Diagnostic Exam Pricelist

*prices may change without prior notice

PHYSICAL MEDICINE AND REHABILITATION
Services Rate
Consultation Fee 1000
Inpatient Treatment 1,150
Outpatient(OP) Regular Intervention 900
OP Moderate Intervention 800
OP Low Intervention 700
OP Minimal Intervention 600
Fitness with Supervision 600
Fitness without Supervision 500
Additional Fees
Traction Machines +200
Tilt Table +200
OR PROCEDURES
Services IPD Rate OPD Rate
TRABECULECTOMY 8,100 8,100
PTERYGIUM 9,000 9,000
CATARACT WITH IOL INSERTION 8,000 8,000
CHEMOTHERAPY TREATMENT PROCEDURE 2,300 2,300
HEMODIALYSIS 6,350 6,350

LABORATORY
Services IPD Rate OPD Rate
AFB STAINING (7FIHI-NFFI SEN) 575 500
ALBUMIN 460 400
ALKALINE PHOSPHATASE 575 500
ALT/SGPT 460 400
AMMONIA 2,645 2,300
AMYLASE 1,265 1,100
ANTIBODY SCREEN 1,150 1,000
APIT (ADULT/PATIENT) 1,150 1,000
APIT (CHILDREN/PATIENT) 1,150 1,000
ARTERIAL BLOOD GAS 2,645 2,300
ASO (QUANTITATIVE) 1,725 1,500
AST/SGOT 460 400
BF – ASCITIC FLUID CULTURE/AST 3,105 2,700
BF – PLEURAL FLUID CULTURE/AST 3,105 2,700
BF – SYNOVIAL FLUID CULTURE/AST 3,105 2,700
BILIRUBIN – DIRECT 575 500
BILIRUBIN – TOTAL 575 500
BLEEDING TIME 345 300
BLOOD CULTURE (AEROBIC ONLY) 3,105 2,700
BLOOD CULTURE (AEROBIC/ANAEROBIC) 4,600 4,000
BLOOD CULTURE (ANAEROBIC ONLY) 3,105 2,700
BLOOD PERIPHERAL SMEAR/MORPHOLOGY 1,380 1,200
BLOOD TYPING (TUBE METHOD) 460 400
BLOOD UREA NITROGEN (BUN) 345 300
BLOOD URIC ACID (BUA) 345 300
BODY FLUID – ALBUMIN/ PROTEIN 460 400
BODY FLUID – GLUCOSE 345 300
BODY FLUID – LDH 690 600
BODY FLUID – MAGNESIUM 575 500
BODY FLUID – POTASSIUM 575 500
BODY FLUID – SGOT 460 400
BODY FLUID – SGPT 460 400
BODY FLUID – SODIUM 575 500
BODY FLUID ANALYSIS (COMPLETE) 4,140 3,600
BODY FLUID CELL COUNT 460 400
BODY FLUID CRYSTALS 345 300
BODY FLUID GLUCOSE 345 300
BODY FLUID – URIC ACID 345 300
BONE PROFILE 2,760 2,400
CALCIUM – IONIZED 1,380 1,200
CALCIUM – TOTAL 575 500
CARDIAC ENZYMES PROFILE 2,415 2,100
CHLORIDE 575 500
CHOLESTEROL – TOTAL 345 300
CK-MB 1,150 1,000
CK-MB (ECLIA METHOD) 1,265 1,100
CLOTTING TIME 345 300
COAGULATION PROFILE 2,185 1,900
COMPLEMENT C3 1,610 1,400
COMPLETE BLOOD COUNT 575 500
CORD BLOOD TYPE AND SCREEN 3,910 3,400
CREATINE KINASE (CK) 920 800
CREATININE 345 300
CROSS MATCHING ONLY 1,380 1,200
CRP-HS 1,725 1,500
