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Laboratory
| TB PRC | 12,180.00 | |||
| P63 | 3,500.00 | |||
| ARTERIAL BLOOD GAS | 1,430.00 | |||
| ACP (ACID PHOSPHATASE) | 300.00 | |||
| AFB (ACID FAST BACILLI) SMEAR | 410.00 | |||
| AFP (ALPHA FETO PROTEIN) | 1,100.00 | |||
| ALBUMIN. | 350.00 | |||
| SERUM AMMONIA | 750.00 | |||
| AMYLASE | 410.00 | |||
| ANA (ANTI-NUCLEAR ANTIBODY) QUANTITATIVE | 4,830.00 | |||
| ANTI-dsDNA (ANTI DOUBLE STRANDED DNA) | 6,430.00 | |||
| ANTI-LKM (ANTI LIVER KIDNEY MICROSOME) | 12,500.00 | |||
| ANTI-RNP (ANTI RIBONUCLEOPROTEIN) | 10,010.00 | |||
| ANTI-HAV IgG | 690.00 | |||
| ANTI-HAV IgM | 690.00 | |||
| ANTI-HBc IgG | 680.00 | |||
| ANTI-HBc IgM | 810.00 | |||
| ANTI-HBe | 610.00 | |||
| ANTI-HBs (CLIA) | 860.00 | |||
| ANTI-HCV | 1,500.00 | |||
| ANTI-Sm (ANTI SMITH) | 6,210.00 | |||
| ASO (ANTI STREPTOLYSIN O) TITER | 850.00 | |||
| ASO (ANTI STREPTOLYSIN O) QUANTITATIVE | 700.00 | |||
| B1, B2 | 690.00 | |||
| BETA hCG | 750.00 | |||
| BLEEDING TIME AND CLOTTING TIME | 290.00 | |||
| BLOOD & OTHER BODY FLUIDS CULTURE AND SENSITIVITY | 2,400.00 | |||
| BLOOD pH | 480.00 | |||
| BLOOD TYPING | 580.00 | |||
| BLOOD TYPIN | 350.00 | |||
| BUA (BLOOD URIC ACID) | 320.00 | |||
| BUN | 320.00 | |||
| C3 | 3,740.00 | |||
| C4 | 3,220.00 | |||
| CA 125 (OVARY) | 2,250.00 | |||
| CA 15-3 (BREAST) | 2,250.00 | |||
| CA 19-9 (PANCREAS) | 2,850.00 | |||
| CA 72-3 (STOMACH) | 2,550.00 | |||
| IONIZED CALCIUM | 580.00 | |||
| TOTAL CALCIUM | 460.00 | |||
| CEA (CARCINOEMBRYONIC ANTIGEN) | 1,330.00 | |||
| BODY FLUID CELL COUNT AND DIFFERETIAL COUNT | 375.00 | |||
| CELL BLOCK | 1,600.00 | |||
| SERUM CHLORIDE (Cl) | 460.00 | |||
| URINE CHLORIDE (Cl) | 580.00 | |||
| CHOLESTEROL | 350.00 | |||
| CMV IgG | 5,600.00 | |||
| CMV IgM | 0.00 | |||
| COMPLETE BLOOD COUNT | 200.00 | |||
| COOMBS TEST | 400.00 | |||
| CORTISOL | 1,125.00 | |||
| CPK – MB | 1,610.00 | |||
| CPK – MM | 1,040.00 | |||
| CRP (C-REACTIVE PROTEIN) | 520.00 | |||
| CREATININE CLEARANCE | 480.00 | |||
| CPK TOTAL | 300.00 | |||
| CREATININE | 410.00 | |||
| CROSSMATCHING | 1,500.00 | |||
| SPUTUM CULTURE AND SENSITIVITY | 2,240.00 | |||
| D-DIMER | 2,530.00 | |||
| DENGUE COMBO (IgG/IgM, NS1) | 2,130.00 | |||
| DIABETES PROFILE | 1,800.00 | |||
| DIGOXIN DRUG ASSAY | 950.00 | |||
| DRUG TEST – MET & THC | 300.00 | |||
