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PUSHPAWATI SINGHANIA HOSPITAL & RESEARCH INSTITUTE A MULTISPECIALITY HOSPITAL (formally known as Puspawati Singhania Research Institute for liver,Renal & Digestive Diseases) (w.e.f. 01.04.2020) OPD CHARGES FEES (Rs) SR. NO. CONSULTANT NAME FIRST SUBS. GASTROENTEROLOGY 1PROF.(DR). R.K.TANDON 20001500 2LT. COL. (DR) ARUN KUMAR 12001200 3DR. DINESH SINGHAL 10001000 4DR. MANOJ KUMAR 10001000 5DR. NRIPEN SAIKIA 10001000 6DR. RAJIV BAIJAL 10001000 7DR. RAHUL GUPTA 20002000 8DR. SHUBHAM VATSYA 900900 SURGICAL GASTROENTEROLOGY & LIVER TRANSPLANT 1DR. K.R VASUDEVAN 12001200 2DR. MANOJ GUPTA 10001000 3DR. BHUSHAN P. BHOLA 12001200 NEPHROLOGY 1DR. SANJEEV SAXENA 12001200 2DR. RAVI BANSAL 10001000 3DR. RAJESH GOEL 800800 UROLOGY 1DR. P.P.SINGH 12001200 2DR. JAGDEEP BALYAN 11001100 3DR. A.S.MALHOTRA 11001100 CARDIOLOGIST 1DR. T.S.KLER 10001000 2DR. VINAYAK AGRAWAL 12001200 3DR. AVINASH VERMA 10001000 4DR. S. N. PATHAK 10001000 5DR. ABHINAV AGGARWAL 10001000 CARDIO SURGERY 1DR. BALRAM AIRAN 10001000 2DR. VIJAY MOHAN KOHLI 12501250 3DR GAURAV GUPTA 10001000 NEUROLOGOY 1DR. SHAMSHER DWIVEDEE 20001800 NEURO SURGERY 1DR. SUMIT GOYAL 10001000 ENDOCRINOLOGY 1DR. MONIKA SHARMA 1001000 PULMONOLOGY 1DR. G.C. KHILNANI 15001500 2DR. NEETU JAIN 10001000 G.I SURGERY 1DR. SANJAY CHAUREY 15001500 2DR. RAJEEV KHANNA 12001000 3DR. HARISH KAPILA 15001500 ONCOLOGY (SURGERY) 1DR. ARVIND KUMAR 15001500 2DR. SALEEM NAYAK 15001500 3DR. VIVEK GUPTA 15001500 4DR. VIKRANT SHARMA 15001500 ONCOLOGY 1DR. AMISH VORA 15001500 2DR. AMIT UPADHYAY 15001500 ORTHOPEDICS 1DR. P.P. KOTWAL 15001500 2DR. GAURAV PRAKASH BHARDWAJ 12001200

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3DR. U.K.SADHOO 12001200 4DR. G.S.TUCKER 12001200 5DR. ANIL MISHRA 10001000 6DR. MILIND GAJEWAR 20002000 PLASTIC SURGERY 1DR. ROHIT NAYAR 10001000 2DR. ANSHUMALI MISRA 10001000 INTERVENTIONAL RADIOLOGY 1DR. ASHWIN GARG 800800 PSYCHIATRY 1DR. PARAMJEET SINGH 12001200 GYNAECOLOGY 1DR. BIRBALA RAI 12001200 2DR. RAHUL MANCHANDA 14001400 INTERNAL MEDICINE 1DR. ANURAG MAHAJAN 11001100 2DR. MANISH MOHIL 11001100 3DR. SUMAN BANARJEE 600600 BARIATRIC SURGERY 1DR. SUSHANT WADHERA 15001500 PAEDIATRIC 1DR. JOSYULA PRABHAKAR RAO 800800 OPHTHALMOLOGY 1DR. VANDANA KHULLAR 12001200 DERMATOLOGY 1DR. AMIT VIJ 700700 VESCULAR ENDOVASCULAR 1DR. NAVIN CHOBDAR 10001000 ENT 1DR. MEENA AGGARWAL 1000900 PAIN MANAGEMENT 1DR. MADHUJEET GUPTA 800800 CLINICAL PSYCHOLOGY/PSYCHOTHERAPY 1MS. KAUSTUBHI SHUKLA 1200750 PHYSIOTHERAPY 1MR. LAKSHYA 500500 DEITICIAN 1MRS. DEBJANI BANERJEE 600600 1 RMO/CMO CHARGES 600 2ANNUAL REGISTRATION CHARGES 200 3 ONE FOLLOW-UP CONSULTATION IS FREE WITHIN 3 WORKING DAYS OF PAID CONSULTATION

ROOM CHARGES CHARGES S.NO ROOM CATEGORY (Rs.)/DAY 1PRESIDENT SUITE 32000 2SUITE 25000 3SUPER DELUXE 18000 4SUPER SINGLE 14000 5SINGLE 11000 6DELUXE DOUBLE 9500 7DOUBLE 7500 8FOUR BEDDED 4400 9MEDICAL ICU 13500 10CCU 13000 11LTU 14000 12RTU 12000 13HDU 9500 14CTVS 13500 15NEURO/SURGICAL ICU 14500 16SURGICAL HDU 11000 17DAY CARE FULL 4000 18DAY CARE HALF 2000 19EMERGENCY STAY (PER HOUR) 500

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ICU CHARGES ( IN CASE OF TRANSFER ) CHARGES S.NO ROOM CATEGORY (Rs.)/DAY 1PRESIDENT SUITE 32000 2SUITE 25000 3SUPER DELUXE 18000 4SUPER SINGLE AS PER ICU 5SINGLE AS PER ICU 6DELUX DOUBLE AS PER ICU 7DOUBLE AS PER ICU 8FOUR BEDDED AS PER ICU INFORMATION ABOUT ROOM CHARGES & OTHER SERVICES 1 ROOM / BED TARIFF INCLUDES STANDARD FITTINGS IN THE ROOM ACCORDING TO THE TYPE OF OCCUPANCY / 2 ICU CHARGES INCLUDE: - ROOM RENT, MONITORING, NURSING CHARGES, AND PULSE OXYMETERS 3 ICU CHARGES DO NOT INCLUDE:- CRITICAL CARE CONSULTANTS, VENTILATOR (INITIATION/MAINTENANCE 4 IN CASE OF PATIENT TRANSFERRED FROM THE WARD/ROOM TO ICU THEN WARD/ ROOM WILL HAVE TO BE 5 IN CASE PATIENT IS ADMITTED DIRECTLY IN MICU/SICU & DISCHARGE FROM SAME, ALL CHARGES SHALL BE 6 OUR CHARGES FOR OPD PROCEDURE/INVESTIGATION WILL BE LEVIED AS PER FOUR BED CATEGORY RATES. 7 MORTUARY CHARGES FOR 24 HOUR IS RS 3500 AND BEYOND 24 HRS.EXTRA CHARGES WILL BE @ RS 175 PER 8 IN CASE THE PATIENT REQUEST FOR SPECIAL NURSING CARE IT WOULD BE CHARGED @ RS. 2500/- FOR 12 9 IN CASE THE PATIENT REQUEST SPECIAL GDA CARE IT WOULD BE CHARGED @ RS. 1000/- FOR 12 HRS ADVANCE DEPOSIT AT THE TIME OF ADMISSION S.NO. ROOM CATEGORY CHARGES 1PRESIDENT SUITE 80000 2SUITE 70000 3SUPER DELUXE 60000 4DELUX 55000 5SUPER SINGLE 45000 6SINGLE 40000 7DELUX DOUBLE 35000 8DOUBLE 30000 9FOUR BEDDED 25000 10MEDICAL ICU/CCU/HDU/SICU 85000 NOTE:-IN CASE OF PACKAGE/EMERGENCY 100% OF ESTIMATE HAS TO BE DEPOSITED IN ADVANCE.

DOCTOR VISIT CHARGES(IPD VISIT) VISIT CHARGES(Rs) VISIT CHARGES S.NO. BED CATEGORY 1ST 2ND TOTAL EMR. 1PRESIDENT SUITE 400040008000 6000 2SUITE 300030006000 5000 3SUPER DELUXE 220022004400 3500 4SUPER SINGLE 200020004000 3000 5SINGLE 140014002800 2700 6DELUXE DOUBLE 140014002800 2800 7DOUBLE 120012002400 2000 8FOUR BEDDED 100010002000 2000 9MEDICAL ICU 150015003000 3500 10CCU 160016003200 3500 11LTU 160016003200 3000 12RTU 130013002600 3000 13HDU 130013002600 2500 14CTVS 160016003200 3200 15NEURO/SURGICAL ICU 160016003200 3200 16SURGICAL HDU 150015003000 2700 17DAY CARE FULL 8008001600 1500 18DAY CARE HALF 900 900900

INFORMATION ABOUT DOCTOR VISIT CHARFES & OTHER SERVICES

1 DIETARY CONSULTATION RS 300/- ( ON ADMISSION DAY & DAY OF DISCHARGE DAY) RS 100/- PER DAY (UPTO 2

2 EMERGENCY VISIT CHARGES WILL BE APPLICABLE ON ALL SUNDAYS, HOLIDAYS & 6.00 PM TO 8.00 AM ON 3 ANY VISITS AFTER 6:00 PM WILL BE TREATED AS EMERGENCY VISITS AND CHARGES WILL BE APPLICABLE AS

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4 THE VISITING CHARGES FOR CONSULTANTS SHALL VARY DEPENDING ON THE BED CATEGORY OF PATIENT AND 5 ONE FOLLOW – UP CONSULTATION IS FREE WITHIN 4 WORKING DAYS OF A PAID CONSULTATION, SURGERY OR 6 RMO CONSULTATION RS 600/- WOULD BE CHARGED ADDITIONALY FOR ALL BED CATAGORY

CLINICAL PSYCHOLOGY FOUR TWO SINGLE SUPER PRESIDENT CODE NO DESCRIPTION SUITE BEDDED BEDDED BEDDED DELUXE SUITE PSYPSC0007 PSYCHOLOGY COUNSELING 400 600 850 1250 1500 1800 PSYPSC0008 INTAKE SESSION 500 800 1000 1500 1850 2100 PSYPSC0009 RELAXATION THERAPY COUNSELLING 1000 1250 1500 2000 2500 2800 BRIEF COGNITIVE BEHAVIOR THERAPY PSYPSC0010 800 1200 1500 2000 2500 2800 COUNSELING PSYPSC0011 FAMILY COUNSELING 800 1200 1500 2250 2500 2800

PSYCHOLOGY CONSULTATION CODE.NO SERVICE NAME AMOUNT PSYPSC0015PSYCHOLOGY SESSION- 1ST 1500 PSYPSC0016PSYCHOLOGY SESSION- 30 MINUTES 1000 PSYPSC0017PSYCHOLOGY SESSION- 60 MINUTES 1500 PSYPSC0018PSYCHOLOGY SESSION- 90 MINUTES 2250 PSYPSC0019CHILD DEV.TESTING+COUNSELING(3 SESSIONS) 3500 PSYPSC0020CHILD IQ&DQ TESTING+COUNSELING(3SESSION) 4750 PSYPSC0028NEUROPSYCHOLOGICAL ASSESSMENT 3500 PSYPSC0021RELAXATIONTHERAPY+BIO FEEDBACK(3SESSION) 4500 PSYPSC0022COGNITIVE BEHAVIOR THERAPY (5 SESSIONS) 6750 PSYPSC0023COUPLE & MARRIAGE COUNSELING (5SESSIONS) 13750 PSYPSC0024DE-ADDICTIONCOUNSELING(INDV+FAMILY 6SIT) 15000 PSYPSC0025PRE-MARITAL COUNSELING(TESTING INCLUDED) 5000 PSYPSC0026CAREER COUNSELING (3 SESSIONS) 10000 PSYPSC0027LIFE COACHING 18750 AMBULANCE CHARGES CODE.NO PARTICULAR CHARGES AMUAMB0010PRIMARY- LOCAL (ACLS) (UPTO 10 KM) 3000 AMUAMB0011PRIMARY- LOCAL (BLS) (UPTO 10 KM) 1500 AMUAMB0012ACLS CHARGES ADDITIONAL PER KM 30 AMUAMB0013BLS CHARGES ADDITIONAL PER KM 25 AMUAMB0014LOCAL -ACLS+SPECIALIST DOCTOR 6000 AMUAMB0015LOCAL - ACLS+SUPER SPECIALIST DOCTOR 10000 AMUAMB0016LOCAL - ACLS+NURSE/PERAMEDIC/PERAMDIC 4000 AMUAMB0017LOCAL - ACLS+NURSE/PERAMEDIC+GDA 4500 AMUAMB0018LOCAL - ACLS+SPECIALIST DOCTOR+NURSE/PE 7000 AMUAMB0019LOCAL - ACLS+SPECIALIST DOCTOR+NURSE/PE 7500 AMUAMB0020LOCAL - ACLS+SUPER SPECIALIST DOCTOR+NU 11000 AMUAMB0021LOCAL - ACLS+SUPER SPECIALIST DOCTOR+NU 11500 AMUAMB0022OUTSTATION AMBULANCE ACLS (PER KM) 45 AMUAMB0023OUTSTATION AMBULANCE BLS (PER KM) 35 AMUAMB0026NURSE/PERAMEDIC CHARGES-OUTSTATION AMBUL 2000 AMUAMB0027NURSE/PERAMEDIC CHARGES+GDA -OUTSTATION 3000 AMUAMB0028SPECIALIST DOCTOR CHRG - OUTSTATION AMBU 10000 AMUAMB0029SUPER SPECIALIST DOCTOR CHRG - OUTSTATIO 15000 AMUAMB0030CANNULATION 200 AMUAMB0031CANNULATION + MEDICINE 500 AMUAMB0032CANNULATION + O2 THERAPY/ NEB 800 AMUAMB0033CANNULATION + O2 THERAPY/ NEB. + DRUGS 1500 AMUAMB0034CANNULATION, VENTILATION, INTUBATION 4000 AMUAMB0035NURSING CHARGES 500 AMUAMB0036GDA CHARGES 500

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CODE.NO SERVICE NAME AMOUNT VARIOUS GENERAL PROCEDURES

CODE NO. PROCEDURE CHARGES (Rs) EYE PROCEDURE EYECHK0001EYE DIALATION 330 EYECHK0002EYE PRESSURE WITH RETINAL EXAMINATION 220 EYECHK0003PROBING SYRINGING PER EYE 1000 EYECHK0004SUBTENON INJECTION PER EYE 1200 EYECHK0005FOREIGN BODY REMOVAL PER EYE 2000 EYECHK0006CHALAZION I&C 4350 EYECHK0007TARSORRAPHY PER EYE 3500 EYECHK0008VISION TEST 1000 EYECHK0009OPHTHALMIC CHECK UP 1000 EYECHK0010SLIT LAMP EXAMINATION 1000 EYECHK0011EYE CHECK-UP 100 EYECHK0012REFRACTION EYE TESTING 800 EYECHK0013RETINAL EXAMINATION UNDER DILATATION FUN 1500 EYECHK0014GONIOSCOPY 1000 EYECHK0015WATER DRINKING TEST 3500 EYECHK0016IOP 1000 EYECHK0017RETINAL EXAMINATIONUN DILATED 1000 EYECHK0018APPLANATION TONOMETERY 1000 EYECHK0019CONCRETIONS EXPRESSION 1500 EYECHK0020EPILATION 1000 EYECHK0021SUTURE REMOVAL ONE EYE 1200 EYECHK0022CHALAZION MULTIPLE 4500 EYECHK0023SCHIRMERS TEST 1000 EYECHK0024SYRINGING ONE EYE 1000 ENT PROCEDURE ENTCHK0001 ENT - CHECK UP 250 ENTCHK0010 CHEMICAL CAUTERISATION NOSE/THROAT/EAR 3000 ENTCHK0015 DRESSING (ENT) MINOR 1500 ENTCHK0016 DRESSING (ENT) MAJOR 3000 ENTCHK0017 DIRECT LARYNGOSCOPY RIGID 3000 ENTCHK0031 FOREIGN BODY REMOVAL EAR/NOSE/THROAT 6000 ENTCHK0034 ABSCESS DRAINAGE 6000 ENTCHK0038 PAN ENDOSCOPY 12000 ENTCHK0044 SUBMUCOUS DIATHERMY - B/L 7000 ENTCHK0045 SUBMUCOUS DIATHERMY - U/L 4000 ENTCHK0046SUCTION CLEARENCE NOSE / EAR - B/L 2000 ENTCHK0047SUCTION CLEARENCE NOSE / EAR - UNILATERA 1500 ENTCHK0048 SUTURE REMOVAL 1000 ENTCHK0049 SUTURING 3500 ENTCHK0058BIOPSY 2500 EAR ENTCHK0004 AUDIOMETRY TEST 700 ENTCHK0005FUNGAL / WAX CLEARING 1000 ENTCHK0024EAR PIERCING WITH LOW STUDS 4000 ENTCHK0019 EUM & CLEARATING OF EAR 3000 ENTCHK0020 EAR LOBE REPAIR - B/L 5000 ENTCHK0021 EAR LOBE REPAIR - U/L 3000 ENTCHK0026EUM SUCTION - B/L 2500 ENTCHK0027EUM SUCTION - U/L 1500 ENTCHK0028FACIAL WOUND REPAIR (MAJOR) 6000 ENTCHK0029FACIAL WOUND REPAIR (MINOR) 4000 ENTCHK0039 PINNA PIERCING -B/L 2000 ENTCHK0040 PINNA PIERCING-U/L 1500 ENTCHK0063PROSTHESIS (ENT) CHARGES 2000

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CODE.NO SERVICE NAME AMOUNT NOSE ENTCHK0002 NASAL PACKING POSTERIOR 5500 ENTCHK0061 NASAL PACKING ANTERIOR AND POSTERIOR 7000 ENTCHK0003 NASAL PACKING ANTERIOR 3500 ENTCHK0007 NASAL PACK REMOVAL B/L 2000 ENTCHK0060 NASAL PACK REMOVAL U/L 1500 ENTCHK0011 ANTRAL WASH B/L 6000 ENTCHK0012 ANTRAL WASH U/L 4000 ENTCHK0025 NOSE PIERCING 2500 ENTCHK0035 NASAL ENDOSCOPY 4000 ENTCHK0036 NASAL ENDOSCOPY WITH BIOPSY 6000 ENTCHK0041 REDUCTION OF FRACTURE NASAL BONE 7500 ENTCHK0042 SEBACEOUS CYST NECK EXCISION 7500 ENTCHK0043 SUBMUCOUS INJECTION (STEROID) 2000 ENTCHK0050SYNACHAE REMOVAL FROM NOSE - B/L 7500 ENTCHK0051SYNACHAE REMOVAL FROM NOSE - U/L 5000 ENTCHK0060NASAL PACK REMOVAL U/L 1500 ENTCHK0061NASAL PACKING ANTERIOR N POSTERIOR 7000 THROAT ENTCHK0014 DECANULATION OF TRACHEOSTOMY TUBE 5000 ENTCHK0018 DIRECT LARYNGOSCOPY FIBREOPTIC (FOL) 5000 ENTCHK0037 ORAL BIOPSY 6000 ENTCHK0055 TONGUE-TIE RELEASE 5000 ENTCHK0056 TRACHEOSTOMY 15000 ENTCHK0062 TRACHEOSTOMY EMERGENCY 15000 ENTCHK0057 TRACHEOSTOMY TUBE CHANGE 1500 AUDIOMETRY ENTAUD0001 PURE TONE AUDIOMETRY - PTA 800 ENTAUD0002 IMPEDENCE 800 ENTAUD0003 BERA 3500 ENTAUD0004 SPEECH AUDIOMETRY 800 ENTAUD0005 HEARING AID TRIAL 600 ENTAUD0006 TONE DECAY - TD 600 ENTAUD0007 SHORT INCREMENT SENSTIVITY INDEX - SISI 600 ENTAUD0008 ALTERNATE BINAURAL LOUDNESS BALANCE-ABLB 600 ENTAUD0009 OTOTACOUSTIC EMISSIONS TESTING - OAE 1200 CARDIO PROCEDURE PROINV0031 CAROTID DOPPLER 3300 PROINV0032 ECHOCARDIOGRAPHY 3500 PROINV0033 STRESS ECHOCARDIOGRAPHY 5000 PROINV0034 BEDSIDE EMERGENCY ECHOCARDIOGRAPHY 4950 PROINV0035 EMERGENCY DOCTOR VISIT CHARGES 1400 PROINV0036 ECHOCARDIOGRAPHY SCREENING 2000 PROINV0037 ECHOCARDIOGRAPHY BEDSIDE/EMERGENCY 4400 PROINV0038 DOBUTAMINE STRESS ECHOCARDIOGRAPHY 5500 PROGEN0005 E.C.G 330 PROGEN0028 TMT 2500 PROGEN0018 E.C.G. EMERGENCY 440 PROGEN0019 FIBRINOLYSIS UROKIMASE 2550 CARDIO0001 PRICARDIOCENTESIS 7950 PROGEN0047 TEMPORARY PACE MAKER 11000 CARDIO0003INTRAVENOUS THROMBOLYSIS FOR ACUTE STROKE 13200 CARDIO0004INTRAVENOUS THROMBOLYSIS FOR & HEART ATTACK 11000 CARDIO0005HOLTER MONITORING 3300 CARDIO0006TEMPRARY PACEMAKER PROGRAMING 1550

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CODE.NO SERVICE NAME AMOUNT CARDIO0007PERICARDIAL TAPPING 1350 CARDIO0008PERICARDIAL DRAIN FLUID - ASPIRATION 2750 CARDIO0009PERICARDIAL DRAIN REMOVAL 2750 CARDIO0010PERICARDIAL CENTESIS 5500 CARDIO0011PERICARDIAL CENTESIS WITH CATHETER INSER 8250 CARDIO0023 CAROTID IMT 1000 PROCAD0001TRIAGE CARDIAC PANEL 3100 CARDIO0012HUTT STUDY 8250 PROCAR0001CARDIAC CATH 13200 PROINV0040PTCA (SUBSEQUENT) 27500 PROINV0041PTCA (SUBSEQUENT)+ROTA 70400 CARDIO0013DOBUTAMINE STRESS ECHOCARDIOGRAPHY (PKG) 6400 CARDIO0014TEE 5500 CARDIO0015IABP INSERTION CHARGES 11000 CARDIO0016IABP PUMP RUNNING FOR 24 HOUR 11000 PROINV0044PEDIATRICS ECHOCARDIOGRAPHY 3300 PROINV0045POST PTBD CHECK CHOLANGIOGRAM PRE/INTRA/ 5500 PROINV0046PCN/PTBD WITH PRIMARY STENTING 26400 CARDIO0022FOCUSED VENOUS DOPPLER (TO R/O DVT) 2750 CARDIO0018RENAL ARTERY DOPPLER 3850 CARDIO0019CAROTID & VERTEBRAL ARTERY DOPPLER 3850 CARDIO0020PERIPHERAL UPPER LIMBS ARTERIAL DOPPLER 3850 CARDIO0021PERIPHERAL LOWER LIMBS ARTERIAL DOPPLER 3850 PROINV0047ADVANCED ECHOCARDIOGRAPHY(3D/2D SPECKLED 5000 PROINV0048 CONTRAST ECHO CARDIOGRAM 6000

GASTRO PROCEDURES PROGAS0001 ASCITIC TAP-THERAPEUTIC 2940 PROGAS0002 SENGSTAKEN TUBE COST OF SB TUBE EXTRA 2730 PROGAS0003 LIVER BIOPSY 6300 PROGAS0004 ASCITIC-TAP DIAGNOSTIC 2000 PROGAS0005 PLEURAL TAPPING-DIAGNOSTIC 1790 PROGAS0006 RECTAL BIOPSY SUCTION METHOD 2100 USGSUP0004 ASCITIC TAP-THERAPEUTIC (ULTRASOUND GUIDED) 3890 USGSUP0003 ASCITIC-TAP DIAGNOSTIC (ULTRASOUND GUIDED) 2420 GYNAECOLOGY PROCEDURES PROGYN0001 PAP SMEAR 750 PROGYN0002 ENDOMETRIAL ASPIRATION 3200 PROGYN0003 ENDOMETRIAL BIOPSY 3200 PROGYN0005 ENDOMETERIAL ASPIRATION & BIOPSY 6400 PROGYN0004 IUI UNDER ANESTHESIA 16000 PROGYN0006 IUI 10000 PROGYN0007MULTILOAD REMOVAL 500 VASCULLAR PROCEDURES PRONEP0006PLASMA EXCHANGE SITTING THROUGH APHAERES 24000 PRONEP0007VEIN MAPPING SINGLE SIDE 2200 PRONEP0008VEIN MAPPING BOTH SIDE 3300 PRONEP0009PLASMAEXCHANGETH APHAERE. WITH AB FILTER 60000 PRONEP0010ANKLE BRACHIAL INDEX 1200 PRONEP0011CAPD CATHETERIZATION (SEILDENGER) 9000 PRONEP0012REMOVAL OF CAPD CATHETER 4000 PRONEP0013VEIN MAPPING SINGLE SIDE - SCREENING 1000 PRONEP0014VEIN MAPPING DOUBLE SIDE - SCREENING 1500 PRONEP0015INTRAOPERATIVE DOPPLER USE (USE IN OT) 1600 PRONEP0016SINGLE SIDE VEIN MAPPING - ANTERIAL 1100 PRONEP0017DOUBLE SIDE VEIN MAPPING - ANTERIAL 2200

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CODE.NO SERVICE NAME AMOUNT PRONEP0018VEIN REPAIR - SMALL 3200 PRONEP0019VEIN REPAIR - MEDIUM 7500 PRONEP0020VEIN REPAIR - LARGE 13000 PRONEP0024THROMBOLYSIS FOR MEDIUM VASELES(VASCULAR 15000 PRONEP0025THROMBOLYSIS FOR LARGE VASELES(VASCULAR) 25000 PRONEP0026IVC FILTER (VASCULAR) 15000 PROVAS0001CHECK VENOGRAPHY 8000 UROLOGY PROCEDURES PROURO0001 BLADDER WASH 800 PROURO0002 PERCUTANEOUS NEPROSTOMY 12000 PROURO0003 UROFLOWMETER TEST 1000 PROURO0004 URETHERAL DILATATION 4000 PROURO0005 PROSTATIC MASSAGE 700 PROURO0006 CIRCUMCISION 6500 PROURO0008 URODYNAMIC STUDY 6500 PROURO0013 PAPAVERINE TEST 1500 PROURO0014 INTRA VESICAL BCG/MITOMYCIN 3300 PROURO0015 TRUS PROSTATIC BIOPSY 6000 PROURO0016 TROCAR CYSTOSTOMY 5500 PROURO0017 MICTURATING CYST-URETHEROGRAM 3000 PROURO0018 RETROGRADE PYELOGRAM 3500 PROURO0019 URETHRAL CALIBRATION/CSIC 2500 PROURO0020FLEXIBLE CYSTOURETHROSCOPY 8000 PROURO0022PROSTATE BIOPSY PROCEDURE 5000 PROURO0023SUPRAPUBLIC CYSTOSTOMY 8000 RHEUMATOLOGY PROCEDURE PRORHE0001ARTHROCENTESIS MAJORSYNOVIAL FLUID ASPIR 1800 PRORHE0002ARTHROCENTESIS MINORSYNOVIAL FLUID ASPIR 1100 PRORHE0003INTRA ARTICULAR INJECTION 1200 PRORHE0004SOFT TISSUE INJECTION 600 PRORHE0005MUSCLE BIOPSY 3500 PRORHE0006ALLERGY SKIN TESTING 1600 PRORHE0007MINOR SALIVARY GLAND BIOPSY 2000

ONCOLOGY PROCEDURE PROONC0001 INTRAVENOUS CHEMOTHERAPY PER DAY 5000 PROONC0002 INTRAPLEURAL/INTRAPERITONEAL/INTRALE 4700 PROONC0011 INTRATHECAL CHEMOTHERAPY 4700 PROONC0003 US GUIDED INTRAHEPATIC CHEMOTHERAPY 3300 PROONC0004 CHEMOPORT INSERTION CHARGES 15000 PROONC0005 CHEMO PORT REMOVAL 7500 PROONC0006 CHEMOTHERAPY COUNSELLING CHARGES 2000 PROONC0007 CHEMOPORT ACCESS CHARGES 1000 PROONC0008 IV CHEMOTHERAPY PER DAY (SINGLE DOSE) 1500 PROONC0012 PUNCH/WEDGE/INCISIONAL BIOPSY- SMALL 2500 PROONC0013 PUNCH/WEDGE/INCISIONAL BIOPSY- LARGE 4000 PROONC0014 LN BIOPSY SUPERFICIAL 4000 PROONC0015 LN BIOPSY DEEP 8000 PROONC0016 DIRECT LARYNGOSCOPY (FOL) 3000 PROONC0017 CHEMOPORT NEEDLE INSERTION 600 DIABETES PROCEDURE PRODIA0001 DIABETES SCREENING 200 PRODIA0002 BIOTHESIOMETER 400 PRODIA0003 PODIASCAN 1000 PRODIA0004ANKLE BRACHIAL INDEX 1000

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CODE.NO SERVICE NAME AMOUNT PRODIA0005FLASH GLUCOSE MONITORING SYSTEM 2400

ORTHO PROCEDURE PROORT0001 BE POP APPLIED 2750 PROORT0100PLASTER APPLICATION ( SMALL ) 2000 PROORT0063PLASTER APPLICATION ( MEDIUM ) 3000 PROORT0064PLASTER APPLICATION ( LARGE ) 4000 PROORT0065PLASTER REMOVAL ( SMALL ) 1000 PROORT0066PLASTER REMOVAL ( MEDIUM ) 2000 PROORT0067PLASTER REMOVAL ( LARGE ) 3000 PROORT0068I & D ( SMALL) 3000 PROORT0069I & D ( MEDIUM ) 4500 PROORT0072CLOSE REDUCTION OF FRACTURE/JOINT ( SMALL ) 3000 PROORT0073CLOSE REDUCTION OF FRACTURE/JOINT ( MEDIUM ) 4500 PROORT0074CLOSE REDUCTION OF FRACTURE/JOINT ( LARGE ) 6000 PROORT0075BIOPSY ( SMALL ) 4000 PROORT0076BIOPSY ( MEDIUM ) 6000 PROORT0077INCISIONAL BIOPSY 3000 PROORT0078IMAGE GUIDED BIOPSY 6000 PROORT0079K-WIRE REMOVAL ( SIMPLE ) 2000 PROORT0080K-WIRE REMOVAL ( COMPLEX ) 3000 PROORT0081FIXATOR REMOVAL ( SIMPLE ) 3000 PROORT0082FIXATOR REMOVAL ( COMPLEX ) 6000 PROORT0083SCREW REMOVAL 3000 PROORT0084NAIL AVULSION/REMOVAL 4500 PROORT0085JOINT ASPIRATION+INTRA-ARTICULAR INJ. 5000 PROORT0086US GUIDED JOINT ASPIRATION+INTRA-ARTICULAR INJ 8000 PROORT0087C-ARM GUIDED JOINT ASPIRATION+INTRA-ARTICULAR INJ. 7000 PROORT0088INFILTRATION UNDER LA ( SMALL ) 1000 PROORT0089INFILTRATION UNDER LA ( MEDIUM ) 2000 PROORT0090INFILTRATION UNDER LA ( LARGE ) 3000 PROORT0091INJECTION ( MAYOFACIAL) ( SIMPLE ) 3000 PROORT0092INJECTION ( MAYOFACIAL) ( COMPLEX ) 5000 PROORT0093WOUND SUTURING ( SMALL) 3000 PROORT0094WOUND SUTURING ( MEDIUM ) 4000 PROORT0095WOUND SUTURING ( LARGE) 5000 PROORT0096PERIPHERAL NERVE BLOCK 5000 PROORT0097US GUIDED PERIPHERAL NERVE BLOCK 11000 PROORT0101 CLOSE REDUCTION OF DISLOCATION- SMALL 4000 PROORT0102 CLOSE REDUCTION OF DISLOCATION-MEDIUM 6000 PROORT0103 CLOSE REDUCTION OF DISLOCATION 8000 PROORT0011 CLOSED REDUCTION OF AN UPPER LIMB FRACTU 6820 PROORT0012 CLOSED REDUCTION OF AN LOWER LIMB FRACT 6820 PROORT0015 FACET JOINT INJECTION IN THE SPINE 5720 PROORT0016 CAUDAL BLOCK 7560 PROORT0017 CHANGE OF DRESSING SMALL 1100 PROORT0018 CHANGE OF DRESSING LARGE 2200 PROORT0019 REMOVAL OF STICHES/STAPLES SMALL 1100 PROORT0020 REMOVAL OF STICHES/STAPLES LARGE 2200 PROORT0021 SHOULDER SPICE 4950 PROORT0022 HIP SPICE 6050 PROORT0023 FIGURE OF EIGHT BANDAGE 1100 PROORT0024 ARM-CHEST BANDAGE 1320

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CODE.NO SERVICE NAME AMOUNT PROORT0025 ROBERT JONES BANDAGE 1100 PROORT0026 CLUB FOOT CORRECTIVE POP 5000 PROORT0027 STAPPING WITH DYNAPLAST 1650 PROORT0028 FIGER STAPPING 880 PROORT0030 KNEE ASPIRATION PROCEDURE CHARGES 4400 PROORT0032 THUMB DISLOCATION REDUCTION 4400 PROORT0033 TRACTION APPLICATION 1650 PROORT0035 DRESSING MINOR 500 PROORT0036 DRESSING MEDIUM 800 PROORT0037STITCH REMOVAL - ORTHO ( SMALL ) 800 PROORT0098STITCH REMOVAL - ORTHO ( LARGE ) 1200 PROORT0040 JOINT ASPIRATION PLUS INJECTION 3000 PROORT0041 BELOW KNEE POP 2000 PROORT0042 ABOVE KNEE POP 3000 PROORT0043 CLOSED REDUCTION ( SIMPLE ) 3000 PROORT0044 CLOSED REDUCTION ( COMPLEX ) 4000 PROORT0045SI JOINT FACET INJECTION 6000 PROORT0048FACET INFILTRATION 6000 PROORT0049DRESSING EXTRA LARGE/COMPLEX 1500 PROORT0099THERAPEUTIC PAIN INJECTION 10000 PROORT0100PLASTER APPLICATION ( SMALL ) 2000 PROORT0104 PRPP INJECTION - SIMPLE 5000 PROORT0105 PRPP INJECTION - COMPLEX 8000 PHYSIOTHERAPY PHYPYS0001 ULTRASONIC THERAPY UST 200 PHYPYS0002 SHORTWAVE SWD 200 PHYPYS0004 TENS 200 PHYPYS0005 IFT 200 PHYPYS0006 PHYSIOTHERAPY CHEST+ELECTROTHERAPY 800 PHYPYS0007 PHYSIOTHERAPY CHEST+LIMB 550 PHYPYS0008 PHYSIOTHERAPY CHEST+LIMB-EMERGENCY 1000 PHYPYS0011 PHYSIOTHERAPY CHEST 450 PHYPYS0012 PHYSIOTHERAPY LIMB 450 PHYPYS0013 PAIN PACKAGE (5 DAYS) 2200 PHYPYS0014 PAIN PACKAGE (7 DAYS) 2700 PHYPYS0015 PHYSIOTHERAPY LIMB (5 SITTING) 2000 PHYPYS0018 PACKAGE CHARGE SWD ( 5 SITTINGS ) 900 PHYPYS0019 PACKAGE CHARGE ULTRASONIC ( 5 SITTINGS ) 900 PHYPYS0020 PACKAGE CHARGE IFT ( 5 SITTINGS ) 900 PHYPYS0021PACKAGE CHARGE SWD ( 10 SITTINGS ) 1700 PHYPYS0022PACKAGE CHARGE ULTRASONIC ( 10 SITTINGS ) 1700 PHYPYS0023PACKAGE CHARGE IFT ( 10 SITTINGS ) 1700 PHYPYS0024HOT PACKS/CRYOTHERAPY 150 PHYPYS0025MUSCLE STIMULATOR NMES (THERAPEUTIC) 230 PHYPYS0026PHYSIOTHERAPY CHEST+LIMB (SUBSEQUENT) 500 PHYPYS0027PHYSIOTHERAPY LIMB (SUBSEQUENT) 400 PHYPYS0028PHYSIOTHERAPY CHEST (SUBSEQUENT) 400 PHYPYS0029NON ELECTROTHERAPY MODALITY 230 PHYPYS0030LWD THERAPY 250 PHYPYS0031LASER THERAPY 300 PHYPYS0033CPM < 1 HOUR 250 PHYPYS0034CPM >1 HOUR/ MULTIPLE SESSIONS IN A DAY 1000 PHYPYS0035TRACTION C/L 200 PHYPYS0036KINESIO TAPING APPLICATION CHARGES 250

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CODE.NO SERVICE NAME AMOUNT PHYPYS0037MODALITY UPTO 3 OR MORE 500 PHYPYS0038TILT TABLE THERAPY 250 PHYPYS0039PHYSIOTHERAPY PACKAGE (5 SITTING)- ONLY EXERCISES 1700 PHYPYS0040PHYSIOTHERAPY PACKAGE (10 SITTING)- ONLY EXERCISES 2950 PHYPYS0041ANY TWO MODALITY (5 SITTING) 1700 PHYPYS0042ANY TWO MODALITY (7 SITTING) 2300 PHYPYS0043VITAL STIM (SWALLOWING) 800 PHYPYS0044VITAL STIM (SWALLOWING) FOR 7 DAYS 5300 PHYPYS0045VITAL STIM (SWALLOWING) FOR 10 DAYS 7000 PHYPYS0046BIOFEED BACK 350 PHYPYS0047BIOFEED BACK FOR 5 DAYS 1500 PHYPYS0048BIOFEED BACK FOR 7 DAYS 2000 PHYPYS0050PARAFFIN WAX BATH 150 PHYPYS0051MICROWAVE DIATHERMY 300 PHYPYS0052GAIT TRAINER 450 PHYPYS0053PHYSIOTHERAPY PKG 5 DAYS 3000 PHYPYS0054PHYSIOTHERAPY PKG 5 DAYS COMPREHENSIVE 3200 PHYPYS0055PHYSIOTHERAPY PKG 7 DAYS 4000 PHYPYS0056PHYSIOTHERAPY PKG 7 DAYS COMPREHENSIVE 4200 PHYPYS0057PHYSIOTHERAPY PKG 10 DAYS 5800 PHYPYS0058PHYSIOTHERAPY PKG 10 DAYS COMPREHENSIVE 6200 PHYPYS0059PHYSIOTHERAPY PKG 1 MONTH 15500 PHYPYS0060PHYSIOTHERAPY PKG 1 MONTH COMPREHENSIVE 17000 PHYPYS0061HOME PHYSIOTHERAPY FULL SESSION 1000 PHYPYS0062HOME PHYSIOTHERAPY COMPREHENSIVE 1200 PHYPYS0063NEURO PHYSIOTHERAPY 600 PHYPYS0064INFRARED THERAPY 200 PHYPYS0065BALANCING EXERCISE 250 PHYPYS0066COORDINATION EXERCISE 250 PHYPYS0067PHYSIOTHERAPY FOR PULMONARY REHABILITATION 450 PHYPYS0068GAIT TRAINING- AMBULATION 250 PHYPYS0069PHYSIOTHERAPY FOR CARDIAC REHABILITATION 450 PHYPYS0070PHYSIOTHERAPY FOR KIDNEY TRANSPLANT 450 PHYPYS0071PHYSIOTHERAPY FOR LIVER TRANSPLANT 500 PHYPYS0072STRENGTHNING EXERCISES 200 PHYPYS0073STRETCHING EXERCISES 250 PHYPYS0074VESTIBULAR EXERCISES 350 PHYPYS0075PHYSIOTHERAPY 6 MIN. WALK TEST 450 PHYPYS0076UPPER LIMB TRAINING 400 PHYPYS0077ADL TRAINING 250 PHYPYS0078COMPREHENSIVE MANUAL THERAPY 500 PHYPYS0079CONSULTATION AND ASSESSMENT FEES 500 PHYPYS0080ELECTROTHERAPY UPTO 2 MODALITY 350 PHYPYS0081LIMB EXERCISE THERAPY ONLY 500 PHYPYS0082LIMB EXERCISE THERAPY ONLY (10DAYS) - PACKAGE 4600 PHYPYS0083LIMB EXERCISE THERAPY ONLY – SHORT CASE 300 PHYPYS0084LIMB EXERCISE THERAPY ONLY (SHORT CASE)- PACKAGE FOR 10 DAYS 2800 PHYPYS0085INTEGRATED NEUROREHABILITATION 900 PHYPYS0086INTEGRATED NEUROREHABILITATION (10 DAYS)- PACKAGE 8500 PHYPYS0087INTEGRATED NEUROREHABILITATION (15 DAYS)- PACKAGE 12500 PHYPYS0088INTEGRATED NEUROREHABILITATION (30 DAYS)- PACKAGE 24000 PHYPYS0089MECHANICAL CHEST VIBRATION 150 PHYPYS0090MICRO WAVE/PULSED DIATHERMY 300 PHYPYS0091MOIST HOT PACKS/ CRYOTHERAPY 150

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CODE.NO SERVICE NAME AMOUNT PHYPYS0092MUSCLE CHARTING 500 PHYPYS0093NEURO REHAB (PEDIATRIC) 600 PHYPYS0094PATIENT EDUCATION & HOME PROGRAMME 600 PHYPYS0095SUSPENSION THERAPY 250 PHYPYS0096OCCUPATIONAL THERAPY 700 PHYPYS0097OCCUPATIONAL THERAPY (5 DAYS)- PACKAGE 3200 PHYPYS0098OCCUPATIONAL THERAPY (10 DAYS)- PACKAGE 6200 PHYPYS0099HOME PHYSIOTHERAPY (LONG ONE SESSION) 1500 PHYPYS0100LIVER GYM(M/S CONDITIONING+TRAINING)1 DA 500 PHYPYS0101LIVER GYM(M/S CONDITIONING+TRAINING)10 D 4000 PHYPYS0102LIVER GYM(M/S CONDITIONING+TRAINING)30 D 10000 PHYPYS0103RENAL GYM(M/S CONDITIONING+BALANCE)-1 DA 500 PHYPYS0104RENAL GYM(M/S CONDITIONING+BALANCE)-10DA 4000 PHYPYS0105RENAL GYM(M/S CONDITIONING+BALANCE)-30 D 10000 PHYPYS0106PELVIC FLOOR STRENGTHENING&REHABLITATION 500 PHYPYS0107SMALL JOINT / HAND REHABLITATION - 1DAY 500 PHYPYS0108HOME PHYSIOTHERAPHY ONLY EXERCISE - SHOR 800 DENTAL PROCEDURE ROOT CANAL TREATMENT DNTPRO0002 RCT 4800 DNTPRO0003 RE RCT 7500 DNTPRO0063 ROTARY RCT DENTAL - SINGLE SITTING 6500 DNTPRO0064 ROTARY RCT DENTAL - MULTIPLE SITTING 6000 DNTPRO0082 RE RCT 7500 DNTPRO0097PULPECTOMY 4350 DNTPRO0098PULPECTOMY ( G 1 ) 5400 DNTPRO0099PULPECTOMY ( G 2 ) 7050 DNTPRO0100PULPOTOMY 3800 DNTPRO0101RCT - ANTERIOR TEETH ( G 1 ) 6500 DNTPRO0102RCT - POSTERIOR ( G 1 ) 8500 DNTPRO0103RCT - POSTERIOR ( G 2 ) 8100 DNTPRO0104RCT - POSTERIOR ( G 3 ) 15000 DNTPRO0105RCT ( RCT ) - ANTERIOR TEETH 5400 DNTPRO0106RCT ( RCT ) + POST - G 1 5400 DNTPRO0107RCT ( RCT ) G 1 4350 DNTPRO0108RCT ( RCT ) POST. TEETH 7050 DNTPRO0109RCT + CAD CAM- (P) 35000 DNTPRO0110RCT + CAD CAM G 1 (P) 40000 DNTPRO0111RCT + COMPOSITE 25000 DNTPRO0112RCT + PFM-(P) 30000 DNTPRO0113RCT G 1 (HIGH END) 10000 DNTPRO0114RCT G 2 (HIGH END) 12000 DNTPRO0115RCT G 3 (HIGH END) 15000 DNTPRO0116RE ROOT CANAL (ANTERIOR TOOTH) GR I 8500 DNTPRO0117RE ROOT CANAL (POSTERIOR TOOTH) GR I 10000 DNTPRO0118RE-RCT (ANTERIOR TOOTH) 7050 DNTPRO0119RE-RCT(POSTERIOR TOOTH) 9200 CROWNS DNTPRO0004 CERAMIC CROWN 5000 DNTPRO0005 METAL CROWN 3000 DNTPRO0006 METAL WITH CERAMIC FACING 4500 DNTPRO0038 GLASS CERAMIC CROWN 7000 DNTPRO0042 ZIRCONIA CROWN-5 YEARS 16000 DNTPRO0043 ZIRCONIA CROWNS -10 YEARS 20000

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CODE.NO SERVICE NAME AMOUNT DNTPRO0044 ZIRCONIA CROWNS -15YEARS 22000 DNTPRO0065 RCT+CERAMIC CROWN 10000 DNTPRO0120BRIDGE CAST ( UNITS ) 4300 DNTPRO0121CAD-CAM BRIDGE - G 1 60000 DNTPRO0122CAD-CAM BRIDGE - G 2 75000 DNTPRO0123CAD-CAM BRIDGE - G 3 90000 DNTPRO0124CAD-CAM BRIDGE M2 - G 1 80000 DNTPRO0125CAD-CAM BRIDGE M2 - G 2 100000 DNTPRO0126CAD-CAM BRIDGE M2 - G 3 120000 DNTPRO0127CAD-CAM CROWNS G I 20000 DNTPRO0128CAD-CAM CROWNS G II 25000 DNTPRO0129CAD-CAM CROWNS G III 30000 DNTPRO0130CAD-CAM VENEERS G I 20000 DNTPRO0131CAD-CAMVENEERSG II 25000 DNTPRO0132CAD-CAMVENEERSG III 30000 DNTPRO0133Ceramco Crown 12000 DNTPRO0134CROWN ( ALL CERAMIC ) 19400 DNTPRO0135CROWN ( COMPOSITE ) 3250 DNTPRO0136CROWN ( FULL CAST ) 4350 DNTPRO0137CROWN ( LOW FUSING CERAMIC ) - PER CROWN 16200 DNTPRO0138CROWN ( METAL ) 4350 DNTPRO0139CROWN ( PORCELAIN ) 6500 DNTPRO0140CROWN / BRIDGE PLACEMENT( PER ABUTMENT ) 2000 DNTPRO0141CROWN ACRYLIC ( PER UNIT ) 2200 DNTPRO0142CROWN CERAMIC VITA - NORMAL( PER CROWN ) 6500 DNTPRO0143CROWN LAMINATED ( CERGO ) PER CROWN 21600 DNTPRO0144CROWN PLACEMENT ( LUTING CEMENT ) 1100 DNTPRO0145 CROWN PRECIOUS METAL CERAMIC( HG )- P/U 8650 DNTPRO0146CROWN RECEMENTATION ( G 1 ) 600 DNTPRO0147CROWN RECEMENTATION ( G 2 ) 1200 DNTPRO0148CROWN VITA 3D ( PER CROWN ) 10800 DNTPRO0149GERMAN METAL CERAMIC CROWN (HIGH END) 12000 DNTPRO0150IMMEDIATE LOADING IMPLANT + CROWN G III 150000 DNTPRO0151LAMINATED CROWN (PER CROWN) 25950 DNTPRO0152 ONLAY PORECLAIN FUSED TO METAL-PFM-G1 4350 DNTPRO0153 ONLAY PORECLAIN FUSED TO METAL-PFM-G2 5950 DNTPRO0154 PORCELAIN FUSED TO METAL-PFM-BRIDGE-G1 30000 DNTPRO0155 PORCELAIN FUSED TO METAL-PFM-BRIDGE-G2 36000 DNTPRO0156 PORCELAIN FUSED TO METAL-PFM-BRIDGE-G3 45000 DNTPRO0157 PORCELAIN FUSED TO METAL(PFM)BRD. M2-G1 40000 DNTPRO0158 PORCELAIN FUSED TO METAL(PFM)BRD. M2-G2 48000 DNTPRO0159 PORCELAIN FUSED TO METAL(PFM)BRD. M2-G3 60000 DNTPRO0160PORCELAIN FUSED TO METAL BRIDGE - UNIT 4900 DNTPRO0161TEMPORARY CROWN ( PER CROWN ) 1100 DNTPRO0162VITA 3D CROWN ADV. (PER CROWN) 15000 EXTRACTION DNTPRO0007 EXTRACTION FIRM TOOTH 750 DNTPRO0008 EXTRACTION MOBILE TOOTH 350 DNTPRO0009 EXTRACTION FULLY ERUPTED 8 3000 DNTPRO0010 IMPACTION 7500 DNTPRO0066 SURGICAL EXTRACTION GRADE - 1 2000 DNTPRO0083 SUTURING - DENTAL 1000 DNTPRO0163EXTRAC. of tooth 2500 DNTPRO0164EXTRAC. of tooth (under LA)G IV 5400

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CODE.NO SERVICE NAME AMOUNT DNTPRO0165EXTRAC. of tooth 2 1500 DNTPRO0166IMPACTED TOOTH SUR.EXT.( G 1 ) PER TOOTH 5400 DNTPRO0167IMPACTED TOOTH SURGICAL EXTRAC. 5400 DNTPRO0168 IMPACTED TOOTH SURGICAL EXTRAC(G2)-PT 8100 DNTPRO0169 IMPACTED TOOTH SURGICAL EXTRAC(G3)-PT 10800 DNTPRO0170 IMPACTED TOOTH SURGICAL EXTRAC(G4)-PT 16200 DNTPRO0171IMPACTED TOOTH SURGICAL EXTRAC. (INVERTED) 16200 DNTPRO0172MALALIGNED IMPACTED TOOTH EXT.G 5 - (P) 25000 DNTPRO0173MALALIGNED IMPACTED TOOTH REMOVAL G I 8100 DNTPRO0174MALALIGNED IMPACTED TOOTH REMOVAL G II 10800 DNTPRO0175MALALIGNED IMPACTED TOOTH REMOVAL G III 12000 DNTPRO0176MALALIGNED IMPACTED TOOTH REMOVAL G IV 16200 DNTPRO0177 MAXILLOFACIAL LACERATED WOUND SUTURING-M 5950 DNTPRO0178SOCKET (DRY) 900 DNTPRO0179SOCKET DRESSING 300 DNTPRO0180SUTURE REMOVAL ( LARGE ) 1350 DNTPRO0181SUTURE REMOVAL ( MEDIUM ) 900 DNTPRO0182SUTURE REMOVAL ( SMALL ) 450 DNTPRO0183TOOTH EXTRAC. 900 DNTPRO0184TOOTH EXTRAC. ( G 1 ) 1450 DNTPRO0185TOOTH EXTRAC. ( G 2 ) 1650 DNTPRO0186TOOTH EXTRAC. ( G 3 ) 3800 DNTPRO0187TOOTH EXTRAC. ( LOOSE / MOBILE ) 650 DNTPRO0188TOOTH SURGICAL EXTRAC. 2700 SCALING & POLISHING DNTPRO0036 SCALING 2000 DNTPRO0037 POLISHING 2000 DNTPRO0067 DEEP SCALING 3000 DNTPRO0189AIR POLISHING - G 1 1600 DNTPRO0190AIR POLISHING - G 2 2150 DNTPRO0191AIR POLISHING - G 3 2700 DNTPRO0192Air Polishing GR IV 5000 DNTPRO0193ORAL PROPHYLAXIS + POLISHING + BLEACHING 25000 DNTPRO0194ORAL PROPHYLAXIS THERAPY 1650 DNTPRO0195SCALING ( G 1 ) 1100 DNTPRO0196SCALING ( G 2 ) 2200 DNTPRO0197SCALING ( G 3 ) 2700 DNTPRO0198SCALING ( G 4 ) 3250 DNTPRO0094SCALING ( G 5 ) 3800 RESTORATION DNTPRO0018 TEMPORARY FILLING 250 DNTPRO0019 GIC FILLING 1000 DNTPRO0020 LIGHT CURE FILLINGS 1200 DNTPRO0200Amalgam Replacement GR I 7000 DNTPRO0201COMPLETE TOOTH BUILD UP - G 2 4350 DNTPRO0202COMPOSITE FILLING 950 DNTPRO0203COMPOSITE FILLING ( G 1 ) 2700 DNTPRO0204COMPOSITE FILLING ( G 2 ) 3250 DNTPRO0205COMPOSITE FILLINGS ( ONE SURFACE ) 1100 DNTPRO0206COMPOSITE FILLINGS ( TWO SURFACES ) 1650 DNTPRO0207COMPOSITE FILLINGS( THREE SURFACES ) 2200 DNTPRO0208COMPOSITE TOOTH BUILD UP ( G 1 ) 3250 DNTPRO0209CORE BUILD UP ( G 1 ) 1800 DNTPRO0210CORE BUILD UP ( G 2 ) 2700

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CODE.NO SERVICE NAME AMOUNT DNTPRO0211CORE BUILD UP ( G 3 ) 4350 DNTPRO0212COSMETIC FILLING GR 1 (HIGH END) 2000 DNTPRO0213COSMETIC FILLING GR 2 (HIGH END) 3000 DNTPRO0214DENTAL INLAY 3250 DNTPRO0215DENTAL POST - CASTED ( G 1 ) 4900 DNTPRO0216DENTAL POST - CASTED ( G 2 ) 6500 DNTPRO0217DENTAL SEALANTS 550 DNTPRO0218DIAGNOSTIC BLOCK ( G 1 ) 500 DNTPRO0219DIAGNOSTIC BLOCK ( G 2 ) 600 DNTPRO0220DIASTEMA CLOSURE 8650 DNTPRO0221DIASTEMA CLOSURE ( G 1 ) 10000 DNTPRO0222DIASTEMA CLOSURE ( G 2 ) 15000 DNTPRO0223DIASTEMA CLOSURE ( G 3 ) 15000 DNTPRO0224Diastema Opening GR I 5000 DNTPRO0225Diastema Opening GR II 10000 DNTPRO0226DYCAL LINER 550 DNTPRO0227DYCAL LINER - G 1 1000 DNTPRO0228FILLING GLASS INOMER GR III 2200 DNTPRO0095Filling Glass Inomer GR IV 3000 DNTPRO0229FILLING MIRACLE MIX ( CLASS 2 ) 2200 DNTPRO0230FILLING MIRACLE MIX ( G 1 ) 1650 DNTPRO0231FILLING SILVER ALLOY ( ONE SURFACE ) 550 DNTPRO0232FILLING SILVER ALLOY( THREE SURFACE ) 1100 DNTPRO0233FILLING SILVER ALLOY( TWO SURFACE ) 900 DNTPRO0234GLASS IONOMER CEMENT ( LINER ) 550 DNTPRO0235GLASS IONOMER FILLING ( CLASS 1 ) 1100 DNTPRO0236GLASS IONOMER FILLING ( CLASS 5 ) 1100 DNTPRO0237GLASS IONOMER FILLING ( G 1 ) 1300 DNTPRO0238GLASS IONOMER FILLING ( G 2 ) 1650 DNTPRO0239LAMINATED VENEER ( CERGO ) 21600 DNTPRO0240LAMINATED VENEER ( EMPRESS 2 ) 19450 DNTPRO0241NICKEL- CHROMIUM POST ( CUSTOM MADE ) 6500 DNTPRO0242ORAL PROPHYLAXIS + POLISHING + BLEACHING + 2 FILLINGS 30000 DNTPRO0243PIN RETAINED FILLINGS 2200 DNTPRO0244PIT & FISSURE SEALANT 1100 DNTPRO0245POST & CORE ( DENTAL ) 3250 DNTPRO0246SILVER AMALGAM REPLACEMENT ( PER TOOTH ) 4300 DNTPRO0247SILVER AMALGAM REPLACEMENT + LINER ( PER TOOTH ) 5400 DNTPRO0248TEMPORARY FILLING ( PER TOOTH ) 600 DNTPRO0249TOOTH JEWELLERY ( PER DIAMOND ) 7600 COMPLETE DENTURES DNTPRO0011 COMPLETE DENTURES ACRYLIC 18000 DNTPRO0012 CD LUCITON 25000 DNTPRO0013 FLEXIBLE DENTURE 40000 DNTPRO0080 IMPLANT ATTACHMENT 1500 DNTPRO0081 LUCITON DENTURE ATTACHMENT 40000 DNTPRO0250CAST PARTIAL DENTURE ( METAL ) G I 16200 DNTPRO0251CAST PARTIAL DENTURE ( METAL FRAME ) 10800 DNTPRO0252CAST PARTIAL DENTURE ( PER TOOTH ) 2200 DNTPRO0253COMPLETE DENTURE ( FLEXIBLE PLATE ) 30000 DNTPRO0254COMPLETE DENTURE ( FLEXIBLE TOOTH ) 40000 DNTPRO0255COMPLETE DENTURE LUCITONE ( G 1 ) 50000 DNTPRO0256DENTURE ( REPAIR ) G 1 1100 DNTPRO0257DENTURE ACRYLIC LOWER ( FULL ) 13500

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CODE.NO SERVICE NAME AMOUNT DNTPRO0258DENTURE ACRYLIC UPPER ( FULL ) 13500 DNTPRO0259DENTURE ADJUSTMENT 1500 DNTPRO0260DENTURE ADJUSTMENT - MAJOR 650 DNTPRO0261DENTURE ADJUSTMENT ( MINOR ) 300 DNTPRO0262DENTURE CAST PARTIAL ( ADD. TOOTH ) 2200 DNTPRO0263DENTURE RELINING / REBASING ( G 1 ) 3800 DNTPRO0264DENTURE RELINING / REBASING ( G 2 ) 5400 DNTPRO0265Full lower denture acrylic G I 16200 DNTPRO0266Full lower denture acrylic G II 21600 DNTPRO0267Full upper denture acrylic G I 16200 DNTPRO0268Full upper denture acrylic G II 21600 DNTPRO0269IMP. SUPPORTED COMPLETE DENTURE ( 2) 270000 DNTPRO0270IMP. SUPPORTED COMPLETE DENTURE ( 4 ) 432000 DNTPRO0271IMPALNT SUPPORTED DENTURE ( 2 IMPLANTS ) 270000 DNTPRO0272IMPALNT SUPPORTED DENTURE ( 4 IMPLANTS ) 378000 DNTPRO0273LOWER FULL DENTURE + THREE IMPLANTS 216000 DNTPRO0274OBTURATOR LUCITONE ( 3 TEETH ) 8950 DNTPRO0275PARTIAL DENTURE ACRYLIC PLATE LUCITONE 25000 DNTPRO0276 REM. PART. DENTURE (EVERY ADD. TOOTH) 1100 DNTPRO0277REM. PARTIAL DENTURE ( FIRST 3 TEETH ) 4900 DNTPRO0278REM. PARTIAL DENTURE ( FLEXIBLE PLATE ) 6500 DNTPRO0279REM. PARTIAL DENTURE ( PER TOOTH ) 30000 DNTPRO0280REM. PARTIAL DENTURE (SINGLE UNIT) 2000 DNTPRO0281 REM. PART. DENT FLEX (AD.TOOTH)H.END-G1 2500 DNTPRO0282 REM. PART. DENT FLEX (AD.TOOTH)H.END-G2 3000 DNTPRO0283REM. PARTIAL DENTURE FLEXI(EVERY ADD. TOOTH) 2200 DNTPRO0284REM. PARTIAL DENTURE(FLEX.PLATE)H.END G3 12000 DNTPRO0285REM. PARTIAL DENTURE(FLEXI)H.END G 1 8000 DNTPRO0286REM. PARTIAL DENTURE(RPD)ONE TOOTH - T 1 6500 DNTPRO0287REM.PARTIAL DENTURE(FLEXIPLATE)H.END G2 10000 DNTPRO0288SPACE MAINTAINERS ( REM. ) 2700 DNTPRO0289SPECIAL TRAY FABRICATION - DOUBLE ARCH 2200 DNTPRO0290SPECIAL TRAY FABRICATION - SINGLE ARCH 1100 DNTPRO0291Upper /Lower full denture + 4 implants 378000 DNTPRO0292UPPER FULL DENTURE + THREE IMPLANTS 216000 DNTPRO0293UPPER OBTURATOR DENTURE G I 21600 DNTPRO0294UPPER OBTURATOR DENTURE G II 27000 DNTPRO0295UPPER OBTURATOR PLATE G I 16200 DNTPRO0296UPPER OBTURATOR PLATE G II 21600 REMOVAL PARTIAL DENTURE DNTPRO0014 RPD SINGLE TOOTH 1500 DNTPRO0015 ANY ADDITIONAL TOOTH 1000 DNTPRO0016 CHROME COBALT DENTURE SINGLE TOOTH 5000 DNTPRO0017 ANY ADDITIONAL TOOTH 1500 DNTPRO0021 REMOVABLE PLATES 7500 DNTPRO0068 FLEXIBLE SINGLE TOOTH 7500 DNTPRO0069 ANY ADDITIONAL TOOTH - FLEXIBLE 2500 DNTPRO0070 LUCITON SINGLE TOOTH 6500 DNTPRO0071 ANY ADDITIONAL TOOTH - LUCITON 1500 DENTAL ORTHO PROCEDURE DNTPRO0022 NIGHT GUARD APPLIANCE 9000 DNTPRO0023 STRAIGHT WIRE BRACES METAL - 1ST SITTING 20000 DNTPRO0045 STRAIGHT WIRE BRACES METAL - 2ND SITTING 15000 DNTPRO0046 STRAIGHT WIRE BRACES METAL - 3RD SITTING 15000

