361.00
L5810 Polysomnography, including EEG, child 1,568.00
L5858 Tensilon test for myasthenia gravis; with electromyographic recording 716.00
L5872 Single fiber electromyography, per patient 1,007.00
L5925 Sensory evoked potentials (SEP) study, per patient 626.00
L5990 Minor ambulatory surgery, including foreign body removal, local anesthesia
435.00
L6002 Cytokins 395.00
L6015 Gliadin, Ab 306.00
L6030 Intraocular injection, excluding material cost 417.00
L6031 Intraocular injection of Bevacizumab (Avastin) 917.00
L6160 KRAS mutation, per patient 2,159.00
L6171 Additional charge for intraocular shunt, eg, Ex=PRESS, for trabeculectomy
3,748.00
L6312 CA 72.4 tumor antigen 182.00
L6313 NSE (Neuron specific enolase), tumor antigen 182.00
L6316 Immunoassay for tumor antigen, quantitative; CA 21=1 162.00
L6358 Lymphocyte CD antigen determination, over 6 CD 3,813.00
L6375 CT (Computed tomographic) virtual colonoscopy 1,542.00
L6414 Hickman placement, angiography guidance 4,233.00
L6415 Hickman placement under general anasthesia 6,347.00
L6416 Portacath placement, angiography guidance 6,138.00
L6417 Portacath placement under general anasthesia 8,447.00
L6418 Declotting by thrombolytic agent of Hickman/portacath catheter 233.00
L6497 Copying video, echo, catheterization, CD 137.00
L6498 Administrative radiologic procedure 54.00
L6499 Administrative radiologic procedure 26.00
L6520 Low density lipoprotein (LDL) apheresis 13,599.00
Servicecode Service name
Price for Patient from
Abroad(ILS)
L6538 HLA B57 692.00
L6539 HLA B5701 450.00
L6550 Oncological treatment, adult, with chemotherapeutic/biological medications, per patient per day
1,931.00
L6551 Oncological treatment, child, with chemotherapeutic/biological medications, per patient per day
2,508.00
L6552 Oncological/hematological treatment, adult, without chemotherapeutic/ biological medications, per patient per day
1,160.00
L6553 Oncological/hematological treatment, child, without chemotherapeutic/ biological medications, per patient per day
1,506.00
L6611 Bartonella henselae (Cat scratch) IgG = blood 344.00
L6612 Bartonella henselae (Cat scratch) IgM = blood 344.00
L6689 HIV or HTLV resistance to medication 3,519.00
L6705 HBV, HCV and HIV=1 detection, NAT, at blood bank 182.00
L6707 Hepatitis E, Ab 342.00
L6762 Rubella virus IgG or IgM 170.00
L6776 Toxoplasma, Sabin Feldman dye test 302.00
L6777 Toxoplasmosis confirmation test 783.00
L6778 Toxoplasma avidity testing 417.00
L6815 Ultrasound, pregnant uterus, without image documentation 434.00
L6821 Ophthalmic YAG laser treatment, per patient 569.00
L6822 Ophthalmic Argon laser treatment, per patient 441.00
L6830 Creation of arteriovenous fistula for renal dialysis, native or using graft 17,849.00
L6831 Therapeutic catheterization of AV shunt for renal dialysis, native/with graft
30,011.00
L6849 Interferon Ab 455.00
L6856 Pelvis US, nonobstetric, with image documentation, complete 474.00
L6857 Hips US 474.00
L7001 Physiotherapy, evaluation and treatment planning, child 528.00
L7002 Isokinetic assessment and treatment planning 350.00
L7003 Occupational therapy, evaluation and treatment planning, child 528.00
L7004 Isokinetic physiotherapeutic treatment 291.00
L7118 NTM (Non Tuberculous Mycobacteria) identification 561.00
L7140 Physiotherapy/rehabilitation, group, up to 4 individuals, including child, per individual
114.00
L7154 Toxoplasma, molecular diagnostics = body fluids 1,538.00
L7204 Spermatic veins embolization 10,320.00
L7210 Photocoagulation, PDT, retina, including material 15,062.00
L7525 Replacement/repositioning of biliary drain, percutaneous 3,839.00
L7619 Malignant hyperthermia diagnosis test (muscle biopsy) 11,766.00
L7751 Brachytherapy, gynecological 14,451.00
L7752 Brachytherapy, lung cancer 9,015.00
L7753 Brachytherapy, prostate cancer treatment 57,792.00
L7771 Occupational therapy, group 114.00
L8074 Adrenal imaging, medulla, I=123 MIBG, up to 7 years of age 13,946.00
L8075 Adrenal imaging, medulla, I=123 MIBG, over 7 years of age 24,207.00
L8076 Adrenal imaging, cortex 14,222.00
L8170 Semen production from testis, surgical 8,381.00
L8180 Chemotherapy resistance, Facs 1,107.00
L8181 CD membrane antigen, up to 4 antigens 1,595.00
Servicecode Service name
Price for Patient from
Abroad(ILS)
L8182 Testes removal, for sperm isolation; cadaver, at the forensic medicine institute
