A. ROOM AND BOARD

Services

Pay/Medicare

Charity

I. New Wing (86 Beds)

 

 

Suite Room

2,000.00

 

Private Room

1,300.00

 

Private Room with buddy ref

1,400.00

 

Semi-private for 2 patients

800.00

 

Ward for 4 patients (ceiling fan)

500.00

 

Medical ICU 4 Beds

1,700.00

 

II. Old Wing (100 Beds)

 

 

Payward

500.00

 

Philhealth Ward

500.00

 

Service Bed

200.00

 

III. New Annex Bldg. (146 beds)

 

 

Ward for 5 patients (aircon)

600.00

 

Rabies Room

700.00

 

Reverse Iso Room

700.00

 

Teta Room

700.00

 

IV. Philhealth Bldg. Extension (23 Beds)
Ward for 5 patients (non-aircon)

500.00

 

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B. OPERATING & DELIVERY ROOM FEE

Services

Pay/Medicare

Charity

I. OPERATING ROOM FEE
Major + Cost of Supplies + Additional of Php 500.00/hr. after 2 hours

2,000.00

1,000.00

Minor + Cost of Supplies + Additional of Php 200.00/hr. after 2 hours

750.00

550.00

Monitor – 1st 2 hours

500.00

250.00

Succeeding Hour

150.00/hr.

100.00/hr.

Cautery Machine

500.00 + 150/hour after 2 hours

250.00 + 150/hour after 2 hours

C-Mac (Video Laryngoscope)

2,500.00

1,800.00

Cautery pad

250.00/use

250.00/use

Amniotomy

550.00 + cost of supplies

300.00 + cost of supplies

Repair of Laceration

1500.00 + cost of supplies

750.00 + cost of supplies

Electrocardiogram (ECG)

500.00

250.00

Cardiotocography (CTG)

750.00 + 250/hour after 2 hours

500.00 + 250.00/hour after 2 hours

CPAP (Continuous Positive Airway Press) Machine

1,500.00/day (excludes cost of oxygen and compressed air consumption)

 

II. LABOR ROOM

400.00 + 150/hour after 2 hours

250.00 + 150/hour after 2 hours

III. DELIVERY ROOM FEE

 

 

NSD w/o Epesiotomy

2,000.00 + Cost of Supplies

450.00 + Cost of Supplies

NSD with Epesiotomy

2,500.00 + Cost of Supplies

550.00 + Cost of Supplies

D & C + Cost of Supplies

1,500.00

550.00 + Cost of Supplies

Cost of Supplies Recovery Room

400.00

250.00

IV. PROFESSIONAL FEES (House Case Pay/PHIC Patients)
Anesthesiologist’s Fees

30% of Surgeon’s Fee

 

Surgeon/OB Fee for Medicare Ward Patient based on PHIC

RVU x 80%

 

Surgeon/OB Fee for Medicare Ward Patient based on PHIC

RVU x 80%

 

Room visit of doctors based on PHIC-House Case

300.00/visit at wards & semi-private

500.00/visit at private rooms & suite rooms

 

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C. ULTRASOUND FACILITIES FEES

Services

Pay/Medicare

Charity

Both Breast

1,200.00

820.00

Breast

850.00

750.00

Cardiac UTZ

850.00

650.00

Cranial UTZ

850.00

650.00

Hepatobiliary

750.00

700.00

HBT UTZ

800.00

800.00

HBT/P

1,000.00

750.00

KUB UTZ

900.00

750.00

KUB/P

950.00

850.00

Lower Abdomen

1,000.00

800.00

Upper Abdomen UTZ

1,000.00

800.00

Whole Abdomen

1,300.00

1,250.00

One Organ UTZ

850.00

650.00

Pelvic UTZ

900.00

750.00

Pelvic Trans Abdominal UTZ

900.00

850.00

Pelvic Trans- AB (twin)

