B | C | D | E | F | G | |
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1 | ||||||
2 | *Prices are subject to change without prior notice | |||||
3 | Item Name | Service Type | Department | Fee | PF MIN | PF MAX |
4 | Use of Hypothermia Machine Per Day | Clinical services | Neuro ICU/Acute Stroke Unit | 8,554.00 | 0 | 0 |
5 | 1/2 Handling Fee Platelet Pheresis | Other services | Other charges | 930.5 | 0 | 0 |
6 | 16S Rna Sequencing c/o Nih | Clinical services | Microbiology | 4,200.00 | 0 | 0 |
7 | 17-Hydroxycorticosteroids (17-OCHS) - MEL | Clinical services | Chemistry | 849 | 0 | 0 |
8 | 17-Hydroxyprogesterone | Clinical services | Nuclear Medicine | 3,786.36 | 550 | 930 |
9 | 17-Ketosteroid (17-Ks) - MEL | Clinical services | Chemistry | 582.5 | 0 | 0 |
10 | 17-OH Progesterone - For research use only | Clinical services | Immunology | 1,772.54 | 0 | 0 |
11 | 17-OH Progesterone (PGH) | Ancillary services | Laboratory | 1,632.50 | 0 | 0 |
12 | 17OH Progesterone RIA (MEL) | Clinical services | Chemistry | 3,538.07 | 0 | 0 |
13 | 1P19Q Fishtest Braintumor Tissue(Slmc) | Clinical services | Histopath | 82,634.50 | 0 | 0 |
14 | 1p19Q Gene Detection c/ o PGH | Clinical services | Histopath | 29,121.17 | 0 | 0 |
15 | 2 Hours Stay with Patient at Home | Clinical services | Home Care Services | 1,154.00 | 0 | 0 |
16 | 2 to 4 Hours Stay with Patient at Home | Clinical services | Home Care Services | 1,562.00 | 0 | 0 |
17 | 24 Hour Blood Pressure Monitoring | Clinical services | Cardiac And Peripheral Vascular Center | 3,650.49 | 930 | 1,189.00 |
18 | 24 Hour Blood Pressure Monitoring, Home service, Without Transportation | Clinical services | Cardiac And Peripheral Vascular Center | 5,207.50 | 0 | 0 |
19 | 24 Hour Oxalic Acid Urine | Clinical services | Chemistry | 9,141.50 | 0 | 0 |
20 | 24 Hour Urine Citric Acid/Citrate c/o Hi-Precision | Clinical services | Special Chemistry | 6,268.50 | 0 | 0 |
21 | 24 Hour Urine Copper (hi - Precision) | Ancillary services | Laboratory Chemistry | 6,887.33 | 0 | 0 |
22 | 24 Hour Urine Cortisol | Clinical services | Special Chemistry | 4,016.00 | 0 | 0 |
23 | 24 Hour Urine Mercury (PIPAC) | Clinical services | Chemistry | 2,449.00 | 0 | 0 |
24 | 24 Hour Urine Metanephrine (SLMC) | Clinical services | Chemistry | 7,098.56 | 0 | 0 |
25 | 24 Hour Urine Metanephrine c/o (MEL) | Clinical services | Chemistry | 8,491.50 | 0 | 0 |
26 | 24 Hour Urine Oxalic Acid C/O:HI-Precision | Clinical services | Chemistry | 9,331.88 | 0 | 0 |
27 | 24 hr urine cortisol (SLMC) | Clinical services | Chemistry | 4,019.67 | 0 | 0 |
28 | 24 hr. TOTAL CORTISOL (HI-PRECISION) | Clinical services | Chemistry | 7,313.00 | 0 | 0 |
29 | 24Hour Urine 5HIAA (SLMC) | Clinical services | Chemistry | 5,394.00 | 0 | 0 |
30 | 24Hr Urine Albumin (SLMC) | Clinical services | Chemistry | 692.5 | 0 | 0 |
31 | 24Hr Urine Catecholamine (Hi-Pre) | Clinical services | Chemistry | 9,331.88 | 0 | 0 |
32 | 24Hr Urine Citrate (UST) | Clinical services | Chemistry | 6,829.00 | 0 | 0 |
33 | 24hr urine Metanephrine | Clinical services | Chemistry | 7,451.25 | 0 | 0 |
34 | 24hr urine VMA (Vanilmandelic Acid) | Clinical services | Chemistry | 7,224.05 | 0 | 0 |
35 | 2D With 3D Tee | Clinical services | Cardiac And Peripheral Vascular Center | 12,974.89 | 9,920.00 | 16,459.00 |