1,607.00
L8183 Pathological specimen, preparation of slides, at the forensic medicine institute
131.00
L8184 DNA analysis in liquid blood, soft tissue, semen, at the forensic institute 3,491.00
L8186 DNA analysis in dry blood, at the forensic institute 3,678.00
L8188 DNA analysis in bone tissue, at the forensic institute 12,831.00
L8190 Harvesting of cardiac valve (homograft bank) 2,198.00
L8213 Aminolevulinic acid dehydratase (ALA=D), quantitative = RBC 915.00
L8242 Allogeneic donor lymphocyte infusions, DLI 4,895.00
L8244 Allogeneic lymphocyte proliferation 7,364.00
L8245 Allogeneic lymphocyte activation 46,586.00
L8250 Chromosome 1 and 19 analysis, per patient 2,612.00
L8252 FLT3 and NPM1 internal random duplications, PCR 1,079.00
L8268 Cholyl=14=C=Glycine breath test for bile salts deconjugation
L8269 C=13 urea test, helicobacter pylori = exhaled air 218.00
L8299 Spleen imaging, with heated RBC (red blood cells) 1,529.00
L8307 Examination of abortus for diagnosis of malformations 8,103.00
L8379 EGFR (Epidermal Growth Factor Receptor) mutation, per patient 1,451.00
L8380 ALK mutation, per patient 3,780.00
L8381 BRAF mutation, per patient 963.00
L8400 DNA extraction = whole blood 119.00
L8410 Porphyrins, qualitative = plasma 206.00
L8411 Porphyrins, chromatography = plasma 777.00
L8412 Porphyrins, chromatography = urine 720.00
L8413 Porphyrins, chromatography = feces 824.00
L8414 Porphyrins, chromatography = RBC 893.00
L8599 Pulmonary imaging, dynamic, mucociliary clearence 4,973.00
L8606 DatScan brain imaging 17,087.00
L8802 Somatostatin receptor scintegraphy 27,506.00
L8970 First stage IVF, including hormonal tests 7,194.00
L8971 First stage IVF, excluding hormonal tests 5,610.00
L8972 Second stage IVF, excluding hospitalization days 8,677.00
L8975 Ovarian tissue cryopreservation 7,148.00
L8976 Cryopreserved ovarian tissue storage for 5 years 953.00
L8977 Oocyte retrieval and cryopreservation, eg, vitrification 8,677.00
L8978 Cryopreserved oocytes storage for 5 years 953.00
L8979 Cryopreserved oocytes transfer, intrauterine, including thawing and fertilization
5,592.00
L9000 Radiopharmaceutical therapy, hyper=thyroidism 2,207.00
L9015 Chorionic villus sampling, excluding laboratory processing and interpretation
632.00
L9030 Radiopharmaceutical ablation of gland for thyroid carcinoma 9,096.00
L9035 Radiopharmaceutical therapy for metastases of thyroid carcinoma 14,436.00
L9079 Injection (eg, neurolytic substance) 128.00
L9080 Medical opinion for appointment of legal guardian, including completion of form and reports
888.00
L9183 Emergency hyperbaric oxygen therapy, excluding diving accidents 15,243.00
L9184 Hyperbaric pretreatment assessment 2,151.00
L9201 Physician consulation for a patient insured by another sick fund 216.00
Servicecode Service name
Price for Patient from
Abroad(ILS)
L9211 Fire arm license physician examination 161.00
L9212 Driving license physician examination 161.00
L9215 Fire arm license specialist examination 474.00
L9232 Routine examinations for candidates for renal transplantation 6,834.00
L9241 Perenatal genetic consultation 753.00
L9242 Examination by medical specialist for appointment of legal guardian, for established patient
338.00
L9243 Genetic consultation 753.00
L9244 Physician examination, oncologist 339.00
L9245 Physician examination, hematologist 339.00
L9246 Physician examination, hemato=oncologist 339.00
L9247 Physician examination, internal physician 339.00
L9248 Physician examination, urologist 339.00
L9249 Physician examination, orthopedic physician 339.00
L9250 Stammering treatment, individual/group, per course 11,823.00
L9251 Stammering treatment, individual/group, per patient/session 227.00
L9252 Physician examination, alergologist 339.00
L9253 Physician examination, endocrinologist 339.00
L9254 Physician examination, otorhinolaryngologist 339.00
L9255 Physician examination, obstetrician/gynecologist 339.00
L9256 Physician examination, genetician 339.00
L9257 Physician examination, gastroenterologist 339.00
L9258 Physician examination, pediatrician 339.00
L9259 Cryopreservation, sperm, any additional year, up to 5 test tubes/straws 423.00
L9260 Physician examination, surgeon 339.00
L9261 Physician examination, thoracic surgeon 339.00
L9262 Physician examination, vascular surgeon 339.00