1,000.00

900.00

Pelvic Trans Vaginal UTZ

900.00

850.00

Renal UTZ

875.00

675.00

Scrotal UTZ

850.00

650.00

Inguinal Scrotal

1,000.00

900.00

Thoracic UTZ

800.00

650.00

Thoracic / Chest Markings

1,300.00

1,200.00

Thoracic / Chest Guided

1,500.00

1,350.00

Thyroid

800.00

650.00

Guided Ultrasound

3,000.00

2,700.00

Liver

750.00 + 1,500.00

675.00 + 1,350.00

Thoracic

800.00 + 1,500.00

720.00 + 1,350.00

Cystostomy

520.00 + 1,520.00

500.00 + 1,450.00

Nephrostomy

900.00 + 1,500.00

800.00 + 1,350.00

Stat Fee

700.00

Free

Private: Stat Fees – Additional 25% of the price of the procedure during and after office hours.
Charity: Stat Fees – No additional 25%.
Senior Citizen: Less 20% in all procedures

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D. ICU SPECIAL AREA

Services

Pay/Medicare

Charity

Medical ICU/Bed/Day

1,700.00

 

Surgical ICU/Bed/Day

1,700.00

 

Neo-Natal ICU/Bassinet/Day
     Proper

700.00

 

     Intermediate

500.00

 

Syringes Pump/Use

30.00

 

Incubator/Day

900.00

 

Catheter Insertion

35.00

 

Change Gown

35.00

 

ECG Patches

30.00

 

Nebulization

35.00

 

NGT Insertion

120.00

 

Oxygen

0.25/liter

 

IV Insertion

60.00

 

VR Tubings (Disposable)

1,900.00

 

Mech. Ventilator Respirator
     Adult

1,200.00

 

Cardiac Monitor with Pulse Oximeter

1,400.00

 

Infusion Pump

350.00

 

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E. PHYSICAL THERAPHY/ REHABILITATION MEDICINE

Services

Pay/Medicare

Charity

In-Patient:

 

 

Suite Room

600.00

 

Private/ICU Room

450.00

 

Semi-Private/Payward & Medicare

350.00

 

Surgical, Medical & Pediatrics & Isolation Wards

200.00

 

Out Patient:

 

 

With modalities with treatment

300.00

 

Without modalities with treatment

250.00

 

Intra Articular Steroid Injection Non-UTZ guided (shoulders, knees, wrists, hands, fingers)

1,500.00

1,500.00

Intra Articular Steroid Injection UTZ guided (shoulders, knees, wrists, hands, fingers)

2,000.00

2,000.00

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F. ORTHO DEPARTMENT

Services

Pay/Medicare

Charity

Dermatome

1,500.00

1,000.00

Application Fees:

 

 

Long arm circular cast

250.00

150.00

Short arm circular cast

200.00

100.00

Long leg circular cast

350.00

200.00

Short leg circular cast

350.00

200.00

PTB cast

350.00

200.00

Long arm post mold

150.00

100.00

Short arm post mold

150.00

100.00

Long leg post mold

200.00

100.00

Clubfoot cast

250.00

150.00

Hip spica cast one leg

350.00

200.00

Hip spica both legs

400.00

200.00

Total contact leg cast

250.00

150.00

Removal Fees Using Cast Cutter:
Long arm circular cast

150.00

100.00

Short arm circular cast

125.00

60.00

Long leg circular cast

200.00

125.00

Short leg circular cast

200.00

125.00

PTB cast

200.00

125.00

Clubfoot cast

150.00

100.00

Hip spica cast one leg

200.00

125.00

Hip spica both legs

300.00

150.00

Total contact leg cast

200.00

100.00

Dressing Medium

150.00

100.00

Dressing Large

200.00

100.00

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G. EENT

 

 

Services

Pay/Medicare

Charity

Consultation Fee

100.00

 

Removal of Foreign Bodies

300.00

 

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H. EMERGENCY ROOM

 

 

Services

Pay/Medicare

Charity

ER Consultation Fee

250.00

 

ER Fee

300.00

 

Venoclysis

60.00

 

Nebulization w/out medicines

36.00

 

Incision and Drainage

 

 

     Small

180.00

 

     Big

300.00

 

Removal of sutures with dressing
     OPD/ER

84.00

 

     Dressing (OPD/ER)

60.00

 

     Heplock Insertion

36.00

 

     Circumcision Package

720.00

 

ER/OPD Dressing Ward

 

 

     Small

60.00

 

     Medium

96.00

 

     Large

120.00

 

Thoracenthesis

1,200.00

 

