2D Echo
| IN PATIENT | OUT PATIENT | |||
| Pay | Service | Pay | Service | |
| 2D ECHO W/ CFDS | ||||
| - PROCEDURE | 1,400.00 | 1,400.00 (charge to PhilHealth) |
1,400.00 | 1,400.00** (Pending SS Classification) |
| - PF | 1,000.00 | NONE | 1,100.00* | NONE |
| TOTAL | 2,500.00 | 1,400.00 | 2,500.00 | 1,400.00 |
| 2D ECHO SCAN | ||||
| - PROCEDURE | 500.00 | 500.00 (charge to PhilHealth) |
500.00 | 500.00** (Pending SS Classification) |
| - PF | 300.00 | NONE | 300.00 | NONE |
| TOTAL | 800.00 | 500.00 | 800.00 | 500.00 |
| PERICARDIOCENTESIS | ||||
| - PROCEDURE | 800.00 | 800.00 (charge to PhilHealth) |
800.00 | 800.00** (Pending SS Classification) |
**Pending Social Service Classification
Certifications
| CERTIFICATIONS | NEW RATE |
| Birth Certificate | 50.00 |
| Death Certificate | 50.00 |
| Certificate of Confinement | 50.00 |
| Medical Certificate | 50.00 |
| Medico-Legal Certificate | 50.00 |
| Medical Abstract | 50.00 |
| Certified True Copy | 5.00/page |
Combined Endoscopy
| Accessories for Endoscopic Procedures | |
| Items | Cost |
| ERCP Cannula Fr. 5.5 | 670.00/use |
| Guide Wire | 705.00/use |
| Biliary Stent, Plastic Fr. 10; Length: 7cm | 1,936.00 |
| Biliary Stent, Plastic Fr. 10; Length: 10cm | 1,936.00 |
| Biliary Stent, Plastic Fr. 10; Length: 12cm | 1,936.00 |
| Stent Introducer Set Fr. 10 | 650.00/use |
| Gastrocope Biopsy Forceps, Jumbo | 300.00/use |
| Colonoscope Biopsy Forceps, Jumbo | 300.00/use |
| Injector, Clear | 530.00/use |
| BOSTON* Esophageal Variceal Ligator Set: 7 Ligator Bands | 13,200.00/set |
| Helicobacter Pylori Strip | 400.00 |
| COOK* Medical Multi Band Ligator 6-shooter set | 15,143.00 |
| COOK* Medical Percutaneous Endoscopic Gastrostomy Fr. 24 set | 12,815.00 |
| Endoscopic Procedures | |
| Procedures | Cost |
| Use of Cautery Machine | 2,000.00 |
| Use of Argon Plasma Coagulation (APC) | 3,000.00 |
Dental
| Services | Cost |
| Tooth Restoration | 300.00 |
| Simple Tooth Extraction | 150.00 |
| Posterior Tooth Extraction | 200.00 |
| Odontectomy/ for impacted tooth removal (price may vary) | (minimum) 2,000.00 |
Emergency Room
| Price | Price | ||
| AP PREP | 90.00 | Long Arm Posterior Mold | 810.00 |
| Blood Transfusion | 200.00 | Long Leg Posterior Mold | 1,110.00 |
| Blood Extraction | 65.00 | Nebulization #Times 35 | 85.00 |
| Cardiac Monitor use | 1,500.00/day | NGT Insertion | 165.00 |
| Cardioversion | 835.00 | Overhead Traction | 255.00 |
| Circumcision | 410.00 | O2 Therapy #hrs. | 50.00 |
| Change of Tracheostomy Tube | 180.00 | 010LPM35.5/hr06LMP30/hr04LPM | 25.00 |
| Close Tube Thoracotomy | 1,340.00 | Partial Ungiectomy | 410.00 |
| Closure of Pierced Earlobe | 570.00 | Percutaneous Release Trigger Finger | 400.00 |
| CVP Insertion | 1,165.00 | Postmortem | 500.00 |
| Cystoclysis | 170.00 | Proximal Tibia Skeletal Traction | 385.00 |
