Consolidated Master

Health Benefit Package - 2.0 Specialty Code Package Code Package Code AB PM - JAY Procedure Code AB PM - JAY Specialty Procedure Price HBP 2.0 HBP 1.0 HBP 2.0 Package Name HBP 2.0 Procedure Name % Total Body Surface Area Burns (TBSA) - any % Burns Management BM S1100001 BM001 Thermal burns BM001A (not requiring admission). 7,000 Needs at least 5-6 dressing % Total Body Surface Area Burns (TBSA): Upto 40 %; Includes % TBSA skin grafted, flap cover, Burns Management BM S1100002 BM001 Thermal burns BM001B follow-up dressings etc. as deemed necessary; 40,000 Surgical procedures are required for deep burns that are not amenable to heal with dressings alone. % Total Body Surface Area Burns (TBSA): 40% - 60 %; Includes % TBSA skin grafted, flap cover, Burns Management BM S1100003 BM001 Thermal burns BM001C follow-up dressings etc. as deemed necessary; 50,000 Surgical procedures are required for deep burns that are not amenable to heal with dressings alone. % Total Body Surface Area Burns (TBSA): > 60 %; Includes % TBSA skin grafted, flap cover, follow- Burns Management BM S1100004 BM001 Thermal burns BM001D up dressings etc. as deemed necessary; Surgical 80,000 procedures are required for deep burns that are not amenable to heal with dressings alone. % Total Body Surface Area Burns (TBSA) - any % Burns Management BM S1100001 BM002 Scald burns BM002A (not requiring admission). 7,000 Needs at least 5-6 dressing % Total Body Surface Area Burns (TBSA): Upto 40 %; Includes % TBSA skin grafted, flap cover, Burns Management BM S1100002 BM002 Scald burns BM002B follow-up dressings etc. as deemed necessary; 40,000 Surgical procedures are required for deep burns that are not amenable to heal with dressings alone. % Total Body Surface Area Burns (TBSA): 40% - 60 %; Includes % TBSA skin grafted, flap cover, Burns Management BM S1100003 BM002 Scald burns BM002C follow-up dressings etc. as deemed necessary; 50,000 Surgical procedures are required for deep burns that are not amenable to heal with dressings alone. % Total Body Surface Area Burns (TBSA): > 60 %; Includes % TBSA skin grafted, flap cover, Burns Management BM S1100004 BM002 Scald burns BM002D follow-up dressings etc. as deemed necessary; 80,000 Surgical procedures are required for deep burns that are not amenable to heal with dressings alone. % Total Body Surface Area Burns (TBSA) - any % Burns Management BM S1100001 BM003 Flame burns BM003A (not requiring admission). 7,000 Needs at least 5-6 dressing % Total Body Surface Area Burns (TBSA): Upto 40 %; Includes % TBSA skin grafted, flap cover, Burns Management BM S1100002 BM003 Flame burns BM003B follow-up dressings etc. as deemed necessary; 40,000 Surgical procedures are required for deep burns that are not amenable to heal with dressings alone. % Total Body Surface Area Burns (TBSA): 40 % - 60 %; Includes % TBSA skin grafted, flap cover, Burns Management BM S1100003 BM003 Flame burns BM003C follow-up dressings etc. as deemed necessary; 50,000 Surgical procedures are required for deep burns that are not amenable to heal with dressings alone. % Total Body Surface Area Burns (TBSA): > 60 %; Includes % TBSA skin grafted, flap cover, Burns Management BM S1100004 BM003 Flame burns BM003D follow-up dressings etc. as deemed necessary; 80,000 Surgical procedures are required for deep burns that are not amenable to heal with dressings alone. Electrical contact burns: Low voltage - without part of limb / limb loss; Includes % TBSA skin grafted, flap cover, follow-up dressings etc. as deemed Burns Management BM S1100005 BM004 Electrical contact burns BM004A 30,000 necessary; Surgical procedures are required for deep burns that are not amenable to heal with dressings alone. Electrical contact burns: Low voltage - with part of limb / limb loss; Includes % TBSA skin grafted, flap cover, follow-up dressings etc. as deemed Burns Management BM S1100006 BM004 Electrical contact burns BM004B 40,000 necessary; Surgical procedures are required for deep burns that are not amenable to heal with dressings alone. Electrical contact burns: High voltage - with part of limb / limb loss; Includes % TBSA skin grafted, flap cover, follow-up dressings etc. as deemed Burns Management BM S1100008 BM004 Electrical contact burns BM004C 60,000 necessary; Surgical procedures are required for deep burns that are not amenable to heal with dressings alone. Electrical contact burns: High voltage - without part of limb / limb loss; Includes % TBSA skin grafted, flap cover, follow-up dressings etc. as deemed Burns Management BM S1100007 BM004 Electrical contact burns BM004D 50,000 necessary; Surgical procedures are required for deep burns that are not amenable to heal with dressings alone. Chemical burns: Without significant facial scarring and/or loss of function; Includes % TBSA skin grafted, flap cover, follow-up dressings etc. as Burns Management BM S1100009 BM005 Chemical burns BM005A 40,000 deemed necessary; Surgical procedures are required for deep burns that are not amenable to heal with dressings alone. Chemical burns: With significant facial scarring and/or loss of function; Includes % TBSA skin grafted, flap cover, follow-up dressings etc. as Burns Management BM S1100010 BM005 Chemical burns BM005B 60,000 deemed necessary; Surgical procedures are required for deep burns that are not amenable to heal with dressings alone. Post Burn Contracture surgeries for Functional Improvement (Package including splints, pressure garments, silicone - gel sheet and physiotherapy): Post Burn Contracture surgeries for Functional Excluding Neck contracture; Contracture release Burns Management BM S1100011 BM006 BM006A 50,000 Improvement with - Split thickness Skin Graft (STSG) / Full Thickness Skin Graft (FTSG) / Flap cover is done for each joint with post - operative regular dressings for STSG / FTSG / Flap cover.

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Post Burn Contracture surgeries for Functional Improvement (Package including splints, pressure garments, silicone - gel sheet and physiotherapy): Post Burn Contracture surgeries for Functional Neck contracture; Contracture release with - Split Burns Management BM S1100012 BM006 BM006B 50,000 Improvement thickness Skin Graft (STSG) / Full Thickness Skin Graft (FTSG) / Flap cover is done for each joint with post-operative regular dressings for STSG / FTSG / Flap cover. Emergency ER New Package ER001 Laceration - Suturing / Dressing ER001A Laceration - Suturing / Dressing 2,000 Emergency ER M700001 ER002 Cardiopulmonary emergency ER002A Emergency with stable cardiopulmonary status 2,000 Emergency with unstable cardiopulmonary status Emergency ER New Package ER002 Cardiopulmonary emergency ER002B 10,000 with resuccitation Emergency ER M700004 ER003 Animal bites (Excluding Snake Bite) ER003A Animal bites (Excluding Snake Bite) 1,700 Interventional IN S900003 IN001 Dural AVMs / AVFs IN001A Dural AVMs (per sitting) with glue 70,000 Neuroradiology Interventional IN S900003 IN001 Dural AVMs / AVFs IN001B Dural AVFs (per sitting) with glue 70,000 Neuroradiology Interventional IN S900004 IN001 Dural AVMs / AVFs IN001C Dural AVMs (per sitting) with onyx 150,000 Neuroradiology Interventional IN S900004 IN001 Dural AVMs / AVFs IN001D Dural AVFs (per sitting) with onyx 150,000 Neuroradiology Interventional Cerebral & Spinal AVM embolization - Using Cerebral AVM embolization - Using Histoacryl IN S900007 IN002 IN002A 100,000 Neuroradiology Histoacryl (per sitting) (per sitting) Interventional Cerebral & Spinal AVM embolization - Using Spinal AVM embolization - Using Histoacryl IN S900007 IN002 IN002B 100,000 Neuroradiology Histoacryl (per sitting) (per sitting) Coil embolization for aneurysms Coil embolization for aneurysms Interventional IN S900001 IN003 (includes cost of first 3 coils + balloon and / or stent IN003A (includes cost of first 3 coils + balloon and / or stent 100,000 Neuroradiology if used) if used) Carotico-cavernous Fistula (CCF) embolization Interventional with coils. IN S900005 IN004 Carotico-cavernous Fistula (CCF) embolization IN004A 30,000 Neuroradiology [includes 5 coils, guide catheter, micro-catheter, micro-guidewire, general items] Carotid-cavernous Fistula (CCF) embolization with Interventional balloon IN S900006 IN004 Carotico-cavernous Fistula (CCF) embolization IN004B 64,000 Neuroradiology (includes one balloon, guide catheter, micro- catheter, micro-guidewire, general items) Interventional Pre-operative tumour embolization Pre-operative tumour embolization IN S900014 IN005 IN005A 40,000 Neuroradiology (per session) (per session) Interventional IN S900012 IN006 Intracranial balloon angioplasty with stenting IN006A Intracranial balloon angioplasty with stenting 160,000 Neuroradiology Interventional IN S900013 IN007 Intracranial thrombolysis / clot retrieval IN007A Intracranial thrombolysis / clot retrieval 160,000 Neuroradiology Interventional IN S900011 IN008 Balloon test occlusion IN008A Balloon test occlusion 70,000 Neuroradiology Interventional IN S900008 IN009 Parent vessel occlusion - Basic IN009A Parent vessel occlusion - Basic 30,000 Neuroradiology Interventional IN S900015 IN010 Vertebroplasty IN010A Vertebroplasty 40,000 Neuroradiology Cardiology MC New Package MC001 Right / Left Heart Catheterization MC001A Right Heart Catheterization 5,000 Cardiology MC New Package MC001 Right / Left Heart Catheterization MC001B Left Heart Catheterization 5,000 Cardiology, Interventional MC S1200039 MC002 Catheter directed Thrombolysis MC002A For Deep vein thrombosis (DVT) 30,800 Radiology Cardiology, Interventional MC S1200039 MC002 Catheter directed Thrombolysis MC002B For Mesenteric Thrombosis 30,800 Radiology Cardiology, Interventional MC S1200039 MC002 Catheter directed Thrombolysis MC002C For Peripheral vessels 30,800 Radiology Cardiology MC S1200012 MC003 Balloon Dilatation MC003A Coartication of Aorta 38,600 Cardiology MC New Package MC003 Balloon Dilatation MC003B Pulmonary Artrey Stenosis 38,600 Cardiology MC S1200004 MC004 Balloon Pulmonary / Aortic Valvotomy MC004A Balloon Pulmonary Valvotomy 23,400 Cardiology MC S1200002 MC004 Balloon Pulmonary / Aortic Valvotomy MC004B Balloon Aortic Valvotomy 23,400 Cardiology MC S1200003 MC005 Balloon Mitral Valvotomy MC005A Balloon Mitral Valvotomy 35,700 Cardiology MC S1200001 MC006 Balloon Atrial Septostomy MC006A Balloon Atrial Septostomy 24,400 Cardiology MC S1200014 MC007 ASD Device Closure MC007A ASD Device Closure 36,900 Cardiology MC S1200015 MC008 VSD Device Closure MC008A VSD Device Closure 37,900 Cardiology MC S1200016 MC009 PDA Device Closure MC009A PDA Device Closure 25,000 Cardiology MC S1200019 MC010 PDA stenting MC010A PDA stenting 40,260 S1200024, Cardiology MC MC011 PTCA, inclusive of diagnostic angiogram MC011A PTCA, inclusive of diagnostic angiogram 40,600 S1200025 Cardiology MC New Package MC012 Electrophysiological Study MC012A Electrophysiological Study 20,000 Electrophysiological Study Cardiology MC New Package MC012 Electrophysiological Study MC012B 20,000 with Radio Frequency Ablation Percutaneous Transluminal Septal Myocardial Percutaneous Transluminal Septal Myocardial Cardiology MC S1200027 MC013 MC013A 34,000 Ablation Ablation Cardiology, CTVS MC S1200021 MC014 Temporary Pacemaker implantation MC014A Temporary Pacemaker implantation 19,200 Single Chamber Permanent Pacemaker Permanent Pacemaker Implantation - Cardiology, CTVS MC S1200023 MC015 MC015A 24,500 Implantation Single Chamber Double Chamber Permanent Pacemaker Permanent Pacemaker Implantation - Cardiology, CTVS MC S1200022 MC016 MC016A 33,000 Implantation Double Chamber S1200011, Cardiology MC MC017 Peripheral Angioplasty MC017A Peripheral Angioplasty 34,500 S1200010 Bronchial artery Embolisation Bronchial artery Embolisation Cardiology MC S1200035 MC018 MC018A 32,800 (for Haemoptysis) (for Haemoptysis) Cardiology, MC S1200020 MC019 Pericardiocentesis MC019A Pericardiocentesis 12,100 General Surgery Cardiology MC S1200013 MC020 Systemic Thrombolysis (for MI) MC020A Systemic Thrombolysis (for MI) 17,900 General Medicine, Pediatric MG M100011 MG001 Acute febrile illness MG001A Acute febrile illness 1,800 Medical Management General Medicine, Pediatric MG M100055 MG002 Severe sepsis MG002A Severe sepsis 1,800 Medical Management General Medicine, Pediatric MG M100055 MG002 Severe sepsis MG002B Septic shock 1,800 Medical Management General Medicine, Pediatric MG M100014 MG003 Malaria MG003A Malaria 1,800 Medical Management General Medicine, Pediatric M100051, MG MG003 Malaria MG003B Complicated malaria 1,800 Medical Management M200074 General Medicine, Pediatric M100015, MG MG004 Dengue fever MG004A Dengue fever 1,800 Medical Management M200030 General Medicine, Pediatric MG M100050 MG004 Dengue fever MG004B Dengue hemorrhagic fever 1,800 Medical Management General Medicine, Pediatric M100050, MG MG004 Dengue fever MG004C Dengue shock syndrome 1,800 Medical Management M200075 General Medicine, Pediatric M100016, MG MG005 Chikungunya fever MG005A Chikungunya fever 1,800 Medical Management M200032

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General Medicine, Pediatric M100018, MG MG006 Enteric fever MG006A Enteric fever 1,800 Medical Management M200031 General Medicine, Pediatric M100039, MG MG007 HIV with complications MG007A HIV with complications 1,800 Medical Management M200036 General Medicine, Pediatric MG M100017 MG008 Leptospirosis MG008A Leptospirosis 1,800 Medical Management General Medicine, Pediatric MG M100001 MG009 Acute gastroenteritis with dehydration MG009A Acute gastroenteritis with moderate dehydration 1,800 Medical Management General Medicine, Pediatric MG M100048 MG009 Acute gastroenteritis with dehydration MG009B Acute gastroenteritis with severe dehydration 1,800 Medical Management M100036, General Medicine, Pediatric MG M200001, MG010 Diarrohea MG010A Chronic diarrohea 1,800 Medical Management M200028 M100036, General Medicine, Pediatric MG M200001, MG010 Diarrohea MG010B Persistent diarrohea 1,800 Medical Management M200028 General Medicine, Pediatric M100003, MG MG011 Dysentery MG011A Dysentery 1,800 Medical Management M200002 General Medicine, Pediatric M100022, MG MG012 Acute viral hepatitis MG012A Acute viral hepatitis 1,800 Medical Management M200033 General Medicine, Pediatric MG New Package MG013 Chronic Hepatitis MG013A Chronic Hepatitis 1,800 Medical Management General Medicine, Pediatric M100021, MG MG014 Liver abscess MG014A Liver abscess 1,800 Medical Management M200073 General Medicine, Pediatric M100038, MG MG015 Visceral leishmaniasis MG015A Visceral leishmaniasis 1,800 Medical Management M200034 General Medicine, Pediatric M100019, MG MG016 Pneumonia MG016A Pneumonia 1,800 Medical Management M200003 General Medicine, Pediatric M100047, MG MG017 Severe pneumonia MG017A Severe pneumonia 1,800 Medical Management M200065 General Medicine, Pediatric M100033, MG MG018 Empyema MG018A Empyema 1,800 Medical Management M200043 General Medicine, Pediatric MG M100033 MG019 Lung abscess MG019A Lung abscess 1,800 Medical Management General Medicine, Pediatric MG M100027 MG020 Pericardial / Pleural tuberculosis MG020A Pericardial tuberculosis 1,800 Medical Management General Medicine, Pediatric MG M100027 MG020 Pericardial / Pleural tuberculosis MG020B Pleural tuberculosis 1,800 Medical Management General Medicine, Pediatric M100013, MG MG021 Urinary Tract Infection MG021A Urinary Tract Infection 1,800 Medical Management M200004 General Medicine, Pediatric MG M100035 MG022 Viral encephalitis MG022A Viral encephalitis 1,800 Medical Management General Medicine, Pediatric MG New Package MG023 Septic Arthritis MG023A Septic Arthritis 1,800 Medical Management General Medicine, Pediatric MG New Package MG024 Skin and soft tissue infections MG024A Skin and soft tissue infections 1,800 Medical Management General Medicine, Pediatric MG M100002 MG025 Recurrent vomiting with dehydration MG025A Recurrent vomiting with dehydration 1,800 Medical Management General Medicine, Pediatric M100026, MG MG026 Pyrexia of unknown origin MG026A Pyrexia of unknown origin 1,800 Medical Management M200014 General Medicine MG New Package MG027 Bronchiectasis MG027A Bronchiectasis 1,800 General Medicine, Pediatric MG M100005 MG028 Acute bronchitis MG028A Acute bronchitis 1,800 Medical Management M100012, General Medicine MG MG029 Acute excaberation of COPD MG029A Acute excaberation of COPD 1,800 M100046 General Medicine, Pediatric MG M100020 MG030 Acute excaberation of Interstitial Lung Disease MG030A Acute excaberation of Interstitial Lung Disease 1,800 Medical Management General Medicine, Pediatric MG M100031 MG031 Endocarditis MG031A Bacterial Endocarditis 1,800 Medical Management General Medicine, Pediatric MG M100031 MG031 Endocarditis MG031B Fungal Endocarditis 1,800 Medical Management General Medicine, Pediatric MG M100029 MG032 Vasculitis MG032A Vasculitis 1,800 Medical Management General Medicine, Pediatric MG M100037 MG033 Pancreatitis MG033A Acute pancreatitis 1,800 Medical Management General Medicine, Pediatric MG M100037 MG033 Pancreatitis MG033B Chronic pancreatitis 1,800 Medical Management General Medicine, Pediatric MG New Package MG034 Ascites MG034A Ascites 1,800 Medical Management M100060, General Medicine, Pediatric MG M200081, MG035 Acute transverse myelitis MG035A Acute transverse myelitis 1,800 Medical Management M200089 General Medicine, Pediatric MG New Package MG036 Atrial Fibrillation MG036A Atrial Fibrillation 1,800 Medical Management General Medicine MG New Package MG037 Cardiac Tamponade MG037A Cardiac Tamponade 1,800 General Medicine, Pediatric M100008, MG MG038 Congestive heart failure MG038A Congestive heart failure 1,800 Medical Management M200076 General Medicine, Pediatric MG M100045 MG039 Asthma MG039A Acute asthmatic attack 1,800 Medical Management General Medicine, Pediatric MG M100066 MG039 Asthma MG039B Status asthmaticus 1,800 Medical Management General Medicine, Pediatric MG M100044 MG040 Respiratory failure MG040A Type 1 respiratory failure 1,800 Medical Management General Medicine, Pediatric MG M100044 MG040 Respiratory failure MG040B Type 2 respiratory failure 1,800 Medical Management General Medicine, Pediatric M100067, Due to any cause (pneumonia, asthma, COPD, MG MG040 Respiratory failure MG040C 1,800 Medical Management M200088 ARDS, foreign body, poisoning, head injury etc.) General Medicine, Pediatric M100056, MG MG041 Upper GI bleeding MG041A Upper GI bleeding (conservative) 1,800 Medical Management M200070 General Medicine, Pediatric MG M100057 MG041 Upper GI bleeding MG041B Upper GI bleeding (endoscopic) 1,800 Medical Management General Medicine, Pediatric M100058, MG MG042 Lower GI hemorrhage MG042A Lower GI hemorrhage 1,800 Medical Management M200071 General Medicine, Pediatric MG New Package MG043 Addison’s disease MG043A Addison’s disease 1,800 Medical Management General Medicine MG M100004 MG044 Renal colic MG044A Renal colic 1,800 General Medicine, Pediatric M100064, MG MG045 AKI / Renal failure MG045A AKI / Renal failure 1,800 Medical Management M200067 General Medicine, Pediatric MG M100030 MG046 Seizures MG046A Seizures 1,800 Medical Management General Medicine, Pediatric M100065, MG MG047 Status epilepticus MG047A Status epilepticus 1,800 Medical Management M200091 General Medicine MG M100054 MG048 Cerebrovascular accident MG048A Cerebrovascular accident 1,800

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M100063, General Medicine MG MG049 Cerebral sino-venous thrombosis / Stroke MG049A Cerebral sino-venous thrombosis 1,800 M200087 General Medicine MG New Package MG049 Cerebral sino-venous thrombosis / Stroke MG049B Acute stroke 1,800 General Medicine MG New Package MG049 Cerebral sino-venous thrombosis / Stroke MG049C Acute ischemic stroke 1,800 General Medicine MG New Package MG049 Cerebral sino-venous thrombosis / Stroke MG049D Acute heamorrhagic stroke 1,800 General Medicine, Pediatric M100059, MG MG050 Immune mediated CNS disorders MG050A Immune mediated CNS disorders 1,800 Medical Management M200080 General Medicine, Pediatric M100062, MG MG051 Hydrocephalus MG051A Hydrocephalus 1,800 Medical Management M200083 General Medicine, Pediatric MG New Package MG052 Myxedema coma MG052A Myxedema coma 1,800 Medical Management General Medicine, Pediatric MG New Package MG053 Thyrotoxic crisis MG053A Thyrotoxic crisis 1,800 Medical Management General Medicine MG New Package MG054 Gout MG054A Gout 1,800 General Medicine, Pediatric MG M100006 MG055 Pneumothroax MG055A Pneumothroax 1,800 Medical Management General Medicine, Pediatric M100040, MG MG056 Neuromuscular disorders MG056A Neuromuscular disorders 1,800 Medical Management M200054 General Medicine, Pediatric MG New Package MG057 Hypoglycemia MG057A Hypoglycemia 1,800 Medical Management General Medicine MG New Package MG058 Diabetic Foot MG058A Diabetic Foot 1,800 General Medicine, Pediatric M100010, MG MG059 Diabetic ketoacidosis MG059A Diabetic ketoacidosis 1,800 Medical Management M200025 General Medicine, Pediatric MG New Package MG060 Electrolyte Imbalance MG060A Hypercalcemia 1,800 Medical Management General Medicine, Pediatric MG New Package MG060 Electrolyte Imbalance MG060B Hypocalcemia 1,800 Medical Management General Medicine, Pediatric MG New Package MG060 Electrolyte Imbalance MG060C Hyponatremia 1,800 Medical Management General Medicine, Pediatric MG New Package MG060 Electrolyte Imbalance MG060D Hypernatremia 1,800 Medical Management General Medicine, Pediatric MG M100053 MG061 Hyperosmolar Non-Ketotic coma MG061A Hyperosmolar Non-Ketotic coma 1,800 Medical Management General Medicine, Pediatric MG M100007 MG062 Accelerated hypertension MG062A Accelerated hypertension 1,800 Medical Management General Medicine, Pediatric MG M100049 MG063 Hypertensive emergencies MG063A Hypertensive emergencies 1,800 Medical Management General Medicine, Pediatric M100009, MG MG064 Severe anemia MG064A Severe anemia 1,800 Medical Management M200021 General Medicine, Pediatric MG M100042 MG065 Sickle cell Anemia MG065A Sickle cell Anemia 1,800 Medical Management General Medicine, Pediatric MG New Package MG066 Anaphylaxis MG066A Anaphylaxis 1,800 Medical Management General Medicine, Pediatric MG M100052 MG067 Heat stroke MG067A Heat stroke 1,800 Medical Management General Medicine, Pediatric MG M100028 MG068 Systematic lupus erythematosus MG068A Systematic lupus erythematosus 1,800 Medical Management General Medicine, Pediatric M100061, MG MG069 Guillian Barre Syndrome MG069A Guillian Barre Syndrome 1,800 Medical Management M200082 General Medicine, Pediatric MG M100023 MG070 Snake bite MG070A Snake bite 1,800 Medical Management General Medicine, Pediatric MG M100024 MG071 Poisoning MG071A Acute organophosphorus poisoning 1,800 Medical Management General Medicine, Pediatric M100025, MG MG071 Poisoning MG071B Other poisonings 1,800 Medical Management M200068 M100070, General Medicine MG MG072 Haemodialysis / Peritoneal Dialysis MG072A Haemodialysis Dialysis 1,500 S100214 M100070, General Medicine MG MG072 Haemodialysis / Peritoneal Dialysis MG072B Peritoneal Dialysis 1,500 S100252 General Medicine, Pediatric MG M100069 MG073 Plasmapheresis MG073A Plasmapheresis 2,000 Medical Management M100068, General Medicine, Pediatric MG M200099, MG074 Blood transfusion MG074A Whole Blood transfusion 2,000 Medical Management M200100 M100068, General Medicine, Pediatric Blood component including platelet transfusion MG M200099, MG074 Blood transfusion MG074B 2,000 Medical Management (RDP, PC, SDP) M200100 General Medicine, Pediatric M100071, High end radiological diagnostic High end radiological diagnostic MG MG075 MG075A 5,000 Medical Management M200101 (CT, MRI, Imaging including nuclear imaging) (CT, MRI, Imaging including nuclear imaging) General Medicine, Pediatric M100072, High end histopathology (Biopsies) and advanced High end histopathology (Biopsies) and advanced MG MG076 MG076A 5,000 Medical Management M200102 serology investigations serology investigations M800007, Mental Disorders MM MM001 Mental Retardation MM001A Mental Retardation 1,500 M800014 M800001, Mental Disorders MM MM002 Mental disorders - Organic, including symptomatic MM002A Mental disorders - Organic, including symptomatic 1,500 M800008 M800003, Mental Disorders MM MM003 Schizophrenia, schizotypal and delusional disorders MM003A Schizophrenia, schizotypal and delusional disorders 1,500 M800010 M800005, Mental Disorders MM MM004 Neurotic, stress-related and somatoform disorders MM004A Neurotic, stress-related and somatoform disorders 1,500 M800012 M800004, Mental Disorders MM MM005 Mood (affective) disorders MM005A Mood (affective) disorders 1,500 M800011 M800006, Behavioural syndromes associated with Behavioural syndromes associated with Mental Disorders MM MM006 MM006A 1,500 M800013 physiological disturbances and physical factors physiological disturbances and physical factors M800002, Mental and Behavioural disorders due to Mental and Behavioural disorders due to Mental Disorders MM MM007 MM007A 1,500 M800009 psychoactive substance use psychoactive substance use Pre - Electro Convulsive Therapy (ECT) and Pre - Pre - Electro Convulsive Therapy (ECT) and Pre - Transcranial Magnetic Stimulation (TMS) Package Transcranial Magnetic Stimulation (TMS) Package (Cognitive Tests, Complete Haemogram, Liver (Cognitive Tests, Complete Haemogram, Liver Function Test, Renal Function Test, Serum Function Test, Renal Function Test, Serum Mental Disorders MM M800015 MM008 MM008A 10,000 Electrolytes, Electro Cardiogram (ECG), CT / MRI Electrolytes, Electro Cardiogram (ECG), CT / MRI Brain, Electroencephalogram, Thyroid Function Brain, Electroencephalogram, Thyroid Function Test, VDRL, HIV Test, Vitamin B12 levels, Folate Test, VDRL, HIV Test, Vitamin B12 levels, Folate levels, Lipid Profile, Homocysteine levels) levels, Lipid Profile, Homocysteine levels) Mental Disorders MM M800016 MM009 Electro Convulsive Therapy (ECT) - per session MM009A Electro Convulsive Therapy (ECT) - per session 3,000 Transcranial Magnetic Stimulation (TMS) - per Transcranial Magnetic Stimulation (TMS) - per Mental Disorders MM M800017 MM010 MM010A 1,000 session session

