- Pricelist
- Procedures
| EX0214 | THYROGLOBULIN (TG) | 2725.00 |
| EXM0004 | ANTI-THYROGLOBULIN (ANTI-TG) | 3873.00 |
| EXM0005 | THYROGLOBULIN (TG) | 2725.00 |
| EXM0006 | ANTI-THYROGLOBULIN (ANTI-TG) | 3873.00 |
| EXM0007 | THYROGLOBULIN (TG) | 2725.00 |
| EXM0008 | ANTI-THYROGLOBULIN (ANTI-TG) | 3873.00 |
| EXM0009 | THYROGLOBULIN (TG) | 2725.00 |
| EXM0010 | ANTI-THYROGLOBULIN (ANTI-TG) | 3873.00 |
| EXM0009 | THYROGLOBULIN (TG) | 2725.00 |
| EXM0010 | ANTI-THYROGLOBULIN (ANTI-TG) | 3873.00 |
| EXM0009 | THYROGLOBULIN (TG) | 2725.00 |
| EXM0010 | ANTI-THYROGLOBULIN (ANTI-TG) | 3873.00 |
| EX0214 | MELAN A | 4,620.00 |
| EXM0004 | TSH (IRMA) | 1,625.00 |
| EXM0005 | FREE T3 | 1,625.00 |
| EXM0006 | FREE T4 | 1,625.00 |
| EXM0007 | TOTAL T3 | 1,625.00 |
| EXM0008 | TOTAL T4 | 1,625.00 |
| EXM0009 | THYROGLOBULIN (TG) | 2,725.00 |
| EXM0010 | ANTI-THYROGLOBULIN (ANTI-TG) | 3,873.00 |
| EXM0011 | ANTI-TM (ANTI-TPO) | 3,673.00 |
| EXM0012 | PROSTATE SPECIFIC ANTIGEN (PSA) | 1,502.00 |
| EXM0013 | UREA BREATH TEST | 3,015.00 |
| EXM0014 | ROUTINE BONE DENSITOMETRY | 4,151.00 |
| EXM0015 | BONE DENSITOMETRY WHOLE BODY | 4,908.00 |
| EXM0016 | (ADD-ON) VERTEBRAL FUNCTION ASSESSMENT (VFA) | 1,151.00 |
| EXM0017 | ROUTINE BONE DENSITOMETRY INCLUDING FOREARM; TOO LOW THAN RBD (37) | 3,300.00 |
| EXM0018 | BONE DENSITOMETRY WHOLE BODY WITH VFA | 3,700.00 |
| EXM0019 | BONE SCINTIGRAPHY | 7,950.00 |
| EXM0020 | BONE SCINTIGRAPHY WITH SPECT/CT | 10,706.00 |
| EXM0021 | THREE-PHASE BONE SCINTIGRAPHY | 9,646.00 |
| EXM0022 | THYROID UPTAKE | 2,200.00 |
| EXM0023 | THYROID SCINTIGRAPHY (TC-99M) | 1,900.00 |
| EXM0024 | THYROID UPTAKE AND SCAN (I-131) | 4,100.00 |
| EXM0025 | DIAGNOSTIC WHOLE BODY SCAN (2 MCI I-131) | 6,700.00 |
| EXM0026 | POST-RAI THERAPY WHOLE BODY SCAN | 4,240.00 |
| EXM0027 | DUAL ISOTOPE PARATHYROID SCINTIGRAPHY (MIBI AND T1-201) | 12,400.00 |
| EXM0028 | DUAL-PHASE PARATHYROID SCINTIGRAPHY (MIBI) | 12,190.00 |
| EXM0029 | DMSA RENAL CORTICAL SCAN | 6,500.00 |
| EXM0030 | IN-VIVO (CAMERA-BASED) GFR DETERMINATION | 6,300.00 |
| EXM0031 | IN-VITRO GFR DETERMINATION | 6,300.00 |
| EXM0032 | DYNAMIC RENAL SCAN (DTPA) | 4,600.00 |
| EXM0034 | (ADD-ON) DIURETIC-AUGMENTED | 1800.00 |