Thoracostomy (ER)

2,400.00

 

IV Cut down

600.00

 

Tracheostomy

4,800.00

 

Phlebotomy

600.00

 

Abdominal Paracenthesis

600.00

 

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I. WARD/ER/OPD PROCEDURES

Services

Pay/Medicare

Charity

OPD Consultation

Free

 

Catheter Insertion

72.00

 

NGT Insertion

120.00

 

Minor amputation

250.00/digit

 

Debridement

 

 

     Small

180.00

 

     Medium

240.00

 

     Large

300.00

 

Excision Procedure

 

 

     Small

300.00

 

     Medium

420.00

 

     Large

540.00

 

Fine Needle Aspiration (OPD)

600.00

 

Removal of Foreign Body

300.00

 

Ungiectomy

200.00/digit

 

Suprapubic Cystostomy

600.00

 

Change of Tracheostomy Tube

600.00

 

Cautery/Cauterization

300.00

 

Other Minor ER Procedures

300.00

 

Blood Transfusion

60.00

 

Pulse Oximeter

180.00

 

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J. PEDIATRIC/NICU SERVICE FEE

Services

Pay/Medicare

Charity

Exchange Transfusion

3,600.00

 

Endotracheal Intubation

600.00

 

Lumbar Tap

600.00

 

Umbilical Catherization

600.00

 

Pulse Oximeter

600.00

 

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K. ADULTS SERVICE FEE

Services

Pay/Medicare

Charity

Venoclysis

60.00

 

Gastric Lavage

240.00

 

NGT Insertion

120.00

 

Blood Transfusion

60.00

 

Endotracheal Intubations

600.00

 

Foley Catheter Insertion

120.00

 

Lumbar Tap

600.00

 

a. APPARATUS/EQUIPMENT USE
Doppler (ER)

25.00/use

 

Fetal Monitor

100.00/use

 

Drop light

15.00/hr.

 

Bililight

35.00/hr.

 

Bluelight

75.00/hr.

 

Defibrillator

500.00/use

 

b. GAS STERILIZATION

 

 

Small

100.00

 

Medium

150.00

 

Large

200.00

 

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L. LABORATORY TESTS

Services

Pay/Medicare

Charity

1. Blood Chemistry

 

 

Fasting Blood Sugar*

₱ 110.00

₱ 100.00

Blood Urea Nitrogen*

140.00

125.00

Creatinine

150.00

135.00

Uric Acid

130.00

115.00

Lipid Profile (LP) (Package)*

500.00

500.00

Triglycerides Only*

170.00

150.00

Total Cholesterol

170.00

150.00

HDL Only*

170.00

150.00

SGOT/AST*

200.00

180.00

SGPT/ALT*

200.00

180.00

Sodium

350.00

315.00

Potassium

350.00

315.00

Calcium

350.00

315.00

Chloride

350.00

315.00

PH

350.00

315.00

Blood Gas

1,500.00

1,350.00

Magnesium

750.00

675.00

Phosphorus

750.00

675.00

Albumin

300.00

270.00

Total Protein

300.00

270.00

TPAG

600.00

540.00

Alkaline Phosphatase

450.00

405.00

Total Bilirubin

700.00

630.00

Direct Bilirubin

700.00

630.00

Alpha Amylase

600.00

540.00

Random Blood Sugar

110.00

100.00

HbA1c

980.00

882.00

OGTT

700.00

630.00

OGCT

400.00

360.00

B-HCG

1,500.00

1,400.00

CA 125

1,400.00

1,350.00

CA 19-9

1,400.00

1,300.00

LDH

1,100.00

1,000.00

*Note: Stat Fee of 20% will apply
2. Hematology

 

 

Complete Blood Count 5 parts

300.00

270.00

Hemoglobin/Hematocrit

100.00

90.00

White Blood Cell Count

100.00

90.00

WBC Differential Count

100.00

90.00

Thrombocyte Count (APC)

100.00

90.00

Peripheral Blood Smear Studies

450.00

400.00

Erythrocyte Sedimentation Rate

140.00

125.00

BT or Bleeding Time

50.00

35.00

CT or Clotting Time (IVY)

50.00

35.00

Clotting Time (Lee-White)

