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JRRMMC's Rates and Fees

WardsExecutive SuiteSuitePrivateSemi-Private
PAYWARD I   Php 2,500.00/day Room Nos. 4101 and 4102 Php 1,500.00/day Rooms Nos. 4103,4105,4107, 4108,4109,4111 and 4114 Php 900.00/day Male:Room Nos. 4104A-c;4112A-D Female:Rooms Nos. 4106A-c;4110A-C 4113A-D
PAYWARD II Php 3,000.00/day Rooms No. 4201 Php 2,500.00/day Room No. 4202 Php 2,200.00/day Room No. 4214 Php 1,500.00/day Room Nos.4212 and 4203 to 4210 Php 900.00/day Male: 4216 - Bed A-E Female: 4115 - Bed A-E
ICU Php 3,000.00/day Php 2,800.00/day Php 2,300.00/day Php 1,700.00/day Php 1,300.00/day
Burn Unit Php 1,500.00/day Php 1,500.00/day Php 1,500.00/day Php 900.00/day
Item CodeItem DescriptionItem Price
LAB 0006 BLood Gram Stain/Culture and Sensitivity 730.00
LAB 0007 Blood Gram Stain 80.00
LAB 0008 WOund Gram Stain/Culture and Sensitivity 405.00
LAB 0009 Wound Gram Stain 80.00
LAB0010 Wound Culture and Sensitivity 325.00
LAB0002 Sputum Gram Stain/Culture and Sensitivity 405.00
LAB0005 Cystology Gram Stain/Culture and Sensitivity 405.00
LAB0004 Cystology Gram Stain/Culture and Sensitivity 80.00
LAB0009 India Ink 175.00
LAB001 AFB Smear 80.00
LAB0010 Creatinine Clearance 180.00
LAB004 Aerobic Culture 325.00
LAB005 Aerobic Culture (Urine) 325.00
LAB006 Aerobic Culture (Stool) 325.00
LAB007 Aerobic Culture (Excudates) 325.00
LAB008 Aerobic Culture (CSF) 325.00
LAB009 RPR 110.00
LAB010 Hepatitis A Virus (HAV-IgM) 230.00
LAB011 Hepatitis 230.00
LAB012 HBSAG (RPHA) 230.00
LAB013 HBSAG (EIA) 230.00
LAB014 Anti-Hbc IgM 350.00
LAB015 Anti-Hbs 220.00
LAB015 Anti-Hbs 220.00
LAB016 Anti-Hbc/Hbs AG 455.00
LAB017 HBSAG (Strips) 145.00
LAB018 Hepa B Profile 1180.00
LAB019 Hepa C Profile 1182.00
LAB020 HCV (PA) 335.00
LAB021 HCV (EIA) 415.00
LAB022 HIV 1 & 2 310.00
LAB024 HIV EIA 415.00
LAB025 ASO 130.00
LAB026 CRP 130.00
LAB027 Rheumatoid Factor 130.00
LAB028 Typhoid AG (Typhidot) 945.00
LAB029 Widal 195.00
LAB030 Dengue Antigen IgG 650.00
LAB031 Dengue Antigen IgM 0.00
LAB032 C3 165.00
LAB033 Screening Fee 1700.00
LAB034 Whole Blood Screening Fee 1700.00
LAB035 Packed Red Blood Cells Screening Fee 1700.00
LAB036 PC, FFP, Cyoprecipitates, Crysupermante 900.00
LAB038 PSA (Prostatic Specific Antigen) 950.00
LAB039 Washing of PRBC 500.00
LAB040 ABO/RH Typing 130.00
LAB098 Amylase 180.00
LAB082 Blood Urea Nitrogen 80.00
LAB080 BLood Uric Acid 90.00
LAB105 Calcium 140.00
LAB089 Chloride 140.00
LAB086 Total Cholesterol 90.00
LAB099 CPK-MB 955.00