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Basic neonatal care package: Babies that can be Basic neonatal care package: Babies that can be managed by side of mother in postnatal ward managed by side of mother in postnatal ward without requiring admission in SNCU/NICU: without requiring admission in SNCU/NICU: • Any newborn needing feeding support • Any newborn needing feeding support • Babies requiring closer monitoring or short-term • Babies requiring closer monitoring or short-term Neo - natal Care MN M300001 MN001 care for conditions like: MN001A care for conditions like: 500 o Birth asphyxia (need for positive pressure o Birth asphyxia (need for positive pressure ventilation; no HIE) ventilation; no HIE) o Moderate jaundice requiring phototherapy o Moderate jaundice requiring phototherapy o Large for dates (>97 percentile) Babies o Large for dates (>97 percentile) Babies o Small for gestational age (less than 3rd centile) o Small for gestational age (less than 3rd centile) Special Neonatal Care Package: Babies that Special Neonatal Care Package: Babies that required admission to SNCU or NICU: required admission to SNCU or NICU: Babies admitted for short term care for conditions Babies admitted for short term care for conditions like: like: • Mild Respiratory Distress/tachypnea • Mild Respiratory Distress/tachypnea • Mild encephalopathy • Mild encephalopathy • Severe jaundice requiring intensive phototherapy • Severe jaundice requiring intensive phototherapy Neo - natal Care MN M300002 MN002 • Haemorrhagic disease of newborn MN002A • Haemorrhagic disease of newborn 3,000 • Unwell baby requiring monitoring • Unwell baby requiring monitoring • Some dehydration • Some dehydration • Hypoglycaemia • Hypoglycaemia Mother's stay and food in the hospital for Mother's stay and food in the hospital for breastfeeding, family centred care and (Kangaroo breastfeeding, family centred care and (Kangaroo Mother Care) KMC is mandatory and included in Mother Care) KMC is mandatory and included in the package rate the package rate Intensive Neonatal Care Package Intensive Neonatal Care Package Babies with birthweight 1500-1799 g Babies with birthweight 1500-1799 g or or Babies of any birthweight and at least one of the Babies of any birthweight and at least one of the following conditions: following conditions: • Need for mechanical ventilation for less than 24 • Need for mechanical ventilation for less than 24 hours or non-invasive respiratory support (CPAP, hours or non-invasive respiratory support (CPAP, HFFNC) HFFNC) • Sepsis / pneumonia without complications • Sepsis / pneumonia without complications • Hyperbilirubinemia requiring exchange • Hyperbilirubinemia requiring exchange Neo - natal Care MN M300003 MN003 transfusion MN003A transfusion 5,000 • Seizures • Seizures • Major congenital malformations (pre-surgical • Major congenital malformations (pre-surgical stabilization, not requiring ventilation) stabilization, not requiring ventilation) • Cholestasis significant enough requiring work up • Cholestasis significant enough requiring work up and in-hospital management and in-hospital management • Congestive heart failure or shock • Congestive heart failure or shock Mother's stay and food in the hospital for Mother's stay and food in the hospital for breastfeeding, family centred care and (Kangaroo breastfeeding, family centred care and (Kangaroo Mother Care) KMC is mandatory and included in Mother Care) KMC is mandatory and included in the package rate the package rate Advanced Neonatal Care Package: Advanced Neonatal Care Package: Babies with birthweight of 1200-1499 g Babies with birthweight of 1200-1499 g or or Babies of any birthweight with at least one of the Babies of any birthweight with at least one of the following conditions: following conditions: • Any condition requiring invasive ventilation • Any condition requiring invasive ventilation longer than 24 hours longer than 24 hours • Hypoxic Ischemic encephalopathy requiring • Hypoxic Ischemic encephalopathy requiring Therapeutic Hypothermia Therapeutic Hypothermia • Cardiac rhythm disorders needing intervention • Cardiac rhythm disorders needing intervention Neo - natal Care MN M300004 MN004 MN004A 6,000 (the cost of cardiac surgery or implant will be (the cost of cardiac surgery or implant will be covered under cardiac surgery packages) covered under cardiac surgery packages) • Sepsis with complications such as meningitis or • Sepsis with complications such as meningitis or bone and joint infection, DIC or shock bone and joint infection, DIC or shock • Renal failure requiring dialysis • Renal failure requiring dialysis • Inborn errors of metabolism • Inborn errors of metabolism Mother's stay and food in the hospital for Mother's stay and food in the hospital for breastfeeding, family centred care and (Kangaroo breastfeeding, family centred care and (Kangaroo Mother Care) KMC is mandatory and included in Mother Care) KMC is mandatory and included in the package rate the package rate Critical Care Neonatal Package: Critical Care Neonatal Package: Babies with birthweight of <1200 g Babies with birthweight of <1200 g or or Babies of any birthweight with at least one of the Babies of any birthweight with at least one of the following conditions: following conditions: • Severe Respiratory Failure requiring High • Severe Respiratory Failure requiring High Frequency Ventilation or inhaled Nitric Oxide Frequency Ventilation or inhaled Nitric Oxide (iNO) (iNO) Neo - natal Care MN M300005 MN005 MN005A 7,000 • Multisystem failure requiring multiple organ • Multisystem failure requiring multiple organ support including mechanical ventilation and support including mechanical ventilation and multiple inotropes multiple inotropes • Critical congenital heart disease • Critical congenital heart disease Mother's stay and food in the hospital for Mother's stay and food in the hospital for breastfeeding, family centred care and (Kangaroo breastfeeding, family centred care and (Kangaroo Mother Care) KMC is mandatory and included in Mother Care) KMC is mandatory and included in the package rate the package rate Chronic Care Package: If the baby requires stay Chronic Care Package: If the baby requires stay beyond the upper limit of usual stay in Package no beyond the upper limit of usual stay in Package no Neo - natal Care MN M300006 MN006 MN004A or MN005A for conditions like severe MN006A MN004A or MN005A for conditions like severe 3,000 BPD requiring respiratory support, severe NEC BPD requiring respiratory support, severe NEC requiring prolonged TPN support requiring prolonged TPN support High Risk Newborn Post Discharge Care Package High Risk Newborn Post Discharge Care Package Neo - natal Care MN M300007 MN007 MN007A 2,400 (Protocol Driven) (Protocol Driven) Laser Therapy for Retinopathy of Prematurity Laser Therapy for Retinopathy of Prematurity Neo - natal Care MN M300008 MN008 MN008A 1,500 (Irrespective of no. of eyes affected) - per session (Irrespective of no. of eyes affected) - per session Neo - natal Care MN M300009 MN009 Advanced Surgery for Retinopathy of Prematurity MN009A Advanced Surgery for Retinopathy of Prematurity 15,000 Ventriculoperitoneal Shunt Surgery (VP) or Omaya Ventriculoperitoneal Shunt Surgery (VP) or Omaya Neo - natal Care MN M300010 MN010 MN010A 5,000 Reservoir or External Drainage for Hydrocephalus Reservoir or External Drainage for Hydrocephalus Medical Oncology MO New Package MO001 CT for CA Breast MO001A Cyclophosphamide + Epirubcin 7,200 Medical Oncology MO New Package MO001 CT for CA Breast MO001B Weekly Paclitaxel for Adjuvant Therapy 5,800 Medical Oncology MO New Package MO001 CT for CA Breast MO001C Weekly Paclitaxel in metastatic setting 5,800 Medical Oncology MO New Package MO001 CT for CA Breast MO001D Cyclophosphamide + Methotrexate + 5 - FU 3,200 Medical Oncology MO New Package MO001 CT for CA Breast MO001E Docetaxel + Cyclophosphamide 19,800 Medical Oncology MO New Package MO001 CT for CA Breast MO001F Trastuzumab 21,200 Medical Oncology MO New Package MO001 CT for CA Breast MO001G Tamoxifen 1,200

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Medical Oncology MO New Package MO001 CT for CA Breast MO001H Letrozole 3,900 Medical Oncology MO New Package MO001 CT for CA Breast MO001I Carboplatin + Paclitaxel 14,900 Medical Oncology MO New Package MO001 CT for CA Breast MO001J Capecitabine 7,400 Medical Oncology MO New Package MO001 CT for CA Breast MO001K Carboplatin + Gemcitabine 13,900 Medical Oncology MO New Package MO001 CT for CA Breast MO001L Cyclophosphamide + Adriamycin 4,500 Medical Oncology MO New Package MO001 CT for CA Breast MO001M Fulvestrant 11,000 Medical Oncology MO New Package MO001 CT for CA Breast MO001N Paclitaxel 11,800 Medical Oncology MO New Package MO001 CT for CA Breast MO001O Exemestane 10,400 CT for Metastatic bone malignancy and multiple Medical Oncology MO New Package MO002 MO002A Zoledronic Acid 4,500 myeloma Medical Oncology MO New Package MO003 CT for CA Ovary MO003A Cisplatin + Irinotecan 10,200 Medical Oncology MO New Package MO003 CT for CA Ovary MO003B Lipodox + Carboplatin 17,200 Medical Oncology MO New Package MO003 CT for CA Ovary MO003C Etoposide 3,400 Medical Oncology MO New Package MO003 CT for CA Ovary MO003D Irinotecan 8,400 Medical Oncology MO New Package MO003 CT for CA Ovary MO003E Lipodox 14,800 Medical Oncology MO New Package MO003 CT for CA Ovary MO003F Carboplatin + Gemcitabine 13,900 Medical Oncology MO New Package MO003 CT for CA Ovary MO003G Carboplatin + Paclitaxel 14,700 Medical Oncology MO New Package MO004 CT for Germ Cell Tumor MO004A Carboplatin (AUC 7) 5,800 Medical Oncology MO New Package MO004 CT for Germ Cell Tumor MO004B Bleomycin + Etoposide + Cisplatin 11,600 Medical Oncology MO New Package MO004 CT for Germ Cell Tumor MO004C Etoposide + Cisplatin 10,000 Medical Oncology MO New Package MO004 CT for Germ Cell Tumor MO004D Gemcitabine + Oxaliplatin 17,500 Medical Oncology MO New Package MO004 CT for Germ Cell Tumor MO004E Gemcitabine + Paclitaxel 17,500 Medical Oncology MO New Package MO004 CT for Germ Cell Tumor MO004F Paclitaxel + Ifosfamide + Cisplatin 24,400 Medical Oncology MO New Package MO004 CT for Germ Cell Tumor MO004G Vinblastin + Ifosfamide + Cisplatin 12,600 Medical Oncology MO New Package MO005 CT for Gestational Trophoblastic Neoplasia MO005A EMA - CO 11,400 Medical Oncology MO New Package MO005 CT for Gestational Trophoblastic Neoplasia MO005B EMA - EP 12,200 Medical Oncology MO New Package MO005 CT for Gestational Trophoblastic Neoplasia MO005C Methotrexate 1,100 Medical Oncology MO New Package MO006 CT for Cervical Cancer MO006A Carboplatin + Paclitaxel 14,900 Medical Oncology MO New Package MO006 CT for Cervical Cancer MO006B Cisplatin 2,200 Medical Oncology MO New Package MO007 CT for Endometrial Cancer MO007A Carboplatin + Paclitaxel 14,900 Medical Oncology MO New Package MO007 CT for Endometrial Cancer MO007B Cisplatin + Doxorubicin 4,200 Medical Oncology MO New Package MO008 CT for Vulvar Cancer MO008A Cisplatin + 5 FU 7,600 Medical Oncology MO New Package MO008 CT for Vulvar Cancer MO008B Cisplatin 2,200 Medical Oncology MO New Package MO009 CT for Ewing Sarcoma MO009A VTC + ITMZ for Relapsed Ewing Sarcoma 22,400 Medical Oncology MO New Package MO009 CT for Ewing Sarcoma MO009B EFT 2001 9,700 Medical Oncology MO New Package MO009 CT for Ewing Sarcoma MO009C VAC + IE 12,500 Medical Oncology MO New Package MO010 CT for Osteogenic Sarcoma MO010A Methotrexate + Doxorubicin + Cisplatin 21,800 Methotrexate + Doxorubicin + Cisplatin for Medical Oncology MO New Package MO010 CT for Osteogenic Sarcoma MO010B 27,000 Relapsed Osteogenic Sarcoma Medical Oncology MO New Package MO010 CT for Osteogenic Sarcoma MO010C OGS - 12 29,600 Medical Oncology MO New Package MO010 CT for Osteogenic Sarcoma MO010D OGS - 12 36,200 Medical Oncology MO New Package MO011 CT for Soft Tissue Sarcoma MO011A Gemcitabine + Docetaxel 30,900 Medical Oncology MO New Package MO011 CT for Soft Tissue Sarcoma MO011B Ifosfamide+ Adriamycin 13,700 Medical Oncology MO New Package MO012 CT for Metastatic Melanoma MO012A Dacarbazine + Cisplatin 7,100 Medical Oncology MO New Package MO012 CT for Metastatic Melanoma MO012B Temozolamide 23,100 Medical Oncology MO New Package MO013 CT for Anal Cancer MO013A 5 FU + Mitomycin C 10,500 Medical Oncology MO New Package MO013 CT for Anal Cancer MO013B Capecitabine + Mitomycin C 13,800 Medical Oncology MO New Package MO013 CT for Anal Cancer MO013C Cisplatin + 5 FU 7,600 Medical Oncology MO New Package MO013 CT for Anal Cancer MO013D Carboplatin + Paclitaxel 14,900 Medical Oncology MO New Package MO013 CT for Anal Cancer MO013E Cisplatin + Paclitaxel 13,300 Medical Oncology MO New Package MO014 CT for Colorectal Cancer MO014A 5 FU + Leucovorin 4,700 Medical Oncology MO New Package MO014 CT for Colorectal Cancer MO014B Capecitabine + Irinotecan 12,500 Medical Oncology MO New Package MO014 CT for Colorectal Cancer MO014C Folfox 11,100 Medical Oncology MO New Package MO014 CT for Colorectal Cancer MO014D Folfiri 8,700 Medical Oncology MO New Package MO014 CT for Colorectal Cancer MO014E Capecitabine + Oxaliplatin 16,500 Medical Oncology MO New Package MO014 CT for Colorectal Cancer MO014F Capecitabine 7,200 Medical Oncology MO New Package MO014 CT for Colorectal Cancer MO014G Capecitabine 7,300 Medical Oncology MO New Package MO014 CT for Colorectal Cancer MO014H Folfirinox 15,100 Medical Oncology MO New Package MO015 CT for Esophageal Cancer MO015A Carboplatin + Paclitaxel 14,900 Medical Oncology MO New Package MO015 CT for Esophageal Cancer MO015B Cisplatin + 5 FU 9,600 Medical Oncology MO New Package MO015 CT for Esophageal Cancer MO015C Cisplatin + 5 FU 9,600 Paclitaxel + Carboplatin for definitive Non - Medical Oncology MO New Package MO015 CT for Esophageal Cancer MO015D metastatic 25,100 (With RT) Paclitaxel + Carboplatin for metastatic Medical Oncology MO New Package MO015 CT for Esophageal Cancer MO015E 25,100 (Without RT) Medical Oncology MO New Package MO016 CT for Esophageal / Stomach Cancer MO016A Cisplatin + Docetaxel 12,100 Medical Oncology MO New Package MO016 CT for Esophageal / Stomach Cancer MO016B Irinotecan 8,300 Medical Oncology MO New Package MO016 CT for Esophageal / Stomach Cancer MO016C 5 FU 8,000 Medical Oncology MO New Package MO016 CT for Esophageal / Stomach Cancer MO016D Capecitabine 7,200 Medical Oncology MO New Package MO016 CT for Esophageal / Stomach Cancer MO016E CAPOX 16,500 Medical Oncology MO New Package MO016 CT for Esophageal / Stomach Cancer MO016F Docetaxel + Cisplatin + 5 FU 16,400 Medical Oncology MO New Package MO016 CT for Esophageal / Stomach Cancer MO016G Docetaxel + Cisplatin + Xeloda 19,700 Medical Oncology MO New Package MO016 CT for Esophageal / Stomach Cancer MO016H Docetaxel + Oxaliplatin + 5 FU 20,400 Medical Oncology MO New Package MO016 CT for Esophageal / Stomach Cancer MO016I Docetaxel + Oxaliplatin + Xeloda 24,900 Medical Oncology MO New Package MO016 CT for Esophageal / Stomach Cancer MO016J Folfiri 8,700 Medical Oncology MO New Package MO016 CT for Esophageal / Stomach Cancer MO016K Folfox 11,100 Medical Oncology MO New Package MO016 CT for Esophageal / Stomach Cancer MO016L Paclitaxel 5,800 Medical Oncology MO New Package MO017 CT for Hepatocellular Carcinoma MO017A Doxorubicin 10,000 Medical Oncology MO New Package MO017 CT for Hepatocellular Carcinoma MO017B Sorafenib 7,400 Medical Oncology MO New Package MO018 CT for Panceratic Cancer MO018A Gemcitabine + Nanopaclitaxel 23,500 Medical Oncology MO New Package MO018 CT for Panceratic Cancer MO018B Gemcitabine 9,000 Medical Oncology MO New Package MO018 CT for Panceratic Cancer MO018C Gemcitabine 9,000 Medical Oncology MO New Package MO018 CT for Panceratic Cancer MO018D Folfirinox 15,500 Medical Oncology MO New Package MO018 CT for Panceratic Cancer MO018E Capecitabine 7,400 Medical Oncology MO New Package MO018 CT for Panceratic Cancer MO018F Capecitabine + Gemcitabine 31,500 Medical Oncology MO New Package MO019 CT for Gall Bladder Cancer / Cholangiocarcinoma MO019A Capecitabine 7,300 Medical Oncology MO New Package MO019 CT for Gall Bladder Cancer / Cholangiocarcinoma MO019B Cisplatin + Gemcitabine 10,900 Medical Oncology MO New Package MO019 CT for Gall Bladder Cancer / Cholangiocarcinoma MO019C Folfiri 8,900 Medical Oncology MO New Package MO019 CT for Gall Bladder Cancer / Cholangiocarcinoma MO019D Gemcitabine 9,000 Medical Oncology MO New Package MO019 CT for Gall Bladder Cancer / Cholangiocarcinoma MO019E Gemcitabine 8,900 Medical Oncology MO New Package MO019 CT for Gall Bladder Cancer / Cholangiocarcinoma MO019F Oxaliplatin + Gemcitabine 17,100 Medical Oncology MO New Package MO019 CT for Gall Bladder Cancer / Cholangiocarcinoma MO019G CAPIRI 12,600 Medical Oncology MO New Package MO019 CT for Gall Bladder Cancer / Cholangiocarcinoma MO019H Folfox 11,300 Medical Oncology MO New Package MO020 CT for Gastointestinal stromal tumor MO020A Imatinib 19,400 Medical Oncology MO New Package MO020 CT for Gastointestinal stromal tumor MO020B Sunitinib 24,400 Medical Oncology MO New Package MO021 CT for CA Brain MO021A Temozolamide 13,000 Medical Oncology MO New Package MO021 CT for CA Brain MO021B Temozolamide 67,600 Medical Oncology MO New Package MO022 CT for Mesothelioma MO022A Gemcitabine + Cisplatin 11,100 Medical Oncology MO New Package MO022 CT for Mesothelioma MO022B Pemetrexed + Cisplatin 9,200 Medical Oncology MO New Package MO022 CT for Mesothelioma MO022C Pemetrexed + Carboplatin 10,000 Medical Oncology MO New Package MO023 CT for Thymic Carcinoma MO023A Cisplatin + Etoposide 5,300 Medical Oncology MO New Package MO023 CT for Thymic Carcinoma MO023B Cisplatin + Adriamycin 5,000 Medical Oncology MO New Package MO024 CT for CA Head & Neck MO024A Cisplatin + Docetaxel 12,400

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Medical Oncology MO New Package MO024 CT for CA Head & Neck MO024B Cisplatin 9,800 Medical Oncology MO New Package MO024 CT for CA Head & Neck MO024C Carboplatin + Gemcitabine 14,300 Medical Oncology MO New Package MO024 CT for CA Head & Neck MO024D Docetaxel + Cisplatin + 5 FU 16,500 Medical Oncology MO New Package MO024 CT for CA Head & Neck MO024E Docetaxel 15,000 Medical Oncology MO New Package MO024 CT for CA Head & Neck MO024F Docetaxel 14,400 Medical Oncology MO New Package MO024 CT for CA Head & Neck MO024G Etoposide + Carboplatin 7,100 Medical Oncology MO New Package MO024 CT for CA Head & Neck MO024H Etoposide + Cisplatin 9,200 Medical Oncology MO New Package MO024 CT for CA Head & Neck MO024I Gemcitabine 9,200 Medical Oncology MO New Package MO024 CT for CA Head & Neck MO024J Gemcitabine + Cisplatin 11,100 Medical Oncology MO New Package MO024 CT for CA Head & Neck MO024K Paclitaxel + Carboplatin 7,700 Medical Oncology MO New Package MO024 CT for CA Head & Neck MO024L Paclitaxel + Carboplatin 15,100 Medical Oncology MO New Package MO024 CT for CA Head & Neck MO024M Paclitaxel 5,700 Medical Oncology MO New Package MO024 CT for CA Head & Neck MO024N Paclitaxel 12,200 Medical Oncology MO New Package MO024 CT for CA Head & Neck MO024O Carboplatin 2,400 Medical Oncology MO New Package MO024 CT for CA Head & Neck MO024P Cisplatin 2,200 Medical Oncology MO New Package MO025 CT for Renal Cell Cancer MO025A Sunitinib 26,400 Medical Oncology MO New Package MO026 CT for Ureter / Bladder / Urethra MO026A Cisplatin + Methotrexate + Vinblastin 6,000 Medical Oncology MO New Package MO026 CT for Ureter / Bladder / Urethra MO026B Carboplatin + Gemcitabine 14,300 Medical Oncology MO New Package MO026 CT for Ureter / Bladder / Urethra MO026C Cisplatin + Gemcitabine 11,100 Medical Oncology MO New Package MO026 CT for Ureter / Bladder / Urethra MO026D Cisplatin + 5 FU 7,800 Medical Oncology MO New Package MO026 CT for Ureter / Bladder / Urethra MO026E Cisplatin + Paclitaxel 13,500 Medical Oncology MO New Package MO026 CT for Ureter / Bladder / Urethra MO026F Docetaxel 14,400 Medical Oncology MO New Package MO026 CT for Ureter / Bladder / Urethra MO026G Gemcitabine + Paclitaxel 17,500 Medical Oncology MO New Package MO026 CT for Ureter / Bladder / Urethra MO026H Gemcitabine 9,200 Medical Oncology MO New Package MO026 CT for Ureter / Bladder / Urethra MO026I Methotrexate + Vinblastin + Doxorubicin + Cisplatin 6,600 Medical Oncology MO New Package MO026 CT for Ureter / Bladder / Urethra MO026J Paclitaxel + Carboplatin 15,100 Medical Oncology MO New Package MO026 CT for Ureter / Bladder / Urethra MO026K Paclitaxel 5,700 Medical Oncology MO New Package MO027 CT for CA Penis MO027A Cisplatin + Paclitaxel 13,500 Medical Oncology MO New Package MO027 CT for CA Penis MO027B 5 FU + Cisplatin 7,800 Medical Oncology MO New Package MO027 CT for CA Penis MO027C Capecitabine 7,400 Medical Oncology MO New Package MO027 CT for CA Penis MO027D Paclitaxel + Carboplatin 15,100 Medical Oncology MO New Package MO027 CT for CA Penis MO027E Paclitaxel 5,700 Medical Oncology MO New Package MO027 CT for CA Penis MO027F Paclitaxel 12,200 Medical Oncology MO New Package MO027 CT for CA Penis MO027G Paclitaxel + Carboplatin 7,900 Medical Oncology MO New Package MO028 CT for CA Prostate MO028A Docetaxel 11,700 Medical Oncology MO New Package MO028 CT for CA Prostate MO028B Docetaxel 14,100 Medical Oncology MO New Package MO028 CT for CA Prostate MO028C Etoposide + Carboplatin 7,100 Medical Oncology MO New Package MO028 CT for CA Prostate MO028D LHRH Agonist 15,300 Medical Oncology MO New Package MO028 CT for CA Prostate MO028E Mitoxantrone + Prednisolone 4,200 Medical Oncology MO New Package MO028 CT for CA Prostate MO028F Paclitaxel + Carboplatin 7,700 Medical Oncology MO New Package MO028 CT for CA Prostate MO028G Paclitaxel + Carboplatin 15,100 Medical Oncology MO New Package MO028 CT for CA Prostate MO028H Docetaxel 14,700 CT for B - Cell NHL - High Grade Medical Oncology MO New Package MO029 MO029A R - CEOP 26,200 (Except Burkitt's & PCNSL) CT for B - Cell NHL - High Grade Medical Oncology MO New Package MO029 MO029B R - CHOP 27,000 (Except Burkitt's & PCNSL) Rituxmab + Dexamethasone + Medical Oncology MO New Package MO030 CT for High - Grade NHL - B Cell MO030A 34,900 High Dose Cytarabine + Cisplatin CT for Relapsed B - Cell NHL - High Grade Medical Oncology MO New Package MO031 MO031A GDP - R 35,300 (Except Burkitt's & PCNSL) CT for Relapsed B - Cell NHL - High Grade Medical Oncology MO New Package MO031 MO031B ICE - R 31,900 (Except Burkitt's & PCNSL) CT for PMBCL / Burkitt's Lymphoma / Medical Oncology MO New Package MO032 Seropositive MO032A EPOCH 31,700 B - Cell NHLR Medical Oncology MO New Package MO033 CT for Burkitt's NHL MO033A Codox - M - IVAC / GMALL / BFM / Hyper CVAD 34,500 Medical Oncology MO New Package MO034 CT for Low Grade B - Cell NHL MO034A Bendamustine + Rituximab 30,700 Medical Oncology MO New Package MO034 CT for Low Grade B - Cell NHL MO034B Lenalidomide + Rituximab 27,500 Medical Oncology MO New Package MO035 CT for Low Grade NHL MO035A Rituximab 24,800 Rituximab + Cyclophosphamide + Vincristine + Medical Oncology MO New Package MO035 CT for Low Grade NHL MO035B 25,800 Prednisolone Medical Oncology MO New Package MO036 CT for Chronic Lymphocytic Leukemia MO036A Fludarabine + Cyclophosphamide 18,100 Medical Oncology MO New Package MO036 CT for Chronic Lymphocytic Leukemia MO036B Rituxmab + Chlorambucil 24,900 Medical Oncology MO New Package MO036 CT for Chronic Lymphocytic Leukemia MO036C Rituximab + Fludarabine + Cyclophosphamide 40,700 Medical Oncology MO New Package MO036 CT for Chronic Lymphocytic Leukemia MO036D Lenalidomide 4,800 Medical Oncology MO New Package MO037 CT for Peripheral T - Cell Lymphoma MO037A CHOEP 5,000 Medical Oncology MO New Package MO037 CT for Peripheral T - Cell Lymphoma MO037B CHOP 4,000 Medical Oncology MO New Package MO037 CT for Peripheral T - Cell Lymphoma MO037C SMILE 19,300 Medical Oncology MO New Package MO038 CT for NK - T Cell Lymphoma MO038A GELOX 18,900 Medical Oncology MO New Package MO038 CT for NK - T Cell Lymphoma MO038B LVP 7,600 Medical Oncology MO New Package MO039 CT for Hodgkin's Lymphoma MO039A COPP 3,600 Medical Oncology MO New Package MO039 CT for Hodgkin's Lymphoma MO039B ABVD 10,200 Medical Oncology MO New Package MO039 CT for Hodgkin's Lymphoma MO039C AEVD 10,200 Medical Oncology MO New Package MO040 CT for Relapsed Hodgkin Lymphoma MO040A ICE 9,700 Medical Oncology MO New Package MO040 CT for Relapsed Hodgkin Lymphoma MO040B MINE 9,700 Medical Oncology MO New Package MO040 CT for Relapsed Hodgkin Lymphoma MO040C PTCL - GDP 12,500 Medical Oncology MO New Package MO041 CT for Relapsed NHL & HL MO041A DHAP 11,500 Medical Oncology MO New Package MO042 CT for MM / Amyloidosis / POEMS MO042A LD 6,000 Medical Oncology MO New Package MO042 CT for MM / Amyloidosis / POEMS MO042B POM DEX 6,800 Medical Oncology MO New Package MO043 CT for MM / Amyloidosis MO043A CTD 4,000 Medical Oncology MO New Package MO043 CT for MM / Amyloidosis MO043B MPT 4,100 Medical Oncology MO New Package MO043 CT for MM / Amyloidosis MO043C VCD 14,600 Medical Oncology MO New Package MO043 CT for MM / Amyloidosis MO043D VD 13,300 Medical Oncology MO New Package MO043 CT for MM / Amyloidosis MO043E VMP 12,600 Medical Oncology MO New Package MO043 CT for MM / Amyloidosis MO043F VRD 17,800 Medical Oncology MO New Package MO043 CT for MM / Amyloidosis MO043G VTD 15,000 Medical Oncology MO New Package MO044 CT for Chronic Myeloid Leukemia MO044A Imatinib 19,400 Medical Oncology MO New Package MO045 CT for Myeloproliferative Neoplasm MO045A Hydroxurea 2,200 Medical Oncology MO New Package MO046 CT for Acute Myeloid Leukemia MO046A Consolidation 60,000 Medical Oncology MO New Package MO046 CT for Acute Myeloid Leukemia MO046B Induction 96,000 Consolidation Medical Oncology MO New Package MO047 CT for Acute Lymphoblastic Leukemia MO047A 160,000 (Phase II, CNS Therapy Reinduction) Medical Oncology MO New Package MO047 CT for Acute Lymphoblastic Leukemia MO047B Induction 80,000 Medical Oncology MO New Package MO047 CT for Acute Lymphoblastic Leukemia MO047C Maintenance 4,000 Consolidation Medical Oncology MO New Package MO048 CT for Lymphoblastic Lymphoma MO048A 160,000 (Phase II, CNS Therapy Reinduction) Medical Oncology MO New Package MO048 CT for Lymphoblastic Lymphoma MO048B Induction 80,000 Medical Oncology MO New Package MO048 CT for Lymphoblastic Lymphoma MO048C Maintenance 4,000 CT for Acute Promyelocytic Leukemia Medical Oncology MO New Package MO049 MO049A High Risk Consolidation 32,000 (High Risk) CT for Acute Promyelocytic Leukemia Medical Oncology MO New Package MO049 MO049B High Risk Induction 96,000 (High Risk) CT for Acute Promyelocytic Leukemia Medical Oncology MO New Package MO049 MO049C High Risk Maintenance 8,000 (High Risk)