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CODE.NO SERVICE NAME AMOUNT DNTPRO0024 STRAIGHT WIRE BRACES CERAMIC-1ST SITTING 30000 DNTPRO0047 STRAIGHT WIRE BRACES CERAMIC-2ND SITTING 15000 DNTPRO0048 STRAIGHT WIRE BRACES CERAMIC-3RD SITTING 10000 DNTPRO0049 STRAIGHT WIRE BRACES CERAMIC-4TH SITTING 10000 DNTPRO0026 LINGUAL BRACES -1ST SITTING 50000 DNTPRO0050 LINGUAL BRACES -2ND SITTING 50000 DNTPRO0051 LINGUAL BRACES -3RD SITTING 50000 DNTPRO0025 DAMON SYSTEM 100000 DNTPRO0039 DAMON METAL - IST SITTING 15000 DNTPRO0052 DAMON METAL - 2ND SITTING 15000 DNTPRO0053 DAMON METAL - 3RD SITTING 15000 DNTPRO0054 DAMON METAL - 4TH SITTING 15000 DNTPRO0055 DAMON METAL - 5TH SITTING 15000 DNTPRO0040 DAMON CERAMIC - IST SITTING 40000 DNTPRO0056 DAMON CERAMIC - 2ND SITTING 15000 DNTPRO0057 DAMON CERAMIC - 3RD SITTING 15000 DNTPRO0058 DAMON CERAMIC - 4TH SITTING 15000 DNTPRO0059 DAMON CERAMIC - 5TH SITTING 15000 DNTPRO0041 CLEAR ALIGNERS 200000 DNTPRO0297ARCH BAR APPLICATION 8950 DNTPRO0298BRACKET PLACEMENT (HIGH END) 30000 DNTPRO0299BRACKET PLACEMENT STAGE 1(HIGH END) 15000 DNTPRO0300BRACKET PLACEMENT STAGE 2 (HIGH END) 20000 DNTPRO0301CLEAR ALIGNERS 270000 DNTPRO0302CLEAR ALIGNERS G I 324000 DNTPRO0303CLEAR ALIGNERS G II 378000 DNTPRO0304CLEAR PATH ALIGNERS G I 200000 DNTPRO0305CLEAR PATH ALIGNERS G II 220000 DNTPRO0306CLEAR PATH ALIGNERS G III 250000 DNTPRO0307DENTAL MODELS ( ORTHO.S ) 1100 DNTPRO0308 FIXED ORTHO. APPLIANCES ( PORCELAIN BRACKET ) 64800 DNTPRO0309 FIXED ORTHO. APPLIANCES ( TRANSPARENT BRACKET ) 54000 DNTPRO0310FIXED ORTHO. APPLIANCES (METAL BRACKET ) 43200 DNTPRO0311FUNCTIONAL APPLIANCE 14250 DNTPRO0312FUNCTIONAL APPLIANCE ( G I ) 16200 DNTPRO0313FUNCTIONAL APPLIANCE ( G II ) 19450 DNTPRO0314LINGUAL BRACES G I 120600 DNTPRO0315LINGUAL BRACES G II 150000 DNTPRO0316LINGUAL BRACES G III 180000 DNTPRO0317ORTHO APPLIANCE FIXED ( PORCELIAN ) 64800 DNTPRO0318ORTHO APPLIANCE FIXED (METAL) GR.I 60000 DNTPRO0319ORTHO APPLIANCE FIXED (METAL) GR.II 70000 DNTPRO0320ORTHO APPLIANCE FIXED (METAL) GR.III 80000 DNTPRO0321ORTHO APPLIANCE FIXED (PORCELAIN) GR.I 80000 DNTPRO0322ORTHO APPLIANCE FIXED (PORCELAIN) GR.II 100000 DNTPRO0323ORTHO APPLIANCE FIXED (PORCELAIN) GR.III 120000 DNTPRO0324ORTHO RETENTION / SIMPLE CORRECTION 4350 DNTPRO0325ORTHO TREATMENT STAGE 4 10800 DNTPRO0326ORTHO. BRACES (AMERICAN METAL) G I 80000 DNTPRO0327ORTHO. BRACES (AMERICAN METAL) G II 100000 DNTPRO0328ORTHO. BRACES (AMERICAN METAL)G III 120000 DNTPRO0329ORTHO. BRACES (PORCELAIN) G I 100000 DNTPRO0330ORTHO. BRACES (PORCELAIN) G II 120000 DNTPRO0331ORTHO. BRACES (PORCELAIN) G III 150000

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CODE.NO SERVICE NAME AMOUNT DNTPRO0332ORTHO. RETENTION ( LINGUAL ) 10800 DNTPRO0333ORTHO. TREATMENT ( AMERICAN BRACKETS ) 54000 DNTPRO0334 ORTHO. TREATMENT ( FIXED ORTHOLINGUAL BRACKETS ) 81000 DNTPRO0335ORTHO. TREATMENT ( INST ) 5400 DNTPRO0336ORTHO. TREATMENT ( STAGE 1 ) 21600 DNTPRO0337ORTHO. TREATMENT ( STAGE 1 ) H.END 25000 DNTPRO0338ORTHO. TREATMENT ( STAGE 2 ) 21600 DNTPRO0339ORTHO. TREATMENT ( STAGE 2 ) H.END 25000 DNTPRO0340ORTHO. TREATMENT ( STAGE 3 ) 10800 DNTPRO0341ORTHO. TREATMENT ( STAGE 3 ) H.END 20000 DNTPRO0342ORTHO. TREATMENT ( STAGE 4 ) H.END 20000 DNTPRO0343ORTHO. TREATMENT ( STAGE 5 ) 21600 DNTPRO0344ORTHO. TREATMENT ( STAGE 5 ) H.END 20000 DNTPRO0345ORTHO. TREATMENT ( STAGE 6 ) 21600 DNTPRO0346ORTHO. TREATMENT ( STAGE 6 ) H.END 30000 DNTPRO0347ORTHO. TREATMENT ( STAGE 7 ) 21600 DNTPRO0348ORTHO. TREATMENT ( STAGE 7 ) H.END 30000 DNTPRO0349ORTHOLINGUAL BRACKETS ( G 1 ) 108000 DNTPRO0350ORTHOLINGUAL BRACKETS ( G 2 ) 129600 DNTPRO0351 REM. ORTHO. APPLIANCE RETAINERS ( EACH UNIT ) 6500

DENTAL SURGERIES DNTPRO0027 PERIO SURGERIES FLAP (PER QUADRANT) 7500 DNTPRO0028 GINGIVECTOMY (PER QUADRANT) 7500 DNTPRO0029 FRENECTOMY 7500 DNTPRO0060 PERIO SURGERIES FLAP (FULL MOUTH) 20000 DNTPRO0061 GINGIVECTOMY (FULL MOUTH) 20000 DNTPRO0072 INCISION & DRAINAGE 5000 DNTPRO0073 ENUCLEATION 10000 DNTPRO0074 SUTURING & GRAFTING 3500 DNTPRO0075 SINUS TRACT 7500 DNTPRO0084 BONE GRAFTING 7000 DNTPRO0085 INTER MAXILLARY FIXATION 7000 DNTPRO0086 SPACE MAINTAINER 5000 DNTPRO0087 FLUORIDE APPLICATION 2500 DNTPRO0088 GLASS FIBER POST 3500 DNTPRO0089 EXTRACTION FIRM TOOTH COMPLAX 1200 DNTPRO0090 EXTRACTION OF RCT TREATED 2500 DNTPRO0091 EXTRACTION OF FRACTURE TOOTH 3000 DNTPRO0092 BONE GRAFTING SMALL 4000 DNTPRO0093 SINGLE DENTURE ACRYLIC 12000 DNTPRO0096 SCALING BASIC 1650 DNTPRO0352ALAR ADJUSTMENT ( NOSE ) 7700 DNTPRO0353ALVEOLAR BONE GRAFTING 17800 DNTPRO0354ALVEOLOPLASTY ( DOUBLE ARCH ) 9500 DNTPRO0355ALVEOLOPLASTY ( PER TOOTH ) 1300 DNTPRO0356ALVEOLOPLASTY ( SINGLE ARCH ) 6500 DNTPRO0357APICOECTOMY 8000 DNTPRO0358AVULSED / EXTRUDED TOOTH REIMPLANTATION 6500 DNTPRO0359BIOPSY LARGE SEGMENT 5000 DNTPRO0360BONE GRAFT G 1 ( PER TOOTH ) 5400 DNTPRO0361BONE GRAFT G 2 ( PER TOOTH ) 10800 DNTPRO0362BONE GRAFT G 3 ( PER TOOTH ) 16200 DNTPRO0363BONE GRAFTING - ILIAC CREST ( G 1 ) 17800

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CODE.NO SERVICE NAME AMOUNT DNTPRO0364BONE GRAFTING - ILIAC CREST ( G 2 ) 19950 DNTPRO0365BONE GRAFTING ( POSTERIOR TEETH ) 64800 DNTPRO0366BONE GRAFTING( PER TOOTH ) 4300 DNTPRO0367BONE PLATE / IMPLANT REMOVAL 11200 DNTPRO0368CALDWELL LUC OPERATION ( ORAL SURGERY ) 11900 DNTPRO0369CAUTERIZATION ( ORAL ) 1300 DNTPRO0370CLEFT LIP SURGERY ( BILATERAL ) 29700 DNTPRO0371CLEFT LIP SURGERY ( UNILATERAL ) 23750 DNTPRO0372CLEFT PALATE 23750 DNTPRO0373CONDYLAR FRACTURE OPEN REDUC. ( G 1 ) 23800 DNTPRO0374CONDYLAR FRACTURE OPEN REDUC. ( G 2 ) 33500 DNTPRO0375COSMETIC LIP CORRECTION 17850 DNTPRO0376DISTANT FLAP ( G 1 ) 17850 DNTPRO0377DISTANT FLAP ( G 2 ) 23800 DNTPRO0378EXCI.AL BIOPSY ( DENTAL ) 4300 DNTPRO0379 FACIAL BONES FRACTURE(MULT.)REPAIR-G1 29700 DNTPRO0380 FACIAL BONES FRACTURE(MULT.)REPAIR-G2 38650 DNTPRO0381FLAP SURGERY - PER SEGMENT ( DENTAL ) 5400 DNTPRO0382FORCEFULL MOUTH OPENING 25000 DNTPRO0383FORCEFULL MOUTH OPENING G 1 30000 DNTPRO0384FORCEFULL MOUTH OPENING G 2 40000 DNTPRO0385GENIOPLASTY 29700 DNTPRO0386GLOSSECTOMY ( PARTIAL ) 4900 DNTPRO0387 HEMANGIOMA EXCI. - LARGE ( ORAL SURGERY ) 14600 DNTPRO0388 HEMANGIOMA EXCI. - MEDIUM ( ORAL SURGERY ) 11900 DNTPRO0389 HEMANGIOMA EXCI. - SMALL ( ORAL SURGERY ) 8650 DNTPRO0390HEMIMAND.IBULECTOMY ( ORAL SURGERY ) 23800 DNTPRO0391HEMIMAXILLECTOMY ( G 1 ) 10800 DNTPRO0392HEMIMAXILLECTOMY ( G 2 ) 14600 DNTPRO0393HIGH END BONE GRAFT (PER SOCKET) G I 15000 DNTPRO0394HIGH END BONE GRAFT (PER SOCKET) G II 20000 DNTPRO0395HIGH END BONE GRAFT (PER SOCKET) G III 25000 DNTPRO0396 IMF+ ARCH BAR - MAXILLA FRACTURE 14050 DNTPRO0397INCISION & DRAINAGE ( G 1 ) 3250 DNTPRO0398INCISION & DRAINAGE ( G 2 ) 4350 DNTPRO0399INCISION & DRAINAGE ( G 3 ) 9750 DNTPRO0400INCISION & DRAINAGE, GR I (UNDER GA) 4600 DNTPRO0401INCISION & DRAINAGE, GR II (UNDER GA) 6000 DNTPRO0402INCISIONAL BIOPSY ( ORAL ) 3250 DNTPRO0403INTER MAXI. FIXATION ( IMF ) G 1 10800 DNTPRO0404INTER MAXI. FIXATION ( IMF ) G 3 21600 DNTPRO0405INTER MAXI. FIXATION ( IMF ) G 4 32400 DNTPRO0406 INTERDENTAL WIRING - MAXILLA FRACTURE / INTERMAXI. WIRING 8950 DNTPRO0407 INTERDENTAL WIRING ( MAND.. FRACTURE ) - MAXILLOFACIAL SURGERY 8950 DNTPRO0408 INTERMAXI. FIXATION ( IMF ) REMOVAL ( DENTAL ) 3250 DNTPRO0409JAW RECONSTRUCTION ( G 1 ) 18400 DNTPRO0410JAW RECONSTRUCTION ( G 2 ) 23800 DNTPRO0411JAW RESEC. ( G 1 ) 18400 DNTPRO0412JAW RESEC. ( G 2 ) 23800 DNTPRO0413MALIGNANT TUMOR ( G I ) EXCI. 23800 DNTPRO0414MALIGNANT TUMOR ( G II ) EXCI. 35650 DNTPRO0415 MAND. FRACTURE-OPEN REDUC. & FIXATION-G2 21600 DNTPRO0417 MAND.FRACTURE OPEN REDUC. & FIXATION-G1 16200 DNTPRO0418 MAND.FRACTURE OPEN REDUC. & FIXATION-G3 32400

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CODE.NO SERVICE NAME AMOUNT DNTPRO0416 MAND.. FRACTURE CIRCUMMAND.IBULAR WIRING 15150 DNTPRO0419 MAND.. FRACTURE REDUC. & FIXATION(TITAN.PLT) 29700 DNTPRO0420 MAND.IBULAR CONDYLE OPEN REDUC. & INTERNAL FIXATION ( ORIF ) 20000 DNTPRO0421 MAND.IBULAR DENTOALVEOLAR FRACTURE REDUC. 13700 DNTPRO0422MAND.IBULECTOMY ( ORAL SURGERY ) 35650 DNTPRO0423MAXI. ALVEOLECTOMY ( PER TOOTH ) 450 DNTPRO0424 MAXI. DENTOALVEOLAR FRACTURE REDUC. 14050 DNTPRO0425MAXI. FRACTURES REDUC. + FIXATION - G 1 10800 DNTPRO0426MAXI. FRACTURES REDUC. + FIXATION - G 2 16200 DNTPRO0427MAXI. FRACTURES REDUC. + FIXATION - G 3 21600 DNTPRO0428MAXI. FRACTURES REDUC. + FIXATION - G 4 32400 DNTPRO0429 MAXI. INTER DENTAL WIRING & SPLINTING-G1 4150 DNTPRO0430 MAXI. INTER DENTAL WIRING & SPLINTING-G2 5950 DNTPRO0431MAXILLECTOMY ( DENTAL SURGERY ) 16600 DNTPRO0432MAXILLOFACIAL RHINOPLASTY 29700 DNTPRO0433MAXILLOFACIAL SCAR REVISION ( G 1 ) 9500 DNTPRO0434MAXILLOFACIAL SCAR REVISION ( G 2 ) 14250 DNTPRO0435MINOR SURGICAL PROCEDURES ( G 1 ) 3250 DNTPRO0436MINOR SURGICAL PROCEDURES ( G 2 ) 4350 DNTPRO0437MINOR SURGICAL PROCEDURES ( G 3 ) 4900 DNTPRO0438MINOR SURGICAL PROCEDURES ( G 4 ) 5400 DNTPRO0439NECK DISSECTION ( G 1 ) 18900 DNTPRO0440NECK DISSECTION ( G 2 ) 28500 DNTPRO0441NECK DISSECTION ( G 3 ) 40400 DNTPRO0442NERVE REPOSITIONING 10800 DNTPRO0443NEURECTOMY (MULTIPLE NERVE) 11350 DNTPRO0444NEURECTOMY (SINGLE NERVE) 5350 DNTPRO0445OBTURATOR MAXILLOFACIAL ( G 1 ) 9500 DNTPRO0446OBTURATOR MAXILLOFACIAL ( G 2 ) 15150 DNTPRO0447ODONTOGENIC TUMOR RESEC. ( G 1 ) 14600 DNTPRO0448ODONTOGENIC TUMOR RESEC. ( G 2 ) 23800 DNTPRO0449ODONTOGENIC TUMOR RESEC. / EXCI. - LARGE 11350 DNTPRO0450ODONTOGENIC TUMOR RESEC. / EXCI. - SMALL 13500 DNTPRO0451ORAL CYST ENUCLEATION ( LARGE ) 16750 DNTPRO0452ORAL CYST ENUCLEATION ( SMALL ) 11350 DNTPRO0453ORAL CYST EXCI. / REMOVAL ( SMALL ) 10300 DNTPRO0454 ORAL CYST REMOVAL - MAJOR / LARGE ( DENTAL ) 13500 DNTPRO0455 ORAL PROPHYLAXIS + HORIZONTAL IMPACTED TOOTH REMOVAL 25000 DNTPRO0456 OROANTRAL FISTULA REPAIR ( ORAL SURGERY ) 8950 DNTPRO0457 ORTHOGNATHIC SURGERY - DOUBLE JAW ( G 2 ) 35650 DNTPRO0458 ORTHOGNATHIC SURGERY - SINGLE JAW ( G 1 ) 17850 DNTPRO0459 ORTHOGNATHIC SURGERY - SINGLE JAW ( G 2 ) 20800 DNTPRO0460ORTHOGNATHIC SURGERY -DOUBLE JAW ( G 1 ) 29700 DNTPRO0461PALATAL FISTULA SURGERY 13000 DNTPRO0462PAROTID GL& SURGERY ( G 1 ) 16200 DNTPRO0463PAROTID GL& SURGERY ( G 2 ) 23800 DNTPRO0464 PERFORATION REPAIR SURGERY ( G 1 ) - ORAL SURGERY 8650 DNTPRO0465PLATELET RICH PLASMA AUGMENTATION 4550 DNTPRO0466SINUS LIFT + BONE GRAFT ( PER TOOTH ) 21600 DNTPRO0467SINUS LIFT + BONE GRAFTS ( G 1 ) 21600 DNTPRO0468SINUS LIFT + BONE GRAFTS ( G 2 ) 43200 DNTPRO0469SINUS LIFT + BONE GRAFTS ( G 3 ) 64800 DNTPRO0470SINUS LIFT PROCEDURE G I 40000 DNTPRO0471SINUS LIFT PROCEDURE G II 60000

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CODE.NO SERVICE NAME AMOUNT DNTPRO0472SINUS LIFT PROCEDURE G III 80000 DNTPRO0473SUBMAND.IBULAR GL& REMOVAL 17300 DNTPRO0474SUBMENTAL GL& REMOVAL ( EXTRAORAL ) 13000 DNTPRO0475SUBMENTAL GL& REMOVAL ( INTRAORAL ) 9200 DNTPRO0476SURGICAL EXPOSURE OF TOOTH 1800 DNTPRO0477TMJ ( TMJ ) ARTHROCENTESIS 5950 DNTPRO0478TMJ ( TMJ ) LAVAGE 5950 DNTPRO0479TMJ DISLOCATION REDUC. 5400 DNTPRO0480TMJ SURGERY ( BILATERAL ) 35650 DNTPRO0481TMJ SURGERY ( UNILATERAL ) 18900 DNTPRO0482TONGUE TIE RELEASE ( ORAL SURGERY ) 3800 DNTPRO0483 UP.FACIAL THIRD/CRANIAL BASE FRA.-G1-SIM 40000 DNTPRO0484 UP.FACIAL THIRD/CRANIAL BASE FRA.-G2-COM 50000 DNTPRO0485 UP.FACIAL THIRD/CRANIAL BASE FRA.-G3-MUL 75000 DNTPRO0486WHITE LESION SURGICAL EXCI. + GRAFTING 17850 DNTPRO0487ZYGOMA FRACTURE REPAIR 17850 DNTPRO0511 ORAL PROPHYLAXIS+POLISH+ BLEACH+JEWEL 25000 DNTPRO0512 ORAL PROPHYLAXIS+POLISH+NIGHT GUARD U/L 25000 DNTPRO0513 ORAL PROPHYLAXIS+POLISH+NIGHT GUARD U+L 30000 DNTPRO0514 ORAL PROPHYLAXIS+RVG+IMPACTED TOOTH REMO 25000 DNTPRO0523 PERIODONTIA GINGIVOPLASTY-QUADRANT-G1 3250 DNTPRO0524 PERIODONTIA GINGIVOPLASTY-QUADRANT-G2 3800 DNTPRO0530 SUBMAND.IBULAR CALCULI REMOVAL-INTRAORAL 5400 PERIODONTIC PROCEDURE DNTPRO0488CURETTAGE ( FULL MOUTH ) G 1 10800 DNTPRO0489CURETTAGE ( FULL MOUTH ) G 2 13000 DNTPRO0490CURETTAGE ( FULL MOUTH ) G 3 15150 DNTPRO0491CURETTAGE FULL MOUTH (HIGH END) 10000 DNTPRO0492CURETTAGE G 1 - PER QUADRANT ( DENTAL ) 2700 DNTPRO0493CURETTAGE G 2 - PER QUADRANT ( DENTAL ) 3250 DNTPRO0494CURETTAGE G 3 - PER QUADRANT ( DENTAL ) 3800 DNTPRO0495CURETTAGE G 4 - PER QUADRANT ( DENTAL ) 4350 DNTPRO0496CURETTAGE HALF MOUTH (HIGH END) 5000 DNTPRO0497CURRETTAGE - FULL MOUTH ( G 3 ) 16500 DNTPRO0498FREE FLAPS ( G 1 ) 29700 DNTPRO0499FREE FLAPS ( G 2 ) 38350 DNTPRO0500FREE FLAPS ( G 3 ) 47550 DNTPRO0501FRENECTOMY ( ORAL SURGERY ) 5400 DNTPRO0502GINGIVAL RETRACTION CORD PLACEMENT 450 DNTPRO0503GINGIVECTOMY - PER QUADRANT 8000 DNTPRO0504GUM CURETTAGE ( PER TOOTH ) 300 DNTPRO0505GUM CURETTAGE (PER TOOTH) - G 1 500 DNTPRO0506GUMS COSMETIC TREATMENT ( G 3 ) 1300 DNTPRO0507LOCAL FLAP ( G 1 ) 8950 DNTPRO0508LOCAL FLAP ( G 2 ) 16600 DNTPRO0509 ORAL PROPHYLAXIS + POLISHING + 4 COMPOSITE FILLING 25000 DNTPRO0510 ORAL PROPHYLAXIS + POLISHING + 6 COMPOSITE FILLING 30000 DNTPRO0515PERFORATION REPAIR SURGERY ( G 2 ) 10800 DNTPRO0516PERICORONAL FLAP EXCI. - G 1 1950 DNTPRO0517PERICORONAL FLAP SURGERY 4350 DNTPRO0518PERIODONTAL CURETTAGE GR I (PER TOOTH ) 750 DNTPRO0519PERIODONTAL CURRETTAGE ( PER TOOTH ) 550 DNTPRO0520PERIODONTAL WIRING ( ANTERIOR TEETH ) 5400 DNTPRO0521PERIODONTAL WIRING GR I 7500

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CODE.NO SERVICE NAME AMOUNT DNTPRO0522PERIODONTIA CROWN LENGTHENING 2200 DNTPRO0525ROOT PLANING ( PER QUADRANT ) 1100 DNTPRO0526SPLINTING TEETH ( FIBER ) 1650 DNTPRO0527SPLINTING TEETH ( WIRE ) - PER TOOTH 1100 DNTPRO0528SPLINTING TEETH ( WIRE ) PER TOOTH - G 1 1650 DNTPRO0529SPLINTING TEETH( FIBER ) PER TOOTH - G 1 2200

LASER PROCEDURE DNTPRO0033 LASER PERIO PKT DISINFECTION(PER QUADRAN 7500 DNTPRO0034BLEACHING ULTRA 25000 DNTPRO0035 LASER FRENECTOMY 10000 DNTPRO0062 LASER PERIO PKT DISINFECTION(FULL MOUTH) 20000 DNTPRO0531BLEACHING ( PARTIAL ) 5400 DNTPRO0532BLEACHING TEETH ( TRAY METHOD + SUPPLY ) 8650 DNTPRO0533BRIGHT SMILE (HIGH END) 12000 DNTPRO0534INSTA BLEACH 10800 DNTPRO0535INSTA BLEACHING ( G 1 ) 6500 DNTPRO0536INSTA BLEACHING ( G 2 ) 5400 IMPLANTS DNTPRO0030 IMPLANTS ALPHA BIO 40000 DNTPRO0031 IMPLANTS NOBEL BIOCARE 60000 DNTPRO0032 IMPLANTS BIOHORIZON 50000 DNTPRO0537DENTAL IMPLANT ( ANTERIOR TEETH ) 5400 DNTPRO0538HIGH END IMPLANT 80000 DNTPRO0539IMMEDIATE LOADING IMPLANT + CROWN G II 125000 DNTPRO0540IMMEDIATE LOADING IMPLANT( PER IMPLANT ) 81000 DNTPRO0541IMMEDIATE LOADING IMPLANT+CROWN G I 100000 DNTPRO0542POSTERIOR TEETH IMPLANT + BONE GRAFT 108000 DNTPRO0543 UPPER /LOWER FULL DENTURE + 3 IMPLANTS G II 378000 DNTPRO0544 UPPER /LOWER FULL DENTURE + 4 IMPLANTS G II 486000 DNTPRO0545UPPER /LOWER FULL DENTURE+3 IMPLANTS G I 324000 DNTPRO0546UPPER /LOWER FULL DENTURE+4 IMPLANTS G I 432000 X-RAY DNTPRO0547 DENTAL X-RAY - INTRAORAL PERIAPICAL-IOPA 250 DNTPRO0548DENTAL X-RAY BITEWING 300 DNTPRO0549DENTASCAN 1100 DNTPRO0550LAT CEPH 600 DNTPRO0551LATERAL CEPHALOGRAPH 1300 DNTPRO0552ORTHOPANTAMOGRAM ( OPG ) 550 DNTPRO0553ORTHOPANTAMOGRAM ( OPG ) - DIGITAL 1200 OTHERS DNTPRO0001X RAY DENTAL 400 DNTPRO0076 BLEACHING TRAYS 12000 DNTPRO0077 IMPACTION - (GRADE-I) 5000 DNTPRO0078 LIGHT WEIGHT LUCTION DENTORE 30000 DNTPRO0079 BIOPSY - DENTAL PROCEDURE CHARGES 9000 DNTPRO0554BITE PLANE APPLIANCE ( G 1 ) 5400 DNTPRO0555BITE PLANE APPLIANCE ( G 2 ) 9750 DNTPRO0556CEPHALOMETRIC ANALYSIS 2400 DNTPRO0557COMPOSITE LAMINATES 5400 DNTPRO0558CORONOPLASTY ( PER TOOTH ) 600 DNTPRO0559DENTAL APPLIANCE ( G 1 ) 10800 DNTPRO0560DENTAL APPLIANCE ( G 2 ) 16200 DNTPRO0561DENTAL APPLIANCE ( G 3 ) 21600

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CODE.NO SERVICE NAME AMOUNT DNTPRO0562DENTAL WIRE REMOVAL 2200 DNTPRO0563FLUORIDE TREATMENT 2200 DNTPRO0564FLUORIDE TREATMENT GR I 5000 DNTPRO0565GUARDS (HIGH END) 5000 DNTPRO0566HEMANGIOMA SELEROSING INJECTION 4350 DNTPRO0567HIGH END COMPOSITE LAMINATES G I 5000 DNTPRO0568HIGH END COMPOSITE LAMINATES G II 7500 DNTPRO0569HIGH END COMPOSITE LAMINATES G III 10000 DNTPRO0570 INTRALESIONAL INJECTION - PER SIT-G1 2200 DNTPRO0571 INTRALESIONAL INJECTION - PER SIT-G2 2700 DNTPRO0573 MAXILLOFACIAL LACERATED WOUND SUTURING-L 7150 DNTPRO0574 MAXILLOFACIAL LACERATED WOUND SUTURING-S 4800 DNTPRO0572LOWER NIGHT GUARD GR I 7500 DNTPRO0575MISCELLENIOUS-1 500 DNTPRO0576MISCELLENIOUS-2 800 DNTPRO0577MISCELLENIOUS-3 1000 DNTPRO0578NIGHT GUARD - LOWER 5400 DNTPRO0579NIGHT GUARD - UPPER 5400 DNTPRO0580NIGHT GUARD ( UPPER ) - G 1 7500 DNTPRO0581NIGHT GUARD APPLIANCE ( DENTAL ) 10800 DNTPRO0582OCCLUSAL EQUILIBRATION / ADJUSTMENT 650 DNTPRO0583 ORTHO. STUDY, DIAGNOSTIC CAST & TREATMENT PLAN 2200 DNTPRO0584SELECTIVE GRINDING ( LOWER TEETH ) 300 DNTPRO0585SELECTIVE GRINDING ( PER TOOTH ) 500 DNTPRO0586SELECTIVE GRINDING ( UPPER TEETH ) 300 DNTPRO0587SNORE GUARD 10800 DNTPRO0588SNORE GUARD ( G 1 ) 13000 DNTPRO0589SNORE GUARD ( G 2 ) 16200 DNTPRO0590SPACE MAINTAINERS ( FIXED ) 3250 DNTPRO0591TMJ INJECTIONS 3450 DNTPRO0592 10800 DNTPRO0593WOUND DEBRIDEMENT / DRESSING - LARGE 5400 DNTPRO0594WOUND DEBRIDEMENT / DRESSING - MEDIUM 2700 DNTPRO0595WOUND DEBRIDEMENT / DRESSING - SMALL 2200 DNTPRO0598PORCELAIN FUSED TO METAL-BRIDGE 20000 DNTPRO0599RCT (P) 6000 GENERAL PROCEDURE PROGEN0001 C.V.P. LINES 2500 USGSUP0006 C.V.P. LINES ULTASOUND GUIDED 3000 PROGEN0002 DRESSING - MINOR 350 PROGEN0003 DRESSING - MEDIUM 500 PROGEN0004 DRESSING - MAJOR 1100 PROGEN0006 EXCISION BIOPSY 1650 PROGEN0007 GLUCOMETER TEST 120 PROGEN0008 SHUNT REMOVAL 300 PROGEN0009 INCISION & DRAINGE OF ABSCESS 2600 PROGEN0010 NEBULISATION PROCEDURE 270 PROGEN0011 RYLES TUBE INSERTION 900 PROGEN0012 FOLEYS CATHETERISATION 800 PROGEN0013 IV CANNULATION 200 PROGEN0014 ENEMA 250 PROGEN0015 BOWEL WASH 250 PROGEN0016 SUPRAPUBIC CATHETERISATION 2300 PROGEN0017 LUMBAR PUNCTURE 2400

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CODE.NO SERVICE NAME AMOUNT PROGEN0020 BLADDER IRRIGATION 1100 PROGEN0021 EVALUATION OF DIABETIC AUTONOMIC NEUROPA 4200 PROGEN0022 BONE MARROW ASPIRATION 2800 PROGEN0023 BONE MARROW ASPIRATION & BIOPSY 3900 PROGEN0024 GENERAL PROCEDURE CHARGES 1500 PROGEN0025 INTRA OPERATIVE CARDIAC MONITORY 5400 PROGEN0026 NERVE CONDUCTION STUDY 2 LIMB 2500 PROGEN0027 PARATHYROID SCAN 6500 PROGEN0029 DOPPLER LEFT ARM 3500 PROGEN0030 F.N.A.C. 2200 PROGEN0031 SKIN BIOPSY 1700 PROGEN0032 PERCUTANEOUS TRACHEOOSTOMY 6200 PROGEN0033 INGROWING TOE NAIL 2500 PROGEN0034 EPIDURAL CATHERISATION 2200 PROGEN0035 SLEEP STUDY POLY SOMNOGRAPHY 11000 PROGEN0036 STEAM INHALATION 100 PROGEN0037 SUTURING & PACKING 1000 PROGEN0038 SITZ BATH 70 PROGEN0039 INFUSION PUMP-I 850 PROGEN0040 INFUSION PUMP-II 850 PROGEN0041 INFUSION PUMP-III 850 PROGEN0042 INFUSION PUMP-IV 850 PROGEN0043 ARTERIAL LINE CANNULATION 2100 USGSUP0005 ARTERIAL LINE CANNULATION (ULRASOUND GUIDED) 2600 PROGEN0044 ENDOTRACHEAL INTUBATION 1700 PROGEN0045 INFUSION PUMP - V 850 PROGEN0048 TUBE INSERTION 300 PROGEN0049 FREKKA TUBE INSERTION 1200 PROGEN0050 ILEAC GRAFTING 40000 PROGEN0051BRACHIAL PLEXUS - BLOCK 3000 PROGEN0053STOMA CARE (UNCOMPLICATED) 500 PROGEN0054STOMA CARE (COMPLICATED) 1000 PROGEN0055MINIMUM ANESHESIA CHARGES 800 PROGEN0056ELEASTOMERIC PUMP 1500 PROGEN0057NERVE BLOCK 2000 USGSUP0009NERVE BLOCK (ULRTASOUND GUIDED) 3000 CSSD CHARGES CSSD000001BONE MERROW SET 150 CSSD000002CVP/ARTERIAL LINE SET 200 CSSD000003CATHETERIZATION SET 150 CSSD000004LUMBER PUNCTUR SET 150 CSSD000005SUTURE SET 150 CSSD000006SUTURE REMOVAL SET 150 CSSD000007TRACHEOSTOMY SET 300 CSSD000008LIVER BIOPSY SET 150 CSSD000009KIDNEY BIOPSY SET 150 CSSD000010ASPIRATION SET 300 CSSD000011DRESSING SET MAJOR 250 CSSD000012DRESSING CHARGES MINOR 120 CSSD000013INTERCOSTAL CHEST TUBE ( ICD ) BOTTLE CH 240 CSSD000014PERITONEAL DIALYSIS ( PD ) SET USAGE CHA 240

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CODE.NO SERVICE NAME AMOUNT MISC. PROCEDURES MISLEN0001 ALPHA BED CHARGEES 270 MISLEN0002 GUEST ROOM CHARGES - LARGE 2000 MISLEN0003 GUEST ROOM CHARGES - SMALL 1000 MISLEN0004 WIFI CHARGES 200 MISLEN0005 EXTRA ROOM OCCUPIED CHARGES 2500 MISLEN0006 DISCHARGE SUMMARY LAMINATON CHARGES 200 MISLEN0007 MEDICAL CERTIFICATE CHARGES 200 MISLEN0008 FITNESS CERTIFICATE CHARGES 200 MISLEN0009 VIDEO CASSETTE 400 MISLEN0012 REGISTRATION RENEWAL FEE 200 MISLEN0013 DUPLICATE ENDOSCOPY REPORT CHARGES 250 MISLEN0014 VIDEO CD CHARGES 450 MISLEN0016 STANDBY DOCTOR OT 6000 MISLEN0017 DUPLICATE ATTENDENT PASS CHARGES 60 MISLEN0018 VIDEO PRINTING CHARGES 350 MISLEN0019 SHAVING CHARGES 80 MISLEN0020 HAIR CUTTING 100 MISLEN0023 MORNING KIT 50 MISLEN0024 TPA INVESTIGATOR CHARGES 600 MISLEN0025 DEATH CORRECTION CERTIFICATE 50 TELPHO0001 TELEPHONE 5 TELPHO0002 S.T.D. 10 MISLEN0026PAC 800 MISLEN0027 PHOTOCOPY CHARGES 2 MISLEN0028 LIC SUBMITTING CHARGES 500 MISLEN0035 CD CHARGE (CARDIOLOGY) 1000 MISLEN0038 MEDICAL RECORD DOCUMENTATION CHARGE 1000 MISLEN0039 RESUSCITATION CHARGE 5000 MISLEN0040 MED. RECORD DOCUMENTATION CHARGE- DAY CARE 500 MISLEN0041 AADHAR VERIFICATION CHARGES 250 MISLEN0042 ATTENDENT PASS CHARGES 200 SURCON010 O.T CONSUMABLE – MISC. MINOR 1000 SURCON011 O.T CONSUMABLE – MISC. MAJOR 2000

PULMONOLOGY PROCEDURES FOUR TWO SINGLE SUPER PRESIDENT CODE NO DESCRIPTION SUITE BEDDED BEDDED BEDDED DELUXE SUITE PROPUL0002 PLEURAL BIOPSY 4200 5250 6300 7090 7880 9190

PROPUL0007 MEDICAL THORACOSCOPY 14000 17500 21000 23630 26250 30630

PROPUL0008 INTERCOSTALS CHEST TUBE DRAINAGE 5500 6880 8250 9280 10310 12030

PROPUL0009 PLEURAL TAPPING - THERAPEUTIC 3500 4380 5250 5910 6560 7660

USGSUP0002 PLEURAL TAPPING - THERAPEUTIC (ULTRASOUND 4500GUIDED) 5630 6750 7590 8440 9840

PROPUL0010 PLEURAL TAPPING - DIAGNOSTIC 2500 3130 3750 4220 4690 5470

USGSUP0001 PLEURAL TAPPING - DIAGNOSTIC (ULTRASOUND GUIDED)3000 3750 4500 5060 5630 6560

PROPUL0019 FIBEROPTIC BRONCHOSCOPY DIAGNOSTIC 7200 9000 10800 12150 13500 15750

PROPUL0020 FIBEROPTIC BRONCHOSCOPY +BAL 8200 10250 12300 13840 15380 17940

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CODE.NO SERVICE NAME AMOUNT PROPUL0025 P F T +SPIROMETERY 1800 2250 2700 3040 3380 3940 PROPUL0026PFT + BDR 2500 3130 3750 4220 4690 5470 PROPUL0027EBUS 20000 25000 30000 33750 37500 43750 PROPUL0028EBUS + TBNA 25000 31250 37500 42190 46880 54690 PROPUL0029 NEEDLE FOR EBUS 8000 10000 12000 13500 15000 17500 PROPUL0030 PFT WITH DLCO 2800 3500 4200 4730 5250 6130

PROPUL0031 PFT WITH DLCO+BDR 3200 4000 4800 5400 6000 7000

PROPUL0032 6 MINUTE WALK TEST 2500 3130 3750 4220 4690 5470

PROPUL0033 FOL (FIBEROPTIC LARYNGOSCOPY) 4600 5750 6900 7760 8630 10060

PROPUL0034 BRONCHOSCOPY +BIOPSY 10200 12750 15300 17210 19130 22310

PROPUL0035 BRONCHOSCOPY +BAL+BIOPSY 11200 14000 16800 18900 21000 24500

PROPUL0036 BRONCHOSCOPY +BAL+TBNA/BRUSH 10200 12750 15300 17210 19130 22310

PROPUL0037 BRONCHOSCOPY +BAL+TBNA/BRUSH+BIOPSY 12200 15250 18300 20590 22880 26690

PROPUL0038 NIV- CONSULTATION 2000 2500 3000 3380 3750 4380

PROPUL0040 NIV INTITATION CHARGES (WARD) 1800 2250 2700 3040 3380 3940

PROPUL0041 OXYGEN CHARGES PER DAY (WARD) 1000 1250 1500 1690 1880 2190

PROPUL0042 OXYGEN CHARGES PER HOUR (WARD) 100 130 150 170 190 220

PROPUL0043 BIPAP DAILY CHARGES ( WARD) 1200 1500 1800 2030 2250 2630

PROPUL0044 CHEST TUBE REMOVAL 1000 1250 1500 1690 1880 2190

PROPUL0045 CRYO THERAPY 10000 12500 15000 16880 18750 21880

PROPUL0046 RADIOL PROBE 10000 12500 15000 16880 18750 21880

PROPUL0047 THORACOSCOPY+BIOPSY 16000 20000 24000 27000 30000 35000

PROPUL0048 THORACOSCOPY+PLEURODESIS 17000 21250 25500 28690 31880 37190

PROPUL0049 THORACOSCOPY+BIOPSY+PLEURODESIS 18000 22500 27000 30380 33750 39380

PROPUL0050 PFT MIP/MEP 1500 1880 2250 2530 2810 3280

PROPUL0051 FENO TEST 1500 1880 2250 2530 2810 3280

PROPUL0052 ELECTRO CAUTERY TREATMENT 4000 5000 6000 6750 7500 8750

PROPUL0053 GLUE THERAPY 2500 3130 3750 4220 4690 5470

PROPUL0054 INTRAPLEURAL FIBRONOLYSIS 2000 2500 3000 3380 3750 4380

PROPUL0055 PLEURODESIS 1500 1880 2250 2530 2810 3280

PROPUL0056 PFT WITH LUNG VOLUME 2800 3500 4200 4730 5250 6130

PROPUL0057 PFT+DLCO+LUNG VOLUME 3200 4000 4800 5400 6000 7000

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CODE.NO SERVICE NAME AMOUNT NEPHRO PROCEDURES FOUR TWO SINGLE SUPER PRESIDENT CODE NO DESCRIPTION SUITE BEDDED BEDDED BEDDED DELUXE SUITE PRONEP0001 KIDNEY BIOPSY Package 18500 23125 27750 31219 34688 40515 PRONEP0005CAVHD/CVVHD 9000 11250 13500 15188 16875 19710 DIADLY0006 FEMORAL VEIN CATHETER 3000 3750 4500 5063 5625 6570 DIADLY0007 SUBCLAVION CATHETER 6800 8500 10200 11475 12750 14892 DIADLY0016 TRIPLE LUMIN DIALYSIS CATHETER 10000 12500 15000 16875 18750 21900 DIADLY0017 DOUBLE LUMIN DIALYSIS CATHETER 7500 9375 11250 12656 14063 16425 DUBLE LUMEN INTERNAL JUGLAR CATH. DIADLY0025 8500 10625 12750 14344 15938 18615 (PAED) DIADLY0037 FEMORAL VEIN CATHETER - EMERGENCY 3900 4875 5850 6581 7313 8541 DIADLY0038 SUBCLAVION CATHETER - EMERGENCY 8800 11000 13200 14850 16500 19272 TRIPLE LUMIN DIALYSIS CATHETER- DIADLY0039 11600 14500 17400 19575 21750 25404 EMERGENCY DOUBLE LUMIN DIALYSIS CATHETER- DIADLY0040 8800 11000 13200 14850 16500 19272 EMERGENCY DUBLE LUMEN JUGLAR CATH.(PAED)- DIADLY0041 11600 14500 17400 19575 21750 25404 EMERGENCY DIADLY0045 ISOLATION DIALYSIS CHARGE 5000 6250 7500 8438 9375 10950 NEUROLOGY FOUR TWO SINGLE SUPER PRESIDENT CODE NO DESCRIPTION SUITE BEDDED BEDDED BEDDED DELUXE SUITE PRONEO0001 PORTABLE EEG 5000 6250 7500 8440 9380 10940 PRONEU0001 EEG WITH INDUCTION 3700 4630 5550 6240 6940 8090 PRONEU0002 VEP (EVOKE POTENTIAL) 1500 1880 2250 2530 2810 3280 PRONEU0003 IV THROMBOLYSIS CHARGES 17000 21250 25500 28690 31880 37190 PRONEU0004 LUMBAR PUNCTURE 2800 3500 4200 4730 5250 6130 PRONEU0005 DBS NEUROLOGIST CHARGES 27000 33750 40500 45560 50630 59060 PRONEU0006 BAER 3000 3750 4500 5060 5630 6560 PRONEU0007 SSEP (1/2 LIMBS) 1800 2250 2700 3040 3380 3940 PRONEU0008 EEG - ROUTINE 2340 2930 3510 3950 4390 5120 PRONEU0009 NERVE CONDUCTION STUDY+EMG. 2600 3250 3900 4390 4880 5690 PRONEU0010 EEG VIDEO ROUTINE 2800 3500 4200 4730 5250 6130 PRONEU0011 EEG 12 HOUR VIDEO 8400 10500 12600 14180 15750 18380 PRONEU0012 EEG 24 HOUR VIDEO 14000 17500 21000 23630 26250 30630 PRONEU0013 EEG.06 EMERGENCY 3700 4630 5550 6240 6940 8090 PRONEU0014 PORTABLE EEG 4900 6130 7350 8270 9190 10720 PRONEU0015 PROLONGED EEG (1 HOUR) 4500 5630 6750 7590 8440 9840 PRONEU0016 EEG ADDITIONAL HOUR 1300 1630 1950 2190 2440 2840 PRONEU0017 SEDATION IN NEUROPHYSIOLOGY 600 750 900 1010 1130 1310 PRONEU0018 NERVE CONDUCTION STUDY 1 LIMB 1800 2250 2700 3040 3380 3940 PRONEU0019 NERVE CONDUCTION STUDY 2 LIMB 3500 4380 5250 5910 6560 7660 PRONEU0020 EMG 1 LIMB 2800 3500 4200 4730 5250 6130 PRONEU0021 EMG 2 LIMBS 3700 4630 5550 6240 6940 8090 PRONEU0022 EMG MORE THAN 2 LIMBS 6000 7500 9000 10130 11250 13130 PRONEU0023 REPETITIVE NERVE STIMULATION 4500 5630 6750 7590 8440 9840 PRONEU0024 BLLINK REFLEX 1800 2250 2700 3040 3380 3940 PRONEU0025 VEP 3700 4630 5550 6240 6940 8090 PRONEU0026 BAER 3000 3750 4500 5060 5630 6560 PRONEU0027 BOTOX FOR BLEPHAROSPASM 2800 3500 4200 4730 5250 6130 PRONEU0028 BOTOX FOR FOREHEAD LINES/FROWN LINES 2800 3500 4200 4730 5250 6130 PRONEU0029 BOTOX FOR MIGRAINE 2800 3500 4200 4730 5250 6130 PRONEU0030 BOTOX FOR DYSTONIAS 5000 6250 7500 8440 9380 10940 PRONEU0031 BOTOX FOR SPASTICITY 5000 6250 7500 8440 9380 10940 PRONEU0066 BOTOX FOR HEMIFACIALSPASM 3700 4630 5550 6240 6940 8090 PRONEU0067 BOTOX FOR WRITERS CRAMP 3700 4630 5550 6240 6940 8090 PRONEU0068 BOTOX FOR FOCAL DYSTOMA 4000 5000 6000 6750 7500 8750

PRONEU0032 SLEEP STUDY DIAGNOSTIC (NEUROLOGY) 17000 21250 25500 28690 31880 37190

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CODE.NO SERVICE NAME AMOUNT PRONEU0033 NERVE/MUSCLE BIOPSY 2600 3250 3900 4390 4880 5690 PRONEU0034 SSEP (4LIMBS) 4600 5750 6900 7760 8630 10060 PRONEU0035 BRACHIAL PLEXUS STUDY 6000 7500 9000 10130 11250 13130 PRONEU0036 AUTONOMIC FUNCTION TEST 6000 7500 9000 10130 11250 13130 NERVE CONDUCTION STUDY MORE THAN 2 PRONEU0037 4500 5630 6750 7590 8440 9840 LIMBS PRONEU0038 SLEEP DEPRIVED EEG 2500 3130 3750 4220 4690 5470 PRONEU0039 SSEP UPPER LIMB 2300 2880 3450 3880 4310 5030 PRONEU0040 SSEP LOWER LIMB 2300 2880 3450 3880 4310 5030 PRONEU0041 PORTABLE NCV 2 LIMB 7000 8750 10500 11810 13130 15310 PRONEU0042 PORTABLE NCV 4 LIMB 10800 13500 16200 18230 20250 23630 PRONEU0043 SSR (UL & LL) 1800 2250 2700 3040 3380 3940 SLEEP STUDY WITH CPAP TITRATION ( PRONEU0044 20800 26000 31200 35100 39000 45500 NEUROLOGY) PRONEU0045 PORTABLE EEG (EMERGENCY) 7100 8880 10650 11980 13310 15530 CARPAL TUNNEL SYNDROME INJ. PROCEDURE PRONEU0046 2100 2630 3150 3540 3940 4590 CHARGES PRONEU0047 QST CHARGES 2800 3500 4200 4730 5250 6130 PRONEU0048 NEOSTIGMIN TEST 2600 3250 3900 4390 4880 5690 PRONEU0049 TRANSCRANIAL DOPPLER (TCD) 5700 7130 8550 9620 10690 12470 PRONEU0050 TCD-BUBBLE TEST 5700 7130 8550 9620 10690 12470 PRONEU0051 TCD WITH THROMBOLYSIS 5700 7130 8550 9620 10690 12470 PRONEU0052PORTABLE EEG TEST 5000 6250 7500 8440 9380 10940 PRONEU0053PORTABLE NCS 4200 5250 6300 7090 7880 9190 PRONEU0054PORTABLE EMG 2800 3500 4200 4730 5250 6130 PRONEU0055PORTABLE ABER 2000 2500 3000 3380 3750 4380 PRONEU0056PORTABLE VEP 3700 4630 5550 6240 6940 8090 PRONEU0057 PORTABLE BLINK REFLEX STUDY 2300 2880 3450 3880 4310 5030 PRONEU0058PORTABLE - SSEP 2000 2500 3000 3380 3750 4380 PRONEU0059PORTABLE RNS 2000 2500 3000 3380 3750 4380 PRONEU0060PORTABLE P300 2000 2500 3000 3380 3750 4380 PRONEU0061 EMG & NCV B/L LOWER LIMBS 6000 7500 9000 10130 11250 13130 PRONEU0062EMG & NCV U/L LIMBS 4500 5630 6750 7590 8440 9840 PRONEU0063PORTABLE –SSR 3000 3750 4500 5060 5630 6560 PRONEU0064PORTABLE P-300 3000 3750 4500 5060 5630 6560 PRONEU0065PORTABLE VEP 3700 4630 5550 6240 6940 8090 PRONEU0069 LUMBER DRAINAGE 1400 1750 2100 2360 2630 3060 PRONEU0070 LUMBER DRAINAGE REMOVAL 3500 4380 5250 5910 6560 7660 PRONEU0071 BOTOX THERAPY(SIMPLE) 3500 4380 5250 5910 6560 7660 PRONEU0072 BOTOX THERAPY(COMPLEX) 5000 6250 7500 8440 9380 10940 PRONEU0073 CARPAL TUNNEL INJECTION U/L 1050 1310 1580 1770 1970 2300 PRONEU0074 CARPAL TUNNEL INJECTION B/L 2100 2630 3150 3540 3940 4590 PRONEU0075 EEG 06 HOUR VIDEO 6300 7880 9450 10630 11810 13780 25 50 68.75 87.5 119 1.25 1.50 1.69 1.88 2.19 LABORATORY PSRI TWO SINGLE SUPER PRESIDENT CODE NO DESCRIPTION FOUR SUITE BEDDED BEDDED DELUXE SUITE BEDDED BIOCHEMISTRY LABBIO0001 LIPID PROFILE - COMPLETE 1320 1650 1980 2230 2480 2890 LABBIO0002 TRIGLYCERIDES 370 460 560 620 690 810 LABBIO0003 TOTAL CHOLESTEROL 240 300 360 410 450 530 LABBIO0004 HDL CHOLESTEROL* 350 440 530 590 660 770 LABBIO0005 LDL CHOLESTEROL* 500 630 750 840 940 1090 LABBIO0006 VLDL CHOLESTEROL* 410 510 620 690 770 900 LABBIO0008 LIPID PROFILE - PARTIAL CHOL. & TRIG. 660 830 990 1110 1240 1440 LABBIO0009BUN 250 310 380 420 470 550 LABBIO0010CREATININE 250 310 380 420 470 550 LABBIO0011 ELECTROLYTES NA, K, CL * 720 900 1080 1220 1350 1580 LABBIO0012URIC ACID 310 390 470 520 580 680 LABBIO0013TOTAL CALCIUM 290 360 440 490 540 630 LABBIO0014PHOSPHORUS 270 340 410 460 510 590 LABBIO0015MAGNESIUM 600 750 900 1010 1130 1310

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CODE.NO SERVICE NAME AMOUNT LABBIO0016 PRE-DIALYSIS R.F.T.* 1000 1250 1500 1690 1880 2190 LABBIO0017 POST-DIALYSIS R.F.T.* 700 880 1050 1180 1310 1530 LABBIO0018 SERUM POTASSIUM* 290 360 440 490 540 630 LABBIO0019 L.F.T - COMPLETE 1500 1880 2250 2530 2810 3280 LABBIO0020 L.F.T. - PARTIAL SGOT, SGPT, S.BILL. 800 1000 1200 1350 1500 1750 LABBIO0021SGOT/AST 300 380 450 510 560 660 LABBIO0022SGPT/ALT 300 380 450 510 560 660 LABBIO0023G.G.T. 300 380 450 510 560 660 LABBIO0024 ALK. PHOSPHATASE 270 340 410 460 510 590 LABBIO0026ALBUMIN 220 280 330 370 410 480 LABBIO0028A/G RATIO 530 660 800 890 990 1160 LABBIO0029 BILIRUBIN TOTAL ,DIRECT & INDIRECT 470 590 710 790 880 1030 LABBIO0030 TOTAL PROTEIN, ALBUMIN & GLOBULIN 250 310 380 420 470 550 LABBIO0031LIPASE 700 880 1050 1180 1310 1530 LABBIO0032AMYLASE 600 750 900 1010 1130 1310 LABBIO0033 GLUCOSE RANDOM 150 190 230 250 280 330 LABBIO0034 GLUCOSE FASTING 150 190 230 250 280 330 LABBIO0035GLUCOSE P.P. 150 190 230 250 280 330 LABBIO0037 GLYCOCYLATED Hb* 900 1130 1350 1520 1690 1970 LABBIO0038IRON* 390 490 590 660 730 850 LABBIO0039T.I.B.C.* 410 510 620 690 770 900 LABBIO0040AMMONIA* 1100 1380 1650 1860 2060 2410 LABBIO0041 FLUID / SERUM FOR ADA* 950 1190 1430 1600 1780 2080 LABBIO0042C.P.K.* 500 630 750 840 940 1090 LABBIO0043CPK MB* 580 730 870 980 1090 1270 LABBIO0044 CPK & CPK MB 1050 1310 1580 1770 1970 2300 LABBIO0045LDH* 500 630 750 840 940 1090 LABBIO0046 SPOT URINE ELECTROLYTES NA, K, CL* 750 940 1130 1270 1410 1640 LABBIO0047 24 HOURS URINE FOR CREATININE* 500 630 750 840 940 1090 LABBIO0048 CREATININE CLEARANCE* 550 690 830 930 1030 1200 LABBIO0049 24 HRS URINE FOR PROTEIN* 350 440 530 590 660 770 LABBIO0050 SPOT URINE SODIUM* 290 360 440 490 540 630 LABBIO0051 SPOT URINE POTASSIUM* 290 360 440 490 540 630 LABBIO0052 SPOT URINE CHLORIDE * 290 360 440 490 540 630 LABBIO0053 24 HRS. URINE FOR CALCIUM* 290 360 440 490 540 630 LABBIO0056 MICROALBUMIN , 24 - HOUR URINE* 600 750 900 1010 1130 1310 LABBIO0057 SPOT URINE CREATININE * 250 310 380 420 470 550 LABBIO0058 HEMO-DIALYSIS PROFILE 1650 2060 2480 2780 3090 3610 LABBIO0059 24 HRS URINE ELECTROLYTES * 880 1100 1320 1490 1650 1930 LABBIO0060 SPOT URINE PROTEIN * 290 360 440 490 540 630 LABBIO0061 FLUID FOR GLUCOSE* 230 290 350 390 430 500 LABBIO0062 FLUID FOR ALBUMIN* 230 290 350 390 430 500 LABBIO0063 FLUID FOR PROTEIN* 250 310 380 420 470 550 LABBIO0064 FLUID FOR CREATININE* 260 330 390 440 490 570 LABBIO0065 FLUID FOR AMYLASE* 600 750 900 1010 1130 1310 LABBIO0066 FLUID FOR LIPASE* 700 880 1050 1180 1310 1530 LABBIO0067 FLUID FOR L.D.H* 500 630 750 840 940 1090 LABBIO0068 G.T.T 4 SAMPLES 580 730 870 980 1090 1270 LABBIO0072 R.F.T COMPLETE 1800 2250 2700 3040 3380 3940 LABBIO0073 24 HOURS URINE FOR SODIUM * 290 360 440 490 540 630 LABBIO0074 24 HOURS URINE FOR URIC ACID * 310 390 470 520 580 680 LABBIO0075 URINE SPOT PROTEIN CREATININE RATIO* 650 810 980 1100 1220 1420 LABBIO0078 IONIZED CALCIUM 1190 1490 1790 2010 2230 2600 LABBIO0079 TRANSFERNIN SATURATION* 1280 1600 1920 2160 2400 2800 LABBIO0080IRON TIBC* 770 960 1160 1300 1440 1680 LABBIO0081 MICROALBUMIN, SPOT URINE* 600 750 900 1010 1130 1310 LABBIO0082 ASCITIC FLUID FOR PROTEIN* 250 310 380 420 470 550 LABBIO0083 ASCITIC FLUID FOR ALBUMIN * 240 300 360 410 450 530 LABBIO0084 ASCITIC FLUID FOR GLUCOSE* 240 300 360 410 450 530 LABBIO0085 ASCITIC FLUID FOR CREATININE* 260 330 390 440 490 570 LABBIO0086 ASCITIC FLUID FOR AMYLASE* 600 750 900 1010 1130 1310 LABBIO0087 ASCITIC FLUID FOR LIPASE* 700 880 1050 1180 1310 1530 LABBIO0088 ASCITIC FLUID FOR L.D.H* 500 630 750 840 940 1090

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CODE.NO SERVICE NAME AMOUNT LABBIO0089 PLEURAL FLUID FOR PROTEIN* 250 310 380 420 470 550 LABBIO0090 PLEURAL FLUID FOR ALBUMIN * 240 300 360 410 450 530 LABBIO0091 PLEURAL FLUID FOR GLUCOSE* 240 300 360 410 450 530 LABBIO0092 PLEURAL FLUID FOR CREATININE* 260 330 390 440 490 570 LABBIO0093 PLEURAL FLUID FOR AMYLASE* 600 750 900 1010 1130 1310 LABBIO0094 PLEURAL FLUID FOR LIPASE* 700 880 1050 1180 1310 1530 LABBIO0095 PLEURAL FLUID FOR L.D.H* 500 630 750 840 940 1090 LABBIO0096 C.S.F. FLUID FOR PROTEIN* 320 400 480 540 600 700 LABBIO0098 C.S.F. FLUID FOR GLUCOSE* 250 310 380 420 470 550 LABBIO0099 C.S.F. FLUID FOR L.D.H* 500 630 750 840 940 1090 LABBIO0100 FLUID FOR BUN/UREA* 310 390 470 520 580 680 GLUCOSE CHALLENGE TEST AFTER50ML(2 LABBIO0101 390 490 590 660 730 850 SAMPLE LABBIO0102 CALCIUM/CREATININE RATIO (RANDOM URINE) 590 740 890 1000 1110 1290 LABBIO0103 SPOT URINE CALCIUM 340 430 510 570 640 740 LABBIO0104 24HR URINE FOR PHOSPHORUS* 240 300 360 410 450 530 LABBIO0105 FLUID FOR BILIRUBIN* 550 690 830 930 1030 1200 GLUCOSE CHALLENGE TEST (75G) AT 2 LABBIO0107 390 490 590 660 730 850 HOURS LABBIO0108 24 HOURS URINE MAGNESIUM 550 690 830 930 1030 1200 LABBIO0109 SPOT URINE MAGNESIUM 600 750 900 1010 1130 1310 LABBIO0110 CRP * 600 750 900 1010 1130 1310 LABBIO0111 SERUM SODIUM 260 330 390 440 490 570 LABBIO0106 HEMO-DIALYSIS PROFILE -2 430 540 650 730 810 940 LABBIO0114 SPOT URINE AMYLASE 440 550 660 740 830 960 LABBIO0115 24HR URINE FOR UREA 200 250 300 340 380 440 HS-CRP(CARDIO C-REACTIVE LABBIO0112 1000 1250 1500 1690 1880 2190 PROTEIN),SERUM* LABBIO0113 SODIUM POTTASSIUM (NA+/K+) 440 550 660 740 830 960 BLOOD GAS BGABLO0001 BLOOD GAS EG7 1100 1100 1100 1100 1100 1100

BGABLO0002 BLOOD GAS CG4 1425 1425 1425 1425 1425 1425

BGABLO0003 BLOOD GAS G3 900 900 900 900 900 900

BGABLO0004 BLOOD GAS GEM 1100 1100 1100 1100 1100 1100 CLINICAL PATHOLOGY LABCLP0002 FLUID FOR TLC & DLC * 500 630 750 840 940 1090

LABCLP0003 SEMEN ANALYSIS * 500 630 750 840 940 1090

LABCLP0004 STOOL FOR pH* 150 190 230 250 280 330

LABCLP0005 STOOL FOR REDUCING SUBSTANCES* 190 240 290 320 360 420

LABCLP0006 STOOL OCCULT BLOOD 210 260 320 350 390 460

LABCLP0031 STOOL R/E , ROUTINE 240 300 360 410 450 530

LABCLP0008 URINE FOR PROTEIN 170 210 260 290 320 370

LABCLP0009 URINE FOR BENCE JONES PROTEIN* 240 300 360 410 450 530

LABCLP0010 URINE FOR BILE SALT 290 360 440 490 540 630

LABCLP0011 URINE FOR HAEMOGLOBINURIA* 220 280 330 370 410 480

LABCLP0012 URINE FOR KETONES 275 340 410 460 520 600

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CODE.NO SERVICE NAME AMOUNT LABCLP0013 URINE FOR BILE PIGMENT 275 340 410 460 520 600

LABCLP0014 URINE FOR PREGNANCY TEST 310 390 470 520 580 680

LABCLP0015 URINE FOR SPECIFIC GRAVITY 170 210 260 290 320 370

LABCLP0016 URINE FOR SUGAR 190 240 290 320 360 420

LABCLP0017 URINE FOR UROBILINOGEN 190 240 290 320 360 420

LABCLP0018 URINE R/E, ROUTINE 300 380 450 510 560 660

LABCLP0020 FLUID FOR MALIGNANT CELLS/CYTOLOGY* 1000 1250 1500 1690 1880 2190

LABCLP0021 URINARY CYTOLOGY/ MALIGNANT CELLS* 1000 1250 1500 1690 1880 2190

LABCLP0022 FLUID/STOOL FOR FAT GLOBULES 210 260 320 350 390 460

LABCLP0023 URINE/FLUID FOR CHYLE 520 650 780 880 980 1140

LABCLP0024 URINE FOR EOSINOPHILS* 280 350 420 470 530 610 LABCLP0025 SYNOVIAL EXAMINATION 880 1100 1320 1490 1650 1930 LABCLP0026 FLUID FOR BILE PIGMENT 200 250 300 340 380 440 LABCLP0027 FLUID FOR BILE SALT 290 360 440 490 540 630 LABCLP0028URINE FOR pH 150 190 230 250 280 330 LABCLP0029 HEMOSIDERIN URINE 350 440 530 590 660 770 LABCLP0030 SEMEN FRUCTOSE (QUALITATIVE) 250 310 380 420 470 550 LABCLP0031 STOOL R/E , ROUTINE 240 300 360 410 450 530 LABCLP0032 URINE R/E, ROUTINE & MICROSCOPY 300 380 450 510 560 660 CYTOLOGY LABCYT0001 BRUSH CYTOLOGY 1000 1250 1500 1690 1880 2190