CSF – PROTEIN 690 600
CSF ANALYSIS (COMPLETE) 2,645 2,300
CSF CELL COUNT 460 400
CSF – CHLORIDE 690 600
CSF – CULTURE/AST 3,105 2,700
CSF – GLUCOSE 690 600
CSF – LDH 690 600
D-DIMER 1,380 1,200
D-DIMER (QUANTITATIVE) 1,610 1,400
DIRECT COOMB’S TEST 920 800
ERYTHOCYTE SED. RATE 460 400
ET TUBE/ ET ASPIRATE CULTURE/AST 3,105 2,700
FECAL OCCULT BLOOD 1,150 1,000
GAMMA – GTP 805 700
GLUCOSE – FASTING 345 300
GLUCOSE – RANDOM 345 300
GLUCOSE 1H/2H PPBS 345 300
GLYCOSYLATED HEMOGLOBIN (HBA1C) 1,380 1,200
GRAM STAINING 575 500
HDL – CHOL 805 700
HELICOBACTER PYLORI SCREEN 2,645 2,300
HEMOGLOBIN 460 400
HEMOGLOBIN AND HEMATOCRIT 460 400
HS-CRP 1,725 1,500
IBCT 2,530 2,200
INDIA INK PREPARATION 460 400
INIDIRECT COOMBS TEST 920 800
IRON 2,070 1,800
KOH PREPARATION 460 400
LDH 690 600
LDL – CHOL 805 700
LIPASE 1,265 1,100
LIPID PROFILE 2,070 1,800
LIVER FUNCTION TEST PROFILE 3,450 3,000
MAGNESIUM 575 500
MALARIA IGG/IGM (RAPID TEST) 1,150 1,000
MALARIA SMEAR (THICK AND THIN) 575 500
MICROALBUMIN/CREATININE RATIO 1,380 1,200
MRSA CULTURE AND SENSITIVITY 3,105 2,700
OGIT – 1 H (PREGNANT-SCREENING) 920 800
OGIT – 2 H (NON-PREGNANT/ADULT) 1,265 1,100
OGIT 2 HRS (PREGNANT) 1,265 1,100
OGIT – 3H (NON-PREGNANT/ADULT) 1,495 1,300
OGIT – 3H (PREGNANT) 1,495 1,300
OGIT-NON-PREGNANT FEMALE/MALE (SCREENING) 805 700
ONE UNIT FRESH FROZEN PLASMA WITH CROSSMATCH 3,450 3,000
ONE UNIT PACKED RED CELLS WITH CROSSMATCH 5,060 4,400
ONE UNIT PLATELET CONC. WITH CROSSMATCH 3,450 3,000
ONE WHOLE BLOOD UNIT WITH CROSSMATCH 5,520 4,800
OSMOLALITY – SERUM 1,380 1,200
PAP’S SMEAR 1,495 1,300
PERIPHERAL BLOOD SMEAR 1,380 1,200
PHOSPHORUS 575 500
PLATELET COUNT ONLY 460 400
PLEURAL/PERITONEAL FLUID (COMPLETE) 2,300 2,000
POTASSIUM 575 500
PRO-BNP 3,335 2,900
PROCALCITONIN 3,105 2,700
PROTHROMBIN TIME (PATIENT/TEST) 1,150 1,000
PUS SWAB CULTURE/AST 3,105 2,700
RAPID STREP A SCREEN 1,380 1,200
RENAL FUNCTION TESTS PROFILE 3,450 3,000
RETICULOCYTE COUNT 690 600
RHEUMATOID FACTOR 805 700
RPR 805 700
SEMEN ANALYSIS 920 800
SKIN SWAB CULTURE/AST 3,105 2,700
SODIUM 575 500
SPUTUM CULTURE/AST 3,105 2,700
STOOL ANALYSIS 345 300
STOOL CULTURE/AST 3,105 2,700
STOOL PH 345 300
SWAB CULTURE/AST (ALL TYPES) 3,105 2,700
TB CULTURE 3,910 3,400
TBIL/DBIL/IBIL 1,150 1,000
TISSUE BIOPSY EXTRA LARGE – –