| ERA | 3,000.00 | |||
| ER PR (ESTROGEN RECEPTOR/PROGESTERONE RECEPTOR IMMUNOSTAIN) | 5,600.00 | |||
| ESR (ERYTHROCYTE SEDIMENTATION RATE) | 350.00 | |||
| ESTROGEN / ESTRADIOLE | 2,520.00 | |||
| FBS (FASTING BLOOD SUGAR) | 290.00 | |||
| SERUM FERRITIN | 1,560.00 | |||
| FNAB (FINE NEEDLE ASPIRATE BIOPSY) | 1,400.00 | |||
| FT3 (FREE T3) | 980.00 | |||
| FT4 (FREE T4) | 980.00 | |||
| FSH(FOLLICLE STIMULATING HORMONE) | 980.00 | |||
| GGT (GAMMA GLUTAMYL TRANSFERASE) | 810.00 | |||
| GRAM STAIN | 350.00 | |||
| SERUM H. pylori ASSAY (Helicobacter pylori) | 1,750.00 | |||
| HbA1c | 750.00 | |||
| HBe Ag | 610.00 | |||
| HBsAg TITER (CLIA) | 870.00 | |||
| HBsAg (SCREENING/QUALITATIVE) | 670.00 | |||
| HBV DNA | 10,930.00 | |||
| HDL (HIGH DENSITY LIPOPROTEIN) | 580.00 | |||
| HEMOGLOBIN ELECTROPHORESIS | 9,300.00 | |||
| HEPA A & B PROFILE ( H-B W/O F ) | 2,700.00 | |||
| HEPA B PROFILE (B-G) | 2,700.00 | |||
| HER 2 | 2,800.00 | |||
| HERPES 2 | 1,500.00 | |||
| HISTOPATH (LARGE) | 2,500.00 | |||
| HISTOPATH (MEDIUM) | 2,000.00 | |||
| HISTOPATH (SMALL) | 1,500.00 | |||
| HISTOPATH (XL) | 3,000.00 | |||
| HISTOPATH (XXL) | 4,500.00 | |||
| HISTOPATH XXXL | 6,000.00 | |||
| HISTOPATH | 1,600.00 | |||
| HIV SCREENING | 690.00 | |||
| HIV SCREENING TITER (CLIA) | 1,265.00 | |||
| H. pylori TEST (GASTRO) | 520.00 | |||
| hs-CRP (HIGH SENSITIVITY C- REACTIVE PROTEIN) | 690.00 | |||
| IRON (TOTAL) | 610.00 | |||
| KOH (POTASSIUM HYDROXIDE) | 350.00 | |||
| LDH (LACTATE DEHYDROGENASE) | 620.00 | |||
| LDL (LOW DENSITY LIPOPROTEIN) | 660.00 | |||
| LEPTOSPIRAL TEST | 1,250.00 | |||
| LIPASE | 690.00 | |||
| MAGNESIUM | 580.00 | |||
| MALARIA (SCREENING) | 460.00 | |||
| MALARIAL SMEAR | 350.00 | |||
| MICRAL TEST (MICROALBUMIN TEST) | 810.00 | |||
| NEW BORN SCREENING EXPANDED | 1,850.00 | |||
| NEW BORN SCREENING | 600.00 | |||
| OGCT ( 1 SPECIMEN ) | 480.00 | |||
| OGCT ( 2 SPECIMEN ) | 600.00 | |||
| OGCT ( 4 SPECIMEN ) | 900.00 | |||
| PAPSMEAR | 800.00 | |||
| PBS (PERIPHERAL BLOOD SMEAR) | 350.00 | |||
| PHENOBARBITAL ASSAY | 770.00 | |||
| PHLEBOTOMY SERVICE | 500.00 | |||
| SERUM PHOSPHOROUS | 560.00 | |||
| PLATELET COUNT | 200.00 | |||
| POST PRANDIAL BLOOD SUGAR (2HRS PPBS) | 200.00 | |||
| SERUM POTASSIUM (K) | 550.00 | |||
| URINE POTASSIUM (K) | 580.00 | |||
| PR | 5,200.00 | |||
| PRA | 3,000.00 | |||
