Package Inclusions and Exclusions

CABG Inclusions Room Total 8 Days as per Package & Procedure as per opted room category All Routine Tests such as complete haemogram BT.CT,Electrolytes .Urea Creatinine Blood Groping Investigation Urine PT,& others Surgery Surgeons fee ,OT charges & Anesthesia charges Consultation Covered till Package days Exclusions Drugs & consumables will be chargeable extra Implant /Devices/Patch will be charged on actual Investigation not covered within the package will be charged Extra All services to be charged on actual if the patient stay exceeds beyond package days CT/MRI/ Thallium & IABP if done or used will be extra High Risk Surgery charges Any cross consultation will be charged at actual Admission/Documentation & Critical care charges

ASD/VSD Closure/Repair PDA device closure BMV VALVULOPLASTY

Inclusions Room 3 Days Package as per opted category 2 Room & One ICU

All Routine Tests such as complete haemogram BT.CT,Electrolytes .Urea Creatinine Blood Groping Investigation Urine PT, Drugs & consumables All Routine drugs& consumables upto 8 days of package Procedure PPI SINGLE/DOUBLE CHAMBER Cardiologists fee ,Cath Lab charges Consultation Covered till Package days of Three Days Exclusions Implant /Devices/Patch will be chargeable on actual Drugs& consumables will be charged extra if pre & post stay is more than package days Investigation not covered within the package will be charged Extra All services to be charged on actual if the patient stay exceeds beyond package days CT/MRI/ Thallium & IABP if done or used will be extra Any cross consultation will be charged at actual Admission/Documentation & Critical care charges

Page 5 EPS/RFA

Inclusions Room 1 Day Package as per opted category

All Routine Tests such as complete haemogram BT.CT,Electrolytes .Urea Creatinine Blood Groping Investigation Urine PT, Drugs & consumables Routine Drugs& Consumable’s Procedure EPS/RFA Cardiologists fee ,Cath Lab charges Consultation Covered till one day Package Exclusions Drugs& consumables will be chargeable extra beyond routine Beyond package days Investigation also will be chargeable All services to be charged on actual if the patient stay exceeds beyond package days CT/MRI/ Thallium & IABP if done or used will be extra Any cross consultation will be charged at actual Admission/Documentation & Critical care charges

TAVI Inclusions Room Total 5 Day Room charges as per opted Package 2CCU& 3 Room All Routine Tests such as complete haemogram BT.CT,Electrolytes .Urea Creatinine Blood Groping Investigation Urine PT, Drugs & consumables All Routine drugs& consumables Procedure TAVI Cardiologists fee ,Cath Lab charges Consultation Covered till Package days Exclusions Stay beyond package days Implant /Devices/Patch will be chargeable on actual Drugs& consumables will be charged extra Investigation not covered within the package will be charged Extra All services to be charged on actual if the patient stay exceeds beyond package days Vascular surgeon Charges will be extra if required CT/MRI/ Thallium & IABP if done or used will be extra Any cross consultation will be charged at actual Any additional procedure as per patient medical treatment will be charged at actual Admission/Documentation & Critical care charges

Page 6 ICD implantation Combo/Biventicular Pacemaker

Inclusions Room 3 Days Package as per opted category 2 Room & One ICU

All Routine Tests such as complete haemogram BT.CT,Electrolytes .Urea Creatinine Blood Groping Investigation Urine PT, Drugs & consumables All Routine drugs& consumables upto 8 days of package Procedure Cardiologists fee ,Cath Lab charges Consultation Covered till Package days of Three Days Exclusions Implant /Devices/Patch will be chargeable on actual Drugs& consumables will be charged extra if pre & post stay is more than package days Investigation not covered within the package will be charged Extra All services to be charged on actual if the patient stay exceeds beyond package days CT/MRI/ Thallium & IABP if done or used will be extra Any cross consultation will be charged at actual Admission/Documentation & Critical care charges

CAG+PTCA

Inclusions Room 1 Day room rent & 1 day ICU Package as per opted category

All Routine Tests such as complete haemogram BT.CT,Electrolytes .Urea Creatinine Blood Groping Investigation Urine PT, Drugs & consumables Exemption against Drugs& Consumable’s with limit of Rs 19000/- Procedure CAG+PTCA Cardiologists fee ,Cath Lab charges Consultation Covered till Package days of Three Days Exclusions Beyond the limit Drugs& consumables will be chargeable extra Beyond package days Investigation also will be chargeable All services to be charged on actual if the patient stay exceeds beyond package days CT/MRI/ Thallium & IABP if done or used will be extra 2nd sitting PTCA Procedure will be charges @ 25000/-additional Any cross consultation will be charged at actual Balloon & Stent, Devices & Adjunctive anticoagulant Injections Admission/Documentation & Critical care charges

Page 7 AVR/MVR/DVR Inclusions Room Total 8 Day Room charges as per opted Package All Routine Tests such as complete haemogram BT.CT,Electrolytes .Urea Creatinine Blood Groping Investigation Urine PT, Drugs & consumables All Routine drugs& consumables up to 8 days of package Procedure CAG+PTCA surgeons fee ,OT charges& Anesthesia charges Consultation Covered till Package days Exclusions Stay beyond package days Implant /Devices/Patch will be chargeable on actual Drugs& consumables will be charged extra if pre & post stay is more than package days Investigation not covered within the package will be charged Extra All services to be charged on actual if the patient stay exceeds beyond package days CT/MRI/ Thallium & IABP if done or used will be extra High Risk Surgery charges Any cross consultation will be charged at actual Any additional procedure as per patient medical treatment will be charged at actual Admission/Documentation & Critical care charges

CTVS Pediatric package details Inclusions Room Total Days as per Package & Procedure as per opted room category Over& and above package days will be chargeable as Rs 10000/- for CCU/ICU/RR & Rs 8000/ -for room All Routine Tests such as complete haemogram BT.CT,Electrolytes .Urea Creatinine Blood Groping Investigation Urine PT,& others Drugs & consumables All Routine drugs& consumables Surgery surgeons fee ,OT charges& Anesthesia charges Consultation Covered till Package days Exclusions Drugs& consumables not covered in the package will be chargeable extra Implant /Devices/Patch will be charged on actual Investigation not covered within the package will be charged Extra All services to be charged on actual if the patient stay exceeds beyond package days CT/MRI/ Thallium & IABP if done or used will be extra High Risk Surgery charges Any cross consultation will be charged at actual Rs 30000/- will be charged additional to surgery charges if patient is adult Admission/Documentation & Critical care charges

Page 8 PPI SINGLE CHAMBER AND DOUBLE CHAMBER

Inclusions Room 3 Days Package as per opted category 2 Room & One ICU

All Routine Tests such as complete haemogram BT.CT,Electrolytes .Urea Creatinine Blood Groping Investigation Urine PT, Drugs & consumables All Routine drugs& consumables upto 8 days of package Procedure PPI SINGLE/DOUBLE CHAMBER Cardiologists fee ,Cath Lab charges Consultation Covered till Package days of Three Days Exclusions Implant /Devices/Patch will be chargeable on actual Drugs& consumables will be charged extra if pre & post stay is more than package days Investigation not covered within the package will be charged Extra All services to be charged on actual if the patient stay exceeds beyond package days CT/MRI/ Thallium & IABP if done or used will be extra Any cross consultation will be charged at actual Admission/Documentation & Critical care charges

BENTALL Procedures. Inclusions Room Total 9 Day Room charges as per opted Package All Routine Tests such as complete haemogram BT.CT,Electrolytes .Urea Creatinine Blood Groping Investigation Urine PT, Drugs & consumables All Routine drugs& consumables upto 8 days of package Procedure CAG+PTCA surgeons fee ,OT charges& Anesthesia charges Consultation Covered till Package days Exclusions Stay beyond package days Implant /Devices/Patch will be chargeable on actual Drugs& consumables will be charged extra if pre & post stay is more than package days Investigation not covered within the package will be charged Extra All services to be charged on actual if the patient stay exceeds beyond package days CT/MRI/ Thallium & IABP if done or used will be extra High Risk Surgery charges Any cross consultation will be charged at actual Any additional procedure as per patient medical treatment will be charged at actual Admission/Documentation & Critical care charges

Page 9 CONSULTATION CHARGES

Page 10 Double Dlx Single Dlx Sl No. Description Suite Room Room 1 CONSULTATION - LIVER TRANSPLANT 1000 1500 2000 2 PHC-CONSULTATION GASTROLOGY (NEW) 800 1200 1800 3 CONSULTATION HEPATOLOGIST 1000 1500 2000 4 RADIOLOGY STUDY 4000 5400 6000 5 CONSULTATION ( DIETETICS ) 300 450 600 6 CONSULTATION HOMEOPATHY - DAY 1000 1500 2000 7 PHC - CONSULTATION - LIFESTYLE MANAGEMENT 300 450 600 8 PHC - CONSULTATION - PSYCHOLOGY 300 450 600 9 CONSULTATION ENT - DAY 1000 1500 2000 10 CONSULTATION GASTROENTROLOGY- DAY 1000 1500 2000 11 CONSULTATION NEURO - DAY 1000 1500 2000 12 CONSULTATION GYNAE - DAY 1000 1500 2000 13 CONSULTATION ORTHOPEDICS - DAY 1000 1500 2000 14 CONSULTATION WITH HEAD PSYCHIATRISTS 1500 2250 3000 15 PSYCHIATRY (30 MIN SESSION) 1400 2100 2800 16 PSYCHIATRY (60 MIN SESSION) 2500 3750 5000 17 CONSULTATION GEN SURGERY - DAY 1000 1500 2000 18 CONSULTATION HAEMATOLOGY - DAY 1000 1500 2000 19 AUDIOMETRY - PURE TONE ( SPECIAL TESTS ) 250 375 500 20 VISION TEST 750 1125 1500 21 CONSULTATION VASCULAR SURGERY - DAY 1000 1500 2000 22 CONSULTATION OPHTHALMOLOGY FOLLOWUP 400 600 800 23 CONSULTATION NEPHROLOGY-NIGHT 1500 2250 3000 24 CONSULTATION NEPHROLOGY-HOLIDAY 1500 2250 3000 25 CONSULTATION NEPHROLOGY DAY 1000 1500 2000 26 INTERNATIONAL SOS - OPD CONSULTATION 2500 3750 5000 27 DOCTOR CHARGES 1100 1650 2200 28 CONSULTATION BY DIRECTOR ORTHOPEDICS 1000 1500 2000 29 ORTHOPEDIC CAMP 200 300 400 30 CONSULTATION ONCOLOGY - DAY 1000 1500 2000 31 CONSULTATION ONCOLOGY - NIGHT 1500 2250 3000 32 CONSULTATION ONCOLOGY - HOLIDAY 1500 2250 3000 33 CONSULTATION DENTAL - NIGHT 1500 2250 3000 34 CONSULTATION DENTAL - HOLIDAY 1500 2250 3000 35 CONSULTATION DERMATOLOGY - NIGHT 1500 2250 3000 36 CONSULTATION DERMATOLOGY - HOLIDAY 1500 2250 3000 37 CONSULTATION DIABETOLOGY - NIGHT 1500 2250 3000 38 CONSULTATION DIABETOLOGY - HOLIDAY 1500 2250 3000 39 CONSULTATION ENT - NIGHT 1500 2250 3000 40 CONSULTATION ENT - HOLIDAY 1500 2250 3000 41 CONSULTATION GASTROENTROLOGY - NIGHT 1500 2250 3000 42 CONSULTATION GASTROENTROLOGY - HOLIDAY 1500 2250 3000 43 CONSULTATION GYNAE - NIGHT 1500 2250 3000 44 CONSULTATION OPHTHALMOLOGY - NIGHT 1500 2250 3000 45 CONSULTATION OPHTHALMOLOGY - HOLIDAY 1500 2250 3000 46 CONSULTATION HOMEOPATHY - NIGHT 1500 2250 3000 47 CONSULTATION HOMEOPATHY - HOLIDAY 1500 2250 3000 48 CONSULTATION NEURO - NIGHT 1500 2250 3000 49 CONSULTATION NEURO - HOLIDAY 1500 2250 3000 50 CONSULTATION ORTHOPEDICS - NIGHT 1500 2250 3000

Page 11 51 CONSULTATION ORTHOPEDICS - HOLIDAY 1500 2250 3000 52 CONSULTATION PLASTIC SURGERY - NIGHT 1500 2250 3000 53 CONSULTATION PLASTIC SURGERY - HOLIDAY 1500 2250 3000 54 CONSULTATION PSYCHIATRY - NIGHT 1500 2250 3000 55 CONSULTATION PSYCHIATRY - HOLIDAY 1500 2250 3000 56 CONSULTATION PSYCHOLOGY - DAY 1000 1500 2000 57 CONSULTATION PSYCHOLOGY - HOLIDAY 1500 2250 3000 58 CONSULTATION PSYCHOLOGY - NIGHT 1500 2250 3000 59 CONSULTATION PULMONOLOGY - NIGHT 1500 2250 3000 60 CONSULTATION PULMONOLOGY - HOLIDAY 1500 2250 3000 61 CONSULTATION UROLOGY - NIGHT 1500 2250 3000 62 CONSULTATION UROLOGY - HOLIDAY 1500 2250 3000 63 CONSULATATION ENDOCRINOLOGY - DAY 1000 1500 2000 64 CONSULATATION ENDOCRINOLOGY - NIGHT 1500 2250 3000 65 CONSULATATION ENDOCRINOLOGY - HOLIDAY 1500 2250 3000 66 CONSULTATION GEN SURGERY - NIGHT 1500 2250 3000 67 CONSULTATION GEN SURGERY - HOLIDAY 1500 2250 3000 68 CONSULTATION RHEUMATOLOGY - NIGHT 1500 2250 3000 69 CONSULTATION RHEUMATOLOGY - HOLIDAY 1500 2250 3000 70 CONSULTATION ELECTRO - DAY 1000 1500 2000 71 CONSULTATION ELECTRO - NIGHT 1500 2250 3000 72 CONSULTATION ELECTRO - HOLIDAY 1500 2250 3000 73 CONSULTATION SPEECH THERAPY - NIGHT 1500 2250 3000 74 CONSULTATION SPEECH THERAPY - HOLIDAY 1500 2250 3000 75 CONSULTATION THORACIC SURGERY - NIGHT 1500 2250 3000 76 CONSULTATION THORACIC SURGERY - HOLIDAY 1500 2250 3000 77 CONSULTATION CARDIOTHORACIC - DAY 1000 1500 2000 78 CONSULTATION CARDIOTHORACIC - NIGHT 1500 2250 3000 79 CONSULTATION CARDIOTHORACIC - HOLIDAY 1500 2250 3000 80 CONSULTATION EUROLOGY - DAY 1000 1500 2000 81 CONSULTATION EUROLOGY - NIGHT 1500 2250 3000 82 CONSULTATION EUROLOGY - HOLIDAY 1500 2250 3000 83 CONSULTATION VASCULAR SURGERY - NIGHT 1500 2250 3000 84 CONSULTATION VASCULAR SURGERY - HOLIDAY 1500 2250 3000 85 VISITING CONSULTATION ORTHO 1200 1800 2400 86 CONSULTATION PAED GEN SURGERY HOLIDAY 1500 2250 3000 87 RECTAL / GENTIAL EXAM 600 900 1200 88 CONSULATATION ENDOCRINOLOGY 600 900 1200 89 CONSULTATION BRONCHOSCOPY - DAY 1000 1500 2000 90 CONSULTATION BRONCHOSCOPY - NIGHT 1500 2250 3000 91 CONSULTATION BRONCHOSCOPY - HOLIDAY 1500 2250 3000 92 CONSULTATION CANCER - DAY 1000 1500 2000 93 CONSULTATION CANCER - NIGHT 1500 2250 3000 94 CONSULTATION CANCER - HOLIDAY 1500 2250 3000 95 CONSULTATION DENTAL - DAY 1000 1500 2000 96 CONSULTATION DERMATOLOGY - DAY 1000 1500 2000 97 CONSULTATION DIABETOLOGY - DAY 1000 1500 2000 98 CONSULTATION ENDOCRINOLOGY - DAY 1000 1500 2000 99 CONSULTATION ENDOCRINOLOGY - NIGHT 1500 2250 3000 100 CONSULTATION ENDOCRINOLOGY - HOLIDAY 1500 2250 3000

Page 12 101 CONSULTATION EYE - DAY 1000 1500 2000 102 CONSULTATION EYE - NIGHT 1500 2250 3000 103 CONSULTATION EYE - HOLIDAY 1500 2250 3000 104 CONSULTATION FOR SKIN - DAY 1000 1500 2000 105 CONSULTATION FOR SKIN - NIGHT 1500 2250 3000 106 CONSULTATION FOR SKIN - HOLIDAY 1500 2250 3000 107 CONSULTATION HAEMATOLOGY - NIGHT 1500 2250 3000 108 CONSULTATION HAEMATOLOGY - HOLIDAY 1500 2250 3000 109 CONSULTATION OPHTHALMOLOGY - DAY 1000 1500 2000 110 PHC - CONSULTATION - OPTHALMOLOGY 200 300 400 111 CONSULTATION UROLOGY - DAY 1000 1500 2000 112 CONSULTATION PAED GASTRO - DAY 1000 1500 2000 113 CONSULTATION PAED GASTRO - NIGHT 1500 2250 3000 114 CONSULTATION PAED GASTRO - HOLIDAY 1500 2250 3000 115 CONSULTATION PAED GEN SURGER - DAY 1000 1500 2000 116 CONSULTATION PLASTIC SURGERY - DAY 1000 1500 2000 117 CONSULTATION PAEDATRIC NEUROLOGY - DAY 1000 1500 2000 118 CONSULTATION PAEDATRIC NEUROLOGY - NIGHT 1500 2250 3000 119 CONSULTATION PAEDATRIC NEUROLOGY - HOLIDAY 1500 2250 3000 120 CONSULTATION RHEUMATOLOGY - DAY 1000 1500 2000 121 CONSULTATION SPEECH THERAPY - DAY 1000 1500 2000 122 CONSULTATION THORACIC SURGERY- DAY 1000 1500 2000 123 CONSULTATION CENTRE FOR SIGHT(REVISIT) 150 225 300 124 CONSULTATION PSYCHIATRY - DAY 1000 1500 2000 125 CONSULTATION TEAM PULMONOLOGY - DAY 1000 1500 2000 126 CONSULTATION TEAM PULMONOLOGY - NIGHT 1500 2250 3000 127 CONSULTATION TEAM PULMONOLOGY - HOLIDAY 1500 2250 3000 128 SMOKING CESSATION CLINIC 600 900 1200 129 CONSULTATION STAR OPHTHALMOLOGY 1000 1500 2000 130 CONSULTATION SENIOR OPHTHALMOLOGY 600 900 1200 131 CONSULTATION STAR OPHTHALMOLOGY (REVISIT) 700 880 910 132 CONSULTATION GYNAE - HOLIDAY 1500 2250 3000 133 CONSULTATION PAED GEN SURGERY - NIGHT 1500 2250 3000 134 CONSULTATION DIETETICS - DAY 1000 1500 2000 135 DENTAL SURGICAL EXTRACTION 1200 1800 2400 136 CRITICAL CARE MONITORING CHARGES 1000 137 DOCTOR CHARGES (SPECIALIST TEAM) 4000

Page 13 CARDIAC SURGERY

Page 14 Double Sl No. Description Room Single Room Suite 1 CABG 331500 371500 461500 2 CORONARY ARTERY BYPASS GRAFTING ( CABG ) - BAD VESSELS 337500 386500 476500 3 CORONARY ARTERY BYPASS GRAFTING ( CABG ) HIGH RISK - (P) 376500 406500 511500 4 CORONARY ARTERY BYPASS GRAFTING (CABG) MINI THORACTOMY 321500 371500 461500 5 CORONARY ARTERY BYPASS GRAFTING (CABG) MINI STERNOTOMY 321500 371500 461500 6 CORONARY ARTERY BYPASS GRAFTING ( CABG ) REDO 396500 456500 541500 7 CORONARY ARTERY BYPASS GRAFTING (CABG) MINI REDO 352500 386500 476500 8 CORONARY ARTERY BYPASS GRAFTING ( CABG ) CAROTID ENDARTERECTOMY HIGH RISK - (P) 391500 456500 536500 9 CORONARY ARTERY BYPASS GRAFTING (CABG) + LEFT VENTRICULAR (LV) CLOT REMOVAL 347500 391500 476500 10 CORONARY ARTERY BYPASS GRAFTING (CABG) + LEFT ATRIAL (LA) CLOT REMOVAL 347500 391500 476500 11 CORONARY ARTERY BYPASS GRAFTING (CABG) + LEFT VENTRICULAR (LV) ANEURYSM REPAIR 347500 391500 476500 12 CORONARY ARTERY BYPASS GRAFTING ( CABG ) + TRANSMYOCARDIAL REVASCULARIZATION ( TMR ) 357500 411500 476500 13 CORONARY ARTERY BYPASS GRAFTING (CABG) + RING ANNULOPLASTY 347500 391500 476500 CORONARY ARTERY BYPASS GRAFTING ( CABG ) + CAROTID ENDARTERECTOMY + TRANSMYOCARDIAL 14 REVASCULARIZATION ( TMR ) 461500 535500 631500 15 CORONARY ARTERY BYPASS GRAFTING ( CABG ) + FEMOROFEMORAL BYPASS 361500 411500 511500 16 CORONARY ARTERY BYPASS GRAFTING ( CABG ) + BENTALL'S PROCEDURE 461500 535500 631500 17 CABG (HBSAG+) 337500 386500 476500 CORONARY ARTERY BYPASS GRAFTING (CABG) + CAROTID ENDARTERECTOMY + LEFT VENTRICULAR (LV) 18 ANEURYSM REPAIR 436500 475500 556500 CORONARY ARTERY BYPASS GRAFTING (CABG) REDO + LEFT VENTRICULAR (LV) / LEFT ATRIAL (LA) CLOT 19 REMOVAL 451500 475500 561500 20 CABG-MID CAB+LV/LA CLOT REMOVAL 337500 386500 476500 21 CABG-MID CAB+ANEURYSM REPAIR 337500 386500 476500 22 CORONARY ARTERY BYPASS GRAFTING (CABG) + VENTRICULAR SEPTAL DEFECT (VSD) CLOSURE 361500 411500 511500 23 CORONARY ARTERY BYPASS GRAFTING ( CABG ) + ATRIAL SEPTAL DEFECT ( ASD ) CLOSURE 361500 411500 511500 24 CABG-+VSD CLOSURE+CLOT REMOVAL 396500 456500 531500

25 CORONARY ARTERY BYPASS GRAFTING ( CABG ) + ATRIAL SEPTAL DEFECT ( ASD ) CLOSURE + CLOT REMOVAL 396500 456500 531500 26 CORONARY ARTERY BYPASS GRAFTING ( CABG ) + ASCENDING AORTA REPAIR / REPLACEMENT 426500 475500 561500 27 CABG - REDO + CAROTID 481500 522500 621500 28 CABG - REDO (HBSAG+) 411500 471500 556500 29 CORONARY ARTERY BYPASS GRAFTING (CABG) MINI REDO + CAROTID ENDARTERECTOMY 421500 481500 556500

30 CORONARY ARTERY BYPASS GRAFTING ( CABG ) + CAROTID ENDARTERECTOMY + FEMOROFEMORAL BYPASS 471500 525500 611500 31 MINI STERNOTOMY + CAROTID ENDARTECTOMY ( RIGHT ) 411500 441500 521500 32 33 CORONARY ARTERY BYPASS GRAFT (CABG ) +INTRAORTIC BALLOON PUMP (IABP) 337500 391500 476500 34 REDO MITRAL VALVE REPLACEMENT 436500 475500 561500 35 REDO AVR + AORTIC ROOT RECONSTRUCTION 471500 619250 689000 36 REDO MVR + CABG 471500 525500 611500 37 CORONARY ARTERY BYPASS GRAFTING ( CABG ) + MITRAL VALVE REPLACEMENT ( MVR ) 391500 456500 536500 38 CORONARY ARTERY BYPASS GRAFTING ( CABG ) + AORTIC VALVE REPLACEMENT 391500 456500 536500 39 CABG + TVR 391500 456500 536500 40 CORONARY ARTERY BYPASS GRAFTING ( CABG ) + DOUBLE VALVE REPLACEMENT (DVR) 421500 481500 536500 CORONARY ARTERY BYPASS GRAFTING ( CABG ) + MITRAL VALVE REPLACEMENT ( MVR )+ LEFT ATRIAL ( LA ) 41 CLOT REMOVAL 436500 495500 571500 42 CORONARY ARTERY BYPASS GRAFTING (CABG) REDO + MITRAL VALVE REPLACEMENT 461500 535500 631500 43 CABG-REDO+AVR 461500 535500 631500 44 CORONARY ARTERY BYPASS GRAFTING (CABG) REDO + DOUBLE VALVE REPLACEMENT (DVR) 476500 527500 645500 CORONARY ARTERY BYPASS GRAFTING ( CABG ) REDO + MITRAL VALVE REPLACEMENT ( MVR ) + CLOT 45 REMOVAL 481500 542500 666500

46 CORONARY ARTERY BYPASS GRAFTING (CABG) REDO + AORTIC VALVE REPLACEMENT (AVR) + CLOT REMOVAL 481500 542500 666500

47 CORONARY ARTERY BYPASS GRAFTING (CABG) REDO + DOUBLE VALVE REPLACEMENT (DVR) + CLOT REMOVAL 491500 542500 676500 CORONARY ARTERY BYPASS GRAFTING (CABG) + MITRAL VALVE REPLACEMENT (MVR) + CAROTID 48 ENDARTERECTOMY 461500 535500 631500 CORONARY ARTERY BYPASS GRAFTING (CABG) + AORTIC VALVE REPLACEMENT (AVR) + CAROTID 49 ENDARTERECTOMY 461500 535500 631500 CORONARY ARTERY BYPASS GRAFTING (CABG) + AORTIC VALVE REPLACEMENT (AVR) + LEFT ATRIAL (LA) / 50 LEFT VENTRICULAR (LV) CLOT REMOVAL 436500 495500 571500

Page 15 51 CORONARY ARTERY BYPASS GRAFTING (CABG) + AORTIC VALVE REPLACEMENT (AVR) + ANEURYSM REPAIR 436500 495500 571500 CORONARY ARTERY BYPASS GRAFTING ( CABG ) + MITRAL VALVE REPLACEMENT ( MVR ) + TRICUSPID VALVE 52 REPAIR ( TV REPAIR ) / ANEURYSM REPAIR 436500 495500 571500 53 CABG + DVR + LA/LV CLOT REMOVAL 436500 475500 556500 CORONARY ARTERY BYPASS GRAFTING ( CABG ) + MITRAL VALVE REPLACEMENT ( MVR ) + FEMOROFEMORAL 54 BYPASS 461500 535500 631500

55 CORONARY ARTERY BYPASS GRAFTING (CABG) + AORTIC VALVE REPLACEMENT (AVR) + FEM FEM BYPASS 461500 535500 631500 56 AVREPLACEMENT + MVREPLACEMENT + TRICUSPID REPAIR+ LA CLOT REMOVAL SURGERY 436500 475500 556500 57 CABG+MVR + BENTAL 521500 562500 701500 58 MITRAL VALVE REPLACEMENT 321500 371500 461500 59 MITRAL VALVE REPAIR 321500 371500 461500 60 AORTIC VALVE REPLACEMENT ( AVR ) 321500 371500 461500 61 AORTIC VALVE REPAIR 321500 371500 461500 62 TRICUSPID VALVE REPLACEMENT 321500 371500 461500 63 TRICUSPID VALVE REPAIR ( PEDIATRIC ) 321500 371500 461500 64 DOUBLE VALVE REPLACEMENT ( DVR ) 361500 411500 511500 65 MITRAL VALVE REPLACEMENT ( MVR ) + TRICUSPID VALVE REPAIR 421500 481500 556500 66 MITRAL VALVE REPLACEMENT + AORTIC VALVE REPAIR 421500 481500 556500 67 AORTIC VALVE REPLACEMENT + MITRAL VALVE REPAIR 421500 481500 556500 68 AORTIC VALVE REPLACEMENT + TRICUSPID VALVE REPAIR 421500 481500 556500 69 MITRAL VALVE REPAIR (HEARTPORT) + CAROTID ENDARTERECTOMY 471500 525500 611500 70 MVR + RFA 411500 441500 521500 71 MITRAL VALVE REPLACEMENT + MAZE SURGERY 411500 441500 521500 72 MITRAL VALVE REPLACEMENT + FEMOROFEMORAL BYPASS 426500 475500 556500 73 AORTIC VALVE REPLACEMENT + FEM FEM BYPASS 426500 475500 556500 74 AORTIC VALVE REPLACEMENT REDO 436500 475500 561500 75 AORTIC VALVE REPLACEMENT + TRICUSPID VALVE REPLACEMENT - REDO 461500 535500 631500 76 AORTIC VALVE REPLACEMENT + AORTIC WRAP (ASCENDING / DESCENDING AORTA) 441500 480500 566500 77 MITRAL VALVE REPLACEMENT ( MVR ) REDO + TRICUSPID RING ANNULOPLASTY 471500 525500 611500 78 SUPRARENAL AORTIC ANEURYSM REPAIR 321500 371500 461500 79 MITRAL VALVE REPLACEMENT REDO + LEFT CAROTID ENDARTERECTOMY 506500 542500 621500 80 MITRAL VALVE REPLACEMENT ( MVR ) + TRICUSPID REPAIR (HIGH RISK) - (P) 371500 426500 536500 81 DOUBLE VALVE REPLACEMENT REDO 431500 481500 561500 82 MITRAL VALVE REPAIR + ATRIAL SEPTAL DEFECT / VENTRICULAR SEPTAL DEFECT CORRECTION 416500 461500 556500 83 MITRAL VALVE REPLACEMENT + LEFT ATRIAL (LA) CLOT REMOVAL 337500 391500 476500 84 DOUBLE VALVE REPLACEMENT REDO + TRICUSPID RING ANNULOPLASTY 421500 481500 556500 85 MVR/AVR + PDA 391500 456500 536500 86 REDO DVR + TVR 506500 547500 701500 87 REDO MITRAL VALVE REPLACEMENT 436500 475500 561500 88 REDO AVR + AORTIC ROOT RECONSTRUCTION 471500 619250 689000 89 REDO MVR + CABG 471500 525500 611500 90 CORONARY ARTERY BYPASS GRAFTING ( CABG ) + MITRAL VALVE REPLACEMENT ( MVR ) 391500 456500 536500 91 CORONARY ARTERY BYPASS GRAFTING ( CABG ) + AORTIC VALVE REPLACEMENT 391500 456500 536500 92 CABG + TVR 391500 456500 536500 93 CORONARY ARTERY BYPASS GRAFTING ( CABG ) + DOUBLE VALVE REPLACEMENT (DVR) 421500 481500 536500 CORONARY ARTERY BYPASS GRAFTING ( CABG ) + MITRAL VALVE REPLACEMENT ( MVR )+ LEFT ATRIAL ( LA ) 94 CLOT REMOVAL 436500 495500 571500 95 CORONARY ARTERY BYPASS GRAFTING (CABG) REDO + MITRAL VALVE REPLACEMENT 461500 535500 631500 96 CABG-REDO+AVR 461500 535500 631500 97 CORONARY ARTERY BYPASS GRAFTING (CABG) REDO + DOUBLE VALVE REPLACEMENT (DVR) 476500 527500 645500 CORONARY ARTERY BYPASS GRAFTING ( CABG ) REDO + MITRAL VALVE REPLACEMENT ( MVR ) + CLOT 98 REMOVAL 481500 542500 666500

99 CORONARY ARTERY BYPASS GRAFTING (CABG) REDO + AORTIC VALVE REPLACEMENT (AVR) + CLOT REMOVAL 481500 542500 666500

100 CORONARY ARTERY BYPASS GRAFTING (CABG) REDO + DOUBLE VALVE REPLACEMENT (DVR) + CLOT REMOVAL 491500 542500 676500

Page 16 CORONARY ARTERY BYPASS GRAFTING (CABG) + MITRAL VALVE REPLACEMENT (MVR) + CAROTID 101 ENDARTERECTOMY 461500 535500 631500 CORONARY ARTERY BYPASS GRAFTING (CABG) + AORTIC VALVE REPLACEMENT (AVR) + CAROTID 102 ENDARTERECTOMY 461500 535500 631500 CORONARY ARTERY BYPASS GRAFTING (CABG) + AORTIC VALVE REPLACEMENT (AVR) + LEFT ATRIAL (LA) / 103 LEFT VENTRICULAR (LV) CLOT REMOVAL 436500 495500 571500

104 CORONARY ARTERY BYPASS GRAFTING (CABG) + AORTIC VALVE REPLACEMENT (AVR) + ANEURYSM REPAIR 436500 495500 571500 CORONARY ARTERY BYPASS GRAFTING ( CABG ) + MITRAL VALVE REPLACEMENT ( MVR ) + TRICUSPID VALVE 105 REPAIR ( TV REPAIR ) / ANEURYSM REPAIR 436500 495500 571500 106 CABG + DVR + LA/LV CLOT REMOVAL 436500 475500 556500 CORONARY ARTERY BYPASS GRAFTING ( CABG ) + MITRAL VALVE REPLACEMENT ( MVR ) + FEMOROFEMORAL 107 BYPASS 461500 535500 631500

108 CORONARY ARTERY BYPASS GRAFTING (CABG) + AORTIC VALVE REPLACEMENT (AVR) + FEM FEM BYPASS 461500 535500 631500 109 AVREPLACEMENT + MVREPLACEMENT + TRICUSPID REPAIR+ LA CLOT REMOVAL SURGERY 436500 475500 556500 110 CABG+MVR + BENTAL 521500 562500 701500 111 MITRAL VALVE REPLACEMENT 321500 371500 461500 112 MITRAL VALVE REPAIR 321500 371500 461500 113 AORTIC VALVE REPLACEMENT ( AVR ) 321500 371500 461500 114 AORTIC VALVE REPAIR 321500 371500 461500 115 TRICUSPID VALVE REPLACEMENT 321500 371500 461500 116 TRICUSPID VALVE REPAIR ( PEDIATRIC ) 321500 371500 461500 117 DOUBLE VALVE REPLACEMENT ( DVR ) 361500 411500 511500 118 MITRAL VALVE REPLACEMENT ( MVR ) + TRICUSPID VALVE REPAIR 421500 481500 556500 119 MITRAL VALVE REPLACEMENT + AORTIC VALVE REPAIR 421500 481500 556500 120 AORTIC VALVE REPLACEMENT + MITRAL VALVE REPAIR 421500 481500 556500 121 AORTIC VALVE REPLACEMENT + TRICUSPID VALVE REPAIR 421500 481500 556500 122 DOUBLE VALVE REPLACEMENT (DVR) + TRICUSPID VALVE REPAIR 411500 461500 596500 123 MITRAL VALVE REPAIR (HEARTPORT) + CAROTID ENDARTERECTOMY 471500 525500 611500 124 MVR + RFA 411500 441500 521500 125 MITRAL VALVE REPLACEMENT + MAZE SURGERY 411500 441500 521500 126 MITRAL VALVE REPLACEMENT + FEMOROFEMORAL BYPASS 426500 475500 556500 127 AORTIC VALVE REPLACEMENT + FEM FEM BYPASS 426500 475500 556500 128 AORTIC VALVE REPLACEMENT REDO 436500 475500 561500 129 AORTIC VALVE REPLACEMENT + TRICUSPID VALVE REPLACEMENT - REDO 461500 535500 631500 130 AORTIC VALVE REPLACEMENT + AORTIC WRAP (ASCENDING / DESCENDING AORTA) 441500 480500 566500 131 MITRAL VALVE REPLACEMENT ( MVR ) REDO + TRICUSPID RING ANNULOPLASTY 471500 525500 611500 132 SUPRARENAL AORTIC ANEURYSM REPAIR 321500 371500 461500 133 MITRAL VALVE REPLACEMENT REDO + LEFT CAROTID ENDARTERECTOMY 506500 542500 621500 134 MITRAL VALVE REPLACEMENT ( MVR ) + TRICUSPID REPAIR (HIGH RISK) - (P) 371500 426500 536500 135 DOUBLE VALVE REPLACEMENT REDO 431500 481500 561500 136 MITRAL VALVE REPAIR + ATRIAL SEPTAL DEFECT / VENTRICULAR SEPTAL DEFECT CORRECTION 416500 461500 556500 137 MITRAL VALVE REPLACEMENT + LEFT ATRIAL (LA) CLOT REMOVAL 337500 391500 476500 138 DOUBLE VALVE REPLACEMENT REDO + TRICUSPID RING ANNULOPLASTY 421500 481500 556500 139 MVR/AVR + PDA 391500 456500 536500 140 REDO DVR + TVR 506500 547500 701500 141 DESCENDING AORTA REPLACEMENT 431500 481500 561500

142 AORTIC ARCH REPLACEMENT/DESCENDING THORACIC AORTA/THORACOABDOMINAL ANEURYSM REPAIR - (P) 340000 390500 451500 143 BENTALL PROCEDURES 431500 481500 561500 144 CABROLL - BENTALL / AORTIC DISSECTIONS - (P) 431500 481500 561500 145 AORTA ASCENDING REPAIR (DACRON PATCH REMODELLING) 431500 481500 561500 146 ATRIAL SEPTAL DEFECT ( ASD ) CLOSURE 321500 371500 461500 147 ASD CLOSURE + TV REPAIR 391500 456500 536500 148 REDO-BENTALL PROCEDURE 496500 542500 651500 149 BENTALL'S PROCEDURE + MITRAL VALVE REPAIR / AORTIC VALVE REPAIR 511500 552500 670500 150 HEART PORT SURGERY 361500 411500 511500

Page 17 151 LEFT ATRIAL ( LA ) MYXOMA EXCISION 337500 386500 476500 152 SUPRA CORONARY AORTIC INTERPORTION GRAFT SURGERY 431500 481500 561500 153 BM ASPIRATION 180000 240000 265000 154 DESCENDING AORTA REPLACEMENT 431500 481500 561500

155 AORTIC ARCH REPLACEMENT/DESCENDING THORACIC AORTA/THORACOABDOMINAL ANEURYSM REPAIR - (P) 300000 375000 425000 156 ABDOMINAL AORTIC ANEURYSM ( BIFURCATED ) REPAIR 230000 280000 325000 157 AORTIC BIFEMORAL - (P) 130000 195000 235000 158 DACRON WRAP TO AORTA - (P) 300000 375000 425000 159 FEM POP - (P) 195000 210000 250000 160 CAROTID ENDARTERECTOMY ( LEFT ) 195000 210000 250000 161 CAROTID ENDERECTOMY ( RIGHT ) 195000 210000 250000 162 FEM FEM BYPASS OPERATION - (P) 195000 210000 250000 163 AORTA FEM FEM BYPASS - (P) 130000 195000 235000 164 CAROTID SURGERY 195000 210000 250000

Page 18 CTVS PEDIATRIC

Page 19 Sl No. Description Ward Sharing Single 1 BANDING PULMONARY ARTERY ( PEDIATRIC ) 130000 130000 150000 2 MAJOR AORTOPULMONARY COLLATERAL ARTERY ( MAPCA ) LIGATION -LEFT ( PEDIATRIC ) 130000 130000 150000 3 PATENT DUCTUS ARTERIOSUS LIGATION ( PDA ) 130000 130000 150000 4 BLALOCK TAUSSIG ( BT ) SHUNT ON BYPASS 195000 195000 215000 5 BLALOCK TAUSSIG ( BT ) SHUNT PROCEDURE 195000 195000 215000 6 COARCTATION OF AORTA REPAIR 195000 195000 215000 7 COARCTATION OF AORTA REPAIR ( PEDIATRIC ) 195000 195000 215000 8 ATERIAL SEPTAL DEFECT ( ASD ) CLOSURE - PEDIATRICS 235000 235000 255000 9 ATRIAL SEPTECTOMY ( PEDIATRIC ) 235000 235000 255000 10 GLENN SHUNT BD (BI-DIRECTIONAL) ON BYPASS ( PEDIATRIC ) 235000 235000 255000 11 GLENN SHUNT BD (BI-DIRECTIONAL) WITHOUT BYPASS( PEDIATRIC ) 235000 235000 255000 12 ALCAPA PROCEDURE ( PEDIATRIC ) 275000 275000 295000 13 AORTIC VALVE REPAIR ( PEDIATRIC ) 275000 275000 295000 14 AORTOPULMONARY WINDOW REPAIR ( PEDIATRIC ) 275000 275000 295000 15 ATRIO VENTRICULAR CANAL REPAIR ( PEDIATRIC ) 275000 275000 295000 16 INTRA CARDIAC REPAIR ( TAPVC / VSD + PS ) 275000 275000 295000 17 MITRAL VALVE REPAIR (PAED) - (P) 275000 275000 295000 18 PARTIAL ANOMALOUS PULMONARY VENOUS CONNECTION (PAPVC) REROUTING- PEDIATRIC 275000 275000 295000 19 REV PROCEDURE ( TRANSPOSITION OF GREAT ARTERIES WITH VSD) - PEDIATRIC 275000 275000 295000 20 SENNING OPERATION ( PEDIATRIC ) 275000 275000 295000 21 SUBAORTIC MEMBRANE RESECTION ( PEDIATRIC ) 275000 275000 295000 22 TETROLOGY OF FALLOT (TOF) CORRECTION 275000 275000 295000 23 TRICUSPID V REPAIR (PAEDIATRIC) 275000 275000 295000 24 VALVE REPLACEMENT - (P) 275000 275000 295000 25 VENTRICULAR SEPTAL DEFECT ( VSD ) SURGERY ( PEDIATRIC ) 275000 275000 295000 26 ARTERIAL SWITCH PROCEDURE ( PEDIATRIC ) 300000 300000 320000 27 CONDUIT REPAIR ( CTVS ) 300000 300000 320000 28 DOUBLE SWITCH OPERATION ( DSO ) 300000 300000 320000 29 FONTAN PROCEDURE ( PEDIATRIC ) 300000 300000 320000 30 RASTELLI PROCEDURE ( PEDIATRIC ) 300000 300000 320000 31 TOTAL CAVOPULMONARY CONNECTION ( TCPC ) REPAIR ( PEDIATRIC ) 300000 300000 320000 32 TRUNCUS ARTERIOSUS REPAIR ( PEDIATRIC ) 300000 300000 320000

Page 20 CATH ADULT PROCEDURES

Page 21 Double Sl No. Description Single Room Suite Room 1 ANGIOGRAPHY ECONOMY - (P) 16500 22500 31500 2 CORONARY ANGIOPLASTY (PRIMARY) - SINGLE VESSEL 141500 166500 191500 3 CAROTID ANGIOPLASTY - (P) 141500 166500 191500 4 PERIPHERAL ANGIOPLASTY WITH BARE METAL STENT 141500 166500 191500 5 RENAL STENTING - (P) 141500 166500 191500 6 CAROTID STENTING 141500 166500 191500 7 AORTIC STENTING - (P) 141500 166500 224000 8 PERIPHERAL STENTING - (P) 141500 166500 191500 9 CORONARY STENTING + ROTABLATION 151500 160500 241500 10 PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY ( PTCA ) PRIMARY 161500 166500 224000 11 PACEMAKER - SINGLE CHAMBER - (P) 95000 105000 125000 12 PACEMAKER - DOUBLE CHAMBER - (P) 105000 115000 135000 13 ICD / AICD - (P) 110000 145000 155000 14 BIVENTRICULAR DEVICE / COMBO - (P) 115000 145000 160000 15 RADIOFREQUENCY ABLATION (RFA) - (P) 97000 101000 115000 16 DEVICE CLOSURE OF ACQUIRED VSD - (P) 105000 115000 125000 17 DEVICE CLOSURE - (P) 92000 117000 170000 18 PDA DEVICE CLOSURE- (P) 105000 115000 125000 19 AORTIC CORE PROCEDURE 400000 475000 710000 20 ANGIOGRAPHY CO2 30000 40000 60000 21 PACEMAKER IMPLANTATION BIVENTRICULAR ( PERMANENT ) 115000 135000 155000 22 ELECTROPHYSIOLOGY ( EP ) STUDY - (P) 28000 32000 40000 23 E P STUDY - COMPLICATED - (P) 36000 40000 50000 24 CARTO ELECTROPHYSIOLOGY PROCEDURE WITH CARTO CATHETER 110000 135000 175000 25 RADIOFREQUENCY ABLATION ( THERMOCOOL / HALO / LASSO ) 110000 125000 140000 26 PACEMAKER PROC (PAED) - (P) 75000 90000 115000 27 ELECTROPHYSIOLOGY PROCEDURE WITH ENSITE NAVX WITH VELOCITY 110000 120000 150000 28 3D ABLATION PROCEDURE 80000 95000 125000 29 CARDIOVERSION PACKAGE 20000 34000 50000 30 CARTO ELECTROPHYSIOLOGY PROCEDURE WITH THERMOCOAL CATHETER 110000 120000 150000 31 AICD IMPLANTATION DOUBLE CHAMBER 110000 140000 160000 32 Complex Lead Extraction 141500 166500 191500 33 CARDIOVERSION DAYCARE 11000 34 CHECK ANGIOGRAPHY 15000 20000 25000 35 BALLOON DILATATION OF RVOT (PEDIATRIC) 65000 82000 100000 36 BALLOON DILATATION PULMONARY ARTERY (PEDIATRIC) 65000 82000 100000 37 PULMONARY VALVOTOMY ( OPEN ) 65000 82000 100000 38 AORTIC VALVOTOMY OPEN 65000 82000 100000 39 AORTIC COARACTATION DILATATION 65000 82000 100000 40 BALLOON DILATATION OF CONDUIT (PEDIATRIC) 65000 82000 100000 41 BALLOON DILATATION OF LVOT (PEDIATRIC) 65000 82000 100000 42 BALLOON DILATATION OF THE ASD (PEDIATRIC) 65000 82000 100000 43 BALLOON DILATATION OF SYSTEMIC VENOUS PATHWAY (PEDIATRIC) 65000 82000 100000 44 MITRAL VALVOTOMY OPEN ( OMV ) 65000 82000 100000 45 BALLOON TRICUSPID VALVOTOMY (PEDIATRIC) 65000 82000 100000 46 BALLOON ATRIAL SEPTOSTOMY - ( PEDIATRICS ) 60000 72000 90000 47 BALLOON ATRIAL SEPTOSTOMY (BEDSIDE) - (P) 55000 72000 90000 48 BALLOON VALVULOPLASTY - (P) 90000 102000 125000 49 VALVULOPLASTY WITHOUT ANESTHESIA 85000 102000 125000 50 CLOSURE OF FENESTRATED FONTAN/TCPC - (P) 75000 92000 110000

Page 22 51 COIL CLOSURE OF PDA (WITH ANESTHESIA) - (P) 65000 77000 95000 CARDIAC CATHETERIZATION + MAJOR AORTOPULMONARY COLLATERAL ARTERY ( MAPCA ) COILING - 52 PEDIATRICS 30000 37000 50000 53 PULMONARY ARTERIOVENOUS ( AV ) FISTULA COILING - PEDIATRIC 65000 77000 95000 54 CORONARY ARTERIOVENOUS ( AV ) FISTULA DEVICE CLOSURE - PEDIATRIC 75000 92000 115000 55 MITRAL PARAVALVULAR LEAK DEVICE CLOSURE - PEDIATRICS 75000 92000 115000 56 VENTRICULAR SEPTAL DEFECT ( VSD ) DEVICE CLOSURE - PEDIATRICS 75000 92000 115000 57 COARCTATION OF AORTA STENTING ( PEDIATRICS ) 75000 92000 115000 58 CONDUIT STENTING ( PEDIATRICS ) 75000 92000 115000 59 PULMONARY ARTERY STENTING ( PEDIATRICS ) 75000 92000 115000 60 SYSTEMIC VENOUS PATHWAY STENTING ( PEDIATRICS ) 90000 107000 125000 61 PDA COIL CLOSURE ( PED ) - (P) 90000 102000 125000 62 COIL CLOSURE OF PDA (WITHOUT ANESTHESIA) - (P) 85000 102000 125000 63 ATRIAL SEPTAL DEFECT ( ASD ) DEVICE CLOSURE - PEDIATRICS 85000 102000 125000 64 DEVICE CLOSURE OF ASD (WITHOUT ANESTHESIA) - (P) 80000 97000 115000 65 PATENT DUCTUS ARTERIOSUS ( PDA ) DEVICE CLOSURE - PEDIATRICS 85000 102000 125000 66 DEVICE CLOSURE OF PDA (WITHOUT ANESTHESIA) - (P) 80000 97000 115000 67 CATHETERIZATION ( PEDIATRIC ) 21150 29900 37000 68 PEDIATRIC DIAGNOSTIC STUDY (PAED) - (P) 22150 30900 37300 69 PEDIATRIC DIAGNOSTIC CHECK STUDY (PAED) - (P) 15150 23900 30300 70 PAED. CHECK ANGIO 15650 24400 30800