LAB081 Creatinine 90.00
LAB079 Glucose 80.00
LAB084 HDL/LDL (with Triglyceride and Cholesterol) 675.00
LAB083 Lipid Profile 675.00
LAB088 Potassium 140.00
LAB092 Serum Albumin 80.00
LAB107 Cross Matching 195.00
LAB096 SGOT 140.00
LAB097 SGPT 140.00
LAB103 Troponin I 1,800.00
LAB111 OGCT 0.00
LAB087 Sodium 140.00
LAB090 TP A/G Ratio 155.00
LAB085 Triglyceride 195.00
LAB102 HBAIC 635.00
LAB047 24-Hours Urine TP Determination 220.00
LAB050 Fecalysis 40.00
LAB051 Occult Blood Test 40.00
LAB048 Pregnancy Test 100.00
LAB049 Semen Analysis 90.00
LAB052 Smear for Amoeba 50.00
LAB053 Stone Analysis 320.00
LAB043 Routine Urinalysis 50.00
LAB045 Urine Albumin (Qualilative) 40.00
LAB044 Urine Sugar (Qualilative) 40.00
LAB063 LEE Preparation (Manual) 175.00
LAB061 LEE & White, Cloting Time/Bleeding TIme 50.00
LAB065 Bone Marrow Aspiration 520.00
LAB108 Clotting Time/Bleeding Time 50.00
LAB062 Clot Retraction Time 150.00
LAB056 Complete Blood Count 130.00
LAB067 CSF Analysis (Complete) 260.00
LAB068 CSF Cell Count/Differential Count 95.00
LAB069 Sugar (FBS/RBS) 80.00
LAB070 Protein 80.00
LAB058 DIc Panel (PT, aPTT) 485.00
LAB059 Prothrobin TIme 225.00
LAB060 Activated Prothrobin Time 260.00
LAB071 ESR 80.00
LAB072 Malarial Smear (Slide) 130.00
LAB066 Osmotic Fragility Test 240.00
LAB057 Reticulocyte Count 75.00
LAB106 Schilling's Hemogram 195.00
LAB113 Complete Autopsy 3,900.00
LAB12 Beta HCG(H-Mode) 750.00
LAB074 Frozen Section 710.00
LAB1 Partial Autopsy 1,950.00
LAB10 IUFD and Disposition Fee 100.00
LAB13 Large/Radical (Breast, Uterus, RND) 650.00
LAB14 Histopath (Medium) 455.00
LAB15 PSA (Prostatic Specific Antigen) w/Dilution 1,300.00
LAB11 Arterial Blood Gas 200.00
LAB09 Fresh Frozen Plasma, Cryoprecipitate 1,000.00
LAB055 Direct Coomb's Test 195.00
LAB08 Indirect Coomb's Test 160.00
LAB109 Drug Test 200.00
LAB073 PAP's Smear 130.00
LAB076 Surgical Specimen (Small) 325.00
LAB077 Surgical Specimen (Medium) 455.00
LAB078 Surgical Specimen (Large) 715.00
LAB046 Urine Ketone (Qualilative) 40.00
LAB064 Peripheral Smear 195.00
LAB091 Total Protein 80.00
LAB093 Bilirubin (Total B1 and B2) 195.00
LAB094 ALP 95.00
LAB095 ACP 225.00
LAB100 LDH 195.00
LAB101 OGTT 585.00
LAB104 Beta HCG (H-Mole) with Dilution 950.00
LAB110 HDL 390.00
LAB117 Histopath (Large) 715.00
LAB118 Histopath 780.00
LAB119 Alkaline Phosphatase 95.00
LAB112 HAT 310.00
LAB120 Cell Cytology 325.00
LAB121 (ER) Immunohistochemistry Tests 1,882.40
LAB122 (PR) Immunohistochemistry Tests 1,882.40
