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Diagnostic Services List
| SERVICES | ITEM ID | ITEM DESCRIPTION | |||
|---|---|---|---|---|---|
| LABORATORY OPD | LAB00001 | 2 HR - PP / SUGAR | 300.00 | ||
| LABORATORY OPD | LAB00003 | APTT (ACTIVATED PLASMA THROMBOPLASTINE TIME) | 630.00 | ||
| LABORATORY OPD | LAB00004 | ABG/CBG (BLOOD GAS) | 1,329.00 | ||
| LABORATORY OPD | LAB00007 | ALBUMIN | 300.00 | ||
| LABORATORY OPD | LAB00008 | ALKALINE PHOSPHATASE | 300.00 | ||
| LABORATORY OPD | LAB00013 | ANTI - HAV (IGM) | 1,827.00 | ||
| LABORATORY OPD | LAB00018 | ANTI - HBS (LATEX) | 263.00 | ||
| LABORATORY OPD | LAB00021 | ANTI - HCV (HEPATITIS C-VIRUS) LATEX | 570.00 | ||
| LABORATORY OPD | LAB00023 | ASO ( QUANTITATIVE ) | 515.00 | ||
| LABORATORY OPD | LAB00024 | BETA - HCG (INITIAL) | 1,050.00 | ||
| LABORATORY OPD | LAB00025 | BETA - HCG (1ST ADDTL DILUTION) | 850.00 | ||
| LABORATORY OPD | LAB00026 | BETA - HCG (2ND ADDT'L DILUTION) | 850.00 | ||
| LABORATORY OPD | LAB00027 | BILIRUBIN TOTAL/ DIRECT (B1/B2) PACKAGE | 700.00 | ||
| LABORATORY OPD | LAB00031 | BIOPSY - FINE NEEDLE ASPIRATION | 3,000.00 | ||
| LABORATORY OPD | LAB00032 | BIOPSY - LARGE SPECIMEN | 3,800.00 | ||
| LABORATORY OPD | LAB00033 | BIOPSY - MEDIUM SPECIMEN | 2,300.00 | ||
| LABORATORY OPD | LAB00034 | BIOPSY - SMALL SPECIMEN | 1,600.00 | ||
| LABORATORY OPD | LAB00035 | BIOPSY - X-LARGE SPECIMEN | 5,600.00 | ||
| LABORATORY OPD | LAB00036 | BLEEDING TIME | 130.00 | ||
| LABORATORY OPD | LAB00038 | BLOOD GAS | 1,000.00 | ||
| LABORATORY OPD | LAB00039 | BLOOD SUGAR - HEMOGLUCO TEST (HGT) | 150.00 | ||
| LABORATORY OPD | LAB00040 | BLOOD TYPING / RH | 250.00 | ||
| LABORATORY OPD | LAB00047 | BODY FLUID ANALYSIS | 3,850.00 | ||
| LABORATORY OPD | LAB00052 | CALCIUM | 368.00 | ||
| LABORATORY OPD | LAB00056 | PRO BNP, CARDIAC | 1,523.00 | ||
| LABORATORY OPD | LAB00058 | CBC - COMPLETE BLOOD COUNT | 150.00 | ||
| LABORATORY OPD | LAB00060 | RBC- RED BLOOD CELL | 130.00 | ||
| LABORATORY OPD | LAB00062 | CBG (CAPILLARY BLOOD GAS) | 1,265.00 | ||
| LABORATORY OPD | LAB00063 | CEA (CARCINO EMBRYONIC ANTIGEN) | 1,600.00 | ||
| LABORATORY OPD | LAB00064 | CELL BLOCK | 1,600.00 | ||
| LABORATORY OPD | LAB00072 | CLOT RETRACTION TIME | 165.00 | ||
| LABORATORY OPD | LAB00073 | CLOTTING TIME | 130.00 | ||
| LABORATORY OPD | LAB00075 | COMBS TEST (DIRECT) | 500.00 | ||
| LABORATORY OPD | LAB00076 | COMBS TEST (INDIRECT) | 473.00 | ||
| LABORATORY OPD | LAB00089 | CROSS MATCHING | 1,000.00 | ||
| LABORATORY OPD | LAB00090 | CRP (C-REACTIVE PROTEIN)- PLAIN | 850.00 | ||
| LABORATORY OPD | LAB00091 | CSF (CEREBRO SPINAL FLUID) ANALYSIS | 3,850.00 | ||
| LABORATORY OPD | LAB00092 | CSF - PERICARDIAL FLUID ANALYSIS | 3,850.00 | ||
| LABORATORY OPD | LAB00094 | PLEURAL FLUID ANALYSIS | 3,850.00 | ||
| LABORATORY OPD | LAB00095 | CULTURE & SENSITIVITY TEST- SPUTUM | 1,800.00 | ||
| LABORATORY OPD | LAB00096 | CULTURE & SENSITIVITY TEST- STOOL | 1,800.00 | ||
| LABORATORY OPD | LAB00097 | CULTURE & SENSITIVITY - URINE | 1,800.00 | ||
| LABORATORY OPD | LAB00098 | CULTURE & SENSITIVITY TEST - BLOOD | 2,205.00 | ||
| LABORATORY OPD | LAB00099 | CULTURE & SENSITIVITY TEST - BODY FLUID | 1,890.00 | ||
| LABORATORY OPD | LAB00100 | CULTURE & SENSITIVITY TEST - THROAT CULTURE | 1,800.00 | ||
| LABORATORY OPD | LAB00101 | CULTURE & SENSITIVITY TEST - VAGINAL DISCHARGE | 1,800.00 | ||
| LABORATORY OPD | LAB00102 | CULTURE & SENSITIVITY TEST - WOUND DISCHARGE | 1,800.00 | ||
| LABORATORY OPD | LAB00103 | CYTOLOGY | 950.00 | ||
| LABORATORY OPD | LAB00106 | D-DIMER | 1,250.00 | ||
| LABORATORY OPD | LAB00107 | DENGUE NS1 ANTIGEN | 1,271.00 | ||
| LABORATORY OPD | LAB00110 | ESR (ERYTHROCYTE SEDIMENTATION RATE) | 300.00 | ||
| LABORATORY OPD | LAB00111 | FASTING BLOOD SUGAR (FBS) | 300.00 | ||
| LABORATORY OPD | LAB00116 | FT3 | 970.00 | ||
| LABORATORY OPD | LAB00117 | FT4 | 970.00 | ||
| LABORATORY OPD | LAB00124 | HBAIC (GLYCOSYLATED HEMOGLOBIN) | 920.00 | ||
| LABORATORY OPD | LAB00132 | HBS AG (LATEX) | 242.00 | ||
| LABORATORY OPD | LAB00140 | HGT/CBG (CAPILLARY BLOOD GLUCOSE) | 158.00 | ||
| LABORATORY OPD | LAB00146 | IONIZED CALCIUM | 600.00 | ||
| LABORATORY OPD | LAB00148 | LDH | 650.00 | ||
| LABORATORY OPD | LAB00152 | LIPID PROFILE | 1,200.00 | ||
| LABORATORY OPD | LAB00158 | LIVER PROFILE | 1,500.00 | ||
| LABORATORY OPD | LAB00162 | MALARIAL SMEAR | 350.00 | ||
| LABORATORY OPD | LAB00163 | MICRAL TEST (micro, aib) | 223.00 | ||
| LABORATORY OPD | LAB00164 | NEWBORN G6PD CONFIRMATORY | 605.00 | ||
| LABORATORY OPD | LAB00166 | OCCULT BLOOD SMEAR - STOOL | 950.00 | ||
| LABORATORY OPD | LAB00167 | OGTT - 100 GRAMS (ORAL GLUCOSE TOLERANCE) | 963.00 | ||
| LABORATORY OPD | LAB00168 | OGTT - 50 GRAMS (ORAL GLUCOSE TOLERANCE) | 713.00 | ||
| LABORATORY OPD | LAB00169 | OGTT - 75 GRAMS (ORAL GLUCOSE TOLERANCE) | 863.00 | ||
| LABORATORY OPD | LAB00170 | PAP SMEAR | 400.00 | ||
| LABORATORY OPD | LAB00171 | PERIPHERAL SMEAR | 550.00 | ||
| LABORATORY OPD | LAB00176 | PLATELET COUNT | 150.00 | ||
| LABORATORY OPD | LAB00181 | PREGNANCY TEST URINE | 192.00 | ||
| LABORATORY OPD | LAB00183 | PSA (PROSTATE SPECIFIC ANTIGEN) - EIA | 1,155.00 | ||
| LABORATORY OPD | LAB00185 | PTPA - PROTHROMBIN TIME | 630.00 | ||
| LABORATORY OPD | LAB00187 | RANDOM BLOOD SUGAR (RBS) | 300.00 | ||
| LABORATORY OPD | LAB00188 | RETICULOCYTE COUNT | 165.00 | ||
| LABORATORY OPD | LAB00190 | RF (RHEUMATOID FACTOR) | 420.00 | ||
| LABORATORY OPD | LAB00202 | SMEAR - AFB (ACID FAST BACILLI) | 200.00 | ||
| LABORATORY OPD | LAB00203 | SMEAR - KOH | 158.00 | ||
| LABORATORY OPD | LAB00204 | SMEAR - PROSTATIC | 200.00 | ||
| LABORATORY OPD | LAB00207 | SMEAR- URETHRAL SMEAR | 200.00 | ||
| LABORATORY OPD | LAB00212 | SODIUM POTASSIUM CHLORIDE PACKAGE | 850.00 | ||
| LABORATORY OPD | LAB00213 | SPERM COUNT | 276.00 | ||
| LABORATORY OPD | LAB00215 | STOOL EXAM | 97.00 | ||
| LABORATORY OPD | LAB00217 | T3 | 800.00 | ||
| LABORATORY OPD | LAB00218 | T4 | 800.00 | ||
| LABORATORY OPD | LAB00220 | TOTAL CELL COUNT & DIFF. COUNT | 130.00 | ||
| LABORATORY OPD | LAB00221 | TOTAL PROTEIN | 300.00 | ||
| LABORATORY OPD | LAB00222 | TOTAL PROTEIN / ALBUMIN | 600.00 | ||
| LABORATORY OPD | LAB00228 | TRIGLYCERIDES | 450.00 | ||
| LABORATORY OPD | LAB00231 | TROPONIN T (QUANTITATIVE) WITH TITER | 1,550.00 | ||
| LABORATORY OPD | LAB00232 | TROPONIN QUALITATIVE | 1,200.00 | ||
| LABORATORY OPD | LAB00233 | TSH | 950.00 | ||
| LABORATORY OPD | LAB00235 | TYPHOID RAPID IGM - TYPHIDOT | 1,050.00 | ||
| LABORATORY OPD | LAB00236 | TYPHOID - WIDAL | 385.00 | ||
| LABORATORY OPD | LAB00239 | URINALYSIS | 93.00 | ||
| LABORATORY OPD | LAB00243 | URINE - KETONES | 74.00 | ||
| LABORATORY OPD | LAB00248 | VDRL ( SYPHILIS ) | 242.00 | ||
| LABORATORY OPD | LAB00006 | AFP (ALPHA FETO PROTEIN) -initial | 1,083.50 | ||
| LABORATORY OPD | LAB00249 | BLOOD URIC ACID | 350.00 | ||
| LABORATORY OPD | LAB00250 | SGPT | 300.00 | ||
| LABORATORY OPD | LAB00002 | SMEAR- BONE MARROW | 2,500.00 | ||
| LABORATORY OPD | LAB00251 | AMYLASE | 700.00 | ||
| LABORATORY OPD | LAB00009 | BLOOD UREA NITROGEN (BUN) | 300.00 | ||
| LABORATORY OPD | LAB00010 | CHOLESTEROL TOTAL | 400.00 | ||
| LABORATORY OPD | LAB00011 | CREATININE | 300.00 | ||
| LABORATORY OPD | LAB00015 | LOW DENSITY LIPOPROTEIN (LDL) | 400.00 | ||
| LABORATORY OPD | LAB00019 | HIGH DENSITY LIPOPROTEIN (HDL) | 420.00 | ||
| LABORATORY OPD | LAB00020 | SGOT (AST) | 300.00 | ||
| LABORATORY OPD | LAB00022 | MAGNESIUM | 620.00 | ||
| LABORATORY OPD | LAB00028 | PHOSPHORUS | 620.00 | ||
| LABORATORY OPD | LAB00029 | POTASSIUM (K) | 450.00 | ||
| LABORATORY OPD | LAB00030 | SODIUM (NA) | 450.00 | ||
| LABORATORY OPD | LAB00037 | GRAM STAIN | 200.00 | ||
| LABORATORY OPD | LAB00041 | SMEAR WET | 130.00 | ||
| LABORATORY OPD | LAB00042 | FERRITIN | 950.00 | ||
| LABORATORY OPD | LAB00045 | CK (CREATININE KINASE) - MB | 1,100.00 | ||