150.00

135.00

Malarial Smear

300.00

270.00

Blood Typing (ABO)

140.00

120.00

Blood Typing (Rh)

140.00

120.00

Prothrombin Time

650.00

585.00

Partial Thromboplastin Time

850.00

770.00

Reticulocyte Count

150.00

135.00

3. Clinical Microscopy

 

 

Specimen Cups

5.00

5.00

Routine Fecalysis

70.00

65.00

Fecalysis Concentration Method

150.00

135.00

Routine Urinalysis

70.00

65.00

Occult Blood

500.00

450.00

Urine Pregnancy Test

200.00

180.00

Urine Acetone

70.00

65.00

Urine Sugar

70.00

65.00

Urine Bilirubin

70.00

65.00

Urine Ketones

70.00

65.00

Urine Nitrite

70.00

65.00

Urine Sodium

350.00

315.00

Urine Chloride

350.00

315.00

Urine Potassium

350.00

315.00

4. Blood Bank and Serology
Cross Matching (Manual Method)

800.00

700.00

Cross Matching (Gel Method)

1,500.00

1,400.00

Direct and Indirect COOMB’S Test

500.00

450.00

Plateletpheresis

18,540.00

18,540.00

Erythrocytapheresis

20,220.00

20,220.00

Plasmapheresis

20,220.00

20,220.00

Leukapheresis

20,220.00

20,220.00

Anti Body Screening

850.00

765.00

Whole Blood

1,800.00

1,800.00

Fresh Frozen Plasma (FFP)

1,000.00

1,000.00

Platelet Concentrate

1,000.00

1,000.00

Packed RBC

1,500.00

1,500.00

Blood Unit Holding Fee

300.00

300.00

ASO Titer

400.00

360.00

C Reactive Protein

400.00

360.00

Hepatitis B Antibody

300.00

270.00

HBsAg (Quantitative)

950.00

855.00

Salmonella IgG/IgM

850.00

765.00

High Sensitive Troponin I

2,000.00

1,800.00

Troponin I (Qualitative)

1,300.00

1,170.00

Troponin I (Qualitative) CLIA

2,000.00

1,800.00

HIV 1 and 2

250.00

225.00

HbsAg-Hepatitis B surface antigen

300.00

270.00

Pregnancy Test Serum

200.00

180.00

Dengue NS1 Ag + Ab

1,500.00

1,375.00

Dengue NS1 Antigen

750.00

700.00

Anti-Treponema Palladum

300.00

270.00

Anti HCV (Rapid)

300.00

270.00

Anti-HCV (Quantitative)

1,200.00

1,100.00

Anti HBS (Rapid)

300.00

270.00

Anti-TP (Quantitative)

950.00

855.00

Anti-HBc (Quantitative)

1,150.00

1,035.00

Anti-Hbe (Quantitative)

1,279.00

1,151.10

Anti-Hbs (Quantitative)

1,030.00

927.00

Anti-HAV IgG (Quantitative)

1,167.00

1,050.30

Anti-HAV IgM (Quantitative)

1,270.00

1,143.00

HbeAg (Quantitative)

1,170.00

1,053.00

Free T3

1,100.00

990.00

Free T4

1,100.00

990.00

T3

900.00

810.00

T4

900.00

810.00

TSH

1,200.00

1,080.00

PSA

1,400.00

1,260.00

Cyroprocipitate

1,000.00

1,000.00

5. Bacteriology

 

 

Direct Smear

100.00

90.00

Gram Stain

150.00

135.00

AFB Stain

200.00

180.00

Potassium Hydroxide

150.00

135.00

Sputum AFB

200.00

180.00

CSF Culture and Sensitivity

2,900.00

2,800.00

Pleural fluid Culture and Sensitivity

2,900.00

2,800.00

Peritoneal fluid Culture and Sensitivity

2,900.00

2,800.00

Synovial or Joint fluid Culture and Sensitivity

2,900.00

2,800.00

Culture and Sensitivity of Abscess/Pus

2,900.00

2,800.00

Culture and Sensitivity of Eye/Ear Discharges

2,900.00

2,800.00

Culture and Sensitivity of Tissue scrapings/Skin

2,900.00

2,800.00

Sputum Culture and Sensitivity

2,900.00

2,800.00

Endotracheal Aspirate Culture and Sensitivity

2,900.00

2,800.00

Nasopharyngeal Aspirate/Swab Culture and Sensitivity

2,900.00

2,800.00

Throat Swab Culture and Sensitivity

2,900.00

2,800.00

6. Chemistry Analyzer

 