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CT for Acute Promyelocytic Leukemia Medical Oncology MO New Package MO050 MO050A Low Risk Consolidation 12,000 (Low Risk) CT for Acute Promyelocytic Leukemia Medical Oncology MO New Package MO050 MO050B Low Risk Induction 80,000 (Low Risk) Medical Oncology MO New Package MO051 Febrile Neutopenia MO051A First Line Antibiotics 28,000 Medical Oncology MO New Package MO051 Febrile Neutopenia MO051B Second Line Antibiotics and Antifungals 60,000 Chemotherapy Complications - Tumor Lysis Chemotherapy Complications - Tumor Lysis Medical Oncology MO New Package MO052 MO052A 24,000 Syndrome Syndrome Medical Oncology MO New Package MO053 Granulocyte Colony Stimulating Factor Use MO053A Granulocyte Colony Stimulating Factor Use 12,800 Langerhans Cell Histiocytosis Medical Oncology MO New Package MO054 CT for Langerhans Cell Histiocytosis MO054A 22,400 (Histiocytosis Protocol - Induction) Langerhans Cell Histiocytosis Medical Oncology MO New Package MO054 CT for Langerhans Cell Histiocytosis MO054B 17,000 (Histiocytosis Protocol - Maintenance) Medical Oncology MO New Package MO055 CT for Low Grade Glioma MO055A Vincristine + Carboplatin 5,600 Medical Oncology MO New Package MO055 CT for Low Grade Glioma MO055B Vinblastin 1,900 Medical Oncology MO New Package MO056 CT for Medulloblastoma / Brain PNET MO056A PACKER 4,900 Medical Oncology MO New Package MO056 CT for Medulloblastoma / CNS PNET MO056B CET 8,300 Cabroplatin + Etoposide + Cyclophosphamide + Medical Oncology MO New Package MO057 CT for Neuroblastoma MO057A 7,900 Doxorubicin Medical Oncology MO New Package MO057 CT for Neuroblastoma MO057B RAPID COJEC 6,800 Medical Oncology MO New Package MO057 CT for Neuroblastoma MO057C RETINOID 2,000 Medical Oncology MO New Package MO058 CT for Retinoblastoma MO058A JOE / COPE 7,100 Medical Oncology MO New Package MO059 CT for Rhabdomyosarcoma MO059A VCD 4,800 Medical Oncology MO New Package MO059 CT for Rhabdomyosarcoma MO059B VIE 16,200 Medical Oncology MO New Package MO060 CT for Relapse Rhabdomyosarcoma MO060A VTC + VAC 12,200 Medical Oncology MO New Package MO061 CT for Wilms Tumor MO061A VINC + ACTIN. D 3,000 Medical Oncology MO New Package MO061 CT for Wilms Tumor MO061B VINC + ACTIN. D + DOX 4,200 Medical Oncology MO New Package MO061 CT for Wilms Tumor MO061C Cyclo + Dox + Etop + Vinc + Actino . D 12,300 Consolidation Medical Oncology MO New Package MO062 CT for Pediatric Acute Lymphoblastic Leukemia MO062A 208,600 (Phase II, CNS Therapy Reinduction) Medical Oncology MO New Package MO062 CT for Pediatric Acute Lymphoblastic Leukemia MO062B Induction 72,000 Medical Oncology MO New Package MO062 CT for Pediatric Acute Lymphoblastic Leukemia MO062C Maintenance 2,500 Consolidation Medical Oncology MO New Package MO063 CT for Pediatric Lymphoblastic Lymphoma MO063A 208,600 (Phase II, CNS Therapy Reinduction) Medical Oncology MO New Package MO063 CT for Pediatric Lymphoblastic Lymphoma MO063B Induction 72,000 Medical Oncology MO New Package MO063 CT for Pediatric Lymphoblastic Lymphoma MO063C Maintenance 2,500 Medical Oncology MO New Package MO064 CT for Pediatric Acute Myeloid Leukemia MO064A Consolidation - High Dose Cytarabine 57,600 Medical Oncology MO New Package MO064 CT for Pediatric Acute Myeloid Leukemia MO064B Induction 94,400 Medical Oncology MO New Package MO064 CT for Pediatric Acute Myeloid Leukemia MO064C Induction 92,800 Medical Oncology MO New Package MO065 CT for Pediatric Acute Promyelocytic Leukemia MO065A Consolidation 36,800 Medical Oncology MO New Package MO065 CT for Pediatric Acute Promyelocytic Leukemia MO065B Induction 97,600 Medical Oncology MO New Package MO065 CT for Pediatric Acute Promyelocytic Leukemia MO065C Maintenance 39,300 Medical Oncology MO New Package MO066 CT for Pediatric Hodgkins Lymphoma MO066A COPDAC 7,800 Medical Oncology MO New Package MO066 CT for Pediatric Hodgkins Lymphoma MO066B OPEA 13,000 Medical Oncology MO New Package MO067 CT for Pediatric Hodgkins Lymphoma Relapse MO067A ICE 21,500 Medical Oncology MO New Package MO067 CT for Pediatric Hodgkins Lymphoma Relapse MO067B DECA 17,800 Medical Oncology MO New Package MO067 CT for Pediatric Hodgkins Lymphoma Relapse MO067C IGVD 34,000 Medical Oncology MO New Package MO068 CT for Pediatric Non Hodgkins Lymphoma MO068A LMB 89 - 96 - Consolidation 33,500 Medical Oncology MO New Package MO068 CT for Pediatric Non Hodgkins Lymphoma MO068B LMB 89 - 96 - Induction - COPADAM 33,100 Medical Oncology MO New Package MO068 CT for Pediatric Non Hodgkins Lymphoma MO068C LMB 89 - 96 - Maintenance 15,400 Medical Oncology MO New Package MO068 CT for Pediatric Non Hodgkins Lymphoma MO068D MCP - 842 13,200 Medical Oncology MO New Package MO069 PEDIATRIC-GCT/JEB MO069A PEDIATRIC-GCT/JEB 10,000 Medical Oncology MO New Package MO070 CT for Pediatric Hepatoblastoma MO070A Carboplatin + Cisplatin + Doxorubicin 4,900 Medical Oncology MO New Package MO070 CT for Pediatric Hepatoblastoma MO070B Cisplatin 5,600 Medical Oncology MO New Package MO071 CT for CA Lung MO071A Docetaxel 16,200 Medical Oncology MO New Package MO071 CT for CA Lung MO071B Erlotinib 13,000 Medical Oncology MO New Package MO071 CT for CA Lung MO071C Gefitnib 11,000 Medical Oncology MO New Package MO071 CT for CA Lung MO071D Paclitaxel + Carboplatin 15,100 Medical Oncology MO New Package MO071 CT for CA Lung MO071E Pemetrexed + Carboplatin 10,000 Medical Oncology MO New Package MO071 CT for CA Lung MO071F Topotecan 24,600 Medical Oncology MO New Package MO071 CT for CA Lung MO071G Docetaxel 14,600 Medical Oncology MO New Package MO071 CT for CA Lung MO071H Etoposide + Carboplatin 7,100 Medical Oncology MO New Package MO071 CT for CA Lung MO071I Etoposide + Cisplatin 5,500 Medical Oncology MO New Package MO071 CT for CA Lung MO071J Gemcitabine 8,900 Medical Oncology MO New Package MO071 CT for CA Lung MO071K Gemcitabine + Carboplatin 14,300 Medical Oncology MO New Package MO071 CT for CA Lung MO071L Gemcitabine + Cisplatin 11,100 Medical Oncology MO New Package MO071 CT for CA Lung MO071M Paclitaxel 5,800 Medical Oncology MO New Package MO071 CT for CA Lung MO071N Paclitaxel 12,000 Medical Oncology MO New Package MO071 CT for CA Lung MO071O Paclitaxel + Carboplatin 7,900 Medical Oncology MO New Package MO071 CT for CA Lung MO071P Paclitaxel + Cisplatin 13,500 Medical Oncology MO New Package MO071 CT for CA Lung MO071Q Pemetrexed + Cisplatin 9,200 Medical Oncology MO New Package MO071 CT for CA Lung MO071R Pemetrexed 7,600 Medical Oncology MO New Package MO071 CT for CA Lung MO071S Vinorelbine + Carboplatin 22,800 Medical Oncology MO New Package MO071 CT for CA Lung MO071T Vinorelbine + Cisplatin 20,600 Pediatric Medical MP M200009 MP001 Febrile seizures / other seizures MP001A Febrile seizures 1,800 Management Pediatric Medical MP New Package MP001 Febrile seizures / other seizures MP001B Flury of seizures 1,800 Management Pediatric Medical Management, General MP M200050 MP001 Febrile seizures / other seizures MP001C Neurocysticercosis 1,800 Medicine Pediatric Medical MP New Package MP001 Febrile seizures / other seizures MP001D Epilepsy 1,800 Management Pediatric Medical Management, General MP M200010 MP002 Epileptic encephalopathy MP002A Epileptic encephalopathy 1,800 Medicine Pediatric Medical Management, General MP M200090 MP003 Acute encephalitis MP003A Infectious - uncomplicated 1,800 Medicine Pediatric Medical Management, General MP M200090 MP003 Acute encephalitis MP003B Immune-mediated - uncomplicated 1,800 Medicine Pediatric Medical Management, General MP M200078 MP004 Acute encephalitis syndrome MP004A Acute encephalitis syndrome 1,800 Medicine Acute meningo encephalitis / aseptic meningitis / Pediatric Medical febrile encephalopathy / hypertensive encehalopathy Management, General MP M200048 MP005 MP005A Acute meningo encephalitis 1,800 / metabolic encephalopathy / hepatic Medicine encephalopathy / brain abcess Acute meningo encephalitis / aseptic meningitis / Pediatric Medical febrile encephalopathy / hypertensive encehalopathy MP M200012 MP005 MP005B Aseptic meningitis 1,800 Management / metabolic encephalopathy / hepatic encephalopathy / brain abcess

Page 8 Consolidated Master

Acute meningo encephalitis / aseptic meningitis / Pediatric Medical febrile encephalopathy / hypertensive encehalopathy Management, General MP M200027 MP005 MP005C Febrile encephalopathy 1,800 / metabolic encephalopathy / hepatic Medicine encephalopathy / brain abcess Acute meningo encephalitis / aseptic meningitis / Pediatric Medical febrile encephalopathy / hypertensive encehalopathy MP M200097 MP005 MP005D Hypertensive encehalopathy 1,800 Management / metabolic encephalopathy / hepatic encephalopathy / brain abcess Acute meningo encephalitis / aseptic meningitis / Pediatric Medical M200058, febrile encephalopathy / hypertensive encehalopathy Management, General MP MP005 MP005E Metabolic encephalopathy 1,800 M100041 / metabolic encephalopathy / hepatic Medicine encephalopathy / brain abcess Acute meningo encephalitis / aseptic meningitis / Pediatric Medical febrile encephalopathy / hypertensive encehalopathy Management, General MP M200094 MP005 MP005F Hepatic encephalopathy 1,800 / metabolic encephalopathy / hepatic Medicine encephalopathy / brain abcess Acute meningo encephalitis / aseptic meningitis / Pediatric Medical febrile encephalopathy / hypertensive encehalopathy MP New Package MP005 MP005G Brain abcess 1,800 Management / metabolic encephalopathy / hepatic encephalopathy / brain abcess Pediatric Medical M200049, Management, General MP MP006 Meningitis MP006A Chronic meningitis 1,800 M100034 Medicine Pediatric Medical Management, General MP M200027 MP006 Meningitis MP006B Partially treated pyogenic meningitis 1,800 Medicine Pediatric Medical Management, General MP M200035 MP006 Meningitis MP006C Neuro tuberculosis 1,800 Medicine Pediatric Medical Management, General MP M200095 MP006 Meningitis MP006D Complicated bacterial meningitis 1,800 Medicine Pediatric Medical M200012, Management, General MP MP006 Meningitis MP006E Acute meningitis 1,800 M100034 Medicine Pediatric Medical Management, General MP M200011 MP007 Optic neuritis MP007A Optic neuritis 1,800 Medicine

After Decompressive craniotomy / Pediatric Medical Medical Management for Raised intracranial After Shunt procedure / MP M200096 MP008 MP008A 1,800 Management pressure After other emergency neuro surgical procedures / For ICP monitoring

Pediatric Medical MP M200093 MP009 Intracranial hemorrhage MP009A Intracranial hemorrhage 1,800 Management Pediatric Medical Management, General MP M200084 MP010 Intracranial space occupying lesion MP010A Intracranial space occupying lesion 1,800 Medicine Pediatric Medical Intracranial ring enhancing lesion with Intracranial ring enhancing lesion with Management, General MP M200050 MP011 MP011A 1,800 complication (tuberculoma) complication (tuberculoma) Medicine Pediatric Medical Management, General MP M200092 MP012 Cerebral herniation MP012A Cerebral herniation 1,800 Medicine Pediatric Medical Acute neuroregression / Acute worsening in neuro Acute neuroregression / Acute worsening in neuro Management, General MP M200053 MP013 MP013A 1,800 metabolic and neurodegenerative conditions metabolic and neurodegenerative conditions Medicine Pediatric Medical Management, General MP M200079 MP014 Acute demyelinating myelopathy MP014A Acute demyelinating myelopathy 1,800 Medicine Pediatric Medical MP M200040 MP015 Juvenile myasthenia MP015A Juvenile myasthenia 1,800 Management Pediatric Medical MP M200056 MP016 Acute ataxia MP016A Acute ataxia 1,800 Management Pediatric Medical M100063, Management, General MP MP017 Acute ischemic stroke MP017A Acute ischemic stroke 1,800 M200086 Medicine Pediatric Medical MP M200016 MP018 Wheezing MP018A Wheezing 1,800 Management Pediatric Medical MP M200015 MP019 Chronic cough MP019A Chronic cough 1,800 Management Pediatric Medical Management, General MP M200007 MP020 Acute urticaria / Anaphylaxis acute asthma MP020A Acute urticaria 1,800 Medicine Pediatric Medical Management, General MP M200007 MP020 Acute urticaria / Anaphylaxis acute asthma MP020B Anaphylaxis acute asthma 1,800 Medicine Pediatric Medical MP M200072 MP021 Acute abdomen MP021A Acute abdomen 1,800 Management Pediatric Medical Management, General MP M200062 MP022 Celiac disease MP022A Celiac disease 1,800 Medicine Pediatric Medical Management, General MP M200064 MP023 Unexplained hepatosplenomegaly MP023A Unexplained hepatosplenomegaly 1,800 Medicine Pediatric Medical MP M200037 MP024 Infantile cholestasis MP024A Infantile cholestasis 1,800 Management Pediatric Medical Management, General MP M200006 MP025 Acute glomerulonephritis MP025A Acute glomerulonephritis 1,800 Medicine Pediatric Medical Management, General MP M200026 MP026 Nephrotic syndrome with peritonitis MP026A Nephrotic syndrome with peritonitis 1,800 Medicine Pediatric Medical Management, General MP M200038 MP027 Haemolytic uremic syndrome MP027A Haemolytic uremic syndrome 1,800 Medicine Pediatric Medical MP M200098 MP028 CRRT MP028A CRRT 8,000 Management Pediatric Medical Global developmental delay / Intellectual disability MP M200018 MP029 MP029A Global developmental delay 1,800 Management of unknown etiology Pediatric Medical Global developmental delay / Intellectual disability MP M200018 MP029 MP029B Intellectual disability of unknown etiology 1,800 Management of unknown etiology Pediatric Medical MP M200020 MP030 Rickets - requiring admission for Work Up MP030A Rickets - requiring admission for Work Up 1,800 Management

Page 9 Consolidated Master

Pediatric Medical MP M200029 MP031 Acute severe malnutrition MP031A Acute severe malnutrition 1,800 Management Pediatric Medical MP M200024 MP032 Developmental and behavioral disorders MP032A Developmental and behavioral disorders 1,800 Management Pediatric Medical MP M200022 MP033 Short stature MP033A Short stature 1,800 Management Pediatric Medical MP M200019 MP034 Dysmorphic children MP034A Dysmorphic children 1,800 Management Pediatric Medical MP M200052 MP035 Floppy infant MP035A Floppy infant 1,800 Management Pediatric Medical MP M200060 MP036 Inborn errors of metabolism MP036A Inborn errors of metabolism 1,800 Management Pediatric Medical MP M200061 MP037 Wilson’s disease MP037A Wilson’s disease 1,800 Management Pediatric Medical Management, General MP M200047 MP038 Rheumatoid arthritis MP038A Rheumatoid arthritis 1,800 Medicine Pediatric Medical Management, General MP M200046 MP039 Rheumatic fever MP039A Rheumatic fever 1,800 Medicine Pediatric Medical MP M200045 MP040 Cyanotic spells MP040A Cyanotic spells 1,800 Management Pediatric Medical MP M200045 MP040 Cyanotic spells MP040B Cyanotic spells with CHD 1,800 Management Pediatric Medical MP M200045 MP040 Cyanotic spells MP040C Cyanotic spells with Chest infection 1,800 Management Pediatric Medical MP M200045 MP040 Cyanotic spells MP040D Cyanotic spells with Sepsis 1,800 Management Pediatric Medical MP M200044 MP041 Immune haemolytic anemia MP041A Immune haemolytic anemia 1,800 Management Pediatric Medical Management, General MP M200039 MP042 Idiopathic Thrombocytopenic Purpura MP042A Idiopathic Thrombocytopenic Purpura 1,800 Medicine Pediatric Medical MP M200041 MP043 Kawasaki Disease MP043A Kawasaki Disease 1,800 Management Pediatric Medical Management, General MP M200057 MP044 Steven Johnson syndrome MP044A Steven Johnson syndrome 1,800 Medicine Pediatric Medical MP M200013 MP045 Trauma MP045A Trauma 1,800 Management Pediatric Medical Management, General MP M200059 MP046 Ketogenic diet initiation in refractory epilepsy MP046A Ketogenic diet initiation in refractory epilepsy 1,800 Medicine 2D External Beam Radiotherapy (6 Fractions) Radiation Oncology MR New Package MR001 MR001A Radical 11,000 (Inclusive of Simulation & Planning Cost) 2D External Beam Radiotherapy (6 Fractions) Radiation Oncology MR New Package MR001 MR001B Adjuvant 11,000 (Inclusive of Simulation & Planning Cost) 2D External Beam Radiotherapy (6 Fractions) Radiation Oncology MR New Package MR001 MR001C Neoadjuvant 11,000 (Inclusive of Simulation & Planning Cost) 2D External Beam Radiotherapy - Palliative Radiation Oncology MR New Package MR002 (Upto 10 Fractions) MR002A Palliative 10,000 (Inclusive of Simulation & Planning Cost) 2D External Beam Radiotherapy (25 Fractions) Radiation Oncology MR M600001 MR003 MR003A Radical 20,000 (Inclusive of Simulation & Planning Cost) 2D External Beam Radiotherapy (25 Fractions) Radiation Oncology MR M600001 MR003 MR003B Adjuvant 20,000 (Inclusive of Simulation & Planning Cost) 2D External Beam Radiotherapy (25 Fractions) Radiation Oncology MR M600001 MR003 MR003C Neoadjuvant 20,000 (Inclusive of Simulation & Planning Cost) Linear Accelerator, External Beam Radiotherapy Radiation Oncology MR M600004 MR004 3D CRT (6 Fractions) MR004A Radical 21,000 (Inclusive of Simulation & Planning Cost) Linear Accelerator, External Beam Radiotherapy Radiation Oncology MR M600004 MR004 3D CRT (6 Fractions) MR004B Adjuvant 21,000 (Inclusive of Simulation & Planning Cost) Linear Accelerator, External Beam Radiotherapy Radiation Oncology MR M600004 MR004 3D CRT (6 Fractions) MR004C Neoadjuvant 21,000 (Inclusive of Simulation & Planning Cost) Linear Accelerator, External Beam Radiotherapy Radiation Oncology MR M600004 MR005 3D CRT (25 Fractions) MR005A Radical 40,000 (Inclusive of Simulation & Planning Cost) Linear Accelerator, External Beam Radiotherapy Radiation Oncology MR M600004 MR005 3D CRT (25 Fractions) MR005B Adjuvant 40,000 (Inclusive of Simulation & Planning Cost) Linear Accelerator, External Beam Radiotherapy Radiation Oncology MR M600004 MR005 3D CRT (25 Fractions) MR005C Neoadjuvant 40,000 (Inclusive of Simulation & Planning Cost) Linear Accelerator, External Beam Radiotherapy IMRT (Intensity Modulated Radiotherapy) Radiation Oncology MR M600005 MR006 MR006A Radical 70,000 (20 Fractions) (Inclusive of Simulation & Planning Cost) Linear Accelerator, External Beam Radiotherapy IMRT (Intensity Modulated Radiotherapy) Radiation Oncology MR M600005 MR006 MR006B Adjuvant 70,000 (20 Fractions) (Inclusive of Simulation & Planning Cost) Linear Accelerator, External Beam Radiotherapy IMRT (Intensity Modulated Radiotherapy) Radiation Oncology MR M600005 MR006 MR006C Neoadjuvant 70,000 (20 Fractions) (Inclusive of Simulation & Planning Cost) Linear Accelerator, External Beam Radiotherapy IMRT (Intensity Modulated Radiotherapy) Radiation Oncology MR M600005 MR007 MR007A Radical 42,000 (6 Fractions) (Inclusive of Simulation & Planning Cost) Linear Accelerator, External Beam Radiotherapy IMRT (Intensity Modulated Radiotherapy) Radiation Oncology MR M600005 MR007 MR007B Adjuvant 42,000 (6 Fractions) (Inclusive of Simulation & Planning Cost) Linear Accelerator, External Beam Radiotherapy IMRT (Intensity Modulated Radiotherapy) Radiation Oncology MR M600005 MR007 MR007C Neoadjuvant 42,000 (6 Fractions) (Inclusive of Simulation & Planning Cost)

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Linear Accelerator External Beam Radiotherapy IGRT (Image Guided radiotherapy) with 3D CRT Radiation Oncology MR M600006 MR008 or IMRT MR008A Radical 90,000 (20 Fractions) (Inclusive of Simulation & Planning Cost) Linear Accelerator External Beam Radiotherapy IGRT (Image Guided radiotherapy) with 3D CRT Radiation Oncology MR M600006 MR008 or IMRT MR008B Adjuvant 90,000 (20 Fractions) (Inclusive of Simulation & Planning Cost) Linear Accelerator External Beam Radiotherapy IGRT (Image Guided radiotherapy) with 3D CRT Radiation Oncology MR M600006 MR008 or IMRT MR008C Neoadjuvant 90,000 (20 Fractions) (Inclusive of Simulation & Planning Cost) Linear Accelerator External Beam Radiotherapy IGRT (Image Guided radiotherapy) with 3D CRT Radiation Oncology MR M600006 MR009 or IMRT MR009A Radical 55,000 (6 Fractions) (Inclusive of Simulation & Planning Cost) Linear Accelerator External Beam Radiotherapy IGRT (Image Guided radiotherapy) with 3D CRT Radiation Oncology MR M600006 MR009 or IMRT MR009B Adjuvant 55,000 (6 Fractions) (Inclusive of Simulation & Planning Cost) Linear Accelerator External Beam Radiotherapy IGRT (Image Guided radiotherapy) with 3D CRT Radiation Oncology MR M600006 MR009 or IMRT MR009C Neoadjuvant 55,000 (6 Fractions) (Inclusive of Simulation & Planning Cost) SRT / SBRT with IGRT (Stereotacatic radiotherapy) SRT / SBRT with IGRT Radiation Oncology MR M600007 MR010 MR010A 82,000 (4 Fractions) (Stereotacatic radiotherapy) (Inclusive of Simulation & Planning Cost) SRS with IGRT (Stereotacatic radiotherapy) Radiation Oncology MR M600008 MR011 MR011A SRS with IGRT (Stereotacatic radiotherapy) 70,000 (Inclusive of Simulation & Planning Cost) Respiratory Gating along with Linear Accelerator Respiratory Gating along with Linear Accelerator Radiation Oncology MR M600009 MR012 planning (5 Fractions) MR012A 65,000 planning (Inclusive of Simulation & Planning Cost) Radiation Oncology MR M600012 MR013 Brachytherapy High Dose Radiation MR013A Intracavitory 3,500 Radiation Oncology MR M600014 MR013 Brachytherapy High Dose Radiation MR013B Intraluminal 3,500 Radiation Oncology MR New Package MR013 Brachytherapy High Dose Radiation MR013C Endobiliary 3,500 Radiation Oncology MR New Package MR013 Brachytherapy High Dose Radiation MR013D Endobronchial 3,500 Radiation Oncology MR New Package MR013 Brachytherapy High Dose Radiation MR013E CVS 3,500 Brachytherapy High Dose Radiation (5 doses) Radiation Oncology MR M600013 MR014 (Inclusive of Simulation, Planning Cost, OT & MR014A Interstitial 42,000 other charges ) Brachytherapy High Dose Radiation (5 doses) Radiation Oncology MR M600013 MR014 (Inclusive of Simulation, Planning Cost, OT & MR014B Surface Mould 42,000 other charges ) Orthopedics, Emergency Fracture - Conservative Management - Fracture - Conservative Management - SB New Package SB001 SB001A 2,000 Room Packages Without plaster Without plaster Orthopedics SB S500084 SB002 Application of Traction SB002A Skeletal Tractions with pin 2,000 Orthopedics SB S500085 SB002 Application of Traction SB002B Skin Traction 700 Orthopedics SB S500082 SB003 Application of P.O.P. casts SB003A Upper Limbs 3,000 Orthopedics SB S500082 SB003 Application of P.O.P. casts SB003B Lower Limbs 3,000 Orthopedics SB S500083 SB004 Application of P.O.P. Spikas & Jackets SB004A Spikas 3,500 Orthopedics SB S500083 SB004 Application of P.O.P. Spikas & Jackets SB004B Jackets 3,500 Orthopedics SB S500041 SB005 External fixation of Fracture SB005A Long bone 14,000 Orthopedics SB S500042 SB005 External fixation of Fracture SB005B Small bone 9,500 Orthopedics SB S500043 SB005 External fixation of Fracture SB005C Pelvis 14,000 Orthopedics SB S500087 SB005 External fixation of Fracture SB005D Both bones - forearms 15,000 Orthopedics SB S500073 SB006 Percutaneous - Fixation of Fracture SB006A Percutaneous - Fixation of Fracture 3,000 Orthopedics SB New Package SB007 Elastic nailing for fracture fixation SB007A Femur 11,000 Orthopedics SB New Package SB007 Elastic nailing for fracture fixation SB007B Humerus 11,000 Orthopedics SB New Package SB007 Elastic nailing for fracture fixation SB007C Forearm 11,000 Orthopedics SB S500058 SB008 Internal Fixation of Small Bones SB008A Internal Fixation of Small Bones 8,500 Orthopedics SB S500052 SB009 Fracture - Long Bones - Metaphyseal - ORIF SB009A Fracture - Long Bones - Metaphyseal - ORIF 12,700 S500029, Orthopedics SB SB010 Fixation of Diaphyseal Fracture - Long Bone SB010A Open Reduction Internal Fixation 14,900 S500049 Orthopedics SB S500029 SB010 Fixation of Diaphyseal Fracture - Long Bone SB010B Closed Reduction & Fixation 18,000 Surgery for Comminuted Fracture - Olecranon of Orthopedics SB S500050 SB011 SB011A Plating 11,800 Ulna Orthopedics SB S500086 SB012 Fracture Head radius SB012A Fixation 10,000 Orthopedics SB S500054 SB012 Fracture Head radius SB012B Excision 9,200 Fracture - Single Bone - Forearm - ORIF - Plating / Fracture - Single Bone - Forearm - ORIF - Plating / Orthopedics SB S500053 SB013 SB013A 8,900 Nailing Nailing Fracture - Both Bones - Forearm - ORIF - Plating / Fracture - Both Bones - Forearm - ORIF - Plating / Orthopedics SB S500051 SB014 SB014A 12,700 Nailing Nailing Orthopedics SB S500057 SB015 Fracture Condyle - Humerus - ORIF SB015A Lateral Condyle 8,500 Orthopedics SB S500057 SB015 Fracture Condyle - Humerus - ORIF SB015B Medial Condyle 8,500 Fracture intercondylar Humerus + olecranon Fracture intercondylar Humerus + olecranon Orthopedics SB S500088 SB016 SB016A 15,100 osteotomy osteotomy Orthopedics SB S500023 SB017 Displaced Clavicle Fracture SB017A Open Reduction Internal Fixation 17,000 Orthopedics SB S500046 SB018 Fracture - Acetabulum SB018A Single Approach 28,000 Orthopedics SB S500046 SB018 Fracture - Acetabulum SB018B Combined Approach 33,500 Orthopedics SB S500031 SB019 Fracture - Neck Femur SB019A Closed Reduction and Percutaneous Screw Fixation 10,000