LAB123 (HER2) Immunohistochemistry Tests 1,882.40
LAB125 ANA (SLE) 610.00
LAB126 ANA (SLE) with Dilution 950.00
LAB127 Anti-Cardiolipin IgG 2,650.00
LAB128 Anti-Cardiolipin IgM 2,650.00
LAB129 Anti-Hav IgG 400.00
LAB130 Anti-HAV IgM 375.00
LAB131 Anti-Hbc Total 350.00
LAB132 Anti-Hbc 340.00
LAB133 D-DImer 3,100.00
LAB134 Dengue NS1 Qualilative 1220.00
LAB135 Dengue Screening IgM/IgG 890.00
LAB136 HbeAg 340.00
LAB137 Leptospira IgG and IgM Screening (LAT IgM IgM) 750.00
LAB138 Treponema Pallidum-Particle Agglution (Qualitative) 360.00
LAB139 Treponema Pallidum-Particle Agglution with Dilution 1,300.00
LAB140 Alpha Feto Protein 675.00
LAB141 Alpha Feto Protein with Dilution 935.00
LAB142 CA125 Ovarian CA 1,450.00
LAB143 CA125 Ovarian Ca with Dilution 1,900.00
LAB144 CEA 675.00
LAB145 CEA with Dilution 900.00
LAB146 Stool Concentration Technique 250.00
LAB147 H. Pylori Stool Antigen 1,600.00
LAB148 Micra Test 240.00
LAB149 Urine RBC Morphology 75.00
LAB150 Fungal CUlture 275.00
LAB151 Ameoba Concentration Technique 275.00
LAB152 Hemoglobin Electrophoresis 275.00
LAB154 Lupus Anticoagulan 3,000.00
LAB155 Ammonia (NH4) 825.00
LAB156 C3 Compliment 3 500.00
LAB157 G6PD 1,100.00
LAB16 Histopath (Small) 325.00
LAB17 Blood Washing 300.00
OB001 Endometrial Biopsy 325.00
LAB158 High Sensitivity CRP 600.00
LAB159 Ionized Calcium 440.00
LAB161 Microalbumin/ Creatinine Ratio 1,500.00
LAB162 Phosphorus 200.00
LAB163 TIBC with Iron 650.00
LAB164 Transferrin Saturation 650.00
LAB165 Follicle Stimulating Hormone 600.00
LAB166 Cortisol 575.00
LAB167 LH 650.00
LAB168 Prolacticin 600.00
LAB170 CA19-9 1,800.00
LAB171 CA19-9 with Dilution 2,200.00
LAB172 Blood CS Adult HP 1,800.00
LAB173 Blood CS Pedia HP 2,000.00
Item CodeItem DescriptionItem Price
CVU003 2D ECHOCARDIOGRAPHY-ADULT 2,500.00
CVU004 2D ECHOCARDIOGRAPHY-PEDIA 2,600.00
CVU1 ELECTROCARDIOGRAPHY-ADULT 210.00
CVU002 ELECTROCARDIOGRAPHY-PEDIA 0
CVU011 24 HR HOLTER MONITORING 3,100.00
PMSC018 ECG 210.00
CVU112 TREADMILL STRESS TEST 1,100.00
Item CodeItem DescriptionItem Price
PSY001 PSYCHOLOGICAL TESTING 100.00
PSY0010 NEURO-PSYCHIATRIC CLEARANCE 300.00
PSY002 PSYCHOLOGICAL TEST RESULTS COPY 300.00
PSY003 NEURO-PSYCHIATRIC EVALUATION 300.00
PSY004 PSYCHOMETRIC EXAMINATIONS-OUTSIDE REFERRALS 300.00
PSY005 PSYCHOMETRIC EXAM. -HOSPITAL BASED 200.00
PSY006 PSYCHOLOGICAL\CLINICAL TEST 200.00
PSY007 NEURO-PSYCHIATRIC CLEARANCE: NATURALIZATION-EMPLOYMENT ABROAD 0
PSY008 NEURO-PSYCHIATRIC CLEARANCE: FELLOWSHIP-GOVERNMENT AND OTHER 500.00
