3! # # $ &% "! 9 3 9 $ $ (!& P SERVIZIO IMMUNO-TRASFUSIONALE BELCOLLE CENTRO STAMPA AZIENDALE codice descrizione prestazione quantità tariffa* importo 0,57 4,0 2,28 110 Carta colore naturale, gr al mq80, formato 42X29,7 1.055,0 0,02 16,56 2.801 stampa formato A4, BN fronte 2.110,0 0,01 25,32 2.801 stampa formato A4, BN fronte 3.400,0 0,01 40,80 110 Carta colore naturale, gr al mq80, formato 42X29,7 3.400,0 0,02 53,38 Riepilogo per '' = CENTRO STAMPA AZIENDALE (5 record di dettaglio) Somma 9.969,0 138,34 CITOLOGIA E CITOGENETICA codice descrizione prestazione quantità tariffa* importo 'olimerasica a catena e elettrofo56,81 9,0 511,29 91.36.1 CONSERVAZIONE DI CAMPIONI DI DNA O DI RNA 22,0 40,54 891,88 91.36.5 ESTRAZIONE DI DNA O DI RNA (nucleare o mitocondriale) Da sangue periferico, t 22,0 45,45 999,90 91.29.4 ANALISI DI MUTAZIONE DEL DNA Con reazione polimerasica a catena e ibridazio 78,0 120,08 9.366,24 Riepilogo per '' = CITOLOGIA E CITOGENETICA (4 record di dettaglio) Somma 131,0 11.769,31
A 2 :@ / <? > = < 7 ; 7 4 :2 7 8 1 7 6 0 5 4 0 12 1 0 /. - -+ ) *,+ - -+ ) *,+ LAB. ANALISI BELCOLLE codice descrizione prestazione quantità tariffa* C Ba)1,14 importo 1,0 1,14 90.21.3 90.21.3 -FECI ESAME CHIMICO E MICROSCOPICO (Grassi 1,0 3,23 3,23 91.11.1 91.11.1 -TREPONEMA PALLIDUM ANTICORPI ANTI CARDIOL 1,0 3,36 3,36 90.27.3 90.27.3 -GONADOTROPINA CORIONICA (Prova immunologi 1,0 3,66 3,66 90.60.1 90.60.1 -COMPLEMENTO (C1 Inibitore) 1,0 6,20 6,20 90.94.4 90.94.4 -HELICOBACTER PYLORI ANTICORPI (E.I.A.) 1,0 8,16 8,16 90.77.2 90.77.2 -TEST DI RESISTENZA ALLA PROTEINA C ATTIVA 1,0 9,04 9,04 90.21.2 90.21.2 -FATTORE NATRIURETICO ATRIALE 1,0 9,14 9,14 90.27.2 90.27.2 -GLUCOSIO 6 FOSFATO DEIDROGENASI (G6PDH) [ 1,0 9,30 9,30 90.52.1 90.52.1 -ANTICORPI ANTI MITOCONDRI (AMA) 1,0 9,45 9,45 90.68.2 90.68.2 -IgE SPECIFICHE ALLERGOLOGICHE: SCREENING 1,0 12,03 12,03 90.82.3 90.82.3 -TROPONINA I 1,0 16,37 16,37 90.01.2 90.01.2-17HO PROGESTERONE 1,0 90.11.1 90.11.1 -C PEPTIDE 1,0 90.15.2 90.15.2 -CORTICOTROPINA (ACTH) [P] 1,0 90.35.5 90.35.5 -PARATORMONE (PTH) [S] 1,0 90.29.1 90.29.1 -INSULINA [S] 1,0 90.55.2 90.55.2 -ANTIGENE CARBOIDRATICO 15.3 (CA 15.3) 1,0 90.17.2 90.17.2 -DEIDROEPIANDROSTERONE SOLFATO (DEA-S) 1,0 91.17.1 91.17.1 -VIRUS EPATITE A [HAV] ANTICORPI 1,0 90.35.2 90.35.2 -ORMONI: Dosaggi seriati dopo stimolo ( 5 1,0 33,05 33,05 91.02.1 91.02.1 -MICOBATTERI DA COLTURA IDENTIFICAZIONE ME 1,0 37,49 37,49 90.16.4 90.16.4 -CREATININA CLEARANCE 2,0 1,76 3,52 90.66.4 90.66.4 -Hb - EMOGLOBINA FETALE (Dosaggio) 2,0 3,98 7,96 Pagina 2