| Decontamination | 450.00 | Pterygiectomy | 560.00 |
| Dressing/Removal of Sutures | 175.00 | Re-anchoring of J Tube | 1,050.00 |
| ECG Fee | 200.00 | Removal of Foreign Body (ENT) | 295.00 |
| Excision | 550.00 | Removal of Foreign BOdy (Surgery Ortho) | 555.00 |
| Excision/Biopsy | 650.00 | Removal of Plantar Warts | 550.00 |
| Excision of Facial Moles | 600.00 | Short Arm Posterior Mold | 723.00 |
| Fine Needle Aspitation Biopsy | 390.00 | Suprapubic Catheter Insertion | 555.00 |
| Flushing if Impacted Cerumen | 260.00 | Suctioning | 30.00 |
| FNAB | 380.00 | Suturing (Optha) (Eyebrow, Eyelid non-margin) | 715.00 |
| Foley Catheter Insertion | 165.00 | (Eyelid margin) | 542.00 |
| I&C Chalagion/Internal Hurdeulum | 390.00 | Sugar Tong Mold | 495.00 |
| IJ Catheter Insertion | 570.00 | Tracheostomy | 1,120.00 |
| Incision and Drainage | 555.00 | ||
| Injection Fee | 35.00 | ||
| Injection (IVTT) | 75.00 | ||
| Insertion of AV Shunt | 1,065.00 | ||
| Intubation | 325.00 | ||
| Internal Examination | 85.00 | ||
| IV Insertion | 205.00 |
ENT-HNS
| With PHIC | Without PHIC | |
| Out-patients | no cash out | 2,000.00 |
| In-patients | no cash out | 2,000.00 |
Heart Institute
| Service | Pay | |
| Intra-Op Transesophageal Echocardiography | ||
| Procedure | 4,100.00 | 4,100.00 |
| Professional Fee | 0 | 8,000.00 |
| Total | 4,100.00 | 12,100.00 |
| Stress Echocardiogram | ||
| Procedure | 4,500.00 | 4,500.00 |
| Professional Fee | 0 | 3,000.00 |
| Total | 4,500.00 | 7,500.00 |
| Procedures | Amount |
| Carotid Duplex Study | 4,200.00 |
| Both Lower/Upper Extremities | 4,700.00 |
| One Lower/Upper Extremities | 2,200.00 |
| Cardiovascular Supplies | |||
| Item Description | Cost/Price | Item Description | Cost/Price |
| 6F Judkins Left 5 (Bbraun) | 1,886.00 | Transradial Catheter - Size: 5F JL4 (Merit) | 2,143.00 |
| 6F Judkins Left 6 (Bbraun) | 1,886.00 | Transradial Catheter - Size: 5F JR4 (Merit) | 2,143.00 |
| 6F Nulti Purpose 2 (Bbraun) | 1,886.00 | Femoral Introducer Kit 4F (Merit) | 2,571.00 |
| Pressure Transducer Set (Medex) | 2,586.00 | Femoral Introducer Kit 7F: Adult (Merit) | 1,857.00 |
| 0.025, 150cm Angled, Hydrophilic Coating wires (Terumo) | 4,2286.00 | 3-Port Manifold (Merit) | 857.00 |
| 0.018, 150cm Angled, Hydrophilic Coating wires (Terumo) | 4,286.00 | Inflation Device 20ml inflation capability, comlete with pressure gauge range 0-30 atmospheres (Merit) | 4,286.00 |
| 0.025, 260cm Angled, Hydrophilic Coating wires (Terumo) | 4,286.00 | ||
| Tiger - Size: 6F (Terumo) | 2,686.00 | Bleedback Control Valve (Merit) | 3,929.00 |
| Femoral Introducer Kit 6F: Adult (Terumo) | 2,357.00 | Puncture Needle 618 Adult (Merit) | 643.00 |
| Femoral Introducer Kit 8F: Adult (Terumo) | 2,357.00 | Angiography Control Syringe (Merit) | 700.00 |