| SERUM hCG (PREGNANCY TEST) | 410.00 | |||
| URINE hCG (PREGNANCY TEST) | 350.00 | |||
| PROGESTERONE | 2,100.00 | |||
| PROLACTIN | 980.00 | |||
| PROTEIN / ALBUMIN – 24 HOUR URINE TEST | 480.00 | |||
| TOTAL PROTEIN | 420.00 | |||
| PROTHROMBIN TIME (PT) | 690.00 | |||
| PSA (PROSTATE SPECIFIC ANTIGEN) CLIA | 1,500.00 | |||
| aPTT (ACTIVATED PARTIAL THROMBOPLASTIN TIME) | 810.00 | |||
| RF (RHEUMATOID FACTOR) | 440.00 | |||
| RBS (RANDOM BLOOD SUGAR) | 250.00 | |||
| RESPIRATORY CARE | 1,222.00 | |||
| RETICULOCYTE COUNT | 410.00 | |||
| RHEUMATOID FACTOR | 400.00 | |||
| ROH | 300.00 | |||
| RUBELLA IgG (MEASLES) | 1,050.00 | |||
| RUBELLA IgM (MEASLES) | 1,200.00 | |||
| Salmonella typhi IgG/IgM (TYPHOID TEST) | 1,500.00 | |||
| SEMEN ANALYSIS | 410.00 | |||
| VITAMIN B12 ASSAY | 1,700.00 | |||
| VITAMIN D ASSAY | 1,900.00 | |||
| SGOT (AST) | 350.00 | |||
| SGPT (ALT) | 350.00 | |||
| SERUM SODIUM (Na) | 550.00 | |||
| URINE SODIUM (Na) | 580.00 | |||
| STONE ANALYSIS | 500.00 | |||
| FOBT (FECAL OCCULT BLOOD) | 330.00 | |||
| FA (FECAL ANALYSIS) | 270.00 | |||
| T3 (TRIIODOTHYRONINE) | 750.00 | |||
| T4 (THYROXINE) | 750.00 | |||
| TESTOSTERONE | 1,300.00 | |||
| TIBC (TOTAL IRON BINDING CAPACITY) | 1,220.00 | |||
| TORCH | 5,500.00 | |||
| TOTAL BILIRUBIN | 340.00 | |||
| TOTAL CPK | 675.00 | |||
| TOTAL CREATININE | 350.00 | |||
| TOTAL PROTEIN | 420.00 | |||
| TOXOPLASMA IgM | 1,700.00 | |||
| TOXOPLASMA IgG | 1,500.00 | |||
| TPAG (TOTAL PROTEIN, ALBUMIN, GLOBULIN AND RATIO) | 560.00 | |||
| TPHA | 1,400.00 | |||
| TRANSFERRIN | 8,500.00 | |||
| TRIGLYCERIDES | 430.00 | |||
| TROPONIN I | 2,200.00 | |||
| TSH (THYROID STIMULATING HORMONE) | 1,100.00 | |||
| TYPHOID | 1,300.00 | |||
| URETHRAL DISCHARGE CULTURE AND SENSITIVITY | 750.00 | |||
| 24 HR URINE URIC ACID | 400.00 | |||
| BUA (BLOOD URIC ACID) | 320.00 | |||
| URINALYSIS W/ KETONE | 287.00 | |||
| UA (URINE ANALYSIS) | 270.00 | |||
| URINE – KETONES | 230.00 | |||
| URINE ALBUMIN / CREATININE RATIO | 600.00 | |||
| URINE CALCIUM | 340.00 | |||
| URINE CULTURE AND SENSITIVITY | 950.00 | |||
| URINE MICRAL TEST | 700.00 | |||
| URINE- SUGAR | 100.00 | |||
| VDRL/RPR | 360.00 | |||
| VITAMIN D TEST | 1,764.00 | |||
| VLDL (VERY LOW DENSITY LIPOPROTEIN) | 350.00 | |||
| VMA – 24 HR URINE | 2,250.00 | |||
| RANDOM URINE POTASSIUM | 400.00 | |||
