| HOSPITAL SERVICE FEES | RATE | ||
| 1 | Newborn Screening (Maternity Health Center) | 1800 | |
| LABORATORY CHARGES | |||
| HEMATOLOGY | |||
| 2 | Lipid Profile Inclusive of: | 500 | |
| 2 | Cholesterol | 500 | |
| 2 | Triglyceride | 500 | |
| 2 | HDL (High-Density Lipoprotein) | 500 | |
| 2 | LDL (Low-Density Lipoprotein) | 500 | |
| 2 | VLDL (Very Low-Density Lipoprotein) | 500 | |
| 3 | Liver Profile/Liver Function Tests, inclusive of: | 600 | |
| 3 | Serum Glutamic Pyruvic Transaminase (SGIJI) | 600 | |
| 3 | Serum Glutamic Oxaloacetic Transaminase (SGOT) | 600 | |
| 3 | 3 Alkaline Phosphatase 600.00 | 600 | |
| 3 | Total Bilirubin | 600 | |
| 3 | Albumin | 600 | |
| 3 | Total Protein and Globulin | 600 | |
| 4 | Electrolytes Panel, Inclusive of: | 500 | |
| 4 | Sodium | 500 | |
| 4 | Potassium | 500 | |
| 4 | Chloride | 500 | |
| XRAY | |||
| 5 | Mandible Anteroposterior-Lateral | 400 | |
| 6 | Temporomandibular joint (TMJ) | 800 | |
| 7 | Nasal Bridge | 700 | |
| 8 | Chest Anteroposterior or Anteroposterior/Lateral | 350 | |
| or 1osteroanterior/Lateral (Adult) | |||
| 9 | Chest Anteroposterior/Lateral (Child) | 450 | |
| 10 | Apicolodotic View | 200 | |
| 11 | Spot View | 400 | |
| 12 | Skull Anteroposterior/Lateral or Skull Series | 600 | |
| 13 | Paranasal Sinuses Series | 600 | |
| 14 | Knee Anteroposterior/Lateral | 800 | |
| 15 | Both Knees Anteroposterior/Lateral | 400 | |
| 16 | Foot Posteroanterior/Oblique | 450 | |
| 17 | Feet Posteroanterior/Oblique | 800 | |
| 18 | Leg Anteroposterior/Lateral | 450 | |
| 19 | Both Legs Anteroposterior/Lateral | 800 | |
| 20 | Thigh/Femur Anteroposterior/Lateral | 450 | |
| 21 | Thigh/Femur Anteroposterior/Lateral, Both | 800 | |
| 22 | Hip Anteroposterior | 350 | |
| 23 | Both Hips | 700 | |
| 24 | Lumbosacral Spine Anteroposterior/Lateral | 500 | |
| 25 | Cervical Spine Anteroposterior/Lateral | 400 | |
| 26 | Clavicle Anteroposterior | 300 | |
| 27 | Both Clavicles Anteroposterior | 500 | |
| 28 | Shoulder Anteroposterior | 400 | |
| 29 | Both Shoulders Anteroposterior | 700 | |
| 30 | Elbow Anteroposterior/Lateral | 400 | |
| 31 | Both Elbows Anteroposterior/Lateral | both 700 | |
| 32 | Forearm Anteroposterior/Lateral | single 400 both 700 | |
| 33 | Arm/Humerus Anteroposterior/Lateral | single 400 both 700 | |
| 34 | Scout Film Abdomen | 500 | |
| 35 | Plain Abdomen | 500 | |
| 36 | Abdomen Supine/ Upright | 500 | |
| 37 | Plain KUB | 500 | |
| 38 | Barium Swallow | 1000 | |
| 39 | Wrist Anteroposterior/Lateral | 600 | |
| 40 | Both Wrists Anteroposterior/Lateral | 350 | |
| 41 | Hand Anteroposterior/Oblique or Posteroanterior/Lateral | 450 | |
| 42 | Both Hands Anteroposterior/Oblique or Posteroanterior/Lateral | 800 | |
| 43 | Babygram | 300 | |
| WATER’S VIEW | |||