LABCYT0002 PAP SMEAR * 1000 1250 1500 1690 1880 2190

LABCYT0003 F.N.A.C.* 1600 2000 2400 2700 3000 3500

LABCYT0004 BONE MARROW ASPIRATE CYTOLOGY* 1540 1930 2310 2600 2890 3370 LABCYT0005 URINE FOR DECOY CELLS 770 960 1160 1300 1440 1680 LABCYT0006 FLUID FOR MALIGNANT CELLS/CYTOLOGY* 1000 1250 1500 1690 1880 2190 LABCYT0008 NIPPLE DISCHARGE - CYTOLOGY 1380 1730 2070 2330 2590 3020 LABCYT0009 PNEUMOCYSTIS CARINII SILVER STAIN 450 560 680 760 840 980 LABCYT0010 BRONCHIAL LAVAGE FOR ASPERGILLUS PCP 450 560 680 760 840 980 LABCYT0007 URINARY CYTOLOGY/ MALIGNANT CELLS* 1000 1250 1500 1690 1880 2190 HAEMATOLOGY LABHAE0001 HB 210 260 320 350 390 460

LABHAE0002 TLC 210 260 320 350 390 460

LABHAE0003 DLC 210 260 320 350 390 460

LABHAE0004 ESR 300 380 450 510 560 660

LABHAE0005 HAEMOGRAM WITHOUT DLC 430 540 650 730 810 940

LABHAE0006 HAEMOGRAM 540 680 810 910 1010 1180

LABHAE0007 PLATELET COUNT 240 300 360 410 450 530

LABHAE0008 ABSOLUTE EOSINOPHIL COUNT AEC 250 310 380 420 470 550

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CODE.NO SERVICE NAME AMOUNT LABHAE0009 HAEMATOCRIT PCV 200 250 300 340 380 440

LABHAE0010 RETICULOCYTE COUNT 390 490 590 660 730 850

LABHAE0011 P.S. FOR MORPHOLOGY 450 560 680 760 840 980

LABHAE0012 P.S. FOR M.P. 400 500 600 680 750 880

LABHAE0013 MALARIA ANTIGEN* 1000 1250 1500 1690 1880 2190

LABHAE0014 BLEEDING TIME* 250 310 380 420 470 550

LABHAE0015 CLOTTING TIME* 250 310 380 420 470 550

LABHAE0034 PROTHROMBIN TIME P.T.* 600 750 900 1010 1130 1310

LABHAE0017 L.E. CELL* 500 630 750 840 940 1090

LABHAE0033 ACTIVATED PARTIAL THROMBOPLASTIN TIME* 800 1000 1200 1350 1500 1750

LABHAE0019 G-6 P.D.* 860 1080 1290 1450 1610 1880

LABHAE0020 CLOT RETRACTION TIME (CRT)* 280 350 420 470 530 610

LABHAE0021 ABSOLUTE NEUTROPHIL COUNT * 240 300 360 410 450 530

LABHAE0022 ABSOLUTE LYMPHOCYTE COUNT * 240 300 360 410 450 530

LABHAE0024 P.S. FOR MICRO FILARIA 450 560 680 760 840 980

LABHAE0025 P.S. FOR HAEMOLYSIS 450 560 680 760 840 980 LABHAE0026 HB ELECTROPHORESIS (HPLC) 1500 1880 2250 2530 2810 3280 LABHAE0028 BONE MARROW ASPIRATE FOR MORPHOLOGY 1600 2000 2400 2700 3000 3500 LABHAE0029P.S FOR SEPSIS 450 560 680 760 840 980 LABHAE0030 HAEMOGRAM[PAEDIATRIC WITHOUT ESR] 430 540 650 730 810 940 LABHAE0032 FIBRIN DEGRADATION PRODUCT 1200 1500 1800 2030 2250 2630 IMMUNOLOGY LABIMU0001 CA 125 * 1650 2060 2480 2780 3090 3610 LABIMU0002 CA 19-9 * 1700 2130 2550 2870 3190 3720 LABIMU0003 CEA * 1020 1280 1530 1720 1910 2230 LABIMU0004 CMV IgG * 950 1190 1430 1600 1780 2080 LABIMU0005 CMV IgM * 950 1190 1430 1600 1780 2080 LABIMU0006 CORTISOL * 850 1060 1280 1430 1590 1860 LABIMU0008 T3,FREE;FT3 * 550 690 830 930 1030 1200 LABIMU0009 T3 FREE,T4 FREE(FT3,FT4)* 940 1180 1410 1590 1760 2060 LABIMU0010 T4,FREE;FT4 * 550 690 830 930 1030 1200 LABIMU0011 FT4 &TSH * 880 1100 1320 1490 1650 1930 LABIMU0014 PSA TOTAL * 1250 1560 1880 2110 2340 2730 LABIMU0016 THYROID PROFILE TEST - FT3, FT4,TSH * 1400 1750 2100 2360 2630 3060 LABIMU0017 TSH * 550 690 830 930 1030 1200 LABIMU0018 A.M.A * 940 1180 1410 1590 1760 2060 LABIMU0019 A.N.A * 1200 1500 1800 2030 2250 2630 LABIMU0020 A.S.M.A * 1200 1500 1800 2030 2250 2630 LABIMU0021 ALPHA FETO PROTEIN * 1200 1500 1800 2030 2250 2630 LABIMU0022 AMOEBIC SEROLOGY * 1400 1750 2100 2360 2630 3060 LABIMU0023 ANTI Ds DNA* 1150 1440 1730 1940 2160 2520 LABIMU0024 FERRITIN * 1150 1440 1730 1940 2160 2520 LABIMU0025 HAV IgM * 2000 2500 3000 3380 3750 4380 LABIMU0046 HEV IgM * 2500 3130 3750 4220 4690 5470 LABIMU0027 HYDATID SEROLOGY * 1230 1540 1850 2080 2310 2690 LABIMU0028 LKM ANTIBODIES * 1540 1930 2310 2600 2890 3370

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CODE.NO SERVICE NAME AMOUNT LABIMU0029 TISSUE TRANSGLUTAMINASE ANTIBODY IgA * 1670 2090 2510 2820 3130 3650 LABIMU0030 PCT-QPROCALCITONIN * 3580 4480 5370 6040 6710 7830 LABIMU0031 HBe ANTIGEN * 1650 2060 2480 2780 3090 3610 LABIMU0032 HBe ANTIBODY * 1650 2060 2480 2780 3090 3610 LABIMU0033 HB CORE IgM * 1650 2060 2480 2780 3090 3610 LABIMU0035 VITAMIN D-25 2000 2500 3000 3380 3750 4380 LABIMU0036 BETA HCG, SERUM* 950 1190 1430 1600 1780 2080 LABIMU0037 IMMUNOGLOBULIN IGE 1000 1250 1500 1690 1880 2190 LABIMU0038D-DIMER 2000 2500 3000 3380 3750 4380 LABIMU0040NT-PRO BNP 2500 3130 3750 4220 4690 5470 LABIMU0041 TROPONIN-I HIGH SENSITIVE 1760 2200 2640 2970 3300 3850 LABIMU0042PTH* 1800 2250 2700 3040 3380 3940 LABIMU0043 VITAMIN B-12* 1200 1500 1800 2030 2250 2630 LABIMU0044FOLIC ACID* 1300 1630 1950 2190 2440 2840 LABIMU0045 TACROLIMUS LEVEL 2770 3460 4160 4670 5190 6060 LABIMU0048 SERUM GALACTOMANNAN 5600 7000 8400 9450 10500 12250 LABIMU0049 BAL FLUID FOR GALACTIOMANNAN 5600 7000 8400 9450 10500 12250 LABIMU0051 COVID IGG ANTIBODY 1650 2060 2480 2780 3090 3610 LABMIC0028 STOOL-CL. DIFFICILE TOXIN * 2600 3250 3900 4390 4880 5690 LABMIC0029 CRYPTO COCEAL ANTIGEN * 2000 2500 3000 3380 3750 4380

MICROBIOLOGY LABMIC0002 AFB MICROSCOPY * 360 450 540 610 680 790 LABMIC0003 CANDIDA CULTURE / FUNGAL CULTURE VITEK* 1050 1310 1580 1770 1970 2300 LABMIC0004 CANDIDA MICROSCOPY * 420 530 630 710 790 920 LABMIC0005 PYOGENIC CULTURE (C/S) VITEK* 1050 1310 1580 1770 1970 2300 LABMIC0006 PYOGENIC MICROSCOPY * 330 410 500 560 620 720 LABMIC0007 SEMEN CULTURE & SENSITIVITY(C/S) VITEK* 1050 1310 1580 1770 1970 2300

LABMIC0008 STOOL CULTURE & SENSITIVITY(C/S) VITEK* 1050 1310 1580 1770 1970 2300 STOOL HANGING DROP FOR VIBRIO LABMIC0009 250 310 380 420 470 550 CHOLERAE* LABMIC0012 URINE CULTURE & SENSITIVITY (C/S) VITEK* 1050 1310 1580 1770 1970 2300 LABMIC0013 INDIA INK PREPARATION * 330 410 500 560 620 720 LABMIC0016 BLOOD/PYOGENIC C/S (BACT/ALERT 3D) 2050 2560 3080 3460 3840 4480 LABMIC0017 NOCARDIA MICROSCOPY * 430 540 650 730 810 940 LABMIC0018 KOH PREPARATION FOR FUNGUS * 420 530 630 710 790 920 LABMIC0019 STOOL FOR CRYPTOSPORIDIUM * 330 410 500 560 620 720 WET MOUNT SMEAR EXAM. FOR LABMIC0021 290 360 440 490 540 630 TRICHOMONAS* LABMIC0022 WATER CULTURE* 220 280 330 370 410 480 LABMIC0023 MRSA SCREENING 960 1200 1440 1620 1800 2100 LABMIC0027 VRE - SCREENING 550 690 830 930 1030 1200 SEROLOGY LABSER0001 CRP * 580 730 870 980 1090 1270

LABSER0002 DENGUE IgG/ DENGUE IgM * 600 750 900 1010 1130 1310

LABSER0003 MANTOUX TEST * 350 440 530 590 660 770

LABSER0004 R.A. FACTOR * 650 810 980 1100 1220 1420

LABSER0005 WIDAL * 500 630 750 840 940 1090

LABSER0006 DENGUE NS1 * 600 750 900 1010 1130 1310

LABSER0007 CHIKUNGUNYA IgM * 660 830 990 1110 1240 1440

LABSER0008 SERUM TYPHI DOT IgG * 700 880 1050 1180 1310 1530

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CODE.NO SERVICE NAME AMOUNT LABSER0009 SERUM TYPHI DOT IgM * 700 880 1050 1180 1310 1530

LABSER0010 A.S.O* 1050 1310 1580 1770 1970 2300

LABSER0011 STOOL- C DIFFICILE TOXIN* 2860 3580 4290 4830 5360 6260 LABSER0012 DENGUE NS1 ELISA* 600 750 900 1010 1130 1310 LABSER0013 DENGUE FEVER IGG ANTIBODY, EIA 990 1240 1490 1670 1860 2170 LABSER0014 DENGUE FEVER IGM ANTIBODY, EIA 990 1240 1490 1670 1860 2170 LABSER0015 SCRUB TYPHUS[RAPID TEST] IgM * 1000 1250 1500 1690 1880 2190 HISTOPATHOLOGY BLOCK ISSUE CHARGES (SINGLE BLOCK) LABHIS0001 220 280 330 370 410 480 EACH LABHIS0002 SLIDE ISSUE CHARGES (SINGLE SLIDE) EACH 220 280 330 370 410 480 BLOCK/SLIDE REVIEW UP TO 2 LABHIS0003 770 960 1160 1300 1440 1680 SLIDES/BLOCKS LABHIS0004 BLOCK/SLIDE REVIEW 3-5 SLIDES/BLOCKS 1540 1930 2310 2600 2890 3370

LABHIS0005 BLOCK/SLIDE REVIEW > 5 SLIDES/BLOCKS 1980 2480 2970 3340 3710 4330

LABHIS0006 FROZEN SECTION FOR MARGIN / DIAGNOSIS 2100 2630 3150 3540 3940 4590

LABHIS0007 FROZEN SECTION FOR 3 RESECTED MARGINS 2750 3440 4130 4640 5160 6020 LABHIS0008 FROZEN SECTION FOR 4-6 SECTIONS 4200 5250 6300 7090 7880 9190 LABHIS0009 HISTOPATHOLOGY SMALL SPECIMEN BIOPSY 1500 1880 2250 2530 2810 3280 HISTOPATHOLOGY MEDIUM SPECIMEN LABHIS0010 2000 2500 3000 3380 3750 4380 BIOPSY LABHIS0011 HISTOPATHOLOGY LARGE SPECIMEN BIOPSY 2800 3500 4200 4730 5250 6130

LABHIS0012 HISTOPATHOLOGY LARGE RADICAL EXCISION 4200 5250 6300 7090 7880 9190

LABHIS0013 SPECIAL STAIN(AFB/PAS/RETICULIN/LRON/EAC 280 350 420 470 530 610 LABHIS0014 BONE MARROW BIOPSY 2000 2500 3000 3380 3750 4380 LABHIS0015 LIVER BIOPSY 2800 3500 4200 4730 5250 6130 LABHIS0016 PROSTATIC BIOPSY (4/6 QUADRANT) 2800 3500 4200 4730 5250 6130 LABHIS0017 PROSTATIC BIOPSY (12 QUADRANT) 4200 5250 6300 7090 7880 9190 LABHIS0018 TURP 2800 3500 4200 4730 5250 6130 LABHIS0019 REMAINING FROZEN TISSUE (SMALL) 1270 1590 1910 2140 2380 2780 LABHIS0020 REMAINING FROZEN TISSUE (MEDIUM) 1930 2410 2900 3260 3620 4220 LABHIS0021 REMAINING FROZEN TISSUE (LARGE) 2530 3160 3800 4270 4740 5530 LABHIS0022 REMAINING FROZEN TISSUE (EXTRA LARGE) 3630 4540 5450 6130 6810 7940 LABHIS0027 IHC 1 MARKER 1650 2060 2480 2780 3090 3610 LABHIS0028 IHC 2 MARKER 3000 3750 4500 5060 5630 6560 LABHIS0029 IHC 3 MARKER 3900 4880 5850 6580 7310 8530 LABHIS0030 IHC 4 MARKER 4500 5630 6750 7590 8440 9840 LABHIS0031 IHC 5 MARKER 5000 6250 7500 8440 9380 10940 LABHIS0023 TBNA FOR MALIGNANT CELLS 1380 1730 2070 2330 2590 3020

RADIOLOGY X-RAY CODE NO. PROCEDURES OPD IPD IMGXRA0001CHEST X-RAY P.A. VIEW 680 610 IMGXRA0002K.U.B. X-RAY 920 830 IMGXRA0003ABDOMEN ERECT 680 610 IMGXRA0004ABDOMEN ERECT & SUPINE 920 830 IMGXRA0005PARANASAL SINUSES 550 500 IMGXRA0006SKULL A.P 550 500 IMGXRA0007SKULL A.P. LATERAL 1100 1000 IMGXRA0008CERVICAL SPINE A.P. LATERAL 1100 1000

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CODE.NO SERVICE NAME AMOUNT IMGXRA0009LEG A.P. LATERAL 1100 1000 IMGXRA0010KNEE A.P. LATERAL 1100 1000 IMGXRA0011ANKLE JOINT A.P. & LATERAL 1100 1000 IMGXRA0012HAND A.P. & LATERAL 1100 1000 IMGXRA0013WRIST A.P. & LATERAL 1100 1000 IMGXRA0014SHOULDER JOINT A.P.LATERAL 1100 1000 IMGXRA0015ELBOW JOINT A.P. & LATERAL 1100 1000 IMGXRA0016CHEST OBLIQUE/LATERAL 1100 1000 IMGXRA0017ABDOMEN SUPINE 680 610 IMGXRA0018PELVIS WITH BOTH HIP JOINTS 550 500 IMGXRA0019RIBS OBLIQUE 550 500 IMGXRA0020S.I.JOINT 1-FILM 550 500 IMGXRA0021S.I. JOINT A.P. & BOTH OBLIQUE - 3 FILM 1580 1430 IMGXRA0022SOFT TISSUES NECK 1 FILM 550 500 IMGXRA0023DORSAL LUMBER SPINE 1100 1000 IMGXRA0024LUMBAR SACRAL SPINE 550 500 IMGXRA0025LUMBAR SACRAL SPINE A.P. LATERAL 1100 1000 IMGXRA0026ORBIT 1 FILM 550 500 IMGXRA0027ORBIT A.P. & LATERAL 1100 1000 IMGXRA0028SOFT TISSUE NECK 550 500 IMGXRA0029BED-SIDED X-RAY 830 750 IMGXRA0030EXTRA X-RAY FILM 550 500 IMGXRA0031ABDOMEN LATERAL VIEW 680 610 IMGXRA0032CHEST X-RAY 680 610 IMGXRA0033DORSAL LUMBER SPINE AP&CAT 1100 1000 IMGXRA0034BED SIDE EMERGENCY 900 IMGXRA0035FOOT AP 550 500 IMGXRA0036FOOT LATERAL 550 500 IMGXRA0037BARIUM MEAL FOLLOW THROUGH 6050 5500 IMGXRA0038BARIUM ENEMA DOUBLE CONTRAST 7260 6600 IMGXRA0039BARIUM COMPLETE 7260 6600 IMGXRA0040BARIUM UPPER G.I. SERIES 5090 4620 IMGXRA0041SMALL BOWEL ENEMA TUBELESS 6780 6160 IMGXRA0042GASTROGRAFFIN STUDY 5450 4950 IMGXRA0043SMALL BOWEL ENEMA WITH TUBE 8110 7370 IMGXRA0044CONTRAST NON IONIC FOR XRAY 1940 1760 IMGXRA0045CONTRAST IONIC FOR XRAY 610 550 IMGXRA0046CONTRAST 1940 1760 IMGXRA0047DILATATION UNDER FLUROSCOPIC GUIDANCE 2180 1980 IMGXRA0048ERCP FLUORO CHARGE 2180 1980 IMGXRA0049MICTURATING CYST-URETHEROGRAM 5450 4950 IMGXRA0050RETROGRADE PYELOGRAM 6300 5720 IMGXRA0051EMERGENCY DOCTOR VISIT (XRAY) 2200 2000 IMGXRA0056BARIUM SWALLOW 4000 3630 IMGXRA0057T-TUBE CHOLANGRAM WITH CONTRAST 5090 4620 IMGXRA0058RADIOLOGY E.R.C.P 4400 4000 IMGXRA0059I.V.P./I.V.U. NON-IONIC CONTRAST 6420 5830 IMGXRA0060XRAY WRIST ONE VIEW 550 500 IMGXRA0061XRAY CERVICAL ONE VIEW 550 500 IMGXRA0062XRAY ORBIT AP/OBL 1100 1000 IMGXRA0063XRAY ORBIT ONE VIEW 550 500 IMGXRA0064XRAY TM JOINT 920 830 IMGXRA0065XRAY MASTOID 1460 1320 IMGXRA0066XRAY MANDIBLE 1460 1320 IMGXRA0067XRAY MANDIBLE ONE VIEW 550 500 IMGXRA0068XRAY HAND ONE VIEW 550 500 IMGXRA0069XRAY B/L HIP JOINT 920 830 IMGXRA0070XRAY SINGLE JOINT 550 500 IMGXRA0071XRAY BED SIDE ABDOMEN IN EMERGENCY ONE V 1100 1000 IMGXRA0072XRAY BED SIDE ABDOMEN ONE VIEW 800 720 IMGXRA0073XRAY BED SIDE ABDOMEN E/S 1430 IMGXRA0074XRAY BED SIDE ABDOMEN E/S IN EMERGENCY 1650 IMGXRA0075XRAY CHEST EMERGENCY 800 720 IMGXRA0076XRAY ABDOMEN E/S EME 1460 1320

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CODE.NO SERVICE NAME AMOUNT IMGXRA0077XRAY ABDOMEN ONE VIEW EMERGENCY 920 830 IMGXRA0078CHEST AP WITH EMERGENCY 920 830 IMGXRA0079CHEST AP WITH BEDSIDE + EMERGENCY 1100 1000 IMGXRA0080CHEST PA WITH EMERGENCY 920 830 IMGXRA0081ABDOMEN ERECT AND SUPINE WITH EMERGENCY 1460 1320 IMGXRA0082ABDOMEN ERECT WITH EMERGENCY 920 830 IMGXRA0083ABDOMEN SUPINE WITH EMERGENCY 920 830 IMGXRA0084ABDOMEN ERECT WITH BED SIDE 830 IMGXRA0085ABDOMEN SUPINE WITH BED SIDE 830 IMGXRA0086ABDOMEN ERECT BED SIDE WITH EMERGENCY 1100 1000 IMGXRA0087ABDOMEN SUPINE BEDSIDE WITH EMERGENCY 1100 1000 IMGXRA0088CERVICAL AP 550 500 IMGXRA0089CERVICAL LAT 550 500 IMGXRA0090KNEE AP 550 500 IMGXRA0091KNEE LAT 550 500 IMGXRA0092Xray Colon Transit Study 1580 1430 IMGXRA0093HSG INCLUDING CONTRAST 5330 4840 IMGXRA0094IMAGING GUIDED VASCULAR ACCESS 5450 4950 IMGXRA0095SKULL LAT VIEW 550 500 IMGXRA0096NASAL BONE B/L LAT VIEW 1100 1000 IMGXRA0097MASTOID LAT VIEW (ONE SIDE) 550 500 IMGXRA0098MASTOID LAT VIEW BOTH SIDE 1100 1000 IMGXRA0099MANDIBLE AP VIEW 550 500 IMGXRA0100MANDIBLE LAT VIEW (OPEN MOUTH) 550 500 IMGXRA0101MANDIBLE LAT VIEW (CLOSE MOUTH) 550 500 IMGXRA0102SUBMENTO-VERTICAL VIEW 550 500 IMGXRA0103SELLA TURCICA LAT VIEW (ONE SIDE) 550 500 IMGXRA0104SELLA TURCICA LAT VIEW (BOTH SIDE) 1100 1000 IMGXRA0105CERVICAL SPINE OBL VIEW 550 500 IMGXRA0106CERVICAL SPIEN OPEN MOUTH AP VIEW 550 500 IMGXRA0107DORSAL SPINE OBL VIEW 550 500 IMGXRA0108LUMBOSACRAL SPINE OBL VIEW 550 500 IMGXRA0109LUMBOSACRAL SPINE LAT - FLEX / EXT VIEW 1100 1000 IMGXRA0110CHEST OBL VIEW 550 500 IMGXRA0111SCAPULA AP VIEW 550 500 IMGXRA0112SCAPULA LAT VIEW 550 500 IMGXRA0113HUMERUS AP / LAT VIEW 1100 1000 IMGXRA0114ELBOW LAT VIEW 550 500 IMGXRA0115FOREARM AP/LAT VIEW 1100 1000 IMGXRA0116WRIST JOINT OBL VIEW 550 500 IMGXRA0117FINGER AP/LAT/OBL VIEW 1340 1210 IMGXRA0118FOOT OBL VIEW 550 500 IMGXRA0119ANKLE OBL VIEW 550 500 IMGXRA0120BOTH KNEE SKYLINE VIEW 550 500 IMGXRA0121BOTH KNEE AP/LAT VIEW 1640 1490 IMGXRA0122LEG LAT VIEW 550 500 IMGXRA0123FEMUR AP/LAT VIEW 1100 1000 IMGXRA0124HIP JOINT LAT VIEW (ONE SIDE) 550 500 IMGXRA0125BOTH HIP JOINT LAT VIEW 1100 1000 IMGXRA0126ABDOMEN LEFT LATERAL DECUBITUS 550 500 IMGXRA0127LOOPOGRAM/POUCHOGRAM(IN FLOUROSCOPY TEST 4780 4350 IMGXRA0128BARIUM ENEMA 6180 5610 IMGXRA0129SINOGRAM /FISTULOGRAM UNDER FLOUROSCOPY 4780 4350 IMGXRA0130DORSAL AP 680 610 IMGXRA0131TWISTS XRAY 550 500 IMGXRA0132blocked X-RAY OPG 730 660 IMGXRA0134XRAY LEFT HAND WITH WRIST FOR BONE 920 830 IMGXRA0135XRAY SCANOGRAM AP VIEW 2420 2200 IMGXRA0136XRAY WHOLE SPINE - AP 1820 1650 IMGXRA0137XRAY WHOLE SPINE-LAT 1820 1650 IMGXRA0138XRAY WHOLE SPINE - AP & LAT 3630 3300 IMGXRA0139XRAY WHOLE SPINE - RIGHT BENDING 1820 1650 IMGXRA0140XRAY WHOLE SPINE -LEFT BENDING 1820 1650 IMGXRA0141XRAY WHOLE SPINE - AP. VIEW 1820 1650

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CODE.NO SERVICE NAME AMOUNT IMGXRA0142XRAY WHOLE SPINE - LAT. VIEW 1820 1650 IMGXRA0143XRAY WHOLE SPINE - EXTENSION VIEW 1820 1650 IMGXRA0144XRAY WHOLE SPINE - FLEXION VIEW RS. 1820 1650

ULTRASOUND CODE NO. PROCEDURES OPD IPD IMGULT0001UPPER ABDOMEN ULTRASOUND 1580 1430 IMGULT0002LOWER ABDOMEN 1580 1430 IMGULT0003WHOLE ABDOMEN ULTRASOUND 2910 2640 IMGULT0004SCREENING 1460 1320 IMGULT0005K.U.B. 1580 1430 IMGULT0006PELVIS 1580 1430 IMGULT0007PREGNANCY 2670 2420 IMGULT0008SCROTUM 2550 2310 IMGULT0009THYROID 2060 1870 IMGULT0010ORBIT 2060 1870 IMGULT0011SMALL PARTS 2060 1870 IMGULT0012ULTRASOUND GUIDED F.N.A.C 5060 4600 IMGULT0014ULTRASOUND GUIDED LIVER ABSCESS ASPIRATI 6660 6050 IMGULT0015ULTRASOUND GUIDED DIAG.TAPPING/PROCEDURE 2120 1930 IMGULT0016ULTRASOUND GUIDED LIVER BIOPSY 6600 6000 IMGULT0017ULTRASOUND GUIDED RENAL BIOPSY 8110 7370 IMGULT0021HEPATIC VENOGRAPHY ULTRASOUND GUIDED 7870 7150 IMGULT0022RENAL VENOGRAPHY TRANSFEMORAL 24200 22000 IMGULT0023HEPATIC VENOGRAPHY TRANSJUGULAR 24200 22000 IMGULT0024LIVER BIOPSY TRANSJUGULAR 42350 38500 IMGULT0025ULTRASOUND NECK 2060 1870 IMGULT0027ULTRAOUND OBSTETRIC NT/NB SCAN 2790 2530 IMGULT0028ULTRASOUND BREAST 2060 1870 IMGULT0029ULTRASOUND & COLOUR DOPPLER WITH FLIM 4360 3960 IMGULT0030TRANS RECTAL ULTRASOUND 2910 2640 IMGULT0031TRANS VAGINAL ULTRASOUND 2180 1980 IMGULT0032CRANIAL ULTRASOUND 2060 1870 IMGULT0033ULTRASOUND FOR LEVEL II 3630 3300 IMGULT0035PERPHERAL & CAROTID ONE SIDED 5210 4730 IMGULT0036ULTRASOUND WHOLE ABDOMEN - BED SIDE 3960 IMGULT0039TRUS GUIDED PROSTATE BIOPSY 9080 8250 IMGULT0040MULT.REPATIC ABSESSES ORSINGLE LARGE>400 9080 8250 IMGULT0041THERAPEUTIC ASP. PLEURAL/ASCITIC FLUID 5570 5060 IMGULT0042ULTRASOUND WHOLE ABDOMEN - BED SIDE EMER 5570 5060 IMGULT0045UPPER ABDOMEN WITH LIVER ELASTOGRAPHY 5570 5060 IMGULT0046PELVIS WITH PROSTATE ELASTOGRAPHY 5570 5060 IMGULT0047SONOMMOGRAPHY WITH ELASTOGRAPHY 5570 5060 IMGULT0048ELASTOGRAPHY PLAIN 4840 4400 IMGULT0049PROSTATE WITH ELASTOGRAPHY 5570 5060 IMGULT0050WHOLE ABDOMEN WITH ELASTOGRAPHY 6420 5830 IMGULT0051EMERGENCY DOCTOR VISIT CHARGES 2200 2000 IMGULT0052ULTRASOUND DOPPLER BOTH LOWER LIMBS ARTE 8110 7370 IMGULT0053ULTRASOUND DOPPLER BOTH LOWER LIMBS VENO 8110 7370 IMGULT0054ULTRASOUND RENAL DOPPLER 4000 3630 IMGULT0055ULTRASOUND SCREENING GUIDED PROCEDURE 2420 2200 IMGULT0056ULTRASOUND SCREENING GUIDED PROCEDURE BE 3630 3300 IMGULT0057USG DOP SINGLE EXT PREOP MAP HD FISTULA 8110 7370 IMGULT0058USG DOPPLER OF HEMODIALYSIS FISTULA 8110 7370 IMGULT0059ULTRASOUND FOLLICULAR STUDY (ONE VISIT) 970 880 IMGULT0060ULTRASOUND FOLLICULAR STUDY(FOUR VISIT) 2420 2200 IMGULT0061TRUS GUIDED PROSTATE BIOPSY WITH D.GUIDE 10290 9350 IMGULT0062ULTRASOUND GUIDED BIOPSY 8470 7700 IMGULT0063THERAPEUTIC ASPIRATION FROM ANY SITE USG 6660 6050 IMGULT0064US GUIDED VASCULAR ACCESS 5450 4950 IMGULT0065USG DOPPLER RIGHT LOWER ARTERIAL/VENOUS 7390 6710 IMGULT0066USG DOPPLER LEFT LOWER ARTERIAL/VENOUS 7390 6710 IMGULT0067LIVER RECIPIENT DOPP NORMAL TIME10 SCANS 65340 59400 IMGULT0068INTRAOPERATIVE DOPPLER LIVER TRANSPLANT 3270 2970

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CODE.NO SERVICE NAME AMOUNT IMGULT0069PRE SUR. GUIDED WIRE PLACEMENT IN SOL 6050 5500 IMGULT0070ULTRASOUND GUIDED CATHETER LVP 10890 9900 IMGULT0071ULTRASOUND CAROTID DOPPLER 4360 3960 IMGULT0072USG GUIDED BREAST MARKER PLACEMENT 9680 8800 IMGULT0073USG GUIDED BREAST BIOPSY 9680 8800 IMGULT0074USG GUIDED HOOK WIRE PLACEMENT 8470 7700 IMGULT0075USG ILIAC VESSELS DOPPLER 8110 7370 IMGULT0077PENILE DOPPLER 6600 6600 CT-SCAN CODE NO. PROCEDURES OPD IPD IMGCTS0001CT SCAN BRAIN 3300 3630 IMGCTS0002CT SCAN BRAIN WITH CONTRAST 4400 4840 IMGCTS0003CT SCAN TEMPORAL 6380 6380 IMGCTS0004CT SCAN TEMPORAL WITH CONTRAST 8910 8910 IMGCTS0005CT SCAN - P.N.S. CORONAL HRCT 4180 4840 IMGCTS0006CT SCAN CORONAL / AXIAL 6380 6380 IMGCTS0007CT SCAN CORONAL/AXIAL WITH CONTRAST 8910 8910 IMGCTS0008SELLA AXIAL & CORONAL 4840 4840 IMGCTS0009SELLA AXIAL & CORONAL WITH CONTRAST 8910 8910 IMGCTS0010CT SCAN ORBIT AXIAL & CORONAL 6380 6380 IMGCTS0011CT SCAN ORBIT AXIAL & CORONAL WITH CON 8360 8360 IMGCTS0012CT SCAN ORBIT & HEAD 7370 7370 IMGCTS0013CT SCAN ORBIT & HEAD WITH CONTRAST 10670 10670 IMGCTS0014CT SCAN UPPER/LOWER ABDOMEN 4950 5500 IMGCTS0015CT SCAN UPPER/LOWER ABDOMEN WITH CONTRAS 6600 7590 IMGCTS0016CT SCAN THORAX HRCT 6300 6710 IMGCTS0017CT SCAN - CECT THORAX + HRCT WITH CONTRA 8470 8910 IMGCTS0018CT SCAN - THORAX & UPPER ABDOMEN 11550 11550 IMGCTS0019CT SCAN - THORAX & UPPER ABDOMEN WITH CO 13970 13970 IMGCTS0020CT SCAN - THORAX & WHOLE ABDOMEN 12650 14520 IMGCTS0021CT SCAN - THORAX & WHOLE ABDOMEN WITH CO 15950 17710 IMGCTS0022CT SCAN - NECK, THORAX & WHOLE ABDOMEN 18480 18480 IMGCTS0023CT SCAN - NECK, THRAX & WHOLE ABDOMEN WI 23650 23650 IMGCTS0024CT SCAN - NECK 6270 6270 IMGCTS0025CT SCAN - NECK WITH CONTRAST 7590 7590 IMGCTS0026CT SCAN - NECK & HEAD 8250 8250 IMGCTS0027CT SCAN - NECK & HEAD WITH CONTRAST 10890 10890 IMGCTS0028CT SCAN - NECK & THORAX 10670 10670 IMGCTS0029CT SCAN - NECK & THORAX WITH CONTRAST 13310 13310 IMGCTS0030CT SCAN - NECK, THORAX & UPPER ABDOMEN 16060 16060 IMGCTS0031CT SCAN - NECK, THORAX & UPPER ABDOMEN W 20570 20570 IMGCTS0032CT SCAN - SPIRAL 3 PHASE STUDIES 12100 12100 IMGCTS0033CT SCAN - SPIRAL 3 PHASE STUDIES WITH C 16940 16940 IMGCTS0034CT SPINE - SPINE PER PART 5280 5280 IMGCTS0035CT SPINE PER PART WITH CONTRAST 8140 8140 IMGCTS0036CT ANGIO 12870 12870 IMGCTS0037CT ANGIO WITH CONTRAST 15400 15400 IMGCTS00383D, CT 7370 7370 IMGCTS0039CALCIUM SCORING 7370 7370 IMGCTS0040CT GUIDED FNAC 8800 8800 IMGCTS0041CT SCAN - WHOLE ABDOMEN 8250 9680 IMGCTS0042CT SCAN - WHOLE ABDOMEN WITH CONTRAST 10450 12100 IMGCTS0043WHOLE ABDOMEN CT + DUAL PHASE LIVER - WI 16940 16940 IMGCTS0044CT KUB PLAIN 7150 7920 IMGCTS0045CT KUB WITH CONTRAST 11000 12100 IMGCTS0046CONTRAST NON IONIC FOR CT 2420 2420 IMGCTS0047CONTRAST IONIC FOR CT 660 660 IMGCTS0048CT SCAN - CECT TRIPAL PHASE 16940 16940 IMGCTS0049CT SCAN - CECTTENTROCLYSIS 16940 16940 IMGCTS0050CT SCAN-P.N.S CORONAL HRCT WITH CONTRAST 6380 7260 IMGCTS0051EMERGENCY DOCTOR VISIT CHARGES CT SCAN 1980 1980 IMGCTS0052BONE DENSITOMETRY ROUTINE 4620 4620 IMGCTS0053CT HRCT CEST 6710 6710 IMGCTS0054CT PULMONARY ANGIO 16060 16060

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CODE.NO SERVICE NAME AMOUNT IMGCTS0055CT ABDOMEN ANGIO 16940 16940 IMGCTS0056CT HRCT CHEST WITH CONTRAST 9680 . IMGCTS0057CT ENTEROGRAPHY 16940 16940 IMGCTS0058CT RENAL ANGIO 12650 14630 IMGCTS0059CT BRAIN ANGIO 13970 13970 IMGCTS0060CT FACE 6490 6490 IMGCTS0061CD CHARGES CT SCAN 440 440 IMGCTS0062CT PNS PLAIN 4840 4840 IMGCTS0063CT PNS WITH CONTRAST 6490 6490 IMGCTS0064CT NECK ANGIO 14630 14630 IMGCTS0065CT BRAIN & NECK ANGIO 21780 21780 IMGCTS0066CT PELVIS PLAIN 5500 5500 IMGCTS0067PELVIS PLAIN AND CONTRAST 7260 7260 IMGCTS0068CT CERVICAL PLAIN 7260 7260 IMGCTS0069CT CERVICAL WITH CONTRAST 8470 8470 IMGCTS0070CT L-S SPINE PLAIN 6050 6050 IMGCTS0071CT L-S SPINE PLAIN WITH CONTRAST 7370 7370 IMGCTS0072CT D-L SPINE PLAIN 16390 16390 IMGCTS0073CT D-L SPINE WITH CONTRAST 17600 17600 IMGCTS0074CT ANKLE JOINT 6600 7260 IMGCTS0075CT FOOT 7260 7260 IMGCTS0076CT KNEE JOINT 6600 7260 IMGCTS0077CT ELBOW JOINT 6600 7260 IMGCTS0078CT SHOULDER JOINT 6600 7260 IMGCTS0079CT PERIPHERAL ANGIO 18590 18590 IMGCTS0080CT TM JOINT 6600 7260 IMGCTS0081CT MANDIBLE 7260 7260 IMGCTS0082CT HAND 7260 7260 IMGCTS0083CT WRIST 7260 7260 IMGCTS0084CT SINOGRAM / FISTULOGRAM 9680 9680 IMGCTS0085DUAL / TRIPLE PHASE CECT LOWER ABDOMEN 14520 14520 IMGCTS0086DUAL / TRIPLE PHASE CECT UPPER ABDOMEN 14520 14520 IMGCTS0087DUAL / TRIPLE PHASE CECT WHOLE ABDOMEN 16940 16940 IMGCTS0088EXTRA FILM MRI/CT SCAN 440 440 IMGCTS0089CT NEEDLE ASPR. OF FLUID COLL./ABSCESSES 10450 10450 IMGCTS0090CT DORSAL SPINE 6050 6050 IMGCTS0091THERAPEUTIC ASPIRATION FROM ANY SITE CT 6050 6050 IMGCTS0092CT VOLUMETRY 7150 7150 IMGCTS0093DUAL /TRIPLE PHASE CECT WA & VOLUMETRY 23100 23100 IMGCTS0094DUAL /TRIPLE PHASE CECT UA & VOLUMETRY 20350 20350 IMGCTS0095CT GUIDED BIOPSY 11000 11000 IMGCTS0096CT SCANOGRAM 3300 3300 IMGCTS0097CT ANGIO ABDOMEN 15400 15400 IMGCTS0098CT ANGIOGRAPHY CHEST 9900 9900 IMGCTS0099VIZIPAQUE CONTRAST 2200 2200 IMGCTS0100CT SCAN GUIDED MARKING 5500 5500 IMGCTS0101CT SCAN GUIDED INTERVENTION PROCEDURE 12100 12100 IMGCTS0102CT VIRTUAL BRONCHOSCOPY 8800 8800 IMGCTS0103CT VIRTUAL COLONOSCOPY 11000 11000 IMGCTS0104CT ANGIOGRAPHY UPPER LIMB 15400 15400 IMGCTS0105CT ANGIOGRAPHY LOWER LIMB 15400 15400 IMGCTS01062ND OPINION UPTO 2 REPORTS FOR CT/MR 1100 1100 IMGCTS01072ND OPINION UPTO 5 REPORTS FOR CT/MR 2200 2200 IMGCTS0108CT UROGRAM 11000 11000 IMGCTS0111CT EXTREMITIS JOINT 8000 8000 MRI CODE NO. PROCEDURES OPD IPD IMGMRI0001MRI CERVICAL SPINE SCREENING 4000 4400 IMGMRI0002MR ANGIO ABDOMEN & PELVIS WITH CONTRAST 22000 24200 IMGMRI00033D MRI EXTRA CHARGES 3000 3300 IMGMRI0004ADDITIONAL CONTRAST STUDY CHARGES 3500 3850 IMGMRI0005CONTRAST CHARGES ( MRI) 3500 3850 IMGMRI0006CONTRAST CHARGES FOR BRAIN 3500 3850 IMGMRI0007VIBRANT MR MAMMOGRAPHY PACKAGE WITH INTR 15000 16500

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CODE.NO SERVICE NAME AMOUNT IMGMRI0008MR TRACTOGRAPHY ADDITIONAL CONT.STUDY 3500 3850 IMGMRI0009DOUBLE DOSE CONT.MR MAMMOGRAPHY WITH PER 15000 16500 IMGMRI0010MRI BRAIN WITH WHOLE SPINE SCREENING-MUL 19500 21450 IMGMRI0011MRI BRAIN WITH WHOLE SPINE SCREENING-MUL 16000 17600 IMGMRI0012MRI CISTERNOGRAPHY ADDITIONAL CONT.STUDY 3500 3850 IMGMRI0013MRI FACE & NECK ADDITIONAL CONT.STUDY 3500 3850 IMGMRI0014MRI KUB+MR UROGRAM ADDITIONAL CONT.STUDY 3500 3850 IMGMRI0015MRI BRAIN WITH VOLUMETRIC ANALYSIS OF CA 12000 13200 IMGMRI0016MRI BRAIN+CSF FLOW STUDY ADDIT.CONT.STUD 15000 16500 IMGMRI0017MRI WITH CARTILAGE IMAGING ADDIT.CONT.ST 15500 17050 IMGMRI0018MRI BRAIN WITH EPILEPSY PROTOCOL WITH HI 11000 12100 IMGMRI0019MRI UPPER ABDOMEN ADDITIONAL CONT.STUDY 3500 3850 IMGMRI0020CARDIAC MRI ADDITIONAL CONT. STUDY 4000 4400 IMGMRI0021MRI PROSTATE ADDITIONAL CONT.STUDY 4000 4400 IMGMRI0022MRI SCREENING FOLLOW UP 4000 4400 IMGMRI0023MRI SCREENING SI JOINTS 4000 4400 IMGMRI0024MRI MAVRIC SCREENING 6000 6600 IMGMRI0025CONTRAST CHARGES-2 7000 7700 IMGMRI0026MRI BRAIN+DIFFUSION WEIGHTED IMAGING ADD 12000 13200 IMGMRI0027VIBRANT CONT.MR MAMMOGRAPHY WITH DIFFUSI 15000 16500 IMGMRI0028MR ANGIOGRAPHY CERVICAL SPINE 7000 8800 IMGMRI0029MR ANGIOGRAPHY DORSAL SPINE 7000 8800 IMGMRI0030MR ANGIOGRAPHY LS SPINE 7000 8800 IMGMRI0031MR ANGIOGRAPHY ONE ANATOMICAL AREA 7000 8800 IMGMRI0032MR ANGIOGRAPHY WITHOUT CONTRAST 7000 8800 IMGMRI0033MR SPECTROSCOPY 7000 8800 IMGMRI0034MR SPECTROSCOPY OF BRAIN 7000 8800 IMGMRI0035MR VENOGRAPHY 7000 8800 IMGMRI0036MRA BRAIN 7000 8800 IMGMRI0037MRA CHEST 7000 8800 IMGMRI0038MRA NECK 7000 8800 IMGMRI0039MRA/MRV ONE ANATOMICAL AREA 7000 8800 IMGMRI0040MRCP 7000 8800 IMGMRI0041SpA PROTOCOL(MRI SI JOINT WITH WHOLE SPI 12000 13200 IMGMRI0042MRI BOTH TEMPORAL BONE 7000 8800 IMGMRI0043MRI BRAIN 7000 8800 IMGMRI0044MRI BRAIN - 7000 8800 IMGMRI0045MRI CADAVERIC KNEE-RESEARCH 8000 8800 IMGMRI0046MRI CALF 7000 8800 IMGMRI0047MRI CERVICAL DORSAL SPINE 7000 8800 IMGMRI0048MRI CERVICAL SPINE 7000 8800 IMGMRI0049MRI CERVICAL SPINE / NECK 7000 8800 IMGMRI0050MRI CHEST 7000 8800 IMGMRI0051MRI COCCYX 7000 8800 IMGMRI0052MRI CSF 7000 8800 IMGMRI0053MRI DL SPINE 7000 8800 IMGMRI0054MRI DORSAL SPINE 7000 8800 IMGMRI0055MRI EXTREMITIES(SINGLE) 7000 8800 IMGMRI0056MRI FACE 7000 8800 IMGMRI0057MRI FEMUR 7000 8800 IMGMRI0058MRI FUNCTIONAL ( SPEECH ) 8000 8800 IMGMRI0059MRI FUNCTIONAL (MOTOR ) 8000 8800 IMGMRI0060MRI GLUTEAL REGION 7000 8800 IMGMRI0061MRI HIP JOINTS 7000 8800 IMGMRI0062MRI KUB 7000 8800 IMGMRI0063MRI LEFT ANKLE 7000 8800 IMGMRI0064MRI LEFT ELBOW 7000 8800 IMGMRI0065MRI LEFT FOOT 7000 8800 IMGMRI0066MRI LEFT FOREARM 7000 8800 IMGMRI0067MRI LEFT HAND 7000 8800 IMGMRI0068MRI LEFT KNEE 7000 8800 IMGMRI0069MRI LEFT LEG 7000 8800 IMGMRI0070MRI LEFT SHOULDER 7000 8800 IMGMRI0071MRI LEFT THIGH 7000 8800

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CODE.NO SERVICE NAME AMOUNT IMGMRI0072MRI LEFT WRIST 7000 8800 IMGMRI0073MRI LOWER ABDOMEN 7000 8800 IMGMRI0074MRI LOWER ABDOMEN (PELVIS) 7000 8800 IMGMRI0075MRI LS SPINE 7000 8800 IMGMRI0076MRI NASOPHARYNX AND PNS 7000 8800 IMGMRI0077MRI NECK 7000 8800 IMGMRI0078MRI ONE ANATOMICAL AREA 7000 8800 IMGMRI0079MRI ORBIT 7000 8800 IMGMRI0080MRI PELVIS 7000 8800 IMGMRI0081MRI PITUITARY GLAND 7000 8800 IMGMRI0082MRI PNS 7000 8800 IMGMRI0083MRI RIGHT ANKLE 7000 8800 IMGMRI0084MRI RIGHT ELBOW 7000 8800 IMGMRI0085MRI RIGHT FOOT 7000 8800 IMGMRI0086MRI RIGHT FOREARM 7000 8800 IMGMRI0087MRI RIGHT HAND 7000 8800 IMGMRI0088MRI RIGHT KNEE 7000 8800 IMGMRI0089MRI RIGHT LEG 7000 8800 IMGMRI0090MRI RIGHT SHOULDER 7000 8800 IMGMRI0091MRI RIGHT THIGH 7000 8800 IMGMRI0092MRI RIGHT WRIST 7000 8800 IMGMRI0093MRI SI JOINTS 7000 8800 IMGMRI0094MRI SINGLE KNEE 7000 8800 IMGMRI0095MRI TEMPORAL BONE 7000 8800 IMGMRI0096MRI UPPER ABDOMEN 7000 8800 IMGMRI0097MRI VENOGRAPHY 7000 8800 IMGMRI0098MRI WHOLE SPINE SCREENING 7000 8800 IMGMRI0099MRS PROSTATE 7000 8800 IMGMRI0100WHOLE SPINE SCREENING 7000 8800 IMGMRI0101MRI+MRCP WITH FAT QUANTIFICATION-LIVER D 15000 16500 IMGMRI0102MRI BRAIN WITH EPILEPSY PROTOCOL 8500 9350 IMGMRI0103MRI EPILEPSY PROTOCOL 8500 9350 IMGMRI0104MR ANGIO CHEST WITH CONTRAST 10500 11550 IMGMRI0105MRCP FOR TRANSPLANTATION 9000 9900 IMGMRI0106MRI BRAIN SEIZURE PROTOCOL 9000 9900 IMGMRI0107MRI BRAIN + DIFFUSION WEIGHTED IMAGING 9500 10450 IMGMRI0108MRI BRAIN WITH DIFFUSION 9500 10450 IMGMRI0109ANTERIOR ABDOMINAL WALL 10000 11000 IMGMRI0110MR NEUROGRAPHY 10000 11000 IMGMRI0111MR SPECTROSCOPY OF MUSCLES OF LECTATE 10000 11000 IMGMRI0112MR TRACTOGRAPHY SPINAL CORD DTI 10500 11550 IMGMRI0113MRI BRAIN WITH DEMENTIA PROTOCOL 10000 11000 IMGMRI0114MRI CD SPINE WITH SCREENING 10000 11000 IMGMRI0115MR ANGIOGRAPHY LOWER ABDOMEN&LOWER LIMBS 20000 22000 IMGMRI0116MR ANGIOGRAPHY WHOLE ABDOMEN&LOWER LIMBS 24000 26400 IMGMRI0117MRI LS SPINE WITH WHOLE SPINE SCREENING 10000 11000 IMGMRI0118MRI MYELOGRAM 10000 11000 IMGMRI0119WHOLE SPINE SCREENING + ONE PART SPINE 10000 11000 IMGMRI0120MR TRACTOGRAPHY 11000 12100 IMGMRI0121MR TRACTOGRAPHY BRAIN 11000 12100 IMGMRI0122MR TRACTOGRAPHY SPINE 11000 12100 IMGMRI0123MR UROGRAPHY 11000 12100 IMGMRI0124MRCP / MR UROGRAPHY 11000 12100 IMGMRI0125MRI BRACHIAL PLEXUS 11000 12100 IMGMRI0126MR NEUROGRAPHY WITH BRACHIAL PLEXUS CERV 16000 17600 IMGMRI0127MRI BRAIN WITH SCREENING CERVICAL SPINE 11000 12100 IMGMRI0128MRI CISTERNOGRAPHY 11000 12100 IMGMRI0129MRI FACE & NECK 11000 12100 IMGMRI0130MRI KUB + MR UROGRAM 11000 12100 IMGMRI0131MRI UPPER ABDOMEN + MRCP 11000 12100 IMGMRI0132MRI UPPER ABDOMEN WITH MRCP 11000 12100 IMGMRI0133CONTRAST ENHANCED DYNAMIC MRI HAND 11500 12650 IMGMRI0134CONTRAST ENHANCED DYNAMIC-MRI LEG 11500 12650 IMGMRI0135MRI IMAGE GUIDED NEUROSURGERY PROTOCOL W 15500 17050

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CODE.NO SERVICE NAME AMOUNT IMGMRI0136MR ANGIOGRAPHY WITH CONTRAST 11500 12650 IMGMRI0137MR VENOGRAPHY BRAIN WITH CONTRAST 11500 12650 IMGMRI0138MR VENOGRAPHY CHEST WITH CONTRAST 11500 12650 IMGMRI0139MR VENOGRAPHY CHEST WITHOUT CONTRAST 11500 12650 IMGMRI0140MR VENOGRAPHY NECK WITH CONTRAST 11500 12650 IMGMRI0141MR VENOGRAPHY WITH CONTRAST 11500 12650 IMGMRI0142MRA CHEST WITH CONTRAST 11500 12650 IMGMRI0143MRA-NECK WITH CONTRAST 11500 12650 IMGMRI0144MRI BRAIN + CSF FLOW STUDY 11500 12650 IMGMRI0145MRI BRAIN WITH CONTRAST 10500 12650 IMGMRI0146MRI BRAIN WITH CSF FLOW 11500 12650 IMGMRI0147MRI BRAIN WITH CSF STUDY 11500 12650 IMGMRI0148MRI CD SPINE WITH CONTRAST 11500 12650 IMGMRI0149MRI CERVICAL SPINE ( NECK) WITH CONTRAST 10500 12650 IMGMRI0150MRI CERVICAL SPINE WITH CONTRAST 10500 12650 IMGMRI0151MRI CHEST WITH CONTRAST 11500 12650 IMGMRI0152MRI DL SPINE WITH CONTRAST 11500 12650 IMGMRI0153MRI DORSAL SPINE WITH CONTRAST 11500 12650 IMGMRI0154MRI EXTREMITIES CONTRAST (SINGLE) 11500 12650 IMGMRI0155MRI FACE WITH CONTRAST 11500 12650 IMGMRI0156MRI LEFT ANKLE WITH CONTRAST 11500 12650 IMGMRI0157MRI LEFT FOOT WITH CONTRAST 11500 12650 IMGMRI0158MRI LEFT HAND WITH CONTRAST 11500 12650 IMGMRI0159MRI LEFT KNEE WITH CONTRAST 11500 12650 IMGMRI0160MRI LEFT SHOULDER WITH CONTRAST 10500 12650 IMGMRI0161MRI LEFT THIGH WITH CONTRAST 11500 12650 IMGMRI0162MRI LEFT WRIST WITH CONTRAST 11500 12650 IMGMRI0163MRI LOWER ABDOMEN WITH CONTRAST 11500 12650 IMGMRI0164MRI LS SPINE WITH CONTRAST 11500 12650 IMGMRI0165MRI NASOPHARYNX AND PNS WITH CONTRAST 11500 12650 IMGMRI0166MRI NECK WITH CONTRAST 11500 12650 IMGMRI0167MRI ONE ANATOMICAL AREA WITH CONTRAST 11500 12650 IMGMRI0168MRI ORBIT WITH CONTRAST 11500 12650 IMGMRI0169MRI PELVIS WITH CONTRAST 10500 12650 IMGMRI0170MRI PNS CONTRAST 11500 12650 IMGMRI0171MRI RIGHT ANKLE WITH CONTRAST 11500 12650 IMGMRI0172MRI RIGHT FOOT WITH CONTRAST 11500 12650 IMGMRI0173MRI RIGHT HAND WITH CONTRAST 11500 12650 IMGMRI0174MRI RIGHT KNEE WITH CONTRAST 10500 12650 IMGMRI0175MRI RIGHT SHOULDER WITH CONTRAST 11500 12650 IMGMRI0176MRI RIGHT THIGH WITH CONTRAST 11500 12650 IMGMRI0177MRI RIGHT WRIST WITH CONTRAST 11500 12650 IMGMRI0178MRI SHOULDER WITH CONTRAST (SINGLE) 11500 12650 IMGMRI0179MRI SI JOINTS WITH CONTRAST 11500 12650 IMGMRI0180MRI UPPER ABDOMEN WITH CONTRAST 11500 12650 IMGMRI0181MRI WHOLE SPINE SCREENING WITH CONTRAST 11500 12650 IMGMRI0182DYNAMIC CONTRAST STUDY (LIVER/PANCREAS) 12000 13200 IMGMRI0183MR NEUROGRAPHY WITH BRACHIAL PLEXUS DORS 16000 17600 IMGMRI0184MR ANGIO LOWER ABDOMEN&LOWER LIMBS INFRA 20000 22000 IMGMRI0185LIVER FAT QUANTIFICATION MRI 12000 13200 IMGMRI0186MR DEFECOGRAM 12000 13200 IMGMRI0187MR RENAL ANGIOGRAPHY 12000 13200 IMGMRI0188MR SINOGRAM 12000 13200 IMGMRI0189MR SINOGRAM OR FISTULA 12000 13200 IMGMRI0190MRCP WITH LIVER FAT ESTIMATION 12000 13200 IMGMRI0191MRI ARTHROGRAM 12000 13200 IMGMRI0192MR ANGIO WHOLE ABDOMEN SUPRARENAL&LOWER 24000 26400 IMGMRI0193MRI BRAIN + WHOLE SPINE SCREENING 12000 13200 IMGMRI0194MRI BRAIN WITH CISTERNOGRAPHY 15000 16500 IMGMRI0195MRI BRAIN WITH ORBIT 12000 13200 IMGMRI0196MRI BRAIN WITH PNS 12000 13200 IMGMRI0197MR ANGIOGRAPHY 1 ANATOMICAL AREA ADDIT.C 11500 12650 IMGMRI0198MRI BRAIN WITH VOLUMETRY 12000 13200 IMGMRI0199MRI BRAIN WITH WHOLE SPINE SCREENING 12000 13200

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CODE.NO SERVICE NAME AMOUNT IMGMRI0200MRI CARTILAGE IMAGING 12000 13200 IMGMRI0201MRI CARTILAGE IMAGING - LEFT KNEE 12000 13200 IMGMRI0202MRI CARTILAGE IMAGING - RT. KNEE 12000 13200 IMGMRI0203MRI BRAIN SEIZURE PROTOCOL ADDIT.CONT.ST 3500 3850 IMGMRI0204MRI DEFECOGRAM 12000 13200 IMGMRI0205MRI DORSAL SPINE WITH BRACHIAL PLEXUS 12000 13200 IMGMRI0206MRI FISTULOGRAM 12000 13200 IMGMRI0207MRI GROIN FOR SPORTS HERNIA 12000 13200 IMGMRI0208MRI HIP JOINT MAVRIC 12000 13200 IMGMRI0209MRA/MRV 1 ANATOMICAL AREA ADDIT.CONT.STU 3500 3850 IMGMRI0210MRI IMAGE GUIDED NEUROSURGERY PROTOCOL 12000 13200 IMGMRI0211MRI LEFT KNEE CARTILAGE IMAGING 12000 13200 IMGMRI0212MRI LEFT KNEE CARTILAGE IMAGING 12000 13200 IMGMRI0213MRI LEFT SHOULDER-MAVRIC 12000 13200 IMGMRI0214MRI LEFT TM JOINT 12000 13200 IMGMRI0215MRI LIVER FAT ESTIMATION 12000 13200 IMGMRI0216MRI LIVER IRON QUANTIFICATION 12000 13200 IMGMRI0217MRI LIVER WITH CONTRAST ( LAVA) 12000 13200 IMGMRI0218MRI LS SPINE WITH FLEXION & EXTENSION 12000 13200 IMGMRI0219MRI ONE ANATOMICAL AREA WITH MAVRIC 12000 13200 IMGMRI0220MRI ONE PART WITH LAVA 12000 13200 IMGMRI0221MRI ONE PART WITH MAVRIC 12000 13200 IMGMRI0222MRI ONE PART WITH MAVRIC STUDY 12000 13200 IMGMRI0223MRI PERINEUM 12000 13200 IMGMRI0224MRI PROSTATE 12000 13200 IMGMRI0225MRI RENAL ANGIO NON-CONTRAST 12000 13200 IMGMRI0226MRI RENAL ANGIOGRAPHY 12000 13200 IMGMRI0227MRI RIGHT KNEE WITH CARTILAGE IMAGING 12000 13200 IMGMRI0228MRI RIGHT SHOULDER-MAVRIC 12000 13200 IMGMRI0229MRI RIGHT TM JOINT 12000 13200 IMGMRI0230MRI SCROTUM 12000 13200 IMGMRI0231MRI SHOULDER WITH MAVERIC 12000 13200 IMGMRI0232MRI SIALOGRAM 12000 13200 IMGMRI0233MRI SINOGRAM 12000 13200 IMGMRI0234MRI TM JOINT ( SINGLE SIDE ) 12000 13200 IMGMRI0235MRI UPPER ABDOMEN LAVA 12000 13200 IMGMRI0236MR NEUROGRAPHY WITH BRACHIAL PLEXUS 1 PA 16000 17600 IMGMRI0237MRI WITH CARTILAGE IMAGING 12000 13200 IMGMRI0238MRI-NECK FOR SLEEP APNEA 12000 13200 IMGMRI0239MRI LOWER ABDOMEN(PELVIS)ADDITIONAL CONT 3500 3850 IMGMRI0240MRI BRAIN SEIZURE PROTOCOL WITH CONTRAST 12500 13750 IMGMRI0241MRI ONE PART WITH NEUROGRAPHY 13000 14300 IMGMRI0242MRI + MRA BOTH KIDNEY 14000 15400 IMGMRI0243MRI CISTEROGRAPHY WITH CONTRAST 15000 16500 IMGMRI0244MRI FACE & NECK WITH CONTRAST 14500 15950 IMGMRI0245MRI KUB + UROGRAM WITH CONTRAST 14500 15950 IMGMRI0246DYNAMIC MRI CERVICAL SPINE WITH FLEXION& 12000 13200 IMGMRI0247MRI RIGHT KNEE CARTILAGE IMAGING WITH CO 15500 17050 IMGMRI0248FETAL 15000 16500 IMGMRI0249MR ENTEROCLYSIS 15000 16500 IMGMRI0250MR VENOGRAPHY WHOLE ABDOMEN&BOTH LOWER L 24000 26400 IMGMRI0251MRI CERVICAL SPINE WITH WHOLE SPINE SCRE 10000 11000 IMGMRI0252MRI BRAIN + FMRI ONE ACTIVITY 15000 16500 IMGMRI0253MRI BRAIN + FMRI ONE ACTIVIY 15000 16500 IMGMRI0254MRI BRAIN PERFUSION WITH CONTRAST 15000 16500 IMGMRI0255MRI BRAIN WITH CSF FLOW WITH CONTRAST 15000 16500 IMGMRI0256MRI BREASTS WITH CONTRAST 15000 16500 IMGMRI0257MRI ENTEROCLYSIS 15000 16500 IMGMRI0258MRI ENTEROGRAPHY 15000 16500 IMGMRI0259MRI FETAL 15000 16500 IMGMRI0260MRI HIPPOCAMPAL VOLUMETRY WITH T2 RELAXO 12000 13200 IMGMRI0261MR ANGIOGRAPHY WHOLE ABDOMEN WITHOUT CON 16000 17600 IMGMRI0262MRI BRAIN DIFFUSION&PERFUSION WITH CONT. 16000 17600 IMGMRI0263MRI CARTILAGE IMAGING WITH CONTRAST 15500 17050