Item CodeItem DescriptionItem Price
NUC001 THYROID SCAN TC99M 800.00
NUC002 Blood Gram Stain 3,000.00
NUC003 SCINTIMAMMO TC99M HDP 6,105.00
NUC004 TSH 415.00
NUC005 FT3 410.00
NUC006 FT4 410.00
NUC007 FT3,FT4,TSH COMBO 1,235.00
NUC008 RENAL SCAN (DTPA) 4,645.00
NUC009 RENAL SCAN (DMSA) 4,560.00
NUC010 RENAL SCAN LASIX 3,800.00
NUC011 HEPATOBILIARY SCAN 3,500.00
NUC012 WHOLE BODY I-131(3-5mCi) SCAN 4,815.00
NUC013 GI BLEED STUDY 5,000.00
NUC014 LYMPHSCINTIGRAPHY 5,500.00
NUC015 TESTICULAR SCAN 4,890.00
NUC016 MECKEL'S SCAN 4,370.00
NUC017 SCINTIBONE COMBO 5,000.00
NUC019 THYROID I-131 SCAN 2,500.00
NUC020 THYROID SCAN W/ PERFUSION 50.00
NUC021 EXTRA COPY OF RIA RESULT 230.00
NUC022 FT3,TSH ) 820.00
NUC23 FT4,TSH 820.00
NUC024 FT3,FT4 820.00
NUC025 RENAL SCAN CATOPRIL 4,645.00
NUC029 RENAL SCAN (DIURETICS) 4,645.00
NUC030 HIDA SCAN 4,845.00
NUC031 GI BLEED SCAN 10,625.00
NUC032 LIVER & SPLEEN SCAN 7,080.00
NUC033 TI-201 (S-R) 17,590.00
NUC034 MIBI (S-R) 14,515.00
NUC035 STRESS OR REST ONLY 310.00
NUC036 3mCI 4,815.00
NUC037 BONE DENSITOMETRY 2,500.00
NUC038 THYROID SCAN 1,045.00
NUC039 BONE SCAN HDP (ROUTINE) 5,105.00
NUC041 BONE SCAN HDP (SCINTIMAMMO) 6,105.00
NUC042 RENAL SCAN (CAPTOPRIL) 4,645.00
NUC043 (20%) FT3, FT4, TSH 988.00
NUC044 (20%) FT3, TSH 656.00
NUC045 (20%) FT4, TSH 656.00
NUC046 (20%) FT3, FT4 656.00
NUC047 (20%) FT3 328.00
NUC048 (20%) FT4 328.00
NUC049 (20%) TSH 332.00
NUC050 (30%) FT3, FT4, TSH 865.00
NUC051 (30%) FT3, TSH 575.00
NUC052 (30%) FT4, TSH 575.00
NUC053 (30%) FT3 575.00
NUC054 (30%) FT4 287.00
NUC055 (30%) TSH 290.00
NUC056 (20%) THYROID SCAN 836.00
NUC057 (20%) TS with PERFUSION 880.00
NUC058 (30%) TS with PERFUSION 770.00
NUC059 (30%) THYROID SCAN 730.00
NUC060 (20%) BONE SCAN-Routine 4,084.00
NUC061 ((20%) BONE SCAN-With 3 Phase 4,884.00
NUC062 (20%) BONE SCAN-With SCINTIMAMMO 4,884.00
NUC063 (30%) BONE SCAN- ROUTINE 3,570.00
NUCMED001 THYROID SCAN TC99M 1,000.00
NUCMED Bone densitometry (routine) 5,105.00
Nucmed1 DXA (WHOLE BODY) 3,500.00
NUCMED40 SCINTIMMAMOGRAPHY 4,000.00
NUCMED028 RENAL SCAN (GFR) 2,880.00
NUC064 BONE SCAN WITH 3 PHASE 4,270.00
NUC065 BONE SCAN-WITH SCINTIMAMMO 4,270.00
NUC069 SCINTIMAMMOGRAPHY 3,200.00
NUC070 SCINTIMAMMOGRAPHY 2,800.00
NUC071 RENAL SCAN-DTPA 3,716.00
NUC072 RENAL SCAN WITH DIURETICS 3,716.00
NUC073 RENAL SCAN-DMSA 3,648.00
NUC074 RENAL SCAN-CAPTOPRIL 3,716.00
NUC075 RENAL SCAN-GFR 2,304.00
NUC076 RENAL SCAN-DTPA 3,250.00
NUC077 RENAL SCAN-DMSA 3,190.00
NUC078 (30%) RENAL SCAN-CAPTOPRIL 3,250