| NEW BORN HEARING TEST | 650.00 | |||
| RANDOM URINE PROTEIN/CREA RATIO | 690.00 | |||
| CELL CYTOLOGY | 1,400.00 | |||
| THYROGLOBULIN | 6,750.00 | |||
| ANTI THYROGLOBULIN ANTIBODIES | 2,820.00 | |||
| FWB (FRESH WHOLE BLOOD) | 1,800.00 | |||
| PRBC (PACKED RED BLOOD CELLS) | 1,500.00 | |||
| PC (PLATELET CONCENTRATE) | 1,000.00 | |||
| FFP (FRESH FROZEN PLASMA) | 1,000.00 | |||
| FIT (FECAL IMMUNOCHEMICAL TEST) | 560.00 | |||
| CBC WITH PC | 460.00 | |||
| OGTT (3 SAMPLE) | 1,150.00 | |||
| LIPID PROFILE | 1,500.00 | |||
| CD4 COUNT | 5,750.00 | |||
| WIDAL TEST | 300.00 | |||
| ADA (ADENOSINE DEAMINASE) | 7,000.00 | |||
| FECAL H. pylori TEST | 1,750.00 | |||
| AFP (ALPHA FETO PROTEIN) | 1,100.00 | |||
| ALBUMIN. | 350.00 | |||
| ALP | 350.00 | |||
| SERUM AMMONIA | 750.00 | |||
| AMYLASE | 410.00 | |||
| ANA (ANTI-NUCLEAR ANTIBODY) QUANTITATIVE | 4,830.00 | |||
| ANTI-dsDNA (ANTI DOUBLE STRANDED DNA) | 6,430.00 | |||
| ANTI-LKM (ANTI LIVER KIDNEY MICROSOME) | 12,500.00 | |||
| ANTI-RNP (ANTI RIBONUCLEOPROTEIN) | 10,010.00 | |||
| ANTI-HAV IgG | 690.00 | |||
| ANTI-HAV IgM | 690.00 | |||
| ANTI-HBc IgG | 680.00 | |||
| ANTI-HBc IgM | 810.00 | |||
| ANTI-HBe | 610.00 | |||
| ANTI-HBs (CLIA) | 860.00 | |||
| ANTI-HCV | 1,500.00 | |||
| ANTI-Sm (ANTI SMITH) | 6,210.00 | |||
| ASO (ANTI STREPTOLYSIN O) TITER | 850.00 | |||
| ASO (ANTI STREPTOLYSIN O) QUANTITATIVE | 700.00 | |||
| B1, B2 | 690.00 | |||
| BLOOD & OTHER BODY FLUIDS CULTURE AND SENSITIVITY | 2,400.00 | |||
| BLOOD pH | 480.00 | |||
| BLOOD TYPING | 580.00 | |||
| BLOOD TYPIN | 350.00 | |||
| BUA (BLOOD URIC ACID) | 320.00 | |||
| BUN | 320.00 | |||
| C3 | 3,740.00 | |||
| GRAM STAIN | 350.00 | |||
| SERUM H. pylori ASSAY (Helicobacter pylori) | 1,750.00 | |||
| HbA1c | 750.00 | |||
| HBe Ag | 610.00 | |||
| HBsAg TITER (CLIA) | 870.00 | |||
| ANA (ANTI-NUCLEAR ANTIBODY) QUALITATIVE | 4,400.00 | |||
| CELLOPHANE SWAB METHOD (SCOTCH TAPE SWAB) | 350.00 | |||
| GENE XPERT (TB PCR) | 14,270.00 | |||
| DRUG TEST CONFIRMATORY FEE | 1,000.00 | |||
| RPR (RAPID PLASMA REAGIN) TITER | 1,400.00 | |||
| SERUM KETONE | 1,000.00 | |||
| ANTI-CCP (ANTI CYCLIC CITRULLINATED PEPTIDE) | 2,190.00 | |||
| ANTI-TPO (ANTI THYROID PEROXIDASE) | 2,300.00 | |||
| SERUM IgE | 1,200.00 | |||
| DENGUE NS1 ANTIGEN | 1,100.00 | |||
| DENGUE IgG/IgM ANTIBODY | 950.00 | |||