L9263 Physician examination, hand surgeon 339.00
L9264 Physician examination, maxillofacial surgeon 339.00
L9265 Physician examination, proctologist surgeon 339.00
L9266 Physician examination, breast surgeon 339.00
L9267 Physician examination, plastic surgeon 339.00
L9268 Physician examination, anesthesiologist 339.00
L9269 Physician examination, neurosurgeon 339.00
L9270 Physician examination, neurologist 339.00
L9271 Consultation with a specialist 564.00
L9273 Physician examination, nephrologist 339.00
L9274 Physician examination, dermatologist 339.00
L9275 Physician examination, ophthalmologist 339.00
L9276 Physician examination, cardiologist 339.00
L9277 Physician examination, rheumatologist 339.00
L9278 Physician examination, pulmonologist 339.00
L9279 Physician examination, rehabilitation physician 339.00
L9281 Emergency physician consulation at sick fund clinic 354.00
L9301 Clinic nurse evaluation for a patient insured by another sick fund 155.00
L9311 Home visit, nurse 191.00
L9321 Outpatient social treatment 191.00
L9331 Rehabilitative day care center = long term 369.00
L9342 Prosthesis extension 342.00
Servicecode Service name
Price for Patient from
Abroad(ILS)
L9343 Sheltered housing, per day 47.00
L9345 Care hostel, per day 171.00
L9346 Care hostel, extended, per day 212.00
L9347 Short term treatment center, per day 161.00
L9348 Club activity, per month, 8 visits at least, child 459.00
L9349 Treatment boarding school services, per month 9,375.00
L9350 Club activity, per month, 8 visits at least 369.00
L9351 Occupational club activity, per day 57.00
L9352 Sheltered factory, per day 87.00
L9353 Occupational rehabilitation, extended, per day 105.00
L9354 Sheltered housing, extended, per day 116.00
L9355 School, per month, child/adolescent 1,443.00
L9359 Medical evaluation based on documents 159.00
L9360 Risk assessment of sex offenders 4,617.00
L9377 Physician services in parent home 342.00
L9379 Physician services in hostel 185.00
L9394 Physician services in boarding school 114.00
L9413 Medical records printout 57.00
L9420 Calibration of instruments for measuring radiation 932.00
L9480 Results reporting, free of charge 0.00
L9490 Follow up service, free of charge 0.00
L9499 Social worker services 206.00
L9500 Medical examination, first visit = child development 867.00
L9501 Medical examination, follow up = child development 518.00
L9502 Psychological cognitive testing = child development 1,071.00
L9503 Family workup and diagnosis = child development 518.00
L9504 Psychoneurology assessment = child development 1,466.00
L9505 Cognitive evaluation for rehabilitation = child development 1,331.00
L9506 Learning disabilities evaluation = child development 1,806.00
L9507 Multidisciplinary team for rehabilitation = child development 1,821.00
L9510 Speech therapy, evaluation and treatment planning = child development 528.00
L9511 Aquatic physiotherapy/rehabilitation, group, up to 4 individuals, inculding child, hydrotherapy
204.00
L9512 Speech therapy, individual = child development 270.00
L9513 Occupational therapy, individual = child development 270.00
L9514 Physiotherapy, individual = child development 294.00
L9516 Psycho/behavioral therapy = child development 329.00
L9517 Developmental examination = nurse = child development 234.00
L9518 Therapy/counseling, family/conjoint = child development 722.00
L9519 Biofeedback training = child development 581.00
L9520 Evaluation of supportive communication = child development 1,920.00
L9521 Staff meeting with parents = child development 647.00
L9523 Multiprofessional consulation for parents = child development 201.00
L9525 Additional consulation = child development 251.00
L9528 Physiotherapy, group = child development 212.00
L9529 Speech therapy, group = child development 212.00
L9530 Occupational therapy, group = child development 212.00
L9600 Home visit, health care professional = child development 380.00
L9617 Neuropsychological tests before epilepsy surgery 1,718.00
Servicecode Service name
Price for Patient from
Abroad(ILS)
L9636 Additional charge for Plerixafor (Mozobil), per ampoule 32,985.00
L9855 Induced abortion, surgical, including curettage 3,741.00
L9856 Induced abortion, pharmaceutical 2,696.00
L9857 Induced abortion, surgical, following pharmaceutical abortion 0.00
L9899 Prenatal course 815.00