| LABORATORY OPD | LAB00048 | CRP- HS | 950.00 | ||
| LABORATORY OPD | LAB00055 | HEMATOCRIT (HCT) | 150.00 | ||
| LABORATORY OPD | LAB00061 | CHLORIDE | 450.00 | ||
| LABORATORY OPD | LAB00065 | BLOOD EXTRACTION | 100.00 | ||
| LABORATORY OPD | LAB00254 | TROPONIN I | 1,628.00 | ||
| LABORATORY OPD | LAB00256 | TYPHOID - TUBEX | 800.00 | ||
| LABORATORY OPD | LAB00260 | BETA - HCG (3RD ADDT'L DILUTION) | 850.00 | ||
| LABORATORY OPD | LAB00261 | BETA - HCG (4TH ADDT'L DILUTION) | 850.00 | ||
| LABORATORY OPD | LAB00265 | BETA - HCG (5TH ADDT'L DILUTION) | 850.00 | ||
| LABORATORY OPD | LAB00266 | AFP (ALPHA FETO PROTEIN)- 1ST DILUTION | 650.00 | ||
| LABORATORY OPD | LAB00267 | AFP (ALPHA FETO PROTEIN)- 2ND DILUTION | 650.00 | ||
| LABORATORY OPD | LAB00268 | AFP (ALPHA FETO PROTEIN)- 3RD DILUTION | 650.00 | ||
| LABORATORY OPD | LAB00270 | K. EXPANDED NEWBORN SCREENING TEST(ENBS) | 1,800.00 | ||
| LABORATORY OPD | LAB00274 | WHOLE BLOOD PLUS STORAGE FEE | 2,000.00 | ||
| LABORATORY OPD | LAB00273 | PACKED RED BLOOD CELL PLUS STORAGE FEE | 1,700.00 | ||
| LABORATORY OPD | LAB00275 | PLATELET CONCENTRATE | 1,200.00 | ||
| LABORATORY OPD | LAB00276 | PSA - EIA ( SUCCEEDING DILUTION ) | 550.00 | ||
| LABORATORY OPD | LAB00278 | HIV SCREENING TEST | 700.00 | ||
| LABORATORY OPD | LAB00279 | DENGUE NS1 ANTIGEN ( COMBO ) | 1,365.00 | ||
| LABORATORY OPD | LAB00283 | PCT ( PROCALCITONIN ) | 1,995.00 | ||
| LABORATORY OPD | LAB00286<60 | RT - PCR TEST < | 5,000.00 | ||
| LABORATORY OPD | LAB00287 | RT - PCR TEST > | 5,000.00 | ||
| LABORATORY OPD | LAB00288 | RAPID ANTIGEN | 800.00 | ||
| LABORATORY OPD | LAB00289 | BIOPSY - FROM ENDOSCOPY | 2,300.00 | ||
| LABORATORY OPD | LAB00290 | HIV TEST | 700.00 | ||
| LABORATORY OPD | LAB00291 | BILIRUBIN TOTAL | 400.00 | ||
| LABORATORY OPD | LAB00292 | BILIRUBIN DIRECT | 300.00 | ||
| LABORATORY OPD | LAB00293 | PLEURAL FLUID HEMATOCRIT | 500.00 | ||
| LABORATORY OPD | LAB00294 | URINE RBC MORPHOLOGY | 300.00 | ||
| LABORATORY OPD | LAB00295 | PREGNANCY TEST SERUM | 270.00 | ||
| LABORATORY OPD | LAB00296 | GIEMSA STAINING - SMALL BIOPSY | 1,600.00 | ||
| LABORATORY OPD | LAB00300 | CT GUIDED BIOPSY | 3,150.00 | ||
| LABORATORY OPD | LAB00301 | ULTRASOUND GUIDED BIOPSY | 4,159.00 | ||
| LABORATORY OPD | LAB00302 | IMAGING BIOPSY | 3,000.00 | ||
| LABORATORY OPD | LAB00304 | STORAGE FEE | 200.00 | ||
| LABORATORY OPD | LAB00305 | PHLEBOTOMY | 500.00 | ||
| LABORATORY OPD | LAB00401 | FRESH FROZEN PLASMA W/ STORAGE FEE | 1,200.00 | ||
| LABORATORY OPD | LAB00402 | CRYOSTAT W/ STORAGE FEE | 1,200.00 | ||
| LABORATORY OPD | LAB00403 | CA 125 | 1,278.00 | ||
| LABORATORY OPD | LAB00404 | CA 19-9 | 1,139.00 | ||
| LABORATORY IPD | LAB00001 | 2 HR - PP / SUGAR | 450.00 | ||
| LABORATORY IPD | LAB00003 | APTT (ACTIVATED PLASMA THROMBOPLASTINE TIME) | 980.00 | ||
| LABORATORY IPD | LAB00004 | ABG/CBG (BLOOD GAS) | 1,575.00 | ||
| LABORATORY IPD | LAB00007 | ALBUMIN | 500.00 | ||
| LABORATORY IPD | LAB00008 | ALKALINE PHOSPHATASE | 500.00 | ||
| LABORATORY IPD | LAB00013 | ANTI - HAV (IGM) | 1,949.00 | ||
| LABORATORY IPD | LAB00018 | ANTI - HBS (LATEX) | 357.00 | ||
| LABORATORY IPD | LAB00021 | ANTI - HCV (HEPATITIS C-VIRUS) LATEX | 924.00 | ||
| LABORATORY IPD | LAB00023 | ASO ( QUANTITATIVE ) | 578.00 | ||
| LABORATORY IPD | LAB00024 | BETA - HCG (INITIAL) | 1,260.00 | ||
| LABORATORY IPD | LAB00025 | BETA - HCG (1ST ADDTL DILUTION) | 1,100.00 | ||
| LABORATORY IPD | LAB00026 | BETA - HCG (2ND ADDT'L DILUTION) | 1,100.00 | ||
| LABORATORY IPD | LAB00027 | BILIRUBIN TOTAL/ DIRECT (B1/B2) PACKAGE | 950.00 | ||
| LABORATORY IPD | LAB00031 | BIOPSY - FINE NEEDLE ASPIRATION | 3,000.00 | ||
| LABORATORY IPD | LAB00032 | BIOPSY - LARGE SPECIMEN | 3,800.00 | ||
| LABORATORY IPD | LAB00033 | BIOPSY - MEDIUM SPECIMEN | 2,300.00 | ||
| LABORATORY IPD | LAB00034 | BIOPSY - SMALL SPECIMEN | 1,600.00 | ||
| LABORATORY IPD | LAB00035 | BIOPSY - X-LARGE SPECIMEN | 5,600.00 | ||
| LABORATORY IPD | LAB00036 | BLEEDING TIME | 165.00 | ||
| LABORATORY IPD | LAB00038 | BLOOD GAS | 1,400.00 | ||
| LABORATORY IPD | LAB00039 | BLOOD SUGAR - HEMOGLUCO TEST (HGT) | 275.00 | ||
| LABORATORY IPD | LAB00040 | BLOOD TYPING / RH | 330.00 | ||
| LABORATORY IPD | LAB00047 | BODY FLUID ANALYSIS | 4,500.00 | ||
| LABORATORY IPD | LAB00052 | CALCIUM | 525.00 | ||
| LABORATORY IPD | LAB00056 | PRO BNP, CARDIAC | 1,890.00 | ||
| LABORATORY IPD | LAB00058 | CBC - COMPLETE BLOOD COUNT | 324.00 | ||
| LABORATORY IPD | LAB00060 | RBC- RED BLOOD CELL | 250.00 | ||
| LABORATORY IPD | LAB00062 | CBG (CAPILLARY BLOOD GAS) | 1,500.00 | ||
| LABORATORY IPD | LAB00063 | CEA (CARCINO EMBRYONIC ANTIGEN) | 1,760.00 | ||
| LABORATORY IPD | LAB00064 | CELL BLOCK | 1,600.00 | ||
| LABORATORY IPD | LAB00072 | CLOT RETRACTION TIME | 230.00 | ||
| LABORATORY IPD | LAB00073 | CLOTTING TIME | 165.00 | ||
| LABORATORY IPD | LAB00075 | COMBS TEST (DIRECT) | 630.00 | ||
| LABORATORY IPD | LAB00076 | COMBS TEST (INDIRECT) | 630.00 | ||
| LABORATORY IPD | LAB00089 | CROSS MATCHING | 1,100.00 | ||
| LABORATORY IPD | LAB00090 | CRP (C-REACTIVE PROTEIN)- PLAIN | 1,000.00 | ||
| LABORATORY IPD | LAB00091 | CSF (CEREBRO SPINAL FLUID) ANALYSIS | 4,500.00 | ||
| LABORATORY IPD | LAB00092 | CSF - PERICARDIAL FLUID ANALYSIS | 4,500.00 | ||
| LABORATORY IPD | LAB00094 | PLEURAL FLUID ANALYSIS | 4,500.00 | ||
| LABORATORY IPD | LAB00095 | CULTURE & SENSITIVITY TEST- SPUTUM | 3,300.00 | ||
| LABORATORY IPD | LAB00096 | CULTURE & SENSITIVITY TEST- STOOL | 3,300.00 | ||
| LABORATORY IPD | LAB00097 | CULTURE & SENSITIVITY - URINE | 3,300.00 | ||
| LABORATORY IPD | LAB00098 | CULTURE & SENSITIVITY TEST - BLOOD | 3,465.00 | ||
| LABORATORY IPD | LAB00099 | CULTURE & SENSITIVITY TEST - BODY FLUID | 3,465.00 | ||
| LABORATORY IPD | LAB00100 | CULTURE & SENSITIVITY TEST - THROAT CULTURE | 3,300.00 | ||
| LABORATORY IPD | LAB00101 | CULTURE & SENSITIVITY TEST - VAGINAL DISCHARGE | 3,300.00 | ||
| LABORATORY IPD | LAB00102 | CULTURE & SENSITIVITY TEST - WOUND DISCHARGE | 3,300.00 | ||
| LABORATORY IPD | LAB00103 | CYTOLOGY | 950.00 | ||
| LABORATORY IPD | LAB00106 | D-DIMER | 2,000.00 | ||
| LABORATORY IPD | LAB00107 | DENGUE NS1 ANTIGEN | 1,386.00 | ||
| LABORATORY IPD | LAB00110 | ESR (ERYTHROCYTE SEDIMENTATION RATE) | 308.00 | ||
| LABORATORY IPD | LAB00111 | FASTING BLOOD SUGAR (FBS) | 450.00 | ||
| LABORATORY IPD | LAB00116 | FT3 | 1,470.00 | ||
| LABORATORY IPD | LAB00117 | FT4 | 1,470.00 | ||
| LABORATORY IPD | LAB00124 | HBAIC (GLYCOSYLATED HEMOGLOBIN) | 1,320.00 | ||
| LABORATORY IPD | LAB00132 | HBS AG (LATEX) | 289.00 | ||
| LABORATORY IPD | LAB00140 | HGT/CBG (CAPILLARY BLOOD GLUCOSE) | 289.00 | ||
| LABORATORY IPD | LAB00146 | IONIZED CALCIUM | 750.00 | ||
| LABORATORY IPD | LAB00148 | LDH | 1,200.00 | ||
| LABORATORY IPD | LAB00152 | LIPID PROFILE | 1,430.00 | ||
| LABORATORY IPD | LAB00158 | LIVER PROFILE | 1,650.00 | ||
| LABORATORY IPD | LAB00162 | MALARIAL SMEAR | 350.00 | ||
| LABORATORY IPD | LAB00163 | MICRAL TEST (micro, aib) | 255.00 | ||
| LABORATORY IPD | LAB00164 | NEWBORN G6PD CONFIRMATORY | 660.00 | ||
| LABORATORY IPD | LAB00166 | OCCULT BLOOD SMEAR - STOOL | 950.00 | ||
| LABORATORY IPD | LAB00167 | OGTT - 100 GRAMS (ORAL GLUCOSE TOLERANCE) | 1,553.00 | ||
| LABORATORY IPD | LAB00168 | OGTT - 50 GRAMS (ORAL GLUCOSE TOLERANCE) | 1,113.00 | ||
| LABORATORY IPD | LAB00169 | OGTT - 75 GRAMS (ORAL GLUCOSE TOLERANCE) | 1,333.00 | ||
| LABORATORY IPD | LAB00170 | PAP SMEAR | 400.00 | ||
| LABORATORY IPD | LAB00171 | PERIPHERAL SMEAR | 774.00 | ||
| LABORATORY IPD | LAB00176 | PLATELET COUNT | 308.00 | ||
| LABORATORY IPD | LAB00181 | PREGNANCY TEST URINE | 244.00 | ||
| LABORATORY IPD | LAB00183 | PSA (PROSTATE SPECIFIC ANTIGEN) - EIA | 1,575.00 | ||
| LABORATORY IPD | LAB00185 | PTPA - PROTHROMBIN TIME | 980.00 | ||
| LABORATORY IPD | LAB00187 | RANDOM BLOOD SUGAR (RBS) | 450.00 | ||
| LABORATORY IPD | LAB00188 | RETICULOCYTE COUNT | 308.00 | ||
| LABORATORY IPD | LAB00190 | RF (RHEUMATOID FACTOR) | 525.00 | ||
| LABORATORY IPD | LAB00202 | SMEAR - AFB (ACID FAST BACILLI) | 998.00 | ||
| LABORATORY IPD | LAB00203 | SMEAR - KOH | 998.00 | ||
| LABORATORY IPD | LAB00204 | SMEAR - PROSTATIC | 950.00 | ||
| LABORATORY IPD | LAB00207 | SMEAR- URETHRAL SMEAR | 950.00 | ||
| LABORATORY IPD | LAB00212 | SODIUM POTASSIUM CHLORIDE PACKAGE | 1,350.00 | ||
| LABORATORY IPD | LAB00213 | SPERM COUNT | 355.00 | ||
| LABORATORY IPD | LAB00215 | STOOL EXAM | 187.00 | ||
| LABORATORY IPD | LAB00217 | T3 | 1,300.00 | ||
| LABORATORY IPD | LAB00218 | T4 | 1,300.00 | ||
| LABORATORY IPD | LAB00220 | TOTAL CELL COUNT & DIFF. COUNT | 250.00 | ||
| LABORATORY IPD | LAB00221 | TOTAL PROTEIN | 450.00 | ||
| LABORATORY IPD | LAB00222 | TOTAL PROTEIN / ALBUMIN | 780.00 | ||
| LABORATORY IPD | LAB00228 | TRIGLYCERIDES | 750.00 | ||
| LABORATORY IPD | LAB00231 | TROPONIN T (QUANTITATIVE) WITH TITER | 2,000.00 | ||
| LABORATORY IPD | LAB00232 | TROPONIN QUALITATIVE | 1,300.00 | ||
| LABORATORY IPD | LAB00233 | TSH | 1,400.00 | ||
| LABORATORY IPD | LAB00235 | TYPHOID RAPID IGM - TYPHIDOT | 1,575.00 | ||
| LABORATORY IPD | LAB00236 | TYPHOID - WIDAL | 550.00 | ||
| LABORATORY IPD | LAB00239 | URINALYSIS | 181.00 | ||
| LABORATORY IPD | LAB00243 | URINE - KETONES | 158.00 | ||
| LABORATORY IPD | LAB00248 | VDRL ( SYPHILIS ) | 289.00 | ||
| LABORATORY IPD | LAB00006 | AFP (ALPHA FETO PROTEIN) -initial | 1,100.00 | ||
| LABORATORY IPD | LAB00249 | BLOOD URIC ACID | 500.00 | ||
| LABORATORY IPD | LAB00250 | SGPT | 450.00 | ||
| LABORATORY IPD | LAB00002 | SMEAR- BONE MARROW | 2,500.00 | ||
| LABORATORY IPD | LAB00251 | AMYLASE | 1,000.00 | ||
| LABORATORY IPD | LAB00009 | BLOOD UREA NITROGEN (BUN) | 450.00 | ||
| LABORATORY IPD | LAB00010 | CHOLESTEROL TOTAL | 550.00 | ||
| LABORATORY IPD | LAB00011 | CREATININE | 450.00 | ||
| LABORATORY IPD | LAB00015 | LOW DENSITY LIPOPROTEIN (LDL) | 550.00 | ||
| LABORATORY IPD | LAB00019 | HIGH DENSITY LIPOPROTEIN (HDL) | 578.00 | ||
| LABORATORY IPD | LAB00020 | SGOT (AST) | 450.00 | ||
| LABORATORY IPD | LAB00022 | MAGNESIUM | 750.00 | ||
| LABORATORY IPD | LAB00028 | PHOSPHORUS | 750.00 | ||
| LABORATORY IPD | LAB00029 | POTASSIUM (K) | 850.00 | ||
| LABORATORY IPD | LAB00030 | SODIUM (NA) | 850.00 | ||
| LABORATORY IPD | LAB00037 | GRAM STAIN | 250.00 | ||
| LABORATORY IPD | LAB00041 | SMEAR WET | 165.00 | ||
| LABORATORY IPD | LAB00042 | FERRITIN | 1,550.00 | ||
| LABORATORY IPD | LAB00045 | CK (CREATININE KINASE) - MB | 1,300.00 | ||
| LABORATORY IPD | LAB00048 | CRP- HS | 1,200.00 | ||
| LABORATORY IPD | LAB00055 | HEMATOCRIT (HCT) | 380.00 | ||
| LABORATORY IPD | LAB00061 | CHLORIDE | 850.00 | ||
| LABORATORY IPD | LAB00065 | BLOOD EXTRACTION | 0.00 | ||
| LABORATORY IPD | LAB00254 | TROPONIN I | 2,100.00 | ||
| LABORATORY IPD | LAB00256 | TYPHOID - TUBEX | 1,200.00 | ||
| LABORATORY IPD | LAB00260 | BETA - HCG (3RD ADDT'L DILUTION) | 1,100.00 | ||
| LABORATORY IPD | LAB00261 | BETA - HCG (4TH ADDT'L DILUTION) | 1,100.00 | ||
| LABORATORY IPD | LAB00265 | BETA - HCG (5TH ADDT'L DILUTION) | 1,100.00 | ||
| LABORATORY IPD | LAB00266 | AFP (ALPHA FETO PROTEIN)- 1ST DILUTION | 900.00 | ||
| LABORATORY IPD | LAB00267 | AFP (ALPHA FETO PROTEIN)- 2ND DILUTION | 900.00 | ||
| LABORATORY IPD | LAB00268 | AFP (ALPHA FETO PROTEIN)- 3RD DILUTION | 900.00 | ||
| LABORATORY IPD | LAB00270 | K. EXPANDED NEWBORN SCREENING TEST(ENBS) | 1,800.00 | ||
| LABORATORY IPD | LAB00274 | WHOLE BLOOD PLUS STORAGE FEE | 2,000.00 | ||
| LABORATORY IPD | LAB00273 | PACKED RED BLOOD CELL PLUS STORAGE FEE | 1,700.00 | ||
| LABORATORY IPD | LAB00275 | PLATELET CONCENTRATE | 1,200.00 | ||
| LABORATORY IPD | LAB00276 | PSA - EIA ( SUCCEEDING DILUTION ) | 650.00 | ||
| LABORATORY IPD | LAB00278 | HIV SCREENING TEST | 840.00 | ||
| LABORATORY IPD | LAB00279 | DENGUE NS1 ANTIGEN ( COMBO ) | 1,575.00 | ||
| LABORATORY IPD | LAB00283 | PCT ( PROCALCITONIN ) | 2,394.00 | ||
| LABORATORY IPD | LAB00286<60 | RT - PCR TEST < | 5,000.00 | ||
| LABORATORY IPD | LAB00287 | RT - PCR TEST > | 5,000.00 | ||
| LABORATORY IPD | LAB00288 | RAPID ANTIGEN | 800.00 | ||
| LABORATORY IPD | LAB00289 | BIOPSY - FROM ENDOSCOPY | 2,300.00 | ||
| LABORATORY IPD | LAB00290 | HIV TEST | 700.00 | ||
| LABORATORY IPD | LAB00291 | BILIRUBIN TOTAL | 520.00 | ||
| LABORATORY IPD | LAB00292 | BILIRUBIN DIRECT | 450.00 | ||
| LABORATORY IPD | LAB00293 | PLEURAL FLUID HEMATOCRIT | 650.00 | ||
| LABORATORY IPD | LAB00294 | URINE RBC MORPHOLOGY | 390.00 | ||
| LABORATORY IPD | LAB00295 | PREGNANCY TEST SERUM | 300.00 | ||
| LABORATORY IPD | LAB00296 | GIEMSA STAINING - SMALL BIOPSY | 1,600.00 | ||
| LABORATORY IPD | LAB00300 | CT GUIDED BIOPSY | 3,150.00 | ||
| LABORATORY IPD | LAB00301 | ULTRASOUND GUIDED BIOPSY | 5,800.00 | ||
| LABORATORY IPD | LAB00302 | IMAGING BIOPSY | 3,000.00 | ||
| LABORATORY IPD | LAB00304 | STORAGE FEE | 200.00 | ||
| LABORATORY IPD | LAB00305 | PHLEBOTOMY | 500.00 | ||
| LABORATORY IPD | LAB00401 | FRESH FROZEN PLASMA W/ STORAGE FEE | 1,200.00 | ||
| LABORATORY IPD | LAB00402 | CRYOSTAT W/ STORAGE FEE | 1,200.00 | ||
| LABORATORY IPD | LAB00403 | CA 125 | 1,364.00 | ||
| LABORATORY IPD | LAB00404 | CA 19-9 | 1,214.00 | ||
| XRAY OPD | LUMBAR AP AND LATERAL | 1,066.56 | 549.44 | 1,616.00 | |
| XRAY OPD | THORACIC, AP & LATERAL ( SPINE ) | 1,066.56 | 549.44 | 1,616.00 | |
| XRAY OPD | RAD00118 | ADDITIONAL VIEW PER FILM | 208.56 | 107.44 | 316.00 |
| XRAY OPD | RAD00119 | CHEST APICOLORDOTIC VIEW (ADDTL VIEW) | 211.20 | 108.80 | 320.00 |
| XRAY OPD | RAD00120 | CHEST PA (ADULT) (NF) | 318.12 | 163.88 | 482.00 |
| XRAY OPD | RAD00122 | CHEST PA ( PEDIA ) | 430.98 | 222.02 | 653.00 |
| XRAY OPD | RAD00123 | SKULL AP AND LATERAL | 551.10 | 283.90 | 835.00 |
| XRAY OPD | RAD00124 | PARANASAL SINUSES (WATER'S VIEW) | 426.36 | 219.64 | 646.00 |
| XRAY OPD | RAD00125 | CHEST PA/LAT - PEDIA (NF) | 353.10 | 181.90 | 535.00 |
| XRAY OPD | RAD00126 | ABDOMEN AP | 551.10 | 283.90 | 835.00 |
| XRAY OPD | RAD00127 | CHEST PA ( ADULT) | 487.08 | 250.92 | 738.00 |
| XRAY OPD | RAD00128 | CHEST PA/LAT- PEDIA | 487.08 | 250.92 | 738.00 |
| XRAY OPD | RAD00129 | KUB PLAIN AP | 539.88 | 278.12 | 818.00 |
| XRAY OPD | RAD00130 | NASAL BONE PA & LATERAL | 551.10 | 283.90 | 835.00 |
| XRAY OPD | RAD00131 | FACIAL BONES LATERAL & WATER'S VIEW | 551.10 | 283.90 | 835.00 |
| XRAY OPD | RAD00132 | MANDIBLE P & OBLIQUE (JAW) | 426.36 | 219.64 | 646.00 |
| XRAY OPD | RAD00133 | MASTOID (LAWS,STENVER'S & TOWNE'S) | 551.10 | 283.90 | 835.00 |
| XRAY OPD | RAD00134 | PARANASAL SINUSES (CALDWELL /WATER'S/ LATERAL) | 551.10 | 283.90 | 835.00 |
| XRAY OPD | RAD00135 | CLAVICLE - LEFT | 551.10 | 283.90 | 835.00 |
| XRAY OPD | RAD00136 | CLAVICLE - RIGHT | 551.10 | 283.90 | 835.00 |
| XRAY OPD | RAD00137 | PELVIS AP, XRAY | 653.40 | 336.60 | 990.00 |
| XRAY OPD | RAD00138 | SHOULDER LEFT AP | 581.46 | 299.54 | 881.00 |
| XRAY OPD | RAD00139 | SHOULDER RIGHT AP | 581.46 | 299.54 | 881.00 |
| XRAY OPD | RAD00140 | WRIST JOINT, AP, LATERAL & OBLIQUE | 653.40 | 336.60 | 990.00 |
| XRAY OPD | RAD00141 | ELBOW LEFT AP & LATERAL | 581.46 | 299.54 | 881.00 |
| XRAY OPD | RAD00142 | ELBOW RIGHT AP & LATERAL | 581.46 | 299.54 | 881.00 |
| XRAY OPD | RAD00143 | FOREARM LEFT - AP & LATERAL | 581.46 | 299.54 | 881.00 |
| XRAY OPD | RAD00144 | FOREARM RIGHT - AP & LATERAL | 581.46 | 299.54 | 881.00 |
| XRAY OPD | RAD00145 | HAND LEFT- PA/ OBLIQUE | 581.46 | 299.54 | 881.00 |
| XRAY OPD | RAD00146 | HAND RIGHT-PA/ OBLIQUE | 653.40 | 336.60 | 990.00 |
| XRAY OPD | RAD00147 | HIP JOINTS, AP, & FROG LEG PFOJECTION - PEDIA | 581.46 | 299.54 | 881.00 |
| XRAY OPD | RAD00148 | HUMERUS LEFT AP & LATERAL | 581.46 | 299.54 | 881.00 |
| XRAY OPD | RAD00149 | HUMERUS RIGHT AP & LATERAL | 581.46 | 299.54 | 881.00 |
| XRAY OPD | RAD00150 | ANKLE LEFT AP & LATERAL | 581.46 | 299.54 | 881.00 |
| XRAY OPD | RAD00151 | ANKLE RIGHT AP & LATERAL | 581.46 | 299.54 | 881.00 |
| XRAY OPD | RAD00152 | FOOT LEFT AP/ LAT / OBLIQUE | 581.46 | 299.54 | 881.00 |
| XRAY OPD | RAD00153 | FOOT RIGHT AP/ LAT / OBLIQUE | 581.46 | 299.54 | 881.00 |
| XRAY OPD | RAD00154 | FEMUR - AP & LATERAL | 581.46 | 299.54 | 881.00 |
| XRAY OPD | RAD00155 | KNEE JOINT, AP & LATERAL | 581.46 | 299.54 | 881.00 |
| XRAY OPD | RAD00156 | LEG, AP & LATERAL | 581.46 | 299.54 | 881.00 |
| XRAY OPD | RAD00157 | HAND LEFT- PA/OBLIQUE (NF) | 376.20 | 193.80 | 570.00 |
| XRAY OPD | RAD00158 | T-TUBE | 1,328.58 | 684.42 | 2,013.00 |
| XRAY OPD | RAD00159 | CHEST BUCKY AP & OBLIQUE (RIBS) | 615.12 | 316.88 | 932.00 |
| XRAY OPD | RAD00160 | CHEST PA / LATERAL (ADULT) | 615.12 | 316.88 | 932.00 |
| XRAY OPD | RAD00161 | SKULL SERIES (AP / TOWNE'S / LATERAL) | 700.92 | 361.08 | 1,062.00 |
| XRAY OPD | RAD00162 | HIP JOINTS, AP, & FROG LEG PFOJECTION -ADULT | 839.52 | 432.48 | 1,272.00 |
| XRAY OPD | RAD00163 | PELVIMETRY AP / LATERAL (XRAY) | 1,067.22 | 549.78 | 1,617.00 |
| XRAY OPD | RAD00164 | SACRO - ILIAC AP | 1,067.22 | 549.78 | 1,617.00 |
| XRAY OPD | RAD00165 | ABDOMEN AP & UPRIGHT | 714.12 | 367.88 | 1,082.00 |
| XRAY OPD | RAD00166 | COCYX, AP & LATERAL | 1,067.22 | 549.78 | 1,617.00 |
| XRAY OPD | RAD00167 | SPINE- CERVICAL AP & LATERAL (2 VIEWS) | 770.22 | 396.78 | 1,167.00 |
| XRAY OPD | RAD00171 | SCOLIOTIC SERIES | 2,031.48 | 1,046.52 | 3,078.00 |
| XRAY OPD | RAD00172 | HYSTEROSALPHINGOGRAPHY | 1,736.46 | 894.54 | 2,631.00 |
| XRAY OPD | RAD00174 | ESOPHAGRAM WITH BARIUM | 2,042.04 | 1,051.96 | 3,094.00 |
| XRAY OPD | RAD00175 | CYSTOGRAM | 2,042.04 | 1,051.96 | 3,094.00 |
| XRAY OPD | RAD00178 | DACRYCYSTOGRAM | 831.60 | 428.40 | 1,260.00 |
| XRAY OPD | RAD00179 | UPPER GI SERIES WITH BARIUM | 2,069.10 | 1,065.90 | 3,135.00 |
| XRAY OPD | RAD00180 | SMALL INTESTINAL SERIES | 1,695.54 | 873.46 | 2,569.00 |
| XRAY OPD | RAD00181 | BARIUM ENEMA W/ BARIUM | 2,297.46 | 1,183.54 | 3,481.00 |
| XRAY OPD | RAD00182 | IVP EXCL. MEDICINE | 3,670.92 | 1,891.08 | 5,562.00 |
| XRAY OPD | RAD00183 | CERVICAL AP & LATERAL (2 VIEWS) -NF | 460.02 | 236.98 | 697.00 |
| XRAY OPD | RAD00184 | CHEST PA / LAT (ADULT) NF | 454.08 | 233.92 | 688.00 |
| XRAY OPD | RAD00185 | CERVICAL AP & LAT (2 VIEWS) | 770.22 | 396.78 | 1,167.00 |
| XRAY OPD | RAD00186 | CHEST PA ( PEDIA ) NF | 304.26 | 156.74 | 461.00 |
| XRAY OPD | RAD00198 | XRAY READING | 83.16 | 42.84 | 126.00 |
| XRAY OPD | RAD00214 | C-ARM FIRST 2 HOURS | 6,800.00 | 1,200.00 | 8,000.00 |
| XRAY IPD | LUMBAR AP AND LATERAL | 1,932.48 | 995.52 | 2,928.00 | |
| XRAY IPD | THORACIC, AP & LATERAL ( SPINE ) | 1,933.80 | 996.20 | 2,930.00 | |
| XRAY IPD | RAD00118 | ADDITIONAL VIEW PER FILM | 268.62 | 138.38 | 407.00 |
| XRAY IPD | RAD00119 | CHEST APICOLORDOTIC VIEW (ADDTL VIEW) | 207.90 | 107.10 | 315.00 |
| XRAY IPD | RAD00122 | CHEST PA ( PEDIA ) | 823.68 | 424.32 | 1,248.00 |
| XRAY IPD | RAD00123 | SKULL AP AND LATERAL | 953.04 | 490.96 | 1,444.00 |
| XRAY IPD | RAD00124 | PARANASAL SINUSES (WATER'S VIEW) | 748.44 | 385.56 | 1,134.00 |
| XRAY IPD | RAD00126 | ABDOMEN AP | 1,011.78 | 521.22 | 1,533.00 |
| XRAY IPD | RAD00127 | CHEST PA ( ADULT) | 894.96 | 461.04 | 1,356.00 |
| XRAY IPD | RAD00128 | CHEST PA/LAT- PEDIA | 894.96 | 461.04 | 1,356.00 |
| XRAY IPD | RAD00129 | KUB PLAIN AP | 1,011.78 | 521.22 | 1,533.00 |
| XRAY IPD | RAD00130 | NASAL BONE PA & LATERAL | 1,011.78 | 521.22 | 1,533.00 |
| XRAY IPD | RAD00131 | FACIAL BONES LATERAL & WATER'S VIEW | 1,011.78 | 521.22 | 1,533.00 |
| XRAY IPD | RAD00132 | MANDIBLE P & OBLIQUE (JAW) | 759.00 | 391.00 | 1,150.00 |
| XRAY IPD | RAD00133 | MASTOID (LAWS,STENVER'S & TOWNE'S) | 1,026.30 | 528.70 | 1,555.00 |
| XRAY IPD | RAD00134 | PARANASAL SINUSES (CALDWELL /WATER'S/ LATERAL) | 1,011.78 | 521.22 | 1,533.00 |
| XRAY IPD | RAD00135 | CLAVICLE - LEFT | 1,092.96 | 563.04 | 1,656.00 |
| XRAY IPD | RAD00136 | CLAVICLE - RIGHT | 1,026.30 | 528.70 | 1,555.00 |
| XRAY IPD | RAD00137 | PELVIS AP, XRAY | 1,035.54 | 533.46 | 1,569.00 |
| XRAY IPD | RAD00138 | SHOULDER LEFT AP | 963.60 | 496.40 | 1,460.00 |
| XRAY IPD | RAD00139 | SHOULDER RIGHT AP | 963.60 | 496.40 | 1,460.00 |
| XRAY IPD | RAD00140 | WRIST JOINT, AP, LATERAL & OBLIQUE | 1,035.54 | 533.46 | 1,569.00 |
| XRAY IPD | RAD00141 | ELBOW LEFT AP & LATERAL | 963.60 | 496.40 | 1,460.00 |
| XRAY IPD | RAD00142 | ELBOW RIGHT AP & LATERAL | 963.60 | 496.40 | 1,460.00 |
| XRAY IPD | RAD00143 | FOREARM LEFT - AP & LATERAL | 963.60 | 496.40 | 1,460.00 |
| XRAY IPD | RAD00144 | FOREARM RIGHT - AP & LATERAL | 963.60 | 496.40 | 1,460.00 |
| XRAY IPD | RAD00145 | HAND LEFT- PA/ OBLIQUE | 963.60 | 496.40 | 1,460.00 |
| XRAY IPD | RAD00146 | HAND RIGHT-PA/ OBLIQUE | 1,035.54 | 533.46 | 1,569.00 |
| XRAY IPD | RAD00147 | HIP JOINTS, AP, & FROG LEG PFOJECTION - PEDIA | 963.60 | 496.40 | 1,460.00 |
| XRAY IPD | RAD00148 | HUMERUS LEFT AP & LATERAL | 963.60 | 496.40 | 1,460.00 |
| XRAY IPD | RAD00149 | HUMERUS RIGHT AP & LATERAL | 963.60 | 496.40 | 1,460.00 |
| XRAY IPD | RAD00150 | ANKLE LEFT AP & LATERAL | 1,036.86 | 534.14 | 1,571.00 |
| XRAY IPD | RAD00151 | ANKLE RIGHT AP & LATERAL | 1,036.86 | 534.14 | 1,571.00 |
| XRAY IPD | RAD00152 | FOOT LEFT AP/ LAT / OBLIQUE | 1,036.86 | 534.14 | 1,571.00 |
| XRAY IPD | RAD00153 | FOOT RIGHT AP/ LAT / OBLIQUE | 1,036.86 | 534.14 | 1,571.00 |
| XRAY IPD | RAD00154 | FEMUR - AP & LATERAL | 1,036.86 | 534.14 | 1,571.00 |
| XRAY IPD | RAD00155 | KNEE JOINT, AP & LATERAL | 1,036.86 | 534.14 | 1,571.00 |
| XRAY IPD | RAD00156 | LEG, AP & LATERAL | 1,036.86 | 534.14 | 1,571.00 |
| XRAY IPD | RAD00158 | T-TUBE | 2,368.08 | 1219.92 | 3,588.00 |
| XRAY IPD | RAD00159 | CHEST BUCKY AP & OBLIQUE (RIBS) | 1,182.72 | 609.28 | 1,792.00 |
| XRAY IPD | RAD00160 | CHEST PA / LATERAL (ADULT) | 1,182.72 | 609.28 | 1,792.00 |
| XRAY IPD | RAD00161 | SKULL SERIES (AP / TOWNE'S / LATERAL) | 1,358.94 | 700.06 | 2,059.00 |
| XRAY IPD | RAD00162 | HIP JOINTS, AP, & FROG LEG PFOJECTION -ADULT | 1,364.22 | 702.78 | 2,067.00 |
| XRAY IPD | RAD00163 | PELVIMETRY AP / LATERAL (XRAY) | 1,933.80 | 996.20 | 2,930.00 |
| XRAY IPD | RAD00164 | SACRO - ILIAC AP | 1,933.80 | 996.20 | 2,930.00 |
| XRAY IPD | RAD00165 | ABDOMEN AP & UPRIGHT | 1,364.22 | 702.78 | 2,067.00 |
| XRAY IPD | RAD00166 | COCYX, AP & LATERAL | 1,933.80 | 996.20 | 2,930.00 |
| XRAY IPD | RAD00167 | SPINE- CERVICAL AP & LATERAL (2 VIEWS) | 1,761.54 | 907.46 | 2,669.00 |
| XRAY IPD | RAD00168 | LUMBOSACRAL AP & LATERAL | 834.90 | 430.10 | 1,265.00 |
| XRAY IPD | RAD00171 | SCOLIOTIC SERIES | 3,039.30 | 1,565.70 | 4,605.00 |
| XRAY IPD | RAD00172 | HYSTEROSALPHINGOGRAPHY | 3,036.00 | 1,564.00 | 4,600.00 |
| XRAY IPD | RAD00174 | ESOPHAGRAM WITH BARIUM | 3,430.68 | 1,767.32 | 5,198.00 |
| XRAY IPD | RAD00175 | CYSTOGRAM | 3,628.68 | 1,869.32 | 5,498.00 |
| XRAY IPD | RAD00178 | DACRYCYSTOGRAM | 1,247.40 | 642.60 | 1,890.00 |
| XRAY IPD | RAD00179 | UPPER GI SERIES WITH BARIUM | 3,639.24 | 1,874.76 | 5,514.00 |
| XRAY IPD | RAD00180 | SMALL INTESTINAL SERIES | 1,908.72 | 983.28 | 2,892.00 |
| XRAY IPD | RAD00181 | BARIUM ENEMA W/ BARIUM | 4,082.76 | 2,103.24 | 6,186.00 |
| XRAY IPD | RAD00182 | IVP EXCL. MEDICINE | 6,530.04 | 3,363.96 | 9,894.00 |
| XRAY IPD | RAD00185 | CERVICAL AP & LAT (2 VIEWS) | 1,761.54 | 907.46 | 2,669.00 |
| XRAY IPD | RAD00198 | XRAY READING | 104.28 | 53.72 | 158.00 |
| XRAY IPD | RAD00214 | C-ARM FIRST 2 HOURS | 6,800.00 | 1,200.00 | 8,000.00 |
| ULTRASOUND OPD | RAD00004 | FOLLICULAR MONITORING - SUCCEEDING EXAM | 441.54 | 227.46 | 669.00 |
| ULTRASOUND OPD | RAD00006 | PELVIS ULTRASOUND | 617.10 | 317.90 | 935.00 |
| ULTRASOUND OPD | RAD00007 | GALLBLADDER ULTRASOUND | 766.26 | 394.74 | 1,161.00 |
| ULTRASOUND OPD | RAD00008 | KIDNEY | 766.26 | 394.74 | 1,161.00 |
| ULTRASOUND OPD | RAD00009 | LIVER ULTRASOUND | 766.26 | 394.74 | 1,161.00 |
| ULTRASOUND OPD | RAD00010 | TRANSCRANIAL ULTRASOUND | 838.20 | 431.80 | 1,270.00 |
| ULTRASOUND OPD | RAD00011 | SUPERFICIAL MASS ULTRASOUND | 871.86 | 449.14 | 1,321.00 |
| ULTRASOUND OPD | RAD00012 | INGUINAL AREA ULTRASOUND | 871.86 | 449.14 | 1,321.00 |
| ULTRASOUND OPD | RAD00013 | LUNGS ULTRASOUND | 871.86 | 449.14 | 1,321.00 |
| ULTRASOUND OPD | RAD00014 | THYROID ULTRASOUND | 871.86 | 449.14 | 1,321.00 |
| ULTRASOUND OPD | RAD00015 | FOLLICULAR MONITORING - INITIAL | 747.78 | 385.22 | 1,133.00 |
| ULTRASOUND OPD | RAD00016 | ENDOVAGINAL OB ULTRASOUND | 871.86 | 449.14 | 1,321.00 |
| ULTRASOUND OPD | RAD00017 | ENDOVAGINAL GYNE ULTRASOUND | 815.76 | 420.24 | 1,236.00 |
| ULTRASOUND OPD | RAD00021 | KIDNEYS / URINARY BLADDER ULTRASOUND | 959.64 | 494.36 | 1,454.00 |
| ULTRASOUND OPD | RAD00022 | HEPATOBILIARY ULTRASOUND | 961.62 | 495.38 | 1,457.00 |
| ULTRASOUND OPD | RAD00023 | ENDORECTAL (PROSTATE) ULTRASOUND | 961.62 | 495.38 | 1,457.00 |
| ULTRASOUND OPD | RAD00024 | BREAST ULTRASOUND | 995.28 | 512.72 | 1,508.00 |
| ULTRASOUND OPD | RAD00026 | URINARY BLADDER ULTRASOUND | 766.26 | 394.74 | 1,161.00 |
| ULTRASOUND OPD | RAD00027 | TESTES ULTRASOUND | 1,033.56 | 532.44 | 1,566.00 |
| ULTRASOUND OPD | RAD00029 | PANCREAS ULTRASOUND | 766.26 | 394.74 | 1,161.00 |
| ULTRASOUND OPD | RAD00031 | ULTRASOUND GUIDED BIOPSY OR ASPIRATION | 1,017.06 | 523.94 | 1,541.00 |
| ULTRASOUND OPD | RAD00032 | LOWER ABDOMEN ULTRASOUND | 1,193.94 | 615.06 | 1,809.00 |
| ULTRASOUND OPD | RAD00034 | PROSTATE ULTRASOUND | 961.62 | 495.38 | 1,457.00 |
| ULTRASOUND OPD | RAD00037 | UPPER ABDOMEN ULTRASOUND | 1,349.70 | 695.30 | 2,045.00 |
| ULTRASOUND OPD | RAD00039 | CAROTIDS | 4,913.04 | 2,530.96 | 7,444.00 |
| ULTRASOUND OPD | RAD00040 | FETAL CONGENITAL ANOMALY SCAN | 3,570.60 | 1,839.40 | 5,410.00 |
| ULTRASOUND OPD | RAD00043 | OBSTETRIC ULTRASOUND W/ 3 - 4D | 3,614.16 | 1,861.84 | 5,476.00 |
| ULTRASOUND OPD | RAD00044 | VENOUS VASCULAR ULTRASOUND PER EXTREMITY | 3,894.00 | 2,006.00 | 5,900.00 |
| ULTRASOUND OPD | RAD00050 | LOWER QUADRANT OF ABDOMEN ULTRASOUND | 766.26 | 394.74 | 1,161.00 |
| ULTRASOUND OPD | RAD00052 | JOINT ULTRASOUND (ANY) | 897.60 | 462.40 | 1,360.00 |
| ULTRASOUND OPD | RAD00055 | ENDORECTAL - GYNECOLOGIC ULTRASOUND | 961.62 | 495.38 | 1,457.00 |
| ULTRASOUND OPD | RAD00058 | UMBILICUS ULTRASOUND | 766.26 | 394.74 | 1,161.00 |
| ULTRASOUND OPD | RAD00060 | BIOPHYSICAL PROFILE | 1,310.76 | 675.24 | 1,986.00 |
| ULTRASOUND OPD | RAD00062 | WHOLE ABDOMEN ULTRASOUND | 1,569.48 | 808.52 | 2,378.00 |
| ULTRASOUND OPD | RAD00067 | FETAL ECHO CARDIOGRAPHY | 3,072.00 | 2,304.00 | 5,376.00 |
| ULTRASOUND OPD | RAD00102 | VENOUS VASCULAR - ALL EXTREMITIES (4) | 18,546.00 | 9,554.00 | 28,100.00 |
| ULTRASOUND OPD | RAD00121 | ADDITIONAL VIEW PER FILM (UTZ) | 246.18 | 126.82 | 373.00 |
| ULTRASOUND OPD | RAD00187 | SONOHYSTEROGRAM | 4,273.50 | 2,201.50 | 6,475.00 |
| ULTRASOUND OPD | RAD00190 | SONO-HYSTEROSALPINGOGRAM | 2,882.88 | 1,485.12 | 4,368.00 |
| ULTRASOUND OPD | RAD00194 | CAROTIDS ( NP ) | 4,913.04 | 2,530.96 | 7,444.00 |
| ULTRASOUND OPD | RAD00197 | ANY SINGLE ORGAN | 766.26 | 394.74 | 1,161.00 |
| ULTRASOUND OPD | RAD00201 | LIVER ELASTOGRAPHY (FIBRO SCAN) | 3,036.66 | 1,564.34 | 4,601.00 |
| ULTRASOUND OPD | RAD00061 | MAMMOGRAM | 2,706.66 | 1,394.34 | 4,101.00 |
| ULTRASOUND IPD | RAD00004 | FOLLICULAR MONITORING - SUCCEEDING EXAM | 657.36 | 338.64 | 996.00 |
| ULTRASOUND IPD | RAD00006 | PELVIS ULTRASOUND | 1,089.00 | 561.00 | 1,650.00 |
| ULTRASOUND IPD | RAD00007 | GALLBLADDER ULTRASOUND | 1,362.24 | 701.76 | 2,064.00 |
| ULTRASOUND IPD | RAD00008 | KIDNEY | 1,362.24 | 701.76 | 2,064.00 |
| ULTRASOUND IPD | RAD00009 | LIVER ULTRASOUND | 1,362.24 | 701.76 | 2,064.00 |
| ULTRASOUND IPD | RAD00010 | TRANSCRANIAL ULTRASOUND | 1,382.04 | 711.96 | 2,094.00 |
| ULTRASOUND IPD | RAD00011 | SUPERFICIAL MASS ULTRASOUND | 1,391.28 | 716.72 | 2,108.00 |
| ULTRASOUND IPD | RAD00012 | INGUINAL AREA ULTRASOUND | 1,391.28 | 716.72 | 2,108.00 |
| ULTRASOUND IPD | RAD00013 | LUNGS ULTRASOUND | 1,391.28 | 716.72 | 2,108.00 |
| ULTRASOUND IPD | RAD00014 | THYROID ULTRASOUND | 1,391.28 | 716.72 | 2,108.00 |
| ULTRASOUND IPD | RAD00015 | FOLLICULAR MONITORING - INITIAL | 1,528.56 | 787.44 | 2,316.00 |
| ULTRASOUND IPD | RAD00016 | ENDOVAGINAL OB ULTRASOUND | 1,652.64 | 851.36 | 2,504.00 |
| ULTRASOUND IPD | RAD00017 | ENDOVAGINAL GYNE ULTRASOUND | 1,420.32 | 731.68 | 2,152.00 |
| ULTRASOUND IPD | RAD00021 | KIDNEYS / URINARY BLADDER ULTRASOUND | 1,463.22 | 753.78 | 2,217.00 |
| ULTRASOUND IPD | RAD00022 | HEPATOBILIARY ULTRASOUND | 1,550.34 | 798.66 | 2,349.00 |
| ULTRASOUND IPD | RAD00023 | ENDORECTAL (PROSTATE) ULTRASOUND | 1,681.02 | 865.98 | 2,547.00 |
| ULTRASOUND IPD | RAD00024 | BREAST ULTRASOUND | 1,465.20 | 754.80 | 2,220.00 |
| ULTRASOUND IPD | RAD00026 | URINARY BLADDER ULTRASOUND | 1,362.24 | 701.76 | 2,064.00 |
| ULTRASOUND IPD | RAD00027 | TESTES ULTRASOUND | 1,322.64 | 681.36 | 2,004.00 |
| ULTRASOUND IPD | RAD00029 | PANCREAS ULTRASOUND | 1,362.24 | 701.76 | 2,064.00 |
| ULTRASOUND IPD | RAD00031 | ULTRASOUND GUIDED BIOPSY OR ASPIRATION | 2,952.84 | 1,521.16 | 4,474.00 |
| ULTRASOUND IPD | RAD00032 | LOWER ABDOMEN ULTRASOUND | 1,746.36 | 899.64 | 2,646.00 |
| ULTRASOUND IPD | RAD00034 | PROSTATE ULTRASOUND | 1,332.54 | 686.46 | 2,019.00 |
| ULTRASOUND IPD | RAD00037 | UPPER ABDOMEN ULTRASOUND | 2,174.04 | 1,119.96 | 3,294.00 |
| ULTRASOUND IPD | RAD00039 | CAROTIDS | 8,328.54 | 4,290.46 | 12,619.00 |
| ULTRASOUND IPD | RAD00040 | FETAL CONGENITAL ANOMALY SCAN | 4,831.20 | 2,488.80 | 7,320.00 |
| ULTRASOUND IPD | RAD00043 | OBSTETRIC ULTRASOUND W/ 3 - 4D | 5,676.00 | 2,924.00 | 8,600.00 |
| ULTRASOUND IPD | RAD00044 | VENOUS VASCULAR ULTRASOUND PER EXTREMITY | 7,270.56 | 3,745.44 | 11,016.00 |
| ULTRASOUND IPD | RAD00050 | LOWER QUADRANT OF ABDOMEN ULTRASOUND | 1,362.24 | 701.76 | 2,064.00 |
| ULTRASOUND IPD | RAD00052 | JOINT ULTRASOUND (ANY) | 1,417.02 | 729.98 | 2,147.00 |
| ULTRASOUND IPD | RAD00055 | ENDORECTAL - GYNECOLOGIC ULTRASOUND | 1,681.02 | 865.98 | 2,547.00 |
| ULTRASOUND IPD | RAD00058 | UMBILICUS ULTRASOUND | 1,362.24 | 701.76 | 2,064.00 |
| ULTRASOUND IPD | RAD00060 | BIOPHYSICAL PROFILE | 2,135.10 | 1,099.90 | 3,235.00 |
| ULTRASOUND IPD | RAD00062 | WHOLE ABDOMEN ULTRASOUND | 2,414.28 | 1,243.72 | 3,658.00 |
| ULTRASOUND IPD | RAD00067 | FETAL ECHO CARDIOGRAPHY | 5,340.00 | 2,304.00 | 7,644.00 |
| ULTRASOUND IPD | RAD00102 | VENOUS VASCULAR - ALL EXTREMITIES (4) | 29,795.04 | 15,348.96 | 45,144.00 |
| ULTRASOUND IPD | RAD00121 | ADDITIONAL VIEW PER FILM (UTZ) | 239.58 | 123.42 | 363.00 |
| ULTRASOUND IPD | RAD00187 | SONOHYSTEROGRAM | 3,722.40 | 1,917.60 | 5,640.00 |
| ULTRASOUND IPD | RAD00190 | SONO-HYSTEROSALPINGOGRAM | 3,722.40 | 1,917.60 | 5,640.00 |
| ULTRASOUND IPD | RAD00194 | CAROTIDS ( NP ) | 5,105.10 | 2,629.90 | 7,735.00 |
| ULTRASOUND IPD | RAD00197 | ANY SINGLE ORGAN | 1,362.24 | 701.76 | 2,064.00 |
| ULTRASOUND IPD | RAD00201 | LIVER ELASTOGRAPHY (FIBRO SCAN) | 2,970.00 | 1,530.00 | 4,500.00 |
| ULTRASOUND IPD | RAD00061 | MAMMOGRAM | 3,432.00 | 1,768.00 | 5,200.00 |
| CT SCAN OPD | RAD00068 | BRAIN SCAN - PLAIN | 4,173.84 | 2,150.16 | 6,324.00 |
| CT SCAN OPD | RAD00069 | MYELOGRAM PER SEGMENT (SCAN) | 4,860.24 | 2,503.76 | 7,364.00 |
| CT SCAN OPD | RAD00070 | CT SCAN GUIDED BIOPSY OR ASPIRATION | 4,860.24 | 2,503.76 | 7,364.00 |
| CT SCAN OPD | RAD00071 | FACIAL BONES SCAN | 4,854.30 | 2,500.70 | 7,355.00 |
| CT SCAN OPD | RAD00072 | NASOPHARYNX SCAN, PLAIN | 4,854.30 | 2,500.70 | 7,355.00 |
| CT SCAN OPD | RAD00073 | NASOPHARYNX SCAN W/ CONTRAST | 4,854.30 | 2,500.70 | 7,355.00 |
| CT SCAN OPD | RAD00074 | PARANASAL SINUSES SCAN | 4,854.30 | 2,500.70 | 7,355.00 |
| CT SCAN OPD | RAD00075 | PELVIS SCAN | 4,854.30 | 2,500.70 | 7,355.00 |
| CT SCAN OPD | RAD00076 | PITUITARY SCAN | 4,854.30 | 2,500.70 | 7,355.00 |
| CT SCAN OPD | RAD00077 | SPINE - CERVICAL SCAN | 4,854.30 | 2,500.70 | 7,355.00 |
| CT SCAN OPD | RAD00078 | SPINE - LUMBAR SCAN | 4,854.30 | 2,500.70 | 7,355.00 |
| CT SCAN OPD | RAD00079 | TEMPORAL BONES SCAN (MASTOID) | 4,854.30 | 2,500.70 | 7,355.00 |
| CT SCAN OPD | RAD00080 | NECK SCAN | 4,854.30 | 2,500.70 | 7,355.00 |
| CT SCAN OPD | RAD00081 | BRAIN SCAN W/ CONTRAST | 4,854.30 | 2,500.70 | 7,355.00 |
| CT SCAN OPD | RAD00082 | ORBITS SCAN | 4,854.30 | 2,500.70 | 7,355.00 |
| CT SCAN OPD | RAD00083 | ORBITS SCAN W/ CONTRAST | 4,854.30 | 2,500.70 | 7,355.00 |
| CT SCAN OPD | RAD00084 | ENGUINAL CT SCAN (HIP JOINT) | 6,049.56 | 3,116.44 | 9,166.00 |
| CT SCAN OPD | RAD00085 | BRONCHOSCOPY VIRTUAL SCAN | 5,824.50 | 3,000.50 | 8,825.00 |
| CT SCAN OPD | RAD00086 | EXTREMITY W/ 2 JOINTS SCAN | 5,824.50 | 3,000.50 | 8,825.00 |
| CT SCAN OPD | RAD00087 | SPINE - THORASIC SCAN | 5,824.50 | 3,000.50 | 8,825.00 |
| CT SCAN OPD | RAD00088 | COLONOSCOPY VIRTUAL SCAN | 5,824.50 | 3,000.50 | 8,825.00 |
| CT SCAN OPD | RAD00089 | CHEST PLAIN SCAN | 5,824.50 | 3,000.50 | 8,825.00 |
| CT SCAN OPD | RAD00090 | CHEST SCAN W/ CONTRAST | 5,824.50 | 3,000.50 | 8,825.00 |
| CT SCAN OPD | RAD00091 | ABDOMEN, LOWER SCAN | 6,795.36 | 3,500.64 | 10,296.00 |
| CT SCAN OPD | RAD00092 | ABDOMEN, UPPER SCAN | 6,795.36 | 3,500.64 | 10,296.00 |
| CT SCAN OPD | RAD00093 | STONOGRAM SCAN (PLAIN) | 6,795.36 | 3,500.64 | 10,296.00 |
| CT SCAN OPD | RAD00094 | BRONCHOSCOPY VIRTUAL + CHEST SCAN | 7,766.88 | 4,001.12 | 11,768.00 |
| CT SCAN OPD | RAD00097 | CT ANGIO - CRANIAL CT PERFUSION | 9,707.94 | 5,001.06 | 14,709.00 |
| CT SCAN OPD | RAD00098 | UROGRAM SCAN | 9,707.94 | 5,001.06 | 14,709.00 |
| CT SCAN OPD | RAD00099 | CT ANGIO - UROGRAM | 9,049.92 | 4,662.08 | 13,712.00 |
| CT SCAN OPD | RAD00100 | ABDOMEN, WHOLE SCAN | 9,707.94 | 5,001.06 | 14,709.00 |
| CT SCAN OPD | RAD00101 | SPINE - WHOLE SCAN | 9,707.94 | 5,001.06 | 14,709.00 |
| CT SCAN OPD | RAD00104 | CT ANGIO - LIVER | 11,649.00 | 6,001.00 | 17,650.00 |
| CT SCAN OPD | RAD00105 | CT ANGIO - RENAL (KIDNEYS) | 11,649.00 | 6,001.00 | 17,650.00 |
| CT SCAN OPD | RAD00106 | CT ANGIO - INTRACRANIAL | 11,649.00 | 6,001.00 | 17,650.00 |
| CT SCAN OPD | RAD00107 | CT ANGIO - EXTREMITIES UPPER OR LOWER | 11,649.00 | 6,001.00 | 17,650.00 |
| CT SCAN OPD | RAD00108 | CT ANGIO - CRANIAL / CEREBRAL | 11,649.00 | 6,001.00 | 17,650.00 |
| CT SCAN OPD | RAD00109 | CT ANGIO - NECK VESSELS / CAROTIDS | 11,649.00 | 6,001.00 | 17,650.00 |
| CT SCAN OPD | RAD00110 | CT ANGIO - ABDOMEN | 14,561.58 | 7,501.42 | 22,063.00 |
| CT SCAN OPD | RAD00111 | CT ANGI0 - CHEST | 14,561.58 | 7,501.42 | 22,063.00 |
| CT SCAN OPD | RAD00112 | CT ANGIO - HEAD, NECK | 17,474.16 | 9,001.84 | 26,476.00 |
| CT SCAN OPD | RAD00113 | CT ANGIO - AORTOGRAM | 19,415.22 | 10,001.78 | 29,417.00 |
| CT SCAN OPD | RAD00114 | CT ANGIO - HEAD, NECK, CHEST | 19,415.22 | 10,001.78 | 29,417.00 |
| CT SCAN OPD | RAD00115 | CT ANGIO - CHEST, ABDOMEN | 19,415.22 | 10,001.78 | 29,417.00 |
| CT SCAN OPD | RAD00116 | COMBINED STUDIES-HEAD,NECK,CHEST,ABDOMEN | 19,415.22 | 10,001.78 | 29,417.00 |
| CT SCAN OPD | RAD00196 | ADDITIONAL VIEW FOR BRAIN SCAN WITH CONTRAST | 452.76 | 233.24 | 686.00 |
| CT SCAN IPD | RAD00068 | BRAIN SCAN - PLAIN | 6,532.68 | 3,365.32 | 9,898.00 |
| CT SCAN IPD | RAD00069 | MYELOGRAM PER SEGMENT (SCAN) | 6,590.10 | 3,394.90 | 9,985.00 |
| CT SCAN IPD | RAD00070 | CT SCAN GUIDED BIOPSY OR ASPIRATION | 6,590.10 | 3,394.90 | 9,985.00 |
| CT SCAN IPD | RAD00071 | FACIAL BONES SCAN | 6,748.50 | 3,476.50 | 10,225.00 |
| CT SCAN IPD | RAD00072 | NASOPHARYNX SCAN, PLAIN | 6,748.50 | 3,476.50 | 10,225.00 |
| CT SCAN IPD | RAD00073 | NASOPHARYNX SCAN W/ CONTRAST | 6,748.50 | 3,476.50 | 10,225.00 |
| CT SCAN IPD | RAD00074 | PARANASAL SINUSES SCAN | 6,748.50 | 3,476.50 | 10,225.00 |
| CT SCAN IPD | RAD00075 | PELVIS SCAN | 6,748.50 | 3,476.50 | 10,225.00 |
| CT SCAN IPD | RAD00076 | PITUITARY SCAN | 6,748.50 | 3,476.50 | 10,225.00 |
| CT SCAN IPD | RAD00077 | SPINE - CERVICAL SCAN | 6,748.50 | 3,476.50 | 10,225.00 |
| CT SCAN IPD | RAD00078 | SPINE - LUMBAR SCAN | 6,748.50 | 3,476.50 | 10,225.00 |
| CT SCAN IPD | RAD00079 | TEMPORAL BONES SCAN (MASTOID) | 6,748.50 | 3,476.50 | 10,225.00 |
| CT SCAN IPD | RAD00080 | NECK SCAN | 6,748.50 | 3,476.50 | 10,225.00 |
| CT SCAN IPD | RAD00081 | BRAIN SCAN W/ CONTRAST | 7,223.04 | 3,720.96 | 10,944.00 |
| CT SCAN IPD | RAD00082 | ORBITS SCAN | 7,223.04 | 3,720.96 | 10,944.00 |
| CT SCAN IPD | RAD00083 | ORBITS SCAN W/ CONTRAST | 7,695.60 | 3,964.40 | 11,660.00 |
| CT SCAN IPD | RAD00084 | ENGUINAL CT SCAN (HIP JOINT) | 6,763.68 | 3,484.32 | 10,248.00 |
| CT SCAN IPD | RAD00085 | BRONCHOSCOPY VIRTUAL SCAN | 8,098.20 | 4,171.80 | 12,270.00 |
| CT SCAN IPD | RAD00086 | EXTREMITY W/ 2 JOINTS SCAN | 8,098.20 | 4,171.80 | 12,270.00 |
| CT SCAN IPD | RAD00087 | SPINE - THORASIC SCAN | 8,098.20 | 4,171.80 | 12,270.00 |
| CT SCAN IPD | RAD00088 | COLONOSCOPY VIRTUAL SCAN | 8,098.20 | 4,171.80 | 12,270.00 |
| CT SCAN IPD | RAD00089 | CHEST PLAIN SCAN | 9,141.66 | 4,709.34 | 13,851.00 |
| CT SCAN IPD | RAD00090 | CHEST SCAN W/ CONTRAST | 9,141.66 | 4,709.34 | 13,851.00 |
| CT SCAN IPD | RAD00091 | ABDOMEN, LOWER SCAN | 9,448.56 | 4,867.44 | 14,316.00 |
| CT SCAN IPD | RAD00092 | ABDOMEN, UPPER SCAN | 9,448.56 | 4,867.44 | 14,316.00 |
| CT SCAN IPD | RAD00093 | STONOGRAM SCAN (PLAIN) | 9,872.94 | 5,086.06 | 14,959.00 |
| CT SCAN IPD | RAD00094 | BRONCHOSCOPY VIRTUAL + CHEST SCAN | 10,798.26 | 5,562.74 | 16,361.00 |
| CT SCAN IPD | RAD00097 | CT ANGIO - CRANIAL CT PERFUSION | 13,497.66 | 6,953.34 | 20,451.00 |
| CT SCAN IPD | RAD00098 | UROGRAM SCAN | 13,497.66 | 6,953.34 | 20,451.00 |
| CT SCAN IPD | RAD00099 | CT ANGIO - UROGRAM | 11,134.86 | 5,736.14 | 16,871.00 |
| CT SCAN IPD | RAD00100 | ABDOMEN, WHOLE SCAN | 13,497.66 | 6,953.34 | 20,451.00 |
| CT SCAN IPD | RAD00101 | SPINE - WHOLE SCAN | 13,497.66 | 6,953.34 | 20,451.00 |
| CT SCAN IPD | RAD00104 | CT ANGIO - LIVER | 16,197.72 | 8,344.28 | 24,542.00 |
| CT SCAN IPD | RAD00105 | CT ANGIO - RENAL (KIDNEYS) | 16,197.72 | 8,344.28 | 24,542.00 |
| CT SCAN IPD | RAD00106 | CT ANGIO - INTRACRANIAL | 16,197.72 | 8,344.28 | 24,542.00 |
| CT SCAN IPD | RAD00107 | CT ANGIO - EXTREMITIES UPPER OR LOWER | 16,197.72 | 8,344.28 | 24,542.00 |
| CT SCAN IPD | RAD00108 | CT ANGIO - CRANIAL / CEREBRAL | 16,197.72 | 8,344.28 | 24,542.00 |
| CT SCAN IPD | RAD00109 | CT ANGIO - NECK VESSELS / CAROTIDS | 16,197.72 | 8,344.28 | 24,542.00 |
| CT SCAN IPD | RAD00110 | CT ANGIO - ABDOMEN | 20,246.82 | 10,430.18 | 30,677.00 |
| CT SCAN IPD | RAD00111 | CT ANGI0 - CHEST | 20,246.82 | 10,430.18 | 30,677.00 |
| CT SCAN IPD | RAD00112 | CT ANGIO - HEAD, NECK | 24,296.58 | 12,516.42 | 36,813.00 |
| CT SCAN IPD | RAD00113 | CT ANGIO - AORTOGRAM | 26,996.64 | 13,907.36 | 40,904.00 |
| CT SCAN IPD | RAD00114 | CT ANGIO - HEAD, NECK, CHEST | 26,996.64 | 13,907.36 | 40,904.00 |
| CT SCAN IPD | RAD00115 | CT ANGIO - CHEST, ABDOMEN | 26,996.64 | 13,907.36 | 40,904.00 |
| CT SCAN IPD | RAD00116 | COMBINED STUDIES-HEAD,NECK,CHEST,ABDOMEN | 26,996.64 | 13,907.36 | 40,904.00 |
| CARDIOVASCULAR IPD | RAD00066 | 2D ECHO | 4,744.00 | 1,100.00 | 5,844.00 |
| CARDIOVASCULAR IPD | RAD00199 | 2D ECHO (NO TRICOG) | 4,144.00 | 1,100.00 | 5,244.00 |
| CARDIOVASCULAR IPD | OTH00228 | STRESS TEST | 2,400.00 | 1,100.00 | 3,500.00 |
| CARDIOVASCULAR IPD | CARDIOVASCULAR CLEARANCE | 1,000.00 | |||
| CARDIOVASCULAR IPD | RAD00047 | ECG PER TRACING 12 LEADS | 350.00 | 558.00 | 908.00 |
| CARDIOVASCULAR IPD | OTH00044 | ECG PER TRACING 15 LEADS | 450.00 | 558.00 | 1,008.00 |
| CARDIOVASCULAR IPD | OTH00045 | ECG PER TRACING 18 LEADS | 550.00 | 558.00 | 1,108.00 |
| CARDIOVASCULAR IPD | OTH0093 | ECG LONG LEAD II | 250.00 | 558.00 | 808.00 |
| CARDIOVASCULAR IPD | OTH00261 | ECG PROCEDURE | 558.00 | ||
| CARDIOVASCULAR IPD | OTH00220 | EEG - DONE OUTSIDE EMU RM | 8,500.00 | 1,250.00 | 9,750.00 |
| CARDIOVASCULAR IPD | OTH00221 | EEG ( 2 - 4 HRS ) | 9,450.00 | 2,250.00 | 11,700.00 |
| CARDIOVASCULAR IPD | OTH00222 | EEG > 4HRS | 12,850.00 | 2,750.00 | 15,600.00 |
| CARDIOVASCULAR IPD | OTH00218 | EEG - 30 MINS | 7,525.00 | 1,250.00 | 8,775.00 |
| CARDIOVASCULAR IPD | OTH00219 | EEG - ONE HR | 7,525.00 | 1,250.00 | 8,775.00 |
| CARDIOVASCULAR IPD | RAD00136 | SPIROMETRY | 893.00 | 250.00 | 1,143.00 |
| CARDIOVASCULAR OPD | RAD00066 | 2D ECHO | 3,927.00 | 1,100.00 | 5,027.00 |
| CARDIOVASCULAR OPD | RAD00199 | 2D ECHO (NO TRICOG) | 3,627.00 | 1,100.00 | 4,727.00 |
| CARDIOVASCULAR OPD | OTH00228 | STRESS TEST | 2,400.00 | 1,100.00 | 3,500.00 |
| CARDIOVASCULAR OPD | CARDIOVASCULAR CLEARANCE | 1,000.00 | |||
| CARDIOVASCULAR OPD | RAD00047 | ECG PER TRACING 12 LEADS | 350.00 | 558.00 | 908.00 |
| CARDIOVASCULAR OPD | OTH00044 | ECG PER TRACING 15 LEADS | 450.00 | 558.00 | 1,008.00 |
| CARDIOVASCULAR OPD | OTH00045 | ECG PER TRACING 18 LEADS | 550.00 | 558.00 | 1,108.00 |
| CARDIOVASCULAR OPD | OTH0093 | ECG LONG LEAD II | 250.00 | 558.00 | 808.00 |
| CARDIOVASCULAR OPD | OTH00261 | ECG PROCEDURE | 558.00 | ||
| CARDIOVASCULAR OPD | OTH00220 | EEG - DONE OUTSIDE EMU RM | 5,000.00 | 1,250.00 | 6,250.00 |
| CARDIOVASCULAR OPD | OTH00221 | EEG ( 2 - 4 HRS ) | 5,250.00 | 2,250.00 | 7,500.00 |
| CARDIOVASCULAR OPD | OTH00222 | EEG > 4HRS | 7,250.00 | 2,750.00 | 10,000.00 |
| CARDIOVASCULAR OPD | OTH00218 | EEG - 30 MINS | 4,375.00 | 1,250.00 | 5,625.00 |
| CARDIOVASCULAR OPD | OTH00219 | EEG - ONE HR | 4,375.00 | 1,250.00 | 5,625.00 |
| CARDIOVASCULAR OPD | RAD00136 | SPIROMETRY | 840.00 | 250.00 | 1,090.00 |
| E.R OPD | OTH00149 | WOUND DEBRIDEMENT FEE | 200.00 | ||
| E.R OPD | OTH00150 | WOUND DRESSING FEE | 200.00 | ||
| E.R OPD | OTH000174 | ER - DR FEE | 2,000.00 | ||
| E.R OPD | OTH00154 | ER MANAGEMENT | 600.00 | ||
| E.R OPD | OTH00155 | EMERGENCY ER CONSULTATION (OUTPATIENT) | 707.00 | ||
| E.R OPD | OTH00156 | URGENT ER CONSULTATION (OUTPATIENT) | 260.00 | ||
| E.R OPD | OTH00050 | EMERGENCY ROOM FEE ( 1 HR) | 600.00 | ||
| E.R OPD | OTH00051 | EMERGENCY ROOM FEE ( 2 HRS) | 600.00 | ||
| E.R OPD | OTH00052 | EMERGENCY ROOM FEE ( 3 HRS) | 700.00 | ||
| E.R OPD | OTH00053 | EMERGENCY ROOM FEE (SUCCEEDING HR.) | 100.00 | ||
| E.R OPD | OTH00057 | ER - OR FEE | 500.00 | ||
| E.R OPD | OTH00058 | ER- IV INFUSION FEE | 250.00 | ||
| E.R OPD | OTH00059 | ER NEBULIZATION | 60.00 | ||
| E.R OPD | OTHERF000200 | OECB - EMERGENCY BED | 650.00 | ||
| E.R OPD | OTHERF000201 | OECB - VITAL SIGNS MONITOR | 156.00 | ||
| AMBULANCE OPD | OTH00203 | AMBULANCE TRIP TO ILIGAN CITY | 18,000.00 | ||
| AMBULANCE OPD | OTH00008 | AMBULANCE TRIP W/N CITY LIMIT AFTER 5PM | 2,500.00 | ||
| AMBULANCE OPD | OTH00009 | AMBULANCE TRIP OUTSIDE THE CITY-OFFICE HRS | 5,000.00 | ||
| AMBULANCE OPD | OTH00010 | AMBULANCE TRIP W/N CITY LIMIT-OFFICE HRS | 2,500.00 | ||
| AMBULANCE OPD | OTH00014 | AMBULANCE TRIP OUTSIDE THE CITY AFTER 5PM | 2,500.00 | ||
| AMBULANCE OPD | OTH00160 | AMBULANCE TRIP- AIRPORT | 5,000.00 | ||
| HEMODIALYSIS OPD | RAD00051 | HEMODIALYSIS ROOM | 500.00 | ||
| HEMODIALYSIS OPD | OTH00174 | HEMODIALYSIS PROCEDURE | 1,200.00 | ||
| HEMODIALYSIS OPD | OTH00085 | HEMO ADDTL FEE (INITIAL)- STAT (W/O PHIC) | 2,250.00 | ||
| HEMODIALYSIS OPD | OTH00086 | HEMO ADDTL FEE (PER HR) | 250.00 | ||
| HEMODIALYSIS OPD | OTH00087 | HEMO ADDTL FEE (SUC) - STAT (W/O PHIC) | 1,450.00 | ||
| HEMODIALYSIS OPD | OTH00088 | HEMO ADDTL FEE AFTER 5 PM (PER HR) | 250.00 | ||
| HEMODIALYSIS OPD | OTH00089 | HEMO ADDTL FEE- STAT (W/ PHIC) | 900.00 | ||
| HEMODIALYSIS OPD | OTH00294 | HEMO USE OF SOLUTION FOR DIALYZER | 200.00 | ||
| HEMODIALYSIS OPD | OTH00271 | HEMO CLIPPING | 150.00 | ||
| HEMODIALYSIS OPD | OTH00296 | HEMO - IJ/PERM. CATH DRESSING | 100.00 | ||
| HEMODIALYSIS OPD | OTH00297 | HEMO - DRUG ADMINISTRATION | 50.00 | ||
| HEMODIALYSIS OPD | OTH00298 | HEMO - AVF CANNULATION | 100.00 | ||
| HEMODIALYSIS OPD | OTH00299 | HEMO - IJ. CATH. REMOVAL | 100.00 | ||
| OTHER OPD | OTH00098 | L.NEWBORN HEARING SCREENING TEST (NHST) | 250.00 | ||
| OTHER OPD | 1014 | OR FEE | 2,300.00 | ||
| HOSPITAL EQUIPMENT OPD | OTH00254 | REMOVAL OF FOLEY CATHETER | 150.00 | ||
| HOSPITAL EQUIPMENT OPD | OTH00276 | REMOVAL OF IV CATH AND CENTER LINE | 150.00 | ||
| HOSPITAL EQUIPMENT OPD | OTH00255 | REMOVAL OG NGT | 150.00 | ||
| HOSPITAL EQUIPMENT OPD | OTH00130 | REPRODUCTION OF CT SCAN FILM | 300.00 | ||
| HOSPITAL EQUIPMENT OPD | OTH00131 | ROOM - HOT SHOWER PER DAY | 100.00 | ||
| HOSPITAL EQUIPMENT OPD | OTH00132 | ROOM REFRIGERATOR PER DAY | 250.00 | ||
| HOSPITAL EQUIPMENT OPD | OTH00264 | SKIN PREP | 100.00 | ||
| HOSPITAL EQUIPMENT OPD | OTH00256 | SPINAL PREP | 250.00 | ||
| HOSPITAL EQUIPMENT OPD | OTH00135 | SPINAL SET PACK | 500.00 | ||
| HOSPITAL EQUIPMENT OPD | OTHMISC000225 | SPRITE 290ML | 30.00 | ||
| HOSPITAL EQUIPMENT OPD | OTH00267 | SUCTION ASSISTANCE | 100.00 | ||
| HOSPITAL EQUIPMENT OPD | OTH00257 | SUTURE CARE LARGE (SINGLE) | 1,500.00 | ||
| HOSPITAL EQUIPMENT OPD | OTH00258 | SUTURING CARE LARGE (MULTIPLE) | 2,500.00 | ||
| HOSPITAL EQUIPMENT OPD | OTH00139 | THORACENTESIS PACK | 500.00 | ||
| HOSPITAL EQUIPMENT OPD | OTH00270 | TRACHEOSTOMY CARE | 150.00 | ||
| HOSPITAL EQUIPMENT OPD | OTH00152 | TROCAR #10 | 100.00 | ||
| HOSPITAL EQUIPMENT OPD | OTH00153 | TROCAR #14 | 100.00 | ||
| HOSPITAL EQUIPMENT OPD | OTH00259 | UMBILICAL CORD CARE | 100.00 | ||
| HOSPITAL EQUIPMENT OPD | OTH00209 | USE OF COVER ALL | 100.00 | ||
| HOSPITAL EQUIPMENT OPD | OTH00212 | USE OF DELIVERY ROOM - VAGINAL/ I.E. EXAMINATION | 600.00 | ||
| HOSPITAL EQUIPMENT OPD | OTH000226 | USE OF EYE SHEET | 30.00 | ||
| HOSPITAL EQUIPMENT OPD | OTHM00020 | USE OF FETAL HEART DOPPLER | 50.00 | ||
| HOSPITAL EQUIPMENT OPD | OTH000231 | USE OF INFANT WARMER | 700.00 | ||
| HOSPITAL EQUIPMENT OPD | OTH0051 | USE OF INFUSOMAT | 1,000.00 | ||
| HOSPITAL EQUIPMENT OPD | OTH000233 | USE OF NEONATE WARMER | 3,000.00 | ||
| HOSPITAL EQUIPMENT OPD | OTH00144 | USE OF OPERATING ROOM | 1,000.00 | ||
| HOSPITAL EQUIPMENT OPD | OTHMIS000239 | USE OF PNEUMATIC MATTRESS | 113.00 | ||
| HOSPITAL EQUIPMENT OPD | OTH00265 | WOUND DRESSING | 150.00 | ||
| HOSPITAL EQUIPMENT OPD | OTH00266 | WOUND DRESSING LARGE | 250.00 | ||
| HOSPITAL EQUIPMENT OPD | OTH000204 | XEROX | 5.00 | ||
| E.R IPD | OTH00149 | WOUND DEBRIDEMENT FEE | 200.00 | ||
| E.R IPD | OTH00150 | WOUND DRESSING FEE | 200.00 | ||
| E.R IPD | OTH000174 | ER - DR FEE | 2,500.00 | ||
| E.R IPD | OTH00154 | ER MANAGEMENT | 600.00 | ||
| E.R IPD | OTH00155 | EMERGENCY ER CONSULTATION (OUTPATIENT) | 707.00 | ||
| E.R IPD | OTH00156 | URGENT ER CONSULTATION (OUTPATIENT) | 260.00 | ||
| E.R IPD | OTH00050 | EMERGENCY ROOM FEE ( 1 HR) | 600.00 | ||
| E.R IPD | OTH00051 | EMERGENCY ROOM FEE ( 2 HRS) | 600.00 | ||
| E.R IPD | OTH00052 | EMERGENCY ROOM FEE ( 3 HRS) | 700.00 | ||
| E.R IPD | OTH00053 | EMERGENCY ROOM FEE (SUCCEEDING HR.) | 100.00 | ||
| E.R IPD | OTH00057 | ER - OR FEE | 500.00 | ||
| E.R IPD | OTH00058 | ER- IV INFUSION FEE | 250.00 | ||
| E.R IPD | OTH00059 | ER NEBULIZATION | 60.00 | ||
| AMBULANCE IPD | OTH00203 | AMBULANCE TRIP TO ILIGAN CITY | 18,000.00 | ||
| AMBULANCE IPD | OTH00008 | AMBULANCE TRIP W/N CITY LIMIT AFTER 5PM | 2,500.00 | ||
| AMBULANCE IPD | OTH00009 | AMBULANCE TRIP OUTSIDE THE CITY-OFFICE HRS | 5,000.00 | ||
| AMBULANCE IPD | OTH00010 | AMBULANCE TRIP W/N CITY LIMIT-OFFICE HRS | 2,500.00 | ||
| AMBULANCE IPD | OTH00014 | AMBULANCE TRIP OUTSIDE THE CITY AFTER 5PM | 2,500.00 | ||
| AMBULANCE IPD | OTH00160 | AMBULANCE TRIP- AIRPORT | 5,000.00 | ||
| HEMODIALYSIS IPD | OTH040 | MICROBIOLOGICAL TEST (RAW WATER, POINT OF USE, PRODUCT WATER) | 0.00 | ||
| HEMODIALYSIS IPD | RAD00051 | HEMODIALYSIS ROOM | 1,000.00 | ||
| HEMODIALYSIS IPD | OTH00174 | HEMODIALYSIS PROCEDURE | 1,200.00 | ||
| HEMODIALYSIS IPD | OTH00085 | HEMO ADDTL FEE (INITIAL)- STAT (W/O PHIC) | 2,250.00 | ||
| HEMODIALYSIS IPD | OTH00086 | HEMO ADDTL FEE (PER HR) | 250.00 | ||
| HEMODIALYSIS IPD | OTH00087 | HEMO ADDTL FEE (SUC) - STAT (W/O PHIC) | 1,450.00 | ||
| HEMODIALYSIS IPD | OTH00088 | HEMO ADDTL FEE AFTER 5 PM (PER HR) | 250.00 | ||
| HEMODIALYSIS IPD | OTH00089 | HEMO ADDTL FEE- STAT (W/ PHIC) | 900.00 | ||
| HEMODIALYSIS IPD | OTH0041 | ENVI LAB - RAW WATER | 0.00 | ||
| HEMODIALYSIS IPD | OTH0042 | ENVI LAB - PRODUCT WATER | 0.00 | ||
| HEMODIALYSIS IPD | OTH0043 | ENVI LAB - POINT OF USE | 0.00 | ||
| HEMODIALYSIS IPD | OTH0044 | ENVI LAB - RETEST | 0.00 | ||
| HEMODIALYSIS IPD | OTH00294 | HEMO USE OF SOLUTION FOR DIALYZER | 200.00 | ||
| HEMODIALYSIS IPD | OTH00271 | HEMO CLIPPING | 150.00 | ||
| HEMODIALYSIS IPD | OTH00296 | HEMO - IJ/PERM. CATH DRESSING | 100.00 | ||
| HEMODIALYSIS IPD | OTH00298 | HEMO - AVF CANNULATION | 100.00 | ||
| HEMODIALYSIS IPD | OTH00299 | HEMO - IJ. CATH. REMOVAL | 100.00 | ||
| OTHER IPD | OTH00098 | L.NEWBORN HEARING SCREENING TEST (NHST) | 250.00 | ||
| OTHER IPD | 1014 | OR FEE | 2,300.00 | ||
| HOSPITAL EQUIPMENT IPD | OTH00294 | USE OF INFUSION PUMP PER HOUR | 100.00 | ||
| HOSPITAL EQUIPMENT IPD | OTH00093 | USE OF INFUSION PUMP PER DAY | 600.00 | ||
| HOSPITAL EQUIPMENT IPD | OTH00007 | FETAL MONITORING - FIRST HR | 400.00 | ||
| HOSPITAL EQUIPMENT IPD | OTH00030 | DEFIBRILLATOR PER USE | 500.00 | ||
| HOSPITAL EQUIPMENT IPD | OTH000318 | USE OF CARDIAC MONITOR- PER USE | 1,500.00 | ||
| HOSPITAL EQUIPMENT IPD | OTH00044 | ECG PER TRACING 15 LEADS | 450.00 | ||
| HOSPITAL EQUIPMENT IPD | OTH00045 | ECG PER TRACING 18 LEADS | 550.00 | ||
| HOSPITAL EQUIPMENT IPD | OTH00072 | FETAL MONITORING - FIRST HR. | 400.00 | ||
| HOSPITAL EQUIPMENT IPD | OTH00073 | FETAL MONITORING - SUCCEEDING HR | 100.00 | ||
| HOSPITAL EQUIPMENT IPD | OTH00109 | NEBULIZER PER USE EXCL. MEDICINE | 30.00 | ||
| HOSPITAL EQUIPMENT IPD | OTH00138 | SYRINGE PUMP / DAY | 500.00 | ||
| HOSPITAL EQUIPMENT IPD | OTH00232 | USE OF GLUCOMETER | 215.00 | ||
| HOSPITAL EQUIPMENT IPD | OTH00233 | USE OF OUTSIDE HIGH FLOW MACHINE - PER DAY | 4,500.00 | ||
| HOSPITAL EQUIPMENT IPD | OTH00234 | USE OF SUCTION MACHINE | 500.00 | ||
| HOSPITAL EQUIPMENT IPD | OTH00300 | USE OF LAPTOWER MACHINE - LIGHT SOURCE ONLY | 5,000.00 | ||
| HOSPITAL EQUIPMENT IPD | OTHHEF00010 | USE OF OUTSIDE AUTO CPAP MACHINE - PER DAY | 3,500.00 | ||
| HOSPITAL EQUIPMENT IPD | OTHHEF00011 | USE OF OUTSIDE NIV MACHINE - PER DAY | 4,000.00 | ||
| HOSPITAL EQUIPMENT IPD | OTHHEF00012 | USE OF OUTSIDE AUTO BIPAP MACHINE - PER DAY | 3,500.00 | ||
| HOSPITAL EQUIPMENT IPD | OTHHEF00013 | USE OF OUTSIDE HIGH FLOW O2 THERAPY (INITIAL) | 16,900.00 | ||
| HOSPITAL EQUIPMENT IPD | OTHHEF00014 | USE OF OUTSIDE AUTO CPAP (INITIAL) | 11,500.00 | ||
| HOSPITAL EQUIPMENT IPD | OTHHFE00015 | USE OF OUTSIDE AUTO BIPAP (INITIAL) | 11,500.00 | ||
| HOSPITAL EQUIPMENT IPD | OTHHFE00016 | USE OF LAPAROSCOPY TOWER MACHINE | 20,000.00 | ||
| HOSPITAL EQUIPMENT IPD | OTHHFE00017 | USE OF LAPAROSCOPY HAND INSTRUMENT | 5,000.00 | ||
| HOSPITAL EQUIPMENT IPD | OTHMISC000226 | ENDO - USE OF OLYMPUS DUODENOVIDEOSCOPE | 6,991.00 | ||
| HOSPITAL EQUIPMENT IPD | OTHMISC000227 | ENDO - USE OF ENDOSCOPY MACHINE - OLYMPUS ENDOSCOPIC VIDEO INFORMATION SYS. | 8,098.00 | ||
| HOSPITAL EQUIPMENT IPD | OTHMISC000233 | ENDO - USE OF OLYMPUS EMERGENCY COIL SHEALTH+HANDEL BML-110A-1 | 87.00 | ||
| HOSPITAL EQUIPMENT IPD | OTHMISC000235 | ENDO - USE OF OLYMPUS LITHOCRUSH V ROTATABLE BML HANDEL MAJ-441 | 160.00 | ||
| HOSPITAL EQUIPMENT IPD | SUP00015 | CARDIAC MONITOR PER USE | 1,500.00 | ||
| HOSPITAL EQUIPMENT IPD | OTHHEF00018 | DAMAGED NEBULIZER | 4,960.00 | ||
| HOSPITAL EQUIPMENT IPD | OTH00145 | USE OF PORTABLE XRAY MACHINE (PER FILM) | 150.00 | ||
| HOSPITAL EQUIPMENT IPD | RAD00005 | USE OF ULTRASOUND MACHINE | 1,000.00 | ||
| HOSPITAL EQUIPMENT IPD | OTH00093 | USE OF INFUSION PUMP PER DAY | 600.00 | ||
| HOSPITAL EQUIPMENT IPD | OTH00125 | PULSE OXIMETER PER DAY | 500.00 | ||
| HOSPITAL EQUIPMENT IPD | OTH00146 | USE OF VENTILATOR- ICU PER DAY | 4,500.00 | ||
| HOSPITAL EQUIPMENT IPD | OTH00210 | USE OF OUTSIDE VENTILATOR - ICU PER DAY | 4,500.00 | ||
| HOSPITAL EQUIPMENT IPD | OTH00211 | USE OF HIGH FLOW MACHINE - PER DAY | 2,500.00 | ||
| HOSPITAL EQUIPMENT IPD | OTH00215 | USE OF HIGH FLOW O2 THERAPY ( INITIAL ) | 15,000.00 | ||
| HOSPITAL EQUIPMENT IPD | OTH00230 | USE OF CPAP / BIPAP PORTABLE MACHINE | 1,500.00 | ||
| HOSPITAL EQUIPMENT IPD | OTH00018 | CAUTERY MACHINE PER USE | 500.00 | ||
| HOSPITAL EQUIPMENT IPD | OTH00223 | EEG - ADDTL FEE - HOLIDAYS/SUNDAYS | 2,000.00 | ||
| HOSPITAL EQUIPMENT IPD | OTH00120 | PERILITE PER USE | 150.00 | ||
| HOSPITAL EQUIPMENT IPD | OTH00200 | USE OF CAPNOGRAPH MACHINE | 800.00 | ||
| MISCELLANEOUS IPD | RAD00045 | OWN NEBULIZER MACHINE PER USE | 20.00 | ||
| MISCELLANEOUS IPD | OTH00002 | CRYO SURGICAL MACHINE PER USE | 1,000.00 | ||
| MISCELLANEOUS IPD | OTHOO207 | USE OF ENDOSCOPE | 2,000.00 | ||
| MISCELLANEOUS IPD | OTH000318 | USE OF CARDIAC MONITOR- PER USE | 1,500.00 | ||
| MISCELLANEOUS IPD | OTH00164 | ECG W/ ALLIGATOR CLIP + SILVER ELECTRODE | 450.00 | ||
| MISCELLANEOUS IPD | OTH00143 | USE OF INCUBATOR PER DAY | 3,000.00 | ||
| MISCELLANEOUS IPD | OTH00205 | USE OF PHACO EMULSIFICATION MACHINE (A) | 5,000.00 | ||
| MISCELLANEOUS IPD | OTH00206 | USE OF PHACO EMULSIFICATION MACHINE (B) | 3,000.00 | ||
| MISCELLANEOUS IPD | OTH00207 | USE OF PHACO EMULSIFICATION MACHINE (C) | 1,000.00 | ||
| MISCELLANEOUS IPD | OTH00208 | USE OF OPTHA MICROSCOPE | 2,100.00 | ||
| MISCELLANEOUS IPD | OTH00214 | PULSE OXIMETER | 2,000.00 | ||
| MISCELLANEOUS IPD | OTH00217 | USE OF VENTILATOR - COVID STN PER DAY | 5,000.00 | ||
| MISCELLANEOUS IPD | OTH00235 | ABDOMINAL PREP | 500.00 | ||
| MISCELLANEOUS IPD | OTH00236 | ADDITIONAL OR USE IN EXCESS OF 4HOURS (1HOUR) | 100.00 | ||
| MISCELLANEOUS IPD | OTH00237 | ADDITIONAL OR USE IN EXCESS OF 4HOURS (2HOUR) | 100.00 | ||
| MISCELLANEOUS IPD | OTH00003 | ADDTL LR FEE - CLOSE SUPERVISION | 600.00 | ||
| MISCELLANEOUS IPD | OTH00003 | ADDTL LR FEE - CLOSE SUPERVISION | 500.00 | ||
| MISCELLANEOUS IPD | OTH00004 | ADDTL LR FEE - PREMATURE LABOR | 600.00 | ||
| MISCELLANEOUS IPD | OTH00004 | ADDTL LR FEE - PREMATURE LABOR | 500.00 | ||
| MISCELLANEOUS IPD | OTH00004 | ADDTL LR FEE - PREMATURE LABOR | 600.00 | ||
| MISCELLANEOUS IPD | OTH00005 | ADDTL LR FEE - THREATHENED ABORTION | 600.00 | ||
| MISCELLANEOUS IPD | OTH00005 | ADDTL LR FEE - THREATHENED ABORTION | 500.00 | ||
| MISCELLANEOUS IPD | OTH00006 | ADDTL LR FEE- INDUCTION FEE>24 HRS | 600.00 | ||
| MISCELLANEOUS IPD | OTH00006 | ADDTL LR FEE- INDUCTION FEE>24 HRS | 500.00 | ||
| MISCELLANEOUS IPD | OTH00240 | ADMINISTRATIN OF VACCINE AND ROUTINE MEDICATIONS | 600.00 | ||
| MISCELLANEOUS IPD | OTH0021 | ATTACHMENT FORM FOR MUSLIM BIRTH | 25.00 | ||
| MISCELLANEOUS IPD | OTH0022 | ATTACHMENT FORM FOR MUSLIM DEATH | 25.00 | ||
| MISCELLANEOUS IPD | OTH00011 | AUTOCLAVING ( L ) | 500.00 | ||
| MISCELLANEOUS IPD | OTH00239 | BCG (1DOSE) | 250.00 | ||
| MISCELLANEOUS IPD | OTH00241 | BED BATH | 250.00 | ||
| MISCELLANEOUS IPD | OTH00013 | BILI - LIGHT | 500.00 | ||
| MISCELLANEOUS IPD | OTH00295 | BLOOD TRANSFUSSION ADMINISTRATION | 100.00 | ||
| MISCELLANEOUS IPD | OTHMISC00026 | BLOOD TRANSPORT FEE | 250.00 | ||
| MISCELLANEOUS IPD | OTHMISC000234 | BOILED EGG | 15.00 | ||
| MISCELLANEOUS IPD | OTH050 | BOTTLE WATER 500ML | 25.00 | ||
| MISCELLANEOUS IPD | OTH00225 | BROKEN GLASS (S) | 250.00 | ||
| MISCELLANEOUS IPD | OTH00017 | CARBON DIOXIDE 1L/HR | 153.60 | ||
| MISCELLANEOUS IPD | OTHMISC000230 | C-ARM SUCCEDING HOURS | 2,000.00 | ||
| MISCELLANEOUS IPD | OTH00020 | CERTIFICATE OF LIVE BIRTH | 25.00 | ||
| MISCELLANEOUS IPD | OTH00021 | CERTIFICATION FEE | 50.00 |