Page 23 PEDIATRIC PROCEDURES

Page 24 Double Dlx Single Dlx Sl No. Description Suite Room Room 1 ANOPLASTY ( PEDIATRIC ) 16500 19965 21960 2 RENAL ABSCESS DRAINAGE - PERCUTANEOUS ( PEDIATRIC ) 7150 8650 9515 3 ABDOMINAL WALL HAEMATOMA DRAINAGE ( PEDIATRIC ) 11000 13310 14641 4 PARAVERTEBRAL ABSCESS DRAINAGE ( ORTHOPEDICS ) 9900 11979 13180 5 PSOAS ABSCESS DRAINAGE ( PEDIATRIC ) 9900 11979 13180 6 SUBDIAPHRAGMATIC / PERIGASTRIC ABSCESS EXTRA PERITONEAL DRAINAGE ( PEDIATRIC ) 19800 23958 26354 7 PERIANAL ABSCESS DRAINAGE ( PEDIATRIC ) 14300 17303 19033 8 ABSCESS RETROPERITONEAL DRAINAGE ( PEDIATRIC ) 19800 23958 26354 9 ASCITIC TAP ( PEDIATRIC ) 2200 2662 2928 10 LAPAROTOMY DIAGNOSTIC ( PEDIATRIC ) 15400 18634 20497 11 DUODENOJEJUNOSTOMY (FOR DUODENAL ATRESIA / ANNULAR PANCREAS) ( PEDIATRIC ) 27500 33275 36603 12 HYDATID CYST INTRAPERITONEAL DRAINAGE ( PEDIATRIC ) 33000 39930 43923 13 LAPAROTOMY ( PEDIATRIC ) 18700 22627 24890 14 ABDOMEN EXAMINATION UNDER ANESTHESIA ( PEDIATRIC ) 5500 6655 7321 15 EXOMPHALOS REPAIR ( PEDIATRIC ) 33000 39930 43923 16 FUNDOPLICATION (ANTIREFLUX SURGERY) ( PEDIATRIC ) 27500 33275 36603 17 GASTROJEJUNOSTOMY ( GASTROINTESTINAL SURGERY ) 22000 26620 29282 18 GASTROSCHISIS REPAIR ( PEDIATRIC ) 33000 39930 43923 19 GASTROSTOMY ( NEONATAL ) 17600 21296 23426 20 INTUSSUSCEPTION SURGICAL REDUCTION ( PEDIATRIC ) 22000 26620 29282 21 HEMICOLECTOMY ( LEFT ) - PEDIATRIC 27500 33275 36603 22 MAL ROTATION (GUT) CORRECTION + DIVISION OF LADD'S BAND + APPENDICECTOMY ( PEDIATRIC ) 27500 33275 36603 23 ABDOMEN NECROSECTOMY & OPEN DRAINAGE OF PANCREATIC ABSCESS 27500 33275 36603 24 INTESTINAL ATRESIA (NEONATAL) SURGICAL REPAIR ( PEDIATRIC ) 27500 33275 36603 25 INTESTINAL PERFORATION CLOSURE ( PEDIATRIC ) 27500 33275 36603 26 CYSTOGASTROSTOMY - FOR PSEUDOPANCREATIC CYST ( PEDIATRIC ) 27500 33275 36603 27 RAMSTEDT'S OPERATION ( PEDIATRIC ) 22000 26620 29282 28 INTESTINAL RESECTION SINGLE + ANASTOMOSIS ( NEONATE ) 22000 26620 29282 29 INTESTINAL RESECTION MULTIPLE + ANASTOMOSIS ( NEONATE ) 27500 33275 36603 30 HEMICOLECTOMY ( RIGHT ) - PEDIATRIC 27500 33275 36603 31 SPLENORRHAPHY ( PEDIATRIC ) 22000 26620 29282 32 SIGMOID COLON MYOMECTOMY ( PEDIATRIC ) 16500 19965 21962 33 TUBE CAECOSTOMY ( PEDIATRIC ) 11000 13310 14641 34 VOLVULUS (SIGMOID COLON) UNTWISTING (SIMPLE) - PEDIATRIC 16500 19965 21962 35 ANAL DILATATION ( PEDIATRIC ) 4400 5324 5856 36 LORDS PROCEDURE ( PEDIATRIC ) 5500 6655 7321 37 ANAL FISSURE SPHINCTEROTOMY + FISSURECTOMY ( ( PEDIATRIC ) 4400 5324 5856 38 ABDOMINOPERINEAL RESECTION OF RECTUM ( PEDIATRIC ) 30800 37268 40995 39 ANO RECTAL FISTULA (HIGH LEVEL) SURGICAL EXCISION ( PEDIATRIC ) 33770 40862 44948 40 ANO RECTAL FISTULA LOW LEVEL SURGICAL EXCISION ( PEDIATRIC ) 20350 24624 27086 41 ANORECTAL MALFORMATION (HIGH) PULL THROUGH ( PEDIATRIC ) 33000 39930 43923 42 HIRSCHSPRUNG'S SURGERY PULL THROUGH ( PEDIATRIC ) 33000 39930 43923 43 HEMORRHOIDECTOMY ( PEDIATRIC ) 16500 19965 21962 44 POSTERIOR SAGITTAL ANORECTOPLASTY ( PSARP) - LIMITED - ( PEDIATRIC ) 22000 26620 29282 45 POSTERIOR SAGITTAL ANORECTOPLASTY (PSARP) - COMPLETE - ( PEDIATRIC ) 27500 33275 36603 46 RECTAL MYOMECTOMY ( PEDIATRIC ) 16500 19965 21962 47 RECTAL BIOPSY ( PEDIATRIC ) 5500 6655 7321 48 RECTAL POLYP EXCISION ( PEDIATRIC ) 6600 7986 8785 49 SCLERO THERAPY RECTUM ( PEDIATRIC ) 7700 9317 10249 50 THIERSCHS OPERATION / WIRING ( PEDIATRIC ) 7700 9317 10249

Page 25 51 WOUND DEBRIDEMENT - MEDIUM ( PEDIATRICS ) 7150 8652 9517 52 WOUND DEBRIDEMENT - SMALL ( PEDIATRICS ) 3850 4659 5125 53 NAIL BED REPAIR - HAND ( PEDIATRIC ORTHOPEDICS ) 13200 15972 17569 54 NAIL BED RECONSTRUCTION (SINGLE FINGER) - PEDIATRIC 22000 26620 29282 55 HAND / FEET POLYDACTLY CORRECTION ( BIFID ) 16500 19965 21962 56 POLYDACTYLY CORRECTION ( PEDIATRIC ) 11000 13310 14641 57 POLYDACTYLY (SINGLE SKIN TAG) -PEDIATRIC 5500 6655 7321 58 PARONYCHIA SURGICAL TREATMENT ( PEDIATRIC ) 5500 6655 7321 59 SYNDACTYLY RELEASE ( PEDIATRIC ) 11000 13310 14641 60 NECK SINUS ( EXCISION ) ( PEDIATRIC ) 15400 18634 20497 61 BRANCHIAL CYST EXCISION BILATERAL ( PEDIATRIC ) 19800 23958 26354 VISCERAL RECONSTRUCTION BY COLON TRANSPLANT / GASTRIC TUBE ( POST HEAD & NECK CANCER SURGERY 62 33000 39930 43923 ) 63 HEAD - NECK CYST/MOLE/SCAR 6600 7986 8785 64 CYSTIC HYGROMA (MAJOR) EXCISION ( PEDIATRIC ) 19800 23958 26354 65 CYSTIC HYGROMA (MINOR) EXCISION ( PEDIATRIC ) 13200 15972 17569 66 MASS (HEAD NECK) EXCISION ( PEDIATRIC ) 13200 15972 17569 67 CYST (MULTIPLE) EXCISION - ( PEDIATRIC ) 16500 19965 21962 68 TRACHEOSTOMY ( PEDIATRIC ) 17600 21296 23426 69 RANULA EXCISION ( PEDIATRIC ) 17600 21296 23426 70 STERNOCLEIDOMASTOID MUSCLE RELEASE ( PEDIATRIC ) 16500 19965 21962 71 SALIVARY GLAND (SUB MANDIBULAR) REMOVAL - PEDIATRIC 16500 19965 21962 72 PAROTIDECTOMY SUPERFICIAL ( PEDIATRIC ) 27500 33275 36603 73 THYROGLOSSAL CYST EXCISION ( PEDIATRIC ) 19800 23958 26354 74 TONGUE TIE CORRECTION ( PEDIATRIC ) 7700 9317 10249 75 LIVER ABSCESS ASPIRATION - SIMPLE ( PEDIATRIC ) 4400 5324 5856 76 HEPATOBILIARY ASPIRATION OF LIVER ABSCESS MULTIPLE 8800 10648 11713 77 KASAI'S PROCEDURE - HEPATO-PORTOENTEROSTOMY FOR BILIARY ATRESIA ( PEDIATRIC ) 42900 51909 57100 78 CHOLECYSTOSTOMY + CHOLEDOCHODUDENOSTOMY ( PEDIATRIC ) 33000 39930 43923 79 CHOLECYSTECTOMY ( PEDIATRIC ) 16500 19965 21962 80 CHOLEDOCHAL CYST EXCISION ( PEDIATRIC ) 40700 49247 54172 81 OPEN CHOLECYSTECTOMY (PEDIATRIC SURGERY) 27500 33275 36603 82 HYDATID CYST OF LIVER EXCISION ( PEDIATRIC ) 22000 26620 29282 83 HEPATOBILIARY OPEN DRAINAGE OF LIVER ABSCESS 31900 38599 42459 84 HERNIA ( EPIGASTRIC ) REPAIR - PEDIATRIC 22000 26620 29282 85 HERNIA (FEMORAL) REPAIR - PEDIATRIC 22000 26620 29282 86 HERNIA (INCISIONAL) REPAIR WITHOUT MARLEX MESH ( PEDIATRIC ) 27500 33275 36603 87 HERNIA (INGUINAL) REPAIR ( BILATERAL ) -PEDIATRIC 27500 33275 36603 88 HERNIA WITH/WITHOUT MARLEX MESH (UNILATERAL) 27500 33275 36603 89 INGUINAL HERNIOTOMY - RIGHT SIDE ( PEDIATRIC ) 15400 18634 20497 90 INGUINAL HERNIOTOMY 19800 23958 26354 91 HERNIA OBSTRUCTED (ANY TYPE) 17600 21296 23426 92 HERNIA (OBTURATOR) REPAIR - PEDIATRIC 27500 33275 36603 93 HERNIA (SPIGELIAN) REPAIR - PEDIATRIC 27500 33275 36603 94 HERNIA (INCISIONAL - RECURRENT) REPAIR WITH MESH ( PEDIATRIC ) 27500 33275 36603 95 HERNIA (UMBILICAL) REPAIR - PEDIATRIC 17600 21296 23426 96 HYPOSPADIAS CHORDEE CORRECTION ( PEDIATRIC ) 16500 19965 21962 97 HYPOSPADIAS CORRECTION (1ST STAGE) - PEDIATRIC) 16500 19965 21962 98 HYPOSPADIAS CORRECTION (2ND STAGE) - PEDIATRIC 19800 23958 26354 99 HYPOSPADIAS FISTULA REPAIR ( PEDIATRIC ) 13200 15972 17569 100 HYPOSPADIAS REPAIR - SINGLE STAGE ( UROLOGY ) 26400 31944 35138

Page 26 101 LIVER PARTIAL RESECTION - LATERAL SEGMENTECTOMY ( PEDIATRIC ) 27500 33275 36603 102 ADHESIOLYSIS LAPAROSCOPIC ( PEDIATRIC ) 19800 23958 26354 103 ADRENALECTOMY LAPAROSCOPIC ( PEDIATRIC ) 37400 45254 49779 104 FUNDOPLICATION LAPAROSCOPIC ( PEDIATRIC ) 33000 39930 43923 105 PULL THROUGH RESECTION AND ANASTOMOSIS ( LAPAROSCOPIC ) - PEDIATRIC 33000 39930 43923 106 PYELOPLASTY LAPAROSCOPIC ( PEDIATRIC ) 36300 43923 48315 107 INTUSSUSCEPTION REDUCTION LAPAROSCOPIC ( PEDIATRIC ) 22000 26620 29282 108 LADDS BAND RESECTION LAPAROSCOPY ( PEDIATRIC ) 20900 25289 27818 109 APPENDICECTOMY ( LAPAROSCOPIC ) - PEDIATRIC 20900 25289 27818 110 APPENDICECTOMY ( LAPAROSCOPIC ) COMPLICATED ( PEDIATRIC ) 24200 29282 32210 111 RECTAL PROLAPSE REPAIR LAPAROSCOPIC ( PEDIATRIC ) 24200 29282 32210 112 CLITOROVAGINOPLASTY (FEMINIZING GENITOPLASTY) - PEDIATRIC 33000 39930 43923 113 CYST EXCISION (LARGE) - PEDIATRIC 6600 7986 8785 114 LACERATIONS SUTURING - LARGE ( PEDIATRIC ) 17600 21296 23426 115 LACERATIONS SUTURING - SMALL ( PEDIATRIC ) 7700 9317 10249 116 LACERATIONS SUTURING - EXTENSIVE ( PEDIATRIC ) 24200 29282 32210 117 LYMPH NODE BIOPSY ( PEDIATRIC ) 7700 9317 10249 118 MARSUPIALIZATION ( PEDIATRIC ) 16500 19965 21962 119 PILONIDAL SINUS EXCISION ( PEDIATRIC ) 16500 19965 21962 120 SACROCOCCYGEAL TERATOMA EXCISION ( PEDIATRIC ) 27500 33275 36603 121 STRICTUROPLASTY ( PEDIATRIC ) 11000 13310 14641 122 SUBMUCOUS CYST EXCISION ( PEDIATRIC ) 6600 7986 8785 123 WOUND SUTURING MINOR ( PEDIATRIC ) 5500 6655 7321 124 SUTURING SECONDARY ( PEDIATRIC ) 11000 13310 14641 125 TUMOR EXCISION ( PEDIATRIC ) 16500 19965 21962 126 TUMOR (SOFT TISSUE) REMOVAL (SMALL)- PEDIATRIC 7700 9317 10249 127 UMBILECTOMY WITH ENTERING PERITONEAL CAVITY ( PEDIATRIC ) 22000 26620 29282 128 VAGINOPLASTY ( PEDIATRIC ) 27500 33275 36603 129 GYNAECOLOGIAL EXAMINATION UNDER AANESTHESIA ( PEDIATRIC ) 5500 6655 7321 130 IMPERFORATE HYMEN EXCISION ( PEDIATRIC ) 7700 9317 10249 131 OVARIAN TORSION REPAIR ( LAPAROSCOPIC ) - PEDIATRIC 22000 26620 29282 132 ESOPHAGOSCOPY RIGID + REMOVAL OF FOREIGN BODY ( PEDIATRIC ) 11000 13310 14641 133 BRONCHOSCOPY ( PEDIATRIC ) 11000 13310 14641 134 BRONCHOSCOPY + FOREIGN BODY REMOVAL WITH LAVAGE ( PEDIATRIC ) 19800 23958 26354 135 CHEST TUBE INSERTION ( PEDIATRIC ) 7700 9317 10249 136 DIAPHRAGM EVENTERATION REPAIR ( PEDIATRIC ) 38500 46585 51244 137 THORACOSCOPY (DIAGNOSTIC)- PEDIATRIC 22000 26620 29282 138 INTERCOSTAL DRAINAGE ( PEDIATRIC ) 6600 7986 8785 139 LUNG ABSCESS SURGERY ( PEDIATRIC ) 27500 33275 36603 140 LUNG BIOPSY ( PEDIATRIC ) 14300 17303 19033 141 ESOPHAGEAL ATRESIA WITH TRACHEO ESOPHAGEAL FISTULA REPAIR - PRIMARY ( PEDIATRIC ) 33000 39930 43923 142 ESOPHAGOSTOMY + GASTROSTOMY ( PEDIATRIC ) 11000 13310 14641 143 ESOPHAGEAL DILATATION ( PEDIATRIC ) 14300 17303 19033 144 PLEURODESIS ( PEDIATRIC ) 6600 7986 8785 145 PLEURAL TAP ( PEDIATRIC ) 2200 2662 2928 146 RIB RESECTION + DRAINAGE ( PEDIATRIC ) 11000 13310 14641 147 THORACOTOMY + DECORTICATION ( PEDIATRIC ) 33000 39930 43923 148 THORACOTOMY + LOBECTOMY ( PEDIATRIC ) 38500 46585 51244 149 THORACOTOMY + PNEUMONECTOMY ( PEDIATRIC ) 38500 46585 51244 150 THORACOTOMY + SEGMENTAL RESECTION OF LUNG ( PEDIATRIC ) 27500 33275 36603

Page 27 151 THORACOTOMY + EXCISION OF MEDIASTINAL BRONCHOGENIC CYST ( PEDIATRIC ) 33000 39930 43923 152 THORACOTOMY + PLEURECTOMY + EXCISION OF EMPHYSEMATOUS BULLAE ( PEDIATRIC ) 38500 46585 51244 153 LAMINECTOMY & REPAIR OF MENINGOMYELOCELE (PEDIATRIC SURGERY) 33000 39930 43923 154 MYELOMENINGOCELE SURGICAL TREATMENT ( PEDIATRIC ) 27500 33275 36603 155 SHUNT REVISION ( PEDIATRIC ) 11000 13310 14641 156 VENTRICULO PERITONEAL SHUNT PLACEMENT 27500 33275 36603 157 VENTRICULOATRIAL ( VA ) SHUNT - HYDROCEPHALUS ( PEDIATRIC ) 27500 33275 36603 158 VENTRICULAR PUNCTURE ( PEDIATRIC ) 5500 6655 7321 159 CLEFT PALATE REPAIR - COMPLETE CLEFT ( PEDIATRIC ) 27500 33275 36603 160 CLEFT PALATE REPAIR - INCOMPLETE CLEFT ( PEDIATRIC ) 22000 26620 29282 161 PHARYNGOPLASTY ( PEDIATRIC ) 30800 37268 40995 162 CLEFT LIP REPAIR ( LEFT ) - PEDIATRIC 19800 23958 26354 163 CLEFT LIP REPAIR ( BILATERAL )- PEDIATRIC 24200 29282 32210 164 COLUMELLA LENGTHENING ( PEDIATRIC ) 16500 19965 21962 165 LIP SECONDARY DEFORMITY CORRECTION ( PEDIATRIC ) 12540 15174 16691 166 PALATE FISTULA REPAIR ( PEDIATRIC ) 19800 23958 26354 167 Z - PLASTY (SINGLE)- PEDIATRIC 8800 10648 11713 168 Z - PLASTY (MULTIPLE)- PEDIATRIC 17600 21296 23426 169 ABSCESS DRAINAGE ( MEDIUM ) - ( PEDIATRIC ) 14300 17303 19033 170 AUGMENTATION CYSTOPLASTY ( PEDIATRIC ) 28600 34606 38067 171 PERINEPHRIC ABSCESS OPEN DRAINAGE ( PEDIATRIC ) 11000 13310 14641 172 CYSTOLITHOTOMY ( PEDIATRIC ) 8800 10648 11713 173 CYSTOSCOPY ( PEDIATRIC ) 8800 10648 11713 174 CYSTOSCOPIC FULGURATION OF POSTERIOR URETHRAL VALVES ( PEDIATRIC ) 16500 19965 21962 175 CYSTOSCOPY WITH RETROGRADE CATHETERIZATION ( BILATERAL )- PEDIATRIC 11000 13310 14641 176 CYSTOCOPY WITH RETROGRADE URETERIC CATHETERIZATION ( RIGHT )- PEDIATRIC 7700 9317 10249 177 STENT REMOVAL (CYSTOSCOPIC) -PEDIATRIC 5500 6655 7321 178 NEPHROSTOMY TUBE CHANGE ( PEDIATRIC ) 3850 4659 5125 179 STRICTURE (URETHRAL) DILATATION + CALIBRATION ( PEDIATRIC ) 5500 6655 7321 180 DOUBLE J STENT PLACEMENT IN URETER ( BILATERAL ) - PEDIATRIC 14300 17303 19033 181 DOUBLE J STENT PLACEMENT IN URETER ( LEFT ) - PEDIATRIC 9900 11979 13177 182 EPISPADIAS REPAIR ( PEDIATRIC ) 16500 19965 21962 183 EPISPADIAS - EXSTROPHY COMPLEX REPAIR ( PEDIATRIC ) 27500 33275 36603 184 MEATOPLASTY ( PEDIATRIC ) 7700 9317 10249 185 MEATOTOMY ( PEDIATRIC ) 3850 4659 5125 186 MITROFANOFF APPENDICOVESICOSTOMY - PEDIATRIC 25300 30613 33674 187 NEPHRECTOMY (NEONATAL) 22000 26620 29282 188 NEPHRECTOMY (FOR NEPHROBLASTOMA / WILMS TUMOR) - PEDIATRIC 26400 31944 35138 189 NEPHROSTOMY ( OPEN ) - PEDIATRIC 27500 33275 36603 190 NEPHROSTOMY (PERCUTANEOUS) ( PEDIATRIC ) 11000 13310 14641 191 NEPHROLITHOTOMY ( PEDIATRIC ) 38500 46585 51244 192 NEPHROURETERECTOMY ( NEONATAL ) 35200 42592 46851 193 KIDNEY BIOPSY PRECUTANEOUS (STANDBY) - PEDIATRIC 5500 6655 7321 194 PYELOLITHOTOMY ( PEDIATRIC ) 22000 26620 29282 195 PYELOPLASTY ( PEDIATRIC ) 27500 33275 36603 196 PERMACATH INSERTION ( PEDIATRIC ) 8250 10000 11000 197 PERMACATH REMOVAL ( PEDIATRIC ) 8250 10000 11000 198 BLADDER REPAIR (MAJOR) - PEDIATRIC 16500 19965 21962 199 BLADDER REPAIR (MINOR) - PEDIATRIC 8800 10648 11713 200 CYSTECTOMY (TOTAL) - PEDIATRIC 16500 19965 21962

Page 28 201 URETHROSCOPY (DIAGNOSTIC) - PEDIATRIC 5500 6655 7321 202 URETERIC IMPLANTATION ( RIGHT ) - PEDIATRIC 22000 26620 29282 203 URETERIC IMPLANTATION BILATERAL ( PEDIATRIC ) 33000 39930 43923 204 URETEROCOELE EXCISION ( PEDIATRIC ) 11000 13310 14641 205 URETEROLITHOTOMY ( PEDIATRIC ) 16500 19965 21962 206 URETEROSTOMY ( RIGHT ) - PEDIATRIC 16500 19965 21962 207 URETHRAL INJURY REPAIR ( PEDIATRIC ) 16500 19965 21962 208 URETHROSTOMY ( PEDIATRIC ) 11000 13310 14641 209 VESICOSTOMY ( PEDIATRIC ) 16500 19965 21962 210 COLOSTOMY WITH MULTIPLE COLONIC BIOPSIES ( PEDIATRIC ) 26400 31944 35138 211 COLOSTOMY CLOSURE ( PEDIATRIC ) 22000 26620 29282 212 COLOSTOMY TRANSVERSE COLON ( PEDIATRIC ) 30800 37268 40995 213 LOOP COLOSTOMY ( PEDIATRIC ) 16500 19965 21962 214 END COLOSTOMY ( PEDIATRIC ) 16500 19965 21962 215 COLOSTOMY ( PEDIATRIC ) 22000 26620 29282 216 HEINEKO MICULICZ PROCEDURE (NEONATES) 22000 26620 29282 217 END ILEOSTOMY (NEONATES) 22000 26620 29282 218 BISHOP KOOP PROCEDURE (FOR ILEAL ATRESIA) - PEDIATRIC 22000 26620 29282 219 ILIOSTOMY WITH END TO END ANASTOMOSES (FOR ILEAL ATRESIA) - PEDIATRIC 27500 33275 36603 220 CAECOSTOMY TUBE PLACEMENT ( PEDIATRIC ) 12100 14641 16105 221 ORCHIDECTOMY ( LEFT )- PEDIATRIC 14300 17303 19033 222 ORCHIDECTOMY ( BILATERAL )- PEDIATRIC 17600 21296 23426 223 ORCHIDOPEXY ( PEDIATRIC ) 15400 18634 20497 224 ORCHIDOPEXY ( BILATERAL )- PEDIATRIC 19800 23958 26354 225 TORSION TESTIS CORRECTION ( PEDIATRIC ) 19800 23958 26354 226 SKIN GRAFT (LARGE) - PEDIATRIC 33000 39930 43923 227 SKIN GRAFT (MEDIUM) - PEDIATRIC 16500 19965 21962 228 SKIN GRAFT (SMALL) - PEDIATRIC 11000 13310 14641 229 CHEMOPORT INSERTION (PEDIATRIC SURGERY) 8250 10000 11000 230 CENTRAL VENOUS CATHETER ( CVC ) INSERTION - PEDIATRIC 3300 3993 4392 231 CENTRAL UMBILLICAL CUTDOWN FOR VENOUS ACCESS ( PEDIATRIC ) 6600 7986 8785 232 CENTRAL VENOUS ACCESS 8250 9983 10981 233 VENESECTION FOR VENOUS ACCESS ( PEDIATRIC ) 6600 7986 8785 234 MISCELLANEOUS PROCEDURES OPD MISCELLANEOUS MINOR 8800 10648 11713 235 ABSCESS (DEEP SEATED) DRAINAGE - ( PEDIATRIC ) 8800 10648 11713

Page 29 VASCULAR SURGERY

Page 30 Double Sl No. Description Room Single Room Suite 1 CEREBRAL AVM EMBOLIZATION 72210 82050 114870 2 CHEMOEMBOLIZATION - HEPATIC TUMOUR / METS 62960 71540 100160 3 VERTEBRAL BODY HEMANGIOMA / METS EMBOLIZATION 49150 55860 78200 4 AORTOBIFEMORAL ( FEMOROFEMORAL ) BYPASS 60000 75000 90000 5 AXILLO-UNIFEMORAL BYPASS 40000 55000 70000 6 AXILLO BIFEMORAL GRAFTING 50000 65000 80000 7 AORTO ILIAC BYPASS 54000 69000 84000 8 ILEOFEMORAL BYPASS 45000 60000 75000 9 ILIO-POPLITEAL BYPASS 48000 63000 78000 10 ILIO TO VISCERAL ARTERY BYPASS 55000 70000 85000 11 FEMOROPOPLITEAL BYPASS 50000 65000 80000 12 FEMORAL - TIBIAL BYPASS SURGERY 50000 65000 80000 13 FEMORO POPLITEAL BYPASS WITH SYNTHETIC GRAFT ( VASCULAR SURGERY ) 55000 75000 90000 14 FEMORO-POPLITEAL VEIN BYPASS 55000 75000 90000 15 PROFUNDOPLASTY 33000 48000 63000 16 POPLITEAL BYPASS ( RIGHT SIDE ) 40000 55000 70000 17 SFA TO POPLITEAL BYPASS 40000 55000 70000 18 PTA-ATA BYPASS 45000 60000 75000 19 CAROTID ENDARTERECTOMY ( CTVS ) 50000 65000 80000 20 CAROTID BODY TUMOR EXCISION ( CTVS ) 55000 70000 85000 21 CAROTID SUBCLAVIAN BYPASS GRAFTING 50000 65000 80000 22 SUBCLAVIAN ARTERY BYPASS ( VASCULAR SURGERY ) 40000 55000 70000 23 AXILLARY - BRACHIAL BYPASS WITH SYNTHETIC GRAFT ( VASCULAR SURGERY ) 40000 55000 70000 24 AORTO FEMORAL GRAFTING 70000 85000 100000 25 PBS- VEIN GRAFT(LONG) 50000 65000 80000 26 PBS- VEIN GRAFT(SHORT) 53000 68000 83000 27 EMBOLECTOMY BRACHIAL 26000 41000 56000 28 PERIPHERAL ENDARTERECTOMY 27000 42000 57000 29 THROMBOEMBOLECTOMY 37000 52000 67000 30 THROMBOENDARTERECTOMY AORTIC 40000 55000 70000 31 ARTERIAL ENDARTERECTOMY WITH PTFE / VEIN PATCH PLASTY ( VASCULAR SURGERY ) 45000 60000 75000 32 PERIPHERAL ARTERY-DACRON PATCHPLASTY 40000 55000 70000 33 ANEURYSMECTOMY PERIPHERAL VASCULAR (LARGE) 28000 43000 58000 34 ANEURYSM REPAIR (PERIPHERAL) 38000 53000 68000 35 FEMORAL ARTERY REPAIR 25000 40000 55000 36 FEMORAL ARTERY EXPOSURE + CLOSURE 42000 57000 72000 37 VEIN TO VEIN BYPASS/PATCHPLASTY 35000 50000 65000 38 FEMORAL VEIN REPAIR 23000 38000 53000 39 ABDOMINAL AORTIC ANEURYSM REPAIR 65000 80000 95000 40 VARICOSE VEINS LASER THERAPY ( RIGHT SIDE ) - COMPLEX 35000 50000 65000 41 VARICOSE VEINS LASER THERAPY ( BILATERAL ) - SIMPLE 45000 60000 75000 42 VARICOSE VEINS ( OPEN SURGERY ) - UNILATERAL ( VASCULAR SURGERY ) 30000 45000 60000 43 VARICOSE VEINS ( OPEN SURGERY ) - BILATERAL ( VASCULAR SURGERY ) 40000 55000 70000 44 VARICOSE VEINS MICRO SCLEROTHERAPY 45000 60000 75000 45 SCLEROTHERAPY OF VARICOSE VEINS 50000 65000 80000 46 ARTERIOVENOUS FISTULA CREATION 13000 18000 20000 47 ARTERIOVENOUS GRAFT IMPLANT 38000 53000 68000 48 AVF -VEIN CONDUIT 45000 60000 75000 49 BASILIC VEIN TRANSPOSITION ( FOR ARTERIOVENOUS FISTULA ) 40000 55000 70000 50 VASCULAR REPAIR(SMALL) 20000 35000 50000

Page 31 51 VASCULAR REPAIR (LARGE) 35000 50000 65000 52 SYMPATHECTOMY 30000 45000 60000 53 CERVICAL RIB EXCISION ( BILATERAL ) 35000 45000 60000 54 ARTERIOVENOUS MALFORMATION ( AVM ) RESECTION - MAJOR 45000 60000 75000 55 ARTERIOVENOUS MALFORMATION ( AVM ) TREATMENT - MINOR 27000 42000 57000 56 REEXPLORATION ( BLEEDING - LARGE ) 20000 25000 37500 57 ILIO-FEM POP BYPASS 50000 65000 80000 58 FEM-POP-ATA/PTA BYPASS 50000 65000 80000 59 STEM CELL THEREPY 25000 40000 55000 60 AMPUTATION TOE ( RIGHT ) - CTVS 7000 15000 22000 61 AMPUTATION - TOES 17000 28000 40000 62 AMPUTATION - FOREFOOT / TRANSMETATARSAL 22000 32000 45000 63 WOUND DEBRIDEMENT - SMALL ( PLASTIC SURGERY ) 12000 22000 32000 64 WOUND DEBRIDEMENT - LARGE ( PLASTIC SURGERY ) 18000 26000 36000 65 VENOUS THROMBECTOMY 16000 28000 38000 66 ARTERIOVENOUS ( AV ) FISTULA CREATION 16000 26000 36000 67 ARTERIOVENOUS FISTULA CLOSURE 13000 23000 33000 68 A-V FISTULA (CLOSURE) -LARGE 22000 32000 42000 69 GRAFT REMOVAL 23000 33000 43000 70 GRAFT REMOVAL (LARGE) 35000 45000 55000 71 VARICOSE VEINS LIGATION ( TRENDELENBURG ) SUPERFICIAL - BILATERAL 12000 22000 32000 72 TRENDELENBURG'S OPERATION (BOTH) 20000 30000 40000 73 ANKLE PERFORATORS LIGATION 15000 25000 35000 74 ANKLE PERFORATORS LIGATION (BOTH) 25000 35000 45000 75 SAPHENOFEMORAL LIGATION + STRIPPING / MULTIPLE PERFORATOR LIGATION + AVULSION ( RIGHT SIDE ) 10000 20000 30000 76 SAPHENO-POPLITEAL LIGATION(BOTH ) 16000 26000 36000 77 LSV STIPPING (ONE) 10000 20000 30000 78 SHORT / LONG SAPHENOUS VEINS STRIPPING 16000 26000 36000 79 SSV STIRPPING(ONE) 8000 17000 27000 80 SSV STIRPPING(BOTH) 13000 23000 33000 81 INTRARTERIAL VASODILATATION ( RADIOLOGY ) 20000 30000 40000 82 PERIPHERAL ARTERY EXPOSURE 42000 52000 62000 83 SCLEROTHERAPY 5000 11000 18000 84 SCLEROTHERAPY (INJECTION) - ( PEDIATRIC ) 9000 15000 22000 85 HEMANGIOMA EXCISION - SMALL ( ORAL SURGERY ) 10000 20000 30000 86 HEMANGIOMA EXCISION - MEDIUM ( ORAL SURGERY ) 20000 30000 40000 87 HEMANGIOMA EXPLORATION 40000 50000 60000 88 PRP INJECTIONS/ VISCOSUPPLEMENTATION ( SPORTSMED ) - PKG 6000 12000 18000 89 BRONCHIAL ARTERY EMBOLIZATION - (P) 62960 71540 100160 90 EXTERNAL CAROTID ARTERY TUMOR EMBOLIZATION 49150 55860 78200 91 TUMOR EMBOLIZATION ( VERTEBRAL ARTERY AND BASILAR ARTERY SUPPLY ZONE ) 72210 82050 114870 92 ARTERIAL EMBOLIZATION ( EMPIRICAL ) 90160 102450 143430 93 GASTROINTESTINAL BLEED EMBOLIZATION 62960 71540 100160 94 TUMORS GLUE EMBOLIZATION 108120 122860 172000 95 HEMANGIOMA EMBOLIZATION 62120 70590 98820 96 INTRA ARTERIAL EMBOLIZATION 41430 47080 65910 97 TRANSCUTANEOUS OXYGEN PRESSURE TCPO2 MEASUREMENT ( VASCULAR SURGERY ) 1500 2000 3000 98 UTERINE / OVARIAN ARTERY MAPPING FOR EMBOLIZATION ( OBSTETRICS AND GYNECOLOGY ) 18150 20620 28870 99 PELVIC MASS / TUMOR EMBOLIZATION ( THERAPEUTIC ) 45010 51140 71600 100 POST PANCREATITIS SEQUELES / EMBOLIZATION OF VARIOUS CAUSES 36130 41060 57480

Page 32 101 EMBOLIZATION - PREOPERATIVE 2760 3160 4380 102 SPINAL AVM / AVF EMBOLIZATION 126090 143280 200590 103 SPLENIC ARTERY / HEPARIC ARTERY / ANEURYSM EMBOLIZATION 45010 51140 71600 104 TUMOR EMBOLIZATION ( INTERVENTIONAL RADIOLOGY ) 36130 41060 57480 105 TUMOR EMBOLIZATION ( BENIGN / MALIGNANT ) - INTERVENTIONAL RADIOLOGY 54080 61450 86030 106 ANEURYSM EMBOLIZATION - COMPLEX 77400 95200 142800 107 BRONCHIAL EMBOLIZATION 39000 48000 72000 108 CEREBRAL ARETRIOVENOUS MALFORMATION ( AVM ) EMBOLIZATION 56500 69500 104250 109 INTRACRANIAL ANEURYSM EMBOLIZATION 56500 69500 104250 110 PERIPHERAL ARTERY EMBOLIZATION 25300 31100 46650 111 SPINAL ARETRIOVENOUS MALFORMATION ( AVM ) EMBOLIZATION 56500 69500 104250 112 TUMOR EMBOLIZATION ( SIMPLE ) 21100 26000 39000 113 TUMOR EMBOLIZATION ( COMPLEX ) 42000 51700 77550 114 AORTIC BIFEMORAL - (P) 130000 175000 210000 115 DACRON WRAP TO AORTA - (P) 302500 354000 400000 116 FEM POP - (P) 175000 190000 225000 117 CAROTID ENDARTERECTOMY ( LEFT ) 175000 190000 225000 118 CAROTID ENDERECTOMY ( RIGHT ) 175000 190000 225000 119 CAROTID BYPASS GRAFTING 175000 190000 225000 120 LIBERATION PROCEDURE 220000 265000 290000 121 FEMOROFEMORAL BYPASS 175000 190000 225000 122 PERIPHERAL BYPASS SURGERY 175000 190000 225000 123 AORTO ILIAC OR AORTO FEMORAL BYPASS GRAFTING -PRIMARY 37000 44000 48000 124 AXILLOFEMORAL BYPASS 40000 50000 65000 125 EMBOLECTOMY 28750 30000 35000 126 FALSE ANEURYSM REPAI/PERIPHERAL ENDARTERECTOMY 18000 23000 26000 127 VARICOSE VEIN SURGERY (RIGHT LEG) 19000 22000 24000 128 VARICOSE VEIN SURGERY (BOTH LEGS) 22000 30000 35000 129 EXCISION OF AVM 24000 40000 55000 130 VASCULAR REPAIR 24000 40000 55000 131 LLIO-FEM-FEM BYPASS 40000 50000 65000 132 VARICOSE VEINS - LASER SURGERY(UNILATERAL) 32000 45000 60000 133 VARICOSE VEINS - LASER SURGERY(BILATERAL) 42000 55000 70000 134 VARICOSE VEINS- UNILATERAL 22000 29000 39000 135 VARICOSE VEINS- BILATERAL 27000 35000 48000 136 LARYNGOSCOPY FLEXIBLE 1500 2250 3000

Page 33 GENERAL SURGERY

Page 34 Double Sl No. Description Single Room Suite Room 1 WOUND ® GROIN EXPLORATION WITH SECURING OF ACTIVE BLEEDING WITH SUTURING IN LAYERS 20000 27000 30000 2 LUMP PAROTID EXCISION 25000 33750 37500 3 LUMP RT.LEG EXCISION 20000 27000 30000 4 OTHER MISCELLANEOUS SURGERY 10000 13500 20250 5 FEM. ARTERY REPAIR 20000 27000 40500 6 FASCIOTOMY ( PER FASCIOTOMY ) 20000 27000 40500 7 PLICATION OF LV ANEURYSM 16000 21600 32400 8 POPLOTEAL ART. REPAIR 20000 27000 40500 9 PSEUDOANEURYSM REPAIR 16000 21600 32400 10 RE-EXPLORATION 10000 13500 20250 11 RESUTURING 5000 6750 10125 12 OMENTOPLASTY ( GENERAL SURGERY ) 16000 21600 32400 13 STERNAL REWIRING 10000 13500 20250 14 STERNAL WIRE REMOVAL 10000 13500 20250 15 DECOMPRESSING FLAP VALVE 10000 13500 20250 16 DECORTICATION ( PEDIATRIC ) 22800 29700 34700 17 FEMORAL VEIN REPAIR 20000 27000 40500 18 HERNIA REPAIR ( UNILATERAL ) OPEN / LAPAROSCOPIC ( PEDIATRIC ) 16000 21600 32400 19 VENTRICULAR ( LEFT ) ANEURYSM REPAIR 21500 29025 43538 20 VENTRICULAR ( LEFT ) CLOT REMOVAL 21500 29025 43538 21 VENTRICULAR ( LEFT ) ANEURYSM RESECTION 16000 21600 32400 22 PLASTIC SURGERY 10000 13500 20250 23 CYSTOSCOPY - DIAGNOSTIC ( PEDIATRICS ) 10000 13500 20250 24 PLEURAL FLUID ASPIRATION - PEDIATRIC 1000 1350 2025 25 PECTORALIS FLAP RECONSTRUCTION 16000 21600 32400 26 ANNULOPLASTY 16000 21600 32400 27 AMPUTATION O 10000 13500 20250 28 VARICOSE VEIN SURGERY 20000 27000 40500 29 INGUINAL HERNIORRHAPHY - BILATERAL 25000 33750 50625 30 TRANSURETHRAL MICROWAVE THERMOTHERAPY ( TUMT ) PROCEDURE (COOLED) 75000 101250 151875 31 BM ASPIRATION 180000 220000 240000 32 REOPENING ( CTVS ) 10000 13500 20250 33 ENDO - VENOUS LASER SURGERY 65000 80000 85000 34 VASCULAR PROCEDURE - MAJOR 55000 65000 75000 35 CARDIO VASCULAR PROCEDURE - MAJOR LEFT 55000 65000 75000 36 DEBRIDEMENT - MINOR ( PEDIATRICS ) 4950 5885 6325 37 PERICARDIECTOMY 140000 155000 165000 38 CAROTID SURGERY 175000 190000 225000 39 AV FISTULA: CRF 13000 18000 20000 40 ARTERIOVENOUS ( AV ) GRAFT IN CHRONIC RENAL FAILURE ( CRF ) 26000 36000 46000 41 INTERMITTENT PNEUMATIC COMPRESSION 850 1148 1721 42 BRONCHOSCOPY ( RIGID ) - DIAGNOSTIC ( PEDIATRIC ) 5500 8250 11000 43 BRONCHOGRAPHY 12000 18000 24000 44 BRONCHOGRAPHY ( PEDIATRIC ) 12000 18000 24000 45 PLEURAL BIOPSY ( THORACIC SURGERY ) 5000 7500 10000 46 SCLEROTHERAPY (OPD) 1500 2250 3000 47 ABDOMINOPERINEAL PULL THROUGH RESECTION + COLONIC ANASTOMOSIS 19900 29850 39800 48 ADRENALECTOMY ( LAPAROSCOPIC ) 19000 28500 38000 49 AMPUTATION - FOREARM 13400 20100 26800 50 LORDS PROCEDURE - ANAL DILATATION 1800 2700 3600

Page 35 51 ANAL SPHINCTER REPAIR ( GENERAL SURGERY ) 15200 22800 30400 52 ANTERIOR RESECTION OF RECTUM 19900 29850 39800 53 HERNIA ( STRANGULATED - ANY EXCEPT INCISIONAL HERNIA ) REPAIR 13400 20100 26800 54 APPENDICECTOMY ( OPEN ) 9500 14250 19000 55 CATHETERISATION 800 1200 1600 56 CERVICAL SYMPATHECTOMY - GENERAL SURGERY 14200 21300 28400 57 HYDATID CYST ( LIVER ) EXISION + CHEST DRAINAGE ( GI SURGERY ) 3100 4650 6200 58 CHOLECYSTECTOMY ( OPEN ) 13400 20100 26800 59 CHOLECYSTOSTOMY 9500 14250 19000 60 CHOLECYSTECTOMY + CHOLEDOCHOLITHOTOMY 19900 29850 39800 61 LOOP COLOSTOMY CLOSURE 9500 14250 19000 62 COLECTOMY TOTAL + ILEORECTAL ANASTOMOSIS 19900 29850 39800 63 COLON REPLACEMENT SURGERY 19000 28500 38000 64 PALATE CYST / TUMOR ( BENIGN ) EXCISION 5800 8700 11600 65 DECORTICATION + PLEURECTOMY + EMPYEMA EXCISION ( WITHOUT LUNG RESECTION ) 14200 21300 28400 66 DENTAL CYST EXCISION + JAW RECONSTRUCTION ( PLASTIC SURGERY ) 19900 29850 39800 67 DENTAL CYST / TUMOR EXCISION ( GENERAL SURGERY ) 9500 14250 19000 68 LAPAROSCOPY ( DIAGNOSTIC ) - WITH / WITHOUT BIOPSY ( PEDIATRIC ) 4800 7200 9600 69 ADHESIOLYSIS + DIVISION OF BANDS ( GENERAL SURGERY ) 13400 20100 26800 70 APPENDICULAR ABSCESS DRAINAGE ( PEDIATRIC ) 9500 14250 19000 71 PSEUDOPANCREATIC CYST DRAINAGE (INTERNAL) 13400 20100 26800 72 VARICOSE VEINS EXCISION ( ENDOSCOPIC ) - BILATERAL 29700 44550 59400 73 VARICOSE VEINS EXCISION ( ENDOSCOPIC ) RIGHT 20800 31200 41600 74 HERNIA (PARAUMBILICAL) REPAIR 6700 10050 13400 75 EX. LARGE SUPERFICIAL TUMOUR 6700 10050 13400 76 EX. SMALL SUPERFICIAL TUMOUR 4800 7200 9600 77 BRANCHIAL FISTULA EXCISION - RIGHT SIDE ( PEDIATRIC ) 9500 14250 19000 78 CARBUNCLE EXCISION ( GENERAL SURGERY ) 6700 10050 13400 79 CYST EXCISION ( GENERAL SURGERY ) 5200 7800 10400 80 LIPOMA EXCISION - LARGE ( GENERAL SURGERY ) 5000 7500 10000 81 LIPOMA (MULTIPLE) EXCISION 9500 14250 19000 82 SCROTAL CYSTS ( MULTIPLE ) EXCISION - GENERAL SURGERY 4800 7200 9600 83 PILONIDAL SINUS EXCISION 5800 8700 11600 84 SEBACEOUS CYST EXCISION ( LESS THAN 1 CM ) 4800 7200 9600 85 VARICOSE VEINS EXCISION ( BILATERAL ) 21800 32700 43600 86 VARICOSE VEINS EXCISION ( RIGHT ) 16600 24900 33200 87 PHARYNGEAL POUCH EXCISION + CRICOPHARYNGEAL MYOTOMY ( GENERAL SURGERY ) 13400 20100 26800 88 RETROPERITONEAL TUMOR EXCISION 17100 25650 34200 89 RECURRENT THYROGLOSSAL FISTULA/DUCT/CYST ( PEDIATRIC ) 13400 20100 26800 90 LAPAROTOMY EXPLORATORY ( PEDIATRIC ) 9500 14250 19000 91 HERNIA (FEMORAL) REPAIR - GENERAL SURGERY 9500 14250 19000 92 FISSURECTOMY 5800 8700 11600 93 FISTULECTOMY (COMPLEX) 7900 11850 15800 94 GASTROJEJUNOSTOMY ( PEDIATRIC ) 9500 14250 19000 95 LAPAROTOMY + GASTROSTOMY 9500 14250 19000 96 HEMORRHOIDECTOMY 9500 14250 19000 97 HEMI COLECTOMY (TRANSVERSE) - GENERAL SURGERY 13400 20100 26800 98 HERNIOPLASTY ( RIGHT ) 13400 20100 26800 99 HERNIOPLASTY ( BILATERAL ) 17800 26700 35600 100 VAGOTOMY ( HIGHLY SELECTIVE ) 13400 20100 26800

Page 36 101 HIRSCHSPRUNG'S DISEASE RESECTION 19900 29850 39800 102 HYDATID CYST OF LIVER EXCISION (DECAPITATION + INTERNAL DRAINAGE) - GENERAL SURGERY 19900 29850 39800 103 HYDROCOELE REPAIR ( RIGHT ) 9500 14250 19000 104 COLOSTOMY ( IMPERFORATE ANUS ) 9500 14250 19000 105 ANORECTAL ABSCESS INCISION AND DRAINAGE 3800 5700 7600 106 OMPHALOCELE ( HERNIA REPAIR ) - 1ST STAGE ( PEDIATRIC ) 13400 20100 26800 107 INGUINAL HERNIA ( RECURRENT ) REPAIR BILATERAL - OPEN / LAPAROSCOPIC ( PEDIATRIC ) 9500 14250 19000 108 INGUINAL HERNIOTOMY BILATERAL 6700 10050 13400 109 INSULINOMA EXCISION 19900 29850 39800 110 INTESTINAL FISTULA REPAIR 19900 29850 39800 111 INTUSSUSCEPTION SURGICAL REDUCTION 13400 20100 26800 112 JEJUNAL INTERPOSITION (POST POLY GASTRECTOMY) 19900 29850 39800 113 COLECTOMY ( LAPAROSCOPIC ) 25200 37800 50400 114 LEFT LOBECTOMY 17100 25650 34200 115 LINGUAL THYROID EXCISION 5800 8700 11600 116 FIBROADENOMA EXCISION ( PEDIATRIC ) 6700 10050 13400 117 AXILLARY LYMPH NODE EXCISIONAL BIOPSY (UNDER GA) 4800 7200 9600 118 OMPHALO MESENTERIC CYST EXCISION 13400 20100 26800 119 PANCREATIC NECROSECTOMY ( LAPAROSCOPIC ) 17100 25650 34200 120 ESOPHAGOSCOPY (PEDIATRIC SURGERY) 2300 3450 4600 121 LIVER ABSCESS (MULTIPLE) DRAINAGE 9500 14250 19000 122 THORACOTOMY + LUNG BIOPSY ( OPEN ) 9500 14250 19000 123 FOREIGN BODY ( ESOPHAGUS ) REMOVAL - OPEN 9500 14250 19000 124 FISTULA IN ANO ( HIGH LEVEL ) REPAIR / FISTULECTOMY 13400 20100 26800 125 FISTULA IN ANO ( LOW LEVEL ) REPAIR / FISTULECTOMY 6700 10050 13400 126 ORCHIDECTOMY ( RIGHT ) - GENERAL SURGERY 8600 12900 17200 127 ORCHIDOPEXY ( RIGHT ) - GENERAL SURGERY 9500 14250 19000 128 PARACENTESIS - GENERAL SURGERY 1700 2550 3400 129 HEMTHYROIDECTOMY - GENERAL SURGERY 17100 25650 34200 130 AMPUTATION PENIS - PARTIAL ( GENERAL SURGERY ) 6700 10050 13400 131 GASTRECTOMY (SUBTOTAL) 13400 20100 26800 132 NEAR TOTAL PANCREATECTOMY (PEDIATRIC SURGERY) 19900 29850 39800 133 LIVER PARTIAL RESECTION (LATERAL SEGMENTECTOMY) 17100 25650 34200 134 ISCHIORECTAL ABSCESS DRAINAGE ( PEDIATRIC ) 5800 8700 11600 135 PROCTOCOLECTOMY TOTAL + ILEOSTOMY ( TERMINAL ) 19900 29850 39800 136 PYLOROMYOTOMY (FOR PYLORIC STENOSIS) - ( PEDIATRIC ) 9500 14250 19000 137 NECK DISSECTION RADICAL ( GENERAL SURGERY ) 19900 29850 39800 138 RANULA EXCISION ( GENERAL SURGERY ) 6700 10050 13400 139 HERNIA (SPIGELIAN) REPAIR - GENERAL SURGERY 13400 20100 26800 140 RECTAL PROLAPSE REPAIR 13400 20100 26800 141 RECURRENT INGUINAL HERNIA REPAIR - OPEN / LAPAROSCOPIC ( PEDIATRICS ) 13400 20100 26800 142 SUBMANDIBULAR DUCT CALCULUS REMOVAL - INTRAORAL ( GENERAL SURGERY ) 4800 7200 9600 143 HERNIA ( CONGENITAL DIAPHRAGMATIC ) REPAIR - PEDIATRIC 14200 21300 28400 144 TORN EAR LOBULE ( REPAIR ) - BILATERAL ( PEDIATRIC ) 4800 7200 9600 145 COMMON HEPATIC DUCT RESECTION + REPAIR 21800 32700 43600 146 EXPLORATORY LAPAROTOMY + RESECTION AND ANASTOMOSIS ILEUM 13400 20100 26800 147 VOLVULUS ( COLON ) RESECTION + ANASTOMOSIS 19900 29850 39800 148 RETROPERITONEAL ABSCESS DRAINAGE ( GI SURGERY ) 13400 20100 26800 149 RIB RESECTION & DRAINAGE 6000 9000 12000 150 LOBECTOMY - RIGHT 21800 32700 43600

Page 37 151 SCALENE NODE BIOPSY 2300 3450 4600 152 SCALENOTOMY ( SCALENUS ANTICUS SYNDROME ) 7700 11550 15400 153 SIGMOID COLECTOMY ( ONCOSURGERY ) 19800 29700 39600 154 SIGMOIDOSCOPY (FLEXIBLE) 2000 3000 4000 155 PERFORATED ULCER CLOSURE - COMPLICATED 9500 14250 19000 156 SPHINCTEROTOMY ( GASTROENTEROLOGY ) 5800 8700 11600 157 HEMORRHOIDECTOMY ( STAPLED ) / MINIMALLY INVASIVE PROCEDURE FOR HEMORRHOIDS ( MIPH ) 10400 15600 20800 158 HERNIA ( INCISIONAL - STRANGULATED ) REPAIR - GENERAL SURGERY 13400 20100 26800 159 COLECTOMY TOTAL ( LAPAROSCOPIC ) 19800 29700 39600 160 SUBMANDIBULAR GLAND EXCISION ( ENDO SURGERY) 12500 18750 25000 161 SALIVARY GLAND ( SUBMANDIBULAR ) REMOVAL / SIALADENECTOMY 6700 10050 13400 162 SUBMUCOUS CYST EXCISION ( GENERAL SURGERY ) 4800 7200 9600 163 THYROIDECTOMY (SUBTOTAL) - GENERAL SURGERY 17800 26700 35600 164 PAROTIDECTOMY SUPERFICIAL ( GENERAL SURGERY ) 13400 20100 26800 165 SUPRAPUBIC ASPIRATION ( PEDIATRIC ) 2000 3000 4000 166 HERNIA ( HIATUS ) REPAIR ( TRANSABDOMINAL ) 19900 29850 39800 167 PORTAL HYPERTENSION SURGERY 19900 29850 39800 168 RECURRENT ULCER SURGERY 19900 29850 39800 169 SUTURE OF PANCREAS 13900 20850 27800 170 THIERSCH OPERATION 4800 7200 9600 171 THYROID LOBECTOMY 14900 22350 29800 172 AMPUTATION PENIS - TOTAL ( GENERAL SURGERY ) 17100 25650 34200 173 GASTRECTOMY (TOTAL) 19900 29850 39800 174 PAROTIDECTOMY (TOTAL) - GENERAL SURGERY 19900 29850 39800 175 THYROIDECTOMY (NEAR TOTAL) - GENERAL SURGERY 19800 29700 39600 176 TUBE CAECOSTOMY 6700 10050 13400 177 UMBILECTOMY 6700 10050 13400 178 VOLVULUS OF COLON UNTWISTING - SIMPLE ( GI SURGERY ) 13400 20100 26800 179 VAGOTOMY ( TOTAL ) + DRAINAGE 13400 20100 26800 180 VENTRAL HERNIA REPAIR - LAPAROSCOPIC ( GI SURGERY ) 13400 20100 26800 181 DIGITAL RECTAL EXAMINATION + MANUAL EVACUATION 1500 2250 3000 182 PROCTOSCOPY 1200 1800 2400 183 FISSURECTOMY + SPHINCTEROTOMY - GENERAL SURGERY 15000 25000 37500 184 PILONIDAL SINUS EXCISION WITH PRIMARY CLOSURE 45000 60750 91125 185 SPLENECTOMY ( LAPAROSCOPIC ) 13400 20100 26800 186 WOUND EXPLORATION 5000 10000 15000 187 ELBOW LT WITH BRACHIAL 10000 15000 20000 188 ARTERY REPAIR WITH SUTURING 10000 15000 20000 189 SKIN REJUVENATION 250 375 500 190 LAP ADHESIONOLYSIS 11100 16650 22200 191 LAP DUODENAL PERFORATION CLOSURE 19800 29700 39600 192 LAP INCISIONAL HERNIA RECURRENT 14900 22350 29800 193 HERNIA (UMBILICAL) REPAIR ( LAPAROSCOPIC ) - GENERAL SURGERY 14900 22350 29800 194 HERNIA ( VENTRAL / INCISIONAL ) REPAIR - LAPAROSCOPIC 14900 22350 29800 195 HERNIA LAPAROSCOPIC REPAIR (TOTAL - EXTRAPERITONEAL) BILATERAL 19800 29700 39600 196 APPENDISECTOMY WITH ADHESIOLYSIS ( LAPAROSCOPIC ) 18000 27000 36000 197 CHOLECYSTECTOMY ( LAPAROSCOPIC ) 18000 27000 36000 198 HERNIA (HIATUS) REPAIR ( LAPAROSCOPIC ) - GENERAL SURGERY 18000 27000 36000 199 ABSCESS ASPIRATION ( ORTHOPEDICS ) 1400 2100 2800 200 ABSCESS DRAINAGE - SMALL ( ORTHOPEDICS ) 1400 2100 2800