| 44 | Submentovertical view | 400 | |
| 45 | Verticosubmental view | 400 | |
| SOFT TISSUE LATERAL | |||
| 46 | Neck | 400 | |
| 47 | Nose | 400 | |
| SPINE XRAY | |||
| 48 | Thoracolumbar Anteroposterior/Lateral | 650 | |
| 49 | LumbosacralAnteroposterior/Lateral | 500 | |
| 50 | Thoracic Cage Anteroposterior | 500 | |
| 51 | Thoracic Spine Anteroposterior/Lateral | 500 | |
| COMPUTED TOMOGRAPHY (CT) SCAN PROCEDURES RATES | |||
| 52 | Cranial (Plain) | 3200 | |
| 53 | Chest (High Resolution) | 4800 | |
| 54 | Lower Abdomen (Routine) | 5175 | |
| 55 | Whole Abdomen with Contrast | 13000 | |
| 56 | Cervical Spine (Contrast) | 7340 | |
| 57 | Mastoid Plain | 7000 | |
| 58 | Mastoid with Contrast | 9000 | |
| 59 | Upper Abdomen with Contrast | 9000 | |
| 60 | Stonogram | 6500 | |
| 61 | Mandible Plain | 8000 | |
| 62 | Mandible with Contrast | 10000 | |
| 63 | Facial with Contrast | 9000 | |
| 64 | Temporal Plain | 8000 | |
| 65 | Temporal with Contrast | 10000 | |
| 66 | Neck with Contrast | 9000 | |
| MEDICAL CERTIFICATE | |||
| 67 | Ordinary | 50 | |
| 68 | Medico Legal | 150 | |
| 69 | Clinical Abstract | 100 | |
| 70 | Discharge Summary | 50 | |
| 71 | Confinement Certificate | 50 | |
| 72 | Operative Record | 50 | |
| LABORATORY TESTS: | |||
| 73 | Electrolytes Panel, Inclusive of: | 600 | |
| 73 | Sodium | 600 | |
| 73 | Potassium | 600 | |
| 73 | Chloride | 600 | |
| 73 | Ionized Calcium | 600 | |
| ROOM RATES: | |||
| SERVICE WARD | |||
| OPERATING ROOM | |||
| NONPHILHEALTH SERVICE WARD | |||
| USE OF OPERATING ROOM | |||
| 74 | Use of Anesthesia Machine (Per Use) | 200 per use | |
| 75 | Use of Cardiac Monitor (Per Day) | 200 | |
| 76 | Use of Cauter Machine (Per Use) | 200 | |
| 77 | Use of Pulse Oximeter | 100 | |
| PHILHEALTH SERVICE WARD | |||
| DELIVERY ROOM RATES | |||
| NONPHILHEALTH SERVICE WARD | |||
| 78 | Use of Incubator | 300 | |
| PHILHEALTH SERVICE WARD | |||
| 79 | Use of Oxygen (Per Tank) | 1000 | |
| 80 | Use of Nebulizer (Per Use) | 100 | |
| 81 | Coionoscopy | 4500 | |
| 82 | Gastroscopy | 3500 | |
| LABORATORY CHARGES | |||
| 83 | Complete Blood Count (CBC) with Platelet Count | 200 | |
| 84 | Complete Blood Count (CBC only) (Manual Method) | 150 | |
| 85 | Hemoglobin (Hgb) + Hematocrit (Hct) | 100 | |
| 86 | Platelet Count Only | 100 | |
| 87 | Clotting Time and Bleeding Time | 150 | |
| 88 | Clotting Reaction Time | 150 | |
| 89 | Reticulocyte Count | 100 | |
| 90 | Peripheral Blood Smear | 200 | |
| 91 | Malaria Thin and Thick Smear | 100 | |
| 92 | Le Prep (Lupus Erythematosus Preparation) | 200 | |
| 93 | Prothrombin Time with International Normalized Ratio + Activated Partial Thromboplastin Time | 700 | |
| 94 | Prothrombin Time with International Normalized Ratio | 400 | |
| CLINICAL MICROSCOPY AND PARASITOLOGY | |||