TISSUE BIOPSY LARGE – –
TISSUE BIOPSY MEDIUM – –
TISSUE BIOPSY SMALL – –
TOTAL PROTEIN 460 400
TOTAL PROTEIN/ ALB/ GLOB/ RATIO 1,035 900
TRIGLYCERIDES 460 400
TROPONIN I 1,840 1,600
TROPONIN T 1,150 1,000
TYPHIDOT DUAL IGG/IGM 1,265 1,100
URINE 24 HRS ALBUMIN 460 400
URINE 24 HRS CALCIUM 575 500
URINE 24 HRS CHLORIDE 575 500
URINE 24 HRS CREATININE 345 300
URINE 24 HRS GLUCOSE 345 300
URINE 24 HRS MAGNESIUM 575 500
URINE 24 HRS PHOSPHORUS 575 500
URINE 24 HRS POTASSIUM 575 500
URINE 24 HRS PROTEIN 460 400
URINE 24 HRS SODIUM 575 500
URINE ANALYSIS 345 300
URINE BENCE JONES PROTEIN 805 700
URINE CREATININE CLEARANCE 1,840 1,600
URINE CULTURE/AST 3,105 2,700
URINE KETONE (QUALITATIVE) 345 300
URINE MICRAL TEST 920 800
URINE OSMOLALITY 1,495 1,300
URINE PH 345 300
URINE/SERUM PREGNANCY TEST 575 500
URINE PROTEIN (QUALITATIVE) 345 300
URINE RANDOM CALCIUM 575 500
URINE RANDOM CHLORIDE 575 500
URINE RANDOM CREATININE 345 300
URINE RANDOM GLUCOSE 345 300
URINE RANDOM MAGNESIUM 575 500
URINE RANDOM PHOSPHORUS 575 500
URINE RANDOM POTASSIUM 575 500
URINE RANDOM PROTEIN 460 400
URINE RANDOM SODIUM 575 500
URINE RANDOM URIC ACID 345 300
URINE RANDOM ALBUMIN/ CREATININE RATIO 1,265 1,100
URINE RANDOM PROTEIN/ CREATININE RATIO 1,265 1,100
URINE SPECIFIC GRAVITY 345 300
VAGINAL SWAB CULTURE/AST 3,105 2,700
VDRL 805 700
VENOUS BLOOD GAS 2,645 2,300
WOUND CULTURE/AST 3,105 2,700
CROSS MATCHING FEE 1,130 1,130
ONE UNIT WASHED RED BLOOD CELLS 6,900 6,000
PLATELET PHERESIS 1,840 1,600

X-RAY
Services IPD Rate OPD Rate
ABDOMEN AP/L 1,265 1,100
ABDOMEN U&S 1,265 1,100
ABDOMINAL 690 600
ANKLE BILAT AP/L 1,725 1,500
ANKLE AP/L 1,035 900
ARM BILAT AP/L 1,725 1,500
ARM AP/LAT 1,035 900
BARIUM ENEMA 3,680 3,200
BARIUM SWALLOW/ESOPHAGOGRAM 2,185 1,900
CHEST AP 690 600
CHEST AP/L (ADULT) 1,265 1,100
CHEST AP/L (PEDIA) 1,035 900
CHEST APICO 690 600
CHEST DECUB 690 600
CHEST LAT 575 500
CHEST OBLIQUE 575 500
CHEST PA 690 600
CHEST PA (ADULT) 690 600
CHEST PA (PEDIA) 575 500
CHEST PA/L (ADULT) 1,265 1,100
CHEST PA/L (PEDIA) 1,035 900
CLAVICLE 690 600
CONTRAST SINGLE XRAY 3,910 3,400
ELBOW BILAT AP/L 1,265 1,500
ELBOW AP/L 1,035 900
FOOT AP/L/O 1,265 1,100
FOOT AP/L 1,035 900
FOOT BILAT AP/O 1,725 1,500
FOOT AP/O 1,035 900
FOREARM BILAT AP/L 1,725 1,500
FOREARM AP/L 1,035 900