36 | 2D With 3D Tee, LV Analysis | Clinical services | Cardiac And Peripheral Vascular Center | 7,490.25 | 2,100.00 | 3,489.00 |
37 | 2D With TEE Post-Op | Clinical services | Cardiac And Peripheral Vascular Center | 13,021.16 | 9,920.00 | 16,459.00 |
38 | 3 Dimensional Conformal Radiation Therapy | Clinical services | Radiation Oncology | 3,057.76 | 0 | 0 |
39 | 3 Mos.Advance Rental Cylinder | Clinical services | Nursing Services | 1,001.50 | 0 | 0 |
40 | 3 Mos.Advance Rental Of Oxygen | Clinical services | Nursing Services | 2,546.50 | 0 | 0 |
41 | 34Be12 Tissue Processing Only (NKTI) | Clinical services | Histopath | 2,176.50 | 0 | 0 |
42 | 3D Conformal, Truebeam | Clinical services | Radiation Oncology | 4,653.13 | 0 | 0 |
43 | 3D Echocardiogram of Additional Structure | Clinical services | Cardiac And Peripheral Vascular Center | 2,334.55 | 0 | 0 |
44 | 3D/4D Ultrasound | Ancillary services | Women's Health Care Center | 5,779.95 | 1,215.00 | 2,412.00 |
45 | 5 HIAA c/o SLMC | Ancillary services | Laboratory | 4,344.70 | 0 | 0 |
46 | 5HIAA / Urine Setotonin Above 18 y/o (HI-PRE) | Clinical services | Chemistry | 7,444.00 | 0 | 0 |
47 | 5HIAA / Urine Setotonin Below 18 y/o (HI-PRE) | Clinical services | Chemistry | 6,529.50 | 0 | 0 |
48 | 5HIAA/Serotonin (MMC) | Clinical services | Chemistry | 2,789.50 | 0 | 0 |
49 | 5HIAA/Serum Serotonin (Hi-Pre) | Clinical services | Chemistry | 11,997.88 | 0 | 0 |
50 | 5mm Monopolar Cautery | Clinical services | Surgery Suite | 35,808.50 | 0 | 0 |
51 | 7 Test Package (pH,PCO2,PO2,Na,K,CA,Hct) | Clinical services | Chemistry | 6,499.78 | 0 | 0 |
52 | 8 Hours Stay with Patient at Home | Clinical services | Home Care Services | 2,367.00 | 0 | 0 |
53 | AA10 Angled Attachment 10cm | Clinical services | Surgery Suite | 314,832.00 | 0 | 0 |
54 | Ab-to E. Histolytica (UP College of Public Health) | Clinical services | Chemistry | 1,061.50 | 0 | 0 |
55 | Abdomen Paracentesis | Clinical services | Surgery Suite | 1,899.15 | 0 | 0 |
56 | Abdominal Aorta Duplex Scan | Clinical services | Cardiac And Peripheral Vascular Center | 5,398.05 | 1,325.00 | 2,212.00 |
57 | Abdomino-Perineal Resection | Clinical services | Surgery Suite | 12,020.25 | 0 | 0 |
58 | Abound (Sachet) | Clinical services | Dietary | 332.47 | 0 | 0 |
59 | Abound (Sachet) Per Cal. | Clinical services | Dietary | 4.5 | 0 | 0 |
60 | ABSOLUTE EOSINOPHIL COUNT | Clinical services | Hematology | 792.05 | 0 | 0 |
61 | Absorption (Slmc) | Ancillary services | Bloodbank and Transfusion Services | 11,703.70 | 0 | 0 |
62 | ACC - Basic Dressing | Ancillary services | Ambulatory Care Center | 435.5 | 0 | 0 |
63 | ACCI Module 1 - Learning Critical Care By Using The Patient Journey, Model: Cardiology (For Secondary Hospitals) Per Lecture | Other services | Acute and Critical Care Institute | 47,975.00 | 0 | 0 |
64 | ACCI Module 1 - Learning Critical Care By Using The Patient Journey, Model: Cardiology (For Secondary Hospitals) Per Participant | Other services | Acute and Critical Care Institute | 2,400.00 | 0 | 0 |
65 | Accrochordon 10 Warts And Above With the Use Of Emla | Clinical services | Dermatology and Laser | 2,679.35 | 2,070.00 | 3,424.00 |
66 | Accrochordon Nine Warts And Below With the Use Of Emla | Clinical services | Dermatology and Laser | 2,782.00 | 2,140.00 | 3,571.00 |