| 95 | Activated Partial Thromboplastin Time | 400 | |
| 96 | Routine Urinalysis | 60 | |
| 97 | Fecalysis | 60 | |
| 98 | Pregnancy (Rapid- (urine) Test Immunochromatography) | 100 | |
| 99 | Fecal Occult Blood Test (Hydrogen Peroxide Method) | 100 | |
| 100 | Fecal Occult Blood Test (Qualitative) | 100 | |
| 101 | Fecal Occult Blood Test (Rapid-Antigen Immunochromatography) | 200 | |
| 102 | Wet Smear for Trichomonas | 150 | |
| 103 | Pin Worm Identification (Tape Method | 100 | |
| 104 | Stool Concentration Technique | 100 | |
| 105 | Fasting Blood Sugar (FBS) | 120 | |
| 106 | Random Blood Sugar (RBS) | 120 | |
| 107 | 2-Hour Post Prandial Blood Sugar | 120 | |
| 108 | Oral Glucose Tolerance Test (OGTT) | 400 | |
| 109 | Creatinine | 100 | |
| 110 | Creatinine Kinase MB (Qualitative/ Rapid Test) | 350 | |
| 111 | SARSCov2 (COVID) Rapid Antigen Test | 500 | |
| 112 | Urea Nitrogen (BUN) | 100 | |
| 113 | Uric Acid (BUA) | 100 | |
| 114 | Cholesterol | 100 | |
| 115 | Blood Urea Nitrogen | 100 | |
| 116 | Blood Creatinine | 100 | |
| 117 | Blood Uric Acid | 100 | |
| 118 | Liver Profile/Liver Function Tests, Inclusive of: | 500 | |
| 118 | SGPT/ALT (Alanine Aminotransferase Serum glutamic-pyruvic transaminase) | 500 | |
| 118 | SGOT/AST (Aspartate Aminotransferase Serum glutamic-oxaloacetic transaminase) | 500 | |
| 118 | Alkaline Phosphatase | 500 | |
| 118 | Total Bilirubin | 500 | |
| 118 | Total Protein Albumin | 150 | |
| 119 | Alkaline Phosphatase | ||
| 120 | Serum Glutamic Pyruvic Transaminase (SGPT)/Alanine Aminotransferase (ALT) | 150 | |
| 121 | Serum Glutamic Oxaloacetic Transaminase (SGOT)/ Aspartate Aminotransferase (AST) | 150 | |
| 122 | CK-MB (Rapid Test) | 350 | |
| 123 | Troponin I (Qualitative/Rapid Test) | 600 | |
| 124 | Troponin T (Qualitative/Rapid Test) | 400 | |
| 125 | Albumin | 100 | |
| 126 | Total Protein | 100 | |
| 127 | Globulin | 100 | |
| 128 | Amylase | 150 | |
| 129 | Lipase | 150 | |
| 130 | Hemogluco Test | 50 | |
| 131 | Dengue Immunoglobulin G (IgG), | 1400 | |
| Immunoglobulin M (IgM), Nonstructural protein | |||
| 1 (NSI) [Duo Rapid Test] | |||
| 132 | Dengue Immunoglobulin G (lgG)/ | 600 | |
| Immunoglobulin M (lgM) | |||
| 133 | Dengue Nonstructural protein 1 (NS1) Antigen | 800 | |
| only [Rapid Test| | |||
| 134 | Hemodialysis (with Philhealth, with dialyzer and | 4706 | |
| inclusive of supplies, meds, machine usage, misc. | |||
| fees) | |||
| 135 | Hemodialysis (with Philhealth, without dialyzer | 3706 | |
| and inclusive of supplies, meds, machine usage, misc. fees) | |||
| 136 | ASO (Anti-Streptolysin O) | 250 | |
| 137 | Anti-Treponemal Ab Qualitative Assay | 350 | |
| 138 | CRP (C-Reactive Protein) (Quantitative) | 200 | |
| 139 | Hepatitis A,B, C, Profile, Inclusive of: | 2000 | |