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CODE.NO SERVICE NAME AMOUNT IMGMRI0264MR VENOGRAPHY - LOWER ABDOMEN&LOWER LIMB 24000 26400 IMGMRI0265MRI UPPER ABDOMEN+MRCP ADDITIONAL CONT.S 3500 3850 IMGMRI0266MRI SCROTUM WITH CONTRAST 15500 17050 IMGMRI0267MRI TM JOINT (SINGLE) WITH CONTRAST 15500 17050 IMGMRI0268MR VENOGRAPHY WHOLE ABDOMEN WITHOUT CONT 16000 17600 IMGMRI0269CE MRA TRICKS (ONE PART) 16000 17600 IMGMRI0270MRI 1 ANATOMICAL AREA ADDITIONAL CONT.ST 3500 3850 IMGMRI0271MR BRACHIAL PLEXUS (C SPINE) 16000 17600 IMGMRI0272MRI RENAL ANGIOGRAPHY ADDITIONAL CONT.ST 3500 3850 IMGMRI0273MRI DORSAL SPINE WITH WHOLE SPINE SCREEN 10000 11000 IMGMRI0274MRI PELVIS/PROSTATE PERFUSION WITH CONT. 16000 17600 IMGMRI0275MR VENOGRAM BILATERAL LIMB WITHOUT CONT. 20000 22000 IMGMRI0276MRA UPPER LIMBS NON CONTRAST 16000 17600 IMGMRI0277MRI ANGIO WHOLE ABDOMEN WITHOUT CONTRAST 16000 17600 IMGMRI0278MRI ANGIOGRAPHY ABDOMEN WITHOUT CONTRAST 16000 17600 IMGMRI0279MRI BOTH ANKLE 16000 17600 IMGMRI0280MRI BOTH KNEE 16000 17600 IMGMRI0281MRI BOTH SHOULDER 16000 17600 IMGMRI0282MRI BRACHIAL PLEXUS + NEUROGRAPHY 16000 17600 IMGMRI0283MRI BRAIN EPILEPSY PROTOCOL WITH DIFFUSI 8500 9350 IMGMRI0284DYNAMIC MRI LS SPINE WITH FLEXION&EXTEN. 12000 13200 IMGMRI0285MRI CERVICAL SPINE WITH BRACHIAL PLEXUS 16000 17600 IMGMRI0286MR SINOGRAM/FISTULA ADDITIONAL CONT.STUD 3500 3850 IMGMRI0287MRI PROSTATE WITH CONTRAST 16000 17600 IMGMRI0288MRI PROSTATE WITH DIFFUSION 16000 17600 IMGMRI0289MRI TM JOINT DYNAMIC SCAN 16000 17600 IMGMRI0290MRI TM JOINTS ( BOTH SIDE) 16000 17600 IMGMRI0291MRI WHOLE ABDOMEN 16000 17600 IMGMRI0292MULTIPARAMETRIC MRI PROSTATE 16000 17600 IMGMRI0293CARDIAC MRI 18000 19800 IMGMRI0294MRI CARDIAC WITH CONTRAST 18000 19800 IMGMRI0295MRCP/MR UROGRAPHY ADDITIONAL CONT.STUDY 3500 3850 IMGMRI0296MRI DEMYELINATION PROTOCOL 19500 21450 IMGMRI0297MRI TM JOINT (BOTH) WITH CONTRAST 19500 21450 IMGMRI0298MRI CERVICAL SPINE WITH FLEXION&EXTENSIO 12000 13200 IMGMRI0299MRI UPPER ABDOMEN WITH MRCP WITH CONT. 14500 15950 IMGMRI0300MRI BRAIN + DIFFUSION+PERFUSION IMAGING 15000 16500 IMGMRI0301MRA LOWER LIMB NON CONTRAST 20000 22000 IMGMRI0302MRA LOWER LIMBS 20000 22000 IMGMRI0303MR ANGIO WHOLE ABDOMEN WITH CONTRAST 22000 24200 IMGMRI0304MR VENOGRAPHY WHOLE ABDOMEN WITH CONT. 22000 24200 IMGMRI0305MRA UPPER LIMB WITH CONTRAST 22000 24200 IMGMRI0306MRI ABDOMEN & PELVIS WITH CONTRAST 22000 24200 IMGMRI0307MRI ABDOMEN WITH CONTRAST 22000 24200 IMGMRI0308MRI BRAIN + FMRI (MOTOR & SPEECH) 22000 24200 IMGMRI0309MRI BRAIN + FMRI TWO ACTIVITIES 22000 24200 IMGMRI0310MRI WHOLE ABDOMEN WITH CONTRAST 22000 24200 IMGMRI0311MRI ( FUNCTIONAL)BOLD IMAGING 1 ACTIVITY 8000 8800 IMGMRI0312MRI UPPER ABDOMEN WITH DYNAMIC CONT.LAVA 12000 13200 IMGMRI0313MRI WHOLE ABDOMEN ADDITIONAL CONT.STUDY 7000 7700 IMGMRI0314MRA LOWER LIMBS ADDITIONAL CONT.STUDY 7000 7700 IMGMRI0315MRI CARTILAGE IMAGING BOTH HIP JOINTS 24000 26400 IMGMRI0316MRI TWO ANATOMICAL AREA WITH MAVRIC 24000 26400 IMGMRI0317WHOLE BODY SCREENING MRI 25000 27500 IMGMRI0318MRI TWO PART WITH NEUROGRAPHY 26000 28600 IMGMRI0319MRA LIMBS WITH CONTRAST 27000 29700 IMGMRI0320MRA LOWER LIMBS WITH CONTRAST 27000 29700 IMGMRI0321MRI WHOLE BODY SCAN 45000 49500 IMGMRI0322MRI EMERGENCY DOCTOR VISIT CHARGES 1800 1980 IMGMRI0323CARDIAC MRI (ICD) STUDY 10500 11550 IMGMRI0324MR NEUROGRAM 12000 13200 IMGMRI0325MRI BRAIN STROKE PROTOCOL 12000 13200 IMGMRI0326MRI BRAIN STROKE PROTOCOL+PERFUSION STDY 15000 16500 IMGMRI0327MRI BREAST PLAIN 13000 14300

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CODE.NO SERVICE NAME AMOUNT IMGMRI03292ND OPINION UPTO 2 REPORTS FOR CT/MR 1000 1100 IMGMRI03302ND OPINION UPTO 5 REPORTS FOR CT/MR 2000 2200 IMGMRI0331STRESS CARDIAC MRI VIABILITY STRUCTURAL 20000 20000 RADIOLOGY PROCEDURE FOUR TWO SINGLE SUPER PRESIDENTSUI CODE NO DESCRIPTION SUITE BEDDED BEDDED BEDDED DELUXE TE RADPRO0001 PERECUTANEOUS CHOLECCYSTOSTOMY 24200 30250 36300 40840 45380 52940 PERECUTANEOUS BILIARY RADPRO0002 16500 20630 24750 27840 30940 36090 DRAINAGE/NEPHROSTO RADPRO0003 PERCUTANEOUS CHOLANGIOPLASTY 16500 20630 24750 27840 30940 36090 RADPRO0004 PERCUTANEOUS STENT PLACEMENT 24200 30250 36300 40840 45380 52940 RENDEZVOUS PROCEDURES FOR STENTING RADPRO0005 16500 20630 24750 27840 30940 36090 (COMB PERCUTANEOUS ABLATION FOR CYSTS RADPRO0006 24200 30250 36300 40840 45380 52940 SINGLE PERCUTANEOUS ABLATION FOR CYSTS RADPRO0007 13200 16500 19800 22280 24750 28880 SUBSEQUE PERCUTANEOUS CATH.DRAINAGE OF RADPRO0008 16500 20630 24750 27840 30940 36090 ABSCESS RADPRO0009 CT GUIDED CATH. DRAINAGE OF ABSCESS 19800 24750 29700 33410 37130 43310 PERECUTANEOUS TRANS HEPATIC RADPRO0010 7700 9630 11550 12990 14440 16840 CHOLANGIOGRA RADPRO0011 PLEURAL FLUID CATHETER DRAINAGE(PTICD) 16500 20630 24750 27840 30940 36090 ALL BEDSIDE RADIOLOGY PROCEURE/INVESTIGATION WILL CHARGED 150% TRANSFUSION MEDICINE CODE NO. BLOOD BANK INVESTIGATIONS CHARGES BBIBAN001ABO / RH GROUPING 600 BBIBAN002CROSS MATCHING 700 BBIBAN003BLOOD GROUPING & CROSS MATCHING 1300 BBIBAN004DIALYSIS PACKAGE BLOOD PROCESSING CHARGE 3000 BBIBAN006FFP PROCESSING NAT TESTED WITH/WTHOUT FILTER 2000 BBIBAN007PLATELET CONCENTRATE NAT TESTED WITH/WTHOUT FILTER 1600 BBIBAN009DIRECT COOMBS TESTDCT 850 BBIBAN010INDIRECT COOMBS TESTICT 900 BBIBAN011RH ANTIBODY TITRE 1100 BBIBAN012HIV AB I & II 1500 BBIBAN013HBs Ag ELISA 1200 BBIBAN014HCV ELISA 1800 BBIBAN015HBc Ab IgG/TOTAL 1400 BBIBAN016HBs Ab QUALITATIVE 1300 BBIBAN017HBs Ab QUANTITATIVE 1350 BBIBAN018V.D.R.L. QUALITATIVE 400 BBIBAN019V.D.R.L. QUANTITATIVE 450 BBIBAN020THERAPEUTIC PHLEBOTOMY PROCESSING CHARGE 1300 BBIBAN021AUTOLOGOUS TRASFUSION 1000 BBIBAN022GROUP & SAVE 900 BBIBAN024PLATELET APHARESIS PROCEDURE 11000 BBIBAN025PLATELET APHARESIS - HAEMOGRAM - PRE PRO 250 BBIBAN026PLATELET APHARESIS - HAEMOGRAM - POST PR 250 BBIBAN027PLATELET APHARESIS - HAEMOGRAM - PRODUCT 250 BBIBAN028PLATELET APHARESIS - BLOOD GROUP 250 BBIBAN029PLATELET APHARESIS - RAPID TEST 500 BBIBAN030PLATELET APHARESIS - VDRL 250 BBIBAN031PLATELET APHARESIS - MALARIAL PARASITE 250 BBIBAN032HIV - RAPID DIALYSIS 500 BBIBAN033HBS AG - RAPID DIALYSIS 450 BBIBAN034HCV - RAPID DIALYSIS 400 BBIBAN035ICE BOX 200 BBIBAN036HIV RAPID - GENRAL 1000 BBIBAN037HBSAG RAPID GENERAL 1200 BBIBAN038HCV RAPID GENERAL 1250 BBIBAN039WASHED PACKED RED CELL 3700

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CODE.NO SERVICE NAME AMOUNT BBIBAN040LDPRBC 4500 BBIBAN042PRBC 3500 BBIBAN044SURGERY PACKAGE - HIV+HBSAG+HCV 3800 BBIBAN045DIALYSIS PKG BLOOD PROCESSING+LEUCOCYTE 4200 BBIBAN046LEUCOREDUCATION FILTER CHARGES 1200 BBIBAN047ABO ANTIBODY TITRA 1500 BBIBAN049WHOLE BLOOD 4000 BBIBAN050TRANSFER BAG 350 BBIBAN051TH. PLASMA EXCHANGE TH. APHARESIS MACHINE 26000 BBIBAN052TH. PLASMA EXCHANGE TH. APHARESIS W FILTER 61000 BBIBAN053TH. PLASMA EXCHANGE WITH ABGYCOSORB FILT 370000 BBIBAN054ABO FILTER PF PROCESSING CHARGES 80000 BBIBAN055BLOOD BANK SECURITY DEPOSIT (REFUNDABLE) 3000 BBIBAN056RH+ KELL PHENOTYPING PROCESSING CHARGE 1600 BBIBAN057ANTIBODIES SCREENING FOR PATIENTS 550 BBIBAN058EMERGENCY CHARGES AFTER 8PM (APHERESIS) 1050 BBIBAN059PERIPHERAL BLOOD STEMCELL COLLECTION APH 25000 BBIBAN060PLATELET APHERESIS PROCEDURE 11000 DIALYSIS PROCEDURES CODE NO. PROCEDURES CHARGES DIADLY0001DIALYSIS PACKAGE REUSE 2800 DIADLY0004HEMO DIALYSIS PACKAGE SINGLE USE 3450 DIADLY0005PERITONEAL DIALYSIS PACKAGE 6000 DIADLY0008EMERGENCY DIALYSIS PACKAGE F6 4400 DIADLY0011CRRT WITHOUT KITS 16450 DIADLY0014DIALYSIS PACKAGE IN ICU 5500 DIADLY0015F-8 DIALISER USED 3800 DIADLY0020SLEED DIALYSIS PACKAGE F-6 SINGLE USE 7500 DIADLY0022HEMO DIALYSIS PACKAGE(PEAD.) SINGLE USE 3650 DIADLY0023HEMO DIALYSIS PACKAGE(PEAD.) RE- USE 3050 DIADLY0024HEMO DIALYSIS PACKAGE(PEAD.) ICU 5500 DIADLY0029HEMO DIALYSIS PACKAGE HDF 4750 DIADLY0030HEMO DIALYSIS PACKAGE HDF SLED 7000 DIADLY0031CRRT CVVH/SCUF/CVVHD/CVVHDF WITH KIT 39050 DIADLY0032BODY COMPOSITION MONITOR TEST 2000 DIADLY0033HDF IN ICU 6450 DIADLY0034SLED - 8 HOURS 8400 DIADLY0035HAEMODIALYSIS PACKAGE SINGLE USE - 5008S 3750 DIADLY0036HEMO DIALYSIS PACKAGE SINGLE USE – F6 3700 EXECUTIVE DIALYSIS VIPDIA0002EX. HEMO DIALYSIS PACKAGE SINGLE USE 4800 VIPDIA0003EX. EMERGENCY DIALYSIS PACKAGE 5050 VIPDIA0004EX. F-8 DIALYSIS PACKAGE 4700 VIPDIA0005EX. EMERGENCY DIALYSIS PACKAGE F-8 5000 VIPDIA0006EX-HEMO DIALYSIS PACKAGE HDF 5800 VIPDIA0007EX-HEMO DIALYSIS PACKAGE HDF SLED 8650 VIPDIA0008EX.HAEMODIALYSIS PACKAGE SINGLE USE-5008S 4700 CRITICAL CARE PROCEDURES CODE NO. PROCEDURES CHARGES CCSCTC0001CRITICAL CARE CHARGES 2200 CCSCTC0002VENTILATOR CHARGES - LARGE 3000 CCSCTC0003VENTILATER CIRCUIT- LARGE 2400 CCSCTC0004VENTILATOR INITIATION 1800 CCSCTC0005NIMV/ V.PAP / C.PAP 2000 CCSCTC0006LARYNGOSCOPY GUIDED RT 2000 CCSCTC0007FEEDING PUMP CHARGES 500 CCSCTC0008DVT PUMP 700 CCSCTC0009CTNI -TROPONINI TEST FOR ISTATIC ANALYSE 1200 CCSCTC0010INTERCOSTAL CHEST TUBE DRAINAGE 5500 CCSCTC0011BIPAP INTITATION CHARGES 1800 CCSCTC0012CARDIO PULMONARY RESUSCITATION CHARGES 4000 CCSCTC0013GASTIC LAVAGE 1800 CCSCTC0014WEANING FROM VENTILATOR 1200 CCSCTC0015CHEM-8 ABG CARTRIDGE 1200

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CODE.NO SERVICE NAME AMOUNT CCSCTC0016D.C. CARDVERSION 3500 CCSCTC0017THROMBOLYSIS 6000 CCSCTC0018OXYGEN CHARGES PER DAY 1000 CCSCTC0019OXYGEN CHARGES PER HOUR 100 CCSCTC0020DIRECT LARYNGOSCOPY 2000 CCSCTC0021SYRING PUMP 500 CCSCTC0023FLOWTRON DVT (CALF) PER DAY 500 CCSCTC0024FLOWTRON DVT (THIGH) PER DAY 700 CCSCTC0025BIPAP (DAILY CHARGES) 1200 CCSCTC0026VENTILATER CIRCUIT SMALL 800 CCSCTC0027I.C.D REMOVAL 1000 CCSCTC0028NUTRICATH INSERSION 6000 CCSCTC0029NUTRICATH REMOVAL 1000 CCSCTC0030CRITICAL CARE SPECIALIST 2200 CCSCTC0031NEURO - CRITICAL CARE CHARGES 2200 CCSCTC0032CRITICAL CARE CHARGES- COVID 19 5000 CRITICAL CARE CHARGES ARE IN ADDITION TO ROOM CHARGES. INTENSIVE CARE MONITORING CHARGES INCLUDE BED TO ENDOSCOPY FOUR TWO SINGLE SUPER PRESIDENT CODE NO DESCRIPTION SUITE BEDDED BEDDED BEDDED DELUXE SUITE UPPER G.I ENDOSCOPY WITHOUT SEDATION 25 50 68.75 87.5 119 ENDENO0006 UPPER G.I. ENDOSCOPY 4750 5940 7130 8020 8910 10390 ENDENO0084 UGI ENDOSCOPY DIAGNOSTIC (COMPLEX) 6400 8000 9600 10800 12000 14000 ENDENO0007 UPPER G.I. ENDOSCOPY SIDE VIEWING 6000 7500 9000 10130 11250 13130 ENDENO0009 EVL COMPLETE 7670 9590 11510 12940 14380 16780

ENDENO0010 EVL SUBSEQUENT 6830 8540 10250 11530 12810 14940

ENDENO0013 SCLEROTHERAPHY FIRST SITTING 8720 10900 13080 14720 16350 19080

ENDENO0014 SCLEROTHARAPHY SUBS. SITTING 7670 9590 11510 12940 14380 16780

ENDENO0015 SCLEROTHERAPHY INJ. FOR ULCER 7560 9450 11340 12760 14180 16540 ENDOSCOPIC PLACEMENT OF NASO-JEJUNAL ENDENO0018 6830 8540 10250 11530 12810 14940 FT ENDENO0019 FOREIGN BODY REMOVAL FROM ESOPHAGUS 9980 12480 14970 16840 18710 21830

ENDENO0020 FOREIGN BODY REMOVAL FROM STOMACH 9980 12480 14970 16840 18710 21830 ESOPHAGEAL ACHALASIA ( PNEUMATIC) ENDENO0021 11550 14440 17330 19490 21660 25270 DILATATION ENDENO0022 ESOPHAGEAL DILATATION FIRST 8400 10500 12600 14180 15750 18380

ENDENO0023 ESOPHAGEAL DILATATION SUBSEQUENT 7350 9190 11030 12400 13780 16080 ESOPHAGEAL STENTING (COST OF STENT ENDENO0024 13650 17060 20480 23030 25590 29860 EXTRA) ENDENO0025 PYLORIC BALLOON DILATATION 8930 11160 13400 15070 16740 19530

ENDENO0026 ENDOSCOPIC HEMO CLIPS APPLICATION 7880 9850 11820 13300 14780 17240

ENDENO0027 ENDOSCOPIC PLACEMENT OF RT 5250 6560 7880 8860 9840 11480

ENDENO0028 PALCEMENT OF SB TUBE 3680 4600 5520 6210 6900 8050

ENDENO0031 FUNDAL VARICES INJ.(COST OF GLUE EXTRA) 8930 11160 13400 15070 16740 19530 PERCUTANEOUS ENDOSCOPIC ENDENO0033 14700 18380 22050 24810 27560 32160 JEJUNOSTOMY PERCUTANEOUS ENDOSCOPIC ENDENO0034 12600 15750 18900 21260 23630 27560 GASTROSTOMY (PEG)

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CODE.NO SERVICE NAME AMOUNT ENDENO0035 RAPID UREASE TEST 500 630 750 840 940 1090

ENDENO0040 ENTEROSCOPY COMPLETE 25200 31500 37800 42530 47250 55130

ENDENO0041 ENTEROSCOPY UPPER G.I 12080 15100 18120 20390 22650 26430

ENDENO0054 ENDOSCOPIC MECOSAL RESECTION (EMR) 15750 19690 23630 26580 29530 34450

ENDENO0055 ENDOSCOPIC PANCREATIC NECROSECTOMY 21530 26910 32300 36330 40370 47100 ENDOSCOPIC GASTRIC BALLOON ENDENO0072 17330 21660 26000 29240 32490 37910 DEPLOYMENT ENDENO0073 PEG REPLACEMENT (WITHOUT ENDOSCOPY) 4200 5250 6300 7090 7880 9190 ENDOSCOPIC MECOSAL DISSECTION (ESD), ENDENO0074 26780 33480 40170 45190 50210 58580 SMALL ENDOSCOPIC MECOSAL DISSECTION (ESD), ENDENO0075 52500 65630 78750 88590 98440 114840 LARGE ENDENO0077 PILE INJECTION 3250 4060 4880 5480 6090 7110

ENDENO0091 ESOPHAGEAL BALLON DILATATION 8500 10630 12750 14340 15940 18590

ENDENO0092 ENDOSCOPIC GASTRIC BALLOON REMOVAL 10000 12500 15000 16880 18750 21880

ENDENO0093 HAEMOSEAL SPRAY 5000 6250 7500 8440 9380 10940

ENDENO0094 STONE EXTRACTION 7000 8750 10500 11810 13130 15310

ENDENO0095 STENTING 7000 8750 10500 11810 13130 15310

ENDENO0096 METAL STENTING 12000 15000 18000 20250 22500 26250

ENDENO0097 RIGID DILATATION 5000 6250 7500 8440 9380 10940 CAPSULE ENDOSCOPY CAPSULE ENDOSCOPY(COST OF CAPSULE ENDENO0038 17000 17000 17000 17000 17000 17000 EXTRA) LOWER G.I ENDOSCOPY WITHOUT SEDATION ENDENO0002 COLONOSCOPY 7600 9500 11400 12830 14250 16630 COLONOSCOPY ENDENO0085 9500 11880 14250 16030 17810 20780 FULL(CECUM)DIAGNOST.(COMPLEX ENDENO0003 COLONOSCOPY DECOMPRESSION 10600 13250 15900 17890 19880 23190

ENDENO0004 LEFT SIDED COLONOSCOPY 4900 6130 7350 8270 9190 10720

ENDENO0008 SIGMOIDOSCOPY 3300 4130 4950 5570 6190 7220

ENDENO0042 ENTROSCOPY LOWER G.I 12600 15750 18900 21260 23630 27560

ENDENO0057 COLONIC STENTING (COST OF STENT EXTRA) 14200 17750 21300 23960 26630 31060

ENDENO0071 ANOSCOPY/PROCTOSCOPY 1050 1310 1580 1770 1970 2300

ENDENO0043 COLONIC BALLOON DILATATION 14800 18500 22200 24980 27750 32380

ENDENO0049 SIGMOIDOSCOPY WITH PILES INJECTION 5850 7310 8780 9870 10970 12800

ENDENO0050 COLONOSCOPY WITH PILES INJECTION 9450 11810 14180 15950 17720 20670

ENDENO0056 COLONOSCOPY WITH POLYPECTOMY 13250 16560 19880 22360 24840 28980

ENDENO0086 COLONOSCOPY POLYPECTOMY (>5 POLYPS) 15000 18750 22500 25310 28130 32810

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CODE.NO SERVICE NAME AMOUNT ENDENO0011 PROCTOSCOPY + BANDING / INJ. 3350 4190 5030 5650 6280 7330

ENDENO0064 COLON TRANSIT STUDY 3890 4860 5840 6560 7290 8510 E.R.C.P. ENDERP0001 E.R.C.P. DIAGNOSTIC 11600 14500 17400 19580 21750 25380

ENDERP0002 E.R.C.P. + PAPILLOTOMY 17200 21500 25800 29030 32250 37630 ERCP+PAPILLOTOMY+STENTING(STENT ENDERP0003 23200 29000 34800 39150 43500 50750 EXTRA) ERCP+PAPILLOTOMY+MECHANICAL ENDERP0004 24300 30380 36450 41010 45560 53160 LITHOTRIPSY ENDERP0005 ERCP + ENBD (COST OF ENBD TUBE EXTRA) 20100 25130 30150 33920 37690 43970

ENDERP0007 STENT REMOVAL 4350 5440 6530 7340 8160 9520

ENDPTB0001 P.T.B.D. + E.R.C.P. COMBINED 26300 32880 39450 44380 49310 57530

ENDERP0009 PAPILOTOMY 7400 9250 11100 12490 13880 16190

ENDERP0010 STENT DEPLOYMENT (STENT CHARGE EXTRA) 7400 9250 11100 12490 13880 16190

ENDERP0011 MECHANICAL LITHOTRIPSY 13650 17060 20480 23030 25590 29860

ENDERP0012 ENBD (COST OF ENBD TUBE EXTRA) 10600 13250 15900 17890 19880 23190

ENDERP0013 STENT REMOVAL UNDER FLAUROSCOPY 5400 6750 8100 9110 10130 11810

ENDERP0014 STENT EXCHANGE/REPLASEMENT 11000 13750 16500 18560 20630 24060

ENDERP0015 ERCP+PAPILOTOMY+STONE EXTRACTION 21200 26500 31800 35780 39750 46380

ENDENO0078 GASTRO-ANTRAL STENTING 11000 13750 16500 18560 20630 24060 MECHANICAL LITH.+CRE BALLOON (IN ENDENO0079 21000 26250 31500 35440 39380 45940 ADDITION TO ERCP) OTHER ENDENO0016 POLYPECTOMY SINGLE 12600 15750 18900 21260 23630 27560

ENDENO0017 POLYPECTOMY MULTIPLE 14800 18500 22200 24980 27750 32380

ENDENO0030 BANDING OF PILES / INJ. 4730 5910 7100 7980 8870 10350

ENDENO0037 COGULATION APC 10600 13250 15900 17890 19880 23190

ENDENO0039 COGULATION GOLD PROBE 4800 6000 7200 8100 9000 10500

ENDENO0058 HEATER PROBE 10600 13250 15900 17890 19880 23190

ENDENO0052 HYDROGEN BREATH TEST 4800 6000 7200 8100 9000 10500

PROGAS0008 ESOPHAGEAL MANOMETRY 5800 7250 8700 9790 10880 12690

PROGAS0009 ANORECTAL MANOMETRY 5900 7380 8850 9960 11060 12910

ENDENO0061 BIOFEED BACK THERAPY 4250 5310 6380 7170 7970 9300

ENDENO0032 BILLUARY FOR STONE EXTRACTION 3200 4000 4800 5400 6000 7000

ENDENO0062 24 Hr pH METRY 7400 9250 11100 12490 13880 16190

ENDENO0063 MANOMETRY SCREENING FOR Ph PROBE 2700 3380 4050 4560 5060 5910

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CODE.NO SERVICE NAME AMOUNT ENDENO0067 PANCREATIC STONE REMOVAL 13000 16250 19500 21940 24380 28440

ENDENO0068 BRUSHING & BIOPSY 13000 16250 19500 21940 24380 28440

ENDENO0069 PSEUDOCYST DRAINAGE 19000 23750 28500 32060 35630 41560

ENDENO0070 MANUAL RECTAL DECOMPRESSION 3250 4060 4880 5480 6090 7110

ENDENO0083 BRUSHING 2200 2750 3300 3710 4130 4810

ENDENO0080 BALLOON DILATATION BILLARY 6300 7880 9450 10630 11810 13780

ENDENO0081 POEM 52600 65750 78900 88760 98630 115060

ENDENO0082 ANDOLOOP APPLICATION 3300 4130 4950 5570 6190 7220 PACKAGES ENDENO0001 DIAGNOSTIC COLONOSCOPY WITH SEDATION 10000 12500 15000 16880 18750 21880

ENDENO0005 UPPER G.I. ENDOSCOPY WITH SEDATION 6300 7880 9450 10630 11810 13780

ENDENO0045 ENDOSCOPIC ULTRASOUND EUS 12650 15810 18980 21350 23720 27670

ENDENO0046 ENDOSCOPIC ULTRASOUND FNAC 21100 26380 31650 35610 39560 46160

ENDENO0047 ENDOSCOPIC ULTRASOUND CELIAC BLOCK 21100 26380 31650 35610 39560 46160

ENDENO0048 EUS WITH ERCP 27400 34250 41100 46240 51380 59940

ENDEUS0004 EUS GUIDED CYST/ABSCESS DRAINAGE 30450 38060 45680 51380 57090 66610 PEDIATRIC ENDOSCOPY CHARGES ENDPED0009 COLONOSCOPY 7600 9500 11400 12830 14250 16630

ENDPED0010 UPPER G.I. ENDOSCOPY 4600 5750 6900 7760 8630 10060

ENDPED0003 LOWER G.I. SIGMOIDOSCOPY 3300 4130 4950 5570 6190 7220

ENDPED0004 EVL COMPLETE 7800 9750 11700 13160 14630 17060

ENDPED0005 POLYPECTOMY SINGLE 12600 15750 18900 21260 23630 27560

ENDPED0006 POLYPECTOMY MULTIPLE 14700 18380 22050 24810 27560 32160

ENDPED0007 ESOPHAGEAL DILATATION FIRST 8500 10630 12750 14340 15940 18590

ENDPED0008 ESOPHAGEAL DILATATION SUBSEQUENT 7400 9250 11100 12490 13880 16190 ANESTHESIA CHARGES ANETHE0001 ERCP ANAESTHESIA. 1600 2000 2400 2700 3000 3504

ANETHE0002 DIAGNOSTIC ENDOSCOPY ANAESTHESIA 1100 1375 1650 1856 2063 2409

ANETHE0003 RADIOLOGY PROCEDURE ANAESTHESIA 1600 2000 2400 2700 3000 3504

ANETHE0005 DIANOSTIC ENTROSCOPY ANAESTHESIA 1600 2000 2400 2700 3000 3504

ANETHE0006 ANAESTHESIA FOR EBUS 3100 3875 4650 5231 5813 6789 ANAESTHESIA FOR RADIOLOGICAL & ANETHE0007 3000 3750 4500 5063 5625 6570 ENDOSCOPI BEDSIDE ENDOSCOPY PROCEDURE ENDBSP0001 BEDSIDE COLONOSCOPY 10600 13250 15900 17890 19880 23190

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CODE.NO SERVICE NAME AMOUNT ENDBSP0002 BED SIDE COLONOSCOPY DECOMPRESSION 16400 20500 24600 27680 30750 35880 ENDBSP0003 BED SIDE LEFT SIDED COLONOSCOPY 7450 9310 11180 12570 13970 16300 ENDBSP0004 BED SIDE UPPER G.I. ENDOSCOPY 6500 8130 9750 10970 12190 14220 ENDBSP0005 BEDSIDE SIGMOIDOSCOPY 4900 6130 7350 8270 9190 10720 ENDBSP0006 BED SIDE EVL COMPLETE 11700 14630 17550 19740 21940 25590 ENDBSP0007 BED SIDE EVL SUBSEQUENT 8500 10630 12750 14340 15940 18590 ENDBSP0008 BED SIDE SCLEROTHERAPHY FIRST SITTING 12650 15810 18980 21350 23720 27670

ENDBSP0009 BED SIDE SCLEROTHARAPHY SUBS. SITING 9600 12000 14400 16200 18000 21000

ENDBSP0010 BED SIDE SCLEROTHERAPHY INJ. FOR ULCER 12200 15250 18300 20590 22880 26690 BED SIDE ENDOSCOPIC PLACEMENT OF NASO- ENDBSP0011 10600 13250 15900 17890 19880 23190 JE BED SIDE ENDOSCOPIC HEMO CLIPS ENDBSP0012 10600 13250 15900 17890 19880 23190 APPLICATI ENDBSP0013 BEDSIDE ENDOSCOPIC PLACEMENT OF RT 7500 9380 11250 12660 14060 16410

ENDBSP0014 BEDSIDE FUNGAL VARICES INJ. COST OF GLU 13300 16630 19950 22440 24940 29090 ENDBSP0015 BEDSIDE ENTEROSCOPY UPPER G.I 16900 21130 25350 28520 31690 36970 ENDBSP0016 BED SIDE UPPER G.I. ENDOSCOPY SIDE VIEWI 7500 9380 11250 12660 14060 16410

ENDBSP0017 BED SIDE PROCTOSCOPY + BANDING / INJ. 5400 6750 8100 9110 10130 11810 ENDBSP0018 BED SIDE PROCTOSCOPY 4600 5750 6900 7760 8630 10060 ENDBSP0019 BED SIDE POLYPECTOMY SINGLE 15200 19000 22800 25650 28500 33250 ENDBSP0020 BED SIDE POLYPECTOMY MULTIPLE 21100 26380 31650 35610 39560 46160 BED SIDE FOREIGN BODY REMOVAL FROM ENDBSP0021 15400 19250 23100 25990 28880 33690 ESOPH BED SIDE FOREIGN BODY REMOVAL FROM ENDBSP0022 15400 19250 23100 25990 28880 33690 STOMA BED SIDE ESOPHAGEAL PNEUMATIC ENDBSP0023 15400 19250 23100 25990 28880 33690 DILATATION ENDBSP0024 BED SIDE ESOPHAGEAL DILATATION FIRST 12700 15880 19050 21430 23810 27780 BED SIDE ESOPHAGEAL DILATATION ENDBSP0025 10600 13250 15900 17890 19880 23190 SUBSEQUEN BED SIDE ESOPHAGEAL STENTING COST OF ENDBSP0026 19600 24500 29400 33080 36750 42880 STE ENDBSP0027 BED SIDE PYLORIC BALOON DILATATION 13750 17190 20630 23200 25780 30080 ENDBSP0028 BED SIDE PALCEMENT OF SB TUBE 5900 7380 8850 9960 11060 12910 ENDBSP0029 BED SIDE BANDING PILES 6900 8630 10350 11640 12940 15090 ENDBSP0030 BED SIDE BILIARY FOR STONE EXTRACTION 5400 6750 8100 9110 10130 11810 BED SIDE PERCUTANEOUS ENDOSCOPIC ENDBSP0031 24300 30380 36450 41010 45560 53160 JEJUNOS BED SIDE PERCUTANEOUS ENDOSCOPIC ENDBSP0032 13750 17190 20630 23200 25780 30080 GASTROS ENDBSP0033 BED SIDE COGULATION APC 13200 16500 19800 22280 24750 28880 ENDBSP0034 BED SIDE COGULATION GOLD PROBE 7500 9380 11250 12660 14060 16410 ENDBSP0035 BED SIDE ENTEROSCOPY COMPLETE 34750 43440 52130 58640 65160 76020 ENDBSP0036 BED SIDE ENTROSCOPY LOWER G.I 18950 23690 28430 31980 35530 41450 ENDBSP0037 BED SIDE COLONIC BALOON DILATATION 22150 27690 33230 37380 41530 48450 BED SIDE SIGMOIDOSCOPY WITH PILES ENDBSP0038 12700 15880 19050 21430 23810 27780 INJECT BED SIDE COLONOSCOPY WITH PILES ENDBSP0039 9550 11940 14330 16120 17910 20890 INJECTIO ENDBSP0040 BED SIDE EUS FNA 23200 29000 34800 39150 43500 50750

PAIN MANAGEMENT CLINIC FOUR TWO SINGLE SUPER PRESIDENT CODE NO DESCRIPTION SUITE BEDDED BEDDED BEDDED DELUXE SUITE

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CODE.NO SERVICE NAME AMOUNT SURPAN0009 EPIDURAL BLOCK THORACIC 7000 8750 10500 11810 13130 15310 SURPAN0010 EPIDUROGRAPHY 7000 8750 10500 11810 13130 15310 SURPAN0011 FACET JOINT BLOCK DIAGNOSTIC 8000 10000 12000 13500 15000 17500 SURPAN0013 SACROILIAC JOINT BLOCK DIAGNOSTIC 8000 10000 12000 13500 15000 17500 SURPAN0014 TRANSFORAMINAL BLOCK 5000 6250 7500 8440 9380 10940 NEUROPLASTY-PERCUTANEOUS NERVE SURPAN0016 15400 19250 23100 25990 28880 33690 RELEASE SURPAN0028 NERVE ROOT BLOCK- SIMPLE 5000 6250 7500 8440 9380 10940 SURPAN0036 DISCOGRAPHY 5500 6880 8250 9280 10310 12030 SURPAN0037 PERCUTANEOUS DISCECTOMY 27500 34380 41250 46410 51560 60160 SURPAN0040 PARASPINAL OZONE INJECTION 3300 4130 4950 5570 6190 7220 SURPAN0056 TRIGEMINAL GANGLION BLOCK DIAGNOSTIC 6000 7500 9000 10130 11250 13130 SURPAN0063 MYOFASCIAL INJECTION BLOCK 4000 5000 6000 6750 7500 8750 SURPAN0064 CERVICAL EPIDURAL STEROID INJECTION 9900 12380 14850 16710 18560 21660 SURPAN0065 CEVICAL EPIDURAL CATHETERIZATION 9900 12380 14850 16710 18560 21660 SPINAL CORD STIMULATOR IMPLANTATION SURPAN0075 20000 25000 30000 33750 37500 43750 TRIA SURPAN0076 SPINAL CORD STIMULATOR IMPLANTATION 40000 50000 60000 67500 75000 87500 SURPAN0077 NUCLEOPLASTY 27500 34380 41250 46410 51560 60160 SURPAN0078 OZONE DISCECTOMY 8470 10590 12710 14290 15880 18530 SURPAN0079 THERAPEUTIC MYOFACIAL INJECTION 4950 6190 7430 8350 9280 10830 SURPAN0084 INTRA THECAL PUMP IMPLANTATION 33000 41250 49500 55690 61880 72190 SURPAN0085 LUMBAR EPIDURAL STEROID INJECTION 5500 6880 8250 9280 10310 12030 SURPAN0087 INTRADISCAL RFA # 16500 20630 24750 27840 30940 36090 CAUDAL NEUROPLASTY/ADHESIOLYSI/RAIZ SURPAN0089 18150 22690 27230 30630 34030 39700 TEC. SURPAN0090 CAUDAL EPIDURAL STEROID 7000 8750 10500 11810 13130 15310 SURPAN0094 BALOON KYPHOPLASTY 39600 49500 59400 66830 74250 86630 SURPAN0100 PROLOTHERAPY 5500 6880 8250 9280 10310 12030 SURPAN0103 TRIGGER POINT INJECTION 3000 3750 4500 5060 5630 6560 SURPAN0111 BICUPLASTY 27500 34380 41250 46410 51560 60160 SURPAN0113 VERTEBROPLASTY 39600 49500 59400 66830 74250 86630 SURPAN0120 INTRA-THECAL DRUG TRIAL 9680 12100 14520 16340 18150 21180 SURPAN0121 DORSAL COLOUMN STIMULATION TRIAL 20000 25000 30000 33750 37500 43750 SURPAN0122 CONTINUOUS REGIONAL BLOCK 10000 12500 15000 16880 18750 21880 SURPAN0125 MYOFASCIAL PRP THERAPY LEVEL-2 16500 20630 24750 27840 30940 36090 SURPAN0126 MYOFASCIAL PRP THERAPY LEVEL-3 22000 27500 33000 37130 41250 48130 SURPAN0127 VERTEBROPLASTY LEVEL-1 33000 41250 49500 55690 61880 72190 SURPAN0128 PERCUTANEOUS RHIZOTOMY LEVEL-2 22000 27500 33000 37130 41250 48130 SURPAN0129 PERCUTANEOUS RHIZOTOMY LEVEL-3 27500 34380 41250 46410 51560 60160 SURPAN0130 PERCUTANEOUS SYMPATHECTOMY 33000 41250 49500 55690 61880 72190 SURPAN0131EPIDUROSCOPY 33000 41250 49500 55690 61880 72190 SURPAN0132 MINIMALLY INVASIVE SPINE SURGERY LEVEL-1 33000 41250 49500 55690 61880 72190

SURPAN0133 MINIMALLY INVASIVE SPINE SURGERY LEVEL-2 49500 61880 74250 83530 92810 108280 SURPAN0134 MYOFASCIAL PRP THERAPY LEVEL-1 7700 9630 11550 12990 14440 16840 SURPAN0136 PERIPHERAL NERVE RFA 11000 13750 16500 18560 20630 24060 SURPAN0137 INTRAARTICULAR PRP JOINT U/L 11000 13750 16500 18560 20630 24060 SURPAN0138 INTRAARTICULAR PRP JOINT B/L 16500 20630 24750 27840 30940 36090 SURPAN0139 INTRAARTICULAR PRP JOINT (COMPLEX) 22000 27500 33000 37130 41250 48130 SURPAN0163 BURSA INJECTION - USG GUIDED 4000 5000 6000 6750 7500 8750 SURPAN0142 PERIPHERAL JOINT INJ.-USG GUIDED SIMPLEX 4500 5630 6750 7590 8440 9840 PERIPHERAL JOINT INJ.-USG GUIDED SURPAN0143 6500 8130 9750 10970 12190 14220 COMPLEX SURPAN0144 PERIPHERAL NERVE BLOCKS - SIMPLE 5000 6250 7500 8440 9380 10940 SURPAN0145 PERIPHERAL NERVE BLOCKS - INTERMEDIATE 10000 12500 15000 16880 18750 21880 SURPAN0146 PERIPHERAL NERVE BLOCKS - COMPLEX 15000 18750 22500 25310 28130 32810 SURPAN0147 SPINAL NERVE BLOCKS - SIMPLEX 5000 6250 7500 8440 9380 10940 SURPAN0148 SPINAL NERVE BLOCKS - COMPLEX 10000 12500 15000 16880 18750 21880

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CODE.NO SERVICE NAME AMOUNT DESENSITIZATION FOR CHRONIC PAIN- SURPAN0149 7000 8750 10500 11810 13130 15310 SIMPLEX DESENSITIZATION FOR CHRONIC PAIN- SURPAN0150 10000 12500 15000 16880 18750 21880 COMPLEX SURPAN0151 SPINAL JOINT BLOCKS SIMPLEX JTS 10000 12500 15000 16880 18750 21880 SPINAL JOINT BLOCKS SURPAN0152 15000 18750 22500 25310 28130 32810 COMPLEX(HEAD&NECK)JTS PERCUTANEOUS NEUROLYSIS PERIPHERAL SURPAN0153 10000 12500 15000 16880 18750 21880 NERVES SURPAN0154 PERCUTANEOUS NEUROLYSIS AXIAL NERVES 15000 18750 22500 25310 28130 32810 PERCUTANEOUS RHIZOTOMY/RF ABLATION L- SURPAN0155 15000 18750 22500 25310 28130 32810 1 PULSED RF OF SPINAL NERVE DRG SURPAN0156 12000 15000 18000 20250 22500 26250 SYM.GANGLION SURPAN0157 PULSED RF OF PERIPHERAL NERVE 7000 8750 10500 11810 13130 15310 SURPAN0158 PERCUTANEOUS SYMPATHETIC BLOCK 10000 12500 15000 16880 18750 21880 SURPAN0159 INTRA-ARTICULAR ORTHO BIOLOGICS 25000 31250 37500 42190 46880 54690 SURPAN0160 FACET/SI JT. BLOCK 7000 8750 10500 11810 13130 15310 SURPAN0161 MYOFASCIAL BLOCK - USG GUIDED 6000 7500 9000 10130 11250 13130 SURPAN0162 BOTOX TREATMENT FOR PAIN 10000 12500 15000 16880 18750 21880 # CHARGES FOR RFA GENERATOR, PROBE AND RFA NEEDLES WILL BE CHARGED EXTRA

INTERVENTIONAL RADIOLOGY FOUR TWO SINGLE SUPER PRESIDENT CODE NO DESCRIPTION SUITE BEDDED BEDDED BEDDED DELUXE SUITE PROIR00001 PERIPHERAL DSA (DIAGNOSTIC) (ONE LIMB)* 15000 18750 22500 25313 28125 32850 SELECTIVE VESSEL ANGIOGRAPHY/CHECK PROIR00002 12000 15000 18000 20250 22500 26280 ANGIO PROIR00003 PERIPHERAL EMBOLISATION 28000 35000 42000 47250 52500 61320 PROIR00004 PERIPHERAL ARTERIAL ANGIOPLASTY 23000 28750 34500 38813 43125 50370 PROIR00005 PERIPHERAL ARTERIAL ANGIOPLASTY+ STENT 26000 32500 39000 43875 48750 56940 PERIPHERAL ARTERIAL THROMBOLYSIS PROIR00006 28000 35000 42000 47250 52500 61320 RT/LT PROIR00007 PERIPHERAL HEMANGIOMA SCLEROTHERAPY 6000 7500 9000 10125 11250 13140

PROIR00008 PERIPHERAL HEMANGIOMA EMBOLISATION 34000 42500 51000 57375 63750 74460

PROIR00009 UAE FOR FIBROIDS-PRE MYOMECTOMY 20000 25000 30000 33750 37500 43800 PROIR00010 UAE FOR FIBROIDS 22000 27500 33000 37125 41250 48180 PELVIC ANGIOGRAPHY FOR POST PARTUM PROIR00011 15000 18750 22500 25313 28125 32850 HEMOR EMBOLIZATION FOR POST PARTUM PROIR00012 24000 30000 36000 40500 45000 52560 HEMORRHAGE PELVIC CONGESTION SYNDROME PROIR00013 26000 32500 39000 43875 48750 56940 EMBOLIZATION PROIR00014 FALLOPIAN TUBE CATHETERIZATION 20000 25000 30000 33750 37500 43800 PROIR00015 PUDENDAL ARTERY EVALUATION 22000 27500 33000 37125 41250 48180 PROIR00016 VERICOCELE INTERVENTIONAL 32000 40000 48000 54000 60000 70080 PROIR00017 RENAL ARTERY EMBOLIZATION (ONE SIDE) 18000 22500 27000 30375 33750 39420

PROIR00018 PERCUTANOUS NEPHROSTOMY & DRAINAGE 16000 20000 24000 27000 30000 35040 PROIR00019 URETRIC STENT (DOUBLE PIGTAIL/J) 20000 25000 30000 33750 37500 43800 PROIR00020 NEPHROSTOMY CONTRAST 3000 3750 4500 5063 5625 6570 PROIR00021 PICC LINE INSERTION 7000 8750 10500 11813 13125 15330 IMAGE GUIDED DIALYSIS CATHETER PROIR00022 8000 10000 12000 13500 15000 17520 INSERTION PROIR00023 IMAGE GUIDED PERM-CATH PLACEMENT 10000 12500 15000 16875 18750 21900 PROIR00024 IMAGE GUIDED PERM-CATH REMOVAL 5000 6250 7500 8438 9375 10950

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CODE.NO SERVICE NAME AMOUNT PROIR00025 CENTRAL VENOGRAM/ARM VENOGRAM 8000 10000 12000 13500 15000 17520 PROIR00026 CENTRAL VEIN INTERVENTIONAL 15000 18750 22500 25313 28125 32850 PROIR00027 MEDIASTINAL SYNDROMES INTERVENTIONAL 28000 35000 42000 47250 52500 61320

PROIR00028 VENOUS SAMPLING (ADRENAL & RENAL VEIN) 15000 18750 22500 25313 28125 32850 INFERIOR VENA CAVA PROIR00029 36000 45000 54000 60750 67500 78840 MEMBRANOTOMY/STENTING PROIR00030 IVC FILTER RETRIEVAL 35000 43750 52500 59063 65625 76650 PROIR00031 PORTAL VEIN EMBOLISATION 24000 30000 36000 40500 45000 52560 PROIR00032 AORTOGRAM/SPECIFIC SINGLE ARERIOGRAM 10000 12500 15000 16875 18750 21900 PROIR00033 AORTIC ANGIOPLASTY/STENTING 50000 62500 75000 84375 93750 109500 AORTIC STENT GRAFT ENDOLEAK PROIR00034 48000 60000 72000 81000 90000 105120 EMBOLIZATION PROIR00035 ABDOMINAL AORTIC ANEURYSM GRAFT 56000 70000 84000 94500 105000 122640 PROIR00036 BRONCHIAL ARTERY EVALUATION 12000 15000 18000 20250 22500 26280 PROIR00037 BRONCHIAL ARTERY EMBOLIZATION (SIMPLE) 28000 35000 42000 47250 52500 61320 BRONCHIAL ARTERY EMBOLIZATION PROIR00038 40000 50000 60000 67500 75000 87600 (COMPLEX) PROIR00039 INTRA VASCULAR FOREIGN BODY REMOVAL 10000 12500 15000 16875 18750 21900 PERCUTANEOUS TRANSHEPATIC PROIR00040 7000 8750 10500 11813 13125 15330 CHOLANGIOGRAM* PROIR00041 POST PTBD CHECK CHOLANGIOGRAM 5000 6250 7500 8438 9375 10950 PROIR00042 PTBD- POST OPERATIVE/BILIARY LEAK 20000 25000 30000 33750 37500 43800 PROIR00043 PTBD EXTERNAL DRAINAGE(SINGLE)* 15000 18750 22500 25313 28125 32850 PROIR00044 PTBD-EXTERNO-INTERNALISATION 18000 22500 27000 30375 33750 39420 PROIR00045 PTBD--INTERNALISATION 10000 12500 15000 16875 18750 21900 PROIR00046 PCN/PTBD WITH PRIMARY STENTING* 24000 30000 36000 40500 45000 52560 PROIR00047 TRANSJUGLAR LIVER BIOPSY 20000 25000 30000 33750 37500 43800 PROIR00048 TIPS INTERVENTIONAL (SIMPLE) 56000 70000 84000 94500 105000 122640 PROIR00049 TIPS INTERVENTIONAL (COMPLEX) 74000 92500 111000 124875 138750 162060 PROIR00050 ARTERIO-PORTOGRAM 24000 30000 36000 40500 45000 52560 PROIR00051 GI BLEED/ISCHEMIA EVALUATION 20000 25000 30000 33750 37500 43800 PROIR00052 GI BLEED/ISCHEMIA INTERVENTION 36000 45000 54000 60750 67500 78840 PROIR00053 PARTIAL SPLENIC EMBOLIZATION 28000 35000 42000 47250 52500 61320 PROIR00054 EMPERICAL ANY ARTERY EMBOLISATION 23000 28750 34500 38813 43125 50370 PROIR00055 USG GUIDED ANEURYSM EMBOLISATION 16000 20000 24000 27000 30000 35040 CHEMOEMBOLIZATION OF HEPATIC PROIR00056 48000 60000 72000 81000 90000 105120 TUMOUR/METS PROIR00057 TRANS ARTERIAL CHEMOTHERAPY INFUSION 24000 30000 36000 40500 45000 52560 PROIR00058 RFA OF HEPATIC TUMOURS/METS 39000 48750 58500 65813 73125 85410 PROIR00059 NASO JEJUNAL INTUBATION 6000 7500 9000 10125 11250 13140 PROIR00060 HEPATIC VEIN PRESSURE GRATIENT 20000 25000 30000 33750 37500 43800

SURGEON’S FEE FOUR TWO SINGLE SUPER PRESIDENT CODE NO DESCRIPTION SUITE BEDDED BEDDED BEDDED DELUXE SUITE UNIT : G.I SURGERY OESOPHAGUS SUROES0001 ACHALASIA-CARDIOMYOTOMY 22000 27500 33000 37130 41250 48130 REPAIR OF HIATUS HERNIA WITH SUROES0002 23000 28750 34500 38810 43130 50310 FUNDOPLICAT TRANSHIATAL ESOPHAGECTOMY FOR SUROES0003 36000 45000 54000 60750 67500 78750 OESOPHAGEA SUROES0006 CERVICAL OESOPHAGOSTOMY 12000 15000 18000 20250 22500 26250 OPEN/THORACOSCOPIC REMOVAL FB SUROES0008 26000 32500 39000 43880 48750 56880 OESOPHAGUS

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CODE.NO SERVICE NAME AMOUNT SUROES0009 COLONIC PULL UP 36000 45000 54000 60750 67500 78750 OPEN/THORACOSCOPIC REP. SUROES0011 30000 37500 45000 50630 56250 65630 OESO.PERFORATION LAPOES0001 LAP. ACHALASIA-CARDIOMYOTOMY 24000 30000 36000 40500 45000 52500 LAP. REPAIR OF HIATUS HERNIA WITH LAPOES0002 26000 32500 39000 43880 48750 56880 FUNDOP LAPOES0003 LAP. COLONIC PULL UP 42000 52500 63000 70880 78750 91880 LAP. TRANSHIATAL ESOPHAGECTOMY FOR LAPOES0005 42000 52500 63000 70880 78750 91880 OESOP STOMACH SURSTO0001 GASTRIC DRAINAGE G-J/PYLOROPLASTY 21600 27000 32400 36450 40500 47250 SURSTO0002 TRUNCAL VAGOTOMY TV WITH G-J 26400 33000 39600 44550 49500 57750 SURSTO0003 GASTROSTOMY 14000 17500 21000 23630 26250 30630 SURSTO0004 HIGHLY SELECTIVE VAGOTOMY 17000 21250 25500 28690 31880 37190 SURSTO0005 PARTIAL GASTRECTOMY-BENIGN 23000 28750 34500 38810 43130 50310 SURSTO0006 TOTAL GASTRECTOMY BENIGN 32200 40250 48300 54340 60380 70440 SURSTO0007 EXPLORATION FOR UGI BLEED 19000 23750 28500 32060 35630 41560 SURSTO0008 D-2 RADICAL TOTAL GASTRECTOMY 37950 47440 56930 64040 71160 83020 SURSTO0009 D-2 RADICAL DISTAL GASTRECTOMY 33350 41690 50030 56280 62530 72950 SURSTO0010 CARDIOMYOTOMY+DOR FUNDOPLICATION 34800 43500 52200 58730 65250 76130 SURSTO0012 INTESTINAL BEZOAR 15000 18750 22500 25310 28130 32810 LAPSTO0001 LAP. GASTROSTOMY 15000 18750 22500 25310 28130 32810 LAPSTO0002 LAP. GASTRO-JEJUNOSTOMY / PYLORPLASTY 23000 28750 34500 38810 43130 50310 LAPSTO0003 LAP. TRUNCAL VAGOTOMY 30000 37500 45000 50630 56250 65630 LAPSTO0004 LAP. HIGHLY SELECTIVE VAGOTOMY 23000 28750 34500 38810 43130 50310 LAPSTO0005 LAP. PARTIAL GASTRECTOMY-BENIGN 25300 31630 37950 42690 47440 55340 LAPSTO0006 LAP. TOTAL GASTRECTOMY BENIGN 35650 44560 53480 60160 66840 77980 LAPSTO0007 LAP. EXPLORATION FOR UGI BLEED 20000 25000 30000 33750 37500 43750 LAPSTO0008 LAP. D-2 RADICAL DISTAL GASTRECTOMY 34500 43130 51750 58220 64690 75470 LAPSTO0009 LAP. D-2 RADICAL TOTAL GASTRECTOMY 39100 48880 58650 65980 73310 85530 LAP. CARDIOMYOTOMY+ DOOR LAPPRU0009 37950 47440 56930 64040 71160 83020 FUNDOPLICATION SURSTO0011 LAP GASTRIC VOLVULUS 34500 43130 51750 58220 64690 75470 LAP. TRUNCAL VAGOTOMY WITH GASTRO- SURLAP0060 34500 43130 51750 58220 64690 75470 JEJUNO DUODENUM CLOSURE DUODENAL ULCER PERFORATION SURDUO0001 18400 23000 27600 31050 34500 40250 IST P SURDUO0002 REPAIR DUODENAL LEAK 2ND/3RD PART 19550 24440 29330 32990 36660 42770 EXCISION POLYP/SMALL LESION DUODENAL SURDUO0003 19550 24440 29330 32990 36660 42770 DIV SURDUO0004 TUBE DUODENOSTOMY 16000 20000 24000 27000 30000 35000 SURDUO0005 DUODENO-JEJUNOSTOMY 18000 22500 27000 30380 33750 39380 SURDUO0006 UNDER RUNNING DU BLEED 16000 20000 24000 27000 30000 35000 LAPDUO0001 LAP. CLOSURE DUODENAL PERFORATION 26450 33060 39680 44630 49590 57860

LAPDUO0002 LAP. REPAIR DUODENAL LEAK 2ND / 3RD PART 23000 28750 34500 38810 43130 50310

LAPDUO0003 LAP. EXCISION POLYP / SMALL LESION / DIV 23000 28750 34500 38810 43130 50310 LAPDUO0004 LAP. DUODENO-JEJUNOSTOMY 23000 28750 34500 38810 43130 50310 SMALL BOWEL SURSMB0001 RESECTION AND ANASTOMOSIS - SINGLE 19800 24750 29700 33410 37130 43310 SURSMB0002 RESECTION AND ANASTOMOSIS - MULTIPLE 24200 30250 36300 40840 45380 52940 SURSMB0003 STRICTUROPLASTY 15000 18750 22500 25310 28130 32810 SURSMB0004 REPAIR BOWEL PERFORATION 17000 21250 25500 28690 31880 37190 SURSMB0005 INTESTINAL FISTULA 19000 23750 28500 32060 35630 41560 SURSMB0006 EXTERIORIZATION OF BOWEL ENDS 16000 20000 24000 27000 30000 35000

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CODE.NO SERVICE NAME AMOUNT SURSMB0007 ILEOSTOMY - LOOP 18000 22500 27000 30380 33750 39380 SURSMB0008 ILEOSTOMY - END 18000 22500 27000 30380 33750 39380 SURSMB0009 CLOSURE OF ILEOSTOMY 21600 27000 32400 36450 40500 47250 SURSMB0010 MECKEL'S DIVERTICULECTOMY 19200 24000 28800 32400 36000 42000 SURSMB0011 FEEDING JEJUNOSTOMY 18000 22500 27000 30380 33750 39380 INTRAOPERATIVE SURSMB0012 16000 20000 24000 27000 30000 35000 ENTEROSCOPY+LOCALISATION BLEEAR SURSMB0013 REPAIR OF GASTRIC PERPORATION 15000 18750 22500 25310 28130 32810 SURSMB0014 GASTRIC BEZOAR 15000 18750 22500 25310 28130 32810 ABDOMINOPERINEAL PULL THR. RES. & SURPEA0040 30000 37500 45000 50630 56250 65630 ANASTOMOSIS SURPEA0041 HIRSCHSPRUNG RESECTION & ANASTOMOSIS 26000 32500 39000 43880 48750 56880

LAPSMB0001 LAP. RESECTION AND ANASTOMOSIS - SINGLE 22000 27500 33000 37130 41250 48130 LAP. RESECTION AND ANASTOMOSIS - LAPSMB0002 27500 34380 41250 46410 51560 60160 MULTIPLE LAPSMB0003 LAP. STRICTUROPLASTY 16000 20000 24000 27000 30000 35000 LAPSMB0004 LAP. REPAIR BOWEL PERFORATION 19000 23750 28500 32060 35630 41560 LAPSMB0005 LAP. EXTERIORIZATION OF BOWEL ENDS 16000 20000 24000 27000 30000 35000 LAPSMB0006 LAP. ILEOSTOMY - LOOP 17000 21250 25500 28690 31880 37190 LAPSMB0007 LAP. ILEOSTOMY - END 17000 21250 25500 28690 31880 37190 LAPSMB0008 LAP. MECKEL'S DIVERTICULECTOMY 17000 21250 25500 28690 31880 37190 LAPSMB0009 LAP. FEEDING JEJUNOSTOMY 16000 20000 24000 27000 30000 35000 LAPSMB0010 LAP. RELIEF OF INTESTINAL OBSTRUCTION 16000 20000 24000 27000 30000 35000 PANCREAS NECROSECTOMY/DRAINAGE OF PANCREATIC SURPAC0001 30000 37500 45000 50630 56250 65630 ABSC SURPAC0002 CYSTO-GASTROSTOMY 20400 25500 30600 34430 38250 44630 SURPAC0003 CYSTO-JEJUNOSTOMY ROUX EN Y 25200 31500 37800 42530 47250 55130 LATERAL PANCREATICO-JEJUNOSTOMY ROUX SURPAC0004 26000 32500 39000 43880 48750 56880 ENY SURPAC0005 DISTAL PANCREATECTOMY 33600 42000 50400 56700 63000 73500 SURPAC0006 PANCREATICODUODENECTOMY 48000 60000 72000 81000 90000 105000 SURPAC0007 INSULINOMA EXCISION 23000 28750 34500 38810 43130 50310 SURPAC0008 FREYS PROCEDURE 30000 37500 45000 50630 56250 65630 SURPAC0009 ENUCLEATION OF PANCREATIC TUMOUR 18000 22500 27000 30380 33750 39380 DISTAL PANCREATECTOMY WITH SURPAC0010 36600 45750 54900 61760 68630 80060 SPLENECTOMY LAP. NECROSECTOMY / DRAINAGE OF LAPPAC0001 28800 36000 43200 48600 54000 63000 PANCREAT LAPPAC0002 LAP. CYSTO-GATROSTOMY 27600 34500 41400 46580 51750 60380 LAPPAC0003 LAP. CYSTO-JEJUNOSTOMY 28800 36000 43200 48600 54000 63000 LAPPAC0004 LAP. LATERAL PANCREATO-JEJUNOSTOMY 33600 42000 50400 56700 63000 73500 LAPPAC0005 LAP. DISTAL PANCREATECTOMY 28000 35000 42000 47250 52500 61250 LAPPAC0006 LAP. PANCREATICODUODENECTOMY 45000 56250 67500 75940 84380 98440 LAPPAC0007 LAP. INSULINOMA EXCISION 26000 32500 39000 43880 48750 56880 LAPPAC0008 LAP. FREYS PROCEDURE 32000 40000 48000 54000 60000 70000 LAPPAC0009 LAP. ENUCLEATION OF PANCREATIC TUMOR 21000 26250 31500 35440 39380 45940 LAP. DISTAL PANCREACTOMY WITH LAPPAC0010 32000 40000 48000 54000 60000 70000 SPLENECTOM LAPPAC0011 LAP. PANCREATIC PSEUDOCYST 23000 28750 34500 38810 43130 50310 LAP.DEBRIDEMENT INFECTED PANC. LAPPAC0012 25000 31250 37500 42190 46880 54690 NECROSIS PORTAL HYPERTENSION OESO.-GASTRIC DEVASC. WITH SURPHT0001 30000 37500 45000 50630 56250 65630 SPLENECTOMY SURPHT0002 OESOPHAGO GASTRIC DEVASCULARISATION 26000 32500 39000 43880 48750 56880 TRANSECTION OESOPHAGUS WITH EEA SURPHT0003 24000 30000 36000 40500 45000 52500 STAPLER

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CODE.NO SERVICE NAME AMOUNT SURPHT0004 SPLENECTOMY & LIENO-RENAL SHUNT 30000 37500 45000 50630 56250 65630 SURPHT0005 WARREN SHUNT 26000 32500 39000 43880 48750 56880 SURPHT0006 MESO-CAVAL SHUNT 26000 32500 39000 43880 48750 56880 SURPHT0007 PORTA-CAVAL SHUNT SIDE-SIDE 26000 32500 39000 43880 48750 56880 SURPHT0008 PORTO-CAVAL SHUNT END-SIDE 25000 31250 37500 42190 46880 54690 SURPHT0009 PERITONEO-VENOUS SHUNT FOR ASCITES 17000 21250 25500 28690 31880 37190

