Pay/PhilHealth Charity
A. Room and Board    
Private Room (without aircon) ₱ 1,500.00/day  
Private Room (with aircon) 2,000.00/day  
Semi-private for 2 patients (without aircon) 1,000.00/day  
Semi-private for 2 patients (with aircon) 1,500.00/day  
Male Isolation Room 500.00/day ₱ 250.00/day
Female Isolation Room 500.00/day 250.00/day
5+-Bed Male Ward 500.00/day 250.00/day
5+-Bed Female Ward 500.00/day 250.00/day
5+-Bed OB-Ward 500.00/day 250.00/day
Pedia Ward 500.00/day 250.00/day
ANTE/NICU Room 500.00/day  
B. Operating Room Rates    
Major Operating Room Fee ₱ 2,000.00 + Cost of Supplies + Additional ₱500.00/hr after 2 hours ₱ 1,500.00 + Cost of Supplies + Additional ₱ 200.00/hr after 2 hours
Minor Operating Room Fee ₱ 1,500.00 + Cost of Supplies + Additional ₱ 200.00/hr after 2 hours ₱ 1,000.00 + Cost of Supplies + Additional ₱ 200.00/hr after 2 hours
Cardiac Monitor w/ Pulse Oximeter Use    
    1st 2 hours 500.00 250.00
    Succeeding hour 150.00/hr. 100.00/hr.
Cautery Machine Use 500.00 250.00
Pulse Oximeter Use 100.00/hr. 80.00/hr.
Recovery Room 500.00/day 400.00/day
C. Labor Room/ Delivery Room Rates
Labor Room Fee 300.00/day  
Delivery Room Fee 1,000.00  
NSD w/o Episiotomy ₱2,500.00 + cost of supplies ₱1,000.00 +  cost of supplies
NSD w/ Episiotomy repair ₱3,500.00 + cost of supplies ₱1,500.00 + cost of supplies
D & C ₱2,500.00 + cost of supplies ₱1,000.00 + cost of supplies
D. Professional Fees (House Case-Pay/PHIC Patients)
(based on PHIC rate)
Anesthesiologist’s Fee    
    General Practitioner 40% of Surgeon’s Fee (PF1)  
    With Training 48% of Surgeon’s Fee (PF1)  
    Diplomate/Fellow 56% of Surgeon’s Fee (PF1, PF4)  
Surgeon/ OB Fees    
    General Practitioner RVU x PCF 40 = PF1  
    With Training RVU x PCF 48 = PF2  
    Diplomate/Fellow RVU x PCF 56 = PF3  
Daily Visits    
    General Practitioner 500.00  
    Specialist 800.00  
E. Newborn Care Package    
Regular Newborn Screening Test 800.00  
Expanded Newborn Screening Test 1,800.00  
Hepa B Vaccination 500.00  
Eye Prophylaxis 250.00 200.00
Vit. K 150.00  
Thermal Care 200.00 150.00
Newborn Resuscitation 250.00 + cost of supplies 200.00 + cost of supplies
Umbilical Cord Care 150.00 100.00
F. Ward/ Emergency Room/ OPD Rates
Consultation Fee after OPD hours 200.00  
Amputation of Digit 500.00 + cost of supplies  
Bed Linen Replacement (Soiled) 200.00  
Blood Transfusion 100.00 + cost of supplies  
Catheter Insertion 100.00 + cost of supplies  
Circumcision 600.00 + cost of supplies  
Debridement 250.00 + cost of supplies  
Defibrillator Use 800.00  
Doppler Use 20.00  
Dressing 50.00 + cost of supplies  
Ear Flushing 400.00 + cost of  supplies  
ECG Fee 400.00 + cost of supplies  
Endotracheal Intubation 800.00 + cost of supplies  
ER Use beyond 1 hour 300.00/hr.  
Excision of Small Masses 500.00 + cost of supplies  
Gastric Lavage 300.00 + cost of supplies  
Heplock Insertion 50.00 + cost of supplies  
Injection Fee 50.00  
Incision & Drainage 200.00 + cost of supplies  
Incubator Use 1,000 / day  
Internal Examination (IE) Fee 50.00 + cost of supplies  
Intubation Fee 500.00 + cost of supplies  
IV Cutdown 500.00 + cost of supplies  
IV Insertion/ Re-insertion 100.00 + cost of supplies  
Nebulization 50.00 + cost of supplies  
NGT Insertion 50.00 + cost of supplies  
Oxygen 1.50/L  
Paracentasis 250.00 + cost of supplies  
Phototheraphy 200.00/day  
Pulse Oximeter Use 100.00  
Removal of Foreign Body 350.00 + cost of supplies  
Removal of Sutures w/ Dressings 150.00  
Suturing Fee 150.00 + cost of supplies  
Thoracentesis 250.00 + cost of supplies  
Thoracostomy 500.00 + cost of supplies  
Ungiectomy 300.00 + supplies  
Urine Catheter Insertion 150.00 + cost of supplies  
ORTHOPEDIC    
Application Fees only:    