| 139 | Hepatitis A Virus Immunoglobulin G Antibody (Anti-HAV IgG) | 2000 | |
| 139 | Anti Hepatitis A Virus Immunoglobulin M Antibody (Anti-HAV IgM) | 2000 | |
| 139 | Hepatitis B Core Antigen (HBcAg) | 2000 | |
| 139 | Hepatitis B Core Antibody (Anti-Hbc) | 2000 | |
| 139 | Hepatitis B SurfaceAntiger (HBsAg) | 2000 | |
| 139 | Hepatitis B Surface Antibody (Anti-HBs) | 2000 | |
| 139 | Hepatitis B Core Immunoglobulin G and Immunoglobulin M Antibodies (Anti-HBdgM and IgG) | 2000 | |
| 139 | Total Hepatitis B Core Antibody (Total Anti-HBc) | 2000 | |
| 139 | Hepatitis C Virus Antibody (Anti-HCV) | 2000 | |
| 140 | Hepatitis A Profile, Inclusive of: | 550 | |
| 140 | Hepatitis A Virus Immunoglobulin G Antibody (Anti-HAV IgG) | 550 | |
| 140 | Hepatitis A Virus Immunoglobulin M Antibody (Anti-HAV IgM) | 550 | |
| 141 | Hepatitis B Profile, Inclusive of: | 1000 | |
| 141 | Hepatitis B Core Antigen (HBcAg) | 1000 | |
| 141 | Hepatitis B Core Antibody (Anti-Hbc) | 1000 | |
| 141 | Hepatitis B Surf aceAntigen (HBsAg) | 1000 | |
| 141 | Hepatitis B Surface Antibody (Anti-HBs) | 1000 | |
| 141 | Hepatitis B Core Immunoglobulin G and Immunoglobulin M Antibodies (Anti-HBdgM and IgG) | 1000 | |
| 141 | Total Hepatitis B Core Antibody (Total AntiHBc) | 1000 | |
| 142 | Hepatitis B Surface Antigen (HBsAg) Rapid Test 1 | 200 | |
| 143 | Hepatitis B e-Antigen Assay (ELISA) | 200 | |
| 144 | Anti-Hepatitis B Core Immunoglobulin M Assay (ELISA) | 200 | |
| 145 | Anti-Hepatitis B Core Immunoglobulin G Assay (ELISA) | 200 | |
| 146 | Hepatitis C Virus Antigen Antibody Assay | 500 | |
| 147 | Anti Hepatitis A virus Immunoglobulin M Assay (ELISA) | 500 | |
| 148 | Anti Hepatitis A virus Immunoglobulin G Assay (ELISA) | 500 | |
| 149 | Human Immune Deficiency (HIV) Screening [Rapid Test| | 200 | |
| 150 | Human Immune Deficiency (HIV) Antigen Antibody Assay (ELISA) | 200 | |
| 151 | Syphilis/Treponema pallidum Hemagglutination (TPHA) Screening [Rapid Test] | 200 | |
| 152 | Syphilis/ Treponema pallidum Hemagglutination (TPHA) Assay | 400 | |
| 153 | Pan Malaria Antibody Assay | 300 | |
| 154 | Thyroid stimulating hormone Assay | 350 | |
| 155 | Free Prostate Specific Antigen Assay | 3000 | |
| 156 | Alpha Feto Protein Assay | 700 | |
| 157 | Carcino Embroyonic Assay | 700 | |
| 158 | T3 (Triiodothyronine Assay) | 350 | |
| 159 | T4 (Thyroxine Assay) | 350 | |
| 160 | FT3 (Free Triiodothyronine Assay) | 450 | |
| 161 | FT4 (Free Thyroxine Assay) | 450 | |
| 162 | PSA Assay (Prostate Specific Antigen Assay) | 900 | |
| MICROBIOLOGY | |||
| 163 | Gram Stain | 100 | |
| 164 | Acid Fast Stain for TB | 100 | |
| 165 | Acid Fast Bacilli – Direct Sputum Smear Microscopy | 100 | |
| 166 | Potassium Hydroxide test | 150 | |