67 | Accrochordon Per Wart With The Use Of Emla | Clinical services | Dermatology and Laser | 2,793.63 | 0 | 0 |
68 | Accrochordon Per Wart With The Use Of Lidocaine | Clinical services | Dermatology and Laser | 1,811.85 | 1,395.00 | 2,324.00 |
69 | ACCU-TENS | Clinical services | Pain Clinic | 2,105.48 | 1,480.00 | 2,830.00 |
70 | Acetaminophen / Paracetamol | Clinical services | Chemistry | 3,112.50 | 0 | 0 |
71 | Acetone (1L) | Clinical services | Histopath | 1,360.50 | 0 | 0 |
72 | Acetone Qualitative (Urine) | Clinical services | Clinical Microscopy | 621.76 | 0 | 0 |
73 | Acetyl Choline Receptor AB (HI-PRE) | Ancillary services | LAB - Special Chemistry | 8,488.50 | 0 | 0 |
74 | Acetylcholine Receptor Antibody Test (Mmc) | Ancillary services | Laboratory | 19,170.50 | 0 | 0 |
75 | Acid Fast Bacilli (AFB Direct Smear) | Clinical services | Microbiology | 794.65 | 0 | 0 |
76 | Acid Fast Stain Tissue (Slmc) | Clinical services | Histopath | 1,372.50 | 0 | 0 |
77 | Acid Phosphatase - Total (HI-PRE) | Clinical services | Chemistry | 1,768.50 | 0 | 0 |
78 | Acid Phosphatase (SLMC) | Clinical services | Chemistry | 1,575.55 | 0 | 0 |
79 | Acl Reconstruction Package - Intra OperatIVe | Clinical services | Surgery Suite | 130,305.50 | 0 | 0 |
80 | Acl Reconstruction Package - Post OperatIVe | Clinical services | Surgery Suite | 707.5 | 0 | 0 |
81 | Acoustic Reflex with Tympanometry | Clinical services | Center for Hearing and Balcance | 1,302.72 | 0 | 0 |
82 | Act-(Istat) | Clinical services | Chemistry | 1,001.50 | 0 | 0 |
83 | ACTH (Adenocorticotropin Hormone) SLMC | Clinical services | Chemistry | 3,030.91 | 0 | 0 |
84 | Acth (Pgh) | Clinical services | Chemistry | 5,876.50 | 0 | 0 |
85 | Actilyse Vial 4mg/2ml Prefilled Syringe | Clinical services | Pharmacy | 6,002.00 | 0 | 0 |
86 | Activated Clotting Time (ACT) | Clinical services | Hematology | 673.64 | 0 | 0 |
87 | Activated Partial Thromboplastin Time (APTT) | Clinical services | Hematology | 1,564.83 | 0 | 0 |
88 | Activated Partial Thromboplastin Time Mixing Study | Clinical services | Hematology | 1,532.30 | 0 | 0 |
89 | Active Living Program - 1 Day | Clinical services | Wellness and Aesthetics Institute | 4,010.50 | 0 | 0 |
90 | Active Living Program - 14 days | Clinical services | Wellness and Aesthetics Institute | 54,253.50 | 0 | 0 |
91 | Active Living Program - 30 Days | Clinical services | Wellness and Aesthetics Institute | 113,372.50 | 0 | 0 |
92 | Active Living Program - 7 Days | Clinical services | Wellness and Aesthetics Institute | 27,968.00 | 0 | 0 |
93 | Acupuncture - Per Session | Clinical services | Acupuncture | 833.25 | 640 | 1,065.00 |
94 | Acupuncture Needles | Clinical services | Center For Wellness And Aesthetics | 38.5 | 0 | 0 |
95 | Acupuncture, 10 Sessions | Clinical services | Acupuncture | 7,806.42 | 6,010.00 | 9,977.00 |
96 | Acupuncture, 6 Sessions | Clinical services | Acupuncture | 4,710.92 | 3,620.00 | 6,018.00 |
97 | Acute Lymphocytic Leukemia | Clinical services | Immunology | 25,752.53 | 3,035.00 | 3,895.00 |
98 | Acute Myelocytic Leukemia | Clinical services | Immunology | 27,443.00 | 3,035.00 | 3,895.00 |
99 | Acute Myelocytic Leukemia (AML)(SLMC) | Clinical services | Immunology | 18,672.90 | 0 | 0 |
100 | Adamst (NKTI) | Clinical services | Hematology | 51,547.00 | 0 | 0 |