L9900 Provision of therapeutic radiopharmaceutical(s) 1,118.00
L9999 Radiopharmaceutical therapy, pheochromocytoma/neuroblastoma; I=131=MIBG
37,133.00
G0018 Transjugular intrahepatic portosystemic stent/shunt, TIPS 29,976.00
G0024 Obstetric and neonatal hospitalization 5,200.00
G0026 Preterm infant hospitalization 5,200.00
G0028 Cryotherapy of prostatic cancer 31,696.00
G0031 Insertion of stent to abdominal aortic aneurysm, stent graft 101,987.00
G0032 Bone marrow transplantation, haploid, including stem cells separation 527,584.00
G0033 Isolated limb perfusion in patient with sarcoma 96,752.00
G0035 Interventional neuroradiology for intracranial aneurysm embolization/occlusion by catheterization, including use of stent, eg, SILK, and coils
84,988.00
G0036 Insertion of intraocular lens, lens included 7,491.00
G0037 Tension free vaging tape for incontinence (TVT) 7,670.00
G0045 Mastectomy, bilateral 23,469.00
G0047 Breast reconstruction, bilateral 25,761.00
G0048 Breast reconstruction following mastectomy, bilateral 45,103.00
G0049 Breast reconstruction following mastectomy, unilateral 27,340.00
G0050 Breast reconstruction, unilateral, including nipple reconstruction 22,664.00
G0051 Mastectomy, unilateral 15,644.00
G0054 Lower extremities veins surgery, including varicose veins 10,580.00
G0055 Blood vessels surgery, including nonautogenous graft 55,321.00
G0057 Lung transplantation 337,196.00
G0058 Heart=lung transplant 472,079.00
G0059 Bone marrow transplantation; allogenic 313,077.00
G0060 Bone marrow transplantation; autologous 205,690.00
G0061 Renal and/or pancreas transplantation 224,798.00
G0062 Heart transplantation 337,196.00
G0063 Liver transplantation 971,671.00
G0064 Corneal surgery, including cost of cornea 19,264.00
G0066 Inguinal/femoral hernia repair, hospital day care 5,129.00
G0067 Craniotomy 62,738.00
G0070 Open prostatectomy 17,779.00
G0072 Heart surgery, including bypass 73,186.00
G0073 Diagnostic catheterization 14,156.00
G0074 Therapeutic catheterization, excluding cardiac catheterization 33,173.00
G0075 Hysterectomy 14,646.00
G0077 Transurethral prostatectomy 10,984.00
G0078 Hospital circumcision, excluding newborn 3,440.00
G0083 Osteotomy of spine, including implants, diskectomy 27,298.00
G0084 Osteotomy of spine, including implants = other surgeries 50,130.00
G0085 Cardiac catheterization, therapeutic, including insertion of drug eluting stent(s)
39,783.00
G0089 Treatment of heavy burns 191,139.00
Servicecode Service name
Price for Patient from
Abroad(ILS)
G0090 Treatment of medium burns 109,218.00
G0096 Laparoscopic gastric banding, excluding band cost 11,975.00
G00A1 Transcatheter placement of an intravascular stent graft, thoracic aorta 164,224.00
G00A2 Hyperbaric chamber treatment of patients injured in diving accidents, up to 8 hours
32,606.00
G00A3 Hyperbaric chamber treatment of patients injured in diving accidents, over 8 hours, and/or using a mixture of gases eg, Heliox
44,227.00
G00A4 Spermatic veins embolization 10,320.00
G00A5 Chemotherapy administration, inpatients, in addition to inpatient day charge
4,080.00
G00A6 Open/closed reduction with internal fixation of fracture of neck of femur or internal fixation only of fracture of neck of femur
25,170.00
G00A8 Insertion of biventricular cardiac pacemaker 50,756.00
G00A9 Insertion of cardiac pacemaker/defibrillator, excluding machine cost
G00B1 Repair of cleft lip 18,036.00
G00B2 Correction of cleft palate (including Push=Back palatoplasty) 18,036.00
G00B3 Revision of cleft palate repair, velopharyngoplasty 18,036.00
G00B4 Repair of cleft lip & limited rhinoplasty, for cleft palate 18,036.00
G00B5 Closure of fistulae of mouth, for cleft palate 12,224.00
G00B6 Bone graft to facial bone, for cleft palate 21,424.00
G00B7 Jaw distraction osteogenesis, excluding device cost 18,036.00
G00B8 Orthognatic surgery, excluding jaw distraction osteogenesis 35,729.00
G00C1 Fallopian tube catheterization, diagnostic or therapeutic 5,543.00
G00C2 Radiofrequency ablation of liver lesion(s) (tumor or metastases) 13,786.00
G00C3 Esophageal dilation and insertion of stent 23,493.00
G00C4 Minimally invasive radioguided parathyroidectomy (MIRP) 5,805.00
G00C5 Local excision of lesion or tissue of bone (i.e. osteoid osteoma), using CT guidance
8,569.00
G00C6 Intra=amniotic injection for late abortion 3,100.00