| 167 | Hepatitis A and B Profile, .Inclusive of | 2000 | |
| 167 | Hepatitis A Virus Immunoglobulin G Antibody (Anti-HAV IgG) | 2000 | |
| 167 | Hepatitis A Virus Immunoglobulin M Antibody (Anti-HAV 1gM) | 2000 | |
| 167 | Hepatitis B SurfaceAntigen (HBsAg) | 2000 | |
| 167 | Hepatitis B Surface Antibody (Anti-HBs) | 2000 | |
| 167 | Hepatitis B Core Immunoglobulin M Antibody (Anti-HBclgM) | 2000 | |
| 167 | Total Hepatitis B Core Antibody (Total Anti-Hbc) | 2000 | |
| 168 | Potassium hydroxide (KOH) or Wet Mount | 150 | |
| 169 | Blood Culture and Sensitivity with Antimicrobial Removal Device (ARD) | 1400 | |
| 170 | Blood Culture and. Sensitivity | 1000 | |
| ANATOMIC PATHOLOGY | |||
| 171 | Papanicolaou Smear (Pap smear) | 150 | |
| BLOOD BANK | |||
| 172 | Antibody Screening (Column Agglutination Method) |
2000 | |
| 173 | Coombs Test , Indirect Antiglobulin Test (IAT) and Direct Antiglobulin Test (DAT) (Tube Method) |
500 | |
| 174 | Weak D Testing (Tube Method) | 180 | |
| 175 | Weak D Testing (Gel Method) | 350 | |
| 176 | Processing Fee (Aliquoting) | 250 | |
| 177 | Urine Hemoglobin | 60 | |
| 178 | Forward ABO and RH grouping (Slide Method) | 100 | |
| 179 | Reverse and Forward ABO and Rh grouping (Tube Method) |
200 | |
| 180 | Reverse and Forward ABO and Rh grouping (Column Agglutination Method) |
600 | |
| 181 | Crossmatching (Column Agglutination Method) Note: blood typing separate charging as indicated in this list) |
500 | |
| 182 | Indirect Antiglobulin Test (Column Agglutination Method) | 400 | |
| 183 | Direct Antiglobulin Test (Column Agglutination Method) | 400 | |
| 184 | Indirect Antiglobulin Test (Tube Method) | 400 | |
| 185 | Direct Antiglobulin Test (Tube Method) | 400 | |
| 186 | Whole Blood (Processing fee for I unit) | 1800 | |
| 187 | Packed Red Blood Cells (Processing fee for I unit) | 1500 | |
| 188 | Platelet Concentrate Random (Processing fee for I unit) | 1000 | |
| 189 | Fresh Frozen Plasma (Processing fee for I unit) | 1000 | |
| 190 | Therapeutic Phlebotomy | 500 | |
| 191 | Aliquot | 250 | |
| ULTRASOUND | |||
| 192 | Breast (Each) | 700 | |
| 193 | Breast (both) | 1200 | |
| 194 | Liver (Single Organ) | 450 | |
| 195 | Gallbladder (Single Organ) | 450 | |
| 196 | Pancreas | 450 | |
| 197 | Spleen | 450 | |
| 198 | Abdominal Aorta | 500 | |
| 199 | Kidneys | 450 | |
| 200 | Urinary Bladder | 450 | |
| 201 | Inguino/Scrotal | 800 | |
| 202 | Scrotal | 450 | |
| 203 | Inguinal | 450 | |
| 204 | Thyroid/Neck | 500 | |
| 205 | Pelvic (Pregnant or Non-Pregnant) | 500 | |
| 206 | Biophysical Scoring | 800 | |
| 207 | Hepato-Biliary Tree (Liver,GB,BT) | 1000 | |
| 208 | Kidney, ureter, bladder (KUB)-Prostate | 1000 | |
| 209 | Kidney, ureter, bladder (KUB) | 900 | |
| 210 | Prostate | 450 | |
| 211 | BPS | 800 | |