NUC079 (30%) RENAL SCAN-GFR 2,020.00
NUC080 (30%) RENAL SCAN-WITH DIURETICS 3,250.00
NUC081 (30%) TSH 290.00
NUC082 GI BLEED SCAN 7,440.00
NUC083 TESTICULAR SCAN 3,912.00
NUC084 LIVER & SPLEEN SCAN 5,664.00
NUC085 HIDA SCAN 3,390.00
NUC086 GI BLEED SCAN 7,440.00
NUC087 TESTICULAR SCAN 3,420.00
NUC088 LIVER & SPLEEN SCAN 4,950.00
NUC089 MYOCARDIAL PERFUSION-TI-201 (S-R) 14,072.00
NUC090 MYOCARDIAL PERFUSION-MIBI (S-R) 11,612.00
NUC091 MYOCARDIAL PERFUSION-STRESS OR REST ONLY 6,400.00
NUC092 MYOCARDIAL PERFUSION-TI-201 (s-R) 12,310.00

CT-Scan Procedures

Item CodeItem DescriptionItem Price
32 Abdominal/Thoracic/Renal/Ext (Angio) 6,000.00
33 CT Myelo 3350.00
CT SCAN Zygoma 5700.00
CT001 Cranial (Plain) 2,350.00
CT004 Orbital CT Scan (Plain) 2,350.00
CT029 Orbital CT Scan (Contrast) 5,580.00
CT122 Cranial (Contrast) 5,500.00
CT002 Sella CT Scan 3100.00
CT003 Cranial w/Facial Axial/Coronal Cuts (Contrast) 7,100.00
CT0130 Cranial w/Orbital Cuts (Contrast) 7,100.00
CT005 Cranial w/2MM Posterior Fossae 4100.00
CT0056 Cranial w/Orbital Cuts (Plain) 4,250.00
CT006 PNS (Plain) 2,350.00
CT007 PNS (Contrast) 5,580.00
CT008 Orbits 3100.00
CT009 Neck-Routine 3100.00
CT010 Nasopharynx or Oral Cavity (Plain) 2,650.00
CT011 Chest (Plain) 2,650.00
CT121 Chest (Contrast) 7,340.00
CT012 Chest (High Resolution) 4,500.00
CT013 Chest w/ Adrenal Cuts 5,200.00
CT014 Lower Abdomen (Routine) 2,350.00
CT124 Lower Abdomen (Contrast) 6,970.00
CT015 Whole Abdomen (Plain/Contrast) 11,800.00
CT016 Cervical Spine (Contrast) 4,100.00
CT017 Thoracic Spine (Plain) 2,350.00
CT0132 Thoracic Spine (Contrast) 7,340.00
CT018 Lumbar or Lumbosacral Spine (Plain) 2,680.00
CT133 Lumbar or Lumbosacral Spine 7,340.00
CT019 Lower Extrermities (Contrast) 6,120.00
CT126 Lower Extrermities (Plain) 2,650.00
CT020 CT Guided Biopsy 6,340.00
CT021 CT Stonogram 2,680.00
CT022 Upper Abdomen (Contrast) 6,970.00
CT023 Upper Abdomen (Routine) 2,350.00
CT024 Cranial w/ Facial Axial/Coronal Cuts (Plain) 4,250.00
CT025 Cranial w/ Temporal Bone (Plain) 4,250.00
CT129 Cranial w/ Temporal Bone (Contrast) 7,100.00
CT026 Cranial w/ Paranasal Sinuses (Plain) 4,250.00
CT131 Cranial w/ Paranasal Sinuses (Contrast) 7,100.00 CT027 Neck Routine w/ Oral Cavity (Contrast) 5,700.00
CT028 Neck/Zygoma to Clavicle (Plain) 2,650.00
CT029 Orbital w/ Axial-Coronal Cuts (Contrast) 4,100.00
CT030 Pelvis (Plain) 2,350.00
CT030 Pelvis (Contrast) 6,970.00
CT031 PNS w/ Axial-Coronal Cuts (Contrast) 4100.00
CT032 PNS w/ Temporal Cuts (Plain/Contrast) 5100.00