| EXM0035 | DIURETIC-AUGMENTED MAG3 RENAL SCINTIGRAPHY | 9000.00 |
| EXM0037 | CAPTOPRIL DTPA RENAL SCAN (POST) | 6750.00 |
| EXM0039 | DIRECT CYSTOGRAPHY | 5700.00 |
| EXM0040 | INDIRECT CYSTOGRAPHY | 6900.00 |
| EXM0041 | LUNG PERFUSION SCAN | 7175.00 |
| EXM0042 | LUNG VENTILATION SCAN (DTPA AEROSOL) | 10200.00 |
| EXM0044 | THALLIUM EXERCISE STRESS SCAN | 22500.00 |
| EXM0045 | THALLIUM PHARMACOLOGIC STRESS (DIPYRIDAMOLE) | 23500.00 |
| EXM0046 | THALLIUM PHARMACOLOGIC STRESS (DOBUTAMINE) | 34775.00 |
| EXM0047 | THALLIUM REST-REDISTRIBUTION SCAN | 18255.00 |
| EXM0048 | ADD-ON) THALLIUM RE-INJECTION | 3900.00 |
| EXM0049 | SESTAMIBI EXERCISE STRESS SCAN | 20430.00 |
| EXM0050 | SESTAMIBI PHARMACOLOGIC STRESS (DIPYRIDAMOLE) | 17930.00 |
| EXM0051 | SESTAMIBI PHARMACOLOGIC STRESS (DOBUTAMINE) | 26000.00 |
| EXM0053 | MECKEL’S DIVERTICULUM SCAN | 8500.00 |
| EXM0055 | GASTROESOPHAGEAL REFLUX (GER) SCAN | 9002.00 |
| EXM0056 | GASTRIC EMPTYING TIME (GET) SCAN | 6900.00 |
| EXM0058 | LIVER AND SPLEEN SCAN | 7500.00 |
| EXM0059 | HEPATOBILIARY (HIDA) SCAN | 9515.00 |
| EXM0060 | (ADD-ON) WITH SPECT/CT SCAN | 3000.00 |
| EXM0061 | BRAIN PERFUSION SPECT SCAN | 18265.00 |
| EXM0064 | SCINTIMAMMOGRAPHY (BREAST IMAGING) | 10499.00 |
| EXM0065 | SALIVARY GLAND SCAN | 3850.00 |
| EXM0066 | TESTICULAR SCAN | 6500.00 |
| EXM0074 | ER | 3500.00 |
| EXM0075 | PR | 3500.00 |
| EXM0076 | HER2 | 3500.00 |
| EXM0077 | ER PR HER2 | 9600.00 |
| EXM0078 | ER PR HER2 PROCESSING FEE | 6600.00 |
| EXM0079 | THYROID SCINTIGRAPHY (I-131) | 2500.00 |
| EXM0080 | THYROID UPTAKE AND SCAN (1-131 AND TC-99M) | 4250.00 |
| EXM0081 | DIAGNOSTIC WHOLE BODY SCAN (5 MCI I-131) | 6950.00 |
| EXM0082 | IN-VIVO (BLOOD-BASED) GFR DETERMINATION | 6500.00 |
| EXM0083 | BONE SPECT/CT | 10706.00 |
| EXM0084 | DMSA RENAL CORTICAL SCINTIGRAPHY | 6500.00 |
| EXM0085 | DTPA RENAL SCINTIGRAPHY WITH IN-VITRO GFR | 6500.00 |
| EXM0086 | MAG3 RENAL SCINTIGRAPHY WITH IN-VITRO GFR (DTPA) | 7850.00 |
| EXM0087 | DIURETIC-AUGMENTED RENAL SCINTIGRAPHY (MAG3) | 9000.00 |
| EXM0088 | DIURETIC-AUGMENTED RENAL SCINTIGRAPHY (DTPA) | 7900.00 |
| EXM0089 | CYSTOSCINTIGRAPHY (DIRECT) | 5700.00 |
| EXM0090 | CYSTOSCINTIGRAPHY (INDIRECT) | 6900.00 |