| 212 | Pelvic with BPS | 800 | |
| 213 | Pelvic (Twin) | 900 | |
| 214 | Whole Abdomen | 1500 | |
| 215 | Upper Abdomen (Hepatobiliary tree [HBT], Pancreas, Spleen) | 1000 | |
| 216 | Lower Abdomen [Kidney, ureter, bladder (KUB),Prostate, Inguinal} | 1000 | |
| 217 | Hepatobiliary tree/ Right Upper Quadrant (HBT/RUQ) | 1000 | |
| 218 | Transvaginal Ultrasound | 700 | |
| 219 | Transrectal | 700 | |
| 220 | Chest (Both) | 1000 | |
| 221 | Cranial Ultrasound | 600 | |
| ULTRASOUND GUIDED | |||
| 222 | Ultrasound Guided Procedure | 4000 | |
| Others | |||
| 223 | Cerebrospinal Fluid (CSF) | 100 | |
| 224 | Sperm Count | 100 | |
| 225 | Electrocardiography (ECG) | 300 | |
| 226 | 12 Lead ECG | 300 | |
| 227 | 15 Lead ECG (Child) | 400 | |
| 228 | New Born Screening | 1800 | |
| 229 | Out Patient Department (OPD) Fees | Free | |
| 230 | Emergency Room (ER) Fees | Free | |
| 231 | 2D Echo with Color Doppler | 4000 | |
| 232 | Arterial Duplex Scan (LEA) | 4000 | |
| 233 | Venous Duplex Scan (LEV) | 4000 | |
| 234 | Arterial Duplex | 4000 | |
| 235 | Carotid Duplex Scan | 3000 | |
| 236 | Treadmill Stress Test | 2000 | |
| RADIOLOGY | |||
| DIALYSIS | |||
| 237 | Peritoneal Dialysis (with solutions and cap) | 13650 | |
| 238 | Peritoneal Dialysis (with solutions, cap, extension catheter) | 15050 | |
| 239 | Tenchkoff catheter Insertion (with catheter adaptor, PD belt and organizer) | 4670 | |
| AMBULANCE | |||
| 240 | Within Rizal | Free | |
| 241 | From Rizal to Rizal Medical Center (RMC), Amang Rodriguez Memorial Medical Center (ARMMC), Quirino Memorial Medical Center (QMMC) and within Metro Manila | Free | |
| NEW TEST | |||
| 242 | Total Bilirubin (TB), Direct Bilirubin (DB), Indiect Bilirubin (IB) | 450 | |
| 243 | Total Protein Albumin and Globulin (TPAG) | 250 | |
| 244 | Microalbumin Test | 300 | |
| 245 | Alpha Feto Protein (AFP) | 700 | |
| 246 | Lactate Dehydrogenase (LDH) | 250 | |
| 247 | Magnesium | 190 | |
| 248 | Inorganic Phosphorus | 190 | |
| 249 | Total Iron Binding Capacity (TIBC) | 450 | |
| 250 | Total Iron | 350 | |
| 251 | Ferritin | 750 | |
| 252 | Cortisol | 700 | |
| 253 | Follicle Stimulating Hormone (FSH) | 800 | |
| 254 | Luteinizing Hormone (LH) | 800 | |
| 255 | Prolactin | 1200 | |
| 256 | Beta – Human Chorionic Gonadotropin [B-HCG], Serum | 800 | |
| 257 | Typhidot | 500 | |
| 258 | Antinuclear Antibody (ANA) Screening | 500 | |
| 259 | Antinuclear Antibody (ANA) with Titer | 500 | |
| 260 | Rheumatoid Factor Screening with Titer | 150 | |
| 261 | Complement C3 | 350 | |
| 262 | Leptospiral Test | 900 | |
| 263 | Helicobacter pylori (Immunoglobulin G) [ELISA] | 600 | |
| 264 | Helicobacter pylori (Immunoglobulin M) Elisa | 600 | |
| 265 | Culture and Sensitivity (Blood) | 700 | |
| 266 | Culture and Sensitivity (Urine) | 700 | |