Page 38 201 ABSCESS DRAINAGE UNDER LOCAL ANESTHESIA IN OPD/WARD 1600 2400 3200 202 ACNE TREATMENT 1170 1755 2340 203 AIR MATTRESS 200 300 400 204 ALCHOHOL ABLATION OF TUMOR MASS 17800 26700 35600 205 ANTRAL WASH OUT( BILATERAL ) 2200 3300 4400 206 ANTRAL WASH OUT ( RIGHT ) 1400 2100 2800 207 TISSUE EXTRACTION / FLUID ASPIRATION FOR BIOPSY/ LAB. STUDY ( PEDIATRIC ) 1400 2100 2800 208 COLD ABSCESS / TUBERCULAR ABSCESS ASPIRATION 1600 2400 3200 209 PERITONEAL FLUID ASPIRATION - DIAGNOSTIC ( PEDIATRIC ) 630 945 1260 210 WEDGE BIOPSY ( PEDIATRICS ) 4100 6150 8200 211 BONE MARROW BIOPSY ( ONCOSURGERY ) 3100 4650 6200 212 LIVER BIOPSY (PEDIATRIC SURGERY) 2600 3900 5200 213 MUCOSA BIOPSY 1800 2700 3600 214 NERVE BIOPSY 4400 6600 8800 215 PUNCH BIOPSY ( GENERAL SURGERY ) 900 1350 1800 216 BIOPSY TRUCUT - DEEP ( ONCOSURGERY ) 1400 2100 2800 217 BIOPSY ULCER IN OPD/WARD 1400 2100 2800 218 CALORIC TEST ( BEDSIDE ) 720 1080 1440 219 CATHETERISATION IN OPD/WARD 500 750 1000 220 CAUTERIZATION ELECTRIC ( EPISTAXIS ) 1800 2700 3600 221 CAUTERIZATION CHEMICAL (SILVER NITRATE) FOR EPISTAXIS 720 1080 1440 222 CENTRAL LINE PLACEMENT ( NEONATAL ) 6000 8100 12150 223 CLEAN LACERATED WOUND ( CLW ) SUTURING ( PLASTIC SURGERY ) 3600 5400 7200 224 SUTURING - UPTO 3 SINGLE LAYER ( PEDIATRIC ) 1400 2100 2800 225 CLW SUTURING FACE SINGLE LAYER 900 1350 1800 226 CLW SUTURING LOWER LIMB MULTIPLE LAYER 810 1215 1620 227 CLW SUTURING LOWER LIMB SINGLE LAYER 500 750 1000 228 CLW SUTURING SCALP MULTIPLE LAYER 720 1080 1440 229 SUTURING ( SINGLE LAYER ) - UPTO 3 ( PEDIATRICS ) 360 540 720 230 CLW SUTURING SCALP STAPPLING 500 750 1000 231 CLW SUTURING UPPER LIMB MULTIPLE LAYER 900 1350 1800 232 CLW SUTURING UPPER LIMB SINGLE LAYER 540 810 1080 233 COGNITIVE FUNCTION TESTS 720 1080 1440 234 COMEDONE EXTRACTION ( 5 SESSIONS ) 540 810 1080 235 CONTINUOUS POSITIVE AIRWAY PRESSURE ( CPAP ) - PER DAY 2000 2700 4050 236 CONTINUOUS POSITIVE AIRWAY PRESSURE ( CPAP ) - UPTO 10 HOURS 900 1215 1823 237 CRYOSURGERY ( LARGE ) - DERMATOLOGY 5300 7950 10600 238 CRYOSURGERY ( MEDIUM ) - DERMATOLOGY 3600 5400 7200 239 CRYOSURGERY ( SMALL ) - DERMATOLOGY 2200 3300 4400 240 CARDIOTOCOGRAPHY ( CTG ) MONITORING 720 1080 1440 241 CARDIOTOCOGRAPHY ( CTG ) - 2ND VISIT 500 750 1000 242 CU - T INSERTION 3000 4500 6000 243 WOUND DEBRIDEMENT + SUTURING ( LARGE ) 1400 2100 2800 244 DEBRIDEMENT OF WOUND (MEDIUM) 1080 1620 2160 245 DEBRIDEMENT OF WOUND (SMALL) 540 810 1080 246 DEBRIDEMENT OF WOUND LARGE 3000 4500 6000 247 FACE WOUND ( REPAIR ) - MEDIUM ( PEDIATRIC ) 2300 3450 4600 248 FACE WOUND ( REPAIR ) - MINOR ( PEDIATRIC ) 1500 2250 3000 249 TRACHEOSTOMY DECANNULATION ( CRITICAL CARE ) 1080 1620 2160 250 DERMATOPATHOLOGY ( SINGLE LESION ) 900 1350 1800

Page 39 251 DETAILED EVALUATION ADULT ( PSYCHOLOGY ) 1170 1755 2340 252 DETAILED EVALUATION CHILD ( PSYCHOLOGY ) 1080 1620 2160 253 DIAGNOSTIC EVALUATION ( PSYCHOLOGY ) 1400 2100 2800 254 DYSLEXIA BATTERY 1400 2100 2800 255 FOREIGN BODY EAR ( LEFT ) REMOVAL 540 810 1080 256 EAR PIERCING ( PEDIATRIC ) 2000 3000 4000 257 ELECTRIC CAUTERIZATION ( FOR PLANTAR WARTS ) 1600 2400 3200 258 ENDOSCOPIC CHARGES 3500 5250 7000 259 ER CHARGES FOR CLOSED REDUCTION OF FRACTURE 1400 2100 2800 260 EXAMINATION UNDER MICROSCOPE ( EUM ) + SUCTION - BOTH EARS 540 810 1080 261 EXAMININATION UNDER ANESTHESIA 1700 2550 3400 262 EXCHANGE TRANSFUSION 4000 6000 8000 263 FIBREOPTIC LARYNGOSCOPY ( FOL ) 2200 3300 4400 264 NASAL SINUS ENDOSCOPY ( DIAGNOSTIC ) 2200 3300 4400 265 FINGER NAIL REMOVAL (COMPLETE) 1200 1800 2400 266 FOREIGN BODY REMOVAL NOSE / NASAL ( RIGHT ) - GENERAL SURGERY 810 1215 1620 267 GARMENTS PUMP (ONE TIME) 270 405 540 268 GENITAL WART EXCISION (PER ADDITIONAL WART) 500 750 1000 269 WRINKLES GLYCOLIC ACID TREATMENT ( FACE ) 2700 4050 5400 270 HYDROTUBATION 2900 4350 5800 271 INFUSION CHARGES 270 405 540 272 INGROWING TOE NAIL REMOVAL 1400 2100 2800 273 INJECTION FOR HAEMORROHOIDS (OPD/WARD) 2700 4050 5400 274 INJECTION INTRAARTICULAR ( LOCAL ) 3600 5400 7200 275 INJECTION INTRAARTICULAR ( OPD-PKG ) 630 945 1260 276 INJECTION INTRA THECAL 1400 2100 2800 277 INJECTION INTRADERMAL ( MORE THAN 5 LESIONS ) - DERMATOLOGY 900 1350 1800 278 INJECTION INTRADERMAL ( 1 TO 5 LESIONS ) - DERMATOLOGY 500 750 1000 279 NASAL TURBINATE INJECTION ( FOR SUB MUCOSAL FIBROSIS ) 360 540 720 280 INTERMITTENT PNEUMATIC COMPRESSION - BEDISDE 400 600 800 281 IQ TEST 1300 1950 2600 282 KOH EXAM (DERMA) 540 810 1080 283 LAPAROSCOPIC CHARGES 3500 5250 7000 284 LIVER ABSCESS ASPIRATION - SINGLE ( PEDIATRIC ) 2600 3900 5200 285 MEDICOLEGAL CHARGES (MLC) 900 1350 1800 286 MILIA EXTRACTION 1ST 5 LESIONS 720 1080 1440 287 NEUROPSYCHOLOGICAL BATTERY 1400 2100 2800 288 NIMBUS II 372 558 744 289 PATCH TEST - DERMATOLOGY 3600 5400 7200 290 PERSONALITY TEST / ASSESSMENT 720 1080 1440 291 PHIMOSIS CORRECTION 3600 5400 7200 292 PINNA PIERCING ( BILATERAL ) - ENT 540 810 1080 293 PINNA PIERCING ( LEFT ) - ENT 360 540 720 294 POP CAST APPLICATION - FULL ( ABOVE ELBOW ) 2300 3450 4600 295 POP SLAB APPLICATION ( ABOVE ELBOW ) - BEDSIDE 2000 3000 4000 296 POP ABOVE KNEE CAST APPLICATION 2700 4050 5400 297 POP CAST APPLICATION - FULL ( ABOVE KNEE ) - BEDSIDE 2300 3450 4600 298 POP APPLICATION ( MEDIUM ) 3600 5400 7200 299 CASTS APPLICATION ( BELOW ELBOW ) - BEDSIDE 1400 2100 2800 300 POP SLAB APPLICATION ( BELOW ELBOW ) - BEDSIDE 900 1350 1800

Page 40 301 CASTS APPLICATION - FULL ( BELOW KNEE ) - BEDSIDE 1800 2700 3600 302 SLAB APPLICATION ( BELOW KNEE ) - BEDSIDE 1400 2100 2800 303 CONGENITAL TALIPES EQUINOVARUS ( CTEV / CLUB FOOT ) POP CAST APPLICATION 1400 2100 2800 304 POP CYLINDER CAST APPLICATION 2700 4050 5400 305 POP CYLINDER SLAB APPLICATION 2300 3450 4600 306 PLASTER OF PARIS ( POP ) FULL PLASTER - FINGERS ( BEDSIDE ) 630 945 1260 307 POP HIP SPICA ( BILATERAL ) / DOUBLE HIP SPICA APPLICATION - BEDSIDE 7100 10650 14200 308 POP HIP SPICA APPLICATION ( RIGHT ) 4400 6600 8800 309 POP REMOVAL 360 540 720 310 SHOULDER SPICA APPLICATION 4000 6000 8000 311 POP SLAB APPLICATION FINGER 500 750 1000 312 PSYCHOTHERAPY 360 540 720 313 PUNCH GRAFTING ( PER PUNCH ) 900 1350 1800 314 RESUSCITATION ( PEDIATRIC ) 2200 3300 4400 315 ALPHA BED (MEDITECH) 325 439 658 316 SKIN TRACTION 1400 2100 2800 317 STERNAL PUNCTURE 1600 2400 3200 318 STOMACH WASH ( PEDIATRIC ) 270 405 540 319 STRAPPING 360 540 720 320 STRAPPING ANKLE 900 1350 1800 321 STRAPPING BALL BANDAGE 900 1350 1800 322 STRAPPING CHEST 1400 2100 2800 323 STRAPPING CUFF AND COLLAR SLING 900 1350 1800 324 STRAPPING ELBOW 900 1350 1800 325 STRAPPING - FIGURE OF 8 BANDAGE 900 1350 1800 326 STRAPPING FINGER 630 945 1260 327 STRAPPING KNEE 900 1350 1800 328 NASAL BONE FRACTURE - CLOSED REDUCTION 900 1350 1800 329 STRAPPING SHOULDER 1400 2100 2800 330 STRAPPING TOES 630 945 1260 331 STRAPPING WRIST 540 810 1080 332 STREPTOKINASE INJECTION PROCEDURE 2700 4050 5400 333 SUBMUCOSA BIOPSY 1800 2700 3600 334 EAR SUCTION CLEARANCE ( BILATERAL ) 360 540 720 335 EAR SUCTION CLEARANCE ( RIGHT ) 360 540 720 336 SUCTION CLEARANCE OF TRACHEOSTOMY ( EACH TIME ) 360 540 720 337 SUTURE REMOVAL ( ENT ) 90 135 180 338 SYRINGING EAR ( FOR WAX REMOVAL ) -BILATERAL 360 540 720 339 TONE DECAY TEST ( TDT ) 270 405 540 340 TYMPANOMETRY/ IMPEDANCE ¿(AUDIOLOGY) 720 1080 1440 341 VENESECTION 900 1350 1800 342 WOUND STITCH REMOVAL (7 TO 12) 360 540 720 343 WOUND STITCH REMOVAL (LESS THAN 7) 270 405 540 344 WOUND STITCH REMOVAL (MORE THAN 12) 540 810 1080 345 WOUND STITCHING (< 6 STITCHES TWO LAYERS) 1080 1620 2160 346 WOUND STITCHING (< 6 STITCHES) 540 810 1080 347 WOUND STITCHING (> SIX STITCHES ) 1600 2400 3200 CHEMICAL CAUTERIZATION WITH TRICHLOROACETIC ACID ( TCA ) FOR XANTHELASMA - EACH ADDITIONAL 348 LESION AFTER 2 ) 500 750 1000

349 CHEMICAL CAUTERIZATION WITH TRICHLOROACETIC ACID ( TCA ) FOR XANTHELASMA - UPTO 2 LESIONS 900 1350 1800 350 ENDOMETRIAL BIOPSY 4000 6000 8000

Page 41 NUEROLOGY PROCEDURES

Page 42 Double Sl No Description Single Room Suite Room 1 ANEURYSM ( COMPLEX ) MANAGEMENT ( NEUROSURGERY ) 45500 68250 91000 ANEURYSMS + ARTERIOVENOUS MALFORMATION REPAIR ( SMALL / LOCALIZED / UNCOMPLICATED ) - 2 INTERMEDIATE 44000 66000 88000 3 ARTERIAL EMBOLIZATION (EXTRACRANIAL) 18800 28200 37600 4 AVULSION SUTURING 3500 5250 7000 5 BALLOON TEST OCCLUSION 21200 31800 42400 6 BOTOX INJECTION FOR FATERPASTICITY 3000 5000 8000 7 BOTOX MULTIPLE SIDE INJ. 5000 8000 12000 8 BRACHIAL PLEXUS SURGERY 50000 75000 100000 9 BRONCHIAL PLEXUS 42000 63000 84000 10 BURR HOLE 16200 24300 32400 11 CARPAL TUNNEL RELEASE 31900 47850 63800 12 CEREBRAL AVM EMBOLIZATION ( BESIDES VB TERRITORY) 32100 48150 64200 13 CEREBROSPINAL FLUID ( CSF ) DIVERSION PROCEDURES 48790 57270 67880 14 CEREBROSPINAL FLUID ( CSF ) DIVERSION PROCEDURES - LAPAROSCOPE ASSISTED 47610 55890 66240 15 CERVICAL / LUMBAR / DORSAL DISCECTOMY ( MICROSCOPIC ) 48790 57270 67880 16 CERVICAL / LUMBAR DISC REPLACEMENT 50000 75000 100000 17 CERVICAL / LUMBAR DISCECTOMY ( ENDOSCOPIC ) 37300 55950 74600 18 CERVICAL CORPECTOMY ( MULTI SEGMENT ) + RECONSTRUCTION 76530 89830 106470 19 CERVICAL CORPECTOMY ( SINGLE SEGMENT ) + FUSION 67560 79300 93990 20 CERVICAL DISCECTOMY 28000 42000 56000 21 CERVICAL DISCECTOMY + FUSION 57070 66990 79400 22 CERVICAL INSTRUMENTATION 34000 51000 68000 23 CERVICAL LAMINECTOMY ( SINGLE LEVEL ) 26000 39000 52000 24 CERVICAL MICRODISECTOMY WITHOUT FUSION 57070 66990 79400 25 CHECK ANGIOGRAM ( RADIOLOGY ) 4000 6000 8000 26 CHRONIC INTRADURAL HEMATOMA SURGERY 30000 45000 60000 27 CRANIAL THERAPEUTIC PROCEDURE ( ENDOSCOPIC ) 37300 55950 74600 28 CRANIOPLASTY 37300 55950 74600 29 CRANIOTOMY - EPILEPSY SURGERY 44100 66150 88200 30 CRANIOTOMY - HEAD INJURY 38000 57000 76000 31 CRANIOTOMY - INTRACEREBRAL HEMATOMA EVACUATION 40000 60000 80000 32 CRANIOTOMY - MICROVASCULAR DECOMPRESSION 44100 66150 88200 33 CRANIOTOMY - VASCULAR MALFORMATION REPAIR 50000 75000 100000 34 CRANIOTOMY ( ELECTIVE ) - FOR TUMORS 44100 66150 88200 35 CRANIOTOMY ( EMERGENCY ) - CARDIOVASCULAR ACCIDENT ( CVA ) 50000 75000 100000 36 CRANIOTOMY ( FOR EXTRADURAL LESION ) 31900 47850 63800 37 CRANIOTOMY INTRA CEREBRAL TUMOUR 42000 63000 84000 38 CRANIOTOMY REDO ( FOR PROCEDURES DONE OUTSIDE ) 50000 75000 100000 39 CRANIOVERTEBRAL JUNCTION ( CV JUNCTION ) FUSION - POSTERIOR 37300 55950 74600 40 CRANIOVERTEBRAL JUNCTION ANOMALY SURGERY ( ANTERIOR + POSTERIOR ) 95290 111870 132580 41 CSF RHINORRHEA - LEVEL A 44000 66000 88000 42 CV JUNCTION COMBINED 52000 78000 104000 DECOMPRESSION ANTERIOR & POSTERIOR ( SIMUTANOUS) & RECONSTRUTION WITH ANT. &/ OR POST. 43 FUSION OF SPINE 95290 111870 132580 44 DECOMPRESSION ANTERIOR OR ANTERO - LATERAL - SPINE 95290 111870 132580 45 DECOMPRESSION ANTEROLATERAL + SPINAL FUSION 69100 103650 138200 46 DECOMPRESSION CRANIOTOMY 36000 54000 72000 47 DECOMPRESSION POSTERIOR & FUSION SPINE (LEVEL I) 67560 79300 93990 48 DIGITAL SUBTRACTION ANGIOGRAPHY ( DSA ) VENOGRAM 6300 9450 12600 49 DISC REPLACEMENT ( CERVICAL / LUMBAR ) - LEVEL I 76530 89830 106470 50 DISCECTOMY - ENDOSCOPIC ( CERVICAL /LUMBER) 57070 66990 79400

Page 43 51 DISCOGRAPHY 5320 6240 7400 52 DORSAL ANTEROLAT APPROACH 52000 78000 104000 53 DORSAL LAMINECTOMY 26000 39000 52000 54 DSA (DIGITAL SUBTRACTION ANGIOGRAPHY) 25000 33750 50625 55 DURAPLASTY 16000 24000 32000 56 ELECTROENCEPHALOGRAM ( EEG ) 3889 5833 7778 57 ELECTROMYOGRAPHY ( EMG ) 2000 3000 4000 58 EMG ( ELECTROMYOGRAPHY) 3450 5175 6900 59 FEMORAL ENDARTERECTOMY 37300 55950 74600 60 FORAMEN MAGNUM TUMOR SURGERY 50000 75000 100000 61 IAR (INTRA ARTERIAL RECANALISATION 43100 56300 84450 62 INTRAARTERIAL RECANALIZATION 41250 47440 61875 63 INTRAARTERIAL THROMBOLYSIS 21200 31800 42400 64 INTRACRANIAL ANEURYSM SURGERY - SINGLE 32100 48150 64200 65 INTRACRANIAL ANEURYSM SURGERY - TWO ( SAME SESSION ) 45500 68250 91000 66 INTRACRANIAL ANGIOPLASTY ( NEUROSURGERY ) 32100 48150 64200 67 INTRACRANIAL ANGIOPLASTY ( VASOSPASM ) 32100 48150 64200 68 INTRACRANIAL PRESSURE MONITORING BY TWIST DRILL PROCEDURE 5320 6240 7400 69 INTRACRANIAL STENTING ( INTERVENTIONAL RADIOLOGY ) 32100 48150 64200 70 LACERATION SUTURING - EXTENSIVE ( FOREHEAD, CHEEKS, EYELID & CHIN) 3400 5100 6800 71 LACERATION SUTURING - LARGE ( NEUROSURGERY ) 4000 6000 8000 72 LACERATION SUTURING - SMALL ( NEUROSURGERY ) 3000 4500 6000 73 LACERATION SUTURING ( NEUROSURGERY ) 3800 4460 5280 74 LAMINECTOMY 38300 44960 53280 75 LAMINECTOMY - SPINA BIFIDA OCCULTA ( PEDIATRIC ) 25000 37500 50000 76 LAMINOPLASTY 48790 57270 67880 77 LUMBAR CANAL STENOSIS 28000 42000 56000 78 LUMBAR DISC SURGERY REVISION ( DONE OUTSIDE ) 44100 66150 88200 79 LUMBAR DISCECTOMY 30000 45000 60000 80 LUMBAR DISCECTOMY + FUSION 32000 48000 64000 81 LUMBAR LAMINECTOMY ( NEUROSURGERY ) 26000 39000 52000 82 MENINGOMYELOCOELE SURGERY 20000 30000 40000 83 MUSCLE BIOPSY ( PEDIATRIC ) 3500 5250 7000 84 NERVE BIOPSY By SRL 4444 6667 8889 85 NERVE CONDUCTION STUDY ( NCS ) 5000 7500 10000 86 NERVE CONDUCTION VELOCITY ( NCV ) STUDY 5556 8333 11111 87 NERVE REPAIR 28000 42000 56000 88 NEUROENDOSCOPIC PROCEDURE ( DIAGNOSTIC ) 38300 44960 53280 89 NEUROLYSIS 24000 36000 48000 90 PARENT VESSEL OCCLUSION 13300 19950 26600 91 PEDICLE SCREW FIXATION 34000 51000 68000 92 PERCUTANEOUS BIOPSY 4800 7200 9600 93 PERIPHERAL NERVE RELEASE 48790 57270 67880 94 PITUITARY TUMOR EXCISION ( TRANSSPHENOIDAL ) 40000 60000 80000 95 POSTERIOR FOSSA SURGERY 46000 69000 92000 96 POSTERIOR FUSION FOR CV JUNTION 57070 66990 79400 97 PUMP IMPLANTATION ( THERAPEUTIC ) 37300 55950 74600 98 PUMP IMPLATATION 30000 45000 60000 99 REVISION OF LUMBER DISC SURGERY(DONE OUTSIDE) 67560 79300 93990 100 SCALP SUTURING ( MAJOR ) 7590 8910 10560

Page 44 101 SCALP SWELLING EXCISION ( LARGE ) 7590 8910 10560 102 SCALP SWELLING EXCISION ( SMALL ) 3800 4460 5280 103 SKULL BONE SURGERY ( NEUROSURGERY ) 46000 69000 92000 104 SPINAL ANGIOGRAPHY ( NEUROSURGERY ) 12010 14100 16710 105 SPINAL AVM 49270 57840 68550 106 SPINAL DYSRAPHISM SURGERY 48790 57270 67880 107 SPINAL INJECTIONS ( THERAPEUTIC ) - FOR PAIN 12800 19200 25600 108 SPINAL TUMOR ( EXTRADURAL ) SURGERY 32000 48000 64000 109 SPINAL TUMOR ( INTRADURAL ) SURGERY 38000 57000 76000 110 SPINAL TUMOR ( INTRAMEDULLARY ) SURGERY 40000 60000 80000 111 SPINE DECOMPRESSION ( ANTERIOR ) 62200 93300 124400 112 STEREOTACTIC BIOPSY 25000 37500 50000 113 STEREOTAXY 24000 36000 48000 114 STEROTACTIC DEEP BRAIN STIMULATION ( DBS ) SURGERY 62200 93300 124400 115 SUBDURAL HEMATOMA ( SDH ) EVACUATION 25000 37500 50000 116 THECOPERITONEAL SHUNT ( TP SHUNT ) 20000 30000 40000 117 THERAPEUTIC SPINAL INJECTIONS FOR PAIN 19530 22930 27170 118 THROMBOLYSIS INTRAVENOUS 23500 35250 47000 119 TOMORS FORAMEN MAGNUM/ SPINAL INTRA MEDULLARY 76530 89830 106470 120 TRANS ORAL DECOMPRESSION FOR CV JUNCTION ANOMALY 67560 79300 93990 121 TRANSPHENOIDAL PROCEDURE FOR PITUITARY/ CSF RHIRRORHEA 67560 79300 93990 122 TRANSSPHENOIDAL PROCEDURE FOR PITUITARY / CSF RHINORRHEA 44100 66150 88200 123 TRIGEMINAL NEURALGIA BLOCK 38000 57000 76000 124 TUMOR EMBOLISTION SIMPLE 13300 19950 26600 125 TUMOR SPINAL EXTRADURAL 48790 57270 67880 126 TUMORS EMBOLISATION COMPLEX 23500 35250 47000 127 TUMORS SPINAL INTRADURAL 67560 79300 93990 128 V P SHUNT / VA SHUNT ( PEDIATRICS ) 24000 36000 48000 129 VASODILATATION INTRAAARTERIAL 11800 17700 23600 130 VENOUS STENTING ( NEUROSURGERY ) 23500 35250 47000 131 VERTEBRAL BIOPSY ( PERCUTANEOUS ) 16200 24300 32400 132 VERTEBROPLASTY 38300 44960 53280

Page 45 UROLOGY PROCEDURES

Page 46 Double Sl No. Description Single Room Suite Room 1 Autotransplantation 66700 100000 133400 2 Adrenalectomy (Unilateral) - Open/ Laparoscopic/ Robotic 26700 40000 53400 3 Adrenalectomy ( Bilateral ) - Open/ Laparoscopic/ Robotic 40000 60000 80000 4 Nephrectomy Partial - Open/ Laparoscopic/ Robotic 50000 75000 100000 5 Nephrectomy Radical - Open/ Laparoscopic/ Robotic 33300 50000 66600 6 Nephrectomy Radical with IVC Thrombectomy - Open/ Laparoscopic/ Robotic 50000 75000 100000 7 Nephrectomy Simple - Open/ Laparoscopic/ Robotic 33300 50000 66600 8 NephroUreterectomy Radical - Open/ Laparoscopic/ Robotic 50000 75000 100000 9 Nephrolithotomy - Open/ Laparoscopic/ Robotic 26700 40000 53400 10 Anatrophic Nephrolithotomy 33300 50000 66600 11 Nephropexy (Open/ Lap/ Retroperitoneoscopic ) 20000 30000 40000 12 Nephrostomy Open/ Percutaneous 10000 15000 20000 13 Nephrostomy Tube Change 3300 5000 6600 14 Pyeloplasty - Open/ Laparoscopic/ Robotic 26700 40000 53400 15 Endopyelotomy 23300 35000 46600 16 Ureterocalicostomy 33300 50000 66600 17 Pyelolithotomy - Open/ Laparoscopic/ Robotic 26700 40000 53400 18 Percutaneous Nephrolithotomy ( PCNL ) - Single tract/ Small stone load 20000 30000 40000 19 Percutaneous Nephrolithotomy ( PCNL ) - Multiple tract/ Large stone load 30000 45000 60000 20 Percutaneous Nephrolithotomy (PCNL) - Second Stage/ Relook 6700 10000 13400 21 Retrograde Intrarenal Surgery (RIRS) 23300 35000 46600 22 Lithotripsy ( for Residual Stone - Post PCNL ) 13300 20000 26600 23 Lithotripsy <1 cm stone (ESWL) 23300 35000 46600 24 Lithotripsy >1 cm stone (ESWL) 30000 45000 60000 25 Laparoscopic Renal Cyst Deroofing (Rovsing's) 20000 30000 40000 26 Lymphatic Ligation - Laparoscopic ( Urology ) 26700 40000 53400 27 Diagnostic Laparoscopy ( Urology ) 16700 25000 33400 28 Ureteric Reimplantation ( Bilateral ) 40000 60000 80000 29 Ureteric Reimplantation (Unilateral ) 26700 40000 53400 30 UreteroUreterostomy 33300 50000 66600 31 Ureterocele Incision ( Unilateral ) 10000 15000 20000 32 Ureterocele Incision ( Bilateral ) 16700 25000 33400 33 Ureterolithotomy 26700 40000 53400 34 Ureterolysis ( Bilateral ) 40000 60000 80000 35 Ureterolysis ( Unilateral ) 26700 40000 53400 36 Ureteroscopy (Diagnostic) 10000 15000 20000 37 Relook Ureteroscopy (URS) + DJ stent removal 6700 10000 13400 38 Ureteroscopic Stone Removal (URS) 16700 25000 33400 39 DJ Stenting ( Bilateral ) 8000 12000 16000 40 DJ Stenting (Unilateral ) 6700 10000 13400 41 Ureterolithotomy Retroperitoneoscopic/Laparoscopic/Open 23300 35000 46600 42 Ureteric Reimplantation Laparoscopic ( Bilateral ) 40000 60000 80000 43 Ureteric Reimplantation Laparoscopic ( Unilateral ) 26700 40000 53400 44 Ureteroureterostomy / Boari Flap 33300 50000 66600 45 Ileal Repalcement of Ureter 33300 50000 66600 46 Cystoscopy ( Diagnostic/with biopsy/with clot evacuation) ) 6700 10000 13400 47 Suprapubic Catheterisation (SPC) 6700 10000 13400 48 Bladder Rupture Repair (Minor) 10000 15000 20000 49 Bladder Rupture Repair (Major) 20000 30000 40000 50 Cystolithotomy Percutaneous 16700 25000 33400

Page 47 51 Cystolithotripsy - Small 13300 20000 26600 52 Cystolithotripsy - Large 20000 30000 40000 53 Foreign Body Removal ( Cystoscopic ) 13300 20000 26600 54 Transurethral Resection of Bladder Tumor ( TURBT ) - Small 10000 15000 20000 55 Transurethral Resection of Bladder Tumor ( TURBT ) - Large 20000 30000 40000 56 Cystectomy (Partial) 33300 50000 66600 57 Radical Cystectomy with Ileal Conduit - Open/ Laparoscopic/ Robotic 50000 75000 100000 58 Radical Cystectomy with Neobladder - Open/ Laparoscopic/ Robotic 66700 100000 133400 59 Neobladder Construction ( Urology ) 40000 60000 80000 60 Bladder Diverticulectomy (Open/ Laparoscopic/ Robotic ) 26700 40000 53400 61 Augmentation Ileocystoplasty 40000 60000 80000 62 Mitrofanoff Appendicovesicostomy 40000 60000 80000 63 Vesicostomy 16700 25000 33400 64 VesicoVaginal Fistula ( VVF ) / Ureterovaginal Fistula Repair 26700 40000 53400 65 Detrusor Seromyotomy 16700 25000 33400 66 Incontinence Surgery ( Endoscopic/ Injectable ) 13300 20000 26600 67 Bladder Neck Suspension (Sling / Burch / Raz / Stamey) 20000 30000 40000 68 Artificial Urinary Sphincter (AUS) 40000 60000 80000 69 Endoscopic Submucosal Deflux Injection ( STING ) -Bilateral 10000 15000 20000 70 Endoscopic Submucosal Deflux Injection ( STING ) - Unilateral 6700 10000 13400 71 Botox Injection ( Intravesical / Intrasphinteric ) 13300 20000 26600 72 Prostate Biopsy - TransRectal Ultrasound ( TRUS ) Guided excluding HPE with IHC 16700 25000 33400 73 Prostate Biopsy - MRI/TRUS Fusion 26700 40000 53400 74 Transurethral Incision of Prostate (TUIP)/ Bladder Neck Incision (BNI) 16700 25000 33400 75 Transurethral Resection Of Prostate ( TURP ) < 50 gms 26700 40000 53400 76 Transurethral Resection Of Prostate ( TURP ) 50-100 gms 40000 60000 80000 77 Transurethral Resection Of Prostate ( TURP ) > 100 gms 50000 75000 100000 78 Prostatectomy Radical - Open/ Laparoscopic/ Robotic 50000 75000 100000 79 Prostatectomy Retropubic 50000 75000 100000 80 Prostatectomy Open 33300 50000 66600 81 Pelvic Lymphadenectomy - Laparoscopic/ Robotic 26700 40000 53400 82 Laparoscopic/ Robotic Seminal Vesicle Surgery ( Urology ) 26700 40000 53400 83 Posterior Urethral Valve ( PUV ) Fulguration 10000 15000 20000 84 Optical Internal Urethrotomy (OIU) 13300 20000 26600 85 Urethroplasty (Single Stage) - Anastomotic 26700 40000 53400 86 Urethroplasty (Single Stage) - Substitution (BMG) 40000 60000 80000 87 Urethroplasty (Two Stage) - 1st Stage 13300 20000 26600 88 Urethroplasty (Two Stage) - 2nd Stage 20000 30000 40000 89 Urethrostomy Perineal 16700 25000 33400 90 Urethrectomy 16700 25000 33400 91 Urethro vaginal Fistula Repair 26700 40000 53400 92 Urethral Diverticulum Excision/ Repair 16700 25000 33400 93 Urethral Fistula Repair/ Closure 10000 15000 20000 94 Urethral Caruncle Excision 10000 15000 20000 95 Epispadias Repair second stage 20000 30000 40000 96 Epispadias Repair 26700 40000 53400 97 Bladder Exostrophy Repair 26700 40000 53400 98 Hypospadias Repair - Single Stage 26700 40000 53400 99 Hypospadias Repair ( Two Stage ) - 1st Stage 13300 20000 26600 100 Hypospadias Repair ( Two Stage ) - 2nd Stage 20000 30000 40000

Page 48 101 Chordee Correction 10000 15000 20000 102 Cystocele / Rectocele Repair 16700 25000 33400 103 Pelvic Floor Repair (Major) 26700 40000 53400 104 Pelvic Floor Repair (Minor) 16700 25000 33400 105 TVT/ TVT-O 16700 25000 33400 106 Meatotomy 5000 7500 10000 107 Meatoplasty 8000 12000 16000 108 Circumcision/ Frenuloplasty 8000 12000 16000 109 Paraphimosis Reduction 3300 5000 6600 110 Penectomy Partial 23300 35000 46600 111 Penectomy Total without Lymphadectomy 30000 45000 60000 112 Inguinal Lymphadenectomy (Superficial) Bilateral 30000 45000 60000 113 Inguinal Lymphadenectomy (Superficial) Unilateral 20000 30000 40000 114 Penile Implant Surgery 33300 50000 66600 115 Wedge biopsy Penile 1700 2500 3400 116 Penis Fracture Repair 13300 20000 26600 117 Nesbit's Procedure 13300 20000 26600 118 Peyronnie Plaque Excision& Vein Grafting 20000 30000 40000 119 Priapism treatment - Injection/Aspiration 6700 10000 13400 120 Glanulo-Cavernous Shunt (Priapism) 13300 20000 26600 121 Lithotripsy for Erectile Dysfunction 33300 50000 66600 122 MicroVaricocelectomy ( Bilateral ) 30000 45000 60000 123 MicroVaricocelectomy ( Unilateral ) 20000 30000 40000 124 Hydrocelectomy Bilateral 13300 20000 26600 125 Hydrocele Repair - Unilateral 10000 15000 20000 126 Orchidectomy - Bilateral 16700 25000 33400 127 Orchidectomy (Unilateral ) 13300 20000 26600 128 Orchidectomy Laparoscopic - Bilateral 20000 30000 40000 129 Orchidectomy Laparoscopic - Unilateral 13300 20000 26600 130 High Inguinal Orchiectomy 16700 25000 33400 131 Retroperitoneal Lymph Node Dissection ( RPLND ) - Urology 50000 75000 100000 132 Orchidopexy ( Unilateral ) 20000 30000 40000 133 Orchidopexy ( Bilateral ) 30000 45000 60000 134 Torsion Testis - Surgical Correction ( Bilateral ) 20000 30000 40000 135 Testicular Prosthesis (Unilateral) 13300 20000 26600 136 Testicular Prosthesis ( Bilateral ) 20000 30000 40000 137 Testicular Biopsy ( Urology ) 6700 10000 13400 138 Vasectomy-Bilateral 6700 10000 13400 139 Vasectomy Reversal - Bilateral 40000 60000 80000 140 Vasectomy Reversal - Unilateral 26700 40000 53400 141 Scrotal Exploration ( Urology ) 8000 12000 16000 142 Excision of multiple scrotal cyst 8000 12000 16000 143 Scrotal Exploration + Microsurgical Vasoepididymal Anastomosis (VEA) - Bilateral 40000 60000 80000 144 Scrotal Exploration + Microsurgical Vasoepididymal Anastomosis (VEA) - Unilateral 26700 40000 53400 145 Scrotal Exploration + Microsurgical Vaso-vasal Anastomosis (VVA) - Bilateral 40000 60000 80000 146 Scrotal Exploration + Microsurgical Vaso-vasal Anastomosis (VVA) - Unilateral 26700 40000 53400 147 Epididymal Cyst Excision - Bilateral 13300 20000 26600 148 Epididymal Cyst Excision/Epididymectomy/Spermatocelectomy - Unilateral 10000 15000 20000 149 AV Fistula 10000 15000 20000 150 Permacath Insertion 10000 15000 20000

Page 49 151 Permacath Removal (Urology) 3300 5000 6600 152 Continuous Ambulatory Peritoneal Dialysis (CAPD) Catheter Insertion 13300 20000 26600 153 Continuous Ambulatory Peritoneal Dialysis ( CAPD ) Catheter Repositioning 13300 20000 26600 154 Continuous Ambulatory Peritoneal Dialysis (CAPD) Catheter Removal 6700 10000 13400 155 Suturing Secondary ( Large ) 6700 10000 13400 156 Suturing Secondary ( Small ) 3300 5000 6600 157 Abscess Drainage ( Urology ) 3300 5000 6600 158 Kidney Transplant 450000 159 Kidney Transplant Robotic 650000 160 TRUS Biopsy 30000 161 Cystoscopy under LA 15000 162 Cystoscopy under GA 26000 163 Stent removal under LA 8000 164 Stent removal under GA 19000 165 BCG instillation 6000 166 Catheter Removal + Voiding trail 2500 167 Lithotripsy (for Residual Stone - Post PCNL) 16000 168 Lithotripsy <1 cm stone (ESWL) 26000 169 Lithotripsy >1 cm stone (ESWL) 33000 170 Circumcision/ Frenuloplasty/ Meatoplasty 20000 171 Penile biopsy 8000 172 Meatotomy 12000 173 PESA/ TESA/ Testicular Biopsy 20000 174 Hydrocelectomy Unilateral 20000 175 Hydrocelectomy Biilateral 25000 176 Vasectomy 16000 177 Testicular Biopsy (Daycare Package) 17000 178 Urethral Catheterization ( foleys / silicon ) 1500 2250 3000 179 Catheter Removal ( Urology ) 500 750 1000 180 NMP22 Bladder Check Test 5000 7500 10000 181 Voiding Cystometry (Urodynamics) 6500 9750 13000 182 Video Urodynamics 10000 15000 20000 183 Uroflowmetry 1000 1500 2000 184 Uroflowmetry + Bladder scan 1600 2400 3200 185 Bladder Scan 600 900 1200 186 Tube/catheter/Suture removal 500 750 1000 187 Urethral dilatation/ calibration 2000 3000 4000 188 BCG instillation 2500 3750 5000 189 Dressing - Major 1000 1500 2000 190 Dressing - Minor 500 750 1000 191 Micturating Cystourethrogram (MCU) 3000 4500 6000 192 Retrograde Urethrogram (RGU) 3000 4500 6000 193 Nephrostogram 2500 3750 5000 194 Csytogram 3000 4500 6000 195 Retrograde Pyelogram (RGP) 10000 15000 20000 196 DJ Stent removal 5000 7500 10000 197 Pelvic Floorostimulation 1000 1500 2000 198 PIPE test 2000 3000 4000 199 Urethral Catheterisation (Silicon) 2200 3300 4400 200 Urethral Calibration 1500 2250 3000

Page 50 201 RGU + MCU 5000 7500 10000

Page 51 DENTAL PROCEDURES

Page 52 Double Sl No. Description Single Room Suite Room 1 DENTAL ROOT CANAL (MOLAR) 3000 4500 6000 2 DENTAL ROOT CANAL 2500 3750 5000 3 DENTAL SCALING (PER SITTING) 500 750 1000 4 DENTAL X-RAY 100 150 200 5 DENTAL COMPOSITE FILLING 500 750 1000 6 DENTAL AMALGAM FILLING (SILVER) 500 750 1000 7 DENTAL DENTURE(METAL) 10000 15000 20000 8 DENTAL CROWN (METAL) 5000 7500 10000 9 DENTAL CROWN (ALL CREAMIC) 10000 15000 20000 10 DENTAL AMALGAM FILLING 500 750 1000 11 DENTAL DENTURE (PARTIAL) 1500 2250 3000 12 DENTAL DENTURE ADDL TOOTH 500 750 1000 13 DENTAL ORTHO GNATHIC SURGERY (DENTAL SURGERY) 105000 157500 210000 14 DENTAL COSMETIC TREATMENT OF GUMS GRADE III 1200 1800 2400 15 DENTAL I.M.F(INTRAMAXILLARY FIXATION)GRADE II 6000 9000 12000 16 DENTAL ALLCERAMIC METAL FREE CROWN(PER CROWN) 18000 27000 36000 17 DENTAL AMALGAM REPLACEMENT (PER TOOTH) 4000 6000 8000 18 DENTAL AMALGAM REPLACEMENT WITH LINER 5000 7500 10000 19 DENTAL APICOECTOMY 7500 11250 15000 20 DENTAL BITEWING X RAY 250 375 500 21 DENTAL BLEACHING (PARTIAL) 5000 7500 10000 22 DENTAL BLEACHING OF TEETH BY TRAY METHOD AND SUPPLY 8000 12000 16000 23 DENTAL BONE GRAFT (PER TOOTH) GRADE 1 5000 7500 10000 24 DENTAL BONE GRAFT (PER TOOTH) GRADE 2 10000 15000 20000 25 DENTAL BONE GRAFT (PER TOOTH) GRADE 3 15000 22500 30000 26 DENTAL BONE GRAFTINGÁ(PER TOOTH) 4000 6000 8000 27 DENTAL BRIDGE CAST(UNITS) 4000 6000 8000 28 DENTAL CAST PARTIAL DENTURE(METAL FRAME) 15000 22500 30000 29 DENTAL CAST PARTIAL DENTURE(PER TOOTH) 2000 3000 4000 30 DENTAL COMPOSITE CROWN 3000 4500 6000 31 DENTAL COMPOSITE FILLINGS ONE SURFACE 1000 1500 2000 32 DENTAL COMPOSITE FILLINGS TWO SURFACE 1500 2250 3000 33 DENTAL COMPOSITE FILLINGSÁTHREE SURFACE 2000 3000 4000 34 DENTAL COMPOSITE LAMINATES 5000 7500 10000 35 DENTAL COSMETIC TREATMENT OF GUMS GRADE I 600 900 1200 36 DENTAL COSMETIC TREATMENT OF GUMS GRADE II 900 1350 1800 37 CROWN / BRIDGE PLACEMENT ( PER ABUTMENT ) 1000 1500 2000 38 DENTAL CROWN PLACEMENT ( LUTING ) 1000 1500 2000 39 DENTAL CURRETTAGE(PER QUAD) GR-I 2500 3750 5000 40 DENTAL CURRETTAGE(PER QUAD) GR-II 3000 4500 6000 41 DENTAL CURRETTAGE(PER QUAD) GR-III 3500 5250 7000 42 DENTAL CURRETTAGE(PER QUAD) GR-IV 4000 6000 8000 43 DENTAL PROPHYLAXIS 1500 2250 3000 44 DENTAL DENTASCAN 1000 1500 2000 45 DENTAL DENTURE ADJUSTMENT MINOR) 250 375 500 46 DENTAL DENTURE REPAIR GR I 1000 1500 2000 47 DENTAL DIASTEMA CLOSURE 8000 12000 16000 48 DENTAL DIASTEMA CLOSURE GRADE II 10000 15000 20000 49 DENTAL DIGITAL OPG WITH CD 550 825 1100 50 DENTAL DYCAL LINER 500 750 1000

Page 53 51 DENTAL FILLING SILVER ALLOY ONE SURFACE 500 750 1000 52 DENTAL FILLING SILVER ALLOY THREE SURFACE 1000 1500 2000 53 DENTAL FILLING SILVER ALLOY TWO SURFACE 800 1200 1600 54 DENTAL FIXED ORTHODONTIC APPLIANCES METAL BRACKET 40000 60000 80000 55 DENTAL FIXED ORTHODONTIC APPLIANCES PORCELAIN BRACKET(TOOTH COLOUR) 60000 90000 120000 56 DENTAL FIXED ORTHODONTIC APPLIANCES TRANSPARENT BRACKET 50000 75000 100000 57 DENTAL FLAP OPERATION (PER SEGMENT) 5000 7500 10000 58 DENTAL FLUORIDE TREATMENT 2000 3000 4000 59 DENTAL FRENECTOMY 5000 7500 10000 60 DENTAL FULL MOUTH CURETTAGE GR-I 10000 15000 20000 61 DENTAL FULL MOUTH CURETTAGE GR-II 12000 18000 24000 62 DENTAL FULL MOUTH CURETTAGE GR-III 14000 21000 28000 63 DENTAL FULL CAST CROWN 4000 6000 8000 64 DENTAL FULL LOWER DENTURE ACRYLIC 12500 18750 25000 65 DENTAL FULL UPPER DENTURE ACRYLIC 12500 18750 25000 66 DENTAL GLASS IONOMER FILLINGS CLASS FIVE 1000 1500 2000 67 DENTAL GLASS IONOMER FILLINGS CLASS ONE 1000 1500 2000 68 DENTAL GLASS LONOMER LINER 500 750 1000 69 GUM CURETTAGE ( PER TOOTH ) 250 375 500 70 DENTAL GUM CURRETTAGE (PER TOOTH) 250 375 500 71 DENTAL I.M.F(INTRAMAXILLARY FIXATION) GRADE I 900 1350 1800 72 DENTAL I.M.F(INTRAMAXILLARY FIXATION) GRADE III 20000 30000 40000 73 DENTAL I.M.F(INTRAMAXILLARY FIXATION) GRADE IV 30000 45000 60000 74 DENTAL IMMEDIATE LOADING IMPLANTS(PER IMPLANT) 75000 112500 150000 75 DENTAL IMPACTED TOOTH EXTRACTION 5000 7500 10000 76 DENTAL IMPACTED TOOTH REMOVAL (PER TOOTH) GRADE 1 5000 7500 10000 77 DENTAL IMPACTED TOOTH REMOVAL (PER TOOTH) GRADE 2 7500 11250 15000 78 DENTAL IMPACTED TOOTH REMOVAL (PER TOOTH) GRADE 3 10000 15000 20000 79 DENTAL IMPACTED TOOTH REMOVAL (PER TOOTH) GRADE 4 15000 22500 30000 80 DENTAL INLAYS 3000 4500 6000 81 DENTAL INSTA BLEACH 10000 15000 20000 82 DENTAL INSTABLEACHING GRII 5000 7500 10000 83 DENTAL INSTABLEACHING GRI 6000 9000 12000 84 DENTAL INTRAORAL PERIAPICAL X RAYS 100 150 200 85 DENTAL LAMINATED CROWN(CERGO)PER CROWN 20000 30000 40000 86 DENTAL LAMINATED VENEER (CERGO) 20000 30000 40000 87 DENTAL LAMINATED VENEER (EMPRESS-II) 18000 27000 36000 88 LATERAL CEPHALOGRAPH 550 825 1100 89 DENTAL LATERAL CEPHALOGRAPH 1200 1800 2400 90 CROWN ( LOW FUSING CERAMIC ) - PER CROWN 15000 22500 30000 91 DENTAL LOWER FULL DENTURE WITH THREE IMPLANT 200000 300000 400000 92 DENTAL MINOR SURGERY GRADE I 3000 4500 6000 93 DENTAL MINOR SURGERY GRADE II 4000 6000 8000 94 DENTAL MINOR SURGERY GRADE III 4500 6750 9000 95 DENTAL MINOR SURGERY GRADE IV 6000 9000 12000 96 DENTAL MODELS ( ORTHODONTICS ) 1000 1500 2000 97 NICKEL- CHROMIUM POST ( CUSTOM MADE ) 6000 9000 12000 98 NIGHT GUARD APPLIANCE ( DENTAL ) 5000 7500 10000 99 CROWN CERAMIC VITA - NORMAL ( PER CROWN ) 6000 9000 12000 100 ORTHODONTIC STUDY, DIAGNOSTIC CAST AND TREATMENT PLAN 2000 3000 4000