G00C7 Arthroplasty with prosthetic replacement or implant of total or partial wrist (distal radius, carpocarpal or carpometacarpal joints)
11,540.00
G00C8 Arthroplasty with prosthetic replacement or implant of foot or toe joint 20,001.00
G00D1 Implantation or replacement of artificial urinary sphincter 45,327.00
G00D2 Insertion of skin tissue expander(s), excluding breast 19,247.00
G00D3 Closed (percutaneous) biopsy of brain, stereotactic method including burr holes
14,491.00
G00D4 Orthopedic oncologic surgery, excision of soft tissues 60,411.00
G00D5 Orthopedic oncologic surgery, revision of an artificial joint or implant 192,264.00
G00D6 Orthopedic oncologic surgery, complex amputation or disarticulation 69,549.00
G00D7 Orthopedic oncologic surgery, destructive and reconstructive surgery 172,130.00
G00D8 Thoracic surgery 37,307.00
G00E1 Intra=arterial administration of chemotherapy or chemoembolization, under angiography
11,887.00
G00E2 Arthroscopy, diagnostic and/or surgical procedures, without using implants
10,199.00
G00E3 Arthroscopy, complex and/or high skill surgical procedures, using implants
20,396.00
G00E4 Arthroscopy, complex, unusual surgical procedures, including cartilage transplantation
27,196.00
Servicecode Service name
Price for Patient from
Abroad(ILS)
G00E5 Insertion (initial or replacement) of single/dual chamber cardiac pacemaker
25,530.00
G00E6 Radical trachelectomy and lymphadenectomy 15,849.00
G00E7 Brachytherapy for ocular tumors 28,330.00
G00E9 Video and radio=telemetered electroencephalographic monitoring 43,706.00
G00F1 Creation of arteriovenous fistula for renal dialysis, native or using graft 17,849.00
G00F2 Laparoscopic gastric bypass 51,026.00
G00F3 Thoracic sympathectomy 8,449.00
G00F4 Thyroidectomy, complete/partial 15,299.00
G00F5 Gastrectomy, total/partial 52,101.00
G00F6 Laparoscopic appendectomy 16,672.00
G00F7 Whipple operation (radical pancreatic duodenectomy or radical subtotal pancreatectomy)
90,655.00
G00F8 Vertebroplasty 9,068.00
G00F9 Wada test 9,899.00
G00G1 Catheterization, insertion of umbrella like device for repair of cardial septal defects or patent ductus arteriosus (PDA)
73,186.00
G00G2 Kyphoplasty 42,980.00
G00G3 Mastectomy, partial (eg, lumpectomy), excludes biopsy of breast 7,932.00
G00G4 Brachytherapy, prostate cancer treatment 57,792.00
G00G5 Therapeutic catheterization of AV shunt for renal dialysis, native/with graft
30,011.00
G00G6 Extracorporeal shockwave lithotripsy, salivary stones 6,902.00
G00G7 Deflux injection, vesicoureteral reflux therapy, unilateral 9,893.00
G00G8 Deflux injection, vesicoureteral reflux therapy, bilateral 17,477.00
G00G9 Extracorporeal shockwave lithotripsy, kidney; simple 9,000.00
G00H2 Inpatient, per day, up to 3 days in acute care hospital, excluding departments with specific code
5,200.00
G00H4 Inpatient, per day, for fourth day or longer in acute care hospital, excluding departments with specific code
4,524.00
G00H5 Inpatient, per day, Dermatology and Venereology Department in acute care hospital
4,524.00
G00H6 Inpatient, per day, Ophthalmology and Pediatric Ophthalmology Departments in acute care hospital
4,524.00
G00H7 Inpatient, per day, Rehabilitation Department in acute care hospital 4,524.00
G00J3 Inpatient day, Acute Geriatric, Pulmonary and Tuberculosis Departments, geriatric hospitals and centers
3,502.00
G00J4 Inpatient day, Geriatric Rehabilitation Department, geriatric hospitals and centers
2,190.00
G00J5 Inpatient day, Complex Care Nursing Department, geriatric hospitals and centers
1,322.00
G00J7 Inpatient day, Departments for the Independent, geriatric hospitals and centers
484.00
G00J8 Inpatient day, Departments for the Frail, geriatric hospitals and centers 772.00
G00M1 Inpatient day, Department of Internal Medicine in acute care hospital 3,684.00
G00M2 Inpatient day, Rheumatology Department in acute care hospital 3,684.00
G00M3 Inpatient day, Department of Pulmonary Medicine in acute care hospital 3,684.00
G00M4 Inpatient day, Department of Geriatric Internal Medicine in acute care hospital
3,684.00
G00M5 Inpatient day, Gastroenterology Department in acute care hospital 3,684.00
Servicecode Service name
Price for Patient from
Abroad(ILS)
G00M6 Inpatient day, Observation Department in acute care hospital 3,684.00
