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 Charalambos.Solomides@jefferson.edu Technician Raymond O’Neill (215) 955 – 6352 Raymond.ONeill@jefferson.edu PI Signature: Date: Administrator Signature: Date: ***Fees are determined by TJU Policy for research pricing***