 

Occult Blood (Quantitative)

1,004.00

804.00

C Reactive Protein (Quantitative)

1,058.00

847.00

HBsAg (Quantitative)

869.00

695.00

HgBA1C

585.00

468.00

Iron

110.00

88.00

GGT

115.00

92.00

Lipase

505.00

404.00

HCG

965.00

772.00

D-Dimer

1,400.00

1,120.00

Microalbumin

1,000.00

800.00

AFP

1,600.00

1,280.00

Testosterone

1,070.00

856.00

CEA

1,300.00

1,040.00

Progesterone

1,330.00

1,064.00

HsCRP

950.00

760.00

Ctnl

1,600.00

1,280.00

Cortisol

1,180.00

944.00

7. Culture And Sensitivity

 

 

Blood

2,900.00

2,800.00

Urine

2,900.00

2,800.00

Sputum

2,900.00

2,800.00

Vaginal Discharge

2,900.00

2,800.00

Urethral Discharge

2,900.00

2,800.00

CSW C/S

 

1,000.00

8. Other Services and Supplies

 

 

Venous Collection

50.00

50.00

Arterial Collection

80.00

80.00

Phlebotomy

500.00

400.00

True Copy (Result)

20.00

20.00

RNA Extraction and RT-PCR

3,800.00/test

 

Dialysis Fee

3,600.00

 

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M. SOCIAL HYGIENE CLINIC

Services

Pay/Medicare

Charity

Anti-TreponemaPallidium (Syphillis) Test (Anti-TP Titer)

350.00

270.00

Pap Smear

350.00

P 100.00

HBsAg(CSW)

300.00

270.00

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N. X-RAY & OTHER RADIOLOGICAL PROCEDURE

Services

Pay/Medicare

Charity

Abdomen Supine

200.00

180.00

Abdomen Upright

200.00

180.00

Abdomen Lateral

200.00

180.00

Abdomen Supine/Upright

450.00

400.00

Chest PA:

 

 

     Pedia

170.00

150.00

     Adult

200.00

180.00

Chest PAL/APL:

 

 

     Pedia

300.00

275.00

     Adult

400.00

375.00

Chest Apicogram

170.00

150.00

Chest BUCKY:

 

 