S U JW OM N V UM V O O N U T L M S K M J R Q O L NM K J I H HF D E GF H HF D E GF J)7,44 2,0 14,88 91.21.3 91.21.3 -VIRUS EPSTEIN BARR [EBV] ANTICORPI ETEROF 2,0 7,64 15,28 91.27.1 91.27.1 -VIRUS VARICELLA ZOSTER ANTICORPI (E.I.A.) 2,0 7,75 15,50 91.02.3 91.02.3 -MICOBATTERI IN CAMPIONI BIOLOGICI ESAME C 2,0 8,62 17,24 90.28.4 90.28.4 -IMMUNOGLOBULINE: CATENE KAPPA E LAMBDA [S 2,0 9,30 18,60 90.72.4 90.72.4 -PROTEINA S LIBERA [P] 2,0 9,81 19,62 90.48.2 90.48.2 -ANTICORPI ANTI CITOPLASMA DEI NEUTROFILI 2,0 11,41 22,82 90.47.3 90.47.3 -ANTICORPI ANTI ANTIGENI NUCLEARI ESTRAIBI 2,0 13,32 26,64 90.66.5 90.66.5 -Hb - EMOGLOBINE ANOMALE (HbS, HbD, HbH, e 2,0 14,36 28,72 90.13.2 90.13.2 -CICLOSPORINA 2,0 16,27 32,54 90.21.1 90.21.1 -FARMACI DIGITALICI 2,0 19,01 38,02 90.15.3 90.15.3 -CORTISOLO [S/U] 2,0 38,22 91.18.1 91.18.1 -VIRUS EPATITE B [HBV] ANTICORPI HBcAg IgM 2,0 38,22 91.10.4 91.10.4 -TREPONEMA PALLIDUM ANTICORPI (Ricerca qua 3,0 3,46 10,38 90.09.1 90.09.1 -APTOGLOBINA 3,0 4,65 13,95 90.26.4 90.26.4 -GLUCOSIO (Curva da carico 3 determinazion 3,0 5,96 17,88 90.93.3 90.93.3 -ESAME COLTURALE CAMPIONI BIOLOGICI DIVERS 3,0 6,47 19,41 91.22.1 91.22.1 -VIRUS HERPES SIMPLEX (TIPO 1 o 2) ANTICOR 3,0 7,75 23,25 90.66.3 90.66.3 -Hb - EMOGLOBINA A2 3,0 9,61 28,83 90.72.5 90.72.5 -PROTEINA S TOTALE [P] 3,0 9,81 29,43 90.10.1 90.10.1 -BETA2 MICROGLOBULINA [S/U] 3,0 10,79 32,37 90.48.3 90.48.3 -ANTICORPI ANTI DNA NATIVO 3,0 11,88 35,64 90.41.5 90.41.5 -TIREOGLOBULINA (Tg) 3,0 57,33 90.68.3 90.68.3 -IgE TOTALI 3,0 57,33 91.18.4 91.18.4 -VIRUS EPATITE B [HBV] ANTIGENE HBeAg 3,0 57,33 90.69.2 90.69.2 -IMMUNOFISSAZIONE 3,0 29,70 89,10 90.74.2 90.74.2 -REAZIONE DI WAALER ROSE 4,0 2,14 8,56 Pagina 3
fe b cd c ^ _b a ^ _ ` ^ ^] [ \Z X Y YZ [ \Z X Y YZ g2,56 4,0 10,24 90.46.5 90.46.5 -ANTICOAGULANTE LUPUS-LIKE (LAC) 4,0 4,65 18,60 90.60.2 90.60.2 -COMPLEMENTO: C1Q, C3, C3 ATT., C4 (Ciascu 4,0 6,61 26,44 91.14.1 91.14.1 -VIRUS CITOMEGALOVIRUS ANTICORPI (E.I.A.) 4,0 7,75 31,00 91.10.3 91.10.3 -TREPONEMA PALLIDUM ANTICORPI (I.F.) [FTA- 4,0 8,16 32,64 91.14.3 91.14.3 -VIRUS CITOMEGALOVIRUS ANTICORPI IgM (E.I. 4,0 8,78 35,12 90.49.5 90.49.5 -ANTICORPI ANTI GLIADINA (IgG, IgA) 4,0 11,41 45,64 91.21.1 91.21.1 -VIRUS EPSTEIN BARR [EBV] ANTICORPI (EA o 4,0 13,48 53,92 90.27.5 90.27.5 -GONADOTROPINA CORIONICA (Subunità beta, m 4,0 19,01 76,04 90.55.1 90.55.1 -ANTIGENE CARBOIDRATICO 125 (CA 125) 4,0 76,44 90.11.5 90.11.5 -CALCITONINA 4,0 76,44 91.17.5 91.17.5 -VIRUS EPATITE B [HBV] ANTICORPI HBcAg 4,0 76,44 91.18.2 91.18.2 -VIRUS EPATITE B [HBV] ANTICORPI HBeAg 4,0 76,44 91.08.5 91.08.5 -STREPTOCOCCO ANTICORPI ANTI ANTISTREPTOLI 5,0 3,18 15,90 90.30.2 90.30.2 -LIPASI [S] 5,0 3,20 16,00 90.61.4 90.61.4 -D-DIMERO (EIA) 5,0 8,52 42,60 90.72.2 90.72.2 -PROTEINA C ANTICOAGULANTE FUNZIONALE [P] 5,0 9,09 45,45 90.52.4 90.52.4 -ANTICORPI ANTI NUCLEO (ANA) 5,0 9,66 48,30 90.05.5 90.05.5 -ALFA 1 FETOPROTEINA [S/La/Alb] 5,0 95,55 90.32.3 90.32.3 -LUTEOTROPINA (LH) [S/U] 5,0 95,55 90.23.2 90.23.2 -FOLATO [S/(Sg)Er] 5,0 95,55 90.47.5 90.47.5 -ANTICORPI ANTI CARDIOLIPINA (IgG, IgA, Ig 6,0 12,55 75,30 90.13.5 90.13.5 -COBALAMINA (VIT. B12) [S] 6,0 114,66 90.19.2 90.19.2 -ESTRADIOLO (E2) [S/U] 6,0 114,66 91.18.3 91.18.3 -VIRUS EPATITE B [HBV] ANTICORPI HBsAg 6,0 114,66 90.44.5 90.44.5 -VITAMINA D 7,0 16,27 113,89 90.23.3 90.23.3 -FOLLITROPINA (FSH) [S/U] 7,0 133,77 Pagina 4
z o k y u q x v wp u s tp r o qp n l mj h i kj l mj h i kj { 7,0 133,77 90.43.3 90.43.3 -TRIODOTIRONINA LIBERA (FT3) 7,0 133,77 90.38.2 90.38.2 -PROLATTINA (PRL) [S] 7,0 133,77 91.26.4 91.26.4 -VIRUS ROSOLIA ANTICORPI 8,0 7,75 62,00 90.18.5 90.18.5 -ERITROPOIETINA 8,0 17,66 141,28 90.55.3 90.55.3 -ANTIGENE CARBOIDRATICO 19.9 (CA 19.9) 8,0 152,88 90.38.1 90.38.1 -PROGESTERONE [S] 8,0 152,88 90.64.2 90.64.2 -FATTORE REUMATOIDE 9,0 2,14 19,26 90.56.3 90.56.3 -ANTIGENE CARCINO EMBRIONARIO (CEA) 9,0 171,99 90.51.4 90.51.4 -ANTICORPI ANTI MICROSOMI (AbTMS) O ANTI T 9,0 171,99 90.94.2 90.94.2 -ESAME COLTURALE DELL' URINA [URINOCOLTURA 10,0 6,47 64,70 91.22.4 91.22.4 -VIRUS IMMUNODEF. ACQUISITA [HIV 1-2] ANTI 10,0 8,78 87,80 90.54.4 90.54.4 -ANTICORPI ANTI TIREOGLOBULINA (AbTg) 10,0 191,10 90.05.1 90.05.1 -ALBUMINA [S/U/dU] 11,0 2,58 28,38 90.28.1 90.28.1 -Hb - EMOGLOBINA GLICATA 11,0 10,59 116,49 90.57.5 90.57.5 -ANTITROMBINA III FUNZIONALE 12,0 2,79 33,48 91.18.5 91.18.5 -VIRUS EPATITE B [HBV] ANTIGENE HBsAg 12,0 19,01 228,12 90.15.4 90.15.4 -CREATINCHINASI (CPK o CK) 13,0 1,96 25,48 91.09.4 91.09.4 -TOXOPLASMA ANTICORPI (E.I.A.) 16,0 7,75 124,00 90.52.5 90.52.5 -ANTICORPI ANTI ORGANO 16,0 14,51 232,16 91.19.5 91.19.5 -VIRUS EPATITE C [HCV] ANTICORPI 16,0 305,76 90.64.3 90.64.3 -FATTORI DELLA COAGULAZIONE (II, V, VII, V 21,0 14,31 300,51 90.14.2 90.14.2 -COLESTEROLO LDL 26,0 0,67 17,42 90.21.4 90.21.4 -FECI SANGUE OCCULTO 27,0 0,79 21,33 90.29.2 90.29.2 -LATTATO DEIDROGENASI (LDH) [S/F] 28,0 2,56 71,68 90.07.2 90.07.2 -AMINOACIDI DOSAGGIO SINGOLO [S/U/Sg/P] 28,0 3,46 96,88 90.72.3 90.72.3 -PROTEINA C REATTIVA (Quantitativa) 28,0 4,75 133,00 Pagina 5