    Long arm circular cast 500.00 300.00
    Short arm circular cast 500.00 300.00
    Long leg circular cast 500.00 300.00
    Short leg circular cast 500.00 300.00
    Patella Tendon Bearing (PTB) cast 500.00 300.00
    Long arm post mold 300.00 200.00
    Short arm post mold 300.00 200.00
    Long leg post mold 300.00 200.00
    Short leg post mold 300.00 200.00
    Clubfoot cast 500.00 300.00
    Hip spica cast one leg 500.00 300.00
    Hip spica cast both legs 800.00 500.00
    Total contact leg cast 500.00 300.00
Removal Fees using Cast Cutter:    
    Long arm circular cast 250.00 150.00
    Short arm circular cast 250.00 150.00
    Long leg circular cast 250.00 150.00
    Short leg circular cast 250.00 150.00
    Patella Tendon Bearing (PTB) cast 250.00 150.00
    Clubfoot cast 250.00 150.00
    Hip spica cast one leg 250.00 150.00
    Hip spica cast both legs 250.00 150.00
    Total contact leg cast 250.00 150.00
G. Laboratory Fees    
Blood Chemistry    
    Fasting Blood Sugar 120.00 100.00
    Random Blood Sugar 160.00 110.00
    Blood Urea Nitrogen 150.00 130.00
    Creatinine 150.00 130.00
    Uric Acid 130.00 110.00
    Lipid Profile (LP) 520.00 490.00
    Triglycerides 155.00 135.00
    Total Cholesterol 145.00 125.00
    HDL 155.00 135.00
    LDL 155.00 135.00
    SGOT 190.00 180.00
    SGPT 190.00 180.00
    Sodium 300.00 280.00
    Potassium 300.00 280.00
    Calcium 310.00 290.00
    Chloride 200.00 180.00
    Blood pH 350.00 300.00
    Blood Gas Analysis 1,700.00 1,200.00
    Magnesium 350.00 300.00
    Phosphorus 350.00 300.00
    Albumin 350.00 300.00
    Total Protein 500.00 300.00
    CPK-MB, Qualitative 1,200.00 1,000.00
    Troponin T 1,800.00 1,500.00
    Troponin I 1,800.00 1,500.00
    Alkaline Phosphatase 600.00 400.00
    Total Bilirubin 800.00 650.00
    Direct Bilirubin 800.00 650.00
    Alpha Amylase 800.00 650.00
 Note: Stat Fee of 20% will apply
Hematology    
    Complete Blood Count (CBC) 250.00 240.00
    CBC with Platelet Count 210.00 200.00
    APC 100.00 90.00
    Hemoglobin/ Hemotocrit 70.00 60.00
    White Blood Cell Count (WBC) 100.00 90.00
    WBC Differential Count 100.00 90.00
    Platelet Count 120.00 110.00
    CT/BT 120.00 110.00
    Blood Typing (ABO) 180.00 160.00
    Blood Typing (Rh) 120.00 110.00
    Peripheral Blood Smear Studies 400.00  
    Erythrocyte Sedimentation Rate 200.00  
    Prothrombin Time 800.00  
    Partial Thromboplastin Time 800.00  
Clinical Microscopy    
    Fecalysis 100.00 70.00
    Urinalysis 100.00 90.00
    Occult Blood 500.00  
    Urine Acetone 200.00 150.00
    Urine Glucose 200.00 150.00
Serology/ Immunology    
    Cross Matching 300.00  
    Blood Unit Holding Fee (per unit) 200.00 100.00
    ASO Titer 420.00 400.00
    FOBT 420.00 400.00
    C-reactive Protein 420.00 400.00
    HBsAg (Rapid) 290.00 270.00
    Hepatitis B Antibody/ Anti-HBs (Rapid) 600.00  
    Anti-TP/ RPR 350.00 330.00
    Pregnancy Test (Serum) 200.00 180.00
    Pregnancy Test (Urine) 180.00 160.00
    Salmonella TyphiIgG/lgm 820.00 800.00
    HIV 1 and 2 (Rapid) 300.00  
    Dengue Test IgG/IgM 1,500.00 1,400.00
    Dengue Duo (Ag+Ab) 2,500.00 2,400.00
    HBA1C 980.00  
    Coombs Test 800.00 500.00
    Widal Test 200.00 150.00
    Free T3 1,100.00  
    Free T4 1,100.00  
    T3 900.00  
    T4 900.00  
    TSH 1,200.00  
    PSA 1,400.00  
Bacteriology    
    Gram Stain 130.00 90.00
    AFB Stain 150.00 100.00
    KOH (Potassium Hydroxide) 120.00 100.00
Other Laboratory Services    
    PAP Smear 500.00 300.00
H. X-Ray and Other Radiologic Procedures Fees
Chest PA (Adult) 250.00 140.00
Chest PA (Pedia) 250.00 140.00
Chest APL (Pedia) 450.00 300.00
Chest PAL (Adult) 450.00 300.00
Chest PAL (Pedia) 450.00 300.00
Chest Bucky (Adult) 250.00 160.00
Chest Bucky (Pedia) 280.00 130.00