| EXM0091 | ER PROCESSING FEE | 2301.00 |
| EXM0092 | PR PROCESSING FEE | 2301.00 |
| EXM0093 | HER2NEU PROCESSING FEE | 2,200.00 |
| EXM0094 | DYNAMIC RENAL SCAN (MAG3) | 9,000.00 |
| EXM0100 | DIAGNOSTIC WHOLE BODY SCAN (MIBI) | 9,825.00 |
| EXM0101 | DIAGNOSTIC WBS (Tl-201) | 8,355.00 |
| EXM0102 | IN-VITRO (BLOOD-BASED) GFR | 6,500.00 |
| EXM0103 | MAG3 RENAL SCINTIGRAPHY | 6,500.00 |
| EXM0106 | THALLIUM EXERCISES STRESS | 22,500.00 |
| EXM0107 | THALLIUM SCAN (REST ONLY) | 24,530.00 |
| EXM0108 | SESTAMIBI SCAN (REST ONLY) | 17,930.00 |
| EXM0109 | SESTAMIBI EXERCISE ONLY | 12,860.00 |
| EXM0110 | SESTAMIBI PHARMACOLOGIC ONLY | 13,465.00 |
| EXM0112 | LUNG PERFUSION WITH SPECT/CT | 12,932.00 |
| EXM0113 | LUNG VENTILATION (AEROSOL) | 10,200.00 |
| EXM0114 | LUNG PERFUSION AND VENTILATION (AEROSOL) | 16,200.00 |
| EXM0115 | MECKEL’S DIVERTICULUM SCAN (TC-99M PERTECHNETATE) | 8,500.00 |
| EXM0116 | GI BLEEDING (TC-99M LABELLED RBCS) | 10,800.00 |
| EXM0117 | HEPATOBILLIARY (HIDA) SCINTIGRAPHY | 7,500.00 |
| EXM0118 | LIVER SCAN | 10,560.00 |
| EXM0119 | LIVER/SPLEEN SCAN | 7,500.00 |
| EXM0120 | HEMANGIOMA (TC-99M LABELLED RBCS) | 7,800.00 |
| EXM0121 | BRAIN PERFUSION (HMPAO) WITH SPECT | 18,265.00 |
| EXM0122 | SALIVARY GLAND SCINTIGRAPHY | 3,850.00 |
| EXM0123 | TESTICULAR SCINTIGRAPHY | 6,500.00 |
| EXM0124 | GALLIUM WHOLE BODY SCAN | 21,350.00 |
| EXM0125 | RADIONUCLIDE DACRYOSCINTIGRAPHY | 3,500.00 |
| EXM0126 | SENTINEL NODE SCINTIGRAPHY | 10,000.00 |
| EXM0127 | (ADD-ON) C.2.8. STAT IMAGING PROCEDURE | 1,200.00 |
| EXM0128 | PHOSPHORUS 32 | 38,045.00 |
| EXM0129 | STRONTIUM 89 | 161,465.00 |
| EXM0136 | RIA – PACKAGE 1 (TSH, FT3, FT4) | 3,315.00 |
| EXM0137 | RIA – PACKAGE 2 (TSH, T3, T4) | 3,315.00 |
| EXM0138 | RIA – PACKAGE 3 (TSH, FT4) | 1,395.00 |
| EXM0139 | RIA – PACKAGE 4 (TSH, FT3) | 1,395.00 |
| EXM0140 | RIA – PACKAGE 5 (FT3, FT4) | 1,470.00 |
| EXM0141 | RIA – PACKAGE 6 (TSH, TG, ANTI-TG) | 2,860.00 |
| EXM0143 | GI BLEEDING (TC-99M LABELLED RBCS) WITH SPECT/CT | 23,320.00 |
| EXM0145 | BREAST PANEL MARKER | 9,600.00 |
| EXM0146 | FREE T3 – GLOBAL | 800 |
| EXM0147 | FREE T4 – GLOBAL | 800 |
| EXM0148 | TSH – GLOBAL | 800 |