HAND BILAT AP/O 1,725 1,500
HAND AP/O 1,035 900
HIP JOINTS AP/L 690 600
HIP 575 500
HYSTEROGRAPHY 1,610 1,400
HYSTEROSALPHINGOGRAPHY 2,300 2,000
KNEE BILAT AP/L 1,725 1,500
KNEE AP/L 1,035 900
KUB PLAIN 690 600
KUB-IVP (INTRAVENOUS PYELOGRAPHY) 3,795 3,300
LEG BILAT AP/L 1,725 1,500
LEG AP/L 1,035 900
LS AP/L 1,380 1,200
LSL AP/L/O 2,185 1,900
MANDIBLE 1,150 1,000
NASAL BONE LATERAL (2 IN 1) 1,150 1,000
NECK AP/L 575 500
PELVIMETRY 1,380 1,200
PELVIS AP 690 600
READERS FEE X2 460 400
REDEARS FEE XRAY 230 200
RETROGRADE PYELOGRAPHY 2,990 2,600
SACRUM/COCCYX AP/L 1,035 900
SCAPULAR Y 690 600
SCOLIOSIS SERIES 2,530 2,200
SHOULDER AP 690 600
SHOULDER AXILLARY VIEW 575 500
SINUSES (WATER’S LAT) 1,150 1,000
SKULL AP 575 500
SKULL AP/L 1,150 1,000
SKULL WATERS 690 600
SMALL INTESTINAL SERIES 2,990 2,600
SOFT TISSUE 1,150 900
SPINE CERVICAL AP/L BOTH OBLIQUE 1,955 1,700
SPINE CERVICAL AP/L 1,150 1,000
SPINE LUMBAR AP/L 1,380 1,200
SPINE THORACIC AP/L 1,380 1,200
THIGH BILAT AP/L 1,725 1,500
THIGH AP/L 1,035 900
T-CAGE 575 500
TL AP/L 1,380 1,200
TMJ 2 IN 1 LEFT/RIGHT 2,415 2,100
TUBE CHOLANGIOGRAPHY 1,840 1,600
UPPER GI SERIES 3,680 3,200
WRIST BILAT AP/L 1,725 1,500
WRIST AP/L 1,035 900
CHEST PA (PE) 345 300
SPINE CERVICAL 575 500
SPINE LUMBAR 575 500
SPINE THORACIC 575 500
VOIDING CYSTOURETHROGRAM 3,680 3,200
BABYGRAM 690 600
C-ARM 6,095 5,300
SKELETAL SURVEY 17,825 15,500
CT-SCAN
Services IPD Rate OPD Rate
ORAL CAVITY CT-SCAN 7,705 6,700
MANDIBLE CT SCAN 10,695 7,300
ANGIOGRAPHY ABDOMEN 19,780 14,600
ANGIOGRAPHY CEREBRAL 18,285 13,300
ANGIO 18,285 13,300
ANGIOGRAPHY PULMONARY 18,285 13,300
ANGIOGRAPHY THORACIC 18,285 13,300
BIOPSY 7,705 6,700
CHEST CT SCAN 10,695 7,300
CONTRAST DELAYED 4,600 4,000
3D RECONSTRUCTION 1,610 1,400
CONTRAST DOUBLED 7,705 6,700
CONTRAST SINGLE 3,910 3,400
CRANIAL CT SCAN 9,890 6,700
CT STONOGRAM 11,500 8,600
FACIAL CT SCAN 10,695 7,300
FOOT CT SCAN 10,695 7,300
KIDNEY CT SCAN 10,695 7,300
LOWER ABDOMEN CT SCAN 10,695 7,300
MASTOID CT SCAN 10,695 7,300
NECK CT SCAN 9,890 6,700
ORBITAL CT SCAN 10,695 7,300
PNS CT SCAN 10,695 7,300
PELVIC CT SCAN 10,695 7,300
PITUITARY CT SCAN 10,695 7,300
SHOULDER CT SCAN 9,890 6,700
SPINE CERVICAL CT SCAN 10,695 7,300
SINE LUMBAR CT SCAN 10,695 7,300
SPINE LS CT SCAN 10,695 7,300