| Transradial Introducer Kit 5F (Terumo) | 2,686.00 | Bag Valve Mask (Adult) 1.5L Bag | 1,602.00 |
| Transradial Introducer Kit 6F (Terumo) | 2,686.00 | Bag Valve Mask (Pedia) 550mL Bag | 1,602.00 |
| Radial Artery Hemostasis Device TR Band (Terumo) | 1,200.00 | Bag VAlve Mask (Infant) 280mL Bag | 1,602.00 |
| Guidewire: 0.035, 150cm, Straight Tip (Merit) | 2,143.00 | Blood Transfusion Set (Terumo) | 107.00 |
| 0.035, 150cm Angled, Hydrophilic Coating wires (Merit) | 2,857.00 | ||
| 0.035, 260cm Angled, Hydrophilic Coating wires (Merit) | 2,857.00 | ||
| Pigtail 4F (Merit) | 2,857.00 | ||
Newborn Screening and Hearing
| OAE Newborn Hearing Screening - Pay Patients | |
| OPD | 325.00 |
| In-Patient | 315.00 |
| with PHIC | 150.00 |
| OAE Newborn Hearing Screening - Service Patients | |
| In-Patient | 100.00 |
| with PHIC | 50.00 |
| Hearing Test for Adults - OPD | 300.00 |
| Auditory Nerve Test | |
| Pay Patients - OPD | |
| Brainstem | 1,500.00 |
| Auditory | 1,500.00 |
| In-Patients | 1,300.00 |
| with PHIC | 700.00 |
| Reader's Fee | 300.00 |
Ophthalmology
| Services | Rate/Cost |
| Fluorescein Angiography | 3,500.00 (c/o PHIC) |
| Fundus photo with printed picture | 800.00 (regular) |
| 640.00 (senior citizen) | |
| Slitlamp (photo, TBUT, etc) | 200.00 (regular) |
| 160.00 (senior) | |
| Visual Field Analyzer | 1,700.00 (regular) |
| 1,260.00 (senior) |
Department of Pathology/Laboratory
| Price | ||
| SARS-COV-2 Antigen Test | 900.00 | |
| Rapid Antibody-Based Test | 1,200.00 | |
| Clinical Microscopy and Parasitology | Price | |
| Urine Microalbumin Test | 250.00 | |
| Acetone | 60.00 | |
| Bence Jones Protein | 30.00 | |
| Bile | 60.00 | |
| Myoglobin | 60.00 | |
| Nitrite | 60.00 | |
| pH | 60.00 | |
| Routine Fecalysis | 60.00 | |
| Routine Urinalysis | 100.00 | |
| Urine Albumin | 30.00 | |
| Urine Sugar | 75.00 | |
| Urobilinogen | 60.00 | |
| Histopathology | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Serology Tests | Price | |
| CA 125 | 1,100.00 | |
| CA 19-9 | 1,750.00 | |
| Anti-HAV IgM | 1,000.00 | |
| Bacteriology | Price | |
| Culture and Sensitivity of miscellaneous specimens | 2,000.00 | |
| AFB | 100.00 | |
| Blood culture & Sensitivity (Bottle and Processing Fee) | 2,000.00 | |
| Stool Culture and Sensitivity | 2,000.00 | |
| Gram's Stain | 100.00 | |
| India Ink | 100.00 | |
| KOH | 100.00 | |
| Physical & Chemical Water | 1,900.00 | |
| Stoll Culture Only | 1,000.00 | |
| Welding | 320.00 | |
| Water Microbiological Analysis (Private) | 500.00 | |
| Water Microbiological Analysis (Government) | 450.00 | |
| Water Microbiological Analysis (Specimen Bottle) | 20.00 | |
| Food Analysis (Salt, Noodles, Borax) | 200.00 | |
| Immunosero | Price |
| AFP (Quanti) | 950.00 |
| Anti-HBs (Qualitative) | 400.00 |
| Anti-TP (Qualitative) | 300.00 |
