Diagnostic Exam Pricelist

*prices may change without prior notice

Services	Rate
PHYSICAL MEDICINE AND REHABILITATION
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

Services	IPD Rate	OPD Rate
OR PROCEDURES
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

Services	IPD Rate	OPD Rate
LABORATORY
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

Services	IPD Rate	OPD Rate
X-RAY
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

Services	IPD Rate	OPD Rate
CT-SCAN
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

Item Description	Rate
OPHTHA- PHACOEMULSIFICATION USUAL CHARGES
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

Item Description	Rate
OPHTHA- PTERYGIUM USUAL CHARGES
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

Item Description	Rate
OPHTHA- TRABECULECTOMY USUAL CHARGES
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

Item Description	Rate
OPHTHA- EVISCERATION OFN OCULAR CONTENETS
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