| BICARBONATE | 250.00 | |||
| S. VANCOMYCIN THROUGH | 7,650.00 | |||
| PROCALCITONIN | 8,650.00 | |||
| FTA – ABS | 5,400.00 | |||
| INTACT PTH | 3,180.00 | |||
| SARS-COV-2 ANTIBODY TEST (CLIA) | 2,200.00 | |||
| CD 20 | 3,900.00 | |||
| CD 3 | 3,250.00 | |||
| CD 68 | 3,900.00 | |||
| CD 15 | 3,250.00 | |||
| KI 67 | 3,250.00 | |||
| Urine RBC Morphology | 230.00 | |||
| TOTAL ANTI HBC | 520.00 | |||
| LH (LUTEINIZING HORMONE) | 980.00 | |||
| URINE CYTOLOGY | 1,600.00 | |||
| OSMOLALITY SERUM | 3,900.00 | |||
| OSMOLALITY URINE | 580.00 | |||
| CARDIOLIPIN ANTIBODY IGg | 10,700.00 | |||
| CARDIOLIPIN ANTIBODY IGm | 10,700.00 | |||
| COVID-19 ANTIGEN TEST | 660.00 | |||
| HE4 | 1,320.00 | |||
| ANTI CARDIOLIPIN | 13,300.00 | |||
| APHERESIS PLATELET | 17,050.00 | |||
| SODIUM BICARB SERUM | 155.00 | |||
| DHEAS | 882.00 | |||
| SHBG | 2,016.00 | |||
| HK-ANTIBODY | 5,000.00 | |||
| HCV RNA | 18,400.00 | |||
| ANA TITER | 4,500.00 | |||
| Glycomark | 4,520.00 | |||
| PRO-BNP | 8,630.00 | |||
| C3 Beta Complement | 2,800.00 | |||
| C4 Beta Compliment | 2,800.00 | |||
| Anti JOI | 5,150.00 | |||
| Anti SSB/LA | 5,150.00 | |||
| Anti SSA/RO | 5,200.00 | |||
| Anti NDNA(Double Stranded DNA) | 3,900.00 | |||
| Anti-Müllerian hormone (AMH) | 9,100.00 | |||
| URINE PROTEIN | 690.00 | |||
| URINE CREATININE | 270.00 | |||
| ANTI MULLERIAN HORMONE TEST | 8,500.00 | |||
| P63 IMMUNOHISTOCHEMISTRY | 4,300.00 | |||
| SMMS | 11,500.00 | |||
| CK 5/6 | 4,300.00 | |||
| CD 10 | 3,900.00 | |||
| HbA1c (GLYCOHEMOGLOBIN) | 750.00 | |||
| BUN (BLOOD UREA NITROGEN) | 320.00 | |||
| ALBUMIN | 350.00 | |||
| B1, B2 (INDIRECT AND DIRECT BILIRUBIN) | 690.00 | |||
| ALP (ALKALINE PHOSPHATASE) | 350.00 | |||
| BLOOD TYPING (GEL METHOD) | 580.00 | |||
| BLOOD TYPING (NEWBORN & INFANTS) | 350.00 | |||
CT-Scan
| CHEST(PLAIN)-CT SCAN | 7,700.00 | |||
| CHEST(W/ CONTRAST)-CT SCAN | 10,500.00 | |||
| CRANIAL/HEAD (PLAIN)-CT SCAN | 6,020.00 | |||
| CRANIAL/HEAD (W/ CONTRAST)-CT SCAN | 10,080.00 | |||
| EXTREMITIES (PLAIN) CT SCAN | 8,800.00 | |||
| EXTREMITIES (W/ CONTRAST)CT SCAN | 12,000.00 | |||
| INTERNAL AUDITORY CANAL (PLAIN) CT SCAN | 8,800.00 | |||
| INTERNALAUDITORY CANAL(W/ CONTRAST)CT SCAN | 12,000.00 | |||
| LOWER ABDOMEN (PLAIN) CT SCAN | 8,800.00 | |||
| LOWER ABDOMEN (W/ CONTRAST) CTSCAN | 12,000.00 | |||
| LUMBAR (PLAIN) CT SCAN | 8,800.00 | |||