| 267 | Culture and Sensitivity (Stool) | 700 | |
| 268 | Mycobacterium tuberculosis (MTB) culture | 2000 | |
| 269 | 24 Hour Urine Potassium | 500 | |
| 270 | 24 Hour Urine Albumin | 500 | |
| 271 | Histopath Small | 900 | |
| 272 | Histopath Medium | 1000 | |
| 273 | Histopath Large | 2800 | |
| 274 | Histopath XLarge | 3000 | |
| 275 | Histopath Body Fluids Cell Block | 600 | |
| 276 | Body Fluids Cell Diff Count | 200 | |
| 277 | Body Fluids Sugar | 200 | |
| 278 | Body Fluids Protein | 200 | |
| 279 | Cytology Smears Fine Needle Aspiration Biopsy (FNAB) 5-8 Smears | 900 | |
| XRAY | |||
| 280 | Mortise View | 600 | |
| 281 | Serendipity View | 600 | |
| 282 | Sunrise View | 600 | |
| PULMO STATION | |||
| 283 | Pulmonary function test without bronchodilator | 1000 | |
| 284 | Pulmonary function test with bronchodilator | 1200 | |
| 285 | Readers fee | 200 | |
| 286 | Use of Cardiotocography (CTG)/fetal monitor | 700 then 150 per hour | |
| ADDITIONAL ICU FEE | |||
| 287 | Intensive Care Unit (ICU) room rate | 1,000/day | |
| 288 | Use of ventilator | 1,000/day | |
| 289 | Nebulizing fee | 50.00/day | |
| ULTRASOUND | |||
| 290 | Non Stress Test (NST) | 400 | |
| 291 | Contraction Stress Test (CST) | 400 | |
| 292 | Twin TVS 1st Trimester | 1000 | |
| 293 | Pelvic Triplets | 2000 | |
| 294 | Modified Biophysical Score (BPS) with Non Stress Test (NST) | 800 | |
| 295 | Twin Biophysical Score (BPS) with Non Stress Test (NST) | 1000 | |
| 296 | Placental Doppler | 1200 | |
| 297 | Obstetric Doppler | 1400 | |
| 298 | Obstetric (OB) Doppler with Biophysical Score (BPS) and Non Stress Test (NST) | 1400 | |
| 299 | Obstetric (OB) Doppler (Twins) | 1800 | |
| 300 | Congenital Anomaly Scan (CAS) | 1400 | |
| 301 | Multiple Pregnancy Congenital Anomaly Scan (CAS) | 1500 | |
| 302 | Multiple Pregnancy Placental Doppler | 2000 | |
| 303 | Congenital Anomaly Scan (CAS)/Obstetric (OB) Doppler | 2000 | |
| 304 | Congenital Anomaly Scan (CAS)/Placental Doppler | 2000 | |
| 305 | Twin Congenital Anomaly Scan (CAS) | 2000 | |
| 306 | Reader’s fee for special procedures | 50 | |
| MEDICAL SUPPLIES | |||
| 307 | Operative sponge (OS) [2 pieces/pack] | 30 | |
| 308 | Narrow Strip | 60 | |
| 309 | Cherries | 30 | |
| 310 | Operating Room (OR) Pack | 500 | |
| 311 | Sterile Gloves | 30 | |
| 312 | Cord Clamp | 15 | |
| 313 | Urine Bag | 65 | |
| OPERATING ROOM PROCEDURES | |||
| 314 | Respirator Tubing | 900 | |
| 315 | Cardiac Defibrillator | 50 | |
| 316 | Suction Machine | 100 | |
| 317 | CTG Machine | 400 | |
| 318 | Infusion Pump | 500 a day | |
| 319 | Photo Therapy or Billilamp | 300 a day | |
| 320 | Droplight | 50 | |
| 321 | Oxygen Concentrator | 20per hour | |
| 322 | Radiant Warmer | 300 per day | |