COLON SURCOL0001 COLOSTOMY 19200 24000 28800 32400 36000 42000 SURCOL0003 CLOSURE OF COLOSTOMY 21600 27000 32400 36450 40500 47250 SURCOL0004 HEMICOLECTOMY (R & L) NON CANCER 22800 28500 34200 38480 42750 49880 SURCOL0006 SUBTOTAL COLECTOMY/TOTAL COLECTOMY 31200 39000 46800 52650 58500 68250 SURCOL0007 TRANSVERSE COLECTOMY 25200 31500 37800 42530 47250 55130 SURCOL0008 SIGMOIDECTOMY 25200 31500 37800 42530 47250 55130 SURCOL0009 ILEO-TRANSVERSE BYPASS 21600 27000 32400 36450 40500 47250 SURCOL0012 TOTAL PROCTOCOLECTOMY WITH (J-POUCH) 48000 60000 72000 81000 90000 105000 SURCOL0013 TUBE CECOSTOMY 12000 15000 18000 20250 22500 26250 SURCOL0014 CECOPEXY 12000 15000 18000 20250 22500 26250 SURCOL0015 VOLVULUS SIGMOID COLON - UNTWIST 18000 22500 27000 30380 33750 39380 SURCOL0016 COLONIC PERFORATION REPAIR 18000 22500 27000 30380 33750 39380 SURCOL0017 HARTMANNS PROCEDURE 24000 30000 36000 40500 45000 52500 SURCOL0018 HARTMANNS REVERSAL 30000 37500 45000 50630 56250 65630 SURCOL0019 RADICAL RIGHT/LEFT HEMICOLECTOMY 27600 34500 41400 46580 51750 60380 SURCOL0020 TOTAL PROCTOCOLECTOMY WITH J-POUCH 48000 60000 72000 81000 90000 105000

SURLAP0061 LAP PROCTECTOMY I. ILEOANAL JPOUCH (UC) 36000 45000 54000 60750 67500 78750 LAPCOL0001 LAP. COLOSTOMY 21600 27000 32400 36450 40500 47250 LAPCOL0003 LAP. R & L HEMICOLECTOMY NON CANCER 25200 31500 37800 42530 47250 55130 LAP. SUBTOTAL COLECTOMY/TOTAL LAPCOL0005 36000 45000 54000 60750 67500 78750 COLECTOMY LAP. TOTAL PROCTOCOLECTOMY WITH (J- LAPCOL0006 55200 69000 82800 93150 103500 120750 POUC LAPCOL0007 LAP. TRANSVERSE COLECTOMY 27600 34500 41400 46580 51750 60380 LAPCOL0008 LAP. SIGMOIDECTOMY 28800 36000 43200 48600 54000 63000 LAPCOL0009 LAP. ILEO-TRANSVERSE BYPASS 24000 30000 36000 40500 45000 52500 LAPCOL0012 LAP. VOLVULUS SIGMOID COLON - UNTWIST 20400 25500 30600 34430 38250 44630 LAPCOL0013 LAP. COLONIC PERFORATION REPAIR 21600 27000 32400 36450 40500 47250 LAPCOL0014 LAP. HARTMANNS PROCEDURE 26400 33000 39600 44550 49500 57750 LAPCOL0015 LAP. HARTMANNS REVERSAL 31200 39000 46800 52650 58500 68250 LAPCOL0016 LAP. RADICAL RIGHT/LEFT HEMICOLECTOMY 31200 39000 46800 52650 58500 68250 RECTUM SURREC0001 ANTERIOR RESECTION 35000 43750 52500 59060 65630 76560 SURREC0002 LOW ANTERIOR RESECTION 36000 45000 54000 60750 67500 78750 SURREC0003 ABDOMINO-PERINEAL RESECTION 37500 46880 56250 63280 70310 82030 SURREC0004 RECTO VAGINAL FISTULA 24000 30000 36000 40500 45000 52500 SURREC0005 RECTO URETHRAL FISTULA 24000 30000 36000 40500 45000 52500 SURREC0006 PELVIC EXENTERATION 42000 52500 63000 70880 78750 91880 SURREC0007 TME 31200 39000 46800 52650 58500 68250 SURREC0008 REDUCTION OF RECTAL PROLAPSE 40800 51000 61200 68850 76500 89250 SURREC0009 RECTOPEXY 26400 33000 39600 44550 49500 57750 COMPLEX GENITOURINARY-INTESTINAL SURREC0011 28800 36000 43200 48600 54000 63000 FISTULA SURREC0012 PERINEAL RECTOSIGMOIDECTOMY 30000 37500 45000 50630 56250 65630 SURREC0013 RECTAL EXPLORATION + HAEMOSTASIS 24000 30000 36000 40500 45000 52500 LAPREC0001 LAP. ANTERIOR RESECTION 34800 43500 52200 58730 65250 76130 LAPREC0002 LAP. LOW ANTERIOR RESECTION 36000 45000 54000 60750 67500 78750

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CODE.NO SERVICE NAME AMOUNT LAPREC0003 LAP. ABDOMINO-PERINEAL RESECTION 36000 45000 54000 60750 67500 78750 LAPREC0004 LAP. PELVIC EXENTERATION 45600 57000 68400 76950 85500 99750 LAPREC0005 LAP. TME 33600 42000 50400 56700 63000 73500 LAPREC0006 LAP. RECTOPEXY 30000 37500 45000 50630 56250 65630 ANAL CANAL SURANC0001 ANAL FISSURE - LATERAL SPHINCTEROTOMY 10000 12500 15000 16880 18750 21880 SURANC0002 ANAL FISSURE - FISSURECTOMY 10000 12500 15000 16880 18750 21880 SURANC0003 LORD'S ANAL DILATATION 7000 8750 10500 11810 13130 15310 SURANC0004 FISTULA-IN-ANO LOW 12650 15810 18980 21350 23720 27670 SURANC0005 FISTULA IN ANO HIGH 16100 20130 24150 27170 30190 35220 SURANC0006 ISCHIORECTAL ABCESS/PERIANAL ABSCESS 13200 16500 19800 22280 24750 28880 SURANC0007 RECTAL POLYP EXCISION 8000 10000 12000 13500 15000 17500 SURANC0008 HAEMORRHOIDECTOMY (OPEN) 15400 19250 23100 25990 28880 33690 SURANC0009 BANDING FOR HAEMORRHOIDS 5000 6250 7500 8440 9380 10940 INJECTION SCLEROTHERAPHY FOR SURANC0010 5000 6250 7500 8440 9380 10940 HAEMORRHOID SURANC0011 THIERSCH'S OPERATION 5000 6250 7500 8440 9380 10940 SURANC0012 ANAL INCONTINENCE - GRACILIS SLING 20000 25000 30000 33750 37500 43750 SURANC0013 SPHINCTER REPAIR FOLLOWING INJURY 18000 22500 27000 30380 33750 39380 SURANC0014 EXCISION OF PERIANALTAG 7000 8750 10500 11810 13130 15310 SURANC0015 PLUG FISTULECTOMY 17000 21250 25500 28690 31880 37190 SURANC0016 STAPLED HAEMORRHOIDECTOMY (MIPH) 16500 20630 24750 27840 30940 36090

SURANC0026 SUTURED HAEMORRHOIDOPEXY 18000 22500 27000 30380 33750 39380 SURANC0017 PILONOIDAL SINUS EXCISION 12000 15000 18000 20250 22500 26250 SURANC0027 PILONOIDAL SINUS EXCISION +FLAP REPAIR 20000 25000 30000 33750 37500 43750 SURANC0028 EPSiT FOR PILONIDAL SINUS 16000 20000 24000 27000 30000 35000 SURANC0018 COMPLEX ANO RECTAL FISTULA 22000 27500 33000 37130 41250 48130 SURANC0019 ADVANCEMENT FLAP 12000 15000 18000 20250 22500 26250 LIGASURE/HARMONIC SURANC0020 13000 16250 19500 21940 24380 28440 HAEMORRHOLDECTOMY SURANC0021 EXAMINATION UNDER ANAESTHESIA (EUA) 6000 7500 9000 10130 11250 13130 SURANC0022 VAAFT FOR LOW FISTULA IN ANO 15000 18750 22500 25310 28130 32810 SURANC0023 VAAFT FOR HIGH/COMPLEX/RECUR.FISTULA 20000 25000 30000 33750 37500 43750 SURANC0024 DIAGNOSTIC FISTULOSCOPY/SINOSCOPY 8000 10000 12000 13500 15000 17500 SURANC0025 LIFT FOR TRANSSPHINTERIC FISTULA 5000 6250 7500 8440 9380 10940 BILIARY SYSTEM SURBIS0001 CHOLECYSTOSTOMY 12000 15000 18000 20250 22500 26250 SURBIS0002 CHOLECYSTECTOMY - OPEN 21600 27000 32400 36450 40500 47250 SURBIS0003 CHOLECYSTECTOMY+OP.CHOLANGIOGRAM 30000 37500 45000 50630 56250 65630 SURBIS0006 OPERATIVE CHOLANGIOGRAM 7000 8750 10500 11810 13130 15310 SURBIS0007 TRANSDUODENAL SPHINCTEROTOMY 22800 28500 34200 38480 42750 49880 SURBIS0008 CHOLEDOCHODUODENOSTOMY 29900 37380 44850 50460 56060 65410 SURBIS0009 BILE DUCT INJURY-T TUBE DRAINAGE 23200 29000 34800 39150 43500 50750 SURBIS0010 H-J FOR BILIARY STRICTURE 32200 40250 48300 54340 60380 70440 SURBIS0012 RADICAL CHOLECYSTECTOMY 38400 48000 57600 64800 72000 84000 SURBIS0013 SEGMENT III HEPATICO- JEJUNOSTOMY 29700 37130 44550 50120 55690 64970 SURBIS0014 CHOLECYSTO- JEJUNOSTOMY 19800 24750 29700 33410 37130 43310 SURBIS0015 CHOLECYSTO-JEJUNOSTOMY WITH G-J 23200 29000 34800 39150 43500 50750 SURBIS0016 CHOLEDOCHAL CYST EXCISION WITH H-J 35200 44000 52800 59400 66000 77000 SURBIS0017 CHOLANGIOSCOPY 5000 6250 7500 8440 9380 10940 SURBIS0018 DOUBLE BYPASS HJ+GJ+CHOLECYSTECTOMY 33000 41250 49500 55690 61880 72190 SURBIS0019 CHOLANGIOSCOPIC LITHOTRIPSY 11000 13750 16500 18560 20630 24060 SURBIS0020 CHOLANGIOSCOPIC LASER LITHOTRIPSY 9000 11250 13500 15190 16880 19690 SURBIS0021 OPERATIVE REMOVAL OF METAL STENT 13000 16250 19500 21940 24380 28440 SURBIS0022 STUMP CHOLECYSTECTOMY 23200 29000 34800 39150 43500 50750

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CODE.NO SERVICE NAME AMOUNT SURBIS0023 CBD EXPLORATION 21600 27000 32400 36450 40500 47250 LAPBIS0001 LAP. CHOLECYSTOSTOMY 14000 17500 21000 23630 26250 30630 LAPBIS0002 LAP. CHOLECYSTECTOMY 20900 26130 31350 35270 39190 45720 LAP. CHOLECYSTECTOMY WITH OPERATIVE LAPBIS0003 27900 34880 41850 47080 52310 61030 CHOL LAP. CHOLECYSTECTOMY WITH CBD LAPBIS0004 28980 36230 43470 48900 54340 63390 EXPLORATIO LAPBIS0006 LAP. OPERATIVE CHOLANGIOGRAM 7000 8750 10500 11810 13130 15310 LAP. CHOLECYS. & TRANSDUODENAL LAPBIS0007 25000 31250 37500 42190 46880 54690 SPHINCTER LAPBIS0008 LAP. CHOLEDOCHODUODENOSTOMY 22800 28500 34200 38480 42750 49880 LAPBIS0009 LAP. BILE DUCT INJURY +T TUBE DRAINAGE 27600 34500 41400 46580 51750 60380

LAPBIS0010 LAP. HEPATICO-JEJUNOSTOMY H-J FOR BILIAR 29900 37380 44850 50460 56060 65410 LAPBIS0011 LAP. RADICAL CHOLECYSTECTOMY 40800 51000 61200 68850 76500 89250 LAPBIS0012 LAP. CHOLECYSTO- JEJUNOSTOMY 22000 27500 33000 37130 41250 48130 LAPBIS0013 LAP. CHOLECYSTO-JEJUNOSTOMY WITH G-J 24255 30320 36380 40930 45480 53060

LAPBIS0014 LAP. CHOLEDOCHAL CYST EXCISION WITH H-J 37400 46750 56100 63110 70130 81810 LAPBIS0015 LAP. CHOLANGIOSCOPY 6300 7880 9450 10630 11810 13780 LAP. DOUBLE BYPASS LAPBIS0016 33810 42260 50720 57050 63390 73960 HJ+GJ+CHOLECYSTECTOMY LAPBIS0017 LAP. CHOLANGIOSCOPIC LITHOTRIPSY 13650 17060 20480 23030 25590 29860 LAPBIS0018 LAP. CHOLANGIOSCOPIC LASER LITHOTRIPSY 10500 13130 15750 17720 19690 22970 LAPBIS0019 LAP. OPERATIVE REMOVAL OF STENT 15750 19690 23630 26580 29530 34450 LAPBIS0020 LAP. CHOLE+CHOLEDOCHODUODENOSTOMY 36000 45000 54000 60750 67500 78750 SURBIS0024 LAP. CBD EXPLORATION 24150 30190 36230 40750 45280 52830 LIVER & SPLEEN SURLIV0001 LEFT LATERAL SEGMENTECTOMY 30000 37500 45000 50630 56250 65630 SURLIV0002 LEFT HEPATECTOMY 40000 50000 60000 67500 75000 87500 SURLIV0003 RIGHT HEPATECTOMY 40000 50000 60000 67500 75000 87500 SURLIV0004 TRISEGMENTECTOMY 40000 50000 60000 67500 75000 87500 SURLIV0005 NON ANATOMIC RESECTION LIVER 20000 25000 30000 33750 37500 43750 SURLIV0006 HYDATID CYST LIVER 28750 35940 43130 48520 53910 62890 SURLIV0007 LIVER ABSCESS - OPEN DRAINAGE 15600 19500 23400 26330 29250 34130 SURLIV0008 LIVER CYST - EXCISION 17000 21250 25500 28690 31880 37190 SURLIV0009 WEDGE LIVER BIOPSY 8000 10000 12000 13500 15000 17500 SURLIV0010 RADIO FREQUENCY ABLATION 13000 16250 19500 21940 24380 28440 SURLIV0011 RECURRENT MULTIPLE HYDATID CYSTS 28750 35940 43130 48520 53910 62890 SURLIV0012 SPLENECTOMY 25000 31250 37500 42190 46880 54690 EXTENDED RIGHT HEPATECTOMY UNDER SURLIV0013 32000 40000 48000 54000 60000 70000 VASCULA LAPLIV0001 LAP. LEFT LATERAL SEGMENTECTOMY 28000 35000 42000 47250 52500 61250 LAPLIV0002 LAP. LEFT HEPATECTOMY 43000 53750 64500 72560 80630 94060 LAPLIV0003 LAP. RIGHT HEPATECTOMY 43000 53750 64500 72560 80630 94060 LAPLIV0004 LAP. EXTENDED RIGHT / LEFT HEPATECTOMY 43000 53750 64500 72560 80630 94060 LAPLIV0005 LAP. NON ANATOMIC RESECTION LIVER 23000 28750 34500 38810 43130 50310 LAPLIV0006 LAP. HYDATID CYST LIVER 29900 37380 44850 50460 56060 65410 LAPLIV0007 LAP. RECURRENT MULTIPLE HYDATID CYSTS 36400 45500 54600 61430 68250 79630 LAPLIV0008 LAP. LIVER ABSCESS - DRAINAIGE 17000 21250 25500 28690 31880 37190 LAPLIV0009 LAP. LIVER CYST - EXCISION 19000 23750 28500 32060 35630 41560 LAPLIV0010 LAP. WEDGE LIVER BIOPSY / CORE BIOPSY 10000 12500 15000 16880 18750 21880 LAPLIV0011 LAP. RADIO FREQUENCY ABLATION 16000 20000 24000 27000 30000 35000 LAPLIV0012 LAP. SPLENECTOMY 34500 43130 51750 58220 64690 75470 LAPLIV0013 LAP. SPLENIC CYST 22000 27500 33000 37130 41250 48130 HERNIAS SURHER0001 INGUINAL HERNIOTOMY - U/L 12000 15000 18000 20250 22500 26250

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CODE.NO SERVICE NAME AMOUNT SURHER0002 INGUINAL HERNIORRHAPHY - U/L 16800 21000 25200 28350 31500 36750 SURHER0003 INGUINAL HERNIA REPAIR WITH MESH- U/L 18000 22500 27000 30380 33750 39380

SURHER0017 INGUINAL HERNIA REPAIR WITH MESH- B/L 24000 30000 36000 40500 45000 52500

SURHER0007 RECURRENT INGUINAL HERNIA MESH REPAIR 21800 27250 32700 36790 40880 47690 SURHER0005 FEMORAL HERNIA REPAIR 18000 22500 27000 30380 33750 39380 SURHER0006 UMBILICAL/ HERNIA REPAIR 20400 25500 30600 34430 38250 44630 SURHER0024 VENTRAL HERNIA REPAIR 20400 25500 30600 34430 38250 44630 SURHER0025 VENTRAL HERNIA REPAIR-LARGE>5 CM 24000 30000 36000 40500 45000 52500 SURHER0008 INCISIONAL HERNIA REPAIR WITH MESH 21600 27000 32400 36450 40500 47250 SURHER0009 OBSTRUCTED VENTRAL/INCISIONAL HERNIA 20400 25500 30600 34430 38250 44630 STRANGULATED/OBSTRUCTED INGUINAL SURHER0010 20400 25500 30600 34430 38250 44630 HERNIA RARE HERNIA, SPIGELIAN OBTURATOR, SURHER0014 21600 27000 32400 36450 40500 47250 LUMBER SURHER0015 INGUINAL HERNIOTOMY - B/L 16800 21000 25200 28350 31500 36750 SURHER0016 INGUINAL HERNIORRHAPHY - B/L 24000 30000 36000 40500 45000 52500 REPAIR OF PARADUODENAL HERNIA SURHER0018 24400 30500 36600 41180 45750 53380 SURGERY SURHER0019 MESH REMOVAL OF INGUINIAL HERNIA 18000 22500 27000 30380 33750 39380 SURHER0020 EPGASTRIC HERNIA REPAIR 18000 22500 27000 30380 33750 39380 COMPLEX HERNIA COMPONENT SEPARATION SURHER0021 44400 55500 66600 74930 83250 97130 REPA SURHER0023 DIAPHRAGMATIC HERNIA REPAIR 30000 37500 45000 50630 56250 65630 SURHER0027 MESH REMOVAL OF ABDOMINAL HERNIA 24400 30500 36600 41180 45750 53380 SURHER0028 PARA-STOMA REPAIR 18000 22500 27000 30380 33750 39380 LAPHER0001 LAP. INGUINAL HERNIOTOMY - U/L 14400 18000 21600 24300 27000 31500 LAPHER0003 LAP. MESH REPAIR INGUINAL HERNIA-U/L 21600 27000 32400 36450 40500 47250 LAPHER0015 LAP. MESH REPAIR INGUINAL HERNIA-B/L 33600 42000 50400 56700 63000 73500 LAPHER0004 LAP. FEMORAL HERNIA REPAIR 21600 27000 32400 36450 40500 47250 LAPHER0005 LAP. UMBILICAL/ HERNIA REPAIR 21600 27000 32400 36450 40500 47250 LAPHER0023 LAP. VENTRAL HERNIA REPAIR 21600 27000 32400 36450 40500 47250 LAPHER0024 LAP. VENTRAL HERNIA REPAIR LARGE >5CM 24400 30500 36600 41180 45750 53380

LAPHER0006 LAP. RECURRENT INGUINAL HERNIA REPAIR 24000 30000 36000 40500 45000 52500

LAPHER0007 LAP. INCISIONAL HERNIA REPAIR WITH MESH 2400 3000 3600 4050 4500 5250 LAP. OBSTRUCTED VENTRAL/INCISIONAL LAPHER0008 24400 30500 36600 41180 45750 53380 HERNI LAP. STRANGULATED/OBSTRUCTED INGUINAL LAPHER0009 25200 31500 37800 42530 47250 55130 HE LAPHER0010 LAP. GIANT ABDOMINAL HERNIA 40800 51000 61200 68850 76500 89250 LAP RARE LAPHER0011 27600 34500 41400 46580 51750 60380 HERNIA/SPIGELIAN/OBTURATOR/LUMB LAPHER0013 LAP. INGUINAL HERNIOTOMY - B/L 21600 27000 32400 36450 40500 47250 LAPHER0020 LAP. EPGASTRIC HERNIA REPAIR 18000 22500 27000 30380 33750 39380 LAPHER0022 LAP DIAPHRAGMATIC HERNIA REPAIR 36000 45000 54000 60750 67500 78750 APPENDIX SURAPP0001 APPENDICECTOMY - OPEN 17250 21560 25880 29110 32340 37730 SURAPP0002 DRAINAGE APPENDICULAR ABSCESS 18000 22500 27000 30380 33750 39380 LAPAPP0001 LAP. APPENDICECTOMY 19550 24440 29330 32990 36660 42770 LAPAPP0002 LAP. DRAINAGE APPENDICULAR ABSCESS 20000 25000 30000 33750 37500 43750 PERITONEUM , RETROPERITONEUM ,UMBILICUS AND ABDOMINAL WALL SURPRU0001 ADHESIOLYSIS 16000 20000 24000 27000 30000 35000 SURPRU0014 DIVISION OF INTRAABNOMINAL BAND 12000 15000 18000 20250 22500 26250 SURPRU0002 EXPLORATORY LAPAROTOMY 16000 20000 24000 27000 30000 35000 SURPRU0003 RETROPERITONEAL TUMOUR EXCISION 25000 31250 37500 42190 46880 54690 DRAINAGE MULIPLE INTRA ABDOMINAL SURPRU0004 17000 21250 25500 28690 31880 37190 COLLECT

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CODE.NO SERVICE NAME AMOUNT SURPRU0005 RETROPERITONEAL DRAINAGE OF ABSCESS 18000 22500 27000 30380 33750 39380 SURPRU0006 MESENTERIC CYST EXCISION 20000 25000 30000 33750 37500 43750 SURPRU0007 UMBILICAL ADENOMA EXCISION 8000 10000 12000 13500 15000 17500 SURPRU0015 URACAL CYST/FISTULA EXCISION-OPEN 14000 17500 21000 23630 26250 30630 SURPRU0008 EXCISION OF DESMOID TUMOUR 15000 18750 22500 25310 28130 32810 SURPRU0009 ABDOMINAL WALL TUMOUR EXCISION-LARGE 14000 17500 21000 23630 26250 30630

SURPRU0016 ABDOMINAL WALL TUMOUR EXCISION- SMALL 10000 12500 15000 16880 18750 21880 SURPRU0010 BURST ABDOMEN REPAIR 12000 15000 18000 20250 22500 26250 SURPRU0011 OMENTECTOMY 17000 21250 25500 28690 31880 37190 SURPRU0012 RESUTURING OF ABDOMEN-LARGE 12000 15000 18000 20250 22500 26250 SURPRU0017 RESUTURING OF ABDOMEN-SMALL 8000 10000 12000 13500 15000 17500 SURPRU0018 LAP / OPEN MESENTRIC LYMPHNODE BIOPSI 7000 8750 10500 11810 13130 15310 SURLAP0013 LAP. ADHESIOLYSIS 18000 22500 27000 30380 33750 39380 SURPRU0013 LAP. REDUCTION OF INTUSSUSCEPTION 16000 20000 24000 27000 30000 35000 SURLAP0007 DIAGNOSTIC LAPAROSCOPY 10000 12500 15000 16880 18750 21880 SURLAP0019 LAP. DRAINGE OF INTRA ABD ABSCESS/COLL. 18000 22500 27000 30380 33750 39380

SURLAP0022 DIAGNOSTIC LAPAROSCOPY WITH BIOPSY 15000 18750 22500 25310 28130 32810 SURLAP0023 LAP. RETROPERITONEAL BIOPSY 18000 22500 27000 30380 33750 39380 SURLAP0033 LAP. OMENTECTOMY 17000 21250 25500 28690 31880 37190 SURLAP0046 LAP.ADHESIOLYSIS/DIVI. OF BAND(MINOR) 13000 16250 19500 21940 24380 28440 SURLAP0040 LAP. EXCISION OMENTAL GROWTH 18000 22500 27000 30380 33750 39380 LAP.RETROPERITONEAL CYST/TUMOUR SURLAP0056 21000 26250 31500 35440 39380 45940 EXCISION SURLAP0057 LAP. EXCISION OF ENTERIC DUPICATION CYST 21000 26250 31500 35440 39380 45940 LAPPRU0008 LAP. PERITONEAL LAVAGE 10000 12500 15000 16880 18750 21880 LAPPRU0011 LAP. DIVISION OF INTRAABNOMINAL BAND 14000 17500 21000 23630 26250 30630 LAP. RETROPERITONEAL DRAINAGE OF LAPPRU0002 17000 21250 25500 28690 31880 37190 ABCESS LAPPRU0003 LAP. MESENTERIC CYST EXCISION 16000 20000 24000 27000 30000 35000 THORAX SURTHX0001 DECORTICATION 17000 21250 25500 28690 31880 37190 SURTHX0002 PNUEMENECTOMY 25000 31250 37500 42190 46880 54690 SURTHX0003 LOBECTOMY 24000 30000 36000 40500 45000 52500 SURTHX0004 REMOVAL OF MEDIASTINAL TUMOUR 25000 31250 37500 42190 46880 54690 SURMIS0043 THORACOTOMY 14000 17500 21000 23630 26250 30630 THORACOSCOPIC SURGERY SURTHO0001 DIAGNOSTIC THORACOSCOPY 12000 15000 18000 20250 22500 26250 SURTHO0007 THORACOSCOPIC LUNG ABCESS DRAINAGE 18000 22500 27000 30380 33750 39380 SURTHO0002 THORACOSCOPIC DECORTICATION 18000 22500 27000 30380 33750 39380 SURTHO0003 THORACOSCOPIC PNUEMENECTOMY 25000 31250 37500 42190 46880 54690 SURTHO0004 THORACOSCOPIC LOBECTOMY 27000 33750 40500 45560 50630 59060 THORACOSCOPIC REMOVAL MEDIASTINAL SURTHO0005 25000 31250 37500 42190 46880 54690 TUMOUR SURTHO0006 DIAGNOSTIC THORACOSCOPY WITH BIOPSY 20000 25000 30000 33750 37500 43750 ENDOCRIONOLOGY SURENC0001 TOTAL THYROIDECTOMY 26450 33060 39680 44630 49590 57860 SURENC0002 SUBTOTAL THYROIDECTOMY 23000 28750 34500 38810 43130 50310 SURENC0003 HEMITHYROIDECTOMY 20700 25880 31050 34930 38810 45280 SURENC0004 THYROID CYST ENUCLEATION 14000 17500 21000 23630 26250 30630 SURENC0005 PARATHYROID ADENOMA EXCISION 21000 26250 31500 35440 39380 45940 PARATHYROIDECTOMY WITH B/L NECK SURENC0006 23000 28750 34500 38810 43130 50310 EXPLORATION SURENC0007 NECK EXPLORATION 14000 17500 21000 23630 26250 30630

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CODE.NO SERVICE NAME AMOUNT SURLAP0037 LAP. ADRENALECTOMY 25000 31250 37500 42190 46880 54690 BREAST SURBRE0001 BREAST LUMP EXCISION-LARGE 9000 11250 13500 15190 16880 19690 SURBRE0008 BREAST LUMP EXCISION-SMALL 6000 7500 9000 10130 11250 13130 SURBRE0009 BREAST ABSCESS DRAINAGE-SMALL 5000 6250 7500 8440 9380 10940 SURBRE0010 BREAST ABSCESS DRAINAGE- LARGE 8000 10000 12000 13500 15000 17500 SURMIS0056 SIMPLE MASTECTOMY 13000 16250 19500 21940 24380 28440 BREAST LUMP EXCISION WITH AXILLARY SURBRE0002 17000 21250 25500 28690 31880 37190 CLEAR SURBRE0003 AXILLARY CLEARANCE 13000 16250 19500 21940 24380 28440 SURBRE0004 MODIFIED RADICAL MASTECTOMY 22000 27500 33000 37130 41250 48130 SURBRE0011 LUMPECTOMY WITH SLNB 22000 27500 33000 37130 41250 48130 SURBRE0005 RADICAL MASTECTOMY 22000 27500 33000 37130 41250 48130 SURBRE0006 GYNACOMASTIA EXCISION B/L 17250 21560 25880 29110 32340 37730 SURBRE0012 GYNACOMASTIA EXCISION U/L 11500 14380 17250 19410 21560 25160 BARIATRIC SURBAR0001 GASTRIC BANDING 25000 31250 37500 42190 46880 54690 SURBAR0003 GASTRIC BY PASS 52000 65000 78000 87750 97500 113750 SURLAP0045 LAPAROSCOPIC SLEEVE GASTRECTOMY 45000 56250 67500 75940 84380 98440 SILS(SINGLE INCISION LAPAROSCOPIC SURGERY LAPSIL0001 LAP. SILS CHOLECYSTECTOMY 25000 31250 37500 42190 46880 54690 LAPSIL0002 LAP. SILS APPENDECTOMY 19000 23750 28500 32060 35630 41560 LAPSIL0003 LAP. SILS HERNIA VENTRAL/UMBLICAL 22000 27500 33000 37130 41250 48130 LAPSIL0004 LAP. SILS FEMORAL HERNIA REPAIR 22000 27500 33000 37130 41250 48130 LAPSIL0005 LAP. SILS INGUINAL HERNIOPLASTY – U/LL 20000 25000 30000 33750 37500 43750 LAPSIL0006 LAP. SILS INGUINAL HERNIOPLASTY – B/L 26000 32500 39000 43880 48750 56880 MISC: LAPAROSCOPIC SURGERY LAPPRU0005 LAP. EXCISION OF DESMOID TUMOR 15000 18750 22500 25310 28130 32810 SURLAP0035 LAP. REMOVAL OF URACHAL CYST 16000 20000 24000 27000 30000 35000 LAPPRU0012 LAP. VARICOCELECTOMY U/L 15000 18750 22500 25310 28130 32810 LAPPRU0007 LAP. VERICOCELECTOMY B/L 18000 22500 27000 30380 33750 39380 MISCELLANEOUS SURPEA0001 ABSCESS DRAINAGE - LARGE 6000 7500 9000 10130 11250 13130 SURPEA0002 ABSCESS DRAINAGE - MEDIUM 4500 5630 6750 7590 8440 9840 SURPEA0003 ABSCESS DRAINAGE - SMALL 3000 3750 4500 5060 5630 6560 SURPEA0004 ASCITIC TAPPING 2000 2500 3000 3380 3750 4380 SURMIS0007 C.P.E. WITH J.J. STENT REMOVAL 4000 5000 6000 6750 7500 8750 SURPEA0007 CATHETERIZATION 2000 2500 3000 3380 3750 4380 SURURO0154 CHEMOPORT INSERTION 16000 20000 24000 27000 30000 35000 GOLD ANCHOR FIDUCIAL MARKER SURURO0238 16000 20000 24000 27000 30000 35000 IMPLANTATION SURURO0239 MULTIPLE PENIE WART EXCISION 16000 20000 24000 27000 30000 35000 SURMIS0065 CHEMOPORT REMOVAL 7500 9380 11250 12660 14060 16410 SURMIS0060 CORN REMOVAL - MULTIPLE 4000 5000 6000 6750 7500 8750 SURMIS0061 CORN REMOVAL - SINGLE 2500 3130 3750 4220 4690 5470 SURPEA0005 CYST ASPIRATION - DEEP 3000 3750 4500 5060 5630 6560 SURPEA0006 CYST ASPIRATION - SMALL 2000 2500 3000 3380 3750 4380 SURMIS0008 DEBRIDEMENT (MAJOR) 12000 15000 18000 20250 22500 26250 SURMIS0019 DEBRIDEMENT (MEDIUM) 6000 7500 9000 10130 11250 13130 SURMIS0062 DEBRIDEMENT (MINOR) 3500 4380 5250 5910 6560 7660 SURPEA0010 DRESSING - MEDIUM 3000 3750 4500 5060 5630 6560 SURPEA0011 DRESSING - SMALL 1000 1250 1500 1690 1880 2190 SURPEA0009 DRESSING LARGE 4000 5000 6000 6750 7500 8750 SURPEA0028 EAR LOBULE REPAIR B/L 6000 7500 9000 10130 11250 13130 SURPEA0027 EAR LOBULE REPAIR U/L 3500 4380 5250 5910 6560 7660 SURPEA0012 ELECTRO CAUTERIZATION 3000 3750 4500 5060 5630 6560 SURMIS0009 EPIDURAL CATHERIZATION 4000 5000 6000 6750 7500 8750 SURMIS0050 EXCISION BRANCHIAL CYST / FISTULA 13000 16250 19500 21940 24380 28440 SURMIS0051 EXCISION OF CARBUNCLE 11000 13750 16500 18560 20630 24060 SURPEA0013 EXCISION OF LARGE SUPERFICIAL TUMOUR 10000 12500 15000 16880 18750 21880

SURPEA0014 EXCISION OF SMALL SUPERFICIAL TUMOUR 5000 6250 7500 8440 9380 10940

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CODE.NO SERVICE NAME AMOUNT SURPEA0036 FACE WOUND REPAIR - MEDIUM 7000 8750 10500 11810 13130 15310 SURPEA0035 FACE WOUND REPAIR - MINOR 4000 5000 6000 6750 7500 8750 SURMIS0010 LIPOMA EXCISION (LARGE) 10000 12500 15000 16880 18750 21880 SURMIS0071 LIPOMA EXCISION (MEDIUM) 8000 10000 12000 13500 15000 17500 SURMIS0072 LIPOMA EXCISION (SMALL) 4000 5000 6000 6750 7500 8750 SURMIS0014 SEBACEOUS CYST - SINGLE 6000 7500 9000 10130 11250 13130 SURMIS0052 SEBACEOUS CYST - MULTIPLE 10000 12500 15000 16880 18750 21880 SURMIS0015 INGROWING TOE-NAIL U/L 4000 5000 6000 6750 7500 8750 SURPEA0015 INGROWING TOE-NAIL B/L 7000 8750 10500 11810 15310 SURMIS0016 SKIN BIOPSY 3000 3750 4500 5060 5630 6560 SURMIS0017 MINOR SURGERY PROCEDURES 2200 2750 3300 3710 4130 4810 SURMIS0021 FLEXIBLE BRONCOSCOPY 7000 8750 10500 11810 13130 15310 SURMIS0027 RELEASE OF TONGUE TIE 3000 3750 4500 5060 5630 6560 ULTRASOUND GUIDED LIVER ABSCESS SURMIS0029 5000 6250 7500 8440 9380 10940 ASPIRATI SURMIS0034 INCISION AND DRAINAGE (LARGE) 7000 8750 10500 11810 13130 15310 SURMIS0074 INCISION AND DRAINAGE (SMALL) 4000 5000 6000 6750 7500 8750 SURMIS0037 SUTURING / RESUTURING (SMALL) 3000 3750 4500 5060 5630 6560 SURMIS0038 SUTURING / RESUTURING (MEDIUM) 5000 6250 7500 8440 9380 10940 SURMIS0039 SUTURING / RESUTURING ( LARGE) 7000 8750 10500 11810 13130 15310 SURMIS0041 INGUINAL EXPLORATION 7000 8750 10500 11810 13130 15310 SURMIS0045 FACET JOINT BLOCK 2000 2500 3000 3380 3750 4380 SURMIS0046 PERM-CATH PLACEMENT 9000 11250 13500 15190 16880 19690 SURMIS0047 PERMA CATH REMOVAL 3000 3750 4500 5060 5630 6560 SURMIS0053 THYROGLOSSAL CYST/FISTULA EXCISION 18000 22500 27000 30380 33750 39380 SURMIS0054 SUBMANDIBULAR DUCT CALCULUS REMOVAL 7000 8750 10500 11810 13130 15310 SCALENOTOMY FOR SCALENOUS ANTICUS SURMIS0055 10000 12500 15000 16880 18750 21880 SYNDRO SURMIS0057 ILEAC GRAFTING 34000 42500 51000 57380 63750 74380 SURMIS0059 ICD INSERTION 5000 6250 7500 8440 9380 10940 SURMIS0063 LUMP EXCISION 4000 5000 6000 6750 7500 8750 SURMIS0075 LUMP EXCISION (LARGE) 6000 7500 9000 10130 11250 13130 SURMIS0064 FOREIGN BODY REMOVAL 6000 7500 9000 10130 11250 13130 SURPEA0008 ICD DRESSING 2000 2500 3000 3380 3750 4380 SURPEA0016 LIVER ABCESS ASPIRATION 6500 8130 9750 10970 12190 14220 SURPEA0017 LIVER ABCESS ASPIRATION - MULTIPLE 5500 6880 8250 9280 10310 12030 SURPEA0019 LYMPH NODE BIOPSY - DEEP 6900 8630 10350 11640 12940 15090 SURPEA0020 LYMPH NODE BIOPSY - SUPERFICIAL 5750 7190 8630 9700 10780 12580 SURPEA0022 PLEURAL TAPPING - THERAPEUTIC 5000 6250 7500 8440 9380 10940 SURPEA0023 PREAURICULAR TAGS EXCISION U/L 6000 7500 9000 10130 11250 13130 SURPEA0024 PREAURICULAR TAGS EXCISION B/L 8000 10000 12000 13500 15000 17500 SURPEA0030 TROCAR CYSTOTOMY 4000 5000 6000 6750 7500 8750 SURPEA0031 TUBE DRAINAGE : EMPYEMA/PNEUMOTHORAX 5000 6250 7500 8440 9380 10940 SURPEA0032 URETHRAL DILATATAION 5500 6880 8250 9280 10310 12030 SURPEA0033 VENESECTION 4000 5000 6000 6750 7500 8750 SURPEA0034 WEDGE BIOPSY 3000 3750 4500 5060 5630 6560 SURPEA0037 WOUND REPAIR - MEDIUM OTHER THEN FACE 10000 12500 15000 16880 18750 21880

SURPEA0038 WOUND REPAIR - MINOR OTHER THEN FACE 6000 7500 9000 10130 11250 13130 SURPEA0039 MISC MINOR PROCEDURE 3000 3750 4500 5060 5630 6560 SURMIS0076 AMPUTATION OF TOES 6000 7500 9000 10130 11250 13130 SURMIS0077 DERMOID CYST EXCISION 8000 10000 12000 13500 15000 17500 EXCISION MULTIPLE SCROTALSABEACEOUS SURMIS0078 7000 8750 10500 11810 13130 15310 CYST SURMIS0079 EXCISION OF SCROTAL SABEACEOUS CYST 4000 5000 6000 6750 7500 8750

SURMIS0080 EXCISION OF SMALL SUPERFICIAL TUMOUR 8000 10000 12000 13500 15000 17500 SURMIS0081 C.V.P. LINES 2500 3130 3750 4220 4690 5470 SURMIS0082 C.V.P. LINES ULTRASOUND GUIDED 3000 3750 4500 5060 5630 6560 SURMIS0068 SKIN GRAFTING (SMALL) 6000 7500 9000 10130 11250 13130

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CODE.NO SERVICE NAME AMOUNT SURMIS0069 SKIN GRAFTING (MEDIUM) 15000 18750 22500 25310 28130 32810 SURMIS0070 SKIN GRAFTING (LARGE) 24000 30000 36000 40500 45000 52500 SURMIS0084 SOFT TISSUE TUMOR EXCISION <5 CM 3000 3750 4500 5060 5630 6560 SURMIS0085 SOFT TISSUE TUMOR EXCISION >5 CM 10000 12500 15000 16880 18750 21880 SURMIS0086 SOFT TISSUE TUMOR EXCISION MULTIPLE >2 15000 18750 22500 25310 28130 32810 SURMIS0087 EXPLORATION OF WOUND SMALL 2000 2500 3000 3380 3750 4380 SURMIS0088 EXPLORATION OF WOUND LARGE 7000 8750 10500 11810 13130 15310 SURMIS0089 LOCAL FLAP RECONSTRUCTION SMALL 4000 5000 6000 6750 7500 8750 SURMIS0090 LOCAL FLAP RECONSTRUCTION LARGE 12000 15000 18000 20250 22500 26250 SURMIS0091 MANUAL REMOVAL OF IMPACTED FECOLITH 1500 1880 2250 2530 2810 3280 SURMIS0092 VAC THERAPY (SMALL) 1500 1880 2250 2530 2810 3280 SURMIS0093 VAC THERAPY (MEDIUM) 2500 3130 3750 4220 4690 5470 SURMIS0094 VAC THERAPY (LARGE) 6000 7500 9000 10130 11250 13130 LAPGIS0001 LAP. SUGAR BAKERS SURGERY 24000 30000 36000 40500 45000 52500 SURGIS0004 COMPONENT SEPARATION 30000 37500 45000 50630 56250 65630 SURPLS0002 ABDOMINOPLASTY 25000 31250 37500 42190 46880 54690 UNIT : ONCOLOGY BREAST ONCOLOGY ONCSUR0055 BREAST CONSERVATION SURGERY 21000 26250 31500 35440 39380 45940 ONCSUR0145 LUMPECTOMY 15000 18750 22500 25310 28130 32810 ONCSUR0056 SIMPLE MASTECTOMY 18000 22500 27000 30380 33750 39380 ONCSUR0057 RADICAL/ MODIFIED RADICAL MASTECTOMY 28000 35000 42000 47250 52500 61250 ONCSUR0187 MASTECTOMY ( ONCO) 25000 31250 37500 42190 46880 54690 ONCSUR0058 AXILLARY LN DISSECTION-UNILATERAL 15000 18750 22500 25310 28130 32810 ONCSUR0123 AXILLARY MASS EXCISION 25000 31250 37500 42190 46880 54690 ONCSUR0059 EXCISION BIOPSY 12000 15000 18000 20250 22500 26250 ONCSUR0060 BCS (LUMPECTOMY+AXILLARY LN) 30000 37500 45000 50630 56250 65630 ONCSUR0131 MICRO DOCHECTOMY BREAST 18000 22500 27000 30380 33750 39380 ONCSUR0132 HADFIELD'S SURGERY BREAST 20000 25000 30000 33750 37500 43750 ONCSUR0138 TRUCUT BIOSPY 2500 3130 3750 4220 4690 5470 ONCSUR0139 WIDE LOCAL EXCISION (SMALL) 12000 15000 18000 20250 22500 26250 ONCSUR0140 WIDE LOCAL EXCISION (LARGE) 25000 31250 37500 42190 46880 54690 ONCSUR0141 EXTRA LARGE SOFT TISSUE TUMOR 25000 31250 37500 42190 46880 54690 ONCSUR0143 MAMMOPLASTY (LEVEL I) 12000 15000 18000 20250 22500 26250 ONCSUR0144 MAMMOPLASTY (LEVEL II) 15000 18750 22500 25310 28130 32810 GENITO-URINARY ONCOLOGY LAP NEPHRECTOMY-PARTIAL/NEPHRON ONCSUR0003 49500 61880 74250 83530 92810 108280 SPARING ONCSUR0067 ORCHIECTOMY-UNI 11000 13750 16500 18560 20630 24060 ONCSUR0146 NEPHRECTOMY-PARTIAL/NEPHRON SPARING 44000 55000 66000 74250 82500 96250 ONCSUR0004 LAP CYSTECTOMY-RADICAL 63250 79060 94880 106730 118590 138360 ONCSUR0147 CYSTECTOMY-RADICAL 49500 61880 74250 83530 92810 108280 ONCSUR0005 LAP RETROPERITONEAL LN DISSECTION 40000 50000 60000 67500 75000 87500 ONCSUR0148 RETROPERITONEAL LN DISSECTION 30000 37500 45000 50630 56250 65630 ONCSUR0006 LAP ADRENALECTOMY-UNILATERAL 40000 50000 60000 67500 75000 87500 ONCSUR0149 ADRENALECTOMY-UNILATERAL 35000 43750 52500 59060 65630 76560 ONCSUR0007 LAP NEPHRECTOMY-RADICAL 40000 50000 60000 67500 75000 87500 ONCSUR0150 NEPHRECTOMY-RADICAL 35000 43750 52500 59060 65630 76560 ONCSUR0008 LAP CYSTECTOMY-PARTIAL 30000 37500 45000 50630 56250 65630 ONCSUR0151 CYSTECTOMY-PARTIAL 27000 33750 40500 45560 50630 59060 PENECTOMY+B/L INGUINAL BLOCK ONCSUR0061 30000 37500 45000 50630 56250 65630 DISSECTION ONCSUR0062 ILIO-INGUINAL LN DISSECTION BILATERAL 25000 31250 37500 42190 46880 54690 ONCSUR0063 INGUINAL LN DISSECTION-BILATERAL 25000 31250 37500 42190 46880 54690 ONCSUR0064 ILIO-INGUINAL LN DISSECTION UNILATERAL 20000 25000 30000 33750 37500 43750 ONCSUR0065 INGUINAL LN DISSECTION-UNILATERAL 18000 22500 27000 30380 33750 39380 ONCSUR0152 ORCHIECTOMY-UNILATERAL 10000 12500 15000 16880 18750 21880 ONCSUR0066 ORCHIECTOMY-BILATERAL 15000 18750 22500 25310 28130 32810

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CODE.NO SERVICE NAME AMOUNT ONCSUR0153 RADICAL CYSTECTOMY WITH ILEAL CONDUIT 55000 68750 82500 92810 103130 120310 LAP RADICAL CYSTECTOMY WITH ILEAL ONCSUR0154 60500 75630 90750 102090 113440 132340 CONDUIT RADICAL CYSTOPROSTATECTOMY WITH ONCSUR0155 66000 82500 99000 111380 123750 144380 ILEAL CONDUIT G.I ONCOLOGY ONCSUR0068 RETROPERITONEAL TUMOR EXCISION-LARGE 50000 62500 75000 84380 93750 109380 ONCSUR0156 SURGERY BY LAPAROSCOPY 15000 18750 22500 25310 28130 32810 LAP COLECTOMY-TOTAL/RADICAL WITH END ONCSUR0020 45000 56250 67500 75940 84380 98440 ILEOSTOMY ONCSUR0069 COLECTOMY-TOTAL/RADICAL 35000 43750 52500 59060 65630 76560 DIAGNOSTIC LAPAROSCOPY WITH ONCSUR0070 20000 25000 30000 33750 37500 43750 ADHESIOLYSIS ONCSUR0009 LAP ESOPHAGECTOMY-TRANS THORACIC 75000 93750 112500 126560 140630 164060 ONCSUR0157 ESOPHAGECTOMY-TRANS THORACIC 60000 75000 90000 101250 112500 131250 LAP WHIPPLES PANCREATICO- ONCSUR0010 75000 93750 112500 126560 140630 164060 DUODENECTOMY ONCSUR0158 WHIPPLES PANCREATICO-DUODENECTOMY 65000 81250 97500 109690 121880 142190 ONCSUR0012 LAP GASTRECTOMY-TOTAL + D2 45000 56250 67500 75940 84380 98440 ONCSUR0013 LAP ESOPHAGECTOMY-TRANS HIATAL 50000 62500 75000 84380 93750 109380 ONCSUR0188 LAP GASTROJEJUNOSTOMY 30000 37500 45000 50630 56250 65630 ONCSUR0189 LAP APR 50000 62500 75000 84380 93750 109380 ONCSUR0190 ABDOMINO PERINEAL RESECTION 45000 56250 67500 75940 84380 98440 ONCSUR0159 ESOPHAGECTOMY-TRANS HIATAL 45000 56250 67500 75940 84380 98440 ONCSUR0014 LAP RADICAL CBD EXCISION 55000 68750 82500 92810 103130 120310 ONCSUR0160 RADICAL CBD EXCISION 45000 56250 67500 75940 84380 98440 LAP GASTRECTOMY-SUBTOTAL + ONCSUR0016 45000 56250 67500 75940 84380 98440 D2/PALLIATIVE ONCSUR0161 GASTRECTOMY-SUBTOTAL + D2/PALLIATIVE 35000 43750 52500 59060 65630 76560

ONCSUR0017 LAP TOTAL PANCREATICO-DUODENECTOMY 70000 87500 105000 118130 131250 153130 ONCSUR0162 TOTAL PANCREATICO-DUODENECTOMY 60000 75000 90000 101250 112500 131250 ONCSUR0021 LAP HEPATECTOMY-RIGHT/LEFT 65000 81250 97500 109690 121880 142190 ONCSUR0163 HEPATECTOMY-RIGHT/LEFT 55000 68750 82500 92810 103130 120310 ONCSUR0164 LIVER TUMOR WIDE EXCISION ( 2-4 ) 45000 56250 67500 75940 84380 98440 ONCSUR0023 LAP GASTRECTOMY-DISTAL RADICAL + D2 45000 56250 67500 75940 84380 98440 ONCSUR0165 GASTRECTOMY-DISTAL RADICAL + D2 40000 50000 60000 67500 75000 87500 ONCSUR0024 LAP COLECTOMY-EXTENDED RIGHT/LEFT 35000 43750 52500 59060 65630 76560 ONCSUR0166 COLECTOMY-EXTENDED RIGHT/LEFT 30000 37500 45000 50630 56250 65630 ONCSUR0025 LAP ANTERIOR RESECTION (LAR) 45000 56250 67500 75940 84380 98440 ONCSUR0167 ANTERIOR RESECTION (LAR) 40000 50000 60000 67500 75000 87500 LAP COLECTOMY- ONCSUR0026 30000 37500 45000 50630 56250 65630 RIGHT/LEFT/TRANSVERSE/SIGMOID COLECTOMY- ONCSUR0168 25000 31250 37500 42190 46880 54690 RIGHT/LEFT/TRANSVERSE/SIGMOID ONCSUR0028 LAP DIAGNOSTIC LAPAROSCOPY & BIOPSY 20000 25000 30000 33750 37500 43750 ONCSUR0169 ILEOSTOMY- DIVERSION OR END 15000 18750 22500 25310 28130 32810 ONCSUR0032 LAP COLOSTOMY-DIVERSION/END 18000 22500 27000 30380 33750 39380 ONCSUR0170 COLOSTOMY-DIVERSION/END 15000 18750 22500 25310 28130 32810 ONCSUR0033 LAP DISTAL PARTIAL PANCREATECTOMY 35000 43750 52500 59060 65630 76560 LAP HEPATECTOMY ONCSUR0011 55000 68750 82500 92810 103130 120310 RIGHT/LEFT/CENTRAL/COMPLEX LAP RADICAL CHOLE-COMPLETION+CBD ONCSUR0015 50000 62500 75000 84380 93750 109380 EXCISION ONCSUR0171 RADICAL CHOLE-COMPLETION+CBD EXCISION 45000 56250 67500 75940 84380 98440

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CODE.NO SERVICE NAME AMOUNT ONCSUR0018 LAP RADICAL CHOLECYSTECTOMY-UPFRONT 40000 50000 60000 67500 75000 87500 ONCSUR0172 RADICAL CHOLECYSTECTOMY 40000 50000 60000 67500 75000 87500 ONCSUR0191 BILATERAL OOPHORECTOMY 25000 31250 37500 42190 46880 54690 ONCSUR0192 LAP TOTAL HYSTERECTOMY 30000 37500 45000 50630 56250 65630 LAP RADICAL CHOLECYSTECTOMY- ONCSUR0019 35000 43750 52500 59060 65630 76560 COMPLETION LAP RESECTION ANASTAMOSIS SMALL BOWEL ONCSUR0027 28000 35000 42000 47250 52500 61250 TUMOR RESECTION ANASTAMOSIS SMALL BOWEL ONCSUR0173 25000 31250 37500 42190 46880 54690 TUMOR ONCSUR0029 LAP HEPATECTOMY-WIDE LOCAL EXCISION 18000 22500 27000 30380 33750 39380

ONCSUR0030 LAP GASTRECTOMY-WEDGE/BYEPASS GJ 18000 22500 27000 30380 33750 39380 SURPRU0002 EXPLORATORY LAPAROTOMY 16000 20000 24000 27000 30000 35000 SURPRU0011 OMENTECTOMY 17000 21250 25500 28690 31880 37190 GYNEC ONCOLOGY ONCSUR0034 LAP TOTAL PELVIC EXENTERATION 55000 68750 82500 92810 103130 120310 ONCSUR0174 TOTAL PELVIC EXENTERATION 50000 62500 75000 84380 93750 109380 ONCSUR0035 LAP RADICAL HYSTERECTOMY 50000 62500 75000 84380 93750 109380 ONCSUR0182 RADICAL HYSTERECTOMY 45000 56250 67500 75940 84380 98440 TAH+BSO+OMENTECTOMY+TOTAL ONCSUR0175 70000 87500 105000 118130 131250 153130 PERITONECTOMY LAP SUPRA LEVATOR/ POSTERIOR ONCSUR0037 50000 62500 75000 84380 93750 109380 EXENTERATION ONCSUR0176 SUPRA LEVATOR/ POSTERIOR EXENTERATION 40000 50000 60000 67500 75000 87500 ONCSUR0038 LAP ANTERIOR EXENTERATION 45000 56250 67500 75940 84380 98440 ONCSUR0177 ANTERIOR EXENTERATION 35000 43750 52500 59060 65630 76560 ONCSUR0039 LAP URINARY CONDUIT / ILEAL POUCH 35000 43750 52500 59060 65630 76560 ONCSUR0178 URINARY CONDUIT / ILEAL POUCH 30000 37500 45000 50630 56250 65630 ONCSUR0179 OVARIAN LAPAROTOMY 48000 60000 72000 81000 90000 105000 ONCSUR0040 LAP RADICAL TRACHELECTOMY 35000 43750 52500 59060 65630 76560 ONCSUR0041 LAP PELVIC LN DISSECTION-BILATERAL 30000 37500 45000 50630 56250 65630 ONCSUR0042 LAP PARA-AORTIC LN DISSECTION 25000 31250 37500 42190 46880 54690 LAP TAH+BSO+OMENTECTOMY+PERITONEAL ONCSUR0043 30000 37500 45000 50630 56250 65630 BIOPSY TAH+BSO+OMENTECTOMY+PARA AORTIC LN ONCSUR0180 56000 70000 84000 94500 105000 122500 SAMPLING LAPAROSCOPY ASSISTED MALIGNANT TUMOR ONCSUR0181 40000 50000 60000 67500 75000 87500 SURGERY ONCSUR0044 LAP PELVIC LN DISSECTION-UNILATERAL 18000 22500 27000 30380 33750 39380 ONCSUR0045 LAP TAH+BSO 18000 22500 27000 30380 33750 39380 ONCSUR0046 LAP COMPLETION OMENTECTOMY 16000 20000 24000 27000 30000 35000 ONCSUR0047 LAP URINARY CONDUIT-ILEAL CONDUIT 20000 25000 30000 33750 37500 43750 ONCSUR0048 LAP U/L SALPINGO OOPHERECTOMY 15000 18750 22500 25310 28130 32810 ONCSUR0071 CRS +TOTAL PERITONECTOMY + HIPEC 100000 125000 150000 168750 187500 218750 ONCSUR0072 CRS+ TOTAL PERITONECTOMY 60000 75000 90000 101250 112500 131250 ONCSUR0073 CRS-SECONDARY/RECURRENT DISEASE 50000 62500 75000 84380 93750 109380 VULVECTOMY/VAGINECTOMY- ONCSUR0074 35000 43750 52500 59060 65630 76560 RADICAL/MODIFIED ONCSUR0075 VULVECTOMY-WIDE LOCAL EXCISION 15000 18750 22500 25310 28130 32810 HEAD & NECK ONCOLOGY COMMANDO WITH FREE FLAP ONCSUR0076 75000 93750 112500 126560 140630 164060 RECONSTRUCTION COMMANDO SURGERY WITH NECK ONCSUR0183 40000 50000 60000 67500 75000 87500 DISSECTION ONCSUR0184 COMPOSITE RESECTION 50000 62500 75000 84380 93750 109380 SURMIS0040 SUBMANDIBULAR GLAND EXCISION 16000 20000 24000 27000 30000 35000 MARGINAL MANDIBULECTOMY WITH NECK ONCSUR0185 45000 56250 67500 75940 84380 98440 DISSECTION ONCSUR0142 SUBTOTAL GLOSSECTOMY 25000 31250 37500 42190 46880 54690

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CODE.NO SERVICE NAME AMOUNT SURENT0137 PARTIAL GLOSSECTOMY 20000 25000 30000 33750 37500 43750 TOTAL GLOSSECTOMY WITH NECK ONCSUR0186 60000 75000 90000 101250 112500 131250 DISSECTION TOTAL LARYNGOPHARYNGECTOMY +FREE ONCSUR0077 60000 75000 90000 101250 112500 131250 FLAP ONCSUR0078 COMMANDO +FREE FLAP + NECK DISSECTION 70000 87500 105000 118130 131250 153130 COMPOSITE RESECTION WITH ITF ONCSUR0079 60000 75000 90000 101250 112500 131250 CLEARANCE TOTAL ONCSUR0080 50000 62500 75000 84380 93750 109380 LARYNGOPHARYNGECTOMY+PEDICLED FLAP

ONCSUR0081 COMMANDO + FLAP + B/L NECK DISSECTION 50000 62500 75000 84380 93750 109380 LARYNGECTOMY-PARTIAL + NECK ONCSUR0082 45000 56250 67500 75940 84380 98440 DISSECTION ONCSUR0083 COMMANDO + FLAP + U/L NECK DISSECTION 45000 56250 67500 75940 84380 98440 ONCSUR0084 SKIN COVER WITH FREE FLAP 45000 56250 67500 75940 84380 98440 ONCSUR0085 FACE SCALP TUMOR WLE +FREE FLAP 45000 56250 67500 75940 84380 98440 ONCSUR0086 COMMANDO + U/L NECK DISSECTION 40000 50000 60000 67500 75000 87500 LARYNGECTOMY-TOTAL WITH NECK ONCSUR0087 45000 56250 67500 75940 84380 98440 DISSECTION ONCSUR0088 PAROTIDECTOMY-RADICAL 35000 43750 52500 59060 65630 76560 ONCSUR0089 TOTAL THYROIDECTOMY + NECK DESECTION 40000 50000 60000 67500 75000 87500 ONCSUR0090 ORBITAL EXENTERATION 35000 43750 52500 59060 65630 76560 ONCSUR0092 MAXILLECTOMY-TOTAL 40000 50000 60000 67500 75000 87500 ONCSUR0093 THYROIDECTOMY-TOTAL/COMPLETION 35000 43750 52500 59060 65630 76560 ONCSUR0094 PAROTIDECTOMY-TOTAL NERVE SPARING 35000 43750 52500 59060 65630 76560

ONCSUR0095 RADICAL/MODIFIED NECK DISSECTION-B/L 35000 43750 52500 59060 65630 76560 ONCSUR0096 THYROIDECTOMY-SUB TOTAL 28000 35000 42000 47250 52500 61250 EYELID TUMOR EXCISION + ONCSUR0097 21000 26250 31500 35440 39380 45940 RECONSTRUCTION ONCSUR0098 PARATHYROIDECTOMY 20000 25000 30000 33750 37500 43750 ONCSUR0099 PAROTIDECTOMY-SUPERFICIAL 25000 31250 37500 42190 46880 54690 ONCSUR0100 RADICAL/MODIFIEDNECK DISSECTION-U\L 25000 31250 37500 42190 46880 54690 LIP TUMOR EXCISION WITH ONCSUR0101 18000 22500 27000 30380 33750 39380 RECONSTRUCTION ONCSUR0102 MAXILLECTOMY-PARTIAL 20000 25000 30000 33750 37500 43750 ONCSUR0103 THYROID LOBECTOMY/HEMITHYROIDECTOMY 20000 25000 30000 33750 37500 43750

ONCSUR0104 SKIN COVER WITH PEDICLED/RANDOM FLAP 15000 18750 22500 25310 28130 32810 ONCSUR0105 FACE/SCALP WLE-PEDICLED FLAP 15000 18750 22500 25310 28130 32810 ONCSUR0106 NECK REXPLORATION 12000 15000 18000 20250 22500 26250 ONCSUR0107 FACE/SCALP TUMOR WLE PRIMARY CLOSURE 12000 15000 18000 20250 22500 26250 LIP TUMOR EXCISION WITH PRIMARY ONCSUR0108 15000 18750 22500 25310 28130 32810 CLOSURE ONCSUR0109 LN BIOPSY-SUPERFICIAL 5000 6250 7500 8440 9380 10940 ONCSUR0110 TARSORRAPHY-PERMANENT 5000 6250 7500 8440 9380 10940 SOFT TISSUE TUMORS ONCOLOGY LIMB SALVAGE +FREE FLAP/TENDON ONCSUR0118 75000 93750 112500 126560 140630 164060 TRANSFER ONCSUR0119 HEMIPELVECTOMY 55000 68750 82500 92810 103130 120310 ONCSUR0120 WLE SUPERFICIAL TUMOR + FREE FLAP 45000 56250 67500 75940 84380 98440 ONCSUR0121 SOFT TISSUE TUMOR EXCISION-LARGE- 35000 43750 52500 59060 65630 76560 ONCSUR0122 AMPUTATION-FORE/HIND QUARTER 30000 37500 45000 50630 56250 65630 ONCSUR0124 DISARTICULATION/AMPUTATION KNEE/ELBOW 25000 31250 37500 42190 46880 54690 ONCSUR0125 STS WLE MEDIUM/PERIPHERAL 17000 21250 25500 28690 31880 37190

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CODE.NO SERVICE NAME AMOUNT ONCSUR0126 WLE SUPERFICIAL TUMOR + PEDICLED FLAP 15000 18750 22500 25310 28130 32810 ONCSUR0127 AMPUTATION-RAY/DIGIT 12000 15000 18000 20250 22500 26250 ONCSUR0128 STS WLE SMALL/PERIPHERAL 10000 12500 15000 16880 18750 21880 ONCSUR0129 WEDGE BIOPSY SUPERFICIAL 3000 3750 4500 5060 5630 6560 THORACIC ONCOLOGY ONCSUR0193 THORACOTOMY WITH PNEUMONECTOMY 55000 68750 82500 92810 103130 120310 ONCSUR0194 THORACOTOMY WITH LOBECTOMY 65000 81250 97500 109690 121880 142190 ONCSUR0195 THORACOTOMY WITH BILOBECTOMY 68000 85000 102000 114750 127500 148750 ONCSUR0196 PULMONARY METASTATECTOMY 40000 50000 60000 67500 75000 87500 ONCSUR0049 VATS BILOBECTOMY/LOBECTOMY 65000 81250 97500 109690 121880 142190 ONCSUR0050 VATS MEDIASTINAL TUMOR-LARGE 45000 56250 67500 75940 84380 98440 ONCSUR0051 VATS PNEUMONECTOMY 60000 75000 90000 101250 112500 131250 ONCSUR0052 VATS MEDIASTINAL TUMOR-SMALL/MEDIUM 30000 37500 45000 50630 56250 65630 ONCSUR0053 VATS PLEURODESIS 24000 30000 36000 40500 45000 52500 ONCSUR0054 VATS DIAGNOSTIC THORACOSCOPY & BIOPSY 25000 31250 37500 42190 46880 54690