SPINE THORACIC CT SCAN 10,695 7,300
TEMPORAL CT SCAN 10,695 7,300
THIGH CT SCAN 10,695 7,300
UPPER ABDOMEN CT SCAN 10,695 7,300
WHOLE ABDOMEN CT SCAN 19,780 14,600
POWER INJECTOR 1,610 1,400
READERS FEE (1) 3,105 2,700
READERS FEE 1,610 1,400
KIDNEYS CT-SCAN 10,695 7,300
UROGRAM 11,500 8,600
KNEE CT-SCAN 10,695 7,300
ANGIOGRAPHY NECK 18,285 13,300
ANKLE CT SCAN 10,695 7,300
UPPER EXTREMITIES CT SCAN 10,695 7,300
ADRENAL GLANDS CTSCAN 8,395 7,300

Ophtha Charges

*prices may change without prior notice

OPHTHA- PHACOEMULSIFICATION USUAL CHARGES
Item Description Rate
RHEX ID 480
APPAVISC HV PFS USP 2% 2ML 513
VISTAMOX 5ML 1090
VISTAPRED 1% STERILE OPTHALMIC 460
EYE DRAPES, 100X120 PRE-CUT W/ POUCHES, BIOFLEX 550
10CC/ML 23GX1″ TERUMO SYRINGE W/NEEDLE 15
OXYGEN CANNULA (ADULT) 60
GLOVES, STERILE, 7.0 (GAMMEX) PF 70
GLOVES, NON-LATEX SIZE 8.0 DERMAPRENE 145
GOGGLES EYE COVER 150
DIAPER UNDERPAD (MEDICOS) 35
1CC/ML 25GX⅝” TERUMO TUBERCULIN SYRINGE W/NEEDLE 10
TEGADERM DRESSING, 6CM x 7CM, 1624W 32
FACEMASK, , EARLOOP 10
BSS 500ML PER USE 300
DECOSEPT PER USE 50
KNIFE KERATOME PER USE 600
KNIFE STAB MANI PER USE 600
MACROSET BBRAUN INTRAFIX (PER USE) 50
MISCELLANEOUS FEE 300
OS NSD 5’S 50
OXYGEN 2 LPM (PER HOUR) 60
PHOTOCOPY SHORT 9
PLASTER USE 75
PROPARACAINE HYDROCHLORIDE PER USE 45
PULSE OXIMETER, PORTABLE 60
SKIN PREPARATION SET 250
SURGERY SET 2 200
TRASH BAG (BLACK/YELLOW) 10
Extracapsular cataract removal w/ insertion of intraocular lens prosthesis (one stage procedure), (e.g., phacoemulsification); 8000
OPHTHA- PTERYGIUM USUAL CHARGES
Item Description Rate
BSS 500ML 750
EPINEPHRINE HIZON LAB 1MG/ML AMP 127.5
EUROCAINE 2% 5ML POLYAMP 54
VISTAMOX 5ML 1090
10CC/ML 23GX1″ TERUMO SYRINGE W/NEEDLE 15
1CC/ML 25GX⅝” TERUMO TUBERCULIN SYRINGE W/NEEDLE 10
BLADE NO.15 10
CLAVE VIAL SPIKE (CODAN) 175
CONTACT LENS, AIR OPTIC 485
EYE DRAPES, 100X120 PRE-CUT W/ POUCHES, BIOFLEX 550
GLOVES, NON-LATEX SIZE 8.0 DERMAPRENE 145
GLOVES, STERILE 7.5 (GAMMEX) – PF 70
SUTURE, NYLON 10-0 562.50
TEGADERM DRESSING, 6CM x 7CM, 1624W 32
MISCELLANEOUS FEE 300
OS NSD 5’S 50
PHOTOCOPY SHORT 9
PULSE OXIMETER, PORTABLE 60
SKIN PREPARATION SET 250
SURGERY SET 2 200
TRASH BAG (BLACK/YELLOW) 10
Ocular surface reconstruction; amniotic membrane transplantation; 9000