CT033 Sella Turcica 3100.00
CT034 Whole Abdomen (Triphasic) 12,900.00
CT035 Temporal Bone (Contrast) 5,580.00
CT040 Temporal Bone (Plain) 2,350.00
CT036 Orbits w/ Axial/Coronal Cuts (Contrast) 4100.00
CT037 Paranasal Sinuses w/ Axial/Coronal Cuts (Contrast) 4100.00
CT038 Additional Cuts 1,110.00
CT039 Facial (Plain) 2,350.00
CT0123 Facial (Contrast) 5,580.00
CT057 Cervical Spine (Plain) 2,650.00
CT016 Cervical Spine (Contrast) 7,340.00
CT100 CT Scan w/ Temporal Cuts 5100.00
CT111 Pulmonary 8300.00
CT112 Neck Routine CT w/ Contrast 7,340.00
CT113 Nasorpharynx or Oral Cavity (Contrast) 7,340.00
CT114 CT Urography 7,920.00
CT201 Thoracolumbar CT-Scan 7300.00
XRY102 Angiography: Brain/Neck 5000.00
XRY103 Angiography: Thoracic/ABD. Aorta/Renal/Ext 6000.00
CT204 Extrimities (Upper) 2,650.00

X-RAY Procedures

XRY059Shoulder Xray360.00
Item CodeItem DescriptionItem Price
91 Intra-Operative Xray 1000.00
PRO1152 Abdominal Xray 400.00
PRO234 Urethrogram 1000.00
UTZ052 Mammography N/A
XRAY0002 Additional Shot 40.00
XRAY1649 Skeletal Survey N/A
XRY Cervico Thoracic 330.00
XRY0012 Chest Adult Xray 250.00
XRY002 Ankle Joint Xray 530.00
XRY003 Antegrade Pyelography 4,800.00
XRY004 Baby Gram Xray 990.00
XRY005 Barium Enema Xray 3,960.00
XRY006 Cervical Spine Xray 530.00
XRY007 Cervical Spine w/Obliques Xray 530.00
XRY008 Cervicothoracic Xray 600.00
XRY009 Chest Adult Xray 530.00
XRY010 Chest Child Xray 530.00
XRY011 High Towne's View Xray 350.00
XRY012 Cystography 4800.00
XRY013 Clavicle Xray 360.00
XRY015 Coccyx Xray 200.00
XRY016 Distal Colonography Xray 3,960.00
XRY017 Elbow Xray 530.00
XRY018 Esophagram/Meglumine Swallow 2,760.00
XRY020 Femur/Thigh Xray 530.00
XRY022 Fistulography 3,840.00
XRY023 Forearm Xray 530.00
XRY024 Foot Xray 530.00
XRY025 Hip Joint/Frog Leg Xray 530.00
XRY026 Hand Xray 530.00
XRY027 Humerus/Arm Xray 530.00
XRY028 Hypotonic Duodenography Xray 1500.00
XRY029 Hysterosalpingography 3,840.00
XRY030 Invetography Xray 1300.00
XRY031 IVP Xray 4,960.00
XRY032 IVP Hypertensive Xray 4,960.00
XRY033 KUB Xray 390.00
XRY034 Knee Xray 530.00
XRY035 Leg Xray 530.00
XRY036 Lordoto/Apicogram Xray 530.00
XRY037 Lumbo Sacrarl Xray 990.00
XRY038 Lumbar Both Oblques Xray N/A
XRY039 Mandible Xray 530.00
XRY040 Mastoids Xray 530.00
XRY041 Myelogram N/A
XRY042 Nasal Bone Xray 530.00
XRY043 Nasopharynx Xray 0.00
XRY044 Neck Xray 530.00
XRY045 Operative Cholangiography Xray 1,000.00
XRY046 Optic Foramen/Caldwel Xray 0.00
XRY047 Oral Cholecystography Xray 0.00