Orthopedics SB S500048 SB019 Fracture - Neck Femur SB019B Intertrochanteric Fracture with Dynamic Hip Screw 15,800 Intertrochanteric Fracture with Proximal Femoral Orthopedics SB S500048 SB019 Fracture - Neck Femur SB019C 16,100 Nail Orthopedics SB S500019 SB020 Ankle Fractures SB020A Open Reduction Internal Fixation 14,000 Orthopedics SB New Package SB021 Cervical spine fixation including odontoid SB021A Cervical spine fixation including odontoid 20,000 Orthopedics SB New Package SB022 Dorsal and lumber spine fixation SB022A Anterior 40,000 Orthopedics SB New Package SB022 Dorsal and lumber spine fixation SB022B Posterior 30,000 Orthopedics SB S500068 SB023 Bone grafting for Non union SB023A Bone grafting for Non union 10,000 Orthopedics SB S500016 SB024 Arthorotomy of any joint SB024A Arthorotomy of any joint 14,000 Orthopedics SB S500045 SB025 Arthrolysis of joint SB025A Elbow 15,000 Orthopedics SB S500045 SB025 Arthrolysis of joint SB025B Knee 15,000 Orthopedics SB S500045 SB025 Arthrolysis of joint SB025C Ankle 15,000 S500017, Orthopedics SB SB026 Arthrodesis SB026A Ankle / Triple with implant 15,000 S500101 Orthopedics SB S500098 SB026 Arthrodesis SB026B Shoulder 15,000

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Orthopedics SB S500100 SB026 Arthrodesis SB026C Wrist 15,000 Orthopedics SB S500099 SB026 Arthrodesis SB026D Knee 15,000 Orthopedics, Surgical SB S500004 SB026 Arthrodesis SB026E Hand 27,000 Oncology Orthopedics, Surgical SB New Package SB026 Arthrodesis SB026F Foot 27,000 Oncology Orthopedics SB S500017 SB026 Arthrodesis SB026G Ankle / Triple without implant 15,000 Orthopedics SB S500011 SB027 Disarticulation SB027A Hind quarter 25,000 Orthopedics SB S500011 SB027 Disarticulation SB027B Fore quarter 25,000 Orthopedics SB S500037 SB028 Closed reduction of joint dislocation SB028A Hip 7,400 Orthopedics SB S500038 SB028 Closed reduction of joint dislocation SB028B Shoulder 5,500 Orthopedics SB S500038 SB028 Closed reduction of joint dislocation SB028C Elbow 5,500 Orthopedics SB S500037 SB028 Closed reduction of joint dislocation SB028D Knee 5,500 Orthopedics SB S500067 SB029 Open Reduction of Small Joint SB029A Open Reduction of Small Joint 8,500 Orthopedics SB S500081 SB030 Tension Band Wiring SB030A Tension Band Wiring 13,000 Orthopedics SB S500095 SB031 Hemiarthroplasty SB031A Unipolar 15,000 Orthopedics SB S500094 SB031 Hemiarthroplasty SB031B Bipolar (Non - Modular) 15,000 Orthopedics SB S500094 SB031 Hemiarthroplasty SB031C Bipolar (Modular) 15,000 Orthopedics SB S500001 SB032 AC Joint reconstruction / Stabilization SB032A Rockwood Type - I 20,500 Orthopedics SB S500001 SB032 AC Joint reconstruction / Stabilization SB032B Rockwood Type - II 20,500 Orthopedics SB S500001 SB032 AC Joint reconstruction / Stabilization SB032C Rockwood Type - III 20,500 Orthopedics SB S500001 SB032 AC Joint reconstruction / Stabilization SB032D Rockwood Type - IV 20,500 Orthopedics SB S500001 SB032 AC Joint reconstruction / Stabilization SB032E Rockwood Type - V 20,500 Orthopedics SB S500001 SB032 AC Joint reconstruction / Stabilization SB032F Rockwood Type - VI 20,500 Orthopedics SB S500018 SB033 Excision Arthoplasty of Femur head SB033A Excision Arthoplasty of Femur head 17,500 Orthopedics SB S500066 SB034 Open Reduction of CDH SB034A Open Reduction of CDH 20,000 Orthopedics SB S500071 SB035 Patellectomy SB035A Patellectomy 11,000 Orthopedics SB S500090 SB036 Arthroscopic Meniscus Repair / Meniscectomy SB036A Arthroscopic Meniscus Repair / Meniscectomy 12,000 Orthopedics SB S500097 SB037 Elbow replacement SB037A Elbow replacement 14,100 Orthopedics SB S500091 SB038 Total Hip Replacement SB038A Cemented 35,000 Orthopedics SB S500092 SB038 Total Hip Replacement SB038B Cementless 37,000 Orthopedics SB S500093 SB038 Total Hip Replacement SB038C Hybrid 32,000 Orthopedics SB New Package SB038 Total Hip Replacement SB038D Revision - Total Hip Replacement 40,000 Orthopedics SB S500096 SB039 Total Knee Replacement SB039A Primary - Total Knee Replacement 25,000 Orthopedics SB New Package SB039 Total Knee Replacement SB039B Revision - Total Knee Replacement 30,000 Bone Tumour Excision (malignant) including GCT Bone Tumour Excision (malignant) including GCT Orthopedics SB S500022 SB040 + Joint replacement SB040A + Joint replacement 57,000 (depending upon type of joint and implant) (depending upon type of joint and implant) Orthopedics, Surgical SB S500020 SB041 Bone Tumour Excision + reconstruction SB041A Bone Tumour Excision + reconstruction 30,000 Oncology Bone Tumour (benign) curettage / Excision Bone Tumour (benign) curettage / Excision and Orthopedics SB S500021 SB042 SB042A 20,000 and bone grafting bone grafting Orthopedics SB S500004 SB043 Single Stage Amputation SB043A Above Elbow 15,000 Orthopedics SB S500003 SB043 Single Stage Amputation SB043B Below Elbow 15,000 Orthopedics SB S500009 SB043 Single Stage Amputation SB043C Above Knee 15,000 Orthopedics SB S500008 SB043 Single Stage Amputation SB043D Below Knee 15,000 Orthopedics SB S500010 SB043 Single Stage Amputation SB043E Foot 15,000 Orthopedics SB S500010 SB043 Single Stage Amputation SB043F Hand 15,000 Orthopedics SB S500006 SB043 Single Stage Amputation SB043G Wrist 15,000 Orthopedics SB S500004 SB044 Two Stage Amputation SB044A Above Elbow 23,200 Orthopedics SB S500003 SB044 Two Stage Amputation SB044B Below Elbow 23,200 Orthopedics SB S500009 SB044 Two Stage Amputation SB044C Above Knee 23,200 Orthopedics SB S500008 SB044 Two Stage Amputation SB044D Below Knee 23,200 Orthopedics SB S500010 SB044 Two Stage Amputation SB044E Foot 23,200 Orthopedics SB S500010 SB044 Two Stage Amputation SB044F Hand 23,200 Orthopedics SB S500006 SB044 Two Stage Amputation SB044G Wrist 23,200 S500005, Orthopedics SB SB045 Amputation - Fingers / Toes SB045A Finger(s) 10,400 S500007 Orthopedics SB S500007 SB045 Amputation - Fingers / Toes SB045B Toe(s) 10,400 Orthopedics SB S500078 SB046 Tendon Grafting / Repair SB046A Tendon Grafting 15,000 Orthopedics SB S500061 SB046 Tendon Grafting / Repair SB046B Tendon Repair 15,000 Orthopedics SB S500079 SB047 Tendon Release / Tenotomy SB047A Tendon Release / Tenotomy 5,000 Orthopedics SB S500080 SB048 Tenolysis SB048A Tenolysis 5,000 Reconstruction of Cruciate Ligament with implant Orthopedics SB S500075 SB049 SB049A Anterior 25,700 and brace Reconstruction of Cruciate Ligament with implant Orthopedics SB S500075 SB049 SB049B Posterior 25,700 and brace Orthopedics SB S500044 SB050 Fasciotomy SB050A Fasciotomy 10,500 Orthopedics SB S500039 SB051 Duputryen’s Contracture release + rehabilitation SB051A Duputryen’s Contracture release + rehabilitation 8,500 Debridement & Closure of injuries - contused Orthopedics SB S500035 SB052 SB052A Anti-biotic + dressing - minimum of 5 sessions 10,900 lacerated wounds Debridement & Closure of injuries - contused Orthopedics SB S500035 SB052 SB052B Anti-biotic + dressing - minimum of 2 sessions 3,000 lacerated wounds Orthopedics SB New Package SB053 Sequestectomy / Curettage SB053A Sequestectomy / Curettage 10,000 Orthopedics SB New Package SB054 Spine deformity correction SB054A Spine deformity correction 40,000 Orthopedics SB S500070 SB055 Osteotomy SB055A Long Bone 18,000 Orthopedics SB S500069 SB055 Osteotomy SB055B Small Bone 10,000 Orthopedics SB S500072 SB056 Pelvic Osteotomy and fixation SB056A Pelvic Osteotomy and fixation 20,000 Orthopedics SB S500055 SB057 High Tibial Osteotomy SB057A High Tibial Osteotomy 16,000 Orthopedics SB S500060 SB058 Ilizarov Fixation SB058A Ilizarov Fixation 15,000 Orthopedics SB S500059 SB059 Limb Lengthening / Bone Transport by Ilizarov SB059A Limb Lengthening / Bone Transport by Ilizarov 23,700 Orthopedics SB New Package SB060 Growth Modulation and fixation SB060A Growth Modulation and fixation 5,000 Orthopedics SB New Package SB061 Corrective Surgery for foot deformities SB061A Vertical Talus 15,000 Orthopedics SB New Package SB061 Corrective Surgery for foot deformities SB061B Other foot deformities 15,000 Orthopedics SB S500089 SB062 Correction of club foot per cast SB062A Correction of club foot per cast 3,000 Orthopedics SB S500089 SB063 Corrective Surgery in Club Foot / JESS Fixator SB063A Corrective Surgery in Club Foot / JESS Fixator 12,000 Orthopedics SB S500014 SB064 Excision of Osteochondroma / Exostosis SB064A Osteochondroma 10,000 Orthopedics SB S500014 SB064 Excision of Osteochondroma / Exostosis SB064B Exostosis 10,000 Orthopedics, S500074, SB SB065 Excision of Bursa SB065A Excision of Bursa 3,000 General Surgery S100015 Orthopedics SB S500063 SB066 Nerve Transposition / Release / Neurolysis SB066A Nerve Transposition 13,000 Orthopedics SB S500063 SB066 Nerve Transposition / Release / Neurolysis SB066B Nerve Release 13,000 Orthopedics SB S500063 SB066 Nerve Transposition / Release / Neurolysis SB066C Nerve Neurolysis 13,000 Orthopedics SB S500062 SB067 Nerve Repair Surgery SB067A Nerve Repair Surgery 13,800 Orthopedics, Neurosurgery SB New Package SB068 Nerve root block SB068A Nerve root block 3,000 Orthopedics SB S500040 SB069 Exploration and Ulnar nerve Repair SB069A Exploration and Ulnar nerve Repair 9,800 Orthopedics SB New Package SB070 Implant Removal under LA SB070A K - Wire 5,000 Orthopedics SB New Package SB070 Implant Removal under LA SB070B Screw 5,000 Orthopedics SB New Package SB071 Implant Removal under RA / GA SB071A Nail 15,000 Orthopedics SB New Package SB071 Implant Removal under RA / GA SB071B Plate 15,000 S200085, Surgical Oncology SC SC001 Glossectomy SC001A Hemiglossectomy 24,000 S200087 Surgical Oncology SC S200090 SC001 Glossectomy SC001B Total Glossectomy 30,000 Surgical Oncology, ENT SC S1500007 SC002 Palatectomy SC002A Soft palate 20,000

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Surgical Oncology, ENT SC S1500008 SC002 Palatectomy SC002B Hard palate 20,000 Surgical Oncology SC New Package SC003 Maxillectomy SC003A Partial 27,000 Surgical Oncology SC S1500015 SC003 Maxillectomy SC003B Radical 33,000 Surgical Oncology SC S1500014 SC003 Maxillectomy SC003C Total 30,000 Surgical Oncology SC S1500010 SC004 Composite resection (Oral Cavity) SC004A Composite resection (Oral Cavity) 40,000 Surgical Oncology SC S1500034 SC005 Oesophageal / Tracheal stenting SC005A Oesophageal stenting 45,000 Surgical Oncology SC New Package SC005 Oesophageal / Tracheal stenting SC005B Tracheal stenting 45,000 Surgical Oncology SC New Package SC006 Transthoracic esophagectomy: 2F / 3F SC006A Open 60,000 Surgical Oncology SC New Package SC006 Transthoracic esophagectomy: 2F / 3F SC006B MIS 60,000 Surgical Oncology SC New Package SC007 Gastric pull-up / Jejunal Graft SC007A Gastric pull-up / Jejunal Graft 36,000 Surgical Oncology SC New Package SC008 Radical Small Bowel Resection SC008A Open 33,000 Surgical Oncology SC S100173 SC008 Radical Small Bowel Resection SC008B Lap. 33,000 Surgical Oncology SC New Package SC009 Intersphincteric resection SC009A Open 40,200 Surgical Oncology SC New Package SC009 Intersphincteric resection SC009B Lap. 40,200 Surgical Oncology SC S1500032 SC010 Surgery for Abdominal wall tumour SC010A Abdominal wall tumour resection 25,000 Abdominal wall tumour resection with Surgical Oncology SC S1500033 SC010 Surgery for Abdominal wall tumour SC010B 39,000 reconstruction Exploratory laparotomy f / b diversion stoma / Surgical Oncology SC New Package SC011 SC011A Exploratory laparotomy f / b diversion stoma 30,000 bypass Exploratory laparotomy f / b diversion stoma / Surgical Oncology SC New Package SC011 SC011B Exploratory laparotomy f / b diversion bypass 30,000 bypass Surgical Oncology SC New Package SC012 Abdominoperineal resection SC012A Open 39,600 Surgical Oncology SC New Package SC012 Abdominoperineal resection SC012B Lap. 39,600 Surgical Oncology SC New Package SC013 Omentectomy SC013A Omentectomy 21,000 Surgical Oncology SC S100222 SC014 Procedures Requiring Bypass Techniques SC014A Procedures Requiring Bypass Techniques 35,000 Surgical Oncology SC S1500036 SC015 Segmentectomy - hepatobiliary system SC015A Segmentectomy - hepatobiliary system 50,000 Surgical Oncology SC S1500031 SC016 Radical / Revision Cholecystectomy SC016A Radical 39,600 Surgical Oncology SC New Package SC016 Radical / Revision Cholecystectomy SC016B Revision 39,600 Surgical Oncology SC S1500030 SC017 Enucleation of pancreatic neoplasm SC017A Enucleation of pancreatic neoplasm 39,600 Surgical Oncology, Pediatric SC New Package SC018 Hepatoblastoma Excision SC018A Hepatoblastoma Excision 52,200 Surgery Surgical Oncology SC S1500046 SC019 Hemipelvectomy - Internal SC019A Hemipelvectomy - Internal 54,000 Surgical Oncology SC New Package SC020 Pelvic Exenteration SC020A Anterior - Open 58,800 Surgical Oncology SC New Package SC020 Pelvic Exenteration SC020B Anterior - Lap. 58,800 Surgical Oncology SC New Package SC020 Pelvic Exenteration SC020C Total - Open 58,800 Surgical Oncology SC New Package SC020 Pelvic Exenteration SC020D Total - Lap. 58,800 Surgical Oncology, Pediatric SC New Package SC021 Wilms tumors: surgery SC021A Wilms tumors: surgery 33,000 Surgery Surgical Oncology SC New Package SC022 Ureteric end to end anastomosis SC022A Ureteric end to end anastomosis 24,000 Surgical Oncology, Urology SC New Package SC023 Distal ureterectomy with reimplantation SC023A Distal ureterectomy with reimplantation 30,000 Surgical Oncology, Urology SC S700076 SC024 Radical cystectomy SC024A With continent diversion - Open 98,000 Surgical Oncology, Urology SC S700077 SC024 Radical cystectomy SC024B With Ileal Conduit - Open 88,000 Surgical Oncology, Urology SC New Package SC024 Radical cystectomy SC024C With Ileal Conduit - Lap. 88,000 Surgical Oncology, Urology SC S700075 SC024 Radical cystectomy SC024D With neobladder - Open 98,000 Surgical Oncology, Urology SC New Package SC024 Radical cystectomy SC024E With neobladder - Lap 98,000 Surgical Oncology, Urology SC S700079 SC024 Radical cystectomy SC024F With ureterosigmoidostomy - Open 75,000 Surgical Oncology, Urology SC New Package SC024 Radical cystectomy SC024G With ureterosigmoidostomy - Lap 75,000 Surgical Oncology, Urology SC S700078 SC024 Radical cystectomy SC024H With ureterostomy -Open 70,000 Surgical Oncology, Urology SC New Package SC024 Radical cystectomy SC024I With ureterostomy -Lap. 70,000 Surgical Oncology SC New Package SC025 Channel TURP SC025A Channel TURP 22,800 Surgical Oncology, Urology SC New Package SC026 Radical Urethrectomy SC026A Radical Urethrectomy 30,000 Penile preserving surgery Penile preserving surgery Surgical Oncology, Urology SC New Package SC027 SC027A 25,000 (WLE, Glansectomy, Laser) (WLE, Glansectomy, Laser) Surgical Oncology SC New Package SC028 Excision of undescended testicular mass SC028A Excision of undescended testicular mass 24,000 Surgical Oncology SC New Package SC029 Germ Cell Tumour Excision SC029A Germ Cell Tumour Excision 30,000 Surgical Oncology, SC New Package SC030 Bilateral salpingoophorectomy SC030A Open 21,000 Obstetrics & Gynecology Surgical Oncology, SC New Package SC030 Bilateral salpingoophorectomy SC030B Lap. 21,000 Obstetrics & Gynecology Surgical Oncology SC New Package SC031 Leiomyoma excision SC031A Open 42,000 Surgical Oncology SC New Package SC031 Leiomyoma excision SC031B MIS 42,000 Surgical Oncology, Class I radical hysterectomy + bilateral SC New Package SC032 Radical Hysterectomy SC032A 27,000 Obstetrics & Gynecology salpingoophorectomy + BPLND - Lap. Surgical Oncology, Class I radical hysterectomy + bilateral SC New Package SC032 Radical Hysterectomy SC032B 27,000 Obstetrics & Gynecology salpingoophorectomy + BPLND - Open Surgical Oncology, Class I radical Hysterectomy +/- bilateral SC New Package SC032 Radical Hysterectomy SC032C 27,000 Obstetrics & Gynecology salpingoophorectomy - Lap. Surgical Oncology, Class I radical Hysterectomy +/- bilateral SC New Package SC032 Radical Hysterectomy SC032D 27,000 Obstetrics & Gynecology salpingoophorectomy - Open Surgical Oncology, SC New Package SC032 Radical Hysterectomy SC032E Class II radical hysterctomy + BPLND 27,000 Obstetrics & Gynecology Surgical Oncology, SC New Package SC032 Radical Hysterectomy SC032F Class III radical hysterctomy + BPLND 27,000 Obstetrics & Gynecology Surgical Oncology, Hysterectomy + bilateral salpingoophorectomy + SC New Package SC032 Radical Hysterectomy SC032G 34,000 Obstetrics & Gynecology omentectomy + peritonectomy and organ resections Surgical Oncology SC S1500040 SC033 Radical vaginectomy SC033A Radical vaginectomy 30,000 Surgical Oncology, SC New Package SC034 Vulvectomy + reconstruction procedures SC034A Vulvectomy + reconstruction procedures 36,000 Obstetrics & Gynecology Surgical Oncology SC S1500043 SC035 Radical Trachelectomy SC035A Radical Trachelectomy 40,000 Surgical Oncology SC New Package SC036 Sacral Tumour Excision SC036A Anterior + Posterior approach 60,000 Surgical Oncology SC New Package SC036 Sacral Tumour Excision SC036B Posterior approach 54,000 Surgical Oncology SC S1500004 SC037 Resection of nasopharyngeal tumour SC037A Resection of nasopharyngeal tumour 40,000 S100138, Surgical Oncology SC SC038 Total Pharyngectomy SC038A Total Pharyngectomy 36,000 S200022 Surgical Oncology SC S100215 SC039 Parapharyngeal Tumour Excision SC039A Parapharyngeal Tumour Excision 31,200 Surgical Oncology SC S1500017 SC040 Laryngectomy SC040A Partial laryngectomy (voice preserving) 39,000 Surgical Oncology SC New Package SC040 Laryngectomy SC040B Total Laryngectomy 36,000 Surgical Oncology SC S1500001 SC041 Tracheal resection SC041A Tracheal resection 36,000 Surgical Oncology SC New Package SC042 Tracheal / Carinal resection SC042A Tracheal / Carinal resection 58,800 Tracheal Stenosis (End to end Anastamosis) Tracheal Stenosis (End to end Anastamosis) Surgical Oncology SC S100139 SC043 SC043A 36,000 (Throat) (Throat) Surgical Oncology SC New Package SC044 Central airway tumour debulking SC044A Central airway tumour debulking 22,800 Surgical Oncology SC New Package SC045 Diagnostic thoracoscopy SC045A Diagnostic thoracoscopy 15,000 Surgical Oncology SC S1500027 SC046 Sleeve resection of lung cancer SC046A Sleeve resection of lung cancer 70,000 Surgical Oncology SC New Package SC047 Mediastinoscopy SC047A Diagnostic 22,200 Surgical Oncology SC New Package SC047 Mediastinoscopy SC047B Staging 22,200 Surgical Oncology SC S100221 SC048 Removal of Chest Wall Tumour SC048A Chest Wall Tumour Excision 36,000 Surgical Oncology SC New Package SC048 Removal of Chest Wall Tumour SC048B Removal of chest wall tumour with reconstruction 51,000 Surgical Oncology SC New Package SC049 Pleurectomy Decortication SC049A Pleurectomy Decortication 39,000 Surgical Oncology SC New Package SC050 Chamberlain procedure SC050A Chamberlain procedure 22,200 Surgical Oncology SC New Package SC051 Extrapleural pneumonectomy SC051A Extrapleural pneumonectomy 66,000 S100219, Surgical Oncology SC SC052 Pneumonectomy SC052A Pneumonectomy 54,000 S100237