| EXM0149 | RIA – PACKAGE 1 (TSH, FT3, FT4) – GLOBAL | 2,400.00 |
| EXM0150 | RIA – PACKAGE 2 (TSH, T3, T4) – GLOBAL | 2,400.00 |
| EXM0151 | RIA – PACKAGE 3 (TSH, FT4) – GLOBAL | 1,600.00 |
| EXM0152 | RIA – PACKAGE 4 (TSH, FT3) – GLOBAL | 1,600.00 |
| EXM0153 | RIA – PACKAGE 5 (FT3, FT4) – GLOBAL | 1,600.00 |
| EXM0154 | TOTAL T3 – GLOBAL | 800 |
| EXM0155 | TOTAL T4 – GLOBAL | 800 |
| EXM0158 | THALLIUM PHARMACOLOGIC STRESS (ADENOSINE) | 26,915.00 |
| EXM0159 | SEND OUT GATA3 IHC STAINING | 4,620.00 |
| EXM0161 | P16 | 4,620.00 |
| EXM0162 | P40 | 4,620.00 |
| EXM0163 | FISH HER | 26,136.00 |
| EXM0164 | GATA-3 | 4,620.00 |
| EXM0165 | CD10 | 4,620.00 |
| EXM0166 | BCL-2 | 4,620.00 |
| EXM0167 | KI67 | 4,620.00 |
| EXM0168 | P63 | 4,620.00 |
| EXM0169 | TTF-1 | 4,620.00 |
| EXM0170 | CK | 4,620.00 |
| EXM0171 | CK7 | 4,620.00 |
| EXM0172 | CK19 | 4,620.00 |
| EXM0173 | CK20 | 4,620.00 |
| EXM0174 | CK5/6 | 4,620.00 |
| EXM0175 | EBER ISH | 19,663.00 |
| EXM0176 | LCA | 4,620.00 |
| EXM0177 | NAPSIN A | 4620.00 |
| EXM0178 | PAX 8 | 4620.00 |
| EXM0181 | CD3 | 4620.00 |
| EXM0182 | CD20 | 4620.00 |
| EXM0183 | CD68 | 6300.00 |
| EXM0184 | ANTI-TG – GLOBAL TG | 1600.00 |
| EXM0185 | TG – GLOBAL | 1500.00 |
| EXM0186 | CD15 | 6300.00 |
| EXM0187 | CD30 | 4620.00 |
| EXM0188 | PAX 5 | 4620.00 |
| EXM0190 | CD34 | 4620.00 |
| EXM0191 | BCL 6 | 4620.00 |
| EXM0192 | AMACR | 6300.00 |
| EXM0193 | P504S | 4900.00 |
| EXM0194 | NKX3.1 | 8431.92 |
| EXM0195 | P63 (PROCESSING WITH READING) | 6300.00 |
| EXM0197 | DMMR (PROCESSING WITH READING) | 15700.00 |
| EXM0198 | CK5/6 (PROCESSING ONLY) | 4620.00 |
| EXM0201 | SYNAPTOPHYSIN (PROCESSING ONLY) | 4620.00 |
| EXM0202 | CHROMOGRANIN (PROCESSING ONLY) | 4620.00 |
| EXM0204 | WT1 (PROCESSING ONLY) | 4620.00 |
| EXM0205 | CALRETININ (PROCESSING ONLY) | 4620.00 |
| EXM0206 | CK (PROCESSING ONLY) | 4620.00 |
| EXM0209 | MAMMOGLOBIN | 4620.00 |
| EXM0210 | INHIBIN-SPECIAL STAIN | 4620.00 |
| EXM0211 | SMA | 4620.00 |
| EXM0212 | DESMIN | 4620.00 |
| EXM0213 | H-CALDESMON | 4620.00 |
| EXM0214 | BREAST ULTRASOUND | 1184.00 |
| EXM0215 | MAMMOGRAM | 1500.00 |
| EXM0216 | COLORECTAL 2A (KRAS:NRAS+BRAF) | 41170.50 |
Tab 2 | Your Content
Global Care Cancer Institute Inc.