     Pedia

170.00

150.00

     Adult

250.00

200.00

Cervical Spine AP

270.00

250.00

Cervical Spine Lateral/Translateral

270.00

250.00

Cervical Spine Oblique

270.00

250.00

Cervical Spine APL

400.00

350.00

Thoracic Spine AP

270.00

250.00

Thoracic Spine Lateral

270.00

250.00

Thoracic Spine APL

400.00

350.00

Thoracic Spine Oblique

270.00

250.00

Lumbar AP

300.00

250.00

Lumbar Lateral

300.00

250.00

Lumbar APL

400.00

350.00

Lumbar Oblique

300.00

250.00

Lumbosacral AP

300.00

250.00

Lumbosacral APL

400.00

350.00

Lumbosacral Oblique

300.00

250.00

Sacrum-coccyx AP

270.00

250.00

Sacrum-coccyx APL

330.00

250.00

Sacrum-coccyx Oblique

270.00

250.00

Sacrum-coccyx Lateral

270.00

250.00

Pelvis AP

200.00

180.00

Pelvis Lateral

200.00

180.00

Pelvis Oblique

200.00

180.00

Pelvis APO/APL

450.00

400.00

Portable X-Ray

600.00

540.00

HIP AP

300.00

250.00

HIP Oblique

300.00

250.00

HIP APO

400.00

350.00

Shoulder AP

200.00

150.00

Shoulder APL/APO

400.00

350.00

Shoulder Oblique

200.00

150.00

Shoulder Scapular Y

200.00

150.00

Shoulder Lateral

200.00

150.00

UPPER/LOWER EXTREMITIES APL:
     8×10

270.00

250.00

     10×12

280.00

260.00

     11×12

290.00

220.00

     11×14

300.00

220.00

     14×14

300.00

220.00

     14×17

300.00

220.00

Skull APL/Translateral

400.00

355.00

Skull/APL/Caldwell’s

670.00

600.00

Skull APL/Towne’s

670.00

600.00

Skull/APL/Water’s

670.00

600.00

Skull APL/Towne’s and Water’s

940.00

850.00

Skull AP

270.00

200.00

Skull Lateral

270.00

200.00

Skull Caldwell’s

270.00

200.00

Skull Towne’s

270.00

200.00

Skull Water’s

270.00

200.00

Invertogram

320.00

320.00

Nasal Bone (Soft Tissue Lateral)

280.00

250.00

Mandible AP

300.00

250.00

Mandible APL

400.00

350.00

Special Procedures:

 

 

     T-Tube Cholangiogram

3,000.00

2,700.00

     Intravenous Pyelography

2,000.00

1,500.00

     Cystogram

1,500.00

1,000.00

     Barium Enema

2,540.00

1,500.00

     Upper GI Series

2,050.00

1,500.00

     Esophagogram

1,500.00

1,200.00

     *Contrast Material (Applicable to Special Procedures Only)

2,500.00

2,500.00

Stat Fees +25% of the procedure if done outside of the department schedule.
Additional payment for extra films and supplies used per procedure.

 

 

 

 

 

CT SCAN

Services

Pay/Medicare

Charity

Brain/Cranial

P 4,500.00 + cost of materials

P 4,050.00 + cost of materials

Whole Abdomen:

P 10,000.00 + cost of materials

P 9,000.00 + cost of materials

Temporal Bone:

P 6,000.00 + cost of materials

P 5,400.00 + cost of materials

Chest:

P 5,000.00 + cost of materials

P 4,500.00 + cost of materials

Neck/Cervical:

P 5,000.00 + cost of materials

P 4,500.00 + cost of materials

Hip/Pelvis:

P 4,500.00 + cost of materials

P 4,050.00 + cost of materials

Cervical:

P 5,000.00 + cost of materials

P 4,500.00 + cost of materials

Thoracic:

P 5,000.00+ cost of materials

P 4,500.00 + cost of materials

Lumbar:

P 5,000.00+ cost of materials

P 4,500.00 + cost of materials

Sacral:

P 5,000.00 + cost of materials

P 4,500.00 + cost of materials

Cervicothoracic:

P 7,500.00 + cost of materials

P 6,750.00 + cost of materials

Thoraco Lumbar:

P 7,000.00 + cost of materials

P 6,300.00 + cost of materials

Lumbo-Sacral:

P 7,000.00 + cost of materials

P 6,300.00 + cost of materials

Whole Spine:

P 11,000.00 + cost of materials

P 9,900.00 + cost of materials

Upper/Lower Abdomen:

P 5,000.00 + cost of materials

P 4,500.00 + cost of materials

Facial

P 4,500.00 + cost of materials

P 4,050.00 + cost of materials

Orbit:

P 5,000.00 + cost of materials

P 4,500.00 + cost of materials

Extremities (Long/Short)

P 6,000.00 + cost of materials

P 5,400.00 + cost of materials

Mandible:

P 4,500.00 + cost of materials

P 4,050.00 + cost of materials

Stonogram/ Urogram:

P 10,000.00 + cost of materials

P 9,000.00 + cost of materials

Kidneys/ Adrenals/ Liver/ Pancreas:

P 4,500.00 + cost of materials

P 4,050.00 + cost of materials

Paranasal/ Sinuses/ Mastoid:

P 6,000.00 + cost of materials

P 5,400.00 + cost of materials

Paranasal Sinuses (Axial/Coronal)

P 6,000.00 + cost of materials

P 5,400.00 + cost of materials

Paranasal Sinuses Inc. Auditory Canal & Temporal Bone

P 7,000.00 + cost of materials

P 6,300.00 + cost of materials

Mammogram:

 

 

     Sonomammogram

4,750.00

4,275.00

     Mammogram

2,625.00

2,362.51

(Inclusive of 25% PF) PF to be paid directly to the consultant or cashier with issuance of the radiologist’s official receipt.