XRY048 Orbit Xray 0.00
XRY049 Parallax View Xray 0.00
XRY055 Retrograde Pyelography Xray 4,800.00
XRY053 Plain Abdomen Child Xray 530.00
XRY054 Plain Abdomen adult Xray 530.00
XRY050 Paranasal Sinuses Xray 200.00
XRY051 Pelvis Xray 360.00
XRY052 Pelvimentary Xray 500.00
XRY056 Sacro Coccygeal Xray 200.00
XRY057 Scoliotic Series Xray 1,520.00
XRY060 Scapula Xray 360.00
XRY061 Sella Turcica Xray 350.00
XRY062 Skull Xray 530.00
XRY066 Submandibular Xray 250.00
XRY063 Sialography 0.00
XRY064 Small Intestine Series Xray (Water Soluble) 6,470.00
XRY064 Small Intestine Series Xray (Barrium) 3,590.00
XRY065 Sternum Xray 0.00
XRY067 T-TUbe Cholangiogram 3,860.00
XRY068 TMJ Xray 0.00
XRY069 Thoracolumbar Spine Xray 990.00
XRY070 Thoraco Lumber Obliques Xray 990.00
XRY071 Thoracic Cage Xray 300.00
XRY073 Upper GI Series Xray 2,760.00
XRY074 Voiding Cystourethrogram Xray 1,000.00
XRY075 Ventriculogram 1,170.00
XRY076 Wrist Joint Xray 530.00
XRY077 SMV (Zygoma) Xray 530.00
XRY078 STL-Nose Xray 530.00
XRY079 Swimmer's View Xray 300.00
XRY080 Caldwell's View Xray 530.00
XRY082 Additional Caldwell's view Xray 40.00
XRY083 Additional Mortise view Xray 40.00
XRY084 Additional Water's view Xray 40.00
XRY085 Additional Oblique view Xray 40.00
XRY081 Additional Axillary view Xray 40.00
XRY123 Baurium Swallow/Modified 3,960.00
XRY11 Chest PA Adult- PA Lateral 530.00
XRY13 Chest PA Child- PA Lateral 530.00
XRY14 Chole -GI Series 530.00
XRY17 Dorsal Vertebral/Thoracic Spine 530.00
XRY18 Dorsal Vertebral-Thoracic Spine 530.00
XRY19 Esophagography (Barium Swallow) 530.00
XRY22 Intravenous Pyelography (IVP) 4,960.00
XRY34 STL Neck 530.00
XRY086 Fluoroscopy N/A
XRY369   650.00
XRY370 Cross Table Lateral Hip 450.00
XRY101 Angiogram 5000.00
XRY104 Cystourethrography (CUG)/VCUG 1000.00
XRY105 KUB-IVP 1100.00

Ultrasound Procedures

Item CodeItem DescriptionItem Price
UTZ001 Upper Abdominal Ultrasound 600.00
XRY0006 Cardiac Ultrasound 810.00
UTZ002 HBT/Liver Ultrasound 640.00
UTZ003 KUB Ultrasound 770.00
UTZ004 Cranial Ultrasound 810.00
UTZ005 Thyroid/ Neck Ultrasound 650.00
UTZ006 KUB + Prostate Ultrasound 990.00
UTZ007 Soft Tissue Ultrasound 640.00
UTZ008 Inguino-Scrotal Ultrasound 1,060.00
UTZ009 Transrectal Ultrasound 800.00
UTZ010 Breast/Sonomamogram Ultrasound 860.00
UTZ011 Fast Ultrasound 940.00
UTZ012 UTZ Guided Biopsy 2,620.00
UTZ013 Utrasound Guided Nephrostomy 2,000.00
UTZ014 UTZ Guided Para/Thoracenthesis 2,000.00
UTZ015 Thoracic/Lung Ultrasound 640.00
UTZ016 Whole Abdomen Ultrasound 940.00