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S1500024, Surgical Oncology SC S1500025, SC053 Lung metastectomy SC053A Open 30,000 S1500026 S1500024, Surgical Oncology SC S1500025, SC053 Lung metastectomy SC053B VATS 30,000 S1500026 Surgical Oncology SC S100231 SC054 Thoracostomy SC054A Thoracostomy 19,800 Surgical Oncology SC New Package SC055 Mediastinal lymphadenectomy SC055A Open 36,000 Surgical Oncology SC New Package SC055 Mediastinal lymphadenectomy SC055B Video - assisted 36,000 Surgical Oncology SC New Package SC056 Mediastinal mass excision with lung resection SC056A Mediastinal mass excision with lung resection 60,000 Surgical Oncology SC New Package SC057 Segmental resection of lung SC057A Open 42,000 Surgical Oncology SC New Package SC057 Segmental resection of lung SC057B Thoracoscopic 42,000 Surgical Oncology SC New Package SC058 Wedge resection lung SC058A Open 36,000 Surgical Oncology SC New Package SC058 Wedge resection lung SC058B Thoracoscopic 36,000 Breast conserving surgery Surgical Oncology SC S1500023 SC059 Breast conserving surgery SC059A 22,800 (lumpectomy + axillary surgery) Surgical Oncology SC New Package SC059 Breast conserving surgery SC059B Breast conserving surgery with Oncoplasty 24,600 Surgical Oncology SC New Package SC060 Axillary Sampling / Sentinel Node Biopsy SC060A Axillary Sampling / Sentinel Node Biopsy 16,200 Surgical Oncology SC S1500022 SC061 Axillary dissection SC061A Axillary dissection 19,800 Surgical Oncology SC New Package SC062 Scalp tumour excision with skull bone excision SC062A Scalp tumour excision with skull bone excision 30,000 Surgical Oncology SC New Package SC063 Neuroblastoma Excision SC063A Neuroblastoma Excision 60,000 Excision of Pinna for Growths / Injuries - Total Surgical Oncology, ENT SC S200014 SC064 Amputation & Excision of External Auditory SC064A Growth - Squamous 21,600 Meatus Excision of Pinna for Growths / Injuries - Total Surgical Oncology, ENT SC S200014 SC064 Amputation & Excision of External Auditory SC064B Growth - Basal 21,600 Meatus Excision of Pinna for Growths / Injuries - Total Surgical Oncology, ENT SC S200014 SC064 Amputation & Excision of External Auditory SC064C Injury 21,600 Meatus Surgical Oncology SC S1500013 SC065 Neck dissection - comprehensive SC065A Neck dissection - comprehensive 16,000 S100130, Surgical Oncology SC SC066 Benign Soft Tissue Tumour - Excision SC066A Benign Soft Tissue Tumour - Excision 12,000 S100131 Surgical Oncology SC New Package SC067 Malignant Soft Tissue Tumour - Excision SC067A Malignant Soft Tissue Tumour - Excision 24,000 Surgical Oncology, Plastic SC S1500005 SC068 Regional flap SC068A Myocutaneous flap 30,600 & Reconstructive Surgery Surgical Oncology, Plastic SC S1500006 SC068 Regional flap SC068B Fasciocutaneous flap 30,600 & Reconstructive Surgery Surgical Oncology SC New Package SC069 Rotationplasty SC069A Rotationplasty 45,000 Surgical Oncology, SC New Package SC070 Bone tumors / soft tissue sarcomas: surgery SC070A Bone tumors / soft tissue sarcomas: surgery 30,000 Orthopedics Surgical Oncology SC New Package SC071 Endoprosthesis Revision SC071A Complete 39,000 Surgical Oncology SC New Package SC071 Endoprosthesis Revision SC071B Partial 24,000 Surgical Oncology SC New Package SC072 Vertebral Tumour Excision and Reconstruction SC072A Vertebral Tumour Excision and Reconstruction 54,000 Surgical Oncology, Plastic SC S1500009 SC073 Microvascular reconstruction (free flaps) SC073A Microvascular reconstruction (free flaps) 45,000 & Reconstructive Surgery Surgical Oncology, CTVS, Plastic & Reconstructive SC New Package SC074 Vascular reconstruction SC074A Vascular reconstruction 57,600 Surgery Surgical Oncology SC New Package SC075 Curopsy / Sclerotherapy SC075A Curopsy / Sclerotherapy 19,200 Surgical Oncology SC New Package SC076 Chemo Port Insertion SC076A Chemo Port Insertion 18,000 Ophthalmology SE S300019 SE001 Ptosis Surgery SE001A Ptosis Surgery 8,000 Ophthalmology SE S300034 SE002 Entropion correction SE002A Entropion correction 6,600 Ophthalmology SE S300035 SE003 Ectropion correction SE003A Ectropion correction 6,500 Ophthalmology SE S300038 SE004 Lid Tear Repair SE004A Lid Tear Repair 5,000 Ophthalmology SE New Package SE005 Lid Abscess Drainage SE005A Lid Abscess Drainage 3,000 Ophthalmology SE S300022 SE006 Lid Tumor excision + Lid Reconstruction SE006A Lid Tumor excision + Lid Reconstruction 10,000 Ophthalmology SE New Package SE007 Chalazion Removal SE007A Chalazion Removal 2,000 Ophthalmology SE S300040 SE008 Squint correction SE008A Minor - upto 2 muscles 4,000 Major - 3 or more muscles (complex surgery Ophthalmology SE S300040 SE008 Squint correction SE008B 14,000 involving four muscles or oblique muscles) Conjunctival tumour excision including Amniotic Conjunctival tumour excision including Amniotic Ophthalmology SE S300033 SE009 SE009A 7,000 Membrane Graft Membrane Graft Canaliculo Dacryocystorhinostomy with Silicon Ophthalmology SE S300008 SE010 Dacryocystorhinostomy SE010A 8,000 Tube / Stent Canaliculo Dacryocystorhinostomy without Silicon Ophthalmology SE S300002 SE010 Dacryocystorhinostomy SE010B 8,000 Tube / Stent Ophthalmology SE New Package SE010 Dacryocystorhinostomy SE010C Dacryocystorhinostomy with Silicon Tube / Stent 8,000 Dacryocystorhinostomy without Silicon Tube / Ophthalmology SE New Package SE010 Dacryocystorhinostomy SE010D 8,000 Stent Ophthalmology SE New Package SE011 Corneal Ulcer Management SE011A Corneal Ulcer Management 4,000 Ophthalmology SE S300004 SE012 Corneal Grafting SE012A Corneal Grafting 8,500 Ophthalmology SE New Package SE012 Corneal Grafting SE012B Corneal Graft - Follow Up 2,000 Ophthalmology SE New Package SE013 Corneal Collagen Crosslinking SE013A Corneal Collagen Crosslinking 9,000 Ophthalmology SE S300007 SE014 Pterygium + Conjunctival Autograft SE014A Pterygium + Conjunctival Autograft 5,000 Ophthalmology SE S300018 SE015 Corneo / Scleral / Corneo scleral tear repair SE015A Corneo / Scleral / Corneo scleral tear repair 11,500 Ophthalmology SE New Package SE016 Corneal / Scleral Patch Graft SE016A Corneal / Scleral Patch Graft 3,000 Ophthalmology SE S300021 SE017 Scleral buckling surgery SE017A Scleral buckling surgery 15,000 Ophthalmology SE S300001 SE018 Scleral Buckle Removal SE018A Scleral Buckle Removal 5,500 Ophthalmology SE S300016 SE019 Limbal Dermoid Removal SE019A Limbal Dermoid Removal 1,000 Phaco emulsification with foldable hydrophobic Ophthalmology SE S300029 SE020 Cataract surgery SE020A 4,500 acrylic IOL Ophthalmology SE S300030 SE020 Cataract surgery SE020B SICS with non-foldable IOL 4,000 Ophthalmology SE S300015 SE021 Surgery for Pediatric Cataract SE021A Paediatric lensectomy 9,200 Pediatric lens aspiration with posterior capsulotomy Ophthalmology SE S300015 SE021 Surgery for Pediatric Cataract SE021B 9,200 & anterior vitrectomy Ophthalmology SE New Package SE021 Surgery for Pediatric Cataract SE021C Paediatric Membranectomy & anterior vitrectomy 9,200 Ophthalmology SE S300003 SE022 Capsulotomy (YAG) SE022A Capsulotomy (YAG) 1,500 Ophthalmology SE New Package SE023 SFIOL (inclusive of Vitrectomy) SE023A SFIOL (inclusive of Vitrectomy) 15,000 Ophthalmology SE New Package SE024 Secondary IOL / IOL Exchange / Explant SE024A Secondary IOL / IOL Exchange / Explant 2,000 Ophthalmology SE S300020 SE025 IRIS Prolapse – Repair SE025A IRIS Prolapse – Repair 4,000 S300024, Ophthalmology SE SE026 Iridectomy SE026A Iridectomy 2,000 S300025 Ophthalmology SE S300006 SE027 Glaucoma Surgery SE027A Cyclocryotherapy / Cyclophotocoagulation 3,700 Glaucoma Surgery (Trabeculectomy only) with or without Mitomycin C, including postoperative medications for 12 weeks Ophthalmology SE S300012 SE027 Glaucoma Surgery SE027B 11,000 (and wherever surgical or laser procedures required for bleb augmentation and anterior chamber maintenance) Ophthalmology SE New Package SE027 Glaucoma Surgery SE027C Glaucoma Shunt Surgery 13,000 Ophthalmology SE New Package SE027 Glaucoma Surgery SE027D Pediatric Glaucoma Surgery 15,000 Ophthalmology SE New Package SE028 EUA for Confirmation of Pediatric Glaucoma SE028A EUA for Confirmation of Pediatric Glaucoma 3,000 Ophthalmology SE New Package SE029 Retinal Laser Photocoagulation SE029A For retinal tear repair Per Eye Per Sitting 1,500

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Pan Retinal Photocoagulation (PRP) - Retinal Laser including 3 sittings / package of retino laser Ophthalmology SE New Package SE029 Retinal Laser Photocoagulation SE029B 8,500 photocoagulation (3 sittings per eye for both eyes) Ophthalmology SE S300037 SE030 ROP Laser - Per Eye SE030A ROP Laser - Per Eye 5,000 Ophthalmology SE S300005 SE031 Retinal Cryopexy SE031A Retinal Cryopexy 3,800 Ophthalmology SE S300028 SE032 Vitreoretinal Surgery (with Silicon Oil Insertion) SE032A Vitreoretinal Surgery (with Silicon Oil Insertion) 17,900 Ophthalmology SE S300027 SE033 SOR (Silicon Oil Removal) SE033A SOR (Silicon Oil Removal) 9,300 Ophthalmology SE New Package SE034 Endophthalmitis (excluding Vitrectomy) SE034A Endophthalmitis (excluding Vitrectomy) 8,000 Ophthalmology SE S300009 SE035 Enucleation SE035A Without implant 8,400 Ophthalmology SE S300010 SE035 Enucleation SE035B With implant 8,400 Ophthalmology SE S300036 SE036 Evisceration SE036A Evisceration 3,800 Ophthalmology, Surgical SE S300011 SE037 Exenteration SE037A Exenteration 15,000 Oncology Socket Reconstruction including Amniotic Socket Reconstruction including Amniotic Ophthalmology SE S300023 SE038 SE038A 11,200 Membrane Graft Membrane Graft Ophthalmology SE S300039 SE039 Orbitotomy SE039A Orbitotomy 14,000 Ophthalmology SE New Package SE040 GA / EUA separate add on package SE040A GA / EUA separate add on package 3,000 General Surgery, Surgical S100103, SG SG001 Oesophagectomy SG001A Oesophagectomy 28,300 Oncology S100195 General Surgery, Pediatric Operations for Replacement of Oesophagus by Operations for Replacement of Oesophagus by SG S100213 SG002 SG002A 30,500 Surgery Colon Colon Bleeding Ulcer - Partial Gastrectomy without General Surgery SG S100009 SG003 Gastrectomy SG003A 25,000 Vagotomy Bleeding Ulcer - Partial Gastrectomy with General Surgery SG S100008 SG003 Gastrectomy SG003B 25,000 Vagotomy General Surgery, Surgical S100009, SG SG003 Gastrectomy SG003C Partial Gastrectomy for Carcinoma 27,800 Oncology S100216 General Surgery, Surgical S100009, SG SG003 Gastrectomy SG003D Subtotal Gastrectomy for Carcinoma 27,800 Oncology S100216 General Surgery, Surgical SG New Package SG003 Gastrectomy SG003E Total Gastrectomy - Lap. 51,600 Oncology General Surgery, Surgical SG S100009 SG003 Gastrectomy SG003F Total Gastrectomy - Open 51,600 Oncology General Surgery, Pediatric SG S100064 SG004 Operative Gastrostomy SG004A Operative Gastrostomy 15,000 Surgery General Surgery SG S100060 SG005 Vagotomy SG005A G J Vagotomy 23,500 General Surgery SG S100060 SG005 Vagotomy SG005B Vagotomy + Pyloroplasty 23,500 General Surgery SG S100196 SG006 Operation for Bleeding Peptic Ulcer SG006A Operation for Bleeding Peptic Ulcer 22,500 General Surgery SG S100089 SG007 Operation for Gastric / Duodenal Perforation SG007A Gastric Perforation 18,500 General Surgery SG S100065 SG007 Operation for Gastric / Duodenal Perforation SG007B Duodenal Perforation 18,500 General Surgery, Pediatric SG S100112 SG008 Pyloroplasty SG008A Pyloroplasty 14,000 Surgery General Surgery, Pediatric SG S100185 SG009 Pyloromyotomy SG009A Pyloromyotomy 15,000 Surgery General Surgery, Surgical SG S100063 SG010 Gastrojejunostomy SG010A Gastrojejunostomy 18,500 Oncology General Surgery, Pediatric SG S100205 SG011 CystoJejunostomy / Cystogastrostomy SG011A CystoJejunostomy - Open 20,000 Surgery General Surgery, Pediatric SG S100205 SG011 CystoJejunostomy / Cystogastrostomy SG011B CystoJejunostomy - Lap. 20,000 Surgery General Surgery, Pediatric SG S100205 SG011 CystoJejunostomy / Cystogastrostomy SG011C Cystogastrostomy - Open 20,000 Surgery General Surgery, Pediatric SG S100182 SG011 CystoJejunostomy / Cystogastrostomy SG011D Cystogastrostomy - Lap. 20,000 Surgery General Surgery, Surgical SG S100088 SG012 Feeding Jejunostomy SG012A Feeding Jejunostomy 10,000 Oncology, Pediatric Surgery General Surgery, Pediatric SG S100095 SG013 Ileostomy SG013A Ileostomy 14,000 Surgery General Surgery, Pediatric SG S100204 SG014 Congenital Atresia & Stenosis of Small Intestine SG014A Congenital Atresia & Stenosis of Small Intestine 23,000 Surgery General Surgery, Pediatric SG S100030 SG015 Operation for Duplication of Intestine SG015A Operation for Duplication of Intestine 18,000 Surgery General Surgery SG S100028 SG016 Diverticulectomy SG016A Excision Duodenal Diverticulum 20,000 General Surgery, Pediatric SG S100041 SG016 Diverticulectomy SG016B Excision Meckel's Diverticulum 15,000 Surgery General Surgery, Pediatric SG S100003 SG017 Appendicectomy SG017A Open 11,000 Surgery General Surgery, Pediatric SG S100180 SG017 Appendicectomy SG017B Lap. 11,000 Surgery General Surgery, Pediatric SG S100091 SG018 Appendicular Perforation SG018A Appendicular Perforation 17,500 Surgery General Surgery, Pediatric S100004, SG SG019 Operative drainage of Appendicular Abscess SG019A Operative drainage of Appendicular Abscess 12,000 Surgery S100200 General Surgery, Surgical SG New Package SG020 Total Colectomy SG020A Open 23,000 Oncology General Surgery, Surgical SG S100174 SG020 Total Colectomy SG020B Lap. 23,000 Oncology General Surgery, Surgical SG New Package SG021 Hemi colectomy SG021A Right - Open 25,000 Oncology General Surgery, Surgical SG S100172 SG021 Hemi colectomy SG021B Right - Lap. 25,000 Oncology General Surgery, Surgical SG New Package SG021 Hemi colectomy SG021C Left - Open 25,000 Oncology General Surgery, Surgical SG S100171 SG021 Hemi colectomy SG021D Left - Lap. 25,000 Oncology General Surgery, Pediatric SG S100144 SG022 Operative Management of Volvulus of Large Bowel SG022A Operative Management of Volvulus of Large Bowel 25,000 Surgery General Surgery, Surgical SG S100018 SG023 Colostomy SG023A Colostomy 14,000 Oncology, Pediatric Surgery

General Surgery, Surgical SG S100202 SG024 Closure of stoma SG024A Closure of stoma 14,500 Oncology, Pediatric Surgery General Surgery SG S100127 SG025 Sigmoid Resection SG025A Sigmoid Resection 21,500 General Surgery SG S100117 SG026 Perineal Procedure for Rectal Prolapse SG026A Perineal Procedure for Rectal Prolapse 14,000 General Surgery SG New Package SG027 Abdominal Procedure for Rectal Prolapse SG027A Open 19,000 General Surgery SG New Package SG027 Abdominal Procedure for Rectal Prolapse SG027B Lap. 19,000 General Surgery, Surgical SG S100108 SG028 Rectal Polyp Excision SG028A Rectal Polyp Excision 9,600 Oncology General Surgery, Surgical SG S100002 SG029 Anterior Resection of rectum SG029A Open 28,500 Oncology

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General Surgery, Surgical SG S100002 SG029 Anterior Resection of rectum SG029B Lap. 28,500 Oncology S100090, General Surgery, Pediatric SG S100120, SG030 Resection Anastomosis SG030A Open 25,000 Surgery S100121 S100090, General Surgery, Pediatric SG S100120, SG030 Resection Anastomosis SG030B Lap. 25,000 Surgery S100121 General Surgery SG S100053 SG031 Procedure for Fissure in Ano SG031A Procedure for Fissure in Ano 8,000 General Surgery SG S100123 SG032 Haemorroidectomy SG032A without Stapler 15,000 General Surgery SG S100123 SG032 Haemorroidectomy SG032B with Stapler 15,000 General Surgery SG S100042 SG033 Management of Pilonidal Sinus SG033A Management of Pilonidal Sinus 5,000 General Surgery SG S100050 SG034 Exicision of Sinus and Curettage SG034A Exicision of Sinus and Curettage 5,000 General Surgery, Pediatric SG S100190 SG035 Exploratory Laparotomy SG035A Exploratory Laparotomy 10,000 Surgery General Surgery, Pediatric S100092, Surgery, Obstetrics & SG SG036 Closure of Burst Abdomen SG036A Closure of Burst Abdomen 15,000 S400060 Gynecology General Surgery, Surgical SG S100070 SG037 Hepatic Resection SG037A Open 20,000 Oncology, Pediatric Surgery

General Surgery, Surgical SG S100177 SG037 Hepatic Resection SG037B Lap. 20,000 Oncology, Pediatric Surgery General Surgery, Pediatric SG S100079 SG038 Abdominal Hydatid Cyst (Single Organ) SG038A Abdominal Hydatid Cyst (Single Organ) 15,800 Surgery General Surgery, Pediatric SG New Package SG039 Cholecystectomy SG039A Without Exploration of CBD - Open 22,800 Surgery General Surgery, Pediatric SG S100153 SG039 Cholecystectomy SG039B With Exploration of CBD - Open 22,800 Surgery General Surgery, Pediatric SG S100181 SG039 Cholecystectomy SG039C Without Exploration of CBD - Lap. 22,800 Surgery General Surgery, Pediatric SG S100175 SG039 Cholecystectomy SG039D With Exploration of CBD - Lap. 22,800 Surgery General Surgery, Pediatric SG S100154 SG040 Operative Cholecystostomy SG040A Open 10,000 Surgery General Surgery, Pediatric SG S100154 SG040 Operative Cholecystostomy SG040B Lap. 10,000 Surgery General Surgery, Pediatric SG S100211 SG041 Operation of Choledochal Cyst SG041A Operation of Choledochal Cyst 24,500 Surgery General Surgery, Pediatric S100132, SG SG042 Splenectomy SG042A Open 25,000 Surgery S100226 S100132, General Surgery, Pediatric SG S100187, SG042 Splenectomy SG042B Lap. 25,000 Surgery S100226 General Surgery, Surgical SG S100016 SG043 Bypass - Inoperable Pancreas SG043A Bypass - Inoperable Pancreas 23,500 Oncology General Surgery, Surgical Distal Pancreatectomy with Distal Pancreatectomy with SG S100107 SG044 SG044A 25,000 Oncology, Pediatric Surgery Pancreatico Jejunostomy Pancreatico Jejunostomy General Surgery, Surgical SG S100106 SG045 PancreaticoDuodenectomy (Whipple's) SG045A PancreaticoDuodenectomy (Whipple's) 30,000 Oncology General Surgery SG S100111 SG046 Porto Caval Anastomosis SG046A Porto Caval Anastomosis 31,500 General Surgery SG S100100 SG047 Mesenteric Caval Anastomosis SG047A Mesenteric Caval Anastomosis 28,500 General Surgery, Pediatric SG S100099 SG048 Mesenteric Cyst – Excision SG048A Mesenteric Cyst – Excision 15,000 Surgery General Surgery, Surgical SG S100122 SG049 Retroperitoneal Tumor – Excision SG049A Retroperitoneal Tumor – Excision 23,000 Oncology, Pediatric Surgery General Surgery SG New Package SG050 Groin Hernia Repair SG050A Inguinal - Open 14,200 General Surgery SG New Package SG050 Groin Hernia Repair SG050B Inguinal - Lap. 14,200 General Surgery SG S100075 SG050 Groin Hernia Repair SG050C Femoral - Open 14,200 General Surgery SG S100075 SG050 Groin Hernia Repair SG050D Femoral - Lap 14,200 General Surgery, Pediatric SG New Package SG050 Groin Hernia Repair SG050E Obturator - Lap. 20,000 Surgery General Surgery, Pediatric SG S100071 SG051 Hernia - Ventral SG051A Epigastric 17,400 Surgery General Surgery, Pediatric SG S100074 SG051 Hernia - Ventral SG051B Umbilical 17,400 Surgery General Surgery, Pediatric SG New Package SG051 Hernia - Ventral SG051C Paraumbilical 17,400 Surgery General Surgery, Pediatric SG S100115 SG051 Hernia - Ventral SG051D Spigelian 17,400 Surgery General Surgery, Pediatric S100072, SG SG052 Repair of Incisional Hernia SG052A Repair of Incisional Hernia 20,000 Surgery S400006 General Surgery, Pediatric SG S100078 SG053 Hiatus Hernia Repair / Fundoplication SG053A Hiatus Hernia Repair - Open 23,500 Surgery General Surgery, Pediatric SG S100184 SG053 Hiatus Hernia Repair / Fundoplication SG053B Hiatus Hernia Repair - Lap. 23,500 Surgery General Surgery, Pediatric SG S100059 SG053 Hiatus Hernia Repair / Fundoplication SG053C Fundoplication - Open 23,500 Surgery General Surgery, Pediatric SG S100059 SG053 Hiatus Hernia Repair / Fundoplication SG053D Fundoplication - Lap. 23,500 Surgery General Surgery SG S100019 SG054 Excision of cyst / Sebaceous Cysts over scrotum SG054A Single Cyst 2,000 General Surgery SG S100019 SG054 Excision of cyst / Sebaceous Cysts over scrotum SG054B Multiple Cysts 7,000 General Surgery SG S100039 SG055 Excision Filarial Scrotum SG055A Excision Filarial Scrotum 6,500 General Surgery, Pediatric S100080, SG SG056 Operation for Hydrocele (U/L) SG056A Operation for Hydrocele (U/L) 5,000 Surgery S100081 General Surgery, Pediatric S100033, SG SG057 Epididymal Cyst / Nodule Excision SG057A Epididymal Cyst exision 4,600 Surgery S100034 General Surgery, Pediatric S100033, SG SG057 Epididymal Cyst / Nodule Excision SG057B Epididymal Nodule excision 4,600 Surgery S100034 General Surgery, Urology SG S100143 SG058 Vasovasostomy SG058A Vasovasostomy 12,000 General Surgery, Surgical SG New Package SG059 Orchidectomy SG059A Orchidectomy 11,200 Oncology, Pediatric Surgery General Surgery, Pediatric SG S100084 SG060 Inguinal Node (dissection) - U/L SG060A Inguinal Node (dissection) - U/L 16,000 Surgery General Surgery, Surgical SG S100160 SG061 Estlander Operation (lip) SG061A Estlander Operation (lip) 9,300 Oncology General Surgery, Surgical SG S100199 SG062 Operation for Carcinoma Lip SG062A Wedge Excision 19,000 Oncology General Surgery, Surgical SG New Package SG062 Operation for Carcinoma Lip SG062B Wedge Excision and Vermilionectomy 23,800 Oncology

Page 16 Consolidated Master

General Surgery, Surgical SG S100209 SG062 Operation for Carcinoma Lip SG062C Cheek advancement 26,800 Oncology General Surgery, Surgical Complete Excision of Growth from Tongue only Complete Excision of Growth from Tongue only SG S100044 SG063 SG063A 9,400 Oncology, Pediatric Surgery (inclusive of Histopathology) (inclusive of Histopathology) General Surgery, Surgical Excision of Growth from Tongue with neck node Excision of Growth from Tongue with neck node SG S100045 SG064 SG064A 23,500 Oncology dissection dissection General Surgery SG S100101 SG065 Microlaryngoscopic Surgery SG065A Microlaryngoscopic Surgery 18,500 General Surgery, Surgical SG S100134 SG066 Submandibular Mass Excision SG066A Submandibular Mass Excision 15,000 Oncology General Surgery, Surgical SG S100114 SG067 Radical Neck Dissection SG067A Radical Neck Dissection 15,000 Oncology, ENT S100014, General Surgery, ENT SG SG068 Surgical removal of Branchial Cyst SG068A Surgical removal of Branchial Cyst 15,000 S200079 General Surgery, Surgical SG S100152 SG069 Carotid Body tumour - Excision SG069A Carotid Body tumour - Excision 20,000 Oncology, CTVS General Surgery, Surgical Oncology, Pediatric Surgery, SG S100168 SG070 Thyroidectomy SG070A Hemi thyroidectomy 17,000 ENT General Surgery, Surgical Oncology, Pediatric Surgery, SG S100169 SG070 Thyroidectomy SG070B Total thyroidectomy 20,000 ENT General Surgery, Surgical Oncology, Pediatric Surgery, SG S100242 SG070 Thyroidectomy SG070C Total Thyroidectomy with Block Dissection 28,000 ENT General Surgery, Surgical SG S100162 SG071 Excision of Parathyroid Adenoma / Carcinoma SG071A Excision of Parathyroid Adenoma 20,400 Oncology, Pediatric Surgery

General Surgery, Surgical SG S100162 SG071 Excision of Parathyroid Adenoma / Carcinoma SG071B Excision of Parathyroid Carcinoma 20,400 Oncology, Pediatric Surgery General Surgery, Pediatric SG S100210 SG072 Thymectomy SG072A Thymectomy 28,000 Surgery General Surgery, Pediatric S100239, SG SG073 Sympathectomy SG073A Sympathectomy 15,000 Surgery S100229 General Surgery, Surgical S100012, SG SG074 Breast Lump Excision (Benign) SG074A Breast Lump Excision (Benign) 6,000 Oncology S100013 General Surgery, Surgical SG S100098 SG075 Mastectomy SG075A Simple Mastectomy 20,000 Oncology General Surgery, Surgical SG S100113 SG075 Mastectomy SG075B Radical / Modified Radical Mastectomy 25,000 Oncology General Surgery SG S100040 SG076 Excision Mammary Fistula SG076A Excision Mammary Fistula 14,500 General Surgery, Pediatric SG S100208 SG077 Intercostal drainage Only SG077A Intercostal drainage Only 4,800 Surgery, CTVS General Surgery, Pediatric SG S100224 SG078 Rib Resection & Drainage SG078A Rib Resection & Drainage 14,000 Surgery General Surgery, Pediatric SG S100233 SG079 Thoracoplasty SG079A Thoracoplasty 20,000 Surgery General Surgery, Pediatric SG S100157 SG080 Decortication (Pleurectomy) SG080A Decortication (Pleurectomy) 28,000 Surgery General Surgery, Pediatric SG S100236 SG081 Lobectomy SG081A Thoracoscopic 27,500 Surgery, Surgical Oncology General Surgery, Pediatric SG New Package SG081 Lobectomy SG081B Open 27,500 Surgery, Surgical Oncology General Surgery, Pediatric SG S100238 SG082 Thoracoscopic Segmental Resection SG082A Thoracoscopic Segmental Resection 25,000 Surgery General Surgery, Pediatric SG S100235 SG083 Lung Hydatid Cyst removal SG083A Lung Hydatid Cyst removal 20,000 Surgery General Surgery, Pediatric SG S100024 SG084 Incision & Drainage of Abscess SG084A Incision & Drainage of Abscess 5,000 Surgery General Surgery SG S100096 SG085 Lipoma / Cyst / other cutaneous swellings Excision SG085A Lipoma Excision 5,000 General Surgery SG New Package SG085 Lipoma / Cyst / other cutaneous swellings Excision SG085B Cyst Excision 5,000 General Surgery SG New Package SG085 Lipoma / Cyst / other cutaneous swellings Excision SG085C Other cutaneous swellings Excision 5,000 General Surgery SG S100244 SG086 Debridement of Ulcer SG086A Debridement of Ulcer 5,000 General Surgery, Surgical SG S100163 SG087 Flap Reconstructive Surgery SG087A Flap Reconstructive Surgery 20,000 Oncology General Surgery, Plastic & SG S100167 SG088 Free Grafts - Wolfe Grafts SG088A Free Grafts - Wolfe Grafts 14,000 Reconstructive Surgery General Surgery SG S100245 SG089 Tissue Reconstruction Flap SG089A Tissue Reconstruction Flap 25,000 General Surgery, Plastic & Reconstructive Surgery, SG S100164 SG090 Split thickness skin grafts SG090A Small (< 4% TBSA) 13,500 Pediatric Surgery General Surgery, Plastic & Reconstructive Surgery, SG S100165 SG090 Split thickness skin grafts SG090B Medium (4 - 8% TBSA) 13,500 Pediatric Surgery General Surgery, Plastic & Reconstructive Surgery, SG S100166 SG090 Split thickness skin grafts SG090C Large (> 8% TBSA) 13,500 Pediatric Surgery General Surgery, Surgical Oncology, Plastic & SG S100225 SG091 Skin Flaps - Rotation Flaps SG091A Skin Flaps - Rotation Flaps 11,400 Reconstructive Surgery General Surgery, SG S100246 SG092 Tendon Transfer SG092A Tendon Transfer 15,000 Orthopedics Lymphatics Excision of Subcutaneous Tissues In Lymphatics Excision of Subcutaneous Tissues In General Surgery SG S100192 SG093 SG093A 10,000 Lymphoedema Lymphoedema General Surgery SG S100251 SG094 AV Fistula without prosthesis SG094A AV Fistula without prosthesis 6,000 General Surgery SG S100142 SG095 Management of Varicose Veins SG095A Management of Varicose Veins 14,000 General Surgery, Pediatric Surgery, Obstetrics & SG New Package SG096 Biopsy SG096A Lymph Node 5,000 Gynecology General Surgery, Pediatric Surgery, Obstetrics & SG New Package SG096 Biopsy SG096B Endometrial Aspiration 2,000 Gynecology General Surgery, Pediatric Surgery, Obstetrics & SG S400061 SG096 Biopsy SG096C Cervix Cancer screening (PAP + Colposcopy) 1,000 Gynecology General Surgery, Pediatric Surgery, Obstetrics & SG New Package SG096 Biopsy SG096D Cervical (Neck) 1,500 Gynecology General Surgery, Pediatric Surgery, Obstetrics & SG New Package SG096 Biopsy SG096E Vulval 1,500 Gynecology General Surgery SG New Package SG097 Stoma Management SG097A Stoma Management follow up of Ileostomy 4,500 General Surgery SG New Package SG097 Stoma Management SG097B Stoma Management follow up of Colostomy 4,500