| LUMBAR (W/ CONTRAST) CT SCAN | 12,000.00 | |||
| MANDIBULAR CT SCAN | 8,450.00 | |||
| MASTOID (W/ CONTRAST) CT SCAN | 12,000.00 | |||
| MASTOID(PLAIN) CT SCAN | 8,800.00 | |||
| NECK (PLAIN)-CT SCAN | 8,800.00 | |||
| NECK (W/ CONTRAST)-CT SCAN | 9,100.00 | |||
| ORBIT (PLAIN) CT SCAN | 8,800.00 | |||
| ORBIT (W/ CONTRAST) CT SCAN | 12,000.00 | |||
| OROPHARYNX (PLAIN) CT SCAN | 8,800.00 | |||
| OROPHARYNX(W/ CONTRAST) CTSCAN | 12,000.00 | |||
| PARANASAL SINUSES (PLAIN) CT SCAN | 8,800.00 | |||
| PARANASAL SINUSES(W/ CONTRAST) CT SCAN | 12,000.00 | |||
| TEMPORAL (PLAIN) CT SCAN | 8,800.00 | |||
| TEMPORAL (W/ CONTRAST) CT SCAN | 12,000.00 | |||
| THORACIC (PLAIN) CT SCAN | 8,800.00 | |||
| THORASIC (W/ CONTRAST)CT SCAN | 12,000.00 | |||
| UPPER ABDOMEN (W/ CONTRAST)CT SCAN | 12,000.00 | |||
| UPPER ABDOMEN CT SCAN (PLAIN) | 8,800.00 | |||
| WHOLE ABDOMEN PLAIN CT SCAN | 13,600.00 | |||
| WHOLE ABDOMEN w/DOUBLE CONTRAST | 20,000.00 | |||
| CONTRAST MEDIA | 2,500.00 | |||
| CT STONOGRAM | 11,520.00 | |||
| WHOLE ABDOMEN TRIPHASIC PLAIN | 11,700.00 | |||
| WHOLE ABDOMEN TRIPHASIC W/ CONTRAST | 25,600.00 | |||
| UROGRAM | 20,800.00 | |||
| AV DUPLEX SCAN | 13,500.00 | |||
| CRANIAL PLAIN W/ BONE WINDOW | 6,880.00 | |||
| WHOLE ABDOMEN W/ IV AND RECTAL CONTRAST | 16,100.00 | |||
| WHOLE ABDOMEN TRIPLE CONTRAST | 21,600.00 | |||
| PAROTID W/ CONTRAST | 10,500.00 | |||
| ORAL CAVITY PLAIN CT SCAN | 8,800.00 | |||
| FACIAL CT SCAN | 8,800.00 | |||
| PELVIS CT SCAN PLAIN | 8,800.00 | |||
| PELVIS CT SCAN W/ CONTRAST | 12,000.00 | |||
| LIVER TRIHASIC CT SCAN | 19,200.00 | |||
| PANCREATIC PROTOCOL | 22,400.00 | |||
| NASOPHARYNX W/ CONTRAST CT SCAN | 12,000.00 | |||
| NASOPHARYNX PLAIN CT SCAN | 8,800.00 | |||
| ORAL CAVITY W/ CONTRAST CT SCAN | 12,000.00 | |||
| THORACOLUMBAR PLAIN CT SCAN | 8,800.00 | |||
| THORACOLUMBAR W/ CONTRAST CT SCAN | 12,000.00 | |||
X-Ray
Chest – PA or AP or Lat 490.00 Chest 1V – Apicolordotic View 490.00 Chest 2V – PA & Lateral View 980.00 Chest 2V -PEDIA (12yrs old and Below) 970.00 Chest 2V w/ Apical Lordotic 1,200.00 Chest 3V PA w/ R & L Oblique 1,700.00 Sternum 2V – AP & Lateral 900.00 Ribs 1V – AP/ Thoracic cage 690.00 Ribs 2V – AP with Oblique (R or L) 990.00 Ribs Both L & R w/ Chest 1V 1,250.00 Abdomen 1V1F 690.00 Abdomen 2V – Upright & Supine 1,200.00 KUB 1V – PLAIN 