Page 54 101 DENTAL ORTHODONTIC TREATMENT (AMERICAN BRACKETS) 50000 75000 100000 102 DENTAL ORTHODONTIC TREATMENT (INST) 5000 7500 10000 103 DENTAL ORTHODONTIC TREATMENT STAGE 1 20000 30000 40000 104 DENTAL ORTHODONTIC TREATMENT STAGE 2 20000 30000 40000 105 DENTAL ORTHODONTIC TREATMENT STAGE 3 10000 15000 20000 106 X-RAY ORTHOPANTOMOGRAM ( OPG ) 500 750 1000 107 DENTAL OTHODONTIC TREATMENT STAGE 03 10000 15000 20000 108 PERFORATION REPAIR SURGERY ( GRADE 1 ) - ORAL SURGERY 8000 12000 16000 109 PERICORONAL FLAP SURGERY 3000 4500 6000 110 PERIODONTAL CURRETTAGE ( PER TOOTH ) 500 750 1000 111 PERIODONTAL WIRING ( ANTERIOR TEETH ) 5000 7500 10000 112 PIN RETAINED FILLINGS 2000 3000 4000 113 CROWN ( PORCELAIN ) 6000 9000 12000 114 PORCELAIN FUSED TO METAL BRIDGE - UNIT 7000 10500 14000 115 POST AND CORE ( GRADE 3 ) 3000 4500 6000 116 BONE GRAFTING ( POSTERIOR TEETH ) 60000 90000 120000 117 CROWN PRECIOUS METAL CERAMIC ( HG ) - PER UNIT 8000 12000 16000 118 DENTAL REDUCTION AND FIXATION OF MAXILLARY FRACTURES GRADE I 10000 15000 20000 119 DENTAL REDUCTION AND FIXATION OF MAXILLARY FRACTURES GRADE II 15000 22500 30000 120 DENTAL REDUCTION AND FIXATION OF MAXILLARY FRACTURES GRADE III 20000 30000 40000 121 DENTAL REDUCTION AND FIXATION OF MAXILLARY FRACTURES GRADE IV 30000 45000 60000 122 DENTAL REMOVABLE ORTHODONTOC APPLIANCE RETAINERS EACH 6000 9000 12000 123 REMOVABLE PARTIAL DENTURE ( FIRST 3 TEETH ) 2000 3000 4000 124 REMOVABLE PARTIAL DENTURE FLEXIBLE ( EVERY ADDITIONAL TOOTH ) 2000 3000 4000 125 REMOVABLE PARTIAL DENTURE ( FLEXIBLE PLATE ) 5000 7500 10000 126 ROOT CANAL TREATMENT ( RCT ) - ANTERIOR TEETH 5000 7500 10000 127 ROOT CANAL TREATMENT ( RCT ) POSTERIOR TEETH 6500 9750 13000 128 ROOT CANAL TREATMENT ( RCT ) GRADE 1 4000 6000 8000 129 ROOT CANAL TREATMENT ( RCT ) + POST - GRADE 1 5000 7500 10000 130 ROOT PLANING ( PER QUADRANT ) 1000 1500 2000 131 DENTAL RPD (FLEXI)PLATE 2500 3750 5000 132 DENTAL RPD ADDITIONAL TOOTH 500 750 1000 133 DENTAL RPD(FLEXI) PER ADDNAL TOOTH 1000 1500 2000 134 SCALING 1500 2250 3000 135 SCALING ( GRADE 1 ) 1000 1500 2000 136 DENTAL SEALANTS 500 750 1000 137 SELECTIVE GRINDING ( LOWER TEETH ) 250 375 500 138 SELECTIVE GRINDING ( UPPER TEETH ) 250 375 500 139 SINUS LIFT + BONE GRAFT ( PER TOOTH ) 20000 30000 40000 140 SINUS LIFT + BONE GRAFTS ( GRADE 1 ) 20000 30000 40000 141 SINUS LIFT + BONE GRAFTS ( GRADE 2 ) 40000 60000 80000 142 SINUS LIFT + BONE GRAFTS ( GRADE 3 ) 60000 90000 120000 143 IMPACTED TOOTH SURGICAL EXTRACTION (INVERTED) 15000 22500 30000 144 TOOTH SURGICAL EXTRACTION ( GRADE 2 ) 2000 3000 4000 145 TEMPORARY CROWN ( PER CROWN ) 1000 1500 2000 146 TEMPORARY FILLING ( PER TOOTH ) 500 750 1000 147 TOOTH EXTRACTION ( GRADE 2 ) 1500 2250 3000 148 TOOTH EXTRACTION 800 1200 1600 149 TOOTH JEWELLERY ( PER DIAMOND ) 7000 10500 14000 150 UPPER FULL DENTURE WITH THREE IMPLANTS 200000 300000 400000

Page 55 151 VIDIAN NEURECTOMY - DENTAL 6000 9000 12000 152 CROWN VITA 3D ( PER CROWN ) 10000 15000 20000 153 DENTAL SURGICAL PROCEDURE UNDER SEDATION GRADE 1 25000 37500 50000 154 DENTAL SURGICAL PROCEDURE UNDER SEDATION GRADE 2 30000 45000 60000 155 DENTAL SURGICAL PROCEDURE UNDER SEDATION GRADE 3 35000 52500 70000 156 DENTAL BLEACHING ZOOM TECH GRADE 1 20000 30000 40000 157 DENTAL BLEACHING ZOOM TECH GRADE 2 25000 37500 50000 158 DENTAL BLEACHING ZOOM TECH GRADE 3 30000 45000 60000 159 ZIRCONIUM CROWN 12000 18000 24000 160 DENTAL IMPLANT ( ANTERIOR TEETH ) 45000 67500 90000 161 COMPLETE DENTURE 20000 30000 40000 162 COMPLETE DENTURE ( FLEXIBLE TOOTH ) 25000 37500 50000 163 ROOT CANAL TREATMENT ( RCT ) SINGLE SITTING 6000 9000 12000 164 DENTAL SINGLE SITTING RCT POSTERIOR 7000 10500 14000 165 SCALING ( GRADE 3 ) 2000 3000 4000 166 REMOVABLE PARTIAL DENTURE PLATE 1500 2250 3000 167 DENTAL MINOR SURGEY UNDER CONSIOUS SEDATION GRADE 1 10000 15000 20000 168 DENTAL MINOR SURGEY UNDER CONSIOUS SEDATION GRADE 2 20000 30000 40000 169 DENTAL GRADE I 20000 30000 45000 170 DENTAL GRADE II 30000 40000 55000 171 DENTAL GRADE III 40000 50000 65000 172 DENTAL GRADE IV 50000 60000 75000

Page 56 DERMATALOGY PROCEDURES

Page 57 Double Sl No. Description Single Room Suite Room 1 BIOPSY SKIN 1800 2700 3600 2 BOTOX 300 450 600 3 ELECTRIC CAUTERY FOR WART/DPN/GRANULOMA PYOGENICERM PER 3 LESIONS 810 1215 1620 4 ELECTRIC CAUTERY FOR WART/DPN/GRANULOMA PYOGENICERM PER LESIONS 270 405 540 5 GLYCOLIC PEEL 990 1485 1980 6 INTRALESIONAL INJECTION 540 810 1080 7 MICRO DERMABRASION 2700 4050 5400 8 MILIA EXTRACTION FIRST 5 LESIONS 810 1215 1620 9 MILIA EXTRACTION FIRST PER LESIONS 180 270 360 10 CALLOSITY EXCISION 630 945 1260 11 REMOVAL OF MOLLUSCUM CONTAGIOSUM FIRST 5 LESION 810 1215 1620 12 REMOVAL OF MOLLUSCUM CONTAGIOSUM PER LESION 180 270 360 13 DERMAROLLOERDERMAROLLOER - FIRST SITTINGS 2000 3000 4000 14 DERMAROLLOER - SECOND SITTINGS 500 750 1000 15 MICRODERMARASION 1500 2250 3000 16 LED LIGHT THERRAPY 1000 1500 2000 17 PHOTOTHERAPY 500 750 1000 18 IONTOPHORESIS 1000 1500 2000 19 SKIN POLISHING - FACE 1000 1500 2000 20 CBP 10000 15000 20000 21 CHEMICAL PEELING BASIC 1000 1500 2000 22 BOTOX INJECTION ( PER UNIT ) 250 375 500 23 DERMAL FILLERS - LIP AUGMENTATION 15000 22500 30000 24 ADVANCED PEEL - FACE ( FINE WRINKLES ) SINGLE SITTING 2500 3750 5000 25 IONTOPHORESIS - POWER PATCH 2000 3000 4000 26 FACELIFT ( NON - SURGICAL ) 1000 1500 2000 27 ACNE SURGERY - SINGLE SITTING 2500 3750 5000 28 ANTI - ACNE PEEL ( SINGLE SITTING ) 1500 2250 3000 29 ANTI - ACNE PEEL ( 6 SITTING COURSE ) 8000 12000 16000 30 ANTI - ACNE PLUS PEEL ( SINGLE SITTING ) 2000 3000 4000 31 ANTI ACNE PLUS PEEL (SIX SITTING COURSE) 10000 15000 20000 32 ANTI MEL PEEL (SINGLE SITTING) 1000 1500 2000 33 ANTI MEL PEEL (SIX SITTING COURSE) 5000 7500 10000 34 ANTI POM PEEL (SIX SITTING COURSE) 5000 7500 10000 35 ANTI POM PEEL(SINGLE SITTING) 1000 1500 2000 36 ANTI - SCAR PEEL ( SINGLE SITTING ) 2000 3000 4000 37 ANTI - SCAR PEEL ( 6 SITTING COURSE) 10000 15000 20000 38 ANTI - TAN PEEL ( SINGLE SITTING ) 1000 1500 2000 39 ANTI - TAN PEEL ( 6 SITTING COURSE ) 5000 7500 10000 40 ANTI - TAN PLUS PEEL ( SINGLE SITTING ) 2000 3000 4000 41 ANTI - TAN PLUS PEEL ( 6 SITTING COURSE ) 10000 15000 20000 42 ANTI - WRINKLE PEEL FOR FINE LINES ( SINGLE SITTING COURSE ) 1000 1500 2000 43 ANTI - WRINKLE PEEL ( 6 SITTING COURSE ) 5000 7500 10000 44 ANTI - WRINKLE + PEEL FOR DYNAMIC WRINKLES ( SINGLE SITTING ) 3000 4500 6000 45 ANTI - WRINKLE PLUS PEEL ( 6 SITTING COURSE ) 15000 22500 30000 46 HAIR TRANSPLANT - LARGE 60 90 120 47 BOTOX INJETION - ELECTROMYOGRAPHY ( EMG ) GUIDED ( ONE LIMB ) 400 600 800 48 BODY PEEL ( COMPLETE ) - SINGLE SITTING 10000 15000 20000 49 BODY PEEL ( COMPLETE ) - 6 SITTING COURSE 50000 75000 100000 50 CRYOSURGERY FOR KELLOID - SINGLE SITTING 2500 3750 5000

Page 58 51 DERMAROLLERS TREATMENT 10000 15000 20000 52 DERMAROLLERS APPLICATION (PER SESSION) 3000 4500 6000 53 DERMAROLLERS - 6 SITTING COURSE 15000 22500 30000 54 SKIN BIOPSY ( EXCISIONAL ) - DIAGNOSTIC 2000 3000 4000 55 KOH MOUNT (3927-SRL) 500 750 1000 56 PATCH TESTING - DIAGNOSTIC 2000 3000 4000 57 SKIN BIOPSY ( BESDSIDE ) 1500 2250 3000 58 WOOD'S LAMP TEST - DIAGNOSTIC 300 450 600 59 ENUCLEATION ( 5 LESIONS ) 1000 1500 2000 60 ENUCLEATION ( PER LESION ) 200 300 400 61 FRACTIONAL ERBIUM TECHNOLOGY ( FET ) THERAPY 25000 37500 50000 62 HAIR RESTORATION SURGERY ( STRIP ) 60 90 120 63 HAIR RESTORATION SURGERY - FOLLICULAR UNIT TRANSPLANT ( FUT ) 80 120 160 64 HANDS & FEET (SINGLE SESSION) 300 450 600 65 HANDS & FEET (SIX SESSION COURSE) 1500 2250 3000 66 INTERSTITIAL LASER THERAPY ( FOR ALOPECIA AREATA ) 1000 1500 2000 67 IONTOPHORESIS ( SINGLE SITTING ) 1000 1500 2000 68 LASER HAIR REDUCTION - BIKNI AREA 20000 30000 40000 69 HAIR REDUCTION ( CHIN ) - LASER 1500 2250 3000 70 HAIR REDUCTION ( FULL BODY ) - LASER 10000 15000 20000 71 LASER HAIR REDUCTION - FULL FACE 5000 7500 10000 72 LASER HAIR REDUCTION - UPPER LIP 1500 2250 3000 73 CARBON DIOXIDE (CO2) LASER FOR LARGE LESION - PER SESSION 50 75 100 74 LASERS CO2 LASER (UPTO TWENTY SHOTS) 1500 2250 3000 75 LASERS FRAXEL (FACE) 5000 7500 10000 76 LASERS Q SWITCH LASER (UPTO TWENTY SHOTS) 1500 2250 3000 77 LASERS Q SWITCH PER SHOT 50 75 100 78 MICRODERMABRASION 1500 2250 3000 79 MICRO DERMABRASION ( 6 SITTING ) 7500 11250 15000 80 NAIL SURGERY - COMPLETE 5000 7500 10000 81 NAIL SURGERY - PARTIAL 2500 3750 5000 82 IONTOPHORESIS ( POWER PATCH ) - SINGLE SITTING 2000 3000 4000 83 PEEL - PURPLE 3000 4500 6000 84 RADIOFREQUENCY ( MULTIPLE LESION ) 1000 1500 2000 85 RADIOFREQUENCY ( PER LESION ) 400 600 800 86 SKIN POLISHING - SINGLE SITTING 1000 1500 2000 87 STEM CELL THERAPY - SINGLE SITTING 5000 7500 10000 88 DIMPLE CREATION SURGERY - TEMPORARY 5000 7500 10000 89 WHOLE BODY (SINGLE SITTING) 500 750 1000 90 WHOLE BODY (SIX SITTING COURSE) 2500 3750 5000 91 LIPOMA EXCISION 9000 13500 18000 92 SEBACEOUS CYST EXCISION 5000 7500 10000 93 SEBACEOUS CYST EXCISION (LARGE) 2000 3000 4000 94 NEW FRASER LASER UPTO 50 SHOTS 6000 9000 12000 95 IPL HAIR REDUCTION FACE (4 SITTINGS) 28000 42000 56000 96 PV THERAPY 8000 11000 15000

Page 59 ENT PROCEDURES

Page 60 Double Sl No. Description Single Room Suite Room 1 ABR 1500 2250 3000 2 ADENO TONSILLECTOMY 13200 19800 26400 3 ANTRAL PUNCTURE BILATERAL 2800 4200 5600 4 ANTRUM WASH DOUBLE 2300 3450 4600 5 ANTRUM WASH SINGLE 900 1350 1800 6 AUDITORY STEADY STATE RESPONSE (ASSR) 990 1485 1980 7 BERA 2300 3450 4600 8 ANTRAL PUNCTURE ( BILATERAL ) 2100 3150 4200 9 BILATERAL STYLOIDECTOMY 13200 19800 26400 10 BILATERAL TRANS. ANTRAL ETHMOIDECTOMY 16600 24900 33200 11 BIOPSY - ENT 1170 1755 2340 12 BRONCHOSCOPE RIGID FOREIGN BODY REMOVAL 7200 10800 14400 13 CALORIC TEST 1170 1755 2340 14 CHANNEL ATRESIA RECANALISATION 16600 24900 33200 15 COBLATION PACKAGE 19800 29700 39600 16 COMMANDO S 33300 49950 66600 17 CORTICAL MASTOIDECTOMY,MODIFIED RADICAL 16600 24900 33200 18 DENTAL IMPLANT (POSTERIOR) 59400 89100 118800 19 DIRECT LARYNGOSCOPE 3200 4800 6400 20 EAR LOBE REPAIR - ONE 1500 2250 3000 21 EAR LOBE REPAIR - TWO 2300 3450 4600 22 ENDOLYMPHATIC SAC DECOMPRESSION 11100 16650 22200 23 ENDOSCOPIC SPA 9500 14250 19000 24 EXCISION HEMANGIOMA 7900 11850 15800 25 EXCISION PHARYNGEAL DIVERTICULUM 16600 24900 33200 26 EXCISIONS ANGIOFILUROMA 11100 16650 22200 27 FACIAL NERVE DECOMPRESSION 16600 24900 33200 28 FESS EXTENDED BILATERAL 20800 31200 41600 29 FESS EXTENDED UNILATERAL 15800 23700 31600 30 FOREHEAD EXPLORATION 16700 25050 33400 31 FOREIGN BODY REMOVAL FROM WOUNDS - DEEP 1170 1755 2340 32 FRACTURE SETTING NASAL BONE 7200 10800 14400 33 GLOMUSJUGULARE TUMOR 22100 33150 44200 34 HA TRIAL FITING 540 810 1080 35 HEARING AID CONSULTATION 300 450 600 36 HEMIGLOSSECTOMY - GENERAL SURGERY 22100 33150 44200 37 HEMI GLOSSECTOMY WITH RADICAL NECK DESECTION 22100 33150 44200 38 HERNIA LARYNGECTOMY 13200 19800 26400 39 HYPOPHARYNGOSCOPY EXAM 3200 4800 6400 40 IMPEDENCE 360 540 720 41 LARYNGECTOMY WITH BLOCK DISSECTION 27600 41400 55200 42 LARYNOGOFISSURE 13200 19800 26400 43 LIMITED GLOSSECTOMY 7900 11850 15800 44 TURBIMECTOMY LOWER ( BILATERAL ) 3000 4500 6000 45 MASTOIDECTOMY WITH TYMPANOPLASTY 16600 24900 33200 46 MICRO LARYNGEAL SURGERY 13200 19800 26400 47 TURBINECTOMY MIDDLE ( BILATERAL ) 3000 4500 6000 48 MODIFIED RADICAL MASTOIDECTOMY 16600 24900 33200 49 MYRINGOTOMY DOUBLE 6800 10200 13600 50 MYRINGOTOMY SINGLE 4800 7200 9600

Page 61 51 NASAL CAUTERY 1170 1755 2340 52 NASAL ENDOSCOPY 1170 1755 2340 53 ANTERIOR NASAL PACKING - UNILATERAL ( GENERAL SURGERY ) 2800 4200 5600 54 NASAL PACKING POST. 2800 4200 5600 55 NASAL PHARYNGO LARYNGO SCOPY 1500 2250 3000 56 OAE 630 945 1260 57 OBLITERATION 13200 19800 26400 58 OESOPHAGOSCOPY RIGID FOREIGN BODY REMOVAL 7200 10800 14400 59 OROANTRAL FISTULA REPAIR WITH FLAP 11100 16650 22200 60 OSSICULAPLASTY 22100 33150 44200 61 GLOSSECTOMY - PARTIAL ( GENERAL SURGERY ) 22100 33150 44200 62 PARTIAL MAXILLECTOMY 22100 33150 44200 63 PERITONSILLAR ABCESS 3200 4800 6400 64 PERITONSILLAR ABSCESS DRAINAGE WITH ANESTHESIA 7200 10800 14400 65 PERITONSILLAR ABSCESS DRAINAGE WITHOUT ANESTHESIA 2800 4200 5600 66 PLAY AUDIOMETRAY 540 810 1080 67 HEMIGLOSSECTOMY + RADICAL NECK DESECTION ( ENT ) 22100 33150 44200 68 RECONSTRUCTION OF EAR (CLOSE) 14500 21750 29000 69 RECONSTRUCTION OF EAR (OPEN) 19400 29100 38800 70 RETRO -PHARYNGEAL ABSCESS DRANAGE 13200 19800 26400 71 RHINOPLASTY (ENT) 19400 29100 38800 72 RHINOTOMY 16600 24900 33200 73 SELECTIVE GRINDING GRADE-II (PER TOOTH) 49500 74250 99000 74 SIS/TDT 540 810 1080 75 SPECIAL TESTS 270 405 540 76 SPEECH SESSION FOLLOW UP 270 405 540 77 SPEECH SESSION IST 360 540 720 78 SPLINT REMOVAL 2300 3450 4600 79 SPLIT EAR LOBULE BOTH 8800 13200 17600 80 SPLIT EAR LOBULE SINGLE 4500 6750 9000 81 SRT/SDS 360 540 720 82 STAPEDECTOMY MASTOID CAVITY 16600 24900 33200 83 SUBMUCONS DIATHERMY 3200 4800 6400 84 SUPRAGLOLTIE LARYNGECTOMY 13200 19800 26400 85 SURGERY FOR PARAPHARYNGEAL ABSCESS 6800 10200 13600 86 THYROPLASTY 11100 16650 22200 87 TONSILLER FLORA 5000 7500 10000 88 TOTAL LARYNGECTOMY 27600 41400 55200 89 TOTAL MAXILLECTOMY 27600 41400 55200 90 TRACHEAL RECONSTRUCTION 13200 19800 26400 91 TRACHEOTOMY 7200 10800 14400 92 TYMPANOTOMY 9500 14250 19000 93 UNILATERAL ANTRUM PUNCTURE 1170 1755 2340 94 UP3 LAZER 17800 26700 35600 95 UP3 RFA 1ST SITTING 8500 12750 17000 96 UP3 RFA SUBEQUENT SITTING 4500 6750 9000 97 VIDEO ENDOSCOPY 500 750 1000 98 NASAL CAUTERIZATION 1100 1650 2200 99 FIBEROPTIC LARNYGOSCOPY 3500 5250 7000 100 COCHLEAR IMPLANT 18000 27000 36000

Page 62 101 GUMS COSMETIC TREATMENT ( GRADE 2 ) 800 1200 1600 102 FESS BILATERAL 15000 22500 30000 103 FESS UNILATERAL 12000 18000 24000 104 MYRINGOPLASTY 15000 22500 30000 105 PTA 360 540 720 106 SEPTOPLASTY 12000 18000 24000 107 SEPTOPLASTY P 15000 22500 30000 108 SPEECH THARAPHY 360 540 720 109 VIDIAN NEURECTOMY 6000 9000 12000 110 EPLEYS MANEUVERS 3750 5625 7500 111 RFTVR ENT 60000 75000 100000 112 TYMPANOPLASTY 15000 25000 37500 113 TONSILLECTOMY 2430 2700 4050 114 TONGUE BIOPSY UDER LOCAL ANAESTHEIA 9000 11250 18000 115 LARYNGOSCOPY FLEXIBLE 1500 2250 3000

Page 63 NEPHROLOGY PROCEDURES

Page 64 Double Sl No Description Room Single Room Suite 1 HEMODIALYSIS UPTO 4HRS 3200 4500 4500 2 DIALYSIS FISTULA INTERVENTION 40000 40000 55000 3 HEMODIALYSIS UPTO 4 HRS WITH HIGH FLUX 4300 4300 5805 4 ADEQUACY TEST 1500 1500 2250 5 CAPD CATHETER IMPLANTATION 10100 10100 15150 6 CONTINUOUS RENAL REPLACEMENT THERAPY ( CRRT ) - DAILY MAINTENANCE 4000 4000 6000 7 DIALYSIS WITH SINGLE USE OF DIALYSER(EMERGENCY) (OPD) 4500 4500 4500 8 PERITONEAL EQUILIBRIUM TEST (PET) 1500 1500 2250 9 KIDNEY BIOPSY (P) 4000 30000 45000 10 SLED 8Hrs. 8500 8500 12750 11 SLED 12 Hrs. 12000 12000 18000 12 CAPD TRG 10000 10000 15000 13 BCM Study (Body Composite Monotiring) 1500 1500 2250 14 CAPD Catheter 500 500 750 15 DIALYSIS CATHERISATION (JUGLAR/SUBCLAVIAN/FEMORAL) 3500 3500 5250 16 Kidney Biopsy (Dayacare) 30000 17 AV Fistula (Daycare) 30000 18 Permacath Package (Others) 20000 19 Permacath Removal Package 4000 20 CRRT Initation 30000 21 Permacath Package (Palindrome) 30000 22 HEMODIALYSIS (VIP) OPD 4400 23 HEMODIALYSIS (ISOLATION) OPD 4000

Page 65 GYNECOLOGY PROCEDURES

Page 66 Double Dlx Single Dlx Sl No Description Suite Room Room 1 ABDOMINAL HYSTERECTOMY ( GENERAL SURGERY ) 45000 65000 97500 2 ABORTION - MIDTRIMESTER 6500 9750 13000 3 ADHESIOLYSIS ( LABIAL ) ( PEDIATRIC ) 14900 22350 29800 4 AMNIOCENTESIS 5000 7500 10000 5 AMNIOINFUSION 4000 6000 8000 6 ASPIRATION OF CYST - SMALL ( PEDIATRICS ) 3000 4500 6000 7 BIOPSY ( LAPAROSCOPIC ) 6900 10350 13800 8 BURCH COLPOSUSPENSION ( LAPAROSCOPIC ) 19800 29700 39600 9 CERVICAL BIOPSY 5000 7500 10000 10 CERVICAL CONE BIOPSY 5000 7500 10000 11 CERVICAL CRYOCAUTERY 10000 13500 20250 12 CERVICAL POLYPECTOMY 5500 8250 11000 13 COLPOSCOPY 2100 3150 4200 14 CRYOTHERAPY/CAUTERY 2000 3000 4000 15 CURETTAGE FRACTIONAL 3500 5250 7000 16 CYSTOCOELE REPAIR 5900 8850 11800 17 DIAGNOSTIC HYSTEROSCOPY WITH IUCD REMOVAL 6900 10350 13800 18 DIAGNOSTIC LAPAROSCOPY LEVEL -1 WITH OR WITHOUT CHROMOPERTUBATION 5900 8850 11800 19 DIAGNOSTIC LAPROSCOPY WITH BIOPSY ( PEDIATRICS ) 8900 13350 17800 20 DILATATION AND CURETTAGE ( DNC ) 3600 5400 7200 21 ECTOPIC PREGNANCY (LAPAROSCOPIC PROCEDURE) 13900 20850 27800 22 END TO END ANASTOMOSIS ( BILATERAL ) 14900 22350 29800 23 ENDOMETRIOTIC SPOTS ABLATION ( LAPAROSCOPIC ) 11900 17850 23800 24 ENTEROCELE REPAIR - LAPAROSCOPIC ( OBSTETRICS AND GYNECOLOGY ) 19800 29700 39600 25 EPISIOTOMY REPAIR 3000 4500 6000 26 EXAMINATION UNDER ANESTHESIA ( EUA ) + NEEDLING ( OBSTETRICS AND GYNECOLOGY ) 3000 4500 6000 27 FENTON'S PROCEDURE ( VAGINAL RECONSTRUCTION ) 5900 8850 11800 28 FIMBRIOLYSIS ( LAPAROSCOPIC ) 13900 20850 27800 29 FORTHERGILL 11900 17850 23800 30 HEMATOCOLPOS DRAINAGE 3000 4500 6000 31 HISTEROSALPINGOGRAPHY ( HSG ) 540 810 1080 32 HYMEN INCISION 3000 4500 6000 33 HYSTERECTOMY LAPAROSCOPIC ( FOR SEVERE EMDOMETRIOSIS ) 24800 37200 49600 34 HYSTERECTOMY RADICAL ( CARCINOMA CERVIX ) 29700 44550 59400 35 HYSTEROSCOPIC MYOMECTOMY ( LARGE ) 14900 22350 29800 36 HYSTEROSCOPIC MYOMECTOMY ( SMALL ) 14900 22350 29800 37 HYSTEROSCOPY (DIAGNOSTIC) 3500 5250 7000 38 HYSTEROSCOPY ADHESIOLYSIS 11900 17850 23800 39 HYSTEROSCOPY DIAGNOSTIC ( WITH / WITHOUT BIOPSY ) 6900 10350 13800 40 HYSTEROTOMY 11900 17850 23800 41 INTRA UTERINE CONTRACEPTIVE DEVICE ( IUCD ) INSERTION 1170 1755 2340 42 INTRA UTERINE CONTRACEPTIVE DEVICE ( IUCD ) REMOVAL 540 810 1080 43 INTRAUTERINE INSEMINATION ( IUI ) 2000 3000 4000 44 LABIAL CYST EXCISION 3500 5250 7000 45 LAPARATOMY ( FOR OVARIAN CANCER ) 29700 44550 59400 46 LAPAROSCOPE ASSISTED VAGINAL HYSTERECTOMY ( LAVH ) 21800 32700 43600 47 LAPAROSCOPE ASSISTED VAGINAL HYSTERECTOMY ( LAVH ) + ADHESIOLYSIS 26300 39450 52600 48 LAPAROSCOPIC OVARION BIOPSY 8900 13350 17800 49 LAPAROSCOPIC SALPINGO-OPHORECTEMY (PEDIATRIC SURGERY) 11900 17850 23800 50 LAPAROSCOPIC STERILIZATION - (P) 5000 7500 10000

Page 67 51 LAPAROSCOPY - OPERATIVE ( FOR ENDOMETRIOSIS ) 13900 20850 27800 52 LAPAROTOMY ( OBSTETRICS AND GYNECOLOGY) 14900 22350 29800 53 LAPAROTOMY + THORACOTOMY + EXCISION OF DUPLCATION CYST (PEDIATRIC SURGERY) 9900 14850 19800 54 LAPAROTOMY FOR ECTOPIC PREGNANCY 14900 22350 29800 55 LARGE LOOP EXCISION OF TRANSFORMATION ZONE (LLETZ) 5000 7500 10000 56 LE FORTS OPERATION (GENITAL PROLAPSE) 8900 13350 17800 57 LOST INTRA UTERINE CONTRACEPTIVE DEVICE ( IUCD ) REMOVAL - LAPAROSCOPIC 9900 14850 19800 58 LOWER SEGMENT CESAREAN SECTION ( LSCS ) 20000 25000 37500 59 MANCHESTER 11900 17850 23800 60 MANCHESTER REPAIR ( FOTHERGILL OPERATION ) 11900 17850 23800 61 MARSUPIALIZATION ( OBSTETRICS & GYNAECOLOGY ) 3500 5250 7000 62 MCDONALD'S SUTURING 3500 5250 7000 63 MEDICAL TERMINATION OF PREGNANCY ( MTP ) + STERLIZATION ( LAPAROSCOPIC ) 11900 17850 23800 64 MULTI LOAD 500 750 1000 65 MYOMECTOMY - LAPAROSCOPIC ( OBSTETRICS AND GYNECOLOGY ) 16800 25200 33600 66 MYOMECTOMY ( LAPAROSCOPIC ) - CARDIOTHORACIC & VASCULAR SURGERY 19800 29700 39600 67 NEOSALPINGOSTOMY ( LAPAROSCOPIC ) 13900 20850 27800 68 NORMAL DELIVERY PACKAGE - GIPSA PKG 10000 15000 22500 69 OOPHORECTOMY ( LAPAROSCOPIC ) 13900 20850 27800 70 OPEN HYSTRECTOMY (ABD/VAG) LEVEL 1 45000 65000 97500 71 OPEN HYSTRECTOMY (ABD/VAG) LEVEL 2 45000 65000 97500 72 OVARIAN CYSTECTOMY - SINGLE ( LAPAROSCOPIC ) 13900 20850 27800 73 PERINEAL TEAR SUTURING 3000 4500 6000 74 PERINEAL TEARS ( 3RD DEGREE ) REPAIR 3000 4500 6000 75 POLYPECTOMY ENDOMETRIAL ( PER VAGINAL ) 3000 4500 6000 76 POST COITAL TEST (PCT) 630 945 1260 77 RECTOCOELE - REPAIR 5900 8850 11800 78 RECTOVAGINAL FISTULA REPAIR - 3RD DEGREE 11900 17850 23800 79 RVF REPAIR 10400 15600 20800 80 SALPINGO OOPHORECTOMY LAPAROSCOPIC - RIGHT 14900 22350 29800 81 SALPINGOSTOMY ( LAPAROSCOPIC ) 14900 22350 29800 82 SLING PROCEDURE (FOR URINARY STRESS INCONTINENCE) 17400 26100 34800 83 STERILIZATION ABDOMINAL 5000 7500 10000 84 SUCTION AND EVACUATION 5600 8400 11200 85 THERMACHOICE UTERINE BALLOON THERAPY 10900 16350 21800 86 TOTAL ABDOMINAL HYSTERECTOMY + SALPINGO OOPHORECTOMY ( RIGHT SIDE ) - COMPLEX 19800 29700 39600 87 TOTAL ABDOMINAL HYSTERECTOMY LAPAROSCOPIC ( TLAH ) 14900 22350 29800 88 TOTAL LAPAROSCOPIC HYSTERECTOMY 45000 65000 97500 89 TRANS ABDOMINAL PROCEDURE FOR URINARY STRESS INCONTINENCE 16400 24600 32800 90 TRANSCERVICAL RESECTION OF ENDOMETRIUM ( TCRE ) 12400 18600 24800 91 TRANSVERSE VAGINAL SEPTUM EXCISION (FOR HEMATOCOLPOS) 5900 8850 11800 92 TUBAL CANNULATION ( HYSTEROSCOPIC ) 14900 22350 29800 93 TUBAL CANNULATION ( OPEN ) 17400 26100 34800 94 TUBAL LIGATION ( LAPAROSCOPIC ) 5500 8250 11000 95 TUBAL RECANALIZATION - LAPAROSCOPIC ( GENERAL SURGERY ) 19800 29700 39600 96 TUBOPLASTY ( LAPAROSCOPIC ) 19800 29700 39600 97 URETHRAL CARUNCLE EXCISION ( OBSTETRICS AND GYNECOLOGY ) 3000 4500 6000 98 URETHRAL FISTULA CLOSURE 11900 17850 23800 99 UTERUS EVACUATION 3500 5250 7000 100 VAGINAL EXPLORATION 3000 4500 6000

Page 68 101 VAGINAL FOREIGN BODY REMOVAL 3100 4650 6200 102 VAGINAL HYSTERECTOMY 17800 26700 35600 103 VAGINAL HYSTERECTOMY (NON DESCENT) 19800 29700 39600 104 VAGINAL HYSTERECTOMY + REPAIR 17800 26700 35600 105 VAGINAL MYOMECTOMY 16800 25200 33600 106 VAGINAL REPAIR ( ANTERIOR + POSTERIOR ) 10900 16350 21800 107 VAGINOPLASTY ( FOR VAGINAL AGENESIS ) 19800 29700 39600 108 VAULT REPAIR ( POST HYSTERECTOMY ) 16800 25200 33600 109 VENTEROSUSPENSION ( LAPAROSCOPIC ) OF UTERUS ALONE 10400 15600 20800 110 VENTRAL SUSPENSION OF UTERUS ( LAPAROTOMY ) 10400 15600 20800 111 VESICOVAGINAL FISTULA ( VVF ) REPAIR - OBSTETRICS AND GYNECOLOGY 18200 27300 36400 112 VESICOVAGINAL FISTULA (SIMPLE) 19800 29700 39600 113 VULVAL BIOPSY 3200 4800 6400 114 VULVAL HAEMATOMA ( POST DELIVERY ) EVACUATION 3500 5250 7000 115 VULVAL HEMATOMA DRAINAGE + VAGINAL INJURY REPAIR 3500 5250 7000 116 VULVECTOMY RADICAL 11900 17850 23800

Page 69 LABORATORY TEST CHARGES

Page 70 S. No. Description Sharing Single Suite 1 LIPOPROTEIN (A) 1033 1550 2067 2 DIGOXIN LEVEL (SERUM) 844 1267 1689 3 LIDOCAINE 14267 21400 28533 4 24HR INSULIN INITIATION / MODIFICATION 883 1325 1767 5 MICROALBUMINURIA, URINE (CU0512-SRL) 89 133 178 6 VMA 3706 5558 7411 7 CA 19.9 (P.C.M) 1467 2200 2933 8 HOMOCYSTEINE 844 1267 1689 9 OSMOLALITY URINE 267 400 533 10 PAP SMEAR 561 842 1122 11 PROTEIN - C 3500 5250 7000 12 LIPASE 1333 2000 2667 13 THYROID ANTIBODIES -ANTI TPO, ANTI TG 2411 3617 4822 14 HBV DNA PCR QUANTITATIVE 10489 15733 20978 15 DENGUE SEROLOGY 1344 2017 2689 16 URINE PROTEIN - URINE CREATININE 200 300 400 17 URINE CREATININE 100 150 200 18 URINARY CALCIUM 144 217 289 19 BONE MERROW ASSESSMENT 639 958 1278 20 MEDIUM TISSUE BIOPSY 707 1060 1413 21 1, 25-DIHYDROXY VITAMIN D3 EIA (8822G-SRL) 2922 4383 5844 22 GLOMERULAR FILTRATION RATE ( GFR ) DETERMINATION BY PLASMA SAMPLE METHOD 1156 1733 2311 23 PUS-AFB(C/S) 617 925 1233 24 ASLO 322 483 644 25 PERICARDIAL FLUID-AFB STAIN 533 800 1067 26 SPUTUM-AFB STAIN 533 800 1067 27 ASCITIC FLUID -GRAM STAIN 178 267 356 28 CLOSTRIDIUM DIFFICILE TOXIN A/B 1833 2750 3667 29 T B PCR (MYCOREAL) 2261 3392 4522 30 BLOOD CULTURE - BACTALERT AND SUSCEPTIBILITY By SRL 1880 2820 3760 31 BLOOD CULTURE FUNGUS By SRL 904 1357 1809 32 SPUTUM CULTURE By SRL 367 550 733 33 THROAT SWAB By SRL 367 550 733 34 LINE TIP AEROBIC CULTURE By SRL 733 1100 1467 35 SKIN TEST-MANTOUX By SRL 122 183 244 36 URINE CULTURE By SRL 1350 2025 2700 37 FUNGUS CULTURE By SRL 1860 2790 3720 38 STOOL CULTURE By SRL 367 550 733 39 BLOOD - AEROBIC (CULTURE) 767 1150 1533 40 NECK LINE TIP-AFB(C/S) 617 925 1233 41 BODY FLUIDS ROUTINE 367 550 733 42 STOOL OCCULT BLOOD 100 150 200 43 URINE MICROSCOPIC 100 150 200 44 HCT 89 133 178 45 RBC. 56 83 111 46 SICKLE CELL PHENOMENON 189 283 378 47 CARDIAC D - DIMER TEST 1272 1908 2544 48 COAGULATION PROFILE 642 963 1284 49 MALARIA ANTIGEN (EDTA) 756 1133 1511 50 THERAPEUTIC PHLEBOTOMY 600 600 600

Page 71 51 APHERESIS TESTING 500 500 500 52 ANTIBODY TITRE 300 300 300 53 ANTIBODY DETECTION 1000 1000 1000 54 TRANSFUSION REACTION INVESTIGATION 3550 3550 55 ANTIBODY SCREENING 300 300 300 56 CROSS MATCHING 150 150 150 57 ANTI A + ANTI B TITRE 282 423 564 58 ANTI - D TITRE 293 440 587 59 AUTOLOGOUS WHOLE BLOOD 4706 7058 9411 60 PLATELET CONCENTRATE (RANDOM DONOR) 2823 4235 5647 61 PLASMA EXCHANGE PROCESS 24444 36667 48889 62 ARTERIAL BLOOD GAS 1030 1545 2060 63 VEIN BLOOD GAS 794 1192 1589 64 ANTIDIURETIC HORMONE 3483 5225 6967 65 ACETONE By SRL 489 733 978 66 HOMOGENTISIC ACID URINE 599 898 1198 67 ANTI-AQUAPORIN-4 (NMO-IGG) ANTIBODIES By SRL 5556 8333 11111 68 ABS TO EXTRACTABLE NUCLEAR AG: SS-A & SS-B 4444 6667 8889 69 MENUPAUSAL MONITORING PANEL 1778 2667 3556 70 LACTATE DEHYDROGENASE, SERUM 361 542 722 71 LACTATE DEHYDROGENASE, FLUID 306 458 611 72 HIRSUTISM EVALUATION PANEL 5278 7917 10556 73 PCOD PANEL By SRL 3889 5833 7778 74 INHIBIN B, LH, FSH & PROLACTIN 2889 4333 5778 75 BOH PANEL 5000 7500 10000 76 THYROID ANTIBODIES, SERUM 2278 3417 4556 77 AUTOIMMUNE HEPATITIS PANEL 1 4167 6250 8333 78 AUTOIMMUNE HEPATITIS PANEL 2 3306 4958 6611 79 IBD SCREENING PANEL 3667 5500 7333 80 LIVER & KIDNEY PROFILE 2750 4125 5500 81 BICARBONATE, SERUM By SRL 440 600 800 82 IMMUNOGLOBULIN 1722 2583 3444 83 ACUTE MYELOID LEUKEMIA PANEL 9889 14833 19778 84 BONE MARROW ASPIRATION By SRL 856 1283 1711 85 TOTAL P1NP 1611 2417 3222 86 CELIAC PROFILE 7222 10833 14444 87 BLOOD UREA NITROGEN, SERUM 428 642 856 88 BLOOD UREA NITROGEN, 24HRS URINE 400 600 800 89 ANTIPHOSPHOLIPID EVAL 5225 7125 9500 90 BILIRUBIN, TOTAL, SERUM 278 417 556 91 BLEEDING TIME & CLOTTING TIME 233 350 467 92 ANTI-NUCLEAR AB-IFA, HEP2, SERUM 1710 2565 3420 93 ANTI PARIETAL CELL ANTIBODIES (APCA) 2333 3500 4667 94 ANTIMITOCHONDRIAL ANTIBODIES, AMA 1889 2833 3778 95 ANTISMOOTH MUSCLE ABS (IFA), SERUM 1889 2833 3778 96 ASCA IgG, SERUM 2667 4000 5333 97 ANTI-THYROGLOBULIN ANTIBODIES 1650 2475 3300 98 ASCA IgA, SERUM 2667 4000 5333 99 LIVER-KIDNEY-MICRO ABS 1889 2833 3778 100 COOMB'S TEST, DIRECT, BLOOD 428 642 856

Page 72 101 INDIRECT COOMBS TEST, SERUM 489 733 978 102 RH ANTIBODY TITER By SRL 794 1192 1589 103 CHOLESTEROL HDL, SERUM 289 433 578 104 G-6-PD ACTIVITY, BLOOD 917 1375 1833 105 GLUCOSE TOLERANCE TEST (GTT) - 8 826 1238 1651 106 GLUCOSE TOLERANCE TEST (GTT-2) 183 275 367 107 GLUCOSE TOLERANCE TEST, PLASMA FLUORIDE By SRL 817 1115 1486 108 G-6-PD, QUANTITATIVE, BLOOD 636 953 1271 109 GESTATIONAL GLUCOSE TOLERANCE-4 428 642 856 110 ANTI-GLOMERULAR BASEMENT MEMBRANE IgG ANTIBODIES 1806 2708 3611 111 CRYOGLOBULIN, SERUM 989 1483 1978 112 ERYTHROPOIETIN, SERUM 1917 2875 3833 113 CARDIAC ENZYME PANEL, SERUM By SRL 3000 4500 6000 114 ANTI-ISLET CELL ANTIBODIES, SERUM 2444 3667 4889 115 ANTI OVARY ANTIBODIES (AOA) By SRL 3056 4583 6111 116 CHLORIDE, SERUM 202 303 404 117 CHLORIDE, FUILD 159 238 318 118 CHLORIDE, URINE 269 403 538 119 BODY FLUID AEROBIC CULTURE By SRL 1730 2595 3460 120 CULTURE BODY FLUID - BACTEC PLUS ANAEROBIC 684 1027 1369 121 DSDNA (WITH TITRES) 1222 1833 2444 122 ANTI CENTROMERE ANTIBODIES By SRL 2444 3667 4889 123 ANTI HISTONES ANTIBODIES 2667 4000 5333 124 ABS TO EXTRACTABLE NUCLEAR AG: SS-A 2333 3500 4667 125 CORONARY RISK PROFILE (LIPID PROFILE) 1230 1845 2460 126 ENDOTRACHEAL SECRETION AEROBIC CULTURE By SRL 623 935 1247 127 ABS TO EXTRACTABLE NUCLEAR AG U1SNRNP 2333 3500 4667 128 C DIFFICILE TOXIN A/B 2222 3333 4444 129 WATER TESTING By SRL 1200 1620 2430 130 EXTRACTABLE NUCLEAR ANTIGENS 6778 10167 13556 131 ABS TO EXTRACTABLE NUCLEAR AG: SCL-70 By SRL 2300 3105 4658 132 ANTIBODIES TO EXTRACTABLE NUCLEAR ANTIGENS 6333 9500 12667 133 TOTAL IgE, SERUM 826 1238 1651 134 THROMBOCHECK PANEL By SRL 18560 27840 37120 135 ACID PHOSPHATASE 611 917 1222 136 PLATELET ABS By SRL 7089 10633 14178 137 ANTIGLIADIN IgG ANTIBODIES, SERUM 3167 4750 6333 138 ABS EOSINOPHIL COUNT, BLOOD 98 147 196 139 URINARY EOSINOPHILS By SRL 134 202 269 140 SEMEN ANALYSIS, SEMEN 244 367 489 141 SEMEN FRUCTOSE, SEMEN 428 642 856 142 TRIPLE TEST By SRL 2611 3917 5222 143 DOUBLE MARKER TEST By SRL 2980 4470 5960 144 PAPANICOLAOU SMEAR By SRL 562 843 1124 145 LIQUIPREP CYTOLOGY-SEMI AUTOMATED 1330 1995 2660 146 QUADRUPLE MARKER By SRL 2933 4400 5867 147 STANDARD INTEGRATED TEST By SRL 5000 7500 10000 148 ECHINOCOCCUS IgG, SERUM 2056 3083 4111 149 CULTURE, URINE WITH SUSCEPTIBILITY 1260 1890 2520 150 ANTIGLIADIN IgA ANTIBODIES, SERUM 3167 4750 6333

Page 73 151 GAMMA GLUTAMYL TRANSFERASE, SERUM 356 533 711 152 ANTI MPO AUTOANTIBODIES 1611 2417 3222 153 ANTI PR3 AUTOANTIBODIES 1544 2317 3089 154 GLUCOSE POST-PRANDIAL PLASMA/SERUM/URINE 92 138 184 155 GLUCOSE, FLUID 98 147 196 156 GLUCOSE CHALLENGE TEST By SRL 92 138 184 157 GLUCOSE POST-PRANDIAL, PLASMA By SRL 133 200 267 158 GLUCOSE, FASTING, PLASMA / URINE By SRL 92 138 184 159 GLUCOSE RANDOM, PLASMA/SERUM By SRL 117 175 233 160 GLUCOSE RANDOM, SERUM By SRL 220 330 440 161 GLUCOSE FASTING SERUM By SRL 220 330 440 162 GLUCOSE, URINE By SRL 220 330 440 163 HLA TYPING CLASS I (SEROLOGY ) & CLASS II (PCR) By SRL 22000 30000 40000 164 URIC ACID, SERUM 340 510 680 165 URIC ACID, 24HRS URINE 257 385 513 166 IGG4 SUB CLASS (SERUM, NEPHELOMETRY) By SRL 7425 10125 13500 167 CREATININE SERUM 440 660 880 168 CREATININE EGFR By SRL 317 475 633 169 CREATININE 24HRS URINE 269 403 538 170 CREATININE CLEARANCE By SRL 508 762 1016 171 TOTAL PROTEIN,ALBUMIN,GLOBULIN, SERUM 214 322 429 172 TOTAL PROTEIN, CSF 538 807 1076 173 TOTAL PROTEIN, FLUID 37 55 73 174 TOTAL PROTEIN, SERUM 289 433 578 175 PROTEIN, 24HRS URINE 269 403 538 176 URINARY PROTEIN CREATININE RATIO 244 367 489 177 RHEUMATOID FACTOR, SERUM 281 422 562 178 ANTISTREPTOLYSIN O, SERUM By SRL 354 532 709 179 ACETONE, URINE By SRL 244 367 489 180 KIDNEY PANEL - 1 By SRL 780 1053 1580 181 ASPARTATE AMINOTRANSFERASE, SERUM 350 525 700 182 ALANINE AMINOTRANSFERASE, SERUM 350 525 700 183 HLA B27 BY PCR 3056 4583 6111 184 HLA-B27, FLOW CYTOMETRY, BLOOD 2111 3167 4222 185 TISSUE CROSSMATCH 2556 3833 5111 186 LIPID SCREEN 894 1342 1789 187 LIVER FUNCTION TEST (WITHOUT GGT) 636 953 1271 188 LIVER FUNCTION PROFILE By SRL 1810 2715 3620 189 ALDOLASE, SERUM 1100 1650 2200 190 MALARIA ANTIGEN DETECTION, BLOOD 960 1440 1920 191 MALARIAL PARASITE (M.P), BLOOD/SMEAR 420 630 840 192 LE CELL EXAMINATION, BLOOD 293 440 587 193 SICKLING TEST, BLOOD 220 330 440 194 COMPREHENSIVE ALLERGY PANELS - ADULTS 10920 16380 21840 195 COMPREHENSIVE ALLERGY - INFANCY 6556 9833 13111 196 ACETYLCHOLINE RECEPTOR AUTOANTIBODIES By SRL 4222 6333 8444 197 MYCOBACTERIA IgG, SERUM 764 1147 1529 198 MYCOBACTERIA IgM, SERUM 764 1147 1529 199 MYCOBACTERIA IgA, SERUM 764 1147 1529 200 ALLERGEN PANEL - NON VEG 4056 6083 8111

Page 74 201 FIBRINOGEN, PLASMA 1222 1833 2444 202 ALLERGEN PANEL - INDOOR 4722 7083 9444 203 ALLERGEN PANEL - OUTDOOR 4056 6083 8111 204 AFB BACTEC CULTURE By SRL 1680 2520 3360 205 AFB CULTURE (BLOOD) By SRL 1210 1815 2200 206 MYCOBACTERIUM CULTURE - BACTEC EXTRA PULMONARY By SRL 1265 1725 2300 207 AFB SUSCEPTIBILITY - MGIT 960 (5 DRUGS) By SRL 5667 8500 11333 208 AFB SUSCEPTIBILITY - MGIT 960 - 10 DRUG 8778 13167 17556 209 AFB STAIN & BACTEC CULTURE (3 SAMPLES) By SRL 210 AFB STAIN & BACTEC CULTURE (5 SAMPLES) By SRL 1711 2567 3422 211 AFB SUSC. SIRE PANEL 4722 7083 9444 212 L.DONOVONI BODIES DETECTION 1100 1650 2200 213 MICROFILARIA DETECTION, BLOOD 354 532 709 214 THYROID PANEL II, SERUM 1850 2775 3700 215 HISTOPATHOLOGY REPORT 1750 2625 3500 216 C4D IMMUNOFLUORESCENCE By SRL 217 RETURN OF PARAFFIN BLOCK/ SLIDE 122 183 244 218 RENAL BIOPSY HE + SPECIAL STAINS By SRL 2056 3083 4111 219 COMPLEMENT C3, SERUM 599 898 1198 220 HP - SKIN BIOPSY By SRL 1000 1500 2000 221 ELECTRON MICROSCOPY - TISSUE 12778 19167 25556 222 FROZEN SECTION {4(122)} By SRL 3795 5175 6900 223 COMPLEMENT C4, SERUM 599 898 1198 224 TOTAL IgG By SRL 764 1147 1529 225 TOTAL IgA By SRL 794 1192 1589 226 LARGE SPECIMEN (ONE BIG/TWO SMALL), TISSUE/PB 3250 4875 6500 227 TOTAL IgM By SRL 1342 2013 2684 228 BONE HISTOPATHOLOGY 733 1100 1467 229 ALBUMIN, SERUM 176 240 320 230 ALBUMIN, FLUID 99 135 180 231 MEDIUM BIOPSY SPECIMEN, TISSUE/PARAFFIN BLOCK 2510 3765 5020 232 ALPHA-1-ANTITRYPSIN, SERUM 1944 2917 3889 233 FINE NEEDLE ASPIRATION (CYTOLOGY SMEARS), SMEARS 630 945 1260 234 FNAC, SLIDE EXAMINATION 1270 1905 2540 235 CYTOLOGY FOR MALIGNANT CELLS 367 550 733 236 CERULOPLASMIN, SERUM 1167 1750 2333 237 FINE NEEDLE ASPIRATION CYTOLOGY, SMEARS 917 1375 1833 238 TRANSFERRIN, SERUM 1211 1817 2422 239 HAPTOGLOBIN By SRL 3889 5833 7778 240 BILIRUBIN, DIRECT, SERUM 278 417 556 241 BILIRUBIN (TOTAL, DIRECT, INDIRECT), SERUM 278 417 556 242 IMMUNOFLUORESCENCE ASSAY By SRL 3889 5833 7778 243 HISTOPATH + IgG, IgA, IgM, C3 By SRL 3333 5000 6667 244 DIRECT LDL CHOLESTEROL, SERUM 342 513 684 245 C-REACTIVE PROTEIN, SERUM By SRL 500 750 1000 246 CRP, SEMI-QUANTITATIVE, SERUM By SRL 354 532 709 247 HIGH SENSITIVITY C-REACTIVE PROTEIN 1010 1515 2020 248 PROSTATE SEXTANT CORE BIOPSY 3178 4767 6356 249 RHEUMATOID FACTOR QUANTITATIVE, SERUM By SRL 250 VANCOMYCIN 5781 8672 11562