Page 17 Consolidated Master

General Surgery, Pediatric S100058, SG SG098 Foreign Body Removal SG098A Foreign Body Removal 5,000 Surgery, ENT S200026 ENT, Surgical Oncology SL S200020 SL001 Pinna surgery for tumour / trauma SL001A Pinna surgery for tumour 8,600 ENT SL S200020 SL001 Pinna surgery for tumour / trauma SL001B Pinna surgery for trauma 8,600 ENT SL S200017 SL002 Tympanoplasty SL002A Tympanoplasty 12,900 ENT SL S200016 SL003 Stapedectomy / tympanotomy SL003A Stapedectomy 13,000 ENT SL S200025 SL003 Stapedectomy / tympanotomy SL003B Tympanotomy 13,000 ENT, Surgical Oncology SL S200003 SL004 Mastoidectomy SL004A Simple 28,000 ENT, Surgical Oncology SL S200004 SL004 Mastoidectomy SL004B Radical 28,000 S200009, ENT, Surgical Oncology SL SL005 Myringotomy with or without Grommet SL005A Unilateral 5,000 S200011 S200008, ENT, Surgical Oncology SL SL005 Myringotomy with or without Grommet SL005B Bilateral 5,000 S200010 ENT SL S200051 SL006 Endoscopic DCR SL006A Endoscopic DCR 19,300 ENT SL New Package SL007 Epistaxis treatment - packing SL007A Epistaxis treatment - packing 1,800 ENT SL S200055 SL008 Functional septo rhinoplasty SL008A Functional septo rhinoplasty 21,800 ENT SL S200047 SL009 Septoplasty SL009A Septoplasty 12,000 ENT SL S200037 SL010 Fracture - setting nasal bone SL010A Fracture - setting nasal bone 8,000 S200043, ENT SL SL011 Inferior turbinate reduction under GA SL011A Inferior turbinate reduction under GA 5,700 S200044 ENT SL S200040 SL012 Open sinus surgery SL012A Open sinus surgery 15,000 ENT SL S200038 SL013 Functional Endoscopic Sinus (FESS) SL013A Functional Endoscopic Sinus (FESS) 11,000 ENT SL S200028 SL014 Ant. Ethmoidal / sphenopalatine artery ligation SL014A Ant. Ethmoidal artery ligation - Open 15,000 ENT SL S200028 SL014 Ant. Ethmoidal / sphenopalatine artery ligation SL014B Ant. Ethmoidal artery ligation - Endoscopic 15,000 ENT SL New Package SL014 Ant. Ethmoidal / sphenopalatine artery ligation SL014C Sphenopalatine artery ligation - Open 15,000 ENT SL New Package SL014 Ant. Ethmoidal / sphenopalatine artery ligation SL014D Sphenopalatine artery ligation - Endoscopic 15,000 ENT SL S200057 SL015 Adenoidectomy SL015A Adenoidectomy 5,000 ENT SL S200074 SL016 Tonsillectomy SL016A Tonsillectomy - U/L 7,500 ENT SL S200074 SL016 Tonsillectomy SL016B Tonsillectomy - B/L 7,500 Peritonsillar abscess drainage / intraoral calculus ENT, Pediatric Surgery SL S200069 SL017 SL017A Peritonsillar abscess drainage 5,800 removal Peritonsillar abscess drainage / intraoral calculus ENT, Pediatric Surgery SL New Package SL017 SL017B Intraoral calculus removal 5,800 removal Thyroglossal / Branchial cyst / sinus / fistula ENT SL S200073 SL018 SL018A Thyroglossal cyst excision 15,300 excision Thyroglossal / Branchial cyst / sinus / fistula ENT SL New Package SL018 SL018B Thyroglossal sinus excision 15,300 excision Thyroglossal / Branchial cyst / sinus / fistula ENT SL S200073 SL018 SL018C Thyroglossal fistula excision 15,300 excision Thyroglossal / Branchial cyst / sinus / fistula ENT SL S200079 SL018 SL018D Branchial sinus excision 15,300 excision Thyroglossal / Branchial cyst / sinus / fistula ENT SL S100011 SL018 SL018E Branchial fistula excision 15,300 excision ENT, Pediatric Surgery SL S200077 SL019 Uvulopalatopharyngoplasty (UPPP) SL019A Uvulopalatopharyngoplasty (UPPP) 18,600 Excision of tumour of oral cavity / paranasal sinus / Excision of tumour of oral cavity / paranasal sinus / ENT, Surgical Oncology SL New Package SL020 SL020A 10,000 laryngopharynx with or without reconstruction laryngopharynx without reconstruction Excision of tumour of oral cavity / paranasal sinus / Excision of tumour of oral cavity / paranasal sinus / ENT, Surgical Oncology SL New Package SL020 SL020B 36,500 laryngopharynx with or without reconstruction laryngopharynx with pedicled flap reconstruction Excision of tumour of oral cavity / paranasal sinus / Excision of tumour of oral cavity / paranasal sinus / ENT, Surgical Oncology SL New Package SL020 SL020C 25,000 laryngopharynx with or without reconstruction laryngopharynx with free flap reconstruction ENT, Surgical Oncology, SL S200075 SL021 Parotidectomy SL021A Total Parotidectomy 28,200 General Surgery ENT, Surgical Oncology, SL S200076 SL021 Parotidectomy SL021B Superficial Parotidectomy 23,800 General Surgery S200089, ENT SL SL022 Removal of Submandibular Salivary gland SL022A Removal of Submandibular Salivary gland 9,000 S100124 ENT SL S200088 SL022 Removal of Submandibular Salivary gland SL022B Removal of Ranula 9,000 ENT SL S100133 SL022 Removal of Submandibular Salivary gland SL022C Removal of Submandibular Lymph node 9,000 Rigid laryngoscopy / bronchoscopy / ENT, Pediatric Surgery SL New Package SL023 SL023A Rigid laryngoscopy - Diagnostic + / - biopsy 7,000 oesophagoscopy - Diagnostic + / - biopsy Rigid laryngoscopy / bronchoscopy / ENT, Pediatric Surgery SL New Package SL023 SL023B Rigid bronchoscopy - Diagnostic + / - biopsy 7,000 oesophagoscopy - Diagnostic + / - biopsy Rigid laryngoscopy / bronchoscopy / ENT, Pediatric Surgery SL New Package SL023 SL023C Rigid oesophagoscopy - Diagnostic + / - biopsy 7,000 oesophagoscopy - Diagnostic + / - biopsy ENT SL S200058 SL024 Microlaryngeal surgery with or without laser SL024A Microlaryngeal surgery with or without laser 17,000 ENT, Surgical Oncology SL New Package SL025 Open laryngeal framework surgery / Thyroplasty SL025A Open laryngeal framework surgery / Thyroplasty 5,000 ENT, All Specialties SL S1500021 SL026 Tracheostomy / Tracheotomy SL026A Tracheostomy 6,000 ENT, All Specialties SL New Package SL026 Tracheostomy / Tracheotomy SL026B Tracheotomy 6,000 ENT, Surgical Oncology, SL New Package SL027 Neck dissection SL027A Selective Benign neck tumour excision 18,800 General Surgery ENT, Surgical Oncology, SL New Package SL027 Neck dissection SL027B Comprehensive Benign neck tumour excision 18,800 General Surgery ENT, Surgical Oncology, SL S200061 SL027 Neck dissection SL027C Selective Pharyngeal diverticulum excision 18,800 General Surgery ENT, Surgical Oncology, SL S200061 SL027 Neck dissection SL027D Comprehensive Pharyngeal diverticulum excision 18,800 General Surgery ENT, General Surgery, Deep neck abscess drainage/ Post trauma neck SL S200068 SL028 SL028A Deep neck abscess drainage 16,800 Pediatric Surgery exploration ENT, General Surgery, Deep neck abscess drainage/ Post trauma neck SL New Package SL028 SL028B Post trauma neck exploration 16,800 Pediatric Surgery exploration ENT, Surgical Oncology, S800073, SL SL029 Anterior skull base surgery SL029A Endoscopic CSF Rhinorrhea Repair 26,000 Neurosurgery S200032 ENT, Surgical Oncology SL New Package SL029 Anterior skull base surgery SL029B Optic nerve decompression 25,500 ENT, Surgical Oncology SL New Package SL029 Anterior skull base surgery SL029C Orbital decompression 25,500 ENT, Surgical Oncology SL S200050 SL029 Anterior skull base surgery SL029D Craniofacial resection 25,500 ENT, Surgical Oncology SL New Package SL029 Anterior skull base surgery SL029E Maxillary swing 25,500 ENT, Surgical Oncology SL S200052 SL030 Advanced anterior skull base surgery SL030A Endoscopic Hypophysectomy 39,800 ENT, Surgical Oncology SL New Package SL030 Advanced anterior skull base surgery SL030B Clival tumour excision 39,800 ENT, Surgical Oncology SL New Package SL031 Lateral skull base procedures SL031A Subtotal petrosectomy 24,700 ENT, Surgical Oncology SL New Package SL031 Lateral skull base procedures SL031B Post-traumatic facial nerve decompression 24,700 ENT, Surgical Oncology SL New Package SL031 Lateral skull base procedures SL031C CSF Otorrhoea repair 24,700 ENT, Surgical Oncology SL New Package SL032 Advanced lateral skull base surgery SL032A Fisch approach 39,900 ENT, Surgical Oncology SL New Package SL032 Advanced lateral skull base surgery SL032B Translabyrinthine approach 39,900 ENT, Surgical Oncology SL New Package SL032 Advanced lateral skull base surgery SL032C Transcochlear approach 39,900 ENT, Surgical Oncology SL S100230 SL032 Advanced lateral skull base surgery SL032D Temporal Bone resection 39,900 Closed reduction / intermaxillary fixation for ENT SL S200036 SL033 SL033A Closed reduction for fracture of maxilla 9,200 fracture of maxilla / mandible / zygoma Closed reduction / intermaxillary fixation for ENT SL New Package SL033 SL033B Closed reduction for fracture of mandible 9,200 fracture of maxilla / mandible / zygoma Closed reduction / intermaxillary fixation for ENT SL New Package SL033 SL033C Closed reduction for fracture of zygoma 9,200 fracture of maxilla / mandible / zygoma Closed reduction / intermaxillary fixation for Closed reduction and Intermaxillary fixation for ENT SL New Package SL033 SL033D 9,200 fracture of maxilla / mandible / zygoma fracture of mandible

Page 18 Consolidated Master

ENT, Oral & Maxillofacial Open reduction and internal fixation of maxilla / SL S200036 SL034 SL034A Open reduction and internal fixation of maxilla 14,000 Surgery, Plastic Surgery mandible / zygoma ENT, Oral & Maxillofacial Open reduction and internal fixation of maxilla / SL New Package SL034 SL034B Open reduction and internal fixation of mandible 14,000 Surgery, Plastic Surgery mandible / zygoma ENT, Oral & Maxillofacial Open reduction and internal fixation of maxilla / SL New Package SL034 SL034C Open reduction and internal fixation of zygoma 14,000 Surgery, Plastic Surgery mandible / zygoma ENT SL New Package SL035 Clinic based therapeutic interventions of ENT SL035A Turbinate reduction 1,200 ENT SL New Package SL035 Clinic based therapeutic interventions of ENT SL035B Biopsy 1,200 ENT SL New Package SL035 Clinic based therapeutic interventions of ENT SL035C Intratympanic injections 1,200 ENT SL New Package SL035 Clinic based therapeutic interventions of ENT SL035D Wide bore aspiration 1,200 Oral & Maxillofacial SM S1600006 SM001 Extraction of impacted tooth under LA SM001A Extraction of impacted tooth under LA 500 Surgery Oral & Maxillofacial S500076, SM SM002 Sequestrectomy SM002A Sequestrectomy 1,500 Surgery S1600003 Oral & Maxillofacial SM S1600004 SM003 TM joint ankylosis of both jaws - under GA SM003A TM joint ankylosis of both jaws - under GA 15,000 Surgery Oral & Maxillofacial SM S1600001 SM004 Fixation of fracture of jaw SM004A Closed reduction (1 jaw) using wires - under LA 5,000 Surgery Oral & Maxillofacial Open reduction (1 jaw) and fixing of plates / wire – SM S1600002 SM004 Fixation of fracture of jaw SM004B 12,000 Surgery under GA Oral & Maxillofacial Enucleation / excision / marsupialization for cyst & SM S1600007 SM005 Surgery for Cyst & tumour of Maxilla / Mandible SM005A 2,500 Surgery tumour of Maxilla under LA Oral & Maxillofacial Enucleation / excision / marsupialization for cyst & SM S1600007 SM005 Surgery for Cyst & tumour of Maxilla / Mandible SM005B 2,500 Surgery tumour of Mandible under LA Oral & Maxillofacial Mandible Tumour Resection and reconstruction / Mandible Tumour Resection and reconstruction / SM S1600008 SM006 SM006A 6,000 Surgery Cancer surgery Cancer surgery Oral & Maxillofacial Release of fibrous bands & grafting - in (OSMF) Release of fibrous bands & grafting - in (OSMF) SM S1600005 SM007 SM007A 3,000 Surgery treatment under GA treatment under GA Neurosurgery SN S800047 SN001 Depressed Fracture SN001A Depressed Fracture 40,000 Neurosurgery SN S800007 SN002 CranioPlasty SN002A CranioPlasty with Endogenous graft 20,000 Neurosurgery SN S800008 SN002 CranioPlasty SN002B CranioPlasty with Exogenous graft 20,000 Neurosurgery SN S800051 SN003 Twist Drill Craniostomy SN003A Twist Drill Craniostomy 15,000 Neurosurgery SN S800009 SN004 Craniostenosis SN004A Craniostenosis 28,000 Neurosurgery SN S800019 SN005 Meningocele SN005A Anterior 36,000 Neurosurgery SN S800020 SN005 Meningocele SN005B Lumbar 36,000 Neurosurgery SN S800021 SN005 Meningocele SN005C Occipital 50,000 Neurosurgery SN S800042 SN006 Surgery for tumour meninges SN006A Gocussa 50,000 Neurosurgery SN S800043 SN006 Surgery for tumour meninges SN006B Posterior 50,000 Neurosurgery SN S800011 SN007 Duroplasty SN007A Duroplasty with Endogenous graft 12,500 Neurosurgery SN S800011 SN007 Duroplasty SN007B Duroplasty with Exogenous graft 12,500 Neurosurgery SN S800002 SN008 Burr hole surgery SN008A Burr hole 7,000 Burr hole surgery with chronic Sub Dural Neurosurgery SN S800003 SN008 Burr hole surgery SN008B 20,000 Haematoma Neurosurgery SN S800012 SN009 Surgery for Haematoma - Intracranial SN009A Head injuries 55,000 Neurosurgery SN S800013 SN009 Surgery for Haematoma - Intracranial SN009B Hypertensive 50,000 Neurosurgery SN S800014 SN009 Surgery for Haematoma - Intracranial SN009C Child - subdural 50,000 Neurosurgery SN S800059 SN010 Excision of Brain Abscess SN010A Excision of Brain Abscess 36,000 S800057, Neurosurgery SN SN011 Abscess Tapping SN011A Abscess Tapping 20,000 S800058 Neurosurgery SN S800078 SN012 Epilepsy Surgery SN012A Epilepsy Surgery 50,000 Neurosurgery SN S800045 SN013 Brain Biopsy SN013A Brain Biopsy 15,000 Neurosurgery SN S800082 SN014 Excision of Orbital Tumour SN014A Excision of Orbital Tumour 40,000 Neurosurgery SN S800052 SN015 Excision of Brain Tumor Supratentorial SN015A Parasagital 50,000 Neurosurgery SN S800053 SN015 Excision of Brain Tumor Supratentorial SN015B Basal 50,000 Neurosurgery SN S800054 SN015 Excision of Brain Tumor Supratentorial SN015C Brainstem 50,000 Neurosurgery SN S800055 SN015 Excision of Brain Tumor Supratentorial SN015D C P Angle 50,000 Neurosurgery SN S800056 SN015 Excision of Brain Tumor Supratentorial SN015E Supratentorial & others 55,000 Neurosurgery SN S800065 SN016 Stereotactic Lesioning SN016A Stereotactic Lesioning 60,000 Neurosurgery SN S800040 SN017 Trans Sphenoidal Surgery SN017A Trans Sphenoidal Surgery 50,000 Neurosurgery SN S800071 SN018 Trans oral Surgery SN018A Trans oral Surgery 40,000 Transoral surgery (Anterior) and CV Junction Transoral surgery (Anterior) and CV Junction Neurosurgery SN S800070 SN019 SN019A 55,000 (Posterior Sterilisation) (Posterior Sterilisation) External Ventricular Drainage (EVD) External Ventricular Drainage (EVD) Neurosurgery SN S800062 SN020 SN020A 30,000 including antibiotics including antibiotics Neurosurgery SN S800044 SN021 Ventricular Puncture SN021A Ventricular Puncture 15,000 Neurosurgery SN S800025 SN022 Shunt Surgery SN022A Ventriculo - peritoneal 30,000 Neurosurgery SN S800025 SN022 Shunt Surgery SN022B Ventriculo - pleural 30,000 Neurosurgery SN S800025 SN022 Shunt Surgery SN022C Ventriculo - atrial 30,000 Neurosurgery SN S800025 SN022 Shunt Surgery SN022D Theco - peritoneal 30,000 Neurosurgery SN S800060 SN023 Aneurysm Clipping including angiogram SN023A Aneurysm Clipping including angiogram 50,000 Superficial Temporal Artery (STA): middle cerebral Superficial Temporal Artery (STA): middle cerebral Neurosurgery SN S800081 SN024 SN024A 60,000 artery (MCA) or (other EC - IC) Bypass procedure artery (MCA) or (other EC - IC) Bypass procedure Neurosurgery SN S800079 SN025 Arterio venous malformation (AVM) excision SN025A Intracranial 50,000 Neurosurgery SN S800079 SN025 Arterio venous malformation (AVM) excision SN025B Intraspinal 50,000 Neurosurgery SN S800080 SN025 Arterio venous malformation (AVM) excision SN025C Scalp 25,000 Neurosurgery SN S800072 SN026 Foramen Magnum Decompression SN026A Foramen Magnum Decompression 45,000 Neurosurgery SN S800026 SN027 Skull Traction SN027A Skull Traction 8,000 Neurosurgery SN S800066 SN028 Posterior Cervical Discetomy without implant SN028A Posterior Cervical Discetomy without implant 30,000 Posterior Cervical Fusion with implant Posterior Cervical Fusion with implant Neurosurgery SN S800067 SN029 SN029A 50,000 (Lateral mass fixation) (Lateral mass fixation) Neurosurgery SN S800068 SN030 Cervical Disc Multiple level without Fusion SN030A Cervical Disc Multiple level without Fusion 40,000 S800005, Neurosurgery SN SN031 Excision of Cervical Ribs SN031A Excision of Cervical Ribs 20,000 S800006 Neurosurgery, Orthopedics SN S800069 SN032 Thoracic / Lumbar Corpectomy with fusion SN032A Thoracic Corpectomy with fusion 60,000 Neurosurgery, Orthopedics SN S800069 SN032 Thoracic / Lumbar Corpectomy with fusion SN032B Lumbar Corpectomy with fusion 60,000 Neurosurgery SN S800018 SN033 Lumbar Discectomy SN033A Lumbar Discectomy 30,000 Neurosurgery, Orthopedics SN S800016 SN034 Laminectomy SN034A Laminectomy with Fusion 40,000 Neurosurgery, Orthopedics SN S800015 SN034 Laminectomy SN034B Laminectomy with Fusion and fixation 40,000 Neurosurgery SN S800017 SN035 Neurectomy SN035A Neurectomy 16,000 Neurosurgery, ENT, Oral & SN S800049 SN035 Neurectomy SN035B Neurectomy - Trigeminal 16,500 Maxillofacial Surgery Neurosurgery SN S800022 SN036 Micro discectomy SN036A Cervical 40,000 Neurosurgery SN S800023 SN036 Micro discectomy SN036B Lumbar 40,000 Neurosurgery SN S800027 SN037 Surgery for Spinal Canal Stenosis SN037A Surgery for Spinal Canal Stenosis 40,000 Neurosurgery, Orthopedics SN S800028 SN038 Spine - Decompression & Fusion SN038A Spine - Decompression & Fusion 40,000 Neurosurgery, Orthopedics SN S800029 SN038 Spine - Decompression & Fusion SN038B Spine - Decompression & Fusion with fixation 40,000 Neurosurgery SN S800032 SN039 Spine - Extradural Haematoma SN039A Spine - Extradural Haematoma 30,000 Neurosurgery SN S800033 SN039 Spine - Extradural Haematoma SN039B Spine - Extradural Haematoma with fixation 30,000 Neurosurgery SN S800036 SN040 Spine - Intradural Haematoma SN040A Spine - Intradural Haematoma 40,000 Neurosurgery SN S800037 SN040 Spine - Intradural Haematoma SN040B Spine - Intradural Haematoma with fixation 40,000 Neurosurgery SN S800030 SN041 Spine - Extradural Tumour SN041A Spine - Extradural Tumour 30,000 Neurosurgery SN S800031 SN041 Spine - Extradural Tumour SN041B Spine - Extradural Tumour with fixation 30,000 Neurosurgery SN S800034 SN042 Spine - Intradural Tumour SN042A Spine - Intradural Tumour 40,000