690.00 Acute Abdomen 2V with Chest 1V 1,500.00 Neck for Soft Tissue Lateral 990.00 Cervical Spine 2V – AP & Lateral View 1,250.00 Cervical Spine w/ Flex & Ext 2,350.00 Cervical Spine 7V Davis 2,550.00 Thoracic Spine 2V – AP & Lateral View 1,250.00 Thoracic Spine Complete/Series 2,550.00 Lumbosacral Spine 2V – AP & Lateral 1,250.00 Lumbar Spine AP, Lateral w/ R & L Oblique 2,000.00 Lumbar Spine Complete/Series 2,950.00 CERVICAL SPINE 2V, THORACIC SPINE 2V, LUMBO SACRAL SPINE 2V 5,000.00 Sacrum / Coccyx 1,250.00 Sacroiliac Joints 1,500.00 Pelvis 1V – AP 690.00 Pelvis 2V – AP & Frog Leg 1,200.00 Hip Lt. or Rt. (inc Pelvis & Hip) 690.00 Hip Bilateral / Bilateral Hips 1,250.00 Hip Bilateral / Bilateral Hips Child 990.00 Shoulder 1V – AP 690.00 Shoulder AP with Rotation One Side 1,250.00 Shoulder AP with Add/Abd One Side (Right or Left) 1,250.00 Shoulder AP with Scapular Y One Side (Right or Left) 990.00 Shoulder Series One Side (Right or Left) 2,300.00 Shoulder Bilateral AP 990.00 Shoulder with Rotation Bilateral 2,100.00 Shoulder AP with Add/Abd Bilateral 2,100.00 Shoulder AP with Scapular Y Bilateral 2,500.00 Shoulder Series Bilateral 4,500.00 Scapula 1V (Lt or Rt) 1,250.00 Scapula Bilateral (Shoulder Blades) 2,500.00 Clavicle (Right or Left) 690.00 Clavicle Bilateral (Both Sides) 1,750.00 Acromioclavicular Joint 690.00 Acromioclavicular Joint w/ Weight Bearing 690.00 Humerus 2V – AP & Lateral (Rt or Lt) 1,250.00 Humerus Bilateral 4V 1,500.00 Elbow 2V – AP & Lateral 990.00 Elbow Oblique 690.00 Elbow Complete (ap, lat, obl) 1,250.00 Elbow Bilateral 4V – AP & Lateral 1,250.00 Elbow Oblique Bilateral 990.00 Elbow Bilateral 4V – AP & Lateral 2,100.00 Forearm 2V – AP & Lateral 1,250.00 Forearm Bilateral 4V – AP & Lateral View 2,350.00 Wrist 2V – PA & Lateral 990.00 Wrist Bilateral 4V – PA & Lateral View 1,750.00 Hand 3V – AP/Lateral/Oblique 990.00 Hand 6V Bilateral – AP/Lateral/Oblique 1,750.00 Finger (affected) 3V – AP/Lateral/Oblique 690.00 Finger w/ comparison (affected Lt or Rt) 990.00 Femur 2V – AP & Lateral View 1,250.00 Femur Bilateral 4V – AP & Lateral 2,000.00 Knee 2V – AP & Lateral 1,250.00 Knee Bilateral 4V – AP & Lateral 2,000.00 Knee Complete One Side (Rt or Lt) 2,000.00 Knee Complete Bilateral (Both) 2,950.00 Knee Tunnel View or Sunrise View or Skyline View side (Rt or Lt) 820.00 Knee Tunnel View or Sunrise View