ONCSUR0130 CHEST WALL/STERNAL TUMOR WLE+RECON 45000 56250 67500 75940 84380 98440 MISCELLANEOUS ONCOLOGY ONCSUR0111 CHEMOPORT INSERTION 16000 20000 24000 27000 30000 35000 ONCSUR0197 CHEMOPORT PLACEMENT (ONCO) 12000 15000 18000 20250 22500 26250 ONCSUR0112 SECONDARY SUTURING-LAPAROTOMY/LARGE 6000 7500 9000 10130 11250 13130 ONCSUR0113 DEBRIDEMENT-LARGE 10000 12500 15000 16880 18750 21880 ONCSUR0114 SECONDARY SUTURING-SMALL 3000 3750 4500 5060 5630 6560 ONCSUR0115 SPLIT THICKNESS SKIN GRAFTING 6000 7500 9000 10130 11250 13130 ONCSUR0116 DEBRIDEMENT-SMALL 4000 5000 6000 6750 7500 8750 ONCSUR0117 CHEMOPORT REMOVAL 5000 6250 7500 8440 9380 10940 NEURO SURGERY SURNEU0001 CRANIOTOMY FOR MULTIPLE ANEURYSM 77800 97250 116700 131288 145875 170382 TRANS ORAL DECOMPRESSION FOR CV SURNEU0002 51700 64625 77550 87244 96938 113223 JUNCTION ANOMALY COMBINED ANTERIOR AND POSTERIOR SURNEU0003 77800 97250 116700 131288 145875 170382 PROCEDURE FOR SPINE ANOMALY SURNEU0004 THERAPEUTIC STEREOTACTIC PROCEDURES 51700 64625 77550 87244 96938 113223 SURNEU0005 SPINAL INTRADURAL TUMOR 42400 53000 63600 71550 79500 92856 SURNEU0006 CRANIOTOMY FOR TRAUMA / BRAIN ABSCESS 51700 64625 77550 87244 96938 113223 SURNEU0007 LAMINECTOMY- CERVICAL/ LUMBAR 36500 45625 54750 61594 68438 79935 SURNEU0008 LAMINECTOMY DECOMPRESSIVE LUMBAR 36500 45625 54750 61594 68438 79935 SURNEU0009 BURR HOLES MULTIPLE 27400 34250 41100 46238 51375 60006 SURNEU0010 CARPAL TUNNEL SYNDROME 14000 17500 21000 23625 26250 30660 SURNEU0011 PERIPHERAL NERVE SURGERY 36500 45625 54750 61594 68438 79935 SURNEU0012 RADIOFREQUENCY RHIZOTOMY 27400 34250 41100 46238 51375 60006 SURNEU0013 CHRONIC SUBDURAL HEMATOMA 27400 34250 41100 46238 51375 60006 SURNEU0014 BURR HOLE SINGLE 4900 6125 7350 8269 9188 10731 SURNEU0015 EXTERNAL VENTRICULAR DRAIN 4900 6125 7350 8269 9188 10731 SURNEU0016 MANIPULATIONS / SKULL TRACTION 4900 6125 7350 8269 9188 10731 SURNEU0017 TRANSSPHEHOIDAL SURGERY 51700 64625 77550 87244 96938 113223 SURNEU0018 VP SHUNT 36500 45625 54750 61594 68438 79935 SURNEU0019 BONE FLAP REMOVAL 36500 45625 54750 61594 68438 79935 SURNEU0020 T P SHUNT 27400 34250 41100 46238 51375 60006 SURNEU0021 DECOMPRESSIVE CRANIOTOMY 51700 64625 77550 87244 96938 113223 SURNEU0022 BRAIN ABSCESS DRAINAGE 36500 45625 54750 61594 68438 79935 SURNEU0023 CRANIOPLASTY 36500 45625 54750 61594 68438 79935 SURNEU0024 SPINAL TUMOR 51700 64625 77550 87244 96938 113223 SURNEU0025 SPINAL DYSRAPHISM (COMPLEX) 51700 64625 77550 87244 96938 113223 SURNEU0026 MICRODISCECTOMY-LUMBAR/CERVICAL 36500 45625 54750 61594 68438 79935 SURNEU0073 DISCECTOMY-LUMBAR/CERVICAL 25000 31250 37500 42188 46875 54750

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CODE.NO SERVICE NAME AMOUNT SURNEU0027 CRANIOTOMY FOR TUMOUR/ANEURYSM/AVM 51700 64625 77550 87244 96938 113223 SURNEU0028 KYPHOPLASTY 36500 45625 54750 61594 68438 79935 SURNEU0029 DEEP BRAIN STIMULATION 77800 97250 116700 131288 145875 170382 LACERATION SUTURING FOR SCALP SURNEU0030 7300 9125 10950 12319 13688 15987 AVULSION SURNEU0031 ICP MONITORING / TWIST DRILL PROCEDURE 4900 6125 7350 8269 9188 10731 SURNEU0032 LACERATION SUTURING (NEURO) 1800 2250 2700 3038 3375 3942 SURNEU0033 NERVE / MUSCLE BIOPSY (NEURO) 1800 2250 2700 3038 3375 3942 SURNEU0034 VENTRICULAR PUNCTURE (NEURO) 1800 2250 2700 3038 3375 3942 SURNEU0035 DEBRIDEMENT (NEURO) 1800 2250 2700 3038 3375 3942 SURNEU0036 SPINAL INSTRUMENTATION 51700 64625 77550 87244 96938 113223 SURNEU0037 SPINAL EXTRAMEDULLARY TUMOR 41000 51250 61500 69188 76875 89790 SPINE SURGERY WITH SIMPLE SURNEU0038 41000 51250 61500 69188 76875 89790 INSTRUMENTATION SURNEU0039 STEREOTACTIC BIOPSY 41000 51250 61500 69188 76875 89790 SURNEU0040 SURGERY FOR SCALP TUMOR 7300 9125 10950 12319 13688 15987 SURNEU0041 BATTERY CHARGE FOR DBS 14000 17500 21000 23625 26250 30660 SURNEU0042 MINI CRANIOTOMY 41000 51250 61500 69188 76875 89790 SURNEU0043 TNTS 51700 64625 77550 87244 96938 113223 COMPLEX MICRODISCECTOMY ( MORE THAN 2 SURNEU0044 51700 64625 77550 87244 96938 113223 LEVELS / OBESE PATIENT /RE-DO) SURNEU0045 CP ANGLE TUMOR 61800 77250 92700 104288 115875 135342 SURNEU0046 VASCULAR SURGERY FOR BRAIN 61800 77250 92700 104288 115875 135342 SPINAL TUMOR DECOMPRESSION WITH SURNEU0047 61800 77250 92700 104288 115875 135342 FIXATION COMPLEX FUSION ( MORE THAN 2 LEVELS / SURNEU0048 61800 77250 92700 104288 115875 135342 OBESE PATIENT /RE-DO) SURNEU0049 SPINAL DYSRAPHISM (SIMPLE) 36500 45625 54750 61594 68438 79935 SURNEU0050 VA SHUNT 36500 45625 54750 61594 68438 79935 SURNEU0072 ENDOSCOPIC VENTRICULOSCOPY 20000 25000 30000 33750 37500 43800 SURNEU0075 FORAMEN MAGNUM DECOMPRESSION 42000 52500 63000 70875 78750 91980 SURNEU0076 ENDOSCOPIC COLLOID CYST REMOVAL 52000 65000 78000 87750 97500 113880 SURNEU0077 ENDOSCOPIC COMPLEX PROCEDURE 72000 90000 108000 121500 135000 157680 ENDOSCOPIC CSF RHINORRHOEA LEAK SURNEU0078 38000 47500 57000 64125 71250 83220 REPAIR SURNEU0079 ENDOSCOPIC DIAGNOSTIC 30000 37500 45000 50625 56250 65700 SURNEU0080 ENDOSCOPIC SPHENOID SINUS SURGERY 38000 47500 57000 64125 71250 83220

SURNEU0081 ENDOSCOPIC VENTRICULAR TUMOR BIOPSY 40000 50000 60000 67500 75000 87600 SURNEU0082 EVD+BURR HOLE 13000 16250 19500 21938 24375 28470 SURNEU0083 ETV(ENDOSCOPIC THIRD VENTRICULOSTOMY 30000 37500 45000 50625 56250 65700 SURNEU0084 NEUROLYSIS 15000 18750 22500 25313 28125 32850 SURNEU0085 NERVE GRAFTING 50000 62500 75000 84375 93750 109500 SURNEU0086 BACLOFEN PUMP INSERTION 30000 37500 45000 50625 56250 65700 SURNEU0087 NERVE / MUSCLE BIOPSY (NEURO) COMPLEX 9000 11250 13500 15188 16875 19710 SURNEU0088 BONE FLAP REMOVAL-INFECTED 20000 25000 30000 33750 37500 43800 SURNEU0089 BRACHIAL PLEXUS INJURY 30000 37500 45000 50625 56250 65700 SURNEU0090 CALVARIAL TUMOR/MASS(EXTRA CRANIAL) 28000 35000 42000 47250 52500 61320

SURNEU0091 CERVICAL/THORACIC/LUMBAR LAMINECTOMY 38000 47500 57000 64125 71250 83220 SURNEU0092 CRANIOPLASTY- COMPLEX 50000 62500 75000 84375 93750 109500 CRANIOTOMY FOR CSF RHINORRHOEA SURNEU0093 40000 50000 60000 67500 75000 87600 REPAIR SURNEU0094 CRANIOTOMY FOR EPILEPSY 52000 65000 78000 87750 97500 113880 SURNEU0095 CRANIOTOMY FOR HEAD INJURY 38000 47500 57000 64125 71250 83220 SURNEU0096 DBS SIMPLE 55000 68750 82500 92813 103125 120450 SURNEU0097 DBS PACE MAKER INSERTION 17000 21250 25500 28688 31875 37230

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CODE.NO SERVICE NAME AMOUNT SURNEU0098 DEEP BRAIN LESIONING 50000 62500 75000 84375 93750 109500 SURNEU0099 DEPRESSED FRACTURE SIMPLE 30000 37500 45000 50625 56250 65700 SURNEU0100 DETETHERING CORD 38000 47500 57000 64125 71250 83220 SURNEU0101 ENCEPHALOCELE 38000 47500 57000 64125 71250 83220 SURNEU0102 GANGLION BLOCK 5000 6250 7500 8438 9375 10950 SURNEU0103 KYPHOPLASTY SIMPLE 25000 31250 37500 42188 46875 54750 SURNEU0104 LACERATION SUTURING COMPLEX 6000 7500 9000 10125 11250 13140 SURNEU0105 LUMBAR DRAIN INSERTION 4000 5000 6000 6750 7500 8760 SURNEU0106 MENINGOMYELOCELE 30000 37500 45000 50625 56250 65700 SURNEU0107 MICROVASCULAR DECOMPRESSION 52000 65000 78000 87750 97500 113880 SURNEU0108 OMMAYA RESERVOIR PLACEMENT 20000 25000 30000 33750 37500 43800 SURNEU0109 ORBITAL TUMOR 42000 52500 63000 70875 78750 91980 SURNEU0110 PLIF 52000 65000 78000 87750 97500 113880 SURNEU0111 POSTERIOR FIXATION (SPINE) 40000 50000 60000 67500 75000 87600 SURNEU0112 PUMP/IPG REPLACEMENT 21000 26250 31500 35438 39375 45990 SURNEU0113 SHUNT REVISION 30000 37500 45000 50625 56250 65700 SURNEU0114 STEREOTAXY DIAGNOSTIC 28000 35000 42000 47250 52500 61320 SURNEU0115 STEM CELL IMPLANTATION 20000 25000 30000 33750 37500 43800 SURNEU0116 STIMULATOR IMPLANTATION 30000 37500 45000 50625 56250 65700 SURNEU0117 STIMULATOR IMPLANTATION-TEMPORARY 15000 18750 22500 25313 28125 32850 SURNEU0118 SYRINGO SUBARACHNOID SHUNT 38000 47500 57000 64125 71250 83220 SURNEU0119 VERTEBROPLASTY MULTIPLE LEVEL 32000 40000 48000 54000 60000 70080 SURNEU0120 CRANIOSYNOSTOSIS 80000 100000 120000 135000 150000 175200 SURNEU0121 HEPATIC VENOGRAPHY TRANSJUGULAR 10000 12500 15000 16875 18750 21900 SURNEU0122 BALLOON TEST OCCLUSION 21000 26250 31500 35438 39375 45990 SURNEU0123 CCF EMBOLISATION 39000 48750 58500 65813 73125 85410 INTRAARTERIAL CHEMO. HEAD & NECK SURNEU0124 48000 60000 72000 81000 90000 105120 TUMOR SURNEU0125 EMBOLISATION SPINAL AV FISTULA COMPLEX 48000 60000 72000 81000 90000 105120 SURNEU0126 FLOW DIVERTOR PLACEMENT 48000 60000 72000 81000 90000 105120 SURNEU0127 INTRACRANIAL ANGIOPLASTY 48000 60000 72000 81000 90000 105120 DSA DORSOLUMABR SPINAL RADICULAR SURNEU0128 18000 22500 27000 30375 33750 39420 ARTERY SURNEU0129 INTRAARTERIAL VASODILATION 15000 18750 22500 25313 28125 32850 SURNEU0130 INTRACRANIAL STENTING IN STROKE 48000 60000 72000 81000 90000 105120 MECHANICAL THROMBECTOMY IN ACUTE SURNEU0131 48000 60000 72000 81000 90000 105120 STROKE SURNEU0132 INTRACRANIAL VENOUS STENTING 39000 48750 58500 65813 73125 85410 SURNEU0133 SIX VESSEL CEREBRAL ANGIOGRAM 18000 22500 27000 30375 33750 39420 COILING COMPLEX ANEURYSM+NECK SURNEU0134 60000 75000 90000 101250 112500 131400 REMODELLIN SURNEU0135 ANGIOPLASTY OF VERTEBRAL ARTERY 42000 52500 63000 70875 78750 91980 SURNEU0136 TIPS 56000 70000 84000 94500 105000 122640 SURNEU0137 MICROCATHETER STUDY UNDER GA 23500 29375 35250 39656 44063 51465 INTERVENTIONAL NEUROLOGY SURNEU0051 INTRAARTERIAL THROMBOLYSIS 32100 40125 48150 54169 60188 70299 SURNEU0052 CAROTID ARTERY STENTING 38100 47625 57150 64294 71438 83439 SURNEU0053 VENOUS THROMBOLYSIS 32100 40125 48150 54169 60188 70299 SURNEU0054 TUMOR EMBOLISATION COMPLEX 38100 47625 57150 64294 71438 83439 SURNEU0055 EMBOLIZATION FOR BLEEDING 41600 52000 62400 70200 78000 91104 CHEMOEMBOLIZATION OF MALIGNANT BRAIN SURNEU0056 49500 61875 74250 83531 92813 108405 TUMOUR INTRA ARTERIAL CHEMOTHERAPY OF BRAIN SURNEU0057 49500 61875 74250 83531 92813 108405 STEM GLIOMAS SURNEU0058 PERIPHERAL ARTERY EMBOLIZATION 20800 26000 31200 35100 39000 45552 SURNEU0059CERBRAL AVM 41600 52000 62400 70200 78000 91104 SURNEU0060 INTRACRANIAL ANEURSYM-SINGLE 41600 52000 62400 70200 78000 91104 SURNEU0061SPINAL AVM 41600 52000 62400 70200 78000 91104 INTRACRANIAL ANGIOPLASTY FOR SURNEU0062 41600 52000 62400 70200 78000 91104 VASOSPASM SURNEU0063 COMPLEX ANEURYSM 49500 61875 74250 83531 92813 108405 SURNEU0064 CHECK ANGIOGRAM 4600 5750 6900 7763 8625 10074 SURNEU0065DSA CEREBRAL 8400 10500 12600 14175 15750 18396

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CODE.NO SERVICE NAME AMOUNT SURNEU0066 SPINAL ANGIOGRAPHY 10600 13250 15900 17888 19875 23214 SURNEU0067 TUMOR EMBOLISATION SIMPLE 22700 28375 34050 38306 42563 49713 SURNEU0068 COMPLEX AVM/AVF TRANSVENOUS APOACH 49500 61875 74250 83531 92813 108405 SURNEU0069 3D ROTATIONAL ANGIOGRAPHY 1400 1750 2100 2363 2625 3066 SURNEU0070DYNA CT 1200 1500 1800 2025 2250 2628 SURNEU0071KYPHOPLASTY 36500 45625 54750 61594 68438 79935 UNIT : E.N.T EAR SURENT0016 MYRINGOPLASTY 25000 31250 37500 42188 46875 54750 SURENT0017 TYMPANOPLASTY 30000 37500 45000 50625 56250 65700 SURENT0020 PRE-AURICULAR SINUS EXCISION 10000 12500 15000 16875 18750 21900 SURENT0023 MYRINGOTOMY U/L 5000 6250 7500 8438 9375 10950 SURENT0042 BONE ANCHORED HEARING AID 30000 37500 45000 50625 56250 65700 SURENT0054 COCHLEAR IMPLANT 60000 75000 90000 101250 112500 131400 DECOMPRESSION OF ENDOLYMPHATIC SURENT0058 50000 62500 75000 84375 93750 109500 SAC/SHUNT SURENT0072 EUM - B/L 3000 3750 4500 5063 5625 6570 SURENT0073 EUM - U/L 2000 2500 3000 3375 3750 4380 SURENT0074 EXCISION OF ACOUSTIC NEUROMA 100000 125000 150000 168750 187500 219000 SURENT0079 EXCISION OF GLOMUS-JUGULARE TUMOUR 100000 125000 150000 168750 187500 219000 SURENT0080 FACIAL NERVE DECOMPRESSION TOTAL 60000 75000 90000 101250 112500 131400 FACIAL NERVE REPAIR SUTURING & SURENT0081 50000 62500 75000 84375 93750 109500 GRAFTING SURENT0100 ABSCESS DRAINAGE PRE & POST AURAL 5000 6250 7500 8438 9375 10950 SURENT0101 MASTOIDECTOMY CORTICAL 20000 25000 30000 33750 37500 43800 SURENT0103 MASTOIDECTOMY WITH ICC 30000 37500 45000 50625 56250 65700 SURENT0109 MEATOPLASTY 10000 12500 15000 16875 18750 21900 SURENT0110 MIDDLE EAR IMPLANT (SOUND BRIDGE) 25000 31250 37500 42188 46875 54750 SURENT0115 MASTOIDECTOMY MODIFIED RADICAL 40000 50000 60000 67500 75000 87600 SURENT0116 MYRINGOPLASTY B/L 40000 50000 60000 67500 75000 87600 SURENT0119 MYRINGOTOMY WITH GROMMET U/L 8000 10000 12000 13500 15000 17520 SURENT0121 MYRINGOTOMY WITH GROMMET B/L 10000 12500 15000 16875 18750 21900 SURENT0132 OSSICULOPLASTY 25000 31250 37500 42188 46875 54750 SURENT0152 STAPEDECTOMY 25000 31250 37500 42188 46875 54750 TUMOUR EXT.AUDITORY CANAL-LARGE SURENT0191 20000 25000 30000 33750 37500 43800 EXCISION TUMOUR EXT.AUDITORY CANAL-SMALL SURENT0192 10000 12500 15000 16875 18750 21900 EXCISION EXAMINATION&REMOVAL POLY/GRANULATION SURENT0203 7500 9375 11250 12656 14063 16425 EAR NOSE SURENT0006 SEPTOPLASTY 15000 18750 22500 25313 28125 32850 SURENT0007 ANTERIOR FESS 13000 16250 19500 21938 24375 28470 SURENT0008 RHINOPLASTY 30000 37500 45000 50625 56250 65700 SURENT0010 NASAL ENDOSCOPY 5000 6250 7500 8438 9375 10950 SURENT0011 FRACTURE NASAL BONE 10000 12500 15000 16875 18750 21900 SURENT0032 ENDOSCOPIC CAUTERISATION B\L NOSE 10000 12500 15000 16875 18750 21900 SURENT0035 LATERAL RHINOTOMY 40000 50000 60000 67500 75000 87600 CAUTERIZATION NOSE/THROAT/EAR SURENT0049 3000 3750 4500 5063 5625 6570 CHEMICAL CAUTERIZATION NOSE/THROAT/EAR SURENT0050 7500 9375 11250 12656 14063 16425 ELECTRIC SURENT0052 CHOANAL ATRESIA 35000 43750 52500 59063 65625 76650 CLOSED REDUCTION OF FACIAL BONE SURENT0053 12000 15000 18000 20250 22500 26280 FRACTURE SURENT0069 ENDOSCOPIC CSF LEAK REPAIR 60000 75000 90000 101250 112500 131400 SURENT0070 ENDOSCOPIC DCR 25000 31250 37500 42188 46875 54750 ENDOSCOPIC OPTIC /ORBITAL SURENT0071 55000 68750 82500 92813 103125 120450 DECOMPRESSION SURENT0075 EXCISION OF ANGIOFIBROMA LARGE 50000 62500 75000 84375 93750 109500 EXCISION OF ANGIOFIBROMA LARGE WITH SURENT0076 100000 125000 150000 168750 187500 219000 ICC

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CODE.NO SERVICE NAME AMOUNT SURENT0077 EXCISION OF ANGIOFIBROMA MEDIUM 50000 62500 75000 84375 93750 109500 SURENT0078 EXCISION OF ANGIOFIBROMA SMALL 40000 50000 60000 67500 75000 87600 SURENT0086 FESS MAJOR - B/L 45000 56250 67500 75938 84375 98550 SURENT0087 FESS MAJOR- U/L 30000 37500 45000 50625 56250 65700 SURENT0097 LIGATION OF SPHENOPALATINE ARTERY 25000 31250 37500 42188 46875 54750 SURENT0106 MAXILLECTOMY PARTIAL 30000 37500 45000 50625 56250 65700 SURENT0107 MAXILLECTOMY WITH ORBITAL EXENTRATION 60000 75000 90000 101250 112500 131400 SURENT0108 MAXILLECTOMY TOTAL 40000 50000 60000 67500 75000 87600 SURENT0122 NASAL ENDOSCOPY WITH BIOPSY 9000 11250 13500 15188 16875 19710 SURENT0124 NASAL PACKING ANTERIOR 4000 5000 6000 6750 7500 8760 SURENT0145 REPAIR OF OROANTRAL FISTULA WITH FLAP 40000 50000 60000 67500 75000 87600 SURENT0146 REDUCTION OF FRACTURE NOSE 10000 12500 15000 16875 18750 21900 SURENT0149 SEPTO - RHINOPLASTY 45000 56250 67500 75938 84375 98550 SURENT0150 SEPTOPLASTY & SMD 17000 21250 25500 28688 31875 37230 SURENT0151 SKULL BASE SURGERY 70000 87500 105000 118125 131250 153300 SURENT0156 SUBMUCOUS DIATHERMY - B/L 4000 5000 6000 6750 7500 8760 SURENT0157 SUBMUCOUS DIATHERMY - U/L 3000 3750 4500 5063 5625 6570 SURENT0158 SUCTION CLEARENCE NOSE/EAR - B/L 4000 5000 6000 6750 7500 8760 SURENT0159 SUCTION CLEARENCE NOSE/EAR - U/L 2500 3125 3750 4219 4688 5475 SURENT0165 SYNAECHAE REMOVAL FROM NOSE - B/L 7500 9375 11250 12656 14063 16425 SURENT0166 SYNAECHAE REMOVAL FROM NOSE-U/L 5000 6250 7500 8438 9375 10950 SURENT0178 TURBINATE REDUCTION 6000 7500 9000 10125 11250 13140 SURENT0179 VIDIAN NEURECTOMY TRANS-NASAL U/L 25000 31250 37500 42188 46875 54750 SURENT0193 NASAL PACKING ANTERIOR & POSTERIOR 10000 12500 15000 16875 18750 21900 SURENT0195 FESS POSTERIOR 25000 31250 37500 42188 46875 54750 SURENT0202 NASAL PACKING ANTERIOR (U/L) 3000 3750 4500 5063 5625 6570 SURENT0207 MAXILLARY SWING OPERATION 60000 75000 90000 101250 112500 131400 SURENT0208 MID FACIAL DEGLOVING 60000 75000 90000 101250 112500 131400 SURENT0213 REMOVAL ANTERIOR NASAL PACKING 2000 2500 3000 3375 3750 4380 SURENT0215 NASAL PACKING B/L 6000 7500 9000 10125 11250 13140 PARTIAL LARYNGEC. WITH BLOCK SURENT0221 45000 56250 67500 75938 84375 98550 DISSECTION THROAT SURENT0001 ADENOTONSILLECTOMY 15000 18750 22500 25313 28125 32850 SURENT0002 ADENOIDECTOMY 7500 9375 11250 12656 14063 16425 SURENT0003 PERITONSILLAR ABSCESS DRAINAGE 8000 10000 12000 13500 15000 17520 ESOPHAGOSCOPY & FOREIGN BODY SURENT0013 10000 12500 15000 16875 18750 21900 REMOVAL SURENT0024 DIRECT LARYNGOSCOPY RIGID 5200 6500 7800 8775 9750 11388 SURENT0025 SUBMANDIBULAR GLAND EXCISION 20000 25000 30000 33750 37500 43800 SUBMANDIBULAR GLAND CALCULUS SURENT0026 9000 11250 13500 15188 16875 19710 REMOVAL BIG SURENT0027 PARAPHARYNGEAL ABSCESS DRAINAGE 10000 12500 15000 16875 18750 21900 SURENT0029 MEDIALISATION THYROPLASTY 25000 31250 37500 42188 46875 54750 SURENT0031 DIRECT LARYNGOSCOPY FIBRE OPTIC 6500 8125 9750 10969 12188 14235 SURENT0034 THYROGLOSSAL FISTULA EXCISION 25000 31250 37500 42188 46875 54750 SURENT0037 PAROTIDECTOMY SUPERFICIAL 30000 37500 45000 50625 56250 65700 SURENT0040 ARYTENOID REPOSITION 20000 25000 30000 33750 37500 43800 SURENT0041 BLOCK DISSECTION OF CERVICAL NODES 25000 31250 37500 42188 46875 54750 SURENT0043 BRACHIAL CYST AND SINUS 25000 31250 37500 42188 46875 54750 SURENT0044 BRONCHOSCOPY DIAGNOSTIC 12000 15000 18000 20250 22500 26280 SURENT0045 BRONCHOSCOPY WITH FB REMOVAL 17000 21250 25500 28688 31875 37230 SURENT0046 BRONCHOSCOPY WITH BIOPSY 15000 18750 22500 25313 28125 32850 SURENT0055 COMMANDO OPERATION 60000 75000 90000 101250 112500 131400 SURENT0056 CONSERVATION SURGERY FOR CA LARYNX 45000 56250 67500 75938 84375 98550 SURENT0057 CYST & BENIGN TUMOUR OF PALATE 15000 18750 22500 25313 28125 32850 SURENT0060 DIRECT LARYNGOSCOPY BIOPSY 7500 9375 11250 12656 14063 16425 SURENT0062 DRAINAGE OF RETRO-PHARYNGEAL ABSCESS 10000 12500 15000 16875 18750 21900

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CODE.NO SERVICE NAME AMOUNT SURENT0088 FRACTURE MANDIBLE REPAIR & PLATING 25000 31250 37500 42188 46875 54750 SURENT0089 ABSCESS DRAINAGE NECK 10000 12500 15000 16875 18750 21900 SURENT0090 INJ. FAT/TEFLON /COLLAGEN IN VOCAL CORD 25000 31250 37500 42188 46875 54750 SURENT0092 LARYNGOFISSURE 25000 31250 37500 42188 46875 54750 SURENT0094 LARYNGOPLASTY 20000 25000 30000 33750 37500 43800 SURENT0098 LYMPH NODE BIOPSY (SMALL/MEDIUM) 5000 6250 7500 8438 9375 10950 SURENT0099 LYMPH NODE BIOPSY (LARGE) 8000 10000 12000 13500 15000 17520 SURENT0111 MLS DIAG./EXCISION OF NODULE / POLYP 22000 27500 33000 37125 41250 48180 SURENT0113 MLS FOR LARYNGEAL PAPILLOMATA 25000 31250 37500 42188 46875 54750 SURENT0127 NEAR TOTAL LARYNGECTOMY 45000 56250 67500 75938 84375 98550 OESOPHAGOSCOPIC FB REMOVAL LOWER SURENT0128 15000 18750 22500 25313 28125 32850 END SURENT0131 ORAL BIOPSY 5000 6250 7500 8438 9375 10950 SURENT0133 PALATOPHARYNGOPLASTY 40000 50000 60000 67500 75000 87600 SURENT0135 PARATHYROIDECTOMY 50000 62500 75000 84375 93750 109500 SURENT0136 PAROTIDECTOMY TOTAL 50000 62500 75000 84375 93750 109500 SURENT0137 PARTIAL GLOSSECTOMY 20000 25000 30000 33750 37500 43800 SURENT0138 PHARYNGEAL DIVERTICULA REPAIR 30000 37500 45000 50625 56250 65700 SURENT0141 OESOPHAGOSCOPY DIAGNOSTIC 8000 10000 12000 13500 15000 17520 SURENT0142 RADICAL NECK DISSECTION 50000 62500 75000 84375 93750 109500 SURENT0143 RANULA EXCISION 15000 18750 22500 25313 28125 32850 SURENT0144 RANULA (PLUNGING) 20000 25000 30000 33750 37500 43800 SURENT0154 STYLOIDECTOMY 20000 25000 30000 33750 37500 43800 SURENT0160 SUPRAGLOTIC PARTIAL LARYNGECTOMY 50000 62500 75000 84375 93750 109500 SURENT0168 THYROGLOSSAL CYST / SINUS 20000 25000 30000 33750 37500 43800 SURENT0169 THYROIDECTOMY HEMI/PARTIAL 25000 31250 37500 42188 46875 54750 SURENT0171 THYROIDECTOMY TOTAL 30000 37500 45000 50625 56250 65700 SURENT0172 TONGUE-TIE RELEASE 4000 5000 6000 6750 7500 8760 SURENT0173 TONSILLECTOMY 12000 15000 18000 20250 22500 26280 SURENT0175 TRACHEOSTOMY- 10000 12500 15000 16875 18750 21900 SURENT0176 TRACHEOSTOMY TUBE DECANULATION 8000 10000 12000 13500 15000 17520 SURENT0177 TRACHEOSTOMY TUBE CHANGE 3000 3750 4500 5063 5625 6570 SURENT0180 UVULECTOMY 5000 6250 7500 8438 9375 10950 SURENT0182 T&A WITH BIL. MYRING. GROMMET INS. 21000 26250 31500 35438 39375 45990 EXCISION+REPAIR LARYNG.&TRACH. SURENT0184 50000 62500 75000 84375 93750 109500 STENOSIS LIGATION EXT.CAROTID/ANT OR POST SURENT0186 15000 18750 22500 25313 28125 32850 ETHMOID PARTIAL LARYNGEC. WITH BLOCK SURENT0187 30000 37500 45000 50625 56250 65700 DISSECTION PARTIAL LARYNGEC. WITH BLOCK SURENT0221 45000 56250 67500 75938 84375 98550 DISSECTION (COMLEX) SURENT0188 PHARYNGEAL FISTULA REPAIR WITHOUT FLAP 12000 15000 18000 20250 22500 26280

SURENT0190 SMG DUCT CALCULUS INTRAORAL REMOVAL 6500 8125 9750 10969 12188 14235 SURENT0196 MLS DIAGNOSTIC 10000 12500 15000 16875 18750 21900 DRAINAGE OF PARAPHARYNGEAL SPACE SURENT0198 10000 12500 15000 16875 18750 21900 ABSCESS SURENT0205 MANDIBULAR SLING OPERATION 50000 62500 75000 84375 93750 109500 SURENT0206 MANDIBULAR WEDGE RESECTION 40000 50000 60000 67500 75000 87600 SURENT0209 PARTIAL MANDIBULECTOMY 50000 62500 75000 84375 93750 109500 SURENT0210 LARYNGECTOMY 40000 50000 60000 67500 75000 87600 LARYNGECTOMY WITH BLOCK DISSECTION SURENT0211 60000 75000 90000 101250 112500 131400 U/L GENERAL ENT SURENT0012 FOREIGN BODY NOSE/EAR/MOUTH 5000 6250 7500 8438 9375 10950 SURENT0022 LABUOPLASTY B/L 3900 4875 5850 6581 7313 8541 SURENT0063 DRESSING MAJOR 3000 3750 4500 5063 5625 6570 SURENT0064 DRESSING MINOR 2000 2500 3000 3375 3750 4380 SURENT0082 FACIAL WOUND REPAIR (MEDIUM) 7500 9375 11250 12656 14063 16425 SURENT0083 FACIAL WOUND REPAIR (MINOR) 5000 6250 7500 8438 9375 10950 SURENT0084 FACIAL WOUND REPAIR(MAJOR) 10000 12500 15000 16875 18750 21900

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CODE.NO SERVICE NAME AMOUNT SURENT0134 PANENDOSCOPY 20000 25000 30000 33750 37500 43800 SURENT0148 SEBACEOUS CYST EXCISION 10000 12500 15000 16875 18750 21900 SURENT0162 SUTURE REMOVAL 1000 1250 1500 1688 1875 2190 SURENT0163 FACIAL WOUND REPAIR (MAJOR) 7500 9375 11250 12656 14063 16425 SURENT0164 SYIRINGING (B/L) 1000 1250 1500 1688 1875 2190 SURENT0167 SYRINGING (U/L) 600 750 900 1013 1125 1314

UNIT : GYNAECOLOGY SURGERY VULVA & VAGINA SURGEON’S FEE SURGYN0007 POLYPECTOMY 5400 6750 8100 9110 10130 11810 SURGYN0012 PAN HYSTERECTOMY 26600 33250 39900 44890 49880 58190 SURGYN0019 EUA & PERIANAL BIOPSY 7300 9130 10950 12320 13690 15970 EXCISION OF VULVAL TUMOUR & SURGYN0025 13300 16630 19950 22440 24940 29090 LABIOPLASTY SURGYN0026 REMOVAL OF VAGINAL/VULVAL CYST 6100 7630 9150 10290 11440 13340 SURGYN0028 VEGINAL HYSTERECTOMY 30900 38630 46350 52140 57940 67590 SURGYN0030 BARTHOLIN CYST / VAGINAL CYST 7300 9130 10950 12320 13690 15970 PERINEAL TEAR REPAIR FIRST/SECOND SURGYN0031 8500 10630 12750 14340 15940 18590 DEGREE SURGYN0032 PERINEAL TEAR REPAIR THIRD DEGREE 15700 19630 23550 26490 29440 34340 SURGYN0034 ABDOMINAL STERILISATION 7300 9130 10950 12320 13690 15970 SURGYN0042 RECTO COELE REPAIR 8500 10630 12750 14340 15940 18590 SURGYN0048 MARSUPLIZATION OF BARTHOLIN ABCESS 7300 9130 10950 12320 13690 15970 SURGYN0058 PERINEORHAPHY 9700 12130 14550 16370 18190 21220 CERVIX UTERUS & TUBES PROCEDURE: SURGYN0001 D&C 4800 6000 7200 8100 9000 10500 SURGYN0002 NORMAL DELIVERY 19400 24250 29100 32740 36380 42440 SURGYN0003 CAESARIAN DELIVERY 16900 21130 25350 28520 31690 36970 SURGYN0004 CERVICAL BIOPSY 4800 6000 7200 8100 9000 10500 SURGYN0005 CERVICAL CRYO 6100 7630 9150 10290 11440 13340 SURGYN0006 MYOMECTOMY 23000 28750 34500 38810 43130 50310 SURGYN0008 EXPL. OF CERVIX/CERVICAL TEAR REPAIR/EPI 7300 9130 10950 12320 13690 15970 SURGYN0009 TUBECTOMY 9700 12130 14550 16370 18190 21220 SURGYN0010 DRAINAGE & PYOMETRA & E.U.A 7300 9130 10950 12320 13690 15970 SURGYN0013 INSERTING CRVIPRIME GEL 4800 6000 7200 8100 9000 10500 SURGYN0014 DISPLACED IUD REMOVAL 7300 9130 10950 12320 13690 15970 SURGYN0015 M.T.P 7300 9130 10950 12320 13690 15970 SURGYN0020 FRACTIONAL CURETTAGE 4800 6000 7200 8100 9000 10500 SURGYN0022 SUCTION EVAIUATION U.S. GUIDANCE 7300 9130 10950 12320 13690 15970 DRAINAGE OF HAEMATOMETRA + SURGYN0023 9700 12130 14550 16370 18190 21220 FRACTIONAL CU SURGYN0024 LAP. ASSISTED VAGINAL HYSTRECTOMY 30300 37880 45450 51130 56810 66280 SURGYN0029 ABDOMINAL TOTAL HYSTERECTOMY 25400 31750 38100 42860 47630 55560 SURGYN0033 FOTHERGILLE REPAIR 16900 21130 25350 28520 31690 36970 SURGYN0035 MTP WITH STERILISATION 14500 18130 21750 24470 27190 31720 SURGYN0036 MTP WITH LAP LIGATION 13300 16630 19950 22440 24940 29090 SURGYN0039 VULVAL/VAGINAL BIOPSY 4800 6000 7200 8100 9000 10500 SURGYN0040 MID TRI ABORTION 12100 15130 18150 20420 22690 26470 SURGYN0041 CYSTOCOELE REPAIR 15700 19630 23550 26490 29440 34340 SURGYN0044 OVARIOTOMY / OOPHERECTOMY 13300 16630 19950 22440 24940 29090 SURGYN0045 WEDGE RESECTIOU OF OVARY 9700 12130 14550 16370 18190 21220 SURGYN0046 HYMENECTOMY 7300 9130 10950 12320 13690 15970 SURGYN0047 OPERATION FOR STRESS INCONTINENCE 23000 28750 34500 38810 43130 50310 SURGYN0057 ENTEROCOELE REPAIR 4800 6000 7200 8100 9000 10500 SURGYN0059 SALPINGECTOMY U/L 15100 18880 22650 25480 28310 33030 SURGYN0060 MINIMALLY INVASIVE NEUROSECTOMY 23000 28750 34500 38810 43130 50310 SURGYN0079 CRYOSURGERY 15100 18880 22650 25480 28310 33030 TLH WITH MORCELLATION(BIG UTERUS OVR SURGYN0091 42400 53000 63600 71550 79500 92750 12W SURGYN0094 MIRENA INSERTION 4800 6000 7200 8100 9000 10500

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CODE.NO SERVICE NAME AMOUNT SURGYN0095 LAPARASCOPIC BILATERAL SALPINGOTOMY 21800 27250 32700 36790 40880 47690 LAPGYN0006 SALPINGECTOMY- U/L 18200 22750 27300 30710 34130 39810 LAPGYN0007 SALPINGECTOMY- B/L 21800 27250 32700 36790 40880 47690 LAPGYN0008 ENDOMETRIAL ABLATION, THERMAL 18200 22750 27300 30710 34130 39810

COLPOSCOPIC PROCEDURE SURGYN0021 ELECTROCAUTERY 4800 6000 7200 8100 9000 10500 SURGYN0027 EXCISION & REMOVAL OF IMPACTED PESSARY 9700 12130 14550 16370 18190 21220 SURGYN0076 DIAG COLPOSCOPY (COMPLEX) 9700 12130 14550 16370 18190 21220 SURGYN0096 DIAG COLPOSCOPY (SIMPLE) 6100 7630 9150 10290 11440 13340 SURGYN0077 DIAG COLPOSCOPY WITH BIOPSY 15100 18880 22650 25480 28310 33030 SURGYN0078 DIAG COLPOSCOPY WITH LEEP 15100 18880 22650 25480 28310 33030 SURGYN0092 HYSTERO SALPINGOGRAM 4800 6000 7200 8100 9000 10500 PROGYN0008 VAGINOSCOPY 13200 16500 19800 22280 24750 28880 HYSTEROSCOPIC PROCEDURE SURGYN0011 HYSTEROSCOPY (COMLEX) 8500 10630 12750 14340 15940 18590 SURGYN0097 HYSTEROSCOPY (SIMPLE) 4800 6000 7200 8100 9000 10500 SURGYN0054 DIAG HYETEROSCOPY 9700 12130 14550 16370 18190 21220 SURGYN0055 DIAG HYSTRO / LAPAROSCOPY (COMLEX) 15100 18880 22650 25480 28310 33030 SURGYN0098 DIAG HYSTRO / LAPAROSCOPY (SIMPLE) 9700 12130 14550 16370 18190 21220 SURGYN0056 HYSTERO LAP. REMOVAL OF IUCD 20600 25750 30900 34760 38630 45060 SURGYN0065 DIAG. HYSTEROSCOPY WITH MYOMECTOMY 20600 25750 30900 34760 38630 45060

SURGYN0067 DIAG HYSTEROSCOPY WITH SMALL POLYP 15200 19000 22800 25650 28500 33250 SURGYN0068 DIAG HYSTEROSCOPY WITH BIOPSY 15200 19000 22800 25650 28500 33250 DIAG HYSTEROSCOPY WITH REMOVALOF SURGYN0069 15200 19000 22800 25650 28500 33250 IUCD SURGYN0070 DIAG HYSTEROSCOPY WITH LARGE POLYP 16300 20380 24450 27510 30560 35660 DIAG HYSTEROSCOPY+ASHERMANS MILD SURGYN0071 16300 20380 24450 27510 30560 35660 GRADE DIAG HYSTEROSCOPY+SUB- SURGYN0072 16300 20380 24450 27510 30560 35660 SEPTATESEPTOPLASTY DIAG HYSTEROSCOPY + LATERAL SURGYN0073 16300 20380 24450 27510 30560 35660 METROPLASTY SURGYN0074 DIAG HYSTEROSCOPY WITH TCRE 20600 25750 30900 34760 38630 45060 DIAG HYSTEROSCOPY WITH ASHERMANS SURGYN0075 20600 25750 30900 34760 38630 45060 MODERAT DIAG HYSTEROSCOPY WITH COMPLETE SURGYN0080 20600 25750 30900 34760 38630 45060 SEPTATE DIAG HYSTEROSCOPY WITH HYSTEROSCOPIC SURGYN0088 20600 25750 30900 34760 38630 45060 STERILISATION HYSTER.TUBAL CANNULATION FOR PROXIMAL SURGYN0099 20600 25750 30900 34760 38630 45060 TUBAL BLOCK B/L HYSTERO.TUBAL CANNULATION FOR SURGYN0100 18200 22750 27300 30710 34130 39810 PROXIMAL TUBAL BLOCK U\L LAPAROSCOPIC PROCEDURE LAPAROSCOPIC SALPINGO OOPHRECTOMY SURGYN0016 24200 30250 36300 40840 45380 52940 U/L LAPAROSCOPIC SALPINGO OOPHRECTOMY SURGYN0017 32100 40130 48150 54170 60190 70220 B/L LAPROSCOPIC PELVIC LYMPHADENECTOMY SURGYN0018 21800 27250 32700 36790 40880 47690 BILTERAL SURGYN0037 LAPROSCOPIC LIGATION OF FALLOPIAN TUBE 8500 10630 12750 14340 15940 18590 SURGYN0038 DIAGNOSTIC LAP WITH D & C 15100 18880 22650 25480 28310 33030 SURGYN0043 LAPAROTOMY FOR OVARIAN MALIGNANCY 38700 48380 58050 65310 72560 84660 SURGYN0049 LAP. OVARIAN CYSTECTOMY 28400 35500 42600 47930 53250 62130 SURGYN0050 LAP. ADHESIOYSIS 16300 20380 24450 27510 30560 35660

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CODE.NO SERVICE NAME AMOUNT LAP. PROCEDURE FOR SEVERE SURGYN0051 29600 37000 44400 49950 55500 64750 ENDOMETRIOSIS SURGYN0052 ABLATION OF ENDONECTRIAL DEPOSITS 16300 20380 24450 27510 30560 35660 SURGYN0053 DIAG LAPAROSCOPY 10900 13630 16350 18390 20440 23840 SURGYN0061 LAPAROSCOPIC HYSTRECTOMY 32700 40880 49050 55180 61310 71530 SURGYN0062 LAP. MYOMECTOMY(SINGLE) 29600 37000 44400 49950 55500 64750 SURGYN0063 LAP. MYOMECTOMY(MULTIPLE) 37500 46880 56250 63280 70310 82030 SURGYN0064 LAPARASCOPIC GYANE SALPINGOTOMY 24200 30250 36300 40840 45380 52940 LAPAROSCOPY AND HYSTEROSCOPY AND SURGYN0066 20600 25750 30900 34760 38630 45060 CHROMOTUBATION SURGYN0081 LAPAROSCOPIC OVARIAN CYSTECTOMY 27800 34750 41700 46910 52130 60810 LAPAROSCOPY FOR MILD TO MODERATE SURGYN0082 24200 30250 36300 40840 45380 52940 ENDOMETRIOSIS SURGYN0083 LAPAROSCOPY WERTHEIMS 38700 48380 58050 65310 72560 84660 SURGYN0084 LAPAROSCOPY SLING SURGERY 38700 48380 58050 65310 72560 84660 SURGYN0085 LAPAROSCOPY CYSTOCOELE REPAIR 14600 18250 21900 24640 27380 31940 SURGYN0086 LAPAROSCOPY RECTOCOELE REPAIR 9700 12130 14550 16370 18190 21220 SURGYN0087 LAPAROSCOPY ENTROCOELE REPAIR 8500 10630 12750 14340 15940 18590 SURGYN0089 LAP. MYOMECTOMY (LARGE) 31500 39380 47250 53160 59060 68910 SURGYN0090 LAP. OVARIAN CYSTECTOMY- B/L 36300 45380 54450 61260 68060 79410 SURGYN0093 LAPROSCOPIC PELVIC LYMPHADENECTOMY 31500 39380 47250 53160 59060 68910 LAPGYN0001 LAP. FIMBRIOPLASTY 18200 22750 27300 30710 34130 39810 LAPGYN0002 LAP. SACRO COLPOPEXY 42400 53000 63600 71550 79500 92750 LAPGYN0003 LAP. OVARIAN DRILLING 15700 19630 23550 26490 29440 34340 LAPGYN0004 LAP. SALPINGOSTOMY- B/L 24200 30250 36300 40840 45380 52940 LAPGYN0005 LAP. SALPINGOSTOMY- U/L 20600 25750 30900 34760 38630 45060 UNIT-ORTHO PLASTER APPLICATION SURPLA0001 PLASTER APPLICATION SMALL 4400 5500 6600 7430 8250 9630 SURPLA0002 PLASTER APPLICATION MEDIUM 6050 7560 9080 10210 11340 13230 SURPLA0003 PLASTER APPLICATION LARGE 7700 9630 11550 12990 14440 16840 SURPLA0004 PLASTER REMOVAL- SINGLE 1000 1250 1500 1690 1880 2190 SURPLA0005 PLASTER REMOVAL- LARGE 2000 2500 3000 3380 3750 4380

DRESSING IN OT SURDRS0001 DRESSING IN OT SMALL 880 1100 1320 1490 1650 1930 SURDRS0003 DRESSING IN OT MEDIUM 1320 1650 1980 2230 2480 2890 SURDRS0002 DRESSING IN OT LARGE 1760 2200 2640 2970 3300 3850 WOUND DEBRIDEMENT & CLOSURE SURWDC0002 WOUND DBR. & CLOSURE SMALL UPTO 5 CM 4400 5500 6600 7430 8250 9630

SURWDC0003 WOUND DBR.& CLOSURE MEDIUM UPTO10 CM 6600 8250 9900 11140 12380 14440 WOUND DBR & CLOSURE LARGE MORE THAN SURWDC0004 9900 12380 14850 16710 18560 21660 10CM WOUND DBR & CLOSURE WITH FLAP SURWDC0005 14300 17880 21450 24130 26810 31280 CLOSURE WOUND DBR & CLOSURE WITH SKIN SURWDC0009 9900 12380 14850 16710 18560 21660 GRAFFTING SURWDC0010 SSG SMALL 5500 6880 8250 9280 10310 12030 SURWDC0011 SSG MEDIUM 8800 11000 13200 14850 16500 19250 SURWDC0012 SSG LARGE 12100 15130 18150 20420 22690 26470 SURWDC0013 FULL THICKNESS SKIN GRAFT SMALL 11000 13750 16500 18560 20630 24060 SURWDC0014 FULL THICKNESS SKIN GRAFT MEDIUM 15400 19250 23100 25990 28880 33690 SURWDC0015 FULL THICKNESS SKIN GRAFT LARGE 19800 24750 29700 33410 37130 43310 SURWDC0016 ROTATION FLAPS SIMPLE 17600 22000 26400 29700 33000 38500 SURWDC0017 ROTATION FLAPS COMPLEX 22000 27500 33000 37130 41250 48130 SURWDC0018 FREE FLAP 26500 33130 39750 44720 49690 57970 SURWDC0019 MYOCUTANEOUS FLAP 24300 30380 36450 41010 45560 53160 SURWDC0020 PEDICLED CUTANEOUS FLAP 32500 40630 48750 54840 60940 71090 SURWDC0021 PEDICLED MYOCUTANEOUS FLAP 38000 47500 57000 64130 71250 83130 SURWDC0022 PEDICLED OSTEOCUTANEOUS FLAP 43500 54380 65250 73410 81560 95160 SURWDC0023 FASCIOTOMY UPPER LIMB 22500 28130 33750 37970 42190 49220

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CODE.NO SERVICE NAME AMOUNT SURWDC0024 FASCIOTOMY SMALL 13200 16500 19800 22280 24750 28880 SURWDC0025 FOREIGN BODY REMOVAL- SIMPLE 6770 8460 10160 11420 12690 14810 SURWDC0026 FOREIGN BODY REMOVA- COMPLEX 15880 19850 23820 26800 29780 34740 SURWDC0027 GROIN FLAP- SMALL 17180 21480 25770 28990 32210 37580 SURWDC0028 GROIN FLAP- LARGE 24530 30660 36800 41390 45990 53660 SURWDC0029 CROSS FINGER FLAP 24530 30660 36800 41390 45990 53660 SURWDC0031 JOINT DEFRIDEMENT - OTHER- LARGE 14750 18440 22130 24890 27660 32270 CLOSE REDUCTION OF DISLOCATION & POP APPLICATION SURCRD0006 CLOSE REDU. SMALL JOINT 6800 8500 10200 11480 12750 14880 SURCRL0001 CLOSE REDU. LARGE JOINT 11000 13750 16500 18560 20630 24060 CLOSE REDUCTION & K-WIRE FIXATION SURCRK0001 SINGLE BONE/JOINT 7700 9630 11550 12990 14440 16840 SURCRK0002 MEDIUM BONE/JOINT 10450 13060 15680 17630 19590 22860 SURCRK0003 COMPLEX BONE/JOINT 14850 18560 22280 25060 27840 32480 OPEN REDUCTION & INTERNAL FIXATION SURORI0001 ORIF SMALL 11000 13750 16500 18560 20630 24060 SURORI0002 ORIF-MEDIUM 16500 20630 24750 27840 30940 36090 SURORI0003 ORIF-LARGE 22000 27500 33000 37130 41250 48130 SURORI0004 ORIF COMPLEX 27500 34380 41250 46410 51560 60160 SURORI0005 ORIF INTRA ARTICULAR - SIMPLE 33000 41250 49500 55690 61880 72190 SURORI0007 ORIF INTRA ARTICULAR - COMPLEX 40000 50000 60000 67500 75000 87500 SURORI0006 ORIF REDO/NU - SIMPLE 31000 38750 46500 52310 58130 67810 SURORI0008 ORIF REDO/NU - COMPLEX 40000 50000 60000 67500 75000 87500 SURORI0009 JOINT STABISATION - SMALL 15000 18750 22500 25310 28130 32810 SURORI0010 JOINT STABISATION - MEDIUM 25000 31250 37500 42190 46880 54690 SURORI0011 JOINT STABISATION - LARGE 35000 43750 52500 59060 65630 76560 BONE GRAFTING SURBGR0001 BONE GRAFTING SMALL 6050 7560 9080 10210 11340 13230 SURBGR0002 BONE GRAFTING MEDIUM 10800 13500 16200 18230 20250 23630 SURBGR0003 BONE GRAFTING LARGE 15000 18750 22500 25310 28130 32810 SURBGR0004 ANTIBIOTIC BONE GRAFTING 22000 27500 33000 37130 41250 48130 SURKNE0071 VASCULARIZED BONE GRAFTING 27500 34380 41250 46410 51560 60160 SURBGR0005 FIBULAR BONE GRAFTING 22000 27500 33000 37130 41250 48130 EXTERNAL FIXATOR SUREXF0001 EX FIX SMALL 11000 13750 16500 18560 20630 24060 SUREXF0002 EX FIX MEDIUM 15400 19250 23100 25990 28880 33690 SUREXF0003 EX FIX LARGE/LRS 19800 24750 29700 33410 37130 43310 SUREXF0004 EX FIX LRS 26800 33500 40200 45230 50250 58630 SUREXF0005 LRS WITH BONE TRANSPLANT 39800 49750 59700 67160 74630 87060 IMPLANT REMOVAL SURIMP0001 SMALL K-WIRE, ONE OR TWO SCREWS 3300 4130 4950 5570 6190 7220 SURIMP0007 EXTERNAL FIXATOR/ILIZAROV REMOVAL 7700 9630 11550 12990 14440 16840 SURIMP0006 REMOVAL OF IMPLANT - MEDIUM 9050 11310 13580 15270 16970 19800 SURIMP0008 IMPLANT REMOVAL ( COMPLEX) 16000 20000 24000 27000 30000 35000 SURIMP0009 PROSTHETIC JOINT REMOVAL 30000 37500 45000 50630 56250 65630 SURIMP0010 PROSTHETIC AB CEMENT SPACER 30000 37500 45000 50630 56250 65630 SURIMP0011 REMOVAL OF IMPLANT - LARGE 15000 18750 22500 25310 28130 32810 SURIMP0012 REMOVAL OF IMPLANT - COMPLEX 20000 25000 30000 33750 37500 43750 ILIZAROV/RING FIXATOR SURLIZ0001 ILIZAROV MEDIUM 19800 24750 29700 33410 37130 43310 SURLIZ0002 ILIZAROV LARGE 31350 39190 47030 52900 58780 68580 SURLIZ0003 ILIZAROV+BONE TRANSPORT 49500 61880 74250 83530 92810 108280 SOFT TISSUE RELEASE SURSTR0001 SOFT TISSUE RELEASE SMALL 6050 7560 9080 10210 11340 13230 SURSTR0003 SOFT TISSUE RELEASE MEDIUM 10000 12500 15000 16880 18750 21880 SURSTR0002 SOFT TISSUE RELEASE LARGE 15200 19000 22800 25650 28500 33250 SURSTR0004 TORTICOLLIS UNIPOLAR RELEASE 17600 22000 26400 29700 33000 38500 SURSTR0005 TORTICOLLIS BIPOLAR RELEASE 19800 24750 29700 33410 37130 43310 OSTEOTOMY & FIXATION SUROSF0001 OSTEOTOMY SMALL 8800 11000 13200 14850 16500 19250 SUROSF0002 OSTEOTOMY MEDIUM 13200 16500 19800 22280 24750 28880 SUROSF0003 OSTEOTOMY LARGE 22000 27500 33000 37130 41250 48130

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CODE.NO SERVICE NAME AMOUNT SUROSF0004 OSTEOTOMY COMPLEX 38500 48130 57750 64970 72190 84220 SUROSF0005 OSTEOTOMY WITH FIXATION SMALL 16500 20630 24750 27840 30940 36090 SUROSF0006 OSTEOTOMY WITH FIXATION MEDIUM 22000 27500 33000 37130 41250 48130 SUROSF0007 OSTEOTOMY WITH FIXATION LARGE 27500 34380 41250 46410 51560 60160 OSTEOTOMY WITH FIXATION COMPLEX SUROSF0008 44000 55000 66000 74250 82500 96250 (EXCEPT PELVIS) SUROSF0009 OSTEOTOMY COMPLEX PELVIS 60000 75000 90000 101250 112500 131250 ARTHROLYSIS SURATL0001 ARTHOLYSIS JOINT SMALL 8800 11000 13200 14850 16500 19250 SURATL0002 ARTHOLYSIS JOINT MEDIUM 12100 15130 18150 20420 22690 26470 SURATL0003 ARTHOLYSIS JOINT LARGE 16500 20630 24750 27840 30940 36090 SURATL0004 SYNOVECTOMY SMALL JOINTS 7700 9630 11550 12990 14440 16840 SURATL0005 SYNOVECTOMY MEDIUM JOINTS 12100 15130 18150 20420 22690 26470 SURATL0006 SYNOVECTOMY LARGE JOINTS 16500 20630 24750 27840 30940 36090 SURATL0007 JOINT ASPIRATION UNDER GA - SUPERFICIAL 3300 4130 4950 5570 6190 7220

SURATL0008 JOINT ASPIRATION UNDER GA - DEEP 5300 6630 7950 8940 9940 11590 SUROTH0005 TMJ ARTHROLYSIS 24200 30250 36300 40840 45380 52940 ARTHOSCOPY SURART0006 DIAGNOSTIC ARTHOSCOPY 11000 13750 16500 18560 20630 24060 SURART0007 THERAPEUTIC ARTHOSCOPY 16500 20630 24750 27840 30940 36090 SURART0008 LIGAMENT RECONSTRUCTION SIMPLE 16500 20630 24750 27840 30940 36090 SURART0009 LIGAMENT RECONSTRUCTION COMPLEX 27500 34380 41250 46410 51560 60160 INFECTION SURINF0001 OSTEOMYELITIS DEB -SMALL 6050 7560 9080 10210 11340 13230 SURINF0002 OSTEOMYELITIS DEB -MEDIUM 8800 11000 13200 14850 16500 19250 SURINF0003 OSTEOMYELITIS DEB -LARGE 13200 16500 19800 22280 24750 28880 SURINF0004 SEQUESTRECTOMY- SMALL 6050 7560 9080 10210 11340 13230 SURINF0005 SEQUESTRECTOMY-MEDIUM 8800 11000 13200 14850 16500 19250 SURINF0006 SEQUESTRECTOMY- LARGE 13200 16500 19800 22280 24750 28880 SURKNE0067 ANTIBIOTIC BEAD APPLICATION-MEDIUM 11000 13750 16500 18560 20630 24060 SURKNE0068 ANTIBIOTIC BEAD APPLICATION-LARGE 15400 19250 23100 25990 28880 33690 SURKNE0081 CURETTAGE - SIMPLE 8800 11000 13200 14850 16500 19250 SURKNE0083 CURETTAGE - LARGE 13200 16500 19800 22280 24750 28880 ARTHROTOMY SURATM0001 SMALL JOINTS 7700 9630 11550 12990 14440 16840 SURATM0002 MEDIUM JOINTS 8800 11000 13200 14850 16500 19250 SURATM0003 LARGE JOINTS 11000 13750 16500 18560 20630 24060 OTHERS SUROTH0001 MANIPULATION UNDER GA SMALL JOINTS 4400 5500 6600 7430 8250 9630 SUROTH0015 MANIPULATION UNDER GA MEDIUM JOINTS 6600 8250 9900 11140 12380 14440 SUROTH0003 SKELETAL TRACTION 3850 4810 5780 6500 7220 8420 SUROTH0004 CLOSE REDUCTION+K WIRE 14850 18560 22280 25060 27840 32480 SUROTH0006 INTRA ARTICULAR INJECTION SMALL JOINT 3300 4130 4950 5570 6190 7220

SUROTH0007 INTRA ARTICULAR INJ. SMALL JOINT(C ARM) 4400 5500 6600 7430 8250 9630 SUROTH0008 SKELETAL TRACTION 3300 4130 4950 5570 6190 7220 SUROTH0009 INTRA ARTICULAR INJECTION L ARGE JOINT 4950 6190 7430 8350 9280 10830

SUROTH0010 INTRA ARTICULAR INJ. LARGE JOINT(C ARM) 6600 8250 9900 11140 12380 14440 SUROTH0011 RESECTION ARTHOPLASTY SIMPLE 11000 13750 16500 18560 20630 24060 SUROTH0012 RESECTION ARTHOPLASTY COMPLEX 22000 27500 33000 37130 41250 48130 COMPUTER ASSISTED TOTAL JOINT SUROTH0013 35200 44000 52800 59400 66000 77000 REPLACMENT SUROTH0014 TOTAL JOINT REPLACEMENT NAVIGATION 39600 49500 59400 66830 74250 86630 INTRA LESIONAL (BONE) INJECTION (SMALL) C SUROTH0022 7000 8750 10500 11810 13130 15310 -ARM INTRA LESIONAL (BONE) INJECTION (LARGE) C SUROTH0023 11000 13750 16500 18560 20630 24060 -ARM TRAUMA (UPPER LIMB)

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CODE.NO SERVICE NAME AMOUNT HAND SURHND0005 FRACTURE MC/PHALANX : SIMPLE, SINGLE 14000 17500 21000 23630 26250 30630