UTZ027 Whole Abdomen Ultrasound with Prostate 1,030.00
UTZ017 Carotid Doppler Ultra 2,000.00
UTZ018 Bilateral upper/lower Extremities-arterial or venous, doppler ultrasound 3,000.00
UTZ019 Bilateral Extremities-arterial & venous doppler ultrasound 3,000.00
UTZ020 Single Extremity arterial/venous doppler ultrasound 2,500.00
UTZ021 Single Extremity- arterial & venous doppler ultradound 3,000.00
UTZ022 Thoracic Spine 2,000.00
UTZ031 Prostate Ultrasound 600.00
UTZ024 Abdominal Doppler Ultrasound 1,400.00
UTZ032 Transbdominal Ultrasound 680.00
UTZ025 Dopper UTZ of Mass 1,400.00
UTZ026 LGBPS Ultrasound 640.00
UTZ027 WAB and Prostate UTZ 1,000.00
UTZ06 Transcranial Ultrasound 2,300.00
UTZ029 Liver Ultrasound 600
XRY45 Bio-Physical Scoring 600.00

Magnetic Resonance Procedures

Item CodeItem DescriptionItem Price
MRI0010 Cranial MRI (Plain) 6,230.00
MRI011 Cranial MRI (Contrast) 12,560.00
MRI002 Head Stroke IAC Sella MRI 6,050.00
MRI003 Neck MRI 5,550.00
MRI045 Chest MRI (Plain) 6,230.00
MRI047 Chest MRI (Contrast) 13,880.00
MRI0021 Cervical Spine MRI (Plain) 6,230.00
MRI0023 Cervical Spine MRI (Plain) 12,560.00
MRI0075 Knee MRI (Plain) 12,560.00
MRI00073 Knee MRI (Contrast) 6,230.00
MRI0053 Shoulder MRI (Plain) 6,230.00
MRI0055 Shoulder MRI (Contrast) 12,560.00
MRI008 Hip/Bony Pelvis MRI 5500.00
MRI0014 Orbit MRI (Plain) 6,230.00
MRI0015 Orbit MRI (Contrast) 12,560.00
MRI0011 Facial MRI (Plain) 2,230.00
MRI0011 Facial MRI (Plain) 6,230.00
MRI0019 Facial MRI (Contrast) 12,560.00
MRI0025 Thoracic MRI (Plain) 6,230.00
MRI0027 Thoracic MRI (Contrast) 12,560.00
MRI0029 Lumbar/Lumbosacral Spine MRI (Plain) 6,230.00
MRI0031 Lumbar/Lumbosacral Spine MRI (Contrast) 12,560.00
MRI0041 Whole Abdomen MRI (Plain) 7,550.00
MRI0043 Whole Abdomen MRI (Contrast) 16,520.00
MRI0049 Pelvis MRI (Plain) 6,230.00
MRI0051 Pelvis MRI (Contrast) 12,560.00
MRI0057 Elbow MRI (Plain) 6,230.00
MRI0059 Pelvis MRI (Contrast) 12,560.00
MRI0061 Hand/Wrist MRI (Plain) 6,230.00
MRI0063 Hand/Wrist MRI (Contrast) 12,560.00
MRI0065 Upper Extremity MRI (Plain) 7,550.00
MRI0067 Upper Extremity MRI (Contrast) 13,880.00
MRI0069 Femur/Leg MRI (Plain) 7,550.00
MRI0071 Femur/Leg MRI (Contrast) 13,880.00
MRI0077 Foot/Ankle MRI (Plain) 6,230.00
MRI0079 Foot/Ankle MRI (Contrast) 12,560.00
MRI0081 MRA MRI (Plain) 6,230.00
MRI0083 MRA MRI (Contrast) 12,560.00
MRI0085 MRCP MRI (Plain) 7,550.00
MRI0879 MRCP MRI (Contrast) 13,880.00
MRI0089 Prostate MRI (Plain) 6,230.00
MRI0091 Prostate MRI (Contrast) 12,560.00