Page 75 251 DIGOXIN, SERUM 878 1317 1756 252 COMPLEMENT C1q 1111 1667 2222 253 OLIGOCLONAL BANDS, CSF 3789 5683 7578 254 PHENOBARBITAL 878 1317 1756 255 THEOPHYLLINE By SRL 826 1238 1651 256 ELECTROLYTES (NA/K/CL) SERUM 795 1193 1590 257 ELECTROLYTES (NA/K/CL) 24HRS URINE 477 715 953 258 ERYTHRO SEDIMENTATION RATE, BLOOD 133 200 267 259 FERTILITY PANEL, SERUM 2611 3917 5222 260 PROTEIN ELECTROPHORESIS, SERUM 672 1008 1344 261 ELECTROPHORESIS, CSF 703 1055 1407 262 ALBUMIN+GLOBULIN+A/G RATIO, SERUM 171 257 342 263 ELECTROPHORESIS,URINE 703 1055 1407 264 BENCE-JONES PROT, 24HRS URINE 550 825 1100 265 PHOSPHORUS, SERUM 299 449 598 266 PHOSPHORUS, 24HRS URINE 202 303 404 267 CH-50 (COMPLEMENT, TOTAL), SERUM By SRL 3850 5198 7796 268 ACUTE LYMPHOBLASTIC LEUKEMIA PANEL 9889 14833 19778 269 ACUTE LEUKEMIA PANEL 8333 12500 16667 270 CHR LYMPHOPROLIFERATIVE DISORDERS 10833 16250 21667 271 NATURAL KILLER PANEL 3889 5833 7778 272 LYMPHOCYTE SUBSET (T-CELLS), BLOOD By SRL 1650 2475 3300 273 LYMPHOCYTE SUBSET ENUMERATION, BLOOD 2056 3083 4111 274 LYMPHOCYTE SUBSET(CD4 PERCENTAGE & ABSOLUTE COUNT) 794 1192 1589 275 KAPPA LIGHT CHAIN QUANTITATIVE, RANDOM URINE By SRL 2444 6000 8000 276 LAMBDA LIGHT CHAIN QUANTITATIVE, RANDOM URINE By SRL 4400 8000 277 LYMPHOCYTE ENUMERATION By SRL 6050 8250 11000 278 PNH DIAGNOSIS (FLOW CYTOMETRY) 7222 10833 14444 279 CD25 (IL2 RECEPTOR) By SRL 280 CD38-PERCENT 2506 3758 5011 281 CD-5, PERCENT By SRL 3080 4200 5600 282 AMH / MIS 2000 3000 4000 283 ANTI PHOSPHOLIPID IgG ANTIBODIES By SRL 159 238 318 284 SAAG FOR ASCITIC FLUID By SRL 286 390 520 285 ANTI ß2 GLYCOPROTEIN 1 IgM 550 825 1100 286 ANTI ß2 GLYCOPROTEIN 1 IgG 550 825 1100 287 GALACTOMANNAN By SRL 4722 7083 9444 288 SERUM LIGHT CHAINS (KAPPA & LAMBDA) 6111 9167 12222 289 ANTI-PHOSPHOLIPID IGM ANTIBODY By SRL 1222 1833 2444 290 SCRUB TYPHUS ANTIBODIES RAPID By SRL 850 1275 1700 291 THROMBOCHECK TOTAL By SRL 28380 38700 51600 292 HPV TYPING BY SEQUENCING 1889 2833 3778 293 HPV DNA DETECTOR 2389 3583 4778 294 HPV DUO 2500 3750 5000 295 PAP DUO-LBC 2556 3833 5111 296 ER/PGR,IHC (ESTROGEN RECEPTOR), TISSUE/PB By SRL 2083 3125 4167 297 ANTINEUTROPHIL CYTOPLASMIC AB(ANCA), SERUM 1889 2833 3778 298 IC SURVEILLANCE (MISCELLANEOUS) By SRL 1000 1350 2025 299 APOLIPOPROTEIN - A1, SERUM 581 872 1162 300 APOLIPOPROTEIN - B, SERUM 581 872 1162

Page 76 301 FACTOR VIII ACTIVITY, PLASMA 2444 3667 4889 302 FACTOR IX ACTIVITY, PLASMA 2111 3167 4222 303 FACTOR XIII ACTIVITY, PLASMA 1333 2000 2667 304 LH, FSH & PROLACTIN, SERUM 1167 1750 2333 305 EBV TETRA PANEL 6444 9667 12889 306 PARVOVIRUS B19 IgG ANTIBODIES, SERUM 3000 4050 6075 307 PARVOVIRUS B19 IgM ANTIBODIES, SERUM 3000 4050 6075 308 BORRELIA BURGDORFERI IgG, SERUM 1667 2500 3333 309 BORRELIA BURGDORFERI IgM ANTIBODIES, SERUM 1722 2583 3444 310 HETEROPHILE ANTIBODIES (HA), SERUM 1000 1500 2000 311 EBV (VCA) IGG, SERUM By SRL 1944 2917 3889 312 N-TERMINAL PRO B-TYPE NATRIURETIC PEPTIDE 4690 7035 9380 313 METHYLMALONIC ACID, URINE 1778 2667 3556 314 EBV (EA) IgG, SERUM 1778 2667 3556 315 TORCH IgM EVALUATION, SERUM 1500 2250 3000 316 ANTI-NMDA RECEPTOR ENCEPHALITIS IGG ABS BY IFA 8000 10800 16200 317 TOXOPLASMA ANTIBODIES, SERUM 1210 1815 2420 318 EBV (NA) IgG, SERUM 1778 2667 3556 319 EBV (NA) IgM, SERUM 1778 2667 3556 320 ASPERGILLUS ANTIBODIES, SERUM 2556 3833 5111 321 ASPERGILLUS FUMIGATUS DNA DETECTION 7556 11333 15111 322 CANDIDA ALBICANS DNA DETECTION 7778 11667 15556 323 RAAS SCREENING PANEL (Plasma Renin,Aldosterone) 5111 7667 10222 324 HISTOPLASMA ANTIBODIES (FLUID) 5111 7667 10222 325 STOOL: OVA & PARASITE 141 212 282 326 STOOL FOR PH AND REDUCING SUBSTANCE 98 147 196 327 OVA & PARASITE: COCCIDIA 459 688 918 328 VDRL, SERUM By SRL 122 183 244 329 STOOL FOR OCCULT BLOOD 134 202 269 330 STOOL - HANGING DROP METHOD 208 312 416 331 MYCOBACTERIUM SPECIATION By SRL 3575 4875 6500 332 H.PYLORI CULTURE 1100 1650 2200 333 LEGIONELLA SPP.CULTURE 1100 1650 2200 334 TBFERON DETECTION By SRL 2333 3500 4667 335 QUANTIFERON TB GOLD 2333 3500 4667 336 CLOSTRIDIUM DIFFICILE TOXIN A/B, STOOL By SRL 2322 3483 4644 337 CULTURE: NEISSERIA GONORRHOEAE 878 1317 1756 338 MYCOREAL By SRL 2333 3500 4667 339 GRAM STAIN By SRL 196 293 391 340 FUNGAL SMEAR 611 917 1222 341 GONOCOCCAL SMEAR 306 458 611 342 BUCCAL SMEAR 276 413 551 343 LEPRA SMEAR 202 303 404 344 MYCOTECT 1944 2917 3889 345 HEPATITIS C ANTIBODIES, SERUM 2140 3210 4280 346 HEPATITIS A IgM, SERUM 1139 1708 2278 347 HEPATITIS B CORE ANTIBODIES (TOTAL), SERUM 1083 1625 2167 348 HEPATITIS B SURFACE ABS (QUANT), SERUM 703 1055 1407 349 HEPATITIS Be ANTIBODIES, SERUM By SRL 794 1192 1589 350 HEPATITIS Be ANTIGEN, SERUM 794 1192 1589

Page 77 351 HEPATITIS B CORE IgM, SERUM 1028 1542 2056 352 HEPATITIS DELTA ANTIBODIES, SERUM By SRL 2389 3583 4778 353 HEPATITIS A ANTIBODIES, SERUM 1944 2917 3889 354 HEP B VIRUS EVALUATION 3556 5333 7111 355 HEP B EVALUATION 1389 2083 2778 356 HEP A & B EVALUATION 6667 10000 13333 357 HGV RT-PCR By SRL 4167 6250 8333 358 HEPATITIS E IgG, SERUM 1528 2292 3056 359 HEPATITIS E IgM, SERUM 1500 2250 3000 360 HEPATITIS B SURFACE ANTIGEN, SERUM By SRL 1110 1665 2220 361 RUBELLA IgM, SERUM 826 1238 1651 362 HAV RNA PCR 3556 5333 7111 363 ALPHA THALASSEMIA PCR 2444 3667 4889 364 CYTOMEGALOVIRUS IgM, SERUM 826 1238 1651 365 SICKLE CELL PCR By SRL 2500 3375 5063 366 CHIKUNGUNYA IgM ANTIBODIES RAPID 611 917 1222 367 COXASACKIE VIRUS IGG 3500 5250 7000 368 COXSACKIE ANTIBODY - IGG, SERUM By SRL 369 COXASACKIE VIRUS IGM 3500 5250 7000 370 COXSACKIE ANTIBODY - IGM, SERUM By SRL 371 ECHOVIRUS ANTIBODIES PANEL, SERUM 7222 10833 14444 372 HIV ABS,IMMUNOBLOT (HIV CONFIRMATION) 3222 4833 6444 373 VITAMIN B12 LEVEL, SERUM 1650 2475 3300 374 BREAST MONITOR I, SERUM 2000 3000 4000 375 ALLERGEN - FOOD PANEL 2 2833 4250 5667 376 ALLERGEN - DUST PANEL 2528 3792 5056 377 ALLERGEN - MILK, SERUM By SRL 1200 1800 2400 378 ALLERGEN - ALTERNARIA TENUIS, SERUM 1430 1950 2600 379 ALLERGEN - ASPERGILLUS FUMIGATUS 1100 1650 2200 380 ANTI-THYROID PEROXIDASE ANTIBODIES 826 1238 1651 381 ALLERGEN - GLUTEN 1100 1650 2200 382 ALLERGEN - FOOD PANEL 3 2833 4250 5667 383 ALLERGEN - FOOD PANEL 7 2944 4417 5889 384 ALLERGEN - BANANA 1430 1950 2600 385 ALLERGEN - BARLEY 1430 1950 2600 386 ALLERGEN - GREENPEPPER 1200 1620 2430 387 ALLERGEN - ALMOND, SERUM 1430 1950 2600 388 ADRENOCORTICOTROPIC HORMONE, PLASMA By SRL 1833 2750 3667 389 ACTH STIMULATION TEST, 1-HOUR, SERUM 2167 3250 4333 390 ALDOSTERONE 24 HR,URINE By SRL 5610 7650 10200 391 ALDOSTERONE, SERUM 2556 3833 5111 392 ALPHA-FETOPROTEIN, SERUM 733 1100 1467 393 ALPHA FETOPROTEIN, AMNIOTIC FLUID 935 1275 1700 394 ALLERGEN - ACACIA 1430 1950 2600 395 ANDROSTENEDIONE, SERUM 2167 3250 4333 396 ANGIOTENSIN CONVERTING ENZYME CSF By SRL 2000 3000 4000 397 ANGIOTENSIN CONVERTING ENZYME, SERUM 1056 1583 2111 398 CA 19-9, SERUM 1322 1983 2644 399 CA 125 (OVARIAN CANCER MONITOR), SERUM 1133 1700 2267 400 IMMUNOFIXATION EP, SERUM 6389 9583 12778

Page 78 401 IMMUNOFIXATION ELEC,CSF 7500 11250 15000 402 IMMUNOFIXATION EP,URINE 7500 11250 15000 403 CALCITONIN (THYROCALCITONIN), SERUM 2444 3667 4889 404 CORTISOL SERUM 770 1155 1540 405 CORTISOL,FREE,24HR URINE 611 917 1222 406 ADENOSINE DEAMINASE 599 898 1198 407 CA 15-3, SERUM 2450 3675 4900 408 C PEPTIDE, SERUM 1211 1817 2422 409 B2-MICROGLOBULIN, SERUM 452 678 904 410 B2-MICROGLOBULIN, URINE 1778 2667 3556 411 DEHYDROEPIANDROSTERONE, SERUM By SRL 2750 3750 5000 412 CYSTATIN C (QUANTITATIVE), SERUM 1167 1750 2333 413 DEHYDROEPIANDROSTERONE-S, SERUM 972 1458 1944 414 DIHYDROTESTOSTERONE, SERUM 2567 3850 5133 415 ESTRADIOL, SERUM ( E2) 520 780 1040 416 ESTRIOL, UNCONJUGATED( E3 ) 1167 1750 2333 417 PROGESTERONE, SERUM 672 1008 1344 418 FERRITIN, SERUM 1050 1575 2100 419 FOLLICLE STIMULATING HORMONE, SERUM 459 688 918 420 GASTRIN, SERUM 1556 2333 3111 421 GLYCOSYLATED HEMOGLOBIN BLOOD 826 1238 1651 422 GLYCOSYLATED HEMOGLOBIN, BLOOD By SRL 1170 1755 2340 423 ALLERGEN: AMOXICILLIN 1430 1950 2600 424 GROWTH HORMONE, SERUM 733 1100 1467 425 HCG, SERUM 750 1125 1500 426 ALLERGEN: AMPICILLIN 1430 1950 2600 427 PREGNANCY TEST, URINE 196 293 391 428 17-A-HYDROXYPROGESTERONE, SERUM 1589 2383 3178 429 INSULIN, SERUM 843 1265 1687 430 INSULIN, SERUM (POST-PRANDIAL) By SRL 431 GLUTAMIC ACID DECARBOXYLASE IgG ANTIBODIES, SERUM 6389 9583 12778 432 INSULIN LIKE GROWTH FACTOR - I, SERUM 3944 5917 7889 433 LUTEINIZING HORMONE, SERUM 459 688 918 434 PROLACTIN, SERUM 489 733 978 435 ALLERGEN - APPLE 1430 1950 2600 436 PLASMA RENIN 4833 7250 9667 437 SEX HORMONE BINDING GLOBULIN, SERUM 2389 3583 4778 438 ALLERGEN - SPINACH 1200 1620 2430 439 PROCALCITONIN By SRL 3500 5250 7000 440 FREE THYROXINE (FT4), SERUM By SRL 489 733 978 441 OSMOLALITY, SERUM By SRL 501 752 1002 442 OSMOLALITY, URINE By SRL 293 440 587 443 FREE TRIIODOTHYRONINE (FT3), SERUM 489 733 978 444 TESTOSTERONE, TOTAL, SERUM 642 963 1284 445 TESTOSTERONE,FREE/TOTAL, SERUM 2078 3117 4156 446 FREE TESTOSTERONE By SRL 1722 2583 3444 447 TSH 3RD GENERATION, SERUM 730 1095 1460 448 TOTAL TSH, SERUM 850 1275 1700 449 THYROGLOBULIN, SERUM 1656 2483 3311 450 ALLERGEN - DRUG ALLERGY 3194 4792 6389

Page 79 451 CARCINO EMBRYONIC ANTIGEN, SERUM 672 1008 1344 452 CARCINO EMBRYONIC ANTIGEN, BODY FLUID 764 1147 1529 453 SEROTONIN, SERUM By SRL 4300 5805 8708 454 PREGNANCY ASSOCIATED PLASMA PROTEIN A, SERUM 1533 2300 3067 455 ANTI - CCP ANTIBODIES 2590 3885 5180 456 ANTI CHROMATIN ANTIBODIES, SERUM 2078 3117 4156 457 ANTI SOLUBLE LIVER ANTIGEN, SERUM 1667 2500 3333 458 CATECHOLAMINES, PLASMA 7556 11333 15111 459 CATECHOLAMINES, URINE 7556 11333 15111 460 IMMUNOREACTIVE TRYPSINOGEN, DRIED BLOOD SPOT 367 550 733 461 TOTAL GALACTOSE, DRIED BLOOD SPOT 293 440 587 462 5-HYDROXYINDOLEACETIC ACID 2811 4217 5622 463 17-ALPHA-HYDROXYPROGESTERONE, DRIED BLOOD SPOT 276 413 551 464 METANEPHRINE-FREE, PLASMA (EDTA PLASMA, ELISA) By SRL 6050 8250 11000 465 METANEPHRINES By SRL 1889 2833 3778 466 VANILLYL MANDELIC ACID, URINE 3500 5250 7000 467 NEONATAL SCREENING PANEL - 3 489 733 978 468 INHIBIN B, SERUM 1978 2967 3956 469 HOMOCYSTEINE, SERUM/PLASMA By SRL 1056 1583 2111 470 TRIGLYCERIDES, SERUM 294 442 589 471 CHOLESTEROL, SERUM 200 300 400 472 NEWBORN SCREENING FOR ACYLCARNITINE-AMINOACIDS,DBS By SRL 4667 7000 9333 473 NEWBORN SCREENING FOR ACYLCARNITINE & AMINO ACIDS By SRL 4200 6300 8400 474 VALPROIC ACID, SERUM 826 1238 1651 475 LIPASE, SERUM 950 1425 1900 476 CARDIOLIPIN ANTIBODIES, SERUM 1389 2083 2778 477 ANTI CARDIOLIPIN ANTIBODIES IgG, SERUM 703 1055 1407 478 ANTI CARDIOLIPIN ANTIBODIES IgM, SERUM 703 1055 1407 479 ALLERGEN - AUBERGINE (BRINJAL) 1430 1950 2600 480 ALLERGEN - ECZEMA/GIT (Veg) PANEL 4278 6417 8556 481 ALLERGEN - ECZEMA/GIT 5833 8750 11667 482 ALLERGEN - RHINITIS/ASTHMA PANEL 4722 7083 9444 483 ALLERGEN - ASCARIS By SRL 1430 1950 2600 484 BRINJAL (SOLANUM MELONGE) By SRL 1430 1950 2600 485 ANIMAL MIX (EX1) By SRL 1430 1950 2600 486 TROPONIN I 856 1283 1711 487 TROPONIN T By SRL 1894 2842 3789 488 MICROALBUMINURIA, URINE By SRL 910 1365 1820 489 LIPOPROTEIN (a), SERUM 1167 1750 2333 490 AMMONIA By SRL 1039 1558 2078 491 AMINO ACID ANALYSIS, PLASMA 7778 11667 15556 492 AMINO ACID ANALYSIS, URINE RANDOM 8556 12833 17111 493 VITAMIN A BY HPLC, SERUM/ EDTA PLASMA 3222 4833 6444 494 VITAMIN B1 BY HPLC, SERUM/ EDTA PLASMA 2222 3333 4444 495 VITAMIN B2 BY HPLC, SERUM/ EDTA PLASMA 2444 3667 4889 496 VITAMIN B6 BY HPLC, SERUM/ PLASMA 2722 4083 5444 497 VITAMIN C BY HPLC, EDTA PLASMA 2556 3833 5111 498 VITAMIN E BY HPLC, SERUM/ EDTA PLASMA 3278 4917 6556 499 FOLIC ACID, SERUM 1100 1650 2200 500 RBC FOLATE, BLOOD 2056 3083 4111

Page 80 501 IRON, SERUM 403 605 807 502 TOTAL IRON BINDING CAPACITY, SERUM 870 1305 1740 503 FREE PSA By SRL 504 PROSTATE SPECIFIC ANTIGEN, SERUM 1330 1995 2660 505 PSA FREE & TOTAL, SERUM 1611 2417 3222 506 MYOGLOBIN By SRL 1778 2667 3556 507 CREATINE KINASE - MB, SERUM By SRL 1180 1770 2360 508 HAM'S (ACIDIFIED-SERUM) TEST, BLOOD 1167 1750 2333 509 HEMOGLOBIN VARIANT ANALYSIS, BLOOD 1630 2445 3260 510 PROTEIN C ACTIVITY, PLASMA 3611 5417 7222 511 PROTEIN S ACTIVITY, PLASMA By SRL 3611 5417 7222 512 AMYLASE, SERUM 398 597 796 513 AMYLASE, 24HRS URINE 508 762 1016 514 PARANEOPLASTIC DISORDER PROFILE 4722 7083 9444 515 PANCREATIC ELASTASE By SRL 5000 5000 5000 516 PROTHROMBIN TIME, PLASMA 600 900 1200 517 ACT PARTIAL THROMBO PLASTIN TIME(APTT) PLASMA 740 1110 1480 518 HEMOPHILIA PANEL 3333 5000 6667 519 ALKALINE PHOSPHATASE, SERUM 233 350 467 520 FRUCTOSAMINE 1028 1542 2056 521 CYFRA 21-1 3117 4675 6233 522 LIVER TRANSPLANT PANEL 1 By SRL 2970 4050 5400 523 PARATHYROID HORMONE (INTACT), SERUM/PLASMA 2210 3315 4420 524 CHROMOGRANIN A 6556 9833 13111 525 IGF-BP3 3889 5833 7778 526 RSV- RESPIRATORY SYNCYTIAL VIRUS-IGG By SRL 3333 5000 6667 527 RSV, IgM ANTIBODY 3333 5000 6667 528 ORGANIC ACIDS SCREEN, URINE 6389 9583 12778 529 CREATINE KINASE (CPK), SERUM 489 733 978 530 INHIBIN A 1944 2917 3889 531 ALLERGEN: APRICOT 1430 1950 2600 532 CYSTATIN C & GFR (CALCULATED FROM CYSTATIN C) By SRL 1589 2383 3178 533 TROPONIN T, HS By SRL 2530 3795 5060 534 BLOCK REVIEW/SLIDE REVIEW UPTO 8 BLOCKS OR SLIDES By SRL 7222 10833 14444 535 VGKC ANTIBODY (SERUM,IMMUNOFLUORESCENCE) By SRL 13000 17550 26325 536 MUSK ANTIBODY, MYASTHENIA GRAVIS (SERUM, RIA) By SRL 10556 15833 21111 537 ANIMAL DANDER PANEL By SRL 4950 6750 9000 538 COMPREHENSIVE ALLERGY SCREENING PANEL ADULT By SRL 6388 9582 12776 539 ALCOHOL (ETHANOL), URINE 2383 3575 4767 540 TETRAHYDROCANNABINOL, URINE 1100 1650 2200 541 PHENYTOIN, SERUM 826 1238 1651 542 ALCOHOL (EHTANOL) , SERUM By SRL 2695 3675 4900 543 ALCOHOL (ETHANOL), URINE By SRL 2222 3333 4444 544 PEPSINOGEN I & II By SRL 12375 16875 22500 545 CARBAMAZEPINE, SERUM 826 1238 1651 546 CA 72-4 By SRL 1944 2917 3889 547 METHAMPHETAMINE, URINE 1100 1650 2200 548 DRUGS OF ABUSE - 9 DRUGS 8060 12090 16120 549 DRUGS OF ABUSE - 6 DRUGS 2889 4333 5778 550 DRUGS OF ABUSE - 5 DRUGS 2211 3317 4422

Page 81 551 AMPHETAMINE, URINE 1100 1650 2200 552 BARBITURATES, URINE 1100 1650 2200 553 BENZODIAZEPINES, URINE 1100 1650 2200 554 CANNABINOIDS, URINE 1100 1650 2200 555 OPIATES,URINE 1100 1650 2200 556 URINE - PCP (PHENCYCLIDINE), URINE 1100 1650 2200 557 COCAINE - URINE 1100 1650 2200 558 KIDNEY STONE ANALYSIS 721 1082 1442 559 PORPHOBILINOGEN, URINE 1894 2842 3789 560 ST2 (GROWTH STIMULATION EXPRESSED GENE 2) By SRL 2222 3333 4444 561 VANCOMYCIN By SRL 6111 9167 12222 562 D-DIMER, PLASMA 1400 2100 2800 563 METHAEMOGLOBIN ESTIMATION, BLOOD 944 1417 1889 564 FIBRINOGEN DEGREDATION PRODUCTS (FDP), PLASMA 1444 2167 2889 565 THROMBIN TIME (T.T.), PLASMA 1056 1583 2111 566 CYCLOSPORINE A, EDTA WHOLE BLOOD 2944 4417 5889 567 URINARY OXALATE, 24HRS URINE 1878 2817 3756 568 ALLERGEN -PHADIATOP ADULT By SRL 1050 1418 2126 569 FIBROMETER NAFLD By SRL 3795 5175 6900 570 DIARRHEA PANEL (IMMUNOCOMPROMISED) By SRL 3500 5250 7000 571 CARBOHYDRATE DEFICIENT TRANSFERRIN (CDT) By SRL 1705 2325 3100 572 COLORECTAL CANCER PANEL By SRL 15180 20700 27600 573 GLIOMA PANEL By SRL 21450 29250 39000 574 ECHOSENS FIBROMETER VIRUS By SRL 3795 5175 6900 575 SCA PANEL By SRL 12760 17400 23200 576 ANTI-PHOSPHOLIPASE A2 RECEPTOR (PLA2R) IGG By SRL 5610 7650 10200 577 MRD FOR B ALL By SRL 17000 25500 34000 578 HLA PANEL REACTIVE ANTIBODIES (PRA) CLASS I By SRL 16500 22500 30000 579 HLA PANEL REACTIVE ANTIBODIES (PRA) CLASS II By SRL 16500 22500 30000 580 HLA PANEL REACTIVE ANTIBODIES (PRA) SCREEN By SRL 8800 12000 16000 581 DONOR SPECIFIC ANTIBODIES (DSA) CLASS I & II By SRL 16500 22500 30000 582 CALCIUM, SERUM 370 555 740 583 CALCIUM, 24HRS URINE 269 403 538 584 LEAD, BLOOD 1956 2933 3911 585 MAGNESIUM, SERUM 740 1110 1480 586 MAGNESIUM, 24HRS URINE 367 550 733 587 LITHIUM, SERUM 349 523 698 588 URINARY GLYCOSAMINOGLYCAN (GAG) QUANTITATION By SRL 3520 4800 6400 589 THALASSEMIA PROFILE 1433 2150 2867 590 MYOGLOBIN, SERUM By SRL 721 1082 1442 591 URINE SUPERSATURATION PANEL 2139 3208 4278 592 SCLERODERMA DIAGNOSTIC PROFILE 6600 9900 13200 593 STD DIAGNOSTIC PANEL 594 ARTHRITIS PANEL (RHEUMATOID ARTHRITIS PANEL) 2056 3083 4111 595 IMMUNOHISTOCHEMISTRY : FIVE MARKER By SRL 5400 8100 10800 596 IMMUNOHISTOCHEMISTRY : SEVEN MARKER By SRL 8100 12150 16200 597 IMMUNOHISTOCHEMISTRY : SINGLE MARKER By SRL 2970 4050 5400 598 IMMUNOHISTOCHEMISTRY : TEN MARKER AND ABOVE By SRL 9000 13500 18000 599 IMMUNOHISTOCHEMISTRY : THREE MARKER By SRL 5000 7500 10000 600 COMPREHENSIVE MYELOMA PROTEIN PANEL By SRL

Page 82 601 ABO GROUP & RH TYPE, EDTA WHOLE BLOOD By SRL 490 735 980 602 HB, TLC & DLC, BLOOD 459 688 918 603 HB, TLC, DLC & ESR 403 605 807 604 COMPLETE BLOOD COUNT, BLOOD 611 917 1222 605 COMPLETE BLOOD COUNT, BLOOD/SMEAR 660 990 1320 606 COMPLETE HEMOGRAM WITH ESR (CBC+PS+ESR) 900 1350 1800 607 HEMOGLOBIN & HEMATOCRIT, BLOOD By SRL 220 330 440 608 HEMOGLOBIN By SRL 111 167 222 609 WHITE CELL COUNT AND DIFFERENTIAL 360 540 720 610 PLATELET COUNT, EDTA WHOLE BLOOD By SRL 300 450 600 611 PERIPHERAL SMEAR EXAM, BLOOD 244 367 489 612 RETICULOCYTE COUNT, BLOOD 227 340 453 613 SYNOVIAL FLUID, ROUTINE 471 707 942 614 PERICARDIAL FLUID ANALYSIS 398 597 796 615 PERITONEAL FLUID, ROUTINE 159 238 318 616 ASCITIC FLUID, ROUTINE 471 707 942 617 CEREBROSPINAL FLUID, ROUTINE 471 707 942 618 PLEURAL FLUID, ROUTINE 471 707 942 619 FLUID, ROUTINE 477 715 953 620 URINE ANALYSIS 310 465 620 621 GASTRIC FLUID pH By SRL 22 33 44 622 Urine pH By SRL 22 33 44 623 SPERM ANTIBODIES 1222 1833 2444 624 SODIUM, SERUM 430 645 860 625 SODIUM (24HRS / SPOT URINE) By SRL 269 403 538 626 SODIUM, URINE 269 403 538 627 POTASSIUM SERUM 420 630 840 628 POTASSIUM (24HRS / SPOT URINE) By SRL 232 348 464 629 POTASSIUM URINE 232 348 464 630 ACID FAST BACILLI SMEAR By SRL 587 880 1173 631 FUNGAL STAIN 709 1063 1418 632 BCR/ABL GENE TRANSLOCATION 5278 7917 10556 633 BCR/ABL -QUANTITATIVE 6611 9917 13222 634 TUMOUR NECROSIS FACTOR (TNF) - ALPHA, SERUM By SRL 6722 10083 13444 635 AFB SUSC. SIREP PANEL 5111 7667 10222 636 CAMPYLOBACTER CULTURE 1500 2250 3000 637 ANAEROBIC CULTURE 889 1333 1778 638 CHROMOSOME ANALYSIS: HEMATOLOGICAL DISORDERS 3667 5500 7333 639 CHROMOSOME BREAKAGE TEST FANCONIS ANEMIA 6944 10417 13889 640 BLOOD LYMPHO CULTURE 2944 4417 5889 641 DOWN'S SYNDROME/ AMBIGUOUS EXTERNAL GENITALIA 2944 4417 5889 642 NEONATAL KARYOTYPING 2944 4417 5889 643 PHILADELPHIA CHROMOSOME 4389 6583 8778 644 ACTIVATED PROTEIN C RESISTANCE (APC-R), PLASMA By SRL 4389 6583 8778 645 TACROLIMUS 3750 5625 7500 646 ANTITHROMBIN ACTIVITY, PLASMA By SRL 3833 5750 7667 647 ANTI THROMBIN III ANTIGEN 5556 8333 11111 648 LUPUS ANTICOAGULANT ABS 1722 2583 3444 649 DRVV SCREEN TIME, PLASMA By SRL 1559 2338 3118 650 DRVV CONFIRM, PLASMA By SRL 1559 2338 3118

Page 83 651 NGAL, PLASMA By SRL 2310 3150 4200 652 LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2 ACTIVITY By SRL 23889 35833 47778 653 BCR-ABL t(9;22) BY FISH 5278 7917 10556 654 HER 2/ NEU 11667 17500 23333 655 HEPATITIS A VIRUS IGG ANTIBODY (HAV IGG) 1167 1750 2333 656 EGFR (FISH) 6556 9833 13111 657 DELETION 13q BY FISH 5278 7917 10556 658 DIGEORGE SYNDROME, 22q11.2 DELETION , FISH By SRL 5500 8250 11000 659 SRY DELETION, FISH By SRL 660 COMPREHENSIVE DIGESTIVE STOOL ANALYSIS 2.0 34100 46500 62000 661 SMALL DENSE LDL COMBO By SRL 662 SDLDL By SRL 2695 3675 4900 663 SIROLIMUS, EDTA/HEPARIN WHOLE BLOOD By SRL 8580 11700 15600 664 URINE OLIGOSACCHARIDE SCREEN By SRL 13750 18750 25000 665 HAPTOGLOBIN GENOTYPING - PCR 3278 4917 6556 666 C TRACHOMATIS DNA DETECT 3056 4583 6111 667 L-LACTATE, CSF 1100 1650 2200 668 L-LACTATE, FLUORIDE PLASMA 1100 1650 2200 669 HCV RNA GENOTYPING 22000 33000 44000 670 HBV GENOTYPING BY PCR By SRL 6389 9583 12778 671 HBV BASAL CORE PROMOTER MUTATION By SRL 4840 6600 8800 672 HBV PRECORE MUTATION By SRL 4840 6600 8800 673 HEPATITIS C VIRUS RNA QUANTITATIVE 8333 12500 16667 674 LEPTOSPIRA IgG, SERUM 1322 1983 2644 675 HOMEOSTATIC MODEL ASSESSMENT (HOMA) 2 By SRL 1045 1425 1900 676 CMV VIRAL LOAD REAL TIME PCR 5833 8750 11667 677 CMV VIRAL LOAD/ GCV RESISTANCE - CMV COMBI TEST 11000 15000 20000 678 HERPES SIMPLEX VIRUS DNA DETECTOR 3611 5417 7222 679 ADENOVIRUS PCR 3611 5417 7222 680 JAPANESE ENCEPHALITIS VIRUS RNA DETECTION 4722 7083 9444 681 DENGUE VIRUS ANTIBODIES 2220 3330 4440 682 DENGUE VIRUS IGG, SERUM By SRL 1650 2228 3341 683 DENGUE RNA PCR 3575 5363 6500 684 LEPTOSPIRA IgM, SERUM 1322 1983 2644 685 DENGUE VIRUS IGM, SERUM By SRL 1050 1418 2126 686 DENGUE DUO ANTIGEN AND ANTIBODY TEST By SRL 4320 4800 6400 687 DENGUE NS1 ANTIGEN TEST By SRL 2140 3210 4280 688 CRYPTOSPORIDIUM ANTIGEN DETECTION 1222 1833 2444 689 TOXOPLASMA IgM, SERUM By SRL 721 1082 1442 690 RAPID FILARIA ANTIGEN 472 708 944 691 HELICOBACTER PYLORI IgA ANTIBODIES, SERUM 2556 3833 5111 692 PNUEMOCYSTIS CARINII DETECTION 2333 3500 4667 693 ACUTE HEPATITIS VIRUS EVALUATION - II 5000 7500 10000 694 HEPATITIS ACUTE EVALUATION 1, SERUM 3222 4833 6444 695 ACUTE HEPATITIS VIRUS - EVALUATION - III 5278 7917 10556 696 HELICOBACTER PYLORI IgG ANTIBODIES, SERUM 2556 3833 5111 697 HTLV I & II ANTIBODIES, SERUM 3556 5333 7111 698 HELICOBACTER PYLORI IgM ANTIBODIES, SERUM 2556 3833 5111 699 JAPANESE ENCEPHALITIS VIRUS IGM ANTIBODIES By SRL 1111 1667 2222 700 FLU REAL TIME PCR 5278 7917 10556

Page 84 701 HERPES SIMPLEX VIRUS 1&2 IgG & IgM, SERUM 1989 2983 3978 702 HEPATITIS B VIRUS DNA QUANTITATIVE 9420 14130 18840 703 PARATHYROID HORMONE-RELATED PEPTIDE PLASMA By SRL 9478 14217 18956 704 JAK2 V617F MUTATION DETECTION By SRL 7150 9750 13000 705 HDV RT-PCR By SRL 4167 6250 8333 706 BISMUTH, BLOOD 4167 6250 8333 707 CITRATE, URINE 24 HR SPECTROPHOTOMETRY By SRL 4000 5400 8100 708 ENTAMOEBA HISTOLYTICA ANTIBODIES, SERUM 1667 2500 3333 709 CHOLINESTERASE (PSEUDO) 1161 1742 2322 710 HEMOSIDERIN, URINE 9998 14997 19996 711 FLUORIDE, PLASMA By SRL 12452 16980 22640 712 MYCOPLASMA PNEUMONIAE IgG ANTIBODIES, SERUM 2167 3250 4333 713 MYCOPLASMA PNEUMONIAE IgM, SERUM 2167 3250 4333 714 VARICELLA ZOSTER IgG, SERUM 1778 2667 3556 715 VARICELLA ZOSTER IgM, SERUM 1778 2667 3556 716 MEASLES IgG & IgM 2778 4167 5556 717 MEASLES IgG ANTIBODIES, SERUM 1611 2417 3222 718 CARNITINE, PLASMA OR SERUM 26094 39142 52189 719 1, 25-DIHYDROXY VITAMIN D3 EIA 4410 6615 8820 720 25 - HYDROXYVITAMIN D, SERUM By SRL 2180 3270 4360 721 ANTI DIURETIC HORMONE (VASOPRESSIN) By SRL 4840 6600 8800 722 BRUCELLA IGG & IGM ANTIBODIES, SERUM By SRL 2750 3750 5000 723 BRUCELLA IGG ANTIBODIES By SRL 1333 2000 2667 724 BRUCELLA IGM ANTIBODIES By SRL 1333 2000 2667 725 BRUCELLA TOTAL ANTIBODIES By SRL 1100 1500 2000 726 T. PALLIDUM HEMAGGLUTINATION 733 1100 1467 727 SYPHILIS ANTIBODIES, SERUM 1056 1583 2111 728 VWF ANTIGEN, PLASMA By SRL 8525 11625 15500 729 VON WILLEBRAND FACTOR, PLASMA 14056 21083 28111 730 RAPID KALAZAR TEST 1500 2250 3000 731 RAPID TYPHI IgM 720 1080 1440 732 WIDAL TEST, SERUM By SRL 183 275 367 733 HLA CLASS I PRA QUALITATIVE By SRL 27420 41130 54840 734 HLA CLASS II PRA QUALITATIVE By SRL 12222 18333 24444 735 WEIL-FELIX TEST, SERUM By SRL 917 1375 1833 736 ARSENIC, BLOOD By SRL 3278 4917 6556 737 ARSENIC, 24 HRS URINE By SRL 2556 3833 5111 738 LEAD, BLOOD By SRL 1889 2833 3778 739 CADMIUM, BLOOD By SRL 3278 4917 6556 740 CADMIUM, 24 HRS URINE By SRL 3278 4917 6556 741 COPPER, SERUM By SRL 1528 2292 3056 742 COPPER, 24 HRS URINE By SRL 1833 2750 3667 743 ZINC, SERUM By SRL 2338 3188 4250 744 ALUMINIUM, PLASMA By SRL 1940 2910 3880 745 COBALT, 24 HRS URINE By SRL 3278 4917 6556 746 CRYPTOCOCCUS NEOFORMANS DNA DETECTION 7500 11250 15000 747 CRYPTOCOCCUS ANTIGEN, SERUM 2167 3250 4333 748 CRYPTOCOCCUS ANTIGEN, CSF By SRL 2167 3250 4333 749 ANA POSITIVE REFLEX TO ENA PROFILE By SRL 3300 4500 6000 750 ANCA POSITIVE REFLEX MPO, PR3 ANTIBODIES 3056 4583 6111

Page 85 751 CSF BACTERIAL CULTURE REFLEXS TO ANTIGEN DETECTION 5333 8000 10667 752 HISTOPATHOLOGY REFLEX TO CUSTOM IHC -ENDOMETRIUM By SRL 1000 1350 2025 753 HISTOPATH REFLEX TO CUSTOM IHC-ENDOBRONCHIAL BX By SRL 1680 2268 2520 754 HISTOPATH REFLEX TO CUSTOM IHC-GI ENDOSCOPIC BX By SRL 1680 2268 2520 755 HISTOPATH REFLEX TO CUSTOM IHC PANEL - PROSTATE By SRL 2040 2754 3060 756 HISTOPATH REFLEX TO CUSTOM IHC PANEL -BRAIN BIOPSY By SRL 4080 5508 6120 757 HISTOPATH REFLEX TO CUSTOM IHC PANEL - OTHERS By SRL 10780 14700 19600 758 MYOGLOBIN (URINE SPOT, ELFA) By SRL 2750 3750 5000 759 HOLOTC (HOLOTRANSCOBALAMINE), ACTIVE B12, SERUM By SRL 1500 2025 3038 760 FILARIA ANTIBODIES, SERUM By SRL 1540 2100 2800 761 TISSUE TRANSGLUTAMINASE IgA, SERUM 1800 2700 3600 762 CHLAMYDIA PNEUMONIAE IgG ANTIBODIES, SERUM 2000 3000 4000 763 CHLAMYDIA PNEUMONIAE IgM ANTIBODIES, SERUM 2000 3000 4000 764 RUBELLA RNA PCR 2667 4000 5333 765 RUBELLA IgG ANTIBODIES, SERUM 826 1238 1651 766 RUBELLA IgG & IgM, SERUM 1389 2083 2778 767 TOXOPLASMA IgG, SERUM 721 1082 1442 768 CYTOMEGALOVIRUS IgG, SERUM 826 1238 1651 769 RUBELLA IGG AVIDITY By SRL 1650 2250 3000 770 SALICYLATE, SERUM By SRL 11880 16200 21600 771 HERPES SIMPLEX VIRUS-1 IgG, SERUM 843 1265 1687 772 HERPES SIMPLEX VIRUS-1 IgM, SERUM 843 1265 1687 773 HERPES SIMPLEX VIRUS-2 IgG, SERUM 843 1265 1687 774 HERPES SIMPLEX VIRUS-2 IgM, SERUM 843 1265 1687 775 HSV 1&2 IGM ABS COMBINED 1100 1650 2200 776 IGG4, SERUM By SRL 8910 12150 16200 777 HAEMOPHILUS INFLUENZAE TYPE B ANTIGEN, SERUM 1100 1650 2200 778 MUMPS IgG & IgM ANTIBODIES 3222 4833 6444 779 MUMPS IgG ANTIBODIES, SERUM 1778 2667 3556 780 MUMPS IgM ANTIBODIES, SERUM 1778 2667 3556 781 NEISSERIA GONORRHOEAE DNA PCR 782 MTHFR GENE MUTATION 8333 12500 16667 783 CYSTICERCUS IgG ANTIBODIES, SERUM 1722 2583 3444 784 HIV-P24 ANTIGEN DETECTION, SERUM 367 550 733 785 HIV P24 ANTIGEN By SRL 794 1192 1589 786 HIV P24 ANTIGEN 367 550 733 787 BACTERIAL MENINGITIDIS MULTIPLEX PCR 3167 4750 6333 788 HIV 1 VIRAL LOAD BY COBAS TAQMAN By SRL 5333 8000 10667 789 HIV DNA DETECTOR 3056 4583 6111 790 BACTERIAL PNEUMONIA PANEL 5222 7833 10444 791 VIRAL PNEUMONIA PANEL - I 4833 7250 9667 792 HEPATITIS B VIRUS DNA QUANTITATIVE By SRL 8494 12742 16989 793 HEPATITIS C VIRUS RNA QUANTITATIVE By SRL 9420 14130 18840 794 FACTOR II MUTATION DETECTION BY REAL TIME PCR 6444 9667 12889 795 FACTOR V MUTATION DETECTION By SRL 5306 7958 10611 796 TORCH IGG & IGM ABS (EIA) 3000 4500 6000 797 B-CELL GENE REARRANGEMENT PCR 13333 20000 26667 798 T-CELL GENE REARRANGEMENT BY PCR 13333 20000 26667 799 TORCH IgG EVALUATION, SERUM 1544 2317 3089 800 TORCH IGM [5 PARAMETERS] 1656 2483 3311

Page 86 801 HLA CLASS I C LOCUS PCR By SRL 9350 12750 17000 802 HLA CLASS II DQ LOCUS PCR By SRL 9350 12750 17000 803 HIV-1&2 ANTIBODIES, SERUM By SRL 1700 2550 3400 804 INTRINSIC FACTOR IgG, SERUM 2056 3083 4111 805 HLA DQ TYPING - CELIAC DISEASE By SRL 806 ADENOVIRUS IgG, SERUM 1444 2167 2889 807 URINE CYSTINE By SRL 8500 11475 17213 808 ADENOVIRUS IgM, SERUM 1444 2167 2889 809 LEGIONELLA PNEUMOPHILA SERO 1 IgG, SERUM 904 1357 1809 810 HIV DRUG RESISTANCE REPORT By SRL 22000 30000 40000 811 URINE KETONE (QUALITATIVE) By SRL 37 55 73 812 JC/BK DNA PCR By SRL 5720 7800 10400 813 MDR-TB RAPID GENOTYPIC TEST By SRL 1667 2500 3333 814 ADRENALIN, PLASMA By SRL 3306 4958 6611 815 NOR-ADRENALIN PLASMA By SRL 3278 4917 6556 816 MYCOBACTERIUM SPECIATION ? EXTENDED By SRL 7150 9750 13000 817 MYCOBACTERIUM SPECIATION - COMMON By SRL 7150 9750 13000 818 GENOTYPIC ASSAY TB SECOND LINE DRUG RESISTANCE By SRL 7150 9750 13000 819 TETANUS IGG ANTIBODY By SRL 820 DIPTHERIA IGG ANTIBODY By SRL 821 HLA A, B, DR LOCI TYPING PCR By SRL 18700 25500 34000 822 HIV VIRAL LOAD BY REAL TIME PCR By SRL 4180 5700 7600 823 HTTG/DGP SCREEN By SRL 1760 2400 3200 824 FECAL CALPROTECTIN, STOOL By SRL 2750 3750 5000 825 HELICOBACTER PYLORI ANTIGEN DETECTION By SRL 1222 1833 2444 826 ALKALINE PHOSPHATASE ISOENZYMES By SRL 759 1139 1518 827 PORPHYRIN SPECIATION, 24 HRS URINE By SRL 5700 8550 11400 828 ASPERGILLUS FUMIGATUS DNA DETECTION (2327-SRL) 913 1370 1826 829 VACCICHEQ By SRL 7216 9840 13120 830 HIV EARLY SCREEN By SRL 917 1375 1833 831 HIV MONITOR (VIRAL LOAD, CD4 / CD8) By SRL 5667 8500 11333 832 HIV ROCHE COBAS MONITOR (VIRAL LOAD, CD4 / CD8) By SRL 11550 15750 21000 833 HIV-1 MONITOR By SRL 6600 9000 12000 834 OBEY - CT PANEL II 3333 5000 6667 835 OT SURVEILLANCE By SRL 1025 1384 2076 836 OT SURVEILLANCE - AEROBIC CULTURE By SRL 2750 3750 5000 837 TISSUE BIOPSY WITH PHOTO (1500IM2-SRL) 933 1400 1867 838 ACID PHOSPHATASE TOTAL + PROSTATIC-LAL 144 217 289 839 ACID PHOSPHATASE (1252-SRL) 267 400 533 840 IRON-SRL 311 467 622 841 PROTEIN S AG, P (83049-SRL) 3344 5017 6689 842 ANTI HBEAB-SRL 700 1050 1400 843 ANTI TPO (THYROID PEROXIDASE ANTIBODIES)-SRL 767 1150 1533 844 CALCIUM, IONIZED, SERUM (8378-SRL) 522 783 1044 845 TB FERON-SRL 3100 4650 6200 846 TORCH IGG & IGM EVALUATION, SERUM (9901M-SRL) 2278 3417 4556 847 ALPHA -1 ANTITRIPSIN-SRL 1856 2783 3711 848 CERULOPLASMIN, SERUM (1516D-SRL) 1111 1667 2222 849 CULTURE; URINE (1285-SRL) 656 983 1311 850 CEREBRO SPINAL FLUID (CSF) LEAK CLOSURE 656 983 1311

Page 87 851 BODY FLUID CULTURE & SUSCEPTIBILITY (1194A-SRL) 656 983 1311 852 GRAM STAIN (2438-SRL) 156 233 311 853 POLARIZING MICROSCOPY 267 400 533 854 WARFARIN SENSITIVITY BY GENOTYPING By SRL 12100 16500 22000 855 HBV DRUG RESISTANCE By SRL 7700 10500 14000 856 KRAS MUTATION DETECTION By SRL 7700 10500 14000 857 CYP2C19 GENOTYPING By SRL 7260 9900 13200 858 KRAS CODON 61 MUTATION DETECTION By SRL 5830 7950 10600 859 XPERT MTB/RIF - PULMONARY By SRL 3950 5925 7900 860 XPERT MTB/RIF - EXTRAPULMONARY By SRL 3950 5925 7900 861 EGFR MUTATION DETECTION 6389 9583 12778 862 SPINAL CEREBRAL ATAXIA TYPE - 1 By SRL 2056 3083 4111 863 SPINAL CEREBRAL ATAXIA TYPE - 2 By SRL 2056 3083 4111 864 SPINAL CEREBRAL ATAXIA TYPE - 3 By SRL 2056 3083 4111 865 SPINAL CEREBRAL ATAXIA TYPE - 6 By SRL 2056 3083 4111 866 SPINAL CEREBRAL ATAXIA TYPE - 7 By SRL 2056 3083 4111 867 JAPANESE ENCEPHALITIS VIRUS- RT-PCR By SRL 3056 4583 6111 868 CLOSTRIDIUM DIFFICILE DNA REAL TIME PCR By SRL 3300 4500 6000 869 CYP3A4*22 GENOTYPING By SRL 5720 7800 10400 870 CYSTIC FIBROSIS DELTA F508 GENE MUTATION By SRL 13310 18150 24200 871 HEREDITARY PANCREATITIS PANEL By SRL 99000 135000 180000 872 C.DIPTHERIA TOXIN A AND B PCR By SRL 3889 5833 7778 873 TRANSSPOT ASSAY By SRL 22000 30000 40000 874 CYSTIC FIBROSIS EXTENDED MUTATION PANEL By SRL 31350 42750 57000 875 MICROSATELLITE INSTABILITY (MSI) By SRL 28600 39000 52000 876 NEUROTROPIC VIRUS PANEL By SRL 4400 5940 6600 877 BK VIRUS DNA QUANTITATIVE By SRL 7480 10200 13600 878 JC VIRUS DNA QUANTITATIVE By SRL 7480 10200 13600 879 SEPTISCREEN By SRL 13660 18441 27662 880 ASPERGILLUS ANTIBODY IgG 2300 3450 4600 881 CUSTOM LEUKEMIA PANEL By SRL 4722 7083 9444 882 HER-2/NEU ONCOPROTEIN (IHC), TISSUE/PB By SRL 1778 2667 3556 883 EGFR,PHOTO, TISSUE/PARAFFIN BLOCK 2222 3333 4444 884 KI-67, TISSUE/PARAFFIN BLOCK By SRL 3420 5130 6840 885 CUSTOM IHC PANEL By SRL 4706 7058 9411 886 CD45 IHC, TISSUE/PARAFFIN BLOCK 2222 3333 4444 887 CEA IHC, TISSUE/PARAFFIN BLOCK 2222 3333 4444 888 CK HMW SQUAMOUS IHC, TISSUE/PARAFFIN BLOCK 2322 3483 4644 889 VIMENTIN IHC, TISSUE/PARAFFIN BLOCK By SRL 2530 3450 4600 890 PAN CYTOKERATIN IHC, TISSUE/PB 2222 3333 4444 891 OC 125, TISSUE/PARAFFIN BLOCK 2222 3333 4444 892 CALRETENIN 2222 3333 4444 893 HEB B SURF AG IHC, TISSUE/PB By SRL 2530 3450 4600 894 CHROMOGRANIN A,IHC, TISSUE/PARAFFIN BLOCK 2222 3333 4444 895 CD117 / C-KIT & PHOTO, TISSUE/PARAFFIN BLOCK 2222 3333 4444 896 ADRENOCORTICOTROPIC HORM, TISSUE/PB By SRL 2222 3333 4444 897 PARAFFIN BLOCK H&E SLIDE, TISSUE/PB 1111 1667 2222 898 REVIEW SLIDE & PHOTO (UPTO 2 SLIDES) By SRL 1333 2000 2667 899 PARAFFIN BLOCKS/H& E SLIDE, TISSUE/PB 1500 2250 3000 900 REVIEW SLIDE & PHOTO (MORE THAN 2 SLIDES) By SRL 1944 2917 3889 901 SPECIAL STAINS, TISSUE/PARAFFIN BLOCK 611 917 1222 902 LEUCOCYTE ALKALINE PHOSPHATASE (LAP) SCORE 1389 2083 2778 903 ALK1 By SRL 2970 4050 5400 904 LYMPHOMA DIFFERENTIAL DIAGNOSIS 6500 9750 13000 905 ANTI - P63 By SRL 2530 3450 4600 906 PLATELET APHERESIS 16990 25485 33980