SURHND0006 FRACTURE MC/PHALANX : COMPLEX, SINGLE 18000 22500 27000 30380 33750 39380

SURHND0007 FRACTURE MC/PHALANX : SIMPLE, MULTIPLE 17000 21250 25500 28690 31880 37190 FRACTURE MC/PHALANX : COMPLEX, SURHND0008 20000 25000 30000 33750 37500 43750 MULTIPLE FRACTURE NU METACARPAL/PHALANX : SURHND0009 22000 27500 33000 37130 41250 48130 ORIF+BG SURHND0010 MC/PHALANX SINGLE CURETTAGE & BG 16500 20630 24750 27840 30940 36090 SURHND0011 MC/PHALANX MULTIPLE CURETTAGE & BG 19800 24750 29700 33410 37130 43310 SURWST0027 MALLET FINGER SINGLE 16500 20630 24750 27840 30940 36090 SURWST0028 MALLET FINGER-COMPLEX SINGLE 24200 30250 36300 40840 45380 52940 SURWST0029 MALLET FINGER MULTIPLE 19800 24750 29700 33410 37130 43310 SURWST0030 MALLET FINGER-COMPLEX MULTIPLE 28600 35750 42900 48260 53630 62560 SURWST0064 SYNOVECTOMY WRIST / HAND 11500 14380 17250 19410 21560 25160 SURHND0012 MALLET FINGER REDO SURGERY 22000 27500 33000 37130 41250 48130 SURHND0013 NEGLECTED MALLET FINGER 24200 30250 36300 40840 45380 52940 SURWST0024 FRACTURE DISLOCATION PIP/DIP/MCP 16500 20630 24750 27840 30940 36090 SURHND0014 FINGER JOINTS : DISLOCATIONS - COMPLEX 19800 24750 29700 33410 37130 43310 SURHND0015 FRACTURE BASE OF THUMB- BENNETT'S 19800 24750 29700 33410 37130 43310 SURHND0016 UCL 1ST MCP JOINT RECONSTRUCTION 24200 30250 36300 40840 45380 52940 SURWST0018 UCL 1ST MCP JOINT REPAIR 19800 24750 29700 33410 37130 43310 SURHND0017 COMPLEX ORIF HAND 22000 27500 33000 37130 41250 48130 EXCISIONAL ARTHROPLASTY CMC JOINT SURHND0070 20000 25000 30000 33750 37500 43750 THUMB SURHND0071 POST BURN CONTRACTURE RELEASE- SINGLE 24530 30660 36800 41390 45990 53660 POST BURN CONTRACTURE RELEASE- SURHND0072 36790 45990 55190 62080 68980 80480 MULTIPLE SURHND0073 K-WIRE SINGLE FRACTURE MC/PHALANX 11000 13750 16500 18560 20630 24060 SURHND0074 K-WIRE MULTIPLE FRACTURE MC/PHALANX 17940 22430 26910 30270 33640 39240 SURHND0075GLOMUS TUMOUR 22000 27500 33000 37130 41250 48130 TRAUMA (LOWER LIMB) HIP & PELVIS SURHIP0024 ORIF ACETABULUM (COMPLEX) 44000 55000 66000 74250 82500 96250 SURHIP0025 ORIF PELVIS (SIMPLE) 33000 41250 49500 55690 61880 72190 SURHIP0026 ORIF PELVIS (COMPLEX) 44000 55000 66000 74250 82500 96250 SURHIP0004 FRACTURE I/T FEMUR-PFNA 18700 23380 28050 31560 35060 40910 INTERLOCKING CLOSE/OPEN NAILING SURHIP0052 21000 26250 31500 35440 39380 45940 LONGBONE- SIMPLE INTERLOCKING CLOSE/OPEN NAILING SURHIP0053 30000 37500 45000 50630 56250 65630 LONGBONE- COMPLEX SURHIP0023 FRACTURE I/T FEMUR-DHS/ DCS 25000 31250 37500 42190 46880 54690 THIGH SURTGH0012 DYNAMIZATION OF INTERLOCKED NAIL 6600 8250 9900 11140 12380 14440 ANKLE & FOOT SURAKL0001 MEDIAL MALLEOLUS 25000 31250 37500 42190 46880 54690 SURAKL0002 LATERAL MALLEOLUS 25000 31250 37500 42190 46880 54690 SURAKL0003 BIMALLEOLAR 40000 50000 60000 67500 75000 87500 SURAKL0004 TRIMALLEOLAR 60000 75000 90000 101250 112500 131250 ARTHROPLASTY (UPPER LIMB) SHOULDER HEMI REPLACEMENT-ARTHOPLASTY SURART0001 30000 37500 45000 50630 56250 65630 SHOULDER SURART0002 TOTAL SHOULDER REPLACEMENT 33000 41250 49500 55690 61880 72190 REVISION. TOTAL SHOULDER REPLACEMENT SURART0003 38500 48130 57750 64970 72190 84220 (1st STAGE)

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CODE.NO SERVICE NAME AMOUNT REVERSE TOTAL SHOULDER REPLACEMENT SURART0005 38500 48130 57750 64970 72190 84220 (2nd STAGE) SURSHL0052 REV. TOTAL JOINT REIMPLANTATION 44000 55000 66000 74250 82500 96250 ELBOW SURELB0011 TOTAL ELBOW REPLACEMENT-SIMPLE 26400 33000 39600 44550 49500 57750 SURELB0032 TOTAL ELBOW RELACEMENT : COMPLEX 33000 41250 49500 55690 61880 72190 SURELB0015 REVISION ELBOW REPLACEMENT 44000 55000 66000 74250 82500 96250 SURELB0005 RADIAL HEAD REPLACEMENT 18700 23380 28050 31560 35060 40910 SURELB0016 HEMIHAMATE ARTHROPLASTY 24500 30630 36750 41340 45940 53590 WRIST SURWST0008 TOTAL WRIST ARTHROPLASTY REPLACEMENT 45000 56250 67500 75940 84380 98440 HAND SURHND0018 FINGER JOINT REPLACEMENT - SINGLE 25000 31250 37500 42190 46880 54690 SURHND0019 FINGER JOINT REPLACEMENT - MULTIPLE 38000 47500 57000 64130 71250 83130 ARTHROPLASTY (LOWER LIMB) HIP SURHIP0002 NECK FEMUR HEMI/BIPOLAR ARTHOPLASTY 27500 34380 41250 46410 51560 60160 SURHIP0029 HIP ARTHROPLASTY TRAUMA 22000 27500 33000 37130 41250 48130 SURHIP0006 THR- SIMPLE 33000 41250 49500 55690 61880 72190 SURHIP0007 THR- COMPLEX 44000 55000 66000 74250 82500 96250 SURHIP0008 REVISION JOINT REPLACEMENT STAGE-1 37400 46750 56100 63110 70130 81810 SURHIP0011 2ND STAGE REVISION JOINT REPLACEMENT 37400 46750 56100 63110 70130 81810 SURHIP0030 REVISION THR ONE STAGE-SIMPLE 40000 50000 60000 67500 75000 87500 SURHIP0031 REVISION THR ONE STAGE -COMPLEX 55000 68750 82500 92810 103130 120310 SURHIP0009 REMOVAL OF HIP PROSTHESIS-SIMPLE 22000 27500 33000 37130 41250 48130 SURHIP0051 REMOVAL OF HIP PROSTHESIS-COMPEX 33000 41250 49500 55690 61880 72190 SURHIP0032 GIRDLESTONE ARTHROPLASTY HIP 22000 27500 33000 37130 41250 48130 SURHIP0014 CORE DECOMPRESSION U/L 22000 27500 33000 37130 41250 48130 KNEE SURKNE0046 TOTAL KNEE REPLACEMENT U/L 33000 41250 49500 55690 61880 72190 SURORT0007 TOTAL KNEE REPLACEMENT B/L 60500 75630 90750 102090 113440 132340 SURORT0252 INTRA ARTICULAR RECONSTRUCTION 30000 37500 45000 50630 56250 65630 SURORT0253 INTRA ARTICULAR RECONSTRUCTION COMPLEX 40000 50000 60000 67500 75000 87500 SURKNE0047 CAS SINGLE KNEE REPLACEMENT 36850 46060 55280 62180 69090 80610 SURKNE0048 UNICOMPARTMENT KNEE ARTHROPLASTY U/L 33000 41250 49500 55690 61880 72190

SURKNE0076 UNICOMPARTMENT KNEE ARTHOPLASTY B/L 60500 75630 90750 102090 113440 132340 SURKNE0049 CONSTRAINED KNEE ARTHROPLASTY 38500 48130 57750 64970 72190 84220 SURKNE0050 HINGE KNEE ARTHROPLASTY 44000 55000 66000 74250 82500 96250 SURKNE0051 PARTIAL KNEE REPLACEMENT U/L 37400 46750 56100 63110 70130 81810 SURKNE0077 PARTIAL KNEE REPLACEMENT B/L 71500 89380 107250 120660 134060 156410 SURKNE0052 DEBRIDEMENT POST TKR –SMALL 11000 13750 16500 18560 20630 24060 SURKNE0053 DEBRIDEMENT POST TKR -LARGE 14850 18560 22280 25060 27840 32480 SURKNE0054 DEBRIDEMENT+PLASTIC CHANGE 16500 20630 24750 27840 30940 36090 SURKNE0055 KNEE REVISION STAGE I ARTHROPLASTY 33000 41250 49500 55690 61880 72190 SURKNE0056 KNEE REVISION STAGE II ARTHROPLASTY 38500 48130 57750 64970 72190 84220

SURKNE0057 ONE STAGE REVISION KNEE 1 COMPONENT 40000 50000 60000 67500 75000 87500 ONE STAGE REVISION KNEE BOTH SURKNE0058 50000 62500 75000 84380 93750 109380 COMPONENTS SURKNE0059 PATELLA REPLACEMENT ALONE POST TKR 18700 23380 28050 31560 35060 40910 SURKNE0060 CHANGE OF PLASTIC ALONE 18700 23380 28050 31560 35060 40910 SURKNE0061 MANIPULATION OF POST TKR KNEE 6050 7560 9080 10210 11340 13230 ANKLE SURAKL0024 TOTAL ANKLE REPLACEMENT 29700 37130 44550 50120 55690 64970

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CODE.NO SERVICE NAME AMOUNT ARTHROSCOPY (UPPER LIMB) SHOULDER SURKNE0023 DIAGNOSTIC ARTHROSCOPY 11000 13750 16500 18560 20630 24060 SURSHL0008 SYNOVIAL BIOPSY 8800 11000 13200 14850 16500 19250 SURSHL0009 LOOSE BODY REMOVAL 15000 18750 22500 25310 28130 32810 SURSHL0010 MULTIPLE LOOSE BODIES 13200 16500 19800 22280 24750 28880 SURSHL0011 DEBRIDEMENT JOINT 15000 18750 22500 25310 28130 32810 SURSHL0012 SHOULDER ACROMIOPLASTY 27500 34380 41250 46410 51560 60160 SURSHL0013 AC JOINT EXCISION 13200 16500 19800 22280 24750 28880 SURSHL0014 SAD WITH AC JOINT EXCISION 30000 37500 45000 50630 56250 65630 SURSHL0015 STIFF SHOULDER RELEASE 13200 16500 19800 22280 24750 28880 SURSHL0055 COMPLEX RELEASE 25000 31250 37500 42190 46880 54690 SURSHL0016 BANKART REPAIR SIMPLE 25000 31250 37500 42190 46880 54690 SURSHL0017 BANKART REPAIR BONY 24200 30250 36300 40840 45380 52940 SURSHL0020 SLAP LESION REPAIR 25000 31250 37500 42190 46880 54690 SURSHL0021 GLOBAL PLICATION 22000 27500 33000 37130 41250 48130 SURSHL0022 BICEPS TENOTOMY 20000 25000 30000 33750 37500 43750 SURSHL0053 BICEPS TENODESIS 25000 31250 37500 42190 46880 54690 SURSHL0023 CUFF REPAIR SIMPLE 18000 22500 27000 30380 33750 39380 SURSHL0024 CUFF REPAIR MEDIUM 24000 30000 36000 40500 45000 52500 SURSHL0025 CUFF REPAIR LARGE 30000 37500 45000 50630 56250 65630 SURSHL0026 SUBACROMIAL DECOMPRESSION 22000 27500 33000 37130 41250 48130 SURSHL0027 MINI-OPEN CUFF REPAIR 24850 31060 37280 41930 46590 54360 SURSHL0028 REVISION CUFF REPAIR 38500 48130 57750 64970 72190 84220 SURSHL0029 REVISION SUR. FAILED BANKART 38500 48130 57750 64970 72190 84220 SURSHL0030 OPEN SUR. RECURRENT DISL. 37500 46880 56250 63280 70310 82030 SURSHL0031 AC JOINT FIXATION 28600 35750 42900 48260 53630 62560 SURSHL0054 SUBACROMIAL BURSECTOMY 11000 13750 16500 18560 20630 24060 ELBOW SURELB0007 LOOSE BODY REMOVAL 36850 46060 55280 62180 69090 80610 SURELB0008 SYNOVECTOMY 18700 23380 28050 31560 35060 40910 SURELB0009 STIFF ELBOW RELEASE 32000 40000 48000 54000 60000 70000 SURELB0010 SURGERY FOR TENNIS ELBOW 15000 18750 22500 25310 28130 32810 SURELB0071 NEEDLE RELEASE FOR TINNIS ELBOW 23000 28750 34500 38810 43130 50310 WRIST SURWST0007 WRIST ARTHROSCOPY 22000 27500 33000 37130 41250 48130 ARTHROSCOPY (LOWER LIMB) HIP SURHIP0019 HIP BIOPSY 14850 18560 22280 25060 27840 32480 SURHIP0020 HIP ARTHROSCOPY DEBRIDEMENT 22000 27500 33000 37130 41250 48130 SURHIP0021 HIP ARTHROSCOPIC REPAIR 29700 37130 44550 50120 55690 64970 KNEE SURKNE0023 DIAGNOSTIC ARTHROSCOPY 11000 13750 16500 18560 20630 24060 SURKNE0024 DEBRIDEMENT ARTHROSCOPY 13200 16500 19800 22280 24750 28880 SURKNE0025 PLICA EXCISION ARTHROSCOPY 13200 16500 19800 22280 24750 28880 SURKNE0026 LATERAL RETINACULUM RELEASE 13200 16500 19800 22280 24750 28880 SURKNE0027 LOOSE BODY REMOVAL 16500 20630 24750 27840 30940 36090 SURKNE0028 MENISECTOMY 16500 20630 24750 27840 30940 36090 SURKNE0029 MENISCAL REPAIR SMALL 18700 23380 28050 31560 35060 40910 SURKNE0030 MENISCAL REPAIR LARGE 22000 27500 33000 37130 41250 48130 SURKNE0082 MENISCAL REPAIR COMPLEX 30000 37500 45000 50630 56250 65630 SURKNE0031 CHONDROPLASTY 14850 18560 22280 25060 27840 32480 SURKNE0032 SYNOVECTOMY MINOR 11000 13750 16500 18560 20630 24060 SURKNE0033 SYNOVECTOMY MAJOR 14850 18560 22280 25060 27840 32480 SURKNE0034 POST TKR 14850 18560 22280 25060 27840 32480 SURKNE0035 ARTHROSCOPIC STIFF KNEE RELEASE MINOR 14850 18560 22280 25060 27840 32480

SURKNE0036 ARTHROSCOPIC STIFF KNEE RELEASE MAJOR 22000 27500 33000 37130 41250 48130 SURKNE0037 POSTERIOR CAPSULECTOMY 22000 27500 33000 37130 41250 48130 SURKNE0038 ACL SINGLE BUNDLE RECONSTRUCTION 22000 27500 33000 37130 41250 48130 SURKNE0084 PRPP INJECTION - SIMPLE 8000 10000 12000 13500 15000 17500 SURKNE0085 PRPP INJECTION - COMPLEX 13000 16250 19500 21940 24380 28440

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CODE.NO SERVICE NAME AMOUNT SURKNE0086 MENISUS REPAIR - SIMPLE 25000 31250 37500 42190 46880 54690 SURKNE0087 MENISUS REPAIR - COMPLEX 35000 43750 52500 59060 65630 76560 SURKNE0088 TENDON REPAIR - SMALL 15000 18750 22500 25310 28130 32810 SURKNE0089 TENDON REPAIR - MEDIUM 20000 25000 30000 33750 37500 43750 SURKNE0090 TENDON REPAIR - LARGE 27000 33750 40500 45560 50630 59060 SURKNE0091 TENDON REPAIR - COMPLEX 35000 43750 52500 59060 65630 76560 SURKNE0092 TENDON TENOLYSIS- SMALL 10000 12500 15000 16880 18750 21880 SURKNE0093 TENDON TENOLYSIS- SIMPLE 15000 18750 22500 25310 28130 32810 SURKNE0094 TENDON TENOLYSIS- COPLEX 20000 25000 30000 33750 37500 43750 SURKNE0039 ACL WITH MENISECTOMY 29700 37130 44550 50120 55690 64970 SURKNE0040 ACL WITH CHONDROPLASTY 33000 41250 49500 55690 61880 72190 SURKNE0041 ACL DOUBLE BUNDLE RECONS 33000 41250 49500 55690 61880 72190 SURKNE0042 ACL EXTRA-ARTICULAR RECONS. 18700 23380 28050 31560 35060 40910 SURKNE0043 ACL AVULSION REFIXATION 22000 27500 33000 37130 41250 48130 SURKNE0044 PCL SINGLE BUNDLE RECONS. 32000 40000 48000 54000 60000 70000 SURKNE0045 PCL DOUBLE BUNDLE RECONS. 35000 43750 52500 59060 65630 76560 SURKNE0078 LIGAMENT RECONSTRUCTION KNEE SIMPLE 27500 34380 41250 46410 51560 60160

SURKNE0079 LIGAMENT RECONSTRUCTION KNEE COMPLEX 38500 48130 57750 64970 72190 84220 SURKNE0080 KNEE RELEASE 22000 27500 33000 37130 41250 48130 ANKLE SURAKL0025 ANKLE ARTHOSCOPY 22000 27500 33000 37130 41250 48130 AMPUTATIONS SURAMP0001 AMPUTATIONS FORE QUARTER 27500 34380 41250 46410 51560 60160 SURAMP0015 DISARTICULATION SHOULDER 22000 27500 33000 37130 41250 48130 SURAMP0002 AMPUTATIONS MID ARM 14850 18560 22280 25060 27840 32480 SURAMP0003 DISARTICULATION ELBOW 14850 18560 22280 25060 27840 32480 SURAMP0004 AMPUTATIONS FOREARM 14850 18560 22280 25060 27840 32480 SURAMP0005 DISARTICULATION WRIST 13200 16500 19800 22280 24750 28880 SURAMP0006 AMPUTATIONS FINGER/TOES 11000 13750 16500 18560 20630 24060 SURAMP0007 AMPUTATIONS HIND QUARTER 27500 34380 41250 46410 51560 60160 SURAMP0016 HEMIPELVECTOMY 52800 66000 79200 89100 99000 115500 SURAMP0008 DISARTICULATION HIP 22000 27500 33000 37130 41250 48130 SURAMP0009 AMPUTATIONS MID THIGH 18700 23380 28050 31560 35060 40910 SURAMP0010 AMPUTATIONS KNEE 16500 20630 24750 27840 30940 36090 SURAMP0011 AMPUTATIONS BELOW KNEE 16500 20630 24750 27840 30940 36090 SURAMP0012 DISARTICULATION ANKLE 11000 13750 16500 18560 20630 24060 AMPUTATIONS/DISARTICULATION FOOT SURAMP0013 11000 13750 16500 18560 20630 24060 SINGLE AMPUTATION/DISARTICULATION FOOT SURAMP0017 16500 20630 24750 27840 30940 36090 MULTIPLE SURAMP0014 AMPUTATIONS THROUGH METATARSALES 11000 13750 16500 18560 20630 24060

SURAMP0018 AMPUTATIONS STAMP RECONSTRUCTION 20000 25000 30000 33750 37500 43750 ARTHRODESIS SURATH0008 ARTHRODESIS OF SMALL JOINTS 18000 22500 27000 30380 33750 39380 SURATH0009 ARTHRODESIS OF MEDIUM JOINTS 23000 28750 34500 38810 43130 50310 SURATH0010 ARTHRODESIS OF LARGE JOINTS 30000 37500 45000 50630 56250 65630 SURATH0011 ARTHRODESIS OF COMPLEX JOINTS 40000 50000 60000 67500 75000 87500 SURATH0006 THUMB BASAL ARTHRITIS : ARTHRODESIS 16500 20630 24750 27840 30940 36090 SURAKL0012 TRIPPLE ARTHRODESIS 42900 53630 64350 72390 80440 93840 SURATH0007 SUBTALAR ARTHRODESIS 27500 34380 41250 46410 51560 60160 TUMORS EXCISION SURTUM0001 SMALL SOFT TISSUE EXCISION 11000 13750 16500 18560 20630 24060 SURTUM0002 MEDIUM SOFT TISSUE EXCISION 16500 20630 24750 27840 30940 36090 SURTUM0003 LARGE SOFT TISSUE EXCISION 22000 27500 33000 37130 41250 48130 BONE EXCISION SURTUM0017 EXOSTOSIS EXCISON SIMPLE 16500 20630 24750 27840 30940 36090 SURTUM0018 EXOSTOSIS EXCISON COMPLEX 22000 27500 33000 37130 41250 48130 SURTUM0007 SMALL BONE TUMOUR EXCISION 11000 13750 16500 18560 20630 24060

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CODE.NO SERVICE NAME AMOUNT SURTUM0008 SMALL BONE EXCISION+ RECONSTRUCTION 16500 20630 24750 27840 30940 36090 SURTUM0009 MEDIUM BONE TUMOUR EXCISION 14300 17880 21450 24130 26810 31280 SURTUM0010 MEDIUM BONE EXCISION+RECNOSTRUCTION 19800 24750 29700 33410 37130 43310 SURTUM0011 LARGE BONE - EXCISION 22000 27500 33000 37130 41250 48130 SURTUM0012 LARGE BONE - EXCISION PLUS RECONS 33000 41250 49500 55690 61880 72190 SURTUM0019 TUMOUR RESECTION ARTHODESIS SMALL 27500 34380 41250 46410 51560 60160

SURTUM0020 TUMOUR RESECTION ARTHODESIS MEDIUM 33000 41250 49500 55690 61880 72190

SURTUM0021 TUMOUR RESECTION ARTHODESIS LARGE 38500 48130 57750 64970 72190 84220

SURTUM0022 TUMOUR RESECTION ARTHOPLASTY SMALL 38500 48130 57750 64970 72190 84220

SURTUM0023 TUMOUR RESECTION ARTHOPLASTY MEDIUM 44000 55000 66000 74250 82500 96250

SURTUM0024 TUMOUR RESECTION ARTHOPLASTY LARGE 49500 61880 74250 83530 92810 108280 SURWST0035 GCT TENDON SHEATH (SINGLE) 27500 34380 41250 46410 51560 60160 SURWST0036 GCT TENDON SHEATH (MULTIPLE) 44000 55000 66000 74250 82500 96250 GCT TENDON SHEATH (SINGLE) REDO SURTUM0025 38500 48130 57750 64970 72190 84220 SURGERY SURWST0037 GCT BONE (SMALL) 27500 34380 41250 46410 51560 60160 SURTUM0026 GCT BONE (MEDIUM) 38500 48130 57750 64970 72190 84220 SURWST0038 GCT BONE (LARGE) 44000 55000 66000 74250 82500 96250 BIOPSY SURTUM0013 BIOPSY IMAGE GUIDED 6050 7560 9080 10210 11340 13230 SURTUM0014 BIOPSY SMALL OPEN 6050 7560 9080 10210 11340 13230 SURTUM0015 BIOPSY LARGE OPEN 8800 11000 13200 14850 16500 19250 SURTUM0016 INCISIONAL BIOPSY 7000 8750 10500 11810 13130 15310 HIP & KNEE SURHIP0035 CR & SPICA APPLICATION FOR DDH 5500 6880 8250 9280 10310 12030 SURHIP0036 OR & SPICA APPLICATION FOR DDH 22000 27500 33000 37130 41250 48130 SURHIP0037 OR & VDO & SPICA FOR DDH 27500 34380 41250 46410 51560 60160 SURHIP0040 SCFE IN SITU PINNING 21500 26880 32250 36280 40310 47030 SURHIP0043 GROWTH MODULATION FEMUR OR TIBIA U/L 11000 13750 16500 18560 20630 24060 SURHIP0044 GROWTH MODULATION FEMUR &TIBIA U/L 15400 19250 23100 25990 28880 33690 TIBIAL DEFORMITY CORR. OSTETOMY SURHIP0045 42000 52500 63000 70880 78750 91880 ILIZAROV SURHIP0046 CONG. PSEUDOARTHROSIS TIBIA PLATING 19800 24750 29700 33410 37130 43310 CONG. PSEUDO TIBIA VASC.FIBULAR SURHIP0048 30800 38500 46200 51980 57750 67380 GRAFTING REPAIR OF QUADRICEPS OR PATELLAR SURHIP0049 19800 24750 29700 33410 37130 43310 TENDON SURHIP0018 ADDUCTOR TENOTOMY 11000 13750 16500 18560 20630 24060 SURKNE0014 KNEE RELEASE OPEN MEDIUM 18700 23380 28050 31560 35060 40910 SURKNE0015 KNEE RELEASE OPEN MAJOR 25800 32250 38700 43540 48380 56440 SURKNE0016 MPFL RECONSTRUCTION 32000 40000 48000 54000 60000 70000 SURKNE0019 TIBIA OPEN WEDGE HTO WITH FIXATION 32500 40630 48750 54840 60940 71090 SURKNE0020 TIBIA CLOSED WEDGE OSTEOTOMY WITH POP 26500 33130 39750 44720 49690 57970 SURKNE0022 HAMSTRING GRAFT HARVEST 11000 13750 16500 18560 20630 24060 PATELLAR / QUADS TENDON SURKNE0064 30700 38380 46050 51810 57560 67160 RECONSTRUCTION ELBOW & WRIST SURWST0005 CARPAL TUNNEL RELEASE 15400 19250 23100 25990 28880 33690 SURELB0033 CARPAL TUNNEL RELEASE - RE DO SURGERY 19800 24750 29700 33410 37130 43310 SURELB0034 CARPAL TUNNEL RELEASE ENDOSCOPIC 22000 27500 33000 37130 41250 48130 SURELB0035 CARPAL T RELEASE + MEDIAN N NEUROLYSIS 22000 27500 33000 37130 41250 48130

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CODE.NO SERVICE NAME AMOUNT DECOMPRESSION MEDIAN NERVE IN SURWST0047 17050 21310 25580 28770 31970 37300 FOREARM SURELB0036 KIENBOCKS DISEASE RADIAL SHORTENING 8800 11000 13200 14850 16500 19250

SURELB0037 KIENBOCKS DISEASE CAPITATE SHORTENING 11000 13750 16500 18560 20630 24060

SURELB0038 VASCULARIZED BONE GRAFTING FOR LUNATE 27500 34380 41250 46410 51560 60160 SURELB0039 PISCIFORM TRANSFER KIENBOCKS 19800 24750 29700 33410 37130 43310 SURWST0045 WAFER RESECTION ULNA 11000 13750 16500 18560 20630 24060 SURWST0020 LIMITED CARPAL FUSION SIMPLE 17600 22000 26400 29700 33000 38500 SURWST0021 LIMITED CARPAL FUSION COMPLEX 22000 27500 33000 37130 41250 48130 SURELB0040 FOUR CORNER FUSION 27500 34380 41250 46410 51560 60160 SURELB0041 CARPAL INSTABILITY SIMPLE RECON. 19800 24750 29700 33410 37130 43310 SURELB0042 CARPAL INSTABILITY COMPLEX RECON. 24200 30250 36300 40840 45380 52940 SURELB0043 TFCC REPAIR : OPEN 22000 27500 33000 37130 41250 48130 SURWST0043 DRUJ LIGAMENT RECONSTRUCTION 27500 34380 41250 46410 51560 60160 SURELB0044 DRUJ INTERPOSITION ARTHROPLASTY 22000 27500 33000 37130 41250 48130 SURWST0017 SAUVE KAP&JI PROCE. FOR DRUJ 16500 20630 24750 27840 30940 36090 SURELB0045 DRUJ SALVAGE PROCE. 19800 24750 29700 33410 37130 43310 SURELB0046 ORIF LIGAMENTOUS INSTABILITY WRIST 24200 30250 36300 40840 45380 52940 SURELB0047 ULNAR SHORTENING 8800 11000 13200 14850 16500 19250 SURELB0048 ULNAR LENTHENING 11000 13750 16500 18560 20630 24060 SURELB0049 ULNAR HEAD RESECTION 8800 11000 13200 14850 16500 19250 SURELB0050 ULNAR HEAD REPLACEMENT 19800 24750 29700 33410 37130 43310 SURWST0019 HEMIHAMATE ARTHROPLASTY 22000 27500 33000 37130 41250 48130 SURELB0051 WRIST RECONSTRUCTION SIMPLE 11000 13750 16500 18560 20630 24060 SURELB0052 WRIST RECONSTRUCTION COMPLEX 16500 20630 24750 27840 30940 36090 SURELB0053 RADIAL STYLOIDECTOMY 11000 13750 16500 18560 20630 24060 SURELB0054 PROXIMAL ROW CARPECTOMY 16500 20630 24750 27840 30940 36090 SURELB0055 NERVE EXPLORATION 15000 18750 22500 25310 28130 32810 SURELB0056 NERVE REPAIR -SMALL 16000 20000 24000 27000 30000 35000 SURELB0072 NERVE TRANSPOSITION 15000 18750 22500 25310 28130 32810 SURELB0073 NEUROLYSIS - SIMPLE 15000 18750 22500 25310 28130 32810 SURELB0074 NEUROLYSIS - COMPLEX 22000 27500 33000 37130 41250 48130 SURELB0058 MAXPAGE SLIDING OPERATION 16500 20630 24750 27840 30940 36090 SURELB0068 NERVE REPAIR & CABLE GRAFTING MINOR 25300 31630 37950 42690 47440 55340

SURELB0069 NERVE REPAIR & CABLE GRAFTING MAJOR 48400 60500 72600 81680 90750 105880 SURELB0070 ANTERIOR TRANSPOSITION OF ULNAR NERVE 20000 25000 30000 33750 37500 43750 SURWST0013 TENDON TRANSFER SINGLE 16500 20630 24750 27840 30940 36090 SURWST0014 TENDON TRANSFER MULTIPLE 22000 27500 33000 37130 41250 48130 SURELB0059 TENDON TRANSFER MULTIPLE COMPLAX 33000 41250 49500 55690 61880 72190 SURELB0061 CUBITAL TUNNEL SYNDROME 16500 20630 24750 27840 30940 36090 SURELB0062 RADIAL TUNNEL SYNDROME 16500 20630 24750 27840 30940 36090 HAND SURHND0020 PARONYCHIA : DRAINAGE 2200 2750 3300 3710 4130 4810 SURHND0021 HAND INFECITONS - DRAINAGE 5500 6880 8250 9280 10310 12030 DUPUYTREN'S CONTRACTURE RELEASE SURHND0022 14300 17880 21450 24130 26810 31280 SIMPLE DUPUYTREN'S CONTRACTURE RELEASE SURHND0023 27500 34380 41250 46410 51560 60160 COMPLEX DUPUYTREN'S CONTRACTURE RELEASE SURHND0024 14300 17880 21450 24130 26810 31280 SINGLE DUPUYTREN'S CONTRACTURE RELEASE SURHND0025 22000 27500 33000 37130 41250 48130 MULTIPLE SURHND0039 FLEX. TENDON : SINGLE : TENOLYSIS 33000 41250 49500 55690 61880 72190 SURHND0040 FLEX. TENDON : MULTIPLE : TENOLYSIS 44000 55000 66000 74250 82500 96250 SURHND0041 FLEX. TENDON : RECONSTRUCTION : SINGLE 38500 48130 57750 64970 72190 84220 FLEX. TENDON : RECONSTRUCTION : SURHND0042 49500 61880 74250 83530 92810 108280 MULTIPLE SURHND0043 STIFF FINGER : SINGLE : CAPSULOTOMY 16500 20630 24750 27840 30940 36090

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CODE.NO SERVICE NAME AMOUNT SURHND0044 STIFF FINGER : MULTIPLE : CAPSULOTOMY 24200 30250 36300 40840 45380 52940 SURHND0045 THUMB BASAL ARTHRITIS : LRTI 22000 27500 33000 37130 41250 48130 SURHND0046 CONGENITAL TRIGGER THUMB RELEASE 15000 18750 22500 25310 28130 32810 SURWST0033 TRIGGER FINGER RELEASE 11000 13750 16500 18560 20630 24060 SURHND0047 TRIGGER THUMB RELEASE U/L 15000 18750 22500 25310 28130 32810 SURHND0048 TRIGGER THUMB RELEASE B/L 20000 25000 30000 33750 37500 43750 SURWST0048 RADIAL CLUB H& CENTRALIZATION 22000 27500 33000 37130 41250 48130 SURWST0049 RADIAL CLUB H& EXT. FIX. APPLICATION 16500 20630 24750 27840 30940 36090 SURWST0032 POLLICIZATION 33000 41250 49500 55690 61880 72190 SURHND0069 POLLICIZATION ( COMPLEX ) 49500 61880 74250 83530 92810 108280 SURHND0049 GANGLION EXCISON SIMPLE 11000 13750 16500 18560 20630 24060 SURHND0050 GANGLION EXCISION COMPLEX 16500 20630 24750 27840 30940 36090 SURHND0051 SYNDACTYLY RELEASE 2 DIGITS SIMPLE 27500 34380 41250 46410 51560 60160 SURHND0052 SYNDACTYLY RELEASE 2 DIGITS COMPLEX 38500 48130 57750 64970 72190 84220

SURKNE0070 SYNDACTYLY RELEASE MULTIPLE SIMPLE 38500 48130 57750 64970 72190 84220

SURKNE0069 SYNDACTYLY RELEASE MULTIPLE COMPLEX 49500 61880 74250 83530 92810 108280 SURWST0039 CONSTRICTION B& RELEASE SINGLE 12100 15130 18150 20420 22690 26470 SURWST0040 CONSTRICTION B& RELEASE MULTIPLE 17600 22000 26400 29700 33000 38500 SURHND0053 DUPLICATED THUMB RECONSTRUCTION 33000 41250 49500 55690 61880 72190 SURHND0054 POLYDACTYLY EXCISION 11000 13750 16500 18560 20630 24060 SURWST0041 MACRODACTYLY DEFATTENING STAGE-1 16500 20630 24750 27840 30940 36090 MACRODACTYLY DEFATTENING & SURWST0042 24200 30250 36300 40840 45380 52940 SHORTENING SURWST0031 OPPONENS PLASTY 18700 23380 28050 31560 35060 40910 SURHND0055 CLEFT HAND REPAIR 38500 48130 57750 64970 72190 84220 SURHND0056 CLEFT FOOT REPAIR 38500 48130 57750 64970 72190 84220 SURHND0057 TOE TO PHALANX TRANSFER 16500 20630 24750 27840 30940 36090 RHEUMATOID HAND RECONSTRUCTION : SURHND0058 33000 41250 49500 55690 61880 72190 SIMPLE RHEUMATOID HAND RECONSTRUCTION : SURHND0059 44000 55000 66000 74250 82500 96250 COMPLEX SURHND0060 SWAN NECK DEFORMITY MULTIPLE FINGER 33000 41250 49500 55690 61880 72190 SURHND0061 SWAN NECK DEFORMITY SINGLE FINGER 27500 34380 41250 46410 51560 60160 SURHND0062 SWAN NECK DEFORMITY TWO FINGERS 38500 48130 57750 64970 72190 84220 SURWST0006 DEQUERVAIN'S RELEASE 11000 13750 16500 18560 20630 24060 SURHND0063 FINGER RECONSTRUCTION SIMPLE 19800 24750 29700 33410 37130 43310 SURHND0064 FINGER RECONSTRUCTION COMPLEX 27500 34380 41250 46410 51560 60160 SURHND0065 HAND RECONSTRUCTION SIMPLE 27500 34380 41250 46410 51560 60160 SURHND0066 HAND RECONSTRUCTION COMPLEX 38500 48130 57750 64970 72190 84220 SURHND0067 SMALL JOINT REPLACEMENT SINGLE 27500 34380 41250 46410 51560 60160 SURHND0068 SMALL JOINT REPLACEMENT MULTIPLE 38500 48130 57750 64970 72190 84220 SURWST0025 VOLAR PLATE ARTHROPLASTY 27500 34380 41250 46410 51560 60160 SURWST0065 GLOMUS TUMOUR SIMPLE 14000 17500 21000 23630 26250 30630 SURWST0066 GLOMUS TUMOUR COMPLEX 16500 20630 24750 27840 30940 36090 FOOT & ANKEL SURAKL0014 HALLUX RIGIDUS 21000 26250 31500 35440 39380 45940 SURAKL0026 HALL. VALGUS - SIMPLE 16500 20630 24750 27840 30940 36090 SURAKL0027 HALL. VALGUS - COMPLEX 27000 33750 40500 45560 50630 59060 SURAKL0028 HALL. VALGUS BUNIONECTOMY 16000 20000 24000 27000 30000 35000 SURAKL0029 HALL. VAGUS SOFT TISSUE PLICATION 16500 20630 24750 27840 30940 36090 SURAKL0030 HALL. VALGUS BUNIONECTOMY + DSTP 32500 40630 48750 54840 60940 71090 HALL. VALGUS SURAKL0031 24800 31000 37200 41850 46500 54250 OSTEOTOMY+DSTP+BUNIONECTOMY SURAKL0032 HALLUX VALGUS OSTEOTOMY 19800 24750 29700 33410 37130 43310 SURAKL0036 CTEV PC TENOTOMY,CORRECTIVE CAST 15500 19380 23250 26160 29060 33910 SURAKL0037 TENDON ACHILLIS REPAIR - ANKLE 29800 37250 44700 50290 55880 65190 SURAKL0038 TENDON ACHILLIS RECONSTRUCTION - ANKLE 37500 46880 56250 63280 70310 82030 SURAKL0039 TA LENGTHENING 17700 22130 26550 29870 33190 38720

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CODE.NO SERVICE NAME AMOUNT SURAKL0040 CTEV SURGERY - PMSTR 27600 34500 41400 46580 51750 60380 SURAKL0058 HIND FOOT OSTESTOMY - SIMPLE 25000 31250 37500 42190 46880 54690 SURAKL0059 HIND FOOT OSTESTOMY - COMPLEX 35000 43750 52500 59060 65630 76560 SURAKL0060 MID FOOT OSTESTOMY - SIMPLE 25000 31250 37500 42190 46880 54690 SURAKL0061 MID FOOT OSTESTOMY - COMPLEX 35000 43750 52500 59060 65630 76560 SURAKL0041 CTEV SURGERY - SUBTALAR RELEASE 19800 24750 29700 33410 37130 43310 SURAKL0042 CTEV SURGERY - POSTERIOR RELEASE 16500 20630 24750 27840 30940 36090 SURAKL0043 CTEV SURGERY SOFT TISSUE+BONY PROCE. 27500 34380 41250 46410 51560 60160 SURAKL0044 STEINDLERS RELEASE 24200 30250 36300 40840 45380 52940 SURAKL0015 HAMMER TOE SOFT TISSUE PROCE. SINGLE 13200 16500 19800 22280 24750 28880

SURAKL0045 HAMMER TOE BONY TISSUE PROCE. SINGLE 17600 22000 26400 29700 33000 38500

SURAKL0016 HAMMER TOE BONY PROCE. MULTIPLE TOES 27500 34380 41250 46410 51560 60160 FIRST MTP JOINT EXCISIONAL SURAKL0046 16500 20630 24750 27840 30940 36090 ARTHROPLASTY SURAKL0047 RHEUMATOID FOREFOOT RECONSTRUCTION 27500 34380 41250 46410 51560 60160 SURAKL0048 MORTON NEUROMA EXCISION 16500 20630 24750 27840 30940 36090 SURAKL0049 ACCES. NAVICULAR EXCISION 16500 20630 24750 27840 30940 36090 ACCES.NAVICULAR EXCISION & KIDNER SURAKL0050 27500 34380 41250 46410 51560 60160 PROCE. SURAKL0051 TENDON EXPLORATION/DEBRI. FOOT & ANKLE 27500 34380 41250 46410 51560 60160 SURAKL0052 TIBIAL HEMIMELIA SIMPLE 19800 24750 29700 33410 37130 43310 SURAKL0053 TIBIAL HEMIMELIA COMPEX 27500 34380 41250 46410 51560 60160 SURAKL0054 TARSAL TUNNEL RELEASE 18700 23380 28050 31560 35060 40910 CONGENITAL VERTICAL TALUS OPEN SURAKL0055 16500 20630 24750 27840 30940 36090 REDUCTION SURAKL0056 CONGENITAL VERTICAL TALUS CAST APPL. 3300 4130 4950 5570 6190 7220 RETROCALCANEAL EXOSTOSIS/BURSA SURAKL0057 11000 13750 16500 18560 20630 24060 EXCISION SURAKL0062 CAUDAL BLOCK 16500 20630 24750 27840 30940 36090 SPINE SURSPI0001 EPIDURAL INJECTION 7700 9630 11550 12990 14440 16840 SURSPI0002 FACET INJECTION 10700 13380 16050 18060 20060 23410 SURSPI0010 KYPHOPLASTY - SIMPLE 28500 35630 42750 48090 53440 62340 SURSPI0019 KYPHOPLASTY - COMPLEX 38500 48130 57750 64970 72190 84220 SURSPI0011 KYPHOPLASTY 2 LEVEL 55000 68750 82500 92810 103130 120310 SURSPI0012 SPINE BIOPSY 16500 20630 24750 27840 30940 36090 SURSPI0014 THERAPEUTIC COMBIND SPINAL INJ. 27500 34380 41250 46410 51560 60160 SURSPI0015 SURGICAL STABILISATION OF SPINAL LISTHIA 26000 32500 39000 43880 48750 56880 SURSPI0016 SPINAL FORAMINOTOMY 25000 31250 37500 42190 46880 54690 SURSPI0017 SPINAL FORAMINOTOMY & NEUROLYSIS 35000 43750 52500 59060 65630 76560 SURSPI0018 NEUROLYSIS 25000 31250 37500 42190 46880 54690 SURSPI0020 SPINAL ROOT BLOCK 16500 20630 24750 27840 30940 36090 DISC SURGERY SURSPI0003 MICRODISCETOMY 18700 23380 28050 31560 35060 40910 SURSPI0004 DISCETOMTY WITH FUSION ONE LEVEL 26400 33000 39600 44550 49500 57750 SURSPI0013 DISCETOMTY WITH FUSION TWO LEVEL 30800 38500 46200 51980 57750 67380 SURSPI0005 FUSION MULTIPLE LEVELS 37400 46750 56100 63110 70130 81810 SURSPI0006 SPINAL CANAL DECOMPRESSION SMALL 18700 23380 28050 31560 35060 40910 SURSPI0007 SPINAL CANAL DECOMPRESSION LARGE 26400 33000 39600 44550 49500 57750 SURSPI0008 CANAL DECOMP PLUS FIXATION 37400 46750 56100 63110 70130 81810 OTHERS SUPRACONDYLAR CLOSED OSTETOMY WITH SURKNE0018 18700 23380 28050 31560 35060 40910 POP SUROTH0016 TENDON HARVESTING UPPER EXTREMITY 11000 13750 16500 18560 20630 24060 HETEROTOPIC MASS EXCISION (MEDIUM SUROTH0017 11000 13750 16500 18560 20630 24060 JOINT)

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CODE.NO SERVICE NAME AMOUNT HETEROTOPIC MASS EXCISON (LARGE SUROTH0018 16500 20630 24750 27840 30940 36090 JOINTS) SUROTH0019 SPRENGEL SHOULDER WOOD WARD PROC. 22000 27500 33000 37130 41250 48130 SUROTH0020 BURSA EXCISION (LARGE) 16000 20000 24000 27000 30000 35000 SUROTH0021 BURSA EXCISION (SMALL) 12000 15000 18000 20250 22500 26250 UNIT : UROLOGY ENDOSCOPIC PROCEDURE SURURO0001 T.U.R.P. 26000 32500 39000 43880 48750 56880

SURURO0189 TURP 50-100gm 32000 40000 48000 54000 60000 70000

SURURO0190 TURP 100-150gm 40000 50000 60000 67500 75000 87500

SURURO0191 TURP 150 gm-200 GM 45000 56250 67500 75940 84380 98440

SURURO0192 TURP> 200 gm 50000 62500 75000 84380 93750 109380

SURURO0041 BLADDER NECK INCISION (BNI) 15000 18750 22500 25310 28130 32810

SURURO0123 TURP+OIU 30000 37500 45000 50630 56250 65630 SURURO0167 TURP+CLT 27000 33750 40500 45560 50630 59060 SURURO0124 TURP+TURBT 34000 42500 51000 57380 63750 74380 SURURO0186 TURBT 27000 33750 40500 45560 50630 59060 SURURO0031 TUR FULGRATION 13000 16250 19500 21940 24380 28440 TRANS URETHRAL RESECTION OF SURURO0224 19000 23750 28500 32060 35630 41560 EJACULATORY DUCTS ( TURED) SURURO0002 CYSTOSCOPY & OPTICAL URETHROTOMY 16000 20000 24000 27000 30000 35000

SURURO0193 OPTICAL INTERNAL URETHROTOMY LONG 18600 23250 27900 31390 34880 40690

SURURO0048 CYCTOSCOPY WITH BLADDER BIOPSY 7500 9380 11250 12660 14060 16410

SURURO0007 CYSTOSCOPY & TUR BLADDER TUMOUR 26000 32500 39000 43880 48750 56880

SURURO0016 CYSTOSCOPY+FULGRATION OF FISTULA 11500 14380 17250 19410 21560 25160

SURURO0018 CYSTOSCOPY CLOT EVACUATION 10500 13130 15750 17720 19690 22970

SURURO0042 CYSTOSCOPY AND DILATATION 7500 9380 11250 12660 14060 16410 CYSTOSCOPIC EXCISION OF VESICAL SURURO0023 9500 11880 14250 16030 17810 20780 DIVERTIC CYSTOSCOPY WITH RETROGRADE CATHETER- SURURO0079 6500 8130 9750 10970 12190 14220 U/L CYSTOSCOPY WITH RETROGRADE CATHETER- SURURO0080 9000 11250 13500 15190 16880 19690 B/L SURURO0141 RGP U/L 7500 9380 11250 12660 14060 16410

SURURO0142 RGP B/L 10500 13130 15750 17720 19690 22970

SURURO0051 URETERORENOSCOPY (URS) 16000 20000 24000 27000 30000 35000

SURURO0100 RE-DO URETEROSCOPY 7000 8750 10500 11810 13130 15310

SURURO0047 URETEROSCOPIC LITHOTRIPSY 18000 22500 27000 30380 33750 39380

SURURO0194 URSL <1cm 19000 23750 28500 32060 35630 41560

SURURO0195 URSL <1cm B/L 28000 35000 42000 47250 52500 61250

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CODE.NO SERVICE NAME AMOUNT SURURO0196 URSL 1cm-2cm 28000 35000 42000 47250 52500 61250

SURURO0197 URSL B/L1cm-2cm 34000 42500 51000 57380 63750 74380

SURURO0198 URSL>2cm 31000 38750 46500 52310 58130 67810

SURURO0199 URSL B/L >2cm 40000 50000 60000 67500 75000 87500 URETEROSCOPIC LASER FULGURATION SURURO0208 31000 38750 46500 52310 58130 67810 TOMOUR CYSTOLITHOTOMY/TROCAR SPC/ SURURO0071 10000 12500 15000 16880 18750 21880 SUPRAPUBIC CY SURURO0204 PERCUTANEOUS CYSTOLITHOTRIPSY (PCCLT) 33000 41250 49500 55690 61880 72190

SURURO0015 CYSTOSCOPY 4700 5880 7050 7930 8810 10280

SURURO0052 DIAGNOSTIC CYSTOCOPY/URETHROSCOPY 6000 7500 9000 10130 11250 13130

SURURO0105 D.J. STENTING UNILATERAL (TWIN) 10000 12500 15000 16880 18750 21880

SURURO0106 D.J. STENTING BILATERAL (TWIN) 15000 18750 22500 25310 28130 32810

SURURO0169 RIRS 21000 26250 31500 35440 39380 45940

SURURO0065 CYSTOLITHOTRIPSY/ LITHOLAPAXY 11000 13750 16500 18560 20630 24060

SURURO0200 CLT- STONE >5 CM 22000 27500 33000 37130 41250 48130

SURURO0201 CLT- STONE 2-3 CM 15000 18750 22500 25310 28130 32810

SURURO0202 CLT- STONE 3-5 CM 18000 22500 27000 30380 33750 39380

SURURO0092 DOUBLE J STENT PLACEMENT - B/L 13000 16250 19500 21940 24380 28440

SURURO0017 DOUBLE J. STENTING- U/L 8000 10000 12000 13500 15000 17500

SURURO0104 D.J STENT REMOVAL (B/L) 9000 11250 13500 15190 16880 19690

SURURO0034 D J STENT REMOVAL - U/L 6500 8130 9750 10970 12190 14220

SURURO0158 STEEL STENTS PLACEMENT U/L 20000 25000 30000 33750 37500 43750

SURURO0159 STEEL STENTS PLACEMENT B/L 25000 31250 37500 42190 46880 54690

SURURO0095 PCNL 23000 28750 34500 38810 43130 50310

SURURO0101 NEPHROSCOPY 8000 10000 12000 13500 15000 17500

SURURO0140 PCNL MULTIPLE PUNCTURE 32000 40000 48000 54000 60000 70000

SURURO0203 PCNL STAGHORN CALCULUS TOTAL 38000 47500 57000 64130 71250 83130

SURURO0205 MINI PERC 30000 37500 45000 50630 56250 65630

SURURO0032 PERCUTANEOUS NEPHROSTOMY B/L (PCN) 22000 27500 33000 37130 41250 48130

SURURO0043 PERCUTANEOUS NEPHROSTOMY 15000 18750 22500 25310 28130 32810 SURURO0168 CHANGE OF NEPHROSTOMY TUBE 4000 5000 6000 6750 7500 8750 SURURO0096 ENDOSCOPIC REPAIR OF URETEROCELE 16000 20000 24000 27000 30000 35000

SURURO0107 BALLOON URETER DILATATION 13500 16880 20250 22780 25310 29530

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CODE.NO SERVICE NAME AMOUNT SURURO0110 ENDOPYELOTOMY 24000 30000 36000 40500 45000 52500 BOTOX INJECTION SURURO0164 13000 16250 19500 21940 24380 28440 (INTRAVESICAL/INTRASPHIN SURURO0162 FLEXIBLE CYSTOURETHROSCOPY 7000 8750 10500 11810 13130 15310 SURURO0166 FLEXIBLE URETROSCOPY 9000 11250 13500 15190 16880 19690 SURURO0170 RIRS <1cm 23000 28750 34500 38810 43130 50310 SURURO0206 RIRS 1cm - 2cm 26000 32500 39000 43880 48750 56880 SURURO0207 RIRS >2 cm 32000 40000 48000 54000 60000 70000 SURURO0171 RIRS (Multiple Stone) 32000 40000 48000 54000 60000 70000 SURURO0033 STING OPERATION FOR VUR U/L 19000 23750 28500 32060 35630 41560

SURURO0035 STING OPERATION FOR VUR B/L 25000 31250 37500 42190 46880 54690 KIDNEY & ADRENALS SURURO0005 ADRENALECTOMY 32000 40000 48000 54000 60000 70000

SURLAP0036 LAP. ADRENALECTOMY 37000 46250 55500 62440 69380 80940 SURURO0004 NEPHRECTOMY 26000 32500 39000 43880 48750 56880 SURURO0131 LAP NEPHRECTOMY 31000 38750 46500 52310 58130 67810 PARTIAL NEPHRECTOMY OR SURURO0053 31000 38750 46500 52310 58130 67810 NEPHROLITHOTOMY SURURO0144 LAP.PARTIAL NEPHRECTOMY 44000 55000 66000 74250 82500 96250 LAPKID0004 LAP. NEPHROLITHOTOMY 30000 37500 45000 50630 56250 65630 RADICAL NEPHRECTOMY WITH SURURO0013 37000 46250 55500 62440 69380 80940 ADRENALECTOMY SURURO0027 LAP. RADICAL NEPHRECTOMY 39000 48750 58500 65810 73130 85310 LAP. RADICAL NEPHRECTOMY WITH LAPKID0005 41000 51250 61500 69190 76880 89690 ADRENALECTOMY SURURO0006 NEPHROURETERECTOMY 32000 40000 48000 54000 60000 70000

SURURO0074 RADICAL NEPHROURETERECTOMY 42000 52500 63000 70880 78750 91880

SURURO0039 LAP NEPHROURETERECTOMY 42000 52500 63000 70880 78750 91880

SURURO0075 NEPHROPEXY 16000 20000 24000 27000 30000 35000 LAPKID0003 LAP. NEPHROPEXY 21000 26250 31500 35440 39380 45940 SURURO0083 PERINEPHRIC ABSCESS DRAINAGE 14000 17500 21000 23630 26250 30630

LAPKID0001 LAP. DRAINAGE OF PERINEPHRIC ABSCESS 17500 21880 26250 29530 32810 38280 RETROPERITONEOSCOPIC DE ROOFING OF SURURO0112 21000 26250 31500 35440 39380 45940 CYST. SURURO0121 LAP. ROVSING 27000 33750 40500 45560 50630 59060 SURURO0143 RETROPERITONEOSCOPIC BIOPSY 15000 18750 22500 25310 28130 32810 SURLAP0023 LAP. RETROPERITONEOSCOPIC BIOPSY 18000 22500 27000 30380 33750 39380

SURURO0133 RETRO PERITONEAL LN DISSECTON 25000 31250 37500 42190 46880 54690

SURURO0125 IVC THROMBECTOMY LEVEL-1 21000 26250 31500 35440 39380 45940

SURURO0126 IVC THROMBECTOMY LEVEL-2 28000 35000 42000 47250 52500 61250

SURURO0127 IVC THROMBECTOMY LEVEL-3 35000 43750 52500 59060 65630 76560 LAPKID0002 LAP. IVC THROMBECTOMY LEVEL-1 25000 31250 37500 42190 46880 54690 CADAVARIC DONOR NEPRECTOMY&BENCH PACKTP0006 42000 52500 63000 70880 78750 91880 SURGERY

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CODE.NO SERVICE NAME AMOUNT SURURO0161 GRAFT NEPHRECTOMY 48000 60000 72000 81000 90000 105000 SURURO0064 NEPHROSTOMY - OPEN 14000 17500 21000 23630 26250 30630 RENAL PELVIS & URETER SURURO0014 ANTERIOR TRANSPOSITION OF URETER 16500 20630 24750 27840 30940 36090

SURURO0024 URETERECTOMY WITH CUFF OF UB 18000 22500 27000 30380 33750 39380

SURURO0026 PYELOLITHOTOMY 18000 22500 27000 30380 33750 39380

SURURO0029 LAP. PYELOPLASTY 25000 31250 37500 42190 46880 54690 RETROPERITONEOSCOPIC SURURO0036 22000 27500 33000 37130 41250 48130 URETEROLITHOTOMY SURURO0049 URETHROLITHOTOMY 17500 21880 26250 29530 32810 38280

SURURO0050 ANDERSON HYNES PYELOPLASTY 24500 30630 36750 41340 45940 53590 SURURO0163 PYELOURETEROSTOMY 40000 50000 60000 67500 75000 87500 SURURO0054 URETERIC REIMPLANTATION- U/L 21500 26880 32250 36280 40310 47030

SURURO0055 URETERIC REIMPLANTATION- B/L 26500 33130 39750 44720 49690 57970

SURURO0067 URETEROSTOMY 13500 16880 20250 22780 25310 29530

SURURO0093 URETEROLYSIS FOR RPF - U/L 21500 26880 32250 36280 40310 47030

SURURO0094 URETEROLYSIS FOR RPF - B/L 28000 35000 42000 47250 52500 61250

SURURO0111 MEGAURETER TAILORING 17000 21250 25500 28690 31880 37190

SURURO0145 MEMOCATH PLACEMENT (URETERAL) U/L 23000 28750 34500 38810 43130 50310

SURURO0146 MEMOCATH PLACEMENT (URETERAL) B/L 33000 41250 49500 55690 61880 72190

LAPRPU0001 LAP. PYELOLITHOTOMY 26000 32500 39000 43880 48750 56880

LAPRPU0005 LAP.URETEROLITHOTOMY 24000 30000 36000 40500 45000 52500

LAPRPU0004 LAP.URETERIC REIMPLANTATION- U/L 23000 28750 34500 38810 43130 50310

LAPRPU0003 LAP.URETERIC REIMPLANTATION- B/L 34000 42500 51000 57380 63750 74380

LAPRPU0007 LAP.URETEROLYSIS FOR RPF - U/L 26500 33130 39750 44720 49690 57970

LAPRPU0006 LAP.URETEROLYSIS FOR RPF - B/L 32500 40630 48750 54840 60940 71090

LAPRPU0002 LAP.MEGAURETER TAILORING 20000 25000 30000 33750 37500 43750 SURURO0183 LAP URETERO URETEROSTOMY 33000 41250 49500 55690 61880 72190

BLADDER PARTIAL CYSTECTOMY & PELVIC SURURO0008 26500 33130 39750 44720 49690 57970 LYMPHADENECTOM SURURO0010 BOARI FLAP RECONSTRUCTION OF URETER 32500 40630 48750 54840 60940 71090

SURURO0037 PELVIC LYMPHADENECTOMY 17500 21880 26250 29530 32810 38280

SURURO0038 ILEAL CONDUIT 29000 36250 43500 48940 54380 63440

SURURO0056 TOTAL CYSTECTOMY 24000 30000 36000 40500 45000 52500

SURURO0057 VESICO - VAGINAL FISTULA/ UV FISTULA REP 29000 36250 43500 48940 54380 63440

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CODE.NO SERVICE NAME AMOUNT SURURO0061 RADICAL CYSTECTOMY 39000 48750 58500 65810 73130 85310

SURURO0063 AUGMENTATION CYSTOPLASTY 38000 47500 57000 64130 71250 83130

SURURO0076 REPAIR OF BLADDER 17000 21250 25500 28690 31880 37190

SURURO0077 VESICAL DIVERTICULECTOMY 15500 19380 23250 26160 29060 33910 DIVERSION OF URINE-URETERO COLIC SURURO0084 21000 26250 31500 35440 39380 45940 ANASTOM SURURO0102 BCG INSTILLATION 4500 5630 6750 7590 8440 9840

SURURO0103 CYSTOMETROGRAM (C.M.G.) 6500 8130 9750 10970 12190 14220

SURURO0120 BLADDER NECK+SACRAL COLPO SUSPENSION 33000 41250 49500 55690 61880 72190

SURURO0128 ORTHOTOPIC BLADDER 40000 50000 60000 67500 75000 87500

SURURO0134 BLADDER NECK RECONSTRUCTION 33000 41250 49500 55690 61880 72190

SURURO0137 APPENDICO VESICOSTOMY 28000 35000 42000 47250 52500 61250

SURURO0138 PARTIAL CYSTECTOMY 19500 24380 29250 32910 36560 42660

SURURO0139 VESICOSTOMY 14000 17500 21000 23630 26250 30630 LAPBLD0007 PELVIC LYMPHADENECTOMY B/L 24000 30000 36000 40500 45000 52500 RADICAL CYSTECTOMY+ORTHOTOPIC SURURO0157 50000 62500 75000 84380 93750 109380 BLADDER LAP.PARTIAL CYSTECTOMY+PELVIC LN LAPBLD0014 33000 41250 49500 55690 61880 72190 DISSEC. LAPBLD0006 LAP PELVIC LYMPHADENECTOMY 20000 25000 30000 33750 37500 43750

LAPBLD0003 LAP ILEAL CONDUIT 26000 32500 39000 43880 48750 56880

LAPBLD0011 LAP TOTAL CYSTECTOMY 22000 27500 33000 37130 41250 48130 LAP VESICO - VAGINAL FISTULA/ UV FISTULA LAPBLD0013 36000 45000 54000 60750 67500 78750 REP LAPBLD0015 LAP. SURGERY FOR VVF-COMPLEX 45000 56250 67500 75940 84380 98440 LAPBLD0008 LAP RADICAL CYSTECTOMY 41000 51250 61500 69190 76880 89690

LAPBLD0001 LAP AUGMENTATION CYSTOPLASTY 40000 50000 60000 67500 75000 87500

LAPBLD0010 LAP REPAIR OF BLADDER 20000 25000 30000 33750 37500 43750

LAPBLD0012 LAP VESICAL DIVERTICULECTOMY 23000 28750 34500 38810 43130 50310 LAP DIVERSION OF URINE-URETERO COLIC LAPBLD0002 25000 31250 37500 42190 46880 54690 ANASTOM LAPBLD0004 LAP ORTHOTOPIC BLADDER 34000 42500 51000 57380 63750 74380

LAPBLD0005 LAP PARTIAL CYSTECTOMY 23000 28750 34500 38810 43130 50310

LAPBLD0007 LAP PELVIC LYMPHADENECTOMY B/L 24000 30000 36000 40500 45000 52500 LAP RADICAL CYSTECTOMY+ORTHOTOPIC LAPBLD0009 65000 81250 97500 109690 121880 142190 BLADDER BOTOX INJECTION SURURO0184 15000 18750 22500 25310 28130 32810 (INTRAVESICAL/INTRASPHINTERIC): SURURO0185 CYSTECTOMY(RADICAL+ILEAL CONDUIT) 50000 62500 75000 84380 93750 109380 CONTINENT CUTANEOUS DIVERSION (INDIANA LAPBLD0016 51000 63750 76500 86060 95630 111560 POUCH) LAPBLD0017 LAP. BOARI FLAP REIMPLANTATION 48000 60000 72000 81000 90000 105000

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CODE.NO SERVICE NAME AMOUNT LAPBLD0018 MITROFANOFF URINARY DIVERSION 48000 60000 72000 81000 90000 105000 ANTERIOR EXENTERATION WITH RADICAL LAPBLD0019 48000 60000 72000 81000 90000 105000 CYSTECTOMY LAPBLD0020 CYSTOCELE REPAIR 20000 25000 30000 33750 37500 43750 LAPBLD0021 LAP SACROCERVICOPEXY 38000 47500 57000 64130 71250 83130 LAPBLD0022 SACROCERVICOPEXY 33000 41250 49500 55690 61880 72190 LAPBLD0023 RETROPERITONIAL TUMOUR EXCISION 26000 32500 39000 43880 48750 56880 SURURO0114 URACHAL CYST REMOVAL 19000 23750 28500 32060 35630 41560 PENIS TOTAL PENECTOMY WITH ILEO-INGUINAL SURURO0012 34000 42500 51000 57380 63750 74380 LYMPH SURURO0225 GROIN DISSECTION UNILATERAL 23000 28750 34500 38810 43130 50310 ILEO-INGUINAL LYMPH NODE DISSSECTION SURURO0226 25000 31250 37500 42190 46880 54690 UNILATERAL ILEO-INGUINAL LYMPH NODE DISSSECTION SURURO0227 30000 37500 45000 50630 56250 65630 BILATERAL SURURO0019 PARTIAL PENECTOMY 23000 28750 34500 38810 43130 50310

SURURO0020 DORSAL SLIT 7000 8750 10500 11810 13130 15310 SURPEA0025 PRIAPISM ASPIRATION 3000 3750 4500 5060 5630 6560 SURURO0228 PRIAPISM SHUNT SURGERY 15000 18750 22500 25310 28130 32810 SURURO0022 RECONSTRUCTION OF PENIS 31000 38750 46500 52310 58130 67810