G00N1 Inpatient day, General Intensive Care Department in acute care hospital 4,524.00
G00N3 Inpatient day, Respiratory Intensive Care Department in acute care hospital
4,524.00
G00N5 Inpatient day, Pediatric Intensive Care Department in acute care hospital 4,524.00
G00N7 Inpatient day, Neurosurgical Intensive Care Department in acute care hospital
4,524.00
G00N9 Additional inpatient day charge, up to 4, in Intensive Care Departments: General, Respirtory, Pediatric and Neurosurgical
9,058.00
G00P1 Inpatient day, Acute geriatric Department in acute care hospital 2,740.00
G00P2 Inpatient day, Geriatric Rehabilitation Department in acute care hospital 2,740.00
G00P3 Inpatient day, Department of high Dependency Nursing in acute care hospital
2,740.00
G00Q1 Acute inpatient day, psychiatric departments, all hospitals 1,882.00
G00Q2 Long term inpatient day, psychiatric departments, all hospitals 1,448.00
G00Q3 Inpatient day, children and adolescents, psychiatric departments, all hospitals
2,262.00
G00Q7 Artificial liver therapy, eg, MARS, additional inpatient day charge 35,912.00
G00Q8 Chronic artificial ventilation care, per day, all hospitals 2,924.00
G00R1 Extracorporeal shockwave lithotripsy, kidney; complex 28,263.00
G00R2 Closed percutaneous biopsy using CT guidance 6,798.00
G00R3 Closed percutaneous biopsy using MRI guidance 10,199.00
G00R4 Continuous intra=arterial administration of chemotherapeutic substance 18,117.00
G00R5 Vertebral excision and fusion 172,130.00
G00R6 Vertebral refusion 192,264.00
G00R7 Secondary insertion of intraocular lens prosthesis 3,179.00
G00R8 Single suture loop pupilloplasty 5,085.00
G00R9 Removal of vitreous 13,776.00
G00S1 Bronchoscopy, rigid or flexible, with placement of bronchial stent(s) (including tracheal/bronchial dilation as required)
17,568.00
G00S2 Partial/primary hip/shoulder replacement 39,662.00
G00S3 Total joint replacement and/or revision 43,714.00
G00S4 Radical neck lymph nodes dissection, unilateral/bilateral 25,076.00
G00S5 Lobectomy of liver 74,242.00
G00S6 Partial hepatectomy 41,555.00
G00S7 Maxillectomy, total/partial, for insertion of surgical obturator 35,710.00
G00S8 Stereotactic radiosurgery, brain 44,488.00
G00S9 Implantation of heart assist system 511,703.00
G00T3 Isolated limb perfusion in patient with melanoma 96,752.00
G00T4 Colonoscopy, with dilation and stent placement 23,493.00
G00T5 Removal of heart pacemaker lead(s) (electrodes) without replacement 31,626.00
G00T6 Removal of heart pacemaker lead(s) (electrodes) with replacement of electrodes and pacemaker device
44,394.00
G00T7 Scoliosis/kyphosis repair operation 110,956.00
G00T8 Emergency coronary artery catheterization for removal of obstruction, including insertion of drug eluting stent(s)
49,067.00
G00T9 Radical hysterectomy, abdominal/vaginal 22,664.00
G00U1 Colorectal surgery 45,415.00
Servicecode Service name
Price for Patient from
Abroad(ILS)
G00U2 Surgical fistulization of lacrimal tract to nasal cavity using balloon dilatation, including dacryocystorhinostomy
6,604.00
G00U3 Intravenous injection of rtPA, acute cerebrovascular stroke within 4.5 hours of stroke symptoms onset
39,662.00
G00U4 Therapeutic catheterization, acute cerebrovascular stroke within 8 hours of stroke symptoms
101,987.00
G00U5 Functional endoscopic nasal/sinus surgery (FESS), simple 13,597.00
G00U6 Functional endoscopic nasal/sinus surgery (FESS), complex 32,626.00
G00U7 Tonsillectomy without/with adenoidectomy 3,737.00
G00U9 Enucleation of eyeball 13,634.00
G00V2 Lengthening and adjustment of vertical expandable prosthetic titanium rib system
22,071.00
G00V3 Replacement of vertical expandable prosthetic titanium rib system implants
49,402.00
G00V4 Percutaneous pulmonary valve replacement, excluding valve cost 37,275.00
G00V5 Percutaneous aortic valve replacement, excluding valve cost 42,429.00
G00V6 Repair of inguinal/femoral hernia, unilateral, inpatient 9,776.00
G00V7 Repair of inguinal/femoral hernia, bilateral, inpatient 13,032.00
G00V8 Plastic surgery following significant weight loss 31,058.00
G00V9 Bone graft to maxilla/mandible, autogenic graft from pelvis/scalp 28,773.00
G00W1 Scleral buckling with implant 9,745.00
G00W2 Trabeculectomy 4,716.00
G00W3 Intraocular valve implantation, eg, Ahmed, for glaucoma therapy 12,902.00
G00W4 Repair of blepharoptosis, under 18 years, unilateral/bilateral 7,525.00