Page 88 ONCOLOGY PROCEDURES

Page 89 Double Sl No. Description Room Single Room Suite 1 CHEMOTHERAPY HIGH DOSE ( PER DAY ) 2000 3000 4000 2 CHEMOTHERAPY INFUSIONAL ( UPTO 6 HRS ) 1200 1800 2400 3 CHEMOTHERAPY INTRAARTERIAL - PER DAY ( ONCOLOGY ) 2000 3000 4000 4 CHEMOTHERAPY INTRAPERICARDIAL - PER DAY 1200 1800 2400 5 CHEMOTHERAPY INTRAPLEURAL ( PER DAY ) 1200 1800 2400 6 CHEMOTHERAPY INTRAVESICAL (PER DAY ) 1170 1755 2340 7 INFUSION CHEMOTHERAPY - MULTIPLE DRUGS 2000 3000 4000 8 CHEMOTHERAPY (PLANNING + COUNSELLING) 1000 1500 2000 9 CHEMOTHERAPY (INFUSIONAL) - SINGLE DRUG (PER DAY) 1170 1755 2340 10 CHEMOTHERAPY (BOLUS) - MULTI DRUG 540 810 1080 11 CHEMOTHERAPY (ORAL) 720 1080 1440 12 LARYGOPHANGO ESOPHAGEAL WITH GASTRIC PULL UP 34700 52050 69400 13 LAPAROSCOPE ASSISTED VAGINA HYSTERECTOMY (LAVH) + SALPINGO OOPHORECTOMY 26300 39450 52600 14 BREAST LUMPECTOMY SMALL (FOR BENIGN DISEASE) 10100 15150 20200 15 OMENTECTOMY 30200 45300 60400 16 VAGINECTOMY PARTIAL 13500 20250 27000 17 REVISION SURGERY ( FOR WIDE LOCAL EXCISION OF BREAST LUMP ) 17800 26700 35600 18 TRUCUT NEEDLE BIOPSY 4500 6750 9000 19 WERTHEIM'S HYSTERECTOMY ( CERVICAL CANCER ) 25100 37650 50200 20 WHIPPLE'S PROCEDURE (PEDIATRIC SURGERY) 27000 40500 54000 21 BONE MARROW BIOPSY - OPEN 3000 4500 6000 22 EXCISION BIOPSY 15 MIN 5000 7500 10000 23 EXCISION OR INCISION BIOPSY < 30 MIN 15000 22500 30000 24 EXCISION OR INCISION BIOPSY < 1 HOUR 20000 30000 40000 25 EXCISION OR INCISION BIOPSY < 2 HOUR 40000 60000 80000 26 TUMOR DEBULKING 40000 60000 80000 27 EYELID INJURIES REPAIR 10000 15000 20000 28 TUMOR EXCISION ( LARGE - SUPERFICIAL ) - PEDIATRIC 15000 22500 30000 29 CONJUNCTIVAL TUMOR EXCISION + CRYOTHERAPY 20000 30000 40000 30 CONJUNCTIVAL TUMOR EXCISION + AMG 27000 40500 54000 31 CONJUNCTIVAL TUMOR EXCISION + CRYOTHERAPY + AMG 25000 37500 50000 32 TUMOR CRYOTHERAPY 2000 3000 4000 33 TUMOR TTT UNDER GA (0- 30 MNS) 10000 15000 20000 34 TUMOR TTT ( TRANS PUPILLARY THERMOTHERAPY ) - 30 MINS TO 1 HR 12500 18750 25000 35 TUMOR TTT (1 - 3 HR) 15000 22500 30000 36 TUMOR TTT ( TRANS PUPILLARY THERMOTHERAPY ) - 3 TO 5 HRS 17500 26250 35000 37 GOLD WEIGHT IMPLANT + LOWER EYELID SPACER 25000 37500 50000 38 GOLD WEIGHT IMPLANT + SCLERAL GRAFT 30000 45000 60000 39 GOLD WEIGHT IMPLANT +LTS 35000 52500 70000 40 GOLD WEIGHT IMPLANTATION + SCLERAL GRAFT + LATERAL TARSAL STRIP ( LTS ) 40000 60000 80000 41 GOLD WEIGHT IMPLANT + LOWER EYELID SPACER 35000 52500 70000 42 GOLD WEIGHT IMPLANT + SCLERAL GRAFT 25000 37500 50000 43 MMC USED IN COMBINATION WITH ANY PROCEDURE (ADD TO SURGERY CHARGE) 1500 2250 3000 44 FNAC, SLIDE EXAMINATION (1515A-SRL) 1500 2250 3000 45 FNAC / ASPIRATION ( DIAGNOSTIC ) USG 3000 4500 6000 46 CHEMOTHERAPY BOLUS - SINGLE DRUG ( PER DAY ) 7500 11250 15000 47 CHEMOTHERAPY + EXAMINATION UNDER ANESTHESIA ( EUA ) 7500 11250 15000 48 CHEMOPTHERAPY + EUA + TTT 9000 13500 18000 49 CHEMOPTHERAPY + EUA + TTT + CRYOTHERAPY 9750 14625 19500 50 PERIOCULAR CHEMOTHERAPY 3000 4500 6000 51 CHEMOTHERAPY INTRATHECAL ( PER DAY ) 2250 3375 4500

Page 90 OPTHALMOLOGY PROCEDURES

Page 91 Double Sl No. Description Single Room Suite Room 1 3 MIRROR EXAMINATION ( BOTH EYES ) 600 900 1200 2 3 MIRROR EXAMINATION ( RIGHT EYE ) 400 600 800 3 AMSLER GRID TEST ( BOTH EYES ) 100 150 200 4 AMSLER GRID TEST ( RIGHT EYE ) 50 75 100 5 APPLANATION TENSION 100 150 200 6 APPLANATION TENSION-ONE EYE 100 150 200 7 APPLANATION TONOMETRY ( BOTH EYES ) 100 150 200 8 APPLANATION TONOMETRY ( RIGHT EYE ) 100 150 200 9 AUTO KERATOMETRY-BOTH EYES 150 225 300 10 AUTO KERATOMETRY-ONE EYE 100 150 200 11 KERATOMETRY AUTOMATED ( BOTH EYES ) 150 225 300 12 KERATOMETRY AUTOMATED ( RIGHT EYE ) 100 150 200 13 AUTOMATED PERIMETERY O.A.P. (GIX)-BOTH EYES 500 750 1000 14 AUTOMATED PERIMETERY O.A.P. (GIX)-ONE EYE 300 450 600 15 AUTOMATED PERIMETERY O.A.P. (M2X)-BOTH EYES 1100 1650 2200 16 AUTOMATED PERIMETERY O.A.P. (M2X)-ONE EYE 750 1125 1500 17 AUTOREFRACTOMETRY-BOTH EYE 50 75 100 18 AUTOREFRACTOMETRY 50 75 100 19 BANDAGE LENS FITTINGS (BCL)-BOTH EYES 500 750 1000 20 BANDAGE LENS FITTINGS (BCL)-ONE EYE 250 375 500 21 BDE CLEANING & LM -BOTH EYES 300 450 600 22 BDE CLEANING & LM -ONE EYE 200 300 400 23 CORNEAL TOPOGRAPHY ( CTG ) PATHFINDER ANALYSIS - BOTH EYES 1200 1800 2400 24 CORNEAL TOPOGRAPHY ( CTG ) PATHFINDER ANALYSIS - RIGHT EYE 800 1200 1600 25 CORNEAL TOPOGRAPHY ( CTG ) SUBSEQUENT SCAN + CHANGE ANALYSIS - BOTH EYES 1200 1800 2400 26 CORNEAL TOPOGRAPHY ( CTG ) SUBSEQUENT SCAN + CHANGE ANALYSIS - RIGHT EYE 800 1200 1600 27 ULCER CAUTERIZATION CHEMICAL ( WITH CARBOLIC ACID ) BOTH EYES 500 750 1000 28 COLOR VISION TEST ( ISHIHARA ) - BOTH EYES 150 225 300 29 COLOR VISION TEST ( ISHIHARA ) - RIGHT EYE 100 150 200 30 COLOUR VISION (ISHIHARA)-BOTH EYE 150 225 300 31 CONTACT LENS TRIAL ( BOTH EYES ) 250 375 500 32 CONTACT LENS TRIAL ( RIGHT EYE ) 250 375 500 33 CONTRAST SENSITIVITY TEST ( BOTH EYES ) 250 375 500 34 CONTRAST SENSITIVITY TEST ( RIGHT EYE ) 150 225 300 35 CORNEAL/CONJUNCTIVAL SCRAPINGS ( BOTH EYES ) 250 375 500 36 CORNEAL/CONJUNCTIVAL SCRAPINGS ( RIGHT EYE ) 150 225 300 37 EPILATION LID ( BOTH EYES ) 100 150 200 38 EPILATION LID ( RIGHT EYE ) 50 75 100 39 EPITHELIAL DEBRIDEMENT + BETADINE CAUTERIZATION ( BOTH EYES ) 300 450 600 40 EPITHELIAL DEBRIDEMENT + BETADINE CAUTERIZATION ( RIGHT EYE ) 200 300 400 41 EXOPHTHALMOMETRY ( BOTH EYES ) 250 375 500 42 EXOPHTHALMOMETRY ( RIGHT EYE ) 250 375 500 43 EYE CAP TEST ( ANTERIOR SEGMENT ) FOR PHOTO DOCUMENTATION - BOTH EYES 300 450 600 44 EYE CAP TEST ( ANTERIOR SEGMENT ) FOR PHOTO DOCUMENTATION - RIGHT EYE 200 300 400 45 FLUORESCEIN ANGIOGRAPHY ( BOTH EYES ) 1800 2700 3600 46 FLUORESCEIN ANGIOGRAPHY ( RIGHT EYE ) 1800 2700 3600 47 FORNIX IRRIGATION ( BOTH EYES ) 200 300 400 48 FORNIX IRRIGATION ( RIGHT EYE ) 150 225 300 49 FUNDUS COLOR PHOTOGRAPHY ( BOTH EYES ) 350 525 700 50 FUNDUS COLOR PHOTOGRAPHY ( RIGHT EYE ) 250 375 500

Page 92 51 GONIOSCOPY ( BOTH EYES ) 400 600 800 52 GONIOSCOPY ( RIGHT EYE ) 250 375 500 53 GRAMS STAIN (GM SMEAR) EACH (LAB CHARGES)-ONE EYE 80 120 160 54 HESS CHARTING ( BOTH EYES ) 300 450 600 55 HESS CHARTING ( RIGHT EYE ) 250 375 500 56 OPHTHALMOSCOPY INDIRECT ( BOTH EYES ) 150 225 300 57 OPHTHALMOSCOPY INDIRECT ( RIGHT EYE ) 150 225 300 58 I.O. (INDIRECT OPHTHALMOSCOPY)-BOTH EYE 150 225 300 59 IOL MASTER (AK + NON CONTACT BIOMETRY-BOTH EYES 1500 2250 3000 60 IOL MASTER - ASTIGMATIC KERATOTOMY + NON CONTACT BIOMETRY ( BOTH EYES ) 900 1350 1800 61 KOH SLIDE PREP. (EACH) (LAB CHARGES)-ONE EYE 80 120 160 62 LOW VISION AIDS TRIAL ( LVA ) - BOTH EYES 500 750 1000 63 LOW VISION AIDS TRIAL ( LVA ) - RIGHT EYE 400 600 800 64 OPTICAL COHERENCE TOMOGRAPHY (OCT) SCAN FIRST - MACULA ( BOTH EYES ) 2200 3300 4400 65 OPTICAL COHERENCE TOMOGRAPHY (OCT) SCAN FIRST - MACULA ( RIGHT EYE ) 2000 3000 4000 66 OPTICAL COHERENCE TOMOGRAPHY (OCT) SCAN SUBSEQUENT + CHANGE ANALYSIS ( BOTH EYES ) 2200 3300 4400 67 OPTICAL COHERENCE TOMOGRAPHY (OCT) SCAN SUBSEQUENT + CHANGE ANALYSIS ( RIGHT EYE ) 2000 3000 4000 68 RETINAL NERVE FIBER LAYER ( RNFL ) ANALYSIS - BOTH EYES 2200 3300 4400 69 RETINAL NERVE FIBER LAYER ( RNFL ) ANALYSIS - RIGHT EYE 2000 3000 4000 70 OPTICAL COHERENCE TOMOGRAPHY (OCT) - SUBSEQUENT SCAN + CHANGE ANALYSIS ( BOTH EYES ) 2200 3300 4400 71 OPTICAL COHERENCE TOMOGRAPHY (OCT) - SUBSEQUENT SCAN + CHANGE ANALYSIS ( RIGHT EYE ) 2000 3000 4000 72 OPHTHALMOLOGICAL CONSULTATION + FUNDUS EXAMINATION ( BOTH EYES ) 500 750 1000 73 ORTHOPTIC CHECKUP ( BOTH EYES ) - OPHTHALMOLOGY 100 150 200 74 ORTHOPTIC CHECK UP ( RIGHT EYE ) - OPHTHALMOLOGY 100 150 200 75 ORTHOPTIC EXERCISES ( BOTH EYES ) PER VISIT - OPHTHALMOLOGY 100 150 200 76 ORTHOPTIC EXERCISES ( RIGHT EYE ) PER VISIT - OPHTHALMOLOGY 100 150 200 77 PACHYMETRY FOR CENTRAL CORNEAL THICKNESS (CCT) MEASUREMENT - BOTH EYES 650 975 1300 78 PACHYMETRY FOR CENTRAL CORNEAL THICKNESS (CCT) MEASUREMENT - RIGHT EYE 400 600 800 79 PACHYMETRY MAP ( ULTRASONIC ) BOTH EYES 900 1350 1800 80 PACHYMETRY MAP ( ULTRASONIC ) RIGHT EYE 600 900 1200 81 R.B STAINING/LG STAINING -BOTH EYES 50 75 100 82 R.B STAINING/LG STAINING -ONE EYE 50 75 100 83 RETINAL INTERFEROMETRY ( BOTH EYES ) 200 300 400 84 RETINAL INTERFEROMETRY ( RIGHT EYE ) 200 300 400 85 RETINAL LASER INTERFEROMETRY-BOTH EYES 200 300 400 86 RETINAL LASER INTERFEROMETRY-ONE EYE 200 300 400 87 SPECIAL ORTHOPTIC -BOTH EYES 250 375 500 88 SPECIAL ORTHOPTIC -ONE EYE 250 375 500 89 SPECULAR MICROSCOPY (MANUAL) - BOTH EYES 500 750 1000 90 SPECULAR MICROSCOPY ( RIGHT EYE ) 300 450 600 91 SUBCONJUNCTIVAL INJECTION ( BOTH EYES ) 500 750 1000 92 SUBCONJUNCTIVAL INJECTION ( RIGHT EYE ) 250 375 500 93 CULTURE / SENSITIVITY SWAB TEST - BOTH EYES 500 750 1000 94 CULTURE / SENSITIVITY SWAB TEST - RIGHT EYE 250 375 500 95 CULTURE / SENSITIVITY SWAB TEST - LEFT EYE 500 750 1000 96 LACRIMAL SYRINGING ( BOTH EYES ) 350 525 700 97 LACRIMAL SYRINGING ( RIGHT EYE ) 200 300 400 98 SYRINGING (LACRIMAL)-BOTH EYE 350 525 700 99 TITMUS COMPREHENSIVE SCREENING ( TIT ) - BOTH EYES 350 525 700 100 TITMUS COMPREHENSIVE SCREENING ( TIT ) - RIGHT EYE 250 375 500

Page 93 101 B SCAN BIOMETRY ULTRASOUND ( BOTH EYES ) 1500 2250 3000 102 B SCAN BIOMETRY ULTRASOUND ( RIGHT EYE ) 1000 1500 2000 103 A SCAN BIOMETRY ULTRASOUND ( BOTH EYES ) 900 1350 1800 104 A SCAN BIOMETRY ULTRASOUND ( RIGHT EYE ) 550 825 1100 105 VIDEO CLIP ( BOTH EYES ) 300 450 600 106 VIDEO CLIP ( RIGHT EYE ) 200 300 400 107 V LEUCOTOMY 87000 117450 130500 108 OPTICAL COHERENCE TOMOGRAPHY ( OCT ) ONE EYE 2000 2700 3000 109 VISUAL FIELDS ( SINGLE EYE) 1400 1890 2100 110 GLAUCOMA WORK UP PACKAGE ( VISUAL FIELDS, OCT, CCT+GONIOSCOPY) +DV 7500 10125 11250 111 CATARACT- PHACO WITH IOL AMO SYMFONY 87000 117450 130500 112 CATARACT- PHACO WITH IOL ZEISS 46000 62100 69000 113 CATARACT-PHACO WITH IOL TECNIS TORIC 55000 74250 82500 114 CATARACT - PHACO WITH IOL AMO TECNIS AK 31500 47250 63000 115 CATARACT - PHACO WITH IOL AMO SENSAR 27900 41850 55800 116 CATARACT - PHACO WITH IOL AMO TECNIS 1 42000 56700 63000 117 CATARACT - PHACO WITH IOL AMO MULTIFOCAL SILICON 55500 83250 111000 118 CATARACT - PHACO WITH IOL AMO MULTIFOCAL AK 64500 96750 129000 119 CATARACT-PHACO WITH IOL B & L AKREOS* 27273 40909.5 54546 120 CATARACT - PHACO WITH IOL B & L AK AO* 31500 47250 63000 121 CATARACT - PHACO WITH IOL B & L MIL 60* 40000 60000 80000 122 CATARACT - PHACO WITH IOL B & L CRYSTALENS* 130000 195000 260000 123 CATARACT-PHACO WITH IOL ZEISS MULTIFOCAL* 40500 60750 81000 124 CATARACT-PHACO WITH IOL ALCON TORIC* 55000 74250 82500 125 CATARACT-PHACO WITH IOL ALCON MULTIFOCAL RESTORE* 64500 96750 129000 126 CATARACT-PHACO WITH IOL ALCON IQ* 40000 60000 80000 127 CATARACT -PHACO WITH IOL ALCON MA - 60* 25425 38137.5 50850 128 CATARACT-PHACO WITH IOL ALCONSINGLE PIECE* 27700 41550 55400 129 CATARACT-PHACO WITH IOL HOYA PC 40000 60000 80000 130 CATARACT-PHACO WITH IOL HOYA YELLOW 45000 67500 90000 131 CATARACT-PHACO WITH IOL EUROVISION ASPHERIC 28000 42000 56000 132 CATARACT-PHACO WITH IOL EUROVISION PLAIN 16000 24000 32000 133 PHACO +IOL AKEROS ADAPT 27273 40909.5 54546 134 CATARACT APPA LENSE PACKAGE WORTH INT 8500 12750 17000 135 FEMTO LASER CATARACT SURGERY 65000 80000 120000 136 CATARACT-MICS+PCIOL 40000 54000 81000 137 IOL EXCHANGE AMO TECNIS AK* 21000 31500 42000 138 IOL EXCHANGE AMO SENSAR* 17400 26100 34800 139 IOL EXCHANGE AMO TECNIS 1* 26750 40125 53500 140 IOL EXCHANGE AMO MULTIFOCAL SILICON* 45000 67500 90000 141 IOL EXCHANGE AMO MULTIFOCAL AK* 54000 81000 108000 142 IOL EXCHANGE B & L AKREOS* 16773 25159.5 33546 143 IOL EXCHANGE B & L AK AO* 21000 31500 42000 144 IOL EXCHANGE B & L MIL 60* 29500 44250 59000 145 IOL EXCHANGE B & L CRYSTALENS* 110000 165000 220000 146 IOL EXCHANGE ALCON TORIC* 32100 48150 64200 147 IOL EXCHANGE ALCON MULTIFOCAL RESTORE* 53920 80880 107840 148 IOL EXCHANGE ALCON IQ* 27150 40725 54300 149 IOL EXCHANGE ALCON MA - 60* 14925 22387.5 29850 150 IOL EXCHANGE ALCON SINGLE PIECE* 17200 25800 34400

Page 94 151 IRIS REFRACTORS 5000 6750 7500 152 ENDO CAPSULAR RING 5000 7500 10000 153 ANIRIDA RING 20000 30000 40000 154 TRABECULECTOMY + MITOMYCIN C THERAPY 30000 45000 60000 155 IOL EXPLANT (ANTERIOR ROOT) 10000 15000 20000 156 IOL EXCHANGE IOL HOYA PC 25000 37500 50000 157 IOL EXCHANGE HOYA YELLOW 30000 45000 60000 158 IOL EXCHANGE EUROVISION ASPHERIC 17500 26250 35000 159 IOL EXCHANGE EUROVISION PLAIN 15800 23700 31600 160 PHACO WITH IOL(A) + TRAB(COMB.) AMO TECNIS AK* 51500 77250 103000 161 PHACO WITH IOL(A) + TRAB(COMB.) AMO SENSAR* 47900 71850 95800 162 PHACO WITH IOL(A) + TRAB(COMB.) AMO TECNIS 1* 60000 90000 120000 163 PHACO WITH IOL(A) + TRAB(COMB.) AMO MULTIFOCAL SILICON* 75500 113250 151000 164 PHACO WITH IOL(A) + TRAB(COMB.) AMO MULTIFOCAL AK* 84500 126750 169000 165 PHACO WITH IOL(A) + TRAB(COMB.) B & L AKREOS* 47273 70909.5 94546 166 PHACO WITH IOL(A) + TRAB(COMB.) B & L AK AO* 51500 77250 103000 167 PHACO WITH IOL(A) + TRAB(COMB.) B & L MIL 60* 60000 90000 120000 168 PHACO WITH IOL(A) + TRAB(COMB.) B & L CRYSTALENS* 150000 225000 300000 169 PHACO WITH IOL(A) + TRAB(COMB.) ALCON TORIC* 62600 93900 125200 170 PHACO WITH IOL(A) + TRAB(COMB.) ALCON MULTIFOCAL RESTORE* 84500 126750 169000 171 PHACO WITH IOL(A) + TRAB(COMB.) ALCON IQ* 50000 75000 100000 172 PHACO WITH IOL(A) + TRAB(COMB.) ALCON MA - 60* 45425 68137.5 90850 173 PHACO WITH IOL(A) + TRAB(COMB.) ALCON SINGLE PIECE* 47700 71550 95400 174 CYCLOCRYOPEXY 8000 12000 16000 175 ROP (PER EYE) 20000 30000 40000 176 GLUE INSERTION 5000 7500 10000 177 VISCOAT* 5000 6750 7500 178 BSS ++* 1950 2925 3900 179 HEALON GV* 3260 4890 6520 180 BCL* 1000 1500 2000 181 PHACO WITH IOL(A) + TRAB(COMB.) HOYA PC 60000 90000 120000 182 PHACO WITH IOL(A) + TRAB(COMB.) HOYA YELLOW 65000 97500 130000 183 PHACO WITH IOL(A) + TRAB(COMB.) EUROVISION ASPHERIC 48000 72000 96000 184 PHACO WITH IOL(A) + TRAB(COMB.) EUROVISION PLAIN 36000 54000 72000 185 SCLERAL FIXATION WITH IOL WITH GLUE 65000 97500 130000 186 LENSECTOMY 20500 30750 41000 187 INTRACAMERAL GAS INJECTION 15000 22500 30000 188 SCLERAL FIXATION WITH IOLANY OTHER IOL IS USED 60000 90000 120000 189 RETINAL DETACHMENT ( BUCKLING ) 40000 60000 80000 190 BUCKLE REMOVAL 15000 22500 30000 191 INJ. AVASTIN (SINGLE PATIENT) 35000 52500 70000 192 INJ. LUCENTIS (SINGLE PATIENT) 64029 96043.5 128058 193 INJ. MACUGEN (SINGLE PATIENT) 45000 67500 90000 194 RETINAL CRYOPREXY (SINGLE) 7500 11250 15000 195 RETINAL CRYOPREXY (MULTIPLE) 10000 15000 20000 196 INTRA VITERAL INJECTION (ONE EYE) 5000 7500 10000 197 VITRECTOMY 45000 67500 90000 198 VITERO RETINAL SURGERY WITH SILICON OIL & PFCL 55000 82500 110000 199 VITREORETINOPATHY ( VR ) COMPLICATED 70000 105000 140000 200 RETINA SURGERY - SILICONE OIL REMOVAL - (P) 15000 22500 30000

Page 95 201 SILICON OIL REMOVAL (FOR OUTSIDE PATIENTS) 20000 30000 40000 202 SQUINT SURGERY HORIZONTAL MUSCLES (LA) 30000 45000 60000 203 SQUINT SURGERY ( VERTICAL MUSCLE ) 30000 45000 60000 204 SQUINT SURGERY UNDER GA (0 TO 30 MINS) 38000 57000 76000 205 SQUINT SURGERY ( MULTIPLE HORIZONTAL MUSCLE ) 40500 60750 81000 206 SQUINT SURGERY ( SINGLE HORIZONTAL MUSCLE ) 43000 64500 86000 207 SQUINT SURGERY 45500 68250 91000 208 PK + CATARACT EXTRACTION WITH IOL AMO TECNIS AK* 71000 106500 142000 209 PK + CATARACT EXTRACTION WITH IOL AMO SENSAR* 67400 101100 134800 210 PK + CATARACT EXTRACTION WITH IOL TECNIS 1* 76750 115125 153500 211 PK + CATARACT EXTRACTION WITH IOL AMO MULTIFOCAL AK* 104000 156000 208000 212 PK + CATARACT EXTRACTION WITH IOL B & L AKREOS* 66773 100159.5 133546 213 PK + CATARACT EXTRACTION WITH IOL B & L AK AO* 71000 106500 142000 214 PK + CATARACT EXTRACTION WITH IOL B & L MIL 60* 79500 119250 159000 215 PK + CATARACT EXTRACTION WITH IOL B & L CRYSTALENS* 160000 240000 320000 216 PK + CATARACT EXTRACTION WITH IOL ALCON TORIC* 82100 123150 164200 217 PK + CATARACT EXTRACTION WITH IOL ALCON MULTIFOCAL RESTORE* 103920 155880 207840 218 PK + CATARACT EXTRACTION WITH IOL ALCON IQ* 77150 115725 154300 219 PK + CATARACT EXTRACTION WITH IOL ALCON MA - 60* 64925 97387.5 129850 220 PK + CATARACT EXTRACTION WITH IOL ALCON SINGLE PIECE* 67200 100800 134400 221 THERAPEUTIC PENETRATING KERATOPLASTY(PK) 50000 75000 100000 222 LAMELLAR KERATOPLASTY 50000 75000 100000 223 PENETRATING KERATOPLASTY (PK) 50000 75000 100000 224 TISSUE ADHESIVE APPLICATION + BANDAGE CONTACT LENSE ( BCL ) 10000 15000 20000 225 PTERYGIUM EXCISION + CONJUNCTIVAL AUTOGRAFT (WITHOUT GLUE) 25000 37500 50000 226 PTERYGIUM EXCISION + CONJUNCTIVAL AUTOGRAFT (WITH GLUE) 30000 45000 60000 227 REPAIR OF CORNEAL TEAR , AC FORMATION 30000 45000 60000 228 CORNEAL SCLERAL TEAR REPAIR. 40000 60000 80000 229 REPAIR OF CORNEAL SCLERAL TEAR & LID 45000 67500 90000 230 PK + CATARACT EXTRACTION WITH IOL HOYA PC 75000 112500 150000 231 PK + CATARACT EXTRACTION WITH IOL HOYA YELLOW 80000 120000 160000 232 PK + CATARACT EXTRACTION WITH IOL EUROVISION ASPHERIC 67500 101250 135000 233 PK + CATARACT EXTRACTION WITH IOL EUROVISION PLAIN 65800 98700 131600 234 FEMTOSECOND ASSISTED KERATOPLASTY 75000 112500 150000 235 CORNEAL GRAFTING - THERAPEUTIC PENETRATING KERATOPLASTY ( TPK ) 75000 112500 150000 236 LASER PACKAGE PER EYE FOR DERMOID REMOVAL 10000 15000 20000 237 ANTERIOR STROMAL PUNCTURE (ASP) + BCL 10000 15000 20000 238 EDTA CHELATION ONE EYE 10000 15000 20000 239 DEEP ANTERIOR LAMELLAR KERATOPLASTY ( DALK ) 50000 75000 100000 240 PHOTO THERAPEUTIC KERATECTOMY 30000 45000 60000 241 I- LASIK 95000 142500 190000 242 CSTR WITH CE + IOL IMPLANT AMO TECNIS AK* 51000 76500 102000 243 CSTR WITH CE + IOL IMPLANT AMO SENSAR* 47400 71100 94800 244 CSTR WITH CE + IOL IMPLANT AMO TECNIS 1* 56750 85125 113500 245 CSTR WITH CE + IOL IMPLANT AMO MULTIFOCAL AK* 84000 126000 168000 246 CSTR WITH CE + IOL IMPLANT B & L AKREOS* 51000 76500 102000 247 CSTR WITH CE + IOL IMPLANT B & L AK AO* 47400 71100 94800 248 CSTR WITH CE + IOL IMPLANT B & L MIL 60* 56000 84000 112000 249 CSTR WITH CE + IOL IMPLANT B & L CRYSTALENS* 140000 210000 280000 250 CSTR WITH CE + IOL IMPLANT ALCON TORIC* 62100 93150 124200

Page 96 251 CSTR WITH CE + IOL IMPLANT ALCON MULTIFOCAL RESTORE* 75000 112500 150000 252 CSTR WITH CE + IOL IMPLANT ALCON IQ* 83920 125880 167840 253 CSTR WITH CE + IOL IMPLANT ALCON MA - 60* 44925 67387.5 89850 254 CSTR WITH CE + IOL IMPLANT ALCON SINGLE PIECE* 47200 70800 94400 255 CSTR WITH CE + IOL IMPLANT HOYA PC 55000 82500 110000 256 CSTR WITH CE + IOL IMPLANT HOYA YELLOW 60000 90000 120000 257 CSTR WITH CE + IOL IMPLANT EUROVISION ASPHERIC 47500 71250 95000 258 CSTR WITH CE + IOL IMPLANT EUROVISION PLAIN 45800 68700 91600 259 COMPREHENSIVE EYE CHECK UP 1200 1800 2400 260 VER 2500 3750 5000 261 ERG 3000 4500 6000 262 EOG 3000 4500 6000 263 ELECTRORETINOGRAPHY ( ERG ) 5000 7500 10000 264 HYPHEMA DRAINAGE (ONE EYE) 15000 22500 30000 265 RETINAL LASER ( RIGHT EYE ) 15000 22500 30000 266 GAS INJECTION (INCLUSIVE OF COST OF INJECTION) 15000 22500 30000 267 CHALAZION UNDER LA 5000 7500 10000 268 CHALAZION UNDER GA (0 - 30 MNS) 13000 19500 26000 OPTICAL COHERENCE TOMOGRAPHY ( OCT ) / RETINAL NERVE FIBER LAYER ( RNFL ) FOR GLAUCOMA ( 269 SUBSEQUENT SCAN + CHANGE ANALYSIS ) - BOTH EYES 3200 4320 4800 270 SUB TENON INJECTION ( LEFT EYE ) 2000 3000 4000 271 POSTERIOR SUB TENON INJECTION 2000 3000 4000 272 FFA (BOTH EYES) 3500 4725 5250

273 ARGON LASER PROCEDURE - PANRETINAL PHOTOCOAGULATION ( PRP ) - MINIMUM 3 SITTINGS ( PER EYE ) 5000 6750 7500 274 BARRAGE LASER / CRYO ( SINGLE QUADRANT ) 7500 11250 15000 275 BARRAGE LASER / CRYO ( MULTIPLE QUADRANT ) 10000 15000 20000 276 GONIOSCOPY 500 750 1000 277 VISUAL FIELDS(BOTH EYES) 2500 3375 3750 278 PARALYTIC SQUINT WORK UP 1500 2250 3000 279 FUNDUS PHOTOGRAPHY 500 750 1000 280 DIURNAL VARIATION STUDY 1200 1800 2400 281 ND YITTRIUM-ALUMINIUM-GARNET (YAG) CAPSULOTOMY ( PER EYE) 3500 4725 5250 282 ND YAG IRIDOTOMY ( PER EYE) 4000 5400 6000 283 ND YAG SYNECHOLYSIS/SWEEPING ( PER EYE) 5000 7500 10000 284 GREEN LASER ( RIGHT EYE ) - PER SITTING ( PEDIATRICS ) 5000 7500 10000 285 GREEN LASER ( LEFT EYE ) - PER SITTING ( PEDIATRICS ) 2500 3750 5000 286 INJECTION MANITOL 500 750 1000 287 CORNEAL SCRAPING MICROSCOPY 700 945 1050 288 CORNEAL FOREIGN BODY REMOVAL ( DEEP - SINGLE ) 1000 1500 2000 289 EXCISION OF WARTS 3500 4725 5250 290 EYE WASH 1000 1500 2000 291 AC WASH 7000 10500 14000 292 DARK ROOM PRONE TEST 1000 1500 2000 293 SUTURE REMOVAL ( PEDIATRIC ) 800 1080 1200 294 PUNCTAL PLUG ( BOTH EYES ) 5500 7425 8250 295 PARACENTESIS ( ENT ) 6000 9000 12000 296 LASIK (ONE EYE) 2500 3750 5000 297 CORNEAL TOPOGRAPHY & PACHYMETRY 2500 3750 5000 298 CORNEAL TOPOGRAPHY ( LEFT EYE ) 2000 3000 4000 299 ICG 7000 9450 10500 300 FUNDUS PHOTOGRAPHY WITH PRINT OR CD 800 1200 1600

Page 97 301 FUNDUS PHOTOGRAPHY WITH PRINT AND CD 1000 1500 2000 302 ECG - DIAG 250 375 500 303 SPECULAR MICROSCOPY BOTH EYES 1500 2250 3000 304 SYNAPTOPHORE EXERCISES (7 SITTINGS WITHIN 10 DAYS) 1000 1500 2000 305 TRANS PUPILLARY THERMO THERAPY 10000 15000 20000 306 LASIK 35000 52500 70000 307 ENDOCAPSULAR (CTR) 5000 7500 10000 308 AMNIOTIC MEMBRANE GRAFT OCULOPLASTY 20000 30000 40000 309 ECTROPION CORRECTION (ONE EYE) 20000 30000 40000 310 ENTROPION CORRECTION - LEFT EYE 15000 22500 30000 311 EPICANTHUS REPAIR 15000 22500 30000 312 LATERAL CANTHPLASTY 10000 15000 20000 313 MEDICAL CANTHOPLASTY 10000 15000 20000 314 SYMBLEPHARON RELEASE OCULOPLASTY 16000 24000 32000 315 SYMBLEPHARON RELEASE OCULOPLASTY (COST OF AMG EXTRA) 25000 37500 50000 316 TARSAL STRIP PROCEDURE 20000 30000 40000 317 ENTROPION CORRECTION (ONE EYE - LOWER LID 25000 37500 50000 318 ASPHERIC LASIK 45000 67500 90000 319 A SCAN 500 750 1000 320 CATARACT ALCON ACRYCENT PACKAGE 40000 60000 80000 321 SKIN GRAFT 30000 45000 60000 322 EAR / NOSE CARTILAGE GRAFT 35000 52500 70000 323 HARD PALATE GRAFT 35000 52500 70000 324 MUCUS MEMBRANE GRAFT 35000 52500 70000 325 SKIN GRAFT TWO EYELID 40000 60000 80000 326 SCLERAL GRAFT OCULOPLASTY 20000 30000 40000 327 EYELID FOLD FORMATION 15000 22500 30000 328 Y-PLASTY OR Z-PLASTY 15000 22500 30000 329 EYELID RECONSTRUCTION - MAJOR ( RIGHT SIDE ) 15000 22500 30000 330 EYELID RECONSTRUCTION FLAP 35000 52500 70000 331 EYELID REPAIR 20000 30000 40000 332 MONOCANALICULAR STENT (ADDITIONAL MATERIAL CHARGE)* 25000 37500 50000 333 BICANALICULAR STENT * 30000 45000 60000 334 EYELID RECONSTRUCTION WITH CUTTLER BEARD STAGE 1 35000 52500 70000 335 EYELID RECONSTRUCTION WITH CUTTLER BEARD STAGE 2 10000 15000 20000 336 EPIBLEPHARON CORRECTION 15000 22500 30000 337 EYELID RECONSTRUCTION TENZEL 35000 52500 70000 338 ORBICULARIS MYECTOMY (BILATERAL) 60000 90000 120000 339 ORBICULARIS MYECTOMY O/E 30000 45000 60000 340 COLLAGEN CROSS LINKING (SINGLE EYE) 29000 43500 58000 341 COLLAGEN CROSS LINKING (BOTH EYE) 50000 75000 100000 342 BLEPHAROPHIMOSIS CORRECTION (CU PLASTY B/E) 30000 45000 60000 343 FASANELLA SERVAT PROCEDURE 20000 30000 40000 344 LPS RESECTION/EXPLORATION / REINSERTION/PLICATION 25000 37500 50000 345 ADJUSTABLE SUTURE LPS RESECTION 30000 45000 60000 346 TARSOFRONTAL SLING ONE EYE ETHIBOND 15000 22500 30000 347 TARSOFRONTAL SLING BOTH EYES ETHIBOND 25000 37500 50000 348 TARSOFRONTAL SLING ONE EYE SILICONE (INCLUDES MATERIAL CHARGES) 25000 37500 50000 349 TARSOFRONTAL SLING BOTH EYES SILICONE (INCLUDES MATERIAL CHARGES) 35000 52500 70000 350 CORRECTION OF EYE LID RETRACTION/LEVATOR RECESSION 20000 30000 40000

Page 98 351 LOWER EYELID RETRACTION CORRECTION 20000 30000 40000 352 LOWER EYELID RETRACTION CORRECTION WITH FAT PEARL GRAFTING 25000 37500 50000 353 MULLERECTOMY 25000 37500 50000 354 CANALICULAR REPAIR 20000 30000 40000 355 CANALICULAR REPAIR WITH MONOCANALICULAR STENT 25000 37500 50000 356 FISTULECTOMY - CS 15000 22500 30000 357 MECKEL'S DIVERTICULECTOMY 15000 22500 30000 358 DCR 25000 37500 50000 359 DCR CONJUCTIVAL WITH JONES TUBE 30000 45000 60000 360 DCR WITH MMC 19000 28500 38000 361 DCR WITH MMC WITH INTUBATION 30000 45000 60000 362 DCR WITH FISTULECTOMY 30000 45000 60000 363 DCT - CS 20000 30000 40000 364 DCT+FISTULECTOMY 25000 37500 50000 365 TURBINECTOMY 5000 7500 10000 366 CONJUNCTIVOPLASTY LR 5000 7500 10000 367 PUNCTAL CAUTERY 5000 7500 10000 368 DCR WITH FISTULECTOMY WITH INTUBATION 30000 45000 60000 369 DCR WITH FISTULECTOMY WITH INTUBATION WITH MMC 30000 45000 60000 370 ANTERIOR VITRECTOMY 22500 33750 45000 371 RECANALIZATION OF CANALICULUS + BICANALICULAR INTUBATION 20000 30000 40000 372 RECANALIZATION OF CANALICULUS + MONOCANALICULAR STENT 20000 30000 40000 373 C3R SURGERY 29000 39150 58725 374 OCULOPLASTY - ORBITOTOMY SURGERY (ANTERIOR / BASIC ) 40000 60000 80000 375 ORBITAL FORIEGN BODY REMOVAL (LARGE) 40000 60000 80000 376 ORBITAL FRACTURE REPAIR WITH SILASTIC SHEET 40000 60000 80000 377 ORBITAL FRACTURE REPAIR WITH POREX SHEET (ADD MATERIAL CHARGES) 40000 60000 80000 378 ORBITAL DECOMPRESSION (BONE + FAT) 40000 60000 80000 379 ORBITAL DECOMPRESSION (FAT ONLY) 30000 45000 60000 380 ORBITAL FLOOR AUGMENTATION WITH SILASTIC IMPLANT 40000 60000 80000 381 ORBITAL FLOOR AUGMENTATION WITH POREX WEDGE IMPLANT (ADD MATERIAL CHARGE) 40000 60000 80000 382 ORBITAL FRACTURE REPAIR (2 WALL, SILASTIC SHEET) 50000 75000 100000 383 BLEPHAROPLASTY (ONE EYE ONE LID) 20000 30000 40000 384 BLEPHAROPLASTY - CS 35000 52500 70000 385 BLEPHAROPLASTY (BOTH LOWER) 35000 52500 70000 386 BLEPHAROPLASTY (QUAD BLEPH) 50000 75000 100000 387 BROW LIFT 25000 37500 50000 388 BROW LIFT (TRANSBLEPH) ONE EYE 25000 37500 50000 389 BROW LIFT (TRANSBLEPH) TWO EYE 35000 52500 70000 390 MID FACE LIFT (CABLE SUTURE0 20000 30000 40000 391 FAT TRANSFER 30000 45000 60000 392 BOTOX (PER UNIT) 400 600 800 393 CHEMODENERVATION OF MEDIAL RECTUS 5000 7500 10000 394 BROW LIFT 2 EYES 35000 52500 70000 395 FORNIX FORMATION SUTURE (FFS) 20000 30000 40000 396 SOCKET RECONSTRUCTION 30000 45000 60000 397 SOCKET RECONSTRUCTION + FFS 25000 37500 50000 398 DERMIS FAT GRAFT 40000 60000 80000 399 EVISCERATION 18000 27000 36000 400 EVISCERATION + IMPLANT 25000 37500 50000

Page 99 401 ENUCLEATION 25000 37500 50000 402 ENUCLEATION + SILICON IMPLANT 25000 37500 50000 403 ORBITAL EXENTERATION 40000 60000 80000 404 IMPLANT EXCHANGE WITH SILICON IMPLANT 25000 37500 50000 405 IMPLANT REMOVAL 20000 30000 40000 406 CUSTOM OCULAR PROSTHESIS 15000 22500 30000 407 ARTIFICIAL BALL IMPLANT - PROSTHESIS MODIFICATION ( OCCULOPLASTIC SURGERY ) 750 1125 1500 408 POLISHING 375 562.5 750 409 REGULAR CONFORMER 750 1125 1500 410 STEM CONFORMER 1500 2250 3000 411 PRESSURE CONFORMER 1500 2250 3000 412 IRIS PAINTED CONFORMER 1500 2250 3000 413 SOCKET EXPANDER 1500 2250 3000 414 ORBITAL PROSTHESIS ACRYLIC 25000 37500 50000 415 ORBITAL PROSTHESIS SILICON 25000 37500 50000 416 SILICON GLUE 375 562.5 750 417 CRUTCH GLASSES 1500 2250 3000 418 RUBBER PLUNGER 75 112.5 150 419 EXAMINATION UNDER ANESTHESIA (0- 30 MINS) 8000 12000 16000 420 GENERAL ANESTHESIA CHARGES (0-30 MIN) 8000 12000 16000 421 GENERAL ANESTHESIA CHARGES (30-60 MIN) 10500 15750 21000 422 GENERAL ANESTHESIA CHARGES (1 HRS.) 13000 19500 26000 423 RESUTURING UNDER GENERAL ANESTHESIA - (P) 15500 23250 31000 424 EXAMINATION UNDER ANESTHESIA (EUA) 8000 12000 16000 425 CHALAZION INCISION AND CURETTAGE 5000 7500 10000 426 CHALAZION EXCISION ( BILATERAL ) 10000 15000 20000 427 ELECTROLYSIS 5000 7500 10000 428 INCISION AND DRAINAGE( ENT ) 8000 12000 16000 429 TARSORRAPHY 5000 7500 10000 430 SUTURE TARSORRAPHY 3000 4500 6000 431 TARSORRAPHY RELEASE 1000 1500 2000 432 MEMBRANECTOMY 20000 30000 40000 433 TENSILON ( EDROPHONIUM CHLORIDE ) TEST 5000 7500 10000 434 NEOSTIGMINE TEST 5000 7500 10000 435 EVERTING SUTURES 10000 15000 20000 436 VISUAL EVOKED POTENTIAL STUDY ( VEP ) 2500 3750 5000 437 B SCAN 1500 2250 3000 438 SYRINGING UNDER ANESTHESIA - ONE EYE (LA) 1000 1500 2000 439 SYRINGING UNDER ANESTHESIA - ONE EYE (GA) (0 TO 30 MNS) 9000 13500 18000 440 SYRINGING AND PROBING - ONE EYE (LA) 5000 7500 10000 441 PROBING + SYRINGING ( RIGHT EYE ) 13000 19500 26000 442 PROBING + SYRINGING 7000 10500 14000 443 PROBING & SYRINGING - BOTH EYES 10000 15000 20000 444 THERAPEUTIC PROBING 1000 1500 2000 445 DIAGNOSTIC ENDOSCOPY 1000 1500 2000 446 PUNCTOPLASTY ( RIGHT EYE ) 5000 7500 10000 447 PUNCTOPLASTY - BOTH EYES 10000 15000 20000 448 CONJUNCTIVOPLASTY SP 5000 7500 10000 449 CANALICULAR CURETTAGE 5000 7500 10000 450 DACRYOSCLEROTHERAPY 5000 7500 10000 451 ETHANOLAMINE OLEATE SCLEROTHERAPY 10000 15000 20000 452 METHLYPREDNISOLONE INJ 250 MG IV 1000 1500 2000 453 METHLYPREDNISOLONE INJ 500 MG IV 2000 3000 4000 454 METHLYPREDNISOLONE INJ 750 MG IV 3000 4500 6000 455 METHLYPREDNISOLONE INJ 1000 MG IV 4000 6000 8000 456 DEXAMETHASONE INJECTION IV 2000 3000 4000 457 CYCLOPHOSPHAMIDE INJ 250 MG IV 300 450 600 458 CYCLOPHOSPHAMIDE INJ 500 MG IV 450 675 900 459 CYCLOPHOSPHAMIDE INJ 750 MG IV 600 900 1200 460 CYCLOPHOSPHAMIDE INJ 1000 MG IV 750 1125 1500 461 INJECTION TRICORT (ONE EYE) 5000 7500 10000 462 RETINA SURGERY - AVASTIN INTRAVITREAL INJECTION - (P) 15000 22500 30000 463 INJECTION LUCENTS 48000 72000 96000

Page 100 PULMONOLOGY PROCEDURES

Page 101 Double Sl No. Description Single Room Suite Room 1 SLEEP STUDY - SPLIT-NIGHT COMPLETE POLYSOMNOGRAPHY 16000 24000 40000 2 ASCITES TAPPING ( PEDIATRIC ) 5000 7500 10000 3 ESOPHAGO-CARDIOMYOTOMY ( ACHALASIA CARDIA ) 20000 30000 40000 4 AXILLARY NODE BIOPSY 11900 17850 23800 5 GROIN DISSECTION - BILATERAL 19800 29700 39600 6 LOBECTOMY LUNG ( THORACIC SURGERY ) 22000 33000 44000 7 LUNG NEEDLE BIOPSY ( PULMONOLOGY ) 3000 4500 6000 8 LUNG BIOPSY OPEN ( THORACIC SURGERY ) 5500 8250 11000 9 MEDIASTINAL LYMPH NODE BIOPSY ( THORACIC SURGERY ) 6500 9750 13000 10 BIOPSY PLEURA 2800 4200 5600 11 BREAST LUMP EXCISION + SENTINEL NODE BIOPSY 11900 17850 23800 12 BREAST LUMP ( BENIGN ) EXCISION 5900 8850 11800 13 BRONCHIAL PROVOCATION TEST 1700 2550 3400 14 BRONCHOPLASTIC RESECTION 24200 36300 48400 15 BRONCHOSCOPY FOREIGN BODY 2200 3300 4400 16 BRONCHOSCOPY - ( PULMONOLOGY ) 4400 6600 8800 17 BRONCHOSCOPY FIBREOPTIC + TBB + TBNA 5500 8250 11000 18 BRONCHOSCOPY + FOREIGN BODY REMOVAL 7800 11700 15600 19 BULLECTOMY 14900 22350 29800 20 CARINAL RECONSTRUCTION 21800 32700 43600 21 CHEST WALL RESECTION + RECONSTRUCTION 9900 14850 19800 22 THORACOSCOPY FOR CHYLOTHORAX 20000 30000 40000 23 BRONCHOPLEURAL FISTULA REPAIR - CERVICAL (PEDIATRIC SURGERY) 22000 33000 44000 24 CLOSURE OF TRACHEOSTOMA 7900 11850 15800 25 CLOT EVACUATION BY THORACOSCOPY 15000 22500 30000 26 BRONCHOSCOPIC BIOPSY (PEDIATRIC SURGERY) 9500 14250 19000 27 COMPLETE BRONCHOSCOPY INCLUDING BRUSH BIOPSY 7800 11700 15600 28 COMPLETE OVERNIGHT POLYSOMNOGRAPHY ( COP ) 8600 12900 17200 29 COMPLETE OVERNIGHT POL WITH CPAP & MSLT (COP WITH CPAP & MSLT) 13600 20400 27200 COMPLETE OVERNIGHT POLYSOMNOGRAPHY ( COP ) WITH CONTINUOUS POSITIVE AIRWAY PRESSURE ( CPAP 30 ) TITRATION (COP WITH CPAP) 9800 14700 19600 COMPLETE OVERNIGHT POLYSOMNOGRAPHY ( POP ) WITH MULTIPLE SLEEP LATENCY TEST ( MSLT ) (COP 31 WITH MSLT) 11100 16650 22200 32 PULMONARY FUNCTION TEST ( PFT ) COMPLETE - NIC 2500 3750 5000 33 DECORTICATION LUNG ( CTVS ) 13900 20850 27800 34 DECORTICATION + LOBECTOMY ( LUNG ) 14900 22350 29800 35 THORACOSCOPY ( DIAGNOSTIC ) + BIOPSY 9900 14850 19800 36 DIAPHRAGMATIC HERNIA REPAIR - LAPAROSCOPIC ( GI SURGERY ) 17800 26700 35600 37 DIAPHRAGMATIC RECONSTRUCTION 19800 29700 39600 38 DIVISION OF BANDS AND ADHESIONS 10900 16350 21800 39 DRAINAGE OF ABDOMINAL ABSCESS 24800 37200 49600 40 ELOESSER FLAP WINDOW 9900 14850 19800 41 EMPYEMECTOMY 15800 23700 31600 42 BENIGN TUMORS ENUCLEATION (THORACIC SURGERY) 17800 26700 35600 43 ESOPHAGEAL SUBSTITUTION ( PEDIATRICS ) 19800 29700 39600 44 ESOPHAGEAL DILATATION (PEDIATRIC SURGERY) 9900 14850 19800 45 ESOPHAGEAL DIVERSION ( THORACIC SURGERY ) 14900 22350 29800 46 ESOPHAGEAL STENTING ( THORACIC SURGERY ) 14900 22350 29800 47 ESOPHAGEAL TRANSECTION ( EEA STAPLER USE ) 14900 22350 29800 48 ESOPHAGECTOMY (TRANSTHORACIC) 24800 37200 49600 49 HEMOTHORAX EVACUATION ( THORACIC SURGERY ) 15800 23700 31600 50 ADRENAL GLAND TUMOR / NEOPLASM EXCISION ( PEDIATRIC ) 20800 31200 41600