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Neurosurgery SN S800035 SN042 Spine - Intradural Tumour SN042B Spine - Intradural Tumour with fixation 40,000 Neurosurgery SN S800038 SN043 Spine - Intramedullar Tumour SN043A Spine - Intramedullar Tumour 50,000 Neurosurgery SN S800039 SN043 Spine - Intramedullar Tumour SN043B Spine - Intramedullar Tumour with fixation 50,000 Neurosurgery SN S800050 SN044 R. F. Lesioning for Trigeminal Neuralgia SN044A R. F. Lesioning for Trigeminal Neuralgia 16,500 Neurosurgery SN S800024 SN045 Brachial Plexus – Repair SN045A Brachial Plexus – Repair 27,000 Neurosurgery, Orthopedics SN S800004 SN046 Carpal Tunnel Release SN046A Carpal Tunnel Release 10,000 Neurosurgery SN S800075 SN047 Nerve Decompression SN047A Nerve Decompression 16,000 Neurosurgery SN S800046 SN048 Cranial Nerve Anastomosis SN048A Cranial Nerve Anastomosis 32,000 Neurosurgery SN S800077 SN049 Peripheral Nerve Surgery SN049A Minor 15,000 Neurosurgery SN S800076 SN049 Peripheral Nerve Surgery SN049B Major 30,000 Neurosurgery SN S800048 SN050 Nerve Biopsy excluding Hensens SN050A Nerve Biopsy excluding Hensens 7,000 Neurosurgery SN S800074 SN051 Muscle Biopsy with report SN051A Muscle Biopsy with report 7,000 Neurosurgery SN S800001 SN052 Anterior Encephalocele SN052A Anterior Encephalocele 50,000 Neurosurgery SN S800064 SN053 Spina Bifida Surgery SN053A Spina Bifida Surgery 36,000 Gamma Knife radiosurgery (GKRS) / SRS for Gamma Knife radiosurgery (GKRS) / SRS for Neurosurgery SN S800083 SN054 SN054A 75,000 tumours / Arteriovenous malformation (AVM) tumours / Arteriovenous malformation (AVM) Obstetrics & Gynecology SO New Package SO001 Lap. Salpingo-oophrectomy SO001A Lap. Salpingo-oophrectomy 14,000 Obstetrics & Gynecology, Laparotomy and proceed for Ovarian Cancers. Laparotomy and proceed for Ovarian Cancers. Surgical Oncology, Pediatric SO S400008 SO002 SO002A 38,000 Omentomy with Bilateral Salpingo-oophorectomy Omentomy with Bilateral Salpingo-oophorectomy Surgery Laparoscopic tubal surgeries Laparoscopic tubal surgeries Obstetrics & Gynecology SO S400028 SO003 SO003A 13,900 (for any indication including ectopic pregnancy) (for any indication including ectopic pregnancy) Procedure on Fallopian Tube for establishing Tubal Procedure on Fallopian Tube for establishing Tubal Obstetrics & Gynecology SO New Package SO004 SO004A 11,600 Patency Patency Obstetrics & Gynecology SO S400051 SO005 Laparotomy for broad ligament haematoma SO005A Laparotomy for broad ligament haematoma 16,000 Obstetrics & Gynecology SO S400002 SO006 Abdominal Myomectomy SO006A Abdominal Myomectomy 20,000 Obstetrics & Gynecology SO S400030 SO007 Hysteroscopic myomectomies SO007A Hysteroscopic myomectomies 9,900 Obstetrics & Gynecology SO S200001 SO008 Polypectomy SO008A Polypectomy 1,500 Obstetrics & Gynecology SO S400032 SO009 Hysteroscopic polypectomy SO009A Hysteroscopic polypectomy 7,200 Obstetrics & Gynecology, SO New Package SO010 Hysterectomy SO010A Abdominal Hysterectomy 20,000 Surgical Oncology Obstetrics & Gynecology, SO S400001 SO010 Hysterectomy SO010B Abdominal Hysterectomy + Salpingo-oophorectomy 20,000 Surgical Oncology Obstetrics & Gynecology SO S400009 SO010 Hysterectomy SO010C Non descent vaginal hysterectomy 20,000 Vaginal hysterectomy with anterior and posterior Obstetrics & Gynecology SO S400010 SO010 Hysterectomy SO010D 20,000 colpoperineorrhaphy Obstetrics & Gynecology, SO S400023 SO010 Hysterectomy SO010E Laparoscopic hysterectomy (TLH) 20,000 Pediatric Surgery Obstetrics & Gynecology, Laparoscopically assisted vaginal hysterectomy SO New Package SO010 Hysterectomy SO010F 20,000 Pediatric Surgery (LAVH) Obstetrics & Gynecology SO S400035 SO011 Caesarean hysterectomy SO011A Caesarean hysterectomy 20,000 Obstetrics & Gynecology SO New Package SO012 Manchester Repair SO012A Manchester Repair 15,000 Obstetrics & Gynecology SO S400003 SO013 Surgeries for Prolapse - Sling Surgeries SO013A Surgeries for Prolapse - Sling Surgeries 28,900 Obstetrics & Gynecology SO New Package SO014 Hysterotomy SO014A Hysterotomy 5,000 Lap. Surgery for Endometriosis Lap. Surgery for Endometriosis Obstetrics & Gynecology SO New Package SO015 SO015A 11,200 (Other than Hysterectomy) (Other than Hysterectomy) Obstetrics & Gynecology SO S400029 SO016 Diagnostic hysteroscopy SO016A With biopsy 6,000 Obstetrics & Gynecology SO S400029 SO016 Diagnostic hysteroscopy SO016B Without biopsy 6,000 Obstetrics & Gynecology SO S400033 SO017 Hysteroscopic IUCD removal SO017A Hysteroscopic IUCD removal 4,700 Obstetrics & Gynecology SO S400068 SO018 D&C (Dilatation&curretage) SO018A D&C (Dilatation&curretage) 3,000 Obstetrics & Gynecology SO S400017 SO019 Dilation and Evacuation (D&E) SO019A Dilation and Evacuation (D&E) 5,000 Obstetrics & Gynecology SO New Package SO020 Pyometra drainage SO020A Pyometra drainage 5,000 Obstetrics & Gynecology SO S400079 SO021 Intrauterine transfusions SO021A Intrauterine transfusions 11,000 Obstetrics & Gynecology SO S400031 SO022 Hysteroscopic adhesiolysis SO022A Hysteroscopic adhesiolysis 6,900 S400027, Obstetrics & Gynecology SO SO023 Laparoscopic adhesiolysis SO023A Laparoscopic adhesiolysis 6,000 S100179 Obstetrics & Gynecology SO S400052 SO024 Trans - vaginal tape / Trans-obturator tape SO024A Trans-vaginal tape 15,200 Obstetrics & Gynecology SO S400052 SO024 Trans - vaginal tape / Trans-obturator tape SO024B Trans-obturator tape 15,200 Obstetrics & Gynecology, SO S400012 SO025 Sacrocolpopexy (Abdominal) SO025A Open 23,900 Urology Obstetrics & Gynecology, SO S400012 SO025 Sacrocolpopexy (Abdominal) SO025B Lap. 23,900 Urology Obstetrics & Gynecology SO S400015 SO026 LLETZ (including PAP smear and colposcopy) SO026A LLETZ (including PAP smear and colposcopy) 9,900 Obstetrics & Gynecology SO New Package SO027 Vaginal Sacrospinus fixation with repair SO027A Vaginal Sacrospinus fixation with repair 15,000 Obstetrics & Gynecology SO S400074 SO028 Excision of Vaginal Septum (vaginal route) SO028A Excision of Vaginal Septum (vaginal route) 14,500 Obstetrics & Gynecology, SO S400075 SO029 Hymenectomy for imperforate hymen SO029A Hymenectomy for imperforate hymen 3,000 Pediatric Surgery Obstetrics & Gynecology SO New Package SO030 Anterior & Posterior Colpoperineorrhapy SO030A Anterior & Posterior Colpoperineorrhapy 8,000 Obstetrics & Gynecology SO S400014 SO031 Vaginoplasty (McIndoe procedure) SO031A Vaginoplasty (McIndoe procedure) 11,000 Obstetrics & Gynecology, SO S400011 SO032 Vaginal repair for vesico-vaginal fistula SO032A Vaginal repair for vesico-vaginal fistula 34,000 Urology Obstetrics & Gynecology, SO S400013 SO033 Rectovaginal fistula repair SO033A Rectovaginal fistula repair 24,000 Pediatric Surgery Obstetrics & Gynecology SO New Package SO034 Vulval Hamatoma drainage SO034A Vulval Hamatoma drainage 3,000 Obstetrics & Gynecology, SO S400020 SO035 Vulvectomy simple SO035A Vulvectomy simple 15,000 Surgical Oncology Obstetrics & Gynecology, Radical Vulvectomy with Inguinal and Pelvic Radical Vulvectomy with Inguinal and Pelvic SO S1500044 SO036 SO036A 38,500 Surgical Oncology lymph node disection lymph node disection Obstetrics & Gynecology SO New Package SO037 Abdomino Perineal repair for Mullerian Anomaly SO037A Abdomino Perineal repair for Mullerian Anomaly 20,000 Obstetrics & Gynecology SO S100105 SO038 Pelvic Abscess Management including Colpotomy SO038A Pelvic Abscess Management including Colpotomy 1,200 Obstetrics & Gynecology, Pediatric Surgery, Surgical SO S400022 SO039 Diagnostic / Staging laparoscopy SO039A Diagnostic / Staging laparoscopy 9,700 Oncology Obstetrics & Gynecology SO S400044 SO040 Laparotomy for benign disorders SO040A Ectopic 14,000 Obstetrics & Gynecology SO New Package SO040 Laparotomy for benign disorders SO040B PID 14,000 Obstetrics & Gynecology SO S400025 SO041 Laparoscopic cystectomy SO041A Laparoscopic cystectomy 15,000 Obstetrics & Gynecology SO S400065 SO042 Cystocele - Anterior repair SO042A Cystocele - Anterior repair 6,000 Obstetrics & Gynecology SO S400004 SO043 Burch SO043A Abdominal 30,000 Obstetrics & Gynecology SO S400004 SO043 Burch SO043B Laparoscopic 30,000 Obstetrics & Gynecology SO S400070 SO044 Electro Cauterisation / Cryo Surgery SO044A Electro Cauterisation / Cryo Surgery 4,000 EUA for (minor girls / unmarried sexually inactive / EUA for (minor girls / unmarried sexually inactive / Obstetrics & Gynecology SO New Package SO045 SO045A 2,000 victims of sexual abuse) victims of sexual abuse) Obstetrics & Gynecology SO New Package SO046 Hospitalisation for Antenatal Complications SO046A Hospitalisation for Antenatal Complications 1,800 Obstetrics & Gynecology SO S400076 SO047 Amniocentesis SO047A Amniocentesis 14,500 Obstetrics & Gynecology SO S400077 SO048 Chorionic villus sampling SO048A Chorionic villus sampling 14,500 Obstetrics & Gynecology SO S400078 SO049 Cordocentesis SO049A Cordocentesis 14,500 Obstetrics & Gynecology SO S400048 SO050 McDonald's stitch SO050A McDonald's stitch 4,000 Obstetrics & Gynecology SO S400049 SO051 Shirodkar's stitch SO051A Shirodkar's stitch 4,000 Obstetrics & Gynecology SO New Package SO052 Medical management of ectopic pregnancy SO052A Medical management of ectopic pregnancy 1,800 Obstetrics & Gynecology SO S400047 SO053 Medical Termination of Pregnancy SO053A MTP upto 8 weeks 3,500 Obstetrics & Gynecology SO S400046 SO053 Medical Termination of Pregnancy SO053B MTP 8 to 12 weeks 5,000 Obstetrics & Gynecology SO S400045 SO053 Medical Termination of Pregnancy SO053C MTP > 12 weeks 6,500 Obstetrics & Gynecology SO S400036 SO054 High risk delivery SO054A Pre-mature delivery 11,500

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Mothers with eclampsia / imminent eclampsia / Obstetrics & Gynecology SO S400038 SO054 High risk delivery SO054B 11,500 severe pre-eclampsia Major Fetal malformation requiring intervention Obstetrics & Gynecology SO S400040 SO054 High risk delivery SO054C 11,500 immediately after birth Obstetrics & Gynecology SO S400041 SO054 High risk delivery SO054D Mothers with severe anaemia (<7 g/dL) 11,500 Other maternal and fetal conditions as per guidelines-eg previous caesarean section, diabetes, Obstetrics & Gynecology SO S400042 SO054 High risk delivery SO054E 11,500 severe growth retardation, etc that qualify for high risk delivery. Obstetrics & Gynecology SO S400043 SO055 Manual removal of placenta SO055A Manual removal of placenta 8,500 Obstetrics & Gynecology SO S400073 SO056 Secondary suturing of episiotomy SO056A Secondary suturing of episiotomy 2,500 Obstetrics & Gynecology SO S400034 SO057 Caesarean Delivery SO057A Caesarean Delivery 11,500 Obstetrics & Gynecology SO New Package SO058 Re exploration after laparotomy / Caesarean Section SO058A Re exploration after Caesarean Section 14,000

Obstetrics & Gynecology SO New Package SO058 Re exploration after laparotomy / Caesarean Section SO058B Re exploration after laparotomy 14,000 Obstetrics & Gynecology SO S400063 SO059 Vulvo vaginal cyst enucleation / drainage SO059A Vulvo vaginal cyst enucleation 4,700 Obstetrics & Gynecology SO New Package SO059 Vulvo vaginal cyst enucleation / drainage SO059B Vulvo vaginal cyst drainage 4,700 Plastic & Reconstructive SP S1000008 SP001 Pressure Sore – Surgery SP001A Pressure Sore – Surgery 30,000 Surgery Plastic & Reconstructive SP S1000009 SP002 Diabetic Foot – Surgery SP002A Diabetic Foot – Surgery 30,000 Surgery Plastic & Reconstructive SP S1000002 SP003 Revascularization of limb / digit SP003A Revascularization of limb / digit 25,000 Surgery Ear Pinna Reconstruction with costal cartilage / Ear Pinna Reconstruction with costal cartilage / Plastic & Reconstructive SP S1000001 SP004 Prosthesis SP004A Prosthesis 30,000 Surgery (including the cost of prosthesis / implants) (including the cost of prosthesis / implants) Plastic & Reconstructive SP S1000006 SP005 Scalp avulsion reconstruction SP005A Scalp avulsion reconstruction 50,000 Surgery Tissue Expander for disfigurement following burns Plastic & Reconstructive SP S1000005 SP006 / trauma / congenital deformity SP006A Tissue Expander for disfigurement following burns 50,000 Surgery (including cost of expander / implant) Tissue Expander for disfigurement following burns Plastic & Reconstructive Tissue Expander for disfigurement following SP S1000005 SP006 / trauma / congenital deformity SP006B 50,000 Surgery trauma (including cost of expander / implant) Tissue Expander for disfigurement following burns Plastic & Reconstructive Tissue Expander for disfigurement following SP S1000005 SP006 / trauma / congenital deformity SP006C 50,000 Surgery congenital deformity (including cost of expander / implant) Plastic & Reconstructive SP S1000003 SP007 Hemangioma SP007A Sclerotherapy under GA 35,000 Surgery Plastic & Reconstructive SP S1000004 SP007 Hemangioma SP007B Debulking 35,000 Surgery S1000004, Plastic & Reconstructive SP S100067, SP007 Hemangioma SP007C Excision 35,000 Surgery S100068 Plastic & Reconstructive SP S1000007 SP008 NPWT SP008A NPWT 2,000 Surgery S1400034, Pediatric Surgery, Oral & S100145, Maxillofacial Surgery, SS S100146, SS001 Cleft Lip and Palate Surgery (per stage) SS001A Cleft Lip and Palate Surgery (per stage) 15,000 Plastic & Reconstructive S100147, Surgery S1600009 Pediatric Surgery SS S1400002 SS002 Ankyloglossia SS002A Ankyloglossia Minor 5,000 Pediatric Surgery SS S1400001 SS002 Ankyloglossia SS002B Ankyloglossia Major 15,000 Pediatric Surgery SS S1400016 SS003 Anti GERD Surgery SS003A Anti GERD Surgery 10,000 Pediatric Surgery SS S1400019 SS004 Gastrostomy + Esophagoscopy + Threading SS004A Gastrostomy + Esophagoscopy + Threading 20,000 Pediatric Surgery SS S1400028 SS005 Ladds Procedure SS005A Ladds Procedure 30,000 Pediatric Surgery SS S1400017 SS006 Duplication Cyst Excision SS006A Duplication Cyst Excision 20,000 Pediatric Surgery SS S1400026 SS007 Intussusception SS007A Non – Operative Reduction in infants 20,000 S1400027, Pediatric Surgery SS SS007 Intussusception SS007B Operative in infants 25,000 S100087 Pediatric Surgery SS S1400021 SS008 Surgery for Hirschsprung’s Disease SS008A Myectomy 25,000 Pediatric Surgery SS S1400022 SS008 Surgery for Hirschsprung’s Disease SS008B Pull Through 20,000 Pediatric Surgery SS S1400023 SS008 Surgery for Hirschsprung’s Disease SS008C Rectal Biopsy - Punch 10,000 Pediatric Surgery SS S1400024 SS008 Surgery for Hirschsprung’s Disease SS008D Rectal Biopsy – Open 10,000 Pediatric Surgery SS S1400025 SS008 Surgery for Hirschsprung’s Disease SS008E Sphinecterotomy 15,000 Pediatric Surgery SS S1400029 SS009 Rectal Polypectomy - Sigmoiescopic Under GA SS009A Rectal Polypectomy - Sigmoiescopic Under GA 8,000 Pediatric Surgery SS S1400010 SS010 Ano Rectal Malformation SS010A Abd - Perineal PSARP 20,000 Pediatric Surgery SS S1400011 SS010 Ano Rectal Malformation SS010B Anoplasty 20,000 Pediatric Surgery SS S1400012 SS010 Ano Rectal Malformation SS010C Cutback 20,000 Pediatric Surgery SS S1400013 SS010 Ano Rectal Malformation SS010D PSARP 20,000 Pediatric Surgery SS S1400014 SS010 Ano Rectal Malformation SS010E Redo - Pullthrough 15,000 Pediatric Surgery SS S500063 SS010 Ano Rectal Malformation SS010F Transposition 15,000 Pediatric Surgery SS S1400018 SS011 Fecal Fistula Closure SS011A Fecal Fistula Closure 25,000 Pediatric Surgery SS S1400020 SS012 GI Tumor Excision SS012A GI Tumor Excision 30,000 Pediatric Surgery SS S1400031 SS013 Congenital Diaphragmatic Hernia SS013A Congenital Diaphragmatic Hernia 25,000 Pediatric Surgery SS S1400033 SS014 Exomphalos / Gastroschisis SS014A Exomphalos 25,000 Pediatric Surgery SS S1400033 SS014 Exomphalos / Gastroschisis SS014B Gastroschisis 25,000 Pediatric Surgery SS S1400003 SS015 Hernia & Hydrocele SS015A Hernia & Hydrocele 20,000 Pediatric Surgery SS S1400030 SS016 Retro - Peritoneal Lymphangioma Excision SS016A Retro - Peritoneal Lymphangioma Excision 25,000 Pediatric Surgery SS S1400004 SS017 Surgery for Sacrococcygeal Teratoma SS017A Surgery for Sacrococcygeal Teratoma 20,000 Pediatric Surgery SS S1400032 SS018 Surgery for Congenital Lobar Emphysema SS018A Surgery for Congenital Lobar Emphysema 25,000 Pediatric Surgery SS S1400005 SS019 Undescended Testis SS019A Bilateral - Palpable + Nonpalpable 15,000 Pediatric Surgery SS S1400006 SS019 Undescended Testis SS019B Bilateral Palpable 15,000 Pediatric Surgery SS S1400007 SS019 Undescended Testis SS019C Bilateral Non - Palpable 20,000 Pediatric Surgery SS S1400009 SS019 Undescended Testis SS019D Unilateral - Palpable 15,000 Pediatric Surgery SS S1400008 SS019 Undescended Testis SS019E Reexploration / Second Stage 20,000 Polytrauma, Orthopedics, Neurosurgery, General ST New Package ST001 Conservative Management of Head Injury ST001A Severe 1,000 Surgery Polytrauma, Orthopedics, Neurosurgery, General ST S800047 ST001 Conservative Management of Head Injury ST001B Depressed Fracture 5,000 Surgery Polytrauma, Orthopedics, Neurosurgery, General Head injury with repair of Facio-Maxillary Injury & Head injury with repair of Facio-Maxillary Injury & ST S600004 ST002 ST002A 31,000 Surgery, Oral & fixations (including implants) fixations (including implants) Maxillofacial Surgery Polytrauma, Orthopedics, Craniotomy and evacuation of Haematoma with Subdural hematoma along with fixation of fracture Neurosurgery, General ST S600006 ST003 ST003A 60,000 fixation of fracture of long bone of single long bone Surgery Polytrauma, Orthopedics, Craniotomy and evacuation of Haematoma with Extradural hematoma along with fixation of fracture Neurosurgery, General ST S600006 ST003 ST003B 60,000 fixation of fracture of long bone of single long bone Surgery

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Polytrauma, Orthopedics, Craniotomy and evacuation of Haematoma with Subdural hematoma along with fixation of fracture Neurosurgery, General ST S600007 ST003 ST003C 75,000 fixation of fracture of long bone of 2 or more long bone. Surgery Polytrauma, Orthopedics, Craniotomy and evacuation of Haematoma with Extradural hematoma along with fixation of fracture Neurosurgery, General ST S600007 ST003 ST003D 75,000 fixation of fracture of long bone of 2 or more long bone. Surgery Polytrauma, Orthopedics, Management of Chest injury with fracture of Long Management of Chest injury with fixation of Single Neurosurgery, General ST S600010 ST004 ST004A 30,000 bone Long bone Surgery Polytrauma, Orthopedics, Management of Chest injury with fracture of Long Management of Chest injury with fixation of 2 or Neurosurgery, General ST S600011 ST004 ST004B 45,000 bone more Long bones Surgery Polytrauma, Orthopedics, Management of Visceral injury and fracture long Surgical intervention for Visceral injury and Neurosurgery, General ST S600008 ST005 ST005A 30,000 bone fixation of fracture of single long bone Surgery Polytrauma, Orthopedics, Management of Visceral injury and fracture long Surgical intervention for Visceral injury and Neurosurgery, General ST S600009 ST005 ST005B 45,000 bone fixation of fracture of 2 or more long bones Surgery Polytrauma, Orthopedics, Neurosurgery, General ST S600005 ST006 Internal fixation of Pelviacetabular fracture ST006A Internal fixation of Pelviacetabular fracture 40,000 Surgery Polytrauma, Orthopedics, Internal fixation with Flap cover Surgery for wound Internal fixation with Flap cover Surgery for wound Neurosurgery, General ST S600003 ST007 ST007A 40,000 in compound fracture in compound fracture Surgery Polytrauma, Orthopedics, Emergency tendons repair ± Peripheral Nerve Emergency tendons repair ± Peripheral Nerve Neurosurgery, General ST S600012 ST008 ST008A 30,000 repair/ reconstructive surgery repair/ reconstructive surgery Surgery Polytrauma, Orthopedics, Neurosurgery, General ST S600001 ST009 Management of Nerve Plexus / Tendon injuries ST009A Nerve Plexus injury repair 50,000 Surgery Polytrauma, Orthopedics, Neurosurgery, General ST S600001 ST009 Management of Nerve Plexus / Tendon injuries ST009B Nerve Plexus injury reconstruction 50,000 Surgery Polytrauma, Orthopedics, Neurosurgery, General ST S600001 ST009 Management of Nerve Plexus / Tendon injuries ST009C Tendon injury repair 50,000 Surgery Polytrauma, Orthopedics, Neurosurgery, General ST S600001 ST009 Management of Nerve Plexus / Tendon injuries ST009D Tendon injury reconstruction 50,000 Surgery Polytrauma, Orthopedics, Neurosurgery, General ST S600001 ST009 Management of Nerve Plexus / Tendon injuries ST009E Tendon Transfer 50,000 Surgery Polytrauma, Orthopedics, Plexus injury along with Vascular injury repair / Neurosurgery, General ST S600002 ST010 ST010A Plexus injury along with Vascular injury repair 60,000 graft Surgery Polytrauma, Orthopedics, Plexus injury along with Vascular injury repair / Neurosurgery, General ST S600002 ST010 ST010B Plexus injury along with Vascular injury graft 60,000 graft Surgery S700001, Urology & Pediatric Surgery SU SU001 Adrenalectomy SU001A Open 27,500 S700003 S700002, Urology & Pediatric Surgery SU SU001 Adrenalectomy SU001B Lap. 27,500 S700004 Urology, Pediatric Surgery SU S700034 SU002 Renal Cyst deroofing or Marsupialization SU002A Open 25,000 Urology, Pediatric Surgery SU S700035 SU002 Renal Cyst deroofing or Marsupialization SU002B Lap. 25,000 Urology, Pediatric Surgery, SU S700006 SU003 Nephrectomy SU003A For Benign pathology - Open 27,500 Surgical Oncology Urology, Pediatric Surgery, SU S700007 SU003 Nephrectomy SU003B For Benign pathology - Lap. 27,500 Surgical Oncology Urology, Pediatric Surgery, SU S700008 SU003 Nephrectomy SU003C Radical (Renal tumor) - Open 27,500 Surgical Oncology Urology, Pediatric Surgery, SU S700009 SU003 Nephrectomy SU003D Radical (Renal tumor) - Lap. 27,500 Surgical Oncology Urology, Pediatric Surgery, SU S700010 SU004 Nephrectomy - Partial or Hemi SU004A Open 42,000 Surgical Oncology Urology, Pediatric Surgery, SU S700011 SU004 Nephrectomy - Partial or Hemi SU004B Lap. 42,000 Surgical Oncology Urology SU S700030 SU005 Nephrolithotomy SU005A Open 30,000 Urology SU S700031 SU005 Nephrolithotomy SU005B Anatrophic 30,000 Urology SU New Package SU006 Open Nephrolithotomy - Follow Up SU006A Open Nephrolithotomy - Follow Up 1,000 S700024, Urology SU SU007 PCNL (Percutaneous Nephrolithotomy) SU007A PCNL (Percutaneous Nephrolithotomy) 35,000 S700025 Urology, Pediatric Surgery, SU S700036 SU008 Nephrostomy - Percutaneous ultrasound guided SU008A Nephrostomy - Percutaneous ultrasound guided 14,000 Interventional Radiology Urology SU New Package SU009 Nephrostomy (PCN) - Follow Up SU009A Nephrostomy (PCN) - Follow Up 1,200 Urology, Pediatric Surgery, SU S700012 SU010 Nephro ureterectomy (Benign) SU010A Open 27,500 Surgical Oncology Urology, Pediatric Surgery, SU S700013 SU010 Nephro ureterectomy (Benign) SU010B Lap. 27,500 Surgical Oncology Urology, Pediatric Surgery, SU S700014 SU011 Nephro ureterectomy with cuff of bladder SU011A Open 27,500 Surgical Oncology Urology, Pediatric Surgery, SU S700015 SU011 Nephro ureterectomy with cuff of bladder SU011B Lap. 27,500 Surgical Oncology Urology SU S700033 SU013 Perinephric Abscess drainage SU013A Open 14,000 Urology SU S700032 SU013 Perinephric Abscess drainage SU013B Percutaneous 14,000 S700039, Urology SU SU014 Ureteroscopy + Stone removal with lithotripsy SU014A Lower Ureter 28,000 S700041 S700040, Urology SU SU014 Ureteroscopy + Stone removal with lithotripsy SU014B Upper Ureter 28,000 S700041 Urology SU New Package SU015 URSL / URSL - Laser - Follow Up SU015A URSL / URSL - Laser - Follow Up 1,000 S700026, Extracoporeal shock - wave Lithotripsy (ESWL) Urology SU SU016 Extracoporeal shock - wave Lithotripsy (ESWL) SU016A 18,500 S700027 stone, with or without stent (one side) Urology SU New Package SU017 ESWL - Follow Up SU017A ESWL - Follow Up 1,000 Urology, Pediatric Surgery SU S700037 SU018 Ureterolithotomy SU018A Open 20,000 Urology, Pediatric Surgery SU S700038 SU018 Ureterolithotomy SU018B Lap. 20,000 Urology SU New Package SU019 Lap Ureterolithotomy - Follow Up SU019A Lap Ureterolithotomy - Follow Up 1,000 Urology SU New Package SU020 Open Ureterolithotomy - Follow Up SU020A Open Ureterolithotomy - Follow Up 1,000 Urology, Pediatric Surgery SU S700016 SU021 Pyeloplasty / Pyeloureterostomy / Pyelopyelostomy SU021A Pyeloplasty - Open 27,500

Urology, Pediatric Surgery SU S700017 SU021 Pyeloplasty / Pyeloureterostomy / Pyelopyelostomy SU021B Pyeloplasty - Laparoscopic 27,500

Urology, Pediatric Surgery SU S700016 SU021 Pyeloplasty / Pyeloureterostomy / Pyelopyelostomy SU021C Pyeloureterostomy - Open 27,500

Urology, Pediatric Surgery SU S700017 SU021 Pyeloplasty / Pyeloureterostomy / Pyelopyelostomy SU021D Pyeloureterostomy - Laparoscopic 27,500

Page 22 Consolidated Master

Urology, Pediatric Surgery SU S700016 SU021 Pyeloplasty / Pyeloureterostomy / Pyelopyelostomy SU021E Pyelopyelostomy - Open 27,500

Urology, Pediatric Surgery SU S700017 SU021 Pyeloplasty / Pyeloureterostomy / Pyelopyelostomy SU021F Pyelopyelostomy - Laparoscopic 27,500 Urology SU New Package SU022 Pyeloplasty SU022A Pyeloplasty - Follow Up 1,500 Urology, Pediatric Surgery SU S700020 SU023 Ureterocalycostomy SU023A Ureterocalycostomy - Open 25,000 Urology, Pediatric Surgery SU S700021 SU023 Ureterocalycostomy SU023B Ureterocalycostomy - Laparoscopic 25,000 Urology, Pediatric Surgery SU S700028 SU024 Pyelolithotomy SU024A Open 28,000 Urology, Pediatric Surgery SU S700029 SU024 Pyelolithotomy SU024B Lap. 28,000 Internal Ureterotomy including cystoscopy as an Internal Ureterotomy including cystoscopy as an Urology SU S700123 SU025 SU025A 10,000 independent procedure independent procedure Ureterolysis for retroperitoneal fibrosis Urology SU S700050 SU026 SU026A Open 28,000 (with or without omental wrapping) Ureterolysis for retroperitoneal fibrosis Urology SU S700051 SU026 SU026B Lap. 28,000 (with or without omental wrapping) Urology, Pediatric Surgery SU S700042 SU027 Ureterostomy SU027A Ureterostomy (Cutaneous) 20,000 Urology, Pediatric Surgery SU S700022 SU028 Uretero-ureterostomy SU028A Open 25,000 Urology, Pediatric Surgery SU S700023 SU028 Uretero-ureterostomy SU028B Lap. 25,000 Urology , Obstetrics & SU S700048 SU029 Uretero-vaginal / Uterine fistula repair SU029A Uretero - vaginal fistula repair - Open 25,000 Gynecology Urology , Obstetrics & SU S700048 SU029 Uretero-vaginal / Uterine fistula repair SU029B Uretero - Uterine fistula repair - Open 25,000 Gynecology Urology , Obstetrics & SU S700049 SU029 Uretero-vaginal / Uterine fistula repair SU029C Uretero - vaginal fistula repair - Laparoscopic 25,000 Gynecology Urology , Obstetrics & SU S700049 SU029 Uretero-vaginal / Uterine fistula repair SU029D Uretero - Uterine fistula repair - Laparoscopic 25,000 Gynecology S700044, Urology, Pediatric Surgery SU SU030 Ureteric reimplantation SU030A Open 23,000 S700045 S700046, Urology, Pediatric Surgery SU SU030 Ureteric reimplantation SU030B Lap. 23,000 S700047 Urology SU S700052 SU031 Boari flap for ureteric stricture SU031A Open 30,000 Urology SU S700053 SU031 Boari flap for ureteric stricture SU031B Lap. 30,000 Urology SU S700054 SU032 Ileal replacement for ureteric stricture SU032A Ileal replacement for ureteric stricture 46,000 S700055, DJ stenting including cystoscopy, ureteric DJ stenting including cystoscopy, ureteric Urology, Pediatric Surgery SU SU033 SU033A 9,800 S700056 catheterization, retrograde pyelogram catheterization, retrograde pyelogram Urology SU New Package SU034 DJ Stent Removal SU034A DJ Stent Removal 5,000 Ureterocele incision including cystoscopy, ureteric Ureterocele incision including cystoscopy, ureteric Urology SU S700058 SU035 SU035A 15,000 catheterization, retrograde pyelogram catheterization, retrograde pyelogram Ureteric sampling including cystoscopy, ureteric Ureteric sampling including cystoscopy, ureteric Urology SU S700057 SU036 SU036A 11,000 catheterization, retrograde pyelogram catheterization, retrograde pyelogram Acute management of upper urinary tract trauma – Acute management of upper urinary tract trauma – Urology, Pediatric Surgery SU S700159 SU037 SU037A 2,000 conservative conservative Urology SU S700018 SU038 Endopyelotomy SU038A Retrograde with laser / bugbee 25,000 Urology SU S700019 SU038 Endopyelotomy SU038B Antegrade with laser / bugbee 25,000 Urology SU New Package SU039 Open Pyelolithotomy - Follow Up SU039A Open Pyelolithotomy - Follow Up 1,200 Urology, Pediatric Surgery SU S700060 SU040 Cystolithotomy - Open, including cystoscopy SU040A Open - including cystoscopy 18,500 Cystolithotripsy / Urethral Stone endoscopic, Urology, Pediatric Surgery SU S700061 SU041 SU041A Cystolithotripsy endoscopic, including cystoscopy 18,500 including cystoscopy Cystolithotripsy / Urethral Stone endoscopic, Urethral Stone removal endoscopic, including Urology, Pediatric Surgery SU S700061 SU041 SU041B 18,500 including cystoscopy cystoscopy Urology, Pediatric Surgery SU S700067 SU042 Diagnostic Cystoscopy SU042A Diagnostic Cystoscopy 6,500 Urology, Surgical Oncology, SU S700073 SU043 Partial Cystectomy SU043A Open 23,000 Pediatric Surgery