| Anti-HAV (Qualitative) | 500.00 |
| Anti-HCV (Qualitative) | 500.00 |
| ASO-Titer (Semi-Quantitative) | 150.00 |
| B-HCG (Quantitative) | 900.00 |
| CA-125 (Quantitative) | 1,000.00 |
| CEA (Quantitative) | 950.00 |
| Chikunggunya IgM (Qualitative) | 900.00 |
| CRP (Quantitative) | 950.00 |
| CRP (Qualitative) | 200.00 |
| FT3 (Quantitative) | 600.00 |
| Dengue Duo NS1 (Qualitative) | 1,350.00 |
| Dengue IgG/IgM (Qualitative) | 700.00 |
| Dengue NS1 (Qualitative) | 900.00 |
| Drug Testing (Regular) | 250.00 |
| Drug Testing (Student) | 225.00 |
| Drug Testing (with Gov't. Company ID) | 200.00 |
| FT4 (Quantitative) | 600.00 |
| H, Pylori (Qualitative) | 800.00 |
| HBsAg (ELISA) (Quantitative) | 800.00 |
| HsCRP (Quantitative) | 950.00 |
| Leptospira IgG/IgM (Qualitative) | 900.00 |
| Occult Blodd (Rapid) | 300.00 |
| Pregnancy test (Serum/Urine) Qualitative | 150.00 |
| Salmonella typhi IgG/IgM | 700.00 |
| Seminal Fluid | 150.00 |
| T3 (Quantitative) | 525.00 |
| T4 (Quantitative) | 520.00 |
| T3T4 (Quantitative) | 950.00 |
| TPSA (Quantitative) | 1,000.00 |
| Trop I (Quantitative) | 1,000.00 |
| TSH | 850.00 |
| Anti-HBs (Quantitative) | 950.00 |
| Trop I (Qualitative) | 900.00 |
| HBeAg | 700.00 |
| Rheumatoid Factor | 250.00 |
| Anti Hbc | 750.00 |
| Anti Hbe | 750.00 |
| Ant HBs | 950.00 |
| Bloodbank | Price |
| Ab Screening | 650.00 |
| Blood Typing | 150.00 |
| CD4 | 2,000.00 |
| Crossmatching Conventional | 200.00 |
| Malaria (ELISA) | 600.00 |
| Syphilis (ELISA) Quantitative | 600.00 |
| Crossmatching LISS | 250.00 |
| RH Typing | 100.00 |
| Du Testing | 200.00 |
| HCV (ELISA) | 700.00 |
| HIV 1/2 (ELISA) | 600.00 |
| HIV Ab (Qualitative) 1/2 (ICT) | 450.00 |
| HBsAg (Qualitative) | 250.00 |
| Peripheral Blood Smears | Price |
| Readers Fee | 200.00 |
| Processing Fee | 250.00 |
| Total | 450.00 |
| Autopsy (For Service Patients: No PROC. and PROF. Fee) | |||
| Processing Fee | Prof. Fee | Total | |
| Full | 3,000.00 | 6,000.00 | 9,000.00 |
| Partial | 2,000.00 | 4,000.00 | 6,000.00 |
| Hematology | Price |
| CBC | 250.00 |
| Protime | 280.00 |
| APTT | 400.00 |
| CTBT | 100.00 |
| Platelet Count | 100.00 |
| Malaria (Thick and Thin Smears) | 200.00 |
| Filaria Smear | 200.00 |
| LWCT | 100.00 |
| L.E. Preparation | 200.00 |
| Hemoglobin | 100.00 |
| Hematocrit | 100.00 |
| Reticulocyte Count | 150.00 |
| ESR | 100.00 |
| Factor VIII Assay | 1,000.00 |
| Factor IX Assay | 1,000.00 |
| LA 1 Testing (Screening) | 1,000.00 |
| LA 2 Testing (Confirmatory) | 1,000.00 |
| Clinical Chemistry | Price |
| 24H Creatinine Clearance | 550.00 |
| Acid Phosphatase | 300.00 |
| Albumin | 130.00 |
| Alkaline Phosphate | 170.00 |
| Amylase | 250.00 |
| Bilirubin | 185.00 |
| BUN | 90.00 |
| Calcium | 190.00 |
| Chloride | 190.00 |
| Cholesterol | 150.00 |
| CK-MB | 1,200.00 |
| Creatinine | 110.00 |