Page 102 51 CERVICAL RIB EXCISION ( THORACIC SURGERY ) 12900 19350 25800 52 ECTOPIC PARATHYROID TUMOR EXCISION ( THORACIC SURGERY ) 19800 29700 39600 53 ESOPHAGEAL DIVERTICULUM EXCISION ( THORACIC SURGERY ) 14900 22350 29800 54 PHEOCHROMOCYTOMA ( EXTRA ADRENAL ) EXCISION 19800 29700 39600 55 MEDIASTINAL TUMOR EXCISION ( THORACIC SURGERY ) 17800 26700 35600 56 PARATHYROID ADENOMA EXCISION ( THORACIC SURGERY ) 17800 26700 35600 57 EXCISION OF UNLATERAL ADRENAL TUMOUR 18800 28200 37600 58 EXPLORATORY THOROCOTOMY 14900 22350 29800 59 GASTROSTOMY ( PEDIATRIC ) 7900 11850 15800 60 CHEST WALL FLAP RECONSTRUCTION ( THORACIC SURGERY ) 9900 14850 19800 61 INSULINOMA EXCISION ( MAMBS ) 23800 35700 47600 62 TUBE DRAINAGE ( FOR EMPYEMA / PNEUMOTHORAX ) 4100 6150 8200 63 LIVER RESECTION ( FOR ENDOCRINE MALIGNANCY ) - GENERAL SURGERY 23800 35700 47600 64 LOBECTOMY 17800 26700 35600 65 LUNG ABSCESS SURGERY ( THORACIC SURGERY ) 19800 29700 39600 66 LUNG BIOPSY OPEN ( GENERAL SURGERY ) 9900 14850 19800 67 LUNG RESECTION + MEDIASTINAL NODE DISSECTION + CHEST WALL RECONSTRUCTION 27700 41550 55400 68 LUNG RESECTION + CHEST WALL RESECTION 25700 38550 51400 69 LUNG VOLUME REDUCTION SURGERY ( BILATERAL ) 21800 32700 43600 70 MEDIASTINAL LYMPHADENECTOMY 5900 8850 11800 71 MEDIASTINAL MASS EXCISION 15800 23700 31600 72 MEDIASTINAL NODE BIOPSY - (P) 9900 14850 19800 73 MULTIPLE SLEEP LATENCY TEST ( MSLT ) 4500 6750 9000 74 MULTIPLE SLEEP LATENCY TEST ( MSLT ) - AFTER COP USE 2500 3750 5000 75 PARATHYROID AUTOTRANSPLANTATION ( THORACIC SURGERY ) 7900 11850 15800 76 PARTIAL PENILE AMPUTATION 990 1485 1980 77 TRACHEOSTOMY PERCUTANEOUS ( CRITICAL CARE ) 3000 4500 6000 78 PERICARDIAL ASPIRATION ( THORACIC SURGERY ) 3200 4800 6400 79 PERICARDIAL TUBE DRAINAGE 5500 8250 11000 80 PERICARDIO- PERITONEAL WINDOW CREATION 9900 14850 19800 81 PERITONAL DIALYSIS CATHETER INSERTION 2100 3150 4200 82 PLEURAL ASPIRATION / TAP ( THORACOCENTESIS ) < 200 ML - DIAGNOSTIC ( GENERAL SURGERY) 1600 2400 3200 83 PLEURAL ASPIRATION - THERAPEUTIC ( THORACIC SURGERY ) 2500 3750 5000 84 PLEURAL BIOPSY ( PULMONOLOGY ) 5900 8850 11800 85 PLEURECTOMY + EMPYEMA EXCISION ( WITHOUT LUNG RESECTION ) 13900 20850 27800 86 PLEURECTOMY + AIR LEAK OBLITERATION 17800 26700 35600 87 PLEURO PERICARDIAL WINDOW CREATION 9900 14850 19800 88 PLEURO PERITONEAL SHUNT 9900 14850 19800 89 PLEURODESIS ( THORACIC SURGERY ) 4500 6750 9000 90 PLICATION DIAPHRAGM 17800 26700 35600 91 RADICAL PLEUROPNEUMONECTOMY 19800 29700 39600 92 PULSE OXIMETER 1500 2250 3000 93 MASTECTOMY RADICAL 16600 24900 33200 94 MASTECTOMY MODIFIED RADICAL ( THORACIC SURGERY ) 19800 29700 39600 95 REMOVAL AND FLAP INSETTING (SMALL) (PLASTIC SURG) 17800 26700 35600 96 RETROPERITONEAL LYMPH NODE DISSECTION ( RPLND ) 19800 29700 39600 97 RIGID BRONCHOSCOPY ( THORACIC SURGERY ) 8800 13200 17600 98 RIGID BRONCHOSCOPY + ELECTROCOAGULATION ( THORACIC SURGERY ) 13200 19800 26400 99 RIGID BRONCHOSCOPY + LASER ABLATION ( THORACIC SURGERY ) 13200 19800 26400 100 SCALENOTOMY ( FOR SCALENUS SYNDROME ) 5000 7500 10000

Page 103 101 LUNG RESECTION ( SEGMENTAL ) 17800 26700 35600 102 SENTINEL NODE BIOPSY ( BILATERAL ) 10900 16350 21800 103 SENTINEL NODE BIOPSY ( LEFT ) 8900 13350 17800 104 MASTECTOMY SIMPLE ( THORACIC SURGERY ) 9900 14850 19800 105 MASTECTOMY ( SIMPLE ) + AXILLARY DISSECTION ( THORACIC SURGERY ) 12900 19350 25800 106 SLEEP STUDY (COMPLETE OVERNIGHT PULSE OXYMETRY) 16000 24000 40000 107 STERNAL DEBRIDEMENT + MUSCLE FLAP ROTATION 21800 32700 43600 108 STERNAL RESECTION + RECONSTRUCTION 19800 29700 39600 109 ACHALASIA CARDIA SURGERY 17800 26700 35600 110 CARCINOID TUMOR + METASTASIS SURGERY 19800 29700 39600 111 GASTROESOPHAGEAL REFLUX ( GER ) + HIATUS HERNIA SURGERY 19800 29700 39600 112 PULMONARY HYDATID CYST ( PEDIATRIC ) 17800 26700 35600 113 HYDATID DISEASE SURGERY - RIGHT ( THORACIC SURGERY ) 14900 22350 29800 114 MAMILLARY DUCT FISTULA SURGERY 8900 13350 17800 115 PARATHYROID HYPERPLASIA SURGERY 19800 29700 39600 116 BRONCHOGENIC CYST SURGERY 17600 26400 35200 117 TRACHEOESOPHAGEAL FISTULA ( TEF ) SURGERY 19800 29700 39600 118 INTESTINE RESECTION AND ANASTAMOSIS ( PEDIATRIC ) 15800 23700 31600 119 SYMPATHECTOMY ( BILATERAL ) FOR HYPERHYDROSIS 25700 38550 51400 120 THORACIC OUTLET OBSTRUCTION SURGERY 16200 24300 32400 121 THORACIC PULMO PACKAGES COMPLEX - (P) 198000 297000 396000 122 THORACOPLASTY 13900 20850 27800 123 PLEURAL BIOPSY - THORACOSCOPIC ( PULMONOLOGY ) 10000 15000 20000 124 LUNG BIOPSY THORACOSCOPIC ( PULMONOLOGY ) 10000 15000 20000 125 VIDEO ASSISTED THORACOSCOPIC SURGERY ( VATS ) - PLEURAL BIOPSY 10000 15000 20000 126 SYMPATHECTOMY THORACOSCOPIC 22000 33000 44000 127 VIDEO ASSISTED THORACOSCOPIC SURGERY ( VATS ) - THYMECTOMY / MEDIASTINAL MASS 22000 33000 44000 128 THORACOTOMY + DECOMPRESSION ANTERIOR ( D6 BODY TUMOR ) 12900 19350 25800 129 HYDATID CYST EXCISION ( THORACOSCOPIC ) 12900 19350 25800 130 THORACOTOMY PROCEDURES 12900 19350 25800 131 THORACOTOMY ( FOR PERFORATING / PENETRATING INJURY ) 12900 19350 25800 132 THYMECTOMY ( CTVS ) 15800 23700 31600 133 THORACIC DUCT EXCISION - TOTAL ( THORACIC SURGERY ) 8900 13350 17800 134 TOTAL GASTRECTOMY FOR Z-E SYNDROME 23800 35700 47600 135 AMPUTATION PENIS - TOTAL ( UROLOGY ) 13900 20850 27800 136 TRACHEAL DILATATION + STENTING 14900 22350 29800 137 GROIN DISSECTION - RIGHT SIDE 13900 20850 27800 138 UNILATERAL GROIN HERNIA 9900 14850 19800 139 LUNG VOLUME REDUCTION SURGERY ( RIGHT ) 19800 29700 39600 140 TUMOR WIDE EXCISION 13900 20850 27800 141 WIDE LOCAL EXCISION + AXILLARY DISSECTION 13900 20850 27800 142 CHEST TUBE DRAINAGE - PEDIATRIC 10000 15000 20000 COMPLETE OVERNIGHT POLYSOMNOGRAPHY ( POP ) WITH CONTINUOUS POSITIVE AIRWAY PRESSURE ( CPAP 143 ) AND MULTIPLE SLEEP LATENCY TEST ( MSLT ) (COP WITH CPAP & MSLT) 12200 18300 24400 144 BRONCHOSCOPY ( RIGID ) - DIAGNOSTIC ( PEDIATRIC ) 5500 8250 11000 145 BRONCHOGRAPHY 12000 18000 24000 146 BRONCHOGRAPHY ( PEDIATRIC ) 12000 18000 24000

Page 104 PAIN CLINIC CHARGES

Page 105 Double Sl No. Description Single Room Suite Room 1 CAUDAL EPIDURAL STEROID INJECTION 1500 2250 3000 2 COELIAC PLEXUS BLOCK DIAG/THER (USG) - (P) 2500 3750 5000 3 SPINAL LIGAMENT INJECTION ( DIAGNOSTIC ) 1000 1500 2000 4 FACET JOINT INJECTION 2500 3750 5000 5 JOINT INJECTION 1000 1500 2000 6 LOCAL INFILTRATION 2000 3000 4000 7 EPIDURAL INJECTION ( LUMBAR ) 1800 2700 3600 8 ACUPUNCTURE ( PER SITTING ) 350 525 700 9 PERIPHERAL NERVE BLOCK 800 1200 1600 10 RADIOFREQUENCY ( RF ) RHIZOTOMY 20000 30000 40000 11 SPINAL NERVE ROOT BLOCK 4000 5400 6000 12 STELLATE GANGLION BLOCK 1000 1500 2000 13 EPIDURAL INJECTION ( THORACIC ) 2500 3750 5000 14 TRIGGER POINT INJECTION - (P) 800 1200 1600

Page 106 PLASTIC SURGERY

Page 107 Double Sl No Description Single Room Room 1 ABDOMINOPLASTY - SMALL ( PEDIATRIC ) 24300 36450 2 BREAST AUGMENTATION 19800 29700 3 BREAST RECONSTRUCTION 29500 44250 4 BREAST REDUCTION 29500 44250 5 CONTRACTURE RLEASE MILD 7700 11550 6 DEBRIDEMENT ( LARGE > 5 CM ) ( PEDIATRIC ) 7700 11550 7 DEBRIDEMENT SMALL (PLASTIC SUR) 5200 7800 8 EAR RECONSTRUCTION ( 1ST STAGE ) 16600 24900 9 EAR RECONSTRUCTION ( 2ND STAGE ) 16600 24900 10 FASCIOCUTANEOUS FLAP PROCEDURE ( LARGE ) 16600 24900 11 FLAP DETACHMENT + FINAL INSET 12400 18600 12 FULL THICKNESS GRAFT - MEDIUM 12400 18600 13 LACERATION REPAIR - LARGE 12400 18600 14 LACERATION ( MULTIPLE ) REPAIR 16600 24900 15 LACERATION ( SINGLE ) REPAIR - SMALL 7700 11550 16 LIPECTOMY ( ABDOMEN ) 12400 18600 17 LIPOSUCTION 16600 24900 18 MANDIBLE FRACTURE - CLOSED REDUCTION ( PLASTIC SURGERY ) 12400 18600 19 MYOCUTANEOUS FLAP 19900 29850 20 ORBITOZYGOMATIC FRACTURE ( COMPLEX ) REPAIR 24300 36450 21 PRESSURE SORE FLAP 16600 24900 22 SPLIT SKIN GRAFTING ( MEDIUM ) 7700 11550 23 SPLIT SKIN GRAFTING ( SMALL ) 5200 7800

Page 108 PHYSIOTHERAPY CHARGES

Page 109 Double Sl No Description Single Room Suite Room 1 PHYSIOTHERAPY (1 SESSION) 500 675 1013 2 INITIAL EVALUATION ( UPTO 45 MINS. ) 500 675 1013 3 PHYSIOTHERAPY CHEST 300 450 600 4 SINGLE JOINT TREATMENT OR SINGLE COMPLAINT 500 675 1013 5 ULTRASOUND THERAPY - BED SIDE (PHYSIOTHERAPY) 125 187.5 250 6 DIATHERMY SHORT WAVE (PHYSIOTHERAPY) 125 187.5 250 7 ELECTRICAL STIMULATION ( TYPE 1 ) 125 187.5 250 8 MUSCLE TESTING DIAGNOSTIC ( PHYSIOTHERAPY ) 125 187.5 250 9 INFRARED THERAPY 125 187.5 250 10 U. V. THERAPEUTIC DOSE 125 187.5 250 11 LUMBAR TRACTION (PHYSIOTHERAPY ) 78 117 156 12 CERVICAL TRACTION (PHYSIOTHERAPY ) 125 187.5 250 13 PARAFFIN WAX BATH 125 187.5 250 14 HOT PACK 100 150 200 15 BREATHING EXERCISES + POSTURAL DRAINAGE 150 225 300 16 CEREBRAL PALSY MASSAGE 300 450 600 17 POST POLIO EXERCISE ( PHYSIOTHERAPY ) 300 450 600 18 CONSULTATION 150 225 300 19 SUPERVISED EXERCISES 40 MINUTES 100 150 200 20 SUPERVISED EXERCISES UPTO 1 HOUR 300 405 608 21 ANTENATAL EXERCISE PROGRAM 30 MINS 300 450 600 22 POSTNATAL EXERCISE ( UP TO 45 MINS ) 300 450 600 23 CONTINUOUS PASSIVE MOTION ( CPM ) 150 225 300 24 COLD PACK 100 150 200 25 LASER THERAPY - ( LLLT ) ( PHYSIOTHERAPY ) 150 225 300 26 LONGWAVE DIATHERMY 125 169 253 27 CLASS IV LASER: PHYSIOTHERAPY 800 1080 1620 28 DRY NEEDLING CHARGES 200 270 405 29 SPORTS TAPPING PER JOINT 100 135 203 30 SINGLE JOINT TREATMENT 500 675 1013 31 ANY ADDITIONAL MODALITY PER SITTING 100 150 200 32 ORTHO SINGLE JOINT TREATMENT OR SINGLE COMPLAINT 300 450 600 33 ANY ADDITIONAL JOINT TREATMENT OR ADDITIONAL COMPLAINT 150 203 304

Page 110 OTHER SERVICES

Page 111 Sl No. DESCRIPTION RATE 1 Ambulance Outstation Calls (Both ALS/BLS) (To & FRO) Per KM 60 2 AMBULANCE-DOCTOR FEES SPECIALIST 1000 3 Ambulance Delhi/NCR Transport (BLS/Without Doctor) 1500 4 Ambulance Delhi/NCR Transport (ALS/With Doctor) 2500 5 Ambulance Delhi/NCR Transport (Mercedes Ambulance) 5000 6 Ambulance Outstation Calls (Mercedes Ambulance) 80 7 Ambulance Nursing Staff Per Staff / Per fusionist Per Staff 1500 8 ALERT CARD(SURGERY) 100 9 ALERT CARD(PTCA) 75 10 ALERT CARD(ANGIO) 75 11 ALERT CARD(ECG) 50 12 ALERT CARD (THALLIUM) 80 13 ESCORTS WELLNESS PROGRAM CARD - PATIENT 1500 14 ESCORTS WELLNESS PROGRAM CARD - CORP 1000 15 ESCORTS WELLNESS PROGRAM FAMILY ENROLL CARD- 1300 16 ESCORTS STAFF WELNESS SCHEME 1000 17 CARDIAC BEEPER SECURITY 5000 18 CARDIAC BEEPER RENTAL CHARGES (2 WEEK) 4000 19 CARDIAC BEEPER RENTAL CHARGES (ONE WEEK) 2000 20 CARDIAC BEEPER RENTAL CHARGES (FOUR WEEK ) 5000 21 CARDIAC BEEPER LATE FEE (PER DAY) 200 22 LOOP RECORDER SECURITY DEPOSIT 5000 23 LOOP RECORDER RENTAL (ONE WEEK) 2500 24 LOOP RECORDER RENTAL (FOUR WEEK) 6000 25 CARDIAC BEEPER CHARGES (WEEK WISE) 500 26 ANGIO CD 1000 27 CT ANGIO CD 500 28 FLUROSCOPY CD 1000 29 LINEN (PER SET) 1000 30 MRI CONTRAST CHARGES 4000 31 DIETICIAN CHARGES 200 32 GOLD CARD CHARGES 750 33 PLATINUM CARD CHARGES 1000 34 MRD FEES 250 35 TRANSCUTANEOUS OXYGEN SATURATION 1500 36 ZEN LOUNGE BED CHARGES (DAY) 300 37 ZEN LOUNGE BED CHARGES (NIGHT) 400 38 VIP CUBICAL SINGLE BED(DAY AND NIGHT) 1800 39 VIP CUBICAL SINGLE BED(NIGHT) 1000 40 VIP CUBICAL DOUBLE BED(DAY AND NIGHT) 2500 41 VIP CUBICAL DOUBLE BED(NIGHT) 1400 42 ZEN LOUNGE CHARGES 200 43 MRD CHARGES 250 44 INJECTION ADMINISTER 250 45 HEART SURGERY BOOKLET (ENGLISH) 40 46 HEART SURGERY BOOKLET (HINDI) 50 47 MCD HEALTH PACKAGE 1530 48 PATIENT PASS CHARGES 100 49 REPORTS PHOTO COPY INSURANCE CASES 300 50 REPORTS PHOTO COPY CASH 1000 51 INSTRUMENT CHARGES 3500 52 DRESSING WOUND ( SMALL ) - PEDIATRICS 250 53 DRESSING ( SMALL - SIMPLE ) 1600 54 DRESSING CHANGE - SMALL ( PLASTIC SURGERY ) 1800 55 PLEURAL TAPPING WITH CHEST TUBE DRAINAGE 3500 56 DOCUMENTATION CHARGES 500 57 MORTUARY CHARGES 2000 58 CONSULTATION CUM REGISTRATION 500 59 REGISTRATION CHARGES 200 60 GOLDEN AGE REGISTRATION 500 61 GOLDEN AGE CLUB - LIFETIME MEMBERSHIP 5000 62 ADMISSION CHARGE 1000

Page 112 ROOM CHARGES

Page 113 Sl No. DESCRIPTION RATE 1 P.SUITE ROOM RENT (0-6 HOURS) 25000 2 ICU/CCU/RR/HCC/EMR 14000 3 ICU ROOM CHARGES - STEP DOWN 7000 4 PAED WARD CHARGES 7000 5 PRESIDENTIAL SUIT 85000 6 SHARING DELUXE ROOM 8000 7 ROOM LIMIT WARDS 7000 8 SINGLE DELUXE ROOM 15000 9 SUITE 28000 10 TRIAGE BED CHARGES 1000

Page 114 CARDIAC DIAGNOSTIC CHARGES

Page 115 S. No. DESCRIPTION Sharing Single Suite 1 2D ECHOCARDIOGRAPHY + COLOR DOPPLER 3300 4950 6600 2 ECHOCARDIOGRAPHY TRANSESOPHAGEAL ( TEE ) 5150 7725 10300 3 3D ECHOCARDIOGRAPHY 3300 5000 6667 4 INTERNAL MAMMARY ARTERY ( IMA ) DUPLEX SCAN 1667 2500 3333 5 STRESS ECHOCARDIOGRAPHY 5690 8535 11380 6 STRESS ECHOCARDIOGRAPHY ( DOBUTAMINE ) 5950 8925 11900 7 CARDIOVASCULAR PROFILE ASSESSMENT 1111 1667 2222 8 R/O PSEUDOANEURYSM 778 1167 1556 9 FEMORAL ARTERY SIZING ( PRE PROCEDURAL ) 556 833 1111 10 FLOW MEDIATED DILATATION ( FMD ) ASSESSMENT 556 833 1111 11 2D ECHOCARDIOGRAPHY ( SCREENING ) 2400 3600 4800 12 STRESS ECHOCARDIOGRAPHY ( DIGITAL ) 5500 8333 11111 13 2D ECHOCARDIOGRAPHY ( CONTRAST ) 8333 12500 16667 14 CAROTIDS COLOR DOPPLER ULTRASOUND 4350 6525 8700 15 ARTERIAL PERIPHERAL COLOR DOPPLER ULTRASOUND ( RIGHT LOWER LIMB ) 3990 5985 7980 16 RENAL COLOR DOPPLER ULTRASOUND 3820 5730 7640 17 VENOUS PERIPHERAL COLOR DOPPLER (LOWER LIMB) ULTRASOUND 3990 5985 7980 18 ARTERIAL PERIPHERAL COLOR DOPPLER ULTRASOUND ( RIGHT UPPER LIMB ) 3990 5985 7980 19 VENOUS COLOR DOPPLER ULTRASOUND (UPPER LIMB BOTH SIDES) 3990 5985 7980 20 TISSUE DOPPLER ECHOCARDIOGRAPHY STUDY 2778 4167 5556 21 VASCULAR DOPPLER STUDY 2222 3333 4444 22 TREAD MILL TEST ( TMT ) 3150 4725 6300 23 HOLTER MONITORING 3740 5610 7480 24 CARDIAC EVENT RECORDER ( 1 WEEK ) 2222 3333 4444 25 PULMONARY FUNCTION TEST ( PFT ) - SIMPLE - NIC 1690 2535 3380 26 PULMONARY FUNCTION TEST ( PFT ) WITH EXERCISE - NIC 2000 3000 4000 27 PULMONARY FUNCTION TEST ( PFT ) WITH BRONCHODILATOR - NIC 2222 3333 4444 28 PULMONARY FUNCTION TEST ( PFT ) WITH DIFFUSION STUDIES 2778 4167 5556 29 ELECTROCARDIOGRAPHY ( ECG ) 12 LEAD 530 795 1060 30 EECP ONE SITTING 1667 2500 3333 31 CAROTID INTIMA MEDIA THICKNESS MEASUREMENT 833 1250 1667 32 ANKLE BRACHIAL INDEX ( ABI ) / PULSE WAVE VELOCITY ( PWV ) 556 833 1111 33 AMBULATORY BLOOD PRESSURE ( BP ) MONITORING 3889 5833 7778 34 ANKLE BRACHIAL INDEX ( ABI ) + CAROTID INTIMA MEDIA THICKNESS MEASUREMENT 1111 1667 2222 35 CONTINUOUS SUBCUTANEOUS INSULIN INFUSION ( CSII ) 1111 1667 2222 36 BODY FAT ANALYSIS 556 833 1111 37 2D ECHOCARDIOGRAPHY ( PEDIATRIC ) 3333 5000 6667 38 TRANSESOPHAGEAL ECHOCARDIOGRAPHY ( TEE ) - PEDIATRIC 3333 5000 6667 39 ECHOCARDIOGRAPHY SCREENING ( PEDIATRIC ) 2222 3333 4444 40 FETAL ECHO 3930 5895 7860 41 STRESS GATED MYOCARDIAL PERFUSION STUDY 15000 22500 30000 42 REST REDISTRIBUTION THALLIUM 15000 22500 30000 43 REST MUGA RADIONUCLIDE VENTRICULOGRAPHY 5000 7500 10000 44 ADENO.THALLIUM GTD-SPECT MYO PERFUSION 15000 22500 30000 45 DOBUTAMINE GTD SPECT MYO PERFUSION 15000 22500 30000 46 RENAL DYNAMIC STUDY WITH GFR (DTPA STUDY) 5000 7500 10000 47 WHOLE BODY BONE SCAN 7380 11070 14760 48 LUNG PERFUSION SCINTIGRAPHY 4889 7333 9778 49 THYROID SCINTIGRAPHY (TECHNETIUM - TC 99M) 3900 5850 7800 50 GALLIUM SCANNING 10556 15833 21111 51 ISOTOPE VENOGRAPHY 5000 7500 10000 52 PARATHYROID SCINTIGRAPHY (DUAL ISOTOPE SUBTRACTION) STATIC IMAGING 5556 8333 11111 53 TUMOR SESTAMIBI SCINTIGRAPHY 6667 10000 13333 54 MECKEL DIVERTICULUM SCINTIGRAPHY 6111 9167 12222 55 SCINTIGRAPHY ( FOR GASTRO INTESTINAL BLEEDING ) 5556 8333 11111 56 PAROTID SCINTIGRAPHY 4889 7333 9778 57 DOBUTAMINE / ISOMETRIC STRESS MRI VENTRICULOGRAPHY 6111 9167 12222 58 POST ENHANCED EXTERNAL COUNTERPULSATION (EECP) THALLIUM STUDY 4278 6417 8556 59 ADENOSINE THALLIUM TEST 13333 20000 26667 60 VENTRICULOGRAPHY 4889 7333 9778 61 MYOCARDIAL PERFUSION SCAN ( REST ) 12222 18333 24444 62 SPECT MYO.PERFUSION 12222 18333 24444 63 DMSA SCINTIGRAPHY 5000 7500 10000

Page 116 CT PROCEDURES

Page 117 Sl. No. Description Sharing Single Suit 1 CT ONE ANATOMICAL PART PLAIN 4500 6075 6750 2 CT ONE ANATOMICAL PART CONTRAST 6000 8100 9000 3 CT GUIDED PROCEDURES 9000 12150 13500 4 HEAD CT ( PLAIN + CONTRAST ) 6667 10000 13333 5 CT CHEST PLAIN 6550 9825 13100 6 CT PELVIS - PLAIN 4400 5940 6600 7 PELVIS CT DIRECT ( CONTRAST ) 6778 10167 13556 8 GATED CT CORONARY ANGIO/CALCIUM SCORING 6778 10167 13556 9 HIP / ACETABULUM CT 3D ( RIGHT ) 7444 11167 14889 10 SPINE ( 3 VERTEBRAL LEVELS ) CT 3D PLAIN 7333 11000 14667 11 COLONOSCOPY VIRTUAL CT ( PLAIN ) 13333 20000 26667 12 CT ABDOMEN - EXCRETORY UROGRAM CONTRAST 13333 20000 26667 13 UPPER ABDOMEN CT FOR LIVER ( TRIPLE PHASE ) 10111 15167 20222 14 CT UROGRAM 10510 15765 21020 15 BRAIN PERFUSION CT ( CONTRAST ) 11111 16667 22222 16 PELVIS ( BOTH HIPS ) CT 3D 10778 16167 21556 17 CT VIRTUAL BRONCHOSCOPY 9167 13750 18333 18 WRIST CT 3D 7333 11000 14667 19 TEMPORAL BONE CT ( PLAIN ) 4667 7000 9333 20 CERVICAL SPINE CT MYELOGRAM ( PLAIN ) 7222 10833 14444 21 POSTERIOR FOSSA CT ( PLAIN ) 3333 5000 6667 22 ABDOMEN CT ( ADRENALS ) 5556 8333 11111 23 ABDOMEN CT PELVIMETRY 5556 8333 11111 24 UPPER ABDOMEN CT FOR LIVER ( DUAL PHASE ) 8000 12000 16000 25 WHOLE ABDOMEN CT ( PLAIN ) 8580 12870 17160 26 LOWER ABDOMEN (PELVIS) CT CONTRAST 6111 9167 12222 27 UPPER ABDOMEN CT ( CONTRAST ) 6111 9167 12222 28 WHOLE ABDOMEN CT ( CONTRAST ) 10333 15500 20667 29 BRAIN CT CISTERNOGRAPHY 8889 13333 17778 30 HEAD CT ( CONTRAST ) 4889 7333 9778 31 BRAIN CT - CRANIOVERTEBRAL ( CV ) JUNCTION ( PLAIN ) 5000 7500 10000 32 SELLA ( PITUITARY FOSSA ) / PITUITARY CT ( CONTRAST - NON IONIC ) 6111 9167 12222 33 HEAD CT ( PLAIN ) 3889 5833 7778 34 CT-CHARGES FOR FILMS(PER FILM) 667 1000 1333 35 CHEST CT ( CONTRAST - NON IONIC ) 7222 10833 14444 36 CHEST HRCT 5556 8333 11111 37 LIMB EXTREMITIES CT ( CONTRAST ) 6111 9167 12222 38 LIMB EXTREMITIES CT ( PLAIN ) 4889 7333 9778 39 JOINTS CT ( CONTRAST ) 6111 9167 12222 40 HIP JOINTS CT 4889 7333 9778 41 MAXILLOFACIAL CT 3D ( PLAIN ) 4333 6500 8667 42 LARYNX CT ( PLAIN ) 5000 7500 10000 43 ORBITS CT ( CONTRAST ) 6111 9167 12222 44 PNS CT ( AXIAL + CORONAL ) CONTRAST 6111 9167 12222 45 PNS HRCT ( AXIAL + CORONAL ) PLAIN 5870 8805 11740 46 CATHETER DRAINAGE CT GUIDED 8111 12167 16222 47 CT PROCEDURES-CHARGES FOR ANAESTHESIA/SEDATION 3667 5500 7333 48 CT GUIDED BIOPSY (ONLY EQUIPMENT USE) 5556 8333 11111 49 ASPIRATION CT GUIDED ( DIAGNOSTIC ) 6778 10167 13556 50 CERVICAL SPINE CT ( PLAIN ) 6111 9167 12222

Page 118 51 LUMBAR SPINE CT ( PLAIN ) 6111 9167 12222 52 THORACIC SPINE CT ( 5 VERTEBRAL LEVELS ) 6111 9167 12222 53 SPINE CT ( PER REGION ) CONTRAST 6111 9167 12222 54 SACRO ILIAC JOINTS (BOTH) CT 3D PLAIN 7333 11000 14667 55 CORONARY ARTERY CT ANGIOGRAPHY 14920 22380 29840 56 CT CORONARY ANGIOGRAPHY WITHOUT CALCIUM SCORING 13500 57 POSTERIOR FOSSA CT ( CONTRAST ) 4444 6667 8889 58 BOTH JAWS CT 3D 7333 11000 14667 59 LOWER JAW ( MANDIBLE ) CT 3D PLAIN 4333 6500 8667 60 HIP CT 3D ( BILATERAL ) 10778 16167 21556 61 LOWER ABDOMEN + PELVIS CT ( PLAIN ) 6111 9167 12222 62 LARYNX CT ( CONTRAST ) 6111 9167 12222 63 HIP JOINT CT ( RIGHT ) 7444 11167 14889 64 NECK ( THYROID TISSUE ) CT - PLAIN 5000 7500 10000 65 UPPER ABDOMEN CT ( PLAIN ) 6111 9167 12222 66 CHEST HRCT ( CONTRAST ) 6920 10380 13840 67 LUMBOSACRAL SPINE CT 5000 7500 10000 68 KUB CT ( PLAIN ) 6950 10425 13900 69 UPPER JAW ( MAXILLA ) CT 3D PLAIN 4333 6500 8667 70 SELLA (PITUITARY FOSSA) / PITUITARY CT ( PLAIN ) 4333 6500 8667 71 POLYTRAUMA CT 5000 7500 10000 72 WHOLE ABDOMEN CT ( 3 PHASE ) 15556 23333 31111 73 HEAD CONTRAST ENHANCED CT ( CECT ) - DIRECT CONTRAST 6111 9167 12222 74 HEAD CT ( SPECIAL INVESTIGATION ) - PLAIN 4889 7333 9778 75 SPINE (5 VERTEBRAL LEVELS) CT PLAIN 5000 7500 10000 76 CHEST CT ( PLAIN + CONTRAST ) 9444 14167 18889 77 WHOLE ABDOMEN CT ( PLAIN + CONTRAST ) 13580 20370 27160 78 UPPER ABDOMEN CT ( PLAIN + CONTRAST ) 10333 15500 20667 79 LOWER ABDOMEN CT ( PLAIN + CONTRAST ) 10333 15500 20667 80 GATED CT CALCIUM SCORING 8000 12000 16000 81 GATED CT CALCIUM SCORING (NEW) 3000 82 CT HEAD ( PLAIN + CONTRAST ) - PEDIATRIC 6250 9375 12500 83 CHEST CT (PLAIN + CONTRAST) - PEDIATRIC 9444 14167 18889 84 PULMONARY ANGIOGRAPHY CT ( PEDIATRIC ) 13444 20167 26889 85 CT DUAL ENERGY FOR STONE CHARACTERISATION 9444 14167 18889 86 LUNGS PERFUSED BLOOD VOLUME CT DUAL ENERGY 9444 14167 18889 87 BRAIN CT DUAL ENERGY PERFUSED BLOOD VOLUME 14667 22000 29333 88 TENDON ( ANY ) CT DUAL ENERGY 9444 14167 18889 89 CT DUAL ENERGY ( URIC ACID DEPOSITS - GOUT DETECTION ) 9444 14167 18889 90 BRAIN CT DUAL ENERGY (FOR DIFFERENTIATING FRESH / OLD INTRACRANIAL BLEED) 9444 14167 18889 91 RECONSTRUCTION ONLY CT 3D 7333 11000 14667 92 CT UROGRAPHY ( CONTRAST ) 11667 17500 23333 93 CT ORTHOPANTOGRAM ( OPG ) 1833 2750 3667 94 DENTASCAN CT 5556 8333 11111 95 PULMONARY ANGIOGRAPHY WITH INDIRECT PERIPHERAL VENOGRAM CT 24444 36667 48889 96 CT BRAIN -CV JUNCTION (CONTRAST) 5556 8333 11111 97 KUB REGION CT (ORAL + IV CONTRAST) 8200 12300 16400 98 CARDIAC CT CALCIUM SCORING 6778 10167 13556 99 ABDOMINAL AORTA CT ANGIOGRAPHY 17222 25833 34444 100 EXTREMITIES ( UPPER ) CT ANGIOGRAPHY 19444 29167 38889 101 PULMONARY CT ANGIOGRAPHY 16920 25380 33840 102 CAROTID ARTERY CT ANGIOGRAPHY 14667 22000 29333 103 PERIPHERAL / EXTREMITY CT ANGIOGRAPHY ( CONTRAST ) 17750 26625 35500 104 CT ANGIO-ABD AORTA CT ANGIO 14667 22000 29333 105 CEREBRAL ARTERIES CT ANGIOGRAPHY 12222 18333 24444 106 RENAL VESSELS CT ANGIOGRAPHY 12222 18333 24444 107 CT ANGIOGRAPHY RENAL VESSELS(DONOR) 12222 18333 24444 108 CT ANGIO TRIPLE RULE OUT FOR CORONARY ARTERY PULMONARY AMBULISM AND AORTIC DISSECTION 29333 44000 58667 109 MYOCARDIAL PERFUSION CT ANGIOGRAPHY (DUAL ENERGY) 22280 33420 44560 110 CHEST + ABDOMEN CT ANGIOGRAPHY 22000 33000 44000 111 THORACIC AORTA CT ANGIOGRAPHY ( PLAIN ) 14667 22000 29333

Page 119 MRI PROCEDURES

Page 120 S. No. Description Sharing Single Suite 1 ANKLE JOINT MRI CONTRAST ( U/L ) 12500 16875 18750 2 ANKLE MRI -U/L 8500 11475 12750 3 ELBOW JOINT MRI CONTRAST ( U/L ) 12500 16875 18750 4 ELBOW MRI -U/L 8500 11475 12750 5 FOOT MRI -U/L 8500 11475 12750 6 HAND MRI CONTRAST ( U/L ) 12500 16875 18750 7 HAND MRI -U/L 8500 11475 12750 8 KNEE JOINT MRI CONTRAST ( U/L ) 12500 16875 18750 9 KNEE JOINT MRI PLAIN ( U/L ) 8500 11475 12750 10 SHOULDER JOINT MRI ( CONTRAST ) - U/L 12500 16875 18750 11 SHOULDER MRI - U/L 8500 11475 12750 12 TEMPORO MANDIBULAR JOINT MRI CONTRAST ( U/L ) 12500 16875 18750 13 TEMPORO MANDIBULAR JOINT MRI PLAIN ( U/L ) 8500 11475 12750 14 WRIST MRI -U/L 8500 11475 12750 15 WRIST JOINT MRI CONTRAST ( U/L ) 12500 16875 18750 16 MRI CERVICAL SPINE (PLAIN) 8500 11475 12750 17 LUMBAR SPINE MRI ( SCREENING CONTRAST) 9000 12150 13500 18 MRI LUMBO SACRAL SPINE SCREENING 6667 10000 13333 19 BRAIN+DSA BRAIN+NECK VESSELS (PLAIN) 18000 24300 27000 20 CERVICAL SPINE MRI ( SCREENING CONTRAST) 9000 12150 13500 21 CERVICAL SPINE MRI ( SCREENING ) 5000 6750 7500 22 CERVICAL SPINE ( CONTRAST ) 12500 16875 18750 23 DORSO LUMBER SPINE SCREENING 6000 8100 9000 24 DORSOLUMBER SPINE MRI ( PLAIN ) 12000 16200 18000 25 SPINE MRI SCREENING - WHOLE ( PLAIN ) 8000 10800 12000 26 SPINE MRI SCREENING - WHOLE ( CONTRAST ) 12000 16200 18000 27 THORACIC SPINE MRI ( SCREENING CONTRAST ) 9000 12150 13500 28 MRI CERVICODORSAL SPINE SCREENING 6000 8100 9000 29 MRI SCAN OF WHOLE SPINE METASTATIC 10000 13500 15000 30 MRI- ONE ANATOMICAL PART - SCREENING 5000 6750 7500 31 CORONARY IMAGING MRI 10000 15000 20000 32 MR MYOCARDIAL PERFUSION IMAGINING 18000 24300 27000 33 MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY ( MRCP ) 9690 14535 19380 34 BRAIN MRI ( PLAIN ) 9444 14167 18889 35 PNS MRI ( CORONAL ) - PLAIN 9444 14167 18889 36 ORBIT MRI (PLAIN) 11111 16667 22222 37 NECK MRI 13333 20000 26667 38 MRI UPPER ABDOMEN 10000 15000 20000 39 LOWER ABDOMEN + PELVIS MRI ( CONTRAST ) 10000 15000 20000 40 MR PERIPHERAL ANGIOGRAPHY 13333 20000 26667 41 MRI CERVICAL SPINE(FLEXION/EXTENSION) 9870 14805 19740 42 HIP JOINT MRI ( PLAIN) BOTH SIDE 9444 14167 18889 43 WHOLE ABDOMEN MRI ( PLAIN ) 12222 18333 24444 44 BRAIN MRI ( CONTRAST ) 16850 25275 33700 45 CERVICAL SPINE WITH SEQUENCE IN FLEXION AND ONE IN EXTENSION ( CONTRAST ) 13889 20833 27778 46 MRI DORSAL SPINE (THORACIC SPINE) CONTRAST 13580 20370 27160 47 MRI CERVICO DORSAL CONTRAST 17778 26667 35556 48 DORSOLUMBAR SPINE MRI ( CONTRAST ) 17778 26667 35556 49 LUMBO SACRAL SPINE MRI ( CONTRAST ) 13889 20833 27778 50 MRI WHOLE SPINE CONTRAST 21111 31667 42222

Page 121 51 SPINE MRI SCREENING - ONE REGION ( PLAIN ) 8889 13333 17778 52 DORSAL SPINE MRI SCREENING 5556 8333 11111 53 THORACIC SPINE MRI ( PLAIN ) 10000 15000 20000 54 LUMBAR SPINE MRI ( CONTRAST ) 10000 15000 20000 55 MRI CERVICODORSAL SPINE (RIMR221-SRL) 6667 10000 13333 56 MRI CERVICO DORSAL SPINE SCREENING CONTRAST 11111 16667 22222 57 DORSO LUMBER SPINE CT ( CONTRAST ) 6667 10000 13333 58 MRI DORSO LUMBAR SPINE SCREENINGCONTRAST 11111 16667 22222 59 MRI LUMBO SACRAL SPINE SCREENING CONTRAST 11111 16667 22222 60 MRI SCAN OF WHOLE SPINE (CU0515-SRL) 11111 16667 22222 61 WHOLE SPINE MRI CONTRAST (FOR METASTATIC WORK UP) 15556 23333 31111 62 BRACHIAL PLEXUS MRI ( PLAIN ) 8889 13333 17778 63 BRACHIAL PLEXUS MRI ( CONTRAST ) 13333 20000 26667 64 MRI BRACHIAL PLEXUS BILATERAL 13333 20000 26667 65 MRI BRACHIAL PLEXUS BILATERAL CONTRAST 17778 26667 35556 66 SPINE MYELOGRAPHY MRI ( PLAIN ) 12222 18333 24444 67 SPINE MYELOGRAPHY MRI ( CONTRAST ) 16667 25000 33333 68 MRI VERTIGO PACKAGE (PLAIN ) -INCL C.SPINE SCREENING 10000 15000 20000 69 MRI VERTIGO PAKAGE INCLUDING CERVICAL SPINE SCREENING CONTRAST 14444 21667 28889 70 MRI MYELOGRAPHY 8333 12500 16667 71 MR MYELOGRAPHY PER SITE CONTRAST 12778 19167 25556 72 BRAIN MRI PLAIN + DIFFUSION WEIGHTED 6667 10000 13333 73 BRAIN MRI CONTRAST (DIFFUSION WEIGHTED IMAGING) 11111 16667 22222 74 MRI BRAIN - IRON OVERLOAD 6667 10000 13333 75 MRI BRAIN - IRON OVERLOAD CONTRAST 11111 16667 22222 76 MRI BRAIN - GREY-WHITE MATTER EVALUATION 7778 11667 15556 77 MRI BRAIN - GREY-WHITE MATTER EVALUATION CONTRAST 12222 18333 24444 78 MRI BRAIN - INNER EAR EVALUATION 9444 14167 18889 79 MRI BRAIN - INNER EAR EVALUATION CONTRAST 13889 20833 27778 80 MRI BRAIN - CP ANGLE 9444 14167 18889 81 MRI BRAIN - CP ANGLE CONTRAST 13889 20833 27778 82 MRI BRAIN - INTERNAL AUDITORY MEATUS 9444 14167 18889 83 MRI BRAIN - INTERNAL AUDITORY MEATUS CONTRAST 13889 20833 27778 84 MRI DIFFUSION TENSOR IMAGING 13333 20000 26667 85 MRI DIFFUSION TENSOR IMAGING CONTRAST 17778 26667 35556 86 BRAIN MRI + CISTERNOGRAPHY 7778 11667 15556 87 MRI-CISTERNOGRAPHY CONTRAST 12222 18333 24444 88 DSA BRAIN 11111 16667 22222 89 DSA BRAIN CONTRAST 15556 23333 31111 90 DSA NECK VESSELS 13333 20000 26667 91 DSA NECK VESSELS CONTRAST 17778 26667 35556 92 DSA BRAIN+NECK VESSEL 16667 25000 33333 93 DSA BRAIN+NECK VESSEL CONTRAST 19250 28875 38500 94 BRAIN+DSA BRAIN+NECK VESSELS CONTRAST 24444 36667 48889 95 BRAIN MRI VENOGRAPHY 8889 13333 17778 96 VENNOGRAPHY BRAIN CONTRAST 12250 18375 24500 97 MRI BRAIN + FMRI ONE ACTIVITY (RIMR094I-SRL) 11111 16667 22222 98 MRI BRAIN + FMRI ONE ACTIVITY (WITH CONTRAST) (RIMR095I-SRL) 15556 23333 31111 99 BRAIN MRI + FUNCTIONAL MRI ( TWO ACTIVITIES ) - PLAIN 16667 25000 33333 100 BRAIN MRI + FUNCTIONAL MRI ( TWO ACTIVITIES ) - CONTRAST 21111 31667 42222

Page 122 101 MRI-MR SPECTROSCOPY OF BRAIN 8889 13333 17778 102 MRI-MR SPECTROSCOPY OF BRAIN CONTRAST 13333 20000 26667 103 MRI-BRAIN+DIFFUSION WEIGHTED IMAGING 11111 16667 22222 104 MRI-BRAIN+DIFFUSION WEIGHTED IMAGING CONTRAST 15556 23333 31111 105 MRI-BRAIN+DIFFUSION + PERFUSION IMAGING 13333 20000 26667 106 BRAIN MRI CONTRAST (DIFFUSION + PERFUSION IMAGING ) 17778 26667 35556 107 BRAIN MRI + CSF FLOW STUDY ( PLAIN ) 13333 20000 26667 108 BRAIN MRI + CSF FLOW STUDY ( CONTRAST ) 17778 26667 35556 109 BRAIN MRI - PLAIN ( EPILEPSY PROTOCOL ) 11111 16667 22222 110 BRAIN MRI - CONTRAST ( EPILEPSY PROTOCOL ) 15556 23333 31111 111 MRI BRAIN + IAM (INTERNAL AUDITORY MEATUS)/EAR 12222 18333 24444 112 MRI BRAIN + IAM (INTERNAL AUDITORY MEATUS)/EAR CONTRAST 16667 25000 33333 113 SELLA (PITUITARY FOSSA) / PITUITARY MRI ( PLAIN ) 11111 16667 22222 114 SELLA (PITUITARY FOSSA) / PITUITARY MRI ( CONTRAST ) 15556 23333 31111 115 BRAIN MRI - PLAIN ( STROKE PROTOCOL ) 10540 15810 21080 116 BRAIN MRI - CONTRAST ( STROKE PROTOCOL ) 14444 21667 28889 117 MR CRANIO VERTEBRAL JUNCTION (CVJ) 9444 14167 18889 118 MR CRANIO VERTEBRAL JUNCTION (CVJ) CONTRAST 13889 20833 27778 119 THORACIC AORTA MRI ANGIOGRAPHY 10000 15000 20000 120 THORACIC AORTA MRI ANGIOGRAPHY ( CONTRAST ) 14444 21667 28889 121 ABDOMINAL AORTA MRI ANGIOGRAPHY 10000 15000 20000 122 ABDOMINAL AORTA MRI ANGIOGRAPHY ( CONTRAST ) 14444 21667 28889 123 MRI AORTA GRAPHY (VESSELS) - THORACO ABDOMINAL 13333 20000 26667 124 MRI AORTA GRAPHY (VESSELS) - THORACO ABDOMINAL CONTRAST 17778 26667 35556 125 MRI AORTOGRAM 13333 20000 26667 126 MRI AORTOGRAM ( CONTRAST ) 17778 26667 35556 127 MRI ANGIOGRAPHY - PULMONARY 11400 17100 22800 128 MRI ANGIOGRAPHY - PULMONARY CONTRAST 14444 21667 28889 129 RENAL MRI ANGIOGRAPHY 10000 15000 20000 130 RENAL ARTERIES ANGIOGRAPHY MRI ( CONTRAST ) 14444 21667 28889 131 PERIPHERAL MRI ANGIOGRAPHY ( CONTRAST ) 17778 26667 35556 132 MRI ANGIOGRAPHY ( WITHOUT CONTRAST ) 10000 15000 20000 133 MRI ANGIOGRAPHY ( CONTRAST ) 14444 21667 28889 134 MRI ANGIOGRAPHY PERIPHERAL SINGLE LIMB 10000 15000 20000 135 MRI ANGIOGRAPHY PERIPHERAL SINGLE LIMB CONTRAST 14444 21667 28889 136 MR ANGIO OTHERS 10000 15000 20000 137 MR ANGIO OTHERS CONTRAST 14444 21667 28889 138 MRI UPPER ABDOMEN (CONTRAST) (RIMR110I-SRL) 14444 21667 28889 139 MRI WHOLE ABDOMEN (CONTRAST) (RIMR116I-SRL) 21250 31875 42500 140 ABDOMEN + UROGRAM MRI ( PLAIN ) 7778 11667 15556 141 ABDOMEN + UROGRAM MRI ( CONTRAST ) 12222 18333 24444 142 MR ABDOMEN + MR UROGRAPHY 11111 16667 22222 143 MR ABDOMEN + MR UROGRAPHY CONTRAST 15556 23333 31111 144 MRI ENTEROCLYSIS 11111 16667 22222 145 MRI ENTEROCLYSIS ( CONTRAST ) 15556 23333 31111 146 MRI DEFECOGRAM 11111 16667 22222 147 MRI DEFECOGRAM ( CONTRAST ) 15556 23333 31111 148 MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY ( MRCP ) CONTRAST - FOR TRANSPLANTATION 13889 20833 27778 149 MRI UPPER ABDOMEN + MRCP (RIMR111I-SRL) 11111 16667 22222 150 MRI UPPER ABDOMEN + MRCP (WITH CONTRAST) (RIMR112I-SRL) 15556 23333 31111