Š ˆ ƒ ~ } ~ ~ } ~ Œ5,16 32,0 165,12 90.14.4 90.14.4 -COLINESTERASI (PSEUDO-CHE) 33,0 1,55 51,15 90.82.5 90.82.5 -VELOCITA' DI SEDIMENTAZIONE DELLE EMAZIE 34,0 1,28 43,52 90.38.4 90.38.4 -PROTEINE (ELETTROFORESI DELLE) [S] Inclus 34,0 5,96 202,64 90.24.5 90.24.5 -FOSFORO 47,0 0,98 46,06 90.42.1 90.42.1 -TIREOTROPINA (TSH) 47,0 898,17 90.69.4 90.69.4 -IMMUNOGLOBULINE IgA, IgG o IgM (Ciascuna) 51,0 5,84 297,84 90.38.5 90.38.5 -PROTEINE [S/U/dU/La] 53,0 1,88 99,64 90.44.3 90.44.3 -URINE ESAME CHIMICO FISICO E MICROSCOPICO 55,0 1,14 62,70 90.65.1 90.65.1 -FIBRINOGENO FUNZIONALE 73,0 2,56 186,88 90.13.3 90.13.3 -CLORURO [S/U/dU] 73,0 2,78 202,94 90.62.2 90.62.2 -EMOCROMO: Hb, GR, GB, HCT, PLT, IND. DERI 83,0 3,31 274,73 90.76.1 90.76.1 -TEMPO DI TROMBOPLASTINA PARZIALE (PTT) 106,0 2,53 268,18 90.32.5 90.32.5 -MAGNESIO TOTALE [S/U/dU/(Sg)Er] 113,0 1,70 192,10 90.75.4 90.75.4 -TEMPO DI PROTROMBINA (PT) 113,0 2,87 324,31 90.43.5 90.43.5 -URATO [S/U/dU] 141,0 1,70 239,70 90.23.5 90.23.5 -FOSFATASI ALCALINA 150,0 2,56 384,00 90.14.1 90.14.1 -COLESTEROLO HDL 161,0 1,86 299,46 90.56.5 90.56.5 -ANTIGENE PROSTATICO SPECIFICO (PSA) 180,0 3.439,80 90.11.4 90.11.4 -CALCIO TOTALE [S/U/dU] 192,0 2,78 533,76 90.40.4 90.40.4 -SODIO [S/U/dU/(Sg)Er] 238,0 2,78 661,64 90.14.3 90.14.3 -COLESTEROLO TOTALE 241,0 2,28 549,48 90.43.2 90.43.2 -TRIGLICERIDI 241,0 5,17 1.245,97 90.37.4 90.37.4 -POTASSIO [S/U/dU/(Sg)Er] 242,0 2,78 672,76 90.25.5 90.25.5 -GAMMA GLUTAMIL TRANSPEPTIDASI (gamma GT) 244,0 2,56 624,64 90.10.5 90.10.5 -BILIRUBINA TOTALE E FRAZIONATA 279,0 3,40 948,60 90.22.3 90.22.3 -FERRITINA [P/(Sg)Er] 289,0 5.522,79 Pagina 6
œ žœ œ œ š Ž Ž ª š ª «š š š Ÿ Ÿ Ÿ1,70 302,0 513,40 90.22.5 90.22.5 -FERRO [S] 308,0 2,56 788,48 90.09.2 90.09.2 -ASPARTATO AMINOTRANSFERASI (AST) (GOT) [S 334,0 2,88 961,92 90.04.5 90.04.5 -ALANINA AMINOTRANSFERASI (ALT) (GPT) [S/U 349,0 2,88 1.005,12 90.16.3 90.16.3 -CREATININA [S/U/dU/La] 361,0 2,56 924,16 90.44.1 90.44.1 -UREA [S/P/U/dU] 368,0 1,70 625,60 Riepilogo per '' = LAB. ANALISI BELCOLLE (138 record di dettaglio) Somma 6.167,0 29.499,45 RADIOLOGIA BELCOLLE codice descrizione prestazione quantità tariffa* Riepilogo per '' = RADIOLOGIA BELCOLLE (1 record di dettaglio) importo š- CHIRURGIA ED 1,0 60,00 60,00 Somma 1,0 60,00 RADIOTERAPIA VITERBO codice descrizione prestazione quantità tariffa* importo 38,00 5.520,0 209.760,00 Riepilogo per '' = RADIOTERAPIA VITERBO (1 record di dettaglio) Somma 5.520,0 209.760,00
Ä Æ Â Ã Ä Å Á µ À½ µ º½ º º ½ ¾ µ ¾ ½ ¼ º½» º µ ³ ± ²± Ì È È É ËÊ Ç RIANIMAZIONE POLO codice descrizione prestazione quantità tariffa* importo Älisi di sangue capillare o a13,69 56,0 766,64 Riepilogo per '' = RIANIMAZIONE POLO (1 record di dettaglio) Somma 56,0 766,64 Riepilogo per 'Reparto' = SERVIZIO IMMUNO-TRASFUSIONALE BELCOLLE (150 record di dettaglio) TOTALE REPARTO 21.844,0 251.993,74