Urology, Surgical Oncology, SU S700074 SU043 Partial Cystectomy SU043B Lap. 23,000 Pediatric Surgery Urology SU New Package SU044 Partial Cystectomy - Follow Up SU044A Partial Cystectomy - Follow Up 1,000 Urology, Pediatric Surgery SU S700089 SU045 Augmentation cystoplasty SU045A Open 30,000 Urology, Pediatric Surgery SU S700090 SU045 Augmentation cystoplasty SU045B Lap. 30,000 Urology SU New Package SU046 Deflux for VUR SU046A Deflux for VUR 1,200 Urology SU New Package SU047 Bladder Diverticulectomy SU047A Bladder Diverticulectomy - Follow Up 1,000 Open bladder diverticulectomy with / without Open bladder diverticulectomy with / without Urology, Pediatric Surgery SU S700091 SU048 SU048A 25,000 ureteric re-implantation ureteric re-implantation Bladder injury repair Bladder injury repair Urology, Pediatric Surgery SU S700070 SU049 SU049A 23,000 (with or without urethral injury) (with or without urethral injury) Bladder injury repair with colostomy Bladder injury repair with colostomy Urology, Pediatric Surgery SU S700072 SU050 SU050A 27,500 (with or without urethral injury) (with or without urethral injury) Extrophy Bladder repair including osteotomy if Extrophy Bladder repair including osteotomy if Urology, Pediatric Surgery SU S700069 SU051 SU051A 65,000 needed + epispadias repair + ureteric reimplant needed + epispadias repair + ureteric reimplant Neurogenic bladder - Package for evaluation / Neurogenic bladder - Package for evaluation / Urology, Pediatric Surgery SU S700154 SU052 investigation (catheter + ultrasound + culture + SU052A investigation (catheter + ultrasound + culture + 14,300 RGU/ MCU) for 1 month (medicines - antibiotics) RGU/ MCU) for 1 month (medicines - antibiotics) Y V Plasty of Bladder Neck / Bladder Neck Y V Plasty of Bladder Neck / Bladder Neck Urology, Pediatric Surgery SU S700088 SU053 SU053A 23,000 Reconstruction Reconstruction Urology SU S700068 SU054 Bladder Neck incision - Endoscopic SU054A Bladder Neck incision - Endoscopic 15,000 TURBT TURBT Urology, Surgical Oncology SU S700062 SU055 SU055A 27,500 (Transurethral Resection of the Bladder Tumor) (Transurethral Resection of the Bladder Tumor) Urology, Surgical Oncology SU New Package SU056 TURBT - Restage SU056A TURBT - Restage 18,000 Post TURBT - Check Cystoscopy (Per sitting) with Post TURBT - Check Cystoscopy (Per sitting) with Urology SU S700066 SU057 SU057A 10,000 cold-cup biopsy cold-cup biopsy Urology SU S700059 SU058 Urachal Cyst excision SU058A Urachal Cyst excision - Open 18,500 Urology SU New Package SU058 Urachal Cyst excision SU058B Urachal Cyst excision - Laparoscopic 18,500 Urology SU New Package SU059 VVF Repair - Follow Up SU059A VVF Repair - Follow Up 1,500 Urology, Medical Oncology SU S700064 SU060 Intravesical BCG / Mitomycin SU060A Induction cycles 15,000 Urology, Medical Oncology SU S700065 SU060 Intravesical BCG / Mitomycin SU060B Maintenance 30,000 Urology, Pediatric Surgery SU S700082 SU061 Suprapubic Drainage - Closed / Trocar SU061A Suprapubic Drainage - Closed / Trocar 5,000 Urology, Surgical Oncology SU S700130 SU062 Stress incontinence surgery SU062A Stress incontinence surgery - Open 23,000 Urology SU New Package SU063 Repair of stress incontinence - Follow Up SU063A Repair of stress incontinence - Follow Up 1,000 Urology, Pediatric Surgery SU S700158 SU064 Emergency management of Acute retention of Urine SU064A Emergency management of Acute retention of Urine 2,000 Urology, Pediatric Surgery SU S700112 SU065 Meatotomy / Meatoplasty SU065A Meatotomy 3,500 Urology, Pediatric Surgery SU S700111 SU065 Meatotomy / Meatoplasty SU065B Meatoplasty 3,500 Urology, Pediatric Surgery SU S700114 SU066 Urethroplasty SU066A Urethroplasty - End to end 28,000 Urology, Pediatric Surgery SU S700115 SU066 Urethroplasty SU066B Urethroplasty - Substitution - single stage 28,000 Urology, Pediatric Surgery SU S700116 SU066 Urethroplasty SU066C Urethroplasty - Substitution - two stage 41,500 Urology, Pediatric Surgery SU S700117 SU066 Urethroplasty SU066D Urethroplasty - Transpubic 32,000 Urology SU New Package SU067 Urethroplasty Follow Up SU067A Urethroplasty Follow Up 1,000 Urology, Pediatric Surgery SU S700121 SU068 Urethral Dilatation SU068A Non endocopic as an independent procedure 2,000 Urology, Pediatric Surgery SU S700122 SU068 Urethral Dilatation SU068B Endocopic as an independent procedure 5,000 Urology, Pediatric Surgery SU S700119 SU069 Perineal Urethrostomy without closure SU069A Perineal Urethrostomy without closure 20,000 Urology, Pediatric Surgery SU S700113 SU070 Post. Urethral Valve fulguration SU070A Post. Urethral Valve fulguration 14,000

Page 23 Consolidated Master

Urology, Pediatric Surgery, Plastic & Reconstructive SU S700124 SU071 Hypospadias repair SU071A Single stage 28,000 Surgery Urology, Pediatric Surgery, Plastic & Reconstructive SU S700125 SU071 Hypospadias repair SU071B Two or more stage (First Stage) 12,000 Surgery Urology, Pediatric Surgery, Plastic & Reconstructive SU S700125 SU071 Hypospadias repair SU071C Two or more stage (Intermediate Stage) 2 Surgery Urology, Pediatric Surgery, Plastic & Reconstructive SU S700125 SU071 Hypospadias repair SU071D Two or more stage (Final Stage) 30,000 Surgery Urology SU New Package SU072 Hypospadias Repair - Follow Up SU072A Hypospadias Repair - Follow Up 1,000 Urology, Pediatric Surgery, SU S700157 SU073 Emergency management of Hematuria SU073A Emergency management of Hematuria 2,000 Emergency Urology SU S700110 SU074 Excision of Urethral Caruncle SU074A Excision of Urethral Caruncle 5,000 Urology, Obstetrics & Gynecology, Pediatric SU S700087 SU075 Urethrovaginal fistula repair SU075A Urethrovaginal fistula repair 30,000 Surgery Urology, Pediatric Surgery SU S700120 SU076 Urethrorectal fistula repair SU076A Urethrorectal fistula repair 40,000 Urology SU S700092 SU077 Open simple prostatetctomy for BPH SU077A Open simple prostatetctomy for BPH 27,500 Urology SU S700106 SU078 Radical prostatectomy SU078A Open 50,000 Urology SU S700107 SU078 Radical prostatectomy SU078B Lap. 50,000 Urology SU S700094 SU079 Holmium Laser Prostatectomy SU079A Holmium Laser Prostatectomy 40,000 Urology SU S700093 SU080 TURP-Transurethral Resection of the Prostate, BPH SU080A Monopolar 27,500

Urology SU S700093 SU080 TURP-Transurethral Resection of the Prostate, BPH SU080B Bipolar 27,500 Transrectal Ultrasound guided prostate biopsy Transrectal Ultrasound guided prostate biopsy Urology SU S700108 SU081 SU081A 10,000 (minimum 12 core) (minimum 12 core) Urology, Surgical Oncology SU S700133 SU082 Penectomy SU082A Partial Penectomy 15,000 Urology, Surgical Oncology SU S700134 SU082 Penectomy SU082B Total Penectomy + Perineal Urethrostomy 25,000 Urology SU S700153 SU083 Surgery for Priapism SU083A Aspiration 15,000 Urology SU S700153 SU083 Surgery for Priapism SU083B Shunt 15,000 Urology SU New Package SU084 Surgery for Priaprism - Follow Up SU084A Surgery for Priaprism - Follow Up 1,000 Urology SU S700152 SU085 Penile prosthesis insertion SU085A Penile prosthesis insertion 35,000 Urology, Surgical Oncology, SU S700139 SU086 Orchiectomy SU086A High inguinal 13,800 Pediatric Surgery

Urology, Surgical Oncology, SU S700140 SU086 Orchiectomy SU086B Simple 10,000 Pediatric Surgery Urology, Surgical Oncology SU S700141 SU087 Bilateral Orchidectomy for hormone ablation SU087A Bilateral Orchidectomy for hormone ablation 10,000 S700128, Urology, Pediatric Surgery SU SU088 Orchiopexy SU088A Orchiopexy with laparoscopy 30,000 S700129 Urology, Pediatric Surgery SU S700126 SU088 Orchiopexy SU088B Orchiopexy without laparoscopy - U/L 15,000 Urology, Pediatric Surgery SU S700127 SU088 Orchiopexy SU088C Orchiopexy without laparoscopy - B/L 15,000 S700148, Urology SU SU089 Surgical Correction of Varicocele SU089A Non Microsurgical 10,000 S700150 S700149, Urology SU SU089 Surgical Correction of Varicocele SU089B Microsurgical 15,000 S700151 Urology, Surgical Oncology, SU S700142 SU090 Radical Retroperitoneal lymph node dissection SU090A Open 36,500 Obstetrics & Gynecology

Urology, Surgical Oncology, SU S700143 SU090 Radical Retroperitoneal lymph node dissection SU090B Lap. 36,500 Obstetrics & Gynecology S700135, Urology, Surgical Oncology SU SU091 Ilio-Inguinal lymphadenectomy SU091A Ilio-Inguinal lymphadenectomy 18,500 S700136 Urology, Obstetrics & Hysterectomy as part of VVF / uterovaginal fistula Hysterectomy as part of VVF / uterovaginal fistula SU New Package SU092 SU092A 5,000 Gynecology repair repair Urology SU New Package SU093 PCNL - Follow Up SU093A PCNL - Follow Up 1,200 Emergency management of Ureteric stone - Emergency management of Ureteric stone - Urology, Pediatric Surgery SU S700156 SU094 Package for evaluation / investigation (ultrasound + SU094A Package for evaluation / investigation (ultrasound + 3,500 culture) for 3 weeks (medicines). culture) for 3 weeks (medicines). Surgical Correction of Category - I Congenital CTVS SV New Package SV001 SV001A Unifocalization of MAPCA 100,000 Heart Disease Surgical Correction of Category - I Congenital Isolated Secundum Atrial Septal Defect (ASD) CTVS SV S1300024 SV001 SV001B 100,000 Heart Disease Repair Surgical Correction of Category - I Congenital CTVS SV S1300050 SV001 SV001C Glenn procedure 100,000 Heart Disease Surgical Correction of Category - I Congenital CTVS SV New Package SV001 SV001D Pulmonary Artery Banding 100,000 Heart Disease Surgical Correction of Category - I Congenital CTVS SV New Package SV001 SV001E Systemic - Pulmonary Artery shunt 100,000 Heart Disease Surgical Correction of Category - I Congenital CTVS SV New Package SV001 SV001F Vascular Ring division 100,000 Heart Disease Surgical Correction of Category - I Congenital CTVS SV S1300047 SV001 SV001G Coarctation repair 100,000 Heart Disease Surgical Correction of Category - II Congenital ASD closure + Partial Anomalous Venous CTVS SV New Package SV002 SV002A 120,000 Heart Disease Drainage Repair Surgical Correction of Category - II Congenital CTVS SV New Package SV002 SV002B ASD Closure + Mitral procedure 120,000 Heart Disease Surgical Correction of Category - II Congenital CTVS SV New Package SV002 SV002C ASD Closure + Tricuspid procedure 120,000 Heart Disease Surgical Correction of Category - II Congenital CTVS SV New Package SV002 SV002D ASD Closure + Pulmonary procedure 120,000 Heart Disease Surgical Correction of Category - II Congenital CTVS SV New Package SV002 SV002E ASD Closure + Infundibular procedure 120,000 Heart Disease Surgical Correction of Category - II Congenital CTVS SV S1200015 SV002 SV002F VSD closure 120,000 Heart Disease Surgical Correction of Category - II Congenital CTVS SV New Package SV002 SV002G Infundibular PS repair 120,000 Heart Disease Surgical Correction of Category - II Congenital CTVS SV New Package SV002 SV002H Valvular PS repair 120,000 Heart Disease Surgical Correction of Category - II Congenital CTVS SV S1300026 SV002 SV002I Partial AV canal repair 120,000 Heart Disease Surgical Correction of Category - II Congenital CTVS SV S1300026 SV002 SV002J Intermediate AV canal repair 120,000 Heart Disease Surgical Correction of Category - II Congenital CTVS SV New Package SV002 SV002K Atrial septectomy + Glenn 120,000 Heart Disease Surgical Correction of Category - II Congenital CTVS SV New Package SV002 SV002L Atrial septectomy + PA Band 120,000 Heart Disease

Page 24 Consolidated Master

Surgical Correction of Category - II Congenital Sinus of Valsalva aneurysm repair with aortic valve CTVS SV New Package SV002 SV002M 120,000 Heart Disease procedure Surgical Correction of Category - II Congenital Sinus of Valsalva aneurysm repair without aortic CTVS SV New Package SV002 SV002N 120,000 Heart Disease valve procedure Surgical Correction of Category - II Congenital CTVS SV New Package SV002 SV002O Sub-aortic membrane resection 120,000 Heart Disease Surgical Correction of Category - III Congenital CTVS SV S1300031 SV003 SV003A Ebstien repair 150,000 Heart Disease Surgical Correction of Category - III Congenital CTVS SV S1300036 SV003 SV003B Double switch operation 150,000 Heart Disease Surgical Correction of Category - III Congenital CTVS SV New Package SV003 SV003C Rastelli Procedure 150,000 Heart Disease Surgical Correction of Category - III Congenital CTVS SV S1300032 SV003 SV003D Fontan procedure 150,000 Heart Disease Surgical Correction of Category - III Congenital CTVS SV S1300029 SV003 SV003E AP window repair 150,000 Heart Disease Surgical Correction of Category - III Congenital CTVS SV New Package SV003 SV003F Arch interruption Repair without VSD closure 150,000 Heart Disease Surgical Correction of Category - III Congenital CTVS SV S1300025 SV003 SV003G Arch interruption Repair with VSD closure 150,000 Heart Disease Surgical Correction of Category - III Congenital CTVS SV New Package SV003 SV003H DORV Repair 150,000 Heart Disease Surgical Correction of Category - III Congenital CTVS SV New Package SV003 SV003I Supravalvular AS repair 150,000 Heart Disease Surgical Correction of Category - III Congenital CTVS SV New Package SV003 SV003J Konno procedure 150,000 Heart Disease Surgical Correction of Category - III Congenital CTVS SV New Package SV003 SV003K Norwood procedure 150,000 Heart Disease Surgical Correction of Category - III Congenital CTVS SV New Package SV003 SV003L VSD closure + RV - PA conduit 150,000 Heart Disease Surgical Correction of Category - III Congenital CTVS SV New Package SV003 SV003M VSD + Aortic procedure 150,000 Heart Disease Surgical Correction of Category - III Congenital CTVS SV New Package SV003 SV003N VSD + Mitral procedure 150,000 Heart Disease Surgical Correction of Category - III Congenital CTVS SV New Package SV003 SV003O VSD + Tricuspid procedure 150,000 Heart Disease Surgical Correction of Category - III Congenital CTVS SV New Package SV003 SV003P VSD + Pulmonary procedure 150,000 Heart Disease Surgical Correction of Category - III Congenital CTVS SV New Package SV003 SV003Q VSD + Infundibular procedure 150,000 Heart Disease Surgical Correction of Category - III Congenital CTVS SV New Package SV003 SV003R VSD + Coarctation repair 150,000 Heart Disease Surgical Correction of Category - III Congenital CTVS SV S1300033 SV003 SV003S TAPVC Repair 150,000 Heart Disease Surgical Correction of Category - III Congenital CTVS SV S1300039 SV003 SV003T Truncus arteriosus repair 150,000 Heart Disease Surgical Correction of Category - III Congenital CTVS SV S1300027 SV003 SV003U Tetralogy of Fallot Repair 150,000 Heart Disease Surgical Correction of Category - III Congenital CTVS SV S1300026 SV003 SV003V Complete AV canal repair 150,000 Heart Disease Surgical Correction of Category - III Congenital CTVS SV S1300035 SV003 SV003W Arterial switch operation 150,000 Heart Disease Surgical Correction of Category - III Congenital CTVS SV S1300037 SV003 SV003X Senning Operation 150,000 Heart Disease Surgical Correction of Category - III Congenital CTVS SV S1300038 SV003 SV003Y Mustard Operation 150,000 Heart Disease Coronary artery bypass grafting (CABG), Coronary artery bypass grafting (CABG), CTVS SV S1300001 SV004 SV004A 118,100 including intra operative balloon pump (if required) including intra operative balloon pump (if required) S1300013, CTVS SV S1300017, SV005 Single Valve Procedure SV005A Aortic Valve 119,000 S1300018 S1300011, CTVS SV S1300015, SV005 Single Valve Procedure SV005B Mitral Valve 119,000 S1300016 S1300012, CTVS SV S1300019, SV005 Single Valve Procedure SV005C Tricuspid Valve 119,000 S1300020 S1300021, CTVS SV SV006 Double Valve Procedure SV006A Double Valve Procedure 142,000 S1300022 CTVS SV New Package SV007 Triple valve procedure SV007A Triple valve procedure 170,000 CTVS SV S1300009 SV008 Closed Mitral Valvotomy including thoracotomy SV008A Closed Mitral Valvotomy including thoracotomy 57,000 CTVS SV S1300023 SV009 Ross Procedure SV009A Ross Procedure 150,000 Surgery for Hypertrophic Obstructive Surgery for Hypertrophic Obstructive CTVS SV S1300030 SV010 SV010A 111,000 Cardiomyopathy (HOCM) Cardiomyopathy (HOCM) CTVS SV New Package SV011 Pericardial window (via thoracotomy) SV011A Pericardial window (via thoracotomy) 30,000 CTVS SV S1300052 SV012 Pericardiectomy SV012A Pericardiectomy 67,000 Patent Ductus Arteriosus (PDA) Closure via Patent Ductus Arteriosus (PDA) Closure via CTVS SV S1300046 SV013 SV013A 57,000 thoracotomy thoracotomy CTVS SV S1300040 SV014 Aortic Root Replacement Surgery SV014A Bental Procedure 150,000 CTVS SV New Package SV014 Aortic Root Replacement Surgery SV014B Aortic Dissection 150,000 CTVS SV New Package SV014 Aortic Root Replacement Surgery SV014C Aortic Aneurysm 150,000 CTVS SV New Package SV014 Aortic Root Replacement Surgery SV014D Valve sparing root replacement 150,000 CTVS SV New Package SV014 Aortic Root Replacement Surgery SV014E AVR + Root enlargement 150,000 Aortic Arch Replacement / Thoracoabdominal CTVS, General Surgery SV S1300041 SV015 SV015A Aortic Arch Replacement using bypass 150,000 aneurysm Repair using bypass Aortic Arch Replacement / Thoracoabdominal CTVS, General Surgery SV New Package SV015 SV015B Thoracoabdominal aneurysm Repair using bypass 150,000 aneurysm Repair using bypass Aortic Aneurysm Repair using Cardiopulmonary CTVS, General Surgery SV S1300042 SV016 Aortic Aneurysm Repair SV016A 120,000 bypass (CPB) CTVS, General Surgery SV New Package SV016 Aortic Aneurysm Repair SV016B Aortic Aneurysm Repair using Left Heart Bypass 120,000 Aortic Aneurysm Repair without using CTVS, General Surgery SV S1300043 SV016 Aortic Aneurysm Repair SV016C 65,500 Cardiopulmonary bypass (CPB) Aortic Aneurysm Repair without using Left Heart CTVS, General Surgery SV New Package SV016 Aortic Aneurysm Repair SV016D 65,500 Bypass CTVS SV S1300092 SV017 Aorto Iliac / Aorto femoral bypass (Uni and Bi) SV017A Aorto Iliac bypass - U/L 64,500 CTVS SV S1300092 SV017 Aorto Iliac / Aorto femoral bypass (Uni and Bi) SV017B Aorto femoral bypass - U/L 64,500 CTVS SV S1300079 SV017 Aorto Iliac / Aorto femoral bypass (Uni and Bi) SV017C Aorto Iliac bypass - B/L 64,500 CTVS SV S1300079 SV017 Aorto Iliac / Aorto femoral bypass (Uni and Bi) SV017D Aorto femoral bypass - B/L 64,500 CTVS SV S1300044 SV018 Pulmonary Embolectomy / Thromboendarterectomy SV018A Pulmonary Embolectomy 141,000

CTVS SV New Package SV018 Pulmonary Embolectomy / Thromboendarterectomy SV018B Thromboendarterectomy 141,000 S1300080, CTVS SV SV019 Peripheral Arterial Surgeries SV019A Femoro - Femoral Bypass 50,000 S1300081

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CTVS SV New Package SV019 Peripheral Arterial Surgeries SV019B Carotid - endearterectomy 50,000 CTVS SV S100152 SV019 Peripheral Arterial Surgeries SV019C Carotid Body Tumor Excision 50,000 CTVS SV New Package SV019 Peripheral Arterial Surgeries SV019D Thoracic Outlet syndrome Repair 50,000 CTVS SV S100151 SV019 Peripheral Arterial Surgeries SV019E Carotid aneurysm repair 50,000 CTVS SV New Package SV019 Peripheral Arterial Surgeries SV019F Subclavian aneurysm repair 50,000 CTVS SV New Package SV019 Peripheral Arterial Surgeries SV019G Axillary aneurysm repair 50,000 CTVS SV New Package SV019 Peripheral Arterial Surgeries SV019H Brachial aneurysm repair 50,000 CTVS SV New Package SV019 Peripheral Arterial Surgeries SV019I Femoral aneurysm repair 50,000 CTVS SV New Package SV019 Peripheral Arterial Surgeries SV019J Popliteal aneurysm repair 50,000 S1300080, CTVS SV SV019 Peripheral Arterial Surgeries SV019K Femoral - popliteal Bypass 50,000 S1300081 CTVS SV S1300082 SV019 Peripheral Arterial Surgeries SV019L Axillo - Brachial Bypass 50,000 CTVS SV New Package SV019 Peripheral Arterial Surgeries SV019M Carotio - carotid Bypass 50,000 CTVS SV New Package SV019 Peripheral Arterial Surgeries SV019N Carotido - subclavian bypass 50,000 CTVS SV New Package SV019 Peripheral Arterial Surgeries SV019O Carotido - axillary bypass 50,000 CTVS SV S1300092 SV019 Peripheral Arterial Surgeries SV019P Axillo - femoral bypass - U/L 50,000 CTVS SV S1300079 SV019 Peripheral Arterial Surgeries SV019Q Axillo - femoral bypass - B/L 50,000 CTVS SV S1300085 SV019 Peripheral Arterial Surgeries SV019R Aorto - carotid bypass 50,000 CTVS SV New Package SV019 Peripheral Arterial Surgeries SV019S Aorto - subclavian bypass 50,000 CTVS, General Surgery, S1300072, SV SV020 Thromboembolectomy SV020A Thromboembolectomy 28,000 Pediatric Surgery S1300091 CTVS SV New Package SV021 Peripheral arterial injury repair (without bypass) SV021A Peripheral arterial injury repair (without bypass) 30,000 CTVS, Pediatric Surgery SV S1300060 SV022 Thoracotomy, Thoraco Abdominal Approach SV022A Thoracotomy, Thoraco Abdominal Approach 30,000 CTVS, Pediatric Surgery SV S1300054 SV023 Lung surgery including Thoracotomy SV023A Lung cyst exision 45,000 CTVS, Pediatric Surgery SV S100157 SV023 Lung surgery including Thoracotomy SV023B Decortication 45,000 CTVS, Pediatric Surgery SV New Package SV023 Lung surgery including Thoracotomy SV023C Hydatid cyst 45,000 Other simple lung procedure excluding lung CTVS, Pediatric Surgery SV New Package SV023 Lung surgery including Thoracotomy SV023D 45,000 resection CTVS SV New Package SV024 Pulmonary Resection SV024A Pulmonary Resection 70,000 S1300061, CTVS, General Surgery, SV S100102, SV025 Foreign Body Removal with scope SV025A Foreign Body Removal with scope 20,000 Pediatric Surgery S100220 CTVS, Surgical Oncology, SV S1300056 SV026 Surgical Correction of Bronchopleural Fistula SV026A Surgical Correction of Bronchopleural Fistula 65,000 Pediatric Surgery CTVS, General Surgery, SV S1300055 SV027 Space - Occupying Lesion (SOL) mediastinum SV027A Space - Occupying Lesion (SOL) mediastinum 65,500 Pediatric Surgery Isolated Intercostal Drainage and Management of Isolated Intercostal Drainage and Management of CTVS, General Surgery, SV S1300066 SV028 ICD, Intercostal Block, Antibiotics & SV028A ICD, Intercostal Block, Antibiotics & 10,000 Pediatric Surgery Physiotherapy Physiotherapy CTVS, Pediatric Surgery SV S1300059 SV029 Diaphragmatic Repair SV029A Diaphragmatic Repair 30,000 CTVS, Surgical Oncology SV S1300045 SV030 Surgery for Cardiac Tumour SV030A Surgery for Cardiac Tumour 95,000 CTVS SV S1300027 SV031 Immediate reoperation (within 5 days) SV031A Tetralogy of Fallot Repair 75,000 CTVS SV New Package SV031 Immediate reoperation (within 5 days) SV031B Aortic Valve 59,500 CTVS SV New Package SV031 Immediate reoperation (within 5 days) SV031C Mitral Valve 59,500 CTVS SV New Package SV031 Immediate reoperation (within 5 days) SV031D Tricuspid Valve 59,500 CTVS SV New Package SV031 Immediate reoperation (within 5 days) SV031E Double Valve Procedure 71,000 CTVS SV New Package SV031 Immediate reoperation (within 5 days) SV031F Triple valve procedure 85,000 Low Cardiac Output syndrome requiring IABP Low Cardiac Output syndrome requiring IABP CTVS SV New Package SV032 SV032A 50,000 insertion post - operatively insertion post - operatively CTVS SV New Package SV033 Re-do sternotomy SV033A Re-do sternotomy 20,000 CTVS SV New Package SV034 Excessive bleeding requiring re-exploration SV034A Excessive bleeding requiring re-exploration 10,000 Unspecified Surgical US U100001 US001 Unspecified Surgical Package US001A Unspecified Surgical Package Upto 1 lakh Package

Note: 1. The migration to the new rates will be done individually by States & UTs as per their readiness. 2. The prices indicated against the procedure in this document, may or may not be containing the price of Implants / High end consumables.

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