| 323 | Hemodialysis (User’s Fee Only-1st Session) | 1200 | |
| 324 | Hemodialysis (User’s Fee Only-Succeeding) | 600 up to Usage of Dialyser | |
| 325 | Respirator/Ventilator (excluding oxygen) | 500 | |
| 326 | Saline Infusion | 700 | |
| 327 | Hysteronosalphingogr | 700 | |
| 328 | Cardiotocography | 400 | |
| 329 | Non-Stress Test (NST) | 400 | |
| PHYSICAL THERAPY | |||
| 330 | Ultrasound | P400 maximum of 2 modalities/ session and P90 per additional modalities for charity |
|
| 330 | Transcutaneous Electric Stimulator (TENS | P400 maximum of 2 modalities/ session and P90 per additional modalities for charity |
|
| 330 | Hot Moist Pack | P400 maximum of 2 modalities/ session and P90 per additional modalities for charity |
|
| 330 | Traction | P400 maximum of 2 modalities/ session and P90 per additional modalities for charity |
|
| 331 | Extracorporeal Shockwave Therapy | 300 / session | |
| 332 | Patient without modalities – Exercise only | 300 All Patients | |
| 333 | Musculoskeletal (MSK) Ultrasound | 1200 | |
| 334 | Reader’s fee | 360 | |
| MAGNETIC RESONANCE IMAGES PROCEDURES | |||
| 335 | Cranial MRI (Plain) | 7170 | |
| 336 | Cranial MRI (Contrast) | 14450 | |
| 337 | Head Stroke IAC Sella MRI | 7000 | |
| 338 | Neck MRI | 6400 | |
| 339 | Chest MRI (Plain) | 7170 | |
| 340 | Chest MRI (Contrast) | 15980 | |
| 341 | Cervical Spine MRI (Plain) | 7170 | |
| 342 | Cervical Spine MRI (Contrast) | 15980 | |
| 343 | Knee MRI (Plain) | 7170 | |
| 344 | Knee MRI (Contrast) | 14450 | |
| 345 | Shoulder MRI (Plain) | 7170 | |
| 346 | Shoulder MRI (Contrast) | 15980 | |
| 347 | Hip/Bony Pelvis MRI | 6325 | |
| 348 | Orbit MRI (Plain) | 7170 | |
| 349 | Orbit MRI (Contrast) | 14450 | |
| 350 | Facial MRI (Plain) | 7170 | |
| 351 | Facial MRI (Contrast) | 14450 | |
| 352 | Thoracic MRI (Plain) | 7170 | |
| 353 | Thoracic MRI (Contrast) | 14450 | |
| 354 | Lumbar/Lumbroscal Spine MRI (Plain) | 7170 | |
| 355 | Lumbar/Lumbroscal Spine MRI (Contrast) | 14450 | |
| 356 | Whole Abdomen MRI (Plain) | 8700 | |
| 357 | Whole Abdomen MRI (Contrast) | 18980 | |
| 358 | Pelvis MRI (Plain) | 7170 | |
| 359 | Pelvis MRI (Contrast) | 14450 | |
| 360 | Elbow MRI (Plain) | 7170 | |
| 361 | Hand/Wrist MRI (Plain) | 7170 | |
| 362 | Hand/Wrist MRI (Contrast) | 14450 | |
| 363 | Upper Extremely MRI (Plain) | 8700 | |
| 364 | Upper Extremely MRI (Contrast) | 15980 | |
| 365 | Femur/Leg MRI (Plain) | 8700 | |
| 366 | Femur/Leg MRI (Contrast) | 15980 | |
| 367 | Foot/Ankle MRI (Plain) | 7170 | |
| 368 | Foot/Ankle MRI (Contrast) | 14450 | |
| 369 | MRA MRI (Plain) | 7170 | |
| 370 | MRA MRI (Contrast) | 14450 | |
| 371 | MRCP MRI (Plain) | 8700 | |
| 372 | MRCP MRI (Contrast) | 15980 | |
| 373 | Prostate MRI (Plain) | 7170 | |
| 374 | Prostate MRI (Contrast) | 14450 | |
