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AP Fee Schedule request form 7.14.17

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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

Fee/Samples Total Fee

Paraffin Histology

Frozen Section Histology

Special Staining

Tier II (MT, VVG, Congo, Sirius, Steiner, Colloidal Fe) $13.00

Tier III-Ag Stains (GMS, PAMS, JMS, Bielchowski, Retic) $4.00

Immunohistochemistry

Established Protocol -1' Ab provided by investigator $30.00

Antibody Protocol Development-Antibody provided by investigator $175.00

Preparation of TMA

Image Analysis

Miscellaneous

Total to be charged to department charge code:

$

For Further Information Please Contact:

Dr Charalambos Solomides Raymond O’Neill

Charalambos.Solomides@jefferson.edu Raymond.ONeill@jefferson.edu

PI Signature: Date:

Administrator Signature: Date:

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

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