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O. 2D ECHO

 

 

Services

Pay/Medicare

Charity

2D Echo

3,200.00

3,200.00

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P. OTHER ANCILLARY PROCEDURES

 

 

Services

Pay/Medicare

Charity

Dental Fee Extraction

 

 

Adult + cost of supplies

400.00

 

Child + cost of supplies

250.00

 

Class I, Class III, and Class IV Restoration
     Light cured + cost of supplies

550.00

 

     Lamination (NEW)

1,500.00

 

Class II Restoration

 

 

     Light Cured + cost of supplies

900.00

 

     Temporary Restoration

250.00

 

Oral Prophylaxis

 

 

     Light

500.00

 

     Moderate

600.00

 

     Heavy

700.00

 

Pulputomy (2 sittings)

1,500.00

 

Impaction + cost of supplies

4,500.00

 

Semi-Impaction (NEW)

1,500.00

 

Removal of sutures (NEW)

200.00

 

Bleeding with suturing + cost of supplies

800.00

 

Eugenol application with cotton

200.00

 

Dental Consultation

200.00

 

Root Fragment

300.00

 

Wabbling + cost of supplies

300.00

 

Application of Ferric Chloride

250.00

 

Removal of Crown Fracture

300.00

 

Removal of Growth

1,000.00

 

Trimming

250.00

 

Professional Fee per visit

800.00

 

Dental X-Ray

300.00

 

Application of Gel Foam

350.00

 

Cutting of Root Tip

200.00

 

Incision and Drainage

800.00

 

Angkylose

1,000.00

 

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Q. OPTHALMOLOGY

Services

Pay/Medicare

Charity

Slit Lamp Fee

50.00

 

Refractor Fee

100.00

 

Ishihara/Colorblind Screening

50.00

 

Incision & Curettage

250.00

 

Shave Excision

300.00

 

Suturing

300.00

 

Foreign body removal

300.00

 

Removal of suture

50.00

 

Biometry

200.00/eye

 

Eye Ultrasound Fee

300.00/eye

 

Consultation

100.00

 

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Pay/Medicare

Charity

R. RENTAL OF PRIVATE CLINICS PER MONTH PER SQM.

500.00

 

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S. NEW BORN SCREENING PACKAGE

Services

Pay/Medicare

Charity

NBST (New Board Screen Test Kit) – Regular

600.00

600.00

NBST (New Board Screen Test Kit) – Expanded (DOH A.O. No. 2014-0045-A)

1,800.00

1,800.00

New Born Hearing Test

250.00

250.00

Hepa B (1st dose)

250.00

250.00

Eye Prophylaxis

100.00

75.00

Vitamin K

100.00

50.00

BCG Vaccination

250.00

100.00

Umbilical Cord Care

50.00

50.00

Thermal Care

50.00

50.00

Resuscitation

50.00

50.00

Newborn Care

 

 

     Normal Delivery

750.00

 

     Caesarian Delivery

1,000.00

 

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T. HIV-TREATMENT HUB (OHAT TRUST FUND)

Services

Pay/Medicare

Charity

HIV- Viral Load Test

 

7,500.00

CD4 Test

 

2,800.00

Antiretroviral Medicines:

 

 

     Lamivudine/Tenofovir/Efavirenz

 

772.00/ bottle

       Tenofovir/Lamivudine/Dolutegravir

 

650.00/ bottle

Consultation Fee

 

1,000.00

Rates fixed herein under OHAT Trust Fund is in compliance with Philhealth Guidelines (Circular No. 2021-025)

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U. OTHER SERVICE FEES AND CHARGES
STD Smear Gram Stain

60.00

 

TV/day+

60.00

 

Electric Fan

36.00

 

Osteorize Feeding

300.00

 

OPD Nebulizer

66.00

 

Dietary Counseling

180.00

 

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V. RENTAL FEES

Services

Pay/Medicare

Charity

Conference Room (max of 30 pax)

2,000.00/8 hrs. + 200.00/hr. in excess of 8 hrs.

 

Conference Room (max of 150 pax)

2,000.00/8 hrs. + 200.00/hr. in excess of 8 hrs.

 

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Read more about Dr. Rafael S. Tumbokon Memorial Hospital (DRSTMH) Scope of Services HERE.