G00W5 Repair of blepharoptosis, 18 years and older, unilateral/bilateral 4,662.00
G0100 Additional charge for DRG in multiple trauma, admission from ER 11,332.00
G0101 ORIF/CRIF of pelvis, closed/open fracture 59,127.00
G0102 Arthroplasty with prosthetic replacement/implant of radial head, excluding open fracture
34,564.00
G0103 Arthroplasty with prosthetic replacement/implant of radial head, open fracture
56,857.00
G0104 ORIF of foot, closed fracture, excluding calcaneus 37,368.00
G0105 ORIF of foot, open fracture, excluding calcaneus 56,857.00
G0106 ORIF of calcaneus/operation on femur, excluding neck, closed fracture 30,021.00
G0107 ORIF of calcaneus/operation on femur, excluding neck, open fracture 47,019.00
G0108 Operation on clavicle/humerus/forearm, closed fracture, including closed dislocation of acromioclavicular joint, excluding distal humerus and shaft of radius/ulna, including bone graft
25,714.00
G0109 Operation on clavicle/humerus/forearm, open fracture, including open dislocation of acromioclavicular joint, excluding distal humerus and shaft of radius/ulna
38,292.00
G0110 ORIF/CRIF/EF of tibia and/or fibula, closed fracture 34,672.00
G0111 ORIF/CRIF/EF of tibia and/or fibula, open fracture, including use of bone marrow aspiration concentrate
59,686.00
G0112 ORIF of patella/ankle / CRIF of calcaneus, closed fracture 21,058.00
G0113 ORIF of patella/ankle / CRIF of calcaneus, open fracture 34,893.00
G0114 CRIF of ankle/foot, closed fracture, excluding calcaneus 11,816.00
G0115 CRIF of ankle/foot, open fracture, excluding calcaneus 22,236.00
G0116 Exploration of tendon/nerve of upper limb, including ganglion decompression/lysis of adhesions
7,393.00
G0117 Suture of extensor tendons of hand, including delayed suture 12,479.00
Servicecode Service name
Price for Patient from
Abroad(ILS)
G0118 Suture of tendons/nerves of upper limb, including delayed suture, excluding extensor tendons of hand
21,362.00
G0120 ORIF/EF of phalange of hand, closed fracture, including bone graft 12,742.00
G0121 ORIF/EF of phalange of hand, open/complex fracture 18,875.00
G0122 ORIF/EF of phalange of hand, with suture of tendons/nerves, closed/open fracture
28,502.00
G0123 ORIF/EF of phalanges of hand, closed fractures, including bone graft 18,537.00
G0124 ORIF/EF of phalanges of hand, open/complex fractures 25,138.00
G0125 ORIF/EF of phalanges of hand, with suture of tendons/nerves, closed/open fractures
34,765.00
G0126 ORIF/EF of metacarpal, closed fracture, including bone graft 14,036.00
G0127 ORIF/EF of metacarpal, open/complex fracture 20,274.00
G0128 ORIF/EF of metacarpal, with suture of tendons/nerves, closed/open fracture
29,900.00
G0129 ORIF/EF of metacarpals, closed fractures, including bone graft 21,824.00
G0130 ORIF/EF of metacarpals, open/complex fractures 28,692.00
G0131 ORIF/EF of metacarpals, with suture of tendons/nerves, closed/open fractures
38,320.00
G0132 ORIF of carpal(s), closed fracture, including bone graft 18,574.00
G0133 ORIF of carpal(s), open/complex fracture, including bone graft 25,178.00
G0134 ORIF of carpal(s), with suture of tendons/nerves, closed/open fracture, including bone graft
34,805.00
G0135 CRIF of hand, with suture of tendons/nerves, closed/open fracture(s) 31,863.00
G0136 Open reduction of closed dislocation of wrist 21,824.00
G0137 Open reduction of open/complex dislocation of wrist 28,692.00
G0138 Open reduction of dislocation of wrist, with suture of tendons/nerves 38,320.00
G0139 Reattachment of any part of upper extremity 65,173.00
G0140 Open/close reduction of fracture(s) of zygoma/maxilla/mandible, including internal fixation
22,280.00
G0141 Open reduction of fractures of orbit/ Le Fort type 2 or 3 / TMJ fracture with dislocation, with insertion of synthetic implant/bone graft to facial bone
34,599.00
G0142 Open reduction of comminuted fractures of facial bones, with insertion of synthetic implant/bone graft
98,681.00
G0144 ORIF of distal humerus, closed fracture, including bone graft 34,564.00
G0145 ORIF of distal humerus, open fracture 56,857.00
G0146 ORIF/EF of shaft of radius/ulna, closed fracture, including bone graft 19,476.00
G0147 ORIF/EF of shaft of radius/ulna, open fracture 34,893.00
G0148 CRIF of distal humerus/forearm/hand, closed fracture, including bone graft
10,931.00