Chest Lat. Decubitus 250.00 140.00
Mandible AP 300.00 250.00
Mandible APL 600.00 400.00
Nasal Bone LAT 250.00 140.00
Skull APL/Translateral 500.00 380.00
Skull APL/Caldwell’s 750.00 500.00
Skull APL/Townes’s 750.00 500.00
Skull APL/Water’s 750.00 500.00
Skull APL/Townes’s & Water’s 1,000.00 700.00
Skull AP 350.00 300.00
Skull Lateral 350.00 300.00
Skull Caldwell’s 350.00 300.00
Skull Townes’s 350.00 300.00
Skull Water’s 350.00 300.00
Invertogram 600.00 500.00
Cervical Spine APL 500.00 250.00
Cervical Spine AP 250.00 200.00
Shoulder AP (Adult) 350.00 300.00
Shoulder AP (Pedia) 350.00 290.00
Shoulder APO 450.00 350.00
Shoulder APL/APO 600.00 400.00
Apicolordotic View 260.00 200.00
Hip AP 250.00 140.00
ThoraticSpine APL 600.00 480.00
ThoraticSpine AP 350.00 300.00
Lumbosacral APL 600.00 480.00
Abdomen 500.00 280.00
    Upright 300.00 180.00
    Supine 300.00 180.00
    Upright/Supine 500.00 420.00
Extremities    
    14×17 400.00 320.00
    11×14 400.00 330.00
    10×12 250.00 160.00
    8×10 220.00 230.00
Sacrum-coccyx AP 350.00 300.00
Sacrum-coccyx APL 600.00 400.00
Pelvis AP 350.00 300.00
Pelvis APO 600.00 400.00
Hip AP 350.00 300.00
Hip APO 600.00 400.00
SPECIAL PROCEDURES:    
T-Tube Cholangiogram 2,500.00 2,000.00
Intravenous Pyelography 3,000.00 2,000.00
Cystogram 2,500.00 2,000.00
Barium Enema 3,500.00 3,000.00
Upper GI Series 3,000.00 2,000.00
Scoliosis Series 1,500.00 1,000.00
Esophagogram 1,500.00 1,000.00
Note: Contrast Material (Applicable to Special Procedures Only Stat fees + 25%
Additional payment for extra films and supplies used per procedure
Subject to the increase on the cost of supplies
I. Other Ancillary Procedures:    
Dental Fee Extraction    
    Adult + Cost of supplies min of ₱ 350.00  
    Child + Cost of supplies min of ₱ 250.00  
Class I, Class III & Class IV Restoration    
    Light cured + Cost of supplies min of ₱ 500.00  
    Amalgam Resto ₱ 300.00  
Class II Restoration    
    Light cured + Cost of supplies min of ₱ 350.00  
    Amalgam Resto ₱ 400.00  
Temporary Restoration min of ₱ 200.00  
Oral Prophylaxis    
    Light min of ₱ 500.00  
    Moderate min of ₱ 600.00  
    Heavy min of ₱ 700.00  
Pulpotomy (2 sittings) ₱ 1,500.00  
Impaction + cost of supplies min of ₱4,000.00  
Bleeding with suturing + cost of Supplies min of ₱ 600.00  
Eugenol application with cotton min of ₱ 200.00  
Dental Consultation ₱150.00  
DENTAL FEES EXTRACTION:    
    Root Fragment min of ₱ 300.00  
    Wabbling + Cost of Supplies min of ₱ 300.00  
    Application of Ferric Chloride min of ₱ 300.00  
    Removal of Crown Fracture min of ₱ 300.00  
    Removal of Growth min of ₱ 900.00  
    Trimming 300.00  
    Dental X-ray 300.00  
    Application of Gel Foam 350.00  
    Cutting of Root Tip 200.00  
    Incision and Drainage 600.00  
J. Ultrasound Fees
Whole Abdomen 2,000.00    
Upper Abdomen 1,500.00    
Lower Abdomen 1,500.00    
Cranial 1,000.00    
Thyroid 1,000.00    
Thoracic 1,000.00    
Cardiac 1,000.00    
Hepatobiliary 1,000.00    
KUB 1,000.00    
KUB-P 1,500.00    
Scrotal 1,000.00    
Pelvic-Trans Abdominal 1,500.00    
Pelvic-TransVaginal 1,500.00    
HBT UTZ 1,000.00    
KUB UTZ 1,000.00    
Breast Ultrasound 1,000.00    
HBT/P 1,000.00    
Pelvic Ultrasound 1,000.00    
TransVaginal Ultrasound 1,000.00    
Renal UTZ 1,000.00    
One Organ 1,000.00    
UTZ Guided Procedure 1,500.00    
Operating Room UTZ Guided Procedure 2,500.00    

 

Other Fees and Charges

 

Amount

Cellphone Charging

₱ 50.00/charge/unit

Extra Electric Fan

50.00/day

Dietary Fees  
Osteorized Feeding  
In-Patients

300.00/500ml bot.

Out-Patients

300.00/500ml bot.

Rental Fees  
Conference Room

₱ 2,500.00/8 hr. + ₱250.00/hr. in excess of 8 hours

Quarter’s Fee (Dorm Type) for non CSTH staff

300.00/day