AP Fee Schedule request form 7.14.17

Thomas Jefferson University
Department of Pathology, Anatomy & Cell Biology
Anatomical Pathology Professional Fees
Name: _______________________________ Institution/Department: ____________________________
City: __________________________ State: ___________________ Zip Code: _____________
Phone Number: ________________________ Email Address: ________________________________
Departmental Charge Code: _______/_______/_______/_______
Number of
Samples
Paraffin Histology
Processing Only
Embedding Only
Sectioning and H & E
Processing and Embedding
Cell Block
Processing, Embedding, Sectioning and H & E
4.Additional H & E Slide
1st Unstained Slide
Additional Unstained Slide
Pull Blocks
Frozen Section Histology
Embedding, Cryosectioning and H & E
Embedding, Cryosectioning and Unstained Slide
Additional Cryostaining Unstained/H & E Slide
Special Staining
Tier I (AFB, Fe, PAS, PAS/D, Gram, Alcian Blue)
Tier II (MT, VVG, Congo, Sirius, Steiner, Colloidal Fe)
Tier III-Ag Stains (GMS, PAMS, JMS, Bielchowski, Retic)
Immunohistochemistry
Established Protocol -1' Ab provided by investigator
Established Protocol -1' Ab provided by Core Lab

Antibody Protocol Development-Antibody provided by investigator
ISH
Dual ISH
Preparation of TMA
TMA (Maximum 40 Cores)
Image Analysis
Set up new Algorithm
Cell counts
Morphometry
Scan
Miscellaneous
Slide Box

Fee/Samples

Total Fee

$3.00
$5.00
$4.00
$8.00
$13.00
$12.00
$4.00
$3.00
$3.00
$2.00
$13.00
$10.00
$4.00

$10.00
$13.00
$4.00
$30.00
$40.00
$175.00
$50.00
$80.00
$350.00
$400.00
$30.00
$50.00
$10.00
$10.00
$

Total to be charged to department charge code:

For Further Information Please Contact:
Director
Dr. Charalambos Solomides
(215) 503 - 6202


Technician
Raymond O’Neill
(215) 955 – 6352


PI Signature: ________________________________________

Date: __________________

Administrator Signature: __________________________________

Date: __________________

***Fees are determined by TJU Policy for research pricing***