Page 123 151 MRI ABDOMEN - LIVER MASS EVALUATION 11111 16667 22222 152 MRI ABDOMEN - LIVER MASS EVALUATION CONTRAST 15556 23333 31111 153 MRI ABDOMEN - RENAL 10250 15375 20500 154 MRI ABDOMEN - RENAL CONTRAST 15556 23333 31111 155 MRI ABDOMEN - RENAL + ANGIO 13333 20000 26667 156 MRI ABDOMEN - RENAL + ANGIO CONTRAST 17778 26667 35556 157 MRI ABDOMEN - PROSTATE 10000 15000 20000 158 MRI ABDOMEN - PROSTATE CONTRAST 14444 21667 28889 159 MRI ABDOMEN - FEMALE PELVIS MRI 10000 15000 20000 160 MRI ABDOMEN - FEMALE PELVIS MRI CONTRAST 14444 21667 28889 161 MRI ABDOMEN - MRI TESTES 10000 15000 20000 162 MRI ABDOMEN - MRI TESTES CONTRAST 14444 21667 28889 163 MRI ABDOMEN - MR VENOGRAM 10000 15000 20000 164 MRI ABDOMEN - MR VENOGRAM CONTRAST 14444 21667 28889 165 FETAL MRI ( PLAIN ) 11111 16667 22222 166 MRI FETAL CONTRAST 15556 23333 31111 167 BREAST MRI ( PLAIN ) 10000 15000 20000 168 BREAST MRI ( CONTRAST ) 14444 21667 28889 169 BREAST DYNAMIC MRI CONTRAST ( LEFT ) 13333 20000 26667 170 BREAST DYNAMIC MRI CONTRAST ( RIGHT ) 17778 26667 35556 171 MRI BREAST SPECTROSCOPY 11111 16667 22222 172 MRI BREAST SPECTROSCOPY CONTRAST 15556 23333 31111 173 MRI SEDATION/ ANAESTHESIA CHARGES 1667 2500 3333 174 MRI EXTRA CD CHARGES 278 417 556 175 MRI EXTRA FILM CHARGES PER FILM 167 250 333 176 MRI 3D EXTRA CHARGES 2222 3333 4444 177 TEMPORO MANDIBULAR JOINT MRI PLAIN (BOTH SIDES) 13889 20833 27778 178 TEMPORO MANDIBULAR JOINT MRI CONTRAST (BOTH SIDES) 18333 27500 36667 179 MRI SHOULDER U/L CONTRAST 13889 20833 27778 180 SHOULDER ( GLENO HUMERAL ) JOINTS MRI PLAIN ( BOTH JOINTS ) 16667 25000 33333 181 SHOULDER JOINT MRI CONTRAST ( BOTH JOINTS ) 18333 27500 36667 182 ELBOW MRI ( BILATERAL ) PLAIN 16667 25000 33333 183 ELBOW MRI ( BILATERAL ) CONTRAST 18333 27500 36667 184 WRIST MRI ( BILATERAL ) 16667 25000 33333 185 WRIST JOINTS MRI CONTRAST ( BILATERAL ) 18333 27500 36667 186 HAND MRI ( BILATERAL ) PLAIN 16667 25000 33333 187 HAND MRI ( BILATERAL ) CONTRAST 18333 27500 36667 188 SACROILIAC JOINTS MRI 9444 14167 18889 189 SACROILIAC JOINTS MRI 3D ( PLAIN ) 16667 25000 33333 190 SACROILIAC JOINTS MRI 3D ( CONTRAST ) 18333 27500 36667 191 HIP JOINT MRI ( CONTRAST ) 13889 20833 27778 192 MRI HIP JOINTS B/L 16667 25000 33333 193 MRI HIP JOINTS B/L CONTRAST 18333 27500 36667 194 KNEE JOINT MRI BOTH SIDES ( PLAIN ) 16667 25000 33333 195 KNEE JOINT MRI BOTH SIDES ( CONTRAST ) 18333 27500 36667 196 ANKLE JOINT MRI ( BILATERAL ) PLAIN 16667 25000 33333 197 ANKLE JOINT MRI ( BILATERAL ) CONTRAST 18333 27500 36667 198 FOOT MRI ( CONTRAST ) 13889 20833 27778 199 FOOT MRI ( BILATERAL ) PLAIN 16667 25000 33333 200 FOOT MRI ( BILATERAL ) CONTRAST 18333 27500 36667

Page 124 201 MRI JOINT - SOFT TISSUE-(ONE REGION) U/L 9444 14167 18889 202 MRI JOINT - SOFT TISSUE-(ONE REGION) U/L CONTRAST 13889 20833 27778 203 MRI JOINT - SOFT TISSUE-(ONE REGION) B/L 16667 25000 33333 204 MRI JOINT - SOFT TISSUE-(ONE REGION) B/L CONTRAST 18333 27500 36667 205 MRI JOINT - SOFT TISSUE LESION LOCAL ANGIO U/L 9444 14167 18889 206 MRI JOINT - SOFT TISSUE LESION LOCAL ANGIO U/L CONTRAST 13889 20833 27778 207 MRI JOINT - SOFT TISSUE LESION LOCAL ANGIO B/L 16667 25000 33333 208 MRI JOINT - SOFT TISSUE LESION LOCAL ANGIO B/L CONTRAST 18333 27500 36667 209 CARTILAGE IMAGING MRI ( PLAIN ) 9444 14167 18889 210 CARTILAGE IMAGING MRI ( CONTRAST ) 13889 20833 27778 211 MRI FOR CARTILAGE EVALUATION B/L 16667 25000 33333 212 MRI FOR CARTILAGE EVALUATION B/L CONTRAST 18333 27500 36667 213 ATLANTOAXIAL DISLOCATION ( AAD ) MRI 9444 14167 18889 214 MRI JOINT - ATLANTO AXIAL CONTRAST 13889 20833 27778 215 MRI ARTHROGRAPHY 16667 25000 33333 216 MRI JOINT - ARTHROGRAPHY ONE JOINT CONTRAST 21111 31667 42222 217 MRI NECK CONTRAST 17778 26667 35556 218 ORBIT MRI ( CONTRAST ) 15556 23333 31111 219 PNS MRI ( CONTRAST ) 13889 20833 27778 220 FACE MRI ( PLAIN) 11111 16667 22222 221 FACE MRI ( CONTRAST ) 15556 23333 31111 222 MRI FACE - MR SAILOGRAPHY 10000 15000 20000 223 MRI FACE - MR SAILOGRAPHY CONTRAST 14444 21667 28889 224 MRI FACE - OTHER 11111 16667 22222 225 MRI FACE - OTHER CONTRAST 15556 23333 31111 226 CARDIAC MRI FOR MORPHOLOGY 20000 30000 40000 227 CARDIAC MRI FOR FUNCTIONAL ASSESSMENT 20000 30000 40000 228 CARDIAC MRI FOR FLOW DYNAMICS 20000 30000 40000 229 CARDIAC MRI FOR ISCHEMIC HEART DISEASE 20000 30000 40000 230 CARDIAC MRI FOR ARVD 20000 30000 40000 231 CARDIAC MRI FOR CARDIOMYOPATHY 20000 30000 40000 232 CARDIAC MRI FOR MYOCARDITIS 20000 30000 40000 233 CARDIAC MRI FOR COLLATERALS 22222 33333 44444 234 CARDIAC MRI FOR VALLULAR ASSESSMENT 20000 30000 40000 235 CARDIAC MRI FOR PERICARDIAL ASSESSMENT 20000 30000 40000 236 CARDIAC MRI STRESS REST 22222 33333 44444 237 CARDIAC MRI OTHERS 20000 30000 40000 238 MRI PLAIN AND DIFFUSION STUDY (ONE BODY PART) 11111 16667 22222 239 MRI CONTRAST + DIFFUSION STUDY (ONE BODY PART) 15556 23333 31111 240 WHOLE BODY MRI(FOR ONCOLOGICAL WORK UP) 16667 25000 33333 241 MRI WHOLE BODY (FOR ONCOLOGICAL WORKUP) CONTRAST 21111 31667 42222 242 WHOLE BODY MRI ( METASTATIC PLAIN ) 13333 20000 26667 243 MRI WHOLE BODY METASTATIC PLAIN CONTRAST 17778 26667 35556 244 MRI SINOGRAM 8889 13333 17778 245 MRI SINOGRAM CONTRAST 13333 20000 26667 246 MRI ONE ANATOMICAL AREA (RIMR084I-SRL) 9444 14167 18889 247 MRI ONE ANATOMICAL AREA (WITH CONTRAST) (RIMR085I-SRL) 13889 20833 27778 248 MR SPV(SPLENO PORTOVENOGRAPH) 8889 13333 17778 249 MR SPV(SPLENO PORTOVENOGRAPH) CONTRAST 13333 20000 26667 250 MRI BRAIN SCREENING 5556 8333 11111 251 LUMBO SACRAL SPINE MRI ( PLAIN ) 9444 14167 18889 252 CARDIAC MRI ( CONTRAST ) 20000 30000 40000

Page 125 X RAY PROCEDURES

Page 126 Double Sl No. Description Single Room Suite Room 1 ABDOMEN - ERECT & SUPINE (PORTABLE) 944 1417 1889 2 ABDOMEN (ROUTINE) 528 792 1056 3 ABDOMEN X-RAY ( ERECT + SUPINE ) 500 750 1000 4 ABDOMEN X-RAY ( ROUTINE ) 500 750 1000 5 BARIUM ENEMA 3056 4583 6111 6 BARIUM MEAL FOLLOW THROUGH 3056 4583 6111 7 BARIUM MEAL STUDY 2444 3667 4889 8 BARIUM SWALLOW 1556 2333 3111 9 CERVICAL SPINE X-RAY ( AP + LATERAL + OBLIQUE VIEW ) 1000 1500 2000 10 CERVICAL SPINE X-RAY ( LATERAL VIEW ) 333 500 667 11 CHEST X-RAY ( AP VIEW ) - PORTABLE 667 1000 1333 12 CHEST X-RAY ( LATERAL VIEW ) LEFT 278 417 556 13 CHEST X-RAY ( PA + LATERAL VIEW ) 667 1000 1333 14 CHEST X-RAY ( PA VIEW ) 511 767 1022 15 COCCYX X-RAY ( AP VIEW ) 500 750 1000 16 DORSOLUMBAR ( THORACOLUMBAR ) SPINE X-RAY ( LATERAL VIEW ) 500 750 1000 17 HAND X-RAY ( AP VIEW ) BOTH SIDE 500 750 1000 18 HAND X-RAY ( PA VIEW ) BOTH 333 500 667 19 INTRAVENOUS PYELOGRAPHY ( IVP ) 3056 4583 6111 20 KNEE JOINT X-RAY ( AP STANDING + LATERAL VIEW ) BOTH SIDE 611 917 1222 21 KNEE JOINT X-RAY ( AP VIEW ) BOTH SIDE 500 750 1000 22 KUB X-RAY 333 500 667 23 LEG X-RAY ( AP VIEW ) 811 1217 1622 24 MANDIBLE X-RAY SPECIAL VIEW ( AP VIEW ) 500 750 1000 25 MASTOID X-RAY ( TOWNE'S VIEW ) 333 500 667 26 MASTOIDS X-RAY 500 750 1000 27 MICTURATING CYSTOURETHROGRAPHY ( MCU ) 2444 3667 4889 28 NASAL BONE X-RAY ( BOTH LATERAL VIEW ) 444 667 889 29 PARANASAL SINUSES ( PNS ) X-RAY ( AP VIEW ) 222 333 444 30 PENILE COLOR DOPPLER ULTRASOUND 3889 5833 7778 31 RETROGRADE URETHROGRAPHY ( RGU ) 2444 3667 4889 32 SACROILIAC JOINT X-RAY ( OBLIQUE VIEW ) BOTH SIDE 500 750 1000 33 SINOGRAPHY ( ICONOS ) 1833 2750 3667 34 SKULL X-RAY ( ANY 1 VIEW ) 333 500 667 35 SKULL X-RAY ( AP VIEW ) 500 750 1000 36 SKULL X-RAY FOR STYLOID PROCESS 333 500 667 37 SOFT TISSUE NECK X-RAY ( LATERAL VIEW ) 333 500 667 38 TEMPOROMANDIBULAR JOINT X-RAY ( OBLIQUE VIEW - OPEN + CLOSED MOUTH ) BOTH SIDES 1000 1500 2000 39 X-RAY FLUOROSCOPY FOR DIAPHRAGM 833 1250 1667 40 X-RAY MAMMOGRAPHY ( BILATERAL ) 3361 5042 6722 41 ANKLE JOINT MRI CONTRAST ( U/L ) 12500 16875 18750 42 ANKLE MRI -U/L 8500 11475 12750 43 Ankle x-ray A P Lateral 900 1350 1800 44 Cervical Spine Lateral Extension view 450 675 900 45 CERVICAL SPINE LATERAL FLEXION & EXTENSION VIEW 900 1215 1350 46 Cervical Spine Lateral Flexion view 450 675 900 47 CHEST AP & LATERAL VIEW 900 1215 1350 48 Chest AP View 450 675 900 49 Chest Lateral View 450 675 900 50 Coccyx x-ray A .P. Lateral 900 1350 1800

Page 127 51 Dorsal Spine AP & Lateral View 900 1350 1800 52 Dorsal Spine AP View 450 675 900 53 Dorsal Spine Lateral View 450 675 900 54 Dorsal spine X-ray Lateral Flexion and Extention 900 1350 1800 55 Dorso-Lumbar spine X-ray A.P , Lateral 900 1350 1800 56 FEMUR X-RAY ( AP + LATERAL VIEW ) U/L 450 675 900 57 FOOT X-RAY (AP+LATERAL VIEW-U/L 900 1215 1350 58 Foot x-ray A P , Oblique view 900 1350 1800 59 FOREARM X-RAY ( AP + LATERAL VIEW ) LEFT SIDE 900 1215 1350 60 Hand x-ray A P , Oblique view 900 1350 1800 61 Heel Bilateral 450 675 900 62 Hip x-ray A P , Lateral view 900 1350 1800 63 Hip x-ray A P view 450 675 900 64 Humerous x-ray A P , Lateral view 900 1350 1800 65 KNEE JOINT X-RAY ( AP VIEW ) U/L 800 1200 1600 66 Knee joint x-ray A P, Lateral View 900 1350 1800 67 Leg x-ray A P , Lateral view 900 1350 1800 68 Lumbar Spine Lateral Extension View 450 675 900 69 LUMBAR SPINE LATERAL FLEXION EXTENSION VIEW 900 1215 1350 70 Lumbar Spine Lateral Flexion View 450 675 900 71 LUMBAR SPINE X-RAY ( AP + LATERAL VIEW ) 900 1215 1350 72 Lumbo-sacral spine x-ray A P, Lateral view 900 1350 1800 73 Para nasal sinuses x-ray P A view 450 675 900 74 Pelvis with both hips AP View 450 675 900 75 Pelvis X-ray A P view 450 675 900 76 SHOULDER JOINT X-RAY ( AP VIEW ) U/L 300 450 600 77 SHOULDER JOINT X-RAY ( LATERAL VIEW ) U/L 300 450 600 78 SHOULDER Y-VIEW 900 1215 1350 79 WRIST X-RAY ( PA + LATERAL VIEW ) 900 1215 1350 80 X-RAY CERVICAL SPINE A.P, LATERAL VIEW 900 1350 1800 81 X-RAY MAMMOGRAPHY - U/L 1200 1800 2400 82 BONE DENSITOMETRY ( DEXA SCAN ) TWO SITES 2900 4350 5800 83 BONE DENSITOMETRY ( DEXA SCAN ) WHOLE BODY FAT ASSESSMENT 4600 6900 9200 84 BONE DENSITOMETRY ( THREE SITES ) 4100 6150 8200 85 BONE DENSITOMETRY ( WHOLE BODY ) 3667 5500 7333 86 DEXA BONE DENSITOMETRY ( SINGLE SITE ) 2300 3450 4600 87 DEXA BONE DENSITOMETRY ( WHOLE BODY BONE MINERAL DENSITY ) 4600 6900 9200

Page 128 ULTRASOUND PROCEDURES

Page 129 Double Sl No. Description Single Room Suite Room 1 TRANSRECTAL ULTRASOUND 1500 2025 2250 2 ULTRA SOUND SCROTAL 1200 1620 1800 3 ULTRASOUND LEVEL-II PREGNANCY 2000 2700 3000 4 USG GUIDED PROCEDURES 7000 9450 10500 5 WHOLE ABDOMEN ULTRASOUND 2840 4260 5680 6 UPPER ABDOMEN ULTRASOUND 1690 2535 3380 7 CHEST ULTRASOUND 1428 2142 2856 8 KUB ULTRASOUND 1470 2205 2940 9 PREGNANCY ULTRASOUND 1556 2333 3111 10 PELVIS TRANSVAGINAL ULTRASOUND 1333 2000 2667 11 BRAIN ULTRASOUND 1667 2500 3333 12 NECK ULTRASOUND 1333 2000 2667 13 VASCULAR COLOR DOPPLER ULTRASOUND 2444 3667 4889 14 SMALL PARTS ULTRASOUND 833 1250 1667 15 ULTRASOUND FOR BIOPHYSICAL PROFILE SCORE ( BPS ) 1833 2750 3667 16 OBSTETRIC COLOR DOPPLER ULTRASOUND 1950 2925 3900 17 FOLLICULAR STUDY ULTRASOUND 2444 3667 4889 18 BREAST ULTRASOUND ( BILATERAL ) 2020 3030 4040 19 ABDOMINAL AORTA COLOR DOPPLER ULTRASOUND 2778 4167 5556 20 BIOPSY (MULTIPLE) ULTRASOUND GUIDED 5556 8333 11111 21 ULTRASOUND DOPPLER 2222 3333 4444 22 LOWER ABDOMEN ULTRASOUND 1333 2000 2667 23 USG GUIDED PROCEDURES 7000 9450 10500

Page 130 GASTROENTEROLOGY CHARGES

Page 131 S. No. Description Sharing Single Suit 1 FIBROSCAN 3000 4500 6000 2 RFA PROCEDURE GASTRO 10000 13500 15000 3 PORTAL VEIN EMBOLIZATION 35000 52500 70000 4 PTBD SINGLE SYSTEM 10000 15000 20000 5 CT GUIDED BONE BIOPSY 8000 12000 16000 6 CT GUIDED TUMOR ABLATION RADIOFREQUENCY 25000 33750 37500 7 CT GUIDED TUMOR ABLATION CHEMICAL 15000 20250 22500 8 ULTRASOUND GUIDED FNAC 3000 4500 6000 9 ULTRASOUND GUIDED BIOPSY 4800 7200 9600 10 CT GUIDED FNAC 5500 8250 11000 11 CT GUIDEDc BIOPSY 7000 10500 14000 12 ULTRASOUND GUIDED ASPIRATION 3000 4500 6000 13 ULTRASOUND GUIDED DRAINAGE 6000 9000 12000 14 ULTRASOUND GUIDED DRAINAGE - TUBE CHANGE 3000 4500 6000 15 CT GUIDE ASPIRATION 5500 8250 11000 16 CT GUIDED DRAINAGE 7000 10500 14000 17 ULTRASOUND GUIDED TUMOR ABLATION - RFA 20000 27000 30000 18 ULTRASOUND GUIDED TUMOR ABLATION - CHEMICAL 10000 13500 15000 19 PTBD MULTIPLE SYSTEMS 14000 21000 28000 20 PTBD INTERNALIZATION/STENTING 7000 10500 14000 21 ANGIOGRAPHY(Gastro) 9000 13500 18000 22 ANGIOPLASTY(Gastro) 30000 45000 60000 23 ANGIOPLASTY & STENTING(Gastro) 30000 45000 60000 24 ASCITIC TAPPING/THERAPEUTIC PARACENTESIS 2200 2700 3000 25 TUMOR EMBOLIZATION (TACE/TAE) 35000 52500 70000 26 SPLENIC ARTERY EMBOLIZATION 35000 52500 70000 27 RADIOEMBOLIZATION, COILING & SHUNT EVALUATION 50000 75000 100000 28 RADIOEMBOLIZATION THERAPY INFUSION 22000 33000 44000 29 HVPG+TRANSJUGULAR LIVER BIOPSY 10000 15000 20000 30 TIPSS 65000 97500 130000 31 TIPSS+EMBOLIZATION 80000 120000 160000 32 BRTO (BALLOON RETROGRADE TRANSVENOUS OBLITERATION) 60000 90000 120000 33 PAIR (PERCUTANEOUS ASPIRATION, INJECTION) - HYDATID 10000 15000 20000 34 PORTAL VEIN PRESSURE MEASUREMENT 15000 22500 30000 35 PORTAL VEIN DILATATION 30000 45000 60000 36 PORTAL VEIN STENTING 30000 45000 60000 37 CT GUIDED CELIAC PLEXUS BLOCK 10000 15000 20000 38 CAPSULE ENDOSCOPY (INPATIENTS) - GI SURGERY 11000 13500 15000 39 GASTRIC BYPASS - P - GI SURGERY 280000 378000 420000 40 EUS with contrast 1100 1350 1500 41 Large volume paracentesis 5500 6750 7500 42 Achalasia Dilatation with anesthesia 12100 14850 16500 43 Achalasia Dilatation without anesthesia 11000 13500 15000 44 Argon Plasma Coagulation without anesthesia 6600 8100 9000 45 Ascitic Tapping without anesthesia 3300 4050 4500 46 BIB Removal with anesthesia 8800 10800 12000 47 BIB Removal without anesthesia 7150 8780 9750 48 Biliary Manometry with anesthesia 10450 12830 14250 49 Biliary Manometry without anesthesia 6600 8100 9000 50 Colonoscopy Full Length with anesthesia 9130 11210 12450

Page 132 51 Colonoscopy Full Length without anesthesia 7700 9450 10500 52 Colonoscopy Left Limited with anesthesia 5500 6750 7500 53 Colonoscopy Left Limited without anesthesia 4400 5400 6000 54 CRE Balloon Dilatation without anesthesia 7150 8780 9750 55 Dilatation without anesthesia 5500 6750 7500 56 Double Balloon Enteroscopy with anesthesia 34650 42530 47250 57 Double Balloon Enteroscopy without anesthesia 30800 37800 42000 58 Elastography 3300 4050 4500 59 EMR with anesthesia(UGI Procedure) 14850 18230 20250 60 EMR with anesthesia(Colonoscopy Procedure) 14850 18230 20250 61 EMR without anesthesia 11000 13500 15000 62 Endoloop without anesthesia 4400 5400 6000 63 Endoprosthesis without anesthesia 7700 9450 10500 64 Endoscopic Pseudocyst Drainage with anesthesia 20350 24980 27750 65 Endoscopic Pseudocyst Drainage without anesthesia 16500 20250 22500 66 GASTRIC VARIX GLUE INJECTION WITH ANESTHESIA 9680 11880 13200 67 Endoscopic Ryles Tube Placement with anesthesia 7150 8780 9750 68 GASTRIC VARIX GLUE INJECTION WITHOUT ANESTHESIA 8250 10130 11250 69 Endoscopic Ryles Tube Placement without anesthesia 6050 7430 8250 70 Endoscopic Ultrasound Diagnostic with anesthesia 9130 11210 12450 71 HEMOCLIP WITH ANESTHESIA(UGI PROCEDURE) 3300 4050 4500 72 Endoscopic Ultrasound Diagnostic without anesthesia 7700 9450 10500 73 Endoscopic Ultrasound Pseudocyst Drainage with anesthesia 14850 18230 20250 74 Endoscopic Ultrasound Pseudocyst Drainage without anesthesia 11000 13500 15000 75 Endoscopic Ultrasound Therapeutic with anesthesia 12650 15530 17250 76 HEMOCLIP WITHOUT ANESTHESIA 6600 8100 9000 77 Endoscopic Ultrasound Therapeutic without anesthesia 8800 10800 12000 78 Endoscopic Variceal Ligation (EVL) without anesthesia 8250 10130 11250 79 INTRAGAASTRIC BALLOON PLACEMENT WITH ANESTHESIA 14300 17550 19500 80 INTRAGAASTRIC BALLOON PLACEMENT WITHOUT ANESTHESIA 13200 16200 18000 81 ERCP Diagnostic with anesthesia 17050 20930 23250 82 ERCP Diagnostic without anesthesia 13200 16200 18000 83 MANOMETRY - ESOHPAGEAL/RECTAL WITH ANESTHESIA(UGI PROCEDURE) 4950 6080 6750 84 ERCP Mechanical Lithotripsy with anesthesia 14850 18230 20250 85 MANOMETRY - ESOHPAGEAL/RECTAL WITH ANESTHESIA(COLONOSCOPY PROCEDURE) 6050 7430 8250 86 MANOMETRY - ESOHPAGEAL/RECTAL WITHOUT ANESTHESIA 6600 8100 9000 87 NASOJEJUNAL FEEDING TUBE PLACEMENT WITH ANESTHESIA 9900 12150 13500 88 NASOJEJUNAL FEEDING TUBE PLACEMENT WITHOUT ANESTHESIA 8470 10400 11550 89 PEG REMOVAL WITH ANESTHESIA 5500 6750 7500 90 ERCP Mechanical Lithotripsy without anesthesia 11000 13500 15000 91 PEG REMOVAL WITHOUT ANESTHESIA 4400 5400 6000 92 ERCP Therapeutic with anesthesia 22000 27000 30000 93 PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (PEG) WITH ANESTHESIA 14300 17550 19500 94 ERCP Therapeutic without anesthesia 18150 22280 24750 95 PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (PEG) WITHOUT ANESTHESIA 13200 16200 18000 96 ESD with anesthesia 20350 24980 27750 97 PERCUTANEOUS LIVER BIOPSY WITH ANESTHESIA 6600 8100 9000 98 ESD without anesthesia 16500 20250 22500 99 PERCUTANEOUS LIVER BIOPSY WITHOUT ANESTHESIA 5500 6750 7500 100 PH MONITORING & MANOMETRY WITH ANESTHESIA 9900 12150 13500

Page 133 101 EUS Elastography without anesthesia 1100 1350 1500 102 PH MONITORING & MANOMETRY WITHOUT ANESTHESIA 8250 10130 11250 103 EUS with contrast with anesthesia 12650 15530 17250 104 PH MONITORING WITH ANESTHESIA 7700 9450 10500 105 EUS with contrast without anesthesia 8800 10800 12000 106 PH MONITORING WITHOUT ANESTHESIA 6600 8100 9000 107 Foreign Body Removal with anesthesia 12100 14850 16500 108 PLACEMENT OF SENGSTAKEN TUBE WITH ANESTHESIA 14300 17550 19500 109 Foreign Body Removal without anesthesia 11000 13500 15000 110 Zenker's Diverticulum without anesthesia 16500 20250 22500 111 Zenker's Diverticulum with anesthesia 20350 24980 27750 112 UGI Endoscopy without anesthesia 4400 5400 6000 113 UGI Endoscopy with anesthesia 5500 6750 7500 114 Single Balloon Enteroscopy without anesthesia 19800 24300 27000 115 Single Balloon Enteroscopy with anesthesia 23650 29030 32250 116 Side Viewing Endoscopy without anesthesia 7150 8780 9750 117 Side Viewing Endoscopy with anesthesia 8250 10130 11250 118 Sclerotherapy of Ulcer without anesthesia 3850 4730 5250 119 Sclerotherapy (EST) without anesthesia 3850 4730 5250 120 Polypectomy Multiple/Big with anesthesia(UGI Procedure) 20350 24980 27750 121 Polypectomy Multiple/Big with anesthesia 20350 24980 27750 122 Polypectomy Multiple/Big without anesthesia 16500 20250 22500 123 Polypectomy Single/Small with anesthesia(UGI Procedure) 12650 15530 17250 124 Polypectomy Single/Small with anesthesia(Colonoscopy Procedure) 14630 17960 19950 125 Polypectomy Single/Small without anesthesia 13200 16200 18000 126 Push Enteroscopy with anesthesia 8580 10530 11700 127 Push Enteroscopy without anesthesia 7150 8780 9750 128 Foreign Body Removal (colonoscopy Procedure) 12430 15260 16950 129 Graft Doppler (Gastro) 2750 3375 3750 130 CBD EXCISION +HEPATICOJEJUNOSTOMY 85000 114750 127500 131 Thromboelastography.(TEG) 2000 2700 3000 132 LAPROSCOPIC SLEEVE GASTRECTOMY 280000 378000 420000 133 EMBOLIZATION FOR BLEEDING 35000 52500 70000 134 H pylori Breath test 4400 5400 6000 135 Hydrogen Breath Test 4950 6080 6750 136 Argon Plasma Coagulation.... 3300 4050 4500 137 CRE Balloon Dilatation... 3300 4050 4500 138 SG dilator 3300 4050 4500 139 Biliary balloon Dilatation 4400 5400 6000 140 Endoloop.. 2200 2700 3000 141 Endoprosthesis... 5500 6750 7500 142 Endoscopic Variceal Ligation. (EVL) with anesthesia 9350 11480 12750 143 Foreign Body Removal 9350 11480 12750 144 Placement of Sengstaken Tube without anesthesia 13200 16200 18000 145 Review of external capsule endoscopy. CD 3850 4730 5250 146 Sclerotherapy (EST). 3300 4050 4500 147 Endoscopic Necrosectomy (subsequent sitting) with anaesthesiaMEDICAL /SURGICAL PROCEDURE 11000 13500 15000 148 Biofeedback (package four sittings) 16500 20250 22500 149 HEPATICOJEJUNOSTOMY 55000 74250 82500 150 HVPG (HEPATIC VENOUS PRESSURE GRADIENT) 8000 12000 16000 151 PEROUTANEOUS LIVER BIOPSY 2300 3450 4600 152 THERAPEUTIC PARACENTESIS 2300 3450 4600

Page 134 LIVER TRANSPLANT CHARGES

Page 135 S. No. Description Sharing Single Suite 1 LIVER TRANSPALNT PACKAGE (PRE WORK UP) 150000 2 LIVER TRANSPLANT PACKAGE (DOMESTIC) 1900000 1900000 2625000 3 RE-EXPLORATION-LTP (WITHIN 24 HOURS) 75000 101250 112500 4 RE-EXPLORATION-LTP(24 HOURS-5 DAYS) 150000 202500 225000 5 RE-EXPLORATION-LTP(AFTER 5 DAYS) 300000 405000 450000

Page 136 ORTHOPAEDIC PACKAGES

Page 137 Double Sl No. Description Single Room Suite Room 1 TOTAL KNEE REPLACEMENT ( TKR ) - UL - (P) 2,20,000 2,60,000 4,40,000 2 TOTAL KNEE REPLACEMENT ( TKR ) - UNICOMPARTMENTAL ( UNILATERAL ) 1,80,000 1,95,000 3,60,000 3 TOTAL HIP REPLACEMENT ( THR ) - UL - (P) 2,20,000 2,60,000 4,40,000 4 TOTAL HIP REPLACEMENT U/L COMPLEX - (P) 2,40,000 2,85,000 4,80,000 5 TOTAL KNEE REPLACEMENT ( TKR ) - UNICOMPARTMENTAL ( BILATERAL ) 2,75,000 3,10,000 5,50,000 6 TOTAL KNEE REPLACEMENT B/L PERSONA - (P) 3,45,000 4,10,000 6,90,000 7 TOTAL KNEE REPLACEMENT U/L + TOTAL HIP REPLACEMENT U/L - (P) 3,45,000 4,10,000 6,90,000 8 TOTAL KNEE REPLACEMENT UNILATERAL + UNICOMPARTMENTAL KNEE ARTHROSCOPY ( UNILATERAL ) (P) 3,45,000 4,10,000 6,90,000 9 TOTAL HIP REPLACEMENT ( THR ) - BL - (P) 3,90,000 4,70,000 7,80,000 10 REVISION TKR 2,95,000 3,40,000 5,90,000 11 REVISION OF TOTAL KNEE REPLACEMENT ( TKR ) - BL - (P) 4,85,000 5,50,000 9,70,000 12 REVISION OF TOTAL KNEE REPLACEMENT ( TKR ) - UL - (P) 2,80,000 3,40,000 5,60,000 13 ACL REVISION – (P) 1,60,000 1,85,000 3,20,000 14 ARTHROSCOPY ( OPERATIVE ) 95,000 1,15,000 1,90,000 15 ANTERIOR CRUCIATE LIGAMENT ( ACL ) RECONSTRUCTION - ARTHROSCOPIC 1,25,000 1,45,000 2,50,000 16 POSTERIOR CRUCIATE LIGAMENT ( PCL ) RECONSTRUCTION - ARTHROSCOPIC 1,50,000 1,80,000 3,00,000 17 CORE DECOMPRESSION - HIP(UNILATERAL) 55,000 70,000 1,10,000 18 CORE DECOMPRESSION - HIP ( BILATERAL ) 70,000 90,000 1,40,000 19 ARTHROSCOPY HIP ( DIAGNOSTIC ) 60,000 80,000 1,20,000 20 TOTAL KNEE REPLACEMENT B/L - COMPLEX - (P) 3,65,000 4,30,000 7,30,000

Page 138 ORTHOPAEDICS PROCEDURES

Page 139 Sl. No. Description Sharing Single Suite 1 K wire fixation of finger 8,800 11,000 17600 2 ORIF mallet finger 27,500 34,500 55000 3 ORIF phalanx/metacarpal 27,500 34,500 55000 4 ORIF scaphoid 27,500 34,500 55000 5 Vascularized bone graft and ORIF for non union scaphoid 27,500 34,500 55000 6 ORIF wrist 27,500 34,500 55000 7 Closed reduction and k wire fixation for wrist 27,500 34,500 55000 8 Osteotomy of malunion of wrist 27,500 34,500 55000 9 ORIF radial head 22,000 27,500 44000 10 ORIF Coronoid 22,000 27,500 44000 11 ORIF olecranon (TBW/ PLATING) 22,000 27,500 44000 12 ORIF inter/intra condylar region of humerus 33,000 41,250 66000 13 CRIF humerus intra-medullary nailing 27,500 34,500 55000 14 Closed reduction and k wire fixation of proximal humerus 16,500 20,500 33000 15 ORIF clavicle 22,000 27,500 44000 16 ORIF glenoid /scapula 27,500 34,500 55000 17 ORIF sterno clavicular dislocation 24,750 31,000 49500 18 CR OF DISLOC-HAND&UPPER EXTREMITY-LA,IV SED/GA 11,000 13,750 22000 19 k wire fixation of toes, phalanx, metatarsals 8,800 11,000 17600 20 ORIF CALCANEUM with k wires 27,500 34,500 55000 21 ORIF talus 27,500 34,500 55000 22 ORIF Ankel 27,500 34,500 55000 23 Closed reduction and interlocking nailing of tibia 30,250 37,800 60500 24 ORIF tibia plating 30,250 37,800 60500 25 Debridement and external fixation of compound tibia 22,000 27,500 44000 26 ORIF tibial plateau 30,250 37,800 60500 27 Closed reduction and internal fixation tibial plateau 30,250 37,800 60500 28 ORIF femoral condyles 30,250 37,800 60500 29 ORIF supra condylar femur plating 30,250 37,800 60500 30 ORIF supra condylar femur intra-medullary nailing 30,250 37,800 60500 31 Closed reduction and interlocked nailing of femur 30,250 37,800 60500 32 Dynamization of interlocked nail 5,500 6,900 11000 33 k wire removal 3,300 4,200 6600 34 Implant removal large 11,000 13,750 22000 35 Implant removal small 8,250 10,400 16500 36 DHS/ Cannulated screw fixation for proximal femoral 22,000 27,500 44000 37 ORIF acetabulum 27,500 34,500 55000 38 CLOSED REDUCTION OF DISLOCATIONS IN HIP AND LE UNDER LA, IV SEDATION OR GA 8,800 11,000 17600 39 ORIF ilium 27,500 34,500 55000 40 ORIF Fracture Pubis 27,500 34,500 55000 41 Close reduction in OT(under GA)/emergency (sedation) 8,250 10,400 16500 42 Above knee / elbow POP slab /cast 8,250 10,400 16500 43 Below knee/ elbow POP slab/cast 5,500 6,900 11000 44 Tendon transfer 33,000 41,250 66000 45 Illizarov fixator application - osteotomy & bone grafting 30,250 37,800 60500 46 Skin Grafting - Small 13,750 17,200 27500 47 Skin Grafting - Large 22,000 27,500 44000 48 Myocutaneous Flap 22,000 27,500 44000 49 Arthrodesis Large Joint 24,750 31,000 49500 50 Arthrodesis Small joint 16,500 20,600 33000

Page 140 51 Amputation Large Joint 19,250 24,000 38500 52 Amputation Small Joint 11,000 13,750 22000 53 Biopsy Bone and soft tissue 8,250 10,400 16500 54 CTEV - Manipulation 2,200 2,750 4400 55 CTEV - surgery 22,000 27,500 44000 56 Fasciotomy 16,500 20,600 33000 57 Dynamization 2,200 2,750 4400 58 Osteotomy - Simple 16,500 20,600 33000 59 Osteotomy - Complex 19,250 24,000 38500 60 External Fixation 11,000 13,750 22000 61 Dressing in Operation theatre 1,100 1,400 2200 62 Examination under anaesthesia/MVA 1,100 1,400 2200 63 Bone Grafting Small 8,250 10,300 16500 64 Bone grafting Big 16,500 20,600 33000 65 Curettage+ Bone grafting for ABC/GCT/LYTIC lession/OM 27,500 34,300 55000 66 Exostoses Excision 19,250 24,000 38500 67 Osteotomy Lower limb 16,500 20,600 33000 68 IAD 11,000 13,750 22000 69 Open Reduction of dislocation 5,500 6,900 11000 70 Endoscopic carpel tunnel release 16,500 20,600 33000 71 Endoscopic carpel tunnel release Open release 8,800 11,000 17600 72 Nerve repair 27,500 34,300 55000 73 Cable grafting 27,500 34,300 55000 74 Acute tendon repair (single) 16,500 20,600 33000 75 Tendon Grafting (Single stage) 19,250 24,000 38500 76 Tendon Grafting 1 stage with silastic rods & pulley recons. 24,750 31,000 49500 77 Tendon Grafting 2 stage with silastic rods & pulley recons. 27,500 34,300 55000 78 Joint leveling procedure in wrist 22,000 27,500 44000 79 Revascularization Lunate using Vascularised Bone Grafting 27,500 34,300 55000 80 DRUJ stabilization procedures 27,500 34,300 55000 81 GCT tendon sheath 27,500 34,300 55000 82 GCt bone 27,500 34,300 55000 83 Hemangioma 27,500 34,300 55000 84 Ganglion 8,800 11,000 17600 85 Radial Club Hand 24,750 31,000 49500 86 Elbow instability-Ligamentous instability 24,750 31,000 49500 87 Cubital Tunnel Syndrome 24,750 31,000 49500 88 Radial tunnel Syndrome 24,750 31,000 49500 89 Tennis Elbow 24,750 31,000 49500 90 Golfer's Elbow 24,750 31,000 49500 91 Olecranon Brusitis 24,750 31,000 49500 92 Proximal Humeral fractures fixation 24,750 31,000 49500 93 Bipolar hemiarthroplasty 30,250 37,800 60500 94 Arthroscopic Capsular Release 27,500 34,300 55000 95 Arthoscopic Bankart repair 27,500 34,300 55000 96 Joint Replacement Order Set 6,380 8,000 12760 97 Skeletal traction application 3,850 4,800 7700 98 ORIF ilium/Pubic rami 27,500 34,300 55000 99 ORIF Acetabulum (Complex) 33,000 41,250 66000 100 ORIF Pelvis Simple 24,750 31,000 49500

Page 141 101 ORIF Pelvis (Complex) 30,250 37,800 60500 102 Closed reduction and external fixation pelvis 16,500 20,625 33000 103 SI joint fixation (Simple) 22,000 27,500 44000 104 SI joint fixation (Complex) 27,500 34,300 55000 105 Bone grafting (Medium) 11,000 13,750 22000 106 Intra articular fragment excision 22,000 27,500 44000 107 Hip arthrotomy 16,500 20,625 33000 108 Cannulated screw fixation (Open) 20,350 25,500 40700 109 Cannulated screw fixation (Closed) 22,000 27,500 44000 110 DHS/DCS (Complex) 24,750 21,000 49500 111 PFN 27,500 34,300 55000 112 Core Decompression Hip 16,500 20,625 33000 113 ORIF Single Bone forearm LCDCP/ nail 27,500 34,300 55000 114 ORIF # single bone of forearm locking plate 27,500 34,300 55000 115 ORIF # both bone of forearm LCDCP/ nail 27,500 34,300 55000 116 ORIF # both bone of forearm locking plate 27,500 34,300 55000 117 ORIF # olecranon with locking plate 24,200 30,250 48400 118 ORIF # humerus plating LCPDP 27,500 34,300 55000 119 ORIF # humerus with locking plate 27,500 34,300 55000 120 ORIF # proximal humerus locking plate 30,800 38,500 61600 121 CRIF # calcanem with K wires 24,750 30,938 49500 122 ORIF # ankle trimalleolar 30,250 37,800 60500 123 ORIF # tibia with locking plate 30,250 37,800 60500 124 Close reduction of dislocations hip and lower extrimities under General Anesthesia, IV sedation or G 11,000 13,750 22000 125 Close reduction and fixation of sacroiliac joint disruption 24,750 31,000 49500 126 Closed reduction and external fixation of pelvic # 27,500 34,300 55000 127 ORIF # patella 27,500 34,300 55000 128 Debridement Large 16,500 20,625 33000 129 Debridement Small 8,250 10,300 16500 130 Open Reduction of dislocation 24,750 31,000 49500 131 Open reduction under GA 27,500 34,300 55000 132 Open reduction with iliac bone grafing 33,000 41,250 66000 133 Open reduction + soft tissue reconstruction 27,500 34,300 55000 134 Recurrent dislocation open stabilisation 27,500 34,300 55000 135 Bristow-Latarjet procedure 33,000 41,250 66000 136 Modified Bristow-Latarjet 33,000 41,250 66000 137 Eden-Hybinnet Procedure 33,000 41,250 66000 138 McLaughlin Procedure 27,500 34,300 55000 139 Arthroscopic Latarjet 38,500 48,200 77000 140 Open reduction + Osteotomy 33,000 41,250 66000 141 Remplissage 27,500 34,300 55000 142 Arthroscopic Remplissage 27,500 34,300 55000 143 Diagnostic Arthroscopy 16,500 20,625 33000 144 Arthroscopic Sub-acromial decomressionASAD 27,500 34,300 55000 145 Arthroscpic SAD + Excision Lateral end Clavicle 33,000 41,250 66000 146 Arthroscopic repair small cuff tear 27,500 34,300 55000 147 Arthroscopic repair medium cuff tear 30,250 37,800 60500 148 Arthroscopic repair large cuff tear 33,000 41,250 66000 149 Artroscopic repair massive cuff tear 38,500 48,125 77000 150 Arthroscopic SLAP repair 27,500 34,300 55000

Page 142 151 Arthroscopic Ganglion cyst debridement 22,000 27,500 44000 152 Arthroscopic Suprascapular nerve release 38,500 48,125 77000 153 Arthroscopic debridement 22,000 27,500 44000 154 Arthroscopic anterior stabilisation 27,500 34,300 55000 155 Arthroscopic posterior stabilisation 27,500 34,300 55000 156 Arthroscopic posterior instability 27,500 34,300 55000 157 Open rotator cuff repair for small-medium tears 27,500 34,300 55000 158 Open repair for large and massive tears 33,000 41,250 66000 159 Open repair of cuff tears ACJ excision 27,500 34,300 55000 160 shoulder resurfacing humeral side 27,500 34,300 55000 161 total shoulder arthroplasty 38,500 48,125 77000 162 Shoulder hemiarthroplasty 27,500 34,300 55000 163 Reverse shoulder arthroplasty 38,500 48,125 77000 164 implant removal from shoulder 13,200 16,500 26400 165 Implant removal from shoulder + refixation 33,000 41,250 66000 166 Proximal humeral plate fixation simple 24,750 31,000 49500 167 Proximal humeral plate fixation complex 27,500 34,300 55000 168 Humeral fracture non-union 27,500 34,300 55000 169 Humeral non-union ORIF + Bone grafting 33,000 41,250 66000 170 Fracture clavicle K wire 16,500 20,625 33000 171 Fracture clavicle ORIF Complex 22,000 27,500 44000 172 Clavicle Non-union ORIF + BG 27,500 34,300 55000 173 A-C joint grade III reconstruction with plate 22,000 27,500 44000 174 A-C joint grade IV-VI reconstruction with plate 27,500 34,300 55000 175 A-C joint reconstruction (Weaver-Dunn) 22,000 27,500 44000 176 A-C Joint anatomic reconstruction 27,500 34,300 55000 177 Arthroscopic A-C joint reconstruction 35,750 44,700 71500 178 Closed reduction and plaster application for fracture 11,000 13,750 22000 179 Shoulder arthrodesis 38,500 48,200 77000 180 Shoulder tumour excision 33,000 41,250 66000 181 Complex shoulder reconstruction 38,500 48,200 77000 182 Scapulo-thoacic bursoscopy 24,200 30,250 48400 183 Scapular osteotomy 33,000 41,250 66000 184 Tendon transfer complex 33,000 41,250 66000 185 Rev TKR - Stg 1 30,250 37,800 60500 186 Debridement & Poly exchange 33,000 41,250 66000 187 Arthroscopy after TKR - joint lavage 24,750 31,000 49500 188 Joint aspiration 11,000 13,750 22000 189 Periprosthetic fracture 38,500 48,125 77000 190 Periprosthetic fracture & poly exchange 41,250 51,500 82500 191 osteotomy femur 30,250 37,800 60500 192 osteotomy tibia 30,250 37,800 60500 193 Fracture tibia / femur - knee 27,500 34,300 55000 194 Arthrodesis 30,250 37,800 60500 195 Arthrotomy (Septic Arthritis) open 19,250 24,000 38500 196 TKR after tumor resection 66,000 82,500 132000 197 Quadriceps Plasty / Repair 30,250 37,800 60500 198 Patella Tendon Ovulsion Re - Repair 30,250 37,800 60500 199 Hamstring Lengthening 22,000 27,500 44000 200 Release of contracture around the knee 22,000 27,500 44000

Page 143 201 Tumours Around the - Excision, Bone grafting, Reconstruction 24,750 31,000 49500 202 Postero medial / posterolateral reconstruction 38,500 48,200 77000 203 MCL repair / reconstruction 38,500 48,200 77000 204 Patellar dislocation - lateral retinacular release & medial plication 30,250 37,800 60500 205 Patellar dislocation + osteotomy 33,000 41,250 66000 206 Meniscal transplant 49,500 32,000 99000 207 ACL / PCL avulsion - fixator (arthroscopic open) 35,750 44,700 71500 208 Osteochondral fracture - pinning 33,000 41,250 66000 209 Arthroscopic fracture reduction and percutaneous fixation 33,000 41,250 66000 210 Arthroscopic Pcica Excision 16,500 20,625 33000 211 Simple Distal Radius # 27,500 34,300 55000 212 Complex Distal Radius # 27,500 34,300 55000 213 Arthroscopic Assisted Distal Radius # 33,000 41,250 66000 214 Arthroscopy small joints 30,250 37,800 60500 215 Spil Ostectomy and Interl Fixations 26,565 33,200 53130 216 ORIF Ilium 22,000 27,500 44000 217 Girdle Stone Arthroplasty 24,750 31,000 49500 218 Rev THR Stage 1 27,500 34,300 55000 219 ORIF Simple 13,750 17,200 27500 220 ORIF Complex 19,250 24,000 38500 221 ORIF minimally invasive 27,500 34,300 55000 222 Hand Reconstruction Simple 24,200 30,250 48400 223 Hand Reconstruction Complex 29,700 37,125 59400 224 Wrist Reconstruction Simple 33,000 41,250 66000 225 Wrist Reconstruction Complex 27,500 34,300 55000 226 Open Carpal Tunnel Release with median nerve neurolysis 22,000 27,500 44000 227 ECRB Release 16,500 20,625 33000 228 Tumor Excision 16,500 20,625 33000 229 Acute tendon repair (complex) 22,000 27,500 44000 230 Unilateral-Total Elbow Joint Replacement 38,500 48,200 77000 231 Total Ankle Arthroplasty 38,500 48,200 77000 232 Elbow Arthroscopic arthrolysis 33,000 41,250 66000 233 Elbow Arthrolysis soft tissue 22,000 27,500 44000 234 Elbow Arthrolysis bony block removal 27,500 34,300 55000 235 Elbow Complex arthrolysis 33,000 41,250 66000 236 Revision Total elbow replacement 44,000 55,000 88000 237 Radial Head Replacement 27,500 34,300 55000 238 Elbow Fusion 33,000 41,250 66000 239 Complex ORIF elbow 33,000 41,250 66000 240 Elbow reconstruction simple 22,000 27,500 44000 241 Elbow reconstruction complex 27,500 34,300 55000 242 Wrist Replacement 38,500 48,200 77000 243 Wrist Revision 44,000 55,000 88000 244 Wrist arthroscopy diagnostic 22,000 27,500 44000 245 Wrist arthroscopy Simple 27,500 34,300 55000 246 Wrist arthroscopy Complex 33,000 41,250 66000 247 Complex ORIF wrist 33,000 41,250 66000 248 Carpal Tunnel with neurolysis 16,500 20,625 33000 249 Finger Reconstruction simple 22,000 27,500 44000 250 Finger Reconstruction complex 27,500 34,300 55000 251 Small joint replacement one 27,500 34,300 55000 252 Small joint replacement two 33,000 41,250 66000 253 Small Joint replacement > 2 38,500 48,200 77000 254 Complex ORIF Hand 33,000 41,250 66000 255 Soft tissue procedure simple 5,500 6,875 11000 256 Complex soft tissue procedure 11,000 13,750 22000 257 Reconstruction bony/soft tissue 16,500 20,625 33000 258 THR for fracture neck of femur 33,000 41,250 66000 259 Toe nail excision partial 3,850 4,900 7700 260 Toe nail excision total 4,950 6,200 9900 261 Total Nail ablation 5,500 6,875 11000 262 Hammer toe/claw toe soft tissue procedure single 7,700 9,625 15400 263 Hammer toe/claw toe bony procedure single 10,450 13,000 20900 264 Hammer toe/claw toe bony procedure multiple toes 13,750 17,200 27500 265 Neil's osteotomy 9,350 11,700 18700 266 First MTP joint excision arthroplasty 19,250 24,000 38500 267 First MTP joint Arthrodesis 24,200 30,250 48400 268 Rheumatoid forefoot reconstruction 27,500 34,300 55000 269 Morton Neuroma excision 13,750 17,200 27500 270 Bunioneet excision 11,000 13,750 22000 271 Halux Valgus bunionectomy 8,800 11,000 17600 272 Halux valgus soft tissue procedure 8,800 11,000 17600 273 Halux Valgus Bismionectomy + DSTP 13,750 17,200 27500 274 Halus Valgus osteotomy 14,850 18,500 29700 275 Halux Valgus Osteotomy + DSTP+ Bunionectomy 24,750 31,000 49500 276 Plantar Plate reconstruction MTP joint 17,050 21,400 34100 277 Accessory Navicular Excision 9,350 11,700 18700 278 Accessory Navicular Excision & Kidner Procedure 13,750 17,200 27500 279 Midfoot Arthrodesis 24,200 30,250 48400 280 Hagland deformity excision 11,000 13,750 22000 281 Hagland deformity excision + FHL transfer 16,500 20,625 33000 282 Peronear Tendon Exploration / Repair 13,200 16,500 26400 283 Tibials Posterior Tendon exploration/repair 13,200 16,500 26400

Page 144 284 Plantar fascitis PRP injection 5,500 6,875 11000 285 Plantar fascitis RF ablation 8,250 10,400 16500 286 Flat foot FDS transfer 13,200 16,500 26400 287 Flat foot FDS transfer + Calcaneal osteotomy 22,000 27,500 44000 288 Complex flat foot Reconstruction with multiple osteotonies 30,800 38,500 61600 289 Ankle Arthroscopy 19,800 24,750 39600 290 Ankle arthroscopy OCD refracture/debridement 22,000 27,500 44000 291 Ankle Arthrodesis 24,200 30,250 48400 292 Mini open ankle fusion 27,500 34,300 55000 293 Brostrum laterral ligament reconstruction 24,750 30,938 49500 294 Deltoid ligament Reconstruction 27,500 34,300 55000 295 Lateral ligament peroneal Tendon Transfer 27,500 34,300 55000 296 Pantalar Arthrodesis 33,000 41,250 66000 297 Tripple arthrodesis 27,500 34,300 55000 298 Elbow Arthroscopy 27,500 34,300 55000 299 Listranc fracture ORIF 24,200 30,250 48400 300 External fixator foot & ankle 22,000 27,500 44000 301 Pilon fracture ORIF 27,500 34,300 55000 302 Talus fracture ORIF single approach 24,750 31,000 49500 303 Talus fracture ORIF two approach 27,500 34,300 55000 304 TA lengthening 22,500 30,000 45000

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