SURURO0025 PENILE BIOPSY 6500 8130 9750 10970 12190 14220

SURURO0030 PENILE PROSTHESIS IMPLANTATION 44000 55000 66000 74250 82500 96250

SURURO0040 FRENULOPLASTY 7000 8750 10500 11810 13130 15310

SURURO0108 PENILE REIMPLANTATION 25000 31250 37500 42190 46880 54690 SURURO0187 REDUCTION OF PARAPHIMOSIS 3300 4130 4950 5570 6190 7220 SURMIS0004 CIRCUMCISION 7000 8750 10500 11810 13130 15310

SURMIS0083 REPAIR OR FRACTURE PENIS 16000 20000 24000 27000 30000 35000 SURURO0175 NESBIT PLICATION 15500 19380 23250 26160 29060 33910 PEYRONIE'S PLAQUE EXCISION+TUNICAL SURURO0176 19000 23750 28500 32060 35630 41560 GRAFT SURURO0177 HYPOSPADIAS REPAIR 25000 31250 37500 42190 46880 54690 SURURO0178 HYPOSPADIAS PROXIMAL 31000 38750 46500 52310 58130 67810 SURURO0179 HYPOSPADIAS DISTAL 24000 30000 36000 40500 45000 52500 SURURO0180 HYPOSPADIAS STAGE I 19000 23750 28500 32060 35630 41560 SURURO0181 HYPOSPADIAS CHORDEE CORRECTION 16500 20630 24750 27840 30940 36090 SURURO0182 HYPOSPADIAS & FISTULA REPAIR 19600 24500 29400 33080 36750 42880 PROSTATE SURURO0009 RADICAL PROSTATECTOMY 42000 52500 63000 70880 78750 91880 TRANSRECTAL TRUCUT BIOPSY OF SURURO0044 7000 8750 10500 11810 13130 15310 PROSTATE SURURO0066 OPEN PROSTATECTOMY 24000 30000 36000 40500 45000 52500 LAPPRO0001 LAP.RADICAL PROSTATECTOMY 46000 57500 69000 77630 86250 100630 SURURO0210 SEMINAL VESICULECTOMY 18000 22500 27000 30380 33750 39380 TESTIS EPIDYDMIS CORD SURLAP0012 LAP. VARICOCELECTOMY B/L 21000 26250 31500 35440 39380 45940 SURLAP0016 LAP. VARICOCELECTOMY U/L 16000 20000 24000 27000 30000 35000

SURURO0215 MICROSCOPIC VAICOCELECTOMY-B/L 32000 40000 48000 54000 60000 70000

SURURO0216 MICROSCOPIC VAICOCELECTOMY-U/L 22000 27500 33000 37130 41250 48130

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CODE.NO SERVICE NAME AMOUNT SURURO0088 VARICOCELECTOMY U/L 13000 16250 19500 21940 24380 28440

SURURO0046 VARICOCELECTOMY B/L 19000 23750 28500 32060 35630 41560

MICROSCOPIC SURURO0217 42000 52500 63000 70880 78750 91880 VASOVASOSTOMY/VASOEPIDIDYMOSTOMY VVA/ VEA (WITH OPERATING MICROSCOPE) - SURURO0098 20000 25000 30000 33750 37500 43750 U/L VVA/ VEA (WITH OPERATING MICROSCOPE) - SURURO0099 24000 30000 36000 40500 45000 52500 B/L SURURO0218 VASOGRAPHY 11000 13750 16500 18560 20630 24060

SURURO0085 VASECTOMY 5500 6880 8250 9280 10310 12030

SURURO0221 SPERMATIC CORD BLOCK- U/L 10000 12500 15000 16880 18750 21880

SURURO0229 SPERMATIC CORD BLOCK- B/L 12000 15000 18000 20250 22500 26250

SURURO0011 HYDROCETECTOMY U/L 7500 9380 11250 12660 14060 16410

SURURO0113 HYDROCETECTOMY B/L 15500 19380 23250 26160 29060 33910 SURURO0116 SEMINIFEROUS TUBULE BIOPSY B/L 12000 15000 18000 20250 22500 26250 SURURO0021 TESTICULAR BIOPSY B/L 11000 13750 16500 18560 20630 24060

SURURO0086 TESTICULAR BIOPSY U/L 6000 7500 9000 10130 11250 13130

SURURO0069 ORCHIDOPEXY - U/L 15000 18750 22500 25310 28130 32810

SURURO0070 ORCHIDOPEXY - B/L 22000 27500 33000 37130 41250 48130

SURURO0072 ORCHIDECTOMY - U/L 12000 15000 18000 20250 22500 26250

SURURO0073 ORCHIDECTOMY - B/L 16500 20630 24750 27840 30940 36090

SURURO0115 HIGH INGUINAL ORCHIDECTOMY 22000 27500 33000 37130 41250 48130

SURURO0089 TORSION TESTIS 15000 18750 22500 25310 28130 32810

SURURO0230 TESTICULAR IMPLANT PLACEMENT U/L 8500 10630 12750 14340 15940 18590

SURURO0231 TESTICULAR IMPLANT PLACEMENT B/L 10000 12500 15000 16880 18750 21880

SURURO0097 SCROTOPLASTY 12000 15000 18000 20250 22500 26250 SURURO0173 SCROTAL EXPLORATION 16000 20000 24000 27000 30000 35000 SURURO0174 EXCISION OF EPIDERMOID CYST 7000 8750 10500 11810 13130 15310 SURURO0090 EPIDIDYMECTOMY 9000 11250 13500 15190 16880 19690 URETHRA SURURO0003 MEATOPLASTY 5000 6250 7500 8440 9380 10940 SURURO0045 URETHERAL DILATATION 3200 4000 4800 5400 6000 7000 SURURO0232 URETHERAL CARUNCLE EXCISION 15000 18750 22500 25310 28130 32810 SURURO0188 OIU (OPTICAL INT URETHROTOMY) 15000 18750 22500 25310 28130 32810 SURURO0058 URETHROPLASTY IN ONE STAGE 26000 32500 39000 43880 48750 56880 SURURO0059 URETHROPLASTY IN 2 STAGE - STAGE I 16500 20630 24750 27840 30940 36090 SURURO0060 URETHROPLASTY IN 2 STAGE - STAGE II 23500 29380 35250 39660 44060 51410 SURURO0062 EPISPADIUS/ EXOSTROPHY REPAIR 25000 31250 37500 42190 46880 54690 SURURO0068 CLOSURE OF URETHRAL FISTULA 12000 15000 18000 20250 22500 26250 SURURO0078 PERINEAL URETHROSTOMY 20000 25000 30000 33750 37500 43750 SURURO0081 URETHRAL INJURY REPAIR 18000 22500 27000 30380 33750 39380

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CODE.NO SERVICE NAME AMOUNT SURURO0082 MEATOTOMY 3500 4380 5250 5910 6560 7660 SURURO0109 POSTERIOR URETHRAL VALVES 18000 22500 27000 30380 33750 39380 SURURO0117 FLAP /BUCCAL/LINGUAL URETHROPLASTY 34000 42500 51000 57380 63750 74380 SURURO0118 BUCCAL MUCOSAL URETHROPLASTY 30000 37500 45000 50630 56250 65630 SURURO0211 BUCCAL MUCOSA URETHROPLASTY-COMPLEX 42000 52500 63000 70880 78750 91880 SURURO0212 URETHROPLASTY ANASTOMATIC-COMPLEX 49000 61250 73500 82690 91880 107190 SURURO0119 BUCCAL GRAFT 16000 20000 24000 27000 30000 35000 SURURO0122 MEMOCATH PLACEMENT(URETHRAL) 19000 23750 28500 32060 35630 41560 SURURO0135 MATHIEU REPAIR 19600 24500 29400 33080 36750 42880 SURURO0136 TOT TAPE 23000 28750 34500 38810 43130 50310 SURURO0213 MIDURETHRAL TVT 22000 27500 33000 37130 41250 48130 SURURO0148 ARTIFICIAL SPHINCTER 33000 41250 49500 55690 61880 72190 SURURO0147 PENILE PROSTHESIS INFLATABLE 46000 57500 69000 77630 86250 100630 SURURO0151 INTRAVESICAL BOTULINUM TOXIN INJECTION 20000 25000 30000 33750 37500 43750 SURURO0152 MICTURATING CYST-URETHEROGRAM 3300 4130 4950 5570 6190 7220 SURURO0153 RETROGRADE PYELOGRAM 4000 5000 6000 6750 7500 8750 SURURO0154 CHEMOPORT INSERTION 16000 20000 24000 27000 30000 35000 SURURO0155 B/L PELVIC LYMPHADENECTOMY 20000 25000 30000 33750 37500 43750 SURURO0214 MALE BULBOURETHRAL SLING 19000 23750 28500 32060 35630 41560 SURURO0209 PERICATHETER STUDY 5000 6250 7500 8440 9380 10940 SURURO0222 URETHRECTOMY 22000 27500 33000 37130 41250 48130 VASCULAR SURURO0130 A.V. FISTULA(PROXIMAL) 13200 16500 19800 22280 24750 28880

SURURO0132 VENOUS RECONSTRUCTION 18200 22750 27300 30710 34130 39810

SURMIS0001 A.V.FISTULA(DISTAL) 11000 13750 16500 18560 20630 24060

SURMIS0002 CLOSER OF A.V. FISTULA 12100 15130 18150 20420 22690 26470

SURMIS0005 REMOVAL OF CAPD CATHETER 8800 11000 13200 14850 16500 19250

SURMIS0006 CAPD CATHETERIZATION 12100 15130 18150 20420 22690 26470

SURURO0149 VENOUS THROMBECTOMY 22000 27500 33000 37130 41250 48130

SURURO0150 RE-DO FISTULA 11000 13750 16500 18560 20630 24060

SURVAS0001 FISTULA THROMBECTOMY 22000 27500 33000 37130 41250 48130 SURVAS0002 VEIN DEBRANCHING (SINGLE) 9900 12380 14850 16710 18560 21660 SURVAS0003 VEIN DEBRANCHING (MULTIPLE) 13200 16500 19800 22280 24750 28880 SURVAS0004 SAPHENOPOPLITEAL JUNCTION LIGATION 19800 24750 29700 33410 37130 43310 SURVAS0005 MULTIPLE AVULSIONS OF VARICOSITIES 13200 16500 19800 22280 24750 28880 SURVAS0006 BASILIC VEIN TRANSPOSITION 26400 33000 39600 44550 49500 57750 SURVAS0007 CEPHALIC VEIN TRANSPOSITION 7700 9630 11550 12990 14440 16840 SURVAS0008 VARICOSE VEINS RFA B/L 44000 55000 66000 74250 82500 96250 SURVAS0046 VARICOSE VEINS RFA U/L 33000 41250 49500 55690 61880 72190 SURVAS0009 PSEUDOANEURYSM EXCISION 24200 30250 36300 40840 45380 52940

SURVAS0018 HIGH RISK FISTULA (PROXIMAL/DISTAL) 17100 21380 25650 28860 32060 37410

SURVAS0016 A.V.GRAFT ( FOREARM) 24200 30250 36300 40840 45380 52940

SURVAS0015 A.V.GRAFT ( ARM) 27500 34380 41250 46410 51560 60160

SURVAS0013 SAPHENO FEMORAL JUNCTION LIGATION 24800 31000 37200 41850 46500 54250

SURVAS0017 FOAM SCLEROTHERPY 11000 13750 16500 18560 20630 24060

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CODE.NO SERVICE NAME AMOUNT SURVAS0012 LASER RETICULAR VEINS (SINGLE) 8800 11000 13200 14850 16500 19250

SURVAS0011 LASER RETICULAR VEINS (MULTIPLE) U/L 15400 19250 23100 25990 28880 33690

SURVAS0010 LASER RETICULAR VEINS (MULTIPLE) B/L 22000 27500 33000 37130 41250 48130

SURVAS0019 SAPHENOPOPLITEAL JUNCTION LIGATION B/L 33000 41250 49500 55690 61880 72190 SURVAS0020 AV ACCESS FOR HAEMODIALYSIS 11000 13750 16500 18560 20630 24060 SURVAS0021 BRONCHIAL ARTERY BYPASS 27500 34380 41250 46410 51560 60160 VARICOSE VEIN EXP.WITH MULTIPLE SURVAS0022 13200 16500 19800 22280 24750 28880 AVULSION SURVAS0023 STEM CELL THERAPY 30800 38500 46200 51980 57750 67380 SURVAS0024 BONE MARROW CELLULAR THERAPY 30800 38500 46200 51980 57750 67380 SURVAS0025 VEIN REPAIR - SMALL 3900 4880 5850 6580 7310 8530 SURVAS0026 VEIN REPAIR - MEDIUM 7700 9630 11550 12990 14440 16840 SURVAS0027 VEIN REPAIR - LARGE 13200 16500 19800 22280 24750 28880 SURVAS0028 FEMOROPOPLITEAL BYPASS 38500 48130 57750 64970 72190 84220 SURVAS0030 FEMORAL EMBOLECTOMY U/L 29700 37130 44550 50120 55690 64970 PERIPHERAL ANEURYSM,LIGATION and SURVAS0031 33000 41250 49500 55690 61880 72190 REANASTOMOSIS SURVAS0032 PERIPHERAL VASCULAR INJURY REPAIR 33000 41250 49500 55690 61880 72190 SURVAS0033 PROFUNDAPLASTY USING PATCH 33000 41250 49500 55690 61880 72190 SURVAS0034 ANY OTHER BYPASS USING VEIN 33000 41250 49500 55690 61880 72190 ANY OTHER BYPASS USING SYNTHETIC SURVAS0035 30800 38500 46200 51980 57750 67380 GRAFT SURVAS0036 DIABETIC FOOT DEBRIDEMENT 16500 20630 24750 27840 30940 36090 SURVAS0037 PERFORATORS SURGERY 13200 16500 19800 22280 24750 28880 SURVAS0039 VENOGRAPHY 16500 20630 24750 27840 30940 36090 SURVAS0040 ARTERIOGRAPHY 16500 20630 24750 27840 30940 36090 SURVAS0041 PERIPHERAL ANGIOPLASTY 30800 38500 46200 51980 57750 67380 SURVAS0042 LAP. CAPD CATHETERIZATION 16500 20630 24750 27840 30940 36090 SURVAS0043 ARTERY REPAIR (SMALL) 5500 6880 8250 9280 10310 12030 SURVAS0044 ARTERY REPAIR (MEDIUM) 9400 11750 14100 15860 17630 20560 SURVAS0045 ARTERY REPAIR (LARGE) 16500 20630 24750 27840 30940 36090 SURVAS0047 FEMORAL EMBOLECTOMY U/L 27500 34380 41250 46410 51560 60160 PERIPHERAL ANEURYSM,LIGATION AND SURVAS0048 33000 41250 49500 55690 61880 72190 REANAST SURVAS0049 PERIPHERAL VASCULAR INJURY REPAIR 33000 41250 49500 55690 61880 72190 SURVAS0050 PROFUNDAPLASTY USING PATCH 33000 41250 49500 55690 61880 72190 SURVAS0051 ANY OTHER BYPASS USING VEIN 33000 41250 49500 55690 61880 72190 ANY OTHER BYPASS USING SYNTHETIC SURVAS0052 30800 38500 46200 51980 57750 67380 GRAFT SURVAS0053 DIABETIC FOOT DEBRIDEMENT 16500 20630 24750 27840 30940 36090 SURVAS0054 PERFORATORS SURGERY 13200 16500 19800 22280 24750 28880 PERIPHERAL ANGIOPLASTY (MEDIUM SURVAS0056 19800 24750 29700 33410 37130 43310 VESSEL) SURVAS0060 COMPLEX A V ACCESS 13800 17250 20700 23290 25880 30190 SURVAS0061 VASCULAR REPAIR 33000 41250 49500 55690 61880 72190 SURVAS0062 AVM EXCISION 33000 41250 49500 55690 61880 72190 SURVAS0063 AVM SCLEROTHERAPHY- MINOR 7700 9630 11550 12990 14440 16840 SURVAS0064 AVM SCLEROTHERAPHY- MAJOR 16500 20630 24750 27840 30940 36090 SURVAS0065 CERVICAL RIP EXCISION 33000 41250 49500 55690 61880 72190 SURVAS0066 AXILLO FEMORAL BY PASS 49500 61880 74250 83530 92810 108280 SURVAS0067 AROTO BIFEMORAL BY PASS 60500 75630 90750 102090 113440 132340 SURVAS0068 AROTIC ANEURYSM REPAIR 66000 82500 99000 111380 123750 144380 SURVAS0069 CAROTID ENDARTERECTOMY 55000 68750 82500 92810 103130 120310 SURVAS0070 PERIPHERAL BY PASS SURGERY 55000 68750 82500 92810 103130 120310 SURVAS0071 PERIPHERAL ANGIOPLASTY-SMALL VESSEL 13200 16500 19800 22280 24750 28880 SURVAS0072 4 LAYER COMPRESSION DRESSING 2200 2750 3300 3710 4130 4810 SURVAS0073 VASCULAR WOUND DRESSING- SMALL 1000 1250 1500 1690 1880 2190 SURVAS0074 THROMBOLYSIS SIMPLE 3300 4130 4950 5570 6190 7220 SURVAS0075 THROMBOLYSIS COMPLEX 8800 11000 13200 14850 16500 19250

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CODE.NO SERVICE NAME AMOUNT SURVAS0076 FISTULA THROMBOLYSIS 5500 6880 8250 9280 10310 12030 SURVAS0077 FISTULA ANGIOPLASTY SIMPLE 11000 13750 16500 18560 20630 24060 SURVAS0078 FISTULA ANGIOPLASTY COMPLEX 16500 20630 24750 27840 30940 36090 SURVAS0079 DIALYSIS CATHETER IN OT-SIMPLE 3000 3750 4500 5060 5630 6560 SURVAS0080 DIALYSIS CATHETER IN OT-COMPLEX 5000 6250 7500 8440 9380 10940 EMERGENCY SURGEON FEES @ 50% EXTRA WILL BE APPLICABLE ON SUNDAYS, HOLIDAYS & 8.00 PM TO 8.00 AM ON ALL

BASIS OF BILLING ASSISTANT SURGEON FEE 15% ON THE SURGEON FEE FOR ALL SURGERIES ASSISTANT SURGEON FEE 50 (% OF SURGEON FEE) CATH LAB CHARGES 60 (% OF SURGEON/PROCEDURE FEE) OPERATION THEATER CHARGES 80 (% OF SURGEON FEE) ANESTHESIA CHARGES 40 (% OF SURGEON FEE) LOCAL ANESTHESIA CHARGES 15 (% OF SURGEON FEE) STAND –BY SURGEON CHARGES 25 (% OF SURGEON FEE) IF REQUIRED STAND –BY ANESTHESIA CHARGES 25 (% OF SURGEON FEE) IF REQUIRED SPECIAL EQUIPMENT CHARGES 10 (% OF SURGEON FEE)

NOTE:- IF MORE THAN ONE SURGEON PERFORMS TWO DIFFERENT PROCEDURES AT THE SAME TIME, ON A PARTICULAR PATIENT,

IN CASE ONE SURGEON PERFORMS A SINGLE PROCEDURE AND PATIENT REQUIRES ANOTHER OPERATION AT THE SAME TIME IF THE SAME SURGEON PERFORMS MULTIPLE SURGERIES THEN THE 1ST PROCEDURE WILL BE CHARGED AS 100%, 2ND 1ST, 2ND & 3RD PROCEDURES WOULD BE DECIDED ON THE BASIS OF SURGEON’S FEES. PROCEDURE WITH THE HIGHEST RE-EXPLORATION SURGERY WITHIN 48 HOURS: 50% PROCEDURE CHARGES CHARGES FOR RE-OPERATION AFTER 48 HOURS WILL BE 100% OF PROCEDURE CHARGES ANY SPECIFIC EQUIPMENT HIRED FROM OUTSIDE THE PSRI HOSPITAL WOULD BE CHARGED ADDITIONALLY AS ACTUAL;

FOUR TWO SINGLE SUPER PRESIDENT CODE NO DESCRIPTION SUITE BEDDED BEDDED BEDDED DELUXE SUITE PROPUL0012 SLEEP STUDY WITH CPAP TITRATION 17000 17000 17000 17000 17000 17000

PROPUL0013 SLEEP STUDY 15000 15000 15000 15000 15000 15000

PROPUL0014 TITRATION STUDY 11000 11000 11000 11000 11000 11000

PACKAGE INCLUDES:

1. ROOM RENT IS THE PART OF PACKAGE 2. VISIT FEE OF SURGEON AND PHYSICIAN VISIT CHARGES 3. PROCEDURE CHARGES PACKAGE EXCLUDES:

1 ANY FURTHER STAY NEEDS TO BE PAID IN ADDITION. 2. ANY UNUSUAL COMPLICATION

PACKAGES FOR ORTHOPEDIC SURGERY FOUR TWO SINGLE SUPER PRESIDENT CODE NO DESCRIPTION SUITE BEDDED BEDDED BEDDED DELUXE SUITE 150000 187000 225000 269000 336000 393000 ORTPKG0001 TKR U/L for 5 Days(Included I Day SICU) Med. & Con. Upto 35000 150000 179000 213000 254000 315000 366000 ORTPKG0003 TSR U/L for 4 Days(Included I Day SICU) Med. & Con. Upto 30000 150000 179000 213000 254000 315000 366000 ORTPKG0004 TER U/L for 4 Days(Included I Day SICU) Med. & Con. Upto 35000 250000 303000 361000 425000 522000 627000 ORTPKG0002 TKR B/L for 7 Days(Included 2 Days SICU) Med. & Con. Upto 50000 240000 291000 346000 408000 501000 602000 ORTPKG0005 THR B/L for 7 Days(Included 2 Days SICU) Med. & Con. Upto 50000 TKR ARTHOPLASTY B/L for 6 Days(Included 2 220000 262000 311000 366000 447000 536000 ORTPKG0006 Days SICU) Med. & Con. Upto 40000 THR ARTHOPLASTY B/L for 6 Days(Included 2 220000 262000 311000 366000 447000 536000 ORTPKG0007 Days SICU) Med. & Con. Upto 40000

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CODE.NO SERVICE NAME AMOUNT TKR B/L (Complex)for 7 Days(Included 2 Days 275000 333000 395000 464000 563000 677000 ORTPKG0008 SICU) Med. & Con. Upto 50000 THR B/L (Complex)for 7 Days(Included 2 Days 270000 327000 388000 455000 552000 665000 ORTPKG0009 SICU) Med. & Con. Upto 50000 75000 93000 113000 132000 159000 191000 ORTPKG0010 ACL (2 Days) Med. & Con. Upto 15000 80000 99000 120000 140000 168000 202000 ORTPKG0011 PCL (2 Days) Med. & Con. Upto 15000 85000 104000 125000 145000 173000 207000 ORTPKG0012 ROTATORY CUFF REPAIR (2 Days) Med. & Con. Upto 20000 85000 104000 125000 145000 173000 207000 ORTPKG0013 BANKART REPAIR (2 Days) Med. & Con. Upto 20000 85000 104000 125000 145000 173000 207000 ORTPKG0014 SUBACROMIAL DECOMPRESSION (2 Days) Med. & Con. Upto 20000 140000 175000 210000 251000 314000 367000 ORTPKG0015 THR U/L for 5 Days(Included I Day SICU) Med. & Con. Upto 30000

PACKAGE INCLUDES:

1. SURGEON’S FEE, ANESTHESIA SERVICES, O.T CHARGES ,O.T GAS CHARGES & VISIT CHARGES 2. VISIT FEE OF SURGEON AND PHYSICIAN VISIT CHARGES PACKAGE EXCLUDES:

1 ANY FURTHER STAY NEEDS TO BE PAID IN ADDITION. 2. ANY UNUSUAL COMPLICATION 3. PROCEDURE CHARGES, IF ANY ADDITIONAL SURGERY 4. ONLY INTERNAL MEDICINE AND ORTHOPEDICS CONSULTANT’S VISITS ARE INCLUDED IN PACKAGE REST OTHER ANY 5. IMPLANT COST WILL BE CHARGED ON ACTUAL BASIS

NOTE

PACKAGE AS ABOVE WILL NOT BE APPLICABLE FOR HIGH RISK CASES. THE FINAL BILL MAY BE HIGHER THAN THIS PACKAGE DEPENDING ON THE ACTUAL STAY / INVESTIGATION /CONDITION OF PACKAGES ARE PREPARED AFTER ALL PERMISSIBLE DISCOUNTED MINIMAL USAGE ITEM FOR NORMAL CONDITIONS CASES PACKAGES ARE NON DISCOUNTABLE 1.28 1.66 2.04 2.58 3.09

PACKAGES FOR LAPAROSCOPIC SURGERY (2 DAYS ) FOUR TWO SINGLE SUPER PRESIDENT CODE NO DESCRIPTION SUITE BEDDED BEDDED BEDDED DELUXE SUITE 67000 86000 111000 137000 173000 207000 LAPPAK0001 LAP CHOLECYSTECTOMY Medicine & Consumable Upto 10000 57000 74000 97000 120000 153000 183000 LAPPAK0003 LAP.INGUINAL HERNIA U/L Medicine & Consumable Upto 7000 80000 102000 132000 164000 208000 251000 LAPPAK0004 LAP.INGUINAL HERNIA B/L Medicine & Consumable Upto 7000 64000 83000 108000 134000 170000 204000 LAPPAK0005 LAP.UMBLICAL HERNIA Medicine & Consumable Upto 7000 64000 83000 108000 134000 170000 204000 LAPPAK0006 LAP.VENTRAL HERNIA Medicine & Consumable Upto 7000

PACKAGE INCLUDES: HOSPITAL STAYS AS PER THE PACKAGE. ANY FURTHER STAY NEEDS TO BE PAID IN ADDITION. SURGEON ’S FEE; OT CHARGES ANESTHETIST’S FEE ANESTHESIA AND DISPOSABLES USED WITHIN THE OT FOR THE SPECIFIC PROCEDURE. MEDICINE & CONSUMABLE AS PER THE PACKAGE LIMIT.

PACKAGE DOES NOT INCLUDE: ANY FURTHER MEDICINE & CONSUMABLE IF REQUIRED NEEDS TO BE PAID IN ADDITION.. IN CASE OF AN ADDITIONAL PROCEDURE, REGULAR CHARGES WILL BE ADDED. ANY RADIOLOGY INVESTIGATION, LAB TESTS WILL BE CHARGED EXTRA ANY OTHER CONSULTANT’S VISIT (OTHER THAN SURGEON) IS TO BE CHARGED EXTRA. HARMONIC SCALPEL INSTRUMENT IF USED WILL BE CHARGED EXTRA

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CODE.NO SERVICE NAME AMOUNT MESH & STAPLER WILL BE CHARGED EXTRA

NOTE: IN CASE OF EMERGENCY PACKAGE RATE WILL BE CHARGED 150%. IN CASE OF HIGH RISK CASES PACKAGE RATE WILL BE CHARGED 125% PACKAGES ARE PREPARED AFTER ALL PERMISSIBLE DISCOUNTED MINIMAL USAGE ITEM FOR NORMAL CONDITIONS CASES PACKAGES ARE NON DISCOUNTABLE

PACKAGES FOR LASER SURGERY FOUR TWO SINGLE SUPER PRESIDENT CODE NO DESCRIPTION SUITE BEDDED BEDDED BEDDED DELUXE SUITE Laser Prostatectomy-for 3 Days Package(Included I LASERP0001 112000 139000 174000 211000 263000 315000 Day SICU) Greenlight Laser Prostatectomy-for 2 Days LASERP0021 226000 248000 275000 307000 348000 395000 Package(Included I Day SICU) Laser Bladder Tumor-For 2 Days Package LASERP0002 88000 106000 130000 157000 192000 231000 (Included 1 Day SICU) LASERP0003 Laser Urehtrotomy- For One Day Package 53000 66000 83000 101000 126000 152000 LASERP0004 Bladder Neck Incision-For One Day Package 58000 73000 92000 114000 143000 173000 Laser Cystolithrotripsy- For One Day Package (upto LASERP0005 50000 63000 80000 98000 124000 149000 1.5 cm) Laser Cystolithrotripsy- For One Day Package ( 1.5 LASERP0006 68000 85000 107000 132000 165000 201000 cm & above) Laser Lithotripsy- URS For One Day Package (upto LASERP0007 62000 76000 94000 115000 142000 170000 1 cm) Laser Lithotripsy- URS For One Day Package (1 LASERP0008 72000 89000 110000 135000 167000 201000 cm & above) Laser Lithotripsy- PCNL For 3 Days Package LASERP0009 98000 120000 150000 181000 224000 266000 (Single Stone) Laser Lithotripsy- PCNL (multi stone) For 4 Days LASERP0010 115000 144000 182000 221000 277000 328000 Package ( Included 1 Dau SICU ) Retrograde Intra Renal Surgery (RIRS)-for 1 Days LASERP0012 93000 115000 144000 178000 222000 272000 Package Retrograde Intra Renal Surgery (RIRS) Small Stone- LASERP0019 85000 106000 132000 163000 204000 248000 for 1 Days Package Retrograde Intra Renal Surgery (RIRS) Multiple LASERP0020 112000 138000 172000 212000 264000 322000 stone -for 1 Days Laser Fulguration of Bladder Lesion- For One Day LASERP0013 44000 56000 71000 88000 111000 133000 Package Laser Endopylotomy- 4 Days Package (Included 1 LASERP0014 91000 115000 147000 178000 223000 263000 Dau SICU LASERP0022 Laser Flexible- URS For One Day Package 70000 86000 108000 132000 165000 200000 Laser Flexible- URS For One Day Package (1 cm & LASERP0015 79000 98000 122000 149000 186000 226000 above) Laser Prostatectomy+OIU-for 3 Days LASERP0023 118000 143000 178000 217000 270000 325000 Package(Included I Day SICU)

PACKAGE INCLUDES: HOSPITAL STAYS AS PER THE PACKAGE. ANY FURTHER STAY NEEDS TO BE PAID IN ADDITION. UROLOGIST’S FEE; OT CHARGES, ANESTHETIST’S FEE, ANESTHESIA AND DISPOSABLES USED WITHIN THE OT FOR THE SPECIFIC PROCEDURE.

PACKAGE DOES NOT INCLUDE: IN CASE OF AN ADDITIONAL PROCEDURE, REGULAR CHARGES WILL BE ADDED. REMOVAL OF DJ STENT IS NOT INCLUDED IN THE PACKAGE. ANY INVESTIGATION AND MEDICATION OUTSIDE OT IS TO BE CHARGED EXTRA. ANY OTHER CONSULTANT’S VISIT (OTHER THAN SURGEON) IS TO BE CHARGED EXTRA. THE DAY PATIENT IS IN SURGICAL ICU, HIS RELATIVES ARE SUPPOSED TO VACATE THE BED/ROOM ALLOTTED. THE SIMILAR IF THE PATIENT’S ATTENDANT OCCUPIES ROOM/ BED WHILE THE PATIENT IS IN SICU, THEN ADDITIONAL CHARGES OF THE NOTE: IN CASE OF EMERGENCY PACKAGE RATE WILL BE CHARGED 150%.

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CODE.NO SERVICE NAME AMOUNT IN CASE OF HIGH RISK CASES PACKAGE RATE WILL BE CHARGED 125% PACKAGES ARE PREPARED AFTER ALL PERMISSIBLE DISCOUNTED MINIMAL USAGE ITEM FOR NORMAL CONDITIONS PACKAGES ARE NON DISCOUNTABLE

PACKAGE FOR KIDNEY TRANSPLANT / RENAL TRANSPLANT CODE NO DESCRIPTION CHARGES PACKTP0001KIDNEY TRANSPLANT (OPEN NEPHRECTOMY) 400000 PACKTP0004KIDNEY TRANSPLANT (LAP NEPHRECTOMY) 435000 PACKTP0005KIDNEY TRANSPLANT CADAVER 475000

PACKAGE INCLUDES:

1. 9 DAYS STAY FOR RECIPIENT & 6 DAYS FOR DONOR 2. POST OPERATIVE LAB & RADIOLOGY CHARGES FOR RECIPIENT & DONOR 3. RECIPIENT & DONOR OT MEDICINE & CONSUMABLE UPTO RS 80000/- 4. SALINE, I.V INFUSION DURING HOSPITAL PACKAGE 5. BLOOD TRANSFUSION SERVICES UPTO 20000/- 6. SURGEON’S FEE & VISIT CHARGES FOR RECIPIENT & DONOR 7. ANESTHESIA SERVICES FOR RECIPIENT & DONOR 8. O.T & O.T GAS CHARGES 9. VISIT FEE OF OTHER SPECIALTY DOCTORS

PACKAGE EXCLUDES: 1. STAY MORE THAN 9 DAYS FOR RECIPIENT AND 6 DAYS FOR DONOR 2. ANY UNUSUAL COMPLICATION 3. PROCEDURE CHARGES, IF ANY ADDITIONAL SURGERY 4. IMMUNOSUPPRESSIVE MEDICINE

NOTE

PACKAGE AS ABOVE WILL NOT BE APPLICABLE ON ACTUAL BASIS FOR HIGH RISK/PEDEATRIC CASES. PACKAGES ARE PREPARED AFTER ALL PERMISSIBLE DISCOUNTED MINIMAL USAGE ITEM FOR NORMAL CONDITIONS CASES PACKAGES ARE NON DISCOUNTABLE LIVER TRANSPLANT PACKAGE CODE NO DESCRIPTION CHARGES LIVTP00001LIVER TRANSPLANT PACKAGE (ADULT) NORMAL 2000000

PACKAGE INCLUDES:

1 ROOM RENT RECIPIENT 15 DAYS( 5 DAYS IN ICU 10 DAYS IN SINGLE WARD) DONOR 8 DAYS( 2 DAY IN ICU 6 DAYS 2 PREIN SINGLE OPERATIVE BED) LAB, BLOOD BANK & RADIOLOGY CHARGES FOR RECIPIENT & DONOR UP TO RS 140000/- 3 RECIPIENT & DONOR OT MEDICINE & CONSUMABLE UPTO RS 700000/- 4 O.T CHARGES & O.T GAS CHARGES 5 PROFESSIONAL FEES OF THE SURGEON, ANESTHETIST, HEMATOLOGIST, PHYSICIAN FOR THE DURATION OF 6 PRETHE PACKAGE.& POST OPERATIVE CONSULTATION 7 POST OPERATIVE LAB, BLOOD BANK & RADIOLOGY CHARGES FOR RECIPIENT & DONOR UP TO RS 140000/- 8 DIET & PHYSIOTHERAPY

PACKAGE EXCLUDES:

1 ROOM CHARGES AND ALL INVESTIGATIONS FOR STAY BEYOND THE DURATION OF THE PACKAGE. 2 MEDICINES & INJECTIONS LIKE AMBISOME, CASPOFUNGIN, IVIG AND HBS IG IMMUNOGLOBULIN (HEPABRIC). 3 DSA LAB PROCEDURES IF ANY. ANY OTHER ADDITIONAL PROCEDURE WITH LIVER TRANSPLANT WILL BE CHARGED EXTRA AS PER APPLICABLE 4 TARIFF OVER & ABOVE THE PACKAGE. 5 VISIT CHARGES OF CONSULTANTS, OTHER THAN THOSE MENTIONED AT SERIAL (H) OF INCLUSIONS AND DRUGS PRESCRIBED NOTE :- PACKAGE AS ABOVE WILL NOT BE APPLICABLE ON ACTUAL BASIS FOR HIGH RISK/PEDEATRIC CASES. :- PRICE OF PACKAGE WILL BE PAYABLE FULL AT THE TIME OF ADMISSION

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CODE.NO SERVICE NAME AMOUNT :- FOR TRANSFUSION,BLOOD SHOULD BE DONATED BY PATIENT'S RELATIVE & FRIENDS

CARDIAC PACKAGES Angiography (Package for One Day) TWO SINGLE SUPER PRESIDENT Code Description Day Care SUITE BEDDED BEDDED DELUXE SUITE CARANG0001 Coronary Angiography 12000 15000 18800 22500 30000 45000 CARANG0002 Peripheral Angiography 12000 15000 18800 22500 30000 45000 CARANG0003 Carotid Angiography 12000 15000 18800 22500 30000 45000 CARANG0004 Renal Angiography 12000 15000 18800 22500 30000 45000 CARANG0005 Coronary + Peripheral Angiography 15000 18750 23500 28200 37500 56300 CARANG0006 Coronary + Carotid Angiography 15000 18750 23500 28200 37500 56300 CARANG0007 Coronary + Renal Angiography 15000 18750 23500 28200 37500 56300 CARANG0008 Check Coronary Angiography 8000 10000 12500 15000 20000 30000 CARANG0012 MYOCARDIAL BIOPSY 12000 10000 12500 15000 20000 30000 CARANG0013 TOTAL ENDOMYOCARDIAL BIOPSY 25000 10000 12500 15000 20000 30000

Package Includes:

1 Cardiologist/Operator fee,Cath lab charges 2 Investigations one time only:- Haemogram, RBS, Urine Routine, Urea, Creatinine, Na, K+, HIV, HBsAg, HCV, ECG and X-ray (Chest) and PT/INR( If patient is on acitrom/warfarin) 3 Medicine & Consumables upto Rs 3500 4 Omnipaque (Non Ionic Dye) included in package

Exclusions 1 Additional antibiotics/medicine , if used will be charged extra at applicable rates. 2 VISIPAQUE dye if used will be charged on actual 3 Additional investigations other than included in the package. 4 CD (if requested by the patient) to be charged extra.

Angioplasty (Package for One Day) TWO SINGLE SUPER PRESIDENT Code Description ICU+WARD SUITE BEDDED BEDDED DELUXE SUITE CARANP0001 Coronary Angioplasty (Routine) (1+1) 150000 187500 225000 300000 450000 CARANP0002 Coronary Angioplasty (PTCA) - Complex (1+1) 225000 281300 337500 450000 675000 CARANP0003 Coronary Angioplasty with Rota (1+1) 250000 312500 375000 500000 750000 CARANP0004 Carotid Angioplasty (1+1) 150000 187500 225000 300000 450000 CARANP0005 Primary Angioplasty (1+1) 225000 281300 337500 450000 675000 CARANP0007 Peripheral Angioplasty (1+1) 150000 187500 225000 300000 450000 CARANP0008 Renal Angioplasty (1+1) 150000 187500 225000 300000 450000 CARANP0009 AAA Graft Stent (1+1) 170000 200000 250000 325000 450000 CARILR0001 ILR IMPLANTATION (1+1) 30000 37500 45000 60000 90000 CARANP0011 ALCOHOL SEPTAL ABLATION (1+1) 150000 187500 225000 300000 450000

Package Includes: 1 Cardiologist/Operator & Anesthesia fee,Cath lab charges 2 Investigations one time only:- Haemogram, RBS, Urine Routine, Urea, Creatinine, Na, K+, HIV, HBsAg, HCV, ECG (pre,post)and X-ray (Chest) pre & post and PT/INR( If patient is on acitrom/warfarin) 3 Medicine & Consumables upto Rs 6000 4 Guiding Catheter Qty-1,PTCA Balloon Qty-1, PTCA Guide wire Qty-1,Inflation Device Qty-1,Y Connector Device Qty-1,Carotid Sheath Qty- 1,PTA Balloon Qty-1 Syringe 20 CC Qty-1 and Onipacque Contrast 200 ml

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CODE.NO SERVICE NAME AMOUNT 1,PTA Balloon Qty-1 Syringe 20 CC Qty-1 and Onipacque Contrast 200 ml 5 Cardiologist visit and Intensivist consult during defined ICU stay shall be included in package.

Exclusions

1 The above package does not include cost of Stents which will be charged at applicable rates. 2 Additional antibiotics/medicine, Extra Balloon & Extra PTCA wire if used will be charged extra at applicable rates.

3 Integrilin, Reopro, Eptiflo or any other Blood Thinner, Distal protection Device (DPD),Rotaburr, Advancer, Rota Wire and Trombus extraction device and Temporary Pacing Lead if use will be charged on actuals. 4 CT,MRI & IABP if required will be charged extra. 5 Any consultation with non cardiac specialty will be charged extra. 6 2nd sitting PTCA Procedure will be charged @ 25000/- if done in the same admission. 7 Additional investigations other than included in the package. 8 Any other incidental procedures 9 CD (if requested by the patient) to be charged extra.

ILR IMPLANTATION CARILR0001 ILR IMPLANTATION (1+1) 30000 37500 45000 60000 90000

Package Includes: 1 Cardiologist/Operator & Anesthesia fee,Cath lab charges 2 Investigations one time only:- Haemogram, RBS, Urine Routine, Urea, Creatinine, Na, K+, HIV, HBsAg, HCV, ECG (pre,post)and X-ray (Chest) pre & post and PT/INR( If patient is on acitrom/warfarin) 3 Medicine & Consumables upto Rs 4000 4 Guiding Catheter Qty-1,PTCA Balloon Qty-1, PTCA Guide wire Qty-1,Inflation Device Qty-1,Y Connector Device Qty-1,Carotid Sheath Qty- 1,PTA Balloon Qty-1 Syringe 20 CC Qty-1 and Onipacque Contrast 200 ml 5 Cardiologist visit and Intensivist consult during defined ICU stay shall be included in package.

Exclusions

1 The above package does not include cost of Stents which will be charged at applicable rates. 2 Additional antibiotics/medicine, Extra Balloon & Extra PTCA wire if used will be charged extra at applicable rates.

3 Integrilin, Reopro, Eptiflo or any other Blood Thinner, Distal protection Device (DPD),Rotaburr, Advancer, Rota Wire and Trombus extraction device and Temporary Pacing Lead if use will be charged on actuals. 4 CT,MRI & IABP if required will be charged extra. 5 Any consultation with non cardiac specialty will be charged extra. 6 2nd sitting PTCA Procedure will be charged @ 25000/- if done in the same admission. 7 Additional investigations other than included in the package. 8 Any other incidental procedures 9 CD (if requested by the patient) to be charged extra.

Venoplasty TWO SINGLE SUPER PRESIDENT Code Description ICU+WARD SUITE BEDDED BEDDED DELUXE SUITE CARANG0011 Venoplasty (1+1) 120000 150000 180000 240000 360000 1.25 1.50 2.00 3.00

Package Includes: 1 Cardiologist/Operator & Anesthesia fee,Cath lab charges 2 Investigations one time only:- Haemogram, RBS, Urine Routine, Urea, Creatinine, Na, K+, HIV, HBsAg, HCV, ECG (pre,post),APTT and PT/INR( If patient is on acitrom/warfarin)

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CODE.NO SERVICE NAME AMOUNT 3 Medicine & Consumables upto Rs 6000 4 Diagonstic Catheter Qty-1,Guide wire exchange lenth Qty-1,Inflation Device Qty-1,Y Connector Device Qty-1, Guidecath Qty -1 ,Arterial Sheath Qty-2, Syringe 20 CC Qty-2 and visipaque Contrast 150 ml 5 Cardiologist, Nephrologist visit and Intensivist consult during defined ICU stay shall be included in package.

Exclusions

1 The above package does not include cost of Stents which will be charged at applicable rates. 2 Additional antibiotics/medicine, Extra Balloon & Extra wire if used will be charged extra at applicable rates.

3 Stent , Balloon will be charged extra. 4 CT,MRI & IABP if required will be charged extra. 5 Any consultation with non cardiac specialty will be charged extra. 6 Additional investigations other than included in the package. 7 Any other incidental procedures 8 CD (if requested by the patient) to be charged extra. Pacemaker/CRTP/CRTD (Package for One Day) TWO SINGLE SUPER PRESIDENT Code Description ICU+WARD SUITE BEDDED BEDDED DELUXE SUITE CARPAC0001 Single chamber pacemaker (1+1) 50000 62500 75000 100000 150000 CARPAC0002 Double chamber pacemaker (1+1) 75000 93800 112500 150000 225000 CARPAC0003 Pacemaker Explantation (simple) (1+1) 50000 62500 75000 100000 150000 CARPAC0004 Pacemaker Explantation (Complex) (1+1) 75000 93800 112500 150000 225000 CARPAC0005 CRTP/CRTD (1+1) 125000 156300 187500 250000 375000 CARPAC0006 Lead Repositioning (1+1) 50000 62500 75000 100000 150000 CARPAC0007 Single chamber pacemaker( Replacment) (1+1) 50000 62500 75000 100000 150000 CARPAC0008 Double chamber pacemaker( Replacment) (1+1) 75000 93800 112500 150000 225000 CARPAC0010 Old Lead Extraction (1+1) 125000 156300 187500 250000 375000 CARPAC0011 Hematoma Evacuation (1+1) 50000 62500 75000 100000 150000 Package Includes: 1 Cardiologist/Operator fee,Cath lab charges 2 Investigations one time only:- Haemogram, RBS, Urine Routine, Urea, Creatinine, Na, K+, HIV, HBsAg, HCV,, ECG (pre,post)and X-ray (Chest) pre & post and PT/INR( If patient is on acitrom/warfarin) 3 Medicine & Consumables upto Rs 15000

Exclusions 1 Cost of Pacemaker, Lead, Additional wires,LV Lead Introducer sheath,Subselection catheter,Micro catheter, Lead Extraction Devices(LLD) and Temporary Pacing Lead would be charged on actuals 2 Additional antibiotics/medicine will be charged extra on actuals. 3 Any consultation with non cardiac specialty will be charged extra. 4 Additional investigations other than included in the package. 5 Any other incidental procedures 6 CD (if requested by the patient) to be charged extra.

EPS/RFA ABLATION (Package for One Day)

TWO SINGLE SUPER PRESIDENT Code Description ICU+WARD SUITE BEDDED BEDDED DELUXE SUITE CAREPS0001 EPS (Mini) (0+1) 15000 18800 22500 30000 45000 CAREPS0002 EPS Complex (0+1) 30000 37500 45000 60000 90000 CAREPS0003 RF Ablation with EP (0+1) 90000 112500 135000 180000 270000

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CODE.NO SERVICE NAME AMOUNT CAREPS0004 RF Ablation with 3D Mapping # (0+1) 250000 312500 375000 500000 750000 CAREPS0005 RF Ablation with Smart Touch (0+1) 325000 406300 487500 650000 975000 CAREPS0006 2D RF Ablation (complex) with EP & Thermo cool (0+1) 130000 162500 195000 260000 390000 CAREPS0007 RF ABLATION(CARTO)WITH SMART TOUCH+PANTR (0+1) 350000 437500 525000 700000 1050000 CAREPS0008 ENSITE( 3D) MAPPING * (0+1) 350000 437500 525000 700000 1050000

Package Includes: 1 Cardiologist/Operator fee,Cath lab charges 2 Investigations one time only:- Haemogram, RBS, Urine Routine, Urea, Creatinine, Na, K+, HIV, HBsAg, HCV,, ECG (pre,post)and X-ray (Chest) pre & post and PT/INR( If patient is on acitrom/warfarin) 3 Medicine & Consumables upto Rs 4000 4 Quadipolar catheter Qty-2. Connector, ablation catheter and connector

Exclusions 1 3D Equipment (CARTO,ENSITE) charges would be extra 2 Deflectable sheets and other complex ablation equipment would be charged extra 3 Additional antibiotics/medicine will be charged extra on actuals. 4 Any consultation with non cardiac specialty will be charged extra. 5 Additional investigations other than included in the package. 6 Any other incidental procedures 7 CD (if requested by the patient) to be charged extra.

TWO SINGLE SUPER PRESIDENT Code Description ICU+WARD SUITE BEDDED BEDDED DELUXE SUITE CAREPS0008 ENSITE( 3D) MAPPING * (0+1) 350000 437500 525000 700000 1050000

Package Includes: 1 Cardiologist/Operator fee,Cath lab charges 2 Investigations one time only:- Haemogram, RBS, Urine Routine, Urea, Creatinine, Na, K+, HIV, HBsAg, HCV,, ECG (pre,post)and X-ray (Chest) pre & post and PT/INR( If patient is on acitrom/warfarin) 3 Medicine & Consumables upto Rs 4000 4 HD Grid /Tacticath Catheter, Ensite Precision Patch/Velocity Patch, HD Grid Connector

Exclusions 1 3D Equipment (CARTO,ENSITE) charges would be extra 2 Deflectable sheets and other complex ablation equipment would be charged extra 3 Additional antibiotics/medicine will be charged extra on actuals. 4 Any consultation with non cardiac specialty will be charged extra. 5 Additional investigations other than included in the package. 6 Any other incidental procedures 7 CD (if requested by the patient) to be charged extra.

ICD Implantation (Package for One Day) Code TWO SINGLE SUPER PRESIDENT Description ICU+WARD SUITE BEDDED BEDDED DELUXE SUITE CARAIC0001 Single chamber (1+1) 85000 106300 127500 170000 255000 CARAIC0002 Double chamber (1+1) 100000 125000 150000 200000 300000 CARAIC0003 Pacemaker Implantation By Epicardialroot (1+1) 85000 106300 127500 170000 255000

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CODE.NO SERVICE NAME AMOUNT Package Includes: 1 Cardiologist/Operator fee,Cath lab charges 2 Investigations one time only:- Haemogram, RBS, Urine Routine, Urea, Creatinine, Na, K+, HIV, HBsAg, HCV,, ECG (pre,post)and X-ray (Chest) pre & post and PT/INR( If patient is on acitrom/warfarin) 3 Medicine & Consumables upto Rs 15000 Exclusions 1 Cost of Device & Lead and combo devices would be charged on actuals 2 Additional antibiotics/medicine if use will be charged extra on actuals. 3 Micro catheter and Temporary Pacing Lead and PTCA Balloon will be charged as per actual 4 Any consultation with non cardiac specialty will be charged extra. 5 Additional investigations other than included in the package. 6 Any other incidental procedures 7 CD (if requested by the patient) to be charged extra.

BMV (Balloon Mitral Valvoplasty) (Package for One Day) TWO SINGLE SUPER PRESIDENT Code Description ICU+WARD SUITE BEDDED BEDDED DELUXE SUITE CARBMV0001 BMV (1+1) 150000 187500 225000 300000 450000

Package Includes: 1 Cardiologist/Operator fee,Cath lab charges 2 Investigations one time only:- Haemogram, RBS, Urine Routine, Urea, Creatinine, Na, K+, HIV, HBsAg, HCV,, ECG (pre,post)and X-ray (Chest) pre & post and PT/INR( If patient is on acitrom/warfarin) 3 Medicine & Consumables upto Rs 4000 4 PTMC balloon,Transheptal Puncture Needle,Mullim Sheath will be charged as per actual

Exclusions 1 Additional investigations other than included in the package. 2 CD (if requested by the patient) to be charged extra. 3 Any consultation with non cardiac specialty will be charged extra. ASD Device Closure (Package for One Day) TWO SINGLE SUPER PRESIDENT Code Description ICU+WARD SUITE BEDDED BEDDED DELUXE SUITE CARASD0001 ASD Device Closure (1+1) 75000 94000 112500 150000 225000

Package Includes: 1 Cardiologist/Operator & Anesthesia fee,Cath lab charges

Investigations one time only:- Haemogram with DLC, 2 Urine Routine, Urea, Creatinine, Na, K, HIV, HBsAg, HCV, ECG (pre,post)and X-ray (Chest) pre & post.

3 Medicine upto Rs 4000 4 Cardiologist visit and Intensivist consult during defined ICU stay shall be included in package.

Exclusions

1 The above package does not include cost of Stents which will be charged at applicable rates. 2 Additional antibiotics/medicine Extra PTCA wire if used will be charged extra at applicable rates. 3 CT,MRI & IABP if required will be charged extra. 4 Any consultation with non cardiac specialty will be charged extra.

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CODE.NO SERVICE NAME AMOUNT 5 Additional investigations other than included in the package. 6 Any other incidental procedures 7 CD (if requested by the patient) to be charged extra.

IVC Filter Implantation (Package for One Day) TWO SINGLE SUPER PRESIDENT Code Description ICU+WARD SUITE BEDDED BEDDED DELUXE SUITE CARIVC0001 IVC Filter Implantation (1+1) 60000 75000 90000 120000 180000

Package Includes:

1 Cardiologist/Operator fee,Cath lab charges

Investigations one time only:- Haemogram with DLC, 2 Urine Routine, Urea, Creatinine, Na, K, HIV, HBsAg, HCV, ECG and X-ray (Chest)

3 Medicine & Consumables upto Rs 3500

Exclusions 1 The package does not include the cost of device / Filters 2 Additional antibiotics/medicine , if used will be charged extra at applicable rates. 3 VISIPAQUE dye if used will be charged on actual 4 Additional investigations other than included in the package.

TAVI (Trans Catheter Aortic Valve Implantation) (Package for One Day) Code TWO SINGLE SUPER PRESIDENT Description ICU+WARD SUITE BEDDED BEDDED DELUXE SUITE CARAVI0001 Trans Catheter Aortic Valve Implantation (3+2) 240000 300000 360000 480000 720000 1.25 1.50 2.00 3.00

Package Includes: 1 Cardiologist/Operator fee,Cath lab charges 2 Investigations one time only:- All Routine Tests such as complete Haemogram BT/ CT , Blood Grouping , Urine, PT,HB , Electrolytes NA ,K, Urea Creatinine x2 3 Medicine upto Rs 15000 & Other Consumable upto Rs 25000 4 Consumable:- Visipaque-2 , Guide Wire-5 , Diagnostic Catheter -4 , Introducer sheath-5 TPI Balloon-1, Proglide -4

Exclusions

1 All Pacemakers/ Device/ Filters/ Implant/Patch charges will be extra on actual 2 Antibiotics , if used will be charged extra to package cost at applicable rates 3 Additional investigations other than included in the package. 4 CD (if requested by the patient) to be charged extra. 5 Any consultation with non cardiac specialty will be charged extra. 6 Stay & all other services will charged extra if patient stay beyond package days

CARDIAC SURGERY PACKAGE TWO SINGLE SUPER PRESIDENT Code Description ICU+WARD SUITE BEDDED BEDDED DELUXE SUITE CARSUR0002 CABG (By pass surgery) 8 260000 330000 400000 510000 660000

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CODE.NO SERVICE NAME AMOUNT CARSUR0027 CABG (By pass surgery) - High Risk 8 320000 400000 470000 590000 710000 CARSUR0028 CABG + Redo 8 325000 420000 510000 630000 770000 CARSUR0029 CABG + Carotid Endarterectomy 8 325000 420000 510000 630000 770000 CARSUR0006 CABG + LV Aneurysm Repair 8 295000 370000 460000 590000 720000 CARSUR0007 CABG with any Valve Repair/Replacement 8 325000 420000 510000 630000 770000 CARSUR0008 CABG + Ring Annuloplasty 8 320000 390000 480000 610000 740000 CARSUR0009 CABG + VSD Closure 8 325000 420000 510000 630000 770000 CARSUR0010 CABG + ASD Closure 8 325000 420000 510000 630000 770000 CARSUR0011 CABG + Ministernotomy 8 260000 330000 400000 510000 660000 CARSUR0012 CABG + MVR + TV Repair / Aneurysm Repair 8 345000 430000 510000 630000 770000 CARSUR0032 PDA 3 65000 80000 100000 125000 150000 CARSUR0033 CABG - REOPEN 8 31250 37500 42190 46880 54690

Inclusions 1 Medicine & Consumable used Ward/OT 2 Routine Investigations related to surgery will be part of package . 3 Ventilator Equipment charges during defined ICU stay(s). 4 CTVS OT charges, procedure changes and surgeon fee shall be included in package. 5 Cardiac Surgeon visit and Intensvisit consult during defined ICU days shall be included in package. Exclusions 1 Room charges and all Investigations for stay beyond the duration of the package. 2 All Prosthetics & Implants ( Patch, Valve , Shunt , Graft , Conduit & high value consumable) will be charges extra on actuals. 3 Intra aortic Balloon, Cell Saver Kit & Femoral CPB Kit will be charged extra on actuals. 4 High End antibiotics/expensive Drugs will be charged extra to package cost. 5 Any consultation with non cardiac specialty will be charged extra. 6 CT, MRI & IABP if required will be charged extra. 7 Any procedure with non cardiac specialty will be charged extra.

CARDIAC SURGERY PACKAGE TWO SINGLE SUPER PRESIDENT Code Description ICU+WARD SUITE BEDDED BEDDED DELUXE SUITE CARSUR0001 EPICARDIAL LEAD PLACEMENT 1 25000 30000 33750 37500 43750

Inclusions 1 Medicine & Consumable used Ward/OT 2 Routine Investigations related to surgery will be part of package . 3 Ventilator Equipment charges during defined ICU stay(s). 4 CTVS OT charges, procedure changes and surgeon fee shall be included in package. 5 Cardiac Surgeon visit and Intensvisit consult during defined ICU days shall be included in package. Exclusions 1 Room charges and all Investigations for stay beyond the duration of the package. 2 High End antibiotics/expensive Drugs will be charged extra to package cost. 3 Any consultation with non cardiac specialty will be charged extra. 4 CT, MRI & IABP if required will be charged extra. 5 Any procedure with non cardiac specialty will be charged extra.

VALVE SURGERY TWO SINGLE SUPER PRESIDENT Code Description ICU+WARD SUITE BEDDED BEDDED DELUXE SUITE CARSUR0013 Any Single Valve Repair/Replacment 8 260000 330000 400000 510000 660000 CARSUR0014 Any Double Valve Repair/Replacment 8 295000 360000 440000 600000 710000 CARSUR0030 Interposition Graft 8 250000 300000 400000 500000 600000 CARSUR0031 AVR/MVR - REDO 8 325000 420000 510000 630000 770000

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CODE.NO SERVICE NAME AMOUNT

Inclusions 1 Medicine & Consumable used Ward/OT 2 Routine Investigations related to surgery will be part of package . 3 Ventilator Equipment charges during defined ICU stay(s). 4 CTVS OT charges, procedure changes and surgeon fee shall be included in package. 5 Cardiac Surgeon visit and Intensvisit consult during defined ICU days shall be included in package. Exclusions 1 Room charges and all Investigations for stay beyond the duration of the package. 2 All Prosthetics & Implants ( Patch, Valve , Shunt , Graft , Conduit & high value consumable) will be charges extra on actuals. 3 Intra aortic Balloon, Cell Saver Kit & Femoral CPB Kit will be charged extra on actuals. 4 High End antibiotics/expensive Drugs will be charged extra to package cost. 5 Any consultation with non cardiac specialty will be charged extra. 6 CT, MRI & IABP if required will be charged extra. 7 Any procedure with non cardiac specialty will be charged extra.

OTHER CARDIAC SURGERY (8 DAYS) TWO SINGLE SUPER PRESIDENT Code Description ICU+WARD SUITE BEDDED BEDDED DELUXE SUITE CARSUR0015 Thoraco Abdominal Aneurysm Repair 8 280000 360000 450000 550000 710000 CARSUR0016 Bentall Procedure 8 335000 420000 510000 600000 730000 CARSUR0017 Ascending Aorta Replacement 8 335000 420000 510000 600000 730000 CARSUR0018 ASD Repair/Closure 8 235000 300000 370000 440000 540000 CARSUR0019 VSD Closure/Repair 8 250000 310000 375000 450000 550000 CARSUR0020 Myxoma LA/RA 8 260000 330000 400000 520000 660000 CARSUR0021 Aneurysmectomy 8 270000 350000 450000 550000 710000 CARSUR0022 Pericardiectomy 8 220000 270000 330000 400000 520000 CARSUR0023 Carotid Endartectomy (5 Days) 8 200000 250000 300000 375000 500000

CARSUR0024 Repair Ruptured Aneurysm Sinus of Valsava on CPB 8 260000 330000 400000 520000 770000

CARSUR0025 Pulmonary Endarterectomy 8 310000 400000 480000 600000 730000 CARSUR0026 Aortic Aneurysm repair (Aneusymoraphy) 8 270000 330000 400000 520000 660000

Inclusions 1 Medicine & Consumable used Ward/OT 2 Routine Investigations related to surgery will be part of package . 3 Ventilator Equipment charges during defined ICU stay(s). 4 CTVS OT charges, procedure changes and surgeon fee shall be included in package. 5 Cardiac Surgeon visit and Intensvisit consult during defined ICU days shall be included in package. Exclusions 1 Room charges and all Investigations for stay beyond the duration of the package. 2 All Prosthetics & Implants ( Patch, Valve , Shunt , Graft , Conduit & high value consumable) will be charges extra on actuals. 3 Intra aortic Balloon, Cell Saver Kit & Femoral CPB Kit will be charged extra on actuals. 4 High End antibiotics/expensive Drugs will be charged extra to package cost. 5 Any consultation with non cardiac specialty will be charged extra. 6 CT, MRI & IABP if required will be charged extra. 7 Any procedure with non cardiac specialty will be charged extra.

LIST OF DRUGS NOT INCLUDED IN CARDIAC PACKAGE S.No. GENERIC NAMES OF ANTIBIOTICS 1 ALBUMIN 2 AMPHOTERICIN B LIPID COMPLEX (ampholip) 3 ANIDULA FUNGIN INJ. 4 AZITHROMYCIN (azee, azithral)

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CODE.NO SERVICE NAME AMOUNT 5 AZTREO 1GM INJECTION 6 AZTREONAM (ajenam) 7 CEFETAMET PIVOXIL (altamet) 8 CEFTAZIDIME (fortum) 9 CEFTIZOXIME (cefizox) 10 CEFTRIAXONE + TAZOBACTUM (xone) 11 CELEMIX 12 CENTRAL VENUS CATH. 13 CERTOFIX TUBE 14 CLARITHROMYCIN (claribid, klacid, crixan, synclar) 15 CLINDAMYCIN (dalacin, dalcinex) 16 DEMECLOCYCLINE (ledermycin) 17 FAROPENEM (faronem) 18 FORTUM INJ 1GM VIAL 19 IMIPENEM+CILASTATIN (cilanem, zienem) 20 INJ. LIPOSOMAL AMPHOTERICIN B (ambisome, fungisome,abelcet) 21 JNTRALIPID 20% 250ML 22 KABITRAN INJ 23 LEADER CATH 24 LINCOMYCIN (lynx) 25 MEROPENAM (meronem, merotroyl) 26 MINOCYCLINE(cynomycin, minoz) 27 PIPERACILIN SODIUM + TAZOBACT SODIUM (tajact, zosyn) 28 PIPERACILLIN SODIUM (pipracil) 29 POLYMYXINS (poly-b) 30 PRIMACOR 10 ML INJECTION 31 SINGLE DPT LINE 32 SOLU- MEDROL INJ 125MG/2 ML VIAL 33 SWAN CAUZ CATH. 34 TARGOCID 200MG INJ 35 TARGOCID 400MG INJ 36 TAZACT 2.25GM INJ 37 TAZACT 4.5GM INJ 38 TICARCILLIN +CLAVULANATE K (timentin) 39 VORICONAZOLE (vgend, voraz)

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