Actual Charges Senior Discount First Case Second Out of Pocket

Rate Case Rate

Hospital Charges
Room Charges 17,500.00 3,500.00 14,000.00
2D ECHO 12,800.00 1,760.00 11,040.00
ADMITTING AND INFORMATION 500.00 100.00 400.00
CENTRAL RESOURCE UNIT 3,004.00 178.00 2,826.00
EMERGENCY ROOM 3,251.41 727.95 2,523.46
LABORATORY 17,465.00 2,456.00 15,009.00
LABORATORY(Credit Note) -185.00 -185
NS 4TH FLOOR WEST WING 1,100.00 220.00 880.00
PHARMACY 25,405.15 2,421.71 22,983.44
X-RAY 2,930.00 586.00 2,344.00
SUBTOTAL HOSPITAL CHARGES >>> 83,770.56 11,949.66 8,820.00 0.00 71,820.90

Professional Fees
DE LIMA, DUNCAN BERTULFO ECHEVERRIA 15,600.00 1,820.00 1,260.00 13,780.00
CHAVEZ IV, JORDAN RELATIVO 0.00 0.00 0.00 0.00
OSIO, FRANCIS HONORATO NACIANCENO 12,600.00 1,320.00 1,260.00 10,020.00
ZENAROSA, GIOVANNI GETULIO TESORERO 13,600.00 1,580.00 1,260.00 12,020.00
ZABALDICA, ANITA YAGO 4,900.00 580.00 1,260.00 4,320.00
SUBTOTAL PROFESSIONAL FEE >>> 34,100.00 3,980.00 3,780.00 30,120.00

GRAND TOTAL >>> 117,870.56 15,929.66 12,600.00 0.00 101,940.90

Less : Payments :
4/12/2021 OR no. 242650 LAB 7311259 SC 24-024-0088 1,380.00
4/12/2021 OR no. 248610 PATIENT DEPOSIT 9,500.00
8/12/2021 OR no. 240071 PARTIAL PAYMENT-Hosp Bill 56,432.00
TOTAL PAYMENTS >>> 67,312.00

FINAL BILL BALANCE DUE: 34,628.90