G0149 CRIF of distal humerus/forearm/hand, open fracture, including complex fracture(s) of hand
22,236.00
G0150 Removal of gastric band 11,975.00
G0151 Sleeve gastrectomy 41,358.00
G0152 Sleeve gastrectomy with removal of gastric band 42,436.00
G0153 Sleeve gastrectomy with repair of diaphragmatic hernia 42,436.00
G0154 Sleeve gastrectomy with total cholecystectomy 43,754.00
G0155 Gastric bypass surgery with removal of gastric band 52,107.00
G0156 Gastric bypass surgery with repair of diaphragmatic hernia 52,107.00
G0157 Gastric bypass surgery with total cholecystectomy 53,334.00
G0158 Laparoscopic ovarian tissue retrieval 6,448.00
G0160 Implantation/replacement/removal of cochlear prosthetic device, excluding device cost
14,468.00
Servicecode Service name
Price for Patient from
Abroad(ILS)
G0161 Repair of cystocele with graft/prosthesis 10,515.00
G0162 Repair of rectocele with graft/prosthesis 10,515.00
G0163 Repair of cystocele and rectocele with graft/prosthesis 17,116.00
G0164 Repair of cystocele with graft/prosthesis and tension free vaging tape for incontinence
15,590.00
G0165 Repair of rectocele with graft/prosthesis and tension free vaging tape for incontinence
15,590.00
G0166 Repair of cystocele and rectocele with graft/prosthesis and tension free vaging tape for incontinence
22,194.00
G0167 Percutaneous insertion of left atrial appendage device, excluding device cost
11,962.00
G0168 Implantation of diaphragmatic pacemaker, excluding device cost 15,452.00
G0169 Pump for spasticity treatment preimplantation assessment, Baclofen 12,864.00
G0170 Implantation of pump for chronic pain relief/spasticity treatment, with drug loading, eg, Baclofen/Morphine, excluding pump cost
13,290.00
G0175 Open cholecystectomy, partial/complete 15,690.00
G0176 Laparoscopic cholecystectomy, partial/complete 15,690.00
G0177 Implantation of vertical expandable prosthetic titanium rib system, excluding system cost
23,830.00
G0178 Implantation of BAHA (Bone Anchored Hearing Aid), excluding device cost
9,326.00
G0180 Implantation of VNS (Vagus Nerve Stimulator) kit for epilepsy treatment, excluding device cost
15,000.00
G0182 Implantation of intracranial neurostimulator pulse generator kit, including leads, or replacement of leads, for movement disorders, excluding devices cost
30,000.00
G0187 Replacement of neurostimulator pulse generator for intracranial stimulation, without leads, for movement disorders, excluding device cost
15,000.00
G01H4 Inpatient, per day, for fourth day or longer in acute care hospital, excluding departments with specific code = out of cap
4,524.00
G01H5 Inpatient, per day, Dermatology and Venereology Department in acute care hospital = out of cap
4,524.00
G01H6 Inpatient, per day, Ophthalmology and Pediatric Ophthalmology Departments in acute care hospital = out of cap
4,524.00
G01H7 Inpatient, per day, Rehabilitation Department in acute care hospital = out of cap
4,524.00
G01M1 Inpatient day, Department of Internal Medicine in acute care hospital = out of cap
3,684.00
G01M2 Inpatient day, Rheumatology Department in acute care hospital = out of cap
3,684.00
G01M3 Inpatient day, Department of Pulmonary Medicine in acute care hospital = out of cap
3,684.00
G01M4 Inpatient day, Department of Geriatric Internal Medicine in acute care hospital = out of cap
3,684.00
G01M5 Inpatient day, Gastroenterology Department in acute care hospital = out of cap
3,684.00
G01M6 Inpatient day, Observation Department in acute care hospital = out of cap 3,684.00
G01N1 Inpatient day, General Intensive Care Department in acute care hospital = out of cap
4,524.00
G01N3 Inpatient day, Respiratory Intensive Care Department in acute care hospital = out of cap
4,524.00
G01N5 Inpatient day, Pediatric Intensive Care Department in acute care hospital = out of cap
4,524.00
Servicecode Service name
Price for Patient from
Abroad(ILS)
G01N7 Inpatient day, Neurosurgical Intensive Care Department in acute care hospital = out of cap
4,524.00
G01P1 Inpatient day, Acute geriatric Department in acute care hospital = out of cap
2,740.00
G01P2 Inpatient day, Geriatric Rehabilitation Department in acute care hospital = out of cap
2,740.00
G01P3 Inpatient day, Department of high Dependency Nursing in acute care hospital = out of cap
2,740.00
G01Q8 Chronic artificial ventilation care, per day, all hospitals = out of cap 2,924.00