OPHTHA- TRABECULECTOMY USUAL CHARGES
Item Description Rate
ACCEPHRINE 1MG/ML AMP 95
EUROCAINE 2% 5ML POLYAMP 54
STERILE WATER FOR INJ [50ML] EURO-MED 74.25
VISTAMOX 5ML 1090
VISTAPRED 1% STERILE OPTHALMIC 460
10CC/ML 23GX1″ TERUMO SYRINGE W/NEEDLE 15
1CC/ML 25GX⅝” TERUMO TUBERCULIN SYRINGE W/NEEDLE 10
COTTON TIPPED APPLICATOR (SIMPLEX) 5
DIAPER UNDERPAD (MEDICOS) 35
DISPOSABLE STERILE SURGICAL GOWN 338
FACEMASK, , EARLOOP 10
GLOVES, EXAMINATION, NITRILE (MEDIUM) 10
GLOVES, NON-LATEX SIZE  8.0 DERMAPRENE 145
GOGGLES EYE COVER 150
KNIFE STAB, 15 DEGREE, MANI 1000
OXYGEN CANNULA (ADULT) 60
SUTURE, NYLON 10-0 562.5
ALCOHOL USE 20
MISCELLANEOUS FEE 300
OXYGEN 2 LPM (PER HOUR) 100
PPE-CAP SHEER BLUE 5
PROPARACAINE HYDROCHLORIDE PER USE 45
SURGERY SET 2 200
Fistulization of scalera for glaucoma; trabeculectomy ab externo w/ scarring from previous ocular surgery or trauma (includes injection of antifibrotic agents); 8100
OPHTHA- EVISCERATION OFN OCULAR CONTENETS
Item Description Rate
CETAMOL 10MG/ML (1% W/V) 452
CORDEX 5MG/ML AMP 136.83
PNSS 20ML EUROMED 43.2
REMOPAIN 30MG/ML AMP 108.5
SEDAFOL 10MG/ML, 20ML AMP 648
10CC/ML 23GX1 TERUMO SYRINGE W/ NEEDLE 15
10CC/ML 23GX1″ TERUMO SYRINGE W/ NEEDLE 15
1CC/ML 25G TERUMO TUBERCULIN SYRINGE 10
ASPIRATING NEEDLE PRECISIONGLIDE G25 5
BLADE NO. 11 10
CAP SHEER BLUE 5
DIAPER UNDERPAD (MEDICOS) 35
ELASTIC BANDAGE 3/X5YDS MCBRIDE 67
FACEMASK EARLOOP 60
GLOVES, STERILE 7.5 (GAMMEX) PF 70
GLOVES, STERILE 8.0 (GAMMEX) PF 70
GLOVES, STERILE, 7.0 (GAMMEX) PF 70
GUEDEL ORAL AIRWAY 100MM (RED) 80
LUBRICATING JELLY, 10 GRAMS, DR. KELLY 18
OXYGEN CANNULA (ADULT) 60
SUCTION CATHETER FR. 16 ROSEMED 30
SUCTION LINER, 3L BICAKCIKAR 520
SUCTION SET, POOLE DRAIN 300
VICRYL 4/0, VCP422H, CUTTING 19MM 495
ALCOHOL USE 30
ANESTHESIA CIRCUIT ADULT REUSE 690
ANESTHESIA MACHINE FEE GENERAL 720
ANESTHESIA MASK REUSE 100
DECOSEPT PER USE 50
DROPLIGHT (PER USE) 200
IM /SKIN TEST FEE 10
INFECTION CONTROL & WASTE DISPOSAL 1150
LAUNDRY AND LINEN FEE 700
OR FACILITY FEE 650
OS NSD 5S 50
OXYGEN 5 LPM (PER HR) 120
PATIENT MONITOR PER HR (RR) 200
PEST CONTROL & DISINFECTION FEE 690
PHOTOCOPY SHORT 9
PLASTER USE 75
PULSE OXIMETER 180
RECOVERY ROOM FEE 600
SUCTION MACHINE FEE 400
SURGERY SET 2 200
TRASH BAG (BLACK/YELLOW) 10
EVISCERATION OF OCULAR CONTENTS 3600