Bilateral 1,250.00 Leg 2V – AP & Lateral View 1,250.00 Leg Bilateral 4V – AP & Lateral 2,000.00 Ankle 2V – Ap & Lateral View 990.00 Ankle Bilateral 4V – AP & Lateral 1,750.00 Ankle 1V – Mortise View 690.00 Ankle Mortise 2V – Bilateral 1,250.00 Foot 2V – AP/Lateral/Oblique 990.00 Foot Bilateral 6V – AP/Lateral/Oblique 1,750.00 Heel / Calcaneous One Side (Rt or Lt) 990.00 Heel / Calcaneous Bilateral (Both) 1,750.00 Toe One Side (Rt or Lt) 1,250.00 Skull 2V – AP & Lateral 990.00 Skull 1V – PA Caldwell View 690.00 Skull 1V – Townes View 990.00 Skull Submentovertex (SMV) View 690.00 Skull Waters View / Open-mouth Waters 690.00 Sinus Series 1,250.00 Facial Bone 990.00 Facial Bone Complete 2,500.00 Facial Bone Bilateral Obliques 1,250.00 Facial Bones Bilateral Lateral Nasal 1,250.00 Facial Bones Zygomatic Arches 990.00 Facial Bones PA Caldwell 690.00 Orbits 3V 1,250.00 Orbits 5V – Series 2,350.00 Mandible One Side (Rt or Lt) 990.00 Mandible 3V 1,750.00 Mandible Series 2,550.00 Mandible Bilateral Obliques 1,250.00 Temporomandibular Joint (TMJ) 2,550.00 Nasal Bone 2V 990.00 Mastoid Series 5V 2,350.00 Bone Survey Adult 12,500.00 Bone Survey Child/Child Abuse 5,000.00 CHOLANGIOGRAM (W/SUPPLIES) 7,500.00 SMALL INTESTINE SERIES W/CONTRAST 6,880.00 UGI SERIES W/O CONTRAST 3,030.00 SPOT FILM 250.00
Ultrasound
ABDOMINAL WALL 1,200.00 BREAST 2,000.00 CHEST UTZ 1,070.00 CHEST MAPPING UNI UTZ 1,070.00 CHEST MAPPING BILATERAL 2,000.00 GALLBLADDER 900.00 HBT 1,570.00 HBT/PANCREAS 1,690.00 PANCREAS 940.00 INGUINAL UTZ 1,000.00 KUB/PROSTATE UTZ 1,950.00 KUB/PELVIC UTZ 1,820.00 KUB UTZ 1,470.00 LIVER 940.00 LIVER/GB 1,220.00 LIVER/SPLEEN 1,220.00 SPLEEN 940.00 LOWER ABDOMEN 2,320.00 NECK 1,300.00 ONE ORGAN 940.00 PROSTATE 940.00 PROSTATE AND URINARY BLADDER 1,220.00 RENAL 1,100.00 RIGHT LOWER QUADRANT 1,220.00 SCROTAL W/ DOPPLER 2,500.00 SUPERFICIAL SOFT TISSUE 1,200.00 THREE ORGAN 1,500.00 THYROID 1,220.00 TRANSRECTAL UTERUS/PROSTATE 1,850.00 UPPER ABDOMEN 2,190.00 URINARY BLADDER 900.00 WHOLE ABDOMEN UTZ 3,500.00 TRANSVAGINAL 1,500.00 BPS or BPP 2,000.00 PELVIC /BIOMETRY 950.00 BIOMETRY 1,500.00 TRANSVAGINAL PROCEDURES (TWINS) 3,062.50 BIOPHYSICAL PROCEDURES (TWINS) 3,500.00 PELVIC PREGNANT PROCEDURES (TWINS) 2,625.00 BIOMETRY PROCEDURES (TWINS) 2,625.00 PELVIC GYNE 1,200.00 TRANSRECTAL 2,000.00 TRANSVAGINAL PROCEDURES (GYNE) 2,000.00