JRRMMC's Rates and Fees
| Wards | Executive Suite | Suite | Private | Semi-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 Code | Item Description | Item 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 Code | Item Description | Item 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 Code | Item Description | Item 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 Code | Item Description | Item 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 Code | Item Description | Item 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 Code | Item Description | Item 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 Code | Item Description | Item 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 Code | Item Description | Item 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 |