| CSF Protein | 500.00 |
| D-Dimer | 1,200.00 |
| FBS/RBS/2-HPP | 85.00 |
| Gamma-Glutamyl Transerase | 500.00 |
| HBA1c | 850.00 |
| HDL-Chlesterol | 150.00 |
| LDH | 250.00 |
| Lipid Profile | 400.00 |
| Lithium | 300.00 |
| Magnesium | 350.00 |
| OGTT | 340.00 |
| Phosphorus | 275.00 |
| Potassium | 190.00 |
| SGOT/AST | 160.00 |
| SGPT/ALT | 160.00 |
| Sodium | 190.00 |
| TPAG | 250.00 |
| Triglyceride | 150.00 |
| Uric Acid | 120.00 |
| Urine Protein | 500.00 |
Psychological Assessment Services
| Services | Rates |
| Neuropsychiatric Evaluation | 350.00 |
| Psychological Test | 700.00 |
| IQ Test | 300.00 |
Pulmonary Care
| Item Description | Price |
| Air Filter (Airvo) 2pcs/pack | 2,995.00 |
| Cleaning Sponges Stick | 270.00 |
| HFNC - Adult size: Small (Lifemed) | 2,200.00 |
| HFNC - Adult size: Medium (Lifemed) | 2,200.00 |
| HFNC - Intermediate Infant Maximum Flow Rate 8LMP (Lifemed) | 2,200.00 |
| Adult Tube and Chamber Kit (includes: humidifier with water chamber, connector | 7,000.00/set |
| Pediatric Tube and Chmaber Kit (includes: humidifier with water chamber) | 7,140.00/set |
| Air Filter (Lifemed) | 214.00 |
| Bacterial Filter (Hudson) | 625.00 |
| Heat and Moisture Exchanger (Covidien) | 625.00 |
| Non Rebreathing Mask (NRBM) | 298.00 |
| Closed Suction Catheter size: French #6 with tubing | 2,000.00 |
| Closed Suction Catheter size: French #8 with tubing | 2,000.00 |
| Closed Suction Catheter size: French #10 with tubing | 2,000.00 |
| Closed Suction Cathter size: French #12 (MedCaptain) | 1,715.00 |
| Aerosol tee connector | 79.21/each |
| Cont. 100ft. roll corrugated tubing (100ft/4ft=25 sets) | 78.21/each |
| Flow-oriented incentive spirometer | 621.42/each |
| Volumetric incentive spirometer | 642.85/each |
| Large Volume Nebulizer | 708.32/each |
| Non-vented full face mask (small & medium) | 6,000.00/each |
| High Flow Nasal Cannula (small, medium & large) | 2,200.00/each |
| Tube and Chamber Kit | 7,200.00/each |
| One (1) piece 6" cuttable corrugated tubing | 19.55/each |
| One (1) T-piece Set-up | 865.75/set |
| Adult/Pediatric Ventilator | 1,300.00/day |
| Neonatal Ventilator | 1,300.00/day |
Radiology
| Mammogram Procedures | Rates | Professional Fee (Pay Clients) |
| Plain Mammography | 1,200.00 | +500.00 of service rate |
| Post Mastectomy Mammography | 1,250.00 | +500.00 of service rate |
| Mammo Guide Needle Biopsy | 1,250.00 | +500.00 of service rate |
| Mammogram with Sillicon | 1,800.00 | +500.00 of service rate |
| Mammogram with Ultrasound | 2,200.00 | +500.00 of service rate |
| Post Mastectomy Mammo with UTZ | 1,800.00 | +500.00 of service rate |
| Mammo comp. Mag./Film | 300.00 | +300.00 of service rate |
| CT-SCAN Procedures | Rates |
| Brain | 2,500.00 |
| Orbits | 2,500.00 |
| Mandible | 2,500.00 |
| PNS/ Facial | 3,000.00 |
| PNS Screening | 1,000.00 |
| Temporal / Mastoid / Pituitary | 2,500.00 |
| Nasopharynx / Oropharynx / Oral Cavity | 2,500.00 |
| Neck / Thyroid | 2,800.00 |
| Chest | 2,800.00 |
| Extremities (Upper/Lower) | 2,800.00 |
| Whole Abdomen / KUB | 4,000.00 |
| Upper / Lower Abdomen | 2,700.00 |
| Kidneys / Adrenal / Liver / Pancreas | 2,700.00 |
| Hip / Pelvis | 2,800.00 |
| Cervical | 2,700.00 |
| Thoraic | 2,800.00 |
| Cervico-Thoraic | 4,500.00 |
| Lumbar | 2,800.00 |
| Thoraco-Lumbar | 4,500.00 |
| Lumbo-Sacral | 2,800.00 |
| Whole Spine | 7,000.00 |
| Stonogram | 4,000.00 |
| Urogram | 4,500.00 |
| CT Angiogram | 5,200.00 |
| HRCT (High Resolution) | 3,000.00 |
| Biopsy | 1,000.00 |
| Note: Contrast Materials are NOT included. For with contrast procedure, the patient should buy the prescribed materials and Contrast Medium. | |
| Ultrasound | Rates |
| Aspiration Biopsy | 700.00 |
| Biometry (pelvic-fetal aging-evaluation) | 750.00 |
| Biometry with biophysical profile | 800.00 |
| Breasts | 1,000.00 |
| Cranial | 750.00 |
| Cardiac | 800.00 |
| Cardio-thoracic | 850.00 |
| Chest with marker | 800.00 |
| F.A.S.T. | 700.00 |
| Guided FNAB | 700.00 |
| Guided para/thoracentesis | 700.00 |
| Guided prostate biopsy | 700.00 |
| Guided IJ catheter insertion | 700.00 |
| Guided femoral catheter insertion | 700.00 |
| Hepatobiliary | 750.00 |
| Hepatopancreas | 800.00 |
| Inguinoscrotal | 850.00 |
| Kidney (renal) | 700.00 |
| KUB (Kidney and Urinary Bladder) | 750.00 |
| KUBP (Kidney, Urinary Bladder and Prostate | 800.00 |
| Liver/ Hepatic | 700.00 |
| Liver Biopsy | 1,800.00 |
| Lung Biopsy | 1,800.00 |
| Lower Abdomen (female) | 1,000.00 |
| Lower Abdomen (male) | 800.00 |
| Mass (soft tissue) | 850.00 |
| Neck | 850.00 |
| Pelvic (tans-vaginal and abdominal) | 850.00 |
| Parotid | 800.00 |
| Prostate | 700.00 |
| Ocular (picture) | 800.00 |
| Scrotal (testicles) | 800.00 |
| Thoracic (lung) | 700.00 |
| Thyroid | 800.00 |
| Upper Abdomen | 1,100.00 |
| Upper Abdomen and Kidneys | 1,300.00 |
| Upper Abdomen and Pelvis | 1,300.00 |
| Whole Abdomen (male and pedis) | 1,500.00 |
| Whole Abdomen (female) | 1,800.00 |
Physical Medicine and Rehabilitation
| Rhabilitation Treatment | Rates |
| Basic Rate (Inclusive of Hot Moist Pack (HMP) or Infrared Radiation (IRR), Transcutaneous Electrical Nerve Stimulator (TENS), Electrical Stimulator (ES) (1-2 sites), and Exercises) |
200.00 |
| Add on: | |
| Therapeutic Ultrasound (per area) | 20.00 |
| Paraffin Wax | 20.00 |
| Additional ES/TENS (per site) | 20.00 |
| Treadmill | 20.00 |
| Tilt Table | 30.00 |
| Cervical Traction Lumbar Traction | 30.00 |
| Low Level Laser Therapy (per area) | 150.00 |
| (additional per area) | 50.00 |
| Occupational Therapy Treatment | |
| Adult/Pediatric | 350.00 |
| Upper